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Matlis GC, Zhang Q, Benson EJ, Weeks MK, Andersen K, Jahnavi J, Lafontant A, Breimann J, Hallowell T, Lin Y, Licht DJ, Yodh AG, Kilbaugh TJ, Forti RM, White BR, Baker WB, Xiao R, Ko TS. Chassis-based fiber-coupled optical probe design for reproducible quantitative diffuse optical spectroscopy measurements. PLoS One 2024; 19:e0305254. [PMID: 39052686 PMCID: PMC11271963 DOI: 10.1371/journal.pone.0305254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/27/2024] [Indexed: 07/27/2024] Open
Abstract
Advanced optical neuromonitoring of cerebral hemodynamics with hybrid diffuse optical spectroscopy (DOS) and diffuse correlation spectroscopy (DCS) methods holds promise for non-invasive characterization of brain health in critically ill patients. However, the methods' fiber-coupled patient interfaces (probes) are challenging to apply in emergent clinical scenarios that require rapid and reproducible attachment to the head. To address this challenge, we developed a novel chassis-based optical probe design for DOS/DCS measurements and validated its measurement accuracy and reproducibility against conventional, manually held measurements of cerebral hemodynamics in pediatric swine (n = 20). The chassis-based probe design comprises a detachable fiber housing which snaps into a 3D-printed, circumferential chassis piece that is secured to the skin. To validate its reproducibility, eight measurement repetitions of cerebral tissue blood flow index (BFI), oxygen saturation (StO2), and oxy-, deoxy- and total hemoglobin concentration were acquired at the same demarcated measurement location for each pig. The probe was detached after each measurement. Of the eight measurements, four were acquired by placing the probe into a secured chassis, and four were visually aligned and manually held. We compared the absolute value and intra-subject coefficient of variation (CV) of chassis versus manual measurements. No significant differences were observed in either absolute value or CV between chassis and manual measurements (p > 0.05). However, the CV for BFI (mean ± SD: manual, 19.5% ± 9.6; chassis, 19.0% ± 10.8) was significantly higher than StO2 (manual, 5.8% ± 6.7; chassis, 6.6% ± 7.1) regardless of measurement methodology (p<0.001). The chassis-based DOS/DCS probe design facilitated rapid probe attachment/re-attachment and demonstrated comparable accuracy and reproducibility to conventional, manual alignment. In the future, this design may be adapted for clinical applications to allow for non-invasive monitoring of cerebral health during pediatric critical care.
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Affiliation(s)
- Giselle C. Matlis
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Qihuang Zhang
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Emilie J. Benson
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, United States of America
| | - M. Katie Weeks
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Kristen Andersen
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Jharna Jahnavi
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Alec Lafontant
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Jake Breimann
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Thomas Hallowell
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Yuxi Lin
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Daniel J. Licht
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
- Division of Neurology, Department of Pediatrics, Children’s National, Washington, District of Columbia, United States of America
- Division of Neurology, George Washington University, Washington, District of Columbia, United States of America
| | - Arjun G. Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Todd J. Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Rodrigo M. Forti
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Brian R. White
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
- Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Wesley B. Baker
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Rui Xiao
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States of America
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Tiffany S. Ko
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
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Favilla CG, Carter S, Hartl B, Gitlevich R, Mullen MT, Yodh AG, Baker WB, Konecky S. Validation of the Openwater wearable optical system: cerebral hemodynamic monitoring during a breath-hold maneuver. NEUROPHOTONICS 2024; 11:015008. [PMID: 38464864 PMCID: PMC10923543 DOI: 10.1117/1.nph.11.1.015008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 03/12/2024]
Abstract
Significance Bedside cerebral blood flow (CBF) monitoring has the potential to inform and improve care for acute neurologic diseases, but technical challenges limit the use of existing techniques in clinical practice. Aim Here, we validate the Openwater optical system, a novel wearable headset that uses laser speckle contrast to monitor microvascular hemodynamics. Approach We monitored 25 healthy adults with the Openwater system and concurrent transcranial Doppler (TCD) while performing a breath-hold maneuver to increase CBF. Relative blood flow (rBF) was derived from changes in speckle contrast, and relative blood volume (rBV) was derived from changes in speckle average intensity. Results A strong correlation was observed between beat-to-beat optical rBF and TCD-measured cerebral blood flow velocity (CBFv), R = 0.79 ; the slope of the linear fit indicates good agreement, 0.87 (95% CI: 0.83 - 0.92 ). Beat-to-beat rBV and CBFv were also strongly correlated, R = 0.72 , but as expected the two variables were not proportional; changes in rBV were smaller than CBFv changes, with linear fit slope of 0.18 (95% CI: 0.17 to 0.19). Further, strong agreement was found between rBF and CBFv waveform morphology and related metrics. Conclusions This first in vivo validation of the Openwater optical system highlights its potential as a cerebral hemodynamic monitor, but additional validation is needed in disease states.
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Affiliation(s)
- Christopher G. Favilla
- University of Pennsylvania, Department of Neurology, Philadelphia, Pennsylvania, United States
| | - Sarah Carter
- University of Pennsylvania, Department of Neurology, Philadelphia, Pennsylvania, United States
| | - Brad Hartl
- Openwater, San Francisco, California, United States
| | - Rebecca Gitlevich
- University of Pennsylvania, Department of Neurology, Philadelphia, Pennsylvania, United States
| | - Michael T. Mullen
- Temple University, Department of Neurology, Philadelphia, Pennsylvania, United States
| | - Arjun G. Yodh
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
| | - Wesley B. Baker
- Children’s Hospital of Philadelphia, Department of Neurology, Philadelphia, Pennsylvania, United States
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Kedia N, McDowell MM, Yang J, Wu J, Friedlander RM, Kainerstorfer JM. Pulsatile microvascular cerebral blood flow waveforms change with intracranial compliance and age. NEUROPHOTONICS 2024; 11:015003. [PMID: 38250664 PMCID: PMC10799239 DOI: 10.1117/1.nph.11.1.015003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/15/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024]
Abstract
Significance Diffuse correlation spectroscopy (DCS) is an optical method to measure relative changes in cerebral blood flow (rCBF) in the microvasculature. Each heartbeat generates a pulsatile signal with distinct morphological features that we hypothesized to be related to intracranial compliance (ICC). Aim We aim to study how three features of the pulsatile rCBF waveforms: the augmentation index (AIx), the pulsatility index, and the area under the curve, change with respect to ICC. We describe ICC as a combination of vascular compliance and extravascular compliance. Approach Since patients with Chiari malformations (CM) (n = 30 ) have been shown to have altered extravascular compliance, we compare the morphology of rCBF waveforms in CM patients with age-matched healthy control (n = 30 ). Results AIx measured in the supine position was significantly less in patients with CM compared to healthy controls (p < 0.05 ). Since physiologic aging also leads to changes in vessel stiffness and intravascular compliance, we evaluate how the rCBF waveform changes with respect to age and find that the AIx feature was strongly correlated with age (R healthy subjects = - 0.63 , R preoperative CM patient = - 0.70 , and R postoperative CM patients = - 0.62 , p < 0.01 ). Conclusions These results suggest that the AIx measured in the cerebral microvasculature using DCS may be correlated to changes in ICC.
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Affiliation(s)
- Nikita Kedia
- University of Pittsburgh School of Medicine, Department of Neurological Surgery, Pittsburgh, Pennsylvania, United States
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
| | - Michael M. McDowell
- University of Pittsburgh School of Medicine, Department of Neurological Surgery, Pittsburgh, Pennsylvania, United States
| | - Jason Yang
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
| | - Jingyi Wu
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
| | - Robert M. Friedlander
- University of Pittsburgh School of Medicine, Department of Neurological Surgery, Pittsburgh, Pennsylvania, United States
| | - Jana M. Kainerstorfer
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
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Favilla CG, Carter S, Hartl B, Gitlevich R, Mullen MT, Yodh AG, Baker WB, Konecky S. Validation of the Openwater wearable optical system: cerebral hemodynamic monitoring during a breath hold maneuver. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.11.23296612. [PMID: 37873126 PMCID: PMC10592983 DOI: 10.1101/2023.10.11.23296612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Bedside cerebral blood flow (CBF) monitoring has the potential to inform and improve care for acute neurologic diseases, but technical challenges limit the use of existing techniques in clinical practice. Here we validate the Openwater optical system, a novel wearable headset that uses laser speckle contrast to monitor microvascular hemodynamics. We monitored 25 healthy adults with the Openwater system and concurrent transcranial Doppler (TCD) while performing a breath-hold maneuver to increase CBF. Relative blood flow (rBF) was derived from the changes in speckle contrast, and relative blood volume (rBV) was derived from the changes in speckle average intensity. A strong correlation was observed between beat-to-beat optical rBF and TCD-measured cerebral blood flow velocity (CBFv), R=0.79; the slope of the linear fit indicates good agreement, 0.87 (95% CI:0.83-0.92). Beat-to-beat rBV and CBFv were strongly correlated, R=0.72, but as expected the two variables were not proportional; changes in rBV were smaller than CBFv changes, with linear fit slope of 0.18 (95% CI:0.17-0.19). Further, strong agreement was found between rBF and CBFv waveform morphology and related metrics. This first in vivo validation of the Openwater optical system highlights its potential as a cerebral hemodynamic monitor, but additional validation is needed in disease states.
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Shoemaker LN, Milej D, Sajid A, Mistry J, Lawrence KS, Shoemaker JK. Characterization of cerebral macro- and microvascular hemodynamics during transient hypotension. J Appl Physiol (1985) 2023; 135:717-725. [PMID: 37560766 PMCID: PMC10642516 DOI: 10.1152/japplphysiol.00743.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/26/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023] Open
Abstract
The aim of the current study was to establish the interplay between blood flow patterns within a large cerebral artery and a downstream microvascular segment under conditions of transiently reduced mean arterial pressure (MAP). We report data from nine young, healthy participants (5 women; 26 ± 4 yr) acquired during a 15-s bout of sudden-onset lower body negative pressure (LBNP; -80 mmHg). Simultaneous changes in microvascular cerebral blood flow (CBF) and middle cerebral artery blood velocity (MCAvmean) were captured using diffuse correlation spectroscopy (DCS) and transcranial Doppler ultrasound (TCD), respectively. Brachial blood pressure (finger photoplethysmography) and TCD waveforms were extracted at baseline and during the nadir blood pressure (BP) response to LBNP and analyzed using a modified Windkessel model to calculate indices of cerebrovascular resistance (Ri) and compliance (Ci). Compared with baseline, rapid-onset LBNP decreased MAP by 22 ± 16% and Ri by 14 ± 10% (both P ≤ 0.03). Ci increased (322 ± 298%; P < 0.01) but MCAvmean (-8 ± 16%; P = 0.09) and CBF (-2 ± 3%; P = 0.29) were preserved. The results provide evidence that changes in both vascular resistance and compliance preserve CBF, as indexed by no significant changes in MCAvmean or DCS microvascular flow, during transient hypotension.NEW & NOTEWORTHY To characterize the relationship between cerebrovascular patterns within the large middle cerebral artery (MCA) and a downstream microvascular segment, we used a novel combination of transcranial Doppler ultrasound of the MCA and optical monitoring of a downstream microvascular segment, respectively, under conditions of transiently reduced mean arterial pressure (i.e., lower body negative pressure, -80 mmHg). A rapid increase in vessel compliance accompanied the maintenance of MCA blood velocity and downstream microvascular flow.
