Arterial Blood Inflow Research Articles

Tissue oxidative metabolism and microhemodynamics of the skin in rats exposed to stress factors of different durations and combinations

BACKGROUND: Changes in tissue oxidative metabolism under the action of stressors of different durations have not been studied. The relationship between NADH and FAD coenzymes and the microcirculatory bed remains unclear.
 AIM: This study aimed to identify the features of the reaction of skin microhemodynamics and tissue oxidative metabolism in rats exposed to acute and chronic stress factors of different durations and their combinations.
 MATERIALS AND METHODS: The experiment was performed on 100 male Wistar rats weighing 200–220 g. The animals were divided into five groups of 20 rats. The first control group and the second and third groups were exposed to acute stress (AS) and chronic hypokinetic stress (HS), respectively; the fourth group (AS-HS) was previously exposed to AS (on the first day) and then to HS (1–10 days); and the fifth group (for 10 days of the HS, then the effect of the AS on day 10). On day 10, the indicators of tissue oxidative metabolism and skin microhemodynamics were recorded.
 RESULTS: AS and HS increased the requirement of cells for ATP and contributed to the predominance of oxidative phosphorylation over other processes, as indicated by an increase in FAD. AS-HS significantly changed oxidative metabolism, separating oxidative phosphorylation and activating glycolysis. HS-AS did not cause such changes. AS increased the microcirculation index and reduced the coefficient of variation, and HS reduced the microcirculation index and increased the mean square deviation. AS–HS significantly increased the microcirculation index, and HS-AS increased the mean square deviation and coefficient of variation but reduced the microcirculation index.
 CONCLUSIONS: AS and HS increase the requirement of cells for ATP and contribute to the predominance of oxidative phosphorylation over other processes. AS-HS modifies oxidative metabolism by disconnecting oxidative phosphorylation and activating glycolysis. HS-AS depletes the metabolic reserves of the body. AS-HS rearranges metabolism along the path of glycolysis, protecting against stress factors and preventing the development of oxidative stress. AS leads to hyperemia and stasis of blood circulation in the microarray, reducing the vasomotor activity of the vessels. HS inhibits the level of tissue perfusion and reduces the inflow of arterial blood into the microcirculatory bed and the outflow of venous blood, leading to spastic, stagnant phenomena and stasis. AS-HS reduces vasoconstriction, preparing a microcirculatory bed for prolonged hypokinesia. HS-AS levels vasodilation and improves the parameters of skin microhemodynamics (mean square deviation and coefficient of variation).

Recent insights into mechanisms of hypoxia-induced vasodilatation in the human brain.

The cerebral vasculature manages oxygen delivery by adjusting arterial blood in-flow in the face of reductions in oxygen availability. Hypoxic cerebral vasodilatation, and the associated hypoxic cerebral blood flow reactivity, involve many vascular, erythrocytic and cerebral tissue mechanisms that mediate elevations in cerebral blood flow via micro- and macrovascular dilatation. This contemporary review focuses on in vivo human work - with reference to seminal preclinical work where necessary - on hypoxic cerebrovascular reactivity, particularly where recent advancements have been made. We provide updates with the following information: in humans, hypoxic cerebral vasodilatation is partially mediated via a - likely non-obligatory - combination of: (1) nitric oxide synthases, (2) deoxygenation-coupled S-nitrosothiols, (3) potassium channel-related vascular smooth muscle hyperpolarization, and (4) prostaglandin mechanisms with some contribution from an interrelationship with reactive oxygen species. And finally, we discuss the fact that, due to the engagement of deoxyhaemoglobin-related mechanisms, reductions in O2 content via haemoglobin per se seem to account for ∼50% of that seen with hypoxic cerebral vasodilatation during hypoxaemia. We further highlight the issue that methodological impediments challenge the complete elucidation of hypoxic cerebral reactivity mechanisms in vivo in healthy humans. Future research is needed to confirm recent advancements and to reconcile human and animal findings. Further investigations are also required to extend these findings to address questions of sex-, heredity-, age-, and disease-related differences. The final step is to then ultimately translate understanding of these mechanisms into actionable, targetable pathways for the prevention and treatment of cerebral vascular dysfunction and cerebral hypoxic brain injury.

