Determination Of Blood Flow Research Articles

Blood flow characteristics of diabetic patients with complications detected by optical measurement

BackgroundDiabetes mellitus (DM) is one of the most common diseases worldwide. Uncontrolled and prolonged hyperglycemia can cause diabetic complications, which reduce the quality of life of patients. Diabetic complications are common in DM patients. Because it is impossible to completely recover from diabetic complications, it is important for early detection. In this study, we suggest a novel method of determining blood flow characteristics based on fluorescence image analysis with indocyanine green and report that diabetic complications have unique blood flow characteristics.MethodsWe analyzed time-series fluorescence images obtained from controls, DM patients, and DM patients with complications. The images were segmented into the digits and the dorsum of the feet and hands, and each part has been considered as arterial and capillary flow. We compared the blood flow parameters in each region among the three groups.ResultsThe DM patients with complications showed similar blood flow parameters to the controls, except the area under the curve and the maximum intensity, which indicate the blood flow volume. These parameters were significantly decreased in DM patients with complications. Although some blood flow parameters in the feet of DM patients with complications were close to normal blood flow, the vascular response of the macrovessels and microvessels to stimulation of the hands was significantly reduced, which indicates less reactivity in DM patients with complications.ConclusionsOur results suggest that DM patients, and DM patients with complications, have unique peripheral blood flow characteristics.

Effect of Local Coil Density on Blood Flow Stagnation in Densely Coiled Cerebral Aneurysms: A Computational Study Using a Cartesian Grid Method.

Aneurysm recurrence is the most critical concern following coil embolization of a cerebral aneurysm. Adequate packing density (PD) and coil uniformity are believed necessary to achieve sufficient flow stagnation, which decreases the risk of aneurysm recurrence. The effect of coil distribution on the extent of flow stagnation, however, especially in cases of dense packing (high PD), has received less attention. Thus, the cause of aneurysm recurrence despite dense packing is still an open question. The primary aim of this study is to evaluate the effect of local coil density on the extent of blood flow stagnation in densely coiled aneurysms. For this purpose, we developed a robust computational framework to determine blood flow using a Cartesian grid method, by which the complex fluid pathways in coiled aneurysms could be flexibly treated using an implicit function. This tool allowed us to conduct blood flow analyses in two patient-specific geometries with 50 coil distribution patterns in each aneurysm at clinically adequate PD. The results demonstrated that dense packing in the aneurysm may not necessarily block completely the inflow into the aneurysm and local flow that formed in the neck region, whose strength was inversely related to this local PD. This finding suggests that local coil density in the neck region still plays an important role in disturbing the remaining local flow, which possibly prevents thrombus formation in a whole aneurysm sac, increasing the risk of aneurysm regrowth and subsequent recurrence.

A patient-specific approach to assessing blood pressure management in patients with hypertension and coronary artery disease.

The objective was to improve the management of patients with hypertension (HTN) and coronary artery disease (CAD), utilizing a model which integrates 3 determinants of coronary blood flow (CBF)-CAD severity, diastolic blood pressure (DBP), and left ventricular (LV) mass. We validated non-parametric equations for CBF estimation in a consecutive patient sample (N=81) with HTN and CAD. There was a highly significant correlation (r=.565; P<.01) between clinical DBP and estimated CBF. Greater LV mass and more severe CAD shifted the relationship towards less CBF at the same DBP. LV mass was more critical when DBP >70mmHg. Estimated changes in CBF at different DBP considering the severity of CAD and LV mass can be calculated. In summary, the severity of CAD from coronary CT or coronary angiography combined with LV mass from echocardiography permits clinicians to guide the extent of, or target for, DBP to avoid seriously compromising CBF.

