Blood Flow Status Research Articles

Intracranial atherosclerosis: From anatomy to pathophysiology.

Background Intracranial atherosclerotic stenosis is an important etiology subtype of ischemic stroke. Stenosis severity was thought to be the main reference index for clinical treatment and research. However, stenosis could not reflect the ischemia risk completely, instead the hemodynamic state across the lesion, the extent of collateral circulation, and perfusion impairment downstream the stenosis are more important. Aims We write this review aimed to summarize novel angiographic methods applied in the evaluation of functional severity of ICAS, and commented on their limitations and prospects in future research. Summary of review The main methods to estimate cerebral blood flow including fractional flow assessed by signal intensity ratio, computational fluid dynamics analysis or pressure wire, quantitative magnetic resonance angiography. Fractional flow as a series cerebral hemodynamic parameters may reflect the status of collateral circulation and cerebral blood flow. But the accuracy of the methods was not validated. The method to calculate fractional flow reserve in cardiovascular disease cannot duplicate in cerebrovascular disease. Fractional flow measurement by floating a pressure guidewire across the intracranial stenosis was technically feasible and safe. In the future researches, a non-invasive method should be established to identify high-risk intracranial lesions and may help in decision-making. Conclusions The relationship between stenosis and cerebral blood flow was individualized. Cerebral hemodynamic criteria should be used to screen patients to endovascular treatment, which will optimize the diagnosis and treatment strategies for patients with symptomatic intracranial artery stenosis.

Cerebral hemodynamics and perfusion brain condition with hypertensive encephalopathy in elderly patients

In work the theoretical generalization and new solution of scientific and practical problems of hypertensive encephalopathy in patients with hypertension grade 2, are new solution of scientific problems determining the status of cerebral blood flow in elderly patients based on analysis of clinical and instrumental examination, which included studying the clinical features daily monitoring of blood pressure, state of cerebral hemodynamic and perfusion of the brain and optimized approaches to treatment and prevention.
 A technology assessment of cerebral blood flow during the development of hypertensive encephalopathy based on current clinical and neurological and neuroimaging methods. Proven features of the dynamic properties of fluctuations in systolic blood pressure, pulse pressure, the average blood pressure throughout the day, determining the nature of the disease. On the basis of brain perfusion SPECT using developed new approaches to diagnosis and correction of hypertensive encephalopathy established reliable quantitative and qualitative relationship between the duplex scanning and results of daily monitoring of blood pressure.

The relationship between cognitive impairment and decreased cerebral blood flow in the frontal area

Diabetes mellitus is associated with increased risk of dementia, especially in patients with mild cognitive impairment, including changes which are unlikely to be found in everyday clinical practice, especially in patients with diabetes, which is associated with the presence of disease complications. Therefore, you must understand the importance of screening for cognitive disorders in the early stages in patients with diabetes mellitus. The aim of our study was to investigate the feasibility of the Stroop test to determine the state of cognitive impairment and cerebral blood flow status in the relevant areas of the brain evidenced by single-photon emission computed tomography (SPECT). The study involved 40 patients aged 60 to 70 years. The 27 women and 13 men. Exclusion criteria were the presence of stroke, traumatic brain injury, the abuse of alcohol. Evaluation of cognitive impairment was carried out using the Stroop test. For information on the perfusion of brain tissue using single photon emission computed tomography (SPECT). Patients were divided into 2 groups. The first group included patients who by SPECT were found hypofrontality, the second - with no signs of it. There has been a significant decrease in executive functions during the Stroop test of the part 3 in the patients of the first group than the second group. That is, the first group of patients, there is a decrease in cerebral blood flow in the anterior cingulate cortex and dorsolateral prefrontal cortex, which is confirmed by a SPECT of hypofrontality. Stroop test, a sensitive test in patients with diabetes mellitus type 2 and can be recommended for the diagnosis of cognitive disorders and diabetes associated disorders, for early detection of abnormalities in the cognitive field that will allow for the timely prevention of the condition and reduce the disability of patients.

Combining arterial-spin labeling with functional magnetic resonance imaging measurement for characterizing patients with minimal hepatic encephalopathy.

