ASSESSING MULTIFACTORIAL ETIOLOGY OF OVERACTIVE BLADDER USING A NOVEL PFM-HIP-TRUNK MUSCLE NETWORK ANALYSIS

使用新型 PFM-髋关节-躯干肌肉网络分析评估膀胱过度活动症的多因素病因

• 批准号: 10741259
• 负责人: Yingchun Zhang
• 金额: $ 44.07万
• 依托单位: UNIVERSITY OF HOUSTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10741259
• 关键词: Abdomen; Affect; Age; Anatomy; Bladder; Body mass index; Categories; Classification; Clinical; Cluster Analysis; Development; Diagnosis; Dryness; Electromyography; Etiology; Frequencies; Functional disorder; High Prevalence; Hip region structure; Impairment; Intervention; Lead; Literature; Measures; Muscle; Muscle Weakness; Muscle function; Musculoskeletal; Nature; Neuromuscular conditions; Overactive Bladder; Palpation; Participant; Pathologic; Pathology; Pathway Analysis; Patients; Pattern; Pelvic Floor Muscle; Pelvic floor structure; Pelvis; Phenotype; Research; Rest; Subgroup; Surface; Syndrome; Techniques; Technology; Testing; Time; Training; Urinary Incontinence; Vagina; Woman; clinical investigation; cost; density; design; detrusor muscle; diagnostic value; digital; individualized medicine; micturition urgency; motor impairment; neuromuscular; novel; parity; personalized medicine; recruit

Abstract Overactive bladder syndrome (OAB), defined as the presence of urinary urgency with or without urgency urinary incontinence, is a debilitating condition that affects an estimated 15.1% of women in the US alone. OAB is widely treated with pelvic floor muscle (PFM) training, by reducing contractions of the detrusor muscle of the bladder. The PFM, hip, and trunk muscles are synergistic in nature and may be an important, yet overlooked mechanistic factor in OAB. The complicated pelvic anatomy has historically prohibited sophisticated applications of surface EMG technology to the PFM, and the intermuscular network between the PFM and hip/trunk muscles. Currently, clinical classification of PFM function is based on a clinician’s qualitative assessment using vaginal palpation via digital examination. Additionally, quantitative assessment of hip/trunk muscle abnormalities potentially associated with PFM dysfunction are not standard. Designing an objective measure of PFM activation and PFM-to-Hip/Trunk intermuscular connectivity is imperative to advance the diagnostic capabilities for OAB. Such advancement can help better understand the musculoskeletal impairments inherently associated with OAB, and further lead to the development of a PFM-Hip/Trunk phenotyping framework which would allow patients with OAB to be categorized to facilitate individualized treatment. Unfortunately, no technology is currently available for quantitatively and objectively assessing comprehensive PFM-Hip/Trunk etiologic factors associated with OAB, which, otherwise, would advance the understanding of the underlying mechanisms and allow for the phenotyping of OAB subtypes for appropriate intervention selection. Our team has successfully 1) developed a novel intra-vaginal high-density surface electromyography (HD-sEMG) technique to reliably and quantitatively assess PFM overactivity; 2) developed a novel muscle network analysis technique to reveal, for the first time, the inter-muscular connectivity pattern alterations among patients with neuromuscular conditions; and 3) demonstrated the feasibility to cluster OAB into phenotypic subgroups, depending on the underlying mechanism. By taking advantage of the advancements in intra-vaginal HD-sEMG sensing and muscle network analysis, this study aims to assess mechanistic fundamentals of neuromuscular features of the comprehensive PFM-Hip-Trunk muscle network. This research represents the first effort to comprehensively assess pelvic floor, hip and trunk muscle activity alterations, PFM-to-Hip/Trunk inter-muscular connectivity, and distinct PFM phenotypic subtypes in OAB. The integration of these multifactorial assessments will advance our understanding of the multifactorial pathology of OAB, particularly OAB-dry patients (urinary urgency without urgency urinary incontinence) which is poorly understood and characterized in the literature. The quantification of relative importance of these pathological contributors will allow for phenotyping OAB-dry subtypes, thus resulting in novel personalized treatments.

抽象的 膀胱过度活动症候群 (OAB)，定义为存在尿急（伴或不伴尿急） 尿失禁是一种使人衰弱的疾病，仅在美国就有 15.1% 的女性受到影响。 OAB 广泛通过盆底肌肉 (PFM) 训练通过减少逼尿肌收缩来治疗 膀胱的肌肉。 PFM、臀部和躯干肌肉本质上是协同作用的，可能是重要的、 然而 OAB 中却被忽视的机制因素。复杂的骨盆解剖结构历来禁止 表面肌电图技术在 PFM 中的复杂应用，以及之间的肌间网络 PFM 和臀部/躯干肌肉。目前，PFM 功能的临床分类是基于临床医生的 通过指检进行阴道触诊进行定性评估。另外，定量评估 可能与 PFM 功能障碍相关的髋部/躯干肌肉异常的评估并不标准。设计 客观测量 PFM 激活和 PFM 至髋部/躯干肌间连接对于 提高 OAB 的诊断能力。这种进步可以帮助更好地理解 与 OAB 固有相关的肌肉骨骼损伤，并进一步导致发展 PFM-髋关节/躯干表型分析框架可对 OAB 患者进行分类，以方便 个体化治疗。不幸的是，目前还没有技术可以定量、客观地 评估与 OAB 相关的综合 PFM-髋关节/躯干病因，否则， 促进对潜在机制的理解并允许对 OAB 亚型进行表型分析 进行适当的干预选择。 我们的团队已成功1）开发出一种新型阴道内高密度表面肌电图 (HD-sEMG) 技术可可靠且定量地评估 PFM 过度活动； 2）开发出一种新的肌肉 网络分析技术首次揭示肌肉间连接模式的变化 患有神经肌肉疾病的患者； 3）证明了将OAB聚类为的可行性 表型亚组，取决于潜在的机制。通过利用进步 在阴道内 HD-sEMG 传感和肌肉网络分析中，本研究旨在评估机制 综合 PFM-髋-躯干肌肉网络的神经肌肉特征的基础知识。这 该研究首次全面评估盆底、臀部和躯干肌肉活动 OAB 中的改变、PFM 到髋部/躯干的肌肉间连接以及不同的 PFM 表型亚型。 这些多因素评估的整合将增进我们对多因素的理解 OAB 的病理学，特别是 OAB 干性患者（尿急但无急迫性尿失禁） 文献中对其了解和描述知之甚少。相对重要性的量化 这些病理贡献者将允许对 OAB-dry 亚型进行表型分析，从而产生新的 个性化治疗。