A comparative study of intraocular pressure and ocular perfusion pressure changes in prehypertensive individuals

Background: According to the WHO, glaucoma is the second leading cause of blindness in the world. Ocular perfusion pressure (OPP), an important determinant of ocular blood flow, represents the balance between the opposing forces of blood pressure (BP) and intraocular pressure (IOP). Alterations in OPP play a significant role in pathogenesis of glaucoma. Although systemic hypertension has been proved to be a potential risk factor for glaucoma, there is a paucity of literature regarding the vascular effects of prehypertension on optic disc. Aims and Objectives: This study aims to study the effects of prehypertension on IOP and OPP. Materials and Methods: A total of 102 voluntary participants in the age group of 20–50 years were selected. The study group comprised 51 subjects with prehypertension and control group included 51 age and sex-matched normotensives. Basal IOP and BP were recorded in sitting position using rebound tonometer and sphygmomanometer, respectively. Mean OPP was calculated. Results: There was significant increase in the IOP and OPP of both the eyes in prehypertensives when compared with normotensives. Conclusion: Elevated IOP levels in prehypertensive individuals are deleterious to optic disc. Raised OPP observed in prehypertensives could be due to effective autoregulation, which could be compromised if there is further increase in BP. Hence, early detection of prehypertension and measures to reduce the BP must be taken to prevent the development of glaucoma.

Simulation at Incomplete Acquisition on Stress-rest Cerebral Blood Flow Quantitative Values One Day Method

The QSPECT dual table autoradiography (DTARG) method can be used for quantitative determination of cerebral blood flow. We verified the influence on quantitative values obtained for cerebral blood flow in the case when usual acquisition was impossible and evaluated those values. Results obtained with an acquisition time of 30 min were considered to be true values, and the correlation and consistency with results of other times were evaluated. Values obtained with a shortened acquisition time showed a high correlation with the true value. As for consistency, there were differences among the various data collection intervals. Nevertheless, regardless of the use of a shortened acquisition time and the data acquisition interval, values obtained with the QSPECT program showed a high correlation with the true value. Based on our findings showing a high correlation, a quantitative evaluation of cerebral blood flow can be performed with the QSPECT DTARG method, even with complications, such as examination interruption, thus, it is considered to be a flexible method.

Acute effects of yoga on ocular perfusion pressure in adult yoga practitioners

Background: Ocular perfusion pressure (OPP) is an important determinant of ocular blood flow. Reduced OPP could be a risk factor for glaucoma. According to the WHO, glaucoma is the second leading cause of blindness in the world. Yoga harmonizes the body with the mind. Studies have demonstrated that yogic exercises affect blood pressure (BP) as well as intraocular pressure (IOP). Although OPP depends on BP and IOP, not much of research has been done to analyze the impact of yoga on OPP. Aims and Objectives: The aim of the study is to analyse the immediate and composite effects of yoga on OPP in adult yoga practitioners. Materials and Methods: 32 healthy adult yoga practitioners in the age group of 18-25 years, were selected. Basal IOP and BP were recorded in sitting position using rebound tonometer and sphygmomanometer, respectively. The second recording was done immediately after 45 min of yoga practice. Mean OPP (MOPP) was calculated. Results: There was no significant difference in the IOP of both eyes before and after yoga. Statistically significant fall in the mean arterial pressure (MAP) and OPP of both eyes was observed immediately after yogic exercises (P < 0.001). Conclusion: In this study, MAP was reduced and IOP remained unchanged following yoga. This implies that simple yoga exercises may be useful as supplementary antihypertensive therapy. Although OPP was reduced in our study, autoregulation might maintain blood flow despite changes in perfusion pressure. More insight into ocular blood flow regulation can be studied using optical coherence tomography.

Influence of para-aminohippuric acid analysis on net portal-drained viscera flux of nutrients in pigs

In nutrition studies, para-aminohippuric acid (PAH) is a marker frequently used to measure blood flow in pigs, which is essential for estimating portal-drained viscera (PDV) flux of nutrients. The aim of this study was to evaluate the PAH analytical method by means of qualimetric statistical procedures to estimate the matrix effect and the accuracy and limits of quantitation of the method. Net PDV flux of nutrients was determined in five multi-catheterized pigs using water, plasma or commercial serum as standard matrix. A proportional systematic error due to matrix effect was found for plasma and serum. Mean recovery was 99.4%, and intra- and inter-day precision of the method was 2.4% and 3.8% relative standard deviation, respectively. The limit of quantification was 0.22 mg PAH/l. Use of water for the PAH standard curves underestimated portal blood flow compared with PAH standards prepared with plasma or commercial serum (706, 954 and 927 ml/min; P<0.05, respectively). Consequently, PDV O2 consumption, glucose and amino acids fluxes were underestimated by 33% (P<0.001). In conclusion, our results stress the importance of using plasma from pigs not infused with PAH or alternatively commercial pig serum to prepare PAH standards to determine blood flow in pigs to avoid underestimation of blood flow.

