Clinical Hemorheology and Microcirculation - Volume Preprint, issue Preprint
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Clinical Hemorheology and Microcirculation, a peer-reviewed international scientific journal, serves as an aid to understanding the flow properties of blood and the relationship to normal and abnormal physiology. The rapidly expanding science of hemorheology concerns blood, its components and the blood vessels with which blood interacts. It includes perihemorheology, i.e., the rheology of fluid and structures in the perivascular and interstitial spaces as well as the lymphatic system. The clinical aspects include pathogenesis, symptomatology and diagnostic methods, and the fields of prophylaxis and therapy in all branches of medicine and surgery, pharmacology and drug research.
The endeavour of the Editors-in-Chief and publishers of
Clinical Hemorheology and Microcirculation is to bring together contributions from those working in various fields related to blood flow all over the world. The editors of
Clinical Hemorheology and Microcirculation are from those countries in Europe, Asia, Australia and America where appreciable work in clinical hemorheology and microcirculation is being carried out. Each editor takes responsibility to decide on the acceptance of a manuscript. He is required to have the manuscript appraised by two referees and may be one of them himself. The executive editorial office, to which the manuscripts have been submitted, is responsible for rapid handling of the reviewing process.
Clinical Hemorheology and Microcirculation accepts original papers, brief communications, mini-reports and letters to the Editors-in-Chief. Review articles, providing general views and new insights into related subjects, are regularly invited by the Editors-in-Chief. Proceedings of international and national conferences on clinical hemorheology (in original form or as abstracts) complete the range of editorial features.
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Clinical Hemorheology and Microcirculation: medical practitioners in all fields including hematology, cardiology, geriatrics, angiology, surgery, obstetrics and gynecology, ophthalmology, otology, and neurology. Pharmacologists, clinical laboratories, blood transfusion centres, manufacturing firms producing diagnostic instruments, and the pharmaceutical industry will also benefit.
Important new topics will increasingly claim more pages of
Clinical Hemorheology and Microcirculation: the role of hemorheological and microcirculatory disturbances for epidemiology and prognosis, in particular regarding cardiovascular disorders, as well as its significance in the field of geriatrics. Authors and readers are invited to contact the editors for specific information or to make suggestions.
Abstract: BACKGROUND: Little is known about the effect of mean arterial blood pressure (MAP) augmentation on the microcirculation in cardiogenic-shock patients with peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) support. We investigated the effect of increasing MAP on the microcirculation in cardiogenic-shock patients with ECMO support. METHODS: A single-center prospective observational study under taken in ICU patients undergoing ECMO support for post-cardiotomy cardiogenic shock was carried out. Patients with MAP <60 mmHg treated with ECMO support were the study cohort. Inotropic and vasopressor agents (dopamine, dobutamine, norepinephrine or epinephrine) were administered to maintain the MAP at 60–90 mmHg. Hemodynamic and…microcirculatory data were obtained at a baseline MAP of <60 mmHg and 1 h after target MAP was reached. As parameters of microcirculation, we measured thenar eminence tissue oxygenation (StO2 ) and its change during the vessel obstruction test and cerebral tissue oxygenation (rSO2 ) with near-infrared spectroscopy. RESULTS: Seventeen patients were enrolled in the study. MAP of all patients increased and reached predefined therapeutic targets (52 [50–54.5] vs.74 [70–78.5] mmHg; p < 0.001). To obtain these targets, doses of inotropic agents were increased (inotrope score increased from 14 [15.5–28] μg/kg/min; p < 0.001). No obvious changes were observed in thenarmuscleStO2 and cerebral rSO2 . Thenar muscle StO2 desaturation slope and resaturation slopes during the vessel obstruction test were also unchanged. CONCLUSIONS: Increasing MAP from <60 mmHg to 60–90 mmHg did not affect microcirculation variables in cardiogenic-shock patients with ECMO support.
Abstract: This in vitro study was designed to examine the effect of some newly synthesized aminoalcanolic derivatives of xanthone (I, II) and aroxyalkyl derivatives of 2-methoxyphenylpiperazine (III, IV) having cardiovascular activity on the haemorheological parameters of RBCs from healthy individuals and patients with chronic venous disease. Additionally, the influence of compounds I-IV on some RBCs associated enzymes such as acetylcholinesterase (Ache), glucose-6-phosphate dehydrogenase (G6PD) and glutathione reductase (GR) as well as glutathione (GSH) content were determined in vitro in RBCs from healthy subjects. The study showed that compounds I, III and IV significantly increased RBCs deformability. Moreover, both xanthone…derivatives reduced RBCs aggregation and diminished RBCs aggregates strength in all RBCs groups. Compounds II and III significantly improved Ache activity, whereas compounds I and II increased G6PD and GR activity and GSH level. In conclusion, compounds I, III and IV, which significantly improved RBCs deformability in vitro , may facilitate the passage of blood in the vascular system. Additionally, compounds I and II which inhibit RBCs aggregates formation in vitro may contribute to more rapid degradation of red blood cell aggregates in circulating blood.
