Perfusion Rate Research Articles

Age-related decline in blood-brain barrier function is more pronounced in males than females in parietal and temporal regions.

The blood-brain barrier (BBB) plays a pivotal role in protecting the central nervous system (CNS), and shielding it from potential harmful entities. A natural decline of BBB function with aging has been reported in both animal and human studies, which may contribute to cognitive decline and neurodegenerative disorders. Limited data also suggest that being female may be associated with protective effects on BBB function. Here, we investigated age and sex-dependent trajectories of perfusion and BBB water exchange rate (kw) across the lifespan in 186 cognitively normal participants spanning the ages of 8-92 years old, using a non-invasive diffusion-prepared pseudo-continuous arterial spin labeling (DP-pCASL) MRI technique. We found that the pattern of BBB kw decline with aging varies across brain regions. Moreover, results from our DP-pCASL technique revealed a remarkable decline in BBB kw beginning in the early 60 s, which was more pronounced in males. In addition, we observed sex differences in parietal and temporal regions. Our findings provide in vivo results demonstrating sex differences in the decline of BBB function with aging, which may serve as a foundation for future investigations into perfusion and BBB function in neurodegenerative and other brain disorders.

Assessment of Intrarenal Pressure through Dilatation State of the Renal Collecting System

Introduction: The aim of the study was to explore the relationship between the dilation states of the renal collecting system in flexible ureteroscopy (f-URS) view and intrarenal pressure (IRP). Methods: Fifteen porcine kidneys were randomly selected and numbered 1 through 15. Pressure transducers were inserted into the renal calyx via puncture and adjusted to a zero position. The distal end of the f-URS probe was placed within the renal pelvis. Perfusion rates of 50 mL/min, 80 mL/min, and 100 mL/min were utilized. We observed the relationship between the dilation state of the renal collecting system and changes in IRP. The state of complete dilation was defined as an unchanging spatial morphology of the renal collecting system as visualized during f-URS. Results: With irrigation rates of 50 mL/min, 80 mL/min, and 100 mL/min, IRP values at the moment of complete dilation of the renal collecting system ranged from 16 to 18 cm H2O, 16–19 cm H2O, and 16–19 cm H2O, respectively. Maximum IRPs ranged from 47 to 49 cm H2O, 82–85 cm H2O, and 97–100 cm H2O, respectively. Prior to complete dilation of the renal collecting system, IRP consistently remained below 20 cm H2O. However, following full dilation of the renal collecting system, IRP rose rapidly and rapidly surpassed 20 cm H2O. Despite sustained elevations in IRP following full dilation, no significant alterations in the renal collecting system dilated morphological were observed with f-URS. Conclusions: In vitro experiments indicate that when the renal collecting system is not fully dilated, the IRP is consistently less than 20 cm H2O. Evaluation of IRP being within a safe range can be determined by assessing the dilation status of the renal collecting system.

Measurement and modeling of xenon gas transfer in the human brain with 1H and hyperpolarized 129Xe MRI

BackgroundThe feasibility of imaging hyperpolarized 129Xe dissolved in brain tissue following inhalation of xenon gas in the lungs has recently been demonstrated in humans. The image contrast in 129Xe brain MRI represents a combination of factors, including regional perfusion, polarization decay and gas transfer rate across the blood-brain barrier. PurposeTo investigate the repeatability of hyperpolarized 129Xe brain MRI in healthy normal individuals and to identify the dominant mechanisms of image contrast by assessing voxel-wise correlation between HP 129Xe brain MRI and models of 129Xe brain uptake derived from 1H arterial spin labeling (ASL) perfusion mapping. Materials and MethodsTo assess repeatability, 3 sets of hyperpolarized 129Xe brain images were acquired from 5 healthy volunteers. Quantitative maps of the human brain, including cerebral blood flow, volume and predicted xenon uptake, were derived from 1H arterial spin labeling and T2-weighted MRI. These maps were then spatially cross-correlated with hyperpolarized 129Xe brain MRI. ResultsSignal to noise ratios of 8.7–17.7 were observed across volunteers for a voxel size of 8 × 8 × 50 mm3 with intra-subject repeatability of between 6 and 29 %. Hyperpolarized 129Xe brain images showed voxel-wise correlations with cerebral blood flow (R = 0.32 to 0.62), volume (R = 0.33 to 0.63) and predicted xenon uptake (R = 0.34 to 0.63), but did not correlate with arterial transit time (R = 0.05 to 0.26). ConclusionVoxel-wise cross correlation between 129Xe and 1H ASL suggests that the regional quantity of dissolved xenon delivered by cerebral blood flow is the dominant mechanism of image contrast in HP 129Xe brain MRI, assuming normal blood-brain barrier function. Combining 1H and 129Xe brain MRI provides new opportunities to quantitatively investigate brain pathophysiology and function.

