Visualization of Pelvic Floor Reflexes

盆底反射的可视化

基本信息

批准号：
7826721
负责人：
CHRISTOS EURIPIDES CONSTANTINOU
金额：
$ 35.8万
依托单位：
PALO ALTO VETERANS INSTIT FOR RESEARCH
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-05-01 至 2012-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7826721
关键词：
Acceleration Address Age Algorithms Area Attention Biological Neural Networks Bladder Bladder Control Characteristics Classification Clinical Code Computer software Coughing Data Data Analyses Databases Detection Development Ensure Epidemic Evaluation Female Image Imagery Indium Length Measurement Mechanics Methods Modeling Motion Movement Muscle Contraction Pathology Patients Pattern Pelvic Floor Muscle Pelvic floor structure Pelvis Physical Examination Physiological Postmenopause Premenopause Problem Solving Procedures Process Reaction Time Reflex action Reporting Rest Role Scanning Side Simulate Speed Stress Urinary Incontinence Structure System Technology Testing Time Tissues Training Ultrasonography Urethra Urinary Incontinence Valsalva Maneuver Weight Woman Work animation clinically significant graphical user interface image processing innovation interdisciplinary approach kinematics muscle strength neuromuscular older women parity pressure prevent programs rectal research clinical testing research study response transmission process urinary bladder neck volunteer

