Hemodynamic Alterations Research Articles

Effect of intraoperative aminophylline infusion on pain intensity after ureteroscopic lithotripsy: A randomized controlled study

ABSTRACT Background Aminophylline relaxes smooth muscle by inhibiting the phosphodiesterase enzyme and activating protein kinase A, and alleviates inflammation by decreasing the production of leukotrienes. We aimed to assess the effect of intraoperative intravenous (IV) aminophylline on postoperative pain in patients undergoing ureteroscopic lithotripsy. Methods A randomized, placebo-controlled trial was conducted on 50 patients who were scheduled for ureteroscopic lithotripsy under general anesthesia. Patients were divided into two equal groups. Group 1 received 4 mg/kg aminophylline diluted in 100 ml saline 0.9% IV over 20 minutes. Group 2 received saline 0.9% with a similar volume and period as the aminophylline group. Visual analogue scale (VAS) score was recorded at arrival to the post-anesthesia care unit (PACU), 1 h, 2 h, 6 h, 12 h, and 24 h after surgery. Catheter-related bladder discomfort (CRBD) was assessed at PACU arrival, 1 h, 2 h, and 6 h postoperatively. Results VAS measurements at arrival to the PACU, 1 h, 2 h, and 6 h postoperative were significantly lower in group 1 than in group 2 (p < 0.05). Total pethidine consumption in the first 24 hours postoperatively was significantly lower in group 1 (43.04 ± 14.52 mg) than in group 2 (59.32 ± 18.34 mg); p = 0.002. Aminophylline significantly decreased the incidence of moderate-to-severe CRBD at PACU arrival and 1 h after surgery (p = 0.005 and 0.007, respectively). There was no significant variation between both groups regarding side effects. Conclusions In patients undergoing ureteroscopic lithotripsy, intraoperative IV aminophylline infusion reduced postoperative pain and opioid consumption. It also decreased the incidence of early moderate-to-severe CRBD without evidence of intraoperative hemodynamic alterations or postoperative side effects.

The Risk of Atrial Fibrillation in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Objective: To evaluate the role of acute exacerbation of COPD in the risk of atrial fibrillation. Study Design: Cross sectional study design.Place and Duration of Study: The study was conducted at Bakhtawar Amin Hospital Multan and Recep Tayyip Erdogan Hospital Muzaffargarh, Pakistan from March 2022 to March 2023.Methods: The patients with acute, hypercapnic chronic obstructive pulmonary disease(COPD) exacerbation were included in the study. A total of 200 patients were analyzed. Baseline data including demographic and clinical details, blood tests, ABG, systolic and diastolic blood pressure, ECG, pulmonary function test, and transthoracic echocardiography were recorded.Results: Of 200 patients, 40(20%) had an episode of paroxysmal atrial fibrillation (AF). Atrial fibrillation was more prevalent in cases with lower FEV1 (P&lt;.05). In addition, it was also more common in cases with higher PaCO2 (P&lt;.05). Atrial Fibrillation was significantly higher in cases with larger LA diameters (34.1 ± 2.3 mm vs 46.1 ± 2.3 mm, P&lt;.05), area (22.8 ± 4.1 cm2 vs 34.1 ± 5.1 cm2, P&lt;.05) and higher PASP (36.1 mmHg ± 2.2 vs 46.4 mmHg ± 3.7, P&lt;.05). RA area was larger in patients with AF and COPD compared to those without AF (25.6 ± 5.1cm2 vs 30.2 ± 6.4 cm2, P&lt;0.05). These findings suggest COPD patients are at increased risk of AF and require measures to reduce the risk. These data will be helpful for further investigation and development of strategies to prevent AF morbidities in COPD patients.Conclusion: In patients with acute exacerbations of chronic obstructive pulmonary disease, blood gas fluctuations, hemodynamic alterations, and abnormal pulmonary functions can lead to an increased risk of atrial fibrillation. How to cite this: Razzaq MA, Atif M, Ullah U, Mehmood M, Irfan M, Sardar K. The Risk of Atrial Fibrillation in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Life and Science. 2024; 5(2): 132-137. doi: http://doi.org/10.37185/LnS.1.1.487

Effects of Perceived Social Stress on Cerebrovascular Hemodynamics in Young and Middle-Aged Adults

