The application of near-infrared spectroscopy in rehabilitation of stroke / 中华神经科杂志

Stroke is a cerebrovascular disease that damages brain tissue due to blockage or rupture of blood vessels, and is one of the leading causes of death and disability worldwide. Diagnosing, monitoring stroke and the treatment effects all rely on neuroimaging that detects changes in the brain. Near-infrared spectroscopy (NIRS) is a novel neuroimaging technique which is based on the non-invasively measuring of concentration changes of oxyhemoglobin and reduced hemoglobin. This review summarizes the underlying mechanisms of NIRS and its current clinical application in stroke, as well as the limitations of NIRS in broader clinical applications.

Application of indocyanine green-based fluorescence imaging in bone and soft tissue tumors / 中华骨科杂志

Objective:To explore the role and value of indocyanine green (ICG) fluorescence imaging in the surgery of bone and soft tissue tumors.Methods:A total of 38 patients with bone and soft tissue tumors, including 17 males and 21 females, aged 36±21 years (range 5-75 years), who underwent resection with application of ICG-based NIR imaging were retrospectively analyzed. ICG was intravenously administrated at a dose of 2 mg/kg on the day before surgery. Intraoperative NIR imaging was performed to confirm the tumor fluorescence and to detect residual tumor after tumor resection. The NIR imaging was post hoc analyzed to explore the influence factor of tumor stain rate and SBR value.Results:Tumor staining with ICG was successful in 34 of the 38 patients, with an overall staining rate of 90%. The ICG tumor stain rate was not influenced by different pathology types, malignant or benign pathology, the reception of neoadjuvant chemotherapies or not, and the length of time between drug administration and surgery ( P>0.05). The median SBR of 34 patients with successful tumor staining was 2.9 (2.3, 5.7). Different pathological types, malignant or benign pathology, whether to receive neoadjuvant chemotherapy, preoperative ICG administration time, preoperative dose of denosumab administration in giant cell tumor of bone patients and tumor response to neoadjuvant chemotherapy had no significant effects on SBR ( P>0.05). After tumor resection, a total of 57 pieces of tissue with residual fluorescence signals were detected and resected under the fluorescence guidance, 30 of which were pathologically confirmed to contain residual tumor lesions, with an overall accuracy of 53%. The accuracy of intralesional resection was significantly higher than that of en bloc resection (71% vs. 16%, χ 2=15.51, P=0.000). Conclusion:A high percentage of bone and soft tissue tumors can be stained with ICG. The tumor stain of ICG was stable and not easily influenced by external factors. This technique was useful to detect residual tumors, especially after piecemeal resection.

Application of near-infrared fluorescence imaging in hepatectomy of hepatocellular carcinoma / 临床肝胆病杂志

Multimodality therapy based on surgery is the main treatment method for hepatocellular carcinoma (HCC), and hepatectomy requires the removal of primary tumor and the preservation of normal liver tissue to the maximum extent. However in clinical surgery, it is difficult to accurately identify tumor tissue and its boundary with visual inspection and palpation, which often results in under-resection or over-resection. Near-infrared fluorescence (NIRF) imaging is a real-time noninvasive imaging technique with low costs and high sensitivity, and extensive studies have been conducted to investigate its application in guiding surgical resection of tumors. With the development of fluorescence imaging system and fluorescence probe, intraoperative tumor localization and boundary determination can be realized to make the surgery more accurate. This article reviews the development of various NIRF probes for intraoperative navigation in HCC and discusses current challenges and potential opportunities of these imaging probes.

Research status and prospect on the cerebral vision in myopic patients / 中华实验眼科杂志

The visual signal generated by the eye receiving external light stimulation reaches the visual center through the visual pathway and is processed and integrated by the visual center to form a subjective sensation called cerebral vision.Cerebral vision reflects the function of the whole visual nervous system from the retina to the visual cortex.Abnormal cerebral vision has been found in myopes using electrophysiology, magnetic resonance imaging (MRI) and functional near-infrared spectroscopy (fNIRS). The abnormal electrophysiological results are mainly found in patients with high myopia and pathological myopia.MRI shows abnormal changes in the structure and function of several vision-related brain regions in patients with high myopia.Recently, by applying near-infrared brain function imaging technology combined with self-developed equipment, our team conducted a series of studies on the brain function of myopic patients and found that adult patients with moderate myopia and patients with pathological myopia have the abnormal cerebral vision.The mechanism of neural regulation of eye accommodation in myopic children needs further investigation.In this article, we reviewed the current status and outlook of myopic brain vision research in terms of myopia classification, myopic brain vision research methods, and myopic visual electrophysiology, MRI, and fNIRS studies.

Risk of perioperative stroke and cerebral autoregulation monitoring: a systematic review / Risco de acidente vascular cerebral perioperatório e monitoramento de autorregulação cerebral: uma revisão sistemática

Abstract Background Perioperative stroke, delirium, and cognitive impairment could be related to management and to variations in blood pressure control, cerebral hypoperfusion and raised blood volume. Cerebral autoregulation (CAR) is a mechanism to maintain cerebral perfusion through the control of the vascular tone and hemodynamic reactions in the circulation. Objective The present systematic review addresses the relationship between impaired CAR and perioperative stroke by evaluating the rate of neurological complications after surgery in studies in which perioperative CAR was tested or monitored. Methods We included randomized clinical trials and prospective observational studies. All studies had adjusted the relative risk, hazard ratio or 95% confidence interval (95%CI) values. These estimation effects were tested using random-effects models. Heterogeneity among the selected studies was assessed using the Higgins and Thompson I2 statistics. Results The Web of Science, PubMed and EMBASE electronic databases were searched to retrieve articles. A total of 4,476 studies published between 1983 and 2019 were analyzed, but only 5 qualified for the data extraction and were included in the final analysis. The combined study cohort comprised 941 patients who underwent CAR monitoring during surgical procedures. All studies provided information about perioperative stroke, which equated to 16% (158 of 941) of the overall patient population. Conclusion The present meta-analysis showed evidence of the impact of CAR impairment in the risk of perioperative stroke. On the pooled analysis, blood fluctuations or other brain insults large enough to compromise CAR were associated with the outcome of stroke (odds ratio [OR]: 2.26; 95%CI: 1.54-2.98;p < 0.0001).

