Differences In Peak Systolic Velocity Research Articles

Age-specific sex-differences in cerebral blood flow velocity in relation to haemoglobin levels.

Cerebral blood flow (CBF) declines with age and abnormalities in CBF are associated with age-related cerebrovascular disease and neurodegeneration. Women have higher CBF than men, although this sex-difference diminishes to some extent with age in healthy subjects. The physiological drivers of these age/sex differences are uncertain, but might be secondary to age and sex-differences in haemoglobin (Hb) level. Hb levels are inversely correlated with CBF, are lower in women, and decline with age in men, but the interrelations between these factors have not been explored systematically either in healthy subjects or across the full age-range in patients with vascular risk factors. We aimed to determine the age-specific interrelations between sex, Hb, and CBF velocity in a large cohort of patients with cerebrovascular disease. In patients with a recent transient ischaemic attack or minor stroke (Oxford Vascular Study) and no ipsilateral or contralateral stenosis of the carotid or intracranial arteries, we related peak-systolic velocity (PSV) and other parameters on transcranial Doppler ultrasound (TCD) of the middle cerebral artery to sex, age, Hb and vascular risk factors. Of 958 eligible subjects (mean age/SD = 68.04/14.26, 53.2% male), younger women (age < 55 years) had higher CBF velocities than men (mean sex difference in PSV at age < 55 years = 16.31 cm/s; p < 0.001), but this difference declined with age (interaction p < 0.001), such that it was no longer significant at age 75-84 (∆PSV = 3.26 cm/s; p = 0.12) and was reversed at age ⩾ 85 (∆PSV = -7.42 cm/s; p = 0.05). These changes mirrored trends in levels of Hb, which were higher in men at age < 55 (∆Hb = 1.92 g/dL; p < 0.001), but steadily decreased with age in men but not in women (interaction p < 0.001), with no residual sex-difference at age ⩾ 85 (∆Hb = 0.12 g/dL; p = 0.70). There was an inverse correlation between Hb and PSV in both women and men (both p ⩽ 0.01), and the sex-difference in PSV at age < 55 was substantially diminished after adjustment for Hb (∆PSV = 6.92; p = 0.036; ∆PSV = 5.92, p = 0.13 with further adjustment for end-tidal CO2). In contrast, the sex difference in PSV was unaffected by adjustment for systolic and diastolic blood pressure, heart rate, and vascular risk factors (history of hypertension, diabetes, hyperlipidaemia and smoking). CBF velocity is strongly correlated with Hb level at all ages, and sex-differences in CBF velocity appear to be explained in major part by age-related sex-differences in Hb.

A Comparative Study of Transcranial Color-Coded Doppler (TCCD) and Transcranial Doppler (TCD) Ultrasonography Techniques in Assessing the Intracranial Cerebral Arteries Haemodynamics.

Cerebrovascular disease (CVD) poses a major public health and socio-economic burden worldwide due to its high morbidity and mortality rates. Accurate assessment of cerebral arteries' haemodynamic plays a crucial role in the diagnosis and treatment management of CVD. The study compared a non-imaging transcranial Doppler ultrasound (TCD) and transcranial color-coded Doppler ultrasound (with (cTCCD) and without (ncTCCD)) angle correction in quantifying middle cerebral arteries (MCAs) haemodynamic parameters. A cross-sectional study involving 50 healthy adults aged ≥ 18 years was conducted. The bilateral MCAs were insonated via three trans-temporal windows (TTWs-anterior, middle, and posterior) using TCD, cTCCD, and ncTCCD techniques. The MCA peak systolic velocity (PSV) and mean flow velocity (MFV) were recorded at proximal and distal imaging depths that could be visualised on TCCD with a detectable spectral waveform. A total of 152 measurements were recorded in 41 (82%) subjects with at least one-sided open TTW across the three techniques. The mean PSVs measured using TCD, ncTCCD, and cTCCD were 83 ± 18 cm/s, 81 ± 19 cm/s, and 93 ± 21 cm/s, respectively. There was no significant difference in PSV between TCD and ncTCCD (bias = 2 cm/s, p = 1.000), whereas cTCCD yielded a significantly higher PSV than TCD and ncTCCD (bias = -10 cm/s, p < 0.001; bias = -12 cm/s, p ≤ 0.001, respectively). The bias in MFV between TCD and ncTCCD techniques was (bias = -0.5 cm/s; p = 1.000), whereas cTCCD demonstrated a higher MFV compared to TCD and ncTCCD (bias = -8 cm/s, p < 0.001; bias = -8 cm/s, p ≤ 0.001, respectively). TCCD is a practically applicable imaging technique in assessing MCA blood flow velocities. cTCCD is more accurate and tends to give higher MCA blood flow velocities than non-imaging TCD and ncTCCD techniques. ncTCCD is comparable to non-imaging TCD and should be considered in clinical cases where using both TCD and TCCD measurements is needed.

