Interferencia entre NIRS cerebral y bilirrubina conjugada en neonatos de extremado bajo peso / Interference between cerebral NIRS and conjugated bilirubin in extremely low birthweight neonates

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Variation in perioperative cerebral and hemodynamic monitoring during carotid endarterectomy.

BACKGROUND: Hemodynamic disturbances cause half of the perioperative strokes following carotid endarterectomy (CEA). Guidelines strongly recommend strict pre- and postoperative blood pressure (BP) monitoring in CEA patients, but do not provide firm practical recommendations. Although in the Netherlands 50 centres perform CEA, no national protocol on perioperative hemodynamic, and cerebral monitoring exists. To assess current monitoring policies of all Dutch CEA-centres, a national survey was conducted. METHODS: Between May and July 2017 all 50 Dutch CEA-centres were invited to complete a 42-question survey addressing perioperative hemodynamic and cerebral monitoring during CEA. Nonresponders received a reminder after 1 and 2 months. By November 2017 the survey was completed by all centres. RESULTS: Preoperative baseline BP was based on a single bilateral BP-measurement at the outpatient-clinic in the majority of centres (n = 28). In 43 centres (86%) pre-operative monitoring (transcranial Doppler (TCD, n = 6), electroencephalography (EEG, n = 11), or TCD + EEG (n = 26)) was performed as a baseline reference. Intraoperatively, large diversity for type of anaesthesia (general: 45 vs. local [LA]:5) and target systolic BP (>100 mm hg - 160 mm hg [n = 12], based on preoperative outpatient-clinic or admission BP [n = 18], other [n = 20]) was reported. Intraoperative cerebral monitoring included EEG + TCD (n = 28), EEG alone (n = 13), clinical neurological examination with LA (n = 5), near-infrared spectroscopy with stump pressure (n = 1), and none due to standard shunting (n = 3). Postoperatively, significant variation was reported in standard duration of admission at a recovery or high-care unit (range 3-48 hr, mean:12 hr), maximum accepted systolic BP (range >100 mm hg - 180 mm Hg [n = 32]), postoperative cerebral monitoring (standard TCD [n = 16], TCD on indication [n = 5] or none [n = 24]) and in timing of postoperative cerebral monitoring (range directly postoperative - 24 hr postoperative; median 3 hr). CONCLUSIONS: In Dutch centres performing CEA the perioperative hemodynamic and cerebral monitoring policies are widely diverse. Diverse policies may theoretically lead to over- or under treatment. The results of this national audit may serve as the baseline dataset for development of a standardized and detailed (inter)national protocol on perioperative hemodynamic and cerebral monitoring during CEA.

Recent progress in development and applications of second near-infrared (NIR-II) nanoprobes.

Optical probes for near-infrared (NIR) light have clear advantages over UV/VIS-based optical probes, such as their low levels of interfering auto-fluorescence and high tissue penetration. The second NIR (NIR-II) window (1000-1350 nm) offers better light penetration, lower background signal, higher safety limit, and higher maximum permitted exposure than the first NIR (NIR-I) window (650-950 nm). Therefore, NIR-II laser-based photoacoustic (PA) and fluorescence (FL) imaging can offer higher sensitivity and penetration depth than was previously available, and deeper lesions can be treated in vivo by photothermal therapy (PTT) and photodynamic therapy (PDT) with an NIR-II laser than with an NIR-I laser. Advances in creation of novel nanomaterials have increased options for improving light-induced bioimaging and treatment. Nanotechnology can provide advantages such as good disease targeting ability and relatively long circulation times to supplement the advantages of optical technologies. In this review, we present recent progress in development and applications of NIR-II light-based nanoplatforms for FL, PA, image-guided surgery, PDT, and PTT. We also discuss recent advances in smart NIR-II nanoprobes that can respond to stimuli in the tumor microenvironment and inflamed sites. Finally, we consider the challenges involved in using NIR-II nanomedicine for effective diagnosis and treatment.

Neurodevelopmental effects of childhood malnutrition: A neuroimaging perspective.

