Regional dynamic cerebral autoregulation across anterior and posterior circulatory territories:A detailed exploration and its clinical implications

Cerebral autoregulation(CA)is the mechanism that maintains stable cerebral blood flow(CBF)despite fluctuations in systemic blood pressure,crucial for brain homeostasis.Recent evidence highlights distinct regional variations in CA between the anterior(carotid)and posterior(vertebrobasilar)circulations.Noninvasive neuromonitoring techniques,such as transcranial Doppler,transfer function analysis,and near-infrared spectroscopy,facilitate the dynamic assessment of CBF and autoregulation.Studies indicate a robust autoregulatory capacity in the anterior circulation,characterized by rapid adjustments in vascular resistance.On the contrary,the posterior circulation,mainly supplied by the vertebral arteries,may have a lower autoregulatory capacity.in acute brain injuries such as intracerebral and subarachnoid hemorrhage,and traumatic brain injuries,dynamic CA can be significantly altered in the posterior circulation.Proposed physiological mechanisms of impaired CA in the posterior circulation include:(1)Decreased sympathetic innervation of the vasculature impairing compensatory vasoreactivity;(2)Endothelial dysfunction;(3)Increased cerebral metabolic rate of oxygen consumption within the visual cortex causing CBFmetabolism(i.e.,neurovascular)uncoupling;and(4)Impaired blood-brain barrier integrity leading to impaired astrocytic mediated release of vasoactive substances(e.g.nitric oxide,potassium,and calcium ions).Furthermore,more research is needed on the effects of collateral circulation,as well as the circle of Willis variants,such as the fetal-type posterior cerebral artery,on dynamic CA.Improving our understanding of these mechanisms is crucial to improving the diagnosis,prognosis,and management of various cerebrovascular disorders.

Splanchnic vasodilation and hyperdynamic circulatory syndrome in cirrhosis

Portal hypertension is a clinical syndrome which leads to several clinical complications, such as the formation and rupture of esophageal and/or gastric varices, ascites, hepatic encephalopathy and hepato-renal syndrome. In cirrhosis, the primary cause of the increase in portal pressure is the enhanced resistance to portal outflow. However, also an increase in splanchnic blood flow worsens and maintains portal hypertension. The vasodilatation of arterial splanchnic vessels and the opening of collateral circulation are the determinants of the increased splanchnic blood flow. Several vasoactive systems/substances, such as nitric oxide, cyclooxygenase-derivatives, carbon monoxide and endogenous cannabinoids are activated in portal hypertension and are responsible for the marked splanchnic vasodilatation. Moreover, an impaired reactivity to vasoconstrictor systems, such as the sympathetic nervous system, vasopressin, angiotensin II and endothelin-1, plays a role in this process. The opening of collateral circulation occurs through the reperfusion and dilatation of preexisting vessels, but also through the generation of new vessels. Splanchnic vasodilatation leads to the onset of the hyperdynamic circulatory syndrome, a syndrome which occurs in patients with portal hypertension and is characterized by increased cardiac output and heart rate, and decreased systemic vascular resistance with low arterial blood pressure. Understanding the pathophysiology of splanchnic vasodilatation and hyperdynamic circulatory syndrome is mandatory for the prevention and treatment of portal hypertension and its severe complications.

CFD Investigation of the Influence of Volute Geometrical Variations on Hydrodynamic Characteristics of Circulator Pump

Improper design of volute geometry can be the main cause that leads to unsteady pressure pulsation and radial force in pumps. Therefore, it is important to understand the influence of volute geometrical parameters on hydrodynamic characteristics of pump and the mechanism. However, the existing studies are limited to investigate the influence of only one or two volute geometrical parameters each time, and a systematic study of the influence of the combinations of different volute geometrical parameters on the pump＇s hydrodynamic characteristics is missing. In this paper, a study on the understanding of the influence of volute geometrical variations on hydrodynamic characteristics of a high speed circulator pump by using computational fluid dynamics（CFD） technology is presented. Five main volute geometrical parameters D3, A8, a0, j0 and Rt are selected and 25 different volute configurations are generated by using design of experiments（DOE） method. The 3D unsteady flow numerical simulations, which are based on the SST k-w turbulence model and sliding mesh technique provided by CFX, are executed on the 25 different volute configurations. The hydraulic performance, pressure pulsation and unsteady radial force inside the pump at design condition are obtained and analyzed. It has been found that volute geometrical parameters D3 and A8 are major influence factors on hydrodynamic characteristics of the pump, while a0, j0 and Rt are minor influence factors. The minimum contribution from both D3 and A8 is 58% on head, and maximum contribution from both D3 and A8 is 90% on pressure pulsation. Regarding the pressure pulsation intensity, two peaks can be found. One is in the tongue area and the other is in the diffusor area. The contributions are around 60% from tongue and 25% from diffusor, respectively. The amplitude of pressure pulsation has a quadratic polynomial functional relationship with respect to D3/D2 and A8/A（10）, and fluctuating level of radial force has a quadratic polynomial functional relationship with respect to D3/D2. While for the other volute parameters a0, j0 and Rt, no special function has been found related to pressure pulsation and radial force. The presented work could be a useful guideline in engineering practice when designing a circulator pump with low hydrodynamic force.

