Preliminary study of reliability of transcutaneous sensors in measuring intraabdominal pressure.

Early recognition of elevated intraabdominal pressure (IAP) in critically ill patients is essential, since it can result in abdominal compartment syndrome, which is a life-threatening condition. The measurement of intravesical pressure is currently considered the gold standard for IAP assessment. Alternative methods have been proposed, where IAP assessment is based on measuring abdominal wall tension, which reflects the pressure in the abdominal cavity. The aim of this study was to evaluate the feasibility of using patch-like transcutaneous sensors to estimate changes in IAP, which could facilitate the monitoring of IAP in clinical practice. This study was performed with 30 patients during early postoperative care. All patients still had an indwelling urinary catheter postoperatively. Four wearable sensors were attached to the outer surface of the abdominal region to detect the changes in abdominal wall tension. Additionally, surface EMG was used to monitor the activity of the abdominal muscles. The thickness of the subcutaneous tissue was measured with ultrasound. Patients performed 4 cycles of the Valsalva manoeuvre, with a resting period in between (the minimal resting period was 30 s, with a prolongation as necessary to ensure that the fluid level in the measuring system had equilibrated). The IAP was estimated with intravesical pressure measurements during all resting periods and all Valsalva manoeuvres, while the sensors continuously measured changes in abdominal wall tension. The association between the subcutaneous thickness and tension changes on the surface and the intraabdominal pressure was statistically significant, but a large part of the variability was explained by individual patient factors. As a consequence, the predictions of IAP using transcutaneous sensors were not biased, but they were quite variable. The specificity of detecting intraabdominal pressure of 20 mmHg and above is 88%, with an NPV of 96%, while its sensitivity and PPV are currently far lower. There are inherent limitations of the chosen preliminary study design that directly caused the low sensitivity of our method as well as the poor agreement with the gold standard method; in spite of that, we have shown that these sensors have the potential to be used to monitor intraabdominal pressure. We are planning a study that would more closely resemble the intended clinical use and expect it to show more consistent results with a far smaller error.

Muscles within muscles: a tensiomyographic and histochemical analysis of the normal human vastus medialis longus and vastus medialis obliquus muscles.

The aim of this study was to show the connection between structure (anatomical and histochemical) and function (muscle contraction properties) of vastus medialis obliquus (VMO) and vastus medialis longus (VML). The non-invasive tensiomyography (TMG) method was used to determine the contractile properties (contraction time; T(c)) of VML and VMO muscle, as a reflection of the ratio between the slow and fast fibers in two groups of nine young men. VML and VMO significantly (P < 0.01) differ in the proportion of type 1 (59.6: 44%) and type 2b (6.3: 15%) fibers. The VML muscle is almost entirely composed of type 1 and type 2a fibers. In many samples of this muscle no type 2b fibers were found. The proportion of slow-twitch type 1 fibers is nearly twice as high as the proportion of fast-twitch type 2a fibers. These observations indicate that VML is a slower and more fatigue-resistant muscle than VMO muscle. These characteristics correspond to the different functions of the VML, which is an extensor of the knee, and to the VMO, which maintains the stable position of the patella in the femoral groove. Our results obtained by TMG provided additional evidence that muscle fibers within the segments of VM muscle were not homogenous with regard to their contractile properties, thereby confirming the histochemical results. T(c) can be attributed to the higher percentage of slow-twitch fibers - type 1. The statistically shorter T(c) (P ≤ 0.001) of VMO (22.8 ±â€…4.0 ms) compared with VML (26.7 ±â€…4.0 ms) in our study is consistent with previously found differences in histochemical, morphological and electrophysiological data. In conclusion, the results of this study provide evidence that the VML and VMO muscles are not only anatomically and histochemically different muscles, but also functionally different biological structures.

Adaptive potential of human biceps femoris muscle demonstrated by histochemical, immunohistochemical and mechanomyographical methods.

The goal of this study was to estimate the ability of biceps femoris (BF) muscle, a hamstring muscle crucial for biarticulate movement, to adapt to changed functional demands. For this purpose and due to ethical reasons, in a group of healthy sedentary men and of 15 sprinters, a non-invasive mechanomyography (MMG) method was used to measure the muscle twitch contraction times (Tc). These correlate with the proportions of slow and fast fibres in the muscle. To further elucidate the data obtained by MMG method and to obtain reference data for the muscle, the fiber type proportions in autoptic samples of BF in sedentary young men were determined according to histochemical reaction for myofibrillar adenosine triphosphatase (mATPase). In one BF sample also myosin heavy chain (MyHC) isoform expression was demonstrated immunohistochemically. With MMG we indirectly demonstrated that biceps femoris muscle has a strong potential to transform into faster contracting muscle after sprint training, since the average Tc in sprinters was much lower (19.5 +/- 2.3 ms) than in the sedentary group (30.25 +/- 3.5 ms). The results of the histochemical and immunohistochemical analysis of BF muscle also imply a high adapting potential of this muscle. Beside type 1, 2a and 2x (2b) fibres a relatively high proportion of intermediate type 2c fibres (5.7% +/- 0.7), which co-expressed MyHC-1 and -2a, was found. Therefore, type 2c might represent a potential pool of fibres, capable of transformation either to slow type 1 or to fast type 2a in order to tune the functional response of BF muscle according to the actual functional demands of the organism.

Spatial fiber type distribution in normal human muscle Histochemical and tensiomyographical evaluation.

The variability of fiber type distribution in nine limb muscles was examined with histochemical and tensiomyographical (TMG) methods in two groups of 15 men aged between 17 and 40 years. The aim of this study was to determine the extent to which the relative occurrence of different fiber types and subtypes varies within human limb muscles in function to depth and to predict fiber type proportions with a non-invasive TMG method. The distribution of different fiber types varied within the muscles, as a function of depth, with a predominance of type 2b fibers at the surface and type 1 fibers in deeper regions of the muscle. For all the analyzed muscles the contraction times measured at stimulus intensity 10% of supramaximal stimulus (10% MS) were significantly (p<0.05) shorter than the contraction times measured at 50% of supramaximal stimulus intensity (50% MS). The Pearson's correlation coefficient between percentage of type 1 muscle fibers measured at the surface of the muscle and contraction time at 10% MS, obtained by TMG was statistically significant (r=0.76,P<0.01). Also the Pearson's correlation coefficient between percentage of type 1 muscle fibers measured in the deep region of the muscle and contraction time at 50% MS obtained by TMG was also statistically significant (r=0.90,P<0.001). These findings suggest that the contraction time obtained by TMG may be useful for non-invasive examining of muscle fiber types spatial distribution in humans.

The muscle adaptation process as a result of pathological changes or specific training procedures.

Muscle responses to tetanic electrical stimulation were detected by the non-invasive tensiomyographic (TMG) measuring method. The main objective of this study was to find out whether the TMG measuring method is suitable for monitoring the unfused tetanus (stimulation frequencies ranging from 1 Hz to the fusion frequency (ff)--the frequency at which tetanus occurs), and whether this monitoring provides any information on skeletal muscles' structural or functional changes. The muscle adaptation process was observed in damped unfused tetanus (DUT). The measured results in the clinical environment as well as on the sports field indicate that DUT is caused by a type II muscle fibres fatigue process. Separate observation of type II muscle fibres enables more efficient treatment and observation of pathological changes, and helps professional athletes and their trainers to better understand the influence of training stimuli on the training process.