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Van Riesen J, Shirzad M, Edgar C, Tari B, Heath M. A 10-min reduction in cerebral blood flow does not alter post-intervention executive function: evidence from lower-body negative pressure. Exp Brain Res 2024; 242:2193-2205. [PMID: 39012475 DOI: 10.1007/s00221-024-06879-8] [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: 01/18/2024] [Accepted: 06/19/2024] [Indexed: 07/17/2024]
Abstract
A single bout of exercise as well as exposure to a hypercapnic environment increases cerebral blood flow (CBF) and is an adaptation linked to a post-intervention executive function (EF) benefit. In the present investigation we sought to determine whether a transient reduction in CBF impairs EF. Accordingly, we employed 10-min -30 mmHg and -50 mmHg lower-body negative pressure (LBNP) interventions as well as a non-LBNP control condition. LBNP was employed because it sequesters blood in the lower legs and safely and reliably decreases CBF. Transcranial Doppler ultrasound was used to measure middle cerebral artery velocity (MCAv) to estimate CBF prior to and during LBNP conditions. As well, assessments of the inhibitory control component of EF (i.e., antipointing) were completed prior to (pre-) and immediately after (i.e., post-) each condition. Antipointing requires that an individual reach mirror-symmetrical to an exogenously presented target and is a task providing the resolution to detect subtle EF changes. Results showed that LBNP produced a 14% reduction in MCAv; however, null hypothesis, equivalence and Bayesian contrasts indicated that antipointing metrics did not vary from pre- to post-intervention, and LBNP-based changes in MCAv magnitude were not reliably correlated with antipointing planning times. Hence, a 10-min reduction in CBF did not impact the efficiency or effectiveness of an inhibitory control measure of EF.
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Affiliation(s)
- James Van Riesen
- Graduate Program in Neuroscience, The University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Mustafa Shirzad
- School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Chloe Edgar
- School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Benjamin Tari
- School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Matthew Heath
- Graduate Program in Neuroscience, The University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada.
- School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada.
- Canadian Centre for Activity and Aging, The University of Western Ontario, 1201 Western Rd, London, ON, N6G 1H1, Canada.
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Nielsen BD, Kristensen S, Donskov A, Terslev L, Dreyer LW, Colic A, Hetland ML, Højgaard P, Ellingsen T, Hauge EM, Chrysidis S, Keller KK. The DANIsh VASculitis cohort study: protocol for a national multicenter prospective study including incident and prevalent patients with giant cell arteritis and polymyalgia rheumatica. Front Med (Lausanne) 2024; 11:1415076. [PMID: 39026552 PMCID: PMC11256208 DOI: 10.3389/fmed.2024.1415076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
The DANIsh VASculitis cohort study, DANIVAS, is an observational national multicenter study with the overall aim to prospectively collect protocolized clinical data and biobank material from patients with polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) diagnosed and/or followed at Danish rheumatology departments. A long-term key objective is to investigate whether the use of new clinically implemented diagnostic imaging modalities facilitates disease stratification in the GCA-PMR disease spectrum. In particular, we aim to evaluate treatment requirements in GCA patients with and without large-vessel involvement, treatment needs in PMR patients with and without subclinical giant cell arteritis, and the prognostic role of imaging with respect to aneurysm development. Hence, in GCA and PMR, imaging stratification is hypothesized to be able to guide management strategies. With an established infrastructure within rheumatology for clinical studies in Denmark, the infrastructure of the Danish Rheumatologic Biobank, and the possibility to cross-link data with valid nationwide registries, the DANIVAS project holds an exceptional possibility to collect comprehensive real-world data on diagnosis, disease severity, disease duration, treatment effect, complications, and adverse events. In this paper, we present the research protocol for the DANIVAS study. Clinical trial registration: https://clinicaltrials.gov/, identifier NCT05935709.
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Affiliation(s)
- Berit D. Nielsen
- Department of Medicine, The Regional Hospital in Horsens, Horsens, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Salome Kristensen
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Agnete Donskov
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lene Terslev
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lene Wohlfahrt Dreyer
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ada Colic
- Department of Rheumatology, Zealand University Hospital, Køge, Denmark
| | - Merete Lund Hetland
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pil Højgaard
- Department of Medicine (2), Holbæk Hospital, Holbæk, Denmark
| | - Torkell Ellingsen
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Stavros Chrysidis
- Department of Rheumatology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Kresten K. Keller
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Persaud P, Belfry GR, Heath M. Menstrual cycle status does not impact exercise-based changes in cerebral blood flow or executive function benefits. J Sports Sci 2024; 42:1061-1071. [PMID: 39052669 DOI: 10.1080/02640414.2024.2382566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 07/13/2024] [Indexed: 07/27/2024]
Abstract
A single bout of exercise enhances executive function (EF) and may relate to an increase in cerebral blood flow (CBF). A limitation in the current literature is that biologically female participants are underrepresented given some evidence that changes in hormone levels across the menstrual cycle impact physiological and psychological variables. Here, biologically female participants completed separate single bouts of moderate intensity exercise (80% of estimated lactate threshold) during the follicular (FOL) and luteal (LUT) phases of their menstrual cycle. In addition, biologically male participants completed a same duration/intensity exercise session. Middle cerebral artery velocity (MCAv) was used to estimate CBF and pre- and postexercise EF was assessed via the antisaccade task. Results showed that resting MCAv was larger in the LUT than FOL phase; however, the exercise-mediated increase in MCAv was equivalent between menstrual cycle phases, and between female and male participants. Antisaccade reaction times reliably decreased from pre- to postexercise and frequentist and non-frequentist statistics demonstrated that the magnitude of the decrease was equivalent across FOL and LUT phases, and between female and male participants. Thus, results evince that menstrual cycle status should not serve as a basis limiting biologically female participants' inclusion in research examining exercise and EF.
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Affiliation(s)
- Priyanka Persaud
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Glen R Belfry
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
- Canadian Centre for Activity and Aging, University of Western Ontario, London, ON, Canada
| | - Matthew Heath
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
- Canadian Centre for Activity and Aging, University of Western Ontario, London, ON, Canada
- Graduate Program in Neuroscience, University of Western Ontario, London, ON, Canada
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Shirzad M, Van Riesen J, Behboodpour N, Heath M. 10-min exposure to a 2.5% hypercapnic environment increases cerebral blood blow but does not impact executive function. LIFE SCIENCES IN SPACE RESEARCH 2024; 40:143-150. [PMID: 38245339 DOI: 10.1016/j.lssr.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 01/22/2024]
Abstract
Space travel and exploration are associated with increased ambient CO2 (i.e., a hypercapnic environment). Some work reported that the physiological changes (e.g., increased cerebral blood flow [CBF]) associated with a chronic hypercapnic environment contributes to a "space fog" that adversely impacts cognition and psychomotor performance, whereas other work reported no change or a positive change. Here, we employed the antisaccade task to evaluate whether transient exposure to a hypercapnic environment influences top-down executive function (EF). Antisaccades require a goal-directed eye movement mirror-symmetrical to a target and are an ideal tool for identifying subtle EF changes. Healthy young adults (aged 19-25 years) performed blocks of antisaccade trials prior to (i.e., pre-intervention), during (i.e., concurrent) and after (i.e., post-intervention) 10-min of breathing factional inspired CO2 (FiCO2) of 2.5% (i.e., hypercapnic condition) and during a normocapnic (i.e., control) condition. In both conditions, CBF, ventilatory and cardiorespiratory responses were measured. Results showed that the hypercapnic condition increased CBF, ventilation and end-tidal CO2 and thus demonstrated an expected physiological adaptation to increased FiCO2. Notably, however, null hypothesis and equivalence tests indicated that concurrent and post-intervention antisaccade reaction times were refractory to the hypercapnic environment; that is, transient exposure to a FiCO2 of 2.5% did not produce a real-time or lingering influence on an oculomotor-based measure of EF. Accordingly, results provide a framework that - in part - establishes the FiCO2 percentage and timeline by which high-level EF can be maintained. Future work will explore CBF and EF dynamics during chronic hypercapnic exposure as more direct proxy for the challenges of space flight and exploration.
