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Kripfgans OD, Pinter SZ, McCracken BM, Colmenero Mahmood CI, Rajajee VK, Tiba H, Rubin JM. Measurement of Cerebral Metabolism Under Non-Chronic Hemodynamic Conditions. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:817-824. [PMID: 38429202 DOI: 10.1016/j.ultrasmedbio.2024.02.002] [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: 09/28/2023] [Revised: 01/16/2024] [Accepted: 02/04/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Blood flow to the brain is a critical physiological function and is useful to monitor in critical care settings. Despite that, a surrogate is most likely measured instead of actual blood flow. Such surrogates include velocity measurements in the carotid artery and systemic blood pressure, even though true blood flow can actually be obtained using MRI and other modalities. Ultrasound is regularly used to measure blood flow and is, under certain conditions, able to provide quantitative volumetric blood flow in milliliters per minute. Unfortunately, most times the resulting flow data is not valid due to unmet assumptions (such as flow profile and angle correction). Color flow, acquired in three dimensions, has been shown to yield quantitative blood flow without any assumptions (3DVF). METHODS Here we are testing whether color flow can perform during physiological conditions common to severe injury. Specifically, we are simulating severe traumatic brain injury (epidural hematoma) as well as hemorrhagic shock with 50% blood loss. Blood flow was measured in the carotid artery of a cohort of 7 Yorkshire mix pigs (40-60 kg) using 3DVF (4D16L, LOGIQ 9, GE HealthCare, Milwaukee, WI, USA) and compared to an invasive flow meter (TS420, Transonic Systems Inc., Ithaca, NY, USA). RESULTS Six distinct physiological conditions were achieved: baseline, hematoma, baseline 2, hemorrhagic shock, hemorrhagic shock plus hematoma, and post-hemorrhage resuscitation. Mean cerebral oxygen extraction ratio varied from 40.6% ± 13.0% of baseline to a peak of 68.4% ± 15.6% during hemorrhagic shock. On average 3DVF estimated blood flow with a bias of -9.6% (-14.3% root mean squared error) relative to the invasive flow meter. No significant flow estimation error was detected during phases of flow reversal, that was seen in the carotid artery during traumatic conditions. The invasive flow meter showed a median error of -11.5% to 39.7%. CONCLUSIONS Results suggest that absolute volumetric carotid blood flow to the brain can be obtained and potentially become a more specific biomarker related to cerebral hemodynamics than current surrogate markers.
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Affiliation(s)
| | - Stephen Z Pinter
- Department of Radiology, University of Michigan, Ann Arbor MI, USA
| | | | - Carmen I Colmenero Mahmood
- Department of Emergency Medicine, University of Michigan, Ann Arbor MI, USA; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor MI, USA
| | | | - Hakam Tiba
- Department of Emergency Medicine, University of Michigan, Ann Arbor MI, USA; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor MI, USA
| | - Jonathan M Rubin
- Department of Radiology, University of Michigan, Ann Arbor MI, USA
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Brasil S, Godoy DA, Videtta W, Rubiano AM, Solla D, Taccone FS, Robba C, Rasulo F, Aries M, Smielewski P, Meyfroidt G, Battaglini D, Hirzallah MI, Amorim R, Sampaio G, Moulin F, Deana C, Picetti E, Kolias A, Hutchinson P, Hawryluk GW, Czosnyka M, Panerai RB, Shutter LA, Park S, Rynkowski C, Paranhos J, Silva THS, Malbouisson LMS, Paiva WS. A Comprehensive Perspective on Intracranial Pressure Monitoring and Individualized Management in Neurocritical Care: Results of a Survey with Global Experts. Neurocrit Care 2024:10.1007/s12028-024-02008-z. [PMID: 38811514 DOI: 10.1007/s12028-024-02008-z] [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: 02/23/2024] [Accepted: 05/01/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Numerous trials have addressed intracranial pressure (ICP) management in neurocritical care. However, identifying its harmful thresholds and controlling ICP remain challenging in terms of improving outcomes. Evidence suggests that an individualized approach is necessary for establishing tolerance limits for ICP, incorporating factors such as ICP waveform (ICPW) or pulse morphology along with additional data provided by other invasive (e.g., brain oximetry) and noninvasive monitoring (NIM) methods (e.g., transcranial Doppler, optic nerve sheath diameter ultrasound, and pupillometry). This study aims to assess current ICP monitoring practices among experienced clinicians and explore whether guidelines should incorporate ancillary parameters from NIM and ICPW in future updates. METHODS We conducted a survey among experienced professionals involved in researching and managing patients with severe injury across low-middle-income countries (LMICs) and high-income countries (HICs). We sought their insights on ICP monitoring, particularly focusing on the impact of NIM and ICPW in various clinical scenarios. RESULTS From October to December 2023, 109 professionals from the Americas and Europe participated in the survey, evenly distributed between LMIC and HIC. When ICP ranged from 22 to 25 mm Hg, 62.3% of respondents were open to considering additional information, such as ICPW and other monitoring techniques, before adjusting therapy intensity levels. Moreover, 77% of respondents were inclined to reassess patients with ICP in the 18-22 mm Hg range, potentially escalating therapy intensity levels with the support of ICPW and NIM. Differences emerged between LMIC and HIC participants, with more LMIC respondents preferring arterial blood pressure transducer leveling at the heart and endorsing the use of NIM techniques and ICPW as ancillary information. CONCLUSIONS Experienced clinicians tend to personalize ICP management, emphasizing the importance of considering various monitoring techniques. ICPW and noninvasive techniques, particularly in LMIC settings, warrant further exploration and could potentially enhance individualized patient care. The study suggests updating guidelines to include these additional components for a more personalized approach to ICP management.
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Affiliation(s)
- Sérgio Brasil
- Division of Neurosurgery, Department of Neurology, School of Medicine University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil.
| | | | - Walter Videtta
- Intensive Care Unit, Hospital Posadas, Buenos Aires, Argentina
| | | | - Davi Solla
- Division of Neurosurgery, Department of Neurology, School of Medicine University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Chiara Robba
- Anesthesia and Intensive Care, Scientific Institute for Research, Hospitalization and Healthcare, Policlínico San Martino, Genoa, Italy
| | - Frank Rasulo
- Neuroanesthesia, Neurocritical and Postoperative Care, Spedali Civili University Affiliated Hospital of Brescia, Brescia, Italy
| | - Marcel Aries
- Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands
- School of Mental Health and Neurosciences, University Maastricht, Maastricht, The Netherlands
| | - Peter Smielewski
- Department of Clinical Neurosciences, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - Geert Meyfroidt
- Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Denise Battaglini
- Anesthesia and Intensive Care, Scientific Institute for Research, Hospitalization and Healthcare, Policlínico San Martino, Genoa, Italy
| | - Mohammad I Hirzallah
- Departments of Neurology, Neurosurgery, and Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Robson Amorim
- Division of Neurosurgery, Department of Neurology, School of Medicine University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Gisele Sampaio
- Neurology Department, São Paulo Federal University Medical School, São Paulo, Brazil
| | - Fabiano Moulin
- Neurology Department, São Paulo Federal University Medical School, São Paulo, Brazil
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | | | | | - Gregory W Hawryluk
- Cleveland Clinic Neurological Institute, Akron General Hospital, Fairlawn, OH, USA
- Uniformed Services University, Bethesda, USA
- Brain Trauma Foundation, New York, USA
| | - Marek Czosnyka
- Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - Ronney B Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Lori A Shutter
- Departments of Critical Care Medicine, Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Soojin Park
- Departments of Neurology and Biomedical Informatics, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY, USA
| | - Carla Rynkowski
- Department of Urgency and Trauma, Medical Faculty, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Jorge Paranhos
- Intensive Care and Neuroemergency, Santa Casa de Misericórdia, São João del Rei, Brazil
| | - Thiago H S Silva
- Department of Intensive Care, School of Medicine University of São Paulo, São Paulo, Brazil
| | - Luiz M S Malbouisson
- Department of Intensive Care, School of Medicine University of São Paulo, São Paulo, Brazil
| | - Wellingson S Paiva
- Division of Neurosurgery, Department of Neurology, School of Medicine University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
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Uryga A, Czosnyka M, Robba C, Nasr N, Kasprowicz M. The time constant of the cerebral arterial bed: exploring age-related implications. J Clin Monit Comput 2024:10.1007/s10877-024-01142-5. [PMID: 38573368 DOI: 10.1007/s10877-024-01142-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/17/2024] [Indexed: 04/05/2024]
Abstract
The time constant of the cerebral arterial bed (τ) represents an estimation of the transit time of flow from the point of insonation at the level of the middle cerebral artery to the arteriolar-capillary boundary, during a cardiac cycle. This study assessed differences in τ among healthy volunteers across different age groups. Simultaneous recordings of transcranial Doppler cerebral blood flow velocity (CBFV) and arterial blood pressure (ABP) were performed on two groups: young volunteers (below 30 years of age), and older volunteers (above 40 years of age). τ was estimated using mathematical transformation of ABP and CBFV pulse waveforms. 77 healthy volunteers [52 in the young group, and 25 in the old group] were included. Pulse amplitude of ABP was higher [16.7 (14.6-19.4) mmHg] in older volunteers as compared to younger ones [12.5 (10.9-14.4) mm Hg; p < 0.001]. CBFV was lower in older volunteers [59 (50-66) cm/s] as compared to younger ones [72 (63-78) cm/s p < 0.001]. τ was longer in the younger volunteers [217 (168-237) ms] as compared to the older volunteers [183 (149-211) ms; p = 0.004]. τ significantly decreased with age (rS = - 0.27; p = 0.018). τ is potentially an integrative marker of the changes occurring in cerebral vasculature, as it encompasses the interplay between changes in compliance and resistance that occur with age.
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Affiliation(s)
- Agnieszka Uryga
- Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wybrzeze Wyspianskiego 27, 50-370, Wroclaw, Poland.
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Chiara Robba
- IRCCS Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV 16, Genoa, Italy
| | - Nathalie Nasr
- Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wybrzeze Wyspianskiego 27, 50-370, Wroclaw, Poland
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- IRCCS Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV 16, Genoa, Italy
- Department of Neurology, Poitiers University Hospital, Poitiers, Laboratoire de Neurosciences Expérimentales et Cliniques, University of Poitiers, U1084, Poitiers, France
| | - Magdalena Kasprowicz
- Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wybrzeze Wyspianskiego 27, 50-370, Wroclaw, Poland
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Matsui Y, Muramatsu F, Nakamura H, Noda Y, Matsumoto K, Kishima H, Takakura N. Brain-derived endothelial cells are neuroprotective in a chronic cerebral hypoperfusion mouse model. Commun Biol 2024; 7:338. [PMID: 38499610 PMCID: PMC10948829 DOI: 10.1038/s42003-024-06030-x] [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: 04/10/2023] [Accepted: 03/08/2024] [Indexed: 03/20/2024] Open
Abstract
Whether organ-specific regeneration is induced by organ-specific endothelial cells (ECs) remains unelucidated. The formation of white matter lesions due to chronic cerebral hypoperfusion causes cognitive decline, depression, motor dysfunction, and even acute ischemic stroke. Vascular ECs are an important target for treating chronic cerebral hypoperfusion. Brain-derived ECs transplanted into a mouse chronic cerebral hypoperfusion model showed excellent angiogenic potential. They were also associated with reducing both white matter lesions and brain dysfunction possibly due to the high expression of neuroprotective humoral factors. The in vitro coculture of brain cells with ECs from several diverse organs suggested the function of brain-derived endothelium is affected within a brain environment due to netrin-1 and Unc 5B systems. We found brain CD157-positive ECs were more proliferative and beneficial in a mouse model of chronic cerebral hypoperfusion than CD157-negative ECs upon inoculation. We propose novel methods to improve the symptoms of chronic cerebral hypoperfusion using CD157-positive ECs.
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Affiliation(s)
- Yuichi Matsui
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Fumitaka Muramatsu
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan
| | - Hajime Nakamura
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshimi Noda
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan
| | - Kinnosuke Matsumoto
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Nobuyuki Takakura
- Department of Signal Transduction, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan.
- World Premier Institute Immunology Frontier Research Center, Osaka University, Osaka, Japan.
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Osaka, Japan.
- Center for Infectious Disease Education and Research, Osaka University, Osaka, Japan.
