{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T15:02:41Z","timestamp":1772118161704,"version":"3.50.1"},"reference-count":28,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,5,17]],"date-time":"2024-05-17T00:00:00Z","timestamp":1715904000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Contrast\u2010enhanced transcranial Doppler (cTCD) study has been established as one of the most common investigations for detecting right\u2010to\u2010left shunt (RLS). Although the conventional Valsalva maneuver (c\u2010VM) has been used to increase the sensitivity of cTCD for RLS, efforts are still needed to improve the detection rate further. We proposed a new provocation method with a syringe\u2010modified Valsalva maneuver (sm\u2010VM) during cTCD and compared the efficacy of this strategy with cTCD measured at resting and with the provocation of c\u2010VM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive patients with suspicion of RLS who underwent cTCD in our institution between September 27, 2021, and April 1, 2022, were included in this study. Examination of cTCD was performed separately at the resting state and provoked with c\u2010VM and sm\u2010VM. The overall proportion of patients with RLS and their distribution with different RLS grades were compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 389 patients (mean age: 49.37 years, male: 52.2%) were included in this study. The positive rate for RLS was significantly higher for cTCD detected with sm\u2010VM than those detected at resting state and with c\u2010VM (46.8% vs. 21.6% and 34.2%, all\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.05). Besides, cTCD detected with sm\u2010VM was also associated with a higher proportion of patients with grade III RLS than those detected at resting state and with c\u2010VM (11.3% vs. 1.8% and 0%, all\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Compared to cTCD detected at resting state and with c\u2010VM, cTCD with sm\u2010VM could further increase the positive detection rate of RLS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.3304","type":"journal-article","created":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T00:45:10Z","timestamp":1715993110000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Contrast\u2010enhanced transcranial Doppler for the detection of right\u2010to\u2010left shunt: A new provocation method with a syringe\u2010modified Valsalva maneuver"],"prefix":"10.1002","volume":"14","author":[{"given":"Jinfeng","family":"Deng","sequence":"first","affiliation":[{"name":"Department of Neurology The Fifth Affiliated Hospital of Sun Yat\u2010sen University  Zhuhai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Neurology The Fifth Affiliated Hospital of Sun Yat\u2010sen University  Zhuhai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shijian","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Neurology The Fifth Affiliated Hospital of Sun Yat\u2010sen University  Zhuhai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongrui","family":"Zhan","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation The Fifth Affiliated Hospital of Sun Yat\u2010sen University  Zhuhai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Neurology The Fifth Affiliated Hospital of Sun Yat\u2010sen University  Zhuhai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2448-2660","authenticated-orcid":false,"given":"Songbiao","family":"Li","sequence":"additional","affiliation":[{"name":"Cardiovascular Center The Fifth Affiliated Hospital of Sun Yat\u2010sen University  Zhuhai 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