Blood Flow Speed Research Articles

Microcirculation disorders in patients with severe COVID-19 and development of bacterial sepsis

It is believed that microcirculation dysfunction in sepsis primarily caused by damage of the endothelium by infectious agents and pro-inflammatory cytokines. Mechanisms of impaired microcirculation in the severe course of COVID-19 and sepsis likely to be similar. However, there are few reports studied microcirculation disorders in patients with COVID-19, and their results are sometimes contradictory. Objective. To assess the microcirculation of patients with severe Covid-19 and the development of bacterial sepsis using nail bed microscopy and laser Doppler flowmetry. Materials and methods. 16 intensive care unit COVID-19 patients subsequently diagnosed with bacterial sepsis were examined. Patients underwent vital capillaroscopy and an occlusive test using laser Doppler flowmetry. The average rate of capillary blood flow, the size of the perivascular zone, the density of capillaries, the presence of intravascular aggregates, the increase in the amplitude of the maximum post-occlusive blood flow and the average value of postocclusive blood flow relative to the initial one were valuated. Additionally, the level of serum proadrenomedullin was evaluated. Studies were performed on the day of admission and in dynamics. Results. By the capillaroscopy analysis, microcirculation disorders were detected in the form of a decrease in the linear speed of capillary blood flow (<400 μm/s), an extention of the perivascular zone (>100 μm), the circulation of microaggregates; the absence of postocclusive hyperemia was determined by an occlusive test. Secondary bacterial infection led to an even greater aggravation of microcirculation disorders: an increase of the perivascular zone, the progression of intravascular aggregation resulting in microthrombosis with a decrease of the density of the capillary network (according to capillaroscopy), as well as a sharp decrease of amplitude maximal increment of blood flow of post-осclusive circulation at the time of an occlusive sample. We also revealed a trend of negative correlation between the level of serum proadrenomedullin and the maximum increase in blood flow during the occlusive test. Conclusion. The secondary bacterial infection in patients with COVID-19 leads to a significant aggravation of microcirculation disorders with the development of perfusion deficiency and interstitial edema. The increased plasma proadrenomedullin level supports the concept of the significant role of endothelial dysfunction in the pathogenesis of severe COVID-10 and bacterial sepsis.

Median arcuate ligament syndrome with predominantly respiratory manifestatios

Introduction. One of the causes of respiratory disorders in young people may be visceral circulation chronic vio-lation in median arcuate ligament syndrome (MALS). The aim of the study was to assess the clinical significance of respiratory disorders in establishing the MALS diagnosis in order to determine the necessary management tactics for patients with this pathology. Materials and methods.49 MALS patients were examined, the main symptoms being respiratory disorders, such as shortness of breath, difficult inhaling and/or exhaling, and others. The medi-an age was 24.7±0.9 years, females predominated (60%). The diagnosis of MALS was confirmed by clinical data, the results of transabdominal ultrasound duplex scanning of the abdominal aorta and its visceral branches using re-spiratory and orthostatic tests. Subsequent comparative analysis of the characteristic respiratory symptoms’ seve-rity before and after surgery (decompression of the celiac trunk) was performed. Research results. 10 main symp-toms of respiratory disorders were identified in patients under study, the frequency of each ranged from 31% to 50%, in most patients they were combined. Spirometry in these patients did not reveal any changes in both static lung volumes or airway patency. Bronchodilation revers-ibility tests were negative. Chest X-ray and/or computed tomography did not reveal any visible changes. During examination, hemodynamically significant compres-sion stenosis of the celiac trunk (CT) was observed in all patients. For all patients, auscultation of the abdominal cavity and detection of systolic murmur were performed. Confirmation of the diagnosis was based on ultrasound of the unpaired visceral arteries with color mapping, im-aging of the severity of CT stenosis, nature and speed of blood flow. An ultrasound study of the diaphragm func-tion revealed a direct statistically significant relationship between the diameter of the orifice of the CT and the am-plitude of the respiratory displacement of the diaphragm dome during quiet breathing (r=0.58), the amplitude of the respiratory displacement of the diaphragm dome during forced breathing (r=0.64), and the thickening frac-tion of the muscular part of the diaphragm, with quiet breathing (r=0.61) and thickening fraction of the muscu-lar part of the diaphragm during forced breathing (r=0.46, not significant, trend). The given correlation coefficients were estimated as a medium-strength relationship, i.e., the narrower the CT mouth, the worse the diaphragm ki-netics. In most patients, after surgical treatment, decom-pression of the celiac trunk, the clinical manifestations of respiratory disorders resolved, which may indicate their connection with diaphragmatic compression stenosis of the CT. Conclusion. The clinical manifestations of respi-ratory disorders in MALS, in most cases, are similar to the symptoms of bronchial asthma, which often led to the establishment of an erroneous diagnosis and ineffective-ness of the prescribed therapy. This theoretically and clin-ically important circumstance must be taken into account in the differential diagnosis of celiac trunk compression syndrome in combination with respiratory disorders. In the presence of hemodynamically significant compres-sion stenosis of the CT and respiratory disorders, it is ad-visable to perform surgical intervention