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Affiliation(s)
- Leena N Shoemaker
- Imaging Program, Lawson Health Research Institute, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- School of Kinesiology, Western University, London, Ontario, Canada
| | - Daniel Milej
- Imaging Program, Lawson Health Research Institute, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Aleena Sajid
- School of Kinesiology, Western University, London, Ontario, Canada
| | - Jigneshkumar Mistry
- Imaging Program, Lawson Health Research Institute, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Keith St Lawrence
- Imaging Program, Lawson Health Research Institute, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - J Kevin Shoemaker
- School of Kinesiology, Western University, London, Ontario, Canada
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
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Fesharaki NJ, Taylor A, Mosby K, Kim JH, Ress D. Global effects of aging on the hemodynamic response function in the human brain. RESEARCH SQUARE 2023:rs.3.rs-3299293. [PMID: 37720046 PMCID: PMC10503846 DOI: 10.21203/rs.3.rs-3299293/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
In functional magnetic resonance imaging, the hemodynamic response function (HRF) is a transient, stereotypical response to local changes in cerebral hemodynamics and oxygen metabolism due to briefly (< 4 s) evoked neural activity. Accordingly, the HRF is often used as an impulse response with the assumption of linearity in data analysis. In cognitive aging studies, it has been very common to interpret differences in brain activation as age-related changes in neural activity. Contrary to this assumption, however, evidence has accrued that normal aging may also significantly affect the vasculature, thereby affecting cerebral hemodynamics and metabolism, confounding interpretation of fMRI aging studies. In this study, use was made of a multisensory stimulus to evoke the HRF in ~ 87% of cerebral cortex in cognitively intact adults with ages ranging from 22-75 years. The stimulus evokes both positive and negative HRFs, which were characterized using model-free parameters in native-space coordinates. Results showed significant age trends in HRF parameter distributions in terms of both amplitudes (e.g., peak amplitude and CNR) and temporal dynamics (e.g., full-width-at-half-maximum). This work sets the stage for using HRF methods as a biomarker for age-related pathology.
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Urner TM, Cowdrick KR, Brothers RO, Boodooram T, Zhao H, Goyal V, Sathialingam E, Quadri A, Turrentine K, Akbar MM, Triplett SE, Bai S, Buckley EM. Normative cerebral microvascular blood flow waveform morphology assessed with diffuse correlation spectroscopy. BIOMEDICAL OPTICS EXPRESS 2023; 14:3635-3653. [PMID: 37497521 PMCID: PMC10368026 DOI: 10.1364/boe.489760] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/05/2023] [Accepted: 05/20/2023] [Indexed: 07/28/2023]
Abstract
Microvascular cerebral blood flow exhibits pulsatility at the cardiac frequency that carries valuable information about cerebrovascular health. This study used diffuse correlation spectroscopy to quantify normative features of these waveforms in a cohort of thirty healthy adults. We demonstrate they are sensitive to changes in vascular tone, as indicated by pronounced morphological changes with hypercapnia. Further, we observe significant sex-based differences in waveform morphology, with females exhibiting higher flow, greater area-under-the-curve, and lower pulsatility. Finally, we quantify normative values for cerebral critical closing pressure, i.e., the minimum pressure required to maintain flow in a given vascular region.
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Affiliation(s)
- Tara M Urner
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Kyle R Cowdrick
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Rowan O Brothers
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Tisha Boodooram
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Hongting Zhao
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Vidisha Goyal
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Eashani Sathialingam
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Ayesha Quadri
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Katherine Turrentine
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Mariam M Akbar
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Sydney E Triplett
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
| | - Shasha Bai
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA 30322, USA
| | - Erin M Buckley
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA 30322, USA
- Children's Research Scholar, Children's Healthcare of Atlanta, 2015 Uppergate Dr., Atlanta, GA 30322, USA
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Wu KC, Martin A, Renna M, Robinson M, Ozana N, Carp SA, Franceschini MA. Enhancing diffuse correlation spectroscopy pulsatile cerebral blood flow signal with near-infrared spectroscopy photoplethysmography. NEUROPHOTONICS 2023; 10:035008. [PMID: 37680339 PMCID: PMC10482352 DOI: 10.1117/1.nph.10.3.035008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
Significance Combining near-infrared spectroscopy (NIRS) and diffuse correlation spectroscopy (DCS) allows for quantifying cerebral blood volume, flow, and oxygenation changes continuously and non-invasively. As recently shown, the DCS pulsatile cerebral blood flow index (pCBF i ) can be used to quantify critical closing pressure (CrCP) and cerebrovascular resistance (CVR i ). Aim Although current DCS technology allows for reliable monitoring of the slow hemodynamic changes, resolving pulsatile blood flow at large source-detector separations, which is needed to ensure cerebral sensitivity, is challenging because of its low signal-to-noise ratio (SNR). Cardiac-gated averaging of several arterial pulse cycles is required to obtain a meaningful waveform. Approach Taking advantage of the high SNR of NIRS, we demonstrate a method that uses the NIRS photoplethysmography (NIRS-PPG) pulsatile signal to model DCS pCBF i , reducing the coefficient of variation of the recovered pulsatile waveform (pCBF i - fit ) and allowing for an unprecedented temporal resolution (266 Hz) at a large source-detector separation (> 3 cm ). Results In 10 healthy subjects, we verified the quality of the NIRS-PPG pCBF i - fit during common tasks, showing high fidelity against pCBF i (R 2 0.98 ± 0.01 ). We recovered CrCP and CVR i at 0.25 Hz, > 10 times faster than previously achieved with DCS. Conclusions NIRS-PPG improves DCS pCBF i SNR, reducing the number of gate-averaged heartbeats required to recover CrCP and CVR i .
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Affiliation(s)
- Kuan Cheng Wu
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, United States
- Boston University, Department of Biomedical Engineering, Boston, Massachusetts, United States
| | - Alyssa Martin
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, United States
| | - Marco Renna
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, United States
| | - Mitchell Robinson
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, United States
| | - Nisan Ozana
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, United States
| | - Stefan A. Carp
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, United States
| | - Maria Angela Franceschini
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, United States
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Ko TS, Catennacio E, Shin SS, Stern J, Massey SL, Kilbaugh TJ, Hwang M. Advanced Neuromonitoring Modalities on the Horizon: Detection and Management of Acute Brain Injury in Children. Neurocrit Care 2023; 38:791-811. [PMID: 36949362 PMCID: PMC10241718 DOI: 10.1007/s12028-023-01690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 01/31/2023] [Indexed: 03/24/2023]
Abstract
Timely detection and monitoring of acute brain injury in children is essential to mitigate causes of injury and prevent secondary insults. Increasing survival in critically ill children has emphasized the importance of neuroprotective management strategies for long-term quality of life. In emergent and critical care settings, traditional neuroimaging modalities, such as computed tomography and magnetic resonance imaging (MRI), remain frontline diagnostic techniques to detect acute brain injury. Although detection of structural and anatomical abnormalities remains crucial, advanced MRI sequences assessing functional alterations in cerebral physiology provide unique diagnostic utility. Head ultrasound has emerged as a portable neuroimaging modality for point-of-care diagnosis via assessments of anatomical and perfusion abnormalities. Application of electroencephalography and near-infrared spectroscopy provides the opportunity for real-time detection and goal-directed management of neurological abnormalities at the bedside. In this review, we describe recent technological advancements in these neurodiagnostic modalities and elaborate on their current and potential utility in the detection and management of acute brain injury.
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Affiliation(s)
- Tiffany S Ko
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, USA.
| | - Eva Catennacio
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Samuel S Shin
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Joseph Stern
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA
| | - Shavonne L Massey
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Todd J Kilbaugh
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA
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Robinson MB, Renna M, Ozana N, Martin AN, Otic N, Carp SA, Franceschini MA. Portable, high speed blood flow measurements enabled by long wavelength, interferometric diffuse correlation spectroscopy (LW-iDCS). Sci Rep 2023; 13:8803. [PMID: 37258644 PMCID: PMC10232495 DOI: 10.1038/s41598-023-36074-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/29/2023] [Indexed: 06/02/2023] Open
Abstract
Diffuse correlation spectroscopy (DCS) is an optical technique that can be used to characterize blood flow in tissue. The measurement of cerebral hemodynamics has arisen as a promising use case for DCS, though traditional implementations of DCS exhibit suboptimal signal-to-noise ratio (SNR) and cerebral sensitivity to make robust measurements of cerebral blood flow in adults. In this work, we present long wavelength, interferometric DCS (LW-iDCS), which combines the use of a longer illumination wavelength (1064 nm), multi-speckle, and interferometric detection, to improve both cerebral sensitivity and SNR. Through direct comparison with long wavelength DCS based on superconducting nanowire single photon detectors, we demonstrate an approximate 5× improvement in SNR over a single channel of LW-DCS in the measured blood flow signals in human subjects. We show equivalence of extracted blood flow between LW-DCS and LW-iDCS, and demonstrate the feasibility of LW-iDCS measured at 100 Hz at a source-detector separation of 3.5 cm. This improvement in performance has the potential to enable robust measurement of cerebral hemodynamics and unlock novel use cases for diffuse correlation spectroscopy.
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Affiliation(s)
- Mitchell B Robinson
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
| | - Marco Renna
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Nisan Ozana
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Bar-Ilan University, Tel Aviv District, Ramat Gan, Israel
| | - Alyssa N Martin
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Nikola Otic
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Stefan A Carp
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Maria Angela Franceschini
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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Favilla CG, Mullen MT, Kahn F, Rasheed IYD, Messe SR, Parthasarathy AB, Yodh AG. Dynamic cerebral autoregulation measured by diffuse correlation spectroscopy. J Cereb Blood Flow Metab 2023:271678X231153728. [PMID: 36703572 PMCID: PMC10369149 DOI: 10.1177/0271678x231153728] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Dynamic cerebral autoregulation (dCA) can be derived from spontaneous oscillations in arterial blood pressure (ABP) and cerebral blood flow (CBF). Transcranial Doppler (TCD) measures CBF-velocity and is commonly used to assess dCA. Diffuse correlation spectroscopy (DCS) is a promising optical technique for non-invasive CBF monitoring, so here we aimed to validate DCS as a tool for quantifying dCA. In 33 healthy adults and 17 acute ischemic stroke patients, resting-state hemodynamic were monitored simultaneously with high-speed (20 Hz) DCS and TCD. dCA parameters were calcaulated by a transfer function analysis using a Fourier decomposition of ABP and CBF (or CBF-velocity). Strong correlation was found between DCS and TCD measured gain (magnitude of regulation) in healthy volunteers (r = 0.73, p < 0.001) and stroke patients (r = 0.76, p = 0.003). DCS-gain retained strong test-retest reliability in both groups (ICC 0.87 and 0.82, respectively). DCS and TCD-derived phase (latency of regulation) did not significantly correlate in healthy volunteers (r = 0.12, p = 0.50) but moderately correlated in stroke patients (r = 0.65, p = 0.006). DCS-derived phase was reproducible in both groups (ICC 0.88 and 0.90, respectively). High-frequency DCS is a promising non-invasive bedside technique that can be leveraged to quantify dCA from resting-state data, but the discrepancy between TCD and DCS-derived phase requires further investigation.