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Affiliation(s)
- Mustafa Shirzad
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada
| | - James Van Riesen
- Canadian Centre for Activity and Aging, University of Western Ontario, 1201 Western Rd, London, ON N6G 1H1, Canada
| | - Nikan Behboodpour
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada
| | - Matthew Heath
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada; Canadian Centre for Activity and Aging, University of Western Ontario, 1201 Western Rd, London, ON N6G 1H1, Canada; Graduate Program in Neuroscience, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada.
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Andel PM, Diamantopoulos AP, Myklebust G, Haugeberg G. Vasculitis distribution and clinical characteristics in giant cell arteritis: a retrospective study using the new 2022 ACR/EULAR classification criteria. Front Med (Lausanne) 2023; 10:1286601. [PMID: 38020143 PMCID: PMC10681091 DOI: 10.3389/fmed.2023.1286601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Giant cell arteritis (GCA) is the most common vasculitis of the elderly. In recent years, advanced imaging has to a certain extent replaced temporal artery biopsy (TAB) to aid diagnosis in many institutions and helped to identify three major phenotypes of GCA, namely, cranial GCA (c-GCA), large-vessel non-cranial GCA (LV-GCA), and a combination of these two patterns called mixed-GCA, which all show different clinical patterns. Recent 2022 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria respect the changing conception and clinical practice during the last two decades. In this cohort study, we present vasculitis distribution and baseline characteristics using the 2022 ACR/EULAR classification criteria as well as the EULAR core data set. Methods In this retrospective study from Southern Norway, we identified all patients diagnosed with GCA between 2006 and 2019 in our single-center fast-track clinic (FTC). We included all patients who were examined using ultrasound (US) of cranial as well as non-cranial large vessels at diagnosis to depict vascular distribution. EULAR core data set, ACR 1990, and 2022 ACR/EULAR classification criteria were used to characterize the cohort. Results Seventy-seven patients were diagnosed with GCA at our institution in the aforementioned period. Seventy-one patients (92.2%) were diagnosed with the help of US and included in the further analysis. The 2022 ACR/EULAR classification criteria allocated 69 patients (97.2%), while the ACR 1990 classification criteria allocated 49 patients (69.0%) in our cohort as having GCA. Mixed-GCA was the most common type in 33 patients (46.5%). Weight loss was significantly more common in patients with large-vessel non-cranial vasculitis in LV-GCA and mixed-GCA. Headache, on the other hand, was significantly more common in patients with involvement of cranial vessels. Conclusion Mixed GCA was the most common form of GCA in our cohort. In our study, the 2022 ACR/EULAR classification criteria seem to be a more useful tool compared with the old ACR 1990 classification criteria to allocate GCA patients diagnosed and treated at our US-based FTC as having GCA.
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Affiliation(s)
- Peter M. Andel
- Division of Rheumatology, Department of Rheumatology, Surgery, Inflammation and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Department, Hospital of South East Norway, Kalnes, Norway
| | - Andreas P. Diamantopoulos
- Division of Internal Medicine, Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
| | | | - Glenn Haugeberg
- Division of Rheumatology, Department of Internal Medicine, Hospital of Southern Norway, Kristiansand, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Ayo-Martin O, Garcia-Garcia J, Hernandez-Fernandez F, Palao M, Poyatos-Herraiz B, Barahona-Espinal TH, Gonzalez-Romero A, Marin-Conesa E, Serrano-Serrano B, Paya M, Segura T. Increased vertebral canal diameter measured by ultrasonography as a sign of vasculitis in patients with giant cell arteritis. Front Med (Lausanne) 2023; 10:1283285. [PMID: 38020125 PMCID: PMC10664249 DOI: 10.3389/fmed.2023.1283285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The diagnosis of giant cell arteritis (GCA) by ultrasonography including large vessels, apart from the temporal artery increases the sensibility of the study and informs about the risk of specific complications. However, there is less information about the study of these arteries, whose affection carries higher proportion of severe complications. Objectives To describe and analyze the value of the diameter of the cervical vertebral canal of the vertebral artery (VA) as a sign of vertebral vasculitis (VV) related to GCA and estimate the risk of stroke complications. Materials and methods Observational study of a population that includes patients with GCA with and without VA vasculitis as well as healthy subjects. We evaluated whether there were differences in VA diameter in the groups and, if so, we estimated the diagnostic capacity of the variable that best defines VA diameter using a ROC curve. Cut-off points with their associated reliability chosen thereafter. Results There were 347 subjects included:107 with GCA of whom 37 had vertebral vasculitis, 240 healthy controls. In patients with GCA and VV, the VA diameter was increased (No GCA 3.4 mm, GCA without VV 3.6 mm, GCA with VV 5.2 mm p < 0.01). According to the ROC curves, the variable defining vertebral diameter with best diagnostic accuracy is the sum of both sides (area under the curve of 0.98). With a cut-off point of 8.45 mm, the reliability values are: sensitivity 94.1%, specificity 94.5%, PPV 82.1% and NPV 98.4%. With a cut-off point of 9.95 mm, the sensitivity is 52.9% and the specificity is 100%. Likewise, VA diameter is independently associated with the presence of stroke in the vertebrobasilar territory (OR 1.6, range 1.2-2.2). Conclusion The VA diameter, measured as the sum of both sides, is an objectively measurable sign with very high reliability for detect vertebral vasculitis in patients with GCA. It is proposed here as a novel echographic sign, which can aid the detection of the involvement of an artery where the complications are especially serious.
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Affiliation(s)
- Oscar Ayo-Martin
- Laboratory of Neurosonology, Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- Instituto de Investigación en Discapacidades Neurológicas (IDINE), Universidad de Castilla-La Mancha, Albacete, Spain
- Faculty of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Jorge Garcia-Garcia
- Laboratory of Neurosonology, Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- Instituto de Investigación en Discapacidades Neurológicas (IDINE), Universidad de Castilla-La Mancha, Albacete, Spain
- Faculty of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Francisco Hernandez-Fernandez
- Laboratory of Neurosonology, Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Maria Palao
- Laboratory of Neurosonology, Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | | | - Ester Marin-Conesa
- Department of Neurology, Hospital Militar de Honduras and Hospital DIME, Tegucigalpa, Honduras
| | - Blanca Serrano-Serrano
- Laboratory of Neurosonology, Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Maria Paya
- Laboratory of Neurosonology, Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Tomas Segura
- Laboratory of Neurosonology, Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- Instituto de Investigación en Discapacidades Neurológicas (IDINE), Universidad de Castilla-La Mancha, Albacete, Spain
- Faculty of Medicine, Universidad de Castilla-La Mancha, Albacete, Spain
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Dalton C, Ahn J, Jeyarajan G, Krigolson OE, Heath M. Distinct cortical haemodynamics during squat-stand and continuous aerobic exercise do not influence the magnitude of a postexercise executive function benefit. J Sports Sci 2023; 41:1459-1470. [PMID: 37884880 DOI: 10.1080/02640414.2023.2275086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
A single bout of aerobic exercise benefits executive function (EF). A potential mechanism for this benefit is an exercise-mediated increase in cerebral blood flow (CBF) that elicits vascular endothelial shear-stress improving EF efficiency. Moderate intensity continuous aerobic exercise (MCE) asymptotically increases CBF, whereas continuous body weight squat-stand exercise (SSE) provides a large amplitude oscillatory response. Some work has proposed that an increase in CBF oscillation amplitude provides the optimal shear-stress for improving EF and brain health. We examined whether a large amplitude oscillatory CBF response associated with a single bout of SSE imparts a larger postexercise EF benefit than an MCE cycle ergometer protocol. Exercise changes in middle cerebral artery velocity (MCAv) were measured via transcranial Doppler ultrasound to estimate CBF, and pre- and postexercise EF was assessed via the antisaccade task. MCE produced a steady state increase in MCAv, whereas SSE produced a large amplitude MCAv oscillation. Both conditions produced a postexercise EF benefit that null hypothesis and equivalence tests showed to be comparable in magnitude. Accordingly, we provide a first demonstration that a single bout of SSE benefits EF; however, the condition's oscillatory CBF response does not impart a larger benefit than a time- and intensity-matched MCE protocol.
