RESUMO
Objective: In order to explore the correlation between the retinol binding protein 4 (RBP4) and prognosis of patients with acute ischemic stroke (AIS), CT perfusion imaging can be used to scan the brain tissue of patients, which can identify abnormal perfusion areas and ischemic penumbra brain tissue, so as to provide a basis for doctors to formulate a reasonable clinical treatment plan. Methods: 200 patients with first-episode acute ischemic stroke were selected from the Department of Neurology of our hospital, including 128 males and 72 females, aged between 32 and 85 years, with an average age of 45 ± 4.3 years. After admission, the patients were tested for xanthol binding protein 4 in time, the patient's demographic data and the basic clinical data were recorded, the degree of brain injury was evaluated, and the short-term outcome was evaluated after treatment. Results: A total of 200 AIS patients with different degrees of brain injury were included in this study, including 128 males and 78 females, aged between 32 and 85 years, with an average age of 45 ± 4.3 years. Among them, 100 patients used CT perfusion imaging for brain scanning as the observation group, 100 patients used traditional imaging methods as the reference group, and 100 healthy people were included as the blank group. At the same time, the contents of total cholesterol, triacylglycerol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were measured by using an automatic biochemical analyzer. The patients were evaluated in the early stage of treatment and the effect of prognostic intervention was recorded. Conclusion: The application of CT perfusion imaging in the adjuvant treatment of AIS patients was helpful to identify the abnormal perfusion area and the brain tissue of ischemic penumbra, so as to provide a basis for doctors' follow-up treatment. At the same time, AIS patients with high serum RBP4 level had mild stroke severity, good short-term prognosis, and improved treatment effect, which improved patients' quality of life.
Assuntos
Lesões Encefálicas , Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Colesterol , Análise de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão/métodos , Prognóstico , Qualidade de Vida , Proteínas Plasmáticas de Ligação ao Retinol , Acidente Vascular Cerebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodosRESUMO
PURPOSE: The purpose of this study was to correlate treatment response with tumor blood perfusion in patient of advanced head-and-neck cancer undergoing neoadjuvant chemotherapy. MATERIALS AND METHODS: A total of 40 patients of advanced head-and-neck cancer, who were planned for neoadjuvant chemotherapy, were included in the study. All patients underwent diagnostic computed tomography (CT) with perfusion study for staging and quantitative measurement of tumor volume as well as perfusion parameters (including tumor blood volume, blood flow, permeability, and time to peak enhancement), at baseline and after completion of neoadjuvant chemotherapy. Total 3 cycles of neoadjuvant chemotherapy with paclitaxel, cisplatin, and 5 fluorouracil were given. Tumor response was evaluated in terms of change in tumor volume and correlated with perfusion parameters. RESULTS: Out of 40 patients, 22 patients had more than 50% reduction in tumor volume, who were grouped as responder and remaining 18 patients had <50% decrease in tumor volume, grouped as nonresponder. Both the groups were similar in terms of age, gender, performance status, stage, nodal status, or addiction. Baseline CT scan shows a significant difference in tumor blood flow (P = 0.048) and marginal difference in time to peak enhancement (P = 0.058) in two groups. However, there is no difference in tumor blood volume (P = 0.32) and permeability surface area (P = 0.07). CONCLUSIONS: Evaluation of tumor blood flow by perfusion CT is helpful in predicting chemotherapy outcome and deciding appropriate treatment modality, but further evaluation with more number of patients is required for validating the predictive role of each perfusion parameters.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias de Cabeça e Pescoço/terapia , Terapia Neoadjuvante/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia , Adolescente , Adulto , Quimioterapia Adjuvante/métodos , Cisplatino/uso terapêutico , Feminino , Fluoruracila/uso terapêutico , Neoplasias de Cabeça e Pescoço/irrigação sanguínea , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Paclitaxel/uso terapêutico , Imagem de Perfusão/métodos , Prognóstico , Estudos Prospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço/irrigação sanguínea , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga Tumoral , Adulto JovemRESUMO
Hyperbaric oxygen (HBO) therapy promotes wound healing in patients with ischemic disease; however, HBO-induced changes in skin peripheral circulation have not been evaluated in clinical practice. Here, we investigated these changes in patients with critical limb ischemia (CLI), with a focus on the angiosome of crural blood vessels with blood flow improved by endovascular therapy (EVT). Six patients with CLI and ulcers who were treated with HBO after EVT (7 limbs; 1 patient had ulcers in the bilateral limbs) and 3 healthy subjects (6 limbs) were enrolled. HBO therapy was performed at 2 atm under 100% oxygen for 90 min per session. Skin perfusion pressure (SPP) was measured in the dorsum and sole of the foot 1 hour before (pre-SPP) and after (post-SPP) HBO therapy. ΔSPP was calculated as post-SPP minus pre-SPP. SPP measurement regions were divided into those that did (direct region) and did not (indirect region) correspond to the vascular angiosome in which angiography findings of the crus were improved after EVT; i.e., when the anterior tibial artery was effectively treated with EVT, the dorsum was the direct region and the sole was the indirect region, and vice versa when the posterior tibial artery was treated. In the direct, indirect, and healthy subject groups, the ΔSPPs were 20.5±8.7 (p=0.002), -6.4±10.9, and -15.1±18.1 (p=0.014), respectively; that of the direct group was significantly greater than that of the other groups. These results suggest that short-term improvement of the peripheral circulation by HBO therapy was significant in patients with successful revascularization.