Our objective is to explore key changes in brain functions in relation to minimal hepatic encephalopathy (MHE). We incorporated both resting-state functional magnetic resonance imaging (fMRI) and arterial spin labeling (ASL) to enhance the detection of MHE. We undertook fMRI scanning for 56 MHE patients and 66 healthy controls. Region functional connectivity was carried out to assess the connectivity status between pairs of regions among 90 brain regions. Additionally, blood flow (BF) status was measured by ASL for all subjects. Spearman's correlation test was implemented to identify any correlation among z-values, results from number connection test type A, and digit symbol tests. Finally, the receiver operating characteristic curve was generated for assessing the accuracy of BF in MHE diagnosis. The corresponding functional connectivity was significantly different between MHE and control groups in 15 regions. For MHE patients, BF showed an increasing pattern in regions of interest. Blood flood in the putamen was positively correlated with number connection test type A neuropsychological performance, whereas it was negatively correlated with the digit symbol test. Blood flood in the right putamen showed the highest value of area under the curve with a sensitivity of 85.7% and specificity of 89.4%. Connectivity impairment resulting from ganglia-thalamo-cortical circuits may play important roles in mediating the development of MHE patients. An increase in the BF, particularly in the right putamen, may be considered as evidence for the presence of MHE.

Home Monitoring Program Reduces Mortality in High-Risk Sociodemographic Single-Ventricle Patients.

A clinician-driven home monitoring program can improve interstage outcomes in single-ventricle patients. Sociodemographic factors have been independently associated with mortality in interstage patients. We hypothesized that even in a population with high-risk sociodemographic characteristics, a home monitoring program is effective in reducing interstage mortality. We defined interstage period as the time period between discharge following Norwood palliation and second-stage surgery. We reviewed the charts of patients for the three-year period before (group 1) and after (group 2) implementation of the home monitoring program. Clinical variables around Norwood palliation, during the interstage period, and at the time of second-stage surgery were analyzed. There were 74 patients in group 1 and 52 in group 2. 59% patients were Hispanic, and 84% lived in neighborhoods where over 5% families lived below poverty line. There was no significant difference in pre-Norwood variables, Norwood discharge variables, age at second surgery, or outcomes at second surgery. There were more Sano shunts performed at the Norwood procedure as the source of pulmonary blood flow in group 2 (p value <0.05). There were more unplanned hospital admissions and percutaneous re-interventions in group 2. Patients in group 2 whose admission criteria included desaturation had a 45% likelihood of having an unplanned re-intervention. Group 2 noted an 80% relative reduction in interstage mortality (p<0.01). In a multiple regression analysis, after accounting for ethnicity, socio-economic status, and source of pulmonary blood flow, enrollment in a home monitoring program independently predicted improved interstage survival (p<0.01). A clinician-driven home monitoring program reduces interstage mortality even when the majority of patients has high-risk sociodemographic characteristics.

The impact of ligation of proximal side branches on blood flow and functional status of the internal thoracic artery in coronary anastomosis.

The effect of proximal side branches on the patency of the internal thoracic artery (ITA) is controversial. We used echocardiography and Doppler to verify the effect of ligation of branches on the flow and coronary flow reserve (CFR) of the grafted ITA in patients after coronary artery bypass grafting (CABG). We prospectively investigated 53 patients with preserved left ventricular ejection fraction (LVEF >50%) who underwent CABG of the ITA. In Group I (25 patients), major branches were ligated during ITA anastomosis to the left anterior descending (LAD) coronary artery, whereas no ligation was performed in Group II (28 patients). Systolic flow (SF), diastolic flow (DF), and total flow (TF = SF + DF) were measured by Doppler echocardiography at the proximal level of the ITA preoperatively, at early postoperative stage, and 6months after surgery. Dobutamine stress echocardiography (DSE) was performed at 6months to determine CFR. The ITA flow was predominantly systolic before surgery and diastolic in the postoperative period. We found no differences between the groups in DF. On DSE, SF (19.5±9mL/min vs 32.7±19mL/min; P=.003) and TF (79±21mL/min vs 101±47mL/min; P=.037) were higher in Group II. There were no differences in CFR (1.9±0.46 vs 2.11±0.56; P=.143). In patients with preserved LVEF, ligation of major side branches during anastomosis to the LAD does not alter ITA flow or CFR.