Spontaneous Intrinsic Hepatic Vascular Oscillations

The liver is well known as a large blood reservoir that can shift both stressed and unstressed volumes passively and actively in response to changes in portal venous and hepatic arterial blood flow, inflow and outflow blood pressures, autonomic nervous stimulation, and various humoral and pathophysiological factors. Not described is the characteristic of the liver to intrinsically modulate its own vascular pressure and volume independent of extrinsic factors.METHODSMale Holtzman rats (n=5) were anesthetized (30 mg/kg sodium pentobarbital, i.p.) and heparinized (500 IU/kg, i.v.), the portal vein and inferior vena cava were isolated and cannulated, the liver was flushed with room temperature normal saline, and the liver quickly removed. Each liver was mounted on a scale in a 37°C chamber (95% O2‐5% CO2) and pump‐perfused (Masterflex) with donor rat blood at a baseline 1 ml/min/g of tissue. The hepatic venous pressure (Phv) was regulated by raising and lowering the blood reservoir. At each Time (see table), portal venous oscillations were counted over 3 to 12 min and the portal venous wavelet pulse pressures (Ppv) were measured over at least 40 wavelets.RESULTSThe portal venous pressures of 3 of the 5 livers oscillated spontaneously. One lasted only 26 min while the others went on for over 200 min. The characteristics of these oscillations varied widely from animal to animal, but there usually was an irregular cycle length and uneven wavelet magnitude that tended to degrade to a diminished size with higher frequency over time (see Figure 1). Rat Time (Min) Maneuver Mean Portal Venous Pulse Pressure (mmHg) Frequency (Wavelets/Min) Frequency (Hz) Cycle Length (Sec) 1 0 Baseline 2.1 ± 0.9 (SD) 8.08 0.135 7.42 95 Baseline 1.5 ± 0.8 16.10 0.268 3.73 107 Change Phv 2.5 ± 1.3 17.00 0.283 3.53 (0 to 10 mmHg) (P<0.001 vs. 95 Min Baseline) 180 Baseline 1.3 ± 0.5 18.67 0.311 3.21 2 0 Baseline 0.8 ± 0.4 14.42 0.240 4.16 60 Baseline 0.4 ± 0.3 20.00 0.333 3.00 130 Baseline 0.4 ± 0.2 23.78 0.396 2.52 3 0 Baseline 0.6 ± 0.3 8.67 0.144 6.92 CONCLUSIONSThis is a very limited data set, providing more questions than answers, but it opens a curiosity to much more investigation to understand the function of these intrinsic hepatic vascular oscillations under normal, reflex, and pathophysiological conditions.

Sex features of cutaneous microvasculature in healthy working-age people

Aim. To study sex characteristics of cutaneous microvascular structure and function in a cohort of healthy working-age people without cardiovascular diseases.Material and methods. The study included 35 healthy men (42±4 years) and 34 women (41 ±5 years). The cardiovascular system was assessed in all patients. The microcirculatory bed of the skin was investigated by the following non-invasive methods: 1) computerized video capillaroscopy; 2) laser Doppler flowmetry; 3) photoplethysmography.Results. According to computerized video capillaroscopy in men, compared with women, there was a smaller number of both functioning capillaries (78 vs 86 capillaries/mm2, respectively (p<0,05)) and their total number (100 vs 120 capillaries/mm2, respectively (p<0,001)). Against the background of a decrease in capillary density in men, there was a higher skin interstitial hydration — 113 vs 96 gm (p<0,005) in men than in women. At the level of precapillary arterioles, where humoral tone regulation prevails. Laser Doppler flowmetry revealed lower pulse amplitude in men than in women — 0,87 vs 1,02 pf, respectively (p<0,05), which indicates a lower arterial blood inflow to exchange microvessels. Against this background, the constrictor response of precapillary arterioles to a sympathetic nervous system stimulation in men is higher than in women — 45% vs 40%, respectively (p<0,05). At the level of large arterioles, where neural tone regulation prevails, photoplethysmography revealed lower augmentation index standardized at a heart rate in men (-4,6 vs 1,7%, respectively, p<0,05), which indicates lower rigidity of muscular vessels in men.Conclusion. In working-age healthy people, sex differences are noted at all cutaneous microvascular levels, which must be taken into account when planning studies.