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Sun H, Li B, Liu J, Xi X, Zhang L, Zhang Y, Li G, Guo H, Gu K, Wang T, Wen C, Liu Y. Real-time model-based cerebral perfusion calculation for ischemic stroke. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107916. [PMID: 37976610 DOI: 10.1016/j.cmpb.2023.107916] [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: 07/11/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Clinical diagnosis of ischemic stroke commonly relies on examining cerebral perfusion changes by using computed tomography perfusion (CTP) techniques. However, the radiation dose in CTP is quite higher in comparison to computed tomography angiography (CTA), with associated costs and time. METHODS Hence, this study established a lumped-parameter model (LPM) of brain tissue microcirculation (BTM) based on CTA, aiming to achieve real-time calculation of cerebral perfusion. After validation of calculated flow results with clinical data, the BTM-LPM model was used to examine the changes in cerebral perfusion following ischemic stroke, in which the effects of nine anatomical structures of the Circle of Willis (CoW) together with various distribution patterns of stenosis in the feeding arteries were considered. RESULTS When compared the calculated flow results from BTM-LPM with the clinically measured data of literature, the mean squared error (MSE) value for the feeding arteries was 3.9 % and its total value for microcirculatory flow in each region was 0.1 %. Notably, the calculation time was 35.6 s. In the case of the CoW missing the left and right posterior communicating artery, a 60 % stenosis of the basilar artery is likely to cause ischemic damage to some temporal and occipital lobes of the right and left hemispheres. While in the case of the CoW missing the anterior communicating artery and the left posterior communicating artery, ischemic damage to the entire frontal lobe and parts of the temporal and parietal lobes of the left hemisphere was found when 80 % stenosis occurred in the left internal carotid artery. CONCLUSIONS The BTM-LPM proposed in this study could accurately calculate cerebral perfusion in real time and demonstrated the importance of CoW anatomy in different ischemic injuries to cerebral tissue. The calculated cerebral perfusion would be a reference value for early diagnosis and preoperative planning of different ischemic injuries to cerebral tissue, thereby the BTM-LPM holds great promising for replacing CTP examination.
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Affiliation(s)
- Hao Sun
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang, Beijing 100124, China
| | - Bao Li
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang, Beijing 100124, China
| | - Jincheng Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang, Beijing 100124, China
| | - Xiaolu Xi
- Wuhan United Imaging Healthcare Surgical Technology Co., Ltd. Hubei, China
| | - Liyuan Zhang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang, Beijing 100124, China
| | - Yanping Zhang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang, Beijing 100124, China
| | - Guangfei Li
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang, Beijing 100124, China
| | - Huamei Guo
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang, Beijing 100124, China
| | - Kenan Gu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang, Beijing 100124, China
| | - Tongna Wang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang, Beijing 100124, China
| | - Chuanqi Wen
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang, Beijing 100124, China
| | - Youjun Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang, Beijing 100124, China.
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Brassard P, Roy MA, Burma JS, Labrecque L, Smirl JD. Quantification of dynamic cerebral autoregulation: welcome to the jungle! Clin Auton Res 2023; 33:791-810. [PMID: 37758907 DOI: 10.1007/s10286-023-00986-2] [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: 08/01/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Patients with dysautonomia often experience symptoms such as dizziness, syncope, blurred vision and brain fog. Dynamic cerebral autoregulation, or the ability of the cerebrovasculature to react to transient changes in arterial blood pressure, could be associated with these symptoms. METHODS In this narrative review, we go beyond the classical view of cerebral autoregulation to discuss dynamic cerebral autoregulation, focusing on recent advances pitfalls and future directions. RESULTS Following some historical background, this narrative review provides a brief overview of the concept of cerebral autoregulation, with a focus on the quantification of dynamic cerebral autoregulation. We then discuss the main protocols and analytical approaches to assess dynamic cerebral autoregulation, including recent advances and important issues which need to be tackled. CONCLUSION The researcher or clinician new to this field needs an adequate comprehension of the toolbox they have to adequately assess, and interpret, the complex relationship between arterial blood pressure and cerebral blood flow in healthy individuals and clinical populations, including patients with autonomic disorders.
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Affiliation(s)
- Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.
- Research center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.
| | - Marc-Antoine Roy
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Joel S Burma
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Lawrence Labrecque
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
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Ooms M, Schooß R, Winnand P, Heitzer M, Hölzle F, Bickenbach J, Rieg A, Modabber A. Influence of perioperative blood pressure regulation on postoperative delirium in patients undergoing head and neck free flap reconstruction. Eur J Med Res 2023; 28:365. [PMID: 37736691 PMCID: PMC10514994 DOI: 10.1186/s40001-023-01367-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a serious complication in patients undergoing microvascular head and neck reconstruction. Whether intraoperative and postoperative blood pressure regulation are risk factors for POD remains unclear. This study aimed to highlight the relationships between intraoperative and postoperative blood pressure regulation and POD in microvascular head and neck reconstruction. METHODS Data from 433 patients who underwent microvascular head and neck reconstruction at our department of oral and maxillofacial surgery between 2011 and 2019 were retrospectively analyzed. The 55 patients with POD were matched with 55 patients without POD in terms of tracheotomy, flap type, and flap location, and the intraoperative and postoperative systolic and mean blood pressure values were compared between the two groups. RESULTS Patients with POD showed lower intraoperative and postoperative minimum mean arterial pressure (MAP) values than patients without POD (60.0 mmHg vs. 65.0 mmHg, p < 0.001; and 56.0 mmHg vs. 62.0 mmHg, p < 0.001; respectively). A lower intraoperative minimum MAP value was identified as predictor for POD (odds ratio [OR] 1.246, 95% confidence interval [CI] 1.057-1.472, p = 0.009). The cut-off value for intraoperative MAP for predicting POD was ≤ 62.5 mmHg (area under the curve [AUC] 0.822, 95% CI 0.744-0.900, p < 0.001). CONCLUSIONS Maintaining a stable intraoperative minimum MAP of > 62.5 mmHg could help to reduce the incidence of POD in microvascular head and neck reconstruction.
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Affiliation(s)
- Mark Ooms
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Ruth Schooß
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Philipp Winnand
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Marius Heitzer
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Johannes Bickenbach
- Department of Intensive Care Medicine, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Annette Rieg
- Department of Anaesthesiology, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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Kattner AA. When it doesn't run in the blood(vessels) - events involved in vascular disorders. Biomed J 2023; 46:100591. [PMID: 37059363 DOI: 10.1016/j.bj.2023.03.004] [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: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 04/16/2023] Open
Abstract
In the current issue of the Biomedical Journal the underlying pathology of hemodynamic compromise in acute small subcortical infarction are elucidated. A follow-up study in patients with childhood Kawasaki disease is presented, as well as an insight into the gradually decreasing antigen expression in cases of acute myeloid leukemia. Furthermore this issue provides an exciting update concerning COVID-19 and the use of CRISPR-Cas, a review about computational approaches in the research of kidney stone formation, factors connected to central precocious puberty, and why a rock star of paleogenetics recently received a Nobel Prize. Additionally, this issue contains an article proposing the repurposing of the lung cancer drug Capmatinib, a study of how the gut microbiome develops in neonates, an impulse about the role of the transmembrane protein TMED3 in esophageal carcinoma, and the revelation about how competing endogenous RNA influences ischemic stroke. Lastly, genetic reasons for male infertility are discussed, as well as the relation between non-alcoholic fatty liver disease and chronic kidney disease.
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Zou Y, Heyn C, Grigorian A, Tam F, Andreazza AC, Graham SJ, Maclntosh BJ, Goldstein BI. Measuring Brain Temperature in Youth Bipolar Disorder Using a Novel Magnetic Resonance Imaging Approach: A Proof-of-concept Study. Curr Neuropharmacol 2023; 21:1355-1366. [PMID: 36946483 PMCID: PMC10324328 DOI: 10.2174/1570159x21666230322090754] [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: 10/03/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND There is evidence of alterations in mitochondrial energy metabolism and cerebral blood flow (CBF) in adults and youth with bipolar disorder (BD). Brain thermoregulation is based on the balance of heat-producing metabolism and heat-dissipating mechanisms, including CBF. OBJECTIVE To examine brain temperature, and its relation to CBF, in relation to BD and mood symptom severity in youth. METHODS This study included 25 youth participants (age 17.4 ± 1.7 years; 13 BD, 12 control group (CG)). Magnetic resonance spectroscopy data were acquired to obtain brain temperature in the left anterior cingulate cortex (ACC) and the left precuneus. Regional estimates of CBF were provided by arterial spin labeling imaging. Analyses used general linear regression models, covarying for age, sex, and psychiatric medications. RESULTS Brain temperature was significantly higher in BD compared to CG in the precuneus. A higher ratio of brain temperature to CBF was significantly associated with greater depression symptom severity in both the ACC and precuneus within BD. Analyses examining the relationship of brain temperature or CBF with depression severity score did not reveal any significant finding in the ACC or the precuneus. CONCLUSION The current study provides preliminary evidence of increased brain temperature in youth with BD, in whom reduced thermoregulatory capacity is putatively associated with depression symptom severity. Evaluation of brain temperature and CBF in conjunction may provide valuable insight beyond what can be gleaned by either metric alone. Larger prospective studies are warranted to further evaluate brain temperature and its association with CBF concerning BD.
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Affiliation(s)
- Yi Zou
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Chinthaka Heyn
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Fred Tam
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Ana Cristina Andreazza
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, M5T 1R8, ON, Canada
| | - Simon J. Graham
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Bradley J. Maclntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Benjamin I. Goldstein
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, M5T 1R8, ON, Canada
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10
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Wu LW, OuYoung T, Chiu YC, Hsieh HF, Hsiu H. Discrimination between possible sarcopenia and metabolic syndrome using the arterial pulse spectrum and machine-learning analysis. Sci Rep 2022; 12:21452. [PMID: 36509825 PMCID: PMC9744729 DOI: 10.1038/s41598-022-26074-5] [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: 06/20/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Sarcopenia is defined as decreased skeletal muscle mass and function, and is an important cause of frailty in the elderly, also being associated with vascular lesions and poor microcirculation. The present study aimed to combine noninvasive pulse measurements, frequency-domain analysis, and machine learning (ML) analysis (1) to determine the effects on the pulse waveform induced by sarcopenia and (2) to develop discriminating models for patients with possible sarcopenia. Radial blood pressure waveform (BPW) signals were measured noninvasively for 1 min in 133 subjects who visited Tri-Service General Hospital for geriatric health checkups. They were assigned to a robust group and a possible-sarcopenia group that combined dynapenia, presarcopenia, and sarcopenia. Two classification methods were used: ML analysis and a self-developed scoring system that used 40 harmonic pulse indices as features: amplitude proportions and their coefficients of variation, and phase angles and their standard deviations. Significant differences were found in several spectral indices of the BPW between possible-sarcopenia and robust subjects. Threefold cross-validation results indicated excellent discrimination performance, with AUC equaling 0.77 when using LDA and 0.83 when using our scoring system. The present noninvasive and easy-to-use measurement and analysis method for detecting sarcopenia-induced changes in the arterial pulse transmission condition could aid the discrimination of possible sarcopenia.
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Affiliation(s)
- Li-Wei Wu
- grid.260565.20000 0004 0634 0356Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan ,grid.260565.20000 0004 0634 0356Health Management Center, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Te OuYoung
- grid.260565.20000 0004 0634 0356Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan ,grid.260565.20000 0004 0634 0356Health Management Center, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chih Chiu
- grid.45907.3f0000 0000 9744 5137Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, No.43, Section 4, Keelung Road, Taipei, 10607 Taiwan
| | - Ho-Feng Hsieh
- grid.45907.3f0000 0000 9744 5137Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, No.43, Section 4, Keelung Road, Taipei, 10607 Taiwan
| | - Hsin Hsiu
- grid.45907.3f0000 0000 9744 5137Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, No.43, Section 4, Keelung Road, Taipei, 10607 Taiwan ,grid.260565.20000 0004 0634 0356Biomedical Engineering Research Center, National Defense Medical Center, Taipei, Taiwan
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11
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Paiva WS, Zippo E, Miranda C, Brasil S, Godoy DA, De Andrade AF, Neville I, Patriota GC, Domingues R, Teixeira MJ. Animal models for the study of intracranial hematomas (Review). Exp Ther Med 2022; 25:20. [PMID: 36561628 PMCID: PMC9748783 DOI: 10.3892/etm.2022.11719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
Intracranial hematomas (ICH) are a frequent condition in neurosurgical and neurological practices, with several mechanisms of primary and secondary injury. Experimental research has been fundamental for the understanding of the pathophysiology implicated with ICH and the development of therapeutic interventions. To date, a variety of different animal approaches have been described that consider, for example, the ICH evolutive phase, molecular implications and hemodynamic changes. Therefore, choosing a test protocol should consider the scope of each particular study. The present review summarized investigational protocols in experimental research on the subject of ICH. With this subject, injection of autologous blood or bacterial collagenase, inflation of intracranial balloon and avulsion of cerebral vessels were the models identified. Rodents (mice) and swine were the most frequent species used. These different models allowed improvements on the understanding of intracranial hypertension establishment, neuroinflammation, immunology, brain hemodynamics and served to the development of therapeutic strategies.