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Affiliation(s)
| | - Michael T Mullen
- Department of Neurology, 6558Temple University, Philadelphia, USA
| | - Farhan Kahn
- Department of Neurology, 6572University of Pennsylvania, Philadelphia, USA
| | | | - Steven R Messe
- Department of Neurology, 6572University of Pennsylvania, Philadelphia, USA
| | | | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, USA
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12
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Carp SA, Robinson MB, Franceschini MA. Diffuse correlation spectroscopy: current status and future outlook. NEUROPHOTONICS 2023; 10:013509. [PMID: 36704720 PMCID: PMC9871606 DOI: 10.1117/1.nph.10.1.013509] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/23/2022] [Indexed: 06/18/2023]
Abstract
Diffuse correlation spectroscopy (DCS) has emerged as a versatile, noninvasive method for deep tissue perfusion assessment using near-infrared light. A broad class of applications is being pursued in neuromonitoring and beyond. However, technical limitations of the technology as originally implemented remain as barriers to wider adoption. A wide variety of approaches to improve measurement performance and reduce cost are being explored; these include interferometric methods, camera-based multispeckle detection, and long path photon selection for improved depth sensitivity. We review here the current status of DCS technology and summarize future development directions and the challenges that remain on the path to widespread adoption.
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Affiliation(s)
- Stefan A. Carp
- Massachusetts General Hospital, Harvard Medical School, Optics at Martinos Research Group, Charlestown, Massachusetts, United States
| | - Mitchell B. Robinson
- Massachusetts General Hospital, Harvard Medical School, Optics at Martinos Research Group, Charlestown, Massachusetts, United States
| | - Maria A. Franceschini
- Massachusetts General Hospital, Harvard Medical School, Optics at Martinos Research Group, Charlestown, Massachusetts, United States
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13
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Biswas A, Parthasarathy AB. Lossless Compressed Sensing of Photon Counts for Fast Diffuse Correlation Spectroscopy. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2022; 10:129754-129762. [PMID: 36644002 PMCID: PMC9835098 DOI: 10.1109/access.2022.3228439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Diffuse Correlation Spectroscopy (DCS), a noninvasive optical technique, measures deep tissue blood flow using avalanche photon counting modules and data acquisition devices such as FPGAs or correlator boards. Conventional DCS instruments use in-processor counter modules that consume 32 bits/channel which is inefficient for low-photon budget situations prevalent in diffuse optics. Scaling these photon counters for large-scale imaging applications is difficult due to bandwidth and processing time considerations. Here, we introduce a new, lossless compressed sensing approach for fast and efficient detection of photon counts. The compressed DCS method uses an array of binary-coded-decimal counters to record photon counts from 8 channels simultaneously as a single 32-bit number. We validate the compressed DCS approach by comparisons with conventional DCS in experiments on tissue simulating phantoms and in-vivo arm cuff occlusion. Lossless compressed DCS was implemented with 87.5% compression efficiency. In tissue simulating phantoms, it was able to accurately estimate a tissue blood flow index, with no statistically significant difference compared to conventional DCS. Compressed DCS also recorded blood flow in vivo, in human forearm, with signal-to-noise ratio and dynamic range comparable to conventional DCS. Lossless 87.5% efficient compressed sensing counting of photon counts meets and exceeds benchmarks set by conventional DCS systems, offering a low-cost alternative for fast (~100 Hz) deep tissue blood flow measurement with optics.
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Affiliation(s)
- Arindam Biswas
- Department of Electrical Engineering, University of South Florida, Tampa, FL 33620, USA
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14
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Ayaz H, Baker WB, Blaney G, Boas DA, Bortfeld H, Brady K, Brake J, Brigadoi S, Buckley EM, Carp SA, Cooper RJ, Cowdrick KR, Culver JP, Dan I, Dehghani H, Devor A, Durduran T, Eggebrecht AT, Emberson LL, Fang Q, Fantini S, Franceschini MA, Fischer JB, Gervain J, Hirsch J, Hong KS, Horstmeyer R, Kainerstorfer JM, Ko TS, Licht DJ, Liebert A, Luke R, Lynch JM, Mesquida J, Mesquita RC, Naseer N, Novi SL, Orihuela-Espina F, O’Sullivan TD, Peterka DS, Pifferi A, Pollonini L, Sassaroli A, Sato JR, Scholkmann F, Spinelli L, Srinivasan VJ, St. Lawrence K, Tachtsidis I, Tong Y, Torricelli A, Urner T, Wabnitz H, Wolf M, Wolf U, Xu S, Yang C, Yodh AG, Yücel MA, Zhou W. Optical imaging and spectroscopy for the study of the human brain: status report. NEUROPHOTONICS 2022; 9:S24001. [PMID: 36052058 PMCID: PMC9424749 DOI: 10.1117/1.nph.9.s2.s24001] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This report is the second part of a comprehensive two-part series aimed at reviewing an extensive and diverse toolkit of novel methods to explore brain health and function. While the first report focused on neurophotonic tools mostly applicable to animal studies, here, we highlight optical spectroscopy and imaging methods relevant to noninvasive human brain studies. We outline current state-of-the-art technologies and software advances, explore the most recent impact of these technologies on neuroscience and clinical applications, identify the areas where innovation is needed, and provide an outlook for the future directions.
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Affiliation(s)
- Hasan Ayaz
- Drexel University, School of Biomedical Engineering, Science, and Health Systems, Philadelphia, Pennsylvania, United States
- Drexel University, College of Arts and Sciences, Department of Psychological and Brain Sciences, Philadelphia, Pennsylvania, United States
| | - Wesley B. Baker
- Children’s Hospital of Philadelphia, Division of Neurology, Philadelphia, Pennsylvania, United States
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Giles Blaney
- Tufts University, Department of Biomedical Engineering, Medford, Massachusetts, United States
| | - David A. Boas
- Boston University Neurophotonics Center, Boston, Massachusetts, United States
- Boston University, College of Engineering, Department of Biomedical Engineering, Boston, Massachusetts, United States
| | - Heather Bortfeld
- University of California, Merced, Departments of Psychological Sciences and Cognitive and Information Sciences, Merced, California, United States
| | - Kenneth Brady
- Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Department of Anesthesiology, Chicago, Illinois, United States
| | - Joshua Brake
- Harvey Mudd College, Department of Engineering, Claremont, California, United States
| | - Sabrina Brigadoi
- University of Padua, Department of Developmental and Social Psychology, Padua, Italy
| | - Erin M. Buckley
- Georgia Institute of Technology, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia, United States
| | - Stefan A. Carp
- Massachusetts General Hospital, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, United States
| | - Robert J. Cooper
- University College London, Department of Medical Physics and Bioengineering, DOT-HUB, London, United Kingdom
| | - Kyle R. Cowdrick
- Georgia Institute of Technology, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Joseph P. Culver
- Washington University School of Medicine, Department of Radiology, St. Louis, Missouri, United States
| | - Ippeita Dan
- Chuo University, Faculty of Science and Engineering, Tokyo, Japan
| | - Hamid Dehghani
- University of Birmingham, School of Computer Science, Birmingham, United Kingdom
| | - Anna Devor
- Boston University, College of Engineering, Department of Biomedical Engineering, Boston, Massachusetts, United States
| | - Turgut Durduran
- ICFO – The Institute of Photonic Sciences, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
- Institució Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain
| | - Adam T. Eggebrecht
- Washington University in St. Louis, Mallinckrodt Institute of Radiology, St. Louis, Missouri, United States
| | - Lauren L. Emberson
- University of British Columbia, Department of Psychology, Vancouver, British Columbia, Canada
| | - Qianqian Fang
- Northeastern University, Department of Bioengineering, Boston, Massachusetts, United States
| | - Sergio Fantini
- Tufts University, Department of Biomedical Engineering, Medford, Massachusetts, United States
| | - Maria Angela Franceschini
- Massachusetts General Hospital, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, United States
| | - Jonas B. Fischer
- ICFO – The Institute of Photonic Sciences, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
| | - Judit Gervain
- University of Padua, Department of Developmental and Social Psychology, Padua, Italy
- Université Paris Cité, CNRS, Integrative Neuroscience and Cognition Center, Paris, France
| | - Joy Hirsch
- Yale School of Medicine, Department of Psychiatry, Neuroscience, and Comparative Medicine, New Haven, Connecticut, United States
- University College London, Department of Medical Physics and Biomedical Engineering, London, United Kingdom
| | - Keum-Shik Hong
- Pusan National University, School of Mechanical Engineering, Busan, Republic of Korea
- Qingdao University, School of Automation, Institute for Future, Qingdao, China
| | - Roarke Horstmeyer
- Duke University, Department of Biomedical Engineering, Durham, North Carolina, United States
- Duke University, Department of Electrical and Computer Engineering, Durham, North Carolina, United States
- Duke University, Department of Physics, Durham, North Carolina, United States
| | - Jana M. Kainerstorfer
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
- Carnegie Mellon University, Neuroscience Institute, Pittsburgh, Pennsylvania, United States
| | - Tiffany S. Ko
- Children’s Hospital of Philadelphia, Division of Cardiothoracic Anesthesiology, Philadelphia, Pennsylvania, United States
| | - Daniel J. Licht
- Children’s Hospital of Philadelphia, Division of Neurology, Philadelphia, Pennsylvania, United States
| | - Adam Liebert
- Polish Academy of Sciences, Nalecz Institute of Biocybernetics and Biomedical Engineering, Warsaw, Poland
| | - Robert Luke
- Macquarie University, Department of Linguistics, Sydney, New South Wales, Australia
- Macquarie University Hearing, Australia Hearing Hub, Sydney, New South Wales, Australia
| | - Jennifer M. Lynch
- Children’s Hospital of Philadelphia, Division of Cardiothoracic Anesthesiology, Philadelphia, Pennsylvania, United States
| | - Jaume Mesquida
- Parc Taulí Hospital Universitari, Critical Care Department, Sabadell, Spain
| | - Rickson C. Mesquita
- University of Campinas, Institute of Physics, Campinas, São Paulo, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, São Paulo, Brazil
| | - Noman Naseer
- Air University, Department of Mechatronics and Biomedical Engineering, Islamabad, Pakistan
| | - Sergio L. Novi
- University of Campinas, Institute of Physics, Campinas, São Paulo, Brazil
- Western University, Department of Physiology and Pharmacology, London, Ontario, Canada
| | | | - Thomas D. O’Sullivan
- University of Notre Dame, Department of Electrical Engineering, Notre Dame, Indiana, United States
| | - Darcy S. Peterka
- Columbia University, Zuckerman Mind Brain Behaviour Institute, New York, United States
| | | | - Luca Pollonini
- University of Houston, Department of Engineering Technology, Houston, Texas, United States
| | - Angelo Sassaroli
- Tufts University, Department of Biomedical Engineering, Medford, Massachusetts, United States
| | - João Ricardo Sato
- Federal University of ABC, Center of Mathematics, Computing and Cognition, São Bernardo do Campo, São Paulo, Brazil
| | - Felix Scholkmann
- University of Bern, Institute of Complementary and Integrative Medicine, Bern, Switzerland
- University of Zurich, University Hospital Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zürich, Switzerland
| | - Lorenzo Spinelli
- National Research Council (CNR), IFN – Institute for Photonics and Nanotechnologies, Milan, Italy
| | - Vivek J. Srinivasan
- University of California Davis, Department of Biomedical Engineering, Davis, California, United States
- NYU Langone Health, Department of Ophthalmology, New York, New York, United States
- NYU Langone Health, Department of Radiology, New York, New York, United States
| | - Keith St. Lawrence
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Western University, Department of Medical Biophysics, London, Ontario, Canada
| | - Ilias Tachtsidis
- University College London, Department of Medical Physics and Biomedical Engineering, London, United Kingdom
| | - Yunjie Tong
- Purdue University, Weldon School of Biomedical Engineering, West Lafayette, Indiana, United States
| | - Alessandro Torricelli