Effect of delayed cord clamping on cerebral hemodynamics in preterm infants

BackgroundUnstable cerebral hemodynamics is an important cause of intracranial hemorrhage in premature infants. The increased blood flow of delayed cord clamping (DCC) compared to immediate cord clamping (ICC) is equivalent to 1/3-1/4 of newborn blood volume. Our objective was to assess whether the increased blood flow causes fluctuations in cerebral blood flow and how. MethodsThis experiment was a prospective, observational study. Neonatologists selected preterm infants eligible for inclusion and exclusion, and divided them into DCC group and ICC group according to the way of umbilical cord ligation performed by obstetrics department, and matched them 1:1 according to gestational age. The peak systolic velocity （PSV) ，end diastolic velocity (EDV)，and resistance index (RI) of middle cerebral artery was measured by Mindray M9 color ultrasonic diagnostic instrument within 1 h, 24±1 h, 48±1 h, 72±1 h, respectively. ResultsThere was no significant difference in PSV, EDV and RI in middle cerebral artery between DCC group and ICC group (P > 0.05). There were no significant differences between groups and time (P > 0.05). The hemoglobin and hematocrit in DCC group were higher than those in ICC group within 2 h after birth (P < 0.05). (P > 0.05). ConclusionDCC can increase hemoglobin and hematocrit in preterm infants, but does not cause cerebral blood flow fluctuation within a certain range. DCC is a safe method of placental transfusion.

Changes in blood flow in the dorsal scapular artery and relationship to shoulder joint function in rotator cuff tears

One of the pain-related factors in rotator cuff tears (RCTs) is abnormal scapular motion, which is thought to be related to the levator scapulae muscle activation. Additionally, attention has recently focused on the peak systolic velocity (PSV) as one of the causes of pain, but blood flow outside of the vessels supplying the rotator cuff has not been clarified. This study aimed to determine the difference in PSV in the dorsal scapular artery (DSA), which is the vessel that supplies the levator scapulae muscles, and the association between PSV and pain and shoulder function in patients with RCTs between the tear and nontear sides. This study included 31 patients with RCTs with tear and nontear sides. Magnetic resonance imaging and radiographic examinations included Cofield classification, Goutallier classification, thickening of the coracohumeral ligament, and measurement of the acromiohumeral interval. Clinical evaluation included an automatic range of motion (ROM) for flexion, abduction, and external rotation (ER), a visual analog scale, and the Shoulder36. PSV was evaluated using ultrasound pulsed Doppler mode to assess PSV of DSA. The PSV of DSA on the first rib was drawn in the medial aspect of the suprascapular angle in the long axis, and the maximum PSV waveform was measured three times. The average value was used for further analysis. The PSV in the DSA was significantly higher (P=.04, 95% confidence interval: 0.2-7.6) on the tear (22.6±7.4 cm/s) than the nontear sides (18.9±6.9 cm/s). In addition, a significant negative correlation (r=-0.46, P=.0087) was found between PSV in DSA and ER on the tear side. This study revealed a significantly increased PSV in the DSA on the tear side in RCTs and negatively correlated with ER ROM. The results suggest that increased PSV in the DSA may contribute to ER ROM limitation in the glenohumeral joint.

Перфузия яичек в оценке аутопластики пахового канала перемещенным апоневротическим лоскутом

BACKGROUND: Numerous methods of eliminating abdominal wall defects developed in the world today do not allow us to talk about solving the problem of hernias. In particular, the causes of chronic postoperative pain associated with the effect of scarring on the spermatic cord have not been fully studied. Testicular flow studies after hernia repair mostly showed different outcomes. AIM: Comparative assessment of blood flow parameters of the testicular, capsular and intratesticular arteries, as well as the diameter of the testicular artery after autoplasty with a displaced aponeurotic flap and Lichtenstein hernioplasty using ultrasound. MATERIALS AND METHODS: A new method of autoplasty was used in 35 patients (Group I). The comparison group (Group II) amounted to 35 patients with Lichtenstein hernioplasty surgery using partially absorbable mesh endoprosthesis (UltraPro). The dynamics of changes in blood flow in the arteries was assessed using color Doppler before surgery, in the early and late postoperative periods. RESULTS: The Wilcoxon paired test showed a significant difference between preoperative and immediately postoperative measurements in both groups. Statistically significant differences between the groups were found in the end-diastolic velocity and resistance index in the testicular, capsular and intratesticular arteries 6 months and 1 year after surgery. The difference in peak systolic velocity was significant in the testicular artery also in the late stages after hernioplasty. The diameter of the testicular artery tended to increase in dynamics, but there was no any statistically significant difference between the groups. CONCLUSIONS: The method of autoplasty in the inguinal canal with a displaced aponeurotic flap does not significantly affect testicular perfusion. In Group II, arterial blood flow indicators 6 months and 1 year after surgery were lower than basal values and had statistically significant differences compared to Group I.

