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.

摘要 膀胱过度活动症(OAB)，定义为有或不有尿急的存在 尿失禁是一种使人虚弱的疾病，仅在美国估计就有15.1%的女性受到影响。 盆底肌肉(PFM)训练可减少逼尿肌的收缩，从而广泛应用于OAB的治疗 膀胱肌。PFM、髋部和躯干肌肉在本质上是协同的，可能是一个重要的， 但在OAB中忽略了机械性因素。复杂的骨盆解剖结构在历史上禁止 表面肌电信号技术在PFM和肌间网络中的复杂应用 PFM和臀部/躯干肌肉。目前，烤瓷修复体功能的临床分类是基于临床医生的 用指检阴道触诊进行定性评估。此外，量化评估 可能与PFM功能障碍相关的髋部/躯干肌肉异常并不是标准的。设计 客观测量PFM激活和PFM到髋部/躯干肌肉间的连通性是必要的 提高OAB的诊断能力。这样的进步有助于更好地理解 肌肉骨骼损伤与OAB固有相关，并进一步导致 PFM-Hip/Trunk表型框架，允许对OAB患者进行分类，以便于 个体化治疗。不幸的是，目前还没有技术可以定量和客观地 评估与OAB相关的综合PFM-髋关节/躯干病因因素，否则将 促进对潜在机制的理解，并允许OAB亚型的表型 进行适当的干预选择。 我们团队已经成功研制出一种新型的阴道内高密度表面肌电图仪 (HD-sEMG)技术可靠、定量地评估烤瓷修复体过度活动；2)开发了一种新的肌肉 网络分析技术首次揭示肌肉间连接模式的变化 在有神经肌肉疾病的患者中；以及3)证明了将OAB聚集到 表型亚群，取决于潜在的机制。通过利用先进的技术 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 PFM-Hip-Trunk综合肌肉网络的神经肌肉特征基础。这 这项研究是全面评估盆底、臀部和躯干肌肉活动的第一项努力 OAB的PFM改变、PFM到髋关节/躯干肌肉间的连通性以及不同的PFM表型。 这些多因素评估的整合将促进我们对多因素的理解 OAB的病理，特别是OAB干性患者(无紧迫性尿失禁的尿急) 这在文献中很少被理解和描述。相对重要性的量化 这些病理因素将允许OAB-Dry亚型的表型，从而导致新的 个性化治疗。