Role of Triphasic CT in Evaluation of Causes and Hemodynamics of Transient Hepatic Attenuation Difference

Background:THAD is important sign of underlying liver disorder. Purpose:To evaluate role of triphasic CT in detecting causes and hemodynamics of transient hepatic attenuation difference that is important sign of an underlying liver disorder. Patients and methods:We retrospectively evaluated 40 patients with THAD, their age ranges were from 25-75 years old. The study was done over a period of 24 months (Jan 2018–Dec 2019), for each patient triphasic CT liver examination was performed, during the arterial, portal and delayed phases. We assessed attenuation of THAD area in different phases, morphology, relation to focal lesions and etiopathogenesis of THAD. Results: 27/40 patients with THAD presented with hyperdensity in the arterial phase and become isodense to the normal liver parenchyma in other phases, 3/40 patients with THAD presented with hyperdensity in the arterial phase, persist in the porto-venous phase and become isodense in the delayed phase. Different morphology of THAD was detected as follow; sectorial pattern (32), polymorphous pattern (5), diffuse (2) and multi-segmental THADs (1). 28/40 patients with THAD are related to focal lesion and12/40 patients with THAD unrelated to focal lesion. We detected etiopathogenesis of THAD as follow; 35/40 patients with THAD was due to portal hypoperfusion, 4/40 was due to primary increase arterial blood inflow and 1/40 was cryptogenic. Conclusion: THADs are benign entities associated to focal lesions or other diseases of the liver, radiologists should be familiar with it to avoid false-positive diagnosis of pseudo lesions and not to overestimate the extent of the disease.

The Effects of Hypocapnia on Brain Tissue Pulsations.

Hypocapnia is known to affect patients with acute stroke and plays a key role in governing cerebral autoregulation. However, the impact of hypocapnia on brain tissue pulsations (BTPs) is relatively unexplored. As BTPs are hypothesised to result from cerebrovascular resistance to the inflow of pulsatile arterial blood, it has also been hypothesised that cerebral autoregulation changes mediated by hypocapnia will alter BTP amplitude. This healthy volunteer study reports measurements of BTPs obtained using transcranial tissue Doppler (TCTD). Thirty participants underwent hyperventilation to induce mild hypocapnia. BTP amplitude, EtCO2, blood pressure, and heart rate were then analysed to explore the impact of hypocapnia on BTP amplitude. Significant changes in BTP amplitude were noted during recovery from hypocapnia, but not during the hyperventilation manoeuvre itself. However, a significant increase in heart rate and pulse pressure and decrease in mean arterial pressure were also observed to accompany hypocapnia, which may have confounded our findings. Whilst further investigation is required, the results of this study provide a starting point for better understanding of the effects of carbon dioxide levels on BTPs. Further research in this area is needed to identify the major physiological drivers of BTPs and quantify their interactions with other aspects of cerebral haemodynamics.

318 Retrospective Review of Improvement of Erectile Function after Low Intensity Shockwave Treatment with Urogold 100™

Erectile dysfunction (ED) can result from insufficient arterial blood inflow and/or from veno-occlusive dysfunction from reduced erectile tissue expandability secondary to erectile tissue fibrosis. Non-surgical strategies to manage ED in the United States (US) are primarily symptomatic-based, such as PDE5 inhibitors and/or intracavernosal injections. In Europe, disease modification strategies such as Low Intensity Shockwave Treatment (LiSWT) using energy levels 0.09 – 0.12 mJ/mm2 have shown, in multiple sham-controlled prospective studies, significant improvement in both ED outcome measures and blood inflow. The European Urological Association lists Li-SWT as a recognized ED treatment. The Urogold 100™ is an electrohydraulic shockwave device that generates energy levels such as 0.09 – 0.12 mJ/mm2 with a unique parabolic reflector. It is FDA-cleared for improved blood flow and connective tissue activation as non-significant risk in humans. The objective was to perform a single site retrospective chart review of the outcome of ED treatment with the Urogold 100™ shockwave device.

REGULATION OF MICROCIRCULATION DURING REMODELING OF SKIN SCAR UNDER INFLUENCE OF LASER

An experimental study was fulfilled on 15 laboratory mail rats. After normotrophic skin scar modeling, the scar tissue was once exposed to high-intensive red, near or far infrared laser in comparable modes. Microcirculation parameters were assessed with laser Doppler flowmetry. It was found that the nature of microcirculation response to high-intensive laser irradiation substantially depended on the laser wavelength and its penetrating depth. Laser resurfacing of the skin scar with CO2 laser in early period led to blood stasis in the vessels and decrease in the vascular wall tone against the background of sympathetic influence increase. The red and near-infrared lasers caused the increased arterial blood inflow and venular outflow, with local regulation by myogenic tone prevailing.