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Affiliation(s)
- Connor Dalton
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Joshua Ahn
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Gianna Jeyarajan
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Olave E Krigolson
- Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - Matthew Heath
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
- Canadian Centre for Activity and Aging, University of Western Ontario, London, ON, Canada
- Graduate Program in Neuroscience, University of Western Ontario, London, ON, Canada
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Bull Haaversen AC, Brekke LK, Kermani TA, Molberg Ø, Diamantopoulos AP. Extended ultrasound examination identifies more large vessel involvement in patients with giant cell arteritis. Rheumatology (Oxford) 2023; 62:1887-1894. [PMID: 35997556 DOI: 10.1093/rheumatology/keac478] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To compare limited with a more extended ultrasound examination (anteromedial ultrasound, A2-ultrasound) to detect large vessel (LV) involvement in patients with newly diagnosed GCA. METHODS Patients with new-onset GCA were included at the time of diagnosis. All patients were examined using limited ultrasound (ultrasound of the axillary artery as visualized in the axilla) and an extended A2-ultrasound method (which also includes the carotid, vertebral, subclavian and proximal axillary arteries), in addition to temporal artery ultrasound. RESULTS One hundred and thirty-three patients were included in the study. All patients fulfilled the criteria according to a proposed extension of the 1990 ACR classification criteria for GCA and had a positive ultrasound examination at diagnosis. Ninety-three of the 133 GCA patients (69.9%) had LV involvement when examined by extended A2-ultrasound, compared with only 56 patients (42.1%) by limited ultrasound (P < 0.001). Twelve patients (9.0%) had vasculitis of the vertebral arteries as the only LVs involved. Five patients (3.8%) would have been missed as having GCA if only limited ultrasound was performed. Forty patients (30.0%) had isolated cranial GCA, 21 patients (15.8%) had isolated large vessel GCA and 72 patients (54.1%) had mixed-GCA. CONCLUSION Extended A2-ultrasound examination identified more patients with LV involvement than the limited ultrasound method. However, extended A2-ultrasound requires high expertise and high-end equipment and should be performed by ultrasonographers with adequate training.
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Affiliation(s)
| | - Lene Kristin Brekke
- Department of Rheumatology, Hospital for Rheumatic Diseases, Haugesund, Norway
| | - Tanaz A Kermani
- Department of Rheumatology, University of California, Los Angeles, CA, USA
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9
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Cerebral blood flow and immediate and sustained executive function benefits following single bouts of passive and active exercise. Brain Cogn 2023; 166:105953. [PMID: 36702069 DOI: 10.1016/j.bandc.2023.105953] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 01/26/2023]
Abstract
Passive exercise occurs when an individual's limbs are moved via an external force and is a modality that increases cerebral blood flow (CBF) and provides an immediate postexercise executive function (EF) benefit. To our knowledge, no work has examined for how long passive exercise benefits EF. Here, healthy young adults (N = 22; 7 female) used a cycle ergometer to complete three 20-min conditions: passive exercise (via mechanically driven flywheel), a traditional light intensity (37 W) "active" exercise condition (i.e., via volitional pedalling) and a non-exercise control condition. An estimate of CBF was obtained via transcranial Doppler ultrasound measurement of middle cerebral artery blood velocity (MCAv) and antisaccades (i.e., saccade mirror-symmetrical to a target) were completed prior to and immediately, 30- and 60-min following each condition to assess EF. Passive and active exercise increased MCAv; however, the increase was larger in the latter condition. In terms of antisaccades, passive and active exercise provided an immediate postexercise reaction time benefit. At the 30-min assessment, the benefit was observed for active but not passive exercise and neither produced a benefit at the 60-min assessment. Thus, passive exercise provided an evanescent EF "boost" and is a finding that may reflect a smaller cortical hemodynamic response.
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10
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Schmidt WA. Vascular ultrasound in rheumatology practice. Best Pract Res Clin Rheumatol 2023; 37:101847. [PMID: 37419758 DOI: 10.1016/j.berh.2023.101847] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Abstract
Rheumatologists are increasingly using vascular ultrasound. Several guidelines now recommend ultrasound as the first diagnostic modality in giant cell arteritis (GCA). The German curriculum for rheumatology training has recently included ultrasound for the acute diagnosis of vasculitis. Recent studies have shown that ultrasound of temporal, axillary, subclavian, and vertebral arteries has sensitivities and specificities of >90%. Vascular ultrasound detects subclinical GCA in approximately 20% of patients with "pure" polymyalgia rheumatica. GCA fast-track clinics might regularly include these patients. A new score based on the intima-media thickness of the temporal and axillary arteries allows the monitoring of structural changes with treatment. The score decreases faster for the temporal arteries than it does for the axillary arteries. Measuring the diameter of the ascending aorta and the aortic arch might become a fast and cost-effective tool for the long-term monitoring of aortic aneurysms in extracranial GCA. Vascular ultrasound also has a role for Takayasu arteritis, thrombosis, Behçet's syndrome, and Raynaud's phenomenon.
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Affiliation(s)
- Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Lindenberger Weg 19, 13125 Berlin, Germany.
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11
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Shen G, Sanchez K, Hu S, Zhao Z, Zhang L, Ma Q. 3D doppler ultrasound imaging of cerebral blood flow for assessment of neonatal hypoxic-ischemic brain injury in mice. PLoS One 2023; 18:e0285434. [PMID: 37159455 PMCID: PMC10168578 DOI: 10.1371/journal.pone.0285434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/21/2023] [Indexed: 05/11/2023] Open
Abstract
Cerebral blood flow (CBF) acutely reduces in neonatal hypoxic-ischemic encephalopathy (HIE). Clinic studies have reported that severe CBF impairment can predict HIE outcomes in neonates. Herein, the present study uses a non-invasive 3D ultrasound imaging approach to evaluate the changes of CBF after HI insult, and explores the correlation between CBF alterations and HI-induced brain infarct in mouse pups. The neonatal HI brain injury was induced in postnatal day 7 mouse pups using the Rice-Vannucci model. Non-invasive 3D ultrasound imaging was conducted to image CBF changes with multiple frequencies on mouse pups before common carotid artery (CCA) ligation, immediately after ligation, and 0 or 24 hours after HI. Vascularity ratio of the ipsilateral hemisphere was acutely reduced after unilateral ligation of the CCA alone or in combination with hypoxia, and partially restored at 24 hours after HI. Moreover, regression analysis showed that the vascularity ratio of ipsilateral hemisphere was moderately correlated with brain infarct size 24 hours after HI, indicating that CBF reduction contributes to of HI brain injury. To further verify the association between CBF and HI-induced brain injury, a neuropeptide C-type natriuretic peptide (CNP) or PBS was intranasally administrated to the brain of mouse pups one hour after HI insult. Brain infarction, CBF imaging and long-term neurobehavioral tests were conducted. The result showed that intranasal administration of CNP preserved ipsilateral CBF, reduced the infarct size, and improved neurological function after HI brain injury. Our findings suggest that CBF alteration is an indicator for neonatal HI brain injury, and 3D ultrasound imaging is a useful non-invasive approach for assessment of HI brain injury in mouse model.
