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Pesquisa : G09.330.100 [Categoria DeCS]
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[PMID]:29364925
[Au] Autor:Wu C; Zheng Z; Jiang L; Gao Y; Xu J; Jin X; Chen Q; Zhang M
[Ad] Endereço:Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine Institute of Emergency Medicine, Zhejiang University, Hangzhou, China.
[Ti] Título:The predictive value of bedside ultrasound to restore spontaneous circulation in patients with pulseless electrical activity: A systematic review and meta-analysis.
[So] Source:PLoS One;13(1):e0191636, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The prognosis of pulseless electrical activity is dismal. However, it is still challengable to decide when to terminate or continue resuscitation efforts. The aim of this study was to determine whether the use of bedside ultrasound (US) could predict the restoration of spontaneous circulation (ROSC) in patients with pulseless electrical activity (PEA) through the identification of cardiac activity. METHODS: This was a systematic review and meta-analysis of studies that used US to predict ROSC. A search of electronic databases (Cochrane Central, MEDLINE, EMBASE) was conducted up to June 2017, and the assessment of study quality was performed with the Newcastle-Ottawa Scale. Statistical analysis was performed with Review Manager 5.3 and Stata 12. RESULTS: Eleven studies that enrolled a total of 777 PEA patients were included. A total of 230 patients experienced ROSC. Of these, 188 had sonographically identified cardiac activity (pseudo-PEA). A meta-analysis showed that PEA patients with cardiac activity on US were more likely to obtain ROSC compared to those with cardiac standstill: risk ratio (RR) = 4.35 (95% confidence interval [CI], 2.20-8.63; p<0,00001) with significant statistical heterogeneity (I2 = 60%). Subgroup analyses were conducted: US evaluation using only on the subxiphoid view: RR = 1.99 (95% CI, 0.79-5.02; p = 0.15); evaluation using various views: RR = 4.09 (95% CI,2.70-6.02; p<0.00001). CONCLUSIONS: In cardiac arrest patients who present with PEA, bedside US has an important role in predicting ROSC. The presence of cardiac activity in PEA patients may encourage more aggressive resuscitation.
[Mh] Termos MeSH primário: Circulação Sanguínea
Sistemas Automatizados de Assistência Junto ao Leito
Ultrassonografia
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191636


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[PMID]:29311541
[Au] Autor:Stremmel C; Schuchert R; Wagner F; Thaler R; Weinberger T; Pick R; Mass E; Ishikawa-Ankerhold HC; Margraf A; Hutter S; Vagnozzi R; Klapproth S; Frampton J; Yona S; Scheiermann C; Molkentin JD; Jeschke U; Moser M; Sperandio M; Massberg S; Geissmann F; Schulz C
[Ad] Endereço:Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-Universität, Marchioninistrasse 15, 81377, Munich, Germany.
[Ti] Título:Yolk sac macrophage progenitors traffic to the embryo during defined stages of development.
[So] Source:Nat Commun;9(1):75, 2018 01 08.
[Is] ISSN:2041-1723
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Tissue macrophages in many adult organs originate from yolk sac (YS) progenitors, which invade the developing embryo and persist by means of local self-renewal. However, the route and characteristics of YS macrophage trafficking during embryogenesis are incompletely understood. Here we show the early migration dynamics of YS-derived macrophage progenitors in vivo using fate mapping and intravital microscopy. From embryonic day 8.5 (E8.5) CX CR1+ pre-macrophages are present in the mouse YS where they rapidly proliferate and gain access to the bloodstream to migrate towards the embryo. Trafficking of pre-macrophages and their progenitors from the YS to tissues peaks around E10.5, dramatically decreases towards E12.5 and is no longer evident from E14.5 onwards. Thus, YS progenitors use the vascular system during a restricted time window of embryogenesis to invade the growing fetus. These findings close an important gap in our understanding of the development of the innate immune system.