Lower limb revascularization in chronic critical ischemia

The article presents the results of examination and treatment of 92 patients with obliterating atherosclerosis under chronic critical ischemia. Based on imaging methods patients were divided into 3 groups with the isolation of a leading occlusive and stenotic segment and the choice of surgical approach accordingly. To ensure the functioning of the popliteal-posterotibial autovenous shunt with high peripheral vascular resistance, a method is provided of end-to-side anastomosis of the distal segment of autovenous shunt with arteriovenous fistula. Based on the determination of intradermal blood flow of the rear of the foot in patients with chronic critical limb ischemia, the effects of revascularization operations were predicted.

Dual-Wavelength Laser Speckle Contrast Imaging (dwLSCI) Improves Chronic Measurement of Superficial Blood Flow in Hands

Laser speckle contrast imaging (LSCI) has been widely used to determine blood flow and perfusion in biological tissues. The physical model of traditional LSCI ignores the effects of scattering property distribution in relation to speckle correlation time τc and blood flow v, which further results in biased estimation. In this study, we developed a dual-wavelength laser speckle contrast imaging (dwLSCI) method and a portable device for imaging the blood flow and tissue perfusion in human hands. Experimental data showed that dwLSCI could retrieve the vein vasculatures under the surface skin, and it further provided accurate measurements of vein blood flow signals, tissue perfusion signals, and fingertip perfusion signals, which assist with assessments of rehabilitation therapy for stroke patients. Fingertip perfusion signals demonstrated better performance in early assessments, while vein blood flow signals assisted the Fugl–Meyer Assessment Scale (FMA) and the Wolf Motor Function Test (WMFT) behavior assessments. As a general noninvasive imaging method, dwLSCI can be applied in clinical studies related to hand functions combined with behavior assessments.

Quantification of fluorescent dyes in organ tissue samples via HPLC analysis.

The determination of regional blood flow via the accumulation of fluorescent microspheres is a concept regularly used in medical research. Typically, the microbeads get extracted from the tissue of interest and are then quantified by measuring the absorption or fluorescence of the incorporated dyes without further separation from the medium. However, in that case the absorption spectra of different dyes can overlap when used simultaneously, leading to an overestimation of the concentration. Additionally, background absorption from the medium can be problematic. Therefore, a high performance liquid chromatography method for the simultaneous detection of four dyes (orange, crimson, yellow-green and red) incorporated in different microbeads in samples from biological media such as organ tissue (brain, heart and kidneys) was developed. Since for biological samples often a large sample size is required for sufficient statistics, the method was optimized to yield very short run times. With this method it was possible to detect very low concentrations of only one microsphere per gram of organ tissue. By applying this sensitive quantification technique, it was demonstrated that the application of microbeads for perfusion measurements might not be reliable due to different organ distributions in each animal.

Reply to Drs. Henni and Abraham: Muscle oxygen content at exercise in patients with claudication

to the editor: We are grateful for the opportunity to further discuss the topic of tissue oxygenation in patients with peripheral artery disease (PAD) ([4][1]). Both near-infrared spectroscopy (NIRS) and transcutaneous oxygen pressure (TcPO2) are useful techniques to determine blood flow to lower

A Quantitative Analysis of Microcirculation in Skin Defects Covered with Topical Wound Dressings or a Newly Developed Collagen Matrix.