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Affiliation(s)
- Guofang Shen
- Department of Basic Sciences, The Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, United States of America
- Department of Hematologic Malignancies Translational Science, Beckman Research Institute of City of Hope, Duarte, CA, United States of America
| | - Kayla Sanchez
- Department of Basic Sciences, The Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, United States of America
| | - Shirley Hu
- Department of Basic Sciences, The Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, United States of America
| | - Zhen Zhao
- Zilkha Neurogenetic Institute and Department of Physiology and Neuroscience, Center for Neurodegeneration and Regeneration, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Lubo Zhang
- Department of Basic Sciences, The Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, United States of America
| | - Qingyi Ma
- Department of Basic Sciences, The Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, United States of America
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12
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Frijlingh M, Juffermans L, de Leeuw R, de Bruyn C, Timmerman D, Van den Bosch T, Huirne JAF. How to use power Doppler ultrasound in transvaginal assessment of uterine fibroids. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:277-283. [PMID: 35195311 PMCID: PMC9543636 DOI: 10.1002/uog.24879] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/29/2021] [Indexed: 06/01/2023]
Abstract
Measuring vascularization in uterine fibroids is important for their diagnosis, treatment and prognosis. Vascularization can be measured by power Doppler ultrasound. The power Doppler signal depends on fibroid characteristics and on a variety of ultrasound-machine settings. Literature describing which machine settings influence the power Doppler signal is limited. Each manufacturer names settings and presets at their own discretion, with little information available publicly. Consistency of machine settings is important for correct interpretation of images in daily practice and is essential in yielding reproducible data for research. The aims of this paper, drawing from both a literature search and semistructured interviews with ultrasound-machine engineers and clinical experts in gynecological ultrasound, were: (1) to provide comprehensive background information on ultrasound physics and fibroid characteristics; (2) to present an overview of machine settings relevant to both two- and three-dimensional power Doppler, including power Doppler frequency, pulse repetition frequency, gain, wall-motion filter, acoustic power, persistence and signal rise; and (3) to provide a step-by-step tutorial on the optimal settings for vascular evaluation of uterine fibroids using power Doppler. The step-by-step tutorial comprises six steps to optimize the power Doppler signal, create a preset and acquire a reliable three-dimensional volume. This step-by-step tutorial should help research groups and clinicians to use power Doppler correctly and reproducibly in the evaluation of uterine fibroids. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M. Frijlingh
- Department of Obstetrics and GynaecologyAmsterdam UMC, AmsterdamThe Netherlands
- Amsterdam Reproduction and DevelopmentAmsterdamThe Netherlands
| | - L. Juffermans
- Department of Obstetrics and GynaecologyAmsterdam UMC, AmsterdamThe Netherlands
- Amsterdam Reproduction and DevelopmentAmsterdamThe Netherlands
| | - R. de Leeuw
- Department of Obstetrics and GynaecologyAmsterdam UMC, AmsterdamThe Netherlands
- Amsterdam Reproduction and DevelopmentAmsterdamThe Netherlands
| | - C. de Bruyn
- Department of Obstetrics and GynaecologyUniversity Hospital AntwerpEdegemBelgium
- Department of Oncology, Laboratory of Tumor Immunology and ImmunotherapyImmunOvar Research GroupKU Leuven, LeuvenBelgium
| | - D. Timmerman
- Department of Obstetrics and GynaecologyUniversity Hospital LeuvenLeuvenBelgium
- Department of Development and RegenerationKU Leuven, LeuvenBelgium
| | - T. Van den Bosch
- Department of Obstetrics and GynaecologyUniversity Hospital LeuvenLeuvenBelgium
- Department of Development and RegenerationKU Leuven, LeuvenBelgium
| | - J. A. F. Huirne
- Department of Obstetrics and GynaecologyAmsterdam UMC, AmsterdamThe Netherlands
- Amsterdam Reproduction and DevelopmentAmsterdamThe Netherlands
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13
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Manzo C, Milchert M, Venditti C, Castagna A, Nune A, Natale M, Brzosko M. Fever Correlation with Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) Concentrations in Patients with Isolated Polymyalgia Rheumatica (PMR): A Retrospective Comparison Study between Hospital and Out-of-Hospital Local Registries. Life (Basel) 2022; 12:life12070985. [PMID: 35888074 PMCID: PMC9317449 DOI: 10.3390/life12070985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Polymyalgia rheumatica (PMR) is the most common systemic inflammatory rheumatic disease affecting the elderly. Giant cell arteritis (GCA) is a granulomatous vasculitis affecting the aorta and its branches associated with PMR in up to 20% of cases. In recent studies based on university hospital registries, fever correlated with the erythrocyte sedimentation rate (ESR) but not with C-reactive protein (CRP) concentrations at the time of diagnosis in patients with isolated PMR. A long delay to a PMR diagnosis was suggested to explain this discrepancy, possibly caused by laboratory alterations (for instance, anemia of chronic disease type) that can influence only ESR. We performed a retrospective comparison study between the university hospital and two out-of-hospital public ambulatory databases, searching for any differences in fever/low-grade fever correlation with ESR and CRP. Methods: We identified all patients with newly diagnosed PMR between 2013 and 2020, only including patients who had a body temperature (BT) measurement at the time of diagnosis and a follow-up of at least two years. We considered BT as normal at <37.2 °C. Routine diagnostic tests for differential diagnostics were performed at the time of diagnosis and during follow-ups, indicating the need for more in-depth investigations if required. The GCA was excluded based on the presence of suggestive signs or symptoms and routine ultrasound examination of temporal, axillary, subclavian, and carotid arteries by experienced ultrasonographers. Patients with malignancies, chronic renal disease, bacterial infections, and body mass index (BMI) > 30 kg/m2 were excluded, as these conditions can increase CRP and/or ESR. Finally, we used the Cumulative Illness Rating Scale (CIRS) for quantifying the burden of comorbidities and excluded patients with a CIRS index > 4 as an additional interfering factor. Results: We evaluated data from 169 (73 from hospital and 96 from territorial registries) patients with newly diagnosed isolated PMR. Among these, 77.7% were female, and 61.5% of patients had normal BT at the time of diagnosis. We divided the 169 patients into two cohorts (hospital and territorial) according to the first diagnostic referral. Age at diagnosis, ESR, CRP, median hemoglobin (HB), and diagnostic delay (days from first manifestations to final diagnosis) were statistically significantly different between the two cohorts. However, when we assessed these data according to BT in the territorial cohort, we found a statistical difference only between ESR and BT (46.39 ± 19.31 vs. 57.50 ± 28.16; p = 0.026). Conclusions: ESR but not CRP correlates with fever/low-grade fever at the time of diagnosis in PMR patients with a short diagnosis delay regardless of HB levels. ESR was the only variable having a statistically significant correlation with BT in a multilevel regression analysis adjusted for cohorts (β = 0.312; p = 0.014).