How predictive are isolated perfused liver data of in vivo hepatic clearance? A meta-analysis of isolated perfused rat liver data

Isolated perfused rat liver (IPRL) experiments have been used to answer clearance-related questions, including evaluating the impact of pathological and physiological processes on hepatic clearance (CLH ). However, to date, IPRL data has not been evaluated for in vivo CLH prediction accuracy. In addition to a detailed overview of available IPRL literature, we present an in-depth analysis of the performance of IPRL in CLH prediction. While the entire dataset poorly predicted CLH (GAFE = 3.2; 64% within 3-fold), IPRL conducted under optimal experimental conditions, such as in the presence of plasma proteins and with a perfusion rate within 2-fold of physiological liver blood flow and corrected for unbound fraction in the presence of red blood cells, can accurately predict rat CLH (GAFE = 2.0; 78% within 3-fold). Careful consideration of experimental conditions is needed to allow proper data analysis. Further, isolated perfused liver experiments in other species, including human livers, may allow us to address the current in vitro-in vivo disconnects of hepatic metabolic clearance and improve our methodology for CLH predictions.

A novel approach for perfusion process design based on a "Grey-Box" kinetic model.

Perfusion cell-culture mode has caught industrial interest in the field of biomanufacturing in recent years. Thanks to new technology, perfusion-culture processes can support higher cell densities, higher productivities and longer process times. However, due to the inherent operational complexity and high running costs, the development and design of perfusion-culture processes remain challenging. Here, we present a model-based approach to design optimized perfusion cultures of Chinese Hamster Ovary cells. Initially, four batches of bench-top reactor continuous-perfusion-culture data were used to fit the model parameters. Then, we proposed the model-based process design approach, aiming to quickly find out the "theoretically optimal" operational parameters combinations (perfusion rate and the proportion of feed medium in perfusion medium) which could achieve the target steady-state VCD while minimizing both medium cost and perfusion rate during steady state. Meanwhile, we proposed a model-based dynamic operational parameters-adjustment strategy to address the issue of cell-growth inhibition due to the high osmolality of concentrated perfusion medium. In addition, we employed a dynamic feedback control method to aid this strategy in preventing potential nutrient depletion scenarios. Finally, we test the feasibility of the model-based process design approach in both shake flask semi-perfusion culture (targeted at 5 × 107 cells/ml) and bench-top reactor continuous perfusion culture (targeted at 1.1 × 108 cells/ml). This approach significantly reduces the number of experiments needed for process design and development, thereby accelerating the advancement of perfusion-mode cell-culture processes.

Dysfunctional mechanotransduction regulates the progression of PIK3CA-driven vascular malformations.

Somatic activating mutations in PIK3CA are common drivers of vascular and lymphatic malformations. Despite common biophysical signatures of tissues susceptible to lesion formation, including compliant extracellular matrix and low rates of perfusion, lesions vary in clinical presentation from localized cystic dilatation to diffuse and infiltrative vascular dysplasia. The mechanisms driving the differences in disease severity and variability in clinical presentation and the role of the biophysical microenvironment in potentiating progression are poorly understood. Here, we investigate the role of hemodynamic forces and the biophysical microenvironment in the pathophysiology of vascular malformations, and we identify hemodynamic shear stress and defective endothelial cell mechanotransduction as key regulators of lesion progression. We found that constitutive PI3K activation impaired flow-mediated endothelial cell alignment and barrier function. We show that defective shear stress sensing in PIK3CA E542K endothelial cells is associated with reduced myosin light chain phosphorylation, junctional instability, and defective recruitment of vinculin to cell-cell junctions. Using 3D microfluidic models of the vasculature, we demonstrate that PIK3CA E542K microvessels apply reduced traction forces and are unaffected by flow interruption. We further found that draining transmural flow resulted in increased sprouting and invasion responses in PIK3CA E542K microvessels. Mechanistically, constitutive PI3K activation decreased cellular and nuclear elasticity resulting in defective cellular tensional homeostasis in endothelial cells which may underlie vascular dilation, tissue hyperplasia, and hypersprouting in PIK3CA-driven venous and lymphatic malformations. Together, these results suggest that defective nuclear mechanics, impaired cellular mechanotransduction, and maladaptive hemodynamic responses contribute to the development and progression of PIK3CA-driven vascular malformations.

