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Reiter HCJ, Andersen CA. Near-infrared spectroscopy with a provocative maneuver to detect the presence of severe peripheral arterial disease. J Vasc Surg Cases Innov Tech 2024; 10:101379. [PMID: 39376645 PMCID: PMC11456852 DOI: 10.1016/j.jvscit.2023.101379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/06/2023] [Indexed: 10/09/2024] Open
Abstract
Current assessment standards for peripheral arterial disease (PAD), such as the ankle brachial index, are limited in their utility and portability. Near-infrared spectroscopy (NIRS) has shown some promise in diagnosing PAD when used in conjunction with a provocative maneuver. The purpose of this study was to assess the viability of NIRS in conjunction with a transient leg elevation provocative maneuver for detecting severe PAD. This retrospective observational cross-sectional study assessed 57 limbs in 34 patients receiving routine vascular screening for PAD at Madigan Army Medical Center. The patient limbs were stratified into normal (n = 17), mild (n = 9), moderate (n = 16), and severe (n = 15) PAD groups based on the clinician assessments. Additionally, the patients were assessed with NIRS measurements taken with the patient in the supine position at rest and using a provocative leg raise maneuver of transient leg elevation of 45° for 60 seconds. The resting tissue oxygen saturation (StO2) and the change in StO2 (ΔStO2) from rest to elevation were recorded and compared between the PAD severity groups via independent measures analysis of variance with the Tukey honest significant difference post hoc test. The supine resting StO2 was not different between the normal (77.5% ± 7.7%), mild (72.5% ± 7.4%), moderate (72.0% ± 10.3%), and severe (74.2% ± 5.4%) PAD groups (P = .23). However, the ΔStO2 with transient leg elevation was significantly greater in the severe PAD group (-17.2% ± 6.0%) compared with the normal (-3.9% ± 4.8%), mild (-6.9% ± 4.7%), and moderate (-9.7% ± 5.2%) PAD groups (P < .002 for all). Similar results were observed in the changes in oxyhemoglobin and deoxyhemoglobin. The leg elevation protocol was also used for two patients before and after lower limb revascularization, which demonstrated that the ΔStO2 corresponded with the clinical assessment of PAD severity. Resting supine NIRS images were unable to detect any differences among normal and limbs with different PAD severity. However, NIRS imaging with 45° leg elevation for 60 seconds showed a significant difference between severe PAD compared healthy patients and those with mild to moderate PAD in a fast, precise, and accurate manner. These preliminary data support the use of NIRS and transient leg elevation as a tool to diagnose severe PAD but do not support the use of NIRS alone as a screening test for PAD. NIRS measurements with leg elevation might be a viable noninvasive, noncontact, and portable method of assessing severe PAD for home monitoring, in rural communities, and/or in standard clinical practice.
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Affiliation(s)
- Homer-Christian J. Reiter
- The Geneva Foundation, University of Washington, Tacoma, WA
- Vascular Surgery, Limb Preservation, and Wound Care Services, Madigan Army Medical Center, Tacoma, WA
| | - Charles A. Andersen
- Vascular Surgery, Limb Preservation, and Wound Care Services, Madigan Army Medical Center, Tacoma, WA
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Wibowo V, Munshi B, Ziolkowski J, Wilson I, Ma R, Jansen S. The Role of Near Infrared Spectroscopy in Diagnosing Stump Ischaemia in Patients with Below Knee Amputation: Case Reports. EJVES Vasc Forum 2023; 60:14-18. [PMID: 37448526 PMCID: PMC10336405 DOI: 10.1016/j.ejvsvf.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/20/2023] [Accepted: 05/23/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Functional near infrared spectroscopy (fNIRS) can be used to quantify stump oxygen saturation (SaO2) as one of many possible causes of pain following major amputation. Although commonly used for cerebral perfusion monitoring during carotid or cardiac surgery, it can also be used to monitor tissue perfusion in the lower limb and predict healing following below knee amputation (BKA). The aim of this study was to measure the SaO2 trend as there is no validated oxygen threshold to diagnose insufficient flow into the arterial collateral network currently. Report NIRS was used to measure SaO2 while performing treadmill exercise. Two BKA patients with chronic stump pain were asked to perform treadmill exercise while using their prosthesis and NIRS optode applied to the posterior stump to monitor SaO2. Cases 1 and 2 showed a decline in SaO2 of 25% and 18%, respectively, while walking on the prosthesis. After superficial femoral artery (SFA) recanalisation and stenting, Case 1 showed improvement by maintaining SaO2 between 54% and 60% throughout treadmill exercise. In Case 2, perfusion could not be further improved, and the patient underwent through knee amputation. Discussion fNIRS detected compressive ischaemia and exercise induced ischaemia as mechanisms of stump pain. Findings provided the multidisciplinary team with objective information, aiding decision making to treat stump pain.
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Affiliation(s)
- Valent Wibowo
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Bijit Munshi
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Jessica Ziolkowski
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Ian Wilson
- Department of Rehabilitation and Aged Care, Osborne Park Hospital, Perth, WA, Australia
| | - Robert Ma
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Shirley Jansen
- Vascular Surgery, Curtin Medical School, Curtin University, Perth, WA, Australia
- Professor Vascular Surgery, Curtin Medical School, Curtin University, Perth, WA, Australia
- Consultant Vascular and Endovascular Surgeon, Head of Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Director Heart and Vascular Research Institute, Harry Perkins Medical Research Institute, Perth, WA, Australia
- Clinical Professor University of Western Australia, Australia
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Chronic PCSK9 inhibitor therapy leads to sustained improvements in endothelial function, arterial stiffness, and microvascular function. Microvasc Res 2023; 148:104513. [PMID: 36870561 DOI: 10.1016/j.mvr.2023.104513] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) effectively decrease low-density lipoprotein cholesterol (LDL-C) and reduce cardiovascular events in patients at very high cardiovascular risk. Recent short-term studies suggest a partially LDL-C independent beneficial effect of PCSK9 inhibitor (PCSK9i) therapy on endothelial function and arterial stiffness, whereas it is unknown if this effect persists and what the effect is on microcirculation. OBJECTIVE To investigate the effects of PCSK9i therapy on vascular parameters beyond its lipid lowering effect. METHODS In this prospective trial, 32 patients at very high cardiovascular risk and indication for PCSK9i therapy were included. Measurements were performed at baseline and after 6 months of PCSK9i treatment. Endothelial function was assessed as flow-mediated dilation (FMD). Arterial stiffness was measured as pulse wave velocity (PWV) and aortic augmentation index (AIx). Peripheral tissue oxygenation (StO2) as a marker of microvascular function was assessed at the distal extremities using near-infrared spectroscopy camera. RESULTS Six months of PCSK9i therapy decreased LDL-C levels from 141 ± 54 to 60 ± 30 mg/dl (-56 ± 21 %, p < 0.001), FMD significantly increased from 5.4 ± 1.7 % to 6.4 ± 1.9 % (+19 ± 10 %, p < 0.001), PWV decreased in male patients significantly from 8.9 ± 2.1 to 7.9 ± 1.5 m/s (-12 ± 9 %, p = 0.025). AIx decreased from 27.1 ± 10.4 % to 23.0 ± 9.7 % (-16 ± 14 %, p < 0.001), StO2 significantly increased from 67 ± 12 % to 71 ± 11 % (+7 ± 6 %, p = 0.012). Brachial and aortic blood pressure showed no significant changes after six months. There was no correlation between LDL-C reduction and changes in vascular parameters. CONCLUSIONS Chronic PCSK9i therapy is associated with sustained improvements in endothelial function, arterial stiffness, and microvascular function independent from lipid lowering.