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Affiliation(s)
- Ciro Manzo
- Rheumatologic Outpatient Ambulatory, Health District No. 59, Azienda Sanitaria Locale Napoli 3 Sud, 80065 Naples, Italy;
- Correspondence:
| | - Marcin Milchert
- Katedra Reumatologii i Chorób Wewnętrznych, Klinika Chorób Wewnętrznych Reumatologii Diabetologii Geriatrii i Immunologii Klinicznej PUM, 71-457 Szczecin, Poland; (M.M.); (M.B.)
| | - Carlo Venditti
- Rheumatologic Outpatient Clinic Health District Campobasso, Via Ugo Petrella 1, 86100 Campobasso, Italy;
| | - Alberto Castagna
- Primary Care Department, Azienda Sanitaria Provinciale Catanzaro, 88068 Soverato, Italy;
| | - Arvind Nune
- Department of Rheumatology, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN, UK;
| | - Maria Natale
- Rheumatologic Outpatient Ambulatory, Health District No. 59, Azienda Sanitaria Locale Napoli 3 Sud, 80065 Naples, Italy;
| | - Marek Brzosko
- Katedra Reumatologii i Chorób Wewnętrznych, Klinika Chorób Wewnętrznych Reumatologii Diabetologii Geriatrii i Immunologii Klinicznej PUM, 71-457 Szczecin, Poland; (M.M.); (M.B.)
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14
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Sun Y, Vixege F, Faraz K, Mendez S, Nicoud F, Garcia D, Bernard O. A Pipeline for the Generation of Synthetic Cardiac Color Doppler. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:932-941. [PMID: 34986095 DOI: 10.1109/tuffc.2021.3136620] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Color Doppler imaging (CDI) is the modality of choice for simultaneous visualization of myocardium and intracavitary flow over a wide scan area. This visualization modality is subject to several sources of error, the main ones being aliasing and clutter. Mitigation of these artifacts is a major concern for better analysis of intracardiac flow. One option to address these issues is through simulations. In this article, we present a numerical framework for generating clinical-like CDI. Synthetic blood vector fields were obtained from a patient-specific computational fluid dynamics CFD model. Realistic texture and clutter artifacts were simulated from real clinical ultrasound cineloops. We simulated several scenarios highlighting the effects of 1) flow acceleration; 2) wall clutter; and 3) transmit wavefronts, on Doppler velocities. As a comparison, an "ideal" color Doppler was also simulated, without these harmful effects. This synthetic dataset is made publicly available and can be used to evaluate the quality of Doppler estimation techniques. Besides, this approach can be seen as a first step toward the generation of comprehensive datasets for training neural networks to improve the quality of Doppler imaging.
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15
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Nguyen TQ, Bechsgaard T, Schmidt MR, Juul K, Moshavegh R, Lönn L, Nielsen MB, Jensen JA, Hansen KL. Transthoracic Vector Flow Imaging in Pediatric Patients with Valvular Stenosis - A Proof of Concept Study. Ultrasound Int Open 2021; 7:E48-E54. [PMID: 34804771 PMCID: PMC8598391 DOI: 10.1055/a-1652-1261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 09/05/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose
Continuous wave Doppler ultrasound is routinely used to detect
cardiac valve stenoses. Vector flow imaging (VFI) is an angle-independent
real-time ultrasound method that can quantify flow complexity. We aimed to
evaluate if quantification of flow complexity could reliably assess valvular
stenosis in pediatric patients.
Materials and Methods
Nine pediatric patients with echocardiographically
confirmed valvular stenosis were included in the study. VFI and Doppler
measurements were compared with transvalvular peak-to-peak pressure differences
derived from invasive endovascular catheterization.
Results
Vector concentration correlated with the catheter measurements
before intervention after exclusion of one outlier (r=−0.83,
p=0.01), whereas the Doppler method did not (r=0.49,
p=0.22). The change in vector concentration after intervention
correlated strongly with the change in the measured catheter pressure difference
(r=−0.86, p=0.003), while Doppler showed a tendency for
a moderate correlation (r=0.63, p=0.07).
Conclusion
Transthoracic flow complexity quantification calculated from
VFI data is feasible and may be useful for assessing valvular stenosis severity
in pediatric patients.
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Affiliation(s)
- Tin-Quoc Nguyen
- Department of Diagnostic Radiology, Rigshospitalet Diagnostisk Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Thor Bechsgaard
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | | | - Klaus Juul
- Department of Pediatric Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Lars Lönn
- Department of Diagnostic Radiology, Rigshospitalet Diagnostisk Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Rigshospitalet Diagnostisk Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Rigshospitalet Diagnostisk Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
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16
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Tari B, Shirzad M, Behboodpour N, Belfry GR, Heath M. Exercise intensity-specific changes to cerebral blood velocity do not modulate a postexercise executive function benefit. Neuropsychologia 2021; 161:108018. [PMID: 34487738 DOI: 10.1016/j.neuropsychologia.2021.108018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 12/20/2022]
Abstract
Executive function is transiently improved (i.e., <60-min) following a single bout of aerobic exercise. A candidate mechanism for this improvement is an exercise-mediated increase in cerebral blood flow (CBF). Further, it has been proposed that an increase in CBF across the continuum of increasing exercise intensities improves the magnitude of a postexercise executive function benefit (i.e., drive theory); however, this proposal has not been empirically tested. Here, participants completed four experimental sessions: a V̇O2peak test to determine cardiorespiratory fitness and estimated lactate threshold (LT), followed by separate 10-min sessions of light- (i.e., 25 W), moderate- (i.e., 80% estimated LT), and heavy-intensity (i.e., 15% of the difference between LT and V̇O2peak) aerobic exercise. An estimate of CBF during exercise was achieved via transcranial Doppler ultrasound and near-infrared spectroscopy to quantify blood velocity (BV) through the middle cerebral artery and deoxygenated hemoglobin (HHb), respectively. Executive function was assessed before and after each session via the executive-mediated antisaccade task (i.e., saccade mirror-symmetrical to a target). Results demonstrated that BV increased in relation to increasing exercise intensity, whereas HHb decreased by a comparable magnitude independent of intensity. In terms of executive function, null hypothesis and equivalence tests indicated a comparable magnitude postexercise reduction in antisaccade reaction time across exercise intensities. Accordingly, the magnitude of CBF change during exercise does not impact the magnitude of a postexercise executive function benefit.
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Affiliation(s)
- Benjamin Tari
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Mustafa Shirzad
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Nikan Behboodpour
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Glen R Belfry
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada; Canadian Centre for Activity and Aging, University of Western Ontario, 1201 Western Rd, London, ON, N6G 1H1, Canada
| | - Matthew Heath
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada; Canadian Centre for Activity and Aging, University of Western Ontario, 1201 Western Rd, London, ON, N6G 1H1, Canada; Graduate Program in Neuroscience, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada.
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17
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Tari B, Shirzad M, Badcock NA, Belfry GR, Heath M. 'Delaying' a saccade: Preparatory phase cortical hemodynamics evince the neural cost of response inhibition. Brain Cogn 2021; 154:105808. [PMID: 34634572 DOI: 10.1016/j.bandc.2021.105808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/12/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022]
Abstract
Minimally delayed (MD) saccades require inhibition of a prepotent response until a target is extinguished, and unlike the more extensively studied antisaccade task, do not require the additional cognitive component of vector inversion (i.e., 180° target spatial transposition). Here, participants completed separate blocks of MD and prepotent stimulus-driven saccades (i.e., respond at target onset) while cortical hemodynamics were measured via functional transcranial Doppler ultrasound. MD saccades produced longer and more variable reaction times (RT). In turn, MD and stimulus-driven saccade preparatory phase cortical hemodynamics increased and decreased, respectively, relative to baseline and the two conditions differed from one another throughout the preparatory phase. The longer RTs and increased cortical hemodynamics of MD saccades is taken to evince response complexity and the increased neural activity to accommodate response inhibition. To our knowledge, such findings provide the first work to examine the neural foundations of MD saccades.