Approximately one in five children worldwide suffers from childhood malnutrition and its complications, including increased susceptibility to inflammation and infectious diseases. Due to improved early interventions, most of these children now survive early malnutrition, even in low-resource settings (LRS). However, many continue to exhibit neurodevelopmental deficits, including low IQ, poor school performance, and behavioral problems over their lifetimes. Most studies have relied on neuropsychological tests, school performance, and mental health and behavioral measures. Few studies, in contrast, have assessed brain structure and function, and to date, these have mainly relied on low-cost techniques, including electroencephalography (EEG) and evoked potentials (ERP). The use of more advanced methods of neuroimaging, including magnetic resonance imaging (MRI) and functional near-infrared spectroscopy (fNIRS), has been limited by cost factors and lack of availability of these technologies in developing countries, where malnutrition is nearly ubiquitous. This report summarizes the current state of knowledge and evidence gaps regarding childhood malnutrition and the study of its impact on neurodevelopment. It may help to inform the development of new strategies to improve the identification, classification, and treatment of neurodevelopmental disabilities in underserved populations at the highest risk for childhood malnutrition.

2-Year Outcomes After Stenting of Lipid-Rich and Nonrich Coronary Plaques.

BACKGROUND: Autopsy studies suggest that implanting stents in lipid-rich plaque (LRP) may be associated with adverse outcomes. OBJECTIVES: The purpose of this study was to evaluate the association between LRP detected by near-infrared spectroscopy (NIRS) and clinical outcomes in patients with coronary artery disease treated with contemporary drug-eluting stents. METHODS: In this prospective, multicenter registry, NIRS was performed in patients undergoing coronary angiography and possible percutaneous coronary intervention (PCI). Lipid core burden index (LCBI) was calculated as the fraction of pixels with the probability of LRP >0.6 within a region of interest. MaxLCBI4mm was defined as the maximum LCBI within any 4-mm-long segment. Major adverse cardiac events (MACE) included cardiac death, myocardial infarction, definite or probable stent thrombosis, or unplanned revascularization or rehospitalization for progressive angina or unstable angina. Events were subcategorized as culprit (treated) lesion-related, nonculprit (untreated) lesion-related, or indeterminate. RESULTS: Among 1,999 patients who were enrolled in the COLOR (Chemometric Observations of Lipid Core Plaques of Interest in Native Coronary Arteries Registry), PCI was performed in 1,621 patients and MACE occurred in 18.0% of patients, of which 8.3% were culprit lesion-related, 10.7% were nonculprit lesion-related, and 3.1% were indeterminate during 2-year follow-up. Complications from NIRS imaging occurred in 9 patients (0.45%), which resulted in 1 peri-procedural myocardial infarction and 1 emergent coronary bypass. Pre-PCI NIRS imaging was obtained in 1,189 patients, and the 2-year rate of culprit lesion-related MACE was not significantly associated with maxLCBI4mm (hazard ratio of maxLCBI4mm per 100: 1.06; 95% confidence interval: 0.96 to 1.17; p = 0.28) after adjusting clinical and procedural factors. CONCLUSIONS: Following PCI with contemporary drug-eluting stents, stent implantation in NIRS-defined LRPs was not associated with increased periprocedural or late adverse outcomes compared with those without significant lipid.

The present and future use of functional near-infrared spectroscopy (fNIRS) for cognitive neuroscience.

The past few decades have seen a rapid increase in the use of functional near-infrared spectroscopy (fNIRS) in cognitive neuroscience. This fast growth is due to the several advances that fNIRS offers over the other neuroimaging modalities such as functional magnetic resonance imaging and electroencephalography/magnetoencephalography. In particular, fNIRS is harmless, tolerant to bodily movements, and highly portable, being suitable for all possible participant populations, from newborns to the elderly and experimental settings, both inside and outside the laboratory. In this review we aim to provide a comprehensive and state-of-the-art review of fNIRS basics, technical developments, and applications. In particular, we discuss some of the open challenges and the potential of fNIRS for cognitive neuroscience research, with a particular focus on neuroimaging in naturalistic environments and social cognitive neuroscience.

A decade of infant neuroimaging research: What have we learned and where are we going?