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Endovascular Revascularization of Isolated Internal Iliac Artery for symptomatic occlusive atherosclerotic disease is a viable and underutilized option for patients with gluteal muscle claudication. J Vasc Surg Cases Innov Tech 2023; 9:101090. [PMID: 36992706 PMCID: PMC10041555 DOI: 10.1016/j.jvscit.2022.101090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/29/2022] [Indexed: 02/19/2023] Open
Abstract
Often confused with pseudoclaudication, gluteal muscle claudication is a difficult condition to diagnose and treat. We present the case of a 67-year-old man with a history of back and buttock claudication. He had undergone lumbosacral decompression with no relief of buttock claudication. Computed tomography angiography of the abdomen and pelvis showed occlusion of the bilateral internal iliac arteries. Exercise transcutaneous oxygen pressure measurements obtained on referral to our institution revealed a significant decrease. He underwent successful recanalization and stenting of the bilateral hypogastric arteries with complete resolution of his symptoms. We also reviewed the reported data to highlight the trend in the management of patients with this condition.
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The Value of Infrared Thermography to Assess Foot and Limb Perfusion in Relation to Medical, Surgical, Exercise or Pharmacological Interventions in Peripheral Artery Disease: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12123007. [PMID: 36553014 PMCID: PMC9777328 DOI: 10.3390/diagnostics12123007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/11/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
Infrared thermography (IRT) is a promising imaging method in patients with peripheral artery disease (PAD). This systematic review aims to provide an up-to-date overview of the employment of IRT as both a diagnostic method and an outcome measure in PAD patients in relation to any kind of intervention. On September 2022, MEDLINE, EMBASE, CENTRAL, Google Scholar, Web of Science, and gray literature were screened. Eligible articles employing IRT in PAD were screened for possible inclusion. The RoB 2.0 tool was used to assess the risk of bias. Twenty-one eligible articles were finally included, recruiting a total of 1078 patients. The IRT was used for PAD diagnosis/monitoring in 11 studies or to assess the effect of interventions (revascularization, pharmacological therapy, or exercise rehabilitation) in 10 studies. The analysis of the included papers raised high concerns about the overall quality of the studies. In conclusion, IRT as a noninvasive technique showed promising results in detecting foot perfusion in PAD patients. However, limits related to devices, points of reference, and measurement conditions need to be overcome by properly designed trials before recommending its implementation in current vascular practice.
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Hooff M, Meijer EJ, Scheltinga MRM, Savelberg HHCM, Schep G. Test–retest reliability of skeletal muscle oxygenation measurement using near‐infrared spectroscopy during exercise in patients with sport‐related iliac artery flow limitation. Clin Physiol Funct Imaging 2022; 42:114-126. [PMID: 35075811 PMCID: PMC9306874 DOI: 10.1111/cpf.12738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022]
Abstract
The ankle‐brachial index is an accurate tool for detecting claudication in atherosclerotic patients. However, this technique fails to identify subtle flow limitations of the iliac arteries (FLIA) in endurance athletes. Near‐infrared spectroscopy (NIRS) is a noninvasive technique that measures skeletal muscle tissue oxygenation status. The aim of the present study is to examine the absolute and relative test–retest reliability of NIRS and evaluate its potential as a diagnostic tool in FLIA. NIRS‐derived exercise variables were analyzed during exercise and recovery in FLIA 17 patients and 19 healthy controls. The relative reliability of absolute variables (such as the maximal value) were slight to yet predominantly substantial (intraclass correlation coefficient [ICC], ICC range: 0.06–0.76) with good to excellent absolute reliability (absolute limits of agreement [ALoA], ALoA range: 0.8 ± 10.2 to 0.7 ± 13.1; coefficient of variation [CV], CV range: 5%–11%). Absolute values encompassing signal amplitudes showed moderate to almost perfect relative reliability (ICC range: 0.51–0.89) and poor to good absolute reliability (ALoA range: −1.3 ± 7.0 to −2.5 ± 15.7; CV range: 15%–32%). Kinetic variables showed moderate to almost perfect relative reliability for most recovery kinetics variables (ICC range: 0.54–0.86) with fair to good absolute reliability (ALoA range: 0.4 ± 12.2 to 3.9 ± 37.9; CV range: 18%–27%). Particularly, kinetic variables showed significant differences between patients and healthy subjects. NIRS is found to be a reliable method for examining muscle tissue oxygenation variables. Given the significant differences in especially recovery kinetics between normal subjects and patients, NIRS may contribute to diagnosing FLIA in endurance athletes.
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Affiliation(s)
- Martijn Hooff
- Department of Sports and Exercise Máxima Medical Centre Veldhoven Noord‐Brabant The Netherlands
- Department of Movement and Nutrition Sciences, Faculty of Health, Medicine and Life Sciences Maastricht University Maastricht Maastricht The Netherlands
| | - Eduard J. Meijer
- Department of Clinical Physics Máxima Medical Centre Veldhoven Noord‐Brabant The Netherlands
| | - Marc R. M. Scheltinga
- Department of Clinical Physics Máxima Medical Centre Veldhoven Noord‐Brabant The Netherlands
- Department of Vascular Surgery Máxima Medical Centre Veldhoven Noord‐Brabant The Netherlands
| | - Hans H. C. M. Savelberg
- Department of Movement and Nutrition Sciences, Faculty of Health, Medicine and Life Sciences Maastricht University Maastricht Maastricht The Netherlands
| | - Goof Schep
- Department of Sports and Exercise Máxima Medical Centre Veldhoven Noord‐Brabant The Netherlands
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Meertens R, Knapp KM, Strain WD, Casanova F, Ball S, Fulford J, Thorn C. In vivo Measurement of Intraosseous Vascular Haemodynamic Markers in Human Bone Tissue Utilising Near Infrared Spectroscopy. Front Physiol 2021; 12:738239. [PMID: 34630158 PMCID: PMC8497693 DOI: 10.3389/fphys.2021.738239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Poor vascular health is associated with reduced bone strength and increased risk of fragility fracture. However, direct measurement of intraosseous vascular health is difficult due to the density and mineral content of bone. We investigated the feasibility of using a commercially available continuous wave near infrared spectroscopy (NIRS) system for the investigation of vascular haemodynamics in human bone in vivo. Approach: An arterial occlusion (AO) protocol was developed for obtaining haemodynamic measurements of the proximal tibia and lateral calf, including assessment of the protocol’s intra operator reproducibility. For 36 participants, intraosseous haemodynamics derived by NIRS were compared to alternative tests of bone health based on dual x-ray absorptiometry (DXA) testing and MRI. Main Results: Near infrared spectroscopy markers of haemodynamics of the proximal tibia demonstrated acceptable reproducibility, comparable with reproducibility assessments of alternative modalities measuring intraosseous haemodynamics, and the use of NIRS for measuring muscle. Novel associations have been demonstrated between haemodynamic markers of bone measured with NIRS and body composition and bone mineral density (BMD) measurements obtained with both DXA and MRI. Significance: Near infrared spectroscopy provides inexpensive, non-invasive, safe, and real time data on changes in oxygenated and deoxygenated haemoglobin concentration in bone at the proximal tibia. This study has demonstrated the potential for NIRS to contribute to research investigating the pathophysiological role of vascular dysfunction within bone tissue, but also the limitations and need for further development of NIRS technology.