Complete Antegrade Transapical Deployment of a Branched Aortic Arch Endograft

Purpose: To describe and prove the concept of a technique for complete transapical deployment of a single-branch aortic arch endograft in a porcine model. Methods: Eight domestic pigs underwent antegrade transapical delivery of a single-branch arch endograft, including a mating stent-graft to the innominate artery. Technical feasibility, operating time, radiation parameters, and hemodynamic changes were studied according to a standardized protocol during baseline (T0), after establishing the transapical access and through-and-through wire (T1), and after stent-graft deployment (T2). Myocardial and cerebral blood flow status was assessed using fluorescent microspheres (FM) and transit-time flow measurement (TTFM) monitoring. Results: Transapical access, introduction and deployment of the endograft, side branch catheterization, and deployment of the mating stent-graft were feasible in 6 of 8 animals. One animal died due to irreversible heart rhythm disorders and one due to accidental graft rotation during deployment, resulting in unintended coverage of the innominate artery. The mean operating and fluoroscopy times were 223±11 minutes and 27.2±6.3 minutes, respectively. During introduction and deployment of the stent-graft, transient aortic valve insufficiency occurred in all animals. Hemodynamic stability recovered within 10 minutes after retrieval of the delivery system in all animals. The innominate artery was patent, with unchanged TTFM measurements throughout the procedure. FM evaluation revealed stable cerebral blood flow. Conclusion: An antegrade transapical access to the aortic arch for implantation of a single-branch endograft is feasible in a porcine model with reversible impact on hemodynamic measures during deployment. Transapical access allows deployment of a complex endograft through a single large-bore access site in a porcine model.

Abstract 105: Collateral Blood Flow and Inflammatory Markers in Intracranial Atherosclerosis: Angiography and Biomarker Correlates in the BIOSIS and SAMMPRIS Trials

Background: Collateral blood flow, modulated by inflammation and arteriogenesis, alters ischemic injury in intracranial atherosclerosis. We investigated the potential link between several inflammatory and arteriogenic biomarkers with angiographic findings at enrollment in BIOSIS/SAMMPRIS. Methods: Baseline angiography and blood biomarkers of BIOSIS/SAMMPRIS, which included subjects with stroke or TIA due to 70-99% intracranial stenosis were analyzed. Collateral blood flow status at angiography was categorized by the combination of antegrade flow (TICI) and corresponding extent of collaterals (ASITN/SIR). Collateral status was analyzed with respect to blood progenitor cell markers (CD34) at baseline and inflammatory biomarkers (Plasminogen Activator Inhibitor-1 (PAI-1), E-selectin, high sensitivity C-reactive protein (hsCRP) and Lipoprotein-associated phospholipase A2 (Lp-PLA 2 ) activity and concentrations) at baseline, 30 days and 4 months. Results: 376 subjects (mean age 60.44 years SD 11; 149/376 (39.6%) women) enrolled in BIOSIS/SAMMPRIS had angiography of collaterals and biomarker data. Collateral perfusion was impaired in 71 (19%) and intermediate in 188 (50%), with robust collaterals in 117 (30%) subjects. Better collateral status was associated with younger age (p=0.001), male sex (p=0.029) and greater baseline physical activity (p=0.007). Baseline blood progenitor cell (CD34+) counts were unrelated to angiographic features at enrollment, whereas inflammatory Lp-PLA 2 activity was linked (p=0.059) with blood flow categories, and lower hsCRP (p=0.025) with better collaterals. Lp-PLA 2 activity was lowest in those with robust collaterals at 30 days (p=0.070) and 4 months (p=0.120). Those with robust collaterals had the greatest decrease in Lp-PLA 2 activity (p=0.021) and concentration (p=0.027) by 30 days, with a continued decline of Lp-PLA 2 activity (p=0.037) to 4 months. Disparate trends in inflammatory markers were seen in the medical and stenting arms. Conclusions: Inflammatory biomarkers are linked with collateral blood flow status in intracranial atherosclerosis. The impact of physical activity, medications and other therapeutic investigations may disclose important mechanisms to avert ischemia.