Ocular pulse amplitude and hemodynamic in controlled asymmetric glaucoma: a cross-sectional study

Purpose: The aim of this study was to explore the relationship between glaucoma severity, ocular pulse amplitude (OPA), and hemodynamic variables.&#x0D; Methods: Thirty-one Asymmetric primary open-angle glaucoma (POAG) cases (one eye with better MD, fellow eye with worst MD) who applied to the glaucoma outpatient clinic of Gulhane Military Medical Faculty Hospital between January 1, 2006, and June 30, 2007, were included in this cross-sectional study. Patients using beta-blockers or alpha-adrenergic agonists were excluded. The patients went on using glaucoma medications. Asymmetricity was assessed if a visual field means deviation (MD) difference ≥6 decibels existed between the eyes. Mean MD and pattern standard deviation, diurnal OPA, and intraocular pressure( IOP) (7 am, 9 am, 11 am, 1 pm, 3 pm, 5 pm, 7 pm, 9 pm,11 pm, 1 am, 4 am), central corneal thickness, peak systolic velocity (PSV), end-diastolic velocity (EDV), PSV/EDV, pulsatility index (PI), resistivity index (RI) for internal carotid artery and ophthalmic artery were measured with color Doppler ultrasonography.&#x0D; Results: The differences in mean diurnal IOP and mean diurnal OPA between the eyes were statistically insignificant. Each diurnal IOP and OPA values and coefficient of variability of diurnal IOP and OPA were statistically insignificant between the groups. There was no significant difference in PSV, EDV, PSV/EDV, PI, and RI between the better-MD and worse-MD eyes. The correlations between mean IOP/mean OPA, and each diurnal IOP/OPA values were insignificant.&#x0D; Conclusion: These results suggest that ocular hemodynamics are affected after a critical point in the evolution of glaucoma. The severity of glaucoma is not directly related to pulsatile ocular blood flow.

A Comparative Study of the Right and Left Carotid Arteries in Relation to Age for Patients With Diabetes and Hypertension

Introduction: Age, hypertension, and diabetes can cause significant alterations in arterial structure and function, including changes in lumen diameter (LD), intimal-medial thickness (IMT), flow velocities, and arterial compliance. These are also considered risk markers of atherosclerosis and cerebrovascular disease. A difference between right and left carotid artery blood flow and IMT has been reported by some researchers, and a difference in the incidence of nonlacunar stroke has been reported between the right and left brain hemispheres. The aim of this study was to determine whether there are differences between the right and left common carotid arteries and internal carotid arteries in patients with hypertension and diabetes for 2 age groups. Methods: We studied 250 patients with both diabetes and hypertension. Patients were divided into 2 age groups with the old age group being 56 to 75 years and the young age group 35 to 55 years. The bilateral common carotid and internal carotid arteries were evaluated with B-mode ultrasound and Doppler examinations. The LD and IMT were measured for both common carotid arteries, and spectral waveform parameters and indices were recorded for both internal carotid arteries. Results: The difference in LD between the left and right common carotid arteries for the old age group was 11.64% and for the young age group was 6.42%, with significant P values of &lt;.05 for both age groups. The difference in IMT between the left and right common carotid arteries was 18.27% in the old age group compared with 15.38% in the young age group, with significant P values of &lt;.05. There was a difference in peak systolic velocity between the left and right internal carotid arteries of 4.85% in the old age group which was not significant, compared with 14.28% in the young age group with a significant P value &lt;.05, whereas the difference in end-diastolic velocity between the left and right internal carotid arteries was not significant for both age groups. Differences between the right and left internal carotid arteries for resistive index, pulsatility index, and pressure gradient were significant only in the young age group. Conclusion: We found significant differences between the right and left common carotid and internal carotid arteries in patients with diabetes and hypertension which were more prominent in the young age group. Values for common carotid IMT and LD were significantly higher in the left common carotid artery versus the right common carotid artery in both age groups. Differences between the 2 carotid sides may be attributed to anatomic variations in the common carotid artery origins which lead to differences in stress between the 2 sides.