Assuntos
Procedimentos Endovasculares , Oxigenoterapia Hiperbárica/métodos , Isquemia , Imagem de Perfusão/métodos , Pele/irrigação sanguínea , Artérias da Tíbia , Angiografia/métodos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Salvamento de Membro/efeitos adversos , Salvamento de Membro/métodos , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/complicações , Fluxo Sanguíneo Regional , Artérias da Tíbia/diagnóstico por imagem , Artérias da Tíbia/cirurgia , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
BACKGROUND: Recently, porous acupuncture (PA), which is anodized to increase its surface area for higher stimulation intensity, was developed and showed significantly improved therapeutic effects with more comfort as compared with original acupuncture (OA) in vivo. However, the impact of PA on the change of local blood flow as well as its efficacy and acceptability has not yet been confirmed in a clinical trial. In a randomized, controlled crossover clinical trial, we investigated the effects of PA on the change in local blood flow using laser Doppler perfusion imaging and considered the sensation of pain intensity and discomfort severity using a visual analogue scale (VAS) to explore its physiological impact and the possibility of PA in clinical use. METHODS: Twenty-one healthy participants were randomly treated with PA or OA on one side of Zusanli (ST36) and each participant served as his or her own control. Baseline local blood flow and galvanic skin response (GSR) were obtained for 5 min and acupuncture interventions were subsequently performed. Next, local blood flow and GSR were subsequently obtained for 10 min after insertion, 10 min after manipulation, and 5 min after the withdrawal of acupuncture. At the end of the experiment, participants were asked to indicate the sensation of pain intensity at each session of insertion, retention, manipulation, and withdrawal as well as the overall pain intensity and discomfort severity. RESULTS: PA significantly increased the local blood flow as compared with OA and there was no significant difference in GSR between patients treated with PA versus OA in each phase of insertion and manipulation. No significant difference in pain intensity or discomfort severity was found during manipulation, retention, or withdrawal of acupuncture. CONCLUSIONS: These results indicate that PA increases local blood flow, which can be closely related to the observed enhanced performance, without any associated discomfort or pain, suggesting its applicability in clinical practice.
Assuntos
Acupuntura/métodos , Nanoporos , Pele/diagnóstico por imagem , Adolescente , Adulto , Feminino , Resposta Galvânica da Pele , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Dor/patologia , Medição da Dor , Imagem de Perfusão/métodos , Fluxo Sanguíneo Regional , Índice de Gravidade de Doença , Pele/irrigação sanguínea , Adulto JovemRESUMO
Multi-energy computed tomography (MECT) refers to acquisition of CT data at multiple energy levels (typically two levels) using different technologies such as dual-source, dual-layer and rapid tube voltage switching. In addition to conventional/routine diagnostic images, MECT provides additional image sets including iodine maps, virtual non-contrast images, and virtual monoenergetic images. These image sets provide tissue/material characterization beyond what is possible with conventional CT. MECT provides invaluable additional information in the evaluation of pulmonary vasculature, primarily by the assessment of pulmonary perfusion. This functional information provided by the MECT is complementary to the morphological information from a conventional CT angiography. In this article, we review the technique and applications of MECT in the evaluation of pulmonary vasculature.