Depression is associated with altered cerebrovascular hemodynamics, including lower cerebral blood flow, higher cerebral pulsatility, and greater arterial stiffness. There is evidence that perceived stress may contribute to depressive symptomology, but it is unknown if stress may directly impact cerebrovascular hemodynamics. The purpose of this investigation was to examine associations among middle cerebral artery (MCA) hemodynamics, arterial stiffness, and perceived stress in young and middle-aged adults. It was hypothesized that individuals with higher reported social stress would have lower MCA mean velocity and higher MCA pulsatility and arterial stiffness. Methods: 168 adults (range 18-64 years; 40 ± 16 years; BMI 26.6 ± 4.6 kg/m2; n=88 females) underwent resting cerebrovascular measures and completed the self-reported perceived stress scale (PSS-10). Brachial blood pressure and carotid pulse pressure were assessed via oscillometric cuff and tonometry, respectively. Arterial stiffness was assessed as carotid-femoral pulse wave velocity (cfPWV) via tonometry and MCA mean velocity and pulsatility index were assessed via Transcranial Doppler. Results: The sample contained 4 adults with high (PSS score ≥27; mean, 28 ± 1), 38 adults with moderate (PSS score 14-26; mean, 17 ± 2), and 126 adults with low stress (PSS score &lt;13; mean, 8 ± 3). Self-reported perceived stress was not significantly linearly associated with MCA mean velocity (r=-0.10), MCA Pulsatility Index (r=-0.08), or arterial stiffness (r=0.05). A secondary analysis comparing adults with moderate/high stress (n=42) to adults with low stress (n=126) revealed a significantly lower MCA mean velocity among moderate/high stress adults (p&lt;0.05), however this difference was attenuated and no longer statistically significant after covarying for age. Conclusions: This data suggests that perceived stress 1) is not associated with altered cerebrovascular hemodynamics or arterial stiffness in our sample of generally healthy young and middle-aged adults, and 2) may not play a major role in altering cerebrovascular hemodynamics in the context of stress-related disorders (e.g., depression), however future research is required to directly test this hypothesis. Iowa State University College of Human Sciences Faculty Seed Grant. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

CYSTATIN C BASED EGFR IS SUPERIOR FOR THE ASSESSMENT OF CARDIOVASCULAR RISK IN PRETERM CHILDREN

Objective: Preterm birth is a risk factor for hypertension (HTN), chronic kidney disease (CKD) and adverse cardiovascular (CV) outcomes. The aims of the study were to evaluate the utility of eGFR based on cystatin C (Cys C) compared to creatinine in regard to associations with office blood pressure (BP) and central systolic BP (cSBP). Design and method: This case-control study included 52 children and adolescents born prematurely (ex-preterms) and 26 at full term (controls) matched for age in 2:1 ratio. All participants underwent office BP and cSBP measurement and laboratory evaluation including assessment of CysC values at the same visit. Results: Mean age of the population was 10.74±3.55 years. There were no significant differences in BP levels, eGFR(creatinine) and eGFR(CysC) between ex-preterm and control group. CysC levels were similar between the ex-preterm and the control group. CysC significantly correlated with cSBP z score (r=0.32, p=0.02, Spearman test). This association remained significant after adjustment for age, sex and BMI z score in the ex-preterm group (B=1.003, 95%CI 1.001-0.005, p=0.006). 42% (n=22) of the ex-preterm children presented cSBP levels greater than the 95th percentile. eGFR(CysC) presented positive association with office DBP (r=-0.37, p= 0.006, Spearman test) and cSBP z score (r= -0.32, p=0.022, Spearman test) in the ex-preterm group, but not in the control group (Figure). eGFR(creatinine) did not associate with BP parameters. eGFR(creatinine) overestimated eGFR levels in ex-preterm group (mean difference 20.56±22.66, p &lt;0.001). Two (3%) and 17(32.6%) ex preterm children had GFR &lt; 90 ml/min/1.73m2 by creatinine-based eGFR compared by eGFR(CysC). Conclusions: eGFR(CysC) presents apositive association with cSBP and thus, may better classify future cardiovascular risk in ex-preterm children. cSBP elevation and its association with CysC maybe a target for future studies to elucidate the role of central hemodynamic alterations in the development of HTN and CV disease in the ex-preterm individuals.

Maternal cardiovascular profile is altered in the preclinical phase of normotensive early and late intrauterine growth restriction