Resumo Antecedentes Acidente vascular cerebral (AVC) perioperatório, delírio e comprometimento cognitivo podem estar relacionados ao manejo e à variações no controle da pressão arterial, à hipoperfusão cerebral, e ao aumento do volume sanguíneo. A autorregulação cerebral (ARC) é um mecanismo para manter a perfusão cerebral por meio do controle do tônus vascular e das reações hemodinâmicas na circulação. Objetivo Este trabalho aborda sistematicamente a determinação da relação entre a falha da ARC e o AVC perioperatório, com uma avaliação da taxa de complicações neurológicas pós-cirúrgicas em estudos em que a ARC perioperatória foi monitorada. Métodos Esta revisão sistemática incluiu ensaios clínicos randomizados e estudos observacionais prospectivos. Todos os estudos ajustaram o risco relativo, a razão de risco ou os valores de intervalo de confiança de 95% (IC95%). Esses efeitos de estimativas foram testados usando modelos de efeitos aleatórios. A heterogeneidade entre os diferentes estudos foi avaliada por meio das estatísticas de Higgins e Thompson I2. Resultados As bases de dados eletrônicas Web of Science, PubMed e Embase foram pesquisadas para selecionar os artigos. Um total de 4.476 estudos publicados entre 1983 e 2019 foram analisados, mas apenas 5 se qualificavam para a extração de dados e foram incluídos na análise final. A coorte combinada do estudo foi composta por 941 pacientes. Todos os estudos forneceram informações sobre AVC perioperatório, o que equivaleu a 16% (158 de 941) da população geral de pacientes. Conclusão Esta meta-análise mostrou evidências do impacto do prejuízo da ARC no risco de AVC perioperatório. Na análise conjunta, as flutuações sanguíneas ou outros insultos cerebrais grandes o suficiente para comprometer a ARC foram associados ao resultado do AVC (razão de probabilidades [RP]: 2,26; IC95%: 1,54-2,98;p < 0,0001).

Application of robot-assisted laparoscopic sentinel lymph node tracing in treating endometrial carcinoma / 中华妇产科杂志

Objective:To investigate the value of robot-assisted laparoscopic indocyanine green sentinel lymph node (SLN) tracing in treating endometrial carcinoma.Methods:Thirty-two patients with early-staging endometrial carcinoma were operated with laparoscopic comprehensive staging laparotomy from January 2019 to December 2021. At the same time, the SLN detection was performed by near-infrared fluorescence imaging tracer technology, in which the tracer was indocyanine green. Sixteen cases were injected with indocyanine green before laparoscopic surgery, and 16 cases were injected with indocyanine green before robot-assisted laparoscopic surgery. The operation index, postoperative complications, prognosis, and lymph node dissection were compared between the two groups.Results:(1) The mean age of patients in the robot group was (54.7±8.1) years old, and was (54.9±8.8) years old in the laparoscopic group. There were no significant difference between the two groups ( t=0.06, P=0.951). (2) Intraoperative blood loss [(131±40) vs (169±57) ml], hemoglobin difference before and after surgery [(11.2±5.4) vs (15.5±5.7) g/L], the length of stay after operation [(6.2±1.3) vs (8.6±1.4) days] between the robot group and the laparoscopic group were compared, and the differences were statistically significant (all P<0.05). (3) SLNs were detected in all 16 patients in the robotic group, and a total of 41 SLNs were detected. SLNs were detected in 15 of the 16 patients in the laparoscopy group, and a total of 40 SLNs were detected. Compared with the laparoscopic group (15/16), the total detection rate of SLN in the robotic group (16/16), there were no statistical significance ( χ2=1.03, P=0.310). Compared with the laparoscopic group (7/15), the SLN bilateral detection rate in the robotic group (10/16), there were also no significant difference ( χ2=0.78, P=0.376). The number of lymph nodes detected in surgery group (16.6±4.1) were lower than those in the laparoscopy surgery group (21.0±7.1), while there were no statistically difference between the two groups ( χ2=2.01, P=0.054). There was no tumor metastasis in the resected lymph nodes and SLN between the two groups. The false negative rate of SLN in diagnosing endometrial cancer postoperative lymph node metastasis was 0, and the negative predictive value was 100%. (4) The pelvic and retroperitoneal lymph nodes were divided into five regions, which were the left pelvis, the right pelvis, the presacral region, the deep inguinal region, and the abdominal aorta. The numbers of SLN of unilateral detection and bilateral pelvic detection between two groups showed no significant differences (all P>0.05). The left pelvis had the most SLN imaging in both groups, followed by the right pelvis, para-aortic, and deep groin. (5) There was one patient in both robotic group and laparoscopic group with postoperative complications, which were urinary retention and pelvic lymph node cyst respectively. There were no significant differences in the incidence of complications between the two groups ( χ2=0.97, P=1.000). The median follow-up time after operation was 14 months (range 6-24 months). During the follow-up period, no local recurrence or distant metastasis was found between the two groups of endometrial cancer patients. Conclusions:Compared with the laparoscopic group, the robot group has less intraoperative blood loss and shorter postoperative hospital stay. The bilateral detection rate of SLN in the group was better than that of laparoscopy.

