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Ratkunas V, Misiulis E, Lapinskiene I, Skarbalius G, Navakas R, Dziugys A, Barkauskiene A, Preiksaitis A, Serpytis M, Rocka S, Lukosevicius S, Iesmantas T, Alzbutas R, Sengupta J, Petkus V. Cerebrospinal fluid volume as an early radiological factor for clinical course prediction after aneurysmal subarachnoid hemorrhage. A pilot study. Eur J Radiol 2024; 176:111483. [PMID: 38705051 DOI: 10.1016/j.ejrad.2024.111483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/29/2024] [Accepted: 04/27/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND The pathological mechanisms following aneurysmal subarachnoid hemorrhage (SAH) are poorly understood. Limited clinical evidence exists on the association between cerebrospinal fluid (CSF) volume and the risk of delayed cerebral ischemia (DCI) or cerebral vasospasm (CV). In this study, we raised the hypothesis that the amount of CSF or its ratio to hemorrhage blood volume, as determined from non-contrast Computed Tomography (NCCT) images taken on admission, could be a significant predictor for CV and DCI. METHODS The pilot study included a retrospective analysis of NCCT scans of 49 SAH patients taken shortly after an aneurysm rupture (33 males, 16 females, mean age 56.4 ± 15 years). The SynthStrip and Slicer3D software tools were used to extract radiological factors - CSF, brain, and hemorrhage volumes from the NCCT images. The "pure" CSF volume (VCSF) was estimated in the range of [-15, 15] Hounsfield units (HU). RESULTS VCSF was negatively associated with the risk of CV occurrence (p = 0.0049) and DCI (p = 0.0069), but was not associated with patients' outcomes. The hemorrhage volume (VSAH) was positively associated with an unfavorable outcome (p = 0.0032) but was not associated with CV/DCI. The ratio VSAH/VCSF was positively associated with, both, DCI (p = 0.031) and unfavorable outcome (p = 0.002). The CSF volume normalized by the brain volume showed the highest characteristics for DCI prediction (AUC = 0.791, sensitivity = 0.80, specificity = 0.812) and CV prediction (AUC = 0.769, sensitivity = 0.812, specificity = 0.70). CONCLUSION It was demonstrated that "pure" CSF volume retrieved from the initial NCCT images of SAH patients (including CV, Non-CV, DCI, Non-DCI groups) is a more significant predictor of DCI and CV compared to other routinely used radiological biomarkers. VCSF could be used to predict clinical course as well as to personalize the management of SAH patients. Larger multicenter clinical trials should be performed to test the added value of the proposed methodology.
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Affiliation(s)
- Vytenis Ratkunas
- Department of Radiology, Lithuanian University of Health Sciences, Eiveniu st. 2, Kaunas 50009, Lithuania
| | - Edgaras Misiulis
- Laboratory of Heat-Equipment Research and Testing, Lithuanian Energy Institute, Breslaujos st. 3, Kaunas 44403, Lithuania.
| | - Indre Lapinskiene
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio st. 21, Vilnius 03101, Lithuania
| | - Gediminas Skarbalius
- Laboratory of Heat-Equipment Research and Testing, Lithuanian Energy Institute, Breslaujos st. 3, Kaunas 44403, Lithuania
| | - Robertas Navakas
- Laboratory of Heat-Equipment Research and Testing, Lithuanian Energy Institute, Breslaujos st. 3, Kaunas 44403, Lithuania
| | - Algis Dziugys
- Laboratory of Heat-Equipment Research and Testing, Lithuanian Energy Institute, Breslaujos st. 3, Kaunas 44403, Lithuania
| | - Alina Barkauskiene
- Center for Radiology and Nuclear Medicine, Vilnius University Hospital Santaros Klinikos, Santariskiu st. 2, Vilnius 08661, Lithuania
| | - Aidanas Preiksaitis
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio st. 21, Vilnius 03101, Lithuania
| | - Mindaugas Serpytis
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio st. 21, Vilnius 03101, Lithuania
| | - Saulius Rocka
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio st. 21, Vilnius 03101, Lithuania
| | - Saulius Lukosevicius
- Department of Radiology, Lithuanian University of Health Sciences, Eiveniu st. 2, Kaunas 50009, Lithuania
| | - Tomas Iesmantas
- Kaunas University of Technology, K. Donelaičio st. 73, Kaunas 44249, Lithuania
| | - Robertas Alzbutas
- Kaunas University of Technology, K. Donelaičio st. 73, Kaunas 44249, Lithuania
| | - Jewel Sengupta
- Kaunas University of Technology, K. Donelaičio st. 73, Kaunas 44249, Lithuania
| | - Vytautas Petkus
- Kaunas University of Technology, K. Donelaičio st. 73, Kaunas 44249, Lithuania