Recovery of Blood Flow From Undersampled Photoacoustic Microscopy Data Using Sparse Modeling.

Photoacoustic microscopy (PAM) leverages the optical absorption contrast of blood hemoglobin for high-resolution, multi-parametric imaging of the microvasculature in vivo. However, to quantify the blood flow speed, dense spatial sampling is required to assess blood flow-induced loss of correlation of sequentially acquired A-line signals, resulting in increased laser pulse repetition rate and consequently optical fluence. To address this issue, we have developed a sparse modeling approach for blood flow quantification based on downsampled PAM data. Evaluation of its performance both in vitro and in vivo shows that this sparse modeling method can accurately recover the substantially downsampled data (up to 8 times) for correlation-based blood flow analysis, with a relative error of 12.7 ± 6.1 % across 10 datasets in vitro and 12.7 ± 12.1 % in vivo for data downsampled 8 times. Reconstruction with the proposed method is on par with recovery using compressive sensing, which exhibits an error of 12.0 ± 7.9 % in vitro and 33.86 ± 26.18 % in vivo for data downsampled 8 times. Both methods outperform bicubic interpolation, which shows an error of 15.95 ± 9.85 % in vitro and 110.7 ± 87.1 % in vivo for data downsampled 8 times.

РЕЗУЛЬТАТЫ ФЛОУМЕТРИЧЕСКОЙ ОЦЕНКИ ФУНКЦИИ АУТОАРТЕРИАЛЬНЫХ ТРАНСПЛАНТАТОВ ПРИ ВЫПОЛНЕНИИ ШУНТИРОВАНИЯ ЛЕВОЙ КОРОНАРНОЙ АРТЕРИИ ПАЦИЕНТАМ ВЫСОКОГО ХИРУРГИЧЕСКОГО РИСКА

AIM. Evaluation of the effectiveness of intraoperative ultrasound flowmetry and identification of differencesin blood flow characteristics by autoarterial shunts in patients with high surgical risk (EvroScore>6) whounderwent surgery in IC conditions and on a working heart.Material and methods. The analysis included 96 patients with high surgical risk who underwent CABG both inthe of on pump and on a working heart conditions. The average age of patients in groups 1 and 2 was 61.5±2.9and 62.4±3.0 years, respectively (p=0.5). All patients of both groups underwent intraoperative ultrasoundflowmetry.Results. The indicators of intraoperative flowmetry confirm the good functioning of autoarterial transplants:the average volume blood flow rate is more than 20 ml/min, the pulsation index is not higher than 5 units andthe diastolic filling is higher than 50%. Previously used methods do not allow us to estimate the speed of bloodflow, to give a quantitative, devoid of subjectivity, assessment of blood flow. Flowmetry is the most commonlyused method for assessing the quality of shunts and can detect 2-4% of shunts that require revision.

Blood flow in the umbilical vein of the fetus in first half of pregnancy

The present investigation aims at studying the blood flow in the umbilical vein in the first half of normal pregnancy. It was shown that the establishing of hemocirculation passes through 4 periods: 8- 10th, 11-12th, 13-16th and after the 16th week of pregnancy. Besides that, statistically verified changes in maximum blood flow speed and index of pulsation in this vessel were revealed. Constant bloodstream spectrum reflects stability of oxygenic bloodsupply of the fetus.