Effect of delayed cord clamping and umbilical cord milking on cerebral hemodynamics in preterm infants: a randomized double-blind controlled trial

Objective To compare the effect of delayed cord clamping (DCC) versus umbilical cord milking (UCM) on cerebral blood flow in preterm infants. Methods This was a single-center, prospective, double-blind, randomized controlled trial. A total of 46 preterm infants, with a gestational age of 30-33+6 weeks, who were born in Suining Central Hospital from November 2, 2018 to November 15, 2019 were enrolled and randomly divided into DCC group and UCM group, with 23 infants in each group. The primary outcome indexes included cerebral hemodynamic parameters[peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI)] measured by ultrasound within 0.5-1 hour, (24±1) hours, (48±1) hours, and (72±1) hours after birth. Secondary outcome indexes included hematocrit, hemoglobin, red blood cell count, and serum total bilirubin levels on the first day after birth and the incidence rate of intraventricular hemorrhage during hospitalization. Results A total of 21 preterm infants in the DCC group and 23 in the UCM group were included in the statistical analysis. There was no significant difference in PSV, EDV, and RI between the two groups at all time points after birth (P > 0.05). There was also no significant difference between the two groups in the hematocrit, hemoglobin, red blood cell count and total bilirubin levels on the first day after birth, and the incidence rate of intraventricular hemorrhage during hospitalization (P > 0.05). Conclusions DCC and UCM have a similar effect on cerebral hemodynamics in preterm infants with a gestational age of 30-33+6 weeks.

Effect of occipitoatlantal decompression on cerebral blood flow dynamics as evaluated by Doppler ultrasonography.

Osteopathic manipulative treatment reduces symptoms in patients with headache disorders, but the underlying mechanisms are unclear. To evaluate blood flow in the intracranial and extracranial vasculature before and after occipitoatlantal decompression (OAD) using Doppler ultrasonography. Healthy, first-year osteopathic medical students from A.T. Still University's Kirksville College of Osteopathic Medicine participated in a randomized, single-blinded, two-period, two-treatment crossover study. The participants were randomly assigned to 1 of 2 treatment interventions: OAD or sham touch. After one week, participants returned to have the other intervention performed. Blood flow parameters-peak systolic velocity (PSV) and end-diastolic velocity (EDV)-in the middle cerebral artery (MCA), internal carotid artery (ICA), and vertebral artery (VA) were evaluated before, immediately after, 5minutes after, and 10minutes after treatment. Differences in PSV, EDV, heart rate (HR), and blood pressure (BP) for both interventions were analyzed for the four time points using mixed-effects models. Thirty healthy medical students (11 men, 19 women; mean age, 24years) participated in this study. EDV increased after OAD in the MCA, ICA, and VA (all p<0.001); no change occurred after sham touch (all p>0.05). EDV was greater for all post-treatment timepoints after OAD in the MCA, ICA, and VA than after sham touch (all p<0.001). Although baseline PSV in the MCA measured before treatment was different between treatment interventions (p=0.01), no difference was found between interventions at any post-treatment time point (all p>0.59). Changes in PSV in the ICA and VA and for HR and BP did not depend on treatment intervention (p>0.06). Increases in EDV occurred in major cranial arteries after OAD but not after sham touch, indicating that OAD improves blood flow to the brain. The exact mechanism of this increase is unknown; however, it can be explained by either parasympathetic stimulation through the secretion of vasodilating neurotransmitters or by a decrease in external tissue pressure on ICA and VA, with the resulting flow causing further dilation in the MCA.

Difference between near-field and far-field of middle cerebral artery doppler pulsatility index and peak systolic velocity: a prospective study

Objective: We purposed to investigate the difference between near-field and far-field of PI (pulsatility index) and peak systolic velocity (PSV) of the middle cerebral artery (MCA) that are important in the management of fetal growth restriction and fetal anemia. Methods: This prospective study was conducted with 130 single uncomplicated pregnancies. Doppler was applied to near-and far-field of proximal MCA while PSV and PI were recorded and compared between two sides as well as according to body mass index (BMI) and gestational weeks of participants. Results: There was no statistically significant difference between near and far-fields of MCA PI (P = 0.75). However, a statistically significant difference in PSV was observed (P = 0.03), and this was especially noticeable in women with normal BMI (P = 0.009). On the other hand, there was no difference between MCA PI or PSV in women with a BMI higher than 25. Also, no significant difference was observed between groups, which were subcategorized according to gestational weeks. Conclusions: Our data suggest that the far-field PSV values may be higher than near-field MCA PSV values; sonographers should bear in mind that while far and near-field PSV can differ, conversely MCA PI can safely be assessed from both the near and far-fields of MCA in case of technical difficulty.