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Affiliation(s)
- Robert Meertens
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Karen M Knapp
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | | | - Francesco Casanova
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Susan Ball
- NIHR Applied Research Collaboration South West Peninsula (PenARC), College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Jon Fulford
- NIHR Exeter Clinical Research Facility, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Clare Thorn
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
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Mahé G, Boge G, Bura-Rivière A, Chakfé N, Constans J, Goueffic Y, Lacroix P, Le Hello C, Pernod G, Perez-Martin A, Picquet J, Sprynger M, Behar T, Bérard X, Breteau C, Brisot D, Chleir F, Choquenet C, Coscas R, Detriché G, Elias M, Ezzaki K, Fiori S, Gaertner S, Gaillard C, Gaudout C, Gauthier CE, Georg Y, Hertault A, Jean-Baptiste E, Joly M, Kaladji A, Laffont J, Laneelle D, Laroche JP, Lejay A, Long A, Loric T, Madika AL, Magnou B, Maillard JP, Malloizel J, Miserey G, Moukarzel A, Mounier-Vehier C, Nasr B, Nelzy ML, Nicolini P, Phelipot JY, Sabatier J, Schaumann G, Soudet S, Tissot A, Tribout L, Wautrecht JC, Zarca C, Zuber A. Disparities Between International Guidelines (AHA/ESC/ESVS/ESVM/SVS) Concerning Lower Extremity Arterial Disease: Consensus of the French Society of Vascular Medicine (SFMV) and the French Society for Vascular and Endovascular Surgery (SCVE). Ann Vasc Surg 2021; 72:1-56. [DOI: 10.1016/j.avsg.2020.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/05/2020] [Indexed: 12/24/2022]
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9
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Kayama T, Sano M, Inuzuka K, Katahashi K, Yata T, Yamanaka Y, Naruse E, Yamamoto N, Takeuchi H, Unno N. A Pilot Study Investigating the Use of Regional Oxygen Saturation as a Predictor of Ischemic Wound Healing Outcome after Endovascular Treatment in Patients with Chronic Limb-Threatening Ischemia. Ann Vasc Dis 2021; 14:23-30. [PMID: 33786096 PMCID: PMC7991714 DOI: 10.3400/avd.oa.20-00132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To determine the prognostic value of regional tissue oxygenation saturation (rSO2) for ulcer healing after endovascular treatment (EVT) of peripheral arterial disease (PAD). Materials and Methods: Among PAD patients, 34 patients with chronic limb-threatening ischemia underwent EVT for limb salvage. We retrospectively analyzed the cutoff rSO2 values on postoperative day 1 to predict ulcer healing and patient prognosis. Skin perfusion pressure (SPP) and transcutaneous oxygen pressure (TcPO2) were also used to assess wound healing. Results: A finger-mounted tissue oximeter can easily measure rSO2 on the dorsal foot. Among the 34 patients, the ulcer healed in 25, and no changes were observed in 2 patients at 1 month after EVT. However, 7 patients needed major amputation at the same time. Wound healing was achieved in all patients with rSO2≥50%. With this cutoff, the sensitivity and specificity of the new device for wound healing were 100% and 64%, respectively. In all the wound healing cases, SPP was ≥45 mmHg, and TcPO2 was ≥40 mmHg. Conclusion: To assess limb ischemia, rSO2 can be measured quickly and easily using this device. We suggest that an rSO2>50% shows good prognosis for ulcer healing.
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Affiliation(s)
- Takafumi Kayama
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Masaki Sano
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kazunori Inuzuka
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kazuto Katahashi
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tatsuro Yata
- Division of Vascular Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Yuta Yamanaka
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Ena Naruse
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Naoto Yamamoto
- Division of Vascular Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Hiroya Takeuchi
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Naoki Unno
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.,Division of Vascular Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
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Saiko G, Lombardi P, Au Y, Queen D, Armstrong D, Harding K. Hyperspectral imaging in wound care: A systematic review. Int Wound J 2020; 17:1840-1856. [PMID: 32830443 PMCID: PMC7949456 DOI: 10.1111/iwj.13474] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 01/18/2023] Open
Abstract
Multispectral and hyperspectral imaging (HSI) are emerging imaging techniques with the potential to transform the way patients with wounds are cared for, but it is not clear whether current systems are capable of delivering real-time tissue characterisation and treatment guidance. We conducted a systematic review of HSI systems that have been assessed in patients, published over the past 32 years. We analysed 140 studies, including 10 different HSI systems. Current in vivo HSI systems generate a tissue oxygenation map. Tissue oxygenation measurements may help to predict those patients at risk of wound formation or delayed healing. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of in vivo label-free HSI, but further work is needed to fully integrate it into the current clinical workflow for different wound aetiologies. As an emerging imaging modality for medical applications, HSI offers great potential for non-invasive disease diagnosis and guidance when treating patients with both acute and chronic wounds.
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Affiliation(s)
| | | | | | | | - David Armstrong
- Keck School of MedicineUniversity of Southern California, Los AngelesCaliforniaCaliforniaCanada
| | - Keith Harding
- School of MedicineCardiff UniversityWalesUK
- A*STARSingapore
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11
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Saiko G, Lombardi P, Au Y, Queen D, Armstrong D, Harding K. Hyperspectral imaging in wound care: A systematic review. Int Wound J 2020. [PMID: 32830443 DOI: 10.1111/iwj.13474.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Multispectral and hyperspectral imaging (HSI) are emerging imaging techniques with the potential to transform the way patients with wounds are cared for, but it is not clear whether current systems are capable of delivering real-time tissue characterisation and treatment guidance. We conducted a systematic review of HSI systems that have been assessed in patients, published over the past 32 years. We analysed 140 studies, including 10 different HSI systems. Current in vivo HSI systems generate a tissue oxygenation map. Tissue oxygenation measurements may help to predict those patients at risk of wound formation or delayed healing. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of in vivo label-free HSI, but further work is needed to fully integrate it into the current clinical workflow for different wound aetiologies. As an emerging imaging modality for medical applications, HSI offers great potential for non-invasive disease diagnosis and guidance when treating patients with both acute and chronic wounds.
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Affiliation(s)
| | | | | | | | - David Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, California, California, Canada
| | - Keith Harding
- School of Medicine, Cardiff University, Wales, UK.,A*STAR, Singapore
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Manfredini F, Lamberti N, Ficarra V, Tsolaki E, Straudi S, Zamboni P, Basaglia N, Gasbarro V. Biomarkers of Muscle Metabolism in Peripheral Artery Disease: A Dynamic NIRS-Assisted Study to Detect Adaptations Following Revascularization and Exercise Training. Diagnostics (Basel) 2020; 10:diagnostics10050312. [PMID: 32429406 PMCID: PMC7277989 DOI: 10.3390/diagnostics10050312] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 12/12/2022] Open
Abstract
We assessed whether muscle metabolism biomarkers (MMb) identified by near-infrared spectroscopy (NIRS) are valid for determining adaptations following revascularization or exercise training in peripheral artery disease (PAD). Eighteen patients (males n = 13; 69 ± 7 years) were randomized to receive revascularization (Rev = 6) or pain-free home-based exercise (Ex = 12). MMb were safely collected via a NIRS-assisted treadmill test as area-under-curve for the spectra of oxygenated (-oxy), deoxygenated (-deoxy), differential (-diff) and total (-tot) hemoglobin traces. MMb, ankle–brachial index (ABI), pain-free (PFWD) and 6-min (6MWD) walking distances were assessed at baseline and after four months. MMb were correlated at baseline with ABI (MMb-oxy r = 0.46) and 6MWD (MMb-tot r = 0.51). After treatments, MMb-oxy showed an expected increase, which was more relevant for Rev group than the Ex (56% vs. 20%), with trends towards normalization for the other MMb. These changes were significantly correlated with variations in ABI (MMb-oxy r = 0.71; p = 0.002) and 6MWD (MMb-tot r = 0.58; p = 0.003). The MMb-diff in Rev group and MMb-deoxy in Ex group at baseline predicted clinical outcomes being correlated with PFWD improvements after 4-month (r = −0.94; p = 0.005 and r = −0.57; p = 0.05, respectively). A noninvasive NIRS-based test, feasible in a clinical setting, identified muscle metabolism biomarkers in PAD. The novel MMb were associated with validated outcome measures, selectively modified after different interventions and able to predict long-term functional improvements after surgery or exercise training.
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Affiliation(s)
- Fabio Manfredini
- Section of Sports Sciences, Department of Biomedical and Surgical Specialties Sciences, University of Ferrara, Italy–Via Luigi Borsari 46, 44121 Ferrara, Italy;
- Unit of Physical Medicine and Rehabilitation, Department of Neurosciences/Rehabilitation, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (S.S.); (N.B.)
- Correspondence: ; Tel.: +39-0532-236187
| | - Nicola Lamberti
- Section of Sports Sciences, Department of Biomedical and Surgical Specialties Sciences, University of Ferrara, Italy–Via Luigi Borsari 46, 44121 Ferrara, Italy;
| | - Valentina Ficarra
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (V.F.); (E.T.); (V.G.)
| | - Elpiniki Tsolaki
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (V.F.); (E.T.); (V.G.)
| | - Sofia Straudi
- Unit of Physical Medicine and Rehabilitation, Department of Neurosciences/Rehabilitation, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (S.S.); (N.B.)
| | - Paolo Zamboni
- Vascular Diseases Center, University of Ferrara, Italy–Via Aldo Moro 8, 44124 Ferrara, Italy;
| | - Nino Basaglia
- Unit of Physical Medicine and Rehabilitation, Department of Neurosciences/Rehabilitation, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (S.S.); (N.B.)
| | - Vincenzo Gasbarro
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (V.F.); (E.T.); (V.G.)