Local regulator adrenomedullin contributes to the circulatory disturbance in cirrhotic rats

AIM： To investigate whether adrenomedullin, a potent vasodilator peptide, plays a role in the circulatory disturbance in cirrhosis. METHODS： Cirrhosis was induced in rats by weekly gavage of carbon tetrachloride. Hemodynamic studies were performed in vivo using radioactive microspheres and in vitro using isolated aortic rings. The adrenomedullin concentrations were measured by radioimmunoassay. RESULTS： Acute administration of adrenomedullin to the control rats reduced the systemic arterial pressure along with an increase of serum levels of the stable metabolite of nitric oxide （NOx）, in a dose-dependent manner. Chronic infusion of adrenomedullin reduced the vascular resistance and increased the blood flow in the systemic and splanchnic circulation. Intravenous administration of anti-adrenomedullin antibody did not affect any hemodynamic parameters in the cirrhotic rats, whereas this antibody ameliorated the blunted contractile response to phenylephrine, o-adrenergic receptor agonist, in the aortic rings of the cirrhotic rats. The adrenomedullin concentrations in the aorta were higher in the cirrhotic rats than in the controls, and correlated with the mean arterial pressure in the cirrhotic rats. Moreover, adrenomedullin blunted the contractile response to phenylephrine in both of the control aorta and cirrhotic aorta, but not in the presence of NG-nitro L-arginine methyl ester, an NO synthase inhibitor. CONCLUSION： Adrenomedullin overproduced in the vascular wall may contribute to the circulatory disturbance in cirrhosis as a local regulator of the vascular tonus rather than a circulating hormone.

Elevated Ferrite Film Circulator with Different Permittivities for Layers: An Analytical Expression for the Input Conductance Employing Perturbation Method

The main idea of this paper is to find an analytical formula for the input conductance of an elevated ferrite film circu-lator to match it systematically to the desired matching network. For solving the ferrite loaded dielectric resonator included in stripline elevated ferrite film circulator, the off diagonal components of the permeability tensor are taken as the perturbation. The electromagnetic fields computations are done for unperturbed structure. The dipolar resonant frequencies corresponding to harmonics of the resonant modes are then calculated using the perturbation integrals. The quality factor of the circulator is derived in terms of these dipolar resonant frequencies. Energy integrals are calculated to find the energy stored in the ferrite and dielectic layers. An analytical expression for the input conductance of the elevated ferrite film circulators is derived by using the quality factor and energy integrals. In this expression the ferrite and dielectric layers can have different permittivities. Some discussions about the effect of ferrite film thickness and permittivity mismatch on the bandwidth of the circulator are investigated by HFSS commercial software.

Preparation and Magnetic Properties of SrFe12O19 Ferrites Suitable for Use in Self-Biased LTCC Circulators

Strontium ferrites with different Bi2O3 content are prepared by the solid phase method, and their magnetic properties are investigated primarily. The Bi2O3 additive and sintering temperature separately exhibit a strong effect on the sintering density, crystal structure, and magnetic properties of the ferrites. As to the ferrites with 3 wt% Bi2O3, the relatively high sintering density ρs, saturation magnetization Ms, and intrinsic coercivity HCi can be obtained at a low sintering temperature of 900℃ even much lower. Furthermore, the effective magnetic anisotropy constant Keff and magnetic anisotropy field Ha of the ferrites are calculated from the magnetization curve by the law of approach to saturation. It is suggested that the low-temperature sintered SrFe12O19 ferrites with Ms of 285.6 kA/m and Ha of 1564.6 kA/m possess a significant potentiality for applying in the self-biased low-temperature co-fired ceramics circulators from 34 to 40GHz.