Validation of a mathematical model for understanding intracranial pressure curve morphology

The physiology underlying the intracranial pressure (ICP) curve morphology is not fully understood. Recent research has suggested that the morphology could be dependent on arterial cerebral inflow and the physiological and pathophysiological properties of the intracranial cavity. If understood, the ICP curve could provide information about the patient’s cerebrovascular state important in individualizing treatment in neuro intensive care patients. A mathematical model based on known physiological properties of the intracranial compartment was created. Clinical measurements from ten neuro intensive care patients in whom intracranial arterial blood inflow, venous blood outflow and cerebrospinal fluid flow over the foramen magnum had been measured with phase contrast MRI, concomitant with ICP measurements were used to validate the model. In nine patients the mathematical model was able to create an ICP curve mimicking the measured by using arterial intracranial inflow and adjusting physiological parameters of the model. The venous outflow and cerebrospinal fluid (CSF) flow over the foramen magnum predicted by the model were within physiologically reasonable limits and in most cases followed the MRI measured values in close adjunct. The presented model could produce an ICP curve in close resemblance of the in vivo measured curves. This strengthens the hypothesis that the ICP curve is shaped by the arterial intracranial inflow and the physiological properties of the intracranial cavity.

MOST IMPORTANT CELLULAR CHANGES INVOLVED IN RENAL ISCHEMIA REPERFUSION INJURY AND THE CONSEQUENT IMPACT ON SELECTED REMOTE ORGANS

Because of the high rate of baseline oxygen use by renal cells, kidney is highly influenced by obstruction of arterial blood inflow and subsequent shortage of the received oxygen, this condition is known as Ischemic injury. There are many clinical settings associated with unavoidable ischemic state such as kidney transplantation, partial nephrectomy or suprarenal procedures of the aorta. During ischemia many cellular changes occur including vascular congestion and adhesion of inflammatory cells to the endothelium with subsequent infiltration into the kidney tissue. Following ischemia, a phase known as Reperfusion begins andinvolves a return of blood and oxygen supply to micro vessels. Reperfusion was expected to restore the damage occurred during the ischemic phase, paradoxically, reperfusion leads to more congestion, red cells trapping and excessive generation of reactive oxygen species (ROS), which can oxidatively modify significantly every type of biomolecule, thereby inducing cell dysfunction and induce reperfusion injury. Ischemia reperfusion injury (IRI) is also related to a phenomenon called Remote Organ Injury (ROI) in which the damaging effect induced by I/R is not only restricted to the tissue that undergoing the initial ischemia but alsoit leads to injury to remote organs such as the liver, lung, gut. ROI usually occurs by the same mechanisms seen in the local injury induced by I/R including the generation of ROS, leukocytes, and inflammatory mediators (e.g; TNF-α). These substances are directly released from the primary injured tissue or indirectly from activated leukocytes or other inflammatory cells causing organ dysfunctions in distant organs. Peer Review History: Received 3 March 2018; Revised 8 March; Accepted 11 March, Available online 15 March 2018 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 8.5/10 Reviewer(s) detail: Dr. Francis Adou Yapo, Felix Houphouet Boigny, University of Abidjan, Ivory Coast, fyapo@yahoo.fr Dr. Fatima Morales Marin, University of Murcia, Spain, fatima.morales@um.es This article has been cited by: Dalia Ibrahim Ismail email orcid ; Alshaymaa Gamal Aboulkhair. The Effect of Aliskiren on Renal Cortical Ischemia/Reperfusion Injury in Albino Rats: A Histological and Immunohistochemical Study. Article 6, Volume 42, Issue 4, Autumn 2020, Page 838-848. Pubmed

An Integrated Software Application for Non-invasive Assessment of Local Aortic Haemodynamic Parameters

Non-invasive assessment of haemodynamic data, such as pressure and flow profiles, is helpful in detecting cardiac disease at an early stage. However, current methods lack spatial accuracy and do not take local variations into account. This paper presents a software tool that extracts the arterial geometry and blood inflow profiles from MR images, which are subsequently used to run a 1D haemodynamic simulation model, and displays its output. The workflow is highly automated but allows user-interaction to correct inaccuracies. The tool was evaluated for inter-observer agreement on one healthy volunteer, and results are shown for one patient with an aortic coarctation. The resulting haemodynamic parameters show high agreement between different users and reveal local changes within a coarctation patient.

