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A model with multiple intracranial aneurysms: possible hemodynamic mechanisms of aneurysmal initiation, rupture and recurrence

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中华神经外科杂志(英文) 2024年第2期10卷 1-8页

作者： Li Wenqiang Wang Chao Wang Yanmin Zhao Yapeng Yang Xinjian Liu Xianzhi Liu Jian Department of Interventional Neuroradiology and Neurosurgery Beijing Neurosurgical Institute and Beijing Tiantan Hospital Beijing China Department of Neurosurgery The First Affiliated Hospital of Zhengzhou University Zhengzhou China

Background hemodynamic factors play an important role in aneurysm initiation, growth, rupture, and recurrence, while the mechanism of the hemodynamic characteristics is still controversial. A unique model of multiple aneurysms (initiation, growth, rupture, and recurrence) is helpful to avoids the confounders and further explore the possible hemodynamic mechanisms of aneurysm in different states.Methods We present a model with multiple aneurysms, and including the states of initiation, growth, rupture, and recurrence, discuss the proposed mechanisms, and describe computational fluid dynamic model that was used to evaluate the likely hemodynamic effect of different states of the aneurysms.Results The hemodynamic analysis suggests that high flow impingement and high WSS distribution at normal parent artery was found before aneurysmal initiation. The WSS distribution and flow velocity were decreased in the new sac after aneurysmal growth. Low WSS was the risk hemodynamic factor for aneurysmal rupture. High flow concentration region on the neck plane after coil embolization still marked in recanalized aneurysm.Conclusions Associations have been identified between high flow impingement and aneurysm recanalization, while low WSS is linked to the rupture of aneurysms. High flow concentration and high WSS distribution at normal artery associated with aneurysm initiation and growth, while after growth, the high-risk hemodynamics of aneurysm rupture was occurred, which is low WSS at aneurysm dome.

关键词： Multiple intracranial aneurysms hemodynamic Aneurysm initiation and growth Rupture Recurrence

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Cerebral and muscle tissue oxygenation during exercise in healthy adults: A systematic review

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Journal of Sport and Health Science 2024年第4期13卷 459-471,F0003页

作者： Diego Orcioli-Silva Victor Spiandor Beretta Paulo Cezar Rocha Santos Felipe Marroni Rasteiro Anita Brum Marostegan Rodrigo Vitorio Claudio Alexandre Gobatto Fulvia Barros Manchado-Gobatto Laboratory of Applied Sport Physiology(LAFAE) School of Applied Sciences(FCA)University of Campinas(UNICAMP)Limeira 13484-350Brazil Posture and Gait Studies Laboratory(LEPLO) Institute of BiosciencesSao Paulo State University(UNESP)Rio Claro 13506-900Brazil Physical Education Department School of Technology and SciencesSao Paulo State University(UNESP)Presidente Prudente 19060-900Brazil Department of Computer Science&Applied Mathematics Weizmann Institute of ScienceRehovot 7610001Israel Center of Advanced Technologies in Rehabilitation Sheba Medical CenterRamat Gan 5265601Israel Department of Sport Exercise and RehabilitationNorthumbria UniversityNewcastle upon Tyne NE18STUK

Background:Near-infrared spectroscopy(NIRS)technology has allowed for the measurement of cerebral and skeletal muscle oxygenation simultaneously during exercise.Since this technology has been growing and is now successfully used in laboratory and sports settings,this systematic review aimed to synthesize the evidence and enhance an integrative understanding of bloodﬂow adjustments and oxygen(O_(2))changes(i.e.,the balance between O_(2) delivery and O_(2) consumption)within the cerebral and muscle systems during exercise.Methods:A systematic review was conducted using PubMed,Embase,Scopus,and Web of Science databases to search for relevant studies that simultaneously investigated cerebral and muscle hemodynamic changes using the near-infrared spectroscopy system during exercise.This review considered manuscripts written in English and available before February 9,2023.Each step of screening involved evaluation by 2 inde-pendent authors,with disagreements resolved by a third author.The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the methodological quality of the studies.Results:Twenty studies were included,of which 80%had good methodological quality,and involved 290 young or middle-aged adults.Different types of exercises were used to assess cerebral and muscle hemodynamic changes,such as cycling(n=11),treadmill(n=1),knee extension(n=5),isometric contraction of biceps brachii(n=3),and duet swim routines(n=1).The cerebral hemodynamics anal-ysis was focused on the frontal cortex(n=20),while in the muscle,the analysis involved vastus lateralis(n=18),gastrocnemius(n=3),biceps brachii(n=5),deltoid(n=1),and intercostal muscle(n=1).Overall,muscle deoxygenation increases during exercise,reaching a plateau in voluntary exhaustion,while in the brain,oxyhemoglobin concentration increases with exercise intensity,reaching a plateau or declining at the exhaustion point.Conclusion:Muscle and cerebral oxygenation respond differently to exercise,with muscle increasing O_(2) utilization and cerebral tissue