Design and verification of a broadband highly-efficient plasmonic circulator

Circulators play a significant role in radar and microwave communication systems.This paper proposes a broadband and highly efficient plasmonic circulator,which consists of spoof surface plasmon polaritons(SSPPs)waveguides and ferrite disks to support non-reciprocal mode coupling.The simulated performance of symmetrically designed circulator shows that it has an insertion loss of roughly 0.5 dB while the isolation and return loss is more than 12 dB in the frequency range of 6.0 GHz–10.0 GHz(relative bandwidth of 50%).Equivalent circuit model has been proposed to explain the operating mechanism of the plasmonic circulator.The equivalent circuit model,numerical simulations,and experimental results are consistent with each other,which demonstrates the good performance of the proposed plasmonic circulator.

Analysis of the injection-locked magnetron with a mismatched circulator

Based on the scatter matrix of the four-port lossless mismatched circulator, the phase differential equation of the injection-locked magnetron is derived by comparing different effects of the mismatched and perfect circulator on the injection ratio. Besides, the locking range of the injection-locked magnetron with the mismatched circulator is deduced by functional operation. In addition, the phase differential equation and the locked bandwidth of the injection-locked system with a mismatched circulator are compared with those of the small injection-ratio case with a perfect circulator. The in- fluence of the circulator reflection coefficient on the injection-locked magnetron is also analyzed by numerical calculation. Theoretical analysis shows that the decrement of the locked bandwidth is less than 1% and decrement of the stable phase difference is less than 1.2% when the reflection coefficient is less than 0.1.

CPW Circulators with Barium Ferrite Thin Films

A miniaturized circulator using barium ferrite films with a coplanar waveguide （CPW） structure is designed and optimized by high frequency electromagnetic field simulations based on finite element methods. The best circulation performance of the film circulator based on 10 pm thick barium ferrite thin films is obtained with an insertion loss of 0.13 dB and an isolation of 22.89 dB around 36.9 GHz. The microwave characteristics of film circulators with CPW and CPW with ground （CPWG） structures have been compared. The influences of the gap between the ground and the signal line, and the ferromagnetic resonance line width on the microwave properties are also studied.

A New Design Method for the Octave-Band Stripline Circulators

In this paper, a new design method for high performance octave-band stripline circulator is given. The optimum design program is given by a construction with double-Y junction aided by a section of quarter-wavelength impedance transformer. All the calculation is simpler than that given by Y. S. Wu, et al[1-7]. Typical performances of the 2-4GHz Y-junction stripline circulator are insertion loss 0.35dB (max), isolation 21dB (min), VSWR 1.25 (max). An octave low-loss and high isolation performance is demonstrated without the need of repeated design cycles.

Heparin improves organ microcirculatory disturbances in caerulein-induced acute pancreatitis in rats

AIM:Microcirculatory disturbances are important early pathophysiological events in various organs during acute pancreatitis.The aim of the study was to evaluate changes in microperfusion of the pancreas,liver,kidney,stomach, colon,skeletal muscle,and to investigate the influence of heparin on the organ microcirculation in caerulein-induced experimental acute pancreatitis. METHODS:Acute pancreatitis was induced by 4 intraperitoneal injections of caerulein(Cn)(15 μg/kg).The organ microcirculation was measured by laser Doppler flowmetry.Serum interleukin 6 and hematocrit levels were analysed. RESULTS:Acute pancreatitis resulted in a significant drop of microperfusion in all examined organs.Heparin administration(2×2.5 mg/kg)improved the microcirculation in pancreas(36.9±4% vs 75.9±10%),liver(56.6±6% vs 75.2±16%),kidney (45.1±6% vs 79.3±5%),stomach (65.2±8% vs 78.1±19%),colon(69.8±6% vs 102.5±19%), and skeletal muscle (59.2±6% vs 77.9±13%).Heparin treatment lowered IL-6(359.0±66 U/mL vs 288.5±58 U/mL) and hematocrit level(53±4% vs 46±3%). CONCLUSION:Heparin administration has a positive influence on organ microcirculatory disturbances accompanying experimental Cn-induced acute pancreatitis.

Supplementing Qi and activating blood circulation method to treat vertebrobasilar dolichoectasia with posterior circulatory watershed infarction:a case report of two patients

Vertebrobasilar dolichoectasia(VBD),a rare posterior circulation vascular variant disease,is an important risk factor for many acute cerebrovascular diseases.An insufficient understanding of VBD often leads to misdiagnose.Two cases of VBD that were initially diagnosed as posterior circulation watershed infarction are reported here.Absence of common causes of stroke including hypoperfusion,blood system diseases,carotid and aortic dissection,and eosinophil elevation,the symptoms of the 2 patients met the diagnostic criteria of VBD.Both patients displayed symptoms that were in line with the Traditional Chinese Medicine(TCM)syndrome pattern of"Qi deficiency and blood stasis".Accordingly,they were comprehensively treated with Supplementing Qi and activating blood circulation method.The clinical manifestations of the 2 patients were remarkably improved and no recurrence of watershed infarction was found in a 1-year follow-up.A detailed medical history and laboratory examination are capable of improving diagnostic accuracy of VBD.TCM treatment based on syndrome identification might be a promising candidate for VBD management.