The past decade has seen the emergence of neuroimaging studies of infant populations. Incorporating imaging has resulted in invaluable insights about neurodevelopment at the start of life. However, little has been enquired of the experimental specifications and study characteristics of typical findings. This review systematically screened empirical studies that used electroencephalography (EEG), magnetoencephalography (MEG), functional near-infrared spectroscopy (fNIRS), and functional magnetic resonance imaging (fMRI) on infants (max. age of 24 months). From more than 21,000 publications, a total of 710 records were included for analyses. With the exception of EEG studies, infant studies with MEG, fNIRS, and fMRI were most often conducted around birth and at 12 months. The vast majority of infant studies came from North America, with very few studies conducted in Africa, certain parts of South America, and Southeast Asia. Finally, longitudinal neuroimaging studies were inclined to adopt EEG, followed by fMRI, fNIRS, and MEG. These results show that there is compelling need for studies with larger sample sizes, studies investigating a broader range of infant developmental periods, and studies from under- and less-developed regions in the world. Addressing these shortcomings in the future will provide a more representative and accurate understanding of neurodevelopment in infancy.

Applications of Functional Near-Infrared Spectroscopy in Fatigue, Sleep Deprivation, and Social Cognition.

Functional near-infrared spectroscopy (fNIRS) is an optical diffusion technique that allows the non-invasive imaging of cortical activity. During the last two decades, rapid technical and methodological advances have made fNIRS a powerful tool to investigate the cerebral correlates of human performance and cognitive functions, including fatigue, sleep deprivation and social cognition. Despite intrinsic limitations such as restricted brain depth and spatial resolution, its applicability, low cost, ecological validity, and tolerance to movements make fNIRS advantageous for scientific research and clinical applications. It can be viewed as a valid and promising brain imaging approach to investigate applied societal problems (e.g., safety, children development, sport science) and complement other neuroimaging techniques. The intrinsic power of fNIRS measurements for the study of social cognition is magnified when applied to the hyperscanning paradigm (i.e., measuring activity in two or more brains simultaneously). Besides consolidating existing findings, future fNIRS research should focus on methodological advances (e.g., artefacts correction, connectivity approaches) and standardization of analysis pipelines, and expand currently used paradigms in more naturalistic but controlled settings.

Absence of neural speech discrimination in preterm infants at term-equivalent age.

Children born preterm are at higher risk to develop language deficits. Auditory speech discrimination deficits may be early signs for language developmental problems. The present study used functional near-infrared spectroscopy to investigate neural speech discrimination in 15 preterm infants at term-equivalent age compared to 15 full term neonates. The full term group revealed a significantly greater hemodynamic response to forward compared to backward speech within the left hemisphere extending from superior temporal to inferior parietal and middle and inferior frontal areas. In contrast, the preterm group did not show differences in their hemodynamic responses during forward versus backward speech, thus, they did not discriminate speech from non-speech. Groups differed significantly in their responses to forward speech, whereas they did not differ in their responses to backward speech. The significant differences between groups point to an altered development of the functional network underlying language acquisition in preterm infants as early as in term-equivalent age.

Monitoring spinal cord hemodynamics and tissue oxygenation: a review of the literature with special focus on the near-infrared spectroscopy technique.

STUDY DESIGN: Review. OBJECTIVES: Clinical studies have shown that the hemodynamic management of patients following acute spinal cord injury (SCI) is an important aspect of their treatment for maintaining spinal cord (SC) perfusion and minimizing ischemic secondary injury to the SC. While this highlights the importance of ensuring adequate perfusion and oxygenation to the injured cord, a method for the real-time monitoring of these hemodynamic measures within the SC is lacking. The purpose of this review is to discuss current and potential methods for SC hemodynamic monitoring with special focus on applications using near-infrared spectroscopy (NIRS). METHODS: A literature search using the PubMed database. All peer-reviewed articles on NIRS monitoring of SC published from inception to May 2019 were reviewed. RESULTS: Among 125 papers related to SC hemodynamics monitoring, 26 focused on direct/indirect NIRS monitoring of the SC. DISCUSSION: Current options for continuous, non-invasive, and real-time monitoring of SC hemodynamics are challenging and limited in scope. As a relatively new technique, NIRS has been successfully used for monitoring human cerebral hemodynamics, and has shown promising results in intraoperative assessment of SC hemodynamics in both human and animal models. Although utilizing NIRS to monitor the SC has been validated, applying NIRS clinically following SCI requires further development and investigation. CONCLUSIONS: NIRS is a promising non-invasive technique with the potential to provide real-time monitoring of relevant parameters in the SC. Currently, in its first developmental stages, further clinical and experimental studies are mandatory to ensure the validity and safety of NIRS techniques.