Early postnatal color Doppler changes in neonates receiving delivery room resuscitation with low 5 min Apgar score-a pilot study.

To evaluate the Doppler changes in the intracranial arteries of neonates exposed to perinatal hypoxic insult and compare it with normal neonates. Color Doppler of bilateral anterior and middle cerebral arteries was performed within 6 h of birth in 26 healthy neonates and 50 neonates who received delivery room resuscitation (DRR) for perinatal depression and had a 5 min Apgar score <7. Comparisons of resistive index (RI) and peak systolic velocity (PSV) were made between the (a) control group (b) patients with low 5 min Apgar score <7 who without clinical features of neonatal encephalopathy at 24 h (c) neonates with perinatal depression with a clinical evidence of disturbed neurological function at 24 h of birth and examination consistent with mild, moderate, or severe encephalopathy using modified Sarnat and Sarnat's classification. Significantly higher RI was observed in the neonates with to perinatal depression compared to the normal neonates. Significantly higher RI was seen in the patients with clinical features of neonatal encephalopathy (Group C) compared to group B. RI <0.6 and >0.82 was associated with severe neonatal encephalopathy. Differences in PSV were not statistically significant in the various groups. The study presents the changes in early cerebral Doppler parameters observed in neonates with low 5 min Apgar score following DRR compared to the normal neonates. We also present the relations of Doppler parameters with increasing severity of neonatal encephalopathy according to Sarnat classification.

Application of contrast-enhanced ultrasound-assisted superficial inferior epigastric artery perforator flap to repair oral and maxillofacial defects

To investigate the application value of contrast-enhanced ultrasound (CEUS) technique to assist the repair of oral and maxillofacial defects by superficial inferior epigastric artery perforator flap. Sixteen oral cancer patients, 10 males and 6 females, who were to undergo superficial inferior epigastric artery perforator flap repair between June 2018 and February 2020, were selected, with an average age of 55.8 years (range, 24-77 years). There were 13 cases of squamous cell carcinoma, 2 cases of adenoid cystic carcinoma, and 1 case of mucinous epidermis-like carcinoma. The color Doppler ultrasound (CDUS) and CEUS were used to screen the superficial inferior epigastric artery, assisted in the design of the flap, and compared it with the actual intraoperative exploration. The sensitivity, specificity, positive predictive value, and negative predictive value of CEUS and CDUS examinations were analyzed. Fourteen of 16 patients were repaired with superficial inferior epigastric artery perforator flap, and 2 patients were repaired with superficial iliac artery flap because the source artery was not found. After surgery, regular follow-up was performed to check for disease recurrence and metastasis and to evaluate the appearance of the patien's donor area, the recovery of transoral feeding function, and the presence of complications. Comparison of preoperative CDUS and CEUS findings and intraoperative exploration showed that CEUS had 100% sensitivity, specificity, positive predictive value, and negative predictive value for vascular exploration of the superficial inferior epigastric artery perforator flap, compared with 57%, 100%, 100%, and 25% for CDUS. The preoperative CDUS identified 25 penetrating vessels in 14 cases repaired with superficial inferior epigastric artery flaps. All vessel signals were enhanced by CEUS enhancement, and an additional 11 penetrating vessels were identified confirmed intraoperatively. The preoperative CEUS measurements of the initial diameter of superficial arteries in the abdominal wall were significantly higher than both CDUS and intraoperative measurements ( P<0.05); the difference in peak systolic velocity between CEUS and CDUS measurements was significant ( t=3.708, P=0.003). One case of superficial epigastric artery perforator flap developed venous embolism crisis at 48 hours after operation, the wound healing delayed. The other incisions in donor sites healed by first intention. All the patients were followed up 3-12 months, with an average of 8 months. No recurrence or metastasis appeared during the follow-up. There was no serious complications such as abdominal wall hernia, the location of abdominal scarring was hidden, and transoral feeding was resumed. The superficial inferior epigastric artery perforator flap with small injury in supply area and hidden scar location is a better choice for repairing oral and maxillofacial defects. The use of CEUS technique to assist the preoperative design of the superficial inferior epigastric artery perforator flap has good feasibility and high accuracy.