Strain rate and the coronary blood flow in patients with high normal blood pressure

Background. The population studies demonstrated the direct relationship between blood pressure (BP) level and risk of cardiovascular complications. The BP elevation (even within high normal values) in the young adults is associated with early involvement of target organs. Moreover, the initial myocardial structural and functional changes associated with BP increase are not studied completely. Modern ultrasound diagnostic opportunities (development of high frequency broadband transthoracic transducer, implementation of Tissue harmonic imaging and development of “speckle tracking” echocardiography method — STE) allow to assess the coronary blood flow status and to reveal the earliest signs of left ventricle (LV) myocardial dysfunction. The aim of our study is to assess the LV longitudinal deformation and coronary blood flow at the level of left anterior descending (LAD) artery and perforant arteries (PA) in young patients with high normal BP (HNBP). Design and methods . The study involved 43 men aged 18–27 years old, who were divided into 2 groups depending on office BP level. The first group consists of the subjects with HNBP, the second group included persons with optimal and normal BP values. The standard physical examination was performed in all patients. Heart condition was assessed by transthoracic EchoCG data. The registration of blood flow spectrum in LAD and in apical PAs was performed by impulse Doppler regimen. LV functional status was assessed by STE with global longitudinal strain analysis. Results. The traditional parameters of systolic and diastolic LV function were comparable in patients with HNBP and in healthy subjects. In patients with prehypertension a significant decrease of global strain rate was registered; they negatively correlate with systolic BP. In patients with HNBP the significant decrease of maximal diastolic blood flow rate in PA was registered. Conclusions. The earliest preclinical sign of myocardial contractile dysfunction in the subjects with HNBP is the decrease of global longitudinal strain. In patients with prehypertension the decrease of maximal diastolic blood flow rate in performant arteries is found.

MR Perfusion-derived Hemodynamic Parametric Response Mapping of Bevacizumab Efficacy in Recurrent Glioblastoma.

To better understand the effect of bevacizumab therapy on tumor blood flow and oxygenation status in patients with recurrent glioblastoma. Retrospective data evaluation was approved by the local ethics committee of the University of Heidelberg (ethics approval number, S-320/2012), and informed consent was waived. A total of 71 patients who received a diagnosis of recurrent glioblastoma underwent conventional anatomic magnetic resonance (MR) imaging and dynamic susceptibility contrast material-enhanced MR imaging at baseline and at the first follow-up examination after initiation of bevacizumab therapy. Parametric response maps (PRMs) were created with multistep (nonlinear) registration of patients' post- to pretreatment images and voxel-wise subtraction between Gaussian-normalized relative cerebral blood volume (nrCBV) and Gaussian-normalized relative cerebral blood flow (nrCBF) maps. Intratumor voxels were stratified as being increased (PRM[+]) or decreased (PRM[-]) if they exceeded a threshold that represented the 95% confidence interval in the normal-appearing brain. Correlation with progression-free and overall survival was performed with Cox proportional hazards models. The risks for disease progression and death significantly increased with (a) higher baseline nrCBV (hazard ratio [HR] = 1.86, P < .01; HR = 1.52, P < .01) and nrCBF (HR = 1.78, P < .01; HR = 1.86, P < .01) values and (b) higher PRM(-) of nrCBV (HR = 1.03, P = .01; HR = 1.02, P = .03) and nrCBF (HR = 1.04, P < .01; HR = 1.03, P < .01), but not with higher PRM(+) of nrCBV and nrCBF, and not for the relative change in mean nrCBV and nrCBF, confirming the superiority of the PRM approach. The magnitude of PRM(-) for both nrCBV and nrCBF significantly increased for higher baseline values (P < .01). Pretreatment hemodynamic parameters are the principal determinant of response to bevacizumab therapy in patients with recurrent glioblastoma. Although the magnitude of PRM(-) is a function of the corresponding pretreatment parameter, the finding of higher PRM(-) and a lack of change in PRM(+) in nonresponders to bevacizumab therapy implies that tumors with a high degree of angiogenesis before bevacizumab therapy retain a higher level of angiogenesis during therapy, despite a greater antiangiogenic effect of bevacizumab, such that a reversal of the biologic behavior and relative prognosis of these tumors does not occur.

