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Cerebral misery perfusion due to carotid occlusive disease

Stroke & Vascular Neurology 2017年第2期2卷 88-93页

作者： Mohana Maddula Nikola Sprigg Philip M Bath Sunil Munshi Acute Stroke Unit Tauranga HospitalTaurangaNew Zealand Division of Clinical Neuroscience University of NottinghamNottinghamUK Department of Stroke Nottingham University Hospitals NHS TrustNottinghamUK

Purpose Cerebral misery perfusion(CMP)is a condition where cerebral autoregulatory capacity is exhausted,and cerebral blood supply in insufficient to meet metabolic demand.We present an educational review of this important condition,which has a range of clinical manifestations.Method A non-systematic review of published literature was undertaken on CMP and major cerebral artery occlusive disease,using Pubmed and Sciencedirect.Findings Patients with CMP may present with strokes in watershed territories,collapses and transient ischaemic attacks or episodic movements associated with an orthostatic component.While positron emission tomography is the gold standard investigation for misery perfusion,advanced MRI is being increasingly used as an alternative investigation modality.The presence of CMP increases the risk of strokes.In addition to the devastating effect of stroke,there is accumulating evidence of impaired cognition and quality of life with carotid occlusive disease(COD)and misery perfusion.The evidence for revascularisation in the setting of complete carotid occlusion is weak.Medical management constitutes careful blood pressure management while addressing other vascular risk factors.Discussion The evidence for the management of patients with COD and CMP is discussed,together with recommendations based on our local experience.In this review,we focus on misery perfusion due to COD.Conclusion Patients with CMP and COD may present with a wide-ranging clinical phenotype and therefore to many specialties.Early identification of patients with misery perfusion may allow appropriate management and focus on strategies to maintain or improve cerebral blood flow,while avoiding potentially harmful treatment.

关键词： perfusion carotid impaired

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Hypothermic oxygenated perfusion for a steatotic liver graft

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Hepatobiliary & Pancreatic Diseases International 2020年第1期19卷 88-90页

作者： Quirino Lai Franco Ruberto Fabio Melandro Zoe Larghi Laureiro Massimo Rossi Gianluca Mennini Department of General Surgery and Organ Transplantation Sapienza University of RomeRomeItaly Department of Anaesthesiology Critical Care Medicine and Pain TherapySapienza University of RomeRomeItaly

To the Editor:Donor steatosis represents a well-known risk factor for primary non-function,early allograft dysfunction,and biliary complications after liver transplantation(LT)[1,2].Recently,machine perfusion(MP)technology has been implemented in the clinical practice,with the primary intent to assess the graft quality and to optimize the organ selection process[3].A limited number of articles has been published specifically investigated the role of MP in steatotic livers[4–10],with few of them looking at the role of hypothermic MP.

关键词： perfusion liver graft

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Association of CT perfusion imaging with plasma levels of TGF-β1 and VEGF in patients with NSCLC

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Asian Pacific Journal of Tropical Medicine 2016年第2期9卷 175-177页

作者： Da-Wei Li Bao-Zhong Wu Yu-Sen Shi Zhi-Qun Li Xu-Dong Liu Xiao-Hua Li Radiology Department Affiliated Hospital of Hainan Medical College

Objective: To study the association of CT perfusion imaging parameters with plasma level of transforming growth factor-β1(TGF-β1) and vascular endothelial growth(VEGF) in patients with non small cell cancer(NSCLC). Methods: A total of 67 patients with NSCLC(NSCLC group) and 64 patients with benign lesion(control group) were given with CT perfusion imaging to obtain blood flow, blood volume, mean transit time, time to peal and permeability surface through CT perfusion software. The plasma levels of TGF-β1 and VEGF were tested by ELISA. The relationship between plasma levels of TGF-β1, VEGF and CT perfusion imaging parameters were analyzed. Results: CT perfusion imaging parameters and the plasma levels of TGF-β1 and VEGF of NSCLC group were significantly higher than the control group(Pperfusion parameters and the levels of TGF-β1 and VEGF in NSCLC group showed significant difference in different tumor node metastasis stages(Pperfusion imaging parameters in patients with NSCLC is closely associated with plasma TGF-β1, VEGF and its biological characteristics. CT perfusion imaging is a convenient method to detect tumor blood perfusion.