Cerebrovascular time constant in patients suffering from hydrocephalus

Objectives: We studied possible link between cerebrospinal fluid (CSF) compensation and indices describing pulsatile inflow of cerebral arterial blood.Methods: A total of 50 infusion tests performed in patients with symptoms of normal pressure hydrocephalus (NPH) were examined retrospectively. Waveforms of CSF pressure, noninvasive arterial blood pressure (ABP), and transcranial Doppler (TCD) cerebral blood flow velocity (CBFV) were used to estimate relative changes in cerebral arterial compliance (Ca) and cerebrovascular resistance (CVR). Product of Ca and CVR, called cerebral arterial time constant (τ, unit: seconds), was calculated at the baseline and plateau phase of the test and compared with CSF compensatory parameters such as resistance to CSF outflow, elasticity, slope of amplitude–pressure line, and pulse amplitude of CSF pressure.Results: Neither of CSF compensatory parameters correlated with hemodynamic indices. However, the change in cerebral perfusion pressure (CPP) provoked change in τ (R = 0·33; P = 0·017) secondary to a change in CVR (R = 0·81; P < 0·0001). Changes in CVR and Ca had a reciprocal character (R = −0·64; P < 0·0001) with magnitude of variation in CVR (68%) prevailing over magnitude of changes in Ca (49%).Discussion: Hemodynamics of pulsatile inflow of cerebral arterial blood assessed by cerebral arterial time constant is not directly linked to dynamics of CSF circulation and pressure–volume compensation but is sensitive to changes in CPP during infusion test.

Insights Into Cerebrospinal Fluid and Cerebral Blood Flows in Infants and Young Children

This study investigates the craniospinal flows of blood and cerebrospinal fluid using phase-contrast magnetic resonance imaging (MRI) on 23 control neonates and infants (5 d-68 mo old). Mean arterial cerebral blood flow increased with age of infant from 180 mL/min after birth to 1330 mL/min around 6 years of age. This corresponds to 51 mL/min/100 g and 95 mL/min/100 g, respectively. Cervical cerebrospinal fluid stroke volume increased from 38 × 10(-3) mL to 752 × 10(-3) mL per cardiac cycle. After arterial systolic blood inflow, we observed a delay of the venous outflow that was always preceded by cerebrospinal fluid flushing out through the spinal canal. These results highlighted the importance of compliance of the spinal compartment and the interaction of blood and cerebrospinal fluid dynamics. The capacity of the spinal compartment to receive intracranial cerebrospinal fluid in presence of fontanels was demonstrated. We provide reference values to understand the physiology of cerebrospinal fluid and cerebral blood.

Assessment of Perfusion Deficits in Ischemic Stroke Using 3D‐GRASE Arterial Spin Labeling Magnetic Resonance Imaging with Multiple Inflow Times

Arterial spin labeling (ASL) MRI provides information on tissue perfusion by consecutive readout of labeled blood captured in arteries or the microvasculature without using contrast agents. We used a single-shot 3D acquisition and readout technique for ASL with multiple inflow times (TI) to evaluate hemodynamic compromise and dynamics of arterial blood inflow expressed by the bolus arrival time (BAT). Thirty-six patients with ischemic stroke were examined with a standard multimodal MRI protocol including dynamic susceptibility contrast (DSC) and multi-TI ASL perfusion imaging. Time-to-peak maps were used to classify hemodynamic impairment as either hypo- or hyperperfusion. Overall there was a good agreement of ASL perfusion maps with DSC perfusion imaging on visual analysis. Correlations were found between ASL-BAT/(DSC-)Mean transit time (MTT) (r = .416; P < .01) and ASL-CBF/MTT (r = -.489; P < .01). Using ASL, BAT in ischemic territory was delayed by 55% (P = .001) in patients with hypoperfusion (n = 28); CBF was reduced by 39% (P<.001). All patients with hyperperfusion (n = 6) had higher CBF on ASL. The use of ASL with multiple TI allows the contrast-free assessment of hemodynamic impairment in ischemic stroke patients. Quantitative ASL perfusion analysis reliably demonstrates areas of delayed BAT and reduced CBF matching findings of DSC.