Muscle oxygenation of the quadriceps and gastrocnemius during maximal aerobic effort / Oxigenación muscular de cuádriceps y gastrocnemio durante el esfuerzo aeróbico máximo / Oxigenação muscular de quadríceps e gastrocnêmio durante o esforço aeróbico máximo

ABSTRACT Introduction: Near infrared spectroscopy (NIRS) is a non-invasive technique that is used in the assessment of tissue oxygenation and the monitoring of physical activity. Objective: To determine the influence of sexual, anthropometric and ergospirometric factors on muscle oxygenation of the quadriceps and gastrocnemius, obtained by NIRS during a stress test. Methods: Twenty healthy subjects participated in this study (10 women). Two Humon Hex® devices were placed on the dominant side of the quadriceps and gastrocnemius muscles to measure muscle oxygen saturation (SmO2). The stress test was performed on a treadmill with electrocardiographic control and measurement of oxygen consumption. SmO2 was obtained at rest and after maximum effort during the stress test. In addition, the height, weight, skinfold and waist contour were measured. Bioimpedance was used to obtain the percentages of fat mass and muscle mass, which were used to calculate the relative fat mass (RFM). Results: The SmO2 of both muscles at rest is higher in males than in females. At maximum effort, the SmO2 of the quadriceps is similar in both groups. The SmO2 of both muscles is positively related to height, body mass, percentage of mass muscle and waist contour, and negatively with percentage of mass fat, RFM and skinfold thickness. The negative correlation between fat percentage and oxygen saturation is more evident in females. It was observed that the variables that quantify maximum effort are not related to the SmO2 values, except for the correlation between HR max and SmO2 of the gastrocnemius muscle in males. Conclusion: The SmO2 of recreational athletes is influenced by the location of the device and the fat mass of the subjects. The biggest differences between the sexes are in the gastrocnemius muscle. Level of Evidence II; Diagnostic Studies - Investigating a Diagnostic Test .

RESUMEN Introducción: La espectroscopia de infrarrojo cercano (NIRS) es una técnica no invasiva usada en la evaluación de la oxigenación tisular y en la monitorización de la actividad física. Objetivos: Determinar la influencia de factores sexuales, antropométricos y ergoespirométricos sobre la oxigenación muscular de cuádriceps y del gastrocnemio, obtenidos por NIRS durante un test de esfuerzo. Métodos: Participaron en este estudio 20 individuos saludables (10 mujeres). Se colocaron dos dispositivos Humon Hex® en el lado dominante de los músculos cuádriceps y gastrocnemio para medir la saturación de oxígeno muscular (SmO2). El test de esfuerzo fue realizado en una cinta ergométrica con control electrocardiográfico y medición del consumo de oxígeno. La SmO2 fue obtenida en reposo y después de esfuerzo máximo durante el test. Además, fueron medidos altura, peso, pliegues cutáneos y contorno de la cintura. Fue usada bioimpedancia para obtener los porcentuales de masa grasa y masa muscular, que fueron usados para calcular la masa grasa relativa (MGR). Resultados: La SmO2 de ambos músculos en reposo es mayor en hombres que en mujeres. En el esfuerzo máximo la SmO2 del cuádriceps es semejante en los dos grupos. La SmO2 de ambos músculos es positivamente relacionada con altura, masa corporal, porcentual de masa muscular y contorno de la cintura y negativamente relacionada con el porcentaje de masa grasa, MGR y espesor de los pliegues cutáneos. La correlación negativa entre el porcentual de grasa y la saturación de oxígeno es más evidente en las mujeres. Se observó que variables que cuantifican el esfuerzo máximo no está relacionadas con los valores SmO2, excepto por la correlación entre FCmáx y SmO2 del músculo gastrocnemio en sexo masculino. Conclusión: La SmO2 de los atletas recreativos es influenciada por la localización del dispositivo y por la masa grasa de los individuos. Las mayores diferencias entre los sexos están en el músculo gastrocnemio. Nivel de Evidencia II; Estudios diagnósticos - Investigación de un examen para diagnóstico .

RESUMO Introdução: A espectroscopia de infravermelho próximo (NIRS) é uma técnica não invasiva usada na avaliação da oxigenação tecidual e no monitoramento da atividade física. Objetivos: Determinar a influência de fatores sexuais, antropométricos e ergoespirométricos sobre a oxigenação muscular do quadríceps e do gastrocnêmio obtidos por NIRS durante um teste de esforço. Métodos: Participaram deste estudo 20 indivíduos saudáveis (10 mulheres). Dois dispositivos Humon Hex® foram colocados no lado dominante dos músculos quadríceps e gastrocnêmio para medir a saturação de oxigênio muscular (SmO2). O teste de esforço foi realizado em uma esteira com controle eletrocardiográfico e mensuração do consumo de oxigênio. A SmO2foi obtida em repouso e depois de esforço máximo durante o teste. Além disso, foram medidos estatura, peso, dobras cutâneas e contorno da cintura. A bioimpedância foi usada para obter os percentuais de massa gorda e massa muscular, que foram usados para calcular a massa gorda relativa (MGR). Resultados: A SmO2de ambos os músculos em repouso é maior em homens do que em mulheres. No esforço máximo, a SmO2do quadríceps é semelhante nos dois os grupos. A SmO2de ambos os músculos é positivamente relacionada com estatura, massa corporal, percentual de massa muscular e contorno da cintura e negativamente relacionada com a porcentagem de massa gorda, MGR e espessura das dobras cutâneas. A correlação negativa entre o percentual de gordura e a saturação de oxigênio é mais evidente nas mulheres. Observou-se que variáveis que quantificam o esforço máximo não estão relacionadas com os valores SmO2, exceto pela correlação entre FCmáx e SmO2do músculo gastrocnêmio no sexo masculino. Conclusão: A SmO2dos atletas recreativos é influenciada pela localização do dispositivo e pela massa gorda dos indivíduos. As maiores diferenças entre os sexos estão no músculo gastrocnêmio. Nível de Evidência II; Estudos diagnósticos - Investigação de um exame para diagnóstico .