[Mh] Termos MeSH primário: Movimento Celular
Células-Tronco Embrionárias/citologia
Macrófagos/citologia
Saco Vitelino/citologia
[Mh] Termos MeSH secundário: Animais
Circulação Sanguínea
Linhagem da Célula
Proliferação Celular
Embrião de Mamíferos/irrigação sanguínea
Embrião de Mamíferos/citologia
Embrião de Mamíferos/embriologia
Células-Tronco Hematopoéticas/citologia
Camundongos Endogâmicos C57BL
Camundongos Knockout
Camundongos Transgênicos
Microscopia Confocal
Fatores de Tempo
Saco Vitelino/embriologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1038/s41467-017-02492-2


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[PMID]:28459157
[Au] Autor:Ozer EK; Goktas MT; Kilinc I; Toker A; Bariskaner H; Ugurluoglu C; Iskit AB
[Ad] Endereço:a Department of Pharmacology, Faculty of Medicine, Selcuk University, Konya, Turkey.
[Ti] Título:Infliximab alleviates the mortality, mesenteric hypoperfusion, aortic dysfunction, and multiple organ damage in septic rats.
[So] Source:Can J Physiol Pharmacol;95(7):866-872, 2017 Jul.
[Is] ISSN:1205-7541
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:Tumor necrosis factor-alpha (TNF-α) is a pivotal mediator that triggers inflammatory process, oxidative stress, and multiple organ injury in sepsis. We investigated the effects of infliximab on survival, mesenteric artery blood flow (MBF), vascular reactivity, and oxidative and inflammatory injuries in cecal ligation and puncture (CLP)-induced sepsis. Wistar rats were divided into Sham, CLP, Sham+infliximab, and CLP+infliximab subgroups. Twenty-four hours before the operations, rats were injected intraperitoneally with infliximab (7 mg/kg) or vehicle (saline; 1 mL/kg). Twenty hours after the operations, MBF and phenylephrine responses of isolated aortic rings were measured. Tissue damages were examined biochemically and histopathologically. Furthermore, survival rates were monitored throughout 96 h. Infliximab improved survival, mesenteric perfusion, and aortic function after CLP. Increases of serum AST, ALT, LDH, BUN, Cr, and inflammatory cytokines (tumor necrosis factor-alpha, interleukin-1 beta, and interleukin-6) induced by CLP were blocked by infliximab. Infliximab prevented malondialdehyde elevations in septic liver, lung, spleen, and kidney tissues, as well as glutathione reductions in septic liver, spleen, and kidney tissues. Protective effects of infliximab on multiple organ damage were also observed histopathologically. Infliximab showed protective effects in sepsis due to its improvement effects on mesenteric perfusion, aortic function, and its anti-inflammatory and antioxidative effects.
[Mh] Termos MeSH primário: Aorta/efeitos dos fármacos
Circulação Sanguínea/efeitos dos fármacos
Infliximab/farmacologia
Mesentério/irrigação sanguínea
Insuficiência de Múltiplos Órgãos/complicações
Sepse/mortalidade
Sepse/fisiopatologia
[Mh] Termos MeSH secundário: Animais
Aorta/fisiopatologia
Feminino
Interleucina-6/metabolismo
Contração Muscular/efeitos dos fármacos
Músculo Liso Vascular/efeitos dos fármacos
Músculo Liso Vascular/fisiopatologia
Ratos
Ratos Wistar
Sepse/complicações
Sepse/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Interleukin-6); B72HH48FLU (Infliximab)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1139/cjpp-2016-0628


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[PMID]:29422100
[Au] Autor:Mikkelsen MLG; Ambrus R; Rasmussen R; Miles JE; Poulsen HH; Moltke FB; Eriksen T
[Ad] Endereço:Department of Veterinary Clinical Sciences, University of Copenhagen, 16 Dyrlægevej, 1870, Frederiksberg C, Denmark. mailo@sund.ku.dk.