Intraoperative Imaging of Nipple Perfusion Patterns and Ischemic Complications in Nipple-Sparing Mastectomies

Nipple-sparing mastectomies (NSM) have gained acceptance in the field of breast oncology. Ischemic complications involving the nipple-areolar complex (NAC) occur in 3-37 % of cases. Skin perfusion can be monitored intraoperatively using indocyanine green (IC-GREEN™, ICG) and a specialized infrared camera-computer system (SPY Elite™). The blood flow pattern to the breast skin and the NAC were evaluated and a classification scheme was developed. Preincision baseline and postmastectomy skin perfusion studies were performed intraoperatively using 3 mL of ICG. The pattern of arterial blood inflow was classified according to whether perfusion appeared to originate predominantly from the underlying breast tissue (V1), the surrounding skin (V2), or a combination of V1 and V2 (V3). Ischemia, resection, or delayed complications of NAC were recorded. Thirty-nine breasts were interrogated. Seven (18 %) demonstrated a V1 pattern, 18 (46 %) a V2 pattern, and 14 (36 %) a V3 pattern. Seven (18 %) NACs were removed; six intraoperatively and the seventh in a delayed fashion. Notably, five of the seven resected NACs had a V1 pattern. Overall, 71 % of all V1 cases demonstrated profound ischemic changes by intraoperative clinical judgment and SPY imaging. The rates of resection of the NAC differed significantly between perfusion patterns (Fisher's exact test, p = 0.0003). Three perfusion patterns for the NAC are defined. The V1 pattern had the highest rate of NAC ischemia in NSM. Imaging NAC and skin perfusion during NSMs is a useful adjunctive tool with potential to direct placement of mastectomy incisions and minimize ischemic complications.

Calf muscle stimulation with the Veinoplus device results in a significant increase in lower limb inflow without generating limb ischemia or pain in patients with peripheral artery disease

Increase in arterial inflow to the lower limbs is important to obtain functional improvement in peripheral artery disease (PAD) patients with claudication. The aim of this study was to assess the effect of electrical stimulation of calf muscles on arterial inflow and tissue oxygen content in PAD in the area of stimulation. Fifteen adult patients [mean (standard deviation) age, 62 (12 ) years; height, 165 (8)cm; weight, 76 (13) kg; lowest ankle-brachial index 0.66 (0.19)] with stable arterial claudication were recruited. All patients performed a treadmill test (3.2 km/h, 10% slope) associated with a transcutaneous oximetry test expressed as decrease from rest of oxygen pressure (DROP) index values (calf changes minus chest changes from rest) with a maximum walking distance (median [25th/75th percentiles]) of 295[133-881] m. The DROP index on the symptomatic side was -25 [-18/-34] mm Hg. On another daythe patients underwent electrical stimulation in the seated position on the leg that was the most symptomatic on the treadmill. After resting values were recorded, the gastrocnemius was stimulated for 20minutes at increasing contraction rates at 5-minute steps of 60, 75, 86, and 100bpm on the most symptomatic side. Arterial blood inflow with duplex Doppler ultrasound scanning of the femoral artery, DROP transcutaneous oxygen pressure value, and oxygen concentration (O2Hb) from the near-infrared spectroscopic signal of the calf were recorded on both sides. Patients were instructed to report eventual contraction-induced pain in the stimulated calf. Results are given as mean (standard deviation) or median [25th/75th percentiles] according to distribution, and the level of statistical significance was set at P< .05 on two-tailed tests. Lower limb inflow (mL/min) was 64 [48/86] vs 63 [57/81] (P> .05) before stimulation, 123 [75/156] vs 57 [44/92] (P< .01) at 60bpm, 127 [91/207] vs 49 [43/68] (P< .01) at 75bpm, 140 [84/200] vs 57 [45/71] (P< .01) at 86bpm, and 154 [86/185] vs 55 [46/94] (P< .01) at 100bpm on the stimulated vs nonstimulated limb, respectively. No apparent decrease or significant leg difference was observed in DROP index or O2Hb values. None of the patients reported contraction-induced pain in the leg. Electrical stimulation of calf muscle with the Veinoplus device results in a significant increase of arterial inflow without measurable muscle ischemia or pain. Potential use of this device as an adjuvant treatment to improve walking capacity in PAD patients remains to be evaluated.

