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; 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 过度活跃的膀胱综合征（OAB），定义为有或没有紧迫性的尿液紧急情况 尿失禁是一种令人衰弱的疾病，仅在美国就影响了15.1％的妇女。 OAB通过减少批评者的收缩，通过骨盆地板肌肉（PFM）训练广泛处理 膀胱的肌肉。 PFM，臀部和树干肌肉本质上是协同作用的，可能是重要的 在OAB中被忽略的机械因素。复杂的骨盆解剖学一直禁止 表面EMG技术在PFM中的软化应用以及之间的肌间网络 PFM和臀部/树干肌肉。当前，PFM功能的临床分类基于临床 通过数字检查使用阴道触诊的定性评估。另外，定量评估 臀部/躯干肌肉异常可能与PFM功能障碍相关。设计 PFM激活和PFM至ip/躯干间连接的客观测量至关重要 提高OAB的诊断功能。这样的进步可以帮助更好地了解 肌肉骨骼障碍固有地与OAB相关，并进一步导致了 PFM-iph/trunk表型框架，将允许OAB患者分类以促进 个性化治疗。不幸的是，目前没有任何技术可用于定量和客观上 评估与OAB有关 提高对基本机制的理解，并允许OAB亚型的表型 适当的干预选择。 我们的团队已成功1）开发了一种新型的体内高密度表面肌电图 （HD-SEMG）可靠和定量评估PFM过度活动的技术； 2）发展了一种新颖的肌肉 网络分析技术首次揭示肌间连通性模式的改变 在神经肌肉疾病的患者中； 3）证明了将OAB聚集到的可行性 表型亚组，具体取决于基本机制。通过利用进步 在体内HD-SEMG感应和肌肉网络分析中，本研究旨在评估机理 综合PFM-trunk肌肉网络的神经肌肉特征的基础。这 研究代表了全面评估骨盆底，臀部和躯干肌肉活动的首次努力 OAB中的变化，PFM到iP/躯干间的肌间连通性以及独特的PFM表型亚型。 这些多因素评估的整合将提高我们对多因素的理解 OAB的病理，尤其是OAB干燥患者（无紧急尿液尿失禁的尿液紧急） 在文献中，这是很少的理解和特征。相对重要的数量 这些病理贡献者将允许表型OAB干燥亚型，从而导致新颖 个性化治疗。