- Politecnico di Milano, Dipartimento di Fisica, Milan, Italy
- National Research Council (CNR), IFN – Institute for Photonics and Nanotechnologies, Milan, Italy
| | - Tara Urner
- Georgia Institute of Technology, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Heidrun Wabnitz
- Physikalisch-Technische Bundesanstalt (PTB), Berlin, Germany
| | - Martin Wolf
- University of Zurich, University Hospital Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zürich, Switzerland
| | - Ursula Wolf
- University of Bern, Institute of Complementary and Integrative Medicine, Bern, Switzerland
| | - Shiqi Xu
- Duke University, Department of Biomedical Engineering, Durham, North Carolina, United States
| | - Changhuei Yang
- California Institute of Technology, Department of Electrical Engineering, Pasadena, California, United States
| | - Arjun G. Yodh
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
| | - Meryem A. Yücel
- Boston University Neurophotonics Center, Boston, Massachusetts, United States
- Boston University, College of Engineering, Department of Biomedical Engineering, Boston, Massachusetts, United States
| | - Wenjun Zhou
- University of California Davis, Department of Biomedical Engineering, Davis, California, United States
- China Jiliang University, College of Optical and Electronic Technology, Hangzhou, Zhejiang, China
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15
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Lafontant A, Mahanna Gabrielli E, Bergonzi K, Forti RM, Ko TS, Shah RM, Arkles JS, Licht DJ, Yodh AG, Kofke WA, White BR, Baker WB. Comparison of optical measurements of critical closing pressure acquired before and during induced ventricular arrhythmia in adults. NEUROPHOTONICS 2022; 9:035004. [PMID: 36039170 PMCID: PMC9407009 DOI: 10.1117/1.nph.9.3.035004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
Significance: The critical closing pressure (CrCP) of cerebral circulation, as measured by diffuse correlation spectroscopy (DCS), is a promising biomarker of intracranial hypertension. However, CrCP techniques using DCS have not been assessed in gold standard experiments. Aim: CrCP is typically calculated by examining the variation of cerebral blood flow (CBF) during the cardiac cycle (with normal sinus rhythm). We compare this typical CrCP measurement with a gold standard obtained during the drops in arterial blood pressure (ABP) caused by rapid ventricular pacing (RVP) in patients undergoing invasive electrophysiologic procedures. Approach: Adults receiving electrophysiology procedures with planned ablation were enrolled for DCS CBF monitoring. CrCP was calculated from CBF and ABP data by three methods: (1) linear extrapolation of data during RVP ( CrCP RVP ; the gold standard); (2) linear extrapolation of data during regular heartbeats ( CrCP Linear ); and (3) fundamental harmonic Fourier filtering of data during regular heartbeats ( CrCP Fourier ). Results: CBF monitoring was performed prior to and during 55 episodes of RVP in five adults. CrCP RVP and CrCP Fourier demonstrated agreement ( R = 0.66 , slope = 1.05 (95%CI, 0.72 to 1.38). Agreement between CrCP RVP and CrCP Linear was worse; CrCP Linear was 8.2 ± 5.9 mmHg higher than CrCP RVP (mean ± SD; p < 0.001 ). Conclusions: Our results suggest that DCS-measured CrCP can be accurately acquired during normal sinus rhythm.
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Affiliation(s)
- Alec Lafontant
- Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Neurology, Philadelphia, Pennsylvania, United States
| | - Elizabeth Mahanna Gabrielli
- University of Miami Miller School of Medicine, Department of Anesthesiology, Perioperative Medicine and Pain Management, Miami, Florida, United States
| | - Karla Bergonzi
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
| | - Rodrigo M. Forti
- Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Neurology, Philadelphia, Pennsylvania, United States
| | - Tiffany S. Ko
- Children’s Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States
| | - Ronak M. Shah
- Perelman School of Medicine at the University of Pennsylvania, Department of Anesthesiology and Critical Care, Philadelphia, Pennsylvania, United States
| | - Jeffrey S. Arkles
- Perelman School of Medicine at the University of Pennsylvania, Department of Medicine, Division of Cardiovascular Medicine, Philadelphia, Pennsylvania, United States
| | - Daniel J. Licht
- Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Neurology, Philadelphia, Pennsylvania, United States
| | - Arjun G. Yodh
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
| | - W. Andrew Kofke
- Perelman School of Medicine at the University of Pennsylvania, Department of Anesthesiology and Critical Care, Philadelphia, Pennsylvania, United States
| | - Brian R. White
- Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Pediatric Cardiology, Philadelphia, Pennsylvania, United States
| | - Wesley B. Baker
- Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics, Division of Neurology, Philadelphia, Pennsylvania, United States
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16
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Félix H, Oliveira ES. Non-Invasive Intracranial Pressure Monitoring and Its Applicability in Spaceflight. Aerosp Med Hum Perform 2022; 93:517-531. [DOI: 10.3357/amhp.5922.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION: Neuro-ophthalmic findings collectively defined as Spaceflight-Associated Neuro-ocular Syndrome (SANS) are one of the leading health priorities in astronauts engaging in long duration spaceflight or prolonged microgravity exposure. Though multifactorial in etiology,
similarities to terrestrial idiopathic intracranial hypertension (IIH) suggest these changes may result from an increase or impairing in intracranial pressure (ICP). Finding a portable, accessible, and reliable method of monitoring ICP is, therefore, crucial in long duration spaceflight. A
review of recent literature was conducted on the biomedical literature search engine PubMed using the search term “non-invasive intracranial pressure”. Studies investigating accuracy of noninvasive and portable methods were assessed. The search retrieved different methods that
were subsequently grouped by approach and technique. The majority of publications included the use of ultrasound-based methods with variable accuracies. One of which, noninvasive ICP estimation by optical nerve sheath diameter measurement (nICP_ONSD), presented the highest statistical correlation
and prediction values to invasive ICP, with area under the curve (AUC) ranging from 0.75 to 0.964. One study even considers a combination of ONSD with transcranial Doppler (TCD) for an even higher performance. Other methods, such as near-infrared spectroscopy (NIRS), show positive and promising
results [good statistical correlation with invasive techniques when measuring cerebral perfusion pressure (CPP): r = 0.83]. However, for its accessibility, portability, and accuracy, ONSD seems to present itself as the up to date, most reliable, noninvasive ICP surrogate and a valuable spaceflight
asset.Félix H, Santos Oliveira E. Non-invasive intracranial pressure monitoring and its applicability in spaceflight. Aerosp Med Hum Perform. 2022; 93(6):517–531.
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17
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Liang Y, Mo P, Yang X, He Y, Zhang W, Zeng X, Xie L, Gao Q. Estimation of critical closing pressure using intravascular blood pressure of the common carotid artery. Med Eng Phys 2022; 102:103759. [DOI: 10.1016/j.medengphy.2022.103759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/01/2022] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
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18
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Self-Similar Functional Circuit Models of Arteries and Deterministic Fractal Operators: Theoretical Revelation for Biomimetic Materials. Int J Mol Sci 2021; 22:ijms222312897. [PMID: 34884701 PMCID: PMC8657472 DOI: 10.3390/ijms222312897] [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] [Received: 10/21/2021] [Revised: 11/15/2021] [Accepted: 11/24/2021] [Indexed: 12/15/2022] Open
Abstract
In this paper, the self-similar functional circuit models of arteries are proposed for bioinspired hemodynamic materials design. Based on the mechanical-electrical analogous method, the circuit model can be utilized to mimic the blood flow of arteries. The theoretical mechanism to quantitatively simulate realistic blood flow is developed by establishing a fractal circuit network with an infinite number of electrical components. We have found that the fractal admittance operator obtained from the minimum repeating unit of the fractal circuit can simply and directly determine the blood-flow regulation mechanism. Furthermore, according to the operator algebra, the fractal admittance operator on the aorta can be represented by Gaussian-type convolution kernel function. Similarly, the arteriolar operator can be described by Bessel-type function. Moreover, by the self-similar assembly pattern of the proposed model, biomimetic materials which contain self-similar circuits can be designed to mimic physiological or pathological states of blood flow. Studies show that the self-similar functional circuit model can efficiently describe the blood flow and provide an available and convenient structural theoretical revelation for the preparation of in vitro hemodynamic bionic materials.
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19
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Flanders TM, Lang SS, Ko TS, Andersen KN, Jahnavi J, Flibotte JJ, Licht DJ, Tasian GE, Sotardi ST, Yodh AG, Lynch JM, Kennedy BC, Storm PB, White BR, Heuer GG, Baker WB. Optical Detection of Intracranial Pressure and Perfusion Changes in Neonates With Hydrocephalus. J Pediatr 2021; 236:54-61.e1. [PMID: 34004191 PMCID: PMC8403158 DOI: 10.1016/j.jpeds.2021.05.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/30/2021] [Accepted: 05/10/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To demonstrate that a novel noninvasive index of intracranial pressure (ICP) derived from diffuse optics-based techniques is associated with intracranial hypertension. STUDY DESIGN We compared noninvasive and invasive ICP measurements in infants with hydrocephalus. Infants born term and preterm were eligible for inclusion if clinically determined to require cerebrospinal fluid (CSF) diversion. Ventricular size was assessed preoperatively via ultrasound measurement of the fronto-occipital (FOR) and frontotemporal (FTHR) horn ratios. Invasive ICP was obtained at the time of surgical intervention with a manometer. Intracranial hypertension was defined as invasive ICP ≥15 mmHg. Diffuse optical measurements of cerebral perfusion, oxygen extraction, and noninvasive ICP were performed preoperatively, intraoperatively, and postoperatively. Optical and ultrasound measures were compared with invasive ICP measurements, and their change in values after CSF diversion were obtained. RESULTS We included 39 infants, 23 with intracranial hypertension. No group difference in ventricular size was found by FOR (P = .93) or FTHR (P = .76). Infants with intracranial hypertension had significantly higher noninvasive ICP (P = .02) and oxygen extraction fraction (OEF) (P = .01) compared with infants without intracranial hypertension. Increased cerebral blood flow (P = .005) and improved OEF (P < .001) after CSF diversion were observed only in infants with intracranial hypertension. CONCLUSIONS Noninvasive diffuse optical measures (including a noninvasive ICP index) were associated with intracranial hypertension. The findings suggest that impaired perfusion from intracranial hypertension was independent of ventricular size. Hemodynamic evidence of the benefits of CSF diversion was seen in infants with intracranial hypertension. Noninvasive optical techniques hold promise for aiding the assessment of CSF diversion timing.
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Affiliation(s)
- Tracy M Flanders
- Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Shih-Shan Lang
- Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Tiffany S Ko
- Division of Neurology, Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Kristen N Andersen
- Division of Neurology, Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Jharna Jahnavi
- Division of Neurology, Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - John J Flibotte
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Daniel J Licht
- Division of Neurology, Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Gregory E Tasian
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Division of Urology, Children's Hospital of Philadelphia
| | - Susan T Sotardi
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania
| | | | - Benjamin C Kennedy
- Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Phillip B Storm
- Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Brian R White
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Gregory G Heuer
- Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Wesley B Baker
- Division of Neurology, Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania.