Innovative skin substitutes and temporary wound dressings are frequently used in the treatment of superficial and partial-thickness wounds. The aim of this study was to compare 2 commonly used temporary skin dressings with a newly developed collagen matrix to determine changes in microcirculation as measured by blood flow, hemoglobin oxygenation, and relative hemoglobin values during healing of partial-thickness skin defects. This animal study involved 28 adult male Lewis rats. On the back of each rat, 2 standardized partial-thickness skin defects were generated through a skin dermatome (n = 56). Then, wounds were treated with polylactide-based copolymer skin substitute (Suprathel, PolyMedics, Denkendorf, Germany; n = 14), biosynthetic skin dressing (Biobrane, Smith & Nephew, Hamburg, Germany; n = 14), or Collagen Cell Carrier (CCC; Naturin Viscofan, Weinheim, Germany; n = 14). The remaining control wounds were left untreated (n = 14). Perfusion dynamics were assessed every 10 days for 80 days with the O2C device (LEA Medizintechnik, Gieβen, Germany) to determine blood flow, hemoglobin oxygenation, and relative amount of hemoglobin. Blood flow was increased in all wounds for at least 30 days after wound generation. The relative amounts of hemoglobin were increased in superficial layers (2 mm) for 10 to 20 days. Hemoglobin oxygenation in the superficial layers decreased in the polylactide-based copolymer skin substitute and biosynthetic skin dressing-treated groups and initially increased in the untreated wounds and CCC groups on day 10; these values also decreased. The presented results demonstrate the complex changes in microcirculation in the course of healing partial-thickness wounds with different wound dressings and contribute to a better understanding of these wounds. However, based on the results of the study, a clear recommendation for a specific substitute is not yet possible.

Paravascular spaces at the brain surface: Low resistance pathways for cerebrospinal fluid flow

Clearance of waste products from the brain is of vital importance. Recent publications suggest a potential clearance mechanism via paravascular channels around blood vessels. Arterial pulsations might provide the driving force for paravascular flow, but its flow pattern remains poorly characterized. In addition, the relationship between paravascular flow around leptomeningeal vessels and penetrating vessels is unclear. In this study, we determined blood flow and diameter pulsations through a thinned-skull cranial window. We observed that microspheres moved preferentially in the paravascular space of arteries rather than in the adjacent subarachnoid space or around veins. Paravascular flow was pulsatile, generated by the cardiac cycle, with net antegrade flow. Confocal imaging showed microspheres distributed along leptomeningeal arteries, while their presence along penetrating arteries was limited to few vessels. These data suggest that paravascular spaces around leptomeningeal arteries form low resistance pathways on the surface of the brain that facilitate cerebrospinal fluid flow.

Quantitative Assessment of Coronary Microvascular Function: Dynamic Single-Photon Emission Computed Tomography, Positron Emission Tomography, Ultrasound, Computed Tomography, and Magnetic Resonance Imaging.

A healthy, functional microcirculation in combination with nonobstructed epicardial coronary arteries is the prerequisite of normal myocardial perfusion. Quantitative assessment in myocardial perfusion and determination of absolute myocardial blood flow can be achieved noninvasively using dynamic imaging with multiple imaging modalities. Extensive evidence supports the clinical value of noninvasively assessing indices of coronary flow for diagnosing coronary microvascular dysfunction; in certain diseases, the degree of coronary microvascular impairment carries important prognostic relevance. Although, currently positron emission tomography is the most commonly used tool for the quantification of myocardial blood flow, other modalities, including single-photon emission computed tomography, computed tomography, magnetic resonance imaging, and myocardial contrast echocardiography, have emerged as techniques with great promise for determination of coronary microvascular dysfunction. The following review will describe basic concepts of coronary and microvascular physiology, review available modalities for dynamic imaging for quantitative assessment of coronary perfusion and myocardial blood flow, and discuss their application in distinct forms of coronary microvascular dysfunction.

Blood flow patterns during incremental and steady-state aerobic exercise.