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Kundra TS, Thimmarayappa A, Subash SS, Kaur P. Monitoring of limb perfusion after vascular surgery in critical limb ischemia using near-infrared spectroscopy: A prospective observational study. Ann Card Anaesth 2020; 23:429-432. [PMID: 33109799 PMCID: PMC7879884 DOI: 10.4103/aca.aca_137_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Intra and postoperative perfusion monitoring should be used in critical limb ischemia patients undergoing vascular surgery to improve outcomes and reduce costs. While a pulse oximeter can be applied on the affected limb to monitor the arterial saturation of the limb, thus reflecting flow in that limb, we need to focus on other important parameters like muscle oxygen consumption and regional blood flow for a good outcome. Near-infrared spectroscopy (NIRS) can be used in such patients to monitor regional and tissue oxygenation. Methodology: In this prospective observational study, 30 adult patients undergoing infra-inguinal bypass were recruited. All these patients were given combined spinal-epidural anesthesia. In addition to routine monitoring, a pulse oximeter and NIRS electrodes were applied on the affected limb. rsO2, limb spO2, and Doppler signals were noted before the induction of anesthesia (baseline) and postoperatively at 0, 6, and 12 h. Improvement in rsO2 and limb spO2 values after surgery was noted and fall in these values was evaluated. Pearson correlation between rsO2 and limb spO2 was assessed. The data was analyzed using repeated-measures ANOVA. Results: Pearson correlation between rsO2 and limb spO2 was r > 0.8. Two patients had a fall in rsO2 in postoperative period, which co-related with a fall in limb spO2 and decreased/absent Doppler signals. Conclusion: NIRS represents a noninvasive and reliable means to monitor limb perfusion in patients undergoing vascular surgery for rest pain.
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Affiliation(s)
- Tanveer Singh Kundra
- Department of Anaesthesiology, Government Medical College, Patiala, Punjab, India
| | - Ashwini Thimmarayappa
- Department of Cardiac Anaesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Sunder Singh Subash
- Department of Anaesthesiology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Parminder Kaur
- Department of Critical Care, Max Hospital, Mohali, Punjab, India
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Laher A, Swart M, Honiball J, Perera M, Lawrentschuk N, Adam A. Near-infrared spectroscopy in the diagnosis of testicular torsion: valuable modality or waste of valuable time? A systematic review. ANZ J Surg 2019; 90:708-714. [PMID: 31512384 DOI: 10.1111/ans.15402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Testicular torsion (TT) is a urological emergency that affects one in 4000 males younger than 25 years. Delays in the management of TT may result in testicular ischaemia, testicular necrosis, orchidectomy and infertility. This review assesses the validity of near-infrared spectroscopy (NIRS) as a diagnostic tool in the assessment and diagnosis of TT. METHODS A systematic search of Cochrane Database of Systematic Reviews, EMBASE, Google Scholar, PubMed, Scopus and Web of Science databases was performed in January 2019 using specific search terms. Selected studies were ranked and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS A total of nine studies that included 253 subjects (88 animals and 165 humans) with a mean sample size of 28.1 (standard deviation 40.8) subjects were included. The mean difference in testicular tissue oxygen saturation between torsed and non-torsed testes (Δ%StO2 ) were 45%, 42% (±5%), 26% and 5-18% in four animal studies and 2.0%, 3.0%, 6.7%, 6.8% and 23.0% in five human studies. The tissue oxygen saturation difference between contralateral healthy testes (controls) ranged from 1% to 10% in the five studies that alluded to this. CONCLUSION The current body of evidence does not support the use of NIRS in the work-up of TT. Well-designed clinical trials with large patient samples are required to determine whether NIRS may have some future role as a diagnostic modality in TT.
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Affiliation(s)
- Abdullah Laher
- Department of Emergency Medicine, Faculty of Health Sciences, The University of the Witwatersrand, Johannesburg, South Africa
| | - Marlize Swart
- Department of Emergency Medicine, Faculty of Health Sciences, The University of the Witwatersrand, Johannesburg, South Africa
| | - John Honiball
- Department of Emergency Medicine, Faculty of Health Sciences, The University of the Witwatersrand, Johannesburg, South Africa
| | - Marlon Perera
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, The University of Queensland, Brisbane, Queensland, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia.,Olivia-Newton John Cancer Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ahmed Adam
- Division of Urology, Faculty of Health Sciences, The University of the Witwatersrand, Johannesburg, South Africa
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Gargani L, Bruni C, Barskova T, Hartwig V, Marinelli M, Trivella MG, Matucci-Cerinic M, L'Abbate A. Near-infrared spectroscopic imaging of the whole hand: A new tool to assess tissue perfusion and peripheral microcirculation in scleroderma. Semin Arthritis Rheum 2019; 48:867-873. [DOI: 10.1016/j.semarthrit.2018.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/16/2018] [Accepted: 08/07/2018] [Indexed: 12/13/2022]
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Jalil B, Hartwig V, Salvetti O, Potì L, Gargani L, Barskova T, Matucci Cerinic M, L'Abbate A. Assessment of hand superficial oxygenation during ischemia/reperfusion in healthy subjects versus systemic sclerosis patients by 2D near infrared spectroscopic imaging. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 155:101-108. [PMID: 29512489 DOI: 10.1016/j.cmpb.2017.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/03/2017] [Accepted: 12/11/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Patients affected by systemic sclerosis (SSc) develop functional and structural microcirculatory dysfunction, which progressively evolves towards systemic tissue fibrosis (sclerosis). Disease initially affects distal extremities, which become preferential sites of diagnostic scrutiny. This pilot investigation tested the hypothesis that peripheral microcirculatory dysfunction in SSc could be non-invasively assessed by 2D Near Infrared Spectroscopic (NIRS) imaging of the hand associated with Vascular Occlusion Testing (VOT). NIRS allows measurement of hemoglobin oxygen saturation (StO2) in the blood perfusing the volume tissue under scrutiny. METHODS In five normal volunteers and five SSc patients we applied a multispectral oximetry imaging device (Kent camera, Kent Imaging, Calgary, Canada) to acquire StO2 2D maps of the whole hand palm during baseline, ischemia and reperfusion phase. RESULTS We found significant differences between controls and SSc patients in basal StO2 (82.80 ± 2.51 vs 65.44 ± 7.96%, p = 0.0016), minimum StO2 (59.35 ± 4.29 vs 40.73 ± 6.47%, p = 0.0007), final StO2 (83.83 ± 4.09 vs 68.84 ± 11.41%, p = 0.02) and time to maximum StO2 (40 ± 12.25 vs 62 ± 4.47 s, p = 0.005). CONCLUSIONS This is, to our knowledge, the first application of 2D NIRS imaging of the whole hand to the investigation of microvascular dysfunction in systemic sclerosis. The image processing presented here considered the StO2 in the entire hand allowing a comprehensive view of the spatial heterogeneity of microvascular dysfunction.