Changes in microcirculation of small intestine end-to-end anastomoses in an experimental model

IntroductionSufficient perfusion is essential for a safe intestinal anastomosis. Impaired microcirculation may lead to increased bacterial translocation and anastomosis insufficiency. Thus, it is important to estimate well the optimal distance of the anastomosis line from the last mesenterial vessel. However, it is still empiric. In this experiment the aim was to investigate the intestinal microcirculation at various distances from the anastomosis in a pig model. Materials and methodsOn 8 anesthetized pigs paramedian laparotomy and end-to-end jejuno-jejunostomy were performed. Using Cytocam-IDF camera, microcirculatory recordings were taken before surgery at the planned suture line, and 1 to 3 mesenterial vessel mural trunk distance from it, and at the same sites 15 and 120 min after anastomosis completion. After the microcirculation monitoring, anastomosed and intact bowel segments were removed to test tensile strength. ResultsThe proportion and the density of the perfused vessels decreased significantly after anastomosis completion. The perfusion rate increased gradually distal from the anastomosis, and after 120 min these values seemed to be normalized. Anastomosed bowels had significantly lower maximal tensile strength and higher slope of tensile strength curves than intact controls. ConclusionAlterations in microcirculation and tensile strength were observed. After completing the anastomosis, the improvement in perfusion increased gradually away from the wound edge. The IDF device was useful to monitor intestinal microcirculation providing data to estimate better the optimal distance of the anastomosis from the last order mesenteric vessel.

Analytical solution of three-dimensional temperature field for skin tissue considering blood perfusion rates under laser irradiation and thermal damage analysis

An analytical solution of the three-dimensional transient temperature distribution for skin tissue when heated by a laser heat source is presented in this work. An equation for the three-dimensional bioheat transfer of skin tissue is obtained firstly, and the transient temperature value at any point inside the skin tissue can be solved using the separation variable method and the Newton-Cotes method. Previous research primarily focused on semi-infinite domains, while this work presents an analytical solution for finite domains. A comparison of present analytical solution with simulation software results and numerical solution is given to demonstrate the feasibility of the analytical solution. The three-dimensional temperature distribution of skin tissue irradiated by a laser is theoretically studied. The extent of thermal damage to skin tissue is assessed by substituting the analytical solution of the temperature field for laser-irradiated skin tissue into the thermal damage equation. The calculations in this work reveal that the variation of temperature field in biological tissues is dependent not only on the laser incident light intensity and the optical parameters of the tissues but also on the heat transfer properties of the biological tissues, such as the blood perfusion rates.

High-density perfusion cultures of the marine bacterium Rhodovulum sulfidophilum for the biomanufacturing of oligonucleotides

Therapeutic oligonucleotides (ONs) are typically manufactured via solid-phase synthesis, characterized by limited scalability and huge environmental footprint, limiting their availability. Biomanufactured ONs have the potential to reduce the immunogenic side-effects, and to improve the sustainability of their chemical counterparts. Rhodovulum sulfidophilum was demonstrated a valuable host for the extracellular production of recombinant ONs. However, low viable cell densities and product titer were reported so far. In this work, perfusion cell cultures were established for the intensification of ON biomanufacturing. First, the perfusion conditions were simulated in 50 mL spin tubes, selected as a scale-down model of the process, with the aim of optimizing the medium composition and process parameters. This optimization stage led to an increase in the cell density by 44 % compared to the reference medium formulation. In addition, tests at increasing perfusion rates were conducted until achieving the maximum viable cell density (VCDmax), allowing the determination of the minimum cell-specific perfusion rate (CSPRmin) required to sustain the cell culture. Intriguingly, we discovered in this system also a maximum CSPR, above which growth inhibition starts. By leveraging this process optimization, we show for the first time the conduction of perfusion cultures of R. sulfidophilum in bench-scale bioreactors. This process development pipeline allowed stable cultures for more than 20 days and the continuous biomanufacturing of ONs, testifying the great potential of perfusion processes.