BackgroundMaternal cardiovascular profile of patients developing late fetal growth restriction is yet to be well characterized, although a subclinical impairment of maternal hemodynamics and cardiac function may be present before pregnancy, becoming evident because of the hemodynamic alterations of pregnancy. ObjectivesOur objective was to investigate if maternal hemodynamics and the cardiovascular profile might be different in the preclinical stages (22-24 weeks gestation) of early and late fetal growth restriction in normotensive patients. Study designThis was a prospective echocardiographic study of 1152 normotensive nulliparous pregnant women at 22-24 weeks’ gestation. The echocardiographic evaluation included morphological parameters (left ventricular mass index and relative wall thickness, left atrial volume index) as well as systolic and diastolic maternal left ventricular function (ejection fraction, left ventricular LV global longitudinal strain, E/A, and E/e'). Patients were followed until the end of pregnancy to note the development of normotensive early or late fetal growth restriction. Results1049 patients had no complications, 73 were classified as late fetal growth restriction and 30 as early fetal growth restriction. Left Ventricular MorphologyLeft ventricular end-diastolic diameter was greater in uneventful pregnancies (4.84±0.28 cm) vs late (4.67±0.26 cm) and vs early fetal growth restriction (4.55±0.26 cm) (p<0.001), whereas left ventricular end-systolic diameter was smaller in uneventful pregnancies (2.66±0.39 cm) vs late (2.83±0.40 cm) and early fetal growth restriction (2.82±0.38 cm) (p<0.001). Relative wall thickness was slightly higher in early (0.34±0.05) and late fetal growth restriction (0.35±0.04) vs uneventful pregnancies (0.32±0.05) (p<0.05). Systolic Left Ventricular FunctionAt 22-24 weeks’ cardiac output was higher in uneventful pregnancies (6.58±1.07 L/min) vs late (5.40±0.97 L/min) and vs early fetal growth restriction (4.76±1.05 L/min) (p<0.001), with the lowest values in the early onset group. Left ventricular global longitudinal strain was lower in AGA (-21.6±2.0%), and progressively higher in late (-20.1±2.2%) and early fetal growth restriction (-18.5±2.3%) (p<0.001). Diastolic Left Ventricular FunctionE/e’ ratio showed intermediate values in the late fetal growth restriction (7.90±2.73) vs AGA (7.24±2.43) and vs early fetal growth restriction (10.76±3.25) (p<0.001). Total Peripheral Vascular ResistanceTotal Peripheral Vascular Resistance was also intermediate in the late fetal growth restriction (1300±199 dyne·s·cm-5) vs AGA (993±175 dyne·s·cm-5) and vs early fetal growth restriction (1488±255 dyne·s·cm-5) (p<0.001). ConclusionsEarly and late fetal growth restriction share similar maternal hemodynamic and cardiovascular profiles with a different degree of expression. These features are already present at 22-24 weeks gestation and are characterized by a hypodynamic state. The degree of these cardiovascular changes may influence the timing of the manifestation of the disease: a hypovolemic, high resistance, low cardiac output state might be associated to early onset fetal growth restriction, whereas a milder hypovolemic state seems to favor a development of the disease in the final stages of pregnancy.

Heme oxidation of NO-receptor soluble guanylyl cyclase is an important contributor to cerebrovascular and cognitive dysfunctions

Introduction: Decreased cerebral blood flow (CBF) is one of the major hemodynamic alterations leading to neurodegeneration and age-related cognitive decline. Nitric Oxide (NO)-dependent vasomotor reactivity is central in regulating cerebrovascular hemodynamics and adequate brain blood perfusion. NO receptor Soluble Guanylyl Cyclase (sGC) is the primary mediator of NO-dependent vasodilation. Oxidative stress, often persisting in diseased vasculature, renders sGC insensitive to NO and impairs the NO signaling. The objective of our study was to investigate the role of sGC oxidation in regulation CBF and brain function. Hypothesis: Oxidative stress disrupts NO/cGMP signaling in brain by decreasing sGC activity via oxidation of sGC heme. Approach: To assess causal effect of sGC oxidation on NO signaling function we administered ODQ, a sGC-specific heme oxidizing agent, to simulate long-term effect of sGC oxidation in cerebral vasculature. Two groups of young wild-type male and female mice (4 months old C57BL/6) were treated intraperitoneally (IP) twice a week for one month with ODQ (20 mg/kg) or a solvent as control. Changes in cerebrovascular reactivity and memory function were assessed and compared in treated and control groups. Using a non-invasive pulsed Doppler ultrasound-based system we assessed the changes in blood flow velocity (PVF, % of baseline) in the mouse middle cerebral artery (MCA) of male and female groups. MCA vasodilation was induced by bolus IP injection of NO-donor sodium nitroprusside (SNP) or BAY 58-2667, an allosteric NO-independent sGC activator. Memory function was assessed by the Novel Object Recognition Task (NORT, RI, recognition index) in all experimental groups. Western blotting and densitometry assessed the expression of major sGC subunits (α1, α2 and β1) in cleared brain lysates from ODQ-treated and control groups. Results: We observed a significantly blunted vasodilative response to SNP (1 mg/kg) in ODQ-treated mice vs controls of both genders (PVF, max response at 2 min post-injection, males 73.9 ± 10.4% (n=7/7) vs 58.5 ± 8.6 %, p=0.01; females (n=6/6) 77.4 ± 10.6 % vs 61.9 ± 5.4 %, p=0.01). Changes in response to NO-donor were more pronounced in males than females. The difference in BAY 58-2667 response between ODQ-treated and control groups was not statistically significant. ODQ significantly reduced the long-term memory in males but not female, according to NORT (RI, males (n=7/7) 0.58 ± 0.13 vs 0.69 ± 0.05; p=0.01; females (n=6/6) ODQ 0.59 ± 0.17 vs 0.73 ± 0.1, p=0.13). No statistically significant difference in expression of sGC subunits between control and ODQ-treated (n= 4/4) of male and female groups was determined. Conclusions: ODQ treatment significantly impairs vasodilation response to NO-donor but not to NO-independent sGC activator in mice MCA. ODQ treatment negatively affects long-term memory function in male, but not female mice. ODQ treatment does not significantly affect the expression of sGC subunits. Together our data suggest that the oxidation of sGC heme moiety impairs the regulation of cerebral blood flow of both genders and impairs long-term memory function gender-specifically in young mice. This research was supported by National Institute of Health grants RAG071999A (Iraida Sharina), HL139838, and American Heart Association 23TPA1070711 (Emil Martin). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Deriving fontan-specific normative exercise data from well-functioning adolescents