Near Infrared Spectroscopy Based Clinical Algorithm Applicability During Spinal Neurosurgery and Postoperative Cognitive Disturbances.

Background and Objectives: Postoperative cognitive disturbances (POCD) can significantly alter postoperative recovery. Inadequate intraoperative cerebral oxygen supply is one of the inciting causes of POCD. Near-infrared spectroscopy (NIRS) devices monitor cerebral oxygen saturation continuously and can help to guide intraoperative patient management. The aim of the study was to evaluate the applicability of the NIRS-based clinical algorithm during spinal neurosurgery and to find out whether it can influence postoperative cognitive performance. Materials and Methods: Thirty four patients scheduled for spinal neurosurgery were randomized into a study group (n = 23) and a control group (n = 11). We monitored regional cerebral oxygen saturation (rScO2) throughout surgery, using a NIRS device (INVOS 4100). If rScO2 dropped bilaterally or unilaterally by more than 20% from baseline values, or under an absolute value of 50%, the NIRS-based algorithm was initiated in the study group. In the control group, rScO2 was monitored blindly. To evaluate cognitive function, Montreal-Cognitive Assessment (MoCA) scale was used in both groups before and after the surgery. Results: In the study group, rScO2 dropped below the threshold in three patients and the NIRS-based algorithm was activated. Firstly, we verified correct positioning of the head; secondly, we increased mean systemic arterial pressure in the three patients by injecting repeated intravenous bolus doses of Ephedrine, ultimately resulting in an rScO2 increase above the approved threshold level. None of the three patients showed POCD. In the control group, one patient showed a drop in rScO2 of 34% from baseline and presented with a POCD. RScO2 drop occurred with other stable intraoperative measurements. Conclusions: A significant rScO2 drop may occur during spinal surgery in prone position despite other intraoperative measurements remaining stable, allowing it to stay otherwise unrecognized. Use of the NIRS-based clinical algorithm can help to avoid POCD in patients after spinal surgery.

Right prefrontal cortex specialization for visuospatial working memory and developmental alterations in prefrontal cortex recruitment in school-age children.

OBJECTIVE: The right prefrontal cortex (PFC) plays an essential role in active processing within visuospatial working memory (VSWM). The aim of this study was to examine developmental changes in the recruitment patterns of the PFC during visuospatial memory tasks in school-age participants. METHODS: We recruited 80 school-age children who were classified into three age groups: 7- to 8-year-old, 9- to 10-year-old, and 11- to 12-year-old children. We used near infrared spectroscopy (NIRS) to measure PFC activity during visuospatial memory task. Memory stimuli were presented either sequentially or simultaneously. RESULTS: In all three groups, right-lateralized PFC activity was observed during sequential presentation, suggesting specialization of the right PFC for VSWM. During simultaneous presentation, right-lateralized PFC activity was not observed in 7- to 8-year-old children or 9- to 10-year-old children. In contrast, PFC activity was right-lateralized in 11- to 12-year-old children. CONCLUSIONS: We suggest that specialization of the right PFC for VSWM is already present before school-age, but widely distributed activity in response to visuospatial memory tasks changes to more focal activity in VSWM-specific regions during the early school years. SIGNIFICANCE: Using NIRS, we showed developmental changes in the recruitment patterns of the PFC during visuospatial memory tasks.

Fluid Responsiveness After CArdiac Surgery (FRACAS): A Prospective Observational Study Using Peripheral Near-Infrared Spectroscopy.