Assuntos
Angiografia por Tomografia Computadorizada/métodos , Hemodinâmica , Hipertensão Pulmonar/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Imagem de Perfusão/métodos , Artéria Pulmonar/diagnóstico por imagem , Circulação Pulmonar , Embolia Pulmonar/diagnóstico por imagem , Humanos , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Valor Preditivo dos Testes , Prognóstico , Artéria Pulmonar/fisiopatologia , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , Interpretação de Imagem Radiográfica Assistida por ComputadorRESUMO
OBJECTIVE. The purpose of this study is to quantitatively assess perfusion reductions occurring in hepatocellular carcinoma (HCC) during transcatheter arterial chemoembolization (TACE) using 2D perfusion angiography and to evaluate the relationships between various 2D perfusion angiography parameter changes and short-term tumor response. SUBJECTS AND METHODS. This prospective study included 172 patients (144 men and 28 women; mean [± SD] age, 65.4 ± 10.2 years) who underwent TACE for HCC between November 2015 and November 2017. Two-dimensional perfusion angiography was performed before and after TACE. Pre- and postprocedural CT images were also reviewed. Index lesions were defined as all discrete lesions 1.5 cm or larger. The tumor response was assessed using the modified Response Evaluation Criteria in Solid Tumors. Periprocedural 2D perfusion angiography parameters, including the arrival time, time to peak, wash-in rate, width, AUC, and mean transit time, were compared using the Wilcoxon signed rank test. Correlations between 2D perfusion angiography parameter changes and objective tumor response were evaluated using multivariate logistic regression analysis. RESULTS. A total of 187 lesions meeting the inclusion criteria were identified in 172 patients. All analyzed 2D perfusion angiography parameters were significantly different after versus before TACE (p < 0.001). A significant relationship between periprocedural change in AUC and short-term tumor response was found (odds ratio, 1.535; 95% CI, 1.314-1.793; p < 0.001). CONCLUSION. Two-dimensional perfusion angiography could objectively quantify perfusion reductions and predict short-term tumor response to TACE in patients with HCC.
Assuntos
Angiografia/métodos , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Imagem de Perfusão/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doxorrubicina/administração & dosagem , Óleo Etiodado/administração & dosagem , Feminino , Esponja de Gelatina Absorvível/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Interpretação de Imagem Radiográfica Assistida por Computador , Critérios de Avaliação de Resposta em Tumores SólidosRESUMO
PURPOSE: To compare tumor vascularity in 4 types of rat hepatocellular carcinoma (HCC) models: N1S1, vascular endothelial growth factor (VEGF)-transfected N1S1 (VEGF-N1S1), McA-RH7777, and VEGF-transfected McA-RH7777 (VEGF-McA-RH777) tumors. MATERIALS AND METHODS: The N1S1 and McA-RH7777 cell lines were transfected with expression vectors containing cDNA for rat VEGF. Eighty-eight male Sprague-Dawley rats (weight range, 400-450 g) were randomly divided into 4 groups (ie, 22 rats per model), and 4 types of tumor models were created by using the N1S1, VEGF-N1S1, McA-RH7777, and VEGF-McA-RH777 cell lines. Tumor vascularity was evaluated by perfusion computed tomography (CT), enzyme-linked immunosorbent assay of VEGF, CD34 staining, angiography, and Lipiodol transarterial embolization. Intergroup discrepancies were evaluated by Kruskal-Wallis test. RESULTS: Arterial perfusion (P < .001), portal perfusion (P = .015), total perfusion (P < .001), tumor VEGF level (P = .002), and microvessel density (MVD; P = .007) were significantly different among groups. VEGF-McA-RH7777 tumors showed the greatest arterial perfusion (46.7 mL/min/100 mL ± 15.5), total perfusion (60.7 mL/min/100 mL ± 21.8), tumor VEGF level (3,376.7 pg/mL ± 145.8), and MVD (34.5 ± 7.5). Whereas most tumors in the N1S1, VEGF-N1S1, and McA-RH7777 groups showed hypovascular staining on angiography and minimal Lipiodol uptake after embolization, 5 of 6 VEGF-McA-RH7777 tumors (83.3%) presented hypervascular tumor staining and moderate to compact Lipiodol uptake. CONCLUSIONS: McA-RH7777 tumors were more hypervascular than N1S1 tumors, and tumor vascularity was enhanced further by VEGF transfection. Therefore, the VEGF-McA-RH7777 tumor is recommended to mimic hypervascular human HCC in rats.