[Ti] Título:The influence of norepinephrine and phenylephrine on cerebral perfusion and oxygenation during propofol-remifentanil and propofol-remifentanil-dexmedetomidine anaesthesia in piglets.
[So] Source:Acta Vet Scand;60(1):8, 2018 Feb 08.
[Is] ISSN:1751-0147
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Vasopressors are frequently used to increase blood pressure in order to ensure sufficient cerebral perfusion and oxygenation (CPO) during hypotensive periods in anaesthetized patients. Efficacy depends both on the vasopressor and anaesthetic protocol used. Propofol-remifentanil total intravenous anaesthesia (TIVA) is common in human anaesthesia, and dexmedetomidine is increasingly used as adjuvant to facilitate better haemodynamic stability and analgesia. Little is known of its interaction with vasopressors and subsequent effects on CPO. This study investigates the CPO response to infusions of norepinephrine and phenylephrine in piglets during propofol-remifentanil and propofol-remifentanil-dexmedetomidine anaesthesia. Sixteen healthy female piglets (25-34 kg) were randomly allocated into a two-arm parallel group design with either normal blood pressure (NBP) or induced low blood pressure (LBP). Anaesthesia was induced with propofol without premedication and maintained with propofol-remifentanil TIVA, and finally supplemented with continuous infusion of dexmedetomidine. Norepinephrine and phenylephrine were infused in consecutive intervention periods before and after addition of dexmedetomidine. Cerebral perfusion measured by laser speckle contrast imaging was related to cerebral oxygenation as measured by an intracerebral Licox probe (partial pressure of oxygen) and transcranial near infrared spectroscopy technology (NIRS) (cerebral oxygen saturation). RESULTS: During propofol-remifentanil anaesthesia, increases in blood pressure by norepinephrine and phenylephrine did not change cerebral perfusion significantly, but cerebral partial pressure of oxygen (Licox) increased following vasopressors in both groups and increases following norepinephrine were significant (NBP: P = 0.04, LBP: P = 0.02). In contrast, cerebral oxygen saturation (NIRS) fell significantly in NBP following phenylephrine (P = 0.003), and following both norepinephrine (P = 0.02) and phenylephrine (P = 0.002) in LBP. Blood pressure increase by both norepinephrine and phenylephrine during propofol-remifentanil-dexmedetomidine anaesthesia was not followed by significant changes in cerebral perfusion. Licox measures increased significantly following both vasopressors in both groups, whereas the decreases in NIRS measures were only significant in the NBP group. CONCLUSIONS: Cerebral partial pressure of oxygen measured by Licox increased significantly in concert with the vasopressor induced increases in blood pressure in healthy piglets with both normal and low blood pressure. Cerebral oxygenation assessed by intracerebral Licox and transcranial NIRS showed opposing results to vasopressor infusions.
[Mh] Termos MeSH primário: Anestesia/veterinária
Circulação Sanguínea/efeitos dos fármacos
Córtex Cerebral/efeitos dos fármacos
[Mh] Termos MeSH secundário: Anestésicos Intravenosos/administração & dosagem
Animais
Córtex Cerebral/irrigação sanguínea
Córtex Cerebral/metabolismo
Dexmedetomidina/administração & dosagem
Hipnóticos e Sedativos/administração & dosagem
Norepinefrina/farmacologia
Oxigênio/metabolismo
Fenilefrina/farmacologia
Piperidinas/administração & dosagem
Propofol/administração & dosagem
Suínos
Vasoconstritores/farmacologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anesthetics, Intravenous); 0 (Hypnotics and Sedatives); 0 (Piperidines); 0 (Vasoconstrictor Agents); 1WS297W6MV (Phenylephrine); 67VB76HONO (Dexmedetomidine); P10582JYYK (remifentanil); S88TT14065 (Oxygen); X4W3ENH1CV (Norepinephrine); YI7VU623SF (Propofol)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180210
[St] Status:MEDLINE
[do] DOI:10.1186/s13028-018-0362-z


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[PMID]:29262374
[Au] Autor:Balogh P; Bagchi P
[Ad] Endereço:Mechanical and Aerospace Engineering Department, Rutgers, The State University of New Jersey, Piscataway, New Jersey.