Longer-term soy nut consumption improves cerebral blood flow and psychomotor speed: results of a randomized, controlled crossover trial in older men and women

ABSTRACTBackgroundEffects of soy foods on cerebral blood flow (CBF)—a marker of cerebrovascular function—may contribute to the beneficial effects of plant-based diets on cognitive performance.ObjectivesWe aimed to investigate longer-term effects of soy nut consumption on CBF in older adults. Changes in 3 different domains of cognitive performance were also studied.MethodsTwenty-three healthy participants (age: 60–70 y; BMI: 20–30 kg/m2) participated in a randomized, controlled, single-blinded crossover trial with an intervention (67 g/d of soy nuts providing ∼25.5 g protein and 174 mg isoflavones) and control period (no nuts) of 16 wk, separated by an 8-wk washout period. Adults followed the Dutch food-based dietary guidelines. At the end of each period, CBF was assessed with arterial spin labeling MRI. Psychomotor speed, executive function, and memory were assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB).ResultsNo serious adverse events were reported, and soy nut intake was well tolerated. Body weights remained stable during the study. Serum isoflavone concentrations increased (daidzein mean difference ± SD: 128 ± 113 ng/mL, P < 0.001; genistein: 454 ± 256 ng/mL, P < 0.001), indicating excellent compliance. Regional CBF increased in 4 brain clusters located in the left occipital and temporal lobes (mean ± SD increase: 11.1 ± 12.4 mL · 100 g−1 · min−1, volume: 11,296 mm3, P < 0.001), bilateral occipital lobe (12.1 ± 15.0 mL · 100 g−1 · min−1, volume: 2632 mm3, P = 0.002), right occipital and parietal lobes (12.7 ± 14.3 mL · 100 g−1 · min−1, volume: 2280 mm3, P = 0.005), and left frontal lobe (12.4 ± 14.5 mL · 100 g−1 · min−1, volume: 2120 mm3, P = 0.009) which is part of the ventral network. These 4 regions are involved in psychomotor speed performance, which improved as the movement time reduced by (mean ± SD) 20 ± 37 ms (P = 0.005). Executive function and memory did not change.ConclusionsLonger-term soy nut consumption may improve cerebrovascular function of older adults, because regional CBF increased. Effects may underlie observed improvements in psychomotor speed.This trial was registered at clinicaltrials.gov as NCT03627637.

Immunity Correction by a Foot Method of the Body Systemic Mobilization

Physical rehabilitation, by the foot method of body systemic mobilization, is a new medical technology. In connection with the current global unstable infectious situation, the need arose again to return to the question of finding and developing a systematic approach of simple and generally available physical methods. Aim. Analyze and evaluate the effect of the method of systemic mobilization of the body with the foot on the immune system of the human body, in order to prevent and rehabilitate post-infectious conditions. Material and methods. The research was carried out in various climatic zones. The procedures were based on the techniques of the first, second and third orders, in the second and third age groups. The first group consisted of patients of the second age group (13-60 years old). The second study group was represented by the third age group (60 years +). Materials of the first age group (up to 13 years old) were not submitted to the analysis. The method of exposure stipulated only the canonical motion direction in the selected sessions, the session lasted within 40-70 minutes, every day, for 10-30 days, taking into account weight, age and chronic diseases. 237 male and female patients’ material was reviewed and analyzed. Results and discussion. The method of systemic mobilization of the body exposed to the foot showed more significant positive results in the second age group - 92.8% and less in the third – 78.6% . To achieve positive results, it took more procedures 4 ± 1.0 in a humid climate compared to a dry one. It has been approved that accelerated blood flow in the main and collateral vessels triggers the activity of the lymphatic system. In the primary lymphoid organs, the hematopoietic function is restored and increased, optimizing lymphopoiesis and the state of lymphodynamics. Techniques of the first order (level) restore the flow of lymph through the superficial lymphatic vessels, collecting and producing outflow of lymph from the skin, subcutaneous tissue, superficial fascia and the surface layer of muscle fibers.Techniques of the second order (level) affect the lymph flow of deep lymphatic vessels, collecting lymph from muscles, joints and bones, producing outflow from deeply located tissues, lymphatic vessels lying along the arteries and veins of the same name, actively anastomosing with a network of superficial lymphatic vessels. Techniques of the III order (level) promote lymph flow through the lymphatic capillaries, from intra- and extra-organ lymphatic vessels, trunks and ducts. These techniques create conditions for accelerating drainage in the thoracic duct, producing an “emptying” effect by a direct physical coercion on the vertebral column, penetrating deeply. Conclusion. This method has statistically confirmed studies that indicate its ability to significantly increase the speed of blood flow in the main and adjacent vessels. The method can be considered as having a positive effect on lymphodynamics, in particular on lymphatic capillaries emanating from intra- and extra organ lymphatic vessels, trunks and ducts. By increasing the transport function of the lymphatic vessels, providing a full blood supply (nutrition) to the primary organs of the lymphatic system, exerting a stimulating effect on the spirally oriented lymphangion myocytes, in a soft and carefully worked out way, the foot method of systemic body mobilization creates optimal conditions for the correction of the immune system. Thus, it is able to protect the internal environment of the human body from foreign agents.