The Current Role of Contrast-Enhanced Ultrasound (CEUS) in the Diagnosis and Staging of Bladder Cancer: A Review of the Available Literature.

Contrast-enhanced ultrasound (CEUS) is an advanced imaging technique that integrates conventional US with the intravenous injection of specific US contrast agents (UCAs), combining the non-invasiveness of US with the higher accuracy of contrast-enhanced imaging. In contrast with magnetic resonance imaging (MRI), computed tomography (CT) and cystoscopy, CEUS has few contraindications, and UCAs are non-nephrotoxic agents that can be safely used in patients with kidney failure. CEUS is a well-established method for the detection of liver lesions and for echocardiography, and its indications are expanding. The updated 2018 WFUMB-EFSUMB guidelines have added the urinary bladder under non-hepatic applications of CEUS. The technique is able to distinguish between benign tissue, such as clots or hematoma, and malignant lesions by perfusing the mass with contrast agent. Thanks to the different perfusion rates of the various layers of the bladder wall, CEUS is also able to predict tumor invasion depth and stage. Despite that, current urological guidelines do not include CEUS as a plausible imaging technique for bladder urothelial carcinoma. The main reason for this omission might be the presence of scarce randomized evidence and the absence of large validated series. In this review, we describe the rationale behind the use of CEUS in bladder cancer and the added value of this imaging technique in the detection and staging of bladder lesions. In addition, we researched the available literature on the topic and then described the results of randomized clinical trials and a meta-analysis investigating the accuracy of CEUS in bladder cancer diagnosis and staging. The reported studies show that CEUS is a highly accurate diagnostic and staging tool for BC, reaching levels of specificity and sensitivity in differentiating between Ta-T1, or low-grade BC, and T2, or high-grade BC, that are comparable to those shown by the reference standard methods. Nonetheless, several limitations were found and are highlighted in this review. The aim of this study is to further validate and promote the use of CEUS as a quick, economic and effective diagnostic tool for this high-impact disease.

Biomass specific perfusion rate as a control lever for the continuous manufacturing of biosimilar monoclonal antibodies from CHO cell cultures.

Continuous manufacturing enables high volumetric productivities of biologics such as monoclonal antibodies. However, it is challenging to maintain both high viable cell densities and productivities at the same time for long culture durations. One of the key controls in a perfusion process is the perfusion rate which determines the nutrient availability and potentially controls the cell metabolism. Cell Specific Perfusion Rate (CSPR) is a feed rate proportional to the viable cell density while Biomass Specific Perfusion Rate (BSPR) is a feed rate proportional to the biomass (cell volume multiply bycell density). In this study, perfusion cultures were run at three BSPRs in the production phase. Low BSPR favored a growth arresting state that led to gradual increase in cell volume, which in turn led to an increase in net perfusion rate proportional to the increase in cell volume. Consequently, at low BSPR, while the cell viability and cell density decreased, high specific productivity of 55 pg per cell per day was achieved. In contrast, the specific productivity was lower in bioreactors operating at a high BSPR. The ability to modulate the cell metabolism by using BSPR was confirmed when the specific productivity increased after lowering the BSPR in one of the bioreactors that was initially operating at a high BSPR. This study demonstrated that BSPR significantly influenced cell growth, metabolism, and productivity in cultures with variable cell volumes.

Minimally invasive surgical approach to model hypertrophic scarring in the rabbit ear.