项目摘要

Female urinary incontinence has been recently termed a “silent epidemic”, requiring systematic attention and a multidisciplinary approach towards economically ameliorating its impact. In this study we examine the role of the pelvic floor (PF) in maintaining urinary continence by evaluating the dynamics produced during voluntary and reflex activation. As a result of preparatory work just completed under an R21 study we were able to develop the technology and procedures to attempt to undertake the proposed evaluation as an R01 study. Enabling our approach is the development of criteria and unique new parameters that define the kinematics of PF function. Principal among these parameters, and in addition to the mechanical closure forces are displacement, velocity, acceleration and the trajectory of pelvic floor landmarks. Objectives are to facilitate the visualization of these parameters using a graphical user interface to test the hypothesis that continent older women will present different visualization values than older women with stress incontinence. Movement detection, including motion tracking algorithms and segmentation algorithms will be developed to acquire new parameters of trajectory, displacement, velocity and acceleration, of pelvic structures during different maneuvers. Parameters will be derived from imaging of trans-perineal scanning from asymptomatic volunteers as well as patients presenting with relevant pathology. Additional software innovation in the analysis of these parameters is the ability to define the timing sequences associated with pelvic floor responses. Preliminary observations suggest that timing of response are a significant factor separating the continent from the incontinent subjects. Consequent to evidence generated so far we propose to consider the hypothesis that reflex pelvic floor responses prevent stress urinary incontinence during fast and stressful maneuvers such as coughing are age and parity dependent. Before generalizing this hypothesis we propose to first obtain evidence that spans the age and parity. On the basis of data obtained from ultrasound imaging, we propose to develop a model to simulate the control systems involved in maintaining continence by introducing the Artificial Neural Network (ANN) approach for analysis of the data. ANN will be trained by adjusting the weights of the connections using different algorithms to solve problems including classification and pattern identification. Modified Specific Aim Sections The function of the female Pelvic Floor (PF), which encompasses Pelvic Floor Muscles (PFM), bladder and urethral support, constitutes a very important element in addressing the problem of female Urinary Incontinence (UI). Perineal ultrasound imaging is commonly used in the clinical evaluation of PF function related to UI. However, in real time ultrasound imaging, the diagnostically important information of the dynamic response of the PF cannot be assimilated and quantified by the observer during the scanning process. The trajectories and the timing of the movement of the PF tissues, which may be more important than the amplitudes in the mechanism of female urinary continence, are usually ignored. Our preliminary studies suggest that the structural and functional changes of the PF in women with Stress Urinary Incontinence (SUI) can be highlighted by analyzing the activities of an anatomical triangle comprising of the Urethra-Vesical Junction (UVJ), Ano-Rectal Angle (ARA) and Symphysis Pubis (SP). We propose to develop a software package of 2-D ultrasound image processing to analyze both the static and dynamic responses of the UVJ-ARA-SP triangle and to further disclose its physiological and clinical significance in the mechanism of urinary continence. The proposed study includes the following specific aims: (1) Quantitatively analyze the static characters of the UVJ-ARA-SP triangle and relate to urethral closure pressures and their transmission characteristics. Correlate these with reference to age, physical examination and parity in pre and postmenopausal women who are continent or report SUI. • Graphical user interfaces will be developed to acquire the UVJ-ARA-SP triangle and analyze its static parameters including the area, the three internal angles and the lengths of the three sides. (2) Quantitatively visualize the dynamic characters of the UVJ-ARA-SP triangle. • Different methods of movement detection, including motion tracking algorithms and segmentation algorithms will be developed to acquire new kinematic parameters, including trajectory, displacement, velocity and acceleration, of the UVJ and ARA. • The changes of the parameters of the UVJ-ARA-SP triangle (area, internal angles and lengths of sides) in different maneuvers will be analyzed. • 2D animation will be applied to enhance the ultrasound imaging and highlight the timing of the movement and deformation of the UVJ-ARA-SP triangle in fast and stressful maneuvers, which are important for understanding the neuromuscular control mechanisms in urinary continence. (3) Quantitatively visualize the dynamic profiles of the urethra and ARA in the UVJ-ARA-SP triangle • The visualization of the movement profile of the urethra will be performed to highlight the opening and closure mechanism of the urethra. • The visualization of the movement profile of the ARA will be performed to highlight the mechanisms and functions of the PFM activities. • 2D animation will be applied to enhance the ultrasound imaging and highlight the timing of the movement and deformation of the urethra and ARA in different maneuvers. (4) Classification of PF functions using artificial neural networks (ANN) • ANN for the classification of healthy subjects and SUI patients using the static and dynamic parameters derived from the quantitative measurement of the UVJ-ARA-SP triangle. • ANN to enable evaluation of PF functions using the dynamic trajectories of the UVJ-ARA-SP triangle. Clinical experiments will be performed for the comparison of the static and dynamic characters of the UVJ-ARA-SP triangle of symptomatic subjects and patients with SUI in different maneuvers. To realize these objectives, we hypothesize that continent older women will present higher pelvic floor strength values than older women with stress incontinence in the following parameters: resting PFM strength to voluntary contraction tasks for maximum strength and speed and latency of force development. These values will be higher in age matched nulliparous women. Correlatively we hypothesize that continent older women will present different visualization values in the UVJ-ARA-SP triangle than older women with stress incontinence in the following new parameters obtained from ultrasound imaging: magnitude, direction, velocity, and displacement of the, bladder neck than continent women. Bladder neck approximation will be lower at rest, during PFM contraction and Valsalva maneuvers in continent women. NOTE: We propose to sustain original effort use the originally proposed number of subjects and collect essential data. As indicated above we will NOT carry out the programming for the 2D animation portion of the proposal but instead ensure that data are coded appropriately and be made available.