Depth resolution in multifocus laser speckle contrast imaging.

Laser speckle contrast imaging (LSCI) can be used to evaluate blood flow based on spatial or temporal speckle statistics, but its accuracy is undermined by out-of-focus image blur. In this Letter, we show how the fraction of dynamic versus static light scattering is dependent on focus, and describe a deconvolution strategy to correct for out-of-focus blur. With the aid of a z-splitter, which enables instantaneous multifocus imaging, we demonstrate depth-resolved LSCI that can robustly extract multi-plane structural and flow-speed information simultaneously. This method is applied to in vivo imaging of blood vessels in a mouse cortex and provides improved estimates of blood flow speed throughout a depth range of 300µm.

649 EFFECTS OF THE PREPARATION METHOD ON THE ICG FLUORESCENCE BLOOD FLOW IN THE GASTRIC CONDUIT AFTER ESOPHAGECTOMY

Abstract In this study, we investigated how the blood flow of gastric conduit changed due to the difference in the lesser curvature cut line using ICG fluorescence imaging in patients with esophageal cancer. Methods A total of 193 cases of esophageal cancer surgery with gastric conduit reconstruction were included. (Conventional method) The lesser curvature cut line of the stomach was started from a distance of 5 cm from the pylorus (141 cases). (Current method) Gastric lesser curvature dissection was started from the last branch of the left gastric artery (52 cases). Blood flow of the gastric conduit was measured by the ICG fluorescence imaging, and the correlation between the changes in the gastric conduit and both blood flow and anastomotic failure was examined. Results Median length of the lesser curvature cut line was 10 cm from the pylorus in the current method, which was significantly longer than that in the conventional method (P &amp;lt; 0.001). Congestion at the tip of the gastric conduit were more observed in the conventional method (P = 0.02). The ICG fluorescent blood flow speed in the gastric conduit wall was 2.54 cm/s by the conventional method and 2.82 cm/s by the current method (P = 0.03). There were 23 cases (16.3%) of anastomotic leakage in the conventional method and 4 cases (7.7%) in the current method (P = 0.09). Conclusion By preserving the right gastric artery and vein, improvement of venous return is expected, and it is suggested that blood flow in the gastric conduit wall can be well maintained.

Изменения сосудов головного мозга у пациентов с неалкогольной жировой болезнью печени и нарушением углеводного обмена

Актуальность. Исследование сосудов головного мозга у пациентов с неалкогольной жировой болезнью печени (НАЖБП) может раскрыть новые аспекты раннего выявления нарушений церебральной гемодинамики, а также обнаружить группу больных высокого риска. Цель исследования: изучить особенности изменений в сосудах головного мозга у пациентов с НАЖБП в сочетании с инсулинорезистентностью (ИР) или сахарным диабетом (СД) 2 типа. Материалы и методы. Обследовано 74 пациента с НАЖБП (34 больных с неалкогольным жировым гепатозом (НАЖГ) и 40 больных с неалкогольным стеатогепатитом (НАСГ)). Группа сравнения включала 38 пациентов (16 больных с ИP и 22 пациента с СД 2 типа). Состояние кровотока в cосудах головного мозга изучали с помощью ультразвукового дуплексного сканирования экстракраниального отдела общей сонной артерии (ОСА), наружной сонной артерии (НСА), экстракраниального отдела внутренней сонной артерии, средней мозговой артерии, вертебральной артерии (ВА), глазной артерии. Определяли пиковую систолическую скорость (ПСС) и среднюю по времени максимальную скорость кровотока (ТАМХ) в исследуемых сосудах. Результаты. Обращает на себя внимание асимметричное поражение сосудов головного мозга с более выраженным дефицитом кровотока слева при НАЖБП, что более выражено у больных со стадией НАСГ, особенно в сочетании с ИP. Гемодинамически наиболее значимые изменения установлены в ОСА, а именно выявлено снижение ПСС до (38,1 ± 2,3) см/с справа и до (36,6 ± 3,4) см/с слева, снижение ТАМХ — до (20,4 ± 2,1) см/с справа и до (16,7 ± 1,8) см/с слева. Выводы. У пациентов с НАЖБП, ИP и СД 2 типа выявлено снижение скоростных показателей кровотока по экстракраниальным сосудам головного мозга, преимущественно по ОСА, НСА и ВА (сегмент 3). Наиболее выраженный дефицит кровотока установлен у больных НАСГ в сочетании с ИP, преимущественно слева, особенно по ОСА.