Impacto da transfusão de eritrócitos no transporte e no metabolismo de oxigênio em pacientes com sepse e choque séptico: uma revisão sistemática e metanálise / Impact of red blood cell transfusion on oxygen transport and metabolism in patients with sepsis and septic shock: a systematic review and meta-analysis

RESUMO Considera-se que a transfusão de eritrócitos melhora a respiração celular durante o choque séptico. Contudo, seu impacto agudo no transporte e no metabolismo de oxigênio nessa condição ainda é amplamente debatido. O objetivo deste estudo foi avaliar o impacto da transfusão de eritrócitos na microcirculação e no metabolismo do oxigênio em pacientes com sepse e choque séptico. Conduzimos um levantamento nas bases de dados MEDLINE®, Elsevier e Scopus. Incluímos estudos realizados com seres humanos adultos com sepse e choque séptico. Realizamos uma revisão sistemática e metanálise com utilização do modelo de efeitos aleatórios de DerSimonian e Laird. Consideramos significante valor de p < 0,05. Incluíram-se na análise 19 manuscritos, correspondentes a 428 pacientes. As transfusões de eritrócitos se associaram com aumento de 3,7% na média combinada de saturação venosa mista de oxigênio (p < 0,001), diminuição de razão de extração de oxigênio de -6,98 (p < 0,001) e nenhum efeito significante no índice cardíaco (0,02 L/minuto; p = 0,96). Obtiveram-se resultados similares em estudos que incluíram mensurações simultâneas de saturação venosa mista de oxigênio, razão de extração de oxigênio e índice cardíaco. As transfusões de eritrócitos levaram a aumento significante na proporção de pequenos vasos perfundidos (2,85%; p = 0,553), enquanto os parâmetros de oxigenação tissular revelaram aumento significante no índice de hemoglobina tissular (1,66; p = 0,018). Estudos individuais relataram melhoras significantes na oxigenação tissular e nos parâmetros microcirculatórios sublinguais em pacientes com microcirculação alterada na avaliação inicial. A transfusão de eritrócitos pareceu melhorar o metabolismo sistêmico de oxigênio com aparente independência de variações no débito cardíaco. Observaram-se alguns efeitos benéficos para a oxigenação tissular e parâmetros microcirculatórios, em particular em pacientes com alterações iniciais mais graves. São necessários mais estudos para avaliar seu impacto clínico e individualizar as decisões relativas à transfusão.

ABSTRACT Red blood cell transfusion is thought to improve cell respiration during septic shock. Nevertheless, its acute impact on oxygen transport and metabolism in this condition remains highly debatable. The objective of this study was to evaluate the impact of red blood cell transfusion on microcirculation and oxygen metabolism in patients with sepsis and septic shock. We conducted a search in the MEDLINE®, Elsevier and Scopus databases. We included studies conducted in adult humans with sepsis and septic shock. A systematic review and meta-analysis were performed using the DerSimonian and Laird random-effects model. A p value < 0.05 was considered significant. Nineteen manuscripts with 428 patients were included in the analysis. Red blood cell transfusions were associated with an increase in the pooled mean venous oxygen saturation of 3.7% (p < 0.001), a decrease in oxygen extraction ratio of -6.98 (p < 0.001) and had no significant effect on the cardiac index (0.02L/minute; p = 0,96). Similar results were obtained in studies including simultaneous measurements of venous oxygen saturation, oxygen extraction ratio, and cardiac index. Red blood cell transfusions led to a significant increase in the proportion of perfused small vessels (2.85%; p = 0.553), while tissue oxygenation parameters revealed a significant increase in the tissue hemoglobin index (1.66; p = 0.018). Individual studies reported significant improvements in tissue oxygenation and sublingual microcirculatory parameters in patients with deranged microcirculation at baseline. Red blood cell transfusions seemed to improve systemic oxygen metabolism with apparent independence from cardiac index variations. Some beneficial effects have been observed for tissue oxygenation and microcirculation parameters, particularly in patients with more severe alterations at baseline. More studies are necessary to evaluate their clinical impact and to individualize transfusion decisions.

Application of functional brain imaging using near-infrared technology in patients with stroke / 中国基层医药

Stroke is the leading cause of death in China. How to improve the efficiency of diagnosis and treatment is of great significance. Functional near-infrared spectroscopy (fNIRS), as a non-invasive tool in neurology, has been widely used because of low cost, easy manufacture, reliable operation, and other advantages. This review compares fNIRS with other conventional neuroimaging methods. Findings from this review provide preliminary evidence for fNIRS as a tool to monitor, treat and study stroke. Future studies may focus on the application of fNIRS or its combination with other neuroimaging methods in the prevention of stroke.