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Chaleckas E, Putnynaite V, Lapinskiene I, Preiksaitis A, Serpytis M, Rocka S, Bartusis L, Petkus V, Ragauskas A. Impaired cerebral autoregulation detected in early prevasospasm period is associated with unfavorable outcome after spontaneous subarachnoid hemorrhage: an observational prospective pilot study. Ultrasound J 2024; 16:24. [PMID: 38619783 PMCID: PMC11018731 DOI: 10.1186/s13089-024-00371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/11/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) patients with cerebral autoregulation (CA) impairment at an early post-SAH period are at high risk of unfavorable outcomes due to delayed cerebral ischemia (DCI) or other complications. Limited evidence exists for an association between early-stage CA impairments and SAH patient outcomes. The objective of this prospective study was to explore associations between CA impairments detected in early post-SAH snapshot examinations and patient outcomes. METHODS The pilot observational study included 29 SAH patients whose CA status was estimated 2-3 days after spontaneous aneurysm rupture and a control group of 15 healthy volunteers for comparison. Inflatable leg recovery boots (reboots.com, Germany) were used for the safe controlled generation of arterial blood pressure (ABP) changes necessary for reliable CA examination. At least 5 inflation‒deflation cycles of leg recovery boots with a 2-3 min period were used during examinations. CA status was assessed according to the delay time (∆TCBFV) measured between ABP(t) and cerebral blood flow velocity (CBFV(t)) signals during artificially induced ABP changes at boot deflation cycle. CBFV was measured in middle cerebral artery by using transcranial Doppler device. RESULTS Statistically significant differences in ∆TCBFV were found between SAH patients with unfavorable outcomes (∆TCBFV = 1.37 ± 1.23 s) and those with favorable outcomes (∆TCBFV = 2.86 ± 0.99 s) (p < 0.001). Early assessment of baroreflex sensitivity (BRS) during the deflation cycle showed statistically significant differences between the DCI and non-DCI patient groups (p = 0.039). CONCLUSIONS A relatively small delay of ∆TCBFV <1.6 s between CBFV(t) and ABP(t) waves could be an early warning sign associated with unfavorable outcomes in SAH patients. The BRS during boot deflation can be used as a biomarker for the prediction of DCI. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT06028906. Registered 31 August 2023 - Retrospectively registered, https://www. CLINICALTRIALS gov/study/NCT06028906 .
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Affiliation(s)
- Edvinas Chaleckas
- Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko str. 59, Kaunas, LT-51423, Lithuania
| | - Vilma Putnynaite
- Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko str. 59, Kaunas, LT-51423, Lithuania
| | - Indre Lapinskiene
- Clinic of Anesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Aidanas Preiksaitis
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Mindaugas Serpytis
- Clinic of Anesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Saulius Rocka
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Laimonas Bartusis
- Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko str. 59, Kaunas, LT-51423, Lithuania
| | - Vytautas Petkus
- Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko str. 59, Kaunas, LT-51423, Lithuania.
| | - Arminas Ragauskas
- Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko str. 59, Kaunas, LT-51423, Lithuania
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Kasputyte G, Švagždiene M, Kumpaitiene B, Gailiušas M, Andrejaitiene J, Širvinskas E, Krakauskaite S, Petkus V, Chaleckas E, Ragauskas A, Lenkutis T. CEREBRAL AUTOREGULATION MONITORING TO REDUCE POSTOPERATIVE NEUROLOGICAL COMPLICATIONS FROM CARDIAC SURGERY: ONGOING STUDY. J Cardiothorac Vasc Anesth 2022. [DOI: 10.1053/j.jvca.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Deimantavicius M, Chaleckas E, Boere K, Putnynaite V, Tamosuitis T, Tamasauskas A, Kavaliauskas M, Rocka S, Preiksaitis A, Vosylius S, Krakauskaite S, Berskiene K, Petkus V, Ragauskas A. Feasibility of the optimal cerebral perfusion pressure value identification without a delay that is too long. Sci Rep 2022; 12:17724. [PMID: 36272984 PMCID: PMC9588030 DOI: 10.1038/s41598-022-22566-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 10/17/2022] [Indexed: 01/18/2023] Open
Abstract
Optimal cerebral perfusion pressure (CPPopt)-targeted treatment of traumatic brain injury (TBI) patients requires 2-8 h multi-modal monitoring data accumulation to identify CPPopt value for individual patient. Minimizing the time required for monitoring data accumulation is needed to improve the efficacy of CPPopt-targeted therapy. A retrospective analysis of multimodal physiological monitoring data from 87 severe TBI patients was performed by separately representing cerebrovascular autoregulation (CA) indices in relation to CPP, arterial blood pressure (ABP), and intracranial pressure (ICP) to improve the existing CPPopt identification algorithms. Machine learning (ML)-based algorithms were developed for automatic identification of informative data segments that were used for reliable CPPopt, ABPopt, ICPopt and the lower/upper limits of CA (LLCA/ULCA) identification. The reference datasets of the informative data segments and, artifact-distorted segments, and the datasets of different clinical situations were used for training the ML-based algorithms, allowing us to choose the appropriate individualized CPP-, ABP- or ICP-guided management for 79% of the full monitoring time for the studied population. The developed ML-based algorithms allow us to recognize informative physiological ABP/ICP variations within 24 min intervals with an accuracy up to 79% (compared to the initial accuracy of 74%) and use these segments for timely optimal value identification or CA limits determination in CPP, ABP or ICP data. Prospective clinical studies are needed to prove the efficiency of the developed algorithms.