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Affiliation(s)
- Wellingson Silva Paiva
- Department of Neurology, Division of Neurosurgery, School of Medicine, University of São Paulo, 05403000 São Paulo, Brazil,Medical Research Laboratory 62, Department of Neurology, School of Medicine, University of São Paulo, 05403000 São Paulo, Brazil
| | - Emanuele Zippo
- Department of Neurology, Division of Neurosurgery, School of Medicine, University of São Paulo, 05403000 São Paulo, Brazil
| | - Carolina Miranda
- Neurology Center, Samaritan Hospital, 01232010 São Paulo, Brazil
| | - Sérgio Brasil
- Department of Neurology, Division of Neurosurgery, School of Medicine, University of São Paulo, 05403000 São Paulo, Brazil,Medical Research Laboratory 62, Department of Neurology, School of Medicine, University of São Paulo, 05403000 São Paulo, Brazil,Correspondence to: Dr Sérgio Brasil, Department of Neurology, Division of Neurosurgery, School of Medicine, University of São Paulo, 255 Enéas Aguiar Street, 05403 São Paulo, Brazil
| | - Daniel Augustin Godoy
- Department of Intensive Care, Neurointensive Care Unit, Pasteur Hospital, 4700 Catamarca, Argentina
| | - Almir Ferreira De Andrade
- Department of Neurology, Division of Neurosurgery, School of Medicine, University of São Paulo, 05403000 São Paulo, Brazil,Medical Research Laboratory 62, Department of Neurology, School of Medicine, University of São Paulo, 05403000 São Paulo, Brazil
| | - Iuri Neville
- Department of Neurology, Division of Neurosurgery, School of Medicine, University of São Paulo, 05403000 São Paulo, Brazil
| | | | - Renan Domingues
- Neurology Center, Samaritan Hospital, 01232010 São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Department of Neurology, Division of Neurosurgery, School of Medicine, University of São Paulo, 05403000 São Paulo, Brazil,Medical Research Laboratory 62, Department of Neurology, School of Medicine, University of São Paulo, 05403000 São Paulo, Brazil
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12
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Ouyoung T, Weng WL, Hu TY, Lee CC, Wu LW, Hsiu H. Machine-Learning Classification of Pulse Waveform Quality. SENSORS (BASEL, SWITZERLAND) 2022; 22:8607. [PMID: 36433203 PMCID: PMC9698948 DOI: 10.3390/s22228607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
Pulse measurements made using wearable devices can aid the monitoring of human physiological condition. Accurate estimation of waveforms is often difficult for nonexperts; motion artifacts may occur during tonometry measurements when the skin-sensor contact pressure is insufficient. An alternative approach is to extract only high-quality pulses for use in index calculations. The present study aimed to determine the effectiveness of using machine-learning analysis in discriminating between high-quality and low-quality pulse waveforms induced by applying different contact pressures. Radial blood pressure waveform (BPW) signals were measured noninvasively in healthy young subjects using a strain-gauge transducer. One-minute-long trains of pulse data were measured when applying the appropriate contact pressure (67.80 ± 1.55 mmHg) and a higher contact pressure (151.80 ± 3.19 mmHg). Eight machine-learning algorithms were employed to evaluate the following 40 harmonic pulse indices: amplitude proportions and their coefficients of variation and phase angles and their standard deviations. Significant differences were noted in BPW indices between applying appropriate and higher skin-surface contact pressures. The present appropriate contact pressure could not only provide a suitable holding force for the wearable device but also helped to maintain the physiological stability of the underlying tissues. Machine-learning analysis provides an effective method for distinguishing between the high-quality and low-quality pulses with excellent discrimination performance (leave-one-subject-out test: random-forest AUC = 0.96). This approach will aid the development of an automatic screening method for waveform quality and thereby improve the noninvasive acquisition reliability. Other possible interfering factors in practical applications can also be systematically studied using a similar procedure.
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Affiliation(s)
- Te Ouyoung
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Health Management Center, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Wan-Ling Weng
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei 10607, Taiwan
| | - Ting-Yu Hu
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei 10607, Taiwan
| | - Chia-Chien Lee
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei 10607, Taiwan
| | - Li-Wei Wu
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Health Management Center, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Hsin Hsiu
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei 10607, Taiwan
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13
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Brain Bioenergetics in Chronic Hypertension: Risk Factor for Acute Ischemic Stroke. Biochem Pharmacol 2022; 205:115260. [PMID: 36179931 DOI: 10.1016/j.bcp.2022.115260] [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: 07/30/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022]
Abstract
Chronic hypertension is one of the key modifiable risk factors for acute ischemic stroke, also contributing to determine greater neurological deficits and worse functional outcome when an acute cerebrovascular event would occur. A tight relationship exists between cerebrovascular autoregulation, neuronal activity and brain bioenergetics. In chronic hypertension, progressive adaptations of these processes occur as an attempt to cope with the demanding necessity of brain functions, creating a new steady-state homeostatic condition. However, these adaptive modifications are insufficient to grant an adequate response to possible pathological perturbations of the established fragile hemodynamic and metabolic homeostasis. In this narrative review, we will discuss the main mechanisms by which alterations in brain bioenergetics and mitochondrial function in chronic hypertension could lead to increased risk of acute ischemic stroke, stressing the interconnections between hemodynamic factors (i.e. cerebral autoregulation and neurovascular coupling) and metabolic processes. Both experimental and clinical pieces of evidence will be discussed. Moreover, the potential role of mitochondrial dysfunction in determining, or at least sustaining, the pathogenesis and progression of chronic neurogenic hypertension will be considered. In the perspective of novel therapeutic strategies aiming at improving brain bioenergetics, we propose some determinant factors to consider in future studies focused on the cause-effect relationships between chronic hypertension and brain bioenergetic abnormalities (and vice versa), so to help translational research in this so-far unfilled gap.
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14
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A novel computational model for cerebral blood flow rate control mechanisms to evaluate physiological cases. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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15
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Rein LCDS, Siqueira DED, Guillaumon AT, Avelar WM, Cendes F. Near Infrared Spectroscopy For Cerebral Hemodynamic Monitoring During Carotid Endarterectomy Under General Anesthesia. Open Cardiovasc Med J 2022. [DOI: 10.2174/18741924-v16-e2203250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Near infrared spectroscopy (NIRS) is a noninvasive method for continuous monitoring of cerebral oxygenation.
Objective:
To describe the intraoperative behavior of NIRS variables used to evaluate hemodynamic response in patients with atherosclerotic disease undergoing carotid endarterectomy under general anesthesia.
Methods:
Fifteen volunteers with atherosclerotic carotid disease with indications for endarterectomy were evaluated. After selection of patients, carotid stenosis was confirmed by appropriate diagnostic methods. NIRS was used for intraoperative monitoring. The variables total hemoglobin (Hb), oxygenated hemoglobin (O2Hb), deoxygenated hemoglobin (HHb), and regional oxygen saturation (rSO2) were evaluated at three intraoperative time points: before, during, and after carotid clamping.
Results and Discussion:
Measurements recorded by NIRS showed that, during the first 5 min of clamp time, patients experienced a decline in O2Hb levels, an increase in HHb levels, and a marked decrease in rSO2. Hb remained constant throughout the procedure. At the post-clamping time point, HHb, O2Hb, and rSO2 returned to patterns similar to those observed before clamping.
Conclusion:
NIRS was able to reliably and accurately identify the three stages of carotid endarterectomy and may predict the risk of cerebral hypoxia during carotid clamping under general anesthesia.
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16
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Incremental Doses of Nitrate-Rich Beetroot Juice Do Not Modify Cognitive Function and Cerebral Blood Flow in Overweight and Obese Older Adults: A 13-Week Pilot Randomised Clinical Trial. Nutrients 2022; 14:nu14051052. [PMID: 35268027 PMCID: PMC8912345 DOI: 10.3390/nu14051052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/20/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023] Open
Abstract
Nitrate-rich food increases nitric oxide (NO) production and may have beneficial effects on vascular, metabolic, and brain function. This pilot study tested the effects of prolonged consumption of a range of doses of dietary nitrate (NO3-), provided as beetroot juice, on cognitive function and cerebral blood flow (CBF) in overweight and obese older participants. The study had a 13-week single-blind, randomised, parallel design, and 62 overweight and obese older participants (aged 60 to 75 years) received the following interventions: (1) high NO3- (2 × 70 mL beetroot juice/day) (2) medium NO3- (70 mL beetroot juice/day), (3) low NO3- (70 mL beetroot juice on alternate days), or (4) placebo (70 mL of NO3--depleted beetroot juice on alternate days). Cognitive functions were assessed using the Computerised Mental Performance Assessment System (COMPASS) assessment battery. CBF, monitored by concentration changes in oxygenated and deoxygenated haemoglobin, was assessed in the frontal cortex using near-infrared spectroscopy. The findings of this pilot study showed that cognitive function and CBF were not affected by supplementation with NO3--rich beetroot juice for 13 weeks, irrespective of the NO3- dose administered. These findings require confirmation in larger studies using more sophisticated imaging methods (i.e., MRI) to determine whether prolonged dietary NO3- supplementation influences brain function in older overweight people.
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17
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Tang M, Kubota M, Nitanda Y, Yamamoto T. Changes in Magnetic Resonance Signal Fluctuation in Superior Sagittal Sinus: Deterioration of Arteriolar Vasomotor Function of Young Smokers. Tomography 2022; 8:657-666. [PMID: 35314632 PMCID: PMC8938793 DOI: 10.3390/tomography8020055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Cerebral arteriolar vasomotor function is vital for brain health and has been examined through CO2 inhalation or breath-holding, which are both challenging for patients. We have developed a non-invasive method to evaluate this function with magnetic resonance imaging (MRI) by utilizing respiration-induced natural changes in partial pressure of arterial CO2 (PaCO2). In this study, we applied this method for 20s to evaluate the chronic effect of a few years smoking on the cerebral arteriolar vasomotor function. (2) A single slice (five slice thicknesses: 15 mm to 7 mm) perpendicular to the superior sagittal sinus of was imaged successively for 45 s using spin-echo echo-planar imaging by 3T MRI for ten smokers (24.5 ± 1.6 years) and ten non-smokers (24.3 ± 1.4 years), respectively. The venous oxygenation fluctuation (ΔYr) caused by the respiration-induced changes of PaCO2, which reflects the arteriolar vasomotor function, was calculated from the time series MR signal changes of superior sagittal sinus. (3) The ΔYr values of the smokers (0.7 ± 0.6) were significantly lower than those of the non-smokers (1.3 ± 0.8) (p = 0.04). (4) Degeneration of the cerebral arteriolar vasomotor function due to chronic smoking (even after 20s) was demonstrated by our non-invasive MRI-based method.
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Affiliation(s)
- Minghui Tang
- Department of Diagnostic Imaging, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan;
| | - Masaya Kubota
- Department of Health Sciences, School of Medicine, Hokkaido University, Sapporo 060-8638, Japan;
| | - Yusuke Nitanda
- The 1st Department of Radiology, Kin-ikyo Chuo Hospital, Sapporo 007-8505, Japan;
| | - Toru Yamamoto
- Division of Biomedical Engineering and Science, Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
- Correspondence: ; Tel.: +81-11-706-3412
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Fani L, Roa Dueñas O, Bos D, Vernooij MW, Klaver CCW, Ikram MK, Peeters RP, Ikram MA, Chaker L. Thyroid Status and Brain Circulation: The Rotterdam Study. J Clin Endocrinol Metab 2022; 107:e1293-e1302. [PMID: 34634119 PMCID: PMC8851919 DOI: 10.1210/clinem/dgab744] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Indexed: 11/28/2022]
Abstract
CONTEXT Whether thyroid dysfunction is related to altered brain circulation in the general population remains unknown. OBJECTIVE We determined the association of thyroid hormones with different markers of brain circulation within community-dwelling elderly people. METHODS This was a population-based study of 3 subcohorts of the Rotterdam Study, starting in 1989, 2000, and 2006. A total of 5142 participants (mean age, 63.8 years; 55.4% women), underwent venipuncture to measure serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4). Between 2005 and 2015, all participants underwent phase-contrast brain magnetic resonance imaging to assess global brain perfusion (mL of blood flow/100 mL of brain/minute). Arteriolar retinal calibers were assessed using digitized images of stereoscopic fundus color transparencies in 3105 participants as markers of microcirculation. We investigated associations of TSH, FT4 with brain circulation measures using (non)linear regression models. RESULTS FT4 (in pmol/L) levels had an inverse U-shaped association with global brain perfusion, such that high and low levels of FT4 were associated with lower global brain perfusion than middle levels of FT4. The difference in global brain perfusion between high FT4 levels (25 pmol/L) and middle FT4 levels (FT4 = 15 pmol/L; P nonlinearity = .002) was up to -2.44 mL (95% CI -4.31; -0.56). Higher and lower levels of FT4, compared with middle FT4 levels, were associated with arteriolar retinal vessels (mean difference up to -2.46 µm, 95% CI -4.98; 0.05 for lower FT4). CONCLUSION These results suggest that thyroid dysfunction could lead to brain diseases such as stroke or dementia through suboptimal brain circulation that is potentially modifiable.