Effect of acupuncture on blood oxygen concentration in brain of rats with post-traumatic stress disorder based on functional near-infrared spectroscopy / 针灸推拿医学（英文版）

Objective:To observe the effect of acupuncture on blood oxygen concentration in the brain of rats with post-traumatic stress disorder (PTSD) based on functional near-infrared spectroscopy (fNIRS),thus to reveal the mechanisms of acupuncture in intervening the brain function of PTSD rats.Methods:Sixty Sprague-Dawley (SD) rats were randomly divided into a blank group,a model group,a grasping group,a paroxetine group and an acupuncture group,with 12 rats in each group.Except the blank group,rats in the other groups all received incarceration plus electric shock for 7 d to prepare the PTSD animal model.One hour before the stress model was established,rats in each group received the designated intervention:rats in the blank group and the model group did not receive any intervention;rats in the grasping group received grasping and fixation;rats in the paroxetine group received paroxetine hydrochloride solution by intragastric administration;and rats in the acupuncture group received acupuncture.Six-day treatment was a course,with 2 courses of treatment conducted for a total of 12 d.After the modeling,rats in each treatment group received intervention for 5 d,and the fNIRS system was used to collect and record the changes in the concentrations of oxygenated hemoglobin (HbO2),deoxygenated hemoglobin (d-Hb) and total hemoglobin (t-Hb) of the involved rat's brain regions,and also to assess the brain function.Results:Compared with the blank group,the concentration of HbO2 was significantly increased,the concentration of d-Hb was significantly decreased,and the concentration of t-Hb was significantly increased in the model group and the grasping group after the intervention,and the differences were statistically significant (all P＜0.01).Compared with the model group,the concentrations of HbO2,d-Hb and t-Hb in the grasping group did not change significantly (all P＞0.05).Compared with the grasping group,the concentration of HbO2 was significantly decreased,the concentration of d-Hb was significantly increased,and the concentration of t-Hb was significantly decreased in the paroxetine group and the acupuncture group,and the differences were statistically significant (all P＜0.05).There were no significant differences in the concentrations of HbO2,d-Hb and t-Hb between the paroxetine group and the acupuncture group (all P＞0.05).Conclusion:Acupuncture can regulate the blood oxygen concentration in the brain of PTSD model rats,which may be an important mechanism of acupuncture in intervening the brain function in PTSD rats.

Effect of red blood cell transfusion on cerebral tissue oxygenation in premature infants / 中华实用儿科临床杂志

Objective To analyze the changes in cerebral oxygen saturation( CrSO2 )and cerebral fractional oxygen extraction ratio(CFOE)before,during and after red blood cell(RBC)transfusion in premature infants,and to explore the effect of RBC transfusion on the cerebral tissue oxygenation in premature infants. Methods The preterm infants With gestational age﹤37 Weeks Who Were treated With RBC transfusion Were selected from September 2017 to March 2018 in Neonatal Department of Children＇s Hospital of Fudan University. Near－infrared spectroscopy( NIRS) Was applied to continuously monitor CrSO2 from 2 h before RBC transfusion to 24 h after RBC transfusion. Transcuta﹣neous arterial oxygen saturation(TcSaO2 ),heart rate(HR)and blood pressure(BP)Were synchronously measured by using multi－function monitor. CFOE could be calculated based on the monitored TcSaO2 . Results A total of 71 cases Were included in the study,39 males and 32 females,With a medium gestational age of 29(24－37)Weeks,a mean birth Weight of 2 195(710－3 950)g,17 cases in moderate anemia group and 54 cases in severe anemia group. Compared With the data 2 h before transfusion,CrSO2 increased( t ﹦9. 536,P﹤0. 001),While CFOE decreased( t ﹦ －8. 688,P ﹤0. 001)during transfusion in the Whole study population. The CrSO2 at 2 h before blood transfusion,during blood transfu﹣sion,2,6,12 and 24 h after transfusion Were 0. 579 ± 0. 037,0. 591 ± 0. 032,0. 599 ± 0. 035,0. 596 ± 0. 035,0. 595 ± 0. 027,0. 585 ± 0. 022,respectively in moderate anemia group and Were 0. 571 ± 0. 038,0. 592 ± 0. 039,0. 605 ± 0. 038, 0. 603 ± 0. 035,0. 596 ± 0. 032,0. 596 ± 0. 032,respectively in severe anemia group. The CFOE at 2 h before blood trans﹣fusion,during blood transfusion,2,6,12 and 24 h after transfusion Were 0. 40 ± 0. 04,0. 38 ± 0. 03,0. 37 ± 0. 04,0. 38 ± 0. 04,0. 38 ± 0. 03,0. 38 ± 0. 03,respectively in moderate anemia group and Were 0. 42 ± 0. 04,0. 39 ± 0. 04,0. 38 ± 0. 04, 0. 38 ± 0. 04,0. 39 ± 0. 03,0. 39 ± 0. 03,respectively in severe anemia group. CrSO2 increased(t﹦3. 874,P﹤0. 05), While CFOE decreased(t﹦ －4. 091,P﹤0. 05)at 2 h after transfusion in moderate anemia group. In severe anemia group,CrSO2 significantly increased( t ﹦9. 221,P ﹤0. 001),While CFOE significantly decreased( t ﹦ －8. 583,P ﹤0. 001)during transfusion,and this effect lasted until 2 h after transfusion(t﹦5. 926,－5. 556,P﹤0. 001). Compared With the data 2 h before transfusion,CrSO2 Was significantly increased(t﹦6. 894,P﹤0. 001),While CFOE Was signifi﹣cantly decreased(t﹦ －8. 536,P﹤0. 001)at 24 h after transfusion in severe anemia group. HoWever,there Was no signi﹣ ficant difference in CrSO2 and CFOE betWeen the 24 h after transfusion and 2 h before in the moderate anemia group. Conclusions RBC transfusion improves cerebral tissue oxygenation,and severe anemia group benefit more from blood transfusion. Cerebral oxygenation monitoring With NIRS monitor may provide neW insights for the clinical management of RBC transfusion in preterm infants.

