Variations In Blood Flow Research Articles

Canine regional gastric blood flow measurement using perfusion computed tomography.

This study aimed to determine the feasibility of using perfusion computed tomography (CT) to assess blood flow in different regions of the stomach in dogs. Dynamic perfusion CT scans were conducted on five beagle dogs, and blood flow analysis was performed using the maximum slope and Patlak plot methods. The findings revealed significant variations in blood flow among the fundus, body, and pylorus of the stomach. Specifically, the body showed approximately 1.3 times higher blood flow than the fundus and approximately 5 times higher blood flow than the pylorus. There were no significant differences in blood flow between the two analysis algorithms. The findings suggest that gastric perfusion CT can accurately detect variations in blood flow within the stomach. Using the maximum slope method for analysis allows for noninvasive and rapid measurement of gastric blood flow. This technique may have clinical applications in detecting submucosal diseases that are challenging to identify with endoscopies and serve as a valuable noninvasive tool for longitudinal observations in experimental animal studies.

Seasonal Influence on the Impact of Human Chorionic Gonadotropin (hCG) on Testicular Haemodynamics and Hormonal Responses in Canines: A Comparative Study.

Human chorionic gonadotropin (hCG) is widely used to treat reproductive dysfunction by enhancing testicular blood flow and stimulating hormonal activity. This study investigates the seasonal variations in the response to hCG treatment in male dogs, focusing on its effects on testicular blood flow and plasma concentrations of testosterone and oestrogen. Conducted across different seasons (spring, summer, fall and winter), the study utilised colour Doppler ultrasonography to measure testicular haemodynamics and analysed hormonal levels at multiple time points post-hCG injection. The findings revealed that the response to hCG is modulated by seasonal factors, with significant variations in both blood flow and hormone levels. A significant negative relationship was indicated between testicular blood flow and testosterone levels, particularly during spring and summer. These results suggest that seasonality should be considered when administering hCG for reproductive treatments in canines.

Evaluation of the effect of viscosity on blood flow using viscosity models

The study of blood hemodynamics and rheological properties, particularly blood viscosity, is essential for understanding and treating certain cardiovascular conditions. Blood is a non-Newtonian fluid, meaning its viscosity varies with shear rate, a behavior driven by the aggregation and deformation of red blood cells (RBCs). Accurate modeling of blood viscosity is therefore critical for simulating blood flow in both physiological and pathological states. In this work, various viscosity models were assessed to identify the most suitable that represents the blood’s behavior in relation to shear rate. Although the Newtonian model is simple, it fails to capture the non-Newtonian characteristics of blood, particularly at varying shear rates. In comparison, the Power Law, Walburn-Schneck, and Carreau-Yasuda models offer more detailed and complex approaches to modeling blood viscosity. The Effect of blood viscosity on the overall blood flow was evaluated based on the four viscosity models. The work was carried out in a MATLAB Simulation Environment. The Volumetric blood flow rate was evaluated from the Poiseuille’s equation using three viscosity models whose values were defined by shear rates ranging from (217.5 – 226.5)s−1 . The percentage change in the blood volume resulting from changes in the viscosity was examined for each model. The two viscosity models (Power and Carreau models) concurrently reported equal percentage change of blood flux variation with the corresponding variation of the viscosity due to change in shear rate. This shows that any of the two models can be used to study the variation of blood flow to the viscosity with respect to cardiovascular complications.

Noninvasive optical monitoring of cerebral hemodynamics in a preclinical model of neonatal intraventricular hemorrhage.