[Ti] Título:Direct Numerical Simulation of Cellular-Scale Blood Flow in 3D Microvascular Networks.
[So] Source:Biophys J;113(12):2815-2826, 2017 Dec 19.
[Is] ISSN:1542-0086
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We present, to our knowledge, the first direct numerical simulation of 3D cellular-scale blood flow in physiologically realistic microvascular networks. The vascular networks are designed following in vivo images and data, and are comprised of bifurcating, merging, and winding vessels. Our model resolves the large deformation and dynamics of each individual red blood cell flowing through the networks with high fidelity, while simultaneously retaining the highly complex geometric details of the vascular architecture. To our knowledge, our simulations predict several novel and unexpected phenomena. We show that heterogeneity in hemodynamic quantities, which is a hallmark of microvascular blood flow, appears both in space and time, and that the temporal heterogeneity is more severe than its spatial counterpart. The cells are observed to frequently jam at vascular bifurcations resulting in reductions in hematocrit and flow rate in the daughter and mother vessels. We find that red blood cell jamming at vascular bifurcations results in several orders-of-magnitude increase in hemodynamic resistance, and thus provides an additional mechanism of increased in vivo blood viscosity as compared to that determined in vitro. A striking result from our simulations is negative pressure-flow correlations observed in several vessels, implying a significant deviation from Poiseuille's law. Furthermore, negative correlations between vascular resistance and hematocrit are observed in various vessels, also defying a major principle of particulate suspension flow. To our knowledge, these novel findings are absent in blood flow in straight tubes, and they underscore the importance of considering realistic physiological geometry and resolved cellular interactions in modeling microvascular hemodynamics.
[Mh] Termos MeSH primário: Circulação Sanguínea
Microvasos/fisiologia
Modelos Biológicos
[Mh] Termos MeSH secundário: Eritrócitos/metabolismo
Hematócrito
Microvasos/citologia
Resistência Vascular
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180102
[Lr] Data última revisão:
180102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171221
[St] Status:MEDLINE


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[PMID]:29176804
[Au] Autor:Tu HC; Lee GH; Hsiao TH; Kao TT; Wang TY; Tsai JN; Fu TF
[Ad] Endereço:The Institute of Basic Medical Sciences, National Cheng Kung University, College of Medicine, Tainan, Taiwan.
[Ti] Título:One crisis, diverse impacts-Tissue-specificity of folate deficiency-induced circulation defects in zebrafish larvae.
[So] Source:PLoS One;12(11):e0188585, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Folate (vitamin B9) is an essential nutrient required for cell survival, proliferation, differentiation and therefore embryogenesis. Folate deficiency has been associated with many diseases, including congenital heart diseases and megaloblastic anemia, yet the mechanisms underlying these remains elusive. Here, we examine the impact of folate deficiency on the development of the circulation system using a zebrafish transgenic line which displays inducible folate deficiency. Impaired hematopoiesis includes decreased hemoglobin levels, decreased erythrocyte number, increased erythrocyte size and aberrant c-myb expression pattern were observed in folate deficient embryos. Cardiac defects, including smaller chamber size, aberrant cardiac function and cmlc2 expression pattern, were also apparent in folate deficient embryos. Characterization of intracellular folate content in folate deficiency revealed a differential fluctuation among the different folate derivatives that carry a single carbon group at different oxidation levels. Rescue attempts by folic acid and nucleotides resulted in differential responses among affected tissues, suggesting that different pathomechanisms are involved in folate deficiency-induced anomalies in a tissue-specific manner. The results of the current study provide an explanation for the inconsistent outcome observed clinically in patients suffering from folate deficiency and/or receiving folate supplementation. This study also supports the use of this model for further research on the defective cardiogenesis and hematopoiesis caused by folate deficiency.