Development of a multi-channel NIRS-USG hybrid imaging system for detecting prostate cancer and improving the accuracy of imaging-based diagnosis: a phantom study

PURPOSE: This study aimed to develop a multi-channel near-infrared spectroscopy (NIRS) and ultrasonography (USG) fusion imaging system for imaging prostate cancer and to verify its diagnostic capability by applying the hybrid imaging system to a prostate cancer phantom. METHODS: A multi-channel NIRS system using the near-infrared 785-nm wavelength with 12 channels and four detectors was developed. After arranging the optical fibers around a USG transducer, we performed NIRS imaging and grayscale USG imaging simultaneously. Fusion imaging was obtained by processing incoming signals and the spatial reconstruction of NIRS, which corresponded with grayscale USG acquired at the same time. The NIRS-USG hybrid system was applied to a silicone-based optical phantom of the prostate gland containing prostate cancer to verify its diagnostic capability qualitatively. RESULTS: The NIRS-USG hybrid imaging system for prostate cancer imaging simultaneously provided anatomical and optical information with 2-dimensional registration. The hybrid imaging system showed more NIR attenuation over the prostate cancer model than over the model of normal prostate tissue. Its diagnostic capability to discriminate a focal area mimicking the optical properties of prostate cancer from the surrounding background mimicking the optical properties of normal prostate tissue was verified by applying the hybrid system to a silicone-based optical phantom of prostate cancer. CONCLUSION: This study successfully demonstrated that the NIRS-USG hybrid system may serve as a new imaging method for improving the diagnostic accuracy of prostate cancer, with potential utility for future clinical applications.

Clinical Application of Near-Infrared Spectroscopy in Neonates

The incidence of cerebral palsy has not decreased despite advances in neonatal care. Preterm infants are at a high risk of cerebral palsy. Moreover, preterm infants might experience permanent neurological sequelae due to injury in the preterm brain. Although the etiology of preterm brain injury is not fully understood, preterm brain injury is strongly associated with abnormal cerebral perfusion and oxygenation. Monitoring systemic blood pressure or arterial oxygen saturation using pulse oximetry is not enough to guarantee proper cerebral perfusion or oxygenation. Early detection of improper cerebral perfusion can prevent irreversible cerebral damage. To decrease brain injury through the early detection of under-perfusion and deoxygenation, other diagnostic modalities are needed. Near-infrared spectroscopy can continuously and noninvasively monitor regional oxygen saturation (rSO₂), which reflects the perfusion and oxygenation status of tissues at bedside. Near-infrared spectroscopy represents a balance between tissue oxygen supply and demand. Cerebral rSO₂ monitoring has been used most frequently in neonatal cardiac surgery to monitor cerebral oxygenation and prevent hypoxic damage or shock. Recently, cerebral, renal, or splanchnic rSO₂ in neonates is frequently monitored. The progression of a disease, brain injury, and death can be prevented by detecting changes in rSO₂ values using near-infrared spectroscopy. In this article, the basic principles, usefulness, and applications of near-infrared spectroscopy in neonates are discussed.

Near-infrared spectroscopy parameters in patients undergoing continuous venovenous hemodiafiltration / Espectroscopia no infravermelho próximo em pacientes sob hemodiafiltração venovenosa contínua

ABSTRACT Objective To investigate the impacts of continuous venovenous hemodiafiltration on the microcirculation in patients with acute kidney injury. Methods A prospective observational pilot study conducted in a 40-bed, open clinical-surgical intensive care unit of a private tertiary care hospital located in the city of São Paulo (SP), Brazil. Microcirculation was assessed using near-infrared spectroscopy by means of a 15mm probe placed over the thenar eminence. Vascular occlusion test was performed on the forearm to be submitted to near-infrared spectroscopy by inflation of a sphygmomanometer cuff to 30mmHg higher than the systolic arterial pressure. The primary endpoint was the assessment of near-infrared spectroscopy-derived parameters immediately before, 1, 4 and 24 hours after the initiation of continuous venovenous hemodiafiltration. Results Nine patients were included in this pilot study over a period of 2 months. Minimum tissue oxygen saturation measured during the vascular occlusion test was the only near-infrared spectroscopy-derived parameter to differed over the time (decrease compared to baseline values up to 24 hours after initiation of continuous venovenous hemodiafiltration). Conclusion The impacts of microcirculatory dysfunction on clinical outcomes of patients undergoing to continuous venovenous hemodiafiltration need to be further investigated.

RESUMO Objetivo Avaliar o impacto da hemodiafiltração venovenosa contínua na microcirculação de pacientes com lesão renal aguda. Métodos Estudo piloto, prospectivo e observacional conduzido em uma unidade de terapia intensiva clínico-cirúrgica aberta, com 40 leitos, localizada em um hospital terciário, privado, na cidade de São Paulo (SP), Brasil. A microcirculação foi avaliada empregando-se a espectroscopia no infravermelho próximo, por meio de uma sonda de 15mm posicionada sobre a eminência tenar. O teste de oclusão vascular foi realizado no antebraço a ser submetido à espectroscopia no infravermelho próximo, inflando-se o manguito de um esfigmomanômetro a um valor 30mmHg acima da pressão arterial sistólica. O desfecho primário foi a avaliação dos parâmetros derivados por espectroscopia no infravermelho próximo imediatamente antes, 1, 4 e 24 horas após o início da hemodiafiltração venovenosa contínua. Resultados Foram incluídos nove pacientes neste estudo piloto ao longo de 2 meses. A saturação de oxigênio tecidual mínima mensurada durante o teste de oclusão vascular foi o único parâmetro derivado por espectroscopia no infravermelho próximo que diferiu ao longo do tempo, com queda em relação aos valores iniciais nas primeiras 24 horas após o início da hemodiafiltração venovenosa contínua. Conclusão A influência da disfunção microcirculatória sobre os desfechos clínicos de pacientes submetidos à hemodiafiltração venovenosa contínua precisa ser melhor investigada.