Endothelial shear stress (ESS) is a physiological stimulus for vascular homeostasis, highly dependent on blood flow patterns. Exercise-induced ESS might be beneficial on vascular health. However, it is unclear what type of ESS aerobic exercise (AX) produces. The aims of this study are to characterize exercise-induced blood flow patterns during incremental and steady-state AX. We expect blood flow pattern during exercise will be intensity-dependent and bidirectional. Six college-aged students (2 males and 4 females) were recruited to perform 2 exercise tests on cycle-ergometer. First, an 8-12-min incremental test (test 1) where oxygen uptake (VO2), heart rate (HR), blood pressure (BP), and blood lactate (La) were measured at rest and after each 2-min step. Then, at least 48-hr. after the first test, a 3-step steady state exercise test (test 2) was performed measuring VO2, HR, BP, and La. The three steps were performed at the following exercise intensities according to La: 0-2 mmol/L, 2-4 mmol/L, and 4-6 mmol/L. During both tests, blood flow patterns were determined by high-definition ultrasound and Doppler on the brachial artery. These measurements allowed to determine blood flow velocities and directions during exercise. On test 1 VO2, HR, BP, La, and antegrade blood flow velocity significantly increased in an intensity-dependent manner (repeated measures ANOVA, P<0.05). Retrograde blood flow velocity did not significantly change during test 1. On test 2 all the previous variables significantly increased in an intensity-dependent manner (repeated measures ANOVA, P<0.05). These results support the hypothesis that exercise-induced ESS might be increased in an intensity-dependent way and blood flow patterns during incremental and steady-state exercises include both antegrade and retrograde blood flows.

Computational fluid dynamics characterization of pulsatile flow in central and Sano shunts connected to the pulmonary arteries: importance of graft angulation on shear stress-induced, platelet-mediated thrombosis

Central (aorta) and Sano (right ventricle)-to-pulmonary artery (PA) shunts, palliative operations for infants with complex heart defects, can develop life-threatening thrombosis. We employed computational fluid dynamics (CFD) to study pulsatile flow in these shunts, with the goal to identify haemodynamic characteristics conducive to thrombus formation. CFD, using the finite volume method with cardiac catheterization data, and computer simulations, based on angiography, were employed to determine flow-velocity field, wall shear stress (WSS) profile and oscillatory shear index (OSI). At prominent angulation, in central shunts (4 and 3.5 mm), WSS reached 245 and 123 (Pascal-Pa), peak systole and 137 and 46 Pa, end diastole; and, in Sano shunts (5 and 6 mm), WSS attained 203 and 133 Pa, peak systole and 1.6 and 1.5 Pa, end diastole. Counter-rotating flow vortices augmented WSS. These high WSSs can promote platelet aggregation, leading to thrombus formation. The OSIs averaged 0.39, indicative of multidirectional shearing forces. Shunt burden was assessed by averaging WSS, over its luminal area and the cardiac cycle. For the central shunts, these WSSs were 73.0 and 67.2 Pa; whereas, for the Sano shunts, 34.9 and 19.6 Pa. For modified Blalock-Taussig shunts (4 and 3.5 mm), the averaged WSSs were significantly lower at 26.0 and 27.5 Pa, respectively. CFD modelling is an important tool to determine blood flow behaviour in shunts. Graft angulation presents a risk for shear stress-induced, platelet- mediated thrombosis, which is more likely to occur in elongated central than in Sano shunts.

The influence of gravity on regional lung blood flow in humans: SPECT in the upright and head-down posture.

Previous studies in humans have shown that gravity has little influence on the distribution of lung blood flow while changing posture from supine to prone. This study aimed to evaluate the maximal influence of posture by comparison of regional lung blood flow in the upright and head-down posture in 8 healthy volunteers, using a tilt table. Regional lung blood flow was marked by intravenous injection of macroaggregates of human albumin labeled with 99mTc or 113mIn, in the upright and head-down posture, respectively, during tidal breathing. Both radiotracers remain fixed in the lung after administration. The distribution of radioactivity was mapped using quantitative single photon emission computed tomography (SPECT) corrected for attenuation and scatter. All images were obtained supine during tidal breathing. A shift from upright to the head-down posture caused a clear redistribution of blood flow from basal to apical regions. We conclude that posture plays a role for the distribution of lung blood flow in upright humans, and that the influence of posture, and thereby gravity, is much greater in the upright and head-down posture than in horizontal postures. However, the results of the study demonstrate that lung structure is the main determinant of regional blood flow and gravity is a secondary contributor to the distribution of lung blood flow in the upright and head-down positions.NEW & NOTEWORTHY Using a dual-isotope quantitative SPECT method, we demonstrated that although a shift in posture redistributes blood flow in the direction of gravity, the results are also consistent with lung structure being a greater determinant of regional blood flow than gravity. To our knowledge, this is the first study to use modern imaging methods to quantify the shift in regional lung blood flow in humans at a change between the upright and head-down postures.