关键词： Non small cell lung cancer CT perfusion parameters Transforming growth factor-β1 Vascular endothelial growth

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Features of Computed Tomography perfusion of Mediastinal Lymphadenopathies:a Pathology-based Retrospective Study

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Chinese Medical Sciences Journal 2015年第3期30卷 162-169页

作者： Lin Ou-yang Guang-ming Lu Department of Radiology The PLA 175th Hospital Affiliated Southeast Hospital of Xiamen University Department of Radiology Nanjing General Hospital of Nanjing Military Command

Objective To explore the features of various mediastinal lymphadenopathies using computed tomography perfusion(CTP).Methods CTP parameters(CTPs) of the selected mediastinal nodes from 59 patients with pathology-proven malignant lymph nodes and of those from 29 patients with clinically diagnosed or pathology-proven inflammatory lymphadenopathies were collected.Patients were divided into subgroups by etiology and phase of primary disease,including different pathological malignant nodes and diverse inflammatory nodes.CTPs were defined as blood flow(BF),blood volume(BV),mean transit time(MTT),permeability(PMB),and time to peak(TTP).Differences of CTPs were compared between malignant and benign nodes,and among subgroups,respectively.Results In the mediastinum,no significant differences of CTPs were found between malignant and benign groups(all P>0.05),the same for subgroups of malignant nodes(all P>0.05).Acute lymphadenitis had higher BF and BV than chronic inflammatory,lymphoid tuberculosis,sarcoidosis and malignant nodes.The BF of malignant nodes was markedly slower than that of acute lymphadenitis(P=0.01),but faster than chronic inflammatory nodes(P=0.04) and sarcoidosis(P=0.03),with no significant difference compared with lymphoid tuberculosis.Pneumonia-complicated lymphoid tuberculosis showed the longest MTT while sarcoidosis displayed the shortest MTT,and inflammatory nodes,lymphoid tuberculosis without complicated pneumonia and malignant nodes had moderate MTT.Conclusion CTPs show promising potential in distinguishing various lymphadenopathies in the mediastinum,but more studies are needed to improve their specificity.

关键词： mediastinal lymphadenopathy computed tomography perfusion functional computed tomography

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Indocyanine green fluorescence angiography during liver and pancreas transplantation: a tool to integrate perfusion statement's evaluation

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Hepatobiliary Surgery and Nutrition 2018年第3期7卷 161-166页

作者： Fabrizio Panaro Enrico Benedetti Guillaume Pineton de Chambrun Hussein Habibeh Piera Leon Hassan Bouyabrine Astrid Herrero Francis Navarro Department of General Surgery Division of TransplantationUniversity of Montpellier-College of MedicineSaint Eloi HospitalMontpellier-Cedex 5France Division of Transplantation University of Illinois Hospital and Health Sciences SystemChicagoILUSA Department of Medicine Division of GastroenterologyHospital St.EloiMontpellier University HospitalAugustin Fliche34295-MontpellierFrance

Background: Indocyanine green (ICG) fluorescence imaging is a promising tool for intraoperative decision-making during surgical procedures, in particular to assess organs perfusion. Methods: We used the ICG fluorescence during liver transplantations in six cirrhotic patients to help assessing the graft biliary duct perfusion in order to identify the appropriate level to perform the anastomosis. We also used ICG fluorescence also in five patients receiving kidney-pancreas transplantation to evaluate the perfusion levels of the duodenal stump of the pancreas graft. Results: Follow-up period for the patients was 12 months. The perioperative period was uneventful, no biliary complications such as leaks or stenosis were reported after liver transplantation, no complications of the entero-enteric anastomoses occurred after pancreatic transplantation. Conclusions: ICG fluorescence seems to safely provide important objectifiable perfusion information during organ transplantation procedures that can integrate surgeon's expertise. In fact, detecting intra-operatively perfusion defects, it allows real time modifications on technical strategies potentially useful to reduce the feared risk of anastomotic leakage and consequent severe complications.