Assuntos
Carcinoma Hepatocelular/metabolismo , Neoplasias Hepáticas Experimentais/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Animais , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/genética , Carcinoma Hepatocelular/patologia , Linhagem Celular Tumoral , Embolização Terapêutica/métodos , Óleo Etiodado/administração & dosagem , Regulação Neoplásica da Expressão Gênica , Neoplasias Hepáticas Experimentais/irrigação sanguínea , Neoplasias Hepáticas Experimentais/genética , Neoplasias Hepáticas Experimentais/patologia , Masculino , Tomografia Computadorizada Multidetectores , Neovascularização Patológica , Imagem de Perfusão/métodos , Ratos Sprague-Dawley , Fluxo Sanguíneo Regional , Transdução de Sinais , Fatores de Tempo , Regulação para Cima , Fator A de Crescimento do Endotélio Vascular/genéticaRESUMO
BACKGROUND: The aim of this study was to systematically assess the effects of exercise rehabilitation program accompanied by experiential music for clinical recovery. METHODS: This was a prospective randomized study with 65 stroke survivor patients. All cases underwent a neuropsychological assessment first as a prescreening test, during the admission at the Rehabilitation center (baseline), and 6 months poststroke. All patients received standard treatment for stroke in terms of medical care and rehabilitation. Additionally, all patients were separated into 2 Groups: a music Group (daily listening to experiential/traditional music), and a control Group (CG) with no experiential/traditional music therapy (standard care only). Computed tomography perfusion and full neurological examination including GCS were assessment. As Recovery was defined the improvement of cognitive and motor skills of the limb in the affected site, with an increase of muscle strength at least by 1/5 and with emotional progress. RESULTS: Statistically significant differences were found between the Group CG and the rest of the patients in respect of Lesion size (P = .001) and CBF in affected area (P = .001). Μultivariate analysis revealed that only Group and Lesion size were independent predictors for Recovery (odd ratio [OR][95%confidence interval]) .11(.001-.133) and .798(.668-.954) respectively. CONCLUSION: The findings of this study suggest that the music-based exercise program has a positive effect on mood profile in stroke patients and Recovery rate is higher when exercise rehabilitation program was accompanied by an enriched sound environment with experiential music.
Assuntos
Cognição , Terapia por Exercício , Destreza Motora , Musicoterapia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Afeto , Idoso , Angiografia Cerebral/métodos , Terapia Combinada , Angiografia por Tomografia Computadorizada , Avaliação da Deficiência , Emoções , Feminino , Grécia , Humanos , Masculino , Força Muscular , Imagem de Perfusão/métodos , Estudos Prospectivos , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate endothelium-dependent microvascular reactivity during cardiopulmonary bypass (CPB) in surgery for the correction of cyanotic and acyanotic congenital heart disease (CHD) in children and infants using laser Doppler perfusion monitoring (LDPM). METHODS: This cross-sectional observational study included one hundred consecutive acyanotic (AC, nâ¯=â¯61) and cyanotic (C, nâ¯=â¯39) pediatric patients scheduled for cardiac surgery for correction of CHD. The endothelium-dependent microvascular vasodilation of the skin of the forehead was evaluated using a single-point LDPM coupled with local thermal hyperemia (LTH). RESULTS: LTH induced significant increases in microvascular conductance both in AC and C patients after the induction of anesthesia, during CPB and after weaning from CPB. Nevertheless, the vasodilation induced by LTH was significantly blunted during CPB when compared with values obtained after the induction of anesthesia both in AC and C patients. Microvascular endothelial reactivity nearly normalized after the discontinuation of CPB. CONCLUSION: The evaluation of systemic microvascular reactivity on the forehead skin of infants and children using LDPM appears to be a valuable tool for optimizing microvascular perfusion during CPB in pediatric cardiac surgery.
Assuntos
Ponte Cardiopulmonar/efeitos adversos , Cianose/etiologia , Endotélio Vascular/fisiopatologia , Cardiopatias Congênitas/cirurgia , Microcirculação , Microvasos/fisiopatologia , Pele/irrigação sanguínea , Vasodilatação , Velocidade do Fluxo Sanguíneo , Pré-Escolar , Estudos Transversais , Cianose/diagnóstico , Cianose/fisiopatologia , Feminino , Testa , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/fisiopatologia , Humanos , Hiperemia/fisiopatologia , Hipertermia Induzida , Lactente , Fluxometria por Laser-Doppler , Masculino , Imagem de Perfusão/métodos , Fluxo Sanguíneo Regional , Resultado do TratamentoRESUMO
OBJECTIVE: The inability of leptin to suppress food intake in diet-induced obesity, sometimes referred to as leptin resistance, is associated with several distinct pathological hallmarks. One prevailing theory is that impaired transport of leptin across the blood-brain barrier (BBB) represents a molecular mechanism that triggers this phenomenon. Recent evidence, however, has challenged this notion, suggesting that leptin BBB transport is acquired during leptin resistance. METHODS: To resolve this debate, we utilized a novel cerebral Open Flow Microperfusion (cOFM) method to examine leptin BBB transport in male C57BL/6J mice, fed a chow diet or high fat diet (HFD) for 20 days. RESULTS: Basal plasma leptin levels were 3.8-fold higher in HFD-fed mice (p < 0.05). Leptin administration (2.5 mg/kg) elicited similar pharmacokinetic profiles of circulating leptin. However, while leptin reduced food intake by 20% over 22 h in chow-fed mice, it did not affect food intake in HFD-fed mice. In spite of this striking functional difference, hypothalamic leptin levels, as measured by cOFM, did not differ between chow-fed mice and HFD-fed mice following leptin administration. CONCLUSIONS: These data suggest that leptin transport across the BBB is not impaired in non-obese leptin resistant mice and thus unlikely to play a direct role in the progression of pharmacological leptin resistance.