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Affiliation(s)
- Bushra Jalil
- Istituto di Scienza e Tecnologie dell'Informazione "Alessandro Faedo" CNR, Via Moruzzi 1, 56124 Pisa, Italy
| | - Valentina Hartwig
- Institute of Clinical Physiology, Italian National Research Council (CNR), Via Moruzzi 1, 56124 Pisa, Italy.
| | - Ovidio Salvetti
- Istituto di Scienza e Tecnologie dell'Informazione "Alessandro Faedo" CNR, Via Moruzzi 1, 56124 Pisa, Italy
| | - Luca Potì
- Consorzio Nazionale Interuniversitario per le Telecomunicazioni, Pisa, Italy
| | - Luna Gargani
- Institute of Clinical Physiology, Italian National Research Council (CNR), Via Moruzzi 1, 56124 Pisa, Italy
| | - Tatiana Barskova
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - A L'Abbate
- Institute of Clinical Physiology, Italian National Research Council (CNR), Via Moruzzi 1, 56124 Pisa, Italy; Scuola Superiore Sant'Anna, Institute of Life Sciences, Piazza Martiri della Libertà 33, 56127 Pisa, Italy
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Einalou Z, Maghooli K, Setarehdan SK, Akin A. Graph theoretical approach to functional connectivity in prefrontal cortex via fNIRS. NEUROPHOTONICS 2017; 4:041407. [PMID: 28840159 PMCID: PMC5565675 DOI: 10.1117/1.nph.4.4.041407] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/19/2017] [Indexed: 05/20/2023]
Abstract
Functional near-infrared spectroscopy (fNIRS) has been proposed as an affordable, fast, and robust alternative to many neuroimaging modalities yet it still has long way to go to be adapted in the clinic. One request from the clinicians has been the delivery of a simple and straightforward metric (a so-called biomarker) from the vast amount of data a multichannel fNIRS system provides. We propose a simple-straightforward signal processing algorithm derived from [Formula: see text] data collected during a modified version of the color-word matching Stroop task that consists of three different conditions. The algorithm starts with a wavelet-transform-based preprocessing, then uses partial correlation analysis to compute the functional connectivity matrices at each condition and then computes the global efficiency values. To this end, a continuous wave 16 channels fNIRS device (ARGES Cerebro, Hemosoft Inc., Turkey) was used to measure the changes in [Formula: see text] concentrations from 12 healthy volunteers. We have considered 10% of strongest connections in each network. A strong Stroop interference effect was found between the incongruent against neutral condition ([Formula: see text]) while a similar significance was observed for the global efficiency values decreased from neutral to congruent to incongruent conditions [[Formula: see text], [Formula: see text]]. The findings bring us closer to delivering a biomarker derived from fNIRS data that can be reliably and easily adopted by the clinicians.
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Affiliation(s)
- Zahra Einalou
- Department of Biomedical Engineering, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Keivan Maghooli
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
- Address all correspondence to: Keivan Maghooli, E-mail:
| | - Seyaed Kamaledin Setarehdan
- University of Tehran, Control and Intelligent Processing Center of Excellence, School of Electrical and Computer Engineering, College of Engineering, Tehran, Iran
| | - Ata Akin
- Acibadem University, Department of Medical Engineering, Istanbul, Turkey
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Kurosaki H, Higuchi M, Nogawa R, Kawamata T. Detection of Acute Arterial Occlusion During Artery Bypass Surgery for a Lower Extremity by Monitoring Regional Saturation of Oxygen of the Sole of the Foot. J Cardiothorac Vasc Anesth 2017. [PMID: 28625753 DOI: 10.1053/j.jvca.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hiromichi Kurosaki
- Department of Anesthesiology, Wakayama Medical University, Wakayama City, Japan.
| | - Misako Higuchi
- Department of Anesthesiology, Wakayama Medical University, Wakayama City, Japan
| | - Rika Nogawa
- Department of Anesthesiology, Wakayama Medical University, Wakayama City, Japan
| | - Tomoyuki Kawamata
- Department of Anesthesiology, Wakayama Medical University, Wakayama City, Japan
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Manfredini F, Lamberti N, Rossi T, Mascoli F, Basaglia N, Zamboni P. A Toe Flexion NIRS assisted Test for Rapid Assessment of Foot Perfusion in Peripheral Arterial Disease: Feasibility, Validity, and Diagnostic Accuracy. Eur J Vasc Endovasc Surg 2017; 54:187-194. [PMID: 28571673 DOI: 10.1016/j.ejvs.2017.04.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/17/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Feasibility, validity, and diagnostic accuracy of a non-invasive dynamic ambulatory test were assessed with near infrared spectroscopy (NIRS) evaluating foot perfusion in peripheral arterial disease (PAD). METHODS This was a prospective observational study. Eighty PAD patients (63 males, 71 ± 9 years), including 41 patients with coexisting diabetes, participated. Thirteen healthy subjects (8 males, 26 ± 8 years) were also studied by echo colour Doppler providing 160 diseased and 26 non-diseased limbs. Under identical clinostatic conditions, participants performed a 10-repetition toe flexion tests with NIRS probes on the dorsum of each foot; the area under the curve of the oxygenated haemoglobin trace ("toflex area") was calculated and the ankle-brachial index (ABI) was measured. Time of execution, rate of wrong tests, and adverse reactions were recorded. Within session reliability was assessed by administering the test twice, with a 5 minute interval between tests. The validity was assessed determining whether the toflex area was (a) dependent on the oxygen delivery from the lower limb arteries simulating PAD conditions by a progressive blood flow restriction (40-120% of systolic pressure) in healthy subjects; (b) consistent with the degree of PAD ranked by ABI and correlated with ABI and ankle pressure values in PAD patients. The diagnostic accuracy in detecting PAD was compared with examination using echo colour Doppler ultrasound. RESULTS All tests were rapidly, satisfactorily (<1% mistakes), and safely performed. Toflex area values, superimposable in the two sessions (intra-class correlation coefficient 0.92), were comparable to PAD values following blood flow restriction, consistent with PAD severity, correlated with dorsal pedis artery pressure (r = .21; p = .007) and ABI (r = .65; p < .001) in PAD, but not in the presence of diabetes. Toflex area was similar to echo colour Doppler for detecting PAD following receiver operating characteristic curve analysis (area = 0.987, p < .001; toflex area values ≤ -28 arbitrary units, sensitivity/specificity 95.6/100). CONCLUSION The toe flexion test enables ambulatory assessment of foot perfusion and PAD detection, even in the presence of non-measurable ABI or diseases affecting the microcirculation.
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Affiliation(s)
- F Manfredini
- Department of Biomedical and Surgical Specialties Sciences, Section of Sport Sciences, University of Ferrara, Ferrara, Italy; Department of Rehabilitation Medicine, Hospital University of Ferrara, Ferrara, Italy
| | - N Lamberti
- Department of Biomedical and Surgical Specialties Sciences, Section of Sport Sciences, University of Ferrara, Ferrara, Italy.
| | - T Rossi
- Department of Biomedical and Surgical Specialties Sciences, Section of Sport Sciences, University of Ferrara, Ferrara, Italy
| | - F Mascoli
- Unit of Vascular and Endovascular Surgery, Hospital University of Ferrara, Ferrara, Italy
| | - N Basaglia
- Department of Rehabilitation Medicine, Hospital University of Ferrara, Ferrara, Italy
| | - P Zamboni
- Unit of Translational Surgery, Hospital University of Ferrara, Ferrara, Italy
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Schlomer BJ, Keays MA, Grimsby GM, Granberg CF, DaJusta DG, Menon VS, Ostrov L, Sheth KR, Hill M, Sanchez EJ, Harrison CB, Jacobs MA, Huang R, Burgu B, Hennes H, Baker LA. Transscrotal Near Infrared Spectroscopy as a Diagnostic Test for Testis Torsion in Pediatric Acute Scrotum: A Prospective Comparison to Gold Standard Diagnostic Test Study. J Urol 2017; 198:694-701. [PMID: 28392394 DOI: 10.1016/j.juro.2017.03.134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE A rapid test for testicular torsion in children may obviate the delay for testicular ultrasound. In this study we assessed testicular tissue percent oxygen saturation (%StO2) measured by transscrotal near infrared spectroscopy as a diagnostic test for pediatric testicular torsion. MATERIALS AND METHODS This was a prospective comparison to a gold standard diagnostic test study that evaluated near infrared spectroscopy %StO2 readings to diagnose testicular torsion. The gold standard for torsion diagnosis was standard clinical care. From 2013 to 2015 males with acute scrotum for more than 1 month and who were less than 18 years old were recruited. Near infrared spectroscopy %StO2 readings were obtained for affected and unaffected testes. Near infrared spectroscopy Δ%StO2 was calculated as unaffected minus affected reading. The utility of near infrared spectroscopy Δ%StO2 to diagnose testis torsion was described with ROC curves. RESULTS Of 154 eligible patients 121 had near infrared spectroscopy readings. Median near infrared spectroscopy Δ%StO2 in the 36 patients with torsion was 2.0 (IQR -4.2 to 9.8) vs -1.7 (IQR -8.7 to 2.0) in the 85 without torsion (p=0.004). AUC for near infrared spectroscopy as a diagnostic test was 0.66 (95% CI 0.55-0.78). Near infrared spectroscopy Δ%StO2 of 20 or greater had a positive predictive value of 100% and a sensitivity of 22.2%. Tanner stage 3-5 cases without scrotal edema or with pain for 12 hours or less had an AUC of 0.91 (95% CI 0.86-1.0) and 0.80 (95% CI 0.62-0.99), respectively. CONCLUSIONS In all children near infrared spectroscopy readings had limited utility in diagnosing torsion. However, in Tanner 3-5 cases without scrotal edema or with pain 12 hours or less, near infrared spectroscopy discriminated well between torsion and nontorsion.