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Affiliation(s)
- Benjamin Tari
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada
| | - Mustafa Shirzad
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada
| | - Nicholas A Badcock
- School of Psychological Science, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia
| | - Glen R Belfry
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada; Canadian Centre for Activity and Aging, University of Western Ontario, 1201 Western Rd, London, ON N6G 1H1, Canada
| | - Matthew Heath
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada; Canadian Centre for Activity and Aging, University of Western Ontario, 1201 Western Rd, London, ON N6G 1H1, Canada; Graduate Program in Neuroscience, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada.
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18
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Chrysidis S, Terslev L, Christensen R, Fredberg U, Larsen K, Lorenzen T, Døhn UM, Diamantopoulos AP. Vascular ultrasound for the diagnosis of giant cell arteritis: a reliability and agreement study based on a standardised training programme. RMD Open 2021; 6:rmdopen-2020-001337. [PMID: 32978303 PMCID: PMC7539855 DOI: 10.1136/rmdopen-2020-001337] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/29/2020] [Accepted: 09/05/2020] [Indexed: 12/17/2022] Open
Abstract
Objective To evaluate the impact of a standardised training programme including equipment adjustment for experienced musculoskeletal ultrasonographers without previous experience in vascular ultrasound (US) on the reliability of US in the diagnosis of giant cell arteritis (GCA). Methods In this prospective, non-interventional observational cohort study, patients suspected of GCA were evaluated by US by one of five rheumatologists with long-standing experience in musculoskeletal US (>8 years), trained using a standardised training programme including equipment adjustment. Images of cranial and large vessels were subsequently evaluated first by the performing ultrasonographer and thereafter by a blinded external expert (gold standard). Results In three Danish centres, 112 patients suspected of GCA were included. According to the external expert, vasculitis changes were seen in 66 patients, in 45 of them with only cranial involvement, in 14 with both cranial and large vessel involvement, while in seven patients isolated large vessel vasculitis was found. The reliability was excellent between the local ultrasonographer and the US expert for the overall GCA diagnosis regarding the diagnosis of cranial and for large vessel GCA, with an interobserver agreement of 95–96%, mean kappa values of 0.88–0.92 (95% CI 0.78 to 0.99). Excellent reliability (mean kappa 0.86–1.00) was also found for the US examination of the individual arteries (temporal, facial, common carotid and axillary). Conclusion The US training programme resulted in excellent agreement between trainees and an expert in patients suspected of GCA and may thus be applicable for implementation of vascular US in clinical practice.
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Affiliation(s)
- Stavros Chrysidis
- Department of Rheumatology, Southwest Jutland Hospital Esbjerg, Esbjerg, Denmark .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, Frederiksberg Hospital Parker Institute, Frederiksberg, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ulrich Fredberg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Knud Larsen
- Department of Ear Nose and Throat , Southwest Jutland Hospital Esbjerg, Esbjerg, Denmark
| | - Tove Lorenzen
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Uffe Møller Døhn
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
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19
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Andel PM, Chrysidis S, Geiger J, Haaversen A, Haugeberg G, Myklebust G, Nielsen BD, Diamantopoulos A. Diagnosing Giant Cell Arteritis: A Comprehensive Practical Guide for the Practicing Rheumatologist. Rheumatology (Oxford) 2021; 60:4958-4971. [PMID: 34255830 DOI: 10.1093/rheumatology/keab547] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/14/2021] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
Giant cell arteritis (GCA) is the most common large vessel vasculitis in the elderly population. In recent years, advanced imaging has changed the way GCA can be diagnosed in many locations. The GCA fast-track clinic (FTC) approach combined with ultrasound (US) examination allows prompt treatment and diagnosis with high certainty. FTCs have been shown to improve prognosis while being cost effective. However, all diagnostic modalities are highly operator dependent, and in many locations expertise in advanced imaging may not be available. In this paper, we review the current evidence on GCA diagnostics and propose a simple algorithm for diagnosing GCA for use by rheumatologists not working in specialist centres.
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Affiliation(s)
- Peter M Andel
- Department of Cardiology, Østfold Hospital Trust, Grålum, Norway.,Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway
| | - Stavros Chrysidis
- Department of Rheumatology, Southwest Jutland Hospital Esbjerg, Esbjerg, Denmark
| | - Julia Geiger
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland
| | - Anne Haaversen
- Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway
| | - Glenn Haugeberg
- Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geirmund Myklebust
- Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway
| | - Berit D Nielsen
- Department of Medicine, The Regional Hospital in Horsens, Horsens, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andreas Diamantopoulos
- Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway.,Division of Medicine, Department of Rheumatology, Akershus University Hospital, Oslo, Norway
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20
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21
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Nahas H, Au JS, Ishii T, Yiu BYS, Chee AJY, Yu ACH. A Deep Learning Approach to Resolve Aliasing Artifacts in Ultrasound Color Flow Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:2615-2628. [PMID: 32746180 DOI: 10.1109/tuffc.2020.3001523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite being used clinically as a noninvasive flow visualization tool, color flow imaging (CFI) is known to be prone to aliasing artifacts that arise due to fast blood flow beyond the detectable limit. From a visualization standpoint, these aliasing artifacts obscure proper interpretation of flow patterns in the image view. Current solutions for resolving aliasing artifacts are typically not robust against issues such as double aliasing. In this article, we present a new dealiasing technique based on deep learning principles to resolve CFI aliasing artifacts that arise from single- and double-aliasing scenarios. It works by first using two convolutional neural networks (CNNs) to identify and segment CFI pixel positions with aliasing artifacts, and then it performs phase unwrapping at these aliased pixel positions. The CNN for aliasing identification was devised as a U-net architecture, and it was trained with in vivo CFI frames acquired from the femoral bifurcation that had known presence of single- and double-aliasing artifacts. Results show that the segmentation of aliased CFI pixels was achieved successfully with intersection over union approaching 90%. After resolving these artifacts, the dealiased CFI frames consistently rendered the femoral bifurcation's triphasic flow dynamics over a cardiac cycle. For dealiased CFI pixels, their root-mean-squared difference was 2.51% or less compared with manual dealiasing. Overall, the proposed dealiasing framework can extend the maximum flow detection limit by fivefold, thereby improving CFI's flow visualization performance.
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22
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Yip A, Jernberg ET, Bardi M, Geiger J, Lohne F, Schmidt WA, Myklebust G, Diamantopoulos AP. Magnetic resonance imaging compared to ultrasonography in giant cell arteritis: a cross-sectional study. Arthritis Res Ther 2020; 22:247. [PMID: 33076985 PMCID: PMC7574248 DOI: 10.1186/s13075-020-02335-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/01/2020] [Indexed: 01/18/2023] Open
Abstract
Background There has been a shift in recent years to using ultrasound (US) and magnetic resonance imaging (MRI) as first-line investigations for suspected cranial large vessel vasculitis (LVV) and is a new recommendation by the EULAR 2018 guidelines for imaging in LVV. This cross-sectional study compares the performance of US and MRI and contrast-enhanced magnetic resonance angiography (MRA) for detecting vasculitis in patients with giant cell arteritis (GCA). Methods Patients with new-onset or already diagnosed GCA were recruited. The common temporal arteries and supra-aortic large vessels were evaluated by US and MRI/MRA. Blinded experts read the images and applied a dichotomous score (vasculitis: yes/no) in each vessel. Results Thirty-seven patients with giant cell arteritis (GCA) were recruited. Two patients were excluded. Of the remaining patients, nine had new-onset disease and 26 had established disease. Mean age was 71 years, and median C-reactive protein (CRP) was 7.5 mg/L. The median time between US and MRI was 1 day. Overall, US revealed vasculitic changes more frequently than MRI (p < 0.001). US detected vascular changes in 37% of vessels compared to 21% with MRI. Among patients with chronic disease, US detected vascular changes in 23% of vessels compared to 7% with MRI in (p < 0.001). The same was true for patients with new-onset disease. US detected vasculitic changes in 22% of vessels and MRI detected disease in 6% (p = 0.0004). Compared to contrast-enhanced MRA, US was more sensitive in detecting vasculitic changes in the large arteries, including the axillary, carotid, and subclavian arteries. Conclusion US more frequently detects vasculitic changes in the large arteries compared to contrast-enhanced MRA. When evaluating the cranial vessels, US performs similarly to MRI. This data supports the recommendation that US be considered as a first-line evaluation in patients suspected to have GCA.
