To date,the clinical use of functional near-infrared spectroscopy(NIRS)to detect cerebral ischemia has been largely limited to surgical settings,where motion artifacts are minimal.In this study,we present novel techni...To date,the clinical use of functional near-infrared spectroscopy(NIRS)to detect cerebral ischemia has been largely limited to surgical settings,where motion artifacts are minimal.In this study,we present novel techniques to address the challenges of using NIRS to monitor ambu-latory patients with kidney disease during approximately eight hours of hemodialysis(HD)treatment.People with end-stage kidney disease who require HD are at higher risk for cognitive impairment and dementia than age-matched controls.Recent studies have suggested that HD-related declines in cerebral blood flow might explain some of the adverse outcomes of HD treatment.However,there are currently no established paradigms for monitoring cerebral per-fusion in real-time during HD treatment.In this study,we used NIRS to assess cerebral hemo-dynamic responses among 95 prevalent HD patients during two consecutive HD treatments.We observed substantial signal attenuation in our predominantly Black patient cohort that required probe modifications.We also observed consistent motion artifacts that we addressed by devel-oping a novel NIRS methodology,called the HD cerebral oxygen demand algorithm(HD-CODA),to identify episodes when cerebral oxygen demand might be outpacing supply during HD treatment.We then examined the association between a summary measure of time spent in cerebral deoxygenation,derived using the HD-CODA,and hemodynamic and treatment-related variables.We found that this summary measure was associated with intradialytic mean arterial pressure,heart rate,and volume removal.Future studies should use the HD-CODA to implement studies of real-time NIRS monitoring for incident dialysis patients,over longer time frames,and in other dialysis modalities.展开更多
Although hyperbaric oxygen （HBO） therapy can promote the recovery of neural function in patients who have suffered traumatic brain injury （TBI）, the underlying mechanism is unclear. We hypothesized that hyperbaric...Although hyperbaric oxygen （HBO） therapy can promote the recovery of neural function in patients who have suffered traumatic brain injury （TBI）, the underlying mechanism is unclear. We hypothesized that hyperbaric oxygen treatment plays a neuroprotective role in TBI by increasing regional transcranial oxygen saturation （rSO2） and oxygen partial pressure （PaO2）. To test this idea, we compared two groups： a control group with 20 healthy people and a treatment group with 40 TBI patients. The 40 patients were given 100% oxygen of HBO for 90 minutes. Changes in rSO2 were measured. The controls were also examined for rSO2 and PaO2, but received no treatment, rSO2 levels in the patients did not differ significantly after treatment, but levels before and after treatment were significantly lower than those in the control group. PaO2 levels were significantly decreased after the 30-minute HBO treatment. Our findings suggest that there is a disorder of oxygen metabolism in patients with sub-acute TBI. HBO does not immediately affect cerebral oxygen metabolism, and the underlying mechanism still needs to be studied in depth.展开更多
Regional oxygen saturation (rSO2) is a new method to evaluate regional oxygen supply and demand balance by near-infrared spectroscopy. It has the advantages of noninvasive, continuous and sensitive, and has been succe...Regional oxygen saturation (rSO2) is a new method to evaluate regional oxygen supply and demand balance by near-infrared spectroscopy. It has the advantages of noninvasive, continuous and sensitive, and has been successfully applied in clinical guidance. Regional oxygen saturation is usually referred to as regional cerebral oxygen saturation (rScO2) and regional tissue oxygen saturation (rStO2) depending on the site of monitoring. Initially, cerebral oxygen saturation monitoring has been used in cardiothoracic surgery and in non-cardiac surgery for elderly and critically ill patients. With the increase of clinical application, regional oxygen saturation is gradually extended to the determination of oxygen saturation in peripheral tissues, which is used to evaluate the relationship between peripheral tissue microcirculation function and the prognosis of patients. Timely detection of tissue ischemia and hypoxia and intervention can optimize the whole clinical treatment management, especially for major surgery and critically ill patients can reduce the incidence of complications during hospitalization, shorten hospitalization time, improve the prognosis of patients. This article will focus on the clinical application of cerebral oxygen saturation and tissue oxygen saturation in perioperative period.展开更多
A novel hemodynamic model has been recently introduced,which provides analytical relation-ships between the changes in cerebral blood volume(CBV),cerebral blood flow(CBF),andcerebral metabolic rate of oxy gen(CMRO2),a...A novel hemodynamic model has been recently introduced,which provides analytical relation-ships between the changes in cerebral blood volume(CBV),cerebral blood flow(CBF),andcerebral metabolic rate of oxy gen(CMRO2),and associat ed changes in the tissue concentrationsof oxy-and deoxy-hemoglobin(AO and AD)measured with near-infrared,spectroscopy(NIRS)[S.Fantini,Neuroimage 85,202-221(2014)].This novel model can be applied tomeasurements of the amplit ude and phase of induced hemodynamic oscillations as a function ofthe frequency of oscillation,realizing the novel technique of coherent hemodynamics spectroscopy(CHS)[S.Fantini,Neuroimage 85,202-221(2014);M.L.Pierro et al.,Neuroimage 85,222-233(2014)]:In a previous work,,we have demonstrated an in vivo application of CiHS on hunanSubjects during paced breat hing[M.L.Pierro et al,Neuroimage 85,222-233(2014)].In thiswork,we present a new analysis of the collected data duringpaced breat hing based on a slightlyrevised formulation of the hemodynamic model and ann efficient fitting procedure.While we haveinitially treated all 12 model parameindeependent,we have found that,in this new in-plementation of CHS,the number of independent is eight.In this article,we identifythe eight independent model parameters and,we show that our previous results are consistentwith the new formulation,once the individual parameters of the earlier analysis are combinedinto the new set of independent parameters.展开更多
基金The study was funded by the Commonwealth Universal Research Enhancement Grant Program(CURE)MNH is supported by grants from the National Institutes of Health(NIH):K23DK105207 and R01DK124388.