Assuntos
Barreira Hematoencefálica/efeitos dos fármacos , Leptina/metabolismo , Obesidade/metabolismo , Animais , Transporte Biológico , Peso Corporal , Dieta Hiperlipídica , Ingestão de Alimentos/efeitos dos fármacos , Hipotálamo/metabolismo , Insulina , Leptina/análise , Leptina/farmacologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Imagem de Perfusão/métodosAssuntos
Transtorno Obsessivo-Compulsivo , Imagem de Perfusão/métodos , Estimulação Magnética Transcraniana/métodos , Adulto , Córtex Cerebral/irrigação sanguínea , Terapia Cognitivo-Comportamental/métodos , Corpo Estriado/irrigação sanguínea , Resistência a Medicamentos , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , Transtorno Obsessivo-Compulsivo/terapia , Escalas de Graduação Psiquiátrica , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagem , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Tálamo/irrigação sanguínea , Resultado do TratamentoRESUMO
BACKGROUND: We previously reported the utility of the perfusion value (PV) fluctuation slope for detecting severe ischemia in the lower limb. Our approach was based on a thermal load test mimicking the well-known physiological reaction termed "cold-induced vasodilation," which is known to occur as a 3-phase phenomenon. The slope parameter quantifies the decrease in PVs accompanying the relative cooling (third phase) following the transient increase in blood flow (second phase) induced by the applied thermal load. This phenomenon of "relative" cold-induced vasodilation (rCIVD) can be monitored using laser speckle contrast imaging (LSCI) after applying the thermal load (LTL test). Here, we aimed to determine whether the slope parameter obtained via the LTL test also reflects the improvement in hemodynamics after revascularization. METHODS: The study enrolled 16 patients (18 limbs), who underwent revascularization for peripheral arterial disease (PAD). The measurements were performed at 2 sites in each limb (in total, 34 sites; 2 sites in one patient were excluded because of significant movement during the measurement). For each site, we recorded the slope describing the behavior of PVs (decrease or plateau) in the third phase of rCIVD, following the initial, heating-induced increase in perfusion (second phase of rCIVD). The plateau group (group P), which included patients with an abnormal rCIVD, and the decrease group (group D), which included patients with a normal rCIVD, were defined based on perfusion slope values of <0.20 and ≥ 0.20 perfusion units/min, respectively. We also quantified the transient increase in perfusion (from baseline to peak) as a descriptor of perfusion behavior during the second phase of rCIVD. RESULTS: In group P, the change in median values (25-75%) of the slope, transcutaneous oxygen tension, and ankle-brachial index (ABI) from before to after operation was (-0.02 [-0.04 to 0.02]; 4 [1-11]; and 0.08 [0-0.27]) to (0.39 [0.32-0.59]; 46 [37-54]; and 0.81 [0.72-0.90]). Conversely, in group D, the change in the median values of the slope, transcutaneous oxygen tension, and ABI between before and after operation was (0.38 [0.32-0.49]; 40.5 [35-45]; and0.58 [0.57-0.65]) to (0.44 [0.30-0.64]; 52 [43-56]; and 0.92 [0.81-0.99]). Sites exhibiting perfusion pattern of group D in the third phase of rCIVD showed no significant change in slope after revascularization (P = 0.21), whereas the slope in group P increased significantly after revascularization, becoming similar to the postoperative slopes in group D (P = 0.81). The amount of transient increase in perfusion, which quantified the behavior in the second phase of rCIVD, showed a similar behavior. Preoperatively, all patients in group P had rest pain and/or ulcer of the foot, whereas only few patients in group D had such symptoms. CONCLUSIONS: Normal rCIVD response in the LTL test indicates less-than-severe ischemia, while abnormal rCIVD response measured via the LTL test indicates severe ischemic symptoms, such as critical limb ischemia. Notably, patients with an abnormal rCIVD response can develop a normal rCIVD response following revascularization, thereby reflecting an improvement in blood flow. The LTL test assessing rCIVD response can be useful for detecting severe limb ischemia, such as critical limb ischemia (CLI), and determining the departure from severe limb ischemia by revascularization.