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Affiliation(s)
- Mantas Deimantavicius
- grid.6901.e0000 0001 1091 4533Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko Str. 59, 51423 Kaunas, Lithuania
| | - Edvinas Chaleckas
- grid.6901.e0000 0001 1091 4533Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko Str. 59, 51423 Kaunas, Lithuania
| | - Katherine Boere
- grid.6901.e0000 0001 1091 4533Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko Str. 59, 51423 Kaunas, Lithuania
| | - Vilma Putnynaite
- grid.6901.e0000 0001 1091 4533Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko Str. 59, 51423 Kaunas, Lithuania
| | - Tomas Tamosuitis
- grid.45083.3a0000 0004 0432 6841Department of Intensive Care, Academy of Medicine, Lithuanian University of Health Sciences, Eiveniu Str. 2, 50161 Kaunas, Lithuania
| | - Arimantas Tamasauskas
- grid.45083.3a0000 0004 0432 6841Department of Intensive Care, Academy of Medicine, Lithuanian University of Health Sciences, Eiveniu Str. 2, 50161 Kaunas, Lithuania
| | - Mindaugas Kavaliauskas
- grid.6901.e0000 0001 1091 4533Department of Applied Mathematics, Kaunas University of Technology, Studentų Str. 50-319, 51367 Kaunas, Lithuania
| | - Saulius Rocka
- grid.6441.70000 0001 2243 2806Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Santariskiu Str. 2, 08661 Vilnius, Lithuania
| | - Aidanas Preiksaitis
- grid.6441.70000 0001 2243 2806Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Santariskiu Str. 2, 08661 Vilnius, Lithuania
| | - Saulius Vosylius
- grid.6441.70000 0001 2243 2806Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Siltnamiu Str. 29, 04130 Vilnius, Lithuania
| | - Solventa Krakauskaite
- grid.6901.e0000 0001 1091 4533Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko Str. 59, 51423 Kaunas, Lithuania
| | - Kristina Berskiene
- grid.45083.3a0000 0004 0432 6841Department of Sports Medicine, Lithuanian University of Health Sciences, Tilzes Str. 18, 47181 Kaunas, Lithuania
| | - Vytautas Petkus
- grid.6901.e0000 0001 1091 4533Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko Str. 59, 51423 Kaunas, Lithuania
| | - Arminas Ragauskas
- grid.6901.e0000 0001 1091 4533Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko Str. 59, 51423 Kaunas, Lithuania
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Hamarat Y, Deimantavicius M, Dambrauskas V, Labunskas V, Putnynaite V, Lucinskas P, Siaudvytyte L, Simiene E, Stoskuviene A, Januleviciene I, Petkus V, Ragauskas A. Prospective Pilot Clinical Study of Noninvasive Cerebrovascular Autoregulation Monitoring in Open-Angle Glaucoma Patients and Healthy Subjects. Transl Vis Sci Technol 2022; 11:17. [PMID: 35138342 PMCID: PMC8842541 DOI: 10.1167/tvst.11.2.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To analyze the cerebrovascular autoregulation (CA) dynamics in patients with normal-tension glaucoma (NTG) and high-tension glaucoma (HTG) as well as healthy subjects using noninvasive ultrasound technologies for the first time. Methods The CA status of 10 patients with NTG, 8 patients with HTG, and 10 healthy subjects was assessed, using an innovative noninvasive ultrasonic technique, based on intracranial blood volume slow-wave measurements. Identified in each participant were intraocular pressure, ocular perfusion pressure, and CA-related parameter volumetric reactivity index (VRx), as well as the duration and doses of the longest cerebral autoregulation impairment (LCAI). In addition, we calculated the associations of these parameters with patients' diagnoses. Results The VRx value, the LCAI dose, and duration in healthy subjects were significantly lower than in patients with NTG (P < 0.05). However, no significant differences were noted in these parameters between healthy subjects and HTG and between NTG and HTG groups. Conclusions NTG is associated with the disturbed cerebral blood flow and could be diagnosed by performing noninvasive CA assessments. Translational Relevance The VRx monitoring method can be applied to a wider range of patient groups, especially patients with normal-tension glaucoma.