Intraventricular hemorrhage (IVH) is a common complication in premature infants and is associated with white matter injury and long-term neurodevelopmental disabilities. Standard diagnostic tools such as cranial ultrasound and MRI are widely used in both preclinical drug development and clinical practice to detect IVH. However, these methods only provide endpoint assessments of blood accumulation and lack real-time information about dynamic changes in ventricular blood flow. This limitation could potentially result in missed opportunities to advance drug candidates that may have protective effects against IVH. In this pilot study, we aimed to develop a noninvasive optical approach using diffuse correlation spectroscopy (DCS) to monitor real-time hemodynamic changes associated with hemorrhagic and sub-hemorrhagic events in a preclinical rabbit model of IVH. DCS measurements were conducted during the experimental induction of IVH, and results were compared with ultrasound and histological analysis to validate findings. Significant changes in hemodynamics were detected in all animals subjected to IVH-inducing procedures, including those that did not show clear positive results on ultrasound. The study revealed progressively elevated coefficients of variation in blood flow, particularly driven by increased oscillations within the 0.05-0.1 Hz frequency band. These hemodynamic changes were more pronounced in animals that developed IVH, as confirmed by ultrasound. Our findings suggest that real-time optical monitoring with DCS can provide critical insights into pathological blood flow changes, offering a more sensitive and informative tool for evaluating potential therapeutics in the context of IVH.

Association between cerebral blood flow variation and cognitive decline in older patients undergoing hemodialysis.

The mechanism of cognitive impairment in hemodialysis patients is multifactorial. The relationship between cerebral blood flow and the decline of cognitive function is poorly understood. To investigate the association between cerebral blood flow variation and decline of cognitive function in older patients undergoing hemodialysis. In this prospective observational cohort study of 121 older patients undergoing hemodialysis, we used transcranial Doppler ultrasound (TCD) to measure cerebral arterial mean flow velocity (MFV) throughout dialysis, assessed cognitive function at baseline and 12-month follow-up, and then analyzed associations between MFV and changes on cognitive scores. TCD recordings demonstrated a significant reduction in MFV throughout dialysis, which were significantly correlated with cumulative ultrafiltration volume (rho 0.356, p < 0.001), ΔSBP (rho 0.251, p = 0.005), and ΔMAP (rho 0.194, p = 0.032). Compared with the baseline assessments, cognitive scores of participants at the 12-month follow-up were significantly worsened in global cognition (MOCA), some tests of memory (CFT-memory), executive function (TMT-B, SCWT-C, and SCWT-T), attention/processing speed (SDMT), and visuospatial function (CFT-copy) (p < 0.05). The worsening scores in global cognition (MOCA) (β = 0.066, 95% CI 0.018-0.113, p = 0.007) and some tests of memory (AVLT5) (β = 0.050, 95% CI 0.004-0.097, p = 0.035) and executive function (TMT-B, SCWT-C, SCWT-T) (β = 1.955, 95% CI 0.457-3.453, p = 0.011; β = 0.298, 95% CI 0.112-0.484, p = 0.002 and β = 1.371, 95% CI 0.429-2.303, p = 0.004, respectively) were significantly associated with the reduction of MFV. Hemodialysis may significantly reduce cerebral blood flow in older patients; Repetitive intradialytic decreases in CBF may be one of the mechanisms underlying the decline of cognitive function. https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000C5B5&selectaction=Edit&uid=U0003QEL&ts=4&cx=-djoi2.

Magnetic resonance imaging patterns and perfusion changes of posterior reversible encephalopathy syndrome in children with clinical outcome correlation.