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Affiliation(s)
- Lana Fani
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Oscar Roa Dueñas
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, The Netherlands
| | - Caroline C W Klaver
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus MC, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC, The Netherlands
| | - Robin P Peeters
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Layal Chaker
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, The Netherlands
- Correspondence: Layal Chaker, MD, PhD, Department of Epidemiology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, PO Box 2040, 3000CA Rotterdam, The Netherlands.
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Accounting for arterial and capillary blood gases for calculation of cerebral blood flow in preterm infants. Eur J Pediatr 2022; 181:2087-2096. [PMID: 35150310 PMCID: PMC9056440 DOI: 10.1007/s00431-022-04392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/14/2022] [Accepted: 01/22/2022] [Indexed: 12/04/2022]
Abstract
UNLABELLED One of the most feared neurological complications of premature birth is intraventricular hemorrhage, frequently triggered by fluctuations in cerebral blood flow (CBF). Although several techniques for CBF measurement have been developed, they are not part of clinical routine in neonatal intensive care. A promising tool for monitoring of CBF is its numerical assessment using standard clinical parameters such as mean arterial pressure, carbon dioxide partial pressure (pCO2) and oxygen partial pressure (pO2). A standard blood gas analysis is performed on arterial blood. In neonates, capillary blood is widely used for analysis of blood gas parameters. The purpose of this study was the assessment of differences between arterial and capillary analysis of blood gases and adjustment of the mathematical model for CBF calculation to capillary values. The statistical analysis of pCO2 and pO2 values collected from 254 preterm infants with a gestational age of 23-30 weeks revealed no significant differences between arterial and capillary pCO2 and significantly lower values for capillary pO2. The estimated mean differences between arterial and capillary pO2 of 15.15 mmHg (2.02 kPa) resulted in a significantly higher CBF calculated for capillary pO2 compared to CBF calculated for arterial pO2. Two methods for correction of capillary pO2 were proposed and compared, one based on the mean difference and another one based on a regression model. CONCLUSION Capillary blood gas analysis with correction for pO2 as proposed in the present work is an acceptable alternative to arterial sampling for the assessment of CBF. WHAT IS KNOWN • Arterial blood analysis is the gold standard in clinical practice. However, capillary blood is widely used for estimating blood gas parameters. • There is no significant difference between the arterial and capillary pCO2 values, but the capillary pO2 differs significantly from the arterial one. WHAT IS NEW • The lower capillary pO2 values yield significantly higher values of calculated CBF compared to CBF computed from arterial pO2 measurements. • Two correction methods for the adjustment of capillary pO2 to arterial pO2 that made the difference in the calculated CBF insignificant have been proposed.
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Brasil S, Renck AC, Taccone FS, Fontoura Solla DJ, Tomazini BM, Wayhs SY, Fonseca S, Bassi E, Lucena B, De Carvalho Nogueira R, Paiva W, Teixeira MJ, Frade Costa EM, Sá Malbouisson LM. Obesity and its implications on cerebral circulation and intracranial compliance in severe COVID-19. Obes Sci Pract 2021; 7:751-759. [PMID: 34226849 PMCID: PMC8242615 DOI: 10.1002/osp4.534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 12/16/2022] Open
Abstract
Objective Multiple factors have been identified as causes of intracranial compliance impairment (ICCI) among patients with obesity. On the other hand, obesity has been linked with worst outcomes in COVID-19. Thus, the hypothesis of severe acute respiratory syndrome (SARS) conducing to cerebral hemodynamic disorders (CHD) able to worsen ICCI and play an additional role on prognosis determination for COVID-19 among obese patients becomes suitable. Methods 50 cases of SARS by COVID-19 were evaluated, for the presence of ICCI and cerebrovascular circulatory disturbances in correspondence with whether unfavorable outcomes (death or impossibility for mechanical ventilation weaning [MVW]) within 7 days after evaluation. The objective was to observe whether obese patients (BMI ≥ 30) disclosed worse outcomes and tests results compared with lean subjects with same clinical background. Results 23 (46%) patients among 50 had obesity. ICCI was verified in 18 (78%) obese, whereas in 13 (48%) of 27 non-obese (p = 0,029). CHD were not significantly different between groups, despite being high prevalent in both. 69% unfavorable outcomes were observed among obese and 44% for lean subjects (p = 0,075). Conclusion In the present study, intracranial compliance impairment was significantly more observed among obese subjects and may have contributed for SARS COVID-19 worsen prognosis.
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21
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van Houte J, Mooi FJ, Montenij LJ, Meijs LPB, Suriani I, Conjaerts BCM, Houterman S, Bouwman AR. Correlation of Carotid Doppler Blood Flow With Invasive Cardiac Output Measurements in Cardiac Surgery Patients. J Cardiothorac Vasc Anesth 2021; 36:1081-1091. [PMID: 34756675 DOI: 10.1053/j.jvca.2021.09.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Carotid Doppler ultrasound has been a topic of recent interest, as it may be a promising noninvasive hemodynamic monitoring tool. In this study, the relation between carotid artery blood flow and invasive cardiac output (CO) was evaluated. DESIGN A prospective, observational study. SETTING A single-institution, tertiary referral hospital. PARTICIPANTS Eighteen elective cardiac surgery patients. INTERVENTIONS CO was measured by calibrated pulse contour analysis. Simultaneously, carotid artery pulsed-wave Doppler measurements were obtained in the operating room in three clinical settings: after induction of anesthesia (T1), after a passive leg raise maneuverer (T2), and at the end of surgery (T3). MEASUREMENTS AND MAIN RESULTS Correlation and trending between carotid artery blood flow and invasive CO were evaluated. Furthermore, two Bland-Altman plots were constructed to evaluate the level of agreement between carotid artery-derived CO and invasive CO measurements. Carotid artery blood flow correlated moderately with invasive CO (ρ = 0.67, 95% confidence interval 0.56-0.76, p < 0.05). Concordance between the percentage change of carotid artery blood flow and invasive CO from T1 to T3 was 72%. The level of agreement between carotid artery-derived CO and invasive CO was ±2.29; ±2.57 L/min, with a bias of 0.1; -0.54 L/min, and mean error of 50% and 48%, for the two Bland-Altman analyses, respectively. Intraexamination precision was acceptable. CONCLUSIONS In cardiac surgery patients, carotid artery blood flow correlated moderately with invasive CO measurements. However, the trending ability of carotid artery blood flow was poor, and carotid artery-derived CO tended not to be interchangeable with invasive CO.
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Affiliation(s)
- Joris van Houte
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands; Department of Intensive Care, Catharina Hospital, Eindhoven, The Netherlands.
| | - Frederik J Mooi
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Leon J Montenij
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands; Department of Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
| | - Loek P B Meijs
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Irene Suriani
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Bente C M Conjaerts
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Saskia Houterman
- Department of Education and Research, Catharina Hospital, Eindhoven, The Netherlands
| | - Arthur R Bouwman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
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22
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Hugenroth K, Borchardt R, Ritter P, Groß-Hardt S, Meyns B, Verbelen T, Steinseifer U, Kaufmann TAS, Engelmann UM. Optimizing cerebral perfusion and hemodynamics during cardiopulmonary bypass through cannula design combining in silico, in vitro and in vivo input. Sci Rep 2021; 11:16800. [PMID: 34408243 PMCID: PMC8373878 DOI: 10.1038/s41598-021-96397-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/03/2021] [Indexed: 11/09/2022] Open
Abstract
Cardiopulmonary bypass (CPB) is a standard technique for cardiac surgery, but comes with the risk of severe neurological complications (e.g. stroke) caused by embolisms and/or reduced cerebral perfusion. We report on an aortic cannula prototype design (optiCAN) with helical outflow and jet-splitting dispersion tip that could reduce the risk of embolic events and restores cerebral perfusion to 97.5% of physiological flow during CPB in vivo, whereas a commercial curved-tip cannula yields 74.6%. In further in vitro comparison, pressure loss and hemolysis parameters of optiCAN remain unaffected. Results are reproducibly confirmed in silico for an exemplary human aortic anatomy via computational fluid dynamics (CFD) simulations. Based on CFD simulations, we firstly show that optiCAN design improves aortic root washout, which reduces the risk of thromboembolism. Secondly, we identify regions of the aortic intima with increased risk of plaque release by correlating areas of enhanced plaque growth and high wall shear stresses (WSS). From this we propose another easy-to-manufacture cannula design (opti2CAN) that decreases areas burdened by high WSS, while preserving physiological cerebral flow and favorable hemodynamics. With this novel cannula design, we propose a cannulation option to reduce neurological complications and the prevalence of stroke in high-risk patients after CPB.
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Affiliation(s)
- Kristin Hugenroth
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Faculty of Medicine, RWTH Aachen University, Aachen, Germany. .,Enmodes GmbH, Aachen, Germany.
| | | | | | - Sascha Groß-Hardt
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,Enmodes GmbH, Aachen, Germany
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tom Verbelen
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Tim A S Kaufmann
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,Enmodes GmbH, Aachen, Germany
| | - Ulrich M Engelmann
- Enmodes GmbH, Aachen, Germany. .,Department of Medical Engineering and Applied Mathematics, FH Aachen University of Applied Sciences, Jülich, Germany.
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23
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Lin SK, Hsiu H, Chen HS, Yang CJ. Classification of patients with Alzheimer's disease using the arterial pulse spectrum and a multilayer-perceptron analysis. Sci Rep 2021; 11:8882. [PMID: 33903610 PMCID: PMC8076260 DOI: 10.1038/s41598-021-87903-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 03/23/2021] [Indexed: 11/16/2022] Open
Abstract
Cerebrovascular atherosclerosis has been identified as a prominent pathological feature of Alzheimer's disease (AD); the link between vessel pathology and AD risk may also extend to extracranial arteries. This study aimed to determine the effectiveness of using arterial pulse-wave measurements and multilayer perceptron (MLP) analysis in distinguishing between AD and control subjects. Radial blood pressure waveform (BPW) and finger photoplethysmography signals were measured noninvasively for 3 min in 87 AD patients and 74 control subjects. The 5-layer MLP algorithm employed evaluated the following 40 harmonic pulse indices: amplitude proportion and its coefficient of variation, and phase angle and its standard deviation. The BPW indices differed significantly between the AD patients (6247 pulses) and control subjects (6626 pulses). Significant intergroup differences were found between mild, moderate, and severe AD (defined by Mini-Mental-State-Examination scores). The hold-out test results indicated an accuracy of 82.86%, a specificity of 92.31%, and a 0.83 AUC of ROC curve when using the MLP-based classification between AD and Control. The identified differences can be partly attributed to AD-induced changes in vascular elastic properties. The present findings may be meaningful in facilitating the development of a noninvasive, rapid, inexpensive, and objective method for detecting and monitoring the AD status.
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Affiliation(s)
- Shun-Ku Lin
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Department of Chinese Medicine, Taipei City Hospital, Renai Branch, Taipei, Taiwan
- General Education Center, University of Taipei, Taipei, Taiwan
| | - Hsin Hsiu
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, No. 43, Section 4, Keelung Road, Taipei, 10607, Taiwan.