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Affiliation(s)
- Yasin Hamarat
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania.,0000-0002-1343-5068
| | - Mantas Deimantavicius
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Vilius Dambrauskas
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Vaidas Labunskas
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Vilma Putnynaite
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Paulius Lucinskas
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Lina Siaudvytyte
- Eye Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Evelina Simiene
- Eye Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | | | - Vytautas Petkus
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Arminas Ragauskas
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
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Petkus V, Kumpaitiene B, Svagzdiene M, Sirvinskas E, Zakelis R, Benetis R, Ragauskas A. Cerebrovascular autoregulation impairments during cardiac surgery with cardiopulmonary bypass are associated with postoperative cognitive deterioration. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Krakauskaite S, Petkus V, Kumpaitiene B, Svagzdiene M, Sirvinskas E, Adomaitiene V, Zakelis R, Chomskis R, Benetis R, Ragauskas A. Postoperative Cognitive Deterioration During Cardiac Surgery with Cardiopulmonary Bypass is Related to Impairments of Cerebrovascular Autoregulation. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Krakauskaite S, Petkus V, Preiksaitis A, Chomskis R, Zubaviciute E, Vosylius S, Rocka S, Rastenyte D, Ragauskas A. Optimal Cerebral Perfusion Pressure Targeted Patient-specific Treatment of Severe TBI in ICU. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Petkus V, Preiksaitis A, Chaleckas E, Chomskis R, Zubaviciute E, Vosylius S, Rocka S, Rastenyte D, Aries MJ, Ragauskas A, Neumann JO. Optimal Cerebral Perfusion Pressure: Targeted Treatment for Severe Traumatic Brain Injury. J Neurotrauma 2019; 37:389-396. [PMID: 31583962 DOI: 10.1089/neu.2019.6551] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Identification of individual therapy targets is critical for traumatic brain injury (TBI) patients. Clinical outcomes depend on cerebrovascular autoregulation (CA) impairment. Here, we compare the effectiveness of optimal cerebral perfusion pressure (CPPopt)-targeted therapy in younger (<45 years of age) and elderly (≥45 years of age) TBI patients. Single-center multi-modal invasive arterial blood pressure(t), intracranial pressure (ICP)(t), cerebral perfusion pressure CPP(t), and CPPopt(t) monitoring (n = 81) was performed. ICM+ software was used for continuous CPPopt(t) status assessment by identification of pressure reactivity index (PRx). The most significant prognostic factors were age, Glasgow Coma Scale, serum glucose, and duration of longest CA ompairment event (LCAI) when PRx(t) >0.5 within 24 h after admission. The modeled accuracies for favorable and unfavorable outcome prediction were 86.5% and 90.9%, respectively. Age above 45 years and averaged ICP during all monitoring time above 21.3 mm Hg was associated with unfavorable outcome of an individual patient. Averaged CPP values close to CPPopt were associated with a better outcome in younger patients. Averaged ΔCPPopt <-5.0 mm Hg, averaged PRx >0.36, and LCAI >100 min were significantly associated with mortality for the younger patients. The critical values of averaged PRx >0.26 and LCAI >61 min were significantly associated with mortality for the elderly group. Autoregulation-guided treatment was important for individual TBI management, especially in younger patients. Further randomized multi-center studies are needed to prove final benefit.