BackgroundExercise capacity is reduced in patients with a Fontan circulation compared to their healthy peers secondary to altered haemodynamics of the Fontan circulation. Cardiopulmonary exercise testing is routinely used in Fontan patients to assess their cardiopulmonary response to exercise and help guide management decisions, however their results are routinely compared to normative data derived from healthy individuals. MethodUsing data available from the Pediatric Heart Network, we performed a retrospective study to derive Fontan-specific normative values in a subgroup of well-functioning adolescent patients. We utilised results from the Congenital Heart Adolescent and Teenager (CHAT) Questionnaire to classify patients into well-functioning and lower-functioning groups. ResultsWe generated Fontan-specific regression equations in adolescent male and females for normative values of peak oxygen consumption (VO2), maximal workload and VO2 at anaerobic threshold. ConclusionWe propose that Fontan-specific normative values are a more useful comparison than healthy normative data due to the known circulatory limitations of the Fontan circulation and will assist in management decision and prognostication.

Potentiation of the depressant effect of alcohol by flunitrazepam in rats: an electrocorticographic, respiratory and electrocardiographic study.

Alcohol, a widely commercialized psychotropic drug, and the benzodiazepine Flunitrazepam, an anxiolytic widely prescribed for patients with anxiety and insomnia problems, are well known drugs and both act on the central nervous system. The misuse and the association of these two drugs are public health concerns in several countries and could cause momentary, long-lasting and even lethal neurophysiological problems due to the potentiation of their adverse effects in synergy. The present study observed the result of the association of these drugs on electrophysiological responses in the brain, heart, and respiratory rate in Wistar rats. 8 experimental groups were determined: control, one alcohol group (20% at a dose of 1ml/100g VO), three Flunitrazepam groups (doses 0.1; 0.2 and 0.3mg/kg) and three alcohol-Flunitrazepam groups (20% at a dose of 1ml/100g VO of alcohol, combined with 0.1; 0.2 and 0.3mg/kg of Flunitrazepam, respectively). The results showed that there was a more pronounced reduction in alpha and theta wave power in the alcohol-Flunitrazepam groups, a decrease in the power of beta oscillations and greater sedation. There was a progressive decrease in respiratory rate linked to the increase of Flunitrazepam dose in the alcohol-Flunitrazepam associated administration. It was observed alteration in heart rate and Q-T interval in high doses of Flunitrazepam. Therefore, we conclude that the association alcohol-Flunitrazepam presented deepening of depressant synergistic effects according to the increase in the dose of the benzodiazepine, and this could cause alterations in low frequency brain oscillations, breathing, and hemodynamics of the patient.

Intracranial Pressure and Cerebral Hemodynamics in Infants Before and After Glenn Procedure.