[Mh] Termos MeSH primário: Circulação Sanguínea
Deficiência de Ácido Fólico/fisiopatologia
Larva/metabolismo
Peixe-Zebra/crescimento & desenvolvimento
[Mh] Termos MeSH secundário: Animais
Animais Geneticamente Modificados
Movimento Celular
Proliferação Celular
Desenvolvimento Embrionário
Coração/embriologia
Hematopoese
Peixe-Zebra/embriologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188585


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[PMID]:28983564
[Au] Autor:Omae T; Nagaoka T; Yoshida A
[Ad] Endereço:Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan.
[Ti] Título:Effect of Circulating Omentin-1 on the Retinal Circulation in Patients With Type 2 Diabetes Mellitus.
[So] Source:Invest Ophthalmol Vis Sci;58(12):5086-5092, 2017 Oct 01.
[Is] ISSN:1552-5783
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Purpose: To identify any significant correlations between retinal circulatory parameters and serum concentrations of omentin-1, a novel adipokine produced by adipocytes, in patients suffering from type 2 diabetes mellitus. Methods: Eighty-seven patients suffering from type 2 diabetes and incipient diabetic retinopathy (DR) were analyzed and further divided into two groups according to sex. We compared the patients' retinal circulatory parameters measured with laser Doppler velocimetry and serum omentin-1 concentrations. Results: The plasma omentin-1 concentrations were related positively to the retinal blood flow (RBF) (r = 0.212; P = 0.048) and primarily with female sex (r = 0.288; P = 0.06) and negatively to the retinal arterial vascular resistance (RVR) (r = -0.218; P = 0.043). Moreover, the plasma omentin-1 concentration was modestly but not significantly positively related to the blood velocity. Multiple regression analysis showed that the serum omentin-1 level contributed independently and negatively to the RVR. Conclusions: Increased concentrations of plasma omentin-1 might be linked to elevated RBF levels probably through elevated blood velocity in patients suffering from type 2 diabetes with incipient DR, especially in female patients, which warrants further investigation.
[Mh] Termos MeSH primário: Citocinas/sangue
Diabetes Mellitus Tipo 2/fisiopatologia
Retinopatia Diabética/fisiopatologia
Lectinas/sangue
Vasos Retinianos/fisiologia
[Mh] Termos MeSH secundário: Idoso
Circulação Sanguínea/fisiologia
Velocidade do Fluxo Sanguíneo/fisiologia
Pressão Sanguínea/fisiologia
Ensaio de Imunoadsorção Enzimática
Feminino
Proteínas Ligadas por GPI/sangue
Seres Humanos
Fluxometria por Laser-Doppler
Lipídeos/sangue
Masculino
Meia-Idade
Tonometria Ocular
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cytokines); 0 (GPI-Linked Proteins); 0 (ITLN1 protein, human); 0 (Lectins); 0 (Lipids)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171007
[St] Status:MEDLINE
[do] DOI:10.1167/iovs.17-22030


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[PMID]:28901223
[Au] Autor:Kreutzer C; Kreutzer G
[Ad] Endereço:1 Division of Pediatric Cardiovascular Surgery, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina.
[Ti] Título:The Lymphatic System: The Achilles Heel of the Fontan-Kreutzer Circulation.
[So] Source:World J Pediatr Congenit Heart Surg;8(5):613-623, 2017 Sep.