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Affiliation(s)
- Vytautas Petkus
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Aidanas Preiksaitis
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania.,Department of Neurology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of Neurosurgery, Republic Vilnius University Hospital, Vilnius, Lithuania
| | - Edvinas Chaleckas
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Romanas Chomskis
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Erika Zubaviciute
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Saulius Vosylius
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of Neurosurgery, Republic Vilnius University Hospital, Vilnius, Lithuania
| | - Saulius Rocka
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of Neurosurgery, Republic Vilnius University Hospital, Vilnius, Lithuania
| | - Daiva Rastenyte
- Department of Neurology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Marcel J Aries
- Department of Intensive Care, University of Maastricht Medical Center, Maastricht, The Netherlands
| | - Arminas Ragauskas
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Jan-Oliver Neumann
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
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Hamarat Y, Petkus V, Zakelis R, Kumpaitiene B, Svagzdiene M, Sirvinskas E, Krakauskaite S, Ragauskas A, Benetis R. Cerebrovascular autoregulation impairments and postoperative cognitive deterioration after cardiac surgery. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hamarat Y, Preiksaitis A, Kalvaitis E, Petkus V, Lucinskas P, Putnynaite V, Krakauskaite S, Zubaviciute E, Vosylius S, Rocka S, Rastenyte D, Aries J, Neumann J, Ragauskas A. Patient specific TBI patients’ treatment: single center study. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Misiulis E, Džiugys A, Navakas R, Petkus V. A comparative study of methods used to generate the arterial fiber structure in a clinically relevant numerical analysis. Int J Numer Method Biomed Eng 2019; 35:e3194. [PMID: 30817080 DOI: 10.1002/cnm.3194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 02/13/2019] [Accepted: 02/16/2019] [Indexed: 06/09/2023]
Abstract
The advanced constitutive material models of artery wall require the definition of the mean collagen fiber directions in the material configuration. There are several proposed methods; however, it is unclear how much does the fiber structures obtained by these methods differ one from the other and how much this difference may affect the results of the structural analysis of a clinically relevant scenario. Therefore, in this paper, we address this issue by presenting the results of the comparative study of our developed and currently state-of-the-art fiber definition methods. In addition, we present the verification of our developed numerical model that incorporates the extended Holzapfel-Gasser-Ogden (HGO) constitutive material model and the generalized prestressing algorithm (GPA). In the case of the patient-specific internal carotid artery (ICA), the percentage error of the mean fiber directions defined by different methods does not exceed 17.73% (at least 0.05%, at most 81.82%) and has negligible effect on the stress levels, as the percentage error of the mean circumferential Cauchy stress does not exceed 0.1%. Both fiber definition methods produce comparable fiber structure, but our proposed method has an advantage, as it does not depend on method and software used to model the arterial wall mechanics.
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Affiliation(s)
- Edgaras Misiulis
- Laboratory of Combustion Processes, Lithuanian Energy Institute, Kaunas, Lithuania
- Kaunas University of Technology, K. Donelaičio St. 73, 44249, Kaunas, Lithuania
| | - Algis Džiugys
- Laboratory of Combustion Processes, Lithuanian Energy Institute, Kaunas, Lithuania
- Kaunas University of Technology, K. Donelaičio St. 73, 44249, Kaunas, Lithuania
| | - Robertas Navakas
- Laboratory of Combustion Processes, Lithuanian Energy Institute, Kaunas, Lithuania
| | - Vytautas Petkus
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
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Petkus V, Preiksaitis A, Krakauskaite S, Bartusis L, Chomskis R, Hamarat Y, Zubaviciute E, Vosylius S, Rocka S, Ragauskas A. Non-invasive Cerebrovascular Autoregulation Assessment Using the Volumetric Reactivity Index: Prospective Study. Neurocrit Care 2019; 30:42-50. [PMID: 29951960 DOI: 10.1007/s12028-018-0569-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND This prospective study of an innovative non-invasive ultrasonic cerebrovascular autoregulation (CA) monitoring method is based on real-time measurements of intracranial blood volume (IBV) reactions following changes in arterial blood pressure. In this study, we aimed to determine the clinical applicability of a non-invasive CA monitoring method by performing a prospective comparative clinical study of simultaneous invasive and non-invasive CA monitoring on intensive care patients. METHODS CA was monitored in 61 patients with severe traumatic brain injuries invasively by calculating the pressure reactivity index (PRx) and non-invasively by calculating the volumetric reactivity index (VRx) simultaneously. The PRx was calculated as a moving correlation coefficient between intracranial pressure and arterial blood pressure slow waves. The VRx was calculated as a moving correlation coefficient between arterial blood pressure and non-invasively-measured IBV slow waves. RESULTS A linear regression between VRx and PRx averaged per patients' monitoring session showed a significant correlation (r = 0.843, p < 0.001; 95% confidence interval 0.751 - 0.903). The standard deviation of the difference between VRx and PRx was 0.192; bias was - 0.065. CONCLUSIONS This prospective clinical study of the non-invasive ultrasonic volumetric reactivity index VRx monitoring, based on ultrasonic time-of-flight measurements of IBV dynamics, showed significant coincidence of non-invasive VRx index with invasive PRx index. The ultrasonic time-of-flight method reflects blood volume changes inside the acoustic path, which crosses both hemispheres of the brain. This method does not reflect locally and invasively-recorded intracranial pressure slow waves, but the autoregulatory reactions of both hemispheres of the brain. Therefore, VRx can be used as a non-invasive cerebrovascular autoregulation index in the same way as PRx and can also provide information about the CA status encompassing all intracranial hemodynamics.