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20
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Panerai RB, Haunton VJ, Llwyd O, Minhas JS, Katsogridakis E, Salinet ASM, Maggio P, Robinson TG. Cerebral critical closing pressure and resistance-area product: the influence of dynamic cerebral autoregulation, age and sex. J Cereb Blood Flow Metab 2021; 41:2456-2469. [PMID: 33818187 PMCID: PMC8392773 DOI: 10.1177/0271678x211004131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/19/2021] [Accepted: 02/16/2021] [Indexed: 11/21/2022]
Abstract
Instantaneous arterial pressure-flow (or velocity) relationships indicate the existence of a cerebral critical closing pressure (CrCP), with the slope of the relationship expressed by the resistance-area product (RAP). In 194 healthy subjects (20-82 years, 90 female), cerebral blood flow velocity (CBFV, transcranial Doppler), arterial blood pressure (BP, Finapres) and end-tidal CO2 (EtCO2, capnography) were measured continuously for five minutes during spontaneous fluctuations of BP at rest. The dynamic cerebral autoregulation (CA) index (ARI) was extracted with transfer function analysis from the CBFV step response to the BP input and step responses were also obtained for the BP-CrCP and BP-RAP relationships. ARI was shown to decrease with age at a rate of -0.025 units/year in men (p = 0.022), but not in women (p = 0.40). The temporal patterns of the BP-CBFV, BP-CrCP and BP-RAP step responses were strongly influenced by the ARI (p < 0.0001), but not by sex. Age was also a significant determinant of the peak of the CBFV step response and the tail of the RAP response. Whilst the RAP step response pattern is consistent with a myogenic mechanism controlling dynamic CA, further work is needed to explore the potential association of the CrCP step response with the flow-mediated component of autoregulation.
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Affiliation(s)
- Ronney B Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Victoria J Haunton
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Osian Llwyd
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jatinder S Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Emmanuel Katsogridakis
- Department of Vascular Surgery, Wythenshawe Hospital, Manchester Foundation Trust, Manchester, UK
| | - Angela SM Salinet
- Neurology Department, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Paola Maggio
- Neurology Department, ASST Bergamo EST (BG), Italy
| | - Thompson G Robinson
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
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21
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Cortese L, Lo Presti G, Pagliazzi M, Contini D, Dalla Mora A, Dehghani H, Ferri F, Fischer JB, Giovannella M, Martelli F, Weigel UM, Wojtkiewicz S, Zanoletti M, Durduran T. Recipes for diffuse correlation spectroscopy instrument design using commonly utilized hardware based on targets for signal-to-noise ratio and precision. BIOMEDICAL OPTICS EXPRESS 2021; 12:3265-3281. [PMID: 34221659 PMCID: PMC8221932 DOI: 10.1364/boe.423071] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/18/2021] [Accepted: 05/04/2021] [Indexed: 05/09/2023]
Abstract
Over the recent years, a typical implementation of diffuse correlation spectroscopy (DCS) instrumentation has been adapted widely. However, there are no detailed and accepted recipes for designing such instrumentation to meet pre-defined signal-to-noise ratio (SNR) and precision targets. These require specific attention due to the subtleties of the DCS signals. Here, DCS experiments have been performed using liquid tissue simulating phantoms to study the effect of the detected photon count-rate, the number of parallel detection channels and the measurement duration on the precision and SNR to suggest scaling relations to be utilized for device design.
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Affiliation(s)
- Lorenzo Cortese
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, 08860 Castelldefels (Barcelona), Spain
- These authors equally contributed to this work. Authors are listed in alphabetical order except for the first three and the last
| | - Giuseppe Lo Presti
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, 08860 Castelldefels (Barcelona), Spain
- These authors equally contributed to this work. Authors are listed in alphabetical order except for the first three and the last
| | - Marco Pagliazzi
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, 08860 Castelldefels (Barcelona), Spain
| | - Davide Contini
- Politecnico di Milano, Dipartimento di Fisica, 20133 Milano, Italy
| | | | - Hamid Dehghani
- University of Birmingham, School of Computer Science, Edgbaston, Birmingham, B15 2TT, UK
| | - Fabio Ferri
- Università degli Studi dell’Insubria, Dipartimento di Scienza e Alta Tecnologia and To. Sca. Lab., 22100 Como, Italy
| | - Jonas B. Fischer
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, 08860 Castelldefels (Barcelona), Spain
- HemoPhotonics S.L., 08860 Castelldefels (Barcelona), Spain
| | - Martina Giovannella
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, 08860 Castelldefels (Barcelona), Spain
| | - Fabrizio Martelli
- Università degli Studi di Firenze, Dipartimento di Fisica, 50100 Firenze, Italy
| | - Udo M. Weigel
- HemoPhotonics S.L., 08860 Castelldefels (Barcelona), Spain
| | - Stanislaw Wojtkiewicz
- University of Birmingham, School of Computer Science, Edgbaston, Birmingham, B15 2TT, UK
| | - Marta Zanoletti
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, 08860 Castelldefels (Barcelona), Spain
- Politecnico di Milano, Dipartimento di Fisica, 20133 Milano, Italy
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, 08860 Castelldefels (Barcelona), Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), 08015 Barcelona, Spain
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22
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Wu KC, Sunwoo J, Sheriff F, Farzam P, Farzam PY, Orihuela-Espina F, LaRose SL, Monk AD, Aziz-Sultan MA, Patel N, Vaitkevicius H, Franceschini MA. Validation of diffuse correlation spectroscopy measures of critical closing pressure against transcranial Doppler ultrasound in stroke patients. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-200360R. [PMID: 33774980 PMCID: PMC7998065 DOI: 10.1117/1.jbo.26.3.036008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/08/2021] [Indexed: 05/25/2023]
Abstract
SIGNIFICANCE Intracranial pressure (ICP), variability in perfusion, and resulting ischemia are leading causes of secondary brain injury in patients treated in the neurointensive care unit. Continuous, accurate monitoring of cerebral blood flow (CBF) and ICP guide intervention and ultimately reduce morbidity and mortality. Currently, only invasive tools are used to monitor patients at high risk for intracranial hypertension. AIM Diffuse correlation spectroscopy (DCS), a noninvasive near-infrared optical technique, is emerging as a possible method for continuous monitoring of CBF and critical closing pressure (CrCP or zero-flow pressure), a parameter directly related to ICP. APPROACH We optimized DCS hardware and algorithms for the quantification of CrCP. Toward its clinical translation, we validated the DCS estimates of cerebral blood flow index (CBFi) and CrCP in ischemic stroke patients with respect to simultaneously acquired transcranial Doppler ultrasound (TCD) cerebral blood flow velocity (CBFV) and CrCP. RESULTS We found CrCP derived from DCS and TCD were highly linearly correlated (ipsilateral R2 = 0.77, p = 9 × 10 - 7; contralateral R2 = 0.83, p = 7 × 10 - 8). We found weaker correlations between CBFi and CBFV (ipsilateral R2 = 0.25, p = 0.03; contralateral R2 = 0.48, p = 1 × 10 - 3) probably due to the different vasculature measured. CONCLUSION Our results suggest DCS is a valid alternative to TCD for continuous monitoring of CrCP.
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Affiliation(s)
- Kuan-Cheng Wu
- Massachusetts General Hospital and Harvard Medical School, Optics at Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
- Boston University, Department of Biomedical Engineering, Boston, Massachusetts, United States
| | - John Sunwoo
- Massachusetts General Hospital and Harvard Medical School, Optics at Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
| | - Faheem Sheriff
- Brigham and Women’s Hospital, Department of Neurology, Boston, Massachusetts, United States
| | - Parisa Farzam
- Massachusetts General Hospital and Harvard Medical School, Optics at Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
| | - Parya Y. Farzam
- Massachusetts General Hospital and Harvard Medical School, Optics at Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
| | - Felipe Orihuela-Espina
- Massachusetts General Hospital and Harvard Medical School, Optics at Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
- National Institute for Astrophysics Optics and Electronics, Department of Computational Sciences, Puebla, Mexico
| | - Sarah L. LaRose
- Brigham and Women’s Hospital, Department of Neurology, Boston, Massachusetts, United States
| | - Andrew D. Monk
- Brigham and Women’s Hospital, Department of Neurology, Boston, Massachusetts, United States
| | - Mohammad A. Aziz-Sultan
- Brigham and Women’s Hospital, Department of Neurosurgery, Boston, Massachusetts, United States
| | - Nirav Patel
- Brigham and Women’s Hospital, Department of Neurosurgery, Boston, Massachusetts, United States
| | - Henrikas Vaitkevicius
- Brigham and Women’s Hospital, Department of Neurology, Boston, Massachusetts, United States
| | - Maria Angela Franceschini
- Massachusetts General Hospital and Harvard Medical School, Optics at Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
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23
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Elizondo LI, Vu EL, Kibler KK, Rios DR, Easley RB, Andropoulos D, Acosta S, Rusin C, Brady K, Rhee CJ. Critical Closing Pressure by Diffuse Correlation Spectroscopy in a Neonatal Piglet Model. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 131:295-299. [PMID: 33839861 DOI: 10.1007/978-3-030-59436-7_55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The critical closing pressure (CrCP) of the cerebral vasculature is the arterial blood pressure (ABP) at which cerebral blood flow (CBF) ceases. Because the ABP of preterm infants is low and close to the CrCP, there is often no CBF during diastole. Thus, estimation of CrCP may become clinically relevant in preterm neonates. Transcranial Doppler (TCD) ultrasound has been used to estimate CrCP in preterm infants. Diffuse correlation spectroscopy (DCS) is a continuous, noninvasive optical technique that measures microvascular CBF. Our objective was to compare and validate CrCP measured by DCS versus TCD ultrasound. Hemorrhagic shock was induced in 13 neonatal piglets, and CBF was measured continuously by both modalities. CrCP was calculated using a model of cerebrovascular impedance, and CrCP determined by the two modalities showed good correlation by linear regression, median r 2 = 0.8 (interquartile range (IQR) 0.71-0.87), and Bland-Altman analysis showed a median bias of -3.5 (IQR -4.6 to -0.28). This is the first comparison of CrCP determined by DCS versus TCD ultrasound in a neonatal piglet model of hemorrhagic shock. The difference in CrCP between the two modalities may be due to differences in vasomotor tone within the microvasculature of the cerebral arterioles versus the macrovasculature of a major cerebral artery.
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Affiliation(s)
- Leah I Elizondo
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Eric L Vu
- Northwestern University, Lurie Children's Hospital, Chicago, IL, USA
| | - Kathleen K Kibler
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Danielle R Rios
- University of Iowa, Stead Family Children's Hospital, Iowa City, IA, USA
| | - R Blaine Easley
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Dean Andropoulos
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Sebastian Acosta
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Craig Rusin
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Kenneth Brady
- Northwestern University, Lurie Children's Hospital, Chicago, IL, USA
| | - Christopher J Rhee
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
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24
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Trofimova KA, Agarkova DI, Trofimov AO, Abashkin AY, Bragin DE. Cerebral Critical Closing Pressure in Concomitant Traumatic Brain Injury and Intracranial Hematomas. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1339:33-38. [PMID: 35023087 PMCID: PMC9131855 DOI: 10.1007/978-3-030-78787-5_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The critical closing pressure (CrCP) is the pressure below which the local pial blood pressure is inadequate to prevent blood flow cessation. The cerebral CrCP in concomitant traumatic brain injury (TBI) and intracranial hematomas (TBI + ICH) remains understudied. The aim was to determine the status of the CrCP at сTBI with and without the ICH development. MATERIAL AND METHODS The results of the treatment of 90 patients with severe to moderate сTBI were studied (male/female - 49:41). The average age was 34.2 ± 14.4 years. Depending on the presence of ICH, patients were divided into two groups. All patients were subjected to transcranial Doppler of the both middle cerebral arteries, and evaluation of mean arterial pressure (MAP). Based on data obtained, the CrCPs were calculated. Significance was preset to p < 0.05. RESULTS The mean CrCP values in each group appeared to be significantly higher than a referral value (р < 0.05). The mean CrCP values in the perifocal zone of removed hematoma were significantly higher than in TBI patients without ICH (р = 0.015 and р = 0.048, respectively). Analysis of CrCP values in various types of ICH showed no statistically significant differences (р > 0.05). DISCUSSION The CrCP significantly differs in the groups of TBI patients with and without ICH. The comparability of the groups in respect to the concomitant injury structure proves that the revealed CrCP changes result from the traumatic compression of the brain.