This prospective cohort study aimed to investigate changes in intracranial pressure (ICP) and cerebral hemodynamics in infants with congenital heart disease undergoing the Glenn procedure, focusing on the relationship between superior vena cava pressure and estimated ICP. A single-center prospective cohort study. The study was conducted in a cardiac center over 4 years (2019-2022). Twenty-seven infants with congenital heart disease scheduled for the Glenn procedure were included in the study, and detailed patient demographics and primary diagnoses were recorded. Transcranial Doppler (TCD) ultrasound examinations were performed at three time points: baseline (preoperatively), postoperative while ventilated (within 24-48 hr), and at discharge. TCD parameters, blood pressure, and pulmonary artery pressure were measured. TCD parameters included systolic flow velocity, diastolic flow velocity (dFV), mean flow velocity (mFV), pulsatility index (PI), and resistance index. Estimated ICP and cerebral perfusion pressure (CPP) were calculated using established formulas. There was a significant postoperative increase in estimated ICP from 11 mm Hg (interquartile range [IQR], 10-16 mm Hg) to 15 mm Hg (IQR, 12-21 mm Hg) postoperatively (p = 0.002) with a trend toward higher CPP from 22 mm Hg (IQR, 14-30 mm Hg) to 28 mm Hg (IQR, 22-38 mm Hg) postoperatively (p = 0.1). TCD indices reflected alterations in cerebral hemodynamics, including decreased dFV and mFV and increased PI. Intracranial hemodynamics while on positive airway pressure and after extubation were similar. Glenn procedure substantially increases estimated ICP while showing a trend toward higher CPP. These findings underscore the intricate interaction between venous pressure and cerebral hemodynamics in infants undergoing the Glenn procedure. They also highlight the remarkable complexity of cerebrovascular autoregulation in maintaining stable brain perfusion under these circumstances.

Tissue perfusion monitoring in children with acute circulatory dysfunction: narrative review

Sepsis is one of the main causes of admission to Intensive Care Units (ICU). The hemodynamic objectives usually sought during the resuscitation of the patient in septic shock correspond to macrohemodynamic parameters (heart rate, blood pressure, central venous pressure). However, persistent alterations in microcirculation, despite the restoration of macrohemodynamic parameters, can cause organ failure. This dissociation between the macrocirculation and microcirculation originates the need to evaluate organ tissue perfusion, the most commonly used being urinary output, lactatemia, central venous oxygen saturation (ScvO2), and veno-arterial pCO2 gap. Because peripheral tissues, such as the skin, are sensitive to disturbances in perfusion, noninvasive monitoring of peripheral circulation, such as skin temperature gradient, capillary refill time, mottling score, and peripheral perfusion index may be helpful as early markers of the existence of systemic hemodynamic alterations. Peripheral circulation monitoring techniques are relatively easy to interpret and can be used directly at the patient's bedside. This approach can be quickly applied in the intra- or extra-ICU setting. The objective of this narrative review is to analyze the various existing tissue perfusion markers and to update the evidence that allows guiding hemodynamic support in a more individualized therapy for each patient.

Functional connectivity-hemodynamic (un)coupling changes in chronic mild brain injury are associated with mental health and neurocognitive indices: a resting state fMRI study.

To examine hemodynamic and functional connectivity alterations and their association with neurocognitive and mental health indices in patients with chronic mild traumatic brain injury (mTBI). Resting-state functional MRI (rs-fMRI) and neuropsychological assessment of 37 patients with chronic mTBI were performed. Intrinsic connectivity contrast (ICC) and time-shift analysis (TSA) of the rs-fMRI data allowed the assessment of regional hemodynamic and functional connectivity disturbances and their coupling (or uncoupling). Thirty-nine healthy age- and gender-matched participants were also examined. Patients with chronic mTBI displayed hypoconnectivity in bilateral hippocampi and parahippocampal gyri and increased connectivity in parietal areas (right angular gyrus and left superior parietal lobule (SPL)). Slower perfusion (hemodynamic lag) in the left anterior hippocampus was associated with higher self-reported symptoms of depression (r = - 0.53, p = .0006) and anxiety (r = - 0.484, p = .002), while faster perfusion (hemodynamic lead) in the left SPL was associated with lower semantic fluency (r = - 0.474, p = .002). Finally, functional coupling (high connectivity and hemodynamic lead) in the right anterior cingulate cortex (ACC)) was associated with lower performance on attention and visuomotor coordination (r = - 0.50, p = .001), while dysfunctional coupling (low connectivity and hemodynamic lag) in the left ventral posterior cingulate cortex (PCC) and right SPL was associated with lower scores on immediate passage memory (r = - 0.52, p = .001; r = - 0.53, p = .0006, respectively). Uncoupling in the right extrastriate visual cortex and posterior middle temporal gyrus was negatively associated with cognitive flexibility (r = - 0.50, p = .001). Hemodynamic and functional connectivity differences, indicating neurovascular (un)coupling, may be linked to mental health and neurocognitive indices in patients with chronic mTBI.

Correlation of retrobulbar perfusion deficits with glaucomatous visual field defects.