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Affiliation(s)
- Vytautas Petkus
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania.
| | - Aidanas Preiksaitis
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania.,Department of Neurology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of Neurosurgery, Republic Vilnius University Hospital, Vilnius, Lithuania
| | - Solventa Krakauskaite
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Laimonas Bartusis
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Romanas Chomskis
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Yasin Hamarat
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Erika Zubaviciute
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of Neurosurgery, Republic Vilnius University Hospital, Vilnius, Lithuania
| | - Saulius Vosylius
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of Neurosurgery, Republic Vilnius University Hospital, Vilnius, Lithuania
| | - Saulius Rocka
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of Neurosurgery, Republic Vilnius University Hospital, Vilnius, Lithuania
| | - Arminas Ragauskas
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
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Petkus V, Preiksaitis A, Rocka S, Ragauskas A. Response to Dr. Frederick Adam Zeiler. Neurocrit Care 2018; 29:319. [DOI: 10.1007/s12028-018-0594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Kumpaitiene B, Svagzdiene M, Sirvinskas E, Adomaitiene V, Petkus V, Zakelis R, Krakauskaite S, Chomskis R, Ragauskas A, Benetis R. Cerebrovascular autoregulation impairments during cardiac surgery with cardiopulmonary bypass are related to postoperative cognitive deterioration: prospective observational study. Minerva Anestesiol 2018; 85:594-603. [PMID: 29756691 DOI: 10.23736/s0375-9393.18.12358-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) occurs in approximately 33-83% of patients after cardiac surgery with cardiopulmonary bypass (CPB). Recent clinical data suggest that real-time, intraoperative monitoring of patient-specific cerebrovascular autoregulation (CA) may help to prevent POCD by detecting individual critical limits for mean arterial pressure (MAP) outside which CA is impaired. Objectives of the study were to detect the episodes of impaired CA during cardiac surgery with CPB, and to investigate the association between CA impairment and POCD. METHODS The observational study of non-invasive ultrasonic volumetric CA monitoring included 59 patients undergoing elective coronary artery bypass graft surgery with CPB. All patients underwent series of neuropsychological tests the day before and ten days after the surgery in order to evaluate cognitive function. RESULTS Twenty-two patients (37%) experienced POCD, 37 patients (63%) showed no cognitive deterioration. The duration of the single longest CA impairment event was found reliably associated with occurrence of POCD (P<0.05). The critical duration of the single longest CA impairment event was 5.03 minutes (odds ratio 14.5; CI 3.9-51.8) for studied population. CONCLUSIONS Prospective clinical study showed that single longest CA impairment may result in post-operative deterioration of mental abilities. The duration of the single longest CA impairment event is the risk factor that is associated with POCD.
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Affiliation(s)
| | - Milda Svagzdiene
- Lithuanian University of Health Sciences, Kaunas, Lithuania.,Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Edmundas Sirvinskas
- Lithuanian University of Health Sciences, Kaunas, Lithuania.,Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Vytautas Petkus
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Rolandas Zakelis
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Solventa Krakauskaite
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Romanas Chomskis
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Arminas Ragauskas
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Rimantas Benetis
- Lithuanian University of Health Sciences, Kaunas, Lithuania.,Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Kurganaite J, Ziginskiene E, Petkus V, Chomskis R, Ragauskas A, Bumblyte I. FP439FIRST EXPERIENCE OF NONINVASIVE CEREBROVASCULAR AUTOREGULATION MONITORING IN HEMODIALYSIS PATIENTS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Justina Kurganaite
- Department of Nephrology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Edita Ziginskiene
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Nephrology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vytautas Petkus
- Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Romanas Chomskis
- Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Arminas Ragauskas
- Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Inga Bumblyte
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Nephrology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
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Petkus V, Preiksaitis A, Krakauskaite S, Zubaviciute E, Rocka S, Vosylius S, Rastenyte D, Arminas R. On management of optimal cerebral perfusion pressure in severe traumatic brain injury patients. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Petkus V, Kumpaitiene B, Krakauskaite S, Zakelis R, Svagzdiene M, Sirvinskas E, Chomskis R, Benetis R, Ragauskas A. Continuous non-invasive monitoring of cerebrovascular autoregulation impairments during cardiac surgery with cardiopulmonary bypass in order to protect the brain from postoperative cognitive deterioration. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Svagzdiene M, Kumpaitiene B, Sirvinskas E, Zakelis R, Petkus V, Ragauskas A, Benetis R. Cerebrovascular autoregulation impairment during cardiac surgery is related to postoperative cognitive dysfunction. J Cardiothorac Vasc Anesth 2017. [DOI: 10.1053/j.jvca.2017.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Preiksaitis A, Krakauskaite S, Petkus V, Rocka S, Chomskis R, Dagi TF, Ragauskas A. Association of Severe Traumatic Brain Injury Patient Outcomes With Duration of Cerebrovascular Autoregulation Impairment Events. Neurosurgery 2016; 79:75-82. [DOI: 10.1227/neu.0000000000001192] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Kumpaitiene B, Svagzdiene M, Sirvinskas E, Zakelis R, Petkus V, Chomskis R, Ragauskas A, Benetis R. Disorder of cerebrovascular autoregulation during cardiac surgery with CPB and its relation with the rate of post – operative cognitive dysfunction. J Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/j.jvca.2016.03.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Krakauskaite S, Petkus V, Bartusis L, Zakelis R, Chomskis R, Preiksaitis A, Ragauskas A, Matijosaitis V, Petrikonis K, Rastenyte D. Accuracy, Precision, Sensitivity, and Specificity of Noninvasive ICP Absolute Value Measurements. Acta Neurochir Suppl 2016; 122:317-21. [PMID: 27165929 DOI: 10.1007/978-3-319-22533-3_63] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
An innovative absolute intracranial pressure (ICP) value measurement method has been validated by multicenter comparative clinical studies. The method is based on two-depth transcranial Doppler (TCD) technology and uses intracranial and extracranial segments of the ophthalmic artery as pressure sensors. The ophthalmic artery is used as a natural pair of "scales" that compares ICP with controlled pressure Pe, which is externally applied to the orbit. To balance the scales, ICP = Pe a special two-depth TCD device was used as a pressure balance indicator. The proposed method is the only noninvasive ICP measurement method that does not need patient-specific calibration.