[Is] ISSN:2150-136X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In spite of excellent long term survival the Fontan Kreutzer procedure commonly presents late failure due to end-organ damage. Several advances have been described to refine single ventricle management and surgical techniques. However, very little research has been dedicated to the lymphatic circulation in the precarious Fontan hemodynamic state. The lymphatic circulation is clearly affected since there is increased lymph production, which requires to be drained at a similar or higher pressure than it is produced, commonly resulting in chronic lymphedema. Chronic lymphedema induces fibrosis and end-organ failure even in normal circulation. Diverting lymph drainage to the low-pressured systemic atrium in Fontan may represent a valid alternative for the treatment of devastating complications as protein-losing enteropathy and plastic bronchitis and may prevent or decrease the development of end-organ fibrosis or failure.
[Mh] Termos MeSH primário: Circulação Sanguínea/fisiologia
Técnica de Fontan/métodos
Cardiopatias Congênitas/cirurgia
Ventrículos do Coração/cirurgia
Doenças Linfáticas/fisiopatologia
Sistema Linfático/fisiopatologia
[Mh] Termos MeSH secundário: Seres Humanos
Doenças Linfáticas/etiologia
Vasos Linfáticos/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170914
[St] Status:MEDLINE
[do] DOI:10.1177/2150135117720685


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[PMID]:28676279
[Au] Autor:Takusagawa HL; Liu L; Ma KN; Jia Y; Gao SS; Zhang M; Edmunds B; Parikh M; Tehrani S; Morrison JC; Huang D
[Ad] Endereço:Casey Eye Institute and Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon.
[Ti] Título:Projection-Resolved Optical Coherence Tomography Angiography of Macular Retinal Circulation in Glaucoma.
[So] Source:Ophthalmology;124(11):1589-1599, 2017 Nov.
[Is] ISSN:1549-4713
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To detect macular perfusion defects in glaucoma using projection-resolved optical coherence tomography (OCT) angiography. DESIGN: Prospective observation study. PARTICIPANTS: A total of 30 perimetric glaucoma and 30 age-matched normal participants were included. METHODS: One eye of each participant was imaged using 6×6-mm macular OCT angiography (OCTA) scan pattern by 70-kHz 840-nm spectral-domain OCT. Flow signal was calculated by the split-spectrum amplitude-decorrelation angiography algorithm. A projection-resolved OCTA (PR-OCTA) algorithm was used to remove flow projection artifacts. Four en face OCTA slabs were analyzed: the superficial vascular complex (SVC), intermediate capillary plexus (ICP), deep capillary plexus (DCP), and all-plexus retina (SVC + ICP + DCP). The vessel density (VD), defined as the percentage area occupied by flow pixels, was calculated from en face OCTA. A novel algorithm was used to adjust the vessel density to compensate for local variations in OCT signal strength. MAIN OUTCOME MEASURES: Macular retinal VD, ganglion cell complex (GCC) thickness, and visual field (VF) sensitivity. RESULTS: Focal capillary dropout could be visualized in the SVC, but not the ICP and DVP, in glaucomatous eyes. In the glaucoma group, the SVC and all-plexus retinal VD (mean ± standard deviation: 47.2%±7.1% and 73.5%±6.6%) were lower than in the normal group (60.5%±4.0% and 83.2%±4.2%, both P < 0.001, t test). The ICP and DCP VD were not significantly lower in the glaucoma group. Among the overall macular VD parameters, the SVC VD had the best diagnostic accuracy as measured by the area under the receiver operating characteristic curve (AROC). The accuracy was even better when the worse hemisphere (inferior or superior) was used, achieving an AROC of 0.983 and a sensitivity of 96.7% at a specificity of 95%. Among the glaucoma participants, the hemispheric SVC VD values were highly correlated with the corresponding GCC thickness and VF sensitivity (P < 0.003). The reflectance compensation step in VD calculation significantly improved repeatability, normal population variation, and correlation with VF and GCC thickness. CONCLUSIONS: On the basis of PR-OCTA, glaucoma preferentially affects perfusion in the SVC in the macula more than the deeper plexuses. Reflectance-compensated SVC VD measurement by PR-OCTA detected glaucoma with high accuracy and could be useful in the clinical evaluation of glaucoma.