Current strategies for hypertrophic scar prevention and treatment are limited. To facilitate these efforts, a minimally invasive hypertrophic scar model was created in a rabbit ear for the first time based on previous methods used to induce ischemia. Six New Zealand white rabbits (12 ears total) were studied. First, ischemia was achieved by ligating the cranial artery, cranial vein and central artery, while preserving the caudal artery, caudal vein and central vein, respectively. The relative level of ischemia induced at time of surgery, both baseline and maximum perfusion, was assessed with a fluorescent light-assisted angiography and demonstrated lower rates of perfusion in the ischemic ears. Following vascular injury, a 2-cm full thickness linear wound was created on the ventral ear and closed with 4 - 0 Nylon sutures under high tension. For each rabbit, one ear received a combination of ischemia and wounding with suture tension (n = 6), while the other ear was non-ischemic with wounding and suture tension alone (n = 6). Four weeks post-operatively, ischemic ears developed scar hypertrophy (histological scar thickness: 1.1 ± 0.2mm versus 0.5 ± 0.1mm, p < 0.05). Herein, we describe a novel, prototypical minimally invasive rabbit ear model of hypertrophic scar formation that can allow investigation of new drugs for scar prevention.

Cerebral Oxygen Saturation Associates with Changes in Oxygen Transport Parameters during Cardiopulmonary Bypass.

(1) Background: Adequate organ perfusion during cardiopulmonary bypass (CPB) requires accurate estimation and adjustment of flow rates which conventional methods may not always achieve. Perioperative monitoring of cerebral oxygen saturation (ScO2) may detect changes in oxygen transport. This study aims to compare estimated and measured perfusion flow rates and assess the capacity of ScO2 to detect subtle changes in oxygen transport during CPB. (2) Methods: This observational study included 50 patients scheduled for elective coronary artery bypass grafting (CABG) surgery, all of whom provided written informed consent. Perfusion flow rates were estimated using the DuBois formula and measured using echocardiography and a flow probe in the arterial line of the CPB system. ScO2 was continuously monitored, alongside intermittent measurements of oxygen delivery and extraction ratios. (3) Results: Significant discrepancies were found between estimated flow rates (5.2 [4.8-5.5] L/min) and those measured at the start of the surgery (4.6 [4.0-5.0] L/min). These discrepancies were flow rate-dependent, being more pronounced at lower perfusion rates and diminishing as rates increased. Furthermore, ScO2 showed a consistent correlation with both oxygen delivery (r = 0.48) and oxygen extraction ratio (r = 0.45). (4) Conclusions: This study highlights discrepancies between estimated and actual perfusion flow rates during CPB and underscores the value of ScO2 monitoring as a continuous, noninvasive tool for maintaining adequate organ perfusion, suggesting a need for improved, patient-tailored perfusion strategies.

Optimal development of the new type of ultra-fine fly ash semi flexible pavement grouting material: Rheological, mechanical, pore distribution, and hydration characteristics

In order to solve the problems that the fluidity of semi-flexible pavement grouting materials (SFPGM) is not up to standard, the early strength is not enough, or the fluidity meets the requirements but the early strength is not up to standard, the power plant by-Product -ultra-fine fly ash (UFA) was used to optimized the performance of grouting materials (GM) in this study. The microstructure of hardened slurry was analyzed by XRD, FTIR, MIP and SEM. The findings indicate that when the UFA content increases, the fluidity of the GM initially increases and then declines, whereas the compressive strength initially reduces and then increases. The sample exhibits optimal fluidity performance when the content of UFA is 9 %. The flow cone fluidity of the initial and 20 min is 12.33 % and 17.63 % lower than that of the reference sample. When the amount of UFA is 12 %, the compressive strength of sample is the highest at each age. Additionally, that the fluidity of sample S12 is sub-optimal in all samples, only worse than that of sample S9. In the early stage of GM hydration, UFA with slow hydration rate produces a significant ‘ball-bearings effect’ between irregular cement particles. This is beneficial to the relative sliding between the slurry particles, reduces the yield stress and plastic viscosity of the fresh slurry, and improves the flow performance of the GM. The pozzolanic effects of UFA in GM primarily manifests during the later stages of hydration. The primary hydration products of UFA modified GM include ettringite, C-S-H gel, C-A-S-H gel, calcium carbonate, and aluminium glue (AH3). During the progression of the hydration reaction, the quantity of ettringite (AFt) in the slurry steadily augments, causing the initial fine needle-like structure to evolve into a more fully formed needle-like structure. A complex three-dimensional network of interlocking spatial structures is formed by many hydration products that continually interlace and develop, improving strength. The higher the perfusion rate of the GM, the higher the compactness of the SFPGM, and the better the high temperature stability and low temperature crack resistance.