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Affiliation(s)
- Ashley Yip
- University of British Columbia, Vancouver, BC, Canada
| | | | | | - Julia Geiger
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland
| | - Frode Lohne
- Department of Radiology, Hospital of Southern Norway Trust Kristiansand, Kristiansand, Norway
| | | | - Geirmund Myklebust
- Department of Rheumatology, Hospital of Southern Norway Trust Kristiansand, Kristiansand, Norway
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Nguyen TQ, Traberg MS, Olesen JB, Heerwagen ST, Brandt AH, Bechsgaard T, Pedersen BL, Moshavegh R, Lönn L, Jensen JA, Nielsen MB, Hansen KL. Flow Complexity Estimation in Dysfunctional Arteriovenous Dialysis Fistulas using Vector Flow Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2493-2504. [PMID: 32595057 DOI: 10.1016/j.ultrasmedbio.2020.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 05/25/2020] [Accepted: 05/31/2020] [Indexed: 06/11/2023]
Abstract
Non-invasive assessment is preferred for monitoring arteriovenous dialysis fistulas (AVFs). Vector concentration assesses flow complexity, which may correlate with stenosis severity. We determined whether vector concentration could assess stenosis severity in dysfunctional AVFs. Vector concentration was estimated in four stenotic phantoms at different pulse repetition frequencies. Spectral Doppler peak velocity and vector concentration were measured in 12 patients with dysfunctional AVFs. Additionally, 5 patients underwent digital subtraction angiography (DSA). In phantoms, vector concentration exhibited an inverse relationship with stenosis severity and was less affected by aliasing in severe stenoses. In nine stenoses of 5 patients undergoing DSA, vector concentration correlated strongly with stenosis severity (first stenosis: r = -0.73, p = 0.04; other stenoses; r = -0.69, p = 0.02) and mid-stenotic diameter (first stenosis: r = 0.87, p = 0.006; other stenoses: r = 0.70, p = 0.02) as opposed to peak velocities (p > 0.05). Vector concentration is less affected by aliasing in severe stenoses and correlates with DSA in patients with dysfunctional AVF.
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Affiliation(s)
- Tin-Quoc Nguyen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Marie Sand Traberg
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Jacob Bjerring Olesen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark; BK Medical, Herlev, Denmark
| | | | | | - Thor Bechsgaard
- Department of Radiology, Odense University Hospital, Odense C, Denmark
| | | | - Ramin Moshavegh
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark; BK Medical, Herlev, Denmark
| | - Lars Lönn
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Tari B, Vanhie JJ, Belfry GR, Shoemaker JK, Heath M. Increased cerebral blood flow supports a single-bout postexercise benefit to executive function: evidence from hypercapnia. J Neurophysiol 2020; 124:930-940. [PMID: 32755360 DOI: 10.1152/jn.00240.2020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A single bout of aerobic exercise improves executive function; however, the mechanism for the improvement remains unclear. One proposal asserts that an exercise-mediated increase in cerebral blood flow (CBF) enhances the efficiency of executive-related cortical structures. To examine this, participants completed separate 10-min sessions of moderate- to heavy-intensity aerobic exercise, a hypercapnic environment (i.e., 5% CO2), and a nonexercise and nonhypercapnic control condition. The hypercapnic condition was included because it produces an increase in CBF independent of metabolic demands. An estimate of CBF was achieved via transcranial Doppler ultrasound and near-infrared spectroscopy that provided measures of middle cerebral artery blood velocity (BV) and deoxygenated hemoglobin (HHb), respectively. Exercise intensity was adjusted to match participant-specific changes in BV and HHb associated with the hypercapnic condition. Executive function was assessed before and after each session via antisaccades (i.e., saccade mirror-symmetrical to a target) because the task is mediated via the same executive networks that demonstrate task-dependent modulation following single and chronic bouts of aerobic exercise. Results showed that hypercapnic and exercise conditions were associated with comparable BV and HHb changes, whereas the control condition did not produce a change in either metric. In terms of antisaccade performance, the exercise and hypercapnic, but not control, conditions demonstrated improved postcondition reaction times (RT), and the magnitude of the hypercapnic and exercise-based increase in estimated CBF was reliably related to the postcondition improvement in RT. Accordingly, results evince that an increase in CBF represents a candidate mechanism for a postexercise improvement in executive function.NEW & NOTEWORTHY Single-bout aerobic exercise "boosts" executive function, and increased cerebral blood flow (CBF) has been proposed as a mechanism for the benefit. In this study, participants completed 10 min of aerobic exercise and 10 min of inhaling a hypercapnic gas, a manipulation known to increase CBF independently of metabolic demands. Both exercise and hypercapnic conditions improved executive function for at least 20 min. Accordingly, an increase in CBF is a candidate mechanism for the postexercise improvement in executive function.
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Affiliation(s)
- Benjamin Tari
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - James J Vanhie
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - Glen R Belfry
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - J Kevin Shoemaker
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - Matthew Heath
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
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26
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Shmelev A, Darwazeh G, Ganti A, Hosseini M, Beneat A, Wilkerson D, Wilkerson S, Zatina M. Are systolic velocity duplex metrics negatively affected by flow aliasing in areas of critical internal carotid artery stenosis. J Community Hosp Intern Med Perspect 2020; 9:460-463. [PMID: 32002149 PMCID: PMC6968504 DOI: 10.1080/20009666.2019.1694386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/03/2019] [Indexed: 10/28/2022] Open
Abstract
Purpose: Duplex scanning is a useful noninvasive screening tool for the detection of carotid bifurcation disease. Internal carotid artery (ICA) peak systolic velocity (PSV) and ICA/common carotid artery (CCA) PSV ratios are proven metrics determining 70%-99% ICA stenosis. A potential disadvantage of using dramatically increasing systolic velocity measurements in areas of critical arterial stenosis is flow aliasing. Diastolic velocity should be less influenced by this flow artifact. We evaluate ICA and CCA end diastolic velocity (EDV) metrics in predicting severe ICA stenosis and document the prevalence of an aliasing artifact in a population of patients with critical ICA stenosis. Methods: Consecutive patients undergoing carotid duplex assessments and contrast angiography were compared (n = 140). ICA and CCA PSV and EDV were recorded as was evidence of the flow aliasing of ICA waveforms. ICA/CCA PSV and EDV ratios were calculated. Duplex parameters were compared with angiographic ICA measurements. Receiver-operator characteristic curve (ROC) analysis was used to determine optimal criteria to identify ICA stenosis of 70% to 99%. Results: Of 256 carotid bifurcation duplex studies, critical angiographic stenosis was present in 105 arteries. Only four completed arterial duplex scans demonstrated flow aliasing. In three of these patients, systolic metrics were non-diagnostic versus ICA/CCA EDV ratios. An ICA/CCA EDV ratio of 2.3 provided the best combination of sensitivity 73.8% and specificity 75.18%. Conclusion: ICA/CCA diastolic ratios reliably determine 70% or greater ICA stenosis. Flow aliasing infrequently complicates ICA PSV.