Exercise training mode effects on myokine expression in healthy adults:A systematic review with meta-analysis

Background:The benefits of exercise are well known;however,many of the underlying molecular mechanisms are not fully understood.Skeletal muscle secretes myokines,which mediate muscleorgan crosstalk.Myokines regulate satellite-cell proliferation and migration,inflammatory cascade,insulin secretion,angiogenesis,fatty oxidation,and cancer suppression.To date,the effects of different exercise modes(namely,aerobic and resistance exercise)on myokine response remain to be elucidated.This is crucial considering the clinical implementation of exercise to enhance general health and wellbeing and as a medical treatment.Methods:A systematic search was undertaken in PubMed,MEDLINE,CINAHL,Embase,SPORTDiscus,andWeb of Science in April 2023.Eligible studies examining the effects of a single bout of exercise on interleukin15(IL-15),irisin,secreted protein acidic and rich in cysteine(SPARC),oncostatinM(OSM),and decorin were included.A random-effects meta-analysis was also undertaken to quantify the magnitude of change.Results:Sixty-two studies were included(n=1193).Overall,exercise appeared to induce small to large increases in myokine expression,with effects observed immediately after to 60 min post-exercise,although these were mostly not statistically significant.Both aerobic and resistance exercise resulted in changes in myokine levels,without any significant difference between training modes,and with the magnitude of change differing across myokines.Myokine levels returned to baseline levels within 180 min to 24 h post-exercise.However,owing to potential sources of heterogeneity,most changes were not statistically significant,indicating that precise conclusions cannot be drawn.Conclusion:Knowledge is limited but expanding with respect to the impact of overall and specific effects of exercise on myokine expression at different time points in the systemic circulation.Further research is required to investigate the effects of different exercise modes at multiple time points on myokine response.

Circulating tumor DNA in liquid biopsy: Current diagnostic limitation

With the rapid development of science and technology,cell-free DNA(cfDNA)is rapidly becoming an important biomarker for tumor diagnosis,monitoring and prognosis,and this cfDNA-based liquid biopsy technology has great potential to become an important part of precision medicine.cfDNA is the total amount of free DNA in the systemic circulation,including DNA fragments derived from tumor cells and all other somatic cells.Tumor cells release fragments of DNA into the bloodstream,and this source of cfDNA is called circulating tumor DNA(ctDNA).cfDNA detection has become a major focus in the field of tumor research in recent years,which provides a new opportunity for non-invasive diagnosis and prognosis of cancer.In this paper,we discuss the limitations of the study on the origin and dynamics analysis of ctDNA,and how to solve these problems in the future.Although the future faces major challenges,it also con-tains great potential.

α-Synuclein pathology from the body to the brain:so many seeds so close to the central soil

α-Synuclein is a protein that mainly exists in the presynaptic terminals.Abnormal folding and accumulation of α-synuclein are found in several neurodegenerative diseases,including Parkinson’s disease.Aggregated and highly phospho rylated a-synuclein constitutes the main component of Lewy bodies in the brain,the pathological hallmark of Parkinson s disease.For decades,much attention has been focused on the accumulation of α-synuclein in the brain parenchyma rather than considering Parkinson s disease as a systemic disease.Recent evidence demonstrates that,at least in some patients,the initial α-synuclein pathology originates in the peripheral organs and spreads to the brain.Injection of α-synuclein preformed fibrils into the gastrointestinal tra ct trigge rs the gutto-brain propagation of α-synuclein pathology.However,whether α-synuclein pathology can occur spontaneously in peripheral organs independent of exogenous α-synuclein preformed fibrils or pathological α-synuclein leakage from the central nervous system remains under investigation.In this review,we aimed to summarize the role of peripheral α-synuclein pathology in the pathogenesis of Parkinson’s disease.We also discuss the pathways by which α-synuclein pathology spreads from the body to the brain.

Exploring non-invasive diagnostics for metabolic dysfunctionassociated fatty liver disease

The population with metabolic dysfunction-associated fatty liver disease(MAFLD)is increasingly common worldwide.Identification of people at risk of progression to advanced stages is necessary to timely offer interventions and appropriate care.Liver biopsy is currently considered the gold standard for the diagnosis and staging of MAFLD,but it has associated risks and limitations.This has spurred the exploration of non-invasive diagnostics for MAFLD,especially for steatohepatitis and fibrosis.These non-invasive approaches mostly include biomarkers and algorithms derived from anthropometric measurements,serum tests,imaging or stool metagenome profiling.However,they still need rigorous and widespread clinical validation for the diagnostic performance.