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Affiliation(s)
- Kseniia A Trofimova
- Department of Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Darya I Agarkova
- Department of Neurosurgery, Regional Hospital named after Semashko, Nizhny Novgorod, Russia
| | - Alex O Trofimov
- Department of Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia.
- Department of Neurosurgery, Regional Hospital named after Semashko, Nizhny Novgorod, Russia.
| | - Andrew Y Abashkin
- Department of Neurosurgery, Regional Hospital named after Semashko, Nizhny Novgorod, Russia
| | - Denis E Bragin
- Lovelace Biomedical Research Institute, Albuquerque, NM, USA
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM, USA
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25
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Dar IA, Khan IR, Maddox RK, Selioutski O, Donohue KL, Marinescu MA, Prasad SM, Quazi NH, Donlon JS, Loose EA, Ramirez GA, Ren J, Majeski JB, Abramson K, Durduran T, Busch DR, Choe R. Towards detection of brain injury using multimodal non-invasive neuromonitoring in adults undergoing extracorporeal membrane oxygenation. BIOMEDICAL OPTICS EXPRESS 2020; 11:6551-6569. [PMID: 33282508 PMCID: PMC7687959 DOI: 10.1364/boe.401641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/16/2020] [Accepted: 10/02/2020] [Indexed: 05/27/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is a form of cardiopulmonary bypass that provides life-saving support to critically ill patients whose illness is progressing despite maximal conventional support. Use in adults is expanding, however neurological injuries are common. Currently, the existing brain imaging tools are a snapshot in time and require high-risk patient transport. Here we assess the feasibility of measuring diffuse correlation spectroscopy, transcranial Doppler ultrasound, electroencephalography, and auditory brainstem responses at the bedside, and developing a cerebral autoregulation metric. We report preliminary results from two patients, demonstrating feasibility and laying the foundation for future studies monitoring neurological health during ECMO.
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Affiliation(s)
- Irfaan A. Dar
- Department of Biomedical Engineering, University of Rochester, Rochester, New York 14620, USA
| | - Imad R. Khan
- Department of Neurology, Division of Neurocritical Care, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Ross K. Maddox
- Department of Biomedical Engineering, University of Rochester, Rochester, New York 14620, USA
- Department of Neuroscience, University of Rochester, Rochester, New York 14620, USA
| | - Olga Selioutski
- Department of Neurology, Division of Epilepsy, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Kelly L. Donohue
- Department of Neurology, Division of Neurocritical Care, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Mark A. Marinescu
- Department of Medicine, Division of Cardiology, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Sunil M. Prasad
- Department of Surgery, Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Nadim H. Quazi
- Department of Biology, University of Rochester, Rochester, New York 14620, USA
| | - Jack S. Donlon
- Department of Biomedical Engineering, University of Rochester, Rochester, New York 14620, USA
| | - Emily A. Loose
- Department of Biology, University of Rochester, Rochester, New York 14620, USA
| | - Gabriel A. Ramirez
- Department of Biomedical Engineering, University of Rochester, Rochester, New York 14620, USA
| | - Jingxuan Ren
- Department of Biomedical Engineering, University of Rochester, Rochester, New York 14620, USA
| | - Joseph B. Majeski
- Department of Biomedical Engineering, University of Rochester, Rochester, New York 14620, USA
| | - Kenneth Abramson
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), 08860, Spain
- Instituciò Catalana de Recerca i Estudis Avançats (ICREA), Castelldefels (Barcelona), 08015, Spain
| | - David R. Busch
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Regine Choe
- Department of Biomedical Engineering, University of Rochester, Rochester, New York 14620, USA
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York 14620, USA
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26
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Fisher JAN, Gumenchuk I, Rogovin OS, Yodh AG, Busch DR. Asymmetric, dynamic adaptation in prefrontal cortex during dichotic listening tasks. NEUROPHOTONICS 2020; 7:045008. [PMID: 33163546 PMCID: PMC7641958 DOI: 10.1117/1.nph.7.4.045008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/02/2020] [Indexed: 05/25/2023]
Abstract
Significance: Speech processing tasks can be used to assess the integrity and health of many functional and structural aspects of the brain. Despite the potential merits of such behavioral tests as clinical assessment tools, however, the underlying neural substrates remain relatively unclear. Aim: We aimed to obtain a more in-depth portrait of hemispheric asymmetry during dichotic listening tasks at the level of the prefrontal cortex, where prior studies have reported inconsistent results. Approach: To avoid central confounds that limited previous studies, we used diffuse correlation spectroscopy to optically monitor cerebral blood flow (CBF) in the dorsolateral prefrontal cortex during dichotic listening tasks in human subjects. Results: We found that dichotic listening tasks elicited hemispheric asymmetries in both amplitude as well as kinetics. When listening task blocks were repeated, there was an accommodative reduction in the response amplitude of the left, but not the right hemisphere. Conclusions: These heretofore unobserved trends depict a more nuanced portrait of the functional asymmetry that has been observed previously. To our knowledge, these results additionally represent the first direct measurements of CBF during a speech processing task recommended by the American Speech-Language-Hearing Association for diagnosing auditory processing disorders.
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Affiliation(s)
- Jonathan A. N. Fisher
- New York Medical College, Department of Physiology, Valhalla, New York, United States
| | - Iryna Gumenchuk
- New York Medical College, Department of Physiology, Valhalla, New York, United States
| | - Ora S. Rogovin
- New York Medical College, Department of Physiology, Valhalla, New York, United States
| | - Arjun G. Yodh
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
| | - David R. Busch
- University of Texas Southwestern Medical Center, Department of Anesthesiology and Pain Management, Dallas, Texas, United States
- University of Texas Southwestern Medical Center, Department of Neurology, Dallas, Texas, United States
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27
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Lloyd-Donald P, Spencer W, Cheng J, Romero L, Jithoo R, Udy A, Fitzgerald MC. In adult patients with severe traumatic brain injury, does the use of norepinephrine for augmenting cerebral perfusion pressure improve neurological outcome? A systematic review. Injury 2020; 51:2129-2134. [PMID: 32739152 DOI: 10.1016/j.injury.2020.07.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite multiple interventions, mortality due to severe traumatic brain injury (sTBI) within mature Trauma Systems has remained unchanged over the last decade. During this time, the use of vasoactive infusions (commonly norepinephrine) to achieve a target blood pressure and cerebral perfusion pressure (CPP) has been a mainstay of sTBI management. However, evidence suggests that norepinephrine, whilst raising blood pressure, may reduce cerebral oxygenation. This study aimed to review the available evidence that links norepinephrine augmented CPP to clinical outcomes for these patients. METHODS A systematic review examining the evidence for norepinephrine augmented CPP in TBI patients was undertaken. Strict inclusion and exclusion criteria were developed for a dedicated literature search of multiple scientific databases. Two dedicated reviewers screened articles, whilst a third dedicated reviewer resolved conflicts. RESULTS The systematic review yielded 4,809 articles, of which 1,197 duplicate articles were removed. After abstract/title screening, 45 articles underwent full text review, resulting in the identification of two articles that investigated the effect of norepinephrine administration on clinical outcomes in patients following TBI when compared to other vasopressors. Neither study found a difference in neurological outcome between the vasopressor groups. No articles measured the effect of norepinephrine compared to no vasopressor use on the clinical outcome of patients with sTBI. CONCLUSIONS Despite being a mainstay of pharmacological management for hypotension in patients following sTBI, there is minimal clinical evidence supporting the use of norepinephrine in targeting a CPP for either improving neurological outcomes or reducing mortality. Outcomes-based clinical trials exploring the role of brain tissue perfusion and oxygenation monitoring are required to validate any benefit.
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Affiliation(s)
- Patryck Lloyd-Donald
- Trauma Services, The Alfred Hospital, 89 Commercial Rd, Melbourne VIC, Australia; National Trauma Research Institute, Level 4, 89 Commercial Rd, Melbourne 3004, VIC, Australia
| | - William Spencer
- Trauma Services, The Alfred Hospital, 89 Commercial Rd, Melbourne VIC, Australia; National Trauma Research Institute, Level 4, 89 Commercial Rd, Melbourne 3004, VIC, Australia.
| | - Jacinta Cheng
- Trauma Services, The Alfred Hospital, 89 Commercial Rd, Melbourne VIC, Australia; National Trauma Research Institute, Level 4, 89 Commercial Rd, Melbourne 3004, VIC, Australia.
| | - Lorena Romero
- Library Services, The Alfred Hospital, 89 Commercial Rd, Melbourne VIC, Australia.
| | - Ron Jithoo
- National Trauma Research Institute, Level 4, 89 Commercial Rd, Melbourne 3004, VIC, Australia; Department of Neurosurgery, The Alfred Hospital, 89 Commercial Rd, Melbourne VIC, Australia.
| | - Andrew Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 89 Commercial Rd, Melbourne VIC, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC, Australia.
| | - Mark C Fitzgerald
- Trauma Services, The Alfred Hospital, 89 Commercial Rd, Melbourne VIC, Australia; National Trauma Research Institute, Level 4, 89 Commercial Rd, Melbourne 3004, VIC, Australia.
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28
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Fischer JB, Ghouse A, Tagliabue S, Maruccia F, Rey-Perez A, Báguena M, Cano P, Zucca R, Weigel UM, Sahuquillo J, Poca MA, Durduran T. Non-Invasive Estimation of Intracranial Pressure by Diffuse Optics: A Proof-of-Concept Study. J Neurotrauma 2020; 37:2569-2579. [PMID: 32460617 DOI: 10.1089/neu.2019.6965] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Intracranial pressure (ICP) is an important parameter to monitor in several neuropathologies. However, because current clinically accepted methods are invasive, its monitoring is limited to patients in critical conditions. On the other hand, there are other less critical conditions for which ICP monitoring could still be useful; therefore, there is a need to develop non-invasive methods. We propose a new method to estimate ICP based on the analysis of the non-invasive measurement of pulsatile, microvascular cerebral blood flow with diffuse correlation spectroscopy. This is achieved by training a recurrent neural network using only the cerebral blood flow as the input. The method is validated using a 50% split sample method using the data from a proof-of-concept study. The study involved a population of infants (n = 6) with external hydrocephalus (initially diagnosed as benign enlargement of subarachnoid spaces) as well as a population of adults (n = 6) with traumatic brain injury. The algorithm was applied to each cohort individually to obtain a model and an ICP estimate. In both diverse cohorts, the non-invasive estimation of ICP was achieved with an accuracy of <4 mm Hg and a negligible small bias. Further, we have achieved a good correlation (Pearson's correlation coefficient >0.9) and good concordance (Lin's concordance correlation coefficient >0.9) in comparison with standard clinical, invasive ICP monitoring. This preliminary work paves the way for further investigations of this tool for the non-invasive, bedside assessment of ICP.