Posterior reversible encephalopathy syndrome (PRES) in children has a propensity towards atypical features on magnetic resonance (MR) imaging, with limited literature on perfusion changes and clinicoradiological correlation. We aimed to comprehensively study MR imaging patterns of pediatric PRES, including cerebral blood flow variations on arterial spin labeling, and looked for any MR biomarkers of poor clinical outcome. In this retrospective observational study conducted in a tertiary hospital setting, MR records over a 4-year period (May 2019 to May 2023) were systematically searched along with their clinical details. Patients with an age less than 18years and a clinicoradiological constellation consistent with PRES were included. MR scans were analyzed by two neuroradiologists with 8years' and 10years' experience. Association was sought with poor clinical outcome (defined as modified Rankin Scale score at discharge of > 2). A total of 45 patients (29 boys) were included in the study, with a mean age (± standard deviation) of 11.19 (± 4.53) years. On MR imaging, 95.6% of patients (n = 43) showed atypical features and/or atypical areas of involvement. The superior frontal sulcus (n = 18) was the most predominant MR pattern, and cerebellar involvement was not uncommon (n = 15). Unilateral involvement (n = 3), isolated central pattern (n = 1), and spinal cord involvement (PRES-SCI: n = 1) were also encountered. Brainstem involvement (n = 4) showed a characteristic "V-sign" of anterior medullary hyperintensity. Patchy restricted diffusion (46.6%), punctate hemorrhages (37.7%), and leptomeningeal contrast enhancement (36%) were not uncommon. Arterial spin labeling sequence (available in 24 patients) showed increased cerebral blood flow in the involved areas in 79.2% of patients. Univariate analysis showed a significant association of the presence of hemorrhage (P = 0.003), involvement of brainstem (P = 0.007), deep white matter (P = 0.008), and thalamus (P = 0.026) with poor clinical outcome. Multivariate regression analysis found that hemorrhage on MRI (P = 0.011, odds ratio 8) was an independent factor associated with poor clinical outcome. The conventionally described atypical features in PRES are common in children and therefore may no longer be considered exceptions. Raised perfusion on arterial spin labeling sequence was seen in the majority of cases. Hemorrhage on MRI was an independent predictor of poor clinical outcome in pediatric PRES.

Imaging characteristics of uterine smooth muscle tumors of uncertain malignant potential: a case report and literature review.

Uterine smooth muscle tumors of uncertain malignant potential (STUMPs) are rare tumors of the uterine myometrium that are often misdiagnosed, owing to limited knowledge of their characteristics on ultrasonography (US) and magnetic resonance imaging (MRI). We report a woman in her mid-30s who was hospitalized because of a pelvic tumor. A 6-cm mass was found in her lower left abdomen. US and MRI revealed a well-demarcated mass in the left adnexal area, with both cystic and solid elements, visible blood flow within the septa, a strong signal across >50% of the volume on T2-weighted imaging (T2WI), and a strong signal on diffusion-weighted imaging (DWI). After hysterectomy and bilateral salpingectomy, immunohistochemical examination confirmed STUMP. A review of the literature revealed characteristic imaging features of STUMP. Ultrasonography reveals STUMP as a solitary, well-circumscribed lesion with isoechoic or mixed echogenicity, the absence of posterior shadowing, and variations in blood flow. STUMP is characterized by strong signal intensity on T2WI, small areas of strong signal on T1WI, and non-enhancing cystic areas on contrast-enhanced MRI scans. Early diagnosis is crucial for the management and treatment of STUMP, and here we have summarized the imaging features of the lesion, thereby providing a valuable diagnostic reference.

Arteriovenous Shunts: Their Location and Role in Physiology, Pathology, and Tissue Transfer. A Preliminary Report in the Upper Limb.

Tiny arteriovenous (AV) shunts of 10-150 µm (0.01-0.15 mm) are documented in the hands and feet. Larger shunts up to 0.5 mm (500 µm) have been discovered by the authors in the inner canthus and the human eye. This study seeks their possible existence in the upper limb. Radiographic lead oxide cadaver injection and dissection studies of 14 archival and six new upper limbs were examined. AV shunts of 0.1-0.5 mm were discovered between the brachial, ulnar, and radial arteries and their venae comitantes and between their arterial perforators and the subcutaneous veins. This pilot study provides insight into the possible function of these large AV shunts associated with blood flow variation in temperature, blood pressure, tissue transfer, flap prefabrication, and flap necrosis.

Immediate effects of Thai foot massage on renal blood flow, psychological stress, and heart rate variability in community-dwelling older adults: a randomized controlled trial.