关键词： Near-infrared spectroscopy hemodynamic Blood flow Brain Muscle metabolism

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Point-of-care ultrasonography in cirrhosis-related acute kidney injury:How I do it

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World Journal of Critical Care Medicine 2024年第2期13卷 137-149页

作者： Abhilash Koratala Division of Nephrology Department of MedicineMedical College of WisconsinMilwaukeeWI 53226United States

Discerning the etiology of acute kidney injury(AKI)in cirrhotic patients remains a formidable challenge due to diverse and overlapping causes.The conventional approach of empiric albumin administration for suspected volume depletion may inadvertently lead to fluid overload.In the recent past,point-of-care ultrasonography(POCUS)has emerged as a valuable adjunct to clinical assessment,offering advantages in terms of diagnostic accuracy,rapidity,cost-effectiveness,and patient satisfaction.This review provides insights into the strategic use of POCUS in evaluating cirrhotic patients with AKI.The review distinguishes basic and advanced POCUS,emphasizing a 5-point basic POCUS protocol for efficient assessment.This protocol includes evaluations of the kidneys and urinary bladder for obstructive nephropathy,lung ultrasound for detecting extravascular lung water,inferior vena cava(IVC)ultrasound for estimating right atrial pressure,internal jugular vein ultrasound as an alternative to IVC assessment,and focused cardiac ultrasound for assessing left ventricular(LV)systolic function and identifying potential causes of a plethoric IVC.Advanced POCUS delves into additional Doppler parameters,including stroke volume and cardiac output,LV filling pressures and venous congestion assessment to diagnose or prevent iatrogenic fluid overload.POCUS,when employed judiciously,enhances the diagnostic precision in evaluating AKI in cirrhotic patients,guiding appropriate therapeutic interventions,and minimizing the risk of fluid-related complications.

关键词： Point-of-care Ultrasound hemodynamic Right atrial pressure Hepatorenal Nephrology

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Hypotension prediction index together with cerebral oxygenation in guiding intraoperative hemodynamic management: a case report

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The Journal of Biomedical Research 2022年第1期36卷 73-77页

作者： Yun Li Janet Phan Azaam Mamoor Hong Liu Department of Anesthesiology the Second Hospital of Anhui Medical UniversityHefeiAnhui 230601China Department of Anesthesiology and Pain Medicine University of California Davis HealthSacramentoCA 95817USA California Northstate University College of Medicine SacramentoCA 95757USA

Intraoperative hypotension happens in everyday clinical practice. It was suggested to have a strong association with adverse postoperative outcomes. Hypotension prediction index(HPI) was developed to predict intraoperative hypotension(mean arterial pressure <65 mmHg) in real time. However, pressure autoregulation also plays an important role in maintaining adequate organ perfusion/oxygenation during hypotension. A cerebral oxygenation monitor provides clinicians with the values of organ oxygenation. We reported a case that the cerebral oxygenation monitor was used together with HPI to guide intraoperative blood pressure management. We found that cerebral oxygenation was maintained in the event of hypotension during surgery. The patient had no intraoperative or postoperative adverse outcomes despite the hypotension. We believe this can provide an individualized intraoperative blood pressure management to avoid over-or under-treating hypotension.