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Affiliation(s)
- Jonas B Fischer
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain.,HemoPhotonics S.L., Castelldefels, Barcelona, Spain
| | - Ameer Ghouse
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
| | - Susanna Tagliabue
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain
| | - Federica Maruccia
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain.,Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Rey-Perez
- Neurotrauma Intensive Care Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marcelino Báguena
- Neurotrauma Intensive Care Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paola Cano
- Department of Neurosurgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Riccardo Zucca
- Synthetic Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Udo M Weigel
- HemoPhotonics S.L., Castelldefels, Barcelona, Spain
| | - Juan Sahuquillo
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Neurosurgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria A Poca
- Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Neurosurgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
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29
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van As K, Boterman J, Kleijn CR, Kenjeres S, Bhattacharya N. Laser speckle imaging of flowing blood: A numerical study. Phys Rev E 2020; 100:033317. [PMID: 31639980 DOI: 10.1103/physreve.100.033317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Indexed: 11/07/2022]
Abstract
Laser speckle imaging (LSI) can be used to study dynamic processes in turbid media, such as blood flow. However, it is presently still challenging to obtain meaningful quantitative information from speckle, mainly because speckle is the interferometric summation of multiply scattered light. Consequently, speckle represents a convolution of the local dynamics of the medium. In this paper, we present a computational model for simulating the LSI process, which we aim to use for improving our understanding of the underlying physics. Thereby reliable methods for extracting meaningful information from speckle can be developed. To validate our code, we apply it to a case study resembling blood flow: a cylindrical fluid flow geometry seeded with small spherical particles and modulated with a heartbeat signal. From the simulated speckle pattern, we successfully retrieve the main frequency modes of the original heartbeat signal. By comparing Poiseuille flow to plug flow, we show that speckle boiling causes a small amount of uniform spectral noise. Our results indicate that our computational model is capable of simulating LSI and will therefore be useful in future studies for further developing LSI as a quantitative imaging tool.
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Affiliation(s)
- Kevin van As
- Delft University of Technology, Faculty of Applied Sciences, Dept. of Chemical Engineering, 2629 HZ Delft, The Netherlands.,JM Burgerscentrum for Fluid Mechanics, 2628 CD Delft, The Netherlands
| | - Jorne Boterman
- Delft University of Technology, Faculty of Applied Sciences, Dept. of Chemical Engineering, 2629 HZ Delft, The Netherlands
| | - Chris R Kleijn
- Delft University of Technology, Faculty of Applied Sciences, Dept. of Chemical Engineering, 2629 HZ Delft, The Netherlands.,JM Burgerscentrum for Fluid Mechanics, 2628 CD Delft, The Netherlands
| | - Sasa Kenjeres
- Delft University of Technology, Faculty of Applied Sciences, Dept. of Chemical Engineering, 2629 HZ Delft, The Netherlands.,JM Burgerscentrum for Fluid Mechanics, 2628 CD Delft, The Netherlands
| | - Nandini Bhattacharya
- Delft University of Technology, Faculty of Applied Sciences, Dept. of Imaging Physics, 2628 CJ Delft, The Netherlands
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30
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Favilla CG, Forti RM, Zamzam A, Detre JA, Mullen MT, Yodh AG, Kasner SE, Busch DR, Baker WB, Mesquita RC, Kung D, Messé SR. Perfusion Enhancement with Respiratory Impedance After Stroke (PERI-Stroke). Neurotherapeutics 2019; 16:1296-1303. [PMID: 31140115 PMCID: PMC6985403 DOI: 10.1007/s13311-019-00744-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Intrathoracic pressure influences cardiac output and may affect cerebral blood flow (CBF). We aimed to quantify the cerebral hemodynamic response to intrathoracic pressure reduction in patients with acute ischemic stroke using a noninvasive respiratory impedance (RI) device. We assessed low-level (6 cm H2O) and high-level (12 cm H2O) RI in 17 spontaneously breathing patients within 72 h of anterior circulation acute ischemic stroke. Average age was 65 years, and 35% were female. Frontal lobe tissue perfusion and middle cerebral artery velocity (MCAv) were continuously monitored with optical diffuse correlation spectroscopy (DCS) and transcranial Doppler ultrasound, respectively. High-level RI resulted in a 7% increase in MCAv (p = 0.004). MCAv varied across all studied levels (baseline vs low-level vs high-level, p = 0.006), with a significant test of trend (p = 0.002). Changes were not seen in DCS measured tissue perfusion by nonparametric pairwise comparison. Mixed effects regression analysis identified a small increase in both MCAv (low-level RI: β 2.1, p < 0.001; high-level RI: β 5.0, p < 0.001) and tissue-level flow (low-level RI: β 5.4, p < 0.001; high-level RI: β 5.9, p < 0.001). There was a small increase in mean arterial pressure during low-level and high-level RI, 4% (p = 0.013) and 4% (p = 0.017), respectively. End-tidal CO2 remained stable throughout the protocol. RI was well tolerated. Manipulating intrathoracic pressure via noninvasive RI was safe and produced a small but measurable increase in cerebral perfusion in acute ischemic stroke patients. Future studies are warranted to assess whether RI is feasible and tolerable for prolonged use in hyperacute stroke management.
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Affiliation(s)
- Christopher G Favilla
- Department of Neurology, University of Pennsylvania, Philadelphia, USA.
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce St, 3 West Gates, Philadelphia, PA, 19104-4283, USA.
| | - Rodrigo M Forti
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, USA
- Institute of Physics, University of Campinas, Campinas, 13083-859, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, 13083-888, Brazil
| | - Ahmad Zamzam
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Michael T Mullen
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - Arjun G Yodh
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, USA
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - David R Busch
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, USA
- Department of Anesthesiology & Pain Management, University of Texas Southwestern, Dallas, USA
- Department Neurology & Neurotherapeutics, University of Texas Southwestern, Dallas, USA
| | - Wesley B Baker
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, USA
- Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Rickson C Mesquita
- Institute of Physics, University of Campinas, Campinas, 13083-859, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, 13083-888, Brazil
| | - David Kung
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA
| | - Steven R Messé
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
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31
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Dragojević T, Vidal Rosas EE, Hollmann JL, Culver JP, Justicia C, Durduran T. High-density speckle contrast optical tomography of cerebral blood flow response to functional stimuli in the rodent brain. NEUROPHOTONICS 2019; 6:045001. [PMID: 31620545 PMCID: PMC6782685 DOI: 10.1117/1.nph.6.4.045001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/12/2019] [Indexed: 05/20/2023]
Abstract
Noninvasive, three-dimensional, and longitudinal imaging of cerebral blood flow (CBF) in small animal models and ultimately in humans has implications for fundamental research and clinical applications. It enables the study of phenomena such as brain development and learning and the effects of pathologies, with a clear vision for translation to humans. Speckle contrast optical tomography (SCOT) is an emerging optical method that aims to achieve this goal by directly measuring three-dimensional blood flow maps in deep tissue with a relatively inexpensive and simple system. High-density SCOT is developed to follow CBF changes in response to somatosensory cortex stimulation. Measurements are carried out through the intact skull on the rat brain. SCOT is able to follow individual trials in each brain hemisphere, where signal averaging resulted in comparable, cortical images to those of functional magnetic resonance images in spatial extent, location, and depth. Sham stimuli are utilized to demonstrate that the observed response is indeed due to local changes in the brain induced by forepaw stimulation. In developing and demonstrating the method, algorithms and analysis methods are developed. The results pave the way for longitudinal, nondestructive imaging in preclinical rodent models that can readily be translated to the human brain.
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Affiliation(s)
- Tanja Dragojević
- Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Address all correspondence to Tanja Dragojević, E-mail:
| | - Ernesto E. Vidal Rosas
- Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Joseph L. Hollmann
- Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Joseph P. Culver
- Washington University, School of Medicine, Department of Radiology, St. Louis, Missouri, United States
- Washington University, Department of Physics, St. Louis, Missouri, United States
| | - Carles Justicia
- Institut d’Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Department of Brain Ischemia and Neurodegeneration, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Àrea de Neurociències, Barcelona, Spain
| | - Turgut Durduran
- Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
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32
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Mullen MT, Parthasarathy AB, Zandieh A, Baker WB, Mesquita RC, Loomis C, Torres J, Guo W, Favilla CG, Messé SR, Yodh AG, Detre JA, Kasner SE. Cerebral Blood Flow Response During Bolus Normal Saline Infusion After Ischemic Stroke. J Stroke Cerebrovasc Dis 2019; 28:104294. [PMID: 31416759 DOI: 10.1016/j.jstrokecerebrovasdis.2019.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/11/2019] [Indexed: 01/01/2023] Open
Abstract
GOALS We quantified cerebral blood flow response to a 500 cc bolus of 0.9%% normal saline (NS) within 96 hours of acute ischemic stroke (AIS) using diffuse correlation spectroscopy (DCS). MATERIALS AND METHODS Subjects with AIS in the anterior, middle, or posterior cerebral artery territory were enrolled within 96 hours of symptom onset. DCS measured relative cerebral blood flow (rCBF) in the bilateral frontal lobes for 15 minutes at rest (baseline), during a 30-minute infusion of 500 cc NS (bolus), and for 15 minutes after completion (post-bolus). Mean rCBF for each time period was calculated for individual subjects and median rCBF for the population was compared between time periods. Linear regression was used to evaluate for associations between rCBF and clinical features. RESULTS Among 57 subjects, median rCBF (IQR) increased relative to baseline in the ipsilesional hemisphere by 17% (-2.0%, 43.1%), P< 0.001, and in the contralesional hemisphere by 13.3% (-4.3%, 36.0%), P < .004. No significant associations were found between ipsilesional changes in rCBF and age, race, infarct size, infarct location, presence of large vessel stenosis, NIH stroke scale, or symptom duration. CONCLUSION A 500 cc bolus of .9% NS produced a measurable increase in rCBF in both the affected and nonaffected hemispheres. Clinical features did not predict rCBF response.
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Affiliation(s)
- Michael T Mullen
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania; Leondard David Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
| | | | - Ali Zandieh
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wesley B Baker
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Caitlin Loomis
- Department of Neurology, Yale University, New Haven, Connecticut
| | - Jose Torres
- Department of Neurology, New York University, New York City, New York
| | - Wensheng Guo
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Steven R Messé
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
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Observed and calculated cerebral critical closing pressure are highly correlated in preterm infants. Pediatr Res 2019; 86:242-246. [PMID: 31003233 PMCID: PMC6658334 DOI: 10.1038/s41390-019-0403-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/04/2019] [Accepted: 04/11/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cerebrovascular critical closing pressure (CrCP) is the arterial blood pressure (ABP) at which cerebral blood flow ceases. Preterm ABP is low and close to CrCP. The diastolic closing margin (diastolic ABP minus CrCP) has been associated with intraventricular hemorrhage in preterm infants. CrCP is estimated from middle cerebral artery cerebral blood flow velocity (CBFV) and ABP waveforms. However, these estimations have not been validated due to a lack of gold standard. Direct observation of the CrCP in preterm infants with hypotension is an opportunity to validate synchronously estimated CrCP. METHODS ABP and CBFV tracings were obtained from 24 extremely low birth weight infants. Recordings where diastolic CBFV was zero were identified. The gold standard CrCP was delineated using piecewise regression of ABP and CBFV values paired by rank ordering and then estimated using a published formula. The measured and estimated values were compared using linear regression and Bland-Altman analysis. RESULTS Linear regression showed a high degree of correlation between measured and calculated CrCP (r2 = 0.93). CONCLUSIONS This is the first study to validate a calculated CrCP by comparing it to direct measurements of CrCP from preterm infants when ABP is lower than CrCP.