Assuntos
Hemodinâmica , Hipertermia Induzida , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Imagem de Perfusão/métodos , Doença Arterial Periférica/cirurgia , Ultrassonografia/métodos , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Velocidade do Fluxo Sanguíneo , Monitorização Transcutânea dos Gases Sanguíneos , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Fluxo Sanguíneo Regional , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
BACKGROUND AND PURPOSE: Regional cerebral blood flow has previously been studied in patients with idiopathic normal pressure hydrocephalus with imaging methods that require an intravenous contrast agent or expose the patient to ionizing radiation. The purpose of this study was to assess regional CBF in patients with idiopathic normal pressure hydrocephalus compared with healthy controls using the noninvasive quantitative arterial spin-labeling MR imaging technique. A secondary aim was to compare the correlation between symptom severity and CBF. MATERIALS AND METHODS: Differences in regional cerebral perfusion between patients with idiopathic normal pressure hydrocephalus and healthy controls were investigated with pseudocontinuous arterial spin-labeling perfusion MR imaging. Twenty-one consecutive patients with idiopathic normal pressure hydrocephalus and 21 age- and sex-matched randomly selected healthy controls from the population registry were prospectively included. The controls did not differ from patients with respect to selected vascular risk factors. Twelve different anatomic ROIs were manually drawn on coregistered FLAIR images. The Holm-Bonferroni correction was applied to statistical analyses. RESULTS: In patients with idiopathic normal pressure hydrocephalus, perfusion was reduced in the periventricular white matter (P < .001), lentiform nucleus (P < .001), and thalamus (P < .001) compared with controls. Cognitive function in patients correlated with CBF in the periventricular white matter (r = 0.60, P < .01), cerebellum (r = 0.63, P < .01), and pons (r = 0.71, P < .001). CONCLUSIONS: Using pseudocontinuous arterial spin-labeling, we could confirm findings of a reduced perfusion in the periventricular white matter, basal ganglia, and thalamus in patients with idiopathic normal pressure hydrocephalus previously observed with other imaging techniques.
Assuntos
Circulação Cerebrovascular , Hidrocefalia de Pressão Normal/tratamento farmacológico , Hidrocefalia de Pressão Normal/fisiopatologia , Imageamento por Ressonância Magnética/métodos , Imagem de Perfusão/métodos , Marcadores de Spin , Idoso , Idoso de 80 Anos ou mais , Cognição , Corpo Estriado/diagnóstico por imagem , Feminino , Humanos , Hidrocefalia de Pressão Normal/psicologia , Processamento de Imagem Assistida por Computador , Masculino , Testes Neuropsicológicos , Estudos Prospectivos , Reprodutibilidade dos Testes , Tálamo/diagnóstico por imagem , Substância Branca/diagnóstico por imagemRESUMO
The aim of the study was to explore calf muscle electrostimulation on arterial inflow and walking capacity in claudicants with peripheral artery disease and diabetes mellitus. A prospective, 1-group, pretest-posttest study design was used on 40 high-risk participants (n = 40) who exhibited bilateral limb ischemia (ankle brachial pressure index [ABPI] <0.90), diabetes mellitus, and calf muscle claudication. A program of calf muscle electrical stimulation with varying frequency (1-250 Hz) was prescribed for 1 hour per day for 12 weeks. Spectral waveforms analysis, ABPI, absolute claudication distance (ACD), and thermographic temperature patterns across 4 specified regions of interest (hallux, medial forefoot, lateral forefoot, heel) at rest and after exercise, were recorded at baseline and following intervention to evaluate for therapeutic outcomes. A significant improvement in ACD and ABPI was registered following the intervention ( P = .000 and P = .001, respectively). Resting foot temperatures increased significantly ( P = .000) while the postexercise temperature drops were halved across all regions at follow-up, with hallux ( P = .005) and lateral forefoot ( P = .038) reaching statistical significance. Spectral Doppler waveforms were comparable ( P = .304) between both serial assessments. Electrical stimulation of varying frequency for 1 hour per day for 12 consecutive weeks registered statistically significant improvement in outcome measures that assess arterial inflow and walking capacity in claudicants with diabetes mellitus. These results favor the use of electrostimulation as a therapeutic measure in this high-risk population.