关键词： hypotension prediction index cerebral oxygenation hemodynamic intraoperative

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hemodynamic evaluation of different stent graft schemes in aortic arch covered stent implantation

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Medicine in Novel Technology and Devices 2022年第1期13卷 79-86页

作者： Jingxin Liu Xinyong Cai Yuliang Zhan Hongmin Zhu Haiyong Ao Yizao Wan Honglin Luo Zhiwei Yang Quanchao Zhang Jiangxi Key Laboratory of Nanobiomaterials Institute of Advanced MaterialsEast China Jiaotong UniversityNanchang330013China Department of Cardiology Jiangxi Provincial People's Hospital Affiliated to Nanchang UniversityNanchang330006China School of Materials Science and Engineering Tianjin UniversityTianjin300072China

Implantation of the left subclavian artery(LSA)stent graft used in fenestration technique of the thoracic endovascular aortic repair(TEVAR)may interfere with the aortic helical blood flow that is believed to have important protective functions against atherogenesis.The present study investigated four different LSA stent graft implantation schemes for their resulted blood flow patterns in the thoracic aortic with hemodynamic computational simulation methods:the flush branch(FB),the protruding branch(PB),the straight cuff branch(SCB)and the cured cuff branch(CCB).The results showed that the PB scheme could slightly enhance helicity of the swirling flow in the aorta,but the other three schemes had less effect on blood flow helicity.The PB scheme produced lowTAWSS,high-OSI and high-RRT around the LSA root,and the FB scheme had similar TAWSS,OSI and RRT in both value and distribution to those in the aorta without LSA stent graft implantation.The SCB and CCB schemes led to less area of high-OSI and high-RRT values along the walls of the LSA branch arteries.The results also showed that the PB scheme would significantly reduce blood supply to the LSA,on the contrary,the CCB scheme enhanced LSA blood supply and less effect on the total blood supply to the three branches of the thoracic aorta.In summary,all of the four schemes have no significant effect on the aortic swirling flow,however,in the terms of TAWSS,OSI,RRT and blood supply to the LSA,the CCB model might be the best option with less area of low-WSS,high-OSI,high-RRT and well blood supply in the LSA.

关键词： Helical flow Thoracic endovascular aortic repair Fenestration technique hemodynamic LSA stent Graft

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hemodynamic parameters obtained by transthoracic echocardiography and right heart catheterization： a comparative study in patients with pulmonary hypertension

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Chinese Medical Journal 2011年第12期124卷 1796-1801页

作者： TIAN Zhuang LIU Yong-tai FANG Quan NI Chao CHEN Tai-bo FANG Li-gang GAO Peng JIANG Xiu-chun LI Meng-tao ZENG Xiao-feng Department of Cardiology Peking Union Medical College Hospital Beijing 100730 China Department of Rheumatology Peking Union Medical College Hospital Beijing 100730 China

Background hemodynamic evaluation is crucial for the management of patients with pulmonary hypertention. Clinicians often prefer a rapid and non-invasive method. This study aimed to examine the feasibility of transthoracic echocardiography for the measurements of hemodynamic parameters in patients with pulmonary hypertension. Methods A prospective single-center study was conducted among 42 patients with pulmonary hypertension caused by different diseases. Transthoracic echocardiography and right-heart catheterization were performed within 24 hours. Pulmonary artery systolic, diastolic and mean pressure （PASP, PADP and PAMP）, cardiac output （CO）, and pulmonary capillary wedge pressure （PCWP） were measured by both methods. A linear correlation and a Bland-Altman analysis were performed to compare the two groups of hemodynamic parameters. Results A good correlation was found between invasive and non-invasive measurements for PASP （r=0.96）, PADP （r=0.85）, PAMP （r=0.88）, CO （r=0.82）, and PCWP （r=0.81）. Further agreement analysis done by the Bland-Altman method showed that bias and a 95% confidence interval for PASP, PADP, and CO were clinically acceptable while great discrepancies existed for PAMP and PCWP. Conclusions The non-invasive measurements by PASP, PADP, and CO in patients with pulmonary hypertension correlate well with the invasive determinations. Transthoracic echocardiography （TTE） was inappropriate for estimating PCWP and PAMP.