OBJECTIVES: To describe tissue oxygen saturation (StO2) in response to a vascular occlusion test using thenar eminence and forearm near-infrared spectroscopy (NIRS) and the association with volume responsiveness after cardiac surgery. DESIGN: Single-center, prospective, observational cohort study. SETTING: Cardiothoracic intensive care unit. PARTICIPANTS: Seventy-six post-cardiac surgical adults. INTERVENTIONS: Immediately before and 10 minutes after a 250-to-500 mL fluid bolus, StO2 was measured in response to a vascular occlusion test to calculate tissue deoxygenation (Rdes) and reoxygenation (Rres) rates. Concurrently, systemic hemodynamic, metabolic, and blood gas variables were collected. MEASUREMENTS AND MAIN RESULTS: A total of 203 boluses were captured using thenar NIRS and 141 boluses using forearm NIRS. Approximately 25% of boluses increased cardiac output by ≥15% (volume responders). Thenar and forearm Rdes decreased in responders, but increased (thenar) or remained unchanged (forearm) in nonresponders. A logistic regression model of the association among StO2, Rdes and Rres, and volume responsiveness was significant for thenar measurements (p = 0.001) with an area under the receiver operating characteristic of 0.69 (95% confidence interval: 0.62-0.75). It also was significant (p = 0.02) for forearm measurements, with an area under the receiver operating characteristic of 0.71 (0.62-0.79). Rdes was an independent variable in both instances (odds ratio 0.31 [0.14-0.69], thenar; odds ratio 0.60 [0.45-0.80], forearm). Thenar and forearm NIRS variables were correlated poorly with cardiac output, stroke volume, systemic oxygen delivery and consumption index, mixed venous, and central venous oxygen saturation (Spearman׳s coefficients, r = 0.17-0.46, p < 0.002). CONCLUSION: In post-cardiac surgical patients, thenar and forearm NIRS variables were associated with volume responsiveness although not achieving precision necessary for clinical management.

COLORFUL ENGINEERING.

Advances in fluorescent dye and protein design have led to a wider color palette for microscopy. Nathan Blow explores how this happened and what is still to come.

Recent developments of imaging modalities of carotid artery stenting.

Compared with conventional angiogram-guided procedure, intravascular imaging modalities give us a lot of useful information to make the procedure better. Intravascular imaging modalities give us the information about lesion characters, reference vessel diameter and the interaction between the stent strut and the plaque such as stent strut malapposition or plaque prolapse in real time during the procedure. We can change our strategy according to this information. Intravascular ultrasound (IVUS) is a most common intravascular imaging modality during carotid artery stenting (CAS) in these days. Its advantage is easy to use compared with optical coherence tomograpy (OCT) which has been reported recently in some case reports or case series. However, due to its high resolution, OCT provides more detailed information especially about plaque prolapse and strut malapposition. IVUS and OCT have a potential to improve acute result and reduce the procedural complication by providing the data of lesion character, reference vessel diameter and the interaction of stent strut and vessel wall. Interventionalists who perform CAS procedure should acquire proficiency in imaging modalities during CAS procedure.

Hybrid intravascular imaging: recent advances, technical considerations, and current applications in the study of plaque pathophysiology.

Cumulative evidence from histology-based studies demonstrate that the currently available intravascular imaging techniques have fundamental limitations that do not allow complete and detailed evaluation of plaque morphology and pathobiology, limiting the ability to accurately identify high-risk plaques. To overcome these drawbacks, new efforts are developing for data fusion methodologies and the design of hybrid, dual-probe catheters to enable accurate assessment of plaque characteristics, and reliable identification of high-risk lesions. Today several dual-probe catheters have been introduced including combined near infrared spectroscopy-intravascular ultrasound (NIRS-IVUS), that is already commercially available, IVUS-optical coherence tomography (OCT), the OCT-NIRS, the OCT-near infrared fluorescence (NIRF) molecular imaging, IVUS-NIRF, IVUS intravascular photoacoustic imaging and combined fluorescence lifetime-IVUS imaging. These multimodal approaches appear able to overcome limitations of standalone imaging and provide comprehensive visualization of plaque composition and plaque biology. The aim of this review article is to summarize the advances in hybrid intravascular imaging, discuss the technical challenges that should be addressed in order to have a use in the clinical arena, and present the evidence from their first applications aiming to highlight their potential value in the study of atherosclerosis.