Reply to Editorial Comment on “High Rates of Discordant Ureteral Perfusion During Open Ureteral Reconstruction With Indocyanine Green: Does Near-Infrared Fluorescence Imaging Change Management or Stricture Outcomes?”

Reply to Editorial Comment on “High Rates of Discordant Ureteral Perfusion During Open Ureteral Reconstruction With Indocyanine Green: Does Near-Infrared Fluorescence Imaging Change Management or Stricture Outcomes?”

Reduced cerebrospinal fluid motion in patients with Parkinson’s disease revealed by magnetic resonance imaging with low b-value diffusion weighted imaging

BackgroundParkinson’s disease is characterized by dopamine-responsive symptoms as well as aggregation of α-synuclein protofibrils. New diagnostic methods assess α-synuclein aggregation characteristics from cerebrospinal fluid (CSF) and recent pathophysiologic mechanisms suggest that CSF circulation disruptions may precipitate α-synuclein retention. Here, diffusion-weighted MRI with low-to-intermediate diffusion-weightings was applied to test the hypothesis that CSF motion is reduced in Parkinson’s disease relative to healthy participants.MethodsMulti-shell diffusion weighted MRI (spatial resolution = 1.8 × 1.8 × 4.0 mm) with low-to-intermediate diffusion weightings (b-values = 0, 50, 100, 200, 300, 700, and 1000 s/mm2) was applied over the approximate kinetic range of suprasellar cistern fluid motion at 3 Tesla in Parkinson’s disease (n = 27; age = 66 ± 6.7 years) and non-Parkinson’s control (n = 32; age = 68 ± 8.9 years) participants. Wilcoxon rank-sum tests were applied to test the primary hypothesis that the noise floor-corrected decay rate of CSF signal as a function of b-value, which reflects increasing fluid motion, is reduced within the suprasellar cistern of persons with versus without Parkinson’s disease and inversely relates to choroid plexus activity assessed from perfusion-weighted MRI (significance-criteria: p < 0.05).ResultsConsistent with the primary hypothesis, CSF decay rates were higher in healthy (D = 0.00673 ± 0.00213 mm2/s) relative to Parkinson’s disease (D = 0.00517 ± 0.00110 mm2/s) participants. This finding was preserved after controlling for age and sex and was observed in the posterior region of the suprasellar cistern (p < 0.001). An inverse correlation between choroid plexus perfusion and decay rate in the voxels within the suprasellar cistern (Spearman’s-r=-0.312; p = 0.019) was observed.ConclusionsMulti-shell diffusion MRI was applied to identify reduced CSF motion at the level of the suprasellar cistern in adults with versus without Parkinson’s disease; the strengths and limitations of this methodology are discussed in the context of the growing literature on CSF flow.

Postoperative pulmonary vascular growth in patients with congenital diaphragmatic hernia

BackgroundPostoperative pulmonary growth in congenital diaphragmatic hernias (CDH) remains unclear. We investigated postoperative pulmonary vascular growth using serial lung perfusion scintigraphy in patients with CDH.MethodsNeonates with left CDH who underwent surgery and postoperative lung perfusion scintigraphy at our institution between 2001 and 2020 were included. Patient demographics, clinical courses, and lung scintigraphy data were retrospectively analyzed by reviewing medical records.ResultsTwenty-one patients with CDH were included. Of these, 10 underwent serial lung scintigraphy. The ipsilateral perfusion rate and median age on the 1st and serial lung scintigraphy were 32% (34 days) and 33% (3.6 years), respectively. Gestational age at prenatal diagnosis (p = 0.02), alveolar–arterial oxygen difference (A-aDO2) at birth (p = 0.007), and preoperative nitric oxide (NO) use (p = 0.014) significantly correlated with the 1st lung scintigraphy. No other variables, including operative approach, were significantly correlated with the 1st or serial scintigraphy findings.All patients improved lung perfusion with serial studies [Difference: + 7.0 (4.3–13.25) %, p = 0.001, paired t-test]. This improvement was not significantly correlated with preoperative A-aDO2 (p = 0.96), NO use (p = 0.28), or liver up (p = 0.90). The difference was significantly larger in patients who underwent thoracoscopic repair than in those who underwent open abdominal repair [+ 10.6 (5.0–17.1) % vs. + 4.25 (1.2–7.9) %, p = 0.042].ConclusionOur study indicated a postoperative improvement in ipsilateral lung vascular growth, which is possibly enhanced by a minimally invasive approach, in patients with CDH.

