臺灣博碩士論文加值系統

排尿在人體生理上是重要的功能之一，需要不同的器官、神經與肌肉配合才能順利完成排尿的動作。臨床上，常用來檢查下泌尿道排尿病理生理學之工具為膀胱壓力圖(cystometrograms，CMG)與外尿道括約肌肌電圖(external urethral sphincter electromyograms，EUS EMG)。由這兩項檢查可對下泌尿道的症狀做初步的診斷。目前在泌尿動力學中所累積的經驗，而應用至臨床上對膀胱壓力圖與外尿道括約肌肌電圖的判讀多著重於巨觀幾何學觀點的解讀，諸如膀胱壓力的大小、斜率，來推測膀胱的閥值、順應性等等，這都屬於靜態的結果，然而很多動態的行為無法從這個觀點來解釋。
首先從節律以及分形維度的觀點來探討膀胱逼尿肌與外尿道括約肌的排尿動力學。在節律方面，利用頻譜分析來觀察排尿過程中節律變化的情況。在分形維度方面，針對分數維度布朗運動與分數維度高斯雜訊的模型發展適合的演算法來計算分形維度。
在分析正常大白鼠的實驗數據後，本研究發現膀胱壓力圖與外尿道括約肌肌電圖在排尿過程中有特別的節律存在，搭配分形維度可以區別不同的排尿狀態，可以觀察到不同肌肉間互動的情形。接著探討脊髓受傷大白鼠的異常現象，依此分析脊髓受傷時逼尿肌與括約肌共濟失調的現象並提出創新的見解，希望本研究對生理訊號的分析以及泌尿動力學有更進一步的助益。

In micturition, the bladder is supposed to empty by a contraction of the detrusor and relaxation of the external sphincter during micturition. By contrast, suprasacral spinal cord injury (SCI) patients usually will have both of them contract simultaneously and result in the so-called detrusor-sphincter dyssynergia. In this study, the cystometrograms of the detrusor and the electromyograms of external urethral sphincter of intact and SCI female Wistar rats are used to investigate the detrusor-sphincter synergia and dyssynergia during micturition.
Here, we demonstrate that a temporal “coherent” fractal structure and synchronization of rhythms are two essential features for concerted systemic functions in urodynamics of female Wistar rats. The rhythms of detrusor of the bladder and external urethral sphincter are synchronized around 7Hz and their fractal dimensions as functions of time are temporally “coherent” under 1.5 during voiding in order to facilitate the concerted process. On the other hand, in the spinal cord injured rats, either the temporal coherent structure of fractal or the underlying synchronization of rhythms is impaired, weakened, or absent. Results indicate that, for intact rats, the sphincter muscle is not only active but also recruited in a synchronous fashion with the detrusor. These results have potential implications in the diagnosis of the so-called “dynamical” diseases.

Abstract i
Acknowledgments ii
List of Figures v
List of Tables viii
Chapter 1 Introduction 1
1.1 Rhythms and fractal 1
1.2 Urodynamics 2
1.3 Contributions of the dissertation 5
1.4 Organization of the dissertation 6
Chapter 2 Preliminaries 7
2.1 Fractional Brownian motion 7
2.2 Power spectral theory 9
Chapter 3 Illustrations of EUS EMG signals 11
3.1 Fourier transform and power spectral density 11
3.2 Fractal dimension estimation of the fractional Brownian motion and fractional Gaussian noise 16
Chapter 4 Analysis of Urodynamic Signals 20
4.1 Animal experiments 20
4.2 Data acquisition 22
4.3 Data Analysis 23
4.4 Time series of EUS EMG and CMG of Wistar rats 24
4.5 Fractal dimensions of EUS EMG and CMG of Wistar rats 30
4.5.1 Fractal dimensions of intact Wistar rats with room-temperature stimulation 30
4.5.2 Fractal dimensions of intact Wistar rats with cold-temperature stimulation 37
4.5.3 Fractal dimensions of SCI Wistar rats 41
4.6 Power spectral analyses of EUS EMG and CMG for Wistar rats 52
4.6.1. Power spectra of intact Wistar rats with room-temperature stimulation 52
4.6.2 Power spectra of SCI Wistar rats 55
4.7 Discussion 61
Chapter 5 Conclusion and Directions for Future Research 66
Bibliography 67