[Mh] Termos MeSH primário: Circulação Sanguínea/fisiologia
Angiografia por Tomografia Computadorizada
Glaucoma de Ângulo Aberto/fisiopatologia
Glaucoma de Baixa Tensão/fisiopatologia
Vasos Retinianos/fisiologia
Tomografia de Coerência Óptica/métodos
[Mh] Termos MeSH secundário: Idoso
Algoritmos
Feminino
Angiofluoresceinografia
Glaucoma de Ângulo Aberto/diagnóstico
Seres Humanos
Pressão Intraocular/fisiologia
Glaucoma de Baixa Tensão/diagnóstico
Masculino
Meia-Idade
Fibras Nervosas/patologia
Estudos Prospectivos
Curva ROC
Células Ganglionares da Retina/patologia
Testes de Campo Visual
Campos Visuais/fisiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170706
[St] Status:MEDLINE


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[PMID]:28550170
[Au] Autor:Moller PW; Winkler B; Hurni S; Heinisch PP; Bloch A; Sondergaard S; Jakob SM; Takala J; Berger D
[Ad] Endereço:Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
[Ti] Título:Right atrial pressure and venous return during cardiopulmonary bypass.
[So] Source:Am J Physiol Heart Circ Physiol;313(2):H408-H420, 2017 Aug 01.
[Is] ISSN:1522-1539
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The relevance of right atrial pressure (RAP) as the backpressure for venous return (Q ) and mean systemic filling pressure as upstream pressure is controversial during dynamic changes of circulation. To examine the immediate response of Q (sum of caval vein flows) to changes in RAP and pump function, we used a closed-chest, central cannulation, heart bypass porcine preparation ( = 10) with venoarterial extracorporeal membrane oxygenation. Mean systemic filling pressure was determined by clamping extracorporeal membrane oxygenation tubing with open or closed arteriovenous shunt at euvolemia, volume expansion (9.75 ml/kg hydroxyethyl starch), and hypovolemia (bleeding 19.5 ml/kg after volume expansion). The responses of RAP and Q were studied using variable pump speed at constant airway pressure (P ) and constant pump speed at variable P Within each volume state, the immediate changes in Q and RAP could be described with a single linear regression, regardless of whether RAP was altered by pump speed or P ( = 0.586-0.984). RAP was inversely proportional to pump speed from zero to maximum flow ( = 0.859-0.999). Changing P caused immediate, transient, directionally opposite changes in RAP and Q (RAP: ≤ 0.002 and Q : ≤ 0.001), where the initial response was proportional to the change in Q driving pressure. Changes in P generated volume shifts into and out of the right atrium, but their effect on upstream pressure was negligible. Our findings support the concept that RAP acts as backpressure to Q and that Guyton's model of circulatory equilibrium qualitatively predicts the dynamic response from changing RAP. Venous return responds immediately to changes in right atrial pressure. Concomitant volume shifts within the systemic circulation due to an imbalance between cardiac output and venous return have negligible effects on mean systemic filling pressure. Guyton's model of circulatory equilibrium can qualitatively predict the resulting changes in dynamic conditions with right atrial pressure as backpressure to venous return.
[Mh] Termos MeSH primário: Função do Átrio Direito
Pressão Atrial
Circulação Sanguínea
Ponte Cardiopulmonar
Modelos Cardiovasculares
Veia Cava Inferior/fisiologia
Veia Cava Superior/fisiologia
[Mh] Termos MeSH secundário: Adaptação Fisiológica
Animais
Oxigenação por Membrana Extracorpórea
Ligadura
Modelos Animais
Artéria Pulmonar/cirurgia
Respiração Artificial
Sus scrofa
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170825
[Lr] Data última revisão:
170825
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170528
[St] Status:MEDLINE
[do] DOI:10.1152/ajpheart.00081.2017



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