Assuntos
Diabetes Mellitus Tipo 2 , Terapia por Estimulação Elétrica/métodos , Claudicação Intermitente , Doença Arterial Periférica , Caminhada , Idoso , Índice Tornozelo-Braço/métodos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Teste de Esforço/métodos , Feminino , Humanos , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/etiologia , Claudicação Intermitente/fisiopatologia , Claudicação Intermitente/terapia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Debilidade Muscular/terapia , Imagem de Perfusão/métodos , Doença Arterial Periférica/complicações , Doença Arterial Periférica/fisiopatologia , Doença Arterial Periférica/terapia , Análise de Onda de Pulso/métodos , Resultado do TratamentoRESUMO
PURPOSE: To investigate dynamic contrast enhanced-MRI (DCE-MRI) in the preoperative chemo-radiotherapy (CRT) assessment for locally advanced rectal cancer (LARC) compared to18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). METHODS: 75 consecutive patients with LARC were enrolled in a prospective study. DCE-MRI analysis was performed measuring SIS: linear combination of percentage change (Δ) of maximum signal difference (MSD) and wash-out slope (WOS). 18F-FDG PET/CT analysis was performed using SUV maximum (SUVmax). Tumor regression grade (TRG) were estimated after surgery. Non-parametric tests, receiver operating characteristic were evaluated. RESULTS: 55 patients (TRG1-2) were classified as responders while 20 subjects as non responders. ΔSIS reached sensitivity of 93%, specificity of 80% and accuracy of 89% (cut-off 6%) to differentiate responders by non responders, sensitivity of 93%, specificity of 69% and accuracy of 79% (cut-off 30%) to identify pathological complete response (pCR). Therapy assessment via ΔSUVmax reached sensitivity of 67%, specificity of 75% and accuracy of 70% (cut-off 60%) to differentiate responders by non responders and sensitivity of 80%, specificity of 31% and accuracy of 51% (cut-off 44%) to identify pCR. CONCLUSIONS: CRT response assessment by DCE-MRI analysis shows a higher predictive ability than 18F-FDG PET/CT in LARC patients allowing to better discriminate significant and pCR.
Assuntos
Quimiorradioterapia Adjuvante , Imageamento por Ressonância Magnética , Terapia Neoadjuvante , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/terapia , Adulto , Idoso , Área Sob a Curva , Meios de Contraste/administração & dosagem , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Nanopartículas de Magnetita/administração & dosagem , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão/métodos , Valor Preditivo dos Testes , Curva ROC , Compostos Radiofarmacêuticos/administração & dosagem , Neoplasias Retais/irrigação sanguínea , Neoplasias Retais/patologia , Fluxo Sanguíneo Regional , Indução de Remissão , Reprodutibilidade dos Testes , Siloxanas/administração & dosagem , Resultado do TratamentoRESUMO
OBJECTIVE: This study compares the effectiveness of a neuromuscular electrical stimulation (NMES) device and an intermittent pneumatic compression (IPC) device on enhancing microcirculatory blood flow in the thigh of healthy individuals, when stimulation is carried out peripherally at the calf. MATERIALS AND METHODS: Blood microcirculation of ten healthy individuals was recorded using laser speckle contrast imaging (LSCI) technique. A region of interest (ROI) was marked on each participant thigh. The mean flux within the ROI was calculated at four states: rest, NMES device with visible muscle actuation (VMA), NMES device with no visible muscle actuation (NVMA) and IPC device. RESULTS: Both NMES and IPC devices increased blood flow in the thigh when stimulation was carried out peripherally at the calf. The NMES device increased mean blood perfusion from baseline by 399.8% at the VMA state and 150.6% at the NVMA state, IPC device increased the mean blood perfusion by 117.3% from baseline. CONCLUSION: The NMES device at VMA state increased microcirculation by more than a factor of 3 in contrast to the IPC device. Even at the NVMA state, the NMES device increased blood flow by 23% more than the IPC device. Given the association between increased microcirculation and reduced oedema, NMES may be a more effective modality than IPC at reducing oedema, therefore further research is needed to explore this.
Assuntos
Terapia por Estimulação Elétrica , Dispositivos de Compressão Pneumática Intermitente , Microcirculação , Contração Muscular , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/inervação , Adulto , Velocidade do Fluxo Sanguíneo , Desenho de Equipamento , Voluntários Saudáveis , Humanos , Fluxometria por Laser-Doppler , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão/métodos , Fluxo Sanguíneo Regional , Coxa da PernaRESUMO
Here we report on real-time imaging and quantitative analysis of solute transport in perfusable cylindrical microvessels formed from Madin-Darby canine kidney (MDCK) cells embedded in a collagen matrix. Fluorescence microscopy was used to image the kinetics of doxorubicin transport following injection. To assess the role of efflux pumps on transport, experiments were performed in microvessels formed from MDCK.2, MDCKII-w/t, and MDCKII-MDR1 cells. MDCKII-w/t and MDCKII-MDR1 showed significant doxorubicin accumulation in the cells, characteristic of the pharmacokinetics of doxorubicin. We present a model for doxorubicin transport that takes into account transport across the cell layer. These results demonstrate how real-time imaging of cell microvessels can be used to analyze the mechanisms of transport and distribution following systemic delivery.