Editorial Comment on “High Rates of Discordant Ureteral Perfusion During Open Ureteral Reconstruction with Indocyanine Green: Does Near-Infrared Fluorescence Imaging Change Management or Stricture Outcomes?”

Editorial Comment on “High Rates of Discordant Ureteral Perfusion During Open Ureteral Reconstruction with Indocyanine Green: Does Near-Infrared Fluorescence Imaging Change Management or Stricture Outcomes?”

High Rates of Discordant Ureteral Perfusion During Open Ureteral Reconstruction With Indocyanine Green: Does Near-Infrared Fluorescence Imaging Change Management or Stricture Outcomes?

OBJECTIVETo determine the role of near-infrared fluorescence imaging (NIFI) combined with indocyanine green (ICG) to assess ureteral tissue perfusion in a benign genitourinary reconstruction cohort with a high prevalence of prior abdominopelvic radiation and surgery. MATERIALS AND METHODSA prospective, single-surgeon series, between June 2018 and April 2022, of patients who underwent open genitourinary reconstructive surgeries in which NIFI/ICG was utilized to intraoperatively assess ureteral tissue perfusion prior to ureteral anastomosis. Primary outcome was ureteroanastomotic stricture (UAS). Secondary outcomes included impact of NIFI/ICG on surgical decision-making and ureter resection length. RESULTS39 patients, median age 66, underwent 40 multimodality reconstructive surgeries during which NIFI/ICG was utilized in the open setting. Radiation-induced etiology was present in 32 of 40 (80%) patients. UAS occurred in 1 of 57 (1.8%) anastomoses with median follow-up 23.4 months. Use of NIFI/ICG changed intraoperative decision-making in 63% of cases. Change in intraoperative decision-making was more common in patients with prior abdominopelvic radiation (66%) compared to non-radiated patients (13%), p=0.007. Discordance between subjective (white-light) and objective (NIFI/ICG) ureteral perfusion (white-light) occurred in 61% of ureters. Mean length of resected ureter was higher following objective assessment with NIFI/ICG (3.6 cm) versus subjective assessment (white light) conditions (1.8 cm), p=0.001. CONCLUSIONSUse of NIFI/ICG was associated with low rates of UAS at 2 years follow-up in a cohort with high prevalence of prior radiation. NIFI/ICG was associated with longer lengths of ureter resection and ureteral perfusion assessment discordance compared to subjective surgeon assessment under white-light conditions.

Thermoviscoelastic response of skin tissue via fractional Pennes bioheat and fractional viscoelasticity

In this paper, the thermoviscoelastic response of skin tissue, as a typical class of viscoelastic biological tissue, subject to thermal shock is studied based on the fractional Kelvin-Voigt model and fractional Pennes bioheat conduction. A time-fractional biothermoviscoelastic governing equation is derived and initial-boundary value conditions are given for monolayer skin tissue of finite thickness. The temperature change and thermal stress of viscoelastic skin tissue are obtained by the Laplace transform and its inversion using matlab software. The influences of viscosity coefficient, relaxation times, fractional-order viscosity/heat parameter, and blood perfusion rate of skin tissue on the temperature distribution and the elastic displacement are analyzed. The numerical results show that fractional-order viscosity does not affect temperature, whereas fractional-order heat flow does. Moreover, fractional-order heat flow affects the sensitivity of blood perfusion rate to the thermodynamic response.