ANGI-07MR-PERFUSION DERIVED HEMODYNAMIC PARAMETRIC RESPONSE MAPPING OF BEVACIZUMAB EFFICACY IN RECURRENT GLIOBLASTOMA

BACKGROUND: Bevacizumab has proven beneficial in patients with recurrent glioblastoma (rGB), however its impact on tumor blood flow and oxygenation status remains controversial. Here we examine dynamic susceptibility-weighted contrast-enhanced MRI (DSC-MRI) derived Gaussian-normalized, relative cerebral blood volume and flow (nrCBV, nrCBF) parametric-response-maps (PRMs), for predicting response to bevacizumab in patients with rGB. METHODS: A total of 71 patients diagnosed with rGB underwent conventional-anatomic MRI and DSC-MRI at baseline and at first follow-up after bevacizumab initiation. PRMs were created by a multi-step (non-linear) registration of the patient's post- to pre-treatment scan and voxel-wise subtraction between nrCBV and nrCBF maps. Intratumoral voxels were stratified as increased [PRM(+)] or decreased [PRM(-)] if they exceeded a threshold representing the 95% confidence interval in the normal-appearing brain. Correlation with PFS and OS was performed using Cox-proportional-hazard models. RESULTS: The hazards for progression and death significantly increased with (I) higher baseline nrCBV (HR = 1.86, p < 0.01; HR = 1.52, p < 0.01) and nrCBF values (HR = 1.78, p < 0.01; HR = 1.86, p < 0.01), (II) higher PRM(-) of nrCBV (HR = 1.03, p = 0.01; HR = 1.02, p = 0.03) and nrCBF (HR = 1.04, p < 0.01; HR = 1.03, p < 0.01), but (III) not for higher PRM(+) of nrCBV and nrCBF, and (IV) not for the relative change in mean nrCBV and nrCBF, confirming the superiority of the PRM-approach. The magnitude of PRM(-) for both nrCBV and nrCBF significantly increased for higher baseline values (p < 0.01, respectively). CONCLUSION: Pre-treatment hemodynamic parameters are the principal determinant of BEV-response in rGB and emerge as a potential predictive imaging biomarker for selecting those patients with rGB who may maximally benefit from BEV-treatment. Although the magnitude of PRM(-) is a function of the corresponding pre-treatment parameter, the finding of higher PRM(-) and lack of PRM(+) in BEV non-responders may correspond to a pro-invasive, non-angiogenic evasion.

Value of fractional flow reserve measurement in endovascular therapy for patients with Stanford B type aortic dissection complicated with renal blood flow injury

To analyze the value of fractional flow reserve (FFR) measurement on endovascular therapy for patients with renal artery stenosis. Clinical data of 12 patients with Stanford B type aortic dissection complicated with renal blood flow injury in Anzhen hospital hospitalized from May 2013 to February 2014 were retrospectively analyzed. Renal artery angiography was performed and fractional flow reserve (FFR) was measured before Thoracic endovascular aortic repair. After operation, renal artery FFR was measured again, and renal artery stenting was performed in patients with FFR ≤ 0.90 or average pressure difference between proximal and distal of renal artery > 20 mmHg (1 mmHg = 0.133 kPa) and not applied for patients with FFR > 0.90.The patients were then subsequently followed up clinically. Kidney function were measured after 1 month, and contrast-enhanced ultrasonography data were obtained at 1 and 3 months later, respectively. The FFR of 1 patient was 0.90, while the FFR of other patients were less than 0.90 before thoracic endovascular aortic repair. After the procedure,the angiography showed that the blood flow of renal artery in 8 patients were fluency, and the FFR index was over 0.90. There were 4 patients with FFR less than 0.90. After renal artery stenting, the FFR of these 4 patients were all above 0.90. Compared with pre-procedure, blood urea nitrogen ((8.84 ± 3.99) mmol/L vs. (5.18 ± 1.69) mmol/L, P = 0.011) and uric acid ((359.3 ± 77.3) µmol/L vs. (276.9 ± 108.3) µmol/L, P = 0.008) decreased significantly after 1 month, and there was no significant difference in serum creatinine (P = 0.760). Contrast-enhanced ultrasonography results showed that blood flow of renal artery were fluency after 1 month and 3 months. In patients with aortic dissection complicating renal blood flow injury, the FFR measurement is meaningful in evaluating the blood flow status of target organs and guide the endovascular revascularization.

Fontan Outcomes and Pulmonary Blood Flow at Birth.