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Affiliation(s)
- Bruce J Schlomer
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas.
| | | | | | | | | | - Vani S Menon
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | | | - Kunj R Sheth
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Clanton B Harrison
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | - Micah A Jacobs
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | | | - Berk Burgu
- Ankara Üniversitesi Tıp Fakültesi, Ankara, Turkey
| | - Halim Hennes
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
| | - Linda A Baker
- University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health, Dallas, Texas
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Koutsiaris AG. Deep tissue near infrared second derivative spectrophotometry for the assessment of claudication in peripheral arterial disease. Clin Hemorheol Microcirc 2017; 65:275-284. [DOI: 10.3233/ch-16181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sowa MG, Kuo WC, Ko ACT, Armstrong DG. Review of near-infrared methods for wound assessment. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:091304. [PMID: 27087164 DOI: 10.1117/1.jbo.21.9.091304] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 03/04/2016] [Indexed: 06/05/2023]
Abstract
Wound management is a challenging and costly problem that is growing in importance as people are living longer. Instrumental methods are increasingly being relied upon to provide objective measures of wound assessment to help guide management. Technologies that employ near-infrared (NIR) light form a prominent contingent among the existing and emerging technologies. We review some of these technologies. Some are already established, such as indocyanine green fluorescence angiography, while we also speculate on others that have the potential to be clinically relevant to wound monitoring and assessment. These various NIR-based technologies address clinical wound management needs along the entire healing trajectory of a wound.
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Affiliation(s)
- Michael G Sowa
- National Research Council Canada, Medical Devices Portfolio, 435 Ellice Avenue, Winnipeg, Manitoba R3B 1Y6, Canada
| | - Wen-Chuan Kuo
- National Yang-Ming University, Institute of Biophotonics, No.155, Sec.2, Linong Street, Taipei 112, Taiwan
| | - Alex C-T Ko
- National Research Council Canada, Medical Devices Portfolio, 435 Ellice Avenue, Winnipeg, Manitoba R3B 1Y6, Canada
| | - David G Armstrong
- University of Arizona College of Medicine, Vascular/Endovascular, P.O. Box 245072, Tucson, Arizona 85724-5072, United States
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Hartwig V, Marinelli M, Rocco F, L’Abbate A. Assessment of Microvascular Function Using Near-Infrared Spectroscopic 2D Imaging of Whole Hand Combined with Vascular Occlusion Test. J Med Biol Eng 2016. [DOI: 10.1007/s40846-016-0114-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Silva Junior JAD, Souza DÚF, Ferreira DR, Valeriano MCP, Santos RF, Britto RR, Pereira DAG. Avaliação da saturação tecidual de oxigênio durante o sintoma claudicante em pacientes com doença arterial periférica. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.002115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Contexto O relato de sintoma claudicante em pacientes com doença arterial periférica é utilizado como modulador da intensidade de exercício físico para o tratamento clínico, entretanto os valores de oxigenação tecidual nesse momento são desconhecidos. Objetivo Descrever o suprimento tecidual de oxigênio por meio da espectroscopia de luz próxima ao infravermelho ou Near-Infrared Spectroscopy (NIRS) nos momentos em que o paciente relata sintoma claudicante inicial e máximo em testes de exercício. Métodos Nove pacientes, oito homens com 65,63 ± 6,02 anos de idade, previamente diagnosticados com doença arterial periférica, realizaram teste de exercício de carga constante e de carga incremental com monitorização do nível de oxigenação tecidual através da NIRS. As saturações de oxigênio obtidas no momento em que o paciente relata sintoma claudicante inicial e no momento em que relata sintoma claudicante máximo foram comparadas com os valores de saturação da manobra de oclusão arterial por meio do intervalo de confiança de 95% da diferença. Resultados Verificou-se que os valores de saturação nos momentos de sintoma claudicante inicial e máximo são estatisticamente distintos quando comparados àqueles obtidos na manobra de oclusão arterial, entretanto, através da análise percentual do quão distante esses valores encontram-se é possível observar que, do ponto de vista clínico, eles estão próximos. Conclusões A saturação no momento em que o paciente relata sintomas claudicantes inicial e máximo é bastante próxima do valor de saturação no momento de oclusão e do ponto de vista clínico o relato subjetivo de sintoma do paciente é adequado como parâmetro para a prescrição do exercício físico.
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Mahé G, Kaladji A, Le Faucheur A, Jaquinandi V. Internal Iliac Artery Stenosis: Diagnosis and How to Manage it in 2015. Front Cardiovasc Med 2015; 2:33. [PMID: 26664904 PMCID: PMC4671337 DOI: 10.3389/fcvm.2015.00033] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/18/2015] [Indexed: 01/13/2023] Open
Abstract
Lower extremity arterial disease (LEAD) is a highly prevalent disease affecting 202 million people worldwide. Internal iliac artery stenosis (IIAS) is one of the localization of LEAD. This diagnosis is often neglected when a patient has a proximal walking pain since most physicians evoke a pseudoclaudication. Surprisingly, IIAS management is reported neither in the Trans-Atlantic Inter-Society Consensus II nor in the report of the American College Foundation/American Heart Association guidelines. The aims of this review are to present the current knowledge about the disease, how should it be managed in 2015 and what are the future research trends.
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Affiliation(s)
- Guillaume Mahé
- Pôle Imagerie et Explorations Fonctionnelles , Rennes , France ; INSERM, Clinical Investigation Center (CIC 14 14) , Rennes , France
| | - Adrien Kaladji
- Vascular Surgery, University Hospital , Rennes , France ; INSERM Laboratoire Traitement du Signal et de l'Image (LTSI), UMR 1099 , Rennes , France
| | - Alexis Le Faucheur
- INSERM, Clinical Investigation Center (CIC 14 14) , Rennes , France ; École normale supérieure de Rennes , Rennes , France
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Boezeman RP, Kelder JC, Waanders FG, Moll FL, de Vries JPP. In vivo measurements of regional hemoglobin oxygen saturation values and limb-to-arm ratios of near-infrared spectroscopy for tissue oxygenation monitoring of lower extremities in healthy subjects. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 8:31-6. [PMID: 25565906 PMCID: PMC4284046 DOI: 10.2147/mder.s73103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective Near-infrared spectroscopy (NIRS) is a noninvasive technique that allows monitoring of regional hemoglobin oxygen saturation (rSO2) values and might have a role in the diagnosis of peripheral arterial disease. We assessed the reproducibility and inter-subject variability of rSO2 values and rSO2 limb-to-arm ratios (LARs) in lower extremities of healthy subjects. Methods The rSO2 values and rSO2 LARs were calculated in eight healthy subjects without peripheral arterial disease. The rSO2 values were measured at rest at six fixed spots at each lower limb and a reference spot at each upper arm. NIRS provided the rSO2 values without involvement of any other processing technique. After measurements were completed, rSO2 LARs were calculated by dividing the rSO2 value of a lower extremity spot by the rSO2 value of the arm. Measurements were performed twice on 1 day and repeated on 4 different days. Results Mean coefficients of variation of measurements of rSO2 values and rSO2 LARs at the same spot in the same subject were respectively less than 6% and 8% for every measurement spot over time. Coefficients of variation of measurements at the same spot between different subjects were less than 15% and 19% for every measurement spot respectively. Conclusion NIRS is an easily applicable, noninvasive tool for measurement of tissue oxygenation of lower extremities in healthy subjects. The reproducibility of rSO2 values and rSO2 LARs at the same measurement spot in the same subject is good.