Bors EH and Blinn KA, “Spinal reflex activity from the vesical mucosa in paraplegic patients,” Arch Neurol Psych, vol. 78, pp. 339-354, 1957.
Chang S, Mao ST, Kuo TP, Hu SJ, Lin WC, and Cheng CL, “Fractal geometry in urodynamics of lower urinary tract,” Chinese J Physiol, vol. 41, no. 4, pp. 25–31, 1999.
Chang S, Mao ST, Hu SJ, Lin WC, and Cheng CL, “Studies of detrusor-sphincter synergia and dyssynergia during micturition in rats via fractional Brownian motions,” IEEE Trans Biomed Eng, vol. 47, no. 8, pp. 1066–73, 2000.
Chang S, Hu SJ, and Lin WC, “Fractal dynamics and synchronization of rhythms in urodynamics of female Wistar rats,” J Neurosci Meth, vol. 139, pp. 271–279, 2004.
Chang YC and Chang S, “A Fast Estimation Algorithm on the Hurst Parameter of Discrete-Time Fractional Brownian Motion,” IEEE Trans. Signal Processing, vol. 50, no. 3, pp. 554-559, 2002.
Cheng CL, Ma C, and De Groat WC, “Effect of capsaicin on micturition and associated reflexes in chronic spinal rats,” Brain Res, vol. 678, pp. 40-48, 1995.
Cheng CL, Chai CY, and De Groat WC, “Detrusor-sphincter dyssynergia induced by cold stimulation of the urinary bladder of rats,” Am J Physiol, vol. 272, pp. 1271-1282, 1997.
Cheng CL, Liu JC, Chang SY, Ma CP, and De Groat WC. Effect of capsaicin on the micturition reflex in normal and chronic spinal cord-injured cats. Am J Physiol, vol. 277, pp. 786-794, 1999.
De Groat WC, “Mechanisms underlying the recovery of lower urinary tract function following spinal cord injury,” Paraplegia, vol. 33, pp. 493–505, 1995.
Eugene W and Bruce H, “Stochastic Processes in Engineering Systems,” New York, NY: Springer-Verlag, 1985.
Geirsson G, Lindstrom S, and Fall M, “The bladder cooling reflex in man-characteristics and sensitivity to temperature,” Br J Urol, vol. 71, pp. 675-680, 1993.
Glass L, “Synchronization and rhythmic processes in physiology,” Nature, vol. 410, pp. 277- 284, 2001.
Hunt GA, “Random fourier transforms,” Trans Amer Math Soc, vol. 71, pp. 38–69, 1951.
Ivanov PC, Amaral LAN, Goldberger AL, Havlin S, Rosenblum MG, Struzik ZR, and Stanley HE, “Multifractality in human heartbeat dynamics,” Nature, vol. 399, pp. 461–465, 1999.
Kaplan SA, Chancellor M, and Blaivas JG, “Bladder and sphincter behavior in patients with spinal cord lesions,” J Urol, vol. 146, pp, 113–117, 1991.
Kay SM, “Modern Spectral Estimation: Theory and Application,” Englewood Cliffs, NJ: Prentice-Hall, 1988.
Kolmogorov AN, “Wienersche Spiralen und einige andere interessante Kurven im Hilbertschen Raum,” C.R. (Doklady) Acad Sci USSR, vol. 16, pp. 115–118, 1940.
Kruse MN, Belton AL, and De Groat WC, “Changes in bladder and external urethral sphincter function after spinal cord injury in the rat,” Am J Physiol, vol. 264, pp. 1157-1163, 1993.
Lamperti J, “Semi-stable stochastic process,” Trans Amer Math Soc, vol. 104, pp. 62–78, 1962.
Liu SC, and Chang S, “Dimension estimation of discrete-time Fractional Brownian motion with applications to image texture classification,” IEEE Trans Image Processing, vol. 6, no. 8, pp. 1176-1184, 1997.
Mandelbrot BB, “Some noises with an 1/f spectrum: a bridge between direct current and white noise,” IEEE Trans Inform Theory, vol. 13, no. 2, pp. 289–298, 1967.
Mandelbrot BB, and Van Ness JW, “Fractional Brownian motions, fractional noises and applications,” SIAM Rev, vol. 10, pp. 422–437, 1968.
Mandelbrot BB, “Fractals: Form, Chance, and Dimension,” San Francisco, CA: Freeman, 1977.
Mandelbrot BB, “The Fractal Geometry of Nature,” San Francisco, CA: Freeman, 1982.
Mao ST, Fractal Dimension Analysis of Electromyography of External Urethral Sphincter and Cystometrography in Anesthetized Rats. Master thesis, National Tsing Hua University, Hsinchu, Taiwan, ROC, 1998.
Schäfer C, Rosenblum MG, Kurths J, and Abel HH, “Heartbeat synchronized with ventilation,” Nature, vol. 392, pp. 239–240, 1998.
Shiryayev AN, “Probability,” New York, NY: Springer-Verlag, 1984.
Voss RF, “Fractals in nature: From characterization to simulation,” The Science of Fractal Images. New York, NY: Springer-Verlag, pp. 21–70, 1988.
Williams PL, Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE, and Freguson MWJ, “Gray's Anatomy, 38th ed.,” New York, NY: Churchill Livingstone, 1995.
Walsh PC, Retil AB, Stamey TA, and Vaughan ED (eds), “Campbell’s Urology, 7th ed.,” Philadelphia, PA: WB Saunders Co., 1998.