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Affiliation(s)
- Solventa Krakauskaite
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Vytautas Petkus
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Laimonas Bartusis
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Rolandas Zakelis
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Romanas Chomskis
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Aidanas Preiksaitis
- Faculty of Medicine, Clinic of Neurology and Neurosurgery, Vilnius University, Vilnius, Lithuania.,Department of Neurology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Arminas Ragauskas
- Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania.
| | - Vaidas Matijosaitis
- Department of Neurology, Kaunas Clinics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kestutis Petrikonis
- Department of Neurology, Kaunas Clinics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Daiva Rastenyte
- Department of Neurology, Kaunas Clinics, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Petkus V, Krakauskaitė S, Preikšaitis A, Ročka S, Chomskis R, Ragauskas A. Association between the outcome of traumatic brain injury patients and cerebrovascular autoregulation, cerebral perfusion pressure, age, and injury grades. Medicina (B Aires) 2016; 52:46-53. [DOI: 10.1016/j.medici.2016.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/15/2016] [Indexed: 11/24/2022] Open
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Petkus V, Kalasauskienė A, Ragauskas A, Chomskis R, Krutulytė G, Kalasauskas L. Noninvasive monitoring of cerebrovascular autoregulation response to resistance exercises. Medicina (Kaunas) 2012; 48:39-47. [PMID: 22370507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND OBJECTIVE. A novel noninvasive monitor is presented by demonstrating its capabilities to perform the real-time estimation of dynamics in cerebrovascular autoregulation in athletes during their training. The aim was to explore the characteristics of human cerebrovascular autoregulation by performing the monitoring of cerebrovascular autoregulation responses to resistance exercises in healthy volunteer athletes. MATERIAL AND METHODS. Cerebrovascular autoregulation status was monitored in 20 amateur and 20 elite male athletes (weightlifters and bodybuilders) in the supine position at rest during and after the resistance exercises by using a novel noninvasive monitor "Vittamed." Blood pressure and heart rate were also measured noninvasively. During the exercises, the athletes lifted 50 kg and 80% of 1RM (repetition maximum) weights in a dynamic and static manner in separate tests. RESULTS. The cerebrovascular autoregulation reactivity index showed a temporal improvement in the cerebrovascular autoregulation status for almost all sportsmen after the exercises. No disturbances of cerebrovascular autoregulation response occurred in the weightlifters and amateur athletes after the static and dynamic exercises. However, an unstable status of cerebrovascular autoregulation was observed for the elite bodybuilders during the interval of 400 to 600 s after the exercises. CONCLUSIONS. The data of this study demonstrated significant differences in cerebrovascular autoregulation response to the resistance exercises between the elite bodybuilders and other subjects (amateurs and weightlifters) - a temporarily unstable status of cerebrovascular autoregulation was observed in the group of elite bodybuilders. This study also demonstrated the applicability of the noninvasive device for exploring the physiology of cerebrovascular autoregulation mechanism in elite athletes and healthy volunteers.