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Affiliation(s)
- Reinout Pe Boezeman
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Johannes C Kelder
- Department of Research and Developments, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Frans Gj Waanders
- Department of Perfusion, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Manfredini F, Malagoni AM, Felisatti M, Mandini S, Lamberti N, Manfredini R, Mascoli F, Basaglia N, Zamboni P. Acute oxygenation changes on ischemic foot of a novel intermittent pneumatic compression device and of an existing sequential device in severe peripheral arterial disease. BMC Cardiovasc Disord 2014; 14:40. [PMID: 24684834 PMCID: PMC3978124 DOI: 10.1186/1471-2261-14-40] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 03/27/2014] [Indexed: 11/23/2022] Open
Abstract
Background Intermittent pneumatic compression (IPC) improves haemodynamics in peripheral arterial disease (PAD), but its effects on foot perfusion were scarcely studied. In severe PAD patients we measured the foot oxygenation changes evoked by a novel intermittent IPC device (GP), haemodynamics and compliance to the treatment. Reference values were obtained by a sequential foot-calf device (SFC). Methods Twenty ischemic limbs (Ankle-Brachial Index = 0.5 ± 0.2) of 12 PAD patients (7 male, age: 74.5 ± 10.8 y) with an interval of 48 ± 2 hours received a 35 minute treatment in supine position with two IPC devices: i) a Gradient Pump (GP), which slowly inflates a single thigh special sleeve and ii) an SFC (ArtAssist®, ACI Medical, San Marcos, CA, USA), which rapidly inflates two foot-calf sleeves. Main outcome measure: changes of oxygenated haemoglobin at foot (HbO2foot) by continuous near-infrared spectroscopy recording and quantified as area-under-curve (AUC) for periods of 5 minutes. Other measures: haemodynamics by echo-colour Doppler (time average velocity (TAV) and blood flow (BF) in the popliteal artery and in the femoral vein), patient compliance by a properly developed form. Results All patients completed the treatment with GP, 9 with SFC. HbO2foot during the working phase, considered as average value of the 5 minutes periods, increased with GP (AUC 458 ± 600 to 1216 ± 280) and decreased with SFC (AUC 231 ± 946 to −1088 ± 346), significantly for most periods (P < 0.05). The GP treatment was associated to significant haemodynamic changes from baseline to end of the treatment (TAV = 10.2 ± 3.3 to 13.5 ± 5.5 cm/sec, P = 0.004; BF = 452.0 ± 187.2 to 607.9 ± 237.8 ml/sec, P = 0.0001), not observed with SFC (TAV = 11.2 ± 3.4 to 11.8 ± 4.3 cm/sec; BF = 513.8 ± 203.7 to 505.9 ± 166.5 ml/min, P = n.s.). GP obtained a higher score of patient compliance (P < 0.0001). Conclusions A novel IPC thigh device, unlike a traditional SFC device, increased foot oxygenation in severe PAD, together with favourable haemodynamic response and high compliance to the treatment under the present experimental conditions.
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Krite Svanberg E, Wollmer P, Andersson-Engels S, Åkeson J. Physiological influence of basic perturbations assessed by non-invasive optical techniques in humans. Appl Physiol Nutr Metab 2011; 36:946-57. [DOI: 10.1139/h11-119] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
New non-invasive techniques enabling frequent or continuous assessments of various pathophysiological conditions might be used to improve in-hospital outcome by enabling earlier and more reliable bedside detection of medical deterioration. In this preclinical study, three modern non-invasive optical techniques, laser Doppler imaging (LDI), near-infrared spectroscopy (NIRS), and tissue viability imaging (TVI), were all evaluated with respect to the influence of basic physiological perturbations (including local changes in arm positioning, skin temperature, and regional blood flow conditions) on quasi simultaneously obtained values of skin perfusion, muscle tissue oxygenation (StO2), and skin blood volume, recorded in eighteen healthy volunteers. Skin perfusion measured by LDI responded prominently to changes in positioning of the arm, whereas muscle StO2 measured by NIRS did not change significantly. Total haemoglobin count (HbT) measured by NIRS and blood volume estimated by TVI both increased significantly on lowering of the limb. On local cooling, the perfusion and blood volume were both found to increase considerably, while StO2 and HbT did not change. Local heating induced a more than 10-fold increase in skin perfusion and a small increase in blood volume. On progressive venoarterial occlusion, the perfusion, StO2, HbT, and blood volume values decreased, after transient increases in HbT and blood volume before full arterial occlusion occurred, and all values approached the baseline level on release of the occlusion with a slight overshoot of the StO2. The results obtained have potential bearing on future utilization of these non-invasive techniques in the management of severely injured and (or) critically ill patients.
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Affiliation(s)
- Emilie Krite Svanberg
- Department of Anaesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, entrance 42, 3rd floor, SE – 205 02 Malmö, Sweden
| | - Per Wollmer
- Clinical Physiology and Nuclear Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | | | - Jonas Åkeson
- Department of Anaesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, entrance 42, 3rd floor, SE – 205 02 Malmö, Sweden
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Aziz SM, Khambatta F, Vaithianathan T, Thomas JC, Clark JM, Marshall R. A near infrared instrument to monitor relative hemoglobin concentrations of human bone tissue in vitro and in vivo. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2010; 81:043111. [PMID: 20441329 DOI: 10.1063/1.3398450] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A continuous wave near infrared instrument has been developed to monitor in vivo changes in the hemoglobin concentration of the trabecular compartment of human bone. The transmitter uses only two laser diodes of wavelengths 685 and 830 nm, and the receiver uses a single silicon photodiode operating in the photovoltaic mode. The functioning of the instrument and the depth of penetration of the near infrared signals was determined in vitro using tissue-equivalent phantoms. The instrument achieves a depth of penetration of approximately 2 cm for an optode separation of 4 cm and, therefore, has the capacity to interrogate the trabecular compartment of human bone. The functioning of the instrument was tested in vivo to evaluate the relative oxy-hemoglobin (HbO(2)) and deoxy-hemoglobin (Hb) concentrations of the proximal tibial bone of apparently healthy, normal weight, adult subjects in response to a 3 min on, 5 min off, vascular occlusion protocol. The traces of the relative Hb and HbO(2) concentrations obtained were reproducible in controlled conditions. The instrument is relatively simple and flexible, and offers an inexpensive platform for further studies to obtain normative data for healthy cohorts, and to evaluate disease-specific performance characteristics for cohorts with vasculopathies of bone.
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Affiliation(s)
- Syed Mahfuzul Aziz
- School of Electrical and Information Engineering, University of South Australia, Mawson Lakes, South Australia 5095, Australia.