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Affiliation(s)
- Artem Shmelev
- Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA
| | - Ghaleb Darwazeh
- Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA
| | - Avinash Ganti
- Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA
| | | | - Amanda Beneat
- Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA
| | | | | | - Michael Zatina
- Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA
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Brkic A, Terslev L, Møller Døhn U, Torp‐Pedersen S, Schmidt WA, Diamantopoulos AP. Clinical Applicability of Ultrasound in Systemic Large Vessel Vasculitides. Arthritis Rheumatol 2019; 71:1780-1787. [DOI: 10.1002/art.41039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 07/09/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Alen Brkic
- Stavanger University Hospital Stavanger Norway
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28
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Revzin MV, Imanzadeh A, Menias C, Pourjabbar S, Mustafa A, Nezami N, Spektor M, Pellerito JS. Optimizing Image Quality When Evaluating Blood Flow at Doppler US: A Tutorial. Radiographics 2019; 39:1501-1523. [PMID: 31398088 DOI: 10.1148/rg.2019180055] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Doppler US is an essential component of nearly all diagnostic US procedures. In this era of increased awareness of the effects of ionizing radiation and the side effects of iodine- and gadolinium-based contrast agents, Doppler US is poised to play an even bigger role in medical imaging. It is safe, cost-effective, portable, and highly accurate when performed by an experienced operator. The sensitivities and specificities of Doppler US for detecting blood flow and determining the direction and velocity of blood flow in various organs and vascular systems have increased dramatically in the past decade. With use of advanced flow techniques that are available for use with most modern equipment, US can provide vascular information that is comparable to or even more accurate than that obtained with other cross-sectional and interventional modalities. However, there remains concern that US (including newer more advanced flow-evaluating techniques) will not be used to its full potential owing to dependence on operator skill and expertise. Thorough understanding of image optimization techniques and expanded knowledge of the physical principles, instrumentation, application, advantages, and limitations of this modality are of utmost importance. The authors provide a simple practical guide for optimizing images for vascular flow detection by reviewing various cases and focusing on the parameters that should be optimized. Online supplemental material is available for this article. ©RSNA, 2019 See discussion on this article by Pellerito.
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Affiliation(s)
- Margarita V Revzin
- From the Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.I., S.P., A.M., N.N., M.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.M.); and Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.)
| | - Amir Imanzadeh
- From the Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.I., S.P., A.M., N.N., M.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.M.); and Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.)
| | - Christine Menias
- From the Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.I., S.P., A.M., N.N., M.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.M.); and Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.)
| | - Sarvenaz Pourjabbar
- From the Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.I., S.P., A.M., N.N., M.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.M.); and Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.)
| | - Adel Mustafa
- From the Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.I., S.P., A.M., N.N., M.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.M.); and Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.)
| | - Nariman Nezami
- From the Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.I., S.P., A.M., N.N., M.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.M.); and Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.)
| | - Michael Spektor
- From the Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.I., S.P., A.M., N.N., M.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.M.); and Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.)
| | - John S Pellerito
- From the Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.I., S.P., A.M., N.N., M.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.M.); and Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.)
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Abstract
Despite our understanding that the microvasculature plays a multifaceted role in the development and progression of various conditions, we know little about the extent of this involvement. A need exists for non-invasive, clinically meaningful imaging modalities capable of elucidating microvascular information to aid in our understanding of disease, and to aid in the diagnosis/monitoring of disease for more patient-specific care. In this review article, a number of imaging techniques are summarized that have been utilized to investigate the microvasculature of skin, along with their advantages, disadvantages and future perspectives in preclinical and clinical settings. These techniques include dermoscopy, capillaroscopy, Doppler sonography, laser Doppler flowmetry (LDF) and perfusion imaging, laser speckle contrast imaging (LSCI), optical coherence tomography (OCT), including its Doppler and dynamic variant and the more recently developed OCT angiography (OCTA), photoacoustic imaging, and spatial frequency domain imaging (SFDI). Attention is largely, but not exclusively, placed on optical imaging modalities that use intrinsic optical signals to contrast the microvasculature. We conclude that whilst each imaging modality has been successful in filling a particular niche, there is no one, all-encompassing modality without inherent flaws. Therefore, the future of cutaneous microvascular imaging may lie in utilizing a multi-modal approach that will counter the disadvantages of individual systems to synergistically augment our imaging capabilities.
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Affiliation(s)
- Anthony J Deegan
- Department of Bioengineering, University of Washington, 3720 15th Ave. NE., Seattle, WA 98195, United States of America
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Schmidt WA, Blockmans D. Investigations in systemic vasculitis - The role of imaging. Best Pract Res Clin Rheumatol 2018; 32:63-82. [PMID: 30526899 DOI: 10.1016/j.berh.2018.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/24/2018] [Accepted: 07/27/2018] [Indexed: 12/18/2022]
Abstract
Imaging plays an increasing role for confirming a suspected diagnosis of giant cell arteritis (GCA) or Takayasu arteritis (TAK). Ultrasound, magnetic resonance imaging (MRI), and computed tomography demonstrate a homogeneous, most commonly concentric, arterial wall thickening. 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) displays increased FDG uptake of inflamed artery walls delineating increased metabolism. Ultrasound and MRI are recommended to be the initial imaging modalities in cranial GCA and TAK, respectively. Extracranial disease can be confirmed by all four modalities, particularly by PET in case of inflammation of unknown origin. If the diagnosis remains uncertain, additional investigations including biopsy and/or additional imaging are recommended. Imaging should be performed by a trained specialist using appropriate operational procedures and settings with appropriate equipment. Further research is necessary on the role of imaging for disease monitoring. This review will discuss advantages and disadvantages of imaging modalities in the diagnosis of vasculitis.
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Affiliation(s)
- Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Lindenberger Weg 19, 13125, Berlin, Germany.
| | - Daniel Blockmans
- University Hospital Gasthuisberg, Herestraat 49, B3000, Leuven, Belgium.
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Visalli C, Cavallaro M, Concerto A, La Torre D, Di Salvo R, Mazziotti S, Salamone I. Ultrasonography of traumatic injuries to limb peripheral nerves: technical aspects and spectrum of features. Jpn J Radiol 2018; 36:592-602. [DOI: 10.1007/s11604-018-0765-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/07/2018] [Indexed: 12/16/2022]
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Quien MM, Saric M. Ultrasound imaging artifacts: How to recognize them and how to avoid them. Echocardiography 2018; 35:1388-1401. [PMID: 30079966 DOI: 10.1111/echo.14116] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/10/2018] [Indexed: 12/13/2022] Open
Abstract
Echocardiography has become a critical tool in clinical cardiology in evaluating cardiac physiology and diagnosing cardiac disease states. However, imaging artifacts are commonly encountered and often lead to misdiagnoses of life-threatening diseases, such as aortic dissection and ventricular thrombus. It is, thus, critical for clinicians to understand these artifacts to avoid these misdiagnoses and protect patients from undue intervention. Artifacts can be broken down into two categories: those from violation of ultrasound system assumptions and those from interference by external equipment and devices. This review article discusses the most commonly encountered artifacts by category, explains their physical mechanisms, elaborates on their most common presentations, and instructs clinicians on how to avoid their misinterpretation.
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Affiliation(s)
- Mary M Quien
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
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