This study is to evaluate the correlation between retrobulbar perfusion deficits and glaucomatous visual field defects. Eighty-four patients with glaucoma and 17 normal subjects serving as controls were selected. Color Doppler imaging (CDI) was used to measure the changes in blood flow parameters in the retrobulbar ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary arteries (SPCAs). Visual field testing was performed using a Humphrey perimeter, categorizing the visual field deficits into four stages according to the Advanced Glaucoma Intervention Study (AGIS) scoring method. Subsequently, the correlation of retrobulbar hemodynamic parameter alterations among glaucomatous patients with varying visual field defects was examined. The higher the visual field stage, the lower the peak systolic velocity (PSV) of the OA, CRA, and SPCAs in glaucomatous patients. The CRA had the highest sensitivity to changes in its PSV. The PSV of the temporal SPCA (TSPCA-PSV) was lower in advanced glaucoma than in early-stage glaucoma. The PSVs of the OA, CRA, and TSPCA, as well as the resistance index of the CRA (CRA-RI), were positively correlated with the visual field index and the mean deviation. Except for that of OA, the PSV of the retrobulbar vessels was negatively correlated with the pattern standard deviation (PSD). The OA-PSV and end-diastolic velocity (EDV) of the CRA and TSPCA were lower in patients with superior visual field defects than in those with inferior visual field defects. Greater severity of visual field defects corresponded to poorer retrobulbar blood flow in glaucomatous patients. Patients suffered significant perfusion impairments in the CRA at the early stage, accompanied by SPCA perfusion disorder at the advanced stage. The presence of a bow-shaped defect in the superior or inferior region of the visual field in moderate-stage glaucoma was closely correlated with retrobulbar vascular EDV. ChiCTR2200059048 (2022-04-23).

Processed Electroencephalogram in Intracranial Hypertension and Brain Hypoperfusion: A Case Report

AbstractProcessed electroencephalogram (pEEG) is a record of electrical activity of the brain. In certain circumstances, it can reflect pathophysiological alterations and hemodynamic compromise. A 79-year-old woman diagnosed with subarachnoid hemorrhage and postcardiac arrest status was transferred for emergency ventriculostomy. The frontal monitoring with pEEG (SedLine, Masimo) from baseline showed low frontal activity, left and right spectral edge frequency (SEF) without numerical value, low activity in bilateral density spectral array (DSA), and zero in the patient state index (PSI). After ventricular puncture and placement of the ventriculostomy system, the pEEG showed an increase in the frequency and amplitude of the four-channel waveform of the pEEG, DSA, and numerical value of SEF and PSI. The use of pEEG can determine the depth of anesthesia and perhaps detect various cerebral and systemic pathophysiological and hemodynamic alterations; however, single monitoring may not be as predictive, so the use of multimodal monitoring is recommended.

Association of Graves' disease and Moyamoya syndrome in a Caucasian woman from Western Europe: vascular effects of anti-TSH receptor antibodies?

Moyamoya syndrome (MMS) refers to a rare cerebrovascular disorder characterized by progressive stenosis of the intracranial internal carotid arteries and their proximal branches, leading to an increased risk of stroke. While prevalent in Asia, this condition is considerably less common in Western countries, including Europe. The association between MMS and Graves' disease (GD) has been well documented, primarily in Asian and American populations, notably Latin Americans. In this report, we report the first case of GD with MMS in a Caucasian woman from Western Europe. The precise mechanisms underpinning the correlation between these two conditions remain poorly elucidated but are hypothesized to involve hemodynamic alterations, the toxic effects of anti-thyroid-stimulating hormone receptor antibodies, or a shared genetic predisposition. Our clinical case underscores the significance of thyroid disease screening in suspected MMS cases, as the management of thyroid dysfunction may suffice to improve neurological symptoms. The association between Graves' disease (GD) and Moyamoya syndrome (MMS) can manifest in a Caucasian European patient. Screening for thyroid disease is essential when MMS is suspected, as treating GD might effectively alleviate neurological symptoms. The mechanisms linking GD and MMS remain incompletely understood but may involve hemodynamic shifts, the toxic effect of anti-TSH receptor antibodies, or shared genetic factors.