Cerebral circulation, neurological and neuropsychological disorders in idiopathic arterial hypotension

Objective: to evaluate the cerebral circulation in idiopathic arterial hypotension (IAH) in relation to neurological and neuropsychological disorders. Patients and methods. Sixty-five patients (mean age 40.2 [8, 14] years) with prolonged IAH were examined. Neuropsychological examination was made using the procedure adapted by A.R. Luria; different psychic functions (memory, speech, gnosis, praxis, thinking, attention, counting, writing, and reading) were studied. Cerebral hemodynamics was investigated using duplex scanning of the brachiocephalic arteries (BCA), middle cerebral arteries (MCA), internal jugular (IJV) and vertebral veins (VV). The patients were assigned to 2 groups: 1) 19 (29%) patients with somatoform disorders, 2) 46 (71%) patients with signs of the initial manifestations of chronic cerebrovascular insufficiency. Group 2 patients were older and had a longer history of IAH. Results. In all the patients, cerebral blood supply in the carotid system showed moderately lower arterial blood inflow with a compensatory vascular resistance decrease and balanced venous outflow reduction with increased vascular resistance. Group 2 patients had a substantial (to the lower normal range) blood flow decline in the vertebral artery along with increased peripheral resistance in the VV. The degree of neuropsychological derangement was inversely proportional to blood flow velocity in BCA and MCA and to blood outflow in IJV and VV.

2308 INVESTIGATION OF THE MORPHOLOGICAL CHANGES IN PENILE ERECTION AND PENILE ARTERIAL INFLOW USING TURBO-FLASH MRI

You have accessJournal of UrologyImaging/Radiology: Uroradiology1 Apr 20112308 INVESTIGATION OF THE MORPHOLOGICAL CHANGES IN PENILE ERECTION AND PENILE ARTERIAL INFLOW USING TURBO-FLASH MRI Jintetsu Soh, Yoshio Naya, Atsushi Ochiai, Yasuyuki Naitoh, Noriyuki Kanemitsu, Kazumi Kamoi, kawauchi Akihiro, and tsuneharu Miki Jintetsu SohJintetsu Soh Kyoto, Japan More articles by this author , Yoshio NayaYoshio Naya Kyoto, Japan More articles by this author , Atsushi OchiaiAtsushi Ochiai Kyoto, Japan More articles by this author , Yasuyuki NaitohYasuyuki Naitoh Kyoto, Japan More articles by this author , Noriyuki KanemitsuNoriyuki Kanemitsu Kyoto, Japan More articles by this author , Kazumi KamoiKazumi Kamoi Kyoto, Japan More articles by this author , kawauchi Akihirokawauchi Akihiro Kyoto, Japan More articles by this author , and tsuneharu Mikitsuneharu Miki Kyoto, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2554AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To date, there are no reports concerning real-time imaging analysis of penile erection from the beginning to complete erection, and from sustained erection till the end of erection. The objectives of this study were to observe the morphological changes in normal penile erection chronologically from the beginning to complete erection, and till the end of erection, and to evaluate the required penile arterial inflow for normal erection, using Turbo-FLASH magnetic resonance imaging (MRI) by taking continuous high resolution images without stopping movement for real-time imaging analysis. METHODS The study subjects were 10 volunteers aged 22 to 47 years (median: 31 years) who gave written informed consents. Erection was induced by visual arousal stimulation using videos. Imaging devices and their conditions (1) MRI: MAGNETOM Sonata 1.5T, Siemens AG; (2) Coil: Body Array Coil and Spine Coil; (3) Imaging sequence: True FISP sequence; and (4) Imaging conditions: Repetition Time (TR): 4.38 milliseconds, Echo Time (TE): 2.19 milliseconds, Scan Time: 0.85 seconds/slice. Morphological analysis Using static images and dynamic images, the extensions of caverns of the corpora cavernosa and tunica albuginea were analyzed to evaluate the morphological changes of normal penile erection chronologically under MRI observation (Figure 1). Evaluation of arterial blood inflow into corpora cavernosa The area and volume change ratios of the corpora cavernosa, such as volume change in 1 second, were evaluated. RESULTS The duration from the beginning to complete erection ranged from 110 to 120 seconds (median: 116 seconds) in 5 volunteers who achieved complete erection. The volume changes in the corpora cavernosa from baseline and the maximum change ratio in 1 second ranged from 28 to 35 mL (median: 32 mL), and from 0.5 to 0.8 mL/sec (median: 0.6 mL/sec), respectively (Figure 2). On the other hand, in the other 5 volunteers with incomplete erection, the volume changes in the corpora cavernosa from baseline and the maximum change ratio in 1 second ranged from 5 to 17 mL (median: 12 mL), and from 0.1 to 0.3 mL/sec (median: 0.2 mL/sec), respectively. CONCLUSIONS Using Turbo-FLASH MRI, real-time imaging analysis of the erectile function was performed, which enabled to evaluate the duration from the beginning to complete erection, the required arterial blood inflow into the corpora cavernosa for complete erection and the volume change ratio in 1 second. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e925-e926 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jintetsu Soh Kyoto, Japan More articles by this author Yoshio Naya Kyoto, Japan More articles by this author Atsushi Ochiai Kyoto, Japan More articles by this author Yasuyuki Naitoh Kyoto, Japan More articles by this author Noriyuki Kanemitsu Kyoto, Japan More articles by this author Kazumi Kamoi Kyoto, Japan More articles by this author kawauchi Akihiro Kyoto, Japan More articles by this author tsuneharu Miki Kyoto, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Determination of comprehensive arterial blood inflow in abdominal-pelvic organs: Impact of respiration and posture on organ perfusion