关键词： Indocyanine green (ICG) liver pancreas transplantation perfusion

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Effect of different twirling and rotating acupuncture manipulation techniques on the blood flow perfusion at acupoints

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Journal of Traditional Chinese Medicine 2019年第5期39卷 730-739页

作者： Xu Gang Xi Qianhui Tang Wenchao Liu Tangyi Gao Ming Li Shaoxiong Wen Junling Yang Huayuan School of Acupuncture-Moxibustion and Tuina Shanghai University of Traditional Chinese Medicine

OBJECTIVE: To analyze the effect of different twirling and rotating acupuncture manipulation techniques on the blood flow perfusion at acupoints to provide a reference for the study of acupoint specificity and the quantification and effectiveness of acupuncture methods. METHODS: Twenty healthy male or female college students each received four different acupuncture manipulation techniques, including simple acupuncture, uniform reinforcing-reducing needling, twirling reinforcing needling, and twisting reducing needling. The self-control method was applied. Acupuncture was performed by an acupuncture manipulation simulator at Neiguan (PC 6) and Zusanli (ST 36). The process of twirling and rotating was divided into seven timepoints. The PeriCam perfusion Speckle Imager (PSI) System was used to collect the blood flow perfusion data at each acupoint. The specificity of twirling and rotating acupuncture manipulation was analyzed based on changes in the curve, video, and numerical blood flow perfusion data at each timepoint. RESULTS: There were two peaks in the blood flow perfusion curve of twirling and rotating acupuncture manipulation;one appeared after 3 min of needle retention, and the other appeared 3 min after needle removal. The blood flow perfusion parameters showed that the greatest differences between the four manipulation techniques occurred after 5 and 10 min of needle retention. The specificity of various manipulation techniques was most obvious at these two timepoints. There were significant differences between the four manipulation groups in the blood flow perfusion and the relative change rates of blood flow perfusion at each timepoint. CONCLUSION: Laser speckle imaging enables the real-time, non-invasive, rapid, and accurate collection of blood flow perfusion data during acupuncture. This imaging technique enables the easy attainment of various parameters such as visual images, two-dimensional curves, and data tables. At various timepoints, the four groups significantly differed regarding changes in blo

关键词： Acupuncture Sensitivity and specificity Blood flow perfusion Laser speckle imaging

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Machine perfusion strategies in liver transplantation

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Hepatobiliary Surgery and Nutrition 2019年第5期8卷 490-501页

作者： Andrea Schlegel Xavier Muller Philipp Dutkowski Liver Unit Queen Elizabeth HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK Centre for Liver and Gastrointestinal Research Institute of Immunology and ImmunotherapyCollege of Medical and Dental SciencesUniversity of BirminghamBirminghamUK Department of Surgery and Transplantation University Hospital ZurichZurichSwitzerland

Machine perfusion is a hot topic in liver transplantation and several new perfusion conceptsare currently developed.Prior to introduction into routine clinical practice,however,such perfusionapproaches need to demonstrate their impact on liver function,post-transplant complications,utilizationrates of high-risk organs,and cost benefits.Therefore,based on results of experimental and clinical studies,the community has to recognize the limitations of this technology.In this review,we summarize currentperfusion concepts and differences between protective mechanisms of ex-and in-situ perfusion techniques.Next,we discuss which graft types may benefit most from perfusion techniques,and highlight the currentunderstanding of liver viability testing.Finally,we present results from recent clinical trials involvingmachine liver perfusion,and analyze the value of different outcome parameters,currently used as endpointsfor randomized controlled trials in the field.