Complex retrograde transarterial access and embolization of a giant internal iliac artery aneurysm after occlusion failure of Micro vascular plug (MVP) embolization and preceding EVAR in the distal ectatic Aorta and bilateral iliac artery aneurysms

The therapy of pelvic aneurysms is minimally invasive through interventional radiology using various devices and embolic agents: &#x0D; 1. By using a covered stent/prosthesis to maintain antegrade flow when a landing zone, i.e., a&#x0D; vascular segment angiographically present into which the stent can be placed to bridge the neck of the aneurysm, thereby interrupting aneurysm perfusion. &#x0D; 2. Through complete embolization of the aneurysm using embolic agents/coils. &#x0D; 3. As performed in our case, by covering the aneurysm (Img 14 A-C) with a covered stent /prosthesis, following prior embolization of the branching vessels using macroembolic agents. In cases where there is insufficient occlusion of the aneurysm with residual perfusion, secondary em- bolization becomes considerably more complex due to the occlusion of the anatomically antegrade access and the altered hemodynamics around the aneurysm causing retrograde collateralization. Through detailed analysis of CT angiography, even in static CT, retrograde circulation could be iden- tified, allowing for a minimally invasive secondary approach to the aneurysm without the need for general anesthesia and/or surgery. By completely eliminating the aneurysm, the risk of rupture in the elderly patient was minimally invasively eliminated. The treatment of this patient exemplifies the possibilities that embolization with a wide array of embolic agents and catheters offers in a hemo- dynamically very complex situation.

Hepatic arterial hemodynamics and model for end-stage liver disease (MELD) scores in chronic liver disease: insights from Doppler ultrasonography

BackgroundDoppler ultrasonography is essential to provide insights into hemodynamic alterations and liver function changes in pre-cirrhotic and cirrhotic patients. Utilizing Doppler examinations, this study aims to explore the correlation between hepatic arterial hemodynamics and Model for end-stage liver disease (MELD) scores in chronic liver disease patients.MethodsA study of 50 chronic liver disease patients included sonographic assessments, measuring liver, portal vein size, and flow. Hepatic artery velocity, resistive index (RI), pulsatility index (PI), and acceleration time (AT) were evaluated. Biochemical parameters (serum bilirubin, creatinine, INR) were used to calculate MELD scores, compared with different Doppler sonographic parameters.ResultsThe study found a mean peak systolic velocity (PSV) of 107.42 ± 48.10, with end-diastolic velocity (EDV) of 26.40 ± 14.68, RI of 0.74 ± 0.06, and PI of 1.47 ± 0.24. The mean MELD score was 19.28 ± 6.09. Correlations between MELD scores and PSV, EDV, RI, PI, and AT did not yield statistically significant correlations. 80% of subjects displayed high RI (> 0.7) values in the hepatic artery, and a significant correlation was found between portal vein thrombosis and hepatic artery PSV and RI (p < 0.05).ConclusionsHepatic artery RI and PSV show a significant correlation with portal vein thrombosis. Doppler ultrasonography, while not directly tied to MELD scores, is valuable for non-invasive liver disease monitoring when invasive methods are impractical. Further research is needed to unravel the relationships between hemodynamic changes, MELD scores, and clinical outcomes in a broader patient population.

Evaluation of Aortic Hemodynamics Using Four-Dimensional Flow of Magnetic Resonance Imaging in Rabbits with Liver Fibrosis.

Liver fibrosis (LF) precipitates systemic hemodynamic alterations, however, its impact on the aorta remaining undefined. To assess aorta hemodynamics changes during LF development in a rabbit model. Prospective, experimental. Thirty 7-month-old male rabbits underwent bile duct ligation (BDL) to induce LF. Biweekly four-dimensional (4D) flow imaging incorporating a 3D gradient-echo at 3.0 T scanner for 14 weeks post-BDL. Histopathological exams for 2-5 rabbits were performed at each time point, following each MRI scan. LF was graded using the Metavir scale by a pathologist. 4D flow was analyzed by two radiologists using dedicated postprocessing software. They recorded 4D flow parameters at four aorta sections (aortic sinus, before and after bifurcation of aortic arch, and descending aorta). The linear mixed model; Bonferroni correction; Pearson correlation coefficient (r); receiver operating characteristic (ROC) curve; Delong test. The level of significance was set at P < 0.05. Following BDL, the wall shear stress (WSS) (0.23-0.32 Pa), energy loss (EL) (0.27-1.55 mW) of aorta significantly increased at the second week for each plane, peaking at the sixth week (WSS: 0.35-0.49 Pa, EL: 0.57-2.0 mW). So did the relative pressure difference (RPD) (second week: 1.67 ± 1.63 mmHg, sixth week: 2.43 ± 0.63 mmHg) in plane 2. Notably, the RPD in plane 2 at the second week displayed the highest area under ROC curve of 0.998 (specificity: 1, sensitivity: 0.967). LF were found at the second, fourth, and sixth week after BDL, with grade F2, F3, and F4, respectively. The RPD in plane 2 was most strongly correlated with the severity of LF (r = 0.86). The occurrence of LF could increase WSS, EL, and RPD of aorta as early as the second week following BDL. 1 TECHNICAL EFFICACY: Stage 2.