Correlation between regional cerebral oxygen saturation at admission and outcomes in patients with hypertensive intracerebral hemorrhage / 国际脑血管病杂志

Objective To investigate the effect of regional cerebral oxygen saturation (rSO2 ) at admission on the outcomes in patients with hypertensive intracerebral hemorrhage.Methods Patients with hypertensive intracerebral hemorrhage were enrolled prospectively. Near-infrared spectroscopy was used to detect rSO2 at admission, and various baseline data were collected. Six months after onset, the clinical outcomes were assessed by the modified Rankin Scale scores, and 0-2 was defined as good outcome and > 2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors for clinical outcomes. Results A total of 103 patients with hypertensive intracerebral hemorrhage were enrolled, including 36 females and 67 males (mean age 64. 41 ± 11. 70 years). The mean baseline score of the National Institutes of Health Stroke Scale (NIHSS) was 17. 12 ±8. 58, the mean baseline Glasgow Coma Scale (GCS) score was 9. 82 ± 2. 54; 66 patients had basal ganglion hematoma, 37 had thalamus hemorrhage; hematoma volumes were 2-80 ml, mean 26. 53 ±18. 94 ml; hematoma extended into the ventricles in 54 patients, and 55 patients had midline shift; 70 (68. 0％) had good outcomes, and 33 (32. 0％) had poor outcomes, 12 (11. 7％) of them died. There were significant differences in age, hematoma volume, baseline NIHSS score, baseline GCS score, rSO2 at admission, and the proportions of hematoma extended into the ventricles, midline shift, brain herniation, received hematoma evacuation between the good outcome group and the poor outcome group. Multivariate logistic regression analysis showed that older age (odds ratio [OR] 1. 124, 95％ confidence interval [CI] 1. 035-1. 221; P =0. 005), larger hematoma volume (OR 1. 158, 95％ CI 1. 053-1. 274; P =0. 002), higher baseline NIHSS score (OR 1. 340, 95％ CI 1. 093-1. 642; P = 0. 005), and lower rSO2 at admission (OR 2. 212, 95％ CI 1. 033-4. 737; P = 0. 041) were the independent risk factors for poor outcome at 6 months after onset. Conclusions rSO2 at admission was associated with the poor outcomes in patients with hypertensive intracerebral hemorrhage.

Effect of red blood cell transfusion on the oxygenation of mesenteric tissue in premature infants / 中华儿科杂志

Objective@#To investigate the effect of red blood cell transfusion on the oxygenation of mesenteric tissue in premature infants.@*Methods@#In this prospective cohort study, preterm infants with gestational age <37 weeks who were treated with red blood cell transfusions were enrolled from June 2017 to March 2018 in Department of Neonatology, Children's Hospital of Fudan University. The infants were categorized into feeding intolerance group and feeding tolerance group according to the feeding intolerance standard. Near-infrared spectroscopy was applied to continuously monitor intestinal oxygen saturation from 2 h before red blood cell transfusion to 48 h after red blood cell transfusion. Intergroup differences of basic conditions were analyzed with t test, Mann-Whitney U test and χ2 test. Mixed linear model was used to compare intragroup and intergroup differences in intestinal oxygen saturation over time.@*Results@#A total of 73 cases with gestational age <37 weeks were enrolled, of whom 41 were males and 32 were females, with mean gestational age of (30±4)weeks and mean birth weight of (1 543±688)g; there were 33 cases in feeding intolerance group and 42 cases in feeding tolerance group. The average intestinal oxygen saturations at 2 h before blood transfusion, during blood transfusion, 2, 6, 12, 24, and 48 h after transfusion were 0.50±0.07, 0.52±0.07, 0.52±0.08, 0.51±0.08, 0.51±0.07, 0.51±0.08, and 0.51±0.07 respectively in feeding intolerance group and were 0.51±0.04, 0.55±0.04, 0.57±0.05, 0.57±0.04, 0.56±0.04, 0.56±0.04, and 0.56±0.05 respectively in feeding tolerance group. Compared with 2 h before transfusion, intestinal oxygen saturation were increased during transfusion in both group (feeding intolerance group t=4.992, P=0.000; feeding tolerance group t=9.615, P=0.000), however this effect lasted until 48 h after transfusion in feeding tolerance group (t=5.519, 12.409, 10.033, 9.133, 7.983, all P=0.000). Additionally, the increasement of intestinal oxygen saturation over time were lower in feeding intolerance group(F=8.876, P=0.000). Besides, the level of intestinal oxygen saturation was positively correlated with postmenstrual age (PMA)(F=4.863, P=0.031). In infants with PMA<30 weeks, particularly in feeding intolerance group, the level of intestinal oxygen saturation significantly decreased at 2 h after transfusion (t=23.063, P=0.002).@*Conclusions@#Feeding status and PMA may play a role in development of transfusion-associated necrotizing enterocolitis. Red blood cell transfusion may increase the risk for mesenteric ischemia and is more likely to cause necrotizing enterocolitis in preterm infants with PMA <30 weeks as well as feeding intolerance.@*Clinical Trail@#Children's Hospital of Fudan University, NCT02544100.

Application of near-infrared spectroscopy in monitoring in the neurocritical care unit / 中华神经科杂志

The field of monitoring in neurocritical care has long been lacking a non-invasive monitoring technique that can be real-time evaluated at the bedside. In recent years, near-infrared spectroscopy has drawn attention in neurocritical care. The feasibility of using this technique to monitor cerebral autoregulation, perfusion, oxygenation and intracranial pressure dynamically has been noticed. We reviewed the basic principle of near-infrared spectroscopy and its application in adult neurocritical care patients, and discussed the shortcomings of this technique. More clinical researches are needed in the future to evaluate this promising monitoring technology.