SummaryBackgroundArterial blood flow (BF) to all abdominal-pelvic organs (AP) shows potential for an indicator of comprehensive splanchnic organ circulation (reservoir of blood supply for redistribution) in cardiovascular disease, hepato-gastrointestinal disease or hemodynamic disorders. Our previous assessment of splanchnic hemodynamics, as magnitude of BFAP [measuring by subtracting BF in both femoral arteries (FAs) from the upper abdominal aorta (Ao) above the celiac trunk] using Doppler ultrasound, was reported as the relationship between Ao and FAs, day-to-day variability and response to exercise. For accurate determination of BFAP, it is important to consider the various factors that potentially influence BFAP. However, little information exists regarding the influence of respiration (interplay between inspiration and expiration) and posture on BFAP.Material/MethodsTen healthy males were evaluated in sitting/supine positions following a 12 hr fast. Magnitude of BFAP was determined as measurement of Ao and FAs hemodynamics (blood velocity and vessel diameter) using pulsed Doppler with spectral analysis during spontaneous 4-sec inspiration/4-sec expiration phases.ResultsBF/blood velocity in the Ao and FAs showed significant lower in inspiration than expiration. BFAP showed a significant (P<0.005) reduction of ~20% in inspiratory phase (sitting, 2213±222 ml/min; supine, 2059±215 ml/min) compared with expiratory phase (sitting, 2765±303 ml/min; supine, 2539±253 ml/min), with no difference between sitting and supine.ConclusionsRespiratory-related to alterations in BFAP were observed. It may be speculated that changes in intra-abdominal pressure during breathing (thoracic-abdominal movement) is possibly reflecting transient changes in blood velocity in the Ao and FAs. Respiratory effects should be taken into account for evaluation of BFAP.

Cerebrospinal compensation of pulsating cerebral blood volume in hydrocephalus

Objective: The aim of the study was to develop a computational method for the assessment of brain pressure compensation of cerebrospinal arterial blood inflow. The method was verified using clinical recordings performed during infusion studies in a group of patients diagnosed with hydrocephalus.Materials and methods: We studied 27 patients suspected of having normal pressure hydrocephalus. The infusion test was used to measure the resistance to cerebrospinal fluid outflow, and the elastance coefficient was performed together with recording of the blood flow velocity in the middle cerebral artery. From the blood flow velocity waveform, the pulsatile pattern of increasing cerebral blood volume during one heart cycle was evaluated as a time integral of the arterial blood flow velocity minus the mean arterial blood flow. Cerebrospinal 'compliance index' (Ci) was calculated as the amplitude of change in blood volume divided by the amplitude of intracranial pressure pulse waveform.Results: Compliance index Ci decreased during the infusion test, proportionally inverse to the rise in intracranial pressure controlled by the external infusion of saline (R=−0·76; p<0·005). A relative change in compliance (from baseline to the plateau phase of the study) was positively associated with greater brain elasticity (R=0·61; p<0·005) and poorer compensatory reserve at the phase of infusion (R=0·51; p=0·009)Conclusion: Ci decreases during the infusion study and seems to well replicate the relative changes in cerebrospinal compensatory reserve in hydrocephalus.