Assuntos
Doxorrubicina/farmacocinética , Avaliação Pré-Clínica de Medicamentos/instrumentação , Análise de Injeção de Fluxo/instrumentação , Dispositivos Lab-On-A-Chip , Microscopia de Fluorescência/instrumentação , Microvasos/metabolismo , Animais , Sistemas Computacionais , Cães , Doxorrubicina/administração & dosagem , Avaliação Pré-Clínica de Medicamentos/métodos , Desenho de Equipamento , Análise de Falha de Equipamento , Análise de Injeção de Fluxo/métodos , Células Madin Darby de Rim Canino , Microvasos/citologia , Imagem de Perfusão/instrumentação , Imagem de Perfusão/métodosRESUMO
Intense pulsed light (IPL) with low energy insufficient to completely destroy a vasculature was applied to rabbit ears to investigate vasculature alteration. Glycerol was combined with IPL to enhance the transfer efficacy of IPL energy. Both trans-illumination and laser speckle contrast images were obtained and analyzed after treatment. The application of IPL and glycerol combination induced vasodilation and improvement in blood flow. Moreover, such phenomenon was maintained over time. IPL may be applied to treat blood circulatory diseases by inducing vasodilation and to improve blood flow.
Assuntos
Orelha/irrigação sanguínea , Terapia de Luz Pulsada Intensa , Imagem Óptica/métodos , Imagem de Perfusão/métodos , Vasodilatação , Animais , Velocidade do Fluxo Sanguíneo , Feminino , Glicerol/administração & dosagem , Terapia de Luz Pulsada Intensa/instrumentação , Lasers de Corante , Modelos Animais , Coelhos , Fluxo Sanguíneo Regional , Fatores de TempoRESUMO
Traumatic brain injury (TBI) is a growing health concern affecting civilians and military personnel. Near-infrared (NIR) light has shown benefits in animal models and human trials for stroke and in animal models for TBI. Diodes emitting low-level NIR often have lacked therapeutic efficacy, perhaps failing to deliver sufficient radiant energy to the necessary depth. In this case report, a patient with moderate TBI documented in anatomical magnetic resonance imaging (MRI) and perfusion single-photon emission computed tomography (SPECT) received 20 NIR treatments in the course of 2 mo using a high-power NIR laser. Symptoms were monitored by clinical examination and a novel patient diary system specifically designed for this patient population. Clinical application of these levels of infrared energy for this patient with TBI yielded highly favorable outcomes with decreased depression, anxiety, headache, and insomnia, whereas cognition and quality of life improved. Neurological function appeared to improve based on changes in the SPECT by quantitative analysis. NIR in the power range of 10-15 W at 810 and 980 nm can safely and effectively treat chronic symptoms of TBI.
Assuntos
Lesões Encefálicas/patologia , Lesões Encefálicas/terapia , Encéfalo , Terapia com Luz de Baixa Intensidade/métodos , Imagem de Perfusão/métodos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Encéfalo/fisiopatologia , Lesões Encefálicas/fisiopatologia , Marcha , Humanos , Masculino , FalaRESUMO
OBJECTIVE: To prospectively evaluate the performance of computed tomography perfusion imaging (CTPI) in predicting the early response to transarterial chemo-lipiodol infusion (TACLI) and survival of patients with colorectal cancer liver metastases (CRLM). MATERIALS AND METHODS: Computed tomography perfusion imaging was performed before and 1 month after TACLI in 61 consecutive patients. Therapeutic response was evaluated on CT scans 1 month and 4 months after TACLI; the patients were classified as responders and non-responders based on 4-month CT scans after TACLI. The percentage change of CTPI parameters of target lesions were compared between responders and non-responders at 1 month after TACLI. The optimal parameter and cutoff value were determined. The patients were divided into 2 subgroups according to the cutoff value. The log-rank test was used to compare the survival rates of the 2 subgroups. RESULTS: Four-month images were obtained from 58 patients, of which 39.7% were responders and 60.3% were non-responders. The percentage change in hepatic arterial perfusion (HAP) 1 month after TACLI was the optimal predicting parameter (p = 0.003). The best cut-off value was -21.5% and patients who exhibited a ≥ 21.5% decrease in HAP had a significantly higher overall survival rate than those who exhibited a < 21.5% decrease (p < 0.001). CONCLUSION: Computed tomography perfusion imaging can predict the early response to TACLI and survival of patients with CRLM. The percentage change in HAP after TACLI with a cutoff value of -21.5% is the optimal predictor.