A study on the correlation of abdominal near-infrared spectroscopy monitoring and the risk of necrotizing enterocolitis in preterm infants / 中国新生儿科杂志

Objective To study the correlation between abdominal near-infrared spectroscopy monitoring and the risk of necrotizing enterocolitis (NEC) in preterm infants.Method From September 2015 to June 2016,preterm infants admitted to the NICU of our hospital were enrolled in this study.Nearinfrared spectroscopy (NIRS) was used to monitor the tissue oxygen saturation (StO2) of lower right abdomen of the patients.These preterm infants were assigned into NEC group and non-NEC group depending on whether NEC was developed during hospitalization.The abdominal StO2 within the first week after birth were compared between the two groups.Result A total of 77 infants were enrolled in this study,18 preterm infants in the NEC group and 59 in the non-NEC group.The gestational age and birth weight of the patients in the NEC group were lower than the non-NEC group.The NEC gioup had significantly higher incidences of mechanical ventilation,vasoactive agent usage and comorbidity of infection than the non-NEC group (P ＜0.05).No significant differences in the proportion of gender,application of umbilical venous catheters and the incidence of patent ductus arteriosus between the two groups (P ＞ 0.05).The abdominal StO2 of the NEC group was significantly lower than the non-NEC group (69.0％ ± 5.8％ vs 82.8％ ± 6.7％,P ＜0.001).Multivariate logistic regression analysis showed that lower abdominal StO2 is an independent risk factor for NEC (OR =0.676,95％ CI 0.548 ～ 0.834,P ＜ 0.001).Conclusion Abdominal NIRS monitoring may be helpful for the early diagnosis of NEC.

Near-infrared light combined with tacrolimus ointment for the treatment of facial glucocorticoid-dependent dermatitis: a randomized controlled trial / 中华皮肤科杂志

Objective To evaluate the efficacy and safety of near-infrared light combined with tacrolimus 0.1％ ointment in the treatment of facial glucocorticoid-dependent dermatitis.Methods A total of 68 patients with facial glucocorticoid-dependent dermatitis were enrolled from Department of Dermatology of Yantai Yuhuangding Hospital between December 2014 and December 2015,and randomly and equally divided into treatment group and combination group by a random number table.The treatment group was treated topically with tacrolimus ointment twice a day for 4 weeks.Besides the treatment with tacrolimus ointment,the combination group was irradiated with near-infrared light once a week for 4 sessions.After 4-week treatment,improvement in clinical manifestations such as itching and burning sensation was evaluated,so was the therapeutic effect.Results The combination group showed significantly higher response rate (85.3％ [29/34]) compared with the treatment group (61.8％ [21/34],x2 =4.84,P ＜ 0.05).Additionally,response rates for itching and burning sensation,erythema,scales and papules were all significantly higher in the combination group than in the treatment group (x2 =4.84,6.35,8.42 and 5.52,respectively,all P ＜ 0.05).Conclusion Near-infrared light combined with tacrolimus ointment is effective and safe for the treatment of facial glucocorticoid-dependent dermatitis.

Efeito da irradiação com laser de diodo sobre adesivos dentinários: estudo in vitro / Effect of diode laser irradiation on dentin-bonding agents

A irradiação de sistemas adesivos com laser tem obtido resultados promissores, no entanto, seu mecanismo de ação, bem como a longevidade da camada híbrida obtida após a irradiação com laser ainda não estão bem estabelecidos na literatura. A presente tese teve como objetivo: avaliar a absorvância do laser de Diodo por diferentes sistemas adesivos por meio de espectroscopia no infravermelho próximo; avaliar a evaporação de água e solventes proporcionada pelo laser por meio da variação da massa analisada em balança de precisão; avaliar a resistência de união por meio de teste de microtração após envelhecimento de 12 meses. Os dados obtidos foram analisados por modelos de ANOVA, seguidos de teste Tukey (p<0,05) e os resultados demonstraram que: a irradiação no infravermelho próximo, área do espectro eletromagnético que compreende o laser de Diodo, não apresenta interação com os sistemas adesivos testados; o laser de Diodo é capaz de proporcionar maior alteração de massa, mesmo após contínua evaporação dos solventes com jatos de ar por 60s; sistemas adesivos simplificados apresentaram valores de resistência de união imediato semelhantes aos valores obtidos após 12 meses de envelhecimento. Os dados obtidos neste estudo sugerem que a irradiação com laser de Diodo pode contribuir favoravelmente para a adesão em dentina com sistemas adesivos simplificados após 1 ano.(AU)

The laser irradiation of adhesive systems has obtained promising results, however, its mechanism of action, as well as the longevity of the hybrid layer obtained after laser irradiation are still not yet well established in the literature. This thesis aimed to: assess the diode laser interaction with different adhesive systems by means of near infrared spectroscopy; evaluate the evaporation of solvents and water provided by the laser through the mass variation analyzed at a precision balance; evaluate the bond strength through microtensile bond strength test after 12 months of aging. The data was analyzed through ANOVA models, followed by Tukey test (p<0.05), and the results demonstrated that: in the near-infrared irradiation area, the electromagnetic spectrum comprising the diode laser, shows no interaction with the adhesive systems tested; the diode laser was able to provide greater mass variation, even after continual evaporation of solvents with air jets for 60s; simplified adhesive systems presented immediate bond strength values similar to the ones verified after 12 months of aging. The data obtained in this study suggest that the Diode laser irradiation can contribute favorably for the adhesion between dentin and simplified adhesive systems after 1 year.(AU)