Characteristics of pleomorphic adenomas, adenolymphomas, and malignant tumors of the salivary glands on color doppler ultrasonography and contrast enhanced ultrasonography.

To provide a comprehensive description of the quantitative and qualitative characteristics of pleomorphic adenomas, adenolymphomas, and malignant tumors of the salivary glands on color doppler ultrasonography and contrast-enhanced ultrasonography (CEUS). 64 patients with 35 pleomorphic adenomas, 24 adenolymphomas, and 12 malignant tumors were enrolled in this study. All patients were examined by color doppler ultrasonography and CEUS before operation. In color Doppler ultrasonography, degree of vascularity, peak systolic velocity (PSV) and the vascular resistance index (RI) were obtained. In CEUS, type of enhancement, rim enhancement and area of enhancement were assessed. After the time-intensity curves (TIC) were drawn, the time to peak enhancement (TTP), peak intensity (PI) and the time from peak to one half (TFP) were calculated for the tumors and surrounding salivary parenchyma. Postoperatively, histopathologic examination of surgical specimens was used as the gold standard. Color Doppler ultrasonography showed no significant differences in PSV between tumors, significantly less adenolymphomas had Grade 0-1 vascularity compared to pleomorphic adenomas, and the RI was significantly lower in adenolymphomas compared to pleomorphic adenomas and malignant tumors. CEUS had acceptable diagnostic sensitivity, specificity, and accuracy for differential diagnosis of pleomorphic adenomas and adenolymphomas based on the diagnostic criteria of rim enhancement and slow wash-out rate, respectively. The sensitivity, specificity, and accuracy for differential diagnosis of malignant tumors based on the diagnostic criteria of an ill-defined enhancement margin, an enlarged enhancement area or a fast wash-in rate were also satisfactory. Accurate diagnosis of salivary gland tumors in clinical practice can be increased using color Doppler ultrasound and CEUS in combination with a case history and other imaging.

Effect of Hydration on Doppler Velocity of Renal Arteries.

Doppler sonography is a noninvasive method to evaluate the hemodynamic status of the kidney, and its parameters are used as direct and indirect predictors of certain parenchyma and renovascular diseases. However, the effect of hydration on kidney hemodynamics has not been explored via Doppler sonography. To examine differences in arterial Doppler velocities of normal adult kidney before and after hydration. A total of 60 native kidneys in 30 normal adult participants (mean age, 26 years) were assessed using Doppler sonography. Quantitative ultrasound Doppler parameters of peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) of the main renal artery and the intrarenal (interlobar) arteries were measured immediately before and 1 hour after ingestion of 500 mL of water. We tested differences in Doppler parameters before and after hydration using a paired t test, analyzed the correlation of the increase in PSV to the increase in EDV after hydration using Pearson correlation coefficient (PCC), and examined intraobserver reliability using intraclass correlation coefficient (ICC). Statistical analyses revealed that the differences in PSV and EDV values before and after hydration at the main renal artery and interlobar arteries of the kidney were significant (P<.001), whereas the RI at the main renal artery and interlobar arteries were not (P>.05). PCC for the correlation of the increase in PSV to the increase in EDV was greater than 0.80. ICC for intraobserver repeatability in performing kidney Doppler sonography was 0.92. Our results suggest that Doppler sonography is able to demonstrate changes in kidney hemodynamics within 1 hour after hydration. The normal kidney reflects proportional increases in PSV and EDV at the main renal artery and interlobar arteries, while maintaining vascular resistance. Doppler flow velocities of renal arteries can be considered as noninvasive quantitative markers for evaluating the response of kidney hemodynamics to hydration.

Association of von Willebrand factor (vWF) expression with lymph node metastasis and hemodynamics in papillary thyroid carcinoma.