- Biomedical Engineering Research Center, National Defense Medical Center, Taipei, Taiwan.
| | - Hsi-Sheng Chen
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, No. 43, Section 4, Keelung Road, Taipei, 10607, Taiwan
| | - Chang-Jen Yang
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, No. 43, Section 4, Keelung Road, Taipei, 10607, Taiwan
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24
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Roldán M, Kyriacou PA. Near-Infrared Spectroscopy (NIRS) in Traumatic Brain Injury (TBI). SENSORS (BASEL, SWITZERLAND) 2021; 21:1586. [PMID: 33668311 PMCID: PMC7956674 DOI: 10.3390/s21051586] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 01/03/2023]
Abstract
Traumatic brain injury (TBI) occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently impacts an object or when an object pierces the skull and enters brain tissue. Secondary injuries after traumatic brain injury (TBI) can lead to impairments on cerebral oxygenation and autoregulation. Considering that secondary brain injuries often take place within the first hours after the trauma, noninvasive monitoring might be helpful in providing early information on the brain's condition. Near-infrared spectroscopy (NIRS) is an emerging noninvasive monitoring modality based on chromophore absorption of infrared light with the capability of monitoring perfusion of the brain. This review investigates the main applications of NIRS in TBI monitoring and presents a thorough revision of those applications on oxygenation and autoregulation monitoring. Databases such as PubMed, EMBASE, Web of Science, Scopus, and Cochrane library were utilized in identifying 72 publications spanning between 1977 and 2020 which were directly relevant to this review. The majority of the evidence found used NIRS for diagnosis applications, especially in oxygenation and autoregulation monitoring (59%). It was not surprising that nearly all the patients were male adults with severe trauma who were monitored mostly with continue wave NIRS or spatially resolved spectroscopy NIRS and an invasive monitoring device. In general, a high proportion of the assessed papers have concluded that NIRS could be a potential noninvasive technique for assessing TBI, despite the various methodological and technological limitations of NIRS.
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Affiliation(s)
| | - Panayiotis A. Kyriacou
- Research Centre for Biomedical Engineering, School of Mathematics, Computer Sciences and Engineering, University of London, London EC1V 0HB, UK;
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25
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Matenchuk BA, James M, Skow RJ, Wakefield P, MacKay C, Steinback CD, Davenport MH. Longitudinal study of cerebral blood flow regulation during exercise in pregnancy. J Cereb Blood Flow Metab 2020; 40:2278-2288. [PMID: 31752587 PMCID: PMC7585927 DOI: 10.1177/0271678x19889089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Cerebrovascular adaptation to pregnancy is poorly understood. We sought to assess cerebrovascular regulation in response to visual stimulation, hypercapnia and exercise across the three trimesters of pregnancy. Using transcranial Doppler (TCD) ultrasound, middle and posterior cerebral artery mean blood velocities (MCAvmean and PCAvmean) were measured continuously at rest and in response to (1) visual stimulation to assess neurovascular coupling (NVC); (2) a modified Duffin hyperoxic CO2 rebreathe test, and (3) an incremental cycling exercise test to volitional fatigue in non-pregnant (n = 26; NP) and pregnant women (first trimester [n = 13; TM1], second trimester [n = 21; TM2], and third trimester [n = 20; TM3]) in total 47 women. At rest, MCAvmean and PETCO2 were lower in TM2 compared to NP. PCAvmean was lower in TM2 but not TM1 or TM3 compared to NP. Cerebrovascular reactivity in MCAvmean and PCAvmean during the hypercapnic rebreathing test was not different between pregnant and non-pregnant women. MCAvmean continued to increase over the second half of the exercise test in TM2 and TM3, while it decreased in NP due to differences in ΔPETCO2 between groups. Pregnant women experienced a delayed decrease in MCAvmean in response to maximal exercise compared to non-pregnant controls which was explained by CO2 reactivity and PETCO2 level.
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Affiliation(s)
- Brittany A Matenchuk
- Program for Pregnancy & Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Alberta Diabetes Institute, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Marina James
- Program for Pregnancy & Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Alberta Diabetes Institute, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Rachel J Skow
- Program for Pregnancy & Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Alberta Diabetes Institute, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Paige Wakefield
- Program for Pregnancy & Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Alberta Diabetes Institute, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Christina MacKay
- Program for Pregnancy & Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Alberta Diabetes Institute, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Craig D Steinback
- Program for Pregnancy & Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Alberta Diabetes Institute, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Margie H Davenport
- Program for Pregnancy & Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Alberta Diabetes Institute, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
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26
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Investigating Association between Intraoperative Hypotension and Postoperative Neurocognitive Disorders in Non-Cardiac Surgery: A Comprehensive Review. J Clin Med 2020; 9:jcm9103183. [PMID: 33008109 PMCID: PMC7601108 DOI: 10.3390/jcm9103183] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 12/19/2022] Open
Abstract
Postoperative delirium (POD) and postoperative cognitive decline (deficit) (POCD) are related to a higher risk of postoperative complications and long-term disability. Pathophysiology of POD and POCD is complex, elusive and multifactorial. Intraoperative hypotension (IOH) constitutes a frequent and vital health hazard in the perioperative period. Unfortunately, there are no international recommendations in terms of diagnostics and treatment of neurocognitive complications which may arise from hypotension-related hypoperfusion. Therefore, we performed a comprehensive review of the literature evaluating the association between IOH and POD/POCD in the non-cardiac setting. We have concluded that available data are quite inconsistent and there is a paucity of high-quality evidence convincing that IOH is a risk factor for POD/POCD development. Considerable heterogeneity between studies is the major limitation to set up reliable recommendations regarding intraoperative blood pressure management to protect the brain against hypotension-related hypoperfusion. Further well-designed and effectively-performed research is needed to elucidate true impact of intraoperative blood pressure variations on postoperative cognitive functioning.
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27
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Batterham AP, Panerai RB, Robinson TG, Haunton VJ. Does depth of squat-stand maneuver affect estimates of dynamic cerebral autoregulation? Physiol Rep 2020; 8:e14549. [PMID: 32812372 PMCID: PMC7435029 DOI: 10.14814/phy2.14549] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/16/2020] [Accepted: 07/29/2020] [Indexed: 12/02/2022] Open
Abstract
Repeated squat-stand maneuvers (SSM) are an effective way of measuring dynamic cerebral autoregulation (dCA), but the depth of SSM required to improve dCA estimations has never been studied. We compared beat-to-beat cerebral hemodynamic parameters between maximal depth SSM (SSMD ) and a shallower alternative (SSMS ) in two age groups (younger [20-34 years] vs. older [50-71 years]) at a frequency of 0.05 Hz. Cerebral blood flow velocity, continuous blood pressure (BP) and end-tidal CO2 (EtCO2 ) were measured using transcranial Doppler ultrasound, the Finometer device, and capnography, respectively. Coherence (at 0.05 Hz) was significantly higher in both SSM recordings compared to spontaneous BP oscillations at baseline standing (BS ). Median (IQR) autoregulation index (ARI) was reduced during SSMD (4.46 [4.03-5.22], p < .01) compared to SSMS (5.96 [5.40-6.69]) and BS (6.03 [5.20-6.49], p < .01) with similar relative differences also observed for phase (at 0.05 Hz). End-tidal CO2 was increased in SSMD (38.3 ± 3.7 mmHg, p < .01) compared to both SSMS (36.6 ± 3.6 mmHg) and BS (35.5 ± 3.2 mmHg). The older group demonstrated significantly lower ARI and phase estimates during SSM and found SSMS more effortful than SSMD . In conclusion, both SSMD and SSMS are effective at estimating dCA, and dCA appears to be less efficient during maximal depth SSM compared to baseline rest or a shallower alternative.
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Affiliation(s)
| | - Ronney B. Panerai
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- Biomedical Research Unit in Cardiovascular SciencesNational Institute for Health ResearchClinical Sciences WingGlenfield HospitalLeicesterUK
| | - Thompson G. Robinson
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- Biomedical Research Unit in Cardiovascular SciencesNational Institute for Health ResearchClinical Sciences WingGlenfield HospitalLeicesterUK
| | - Victoria J. Haunton
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- Biomedical Research Unit in Cardiovascular SciencesNational Institute for Health ResearchClinical Sciences WingGlenfield HospitalLeicesterUK
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28
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Kermorgant M, Nasr N, Czosnyka M, Arvanitis DN, Hélissen O, Senard JM, Pavy-Le Traon A. Impacts of Microgravity Analogs to Spaceflight on Cerebral Autoregulation. Front Physiol 2020; 11:778. [PMID: 32719617 PMCID: PMC7350784 DOI: 10.3389/fphys.2020.00778] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/15/2020] [Indexed: 12/16/2022] Open
Abstract
It is well known that exposure to microgravity in astronauts leads to a plethora physiological responses such as headward fluid shift, body unloading, and cardiovascular deconditioning. When astronauts return to Earth, some encounter problems related to orthostatic intolerance. An impaired cerebral autoregulation (CA), which could be compromised by the effects of microgravity, has been proposed as one of the mechanisms responsible for orthostatic intolerance. CA is a homeostatic mechanism that maintains cerebral blood flow for any variations in cerebral perfusion pressure by adapting the vascular tone and cerebral vessel diameter. The ground-based models of microgravity are useful tools for determining the gravitational impact of spaceflight on human body. The head-down tilt bed rest (HDTBR), where the subject remains in supine position at -6 degrees for periods ranging from few days to several weeks is the most commonly used ground-based model of microgravity for cardiovascular deconditioning. head-down bed rest (HDBR) is able to replicate cephalic fluid shift, immobilization, confinement, and inactivity. Dry immersion (DI) model is another approach where the subject remains immersed in thermoneutral water covered with an elastic waterproof fabric separating the subject from the water. Regarding DI, this analog imitates absence of any supporting structure for the body, centralization of body fluids, immobilization and hypokinesia observed during spaceflight. However, little is known about the impact of microgravity on CA. Here, we review the fundamental principles and the different mechanisms involved in CA. We also consider the different approaches in order to assess CA. Finally, we focus on the effects of short- and long-term spaceflight on CA and compare these findings with two specific analogs to microgravity: HDBR and DI.
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Affiliation(s)
- Marc Kermorgant
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
| | - Nathalie Nasr
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
- Department of Neurology, Institute for Neurosciences, Toulouse University Hospital, Toulouse, France
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital, Cambridge, United Kingdom
- Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland
| | - Dina N. Arvanitis
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
| | - Ophélie Hélissen
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
| | - Jean-Michel Senard
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Anne Pavy-Le Traon
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
- Department of Neurology, Institute for Neurosciences, Toulouse University Hospital, Toulouse, France
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29
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Cerebral autoregulation in a fulminant hepatic failure patient who underwent liver transplantation. Ann Hepatol 2020; 18:403-404. [PMID: 31010793 DOI: 10.1016/j.aohep.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 06/28/2018] [Accepted: 07/04/2018] [Indexed: 02/04/2023]
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30
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Oliveira SR, Castelhano J, Sereno J, Vieira HLA, Duarte CB, Castelo-Branco M. Response of the cerebral vasculature to systemic carbon monoxide administration-Regional differences and sexual dimorphism. Eur J Neurosci 2020; 52:2771-2780. [PMID: 32168385 DOI: 10.1111/ejn.14725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 02/22/2020] [Accepted: 02/29/2020] [Indexed: 01/18/2023]
Abstract
Previous studies about the modulation of the vasculature by CO were performed exclusively in male or sexually immature animals. Understanding the sex differences regarding systemic drug processing and pharmacodynamics is an important feature for safety assessment of drug dosing and efficacy. In this work, we used CORM-A1 as source of CO to examine the effects of this gasotransmitter on brain perfusion and the sex-dependent differences. Dynamic contrast-enhanced imaging (DCE)-based analysis was used to characterize the properties of CO in the modulation of cerebral vasculature in vivo, in adult C57BL/6 healthy mice. Perfusion of the temporal muscle, maxillary vein and in hippocampus, cortex and striatum was analysed for 108 min following CORM-A1 administration of 3 or 5 mg/kg. Under control conditions, brain perfusion was lower in females when compared with males. Under CO treatment, females showed a surprisingly overall reduced perfusion compared with controls (F = 3.452, p = .0004), while no major alterations (or even the expected increase) were observed in males. Cortical structures were only modulated in females. A striking female-dominated vasoconstriction effect was observed in the hippocampus and striatum following administration of CO, in this mixed-sex cohort. As these two regions are implicated in episodic and procedural memory formation, CO may have a relevant impact in learning and memory.