Early hyperoxia burden detected by cerebral near-infrared spectroscopy is superior to pulse oximetry for prediction of severe retinopathy of prematurity.

OBJECTIVE: Fractional tissue oxygen extraction (FTOE) is a measure derived from cerebral near-infrared spectroscopy (NIRS) and simultaneous pulse oximetry (SpO2), capturing the proportion of oxygen delivered in arterial blood that is used by the target tissue. FTOE may provide a better proxy measurement of retinal hyperoxia than pulse oximetry alone and could provide insight into the risk for retinopathy of prematurity (ROP). In this study, we directly compared hyperoxia burden calculated from FTOE with hyperoxia burden calculated from SpO2 alone in order to assess the strength of association between hyperoxia and severe ROP. STUDY DESIGN: Infants born before <30 weeks and weighing <1500 g underwent synchronized SpO2 and FTOE recording over the first 4 days following birth. After error correction of the raw recording, hyperoxia burden was calculated as the percentage of the total SpO2 or FTOE recording with measurements exceeding defined thresholds (90/93/95% and 20/15/10%, respectively) and was compared with the outcome of severe ROP, defined as ROP requiring laser therapy, after controlling for important covariates. RESULT: A total of 63 infants were included with a mean±s.d. gestational age of 25.8±1.5 weeks and birth weight of 898.5±206.9 g; 13/63 (20%) had severe ROP. SpO2 hyperoxia burden was not associated with severe ROP at any threshold. FTOE hyperoxia burden was associated with severe ROP at the 15% (P=0.04) and 10% (P=0.03) thresholds. Infants with severe ROP spent 20% and 50% more time exceeding the 15% and 10% thresholds, respectively, as compared with those without severe ROP. CONCLUSION: In the first 96 h of life, FTOE but not SpO2 hyperoxia burden is associated with severe ROP. These preliminary results suggest that NIRS may be a viable alternative technology for targeted oxygen saturation guidelines.

Near-Infrared Spectroscopy Hemoglobin Index Measurement During Fluid Challenge: A Prospective Study in Cardiac Surgery Patients.

OBJECTIVE: Little is known about changes in near-infrared spectroscopy-derived tissue hemoglobin index (HbI). The authors tested the hypothesis that absolute values and changes in brain hemoglobin index (HbIb) and skeletal muscle hemoglobin index (HbIm) could differ from the reference arterial hemoglobin (Hb) during fluid challenge. DESIGN: A prospective, monocenter observational study. SETTING: A 16-bed cardiac surgical intensive care unit in a teaching university hospital. PARTICIPANTS: Fifty consecutive adult patients. INTERVENTIONS: Investigation before and after a fluid challenge. MEASUREMENTS AND MAIN RESULTS: Simultaneous comparative Hb, HbIb and HbIm data points were collected from a blood-gas analyzer and the EQUANOX device (Nonin Medical Inc., Plymouth, MN). Correlations were determined by linear regression. No significant relationship was found between absolute values of Hb and HbIb before (R(2)= 0.04, p = 0.627) and after (R(2) = 0.00006, p = 0.956) fluid challenge. No significant relationship was found between absolute values of Hb and HbIm before (R(2)= 0.030, p = 0.226) and after (R(2) = 0.05, p = 0.117) the fluid challenge. No significant relationship was found between changes in Hb and HbIb (R(2)= 0.26, p = 0.263) and between changes in Hb and HbIm (R(2) = 0.001, p = 0.801) after the fluid challenge. Bland-Altman analysis showed a poor concordance between changes in Hb and HbIb, and changes in Hb and HbIm, with large limits of agreement. CONCLUSIONS: HbIb and HbIm cannot be used to provide continuous noninvasive estimation of Hb, and trends in HbIb and HbIm cannot be considered as noninvasive surrogates for the trend in Hb after cardiac surgery.