The purpose of this study was to analyze the relationship between von Willebrand factor (vWF) expression and lymph node metastasis or hemodynamics parameters in PTC. This work will provide a novel biomarker for the diagnosis of papillary thyroid carcinoma (PTC). A total of 156 PTC patients were divided into metastatic and non-metastatic groups based on the presence or absence of lymph node metastasis. The Adler blood flow grading, color doppler flow imaging (CDFI), and blood flow index (PSV, PI, RI, AT) were measured and analyzed between the two groups. The expression of vWF was examined by immunocytochemical assay and quantitative Real-Time Polymerase Chain Reaction (qRT-PCR). The function of vWF was investigated by methyl thiazolyl tetrazolium (MTT) and the transwell assays. Both metastatic and non-metastatic groups with the major Adler grades as 0-1 had abundant blood flows. There was a significant difference in the rate of lymph node metastasis between Adler 2-3 and Adler 0-1. Moreover, the expression of vWF was found to be associated with lymph node metastasis or Adler blood flow grade in PTC. Significant differences in peak systolic velocity (PSV), systolic acceleration time (AT), and resistance index (RI) were detected in metastatic and non-metastatic groups. In addition, the upregulation of vWF was positively correlated with PSV, RI, and PI in PTC. Functionally, the knockdown of vWF inhibited the development of PTC by suppressing cell proliferation, migration, and invasion. Abnormal expression of vWF is closely related to lymph node metastasis and hemodynamics parameters in PTC patients. Furthermore, vWF plays an oncogene role in PTC progression.

Accuracy of Peak Systolic Velocity of Radial Artery as Predictor of Maturation of Radiocephalic Arteriovenous Fistula in Cipto Mangunkusumo Hospital

Introduction: Hemodialysis is an essential treatment in patients with stage 5 chronic kidney disease (CKD) or End-Stage Renal Disease (ESRD). The maturity of arteriovenous fistulas determines the success of hemodialysis. FAV maturity depends on preoperative preparation. The study aims to examine the preoperative and intraoperative peak systolic velocity (PSV) of the radial artery as a predictor of the successful maturation of the radiocephalic FAV. Method: This study used an analytic cross-sectional design to obtain the relationship of FAV maturation with preoperative and intraoperative PSV. Subjects were those who will undergo radiocephalic FAV surgery with preoperative ultrasound mapping. Shortly after anastomosis, PSV was measured. After 6 weeks, FAV was assessed for its maturity. Results: As many as 71 patients were undergone radiocephalic FAV surgery and followed for six weeks. The mean preoperative PSV of mature fistula was significantly higher than immature (54.6 ± 11.7 cm/s and 26.7 ± 7.7 cm/s; p &lt;0.001). The mean intraoperative PSV of mature fistula was significantly higher than immature (57.9 + 12.6 cm/s and 27.1 + 8.1 cm/s; p &lt;0.001). The mean PSV difference in mature fistulas was significantly higher than immature (3 cm/s and 0 cm/s; p &lt;0.001). Preoperative PSV with a cut-off of 40 cm/s, intraoperative with a cut-off of 42 cm/s, and a difference of PSV with a cut-off of 42 cm/s all had 92.9% accuracy as a predictor of FAV maturation compared to “rule of 6” as a reference standard. Conclusion: Preoperative PSV &gt;40 cm/s and intraoperative PSV &gt;42 cm/s had a good predictor value for radiocephalic FAV maturation. Keywords: peak systolic velocity, maturation, arteriovenous fistula, radial artery

23. Role of trans-cranial Doppler in children with acute liver failure – A prospective observational pilot study

Background and Aims: Early detection of raised intracranial pressure improves outcome in acute liver failure (ALF). We evaluated role of bedside transcranial doppler (TCD) in ALF children for feasibility, correlation with severity of hepatic encephalopathy (HE) and predicting outcome. Methods: 28 ALF children [24 boys, 11 (5–18 years)] with HE (grade I–II = 9, III–IV = 19) and 47 healthy controls [30 boys, 11 (5–18 years)] were prospectively enrolled. Demographic, clinical and laboratory parameters were recorded. Expert radiologist performed TCD of middle cerebral artery (MCA) with 2 MHz probe through temporal window. Peak systolic velocity (Vs), end diastolic velocity (Vd), mean flow velocity (mFV), pulsatility (PI) and resistive index (RI) were calculated by electronic calipers. PI ≥ 1.2 was suggestive of raised ICP. Results: TCD could be performed in all patients and healthy controls except one with poor window. TCD parameters in controls and ALF with grade I–II HE and III–IV HE are shown in Table 1. The peak systolic velocity, PI and RI showed an increasing trend from controls to HE grade I–II to grade III–IV (Table 1). ALF children with HE grade III–IV had significantly higher peak systolic velocity, PI and RI as compared to controls. However, the difference in peak systolic velocity, PI and RI in ALF patients with HE grade I-II versus controls and ALF with HE I-II versus III-IV was not statistically significant. ALF children with PI ≥ 1.2 (n = 7) more often had severe grade (III-IV) of HE (7/7 vs. 12/21; p = 0.03) and poorer outcome (0/7 vs. 8/21 survival without transplantation; p = 0.05) than those with PI < 1.2 (n = 21). Conclusions: Transcranial doppler is feasible in ALF children. The PI, RI and peak systolic velocity of MCA are higher in ALF with grade III-IV HE then controls but they do not differentiate between grades of HE. PI ≥ 1.2 is a predictor of poor outcome. The authors have none to declare.