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Affiliation(s)
- Sara R Oliveira
- CNC-Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal.,Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal.,CEDOC, Chronic Diseases Research Centre, NOVA Medical School/Faculdade de Ciência Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - João Castelhano
- CIBIT, Coimbra Institute for Biomedical Imaging and Life Sciences, ICNAS, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - José Sereno
- CIBIT, Coimbra Institute for Biomedical Imaging and Life Sciences, ICNAS, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Helena L A Vieira
- CEDOC, Chronic Diseases Research Centre, NOVA Medical School/Faculdade de Ciência Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.,Instituto de Biologia Experimental e Tecnológica (iBET), Oeiras, Portugal.,UCIBIO, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Caparica, Portugal
| | - Carlos B Duarte
- CNC-Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal.,Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - Miguel Castelo-Branco
- CIBIT, Coimbra Institute for Biomedical Imaging and Life Sciences, ICNAS, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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31
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van Dijk JG, van Rossum IA, Thijs RD. Timing of Circulatory and Neurological Events in Syncope. Front Cardiovasc Med 2020; 7:36. [PMID: 32232058 PMCID: PMC7082775 DOI: 10.3389/fcvm.2020.00036] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/24/2020] [Indexed: 11/13/2022] Open
Abstract
Syncope usually lasts less than a minute, in which short time arterial blood pressure temporarily falls enough to decrease brain perfusion so much that loss of consciousness ensues. Blood pressure decreases quickest when the heart suddenly stops pumping, which happens in arrhythmia and in severe cardioinhibitory reflex syncope. Loss of consciousness starts about 8 s after the last heart beat and circulatory standstill occurs after 10-15 s. A much slower blood pressure decrease can occur in syncope due to orthostatic hypotension Standing blood pressure can then stabilize at low values often causing more subtle signs (i.e., inability to act) but often not low enough to cause loss of consciousness. Cerebral autoregulation attempts to keep cerebral blood flow constant when blood pressure decreases. In reflex syncope both the quick blood pressure decrease and its low absolute value mean that cerebral autoregulation cannot prevent syncope. It has more protective value in orthostatic hypotension. Neurological signs are related to the severity and timing of cerebral hypoperfusion. Several unanswered pathophysiological questions with possible clinical implications are identified.
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Affiliation(s)
- J Gert van Dijk
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | - Ineke A van Rossum
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | - Roland D Thijs
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
- Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands
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32
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Qin C, Yan X, Jin H, Zhang R, He Y, Sun X, Zhang Y, Guo ZN, Yang Y. Effects of Remote Ischemic Conditioning on Cerebral Hemodynamics in Ischemic Stroke. Neuropsychiatr Dis Treat 2020; 16:283-299. [PMID: 32021218 PMCID: PMC6988382 DOI: 10.2147/ndt.s231944] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 12/16/2019] [Indexed: 12/15/2022] Open
Abstract
Ischemic stroke is one of the most common cerebrovascular diseases and is the leading cause of disability all over the world. It is well known that cerebral blood flow (CBF) is disturbed or even disrupted when ischemic stroke happens. The imbalance between demand and shortage of blood supply makes ischemic stroke take place or worsen. The search for treatments that can preserve CBF, especially during the acute phase of ischemic stroke, has become a research hotspot. Animal and clinical experiments have proven that remote ischemic conditioning (RIC) is a beneficial therapeutic strategy for the treatment of ischemic stroke. However, the mechanism by which RIC affects CBF has not been fully understood. This review aims to discuss several possible mechanisms of RIC on the cerebral hemodynamics in ischemic stroke, such as the improvement of cardiac function and collateral circulation of cerebral vessels, the protection of neurovascular units, the formation of gas molecules, the effect on the function of vascular endothelial cells and the nervous system. RIC has the potential to become a therapeutic treatment to improve CBF in ischemic stroke. Future studies are needed to highlight our understanding of RIC as well as accelerate its clinical translation.
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Affiliation(s)
- Chen Qin
- Department of Neurology, The First Hospital of Jilin University, Changchun 130021, People's Republic of China
| | - Xiuli Yan
- Department of Neurology, The First Hospital of Jilin University, Changchun 130021, People's Republic of China
| | - Hang Jin
- Department of Neurology, The First Hospital of Jilin University, Changchun 130021, People's Republic of China
| | - Ruyi Zhang
- Department of Cardiovascular Center, The First Hospital of Jilin University, Changchun 130021, People's Republic of China
| | - Yaode He
- Department of Neurology, The First Hospital of Jilin University, Changchun 130021, People's Republic of China
| | - Xin Sun
- Department of Neurology, The First Hospital of Jilin University, Changchun 130021, People's Republic of China
| | - Yihe Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun 130021, People's Republic of China
| | - Zhen-Ni Guo
- Department of Neurology, The First Hospital of Jilin University, Changchun 130021, People's Republic of China.,Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun 130021, People's Republic of China
| | - Yi Yang
- Department of Neurology, The First Hospital of Jilin University, Changchun 130021, People's Republic of China.,Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun 130021, People's Republic of China
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Identification of Pulse Onset on Cerebral Blood Flow Velocity Waveforms: A Comparative Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3252178. [PMID: 31355255 PMCID: PMC6634067 DOI: 10.1155/2019/3252178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/02/2019] [Accepted: 06/18/2019] [Indexed: 11/17/2022]
Abstract
The low cost, simple, noninvasive, and continuous measurement of cerebral blood flow velocity (CBFV) by transcranial Doppler is becoming a common clinical tool for the assessment of cerebral hemodynamics. CBFV monitoring can also help with noninvasive estimation of intracranial pressure and evaluation of mild traumatic brain injury. Reliable CBFV waveform analysis depends heavily on its accurate beat-to-beat delineation. However, CBFV is inherently contaminated with various types of noise/artifacts and has a wide range of possible pathological waveform morphologies. Thus, pulse onset detection is in general a challenging task for CBFV signal. In this paper, we conducted a comprehensive comparative analysis of three popular pulse onset detection methods using a large annotated dataset of 92,794 CBFV pulses—collected from 108 subarachnoid hemorrhage patients admitted to UCLA Medical Center. We compared these methods not only in terms of their accuracy and computational complexity, but also for their sensitivity to the selection of their parameters' values. The results of this comprehensive study revealed that using optimal values of the parameters obtained from sensitivity analysis, one method can achieve the highest accuracy for CBFV pulse onset detection with true positive rate (TPR) of 97.06% and positive predictivity value (PPV) of 96.48%, when error threshold is set to just less than 10 ms. We conclude that the high accuracy and low computational complexity of this method (average running time of 4ms/pulse) makes it a reliable algorithm for CBFV pulse onset detection.
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Li F, Wang HB, Peng Q, Sun YC, Zhang R, Pang B, Fang J, Zhang J, Huang YN. [Prediction of syncope with nonlinear dynamic analysis during head-up tilt in vasovagal syncope patients]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:430-438. [PMID: 31209413 DOI: 10.19723/j.issn.1671-167x.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To quantify the relationship between cerebral blood flow velocity and peripheral blood pressure during hypotension period, aiming to predict the brain hypotension before symptomatic occurrence. METHODS Twenty vasovagal syncope (VVS) patients who had a previous clinical history were selected in groups and 20 pair-matched control subjects underwent 70° tilt-up test. The subjects remained supine for 30 minutes before recordings when Doppler probes, electrodes and Finapres device were prepared. After continuous baseline recordings for 10 min, the subjects underwent head up tilt (HUT) test (70°), and were standing upright for 30 minutes or until syncope was imminent. For ethical reasons, the subjects were turned back to supine position immediately after SBP dropped to ≥20 mmHg, when their consciousness persisted. The point of syncope was synchronized for all the subjects by the point SBP reached the minima. Their beat-to-beat blood pressures (BP) were recorded continuously and bilateral middle cerebral artery (MCA) flow velocities were obtained with two 2 MHz Doppler probes from a transcranial Doppler ultrasonography (TCD) system. A nonlinear dynamic method--multimodal pressure flow (MMPF) analysis was introduced to access cerebral autoregulation during different time intervals. We introduced a new indicator--syncope index (SI), which was extracted from blood flow velocity (BFV) signal to evaluate the variation of cerebral vascular tension, and could reflect the deepness of dicrotic notch in BFV signal. RESULTS Compared with the syncope index of the baseline value at the beginning of the tilt test, SI in VVS group showed significantly lower when the VVS occurred (0.16±0.10 vs.0.27±0.10,P<0.01),while there was no significant difference in syncope index between the control group at the end of the tilt test and the baseline value at the beginning of the tilt test. For those VVS patients, pulse index and resistance index had no significant change. Syncope index decreased significantly 3 minutes before the point of syncope (0.23±0.07 vs.0.29±0.07,P<0.01). CONCLUSION Dynamic regulation is exhausted when vasovagal syncope occurred. Tension decrease of small vessels could have some relationship with loss of the cerebral autoregulation capability. The proposed syncope index could be a useful parameter in predicting syncope of VVS patients since it decreased significantly up to 3 minutes earlier from the point of syncope.
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Affiliation(s)
- F Li
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - H B Wang
- Academy of Advanced Interdisciplinary Study, Peking University, Beijing 100871,China
| | - Q Peng
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Y C Sun
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - R Zhang
- Academy of Advanced Interdisciplinary Study, Peking University, Beijing 100871,China
| | - B Pang
- Academy of Advanced Interdisciplinary Study, Peking University, Beijing 100871,China
| | - J Fang
- Academy of Advanced Interdisciplinary Study, Peking University, Beijing 100871,China
| | - J Zhang
- Academy of Advanced Interdisciplinary Study, Peking University, Beijing 100871,China
| | - Y N Huang
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
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Bor-Seng-Shu E, de-Lima-Oliveira M, Nogueira RC, Almeida KJ, Paschoal EHA, Paschoal FM. Decompressive Craniectomy for Traumatic Brain Injury: Postoperative TCD Cerebral Hemodynamic Evaluation. Front Neurol 2019; 10:354. [PMID: 31031689 PMCID: PMC6473100 DOI: 10.3389/fneur.2019.00354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 03/22/2019] [Indexed: 12/31/2022] Open
Abstract
Background: There are no studies describing the cerebral hemodynamic patterns that can occur in traumatic brain injury (TBI) patients following decompressive craniectomy (DC). Such data have potentially clinical importance for guiding the treatment. The objective of this study was to investigate the postoperative cerebral hemodynamic patterns, using transcranial Doppler (TCD) ultrasonography, in patients who underwent DC. The relationship between the cerebral circulatory patterns and the patients' outcome was also analyzed. Methods: Nineteen TBI patients with uncontrolled brain swelling were prospectively studied. Cerebral blood circulation was evaluated by TCD ultrasonography. Patients and their cerebral hemispheres were categorized based on TCD-hemodynamic patterns. The data were correlated with neurological status, midline shift on CT scan, and Glasgow outcome scale scores at 6 months after injury. Results: Different cerebral hemodynamic patterns were observed. One patient (5.3%) presented with cerebral oligoemia, 4 patients (21%) with cerebral hyperemia, and 3 patients (15.8%) with cerebral vasospasm. One patient (5.3%) had hyperemia in one cerebral hemisphere and vasospasm in the other hemisphere. Ten patients (52.6%) had nonspecific circulatory pattern. Abnormal TCD-circulatory patterns were found in 9 patients (47.4%). There was no association between TCD-cerebral hemodynamic findings and outcome. Conclusion: There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient.
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Affiliation(s)
- Edson Bor-Seng-Shu
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, São Paulo University Medical School, São Paulo, Brazil
| | - Marcelo de-Lima-Oliveira
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, São Paulo University Medical School, São Paulo, Brazil
| | - Ricardo Carvalho Nogueira
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, São Paulo University Medical School, São Paulo, Brazil
| | - Kelson James Almeida
- Department of Neurology, Federal University of Piauí Medical School, Teresina, Brazil
| | | | - Fernando Mendes Paschoal
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, São Paulo University Medical School, São Paulo, Brazil.,Department of Neurology, Federal University of Pará Medical School, São Paulo, Brazil
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36
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Zheng G, Chen B, Fang Q, Lin Q, Tao J, Chen L. Baduanjin exercise intervention for community adults at risk of ischamic stroke: A randomized controlled trial. Sci Rep 2019; 9:1240. [PMID: 30718622 PMCID: PMC6362011 DOI: 10.1038/s41598-018-37544-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 12/10/2018] [Indexed: 01/01/2023] Open
Abstract
The aim of current study was to assess the effects of Baduanjin exercise on cerebrovascular function, cardiac structure and cardiac function, static pulmonary function, traditional risk factors of CVD and the related psychological outcomes in older community adults at risk for ischaemic stroke. A randomized controlled trial was conducted in three community between November 2013 and October 2015. Older community-dwelling adults (N = 170) were randomly allocated into either a Baduanjin training (5 × 60 min/weekly) or control group who kept their unaltered lifestyle during a 12-week intervention period. Primary (cerebral haemodynamic parameters) and secondary outcomes (cardiac structure, cardiac function, static pulmonary function, traditional risk factors and the related psychological outcomes) were measured at baseline, after a 12-week intervention period and after an additional 12-week follow-up period. After the 12-week intervention period and additional 12-week follow-up period, the Baduanjin exercise group displayed significant changes in most cerebral haemodynamic parameters compared to the control group: lower systolic blood pressure, diastolic blood pressure, plasma total cholesterol levels, waist circumference, hip circumference and waist/hip ratio; and improved mood, self-confidence, self-esteem, quality of life and sleep quality. A supervised 12-week Baduanjin exercise intervention was effective and safe in modulating cerebral haemodynamics, reducing blood pressure and improving anthropometric parameters and related psychological outcomes in older community adults at risk for ischaemic stroke.