Renal blood flow (RBF) is regulated by an autonomic nervous system and is reduced in older adults. Massage has been previously found to increase blood flow. This two-armed double-blind, randomized controlled trial aimed to investigate the immediate effects of Thai foot massage (TFM) on RBF, psychological stress, and heart rate variability (HRV) in older adult persons. The 26 healthy older adult volunteers were recruited and randomly assigned to the TFM group (13 persons) and the control group (13 persons). The TFM group received a 15-minute Thai foot massage, and the control group received a 15-minute bed rest. Primary outcomes - RBF parameters [peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), volumetric arterial blood flow (VF)] and secondary outcomes - HRV parameters [standard deviation of the normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD), high frequency (HF), low frequency (LF), and low frequency per high frequency (LF/HF)] were measured after each intervention. Results showed that the VF significantly increased after TFM (P < 0.05) but not in control. Meanwhile, the stress index significantly reduced after TFM (P < 0.05). SDNN and RMSSD, the proxies of parasympathetic activity, also significantly increased in the TFM group (p < 0.05). Only RMSSD was significantly enhanced in the control group. No side effects were observed. The TFM could increase RBF and alleviate psychological stress through parasympathetic activity actuation. Therefore, this intervention might improve RBF and relieve stress in the older population. Further study should be carried out on a larger population.

Predicting and Measuring Fluid Responsiveness by Hemodynamic Indices versus Transthoracic Echocardiography in Clinically Shocked Patients

Abstract Background In the last decades dynamic measures had evolved as a better solution to predict fluid responsiveness in clinically shocked patients, out of multiple dynamic parameters we chose transthoracic echocardiographic based measurements of variations of aortic blood flow and inferior vena caval diameter. Aim of the Work to assess accuracy of transthoracic echo measured variation in aortic blood flow and inferior vena caval diameter with limited bolus crystalloid infusion in predicting fluid responsiveness in patients with clinical shock. Patients and Methods This study included 51 selected Patients with acute circulatory failure secondary to clinical shock admitted to ICU. All patients had undergone basic transthoracic echocardiographic (TTE) assessment of aortic blood flow (using left ventricular outflow tract velocity time integral as a surrogate) and inferior vena caval diameter changes with respiratory cycle, these measures were obtained at time of diagnosis of shock and repeated after infusion of 300 ml crystalloid fluid bolus (over fifteen minutes). Results Our results had revealed significant difference between responders and non-responders regarding aortic flow variation after fifteen minutes. Conclusion Based on the results obtained in this study, it was proved that transthoracic echocardiography can be used as an accurate method to predict fluid responsiveness in shocked patient with fluid challenge.

Transient Changes in Cerebral Tissue Oxygen, Glucose, and Temperature by Microstrokes: A Computational Study.

This study focuses on evaluating the disruptions in key physiological parameters during microstroke events to assess their severity. A mathematical model was developed to simulate the changes in cerebral tissue pO2, glucose concentration, and temperature due to blood flow interruptions. The model considers variations in baseline cerebral blood flow (CBF), capillary density, and blood oxygen/glucose levels, as well as ambient temperature changes. Simulations indicate that complete blood flow obstruction still allows for limited glucose availability, supporting nonoxidative metabolism and potentially exacerbating lactate buildup and acidosis. Partial obstructions decrease tissue pO2, with minimal impact on glucose level, which can remain almost unchanged or even slightly increase. Reduced CBF, capillary density, or blood oxygen due to aging or disease enhances hypoxia risk at lower obstruction levels, with capillary density having a significant effect on stroke severity by influencing both pO2 and glucose levels. Conditions could lead to co-occurrence of hypoxia/hypoglycemia or hypoxia/hyperglycemia, each worsening outcomes. Temperature effects were minimal in deep brain regions but varied near the skull by 0.2-0.8°C depending on ambient temperature. The model provides insights into the conditions driving severe stroke outcomes based on estimated levels of hypoxia, hypoglycemia, hyperglycemia, and temperature changes.

Beyond life: Exploring hemodynamic patterns in postmortem mice brains.