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Gerovasili V, Dimopoulos S, Tzanis G, Anastasiou-Nana M, Nanas S. Utilizing the vascular occlusion technique with NIRS technology. INTERNATIONAL JOURNAL OF INDUSTRIAL ERGONOMICS 2010. [DOI: 10.1016/j.ergon.2009.02.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Manfredini F, Malagoni A, Felisatti M, Mandini S, Mascoli F, Manfredini R, Basaglia N, Zamboni P. A Dynamic Objective Evaluation of Peripheral Arterial Disease by Near-Infrared Spectroscopy. Eur J Vasc Endovasc Surg 2009; 38:441-8. [DOI: 10.1016/j.ejvs.2009.06.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 06/06/2009] [Indexed: 11/17/2022]
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Muscle Mitochondrial Function in Patients with Type 2 Diabetes Mellitus and Peripheral Arterial Disease: Implications in Vascular Surgery. Eur J Vasc Endovasc Surg 2009; 38:356-64. [DOI: 10.1016/j.ejvs.2009.04.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 04/20/2009] [Indexed: 11/23/2022]
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Ciftci K, Sankur B, Kahya Y, Akin A. Multilevel Statistical Inference From Functional Near-Infrared Spectroscopy Data During Stroop Interference. IEEE Trans Biomed Eng 2008; 55:2212-20. [DOI: 10.1109/tbme.2008.923918] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mathieu D, Mani R. A review of the clinical significance of tissue hypoxia measurements in lower extremity wound management. INT J LOW EXTR WOUND 2008; 6:273-83. [PMID: 18048873 DOI: 10.1177/1534734607310299] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this paper is to review techniques that are currently available to measure tissue hypoxia in order to benefit the management of wounds. Direct measurement of tissue partial oxygen pressure (PO(2)) is invasive and therefore unappealing in clinical practice. Several techniques (PET scans, MRI derived techniques) are primarily applicable to research rather than clinical applications. Imaging techniques (duplex ultrasonography, arteriography, MRI techniques) are recommended only as part of the workup for revascularisation. Techniques that assess local perfusion include clearance methods, transcutaneous O(2) and CO( 2) pressure measurement, and laser Doppler flowmetry and imaging. These techniques permit interpretation of altered perfusion states. Each technique offers subtly different information concerning microvascular function. All these techniques require strict protocols to derive reliable data. The potential of the promising near infrared reflectance spectroscopy (NIRS) technique is yet to be determined.
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Affiliation(s)
- Daniel Mathieu
- Service d'Urgence Respiratoire, de Réanimation Médicale et de Médecine Hyperbare, Hôpital Calmette, Lille, France.
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Arató E, Kürthy M, Jancsó G, Sínay L, Kasza G, Menyhei G, Masoud S, Varga Z, Bertalan A, Verzár Z, Kollár L, Roth E. [Pathology and diagnostic opportunities of lower limb compartment syndrome]. Magy Seb 2007; 60:301-6. [PMID: 18065369 DOI: 10.1556/maseb.60.2007.6.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The indication for the surgical treatment of lower limb compartment syndrome mostly depends on the clinical signs, which can be uncertain and often delayed, resulting in a late and insufficient intervention. AIM In this study, the progression of compartment syndrome was monitored with the measurement of intracompartmental pressure and tissue oxygen saturation. MATERIALS AND METHODS 16 patients (12 male and 4 female; mean age: 62,7 years) underwent acute lower limb revascularization surgery due to critical (more than 4 hour) limb ischaemia. The indications were the following: 5 iliac artery embolisms and 11 femoral artery occlusions. After revascularization, significant lower limb oedema and swelling were detected. To monitor the elevated intracompartmental pressure (ICP), KODIAG pressure meter was used. Tissue oxygen saturation (StO2) was measured with near-infrared-spectroscopy. RESULTS In 12 cases the IPC exceeded the critical 40 mmHg. In these patients, StO2 was 50-53%, in spite of the successful re-canalisation. An urgent, semi-open fasciotomy was performed in these cases. In four patients, the clinical picture suggested compartment syndrome. However, the measured parameters did not indicate surgical intervention (ICP: 25-35 mmHg, StO2: normal). SUMMARY In addition to the empirical guidelines, we describe an evidence based surgical intervention strategy for lower limb compartment syndrome. Our results and advised parameter intervals help the clinicians to decide between conservative and operative treatment of the disease.
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Affiliation(s)
- Endre Arató
- Pécsi Tudományegyetem, Altalános Orvostudományi Kar, Sebészeti Tanszék, 7623 Pécs.
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Hamaoka T, McCully KK, Quaresima V, Yamamoto K, Chance B. Near-infrared spectroscopy/imaging for monitoring muscle oxygenation and oxidative metabolism in healthy and diseased humans. JOURNAL OF BIOMEDICAL OPTICS 2007; 12:062105. [PMID: 18163808 DOI: 10.1117/1.2805437] [Citation(s) in RCA: 222] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Near-infrared spectroscopy (NIRS) was initiated in 1977 by Jobsis as a simple, noninvasive method for measuring the presence of oxygen in muscle and other tissues in vivo. This review honoring Jobsis highlights the progress that has been made in developing and adapting NIRS and NIR imaging (NIRI) technologies for evaluating skeletal muscle O(2) dynamics and oxidative energy metabolism. Development of NIRS/NIRI technologies has included novel approaches to quantification of the signal, as well as the addition of multiple source detector pairs for imaging. Adaptation of NIRS technology has focused on the validity and reliability of NIRS measurements. NIRS measurements have been extended to resting, ischemic, localized exercise, and whole body exercise conditions. In addition, NIRS technology has been applied to the study of a number of chronic health conditions, including patients with chronic heart failure, peripheral vascular disease, chronic obstructive pulmonary disease, varying muscle diseases, spinal cord injury, and renal failure. As NIRS technology continues to evolve, the study of skeletal muscle function with NIRS first illuminated by Jobsis continues to be bright.
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Affiliation(s)
- Takafumi Hamaoka
- National Institute of Fitness and Sports, Department of Exercise Science, Shiromizu 1, Kanoya, 891-2393 Japan.
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Vardi M, Nini A. Near-infrared spectroscopy for evaluation of peripheral vascular disease. A systematic review of literature. Eur J Vasc Endovasc Surg 2007; 35:68-74. [PMID: 17919945 DOI: 10.1016/j.ejvs.2007.07.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 07/24/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess near-infrared spectroscopy (NIRS) as a method for the diagnosis and evaluation of peripheral vascular disease. SEARCH STRATEGY MEDLINE and CENTRAL were searched with a search protocol presented below. Handsearching through reference lists of the retrieved articles and reviews was conducted. MAIN RESULTS 224 and 57 abstracts from MEDLINE and CENTRAL respectively were retrieved from which 21 studies were selected. NIRS was evaluated for the diagnosis and severity evaluation in patients with peripheral vascular disease. Its parameters were shown to reflect the clinical status of patients, with good correlation to existing methods. CONCLUSIONS Currently NIRS technology can serve as an adjunct method for the diagnosis and evaluation of patients with peripheral vascular disease.
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Affiliation(s)
- M Vardi
- Internal Medicine, Carmel Medical Center, 7 Michal St., Haifa 34362, Israel
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Wolf U, Wolf M, Choi JH, Paunescu LA, Michalos A, Gratton E. Regional Differences of Hemodynamics and Oxygenation in the Human Calf Muscle Detected with Near-Infrared Spectrophotometry. J Vasc Interv Radiol 2007; 18:1094-101. [PMID: 17804770 DOI: 10.1016/j.jvir.2007.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Measurements in muscle tissue are often performed at a selected single location over the muscle of interest. The hypothesis is that the values obtained reflect the status within the entire muscle or muscle group. This, however, may not be the case. The study was performed to investigate whether this hypothesis is true for hemodynamics and oxygenation in the healthy human calf muscle at rest. MATERIALS AND METHODS Hemoglobin flow, blood flow, oxygen consumption, and venous hemoglobin oxygen saturation were mapped at 22 locations in 30 legs of 15 healthy subjects (nine women, six men aged 26-37 years) simultaneously by using frequency-domain near-infrared spectrophotometry with a specially designed probe during venous occlusion. RESULTS For all parameters, spatial heterogeneity was found between subjects and within individual legs. All parameters were highly significantly different when comparing proximal and distal regions. Differences were also found between medial and lateral regions. The global mean values (+/-standard deviation) over all measurements were as follows: hemoglobin flow, 1.27 micromol per 100 mL/min +/- 0.88; blood flow, 0.56 mL per 100 g/min +/- 0.38; oxygen consumption, 0.016 mL per 100 g/min +/- 0.011; and venous oxygen saturation, 77.6% +/- 5.9. The thickness of the overlying adipose tissue had an influence on the measurements and must be considered. CONCLUSION Highly significant spatial heterogeneity of hemodynamics and oxygenation was found in the healthy human calf muscle.
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Affiliation(s)
- Ursula Wolf
- Laboratory for Fluorescence Dynamics, Biomedical Engineering Department, University of California Irvine, 3120 Natural Sciences II Bldg, Irvine, CA 92697-2715, USA
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