Browsing by Subject "Blood Flow Velocity"

Now showing 1 - 4 of 4

Open Access
Assessment of Coronary Blood Flow by Transesophageal Echocardiography.
(J Cardiothorac Vasc Anesth, 2016-01) Maxwell, Cory; Cherry, Anne; Daneshmand, Mani; Swaminathan, Madhav; Nicoara, Alina
Open Access
Differentiating sensitivity of post-stimulus undershoot under diffusion weighting: implication of vascular and neuronal hierarchy.
(PLoS One, 2008-08-13) Harshbarger, Todd B; Song, Allen W
The widely used blood oxygenation level dependent (BOLD) signal during brain activation, as measured in typical fMRI methods, is composed of several distinct phases, the last of which, and perhaps the least understood, is the post-stimulus undershoot. Although this undershoot has been consistently observed, its hemodynamic and metabolic sources are still under debate, as evidences for sustained blood volume increases and metabolic activities have been presented. In order to help differentiate the origins of the undershoot from vascular and neuronal perspectives, we applied progressing diffusion weighting gradients to investigate the BOLD signals during visual stimulation. Three distinct regions were established and found to have fundamentally different properties in post-stimulus signal undershoot. The first region, with a small but focal spatial extent, shows a clear undershoot with decreasing magnitude under increasing diffusion weighting, which is inferred to represent intravascular signal from larger vessels with large apparent diffusion coefficients (ADC), or high mobility. The second region, with a large continuous spatial extent in which some surrounds the first region while some spreads beyond, also shows a clear undershoot but no change in undershoot amplitude with progressing diffusion weighting. This would indicate a source based on extravascular and small vessel signal with smaller ADC, or lower mobility. The third region shows no significant undershoot, and is largely confined to higher order visual areas. Given their intermediate ADC, it would likely include both large and small vessels. Thus the consistent observation of this third region would argue against a vascular origin but support a metabolic basis for the post-stimulus undershoot, and would appear to indicate a lack of sustained metabolic rate likely due to a lower oxygen metabolism in these higher visual areas. Our results are the first, to our knowledge, to suggest that the post-stimulus undershoots have a spatial dependence on the vascular and neuronal hierarchy, and that progressing flow-sensitized diffusion weighting can help delineate these dependences.
Open Access
High-speed label-free functional photoacoustic microscopy of mouse brain in action.
(Nat Methods, 2015-05) Yao, Junjie; Wang, Lidai; Yang, Joon-Mo; Maslov, Konstantin I; Wong, Terence TW; Li, Lei; Huang, Chih-Hsien; Zou, Jun; Wang, Lihong V
We present fast functional photoacoustic microscopy (PAM) for three-dimensional high-resolution, high-speed imaging of the mouse brain, complementary to other imaging modalities. We implemented a single-wavelength pulse-width-based method with a one-dimensional imaging rate of 100 kHz to image blood oxygenation with capillary-level resolution. We applied PAM to image the vascular morphology, blood oxygenation, blood flow and oxygen metabolism in both resting and stimulated states in the mouse brain.
Open Access
Hydroxycarbamide versus chronic transfusion for maintenance of transcranial doppler flow velocities in children with sickle cell anaemia-TCD With Transfusions Changing to Hydroxyurea (TWiTCH): a multicentre, open-label, phase 3, non-inferiority trial.