We previously noted, in a small group of post-Fontan patients, a possible association between hepatic fibrosis scores and the status of pulmonary blood flow at birth. To further explore this observation, we examined data from all Fontan patients seen in our center from July 2010 to March 2015. We identified 200 patients for analysis. Of the 200 patients, 56 underwent transvenous-hepatic biopsy. Of the 200 patients, 13 (6.5%) had protein-losing enteropathy. We divided both the 56 biopsy patients and the entire cohort of 200 patients into 4 groups: (1) unobstructed pulmonary blood flow at birth with functional left ventricles, (2) unobstructed pulmonary blood flow at birth with functional right ventricles, (3) obstructed pulmonary blood flow at birth with functional left ventricles, and (4) obstructed pulmonary blood flow at birth with functional right ventricles. Analysis of the 56 liver-biopsy patient groups showed median hepatic total-fibrosis scores for the 4 groups of 2 (0-6), 2 (0-8), 3 (2-6), and 4 (1-8), respectively, with statistical significance between groups 4 and 1 (p = 0.031). For the entire cohort of 200 patients, we analyzed the incidence of protein-losing enteropathy for each of the four groups and found protein-losing enteropathy percent occurrences of 0, 2.9, 8.8, and 16.1, respectively, with statistical significance between groups 4 and 2 (p = 0.031) and between groups 4 and 1 (p = 0.025). A history of obstructed pulmonary blood flow at birth, coupled with a functional right ventricle, may predict a poorer long-term Fontan outcome.

Management of erectile dysfunction in patients who failed prior vascular intervention

Management of erectile dysfunction in patients who failed prior vascular intervention

The effects of resistance exercise training on macro‐ and micro‐circulatory responses to feeding and skeletal muscle protein anabolism in older men

Increases in limb blood flow in response to nutrition are reduced in older age. Muscle microvascular blood flow (MBF) in response to nutrition is also reduced with advancing age and this may contribute to age-related 'anabolic resistance'. Resistance exercise training (RET) can rejuvenate limb blood flow responses to nutrition in older individuals. We report here that 20 weeks of RET also restores muscle MBF in older individuals. Restoration of MBF does not, however, enhance muscle anabolic responses to nutrition. The anabolic effects of dietary protein on skeletal muscle depend on adequate skeletal muscle perfusion, which is impaired in older people. This study explores fed state muscle microvascular blood flow, protein metabolism and exercise training status in older men. We measured leg blood flow (LBF), muscle microvascular blood volume (MBV) and muscle protein turnover under post-absorptive and fed state (i.v. Glamin to double amino acids, dextrose to sustain glucose ∼7-7.5 mmol l(-1) ) conditions in two groups: 10 untrained men (72.3±1.4 years; body mass index (BMI) 26.5±1.15 kgm(2) ) and 10 men who had undertaken 20weeks of fully supervised, whole-body resistance exercise training (RET) (72.8±1.4 years; BMI 26.3±1.2 kgm(2) ). We measured LBF by Doppler ultrasound and muscle MBV by contrast-enhanced ultrasound. Muscle protein synthesis (MPS) was measured using [1, 2-(13) C2 ] leucine with breakdown (MPB) and net protein balance (NPB) by ring-[D5 ] phenylalanine tracers. Plasma insulin was measured via ELISA and indices of anabolic signalling (e.g. Akt/mTORC1) by immunoblotting from muscle biopsies. Whereas older untrained men did not exhibit fed-state increases in LBF or MBV, the RET group exhibited increases in both LBF and MBV. Despite our hypothesis that enhanced fed-state circulatory responses would improve anabolic responses to nutrition, fed-state increases in MPS (∼50-75%; P<0.001) were identical in both groups. Finally, whereas only the RET group exhibited fed-state suppression of MPB (∼-38%; P<0.05), positive NPB achieved was similar in both groups. We conclude that RET enhances fed-state LBF and MBV and restores nutrient-dependent attenuation of MPB without robustly enhancing MPS or NPB.

Validity of high intensive focused ultrasound in the treatment of uterus myoma and adenomyoma in Hebei Province: a report of 166 cases

To explore the validity of high intensive focused ultrasound (HIFU) in the treatment of uterus myoma and adenomyoma. A total of 166 patients with uterus myoma and adenomyoma received HIFU treatment from July 2011 to November 2013 at our hospital. The follow-ups were conducted at 1, 3, 6 month post-treatment. Their status of clinical symptoms, tumor volume, blood flow and efficacy of HIFU were evaluated. Menstrual blood decreased after treatment. The levels of hemoglobin all returned to normal in anemic patients and dysmenorrhea showed great improvement. Ultrasound showed that uterine ablation lesions significantly diminished after treatment. The effective rate was 71.8% at 1 month, 86.1% at 3 month and 95.4% at 6 month post-treatment and blood flow within ablation lesions decreased after treatment. None of unacceptable side effects occurred. HIFU treatment of uterus myoma and adenomyoma is both feasible and safe with fewer side effects.