Application of Transcranial Color Doppler Ultrasonography for Assessing Middle Cerebral Arteries in Rheumatoid Arthritis.

To assess the role of ultrasonography for assessing middle cerebral arteries (MCAs) in rheumatoid arthritis (RA). Middle cerebral arteries of 32 RA patients and 32 healthy volunteers were examined by ultrasonography. Peak systolic blood flow velocity (PSV), end-diastolic velocity, and resistance index (RI) of MCA were measured using Doppler ultrasound. Results were expressed as mean ± SD. No significant difference in peak systolic velocity was obtained between RA patients (52.44 ± 19.56 cm/s) and healthy volunteers (51.59 ± 16.83 cm/s, P > 0.05). End-diastolic velocity in RA patients was significantly lower (15.41 ± 5.44 cm/s vs 24.54 ± 8.45 cm/s, P < 0.01) and RI markedly higher (0.66 ± 0.10 vs 0.60 ± 0.06, P < 0.05) compared with control values. Resistance index in 32 RA patients increased with disease duration (2 months to 31 years), from a median value of 0.350 to 0.830; there was a strong correlation between RI and disease duration (r = 0.965, P < 0.05). A point of 0.64 in receiver operating characteristic curve was chosen as the cutoff point, and the area under the curve was 0.918. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 90.6%, 87.5%,87.9%, 90.3%, and 89.1%, respectively. Color Doppler ultrasound in RA patients with hemodynamic changes of MCAs could be a relatively sensitive tool for the detection of cerebral atherosclerotic lesions. This could enable timely intervention for early clinical reference.

Cerebral vasoreactivity and intima-media thickness in Down syndrome: A case-control study

Subjects with Down Syndrome (DS) have high prevalence of cerebral vascular amyloidosis, cognitive decline and dementia. In Alzheimer Disease, impaired vasoreactivity has been reported as the results of vascular amyloid deposition. Aim of our study was to verify presence of impaired cerebral vasoreactivity and to study carotid intima media-thickness (IMT) by carotid and transcranial ultrasound. We studied 25 DS and compared them with 25 age- and sex-matched normal controls. Vasomotor reactivity was evaluated by means of breath-holding index (BHI) test. There was no difference in IMT, both considering the two side separately (left: 0.70±0.10 vs 0.69±0.12mm, p=0.6) (right: 0.67±0.13 vs 0.68±0.10mm, p=0.5), and considering the sum of both sides (1.38±0.22 vs 1.38±0.23mm, p=1). There was a significant difference in peak systolic velocities (PSV) (139.75±27.67 vs. 123.89±25.73cm/s, p=0.04) and in pulsatility index (PI) (0.95±0.14 vs. 0.86±0.12, p=0.02). BHI was significantly lower in DS than in controls (1.15±0.38 vs 1.88±0.72, p<0.001). In conclusion, subjects with DS have increased PSV and PI, and show a reduction of BHI, expression of impaired vasomotor reserve, possibly due to micro-vascular impairment. Larger study with longitudinal design is needed to verify our data.

Doppler velocimetry in fetal rats exposed to enoxaparin and unfractionated heparin (UFH) during pregnancy.

To evaluate the effects of enoxaparin and unfractionated heparin (UFH) administered in prophylactic and therapeutic doses on fetal vessels in healthy pregnant Wistar rats, according to Doppler velocimetry measurements. Fifty animals were assigned to one of five groups: controls (saline), prophylactic and therapeutic enoxaparin (1 and 2 mg/kg/day, respectively), and prophylactic and therapeutic UFH (72 and 400 UI/kg/day, respectively). Uterine horns were examined by ultrasound for identification of live fetuses. A sample of these fetuses underwent Doppler velocimetry. Spectral curves, peak systolic velocity (PSV), pulsatility index (PI), and resistance index (RI) of the middle cerebral artery, ductus venosus, and umbilical artery were investigated. Differences were considered statistically significant when p<0.05. No significant differences in PSV, PI, or RI values were observed among the groups. Doppler velocimetry measurements revealed no significant effects of enoxaparin or unfractionated heparin on fetal vessels in pregnant Wistar rats.