Genetic screening of liver cancer:State of the art

Liver cancer,primarily hepatocellular carcinoma,remains a global health challenge with rising incidence and limited therapeutic options.Genetic factors play a pivotal role in the development and progression of liver cancer.This state-of-the-art paper provides a comprehensive review of the current landscape of genetic screening strategies for liver cancer.We discuss the genetic underpinnings of liver cancer,emphasizing the critical role of risk-associated genetic variants,somatic mutations,and epigenetic alterations.We also explore the intricate interplay between environmental factors and genetics,highlighting how genetic screening can aid in risk stratification and early detection via using liquid biopsy,and advancements in high-throughput sequencing technologies.By synthesizing the latest research findings,we aim to provide a comprehensive overview of the state-of-the-art genetic screening methods for liver cancer,shedding light on their potential to revolutionize early detection,risk assessment,and targeted therapies in the fight against this devastating disease.

Liquid biopsy for gastric cancer:Techniques,applications,and future directions

After the study of circulating tumor cells in blood through liquid biopsy(LB),this technique has evolved to encompass the analysis of multiple materials originating from the tumor,such as nucleic acids,extracellular vesicles,tumor-educated platelets,and other metabolites.Additionally,research has extended to include the examination of samples other than blood or plasma,such as saliva,gastric juice,urine,or stool.LB techniques are diverse,intricate,and variable.They must be highly sensitive,and pre-analytical,patient,and tumor-related factors significantly influence the detection threshold,diagnostic method selection,and potential results.Consequently,the implementation of LB in clinical practice still faces several challenges.The potential applications of LB range from early cancer detection to guiding targeted therapy or immunotherapy in both early and advanced cancer cases,monitoring treatment response,early identification of relapses,or assessing patient risk.On the other hand,gastric cancer(GC)is a disease often diagnosed at advanced stages.Despite recent advances in molecular understanding,the currently available treatment options have not substantially improved the prognosis for many of these patients.The application of LB in GC could be highly valuable as a non-invasive method for early diagnosis and for enhancing the management and outcomes of these patients.In this comprehensive review,from a pathologist’s perspective,we provide an overview of the main options available in LB,delve into the fundamental principles of the most studied techniques,explore the potential utility of LB application in the context of GC,and address the obstacles that need to be overcome in the future to make this innovative technique a game-changer in cancer diagnosis and treatment within clinical practice.

Early diagnostic strategies for colorectal cancer

At present,cancer is still an important factor threatening human health.Colorectal cancer(CRC)is one of the top three most common cancers worldwide and one of the deadliest malignancies in humans.The latest data showed that CRC incidence and mortality rank third and second,respectively,among global malignancies.Early and accurate diagnosis is crucial to reduce the morbidity,mortality and improve survival of patients with CRC,but the current early diagnostic methods have limitations.The effectiveness and compliance of diagnostic methods have a certain impact on whether people choose screening.In this editorial,we explore strategies for the early diagnosis of CRC,including stool-based,blood-based,direct visualization,and imaging examinations.

Long-term operation optimization of circulating cooling water systems under fouling conditions

Fouling caused by excess metal ions in hard water can negatively impact the performance of the circulating cooling water system(CCWS)by depositing ions on the heat exchanger's surface.Currently,the operation optimization of CCWS often prioritizes short-term flow velocity optimization for minimizing power consumption,without considering fouling.However,low flow velocity promotes fouling.Therefore,it's crucial to balance fouling and energy/water conservation for optimal CCWS long-term operation.This study proposes a mixed-integer nonlinear programming(MINLP)model to achieve this goal.The model considers fouling in the pipeline,dynamic concentration cycle,and variable frequency drive to optimize the synergy between heat transfer,pressure drop,and fouling.By optimizing the concentration cycle of the CCWS,water conservation and fouling control can be achieved.The model can obtain the optimal operating parameters for different operation intervals,including the number of pumps,frequency,and valve local resistance coefficient.Sensitivity experiments on cycle and environmental temperature reveal that as the cycle increases,the marginal benefits of energy/water conservation decrease.In periods with minimal impact on fouling rate,energy/water conservation can be achieved by increasing the cycle while maintaining a low fouling rate.Overall,the proposed model has significant energy/water saving effects and can comprehensively optimize the CCWS through its incorporation of fouling and cycle optimization.