Oxygen saturation of skin reflects blood flow and stagnation

Skin is the largest organ of human body which can easily be observed non-invasively, but objective assessment of skin status is difficult. Therefore, we have focused on the oxygen saturation, and proposed the iterative optical path-length matrix method (OPLM) for estimating oxygen saturation of skin. Oxygen saturation of skin may help finding pre-disease state. In Kampo medicine (Japanese traditional herbal medicine), inspection of skin and tongue is one of the principal methods for diagnosis of the state. Kampo medicine contains a number of concepts which are useful for preventive medicine. The Oketsu status is a pathological concept in Kampo medicine, primarily denoting blood stasis/stagnation. In this study, we focused on oxygen saturation of skin as an objective index of skin properties, and studied correlation with the blood flow and the Oketsu score. First, we acquired Oketsu score of the patients, and measured oxygen saturation, hemoglobin concentration and blood flow of the patients at two locations: fingertip of the right first finger and dorsal surface of the right hand. Then, correlation among the values was calculated. As the result, the oxygen saturation showed large correlation with the blood flow and the Oketsu score at dorsal surface of hand. The oxygen saturation of skin will reflect systemic blood flow and Oketsu status, and it would help objective diagnosis by measuring skin color spectrum.

A conceptual approach to managing severe traumatic brain injury in a time of uncertainty.

Current controversies in the literature suggest that a reassessment of the current management of severe traumatic brain injury (sTBI) is necessary. This article presents a conceptual framework toward individualizing sTBI treatment with respect to targeting thresholds and strategies on the basis of known physiologic processes and available monitors. Intracranial pressure (ICP) is modeled as an epiphenomenon of cerebral compliance and herniation tendency, as well as cerebral ischemia. By combining serial neurological examinations, imaging studies, and ICP measurements (values, trends, and area-under-the-curve calculations) over time, evidence can be accrued on the necessity of maintaining ICP at a given threshold in the realm of physical changes in the brain. Similarly, by collecting and trending clinical, imaging, and monitoring data on the status of cerebral blood flow, the balance of oxygen consumption and delivery, and the status of cerebral static pressure autoregulation, and analyzing them with respect to measured parameters, such as blood pressure, ICP, and cerebral perfusion pressure, one can attempt to fine-tune these variables as well. Such individualization of management optimizes the possibility of successfully treating demonstrated pathophysiological processes while avoiding unnecessary interventions and treatment toxicity. Monitor values must not be seen as targets but rather as indicators of targetable pathology.

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The rCBV ratio on perfusion-weighted imaging reveals the extent of blood flow on conventional angiography after acute ischemic stroke

ObjectiveIn this study, we evaluated the relationship between the rCBV (regional cerebral blood flow volume) ratio on perfusion-weighted imaging (PWI) and the extent of collateral flow on conventional angiography. MethodsWe recruited 98 patients with AIS (within 24h after ischemic events). All the patients were evaluated by MRI, including PWI and diffusion-weighted imaging (DWI), and underwent digital subtraction angiography (DSA) of the brain. We hypothesized that the rCBV ratio on PWI could reveal the extent of the blood flow and predict early neurological deterioration (END) within 7 days after AIS. ResultsThe rCBV ratio on PWI was significantly correlated with its extent on DSA (p<0.01). During the observation period, 24 patients (24.5%) experienced END. The univariate analysis revealed that severe neurological deficit at admission (p<0.01), the volume of the ischemic lesion on DWI (p<0.01), poor blood flow on DSA (p<0.01), the presence of DPM (p=0.05) and a low rCBV ratio on PWI (p<0.01) were related to END occurrence. The multivariate analysis showed that the presence of a low rCBV ratio on PWI was independently significant as a correlate of END (OR, 5.64; 95% CI, 1.68–18.90; p<0.01). ConclusionThis study shows that the rCBV ratio on PWI may be a useful tool to reveal the status of blood flow after AIS. Moreover, the extent of collateral flow may be an important parameter that subtly influences the fate of DPM in AIS.