Peculiarities of ultrasound diagnostics of paraurethral glands in women of fertile age

Aim. Evaluation of ultrasound diagnostics of paraurethral glands considering their types of location in women of fertile age. Materials and methods. A gynaecological, sexological and ultrasound study of 94 women in the age from 24 to 42 (average age 31.01 ± 6.60) was carried out. Determination of paraurethral glands during ultrasound study was conducted in the format of grey scale (B-mode) using the Doppler colour flow mapping and evaluation of Doppler indices of paraurethral glands both before and after sexual stimu­lation. To optimize the paraurethral glands visual view at the beginning of examination urinary bladder was catheterized and a balloon, filled with gel, was inserted into vagina. Results. The front type of paraurethral glands location was found in the accumulation of glandular tissues in regard to the distal part of urethra in 67 (71.2 %) of the examined, back type – in the area of back urethra in 19 (20.2 %), diffuse type – along urethra in 7 (7.5 %) and absence – in 1 (1.1 %). Paraurethral glands were visualized in the form of clear isoechogenic oval formation with the following dimensions: length – 2.20 ± 0.60 cm, width – 1.52 ± 0.40 cm, thickness – 1.30 ± 0.30 cm, and volume – 4.75 ± 0.50 cm3. The diameter of vessels in the paraurethral glands area was between 0.17 cm and 0.21 cm in calm state and 0.39–0.41 cm – during stimulation. Maximum systolic speed of blood flow (Vps) in calm was 8.9–11.1 cm/sec, while in sexual stimulation it was 13.9–14.1 cm/sec, resistance index (IR) – 0.60–0.62 and 0.63–0.68, respectively, pulsation index (IP) – 1.22–1.44 and 1.61–1.72, respectively. Conclusions. The ultrasound study of vessels of paraurethral glands, when Doppler method is used according to the suggested methodology, gives the opportunity not only to identify its anatomical structure, but also to determine its types. In CDC the increase of diameter of vessels and the optimization of vessels image in the area of paraurethral glands in case of sexual stimulation were marked.

The feasibility of ultrasound-assisted endovascular laser thrombolysis in an acute rabbit thrombosis model.

This study aimed to test the feasibility of combined ultrasound and laser technique, namely, ultrasound-assisted endovascular laser thrombolysis (USELT), for thrombolysis by conducting in vivo tests in a rabbit thrombosis model. An acute thrombus was created in the right jugular vein of rabbit and then was treated with ultrasound only, laser only, and USELT to dissolve the blood clot. A total of 20 rabbits were used. Out of which, the first three rabbits were used to titrate the laser and ultrasound parameters. Then, five rabbits were treated with ultrasound only, five rabbits were treated with laser only, and seven rabbits were treated with USELT. During USELT, 532-nm laser pulses were delivered endovascularly directly to the clot through a fiber optic, and 0.5MHz ultrasound pulses were applied noninvasively to the same region. A laser fluence of 4 to 12mJ/cm2 and ultrasound amplitude of 1 to 2MPa were used. Recanalization of the jugular vein was assessed by performing ultrasound Doppler imaging immediately after the treatment. The maximum blood flow speed after the treatment as compared to its value before the treatment was used to calculate the blood flow recovery in vessel. The blood flow was fully recovered (100%) in three rabbits, partially recovered in two rabbits (more than 50% and less than 100%) with mean percentage recovery of 69.73% and poorly recovered in two rabbits (<50%) with mean percentage recovery of 6.2% in the USELT group. In contrast, the treatment group with ultrasound or laser alone did not show recanalization of vein in any case, all the five rabbits were poorly/not recovered with a mean percentage recovery of 0%. The USELT technology was shown to effectively dissolve the blood clots in an acute rabbit jugular vein thrombosis model.