A Computational Investigation of the Effects of Temporal Synchronization of Left Ventricular Assist Device Speed Modulation with the Cardiac Cycle on Intraventricular Hemodynamics.

Patients with advanced heart failure are implanted with a left ventricular assist device (LVAD) as a bridge-to-transplantation or destination therapy. Despite advances in pump design, the risk of stroke remains high. LVAD implantation significantly alters intraventricular hemodynamics, where regions of stagnation or elevated shear stresses promote thrombus formation. Third generation pumps incorporate a pulsatility mode that modulates rotational speed of the pump to enhance in-pump washout. We investigated how the timing of the pulsatility mode with the cardiac cycle affects intraventricular hemodynamic factors linked to thrombus formation. Computational fluid dynamics simulations with Lagrangian particle tracking to model platelet behavior in a patient-specific left ventricle captured altered intraventricular hemodynamics due to LVAD implantation. HeartMate 3 incorporates a pulsatility mode that modulates the speed of the pump every two seconds. Four different timings of this pulsatility mode with respect to the cardiac cycle were investigated. A strong jet formed between the mitral valve and inflow cannula. Blood stagnated in the left ventricular outflow tract beneath a closed aortic valve, in the near-wall regions off-axis of the jet, and in a large counterrotating vortex near the anterior wall. Computational results showed good agreement with particle image velocimetry results. Synchronization of the pulsatility mode with peak systole decreased stasis, reflected in the intraventricular washout of virtual contrast and Lagrangian particles over time. Temporal synchronization of HeartMate 3 pulsatility with the cardiac cycle reduces intraventricular stasis and could be beneficial for decreasing thrombogenicity.

Macro- and microvascular contributions to cerebral structural alterations in patients with asymptomatic carotid artery stenosis

Atherosclerosis can underly internal carotid artery stenosis (ICAS), a major risk factor for ischemic stroke, as well as small vessel disease (SVD). This study aimed to investigate hemodynamics and structural alterations associated with SVD in ICAS patients. 28 patients with unilateral asymptomatic ICAS and 30 age-matched controls underwent structural (T1-/T2-weighted and diffusion tensor imaging [DTI]) and hemodynamic (pseudo-continuous arterial spin labeling and dynamic susceptibility contrast) magnetic resonance imaging. SVD-related alterations were assessed using free water (FW), FW-corrected DTI, and peak-width of skeletonized mean diffusivity (PSMD). Furthermore, cortical thickness, cerebral blood flow (CBF), and capillary transit time heterogeneity (CTH) were analyzed. Ipsilateral to the stenosis, cortical thickness was significantly decreased in the posterior dorsal cingulate cortex (p = 0.024) and temporal pole (p = 0.028). ICAS patients exhibited elevated PSMD (p = 0.005), FW (p < 0.001), and contralateral alterations in FW-corrected DTI metrics. We found significantly lateralized CBF (p = 0.011) and a tendency for lateralized CTH (p = 0.067) in the white matter (WM) related to ICAS. Elevated PSMD and FW may indicate a link between SVD and WM changes. Contralateral alterations were seen in FW-corrected DTI, whereas hemodynamic and cortical changes were mainly ipsilateral, suggesting SVD might influence global brain changes concurrent with ICAS-related hemodynamic alterations.

Acute cardiac autonomic and hemodynamic responses to resistive breathing: Effect of loading type and intensity.

This study aimed to assess the acute impact of distinct loading breathing types and intensities on cardiac autonomic function and hemodynamic responses in healthy young adults. A randomized, crossover trial involved 28 participants who underwent inspiratory resistive breathing, expiratory resistive breathing (ERB) and combined resistive breathing, each at 30% and 60% of maximal respiratory pressures. Data on heart rate variability (HRV) and hemodynamic parameters were collected during each trial. The study revealed significant main and interaction effects for both the performed task and the intensity across all measured variables (all p < 0.001). ERB at 60% load demonstrated significantly higher HRV values in the standard deviation of normal-to-normal RR intervals, the square root of the mean squared difference of successive normal-to-normal RR intervals and high-frequency power, as well as significantly lower values in heart rate, stroke volume, stroke volume index, cardiac output, cardiac index, end-diastolic volume and end-diastolic volume index, compared to other loaded protocols (all p < 0.001). These findings highlight the acute effect of type-specific and load-dependent resistive breathing on cardiac autonomic and hemodynamic functions, where ERB at 60% intensity showed the most significant cardiovagal modulation while causing the least hemodynamic alterations.