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34
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Wang D, Baker WB, He H, Gao P, Zhu L, Peng Q, Li Z, Li F, Chen T, Feng H. Influence of probe pressure on the pulsatile diffuse correlation spectroscopy blood flow signal on the forearm and forehead regions. NEUROPHOTONICS 2019; 6:035013. [PMID: 31548976 PMCID: PMC6755374 DOI: 10.1117/1.nph.6.3.035013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/04/2019] [Indexed: 05/24/2023]
Abstract
In a pilot study of 11 healthy adults (24 to 39 years, all male), we characterize the influence of external probe pressure on optical diffuse correlation spectroscopy (DCS) measurements of pulsatile blood flow obtained on the forearm and forehead. For external probe pressure control, a hand inflatable air balloon is inserted between the tissue and an elastic strap. The air balloon is sequentially inflated to achieve a wide range of external probe pressures between 20 and 250 mmHg on the forearm and forehead, which are measured with a flexible pressure sensor underneath the probe. At each probe pressure, the pulsatility index (PI) of arteriole blood flow on the forehead and forearm is measured with DCS (2.1-cm source-detector separation). We observe a strong correlation between probe pressure and PI on the forearm ( R = 0.66 , p < 0.001 ), but not on the forehead ( R = - 0.11 , p = 0.4 ). The forearm measurements demonstrate the sensitivity of the DCS PI to skeletal muscle tissue pressure, whereas the forehead measurements indicate that DCS PI measurements are not sensitive to scalp tissue pressure. Note, in contrast to pulsatility, the time-averaged DCS blood flow index on the forehead was significantly correlated with probe pressure ( R = - 0.55 , p < 0.001 ). This pilot data appears to support the initiation of more comprehensive clinical studies on DCS to detect trends in internal pressure in brain and skeletal muscle.
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Affiliation(s)
- Detian Wang
- Army Medical University, Southwest Hospital, Department of Neurosurgery, Chong Qing, China
- China Academy of Engineering Physics, Institute of Fluid Physics, Mianyang, China
| | - Wesley B. Baker
- Children’s Hospital of Philadelphia, Division of Neurology, Philadelphia, Philadelphia, United States
| | - Hui He
- China Academy of Engineering Physics, Institute of Fluid Physics, Mianyang, China
| | - Peng Gao
- China Academy of Engineering Physics, Institute of Fluid Physics, Mianyang, China
| | - Liguo Zhu
- China Academy of Engineering Physics, Institute of Fluid Physics, Mianyang, China
| | - Qixian Peng
- China Academy of Engineering Physics, Institute of Fluid Physics, Mianyang, China
| | - Zeren Li
- China Academy of Engineering Physics, Institute of Fluid Physics, Mianyang, China
| | - Fei Li
- Army Medical University, Southwest Hospital, Department of Neurosurgery, Chong Qing, China
| | - Tunan Chen
- Army Medical University, Southwest Hospital, Department of Neurosurgery, Chong Qing, China
| | - Hua Feng
- Army Medical University, Southwest Hospital, Department of Neurosurgery, Chong Qing, China
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35
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Effective Cerebral Perfusion Pressure: Does the Estimation Method Make a Difference? J Neurosurg Anesthesiol 2019; 32:335-343. [DOI: 10.1097/ana.0000000000000614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Forti RM, Favilla CG, Cochran JM, Baker WB, Detre JA, Kasner SE, Mullen MT, Messé SR, Kofke WA, Balu R, Kung D, Pukenas BA, Sedora-Roman NI, Hurst RW, Choudhri OA, Mesquita RC, Yodh AG. Transcranial Optical Monitoring of Cerebral Hemodynamics in Acute Stroke Patients during Mechanical Thrombectomy. J Stroke Cerebrovasc Dis 2019; 28:1483-1494. [PMID: 30975462 PMCID: PMC6686873 DOI: 10.1016/j.jstrokecerebrovasdis.2019.03.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/28/2019] [Accepted: 03/06/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Mechanical thrombectomy is revolutionizing treatment of acute stroke due to large vessel occlusion (LVO). Unfortunately, use of the modified Thrombolysis in Cerebral Infarction score (mTICI) to characterize recanalization of the cerebral vasculature does not address microvascular perfusion of the distal parenchyma, nor provide more than a vascular "snapshot." Thus, little is known about tissue-level hemodynamic consequences of LVO recanalization. Diffuse correlation spectroscopy (DCS) and diffuse optical spectroscopy (DOS) are promising methods for continuous, noninvasive, contrast-free transcranial monitoring of cerebral microvasculature. METHODS Here, we use a combined DCS/DOS system to monitor frontal lobe hemodynamic changes during endovascular treatment of 2 patients with ischemic stroke due to internal carotid artery (ICA) occlusions. RESULTS AND DISCUSSION The monitoring instrument identified a recanalization-induced increase in ipsilateral cerebral blood flow (CBF) with little or no concurrent change in contralateral CBF and extracerebral blood flow. The results suggest that diffuse optical monitoring is sensitive to intracerebral hemodynamics in patients with ICA occlusion and can measure microvascular responses to mechanical thrombectomy.
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Affiliation(s)
- Rodrigo M Forti
- Institute of Physics, University of Campinas, Campinas, SP, Brazil; Brazilian Institute of Neuroscience and Neurotechnology, Campinas, SP, Brazil; Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania.
| | | | - Jeffrey M Cochran
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wesley B Baker
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael T Mullen
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven R Messé
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - W Andrew Kofke
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ramani Balu
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Kung
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bryan A Pukenas
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neda I Sedora-Roman
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert W Hurst
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Omar A Choudhri
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rickson C Mesquita
- Institute of Physics, University of Campinas, Campinas, SP, Brazil; Brazilian Institute of Neuroscience and Neurotechnology, Campinas, SP, Brazil
| | - Arjun G Yodh
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania
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37
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Tgavalekos K, Pham T, Krishnamurthy N, Sassaroli A, Fantini S. Frequency-resolved analysis of coherent oscillations of local cerebral blood volume, measured with near-infrared spectroscopy, and systemic arterial pressure in healthy human subjects. PLoS One 2019; 14:e0211710. [PMID: 30753203 PMCID: PMC6372153 DOI: 10.1371/journal.pone.0211710] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/19/2019] [Indexed: 01/18/2023] Open
Abstract
We report a study on twenty-two healthy human subjects of the dynamic relationship between cerebral hemoglobin concentration ([HbT]), measured with near-infrared spectroscopy (NIRS) in the prefrontal cortex, and systemic arterial blood pressure (ABP), measured with finger plethysmography. [HbT] is a measure of local cerebral blood volume (CBV). We induced hemodynamic oscillations at discrete frequencies in the range 0.04-0.20 Hz with cyclic inflation and deflation of pneumatic cuffs wrapped around the subject's thighs. We modeled the transfer function of ABP and [HbT] in terms of effective arterial (K(a)) and venous (K(v)) compliances, and a cerebral autoregulation time constant (τ(AR)). The mean values (± standard errors) of these parameters across the twenty-two subjects were K(a) = 0.01 ± 0.01 μM/mmHg, K(v) = 0.09 ± 0.05 μM/mmHg, and τ(AR) = 2.2 ± 1.3 s. Spatially resolved measurements in a subset of eight subjects reveal a spatial variability of these parameters that may exceed the inter-subject variability at a set location. This study sheds some light onto the role that ABP and cerebral blood flow (CBF) play in the dynamics of [HbT] measured with NIRS, and paves the way for new non-invasive optical studies of cerebral blood flow and cerebral autoregulation.
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Affiliation(s)
- Kristen Tgavalekos
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Thao Pham
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Nishanth Krishnamurthy
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Angelo Sassaroli
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Sergio Fantini
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, United States of America
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38
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Kofke WA, Ren Y, Augoustides JG, Li H, Nathanson K, Siman R, Meng QC, Bu W, Yandrawatthana S, Kositratna G, Kim C, Bavaria JE. Reframing the Biological Basis of Neuroprotection Using Functional Genomics: Differentially Weighted, Time-Dependent Multifactor Pathogenesis of Human Ischemic Brain Damage. Front Neurol 2018; 9:497. [PMID: 29997569 PMCID: PMC6028620 DOI: 10.3389/fneur.2018.00497] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 06/07/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Neuroprotection studies are generally unable to demonstrate efficacy in humans. Our specific hypothesis is that multiple pathophysiologic pathways, of variable importance, contribute to ischemic brain damage. As a corollary to this, we discuss the broad hypothesis that a multifaceted approach will improve the probability of efficacious neuroprotection. But to properly test this hypothesis the nature and importance of the multiple contributing pathways needs elucidation. Our aim is to demonstrate, using functional genomics, in human cardiac surgery procedures associated with cerebral ischemia, that the pathogenesis of perioperative human ischemic brain damage involves the function of multiple variably weighted proteins involving several pathways. We then use these data and literature to develop a proposal for rational design of human neuroprotection protocols. Methods: Ninety-four patients undergoing deep hypothermic circulatory arrest (DHCA) and/or aortic valve replacement surgery had brain damage biomarkers, S100β and neurofilament H (NFH), assessed at baseline, 1 and 24 h post-cardiopulmonary bypass (CPB) with analysis for association with 92 single nucleotide polymorphisms (SNPs) (selected by co-author WAK) related to important proteins involved in pathogenesis of cerebral ischemia. Results: At the nominal significance level of 0.05, changes in S100β and in NFH at 1 and 24 h post-CPB were associated with multiple SNPs involving several prospectively determined pathophysiologic pathways, but were not individually significant after multiple comparison adjustments. Variable weights for the several evaluated SNPs are apparent on regression analysis and, notably, are dissimilar related to the two biomarkers and over time post CPB. Based on our step-wise regression model, at 1 h post-CPB, SOD2, SUMO4, and GP6 are related to relative change of NFH while TNF, CAPN10, NPPB, and SERPINE1 are related to the relative change of S100B. At 24 h post-CPB, ADRA2A, SELE, and BAX are related to the relative change of NFH while SLC4A7, HSPA1B, and FGA are related to S100B. Conclusions: In support of the proposed hypothesis, association SNP data suggest function of specific disparate proteins, as reflected by genetic variation, may be more important than others with variation at different post-insult times after human brain ischemia. Such information may support rational design of post-insult time-sensitive multifaceted neuroprotective therapies.
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Affiliation(s)
- William A Kofke
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, United States
| | - Yue Ren
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, United States
| | - Hongzhe Li
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Katherine Nathanson
- Department of Medicine, Division of Translational Medicine and Human Genetics Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Robert Siman
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Qing Cheng Meng
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, United States
| | - Weiming Bu
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, United States
| | - Sukanya Yandrawatthana
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, United States
| | - Guy Kositratna
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, United States
| | - Cecilia Kim
- The Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Joseph E Bavaria
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States
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