关键词： hemodynamic pulmonary hypertension echocardiography right heart catheterization

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hemodynamic management in brain dead donors

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World Journal of Transplantation 2021年第10期11卷 410-420页

作者： Chiara Lazzeri Manuela Bonizzoli Cristiana Guetti Giorgio Enzo Fulceri Adriano Peris Intensive Care Unit and Regional ECMO Referral Centre Azienda Ospedaliero Universitaria CareggiFlorence 50134Italy

Donor management is the key in the complex donation process,since up to 20%of organs of brain death donors(DBD)are lost due to hemodynamic instability.This challenge is made more difficult due to the lack of strong recommendations on therapies for hemodynamic management in DBDs and more importantly to the epidemiologic changes in these donors who are becoming older and with more comorbidities(marginal donors).In the present manuscript we aimed at summarizing the available evidence on therapeutic strategies for hemodynamic management(focusing on vasoactive drugs)and monitoring(therapeutic goals).Evidence on management in elderly DBDs is also summarized.Donor management continues critical care but with different and specific therapeutic goals since the number of donor goals met is related to the number of organs retrieved and transplanted.Careful monitoring of selected parameters(possibly including serial echocardiography)is the clinical tool able to guarantee the achievement and maintaining of therapeutic goals.Despide worldwide differences,norepinephrine is the vasoactive of choice in most countries but,whenever higher doses(>0.2 mcg/kg/min)are needed,a second vasoactive drug(vasopressin)is advisable.Hormonal therapy(desmopressin,corticosteroid and thyroid hormone)are suggested in all DBDs independently of hemodynamic instability.In the single patient,therapeutic regimen(imprimis vasoactive drugs)should be chosen also according to the potential organs retrievable(i.***.heart vs liver and kidneys).

关键词： Brain-dead donors hemodynamic Management Vasoactive drugs Hormanal therapy Echocardiography

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Applications of critical ultrasonography in hemodynamic therapy

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Chinese Medical Journal 2021年第11期134卷 1286-1288页

作者： Wei Huang Da-Wei Liu Xiao-Ting Wang Chinese Critical Ultrasound Study Group(CCUSG) Department of Critical Care Medicine Peking Union Medical College HospitalPeking Union Medical CollegeChinese Academy of Medical SciencesBeijing 100730China 不详

Critical ultrasonography(CUS)is used in almost every branch of critical care medicine because of rapid development of this technology.CUS enables goal-directed,continuous,and dynamic evaluation.The use of CUS in hemodynamic therapy provides a detailed understanding of hemodynamics and optimizes hemodynamic therapy.This article describes the current applications of CUS in hemodynamic therapy from various aspects.

关键词： ultrasonography hemodynamic technology.

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Can adequate hemodynamic management of brain-dead donors improve donor organ procurement?

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World Journal of Transplantation 2022年第4期12卷 79-82页

作者： Myat Soe Thet Alessandra Verzelloni Sef Davorin Sef Department of Cardiac Surgery St Bartholomew’s HospitalLondon EC1A 7BEUnited Kingdom Department of Surgery and Cancer Faculty of MedicineImperial College London&Imperial College Healthcare NHS TrustLondon W21NYUnited Kingdom Department of Anaesthesia and Critical Care Harefield HospitalRoyal Brompton and Harefield HospitalsPart of Guy’s and St Thomas’NHS Foundation TrustLondon UB96JHUnited Kingdom Department of Cardiothoracic Surgery and Transplant Unit Harefield HospitalRoyal Brompton and Harefield HospitalsPart of Guy’s and St Thomas’NHS Foundation TrustLondon UB96JHUnited Kingdom

There is increasing evidence that adequate donor management with a goal of optimization of organ function is essential to maximize the number of organs that can be procured.Therefore,identification of the cause of hemodynamic instability is crucial in order to direct the right therapy.Several donor management goals for better hemodynamic management including serial echocardiography can guide hemodynamic management in potential donors to increase both number and quality of donor hearts.

关键词： Brain-dead donors hemodynamic Management Organ procurement

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hemodynamic study of portal hypertension

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Hepatobiliary & Pancreatic Diseases International 2007年第5期6卷 457-458页

作者： Zhi-Yong Wu Department of General Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China Shanghai Jiao Tong Univ Dept Gen Surg Renji Hosp Sch Med Shanghai 200127 Peoples R China

Hyperdynamic circulation plays a critical role in the development and maintenance of portal hypertension. It is not only the main pathophysiological change in patients with portal

关键词： maintenance variceal cirrhotic hemodynamic shunt bleeding cirrhosis alone proximal stellate

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