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Affiliation(s)
- Guohua Zheng
- College of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China.,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Bai Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Qianying Fang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Qiu Lin
- Department of Physical Education, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Jing Tao
- Fujian Key Laboratory of Rehabilitation Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Lidian Chen
- Collaborative Innovation Center for Rehabilitation Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.
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Norling AM, Marshall RS, Pavol MA, Howard G, Howard V, Liebeskind D, Huston J, Lal BK, Brott TG, Lazar RM. Is Hemispheric Hypoperfusion a Treatable Cause of Cognitive Impairment? Curr Cardiol Rep 2019; 21:4. [PMID: 30661122 DOI: 10.1007/s11886-019-1089-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To review the current literature that supports the notion that cerebral hemodynamic compromise from internal carotid artery stenosis may be a cause of vascular cognitive impairment that is amenable to treatment by revascularization. RECENT FINDINGS Converging evidence suggests that successful carotid endarterectomy and carotid artery stenting are associated with reversal of cognitive decline in many patients with severe but asymptomatic carotid artery stenosis. Most of these findings have been derived from cohort studies and comparisons with either normal or surgical controls. Failure to find treatment benefit in a number of studies appears to have been the result of patient heterogeneity or confounding from concomitant conditions independently associated with cognitive decline, such as heart failure and other cardiovascular risk factors, or failure to establish pre-procedure hemodynamic failure. Patients with severe carotid artery stenosis causing cerebral hemodynamic impairment may have a reversible cause of cognitive decline. None of the prior studies, however, were done in the context of a randomized clinical trial with large numbers of participants. The ongoing CREST-2 trial comparing revascularization with medical therapy versus medical therapy alone, and its associated CREST-H study determining whether cognitive decline is reversible among those with hemodynamic compromise may address this question.
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Affiliation(s)
- Amani M Norling
- Department of Neurology, University of Alabama at Birmingham, 1720 7th Ave S-SC 650, Birmingham, AL, 35294, USA
| | - Randolph S Marshall
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Marykay A Pavol
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - George Howard
- Department of Biostatistics (GH), University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia Howard
- Department of Epidemiology (VH), University of Alabama at Birmingham, Birmingham, AL, USA
| | - David Liebeskind
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - John Huston
- Department of Neuroradiology (JH), Mayo Clinic, Rochester, MN, USA
| | - Brajesh K Lal
- Department of Vascular Surgery (BKL), University of Maryland, Baltimore, MD, USA
| | - Thomas G Brott
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Ronald M Lazar
- Department of Neurology, University of Alabama at Birmingham, 1720 7th Ave S-SC 650, Birmingham, AL, 35294, USA.
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Ishibashi T, Toyama S, Miki K, Karakama J, Yoshino Y, Ishibashi S, Tomita M, Nemoto S. Effects of propofol versus sevoflurane on cerebral circulation time in patients undergoing coiling for cerebral artery aneurysm: a prospective randomized crossover study. J Clin Monit Comput 2019; 33:987-998. [PMID: 30610516 DOI: 10.1007/s10877-018-00251-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/31/2018] [Indexed: 11/28/2022]
Abstract
Many neuroendovascular treatments are supported by real-time anatomical and visual hemodynamic assessments through digital subtraction angiography (DSA). Here we used DSA in a single-center prospective randomized crossover study to assess the intracranial hemodynamics of patients undergoing coiling for cerebral aneurysm (n = 15) during sevoflurane- and propofol-based anesthesia. Color-coded DSA was used to define time to peak density of contrast medium (TTP) at several intravascular regions of interest (ROIs). Travel time at a particular ROI was defined as the TTP at the selected ROI minus TTP at baseline position on the internal carotid artery (ICA). Travel time at the jugular bulb on the anterior-posterior view was defined as the cerebral circulation time (CCT), which was divided into four segmental circulation times: ICA, middle cerebral artery (MCA), microvessel, and sinus. When bispectral index values were kept between 40 and 60, CCT (median [interquartile range]) was 10.91 (9.65-11.98) s under propofol-based anesthesia compared with 8.78 (8.32-9.45) s under sevoflurane-based anesthesia (P < 0.001). Circulation times for the ICA, MCA, and microvessel segments were longer under propofol-based anesthesia than under sevoflurane-based anesthesia (P < 0.05 for all). Our results suggest that, relative to sevoflurane, propofol decreases overall cerebral perfusion.
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Affiliation(s)
- Tomoko Ishibashi
- Department of Anesthesiology, Graduate School of Medicine and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Satoshi Toyama
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, 157-8535, Japan.
| | - Kazunori Miki
- Department of Endovascular Surgery, Graduate School of Medicine and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Jun Karakama
- Department of Endovascular Surgery, Graduate School of Medicine and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yoshikazu Yoshino
- Department of Endovascular Surgery, Graduate School of Medicine and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Satoru Ishibashi
- Department of Neurology, Graduate School of Medicine and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Makoto Tomita
- Clinical Research Center, Graduate School of Medicine and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shigeru Nemoto
- Department of Endovascular Surgery, Graduate School of Medicine and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Leacy JK, Zouboules SM, Mann CR, Peltonen JDB, Saran G, Nysten CE, Nysten HE, Brutsaert TD, O’Halloran KD, Sherpa MT, Day TA. Neurovascular Coupling Remains Intact During Incremental Ascent to High Altitude (4240 m) in Acclimatized Healthy Volunteers. Front Physiol 2018; 9:1691. [PMID: 30546319 PMCID: PMC6279846 DOI: 10.3389/fphys.2018.01691] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/09/2018] [Indexed: 12/21/2022] Open
Abstract
Neurovascular coupling (NVC) is the temporal link between neuronal metabolic activity and regional cerebral blood flow (CBF), supporting adequate delivery of nutrients. Exposure to high altitude (HA) imposes several stressors, including hypoxia and hypocapnia, which modulate cerebrovascular tone in an antagonistic fashion. Whether these contrasting stressors and subsequent adaptations affect NVC during incremental ascent to HA is unclear. The aim of this study was to assess whether incremental ascent to HA influences the NVC response. Given that CBF is sensitive to changes in arterial blood gasses, in particular PaCO2, we hypothesized that the vasoconstrictive effect of hypocapnia during ascent would decrease the NVC response. 10 healthy study participants (21.7 ± 1.3 years, 23.57 ± 2.00 kg/m2, mean ± SD) were recruited as part of a research expedition to HA in the Nepal Himalaya. Resting posterior cerebral artery velocity (PCAv), arterial blood gasses (PaO2, SaO2, PaCO2, [HCO3 -], base excess and arterial blood pH) and NVC response of the PCA were measured at four pre-determined locations: Calgary/Kathmandu (1045/1400 m, control), Namche (3440 m), Deboche (3820 m) and Pheriche (4240 m). PCAv was measured using transcranial Doppler ultrasound. Arterial blood draws were taken from the radial artery and analyzed using a portable blood gas/electrolyte analyzer. NVC was determined in response to visual stimulation (VS; Strobe light; 6 Hz; 30 s on/off × 3 trials). The NVC response was averaged across three VS trials at each location. PaO2, SaO2, and PaCO2 were each significantly decreased at 3440, 3820, and 4240 m. No significant differences were found for pH at HA (P > 0.05) due to significant reductions in [HCO3 -] (P < 0.043). As expected, incremental ascent to HA induced a state of hypoxic hypocapnia, whereas normal arterial pH was maintained due to renal compensation. NVC was quantified as the delta (Δ) PCAv from baseline for mean PCAv, peak PCAv and total area under the curve (ΔPCAv tAUC) during VS. No significant differences were found for Δmean, Δpeak or ΔPCAv tAUC between locations (P > 0.05). NVC remains remarkably intact during incremental ascent to HA in healthy acclimatized individuals. Despite the array of superimposed stressors associated with ascent to HA, CBF and NVC regulation may be preserved coincident with arterial pH maintenance during acclimatization.
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Affiliation(s)
- Jack K. Leacy
- Department of Biology, Mount Royal University, Calgary, AB, Canada
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
| | | | - Carli R. Mann
- Department of Biology, Mount Royal University, Calgary, AB, Canada
| | | | - Gurkan Saran
- Department of Biology, Mount Royal University, Calgary, AB, Canada
| | | | | | - Tom D. Brutsaert
- School of Education, Syracuse University, Syracuse, NY, United States
| | - Ken D. O’Halloran
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
| | | | - Trevor A. Day
- Department of Biology, Mount Royal University, Calgary, AB, Canada
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Aleksandrova EV, Oshorov AV, Sychev AA, Polupan AA, Zakharova NE, Kryukova KK, Batalov AI, Savin IA, Kravchuk AD, Potapov AA. [Autoregulation of cerebral blood flow in severe diffuse axonal brain injury: the role of neuroanatomical factors]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018; 82:5-14. [PMID: 29927420 DOI: 10.17116/neiro20188235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Autoregulation of cerebral blood flow (ACBF) is a system of mechanisms for maintaining stable adequate perfusion of the brain despite changes in systemic arterial pressure. In recent years, new data on the numerous metabolic and systemic mechanisms of cerebral blood flow regulation have been obtained, but the role of neurogenic regulation has not yet been fully understood and, therefore, not considered in clinical practice. AIM The study aim was to assess the effect of anatomical injuries to deep brain structures on the extent and duration of ACBF abnormalities in a model of severe diffuse axonal injury (DAI). RESULTS The study demonstrated that brain injury in the projection of a dopaminergic structure (substantia nigra) and a cholinergic structure (nucleus basalis of Meynert region) was more common in patients with impaired ACBF and was associated with a longer duration of the impairment. CONCLUSION The obtained data may indicate the presence of central (neurogenic) pathways of cerebral vessel tone regulation; traumatic injury of the pathways leads to a more severe and prolonged period of impaired ACBF. Probably, injury to these regulatory structures in some patients has an indirect effect on the course of intracranial hypertension. Further experimental and clinical studies in this direction are needed to elucidate all elements of neurogenic regulation of cerebral vessel tone and ACBF mechanisms.
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Affiliation(s)
- E V Aleksandrova
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - A V Oshorov
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - A A Sychev
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - A A Polupan
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - N E Zakharova
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - K K Kryukova
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - A I Batalov
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - I A Savin
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - A D Kravchuk
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - A A Potapov
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
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Coucha M, Abdelsaid M, Ward R, Abdul Y, Ergul A. Impact of Metabolic Diseases on Cerebral Circulation: Structural and Functional Consequences. Compr Physiol 2018; 8:773-799. [PMID: 29687902 DOI: 10.1002/cphy.c170019] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Metabolic diseases including obesity, insulin resistance, and diabetes have profound effects on cerebral circulation. These diseases not only affect the architecture of cerebral blood arteries causing adverse remodeling, pathological neovascularization, and vasoregression but also alter the physiology of blood vessels resulting in compromised myogenic reactivity, neurovascular uncoupling, and endothelial dysfunction. Coupled with the disruption of blood brain barrier (BBB) integrity, changes in blood flow and microbleeds into the brain rapidly occur. This overview is organized into sections describing cerebrovascular architecture, physiology, and BBB in these diseases. In each section, we review these properties starting with larger arteries moving into smaller vessels. Where information is available, we review in the order of obesity, insulin resistance, and diabetes. We also tried to include information on biological variables such as the sex of the animal models noted since most of the information summarized was obtained using male animals. © 2018 American Physiological Society. Compr Physiol 8:773-799, 2018.