The connective tissue phenotype of glaucomatous cupping in the monkey eye - Clinical and research implications.

In a series of previous publications we have proposed a framework for conceptualizing the optic nerve head (ONH) as a biomechanical structure. That framework proposes important roles for intraocular pressure (IOP), IOP-related stress and strain, cerebrospinal fluid pressure (CSFp), systemic and ocular determinants of blood flow, inflammation, auto-immunity, genetics, and other non-IOP related risk factors in the physiology of ONH aging and the pathophysiology of glaucomatous damage to the ONH. The present report summarizes 20 years of technique development and study results pertinent to the characterization of ONH connective tissue deformation and remodeling in the unilateral monkey experimental glaucoma (EG) model. In it we propose that the defining pathophysiology of a glaucomatous optic neuropathy involves deformation, remodeling, and mechanical failure of the ONH connective tissues. We view this as an active process, driven by astrocyte, microglial, fibroblast and oligodendrocyte mechanobiology. These cells, and the connective tissue phenomena they propagate, have primary and secondary effects on retinal ganglion cell (RGC) axon, laminar beam and retrolaminar capillary homeostasis that may initially be "protective" but eventually lead to RGC axonal injury, repair and/or cell death. The primary goal of this report is to summarize our 3D histomorphometric and optical coherence tomography (OCT)-based evidence for the early onset and progression of ONH connective tissue deformation and remodeling in monkey EG. A second goal is to explain the importance of including ONH connective tissue processes in characterizing the phenotype of a glaucomatous optic neuropathy in all species. A third goal is to summarize our current efforts to move from ONH morphology to the cell biology of connective tissue remodeling and axonal insult early in the disease. A final goal is to facilitate the translation of our findings and ideas into neuroprotective interventions that target these ONH phenomena for therapeutic effect.

Flow Dynamics and HSPC Homing in Bone Marrow Microvessels

SummaryMeasurements of flow velocities at the level of individual arterial vessels and sinusoidal capillaries are crucial for understanding the dynamics of hematopoietic stem and progenitor cell homing in the bone marrow vasculature. We have developed two complementary intravital two-photon imaging approaches to determine blood flow dynamics and velocities in multiple vessel segments by capturing the motion of red blood cells. High-resolution spatiotemporal measurements through a cranial window to determine short-time dynamics of flowing blood cells and repetitive centerline scans were used to obtain a detailed flow-profile map with hemodynamic parameters. In addition, we observed the homing of individual hematopoietic stem and progenitor cells and obtained detailed information on their homing behavior. With our imaging setup, we determined flow patterns at cellular resolution, blood flow velocities and wall shear stress in small arterial vessels and highly branched sinusoidal capillaries, and the cellular dynamics of hematopoietic stem and progenitor cell homing.

The influence of time on determining blood flow restriction pressure.

To investigate the influence of time, within and between days, on arterial occlusion pressure and to determine whether the variability resembles the oscillatory pattern of bSBP. Test-retest. Twenty-two participants completed four testing sessions at 08:00 and 18:00h, 48h apart. Arm circumference, bSBP, and brachial diastolic blood pressure (bDBP) were measured at rest. Arterial occlusion pressure was determined using a cuff inflated on the proximal portion of the upper arm, with a Doppler probe placed over the radial artery. Significant differences [mean (SD)] were observed for arterial occlusion pressure between Morning Day 2 [132 (14) mmHg, p<0.05], and all other visits [Morning Day 1: 138 (16); Evening Day 1: 139 (17); Evening Day 2 138 (14) mmHg]. A time effect was observed for bSBP, with a post-hoc test revealing that Morning Day 2 was different from all other visits. Our findings suggest that arterial occlusion pressure is influenced by the time of day. As such, multiple occlusion measurements across an experiment may be necessary in order to account for potential oscillations in pressure and provide the intended relative restrictive stimulus.