We utilize Laser Speckle Contrast Imaging (LSCI) for visualizing cerebral blood flow in mice during and post-cardiac arrest. Analyzing LSCI images, we noted temporal blood flow variations across the brain surface for hours postmortem. Fast Fourier Transform (FFT) analysis depicted blood flow and microcirculation decay post-death. Continuous Wavelet Transform (CWT) identified potential cerebral hemodynamic synchronization patterns. Additionally, non-negative matrix factorization (NMF) with four components segmented LSCI images, revealing structural subcomponent alterations over time. This integrated approach of LSCI, FFT, CWT, and NMF offers a comprehensive tool for studying cerebral blood flow dynamics, metaphorically capturing the 'end of the tunnel' experience. Results showed primary postmortem hemodynamic activity in the olfactory bulbs, followed by blood microflow relocations between somatosensory and visual cortical regions via the superior sagittal sinus. This method opens new avenues for exploring these phenomena, potentially linking neuroscientific insights with mysteries surrounding consciousness and perception at life's end.

Evaluation of the correlation between cerebral hemodynamics and blood pressure by comparative analysis of variation in cerebral blood flow in hypertensive versus normotensive individuals: A systematic review and meta-analysis.

Current understanding of the cerebral vascular response to variations in blood pressure (BP) among individuals with hypertension is limited. The aim of this meta-analysis was to determine the correlation between hypertension, risk of stroke, and cerebral blood flow (CBF). We reviewed studies published between 2000 and 2023 from PubMed, Google Scholar, and Science Direct that compared mean CBF in normotensive (NTN) and hypertensive (HTN) patients. A random effects model was used to construct the risk ratio (RR), 95% confidence interval (CI), forest plot, and inverse variance weighting. Additionally, a mixed-effects meta-regression was employed to examine the impact of study-specific patient variables. This meta-analysis included eight prospective cross-sectional studies published from 2002 to 2023. It revealed a significant average difference in the standard mean CBF of -0.45 (95% CI -0.60 to -0.30, I2 = 69%, P < 0.00001), distinguishing NTN from HTN subjects. A RR of 0.90 (95% CI 0.63 to 1.30, I2 = 89%, P = 0.04) indicated a significant decrease in CBF among individuals with hypertension. We found a statistically significant relationship between changes in diastolic and systolic BPs and the mean CBF (R -0.81, P = 0.001 and R = -0.90, P = 0.005, respectively). Our research demonstrates a strong relationship between elevated BP and reduced CBF, with hypertension reducing CBF compared to NTN individuals, by increasing cerebrovascular resistance.

Machine learning techniques for predicting microvascular network hemodynamics

Existing techniques to image microvascular networks in vivo do not allow a direct and accurate measurement of several hemodynamic variables such as the wall shear stress (WSS). They cannot also provide a full 3D characterization of blood velocity and red blood cell (RBC) concentration profiles in every vessel in a microvascular network. Such physiological parameters however play critical roles in blood flow regulation, disease progression, angiogenesis, and hemostasis. Theoretical models of network blood flow, often used for hemodynamic predictions in experimentally acquired images of the microvascular network, cannot provide the full 3D blood velocity, RBC concentration and WSS profiles as these models assume one-dimensional flow governed by Poiseuille’s law. In contrast, high-fidelity computational models that simulate flow of blood as a suspension of deformable RBCs and model the 3D vessel geometry can readily predict such physiological variables with high accuracy. Such high-fidelity computational models have recently been applied to predict hemodynamic variables in microvascular networks in silico composed of many vessels and vascular junctions. Such models, however, tend to become computationally expensive with increasing size of the network; therefore, they are not feasible for use in large networks at organ scale. To overcome this limitation, we developed a machine learning (ML) approach that can predict hemodynamic variables in 3D and with high accuracy. The ML models are based on artificial neural network and convolution-based U-net models. Using experimentally acquired images of the microvascular networks, inputs at a few inlets, and a “bank” of database that we have developed, these ML models can predict flow and RBC distribution in all vessels in the network, 3D blood velocity and RBC concentration profiles over the cross-section of every vessel, 3D WSS profiles, and time-dependent variations in blood flow in any vessel. The prediction from the ML models compare very well against the true data. Also, the prediction time using ML is significantly less than that of the high-fidelity models. The current ML models, which to our knowledge are the first of their kind, are highly promising for image-based predictions of sub-cellular resolved capillary hemodynamics in organ-scale networks. This study paves the way for AI to make hemodynamic predictions in organ-scale capillary vessel networks while retaining the sub-cellular scale details and overcoming the limitations of the in vivo imaging techniques, with potential applications in hematological and microvascular disorders, angiogenesis, and vascular-mediated drug delivery. Funded by NIH (R01-EY033003) and NSF (CBET 2302212). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Validating the reproducibility of a low-cost single-channel fNIRS device across hierarchical cognitive tasks.