关键词： Machine perfusion clinical trials viability assessment

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A study on continuous low-flow perfusion with low-potassium dextran for donor isolated lung preservation

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Chinese Medical Journal 1998年第1期111卷 49-51页

作者：邱罕凡廖崇先陈道中 Department of Cardiovascular Surgery Union Hospital Fujian Medical University Fuzhou 350001 China

OBJECTIVE: To test the validity of continuous low-flow perfusion with low-potassium dextran (LPD) to preserve rabbit lung. METHODS: Isolated rabbit lungs were preserved for eight hours either in Ringer's solution by simple storage (Group I) or in continuous low-flow perfusion with LPD (Group II). After preservation, lung functions were assessed to compare these two methods. RESULTS: The water gain in Group I was higher than that in Group II. During reperfusion, the functional test values for the immersed lungs were lower than those for the perfused lungs. The lipid peroxidation product (MDA) was significantly decreased in perfused lungs during reperfusion. CONCLUSIONS: Low-flow perfusion with LPD is better than immersion for the lung preservation.

关键词： Dextrans Lung Organ Preservation Solutions Potassium Animals Comparative Study In Vitro Male Organ Preservation perfusion Rabbits

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Value of cerebral perfusion and vascular reserve for the treatment of symptomatic intracranial arterial stenosis

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Neural Regeneration Research 2008年第1期3卷 79-82页

作者： Li＇an Huang Xuewen Song Anding Xu Department of Neurology First Affiliated Hospital of Jinan University Guangdong 510632 Guangzhou Province China

BACKGROUND： It is crucial to understand cerebral perfusion and vascular reserve in stegnotic arterial blood-supply regions to treat ischemic cerebrovascular diseases. However, effects on symptomatic intracranial arterial stenosis （SICAS） need to be further studied in additional applications. OBJECTIVE： To evaluate and summarize the effects of cerebral perfusion and vascular reserve on the treatment of SICAS. RETRIEVAL STRATEGY： A computer-based online search of English language publications from January 2000 to July 2007 was conducted in PubMed to identify publications that addressed cerebral perfusion and vascular reserve of SICAS. Search key words were ＂intracranial stenosis, perfusion, brain reserve＂. Relevant data were also searched with the China Journal Net, using the same key words in Chinese from January 2000 to January 2007. In total, 101 articles were retrieved. Inclusion criteria：（1） Articles describing the current status for the diagnosis and treatment of SICAS; （2） Articles concerning research developments of cerebral perfusion and vascular reserve of SICAS. Exclusion criteria： duplicated articles. LITERATURE EVALUATION： This study included 21 articles of experimental studies and conference reports. DATA SYNTHESIS： When performing interventional surgery in SICAS patients, it is important to understand cerebral perfusion and vascular reserve in addition to knowing the clinical symptoms and degrees of arterial stenosis. In recent years, there are a growing number of reports on measurements of vascular reserve through the use of magnetic resonance perfusion imaging （MR-PWI）. Investigations demonstrate cerebral perfusion and vascular reserve decrease in many SICAS patients. Many studies show that both improve after surgical intervention. CONCLUSION： Cerebral perfusion could provide direct evidence of whether ischemia has occurred in the brain. Because of lateral circulation and cerebral vascular reserve, intracranial vascular stenosis and/or decreased intracranial vascular blood-flow does not suggest de

关键词： intracranial stenosis perfusion brain reserve

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Comment on“Hypothermic machine perfusion in liver transplantation-a randomized trial”

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Hepatobiliary Surgery and Nutrition 2021年第3期10卷 364-366页

作者： Fabien Robin Heithem Jeddou Department of Hepatobiliary and Digestive Surgery University HospitalRennes 1 UniversityRennesFrance INSERM U1242 Chemistry Oncogenesis Stress SignalingRennes 1 UniversityRennesFrance

We read with great interest the article by van Rijn et al.published in March 2021,in The New England Journal of Medicine(1).In this multicenter,randomized controlled trial,the authors investigated the efficacy of dual hypothermic oxygenated perfusion(D-HOPE)versus static cold storage(SCS)in grafts from donors after cardiac death(DCD)to decrease the rate of non-anastomotic biliary stenosis(NAS)within the first 6 post-transplant months.

关键词： randomized therm perfusion

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