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Ragauskas A, Daubaris G, Petkus V, Sliteris R, Raisutis R, Piper I, Rocka S, Jarzemskas E, Matijosaitis V. Clinical study of craniospinal compliance non-invasive monitoring method. Acta Neurochir Suppl 2008; 102:165-169. [PMID: 19388310 DOI: 10.1007/978-3-211-85578-2_33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND The ability to quantify non-invasively the effect of posture on intracranial physiology by using cine phase-contrast MRI may lead to the development of new diagnostic tests to evaluate such functions as regulation of CBF and ICP, and the effect of pathologies on these functions. METHODS Results similar to MRI technology can be obtained using non-invasive ultrasonic method (Vittamed) for intracranial blood volume pulse wave (IBVPW) measurement and intracraniospinal compliance (ICC) monitoring. FINDINGS IBVPW have been investigated in supine and upright positions of healthy volunteers using Vittamed technology. A group of 13 healthy volunteers (nine females, four males, mean age 25.1 +/- 3.4) was studied. More than 3,000 IBVPW were analysed in order to show the difference of shape and amplitude in supine and upright positions. Averaged shape of ten IBVPW waves was presented in the normalized window with dimensions 1.0 x 1.0. CONCLUSIONS The results show significant difference between averaged IBVPW shapes in upright (highest intracraniospinal compliance) and supine (lower intracraniospinal compliance) body positions. Body posture caused IBVPW subwave P2 and P3 changes deltaP2 = 18% and deltaP3 = 11%. Amplitude of IBVPW in upright body position was significantly higher than in the supine one. The value of IBVPW amplitude's ratio in supine and upright positions was 1.55 +/- 0.61.
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Affiliation(s)
- A Ragauskas
- Telematics Scientific Laboratory, Kaunas University of Technology, Studentu 50-451a, LT-51368 Kaunas, Lithuania.
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Ragauskas A, Daubaris G, Petkus V, Ragaisis V, Ursino M. Clinical study of continuous non-invasive cerebrovascular autoregulation monitoring in neurosurgical ICU. Acta Neurochir Suppl 2005; 95:367-70. [PMID: 16463883 DOI: 10.1007/3-211-32318-x_75] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Ultrasonic "time-of-flight" monitor (Vittamed) was used for continuous monitoring of intracranial blood volume (IBV) pulse, respiratory, slow waves and cerebrovascular autoregulation (CA). The objectives are to compare of invasively and non-invasively monitored slow intracranial waves and CA of ICU patients and to evaluate the phase shift between ABP and IBV respiratory waves as a possible estimator of CA. CA monitoring has been performed in 13 patients with severe TBI (age mean/range 30.5/(18-64)). Data were collected from 87 one-hour sessions of simultaneous invasive and non-invasive wave monitoring and from 53 one-hour sessions of invasive and non-invasive CA monitoring. High correlation (R > 0.9) has been obtained between invasively and non-invasively recorded intracranial slow waves. Bland Altman difference between invasively and non-invasively recorded intracranial slow waves is clinically not significant (mean =-0.07, SD = 0.089, alpha = 0.05). Agreement has been confirmed between invasive and non-invasive CA monitoring data in a wide range of R = [-0.85; +0.96]. Hypothesis of the coincidence of invasive and non-invasive CA assessment is accepted (p < 0.05). Phase shift monitoring of permanent respiratory ABP waves and IBV waves permit continuous non-invasive CA estimation without unnatural physical or pharmacological stimulations of CA system.
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Affiliation(s)
- A Ragauskas
- Kaunas University of Technology, Kaunas, Lithuania.
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Abstract
The paper presents innovative methods and technology for non-invasive intracranial hemodynamics monitoring based on the measurement of brain parenchyma acoustic properties. The clinical investigation of new technology shows the similarity between the invasively recorded intracranial pressure (ICP) and non-invasively recorded intracranial blood volume (IBV) pulse waves, slow waves and slow trends under intensive care unit (ICU) conditions. Also, the applicability of the non-invasive IBV slow wave monitoring technique for cerebrovascular autoregulation non-invasive long-term monitoring is demonstrated by theoretical and experimental studies.
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Affiliation(s)
- Arminas Ragauskas
- Kaunas University of Technology, Telematics Scientific Laboratory, Studentu 50 448, Kaunas 3031, Lithuania.
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Abstract
The objectives are to investigate the peculiarities of the ultrasound pulse propagation through human extra/intracranial media by mathematical simulation and to confirm the simulation results experimentally by proving the suitability of the ultrasonic time-of-flight measurement method for human intracranial media (IM) physiological non-invasive monitoring. The mathematical model of ultrasound pulse propagation through the human extra/intracranial media is described. The simulation of various physiological phenomena were performed to determine the relationship between the characteristics of the transmitted ultrasound pulse through the human head and the acoustic properties of the IM. It is shown that non-invasive monitoring of the IM acoustic properties is possible by measuring the changes of the ultrasonic signal time-of-flight and the oscillation period. The influence made by variations in acoustic parameters of the external tissue/skull bones on the non-invasive measurement data is investigated and methods of compensation of that influence are presented. The models were applied for developing of a new non-invasive sonographic intracranial pressure (ICP) monitor (Vittamed). Comparative studies of this monitor with the invasive ICP monitor (Camino) have shown the possibility of achieving clinically acceptable accuracy of the long term non-invasive ICP monitoring of head injured patients in intensive care units.
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Affiliation(s)
- Vytautas Petkus
- Telematics Scientific Laboratory, Kaunas University of Technology, Lithuania
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