This study evaluates a low-cost, single-channel fNIRS device in cognitive neuroscience, aiming to overcome the financial barriers of commercial systems by testing its efficacy in tasks of varying complexity. Twenty-six participants engaged in motor control (finger-tapping), working memory (n-back), and creativity (AUT) tasks while their prefrontal cortex activity was monitored using the device, with behavioral and cerebral blood flow changes recorded. Results showed the device's capability to detect significant blood flow variations across different tasks, thereby supporting its use in cognitive research. The study confirms the potential of single-channel fNIRS as a cost-effective tool for diverse cognitive assessments, from simple motor actions to complex creative thinking.

Arterial Lesion Location and Outcomes of Intracranial Atherosclerotic Disease.

Intracranial atherosclerosis is a leading cause of stroke with a high recurrence rate despite treatment. Numerous factors are proposed to influence stroke recurrence due to intracranial atherosclerosis including lesion eccentricity, plaque characteristics, and computational fluid dynamic metrics, such as wall shear stress. An overlooked variable that intrinsically relates to intracranial atherosclerosis is the location of the arterial segment where the lesion occurs. Variations in cerebral blood flow, arterial anatomy, and flow dynamics are likely drivers of initial lesion development and thus likely to influence stroke recurrence. To date, treatment trials of intracranial atherosclerosis have not considered arterial segment lesion location as an independent variable, failing to account for variations in flow dynamics between each artery. There are limited available data on differences between arterial segments, confined to only post hoc analyses. In this review, we summarize available data on such differences between arterial segments. With the limited arterial segment data available, multiple differences in recurrence of stroke in territory of lesion were identified across trials.

Blood Flow Rate Of Hemodialysis Patients; A Hospital Based Study

Background: In chronic renal disease, impaired kidney function hinders waste elimination.Hemodialysis is fundamental for removing creatinine, urea, and excess water. The study explores blood flow rates in hemodialysis patients with chronic renal disease, shedding light on dialytic dynamics in this context.Materials and Methods: A total of 100 patients were selected irrespective of age and gender. All hemodialysis patients were recruited in Institute of Kidney Diseases, Hayatabad,Peshawar. Blood flow rate and demographic information were entered into a performa.Microsoft Excel 2007 was used to enter and analyze data.Results: Out of total, 58.3% and 41.7% were found male and female respectively. Highest number of patients observed in age greater than 55 years. The study revealed varying blood flow rates, with 43.9% at 300 ml/min, highlighting the distribution among hemodialysis patients. Three hours hemodialysis were found frequently among dialysis patients.Conclusion: Despite improvements in dialysis care, challenges such as recirculation, co-morbidities, and nutritional issues persist, emphasizing the need for innovative therapeutic approaches and ongoing research to enhance patient outcomes. The study's findings provide valuable insights into optimizing hemodialysis effectiveness.

The association between cerebral blood flow variations during on-pump coronary artery bypass grafting surgery and postoperative delirium.