(Lancet, 2016-02-13) Ware, Russell E; Davis, Barry R; Schultz, William H; Brown, R Clark; Aygun, Banu; Sarnaik, Sharada; Odame, Isaac; Fuh, Beng; George, Alex; Owen, William; Luchtman-Jones, Lori; Rogers, Zora R; Hilliard, Lee; Gauger, Cynthia; Piccone, Connie; Lee, Margaret T; Kwiatkowski, Janet L; Jackson, Sherron; Miller, Scott T; Roberts, Carla; Heeney, Matthew M; Kalfa, Theodosia A; Nelson, Stephen; Imran, Hamayun; Nottage, Kerri; Alvarez, Ofelia; Rhodes, Melissa; Thompson, Alexis A; Rothman, Jennifer A; Helton, Kathleen J; Roberts, Donna; Coleman, Jamie; Bonner, Melanie J; Kutlar, Abdullah; Patel, Niren; Wood, John; Piller, Linda; Wei, Peng; Luden, Judy; Mortier, Nicole A; Stuber, Susan E; Luban, Naomi LC; Cohen, Alan R; Pressel, Sara; Adams, Robert J
BACKGROUND: For children with sickle cell anaemia and high transcranial doppler (TCD) flow velocities, regular blood transfusions can effectively prevent primary stroke, but must be continued indefinitely. The efficacy of hydroxycarbamide (hydroxyurea) in this setting is unknown; we performed the TWiTCH trial to compare hydroxyurea with standard transfusions. METHODS: TWiTCH was a multicentre, phase 3, randomised, open-label, non-inferiority trial done at 26 paediatric hospitals and health centres in the USA and Canada. We enrolled children with sickle cell anaemia who were aged 4-16 years and had abnormal TCD flow velocities (≥ 200 cm/s) but no severe vasculopathy. After screening, eligible participants were randomly assigned 1:1 to continue standard transfusions (standard group) or hydroxycarbamide (alternative group). Randomisation was done at a central site, stratified by site with a block size of four, and an adaptive randomisation scheme was used to balance the covariates of baseline age and TCD velocity. The study was open-label, but TCD examinations were read centrally by observers masked to treatment assignment and previous TCD results. Participants assigned to standard treatment continued to receive monthly transfusions to maintain 30% sickle haemoglobin or lower, while those assigned to the alternative treatment started oral hydroxycarbamide at 20 mg/kg per day, which was escalated to each participant's maximum tolerated dose. The treatment period lasted 24 months from randomisation. The primary study endpoint was the 24 month TCD velocity calculated from a general linear mixed model, with the non-inferiority margin set at 15 cm/s. The primary analysis was done in the intention-to-treat population and safety was assessed in all patients who received at least one dose of assigned treatment. This study is registered with ClinicalTrials.gov, number NCT01425307. FINDINGS: Between Sept 20, 2011, and April 17, 2013, 159 patients consented and enrolled in TWiTCH. 121 participants passed screening and were then randomly assigned to treatment (61 to transfusions and 60 to hydroxycarbamide). At the first scheduled interim analysis, non-inferiority was shown and the sponsor terminated the study. Final model-based TCD velocities were 143 cm/s (95% CI 140-146) in children who received standard transfusions and 138 cm/s (135-142) in those who received hydroxycarbamide, with a difference of 4·54 (0·10-8·98). Non-inferiority (p=8·82 × 10(-16)) and post-hoc superiority (p=0·023) were met. Of 29 new neurological events adjudicated centrally by masked reviewers, no strokes were identified, but three transient ischaemic attacks occurred in each group. Magnetic resonance brain imaging and angiography (MRI and MRA) at exit showed no new cerebral infarcts in either treatment group, but worsened vasculopathy in one participant who received standard transfusions. 23 severe adverse events in nine (15%) patients were reported for hydroxycarbamide and ten serious adverse events in six (10%) patients were reported for standard transfusions. The most common serious adverse event in both groups was vaso-occlusive pain (11 events in five [8%] patients with hydroxycarbamide and three events in one [2%] patient for transfusions). INTERPRETATION: For high-risk children with sickle cell anaemia and abnormal TCD velocities who have received at least 1 year of transfusions, and have no MRA-defined severe vasculopathy, hydroxycarbamide treatment can substitute for chronic transfusions to maintain TCD velocities and help to prevent primary stroke. FUNDING: National Heart, Lung, and Blood Institute, National Institutes of Health.