Visualization of three-dimensional microcirculation of rodents\u2019 retina and choroid for studies of critical illness using optical coherence tomography angiography

We developed a method to measure the relative blood flow speed using optical coherence tomography angiography (OCTA) in retina and choroid, and investigated the feasibility of this method for assessing microcirculatory function in rat models of sepsis and hemorrhagic shock. Two sepsis models, 6-h severe sepsis without treatment and 30-h moderate sepsis maintaining mean arterial pressure, and volume controlled hemorrhagic shock and fluid resuscitation model were used to see the change of microcirculation. The blood flow index (BFI), which was calculated from the OCTA images to represent the average relative blood flow, was decreasing during the 6-h severe sepsis model. Its change is in parallel with the mean arterial blood pressure (MAP) and blood lactate levels. In the 30-h moderate sepsis model, the BFI was decreased while maintaining MAP, and lactate was increased. In the hemorrhagic shock model, the change of BFI is in line with MAP and lactate levels. In all models, BFI change is more sensitive in choroid than in retina. This study presents the OCTA-based retinal and choroidal microcirculatory blood flow monitoring method and shows its utility for assessment of critical illness.

Longer-Term Soy Consumption Improves Cerebral Blood Flow and Psychomotor Speed: Results of a Randomized, Controlled Cross-Over Trial in Older Males and Females

ObjectivesEffects of plant-based diets on cerebral blood flow (CBF), which is a physiological marker of cerebrovascular function, have hardly been studied and may contribute to the beneficial effects of these diets on cognitive performance. Therefore, the primary objective of this study was to investigate longer-term effects of soy nut consumption on CBF in older men and women. Changes in cognitive performance were also studied. MethodsA randomized, controlled, cross-over trial was performed with a sixteen-week intervention period, separated by a wash-out period of eight weeks. Twenty-three males and females, aged 64 ± 3 (mean ± SD) years and with a BMI of 25.9 ± 2.7 kg/m2, started with the soy intervention period (67 g of soy nuts daily providing 25.5 g soy protein) or control period (no nuts). The two periods were separated by a wash-out period of eight weeks. At the end of each period, CBF was assessed with arterial spin labeling magnetic resonance imaging. Cognitive performance was assessed in the main cognitive domains using well-validated CANTAB tests. ResultsSerum isoflavone concentrations significantly increased after the soy intervention (daidzein Δ 133 ± 113 ng/mL, P < 0.001; genistein Δ 456 ± 256 ng/mL, P < 0.001), indicating good compliance. Regional increases in CBF were observed in four brain regions that are involved in object recognition, visual information processing and target reorientation. These brain clusters were located in the (1) left occipital and temporal lobe (Δ 36%, volume 11,296 mm3, P < 0.001), (2) bilateral occipital lobe (Δ 32%, volume 2632 mm3, P = 0.002), (3) right occipital and parietal lobe (Δ 47%, volume 2280 mm3, P = 0.005). The fourth cluster was located in the left frontal lobe (Δ 43%, volume 2120 mm3, P = 0.009), and is part of the ventral network, which is involved in task-relevant stimuli. Movement time during the psychomotor speed test was reduced by 7% (P = 0.005), while no changes were observed in executive function or memory. ConclusionsA longer-term soy nut intervention improved cerebrovascular function in older adults, as regional CBF increased. These effects may underlie observed beneficial effects on cognitive performance in the psychomotor speed domain. Funding SourcesThis research was supported by a grant from the Alpro Foundation.

The Recognition of Excessive blood loss At ChildbirTh (REACT) Study: a two-phase exploratory, sequential mixed methods inquiry using focus groups, interviews and a pilot, randomised crossover study.

To explore how childbirth-related blood loss is evaluated and excessive bleeding recognised; and to develop and test a theory of postpartum haemorrhage (PPH) diagnosis. Two-phase, exploratory, sequential mixed methods design using focus groups, interviews and a pilot, randomised crossover study. Two hospitals in North West England. Women (following vaginal birth with and without PPH), birth partners, midwives and obstetricians. Phase 1 (qualitative): 8 focus groups and 20 one-to-one, semi-structured interviews were conducted with 15 women, 5 birth partners, 11 obstetricians, 1 obstetric anaesthetist and 19 midwives (n=51). Phase 2 (quantitative): 11 obstetricians and ten midwives (n=21) completed two simulations of fast and slow blood loss using a high-fidelity childbirth simulator. Responses to blood loss were described as automatic, intuitive reactions to the speed, nature and visibility of blood flow. Health professionals reported that quantifying volume was most useful after a PPH diagnosis, to validate intuitive decisions and guide ongoing management. During simulations, PPH treatment was initiated at volumes at or below 200ml (fast mean blood loss 79.6ml, SD 41.1; slow mean blood loss 62.6ml, SD 27.7). All participants treated fast, visible blood loss, but only half treated slow blood loss, despite there being no difference in volumes (difference 18.2ml, 95% CI -5.6 to 42.2ml, P=0.124). Experience and intuition, rather than blood loss volume, inform recognition of excessive blood loss after birth. Women and birth partners want more information and open communication about blood loss. Further research exploring clinical decision-making and how to support it is required. During a PPH, clinical decision-making is intuitive with clinicians treating as soon as excessive loss is recognised.