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Affiliation(s)
- Maha Coucha
- South University, School of Pharmacy, Savannah, Georgia, USA
| | | | - Rebecca Ward
- Department of Neuroscience & Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Yasir Abdul
- Charlie Norwood VA Medical Center, Augusta, Georgia, USA.,Department of Physiology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Adviye Ergul
- Charlie Norwood VA Medical Center, Augusta, Georgia, USA.,Department of Physiology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Alstrup AKO, Zois NE, Simonsen M, Munk OL. Monitoring variables affecting positron emission tomography measurements of cerebral blood flow in anaesthetized pigs. Acta Vet Scand 2018. [PMID: 29530059 PMCID: PMC5848525 DOI: 10.1186/s13028-018-0369-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Positron emission tomography (PET) imaging of anaesthetized pig brains is a useful tool in neuroscience. Stable cerebral blood flow (CBF) is essential for PET, since variations can affect the distribution of several radiotracers. However, the effect of physiological factors regulating CBF is unresolved and therefore knowledge of optimal anaesthesia and monitoring of pigs in PET studies is sparse. The aim of this study was therefore to determine if and how physiological variables and the duration of anaesthesia affected CBF as measured by PET using [15O]-water in isoflurane–N2O anaesthetized domestic female pigs. First, we examined how physiological monitoring parameters were associated with CBF, and which parameters should be monitored and if possible kept constant, during studies where a stable CBF is important. Secondly, we examined how the duration of anaesthesia affected CBF and the monitoring parameters. Results No significant statistical correlations were found between CBF and the nine monitoring variables. However, we found that arterial carbon dioxide tension (PaCO2) and body temperature were important predictors of CBF that should be observed and kept constant. In addition, we found that long-duration anaesthesia was significantly correlated with high heart rate, low arterial oxygen tension, and high body temperature, but not with CBF. Conclusions The findings indicate that PaCO2 and body temperature are crucial for maintaining stable levels of CBF and thus optimizing PET imaging of molecular mechanisms in the brain of anaesthetized pigs. Therefore, as a minimum these two variables should be monitored and kept constant. Furthermore, the duration of anaesthesia should be kept constant to avoid variations in monitoring variables.
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Kennedy G, Hardman RJ, Macpherson H, Scholey AB, Pipingas A. How Does Exercise Reduce the Rate of Age-Associated Cognitive Decline? A Review of Potential Mechanisms. J Alzheimers Dis 2018; 55:1-18. [PMID: 27636853 DOI: 10.3233/jad-160665] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The rate of age-associated cognitive decline varies considerably between individuals. It is important, both on a societal and individual level, to investigate factors that underlie these differences in order to identify those which might realistically slow cognitive decline. Physical activity is one such factor with substantial support in the literature. Regular exercise can positively influence cognitive ability, reduce the rate of cognitive aging, and even reduce the risk of Alzheimer's disease (AD) and other dementias. However, while there is substantial evidence in the extant literature for the effect of exercise on cognition, the processes that mediate this relationship are less clear. This review examines cardiovascular health, production of brain derived neurotrophic factor (BDNF), insulin sensitivity, stress, and inflammation as potential pathways, via which exercise may maintain or improve cognitive functioning, and may be particularly pertinent in the context of the aging brain. A greater understanding of these mechanisms and their potential relationships with exercise and cognition will be invaluable in providing biomarkers for investigating the efficacy of differing exercise regimes on cognitive outcomes.
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Affiliation(s)
- Greg Kennedy
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Roy J Hardman
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Helen Macpherson
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia.,Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, VIC, Australia
| | - Andrew B Scholey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
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Reis J. Environmental Risk Factors for Stroke and Cardiovascular Disease. ENCYCLOPEDIA OF CARDIOVASCULAR RESEARCH AND MEDICINE 2018. [PMCID: PMC7150018 DOI: 10.1016/b978-0-12-809657-4.64111-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Besides the classical individual stroke risk factors a new class has appeared, the environmental risk factors. After a review of the evidences demonstrating that air pollution is a potent risk factor (Part 1), we propose an update of other physical, chemical, and biological factors, now considered as risk factors (Part 2). One of the challenges is to precise their specific roles as they can be combined in their noxious impacts (traffic air pollution + noise + weather + infections). This knowledge has practical consequences; From now on, medical advices cannot be limited to individual recommendations but must also deal with environmental public health issues.
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de Azevedo DS, Salinet ASM, de Lima Oliveira M, Teixeira MJ, Bor-Seng-Shu E, de Carvalho Nogueira R. Cerebral hemodynamics in sepsis assessed by transcranial Doppler: a systematic review and meta-analysis. J Clin Monit Comput 2016; 31:1123-1132. [PMID: 27757739 DOI: 10.1007/s10877-016-9945-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/11/2016] [Indexed: 12/14/2022]
Abstract
Cerebral microcirculation is gradually compromised during sepsis, with significant reductions in the function of capillaries and blood perfusion in small vessels. Transcranial Doppler ultrasound (TCD) has been used to assess cerebral circulation in a typical clinical setting. This study was to systematically review TCD studies, assess their methodological quality, and identify trends that can be associated with the temporal evolution of sepsis and its clinical outcome. A meta-analysis of systematic reviews was conducted according to the PRISMA statement. Articles were searched from 1982 until the conclusion of this review in December 2015. Twelve prospective and observational studies were selected. Evaluations of cerebral blood flow, cerebral autoregulation, and carbon dioxide (CO2) vasoreactivity were summarized. A temporal pattern of the evolution of the illness was found. In early sepsis, the median blood flow velocity (Vm) and pulsatility index (PI) increased, and the cerebral autoregulation (CA) remained unchanged. In contrast, Vm normalization, PI reduction and CA impairment were found in later sepsis (patients with severe sepsis or septic shock). Cerebral haemodynamic is impaired in sepsis. Modifications in cerebral blood flow may be consequence to the endothelial dysfunction of the microvasculature induced by the release of inflammatory mediators. A better understanding of cerebral hemodynamics may improve the clinical management of patients with sepsis and, consequently, improve clinical outcomes.
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Affiliation(s)
- Daniel Silva de Azevedo
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, Avenida Doutor Arnaldo, 455, Cerqueira César, São Paulo, SP, CEP 01246-904, Brazil
| | - Angela Salomao Macedo Salinet
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, Avenida Doutor Arnaldo, 455, Cerqueira César, São Paulo, SP, CEP 01246-904, Brazil
| | - Marcelo de Lima Oliveira
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, Avenida Doutor Arnaldo, 455, Cerqueira César, São Paulo, SP, CEP 01246-904, Brazil
| | - Manoel Jacobsen Teixeira
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, Avenida Doutor Arnaldo, 455, Cerqueira César, São Paulo, SP, CEP 01246-904, Brazil
| | - Edson Bor-Seng-Shu
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, Avenida Doutor Arnaldo, 455, Cerqueira César, São Paulo, SP, CEP 01246-904, Brazil.
| | - Ricardo de Carvalho Nogueira
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, Avenida Doutor Arnaldo, 455, Cerqueira César, São Paulo, SP, CEP 01246-904, Brazil
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46
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Bigby SE, Carter JE, Bauquier S, Beths T. Use of Propofol for Induction and Maintenance of Anesthesia in a King Penguin (Aptenodytes patagonicus) Undergoing Magnetic Resonance Imaging. J Avian Med Surg 2016; 30:237-242. [DOI: 10.1647/2015-104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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47
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Manukhina EB, Downey HF, Shi X, Mallet RT. Intermittent hypoxia training protects cerebrovascular function in Alzheimer's disease. Exp Biol Med (Maywood) 2016; 241:1351-63. [PMID: 27190276 DOI: 10.1177/1535370216649060] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Alzheimer's disease (AD) is a leading cause of death and disability among older adults. Modifiable vascular risk factors for AD (VRF) include obesity, hypertension, type 2 diabetes mellitus, sleep apnea, and metabolic syndrome. Here, interactions between cerebrovascular function and development of AD are reviewed, as are interventions to improve cerebral blood flow and reduce VRF. Atherosclerosis and small vessel cerebral disease impair metabolic regulation of cerebral blood flow and, along with microvascular rarefaction and altered trans-capillary exchange, create conditions favoring AD development. Although currently there are no definitive therapies for treatment or prevention of AD, reduction of VRFs lowers the risk for cognitive decline. There is increasing evidence that brief repeated exposures to moderate hypoxia, i.e. intermittent hypoxic training (IHT), improve cerebral vascular function and reduce VRFs including systemic hypertension, cardiac arrhythmias, and mental stress. In experimental AD, IHT nearly prevented endothelial dysfunction of both cerebral and extra-cerebral blood vessels, rarefaction of the brain vascular network, and the loss of neurons in the brain cortex. Associated with these vasoprotective effects, IHT improved memory and lessened AD pathology. IHT increases endothelial production of nitric oxide (NO), thereby increasing regional cerebral blood flow and augmenting the vaso- and neuroprotective effects of endothelial NO. On the other hand, in AD excessive production of NO in microglia, astrocytes, and cortical neurons generates neurotoxic peroxynitrite. IHT enhances storage of excessive NO in the form of S-nitrosothiols and dinitrosyl iron complexes. Oxidative stress plays a pivotal role in the pathogenesis of AD, and IHT reduces oxidative stress in a number of experimental pathologies. Beneficial effects of IHT in experimental neuropathologies other than AD, including dyscirculatory encephalopathy, ischemic stroke injury, audiogenic epilepsy, spinal cord injury, and alcohol withdrawal stress have also been reported. Further research on the potential benefits of IHT in AD and other brain pathologies is warranted.
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Affiliation(s)
- Eugenia B Manukhina
- University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA Institute of General Pathology and Pathophysiology, Moscow 125315, Russian Federation
| | - H Fred Downey
- University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA
| | - Xiangrong Shi
- University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA
| | - Robert T Mallet
- University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA
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Gómez-Sandoval E, Hernandez-Flores M, Soriano-Orozco R, Gómez-Gonzalez MN, Valdez-Medina MDR. Correlation Between Cerebral Venous-Arterial Pco2 Difference With Jugular Venous Oxygen Saturation As Global Cerebral Ischemia in Severe Traumatic Brain Injury. Intensive Care Med Exp 2015. [PMCID: PMC4796996 DOI: 10.1186/2197-425x-3-s1-a492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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49
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de Lima Oliveira M, de Azevedo DS, de Azevedo MK, de Carvalho Nogueira R, Teixeira MJ, Bor-Seng-Shu E. Encephalic hemodynamic phases in subarachnoid hemorrhage: how to improve the protective effect in patient prognoses. Neural Regen Res 2015; 10:748-52. [PMID: 26109948 PMCID: PMC4468765 DOI: 10.4103/1673-5374.156969] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 11/23/2022] Open
Abstract
Subarachnoid hemorrhage is frequently associated with poor prognoses. Three different hemodynamic phases were identified during subarachnoid hemorrhage: oligemia, hyperemia, and vasospasm. Each phase is associated with brain metabolic changes. In this review, we correlated the hemodynamic phases with brain metabolism and potential treatment options in the hopes of improving patient prognoses.
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Affiliation(s)
- Marcelo de Lima Oliveira
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniel Silva de Azevedo
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Milena Krajnyk de Azevedo
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ricardo de Carvalho Nogueira
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Edson Bor-Seng-Shu
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of São Paulo, São Paulo, Brazil
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50
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Vianna LC, Deo SH, Jensen AK, Holwerda SW, Zimmerman MC, Fadel PJ. Impaired dynamic cerebral autoregulation at rest and during isometric exercise in type 2 diabetes patients. Am J Physiol Heart Circ Physiol 2015; 308:H681-7. [PMID: 25599569 DOI: 10.1152/ajpheart.00343.2014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 01/15/2015] [Indexed: 12/21/2022]
Abstract
Type 2 diabetes mellitus patients (T2D) have elevated risk of stroke, suggesting that cerebrovascular function is impaired. Herein, we examined dynamic cerebral autoregulation (CA) at rest and during exercise in T2D patients and determined whether underlying systemic oxidative stress is associated with impairments in CA. Middle cerebral artery blood velocity and arterial blood pressure (BP) were measured at rest and during 2-min bouts of low- and high-intensity isometric handgrip performed at 20% and 40% maximum voluntary contraction, respectively, in seven normotensive and eight hypertensive T2D patients and eight healthy controls. Dynamic CA was estimated using the rate of regulation (RoR). Total reactive oxygen species (ROS) and superoxide levels were measured at rest. There were no differences in RoR at rest or during exercise between normotensive and hypertensive T2D patients. However, when compared with controls, T2D patients exhibited lower RoR at rest and during low-intensity handgrip indicating impaired dynamic CA. Moreover, the RoR was further reduced by 29 ± 4% during high-intensity handgrip in T2D patients (0.307 ± 0.012/s rest vs. 0.220 ± 0.014/s high intensity; P < 0.01), although well maintained in controls. T2D patients demonstrated greater baseline total ROS and superoxide compared with controls, both of which were negatively related to RoR during handgrip (e.g., total ROS: r = -0.71, P < 0.05; 40% maximum voluntary contraction). Collectively, these data demonstrate impaired dynamic CA at rest and during isometric handgrip in T2D patients, which may be, in part, related to greater underlying systemic oxidative stress. Additionally, dynamic CA is blunted further with high intensity isometric contractions potentially placing T2D patients at greater risk for cerebral events during such activities.
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Affiliation(s)
- Lauro C Vianna
- Faculty of Physical Education, University of Brasília, DF, Brazil; Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Shekhar H Deo
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Areum K Jensen
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Seth W Holwerda
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Matthew C Zimmerman
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Paul J Fadel
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri; Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri; and
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