RESUMEN
Creatine chemical exchange saturation transfer (CrCEST) MRI is an emerging high resolution and noninvasive method for measuring muscle specific oxidative phosphorylation (OXPHOS). However, CrCEST measurements are sensitive to changes in muscle pH, which might confound the measurement and interpretation of creatine recovery time (τCr). Even with the same prescribed exercise stimulus, the extent of acidification and hence its impact on τCr is expected to vary between individuals. To address this issue, a method to measure pH pre- and post-exercise and its impact on CrCEST MRI with high temporal resolution is needed. In this work, we integrate carnosine 1H- magnetic resonance spectroscopy (MRS) and 3D CrCEST to establish "mild" and "moderate/intense" exercise stimuli. We then test the dependence of CrCEST recovery time on pH using different exercise stimuli. This comprehensive metabolic imaging protocol will enable personalized, muscle specific OXPHOS measurements in both healthy aging and myriad other disease states impacting muscle mitochondria.
Asunto(s)
Imagen por Resonancia Magnética , Músculo Esquelético , Fosforilación Oxidativa , Espectroscopía de Protones por Resonancia Magnética , Imagen por Resonancia Magnética/métodos , Humanos , Músculo Esquelético/metabolismo , Músculo Esquelético/diagnóstico por imagen , Masculino , Concentración de Iones de Hidrógeno , Espectroscopía de Protones por Resonancia Magnética/métodos , Creatina/metabolismo , Ejercicio Físico/fisiología , Femenino , AdultoRESUMEN
Clinical research centers that support hypothesis-driven investigation have long been a feature of academic medical centers but facilities in which clinical care delivery can be systematically assessed and evaluated have heretofore been nonexistent. The Institute of Medicine report "Crossing the Quality Chasm" identified six core attributes of an ideal care delivery system that in turn relied heavily on system redesign. Although manufacturing and service industries have leveraged modern design principles in new product development, healthcare has lagged behind. In this article, we describe a methodology utilized by our facility to study the clinical care delivery system that incorporates modern design principles.
Asunto(s)
Atención a la Salud , Difusión de Innovaciones , Técnicas de Apoyo para la Decisión , Atención a la Salud/métodos , Humanos , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Satisfacción del Paciente , Calidad de la Atención de Salud , Estados UnidosRESUMEN
Profound economic and social forces are challenging healthcare organizations to deliver higher quality care that is more patient-centered and evidence-based. We describe a novel way in which organizations can respond to the challenge of patient-centered, evidence-based innovation--an in-house learning laboratory for healthcare delivery services and processes. Mayo Clinic's SPARC Innovation Program, initiated in 2002 and fully operational in 2005, facilitates the generation of new ideas, tests prototypes, and disseminates the knowledge required for systemic, repeatable organizational innovation. Results from the innovation program suggest that healthcare organizations can successfully develop and realize value from such learning laboratories.