Communication Of Quality Of Life Indicators, Functional Methods Of Research And Neuromarker BNDF In Patients With Diabetes Mellitus 2 With Diabetic Foot Syndrome

The purpose of the study is to study the correlation rate of the quality of life, electroneuromyography, doppler and neuro markers BNDF in the blood in patients with a type 2 of type with diabetic foot syndrome. Methods: The following 2 groups of patients were formed: 1 gr. - SDS patients, neuropathic form -37 patients, 2 gr. - SDS patients, neuroichmic form -35 patients, 3 gr. - Control group, these are 20 healthy persons of the appropriate age and gender. Results: In all groups of patients, the quality of life is significantly different in the FSHC questionnaire compared with the control group (p &lt;0.05). In patients with a neuroecemic form of diabetic foot syndrome, a significant decrease was found (p &lt;0.05). All indicators of doppler song vessels of legs compared with patients with neuropathic shape. Revealed significant correlations of FSHK and laboratory and instrumental indicators. A correlation connection with the duration of the disease, the duration of the disease, the levels of glycemia of an empty stomach, the level of the glycated haemoglobin, BNDF in the blood, the speed of blood flow in the femoral artery, in the lower leg, is discovered. The definition of neuromuscular transmission showed that the patients of the 1st and 2nd groups have a weak reduction in muscle contraction involuntarily. This confirmed the impairment of neuromuscular transmission in both groups. Conclusions: 1) A questionnaire to determine the quality indicators - FSHK is the most sensitive and informative to determine the quality of life in patients with type 2 diabetes mellitus with neuropathic and neuroecemic forms 2) FSHP questionnaire can be used for dynamic assessment of type 2 diabetes patients with neuropathic and neuroecemic forms in outpatient clinical practice. 3) Revealed significant correlations of FSHK and laboratory and instrumental indicators. A correlation connection with the duration of the disease, the duration of the disease, the levels of glycemia on an empty stomach, the level of the glycated haemoglobin, BNDF in the blood, the speed of blood flow in the femoral artery, in the shin, M-answer when stimulating a tibial nerve.

High-speed quantitative optical imaging of absolute metabolism in the rat cortex.

.Significance: Quantitative measures of blood flow and metabolism are essential for improved assessment of brain health and response to ischemic injury.Aim: We demonstrate a multimodal technique for measuring the cerebral metabolic rate of oxygen () in the rodent brain on an absolute scale ().Approach: We use laser speckle imaging at 809 nm and spatial frequency domain imaging at 655, 730, and 850 nm to obtain spatiotemporal maps of cerebral blood flow, tissue absorption (), and tissue scattering (). Knowledge of these three values enables calculation of a characteristic blood flow speed, which in turn is input to a mathematical model with a “zero-flow” boundary condition to calculate absolute . We apply this method to a rat model of cardiac arrest (CA) and cardiopulmonary resuscitation. With this model, the zero-flow condition occurs during entry into CA.Results: The values calculated with our method are in good agreement with those measured with magnetic resonance and positron emission tomography by other groups.Conclusions: Our technique provides a quantitative metric of absolute cerebral metabolism that can potentially be used for comparison between animals and longitudinal monitoring of a single animal over multiple days. Though this report focuses on metabolism in a model of ischemia and reperfusion, this technique can potentially be applied to far broader types of acute brain injury and whole-body pathological occurrences.