Postoperative delirium (POD) has a major impact on patient recovery after cardiac surgery. Although its pathophysiology remains unclear, there could be a correlation between cerebral blood flow (CBF) variations during cardio-pulmonary bypass (CPB) and POD. Our study aimed to evaluate whether variations in on-pump CBF, compared to pre-anesthesia and pre-CPB values, are associated with POD following coronary artery bypass grafting (CABG) surgery. This prospective observational cohort study included 95 adult patients undergoing elective on-pump CABG surgery. Right middle cerebral artery blood flow velocity (MCAV) was assessed using Transcranial Doppler before anesthesia induction, before CPB and every fifteen minutes during CPB. Pre-anesthesia and pre-CPB values were chosen as baselines. Individual values, measured during CPB, were converted as percentage changes relative to these baselines and named as %MCAV0 and %MCAV1, respectively. POD was assessed using the Confusion Assessment Method for ICU (CAM-ICU) during the first 48 post-operative hours and with the 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) on the fifth post-surgical day. Overall POD incidence was 17.9%. At 30minutes of CPB, %MCAV0 was higher in POD group than in no-POD group (p = .05). %MCAV0 at 45minutes of CPB was significantly higher in POD group (87 (±17) %) than in no-POD group (68 (±24) %), p = .04. %MCAV1 at 30 and 45minutes of CPB were higher in POD group than in no-POD group, at the limit of statistical significance. We found %MCAV1 > 100% in POD group, but not in no-POD group. Significant differences in %MCAV0 became evident after 30minutes of CPB, whereas differences in %MCAV1 at 45 minutes of CPB were at limit of statistical significance. In POD group %MCAV1 was higher than 100% at 30 and 45minutes of CPB, which is supposed to be a sign of cerebral hyperperfusion. Monitoring CBF during CPB could have prognostic value for POD.

Circadian and Diurnal Regulation of Cerebral Blood Flow.

Circadian and diurnal variation in cerebral blood flow directly contributes to the diurnal variation in the risk of stroke, either through factors that trigger stroke or due to impaired compensatory mechanisms. Cerebral blood flow results from the integration of systemic hemodynamics, including heart rate, cardiac output, and blood pressure, with cerebrovascular regulatory mechanisms, including cerebrovascular reactivity, autoregulation, and neurovascular coupling. We review the evidence for the circadian and diurnal variation in each of these mechanisms and their integration, from the detailed evidence for mechanisms underlying the nocturnal nadir and morning surge in blood pressure to identifying limited available evidence for circadian and diurnal variation in cerebrovascular compensatory mechanisms. We, thus, identify key systemic hemodynamic factors related to the diurnal variation in the risk of stroke but particularly identify the need for further research focused on cerebrovascular regulatory mechanisms.

The effect of an endovascular Heaney maneuver to achieve total hepatic isolation on survival, hemodynamic stability, retrohepatic bleeding, and collateral flow in a porcine model

PurposeCombining resuscitative endovascular balloon occlusion of the aorta (REBOA) and the inferior vena cava (REBOVC) with open surgery is a new hybrid approach for treating retrohepatic vena caval injuries. We compared endovascular total hepatic isolation with supraceliac REBOA ± suprahepatic REBOVC and no occlusion in experimental retrohepatic vena cava bleeding regarding survival, bleeding volume, hemodynamic stability, and arterial collateral blood flow.MethodsTwenty-five anesthetized pigs (n = 6–7/group) were randomized to REBOA; REBOA + REBOVC; REBOA + infra and suprahepatic REBOVC + portal vein occlusion (endovascular Heaney maneuver, four-balloon-occlusion, 4BO) or no occlusion. After balloon inflation, free bleeding was initiated from an open sheath in the retrohepatic vena cava. Bleeding volume, right internal thoracic artery (RITA) blood flow, hemodynamics, and arterial blood variables were measured until death or up to 90 min.ResultsThe REBOA group had a longer median survival time (63 min) compared with the 4BO (24 min, P = 0.02) and no occlusion (30 min, P = 0.02) groups, not versus the REBOA + REBOVC group (49 min, P > 0.05). The first 15 min accumulated bleeding was comparable in all groups (P > 0.05); Thereafter, bleeding volume was higher in the REBOA group versus the 4BO group (P < 0.05), not versus the other groups. RITA blood flow and MAP were higher in the REBOA group versus the other groups after 10 min of bleeding (P < 0.05).ConclusionsEndovascular Heaney maneuver was not beneficial for survival or hemodynamic stability in this porcine model, whereas supraceliac REBOA was. Anatomical differences in thoracoabdominal collaterals between pigs and humans must be considered when interpreting these results.