女性尿失禁最近被称为“沉默的流行病”，需要系统的关注和一种多学科的方法来改善其影响。在这项研究中，我们通过评估自愿和反射激活过程中产生的动力学来研究骨盆底（PF）在维持尿中的作用。刚刚根据R21研究完成的准备工作，我们能够开发技术和程序，以尝试作为R01研究进行拟议的评估。实现我们的方法是定义PF功能运动学的标准和独特的新参数的开发。这些参数之间的主要内容，除了机械封闭力外，还包括位移，速度，加速度和骨盆底层标记的轨迹。目的是使用图形用户界面来促进这些参数的可视化，以测试与患有压力尿失禁的老年女性相比，继续老年女性会带来不同的可视化值。将开发运动检测，包括运动跟踪算法和分割算法，以获取不同动作过程中骨盆结构的轨迹，位移，速度和加速度的新参数。参数将来自非对称志愿者以及出现相关病理的患者的跨性交扫描的成像。在分析这些参数时，其他软件创新是能够定义与骨盆底响应相关的定时序列的能力。初步观察表明，反应的时机是将大陆与失禁受试者区分开的重要因素。迄今为止，我们提出的证据构成了以下假设：反射骨盆底反应可以防止在诸如so脚之类的快速和压力性操纵期间的压力尿失禁。在概括这一假设之前，我们建议首先获得跨越年龄和平价的证据。根据从超声成像获得的数据，我们建议开发一个模型，以模拟通过引入人工神经网络（ANN）方法来分析数据所涉及的控制系统。 ANN将通过使用不同的算法来调整连接的权重来训练ANN，以解决包括分类和模式识别在内的问题。修改了特定的目标部分女性骨盆底（PF）的功能，该功能包括骨盆地板肌肉（PFM），膀胱和尿道支撑，构成了解决女性尿失禁问题的非常重要的元素（UI）。会阴超声成像通常用于与UI相关的PF功能的临床评估。但是，在实时超声成像中，诊断为动态响应的诊断重要信息在扫描过程中，观察者不能同化PF和量化PF。 PF组织运动的轨迹和时机，这可能比放大器更重要女性尿势通常被忽略。我们的初步研究表明，压力尿的女性PF的结构和功能变化尿失禁（SUI）可以通过分析尿道隔离连接（UVJ），ANO直肠角（ARA）和Pubis（SP）的解剖三角完成的活性来突出显示。我们建议开发一个 2-D超声图像处理的软件包，以分析UVJ-ARA-SP三角形的静态和动态响应，并进一步披露其在机制中的物理和临床意义尿道。拟议的研究包括以下具体目的：（1）定量分析UVJ-ARA-SP三角形的静态特征，并与尿道闭合压力及其传播特性有关。将这些与年龄，体格检查和均等相关以及继续或报告SUI的绝经后妇女。 •将开发图形用户界面以获取UVJ-ARA-SP三角形并分析其静态参数，包括该区域，三个内角和三个边的长度。（2）定量可视化UVJ-ARA-SP三角形的动态特征。 •将开发出不同的运动检测方法，包括运动跟踪算法和分割算法，以获取新的运动学参数，包括轨迹，位移， UVJ和ARA的速度和加速度。 •将分析不同操作中的UVJ-ara-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-int角度和内部角度内角和长度内角度长度）参数参数变化变化变化。 •2D动画将用于增强超声成像并突出机芯的时机在快速和压力的操作中，UVJ-ara-s-s-Sp三角形的变形对于理解泌尿持续性的神经肌肉控制机制很重要。（3）定量可视化uvj-ara-s-s-s-s-s-triangle中尿道和ara的动态曲线 •将执行尿道运动轮廓的可视化，以突出尿道的开口和封闭机制。 •将执行ARA运动曲线的可视化，以突出PFM活动的机制和功能。 •将使用2D动画来增强超声成像，并突出不同动作中尿道和ARA运动的时机和变形。（4）使用人工神经网络（ANN）对PF函数进行分类 •ANN使用根据UVJ-ARA-SP三角形的定量测量得出的静态和动态参数来对健康受试者和SUI患者进行分类。 •ANN使用UVJ-ara-s-s-s-s-s-Triangle的动态轨迹对PF函数进行评估。将进行临床实验，以比较症状受试者的UVJ-ara-SP三角形的静态和动态特征和不同动作中SUI的患者的静态和动态特征。为了实现这些目标，我们假设大陆老年妇女比在以下参数中具有压力尿失禁的老年女性更高的骨盆底强度值：静止的PFM强度自愿收缩任务，以实现力的最大强度，速度和延迟的延迟。这些价值在年龄匹配的无效妇女中将更高。相关地，我们假设继续老年妇女会出现在以下新参数中，UVJ-ara-s-s-s-s-s-s-s-s-三角形中的可视化值不同。膀胱脖子比继续的女性。在PFM收缩期间，静置的膀胱颈近似将较低，并且在持续女性中的Valsalva操纵中将较低。注意：我们建议维持原始的努力使用原始建议的主题并收集基本数据。如上所述，我们不会执行针对2D动画部分的编程建议，但要确保对数据进行适当的编码并提供。