Super-resolution ultrasound localization microscopy based on a high frame-rate clinical ultrasound scanner: an in-human feasibility study

Non-invasive detection of microvascular alterations in deep tissues in vivo provides critical information for clinical diagnosis and evaluation of a broad-spectrum of pathologies. Recently, the emergence of super-resolution ultrasound localization microscopy (ULM) offers new possibilities for clinical imaging of microvasculature at capillary level. Currently, the clinical utility of ULM on clinical ultrasound scanners is hindered by the technical limitations, such as long data acquisition time, high microbubble (MB) concentration, and compromised tracking performance associated with low imaging frame-rate. Here we present a robust in-human ULM on a high frame-rate (HFR) clinical ultrasound scanner to achieve super-resolution microvessel imaging using a short acquisition time (<10 s). Ultrasound MB data were acquired from different human tissues, including a healthy liver and a diseased liver with acute-on-chronic liver failure, a kidney, a pancreatic tumor, and a breast mass using an HFR clinical scanner. By leveraging the HFR and advanced processing techniques including sub-pixel motion registration, MB signal separation, and Kalman filter-based tracking, MBs can be robustly localized and tracked for ULM under the circumstances of relatively high MB concentration associated with standard clinical MB administration and limited data acquisition time in humans. Subtle morphological and hemodynamic information in microvasculature were shown based on data acquired with single breath-hold and free-hand scanning. Compared with contrast-enhanced power Doppler generated based on the same MB dataset, ULM showed a 5.7-fold resolution improvement in a vessel based on a linear transducer, and provided a wide-range blood flow speed measurement that is Doppler angle-independent. Microvasculatures with complex hemodynamics can be well-differentiated at super-resolution in both normal and pathological tissues. This preliminary study implemented the ultrafast in-human ULM in various human tissues based on a clinical scanner that supports HFR imaging, indicating the potentials of the technique for various clinical applications. However, rigorous validation of the technique in imaging human microvasculature (especially for those tiny vessel structure), preferably with a gold standard, is still required.

Using carpet plots to analyze transit times of low frequency oscillations in resting state fMRI

A “carpet plot” is a 2-dimensional plot (time vs. voxel) of scaled fMRI voxel intensity values. Low frequency oscillations (LFOs) can be successfully identified from BOLD fMRI and used to study characteristics of neuronal and physiological activity. Here, we evaluate the use of carpet plots paired with a developed slope-detection algorithm as a means to study LFOs in resting state fMRI (rs-fMRI) data with the help of dynamic susceptibility contrast (DSC) MRI data. Carpet plots were constructed by ordering voxels according to signal delay time for each voxel. The slope-detection algorithm was used to identify and calculate propagation times, or “transit times”, of tilted vertical edges across which a sudden signal change was observed. We aim to show that this metric has applications in understanding LFOs in fMRI data, possibly reflecting changes in blood flow speed during the scan, and for evaluating alternative blood-tracking contrast agents such as inhaled CO2. We demonstrate that the propagations of LFOs can be visualized and automatically identified in a carpet plot as tilted lines of sudden intensity change. Resting state carpet plots produce edges with transit times similar to those of DSC carpet plots. Additionally, resting state carpet plots indicate that edge transit times vary at different time points during the scan.

Study of changes in perfusion in the foci of demyelination in multiple sclerosis by perfusion MRI

Introduction. Multiple sclerosis is a chronic immune-mediated disease of the central nervous system with disseminated foci of demyelination and progressive neurodegeneration; it is the most common demyelinating disease and the leading cause of disability of neurological patients of a young age, characterized by a wave-like course with alternating periods of remission and relapse. Currently, there is a discussion about the participation of vascular changes in the formation of neurological disorders and about the possibility of correction of therapeutic approaches in connection with the revealed microcirculatory disorders. Perfusion MRI allows you to evaluate hemodynamics at the capillary level in vivo. Purpose. To evaluate perfusion changes in foci of demyelination in multiple sclerosis using the method of dynamic susceptibility contrast (DSC). Materials and methods. The MR study was carried out on a super-high-angle MR-scanner «Ingenia» («Philips») 3 Tesla. The study included 30 healthy volunteers and 80 patients with demyelinating disease from 18 to 48 years old (average age was 34,6±8,02 years).Quantitative and qualitative assessment of perfusion indices in foci of demyelination was carried out. Results. In the active foci of demyelination, an increase in the speed and volume of cerebral blood flow is noted, the most pronounced changes in patients with clinically isolated syndrome. Inactive foci, marked hypoperfusion is noted. Discussion. Evaluation of cerebral perfusion allows a new look at the role of the vascular component in the formation of focal inflammatory changes in the brain in multiple sclerosis, which can determine a new direction of pathogenetic treatment. Conclusion. Perfusion data complements routine MRI and provides a comprehensive assessment of the neurovascular system.