文摘To date,the clinical use of functional near-infrared spectroscopy(NIRS)to detect cerebral ischemia has been largely limited to surgical settings,where motion artifacts are minimal.In this study,we present novel techniques to address the challenges of using NIRS to monitor ambu-latory patients with kidney disease during approximately eight hours of hemodialysis(HD)treatment.People with end-stage kidney disease who require HD are at higher risk for cognitive impairment and dementia than age-matched controls.Recent studies have suggested that HD-related declines in cerebral blood flow might explain some of the adverse outcomes of HD treatment.However,there are currently no established paradigms for monitoring cerebral per-fusion in real-time during HD treatment.In this study,we used NIRS to assess cerebral hemo-dynamic responses among 95 prevalent HD patients during two consecutive HD treatments.We observed substantial signal attenuation in our predominantly Black patient cohort that required probe modifications.We also observed consistent motion artifacts that we addressed by devel-oping a novel NIRS methodology,called the HD cerebral oxygen demand algorithm(HD-CODA),to identify episodes when cerebral oxygen demand might be outpacing supply during HD treatment.We then examined the association between a summary measure of time spent in cerebral deoxygenation,derived using the HD-CODA,and hemodynamic and treatment-related variables.We found that this summary measure was associated with intradialytic mean arterial pressure,heart rate,and volume removal.Future studies should use the HD-CODA to implement studies of real-time NIRS monitoring for incident dialysis patients,over longer time frames,and in other dialysis modalities.
基金supported by a grant from Suzhou Key Medicine Project Fund of China,No.Szxk201504
文摘Although hyperbaric oxygen （HBO） therapy can promote the recovery of neural function in patients who have suffered traumatic brain injury （TBI）, the underlying mechanism is unclear. We hypothesized that hyperbaric oxygen treatment plays a neuroprotective role in TBI by increasing regional transcranial oxygen saturation （rSO2） and oxygen partial pressure （PaO2）. To test this idea, we compared two groups： a control group with 20 healthy people and a treatment group with 40 TBI patients. The 40 patients were given 100% oxygen of HBO for 90 minutes. Changes in rSO2 were measured. The controls were also examined for rSO2 and PaO2, but received no treatment, rSO2 levels in the patients did not differ significantly after treatment, but levels before and after treatment were significantly lower than those in the control group. PaO2 levels were significantly decreased after the 30-minute HBO treatment. Our findings suggest that there is a disorder of oxygen metabolism in patients with sub-acute TBI. HBO does not immediately affect cerebral oxygen metabolism, and the underlying mechanism still needs to be studied in depth.
文摘Regional oxygen saturation (rSO2) is a new method to evaluate regional oxygen supply and demand balance by near-infrared spectroscopy. It has the advantages of noninvasive, continuous and sensitive, and has been successfully applied in clinical guidance. Regional oxygen saturation is usually referred to as regional cerebral oxygen saturation (rScO2) and regional tissue oxygen saturation (rStO2) depending on the site of monitoring. Initially, cerebral oxygen saturation monitoring has been used in cardiothoracic surgery and in non-cardiac surgery for elderly and critically ill patients. With the increase of clinical application, regional oxygen saturation is gradually extended to the determination of oxygen saturation in peripheral tissues, which is used to evaluate the relationship between peripheral tissue microcirculation function and the prognosis of patients. Timely detection of tissue ischemia and hypoxia and intervention can optimize the whole clinical treatment management, especially for major surgery and critically ill patients can reduce the incidence of complications during hospitalization, shorten hospitalization time, improve the prognosis of patients. This article will focus on the clinical application of cerebral oxygen saturation and tissue oxygen saturation in perioperative period.
基金supported by the National Institutes of Health(Grant No.R01-CA154774)by the National Science Foundation(Award No.IIs-1065154).
文摘A novel hemodynamic model has been recently introduced,which provides analytical relation-ships between the changes in cerebral blood volume(CBV),cerebral blood flow(CBF),andcerebral metabolic rate of oxy gen(CMRO2),and associat ed changes in the tissue concentrationsof oxy-and deoxy-hemoglobin(AO and AD)measured with near-infrared,spectroscopy(NIRS)[S.Fantini,Neuroimage 85,202-221(2014)].This novel model can be applied tomeasurements of the amplit ude and phase of induced hemodynamic oscillations as a function ofthe frequency of oscillation,realizing the novel technique of coherent hemodynamics spectroscopy(CHS)[S.Fantini,Neuroimage 85,202-221(2014);M.L.Pierro et al.,Neuroimage 85,222-233(2014)]:In a previous work,,we have demonstrated an in vivo application of CiHS on hunanSubjects during paced breat hing[M.L.Pierro et al,Neuroimage 85,222-233(2014)].In thiswork,we present a new analysis of the collected data duringpaced breat hing based on a slightlyrevised formulation of the hemodynamic model and ann efficient fitting procedure.While we haveinitially treated all 12 model parameindeependent,we have found that,in this new in-plementation of CHS,the number of independent is eight.In this article,we identifythe eight independent model parameters and,we show that our previous results are consistentwith the new formulation,once the individual parameters of the earlier analysis are combinedinto the new set of independent parameters.