Abstract: AIM: To evaluate the Efficacy of intraoperative contrast enhanced ultrasound (Io-CEUS) for assessment of radiofrequency ablation (RFA) during liver tumor surgery. MATERIAL AND METHODS: Retrospective analyis was performed on 18 patients who underwent combined liver tumor surgery and RFA of 27 hepatic tumors between 02/2011 and 12/2016. Io-CEUS was performed by bolus injections of up to 10 ml sulphur hexaflourid microbubbles for diagnostic purposes. To guide the RFA up to 20 ml microbubbles were applied to monitor the procedure and assess the ablation status finally. A fully avascular area or absence of any residual vascularization intratumorally was considered technical…success. These findings were correlated to findings of follow-up imaging results (CEUS, MRI, CT) at least 1 up to 40 months (mean 11 months) after surgery. RESULTS: 13 male and 5 female patients aged between 45– 77 years (mean 59.2±17.1 years) with 26 malignant and one most probable benign hepatic lesion were treated with intraoperative RFA. Io-CEUS detected 23 preoperatively unknown liver lesions leading to a change in therapy in 13/18 cases (72,2% ). All 27 treated lesions showed an avascular area immediately after RFA. According to follow-up imaging results (1 month – 3 years after surgery, mean follow-up time 11 months), 2/18 patients had local recurrences, 8 patients had distant intrahepatic recurrences or extrahepatic recurrence, 8 patients remained tumor-free. Thereby, a success rate of CEUS guided RFA of 89% could be obtained concerning the targeted liver lesions. CONCLUSION: Modern intraoperative ultrasound using B-mode and Io-CEUS is a valuable tool for optimization of diagnostic and therapeutic intraoperative liver procedures and ablative therapies.
Abstract: BACKGROUND: Contrast-enhanced ultrasound (CEUS) is a valuable tool in the diagnostic approach of focal liver lesions, but occasionally subjective and observer-dependent. Semiquantitative evaluation of dynamic CEUS (DCEUS) with standardised software programmes such as Dynamic Vascular Pattern (DVP) could help to improve diagnostic accuracy and objectivity in liver tumour assessment. OBJECTIVES: The present study aimed at evaluation of diagnostic accuracy of DVP in a clinical setting. MATERIALS AND METHODS: DVP images of 52 focal liver lesions [30 hepatocellular carcinomas (HCCs), 15 intrahepatic cholangiocellular carcinomas (ICCs), 7 focal nodular hyperplasias (FNHs)] were analysed by four blinded observers…with different levels of CEUS-experience. Diagnostic accuracies for the assessment of dignity and entity were evaluated. RESULTS: Mean sensitivity, specificity, positive and negative predictive value for detection of malignancy with DVP were 48.4% /67.8% /92.7% and 29.3%, respectively. Total diagnostic accuracies for dignity/entity were 63.9% /38.5% (HCC: 58.3% /25.8%; ICC: 73.3% /50%; FNH: 67.9% /67.9%). Interreader-agreement was moderate (κ = 0.42–0.58). Differential diagnosis between ICC and HCC was most challenging. CONCLUSION: Although developed to improve diagnostic accuracy and objectivity in the assessment of focal liver lesions, DVP alone seems insufficient for differential diagnosis of HCC, ICC and FNH and cannot replace the skills of an experienced observer.
Abstract: BACKGROUD: Contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE) are used for diagnostic purposes. OBJECTIVE: Investigate the diagnostic value of CEUS and SWE for breast lesions of sub-centimeter diameter. METHODS: Sixty-two patients (mean age: 49.3±12.1 years) with 66 lesions (mean diameter, 8.1±1.5 mm) were analyzed. Conventional ultrasound (US), CEUS and SWE were undertaken. Pathologic specimens were obtained through biopsy or surgery. Lesions were measured in kilopascals. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were analyzed. RESULTS: For conventional US, the sensitivity was 92.31%, specificity 28.30%, PPV 24.00%, NPV 93.75%, and…accuracy 40.90%, whereas those for SWE were 61.54%, 98.11%, 88.89%, 91.23%, and 90.91% (p = 0.000) and CEUS were 92.31%, 60.38%, 36.37%, 96.97%, and 66.67% (p = 0.001), respectively. For SWE + CEUS, the sensitivity was 61.54%, specificity 100.00%, PPV 100.00%, NPV 91.38%, and accuracy 92.42% (p = 0.000). There was a significant difference between US and CEUS (p = 0.004), but not for SWE or SWE + CEUS (p = 0.568; p = 0.205). For SWE + CEUS, there was a significant difference with SWE alone and CEUS alone (p = 0.000; p = 0.008). Between SWE and CEUS, the difference was significant (p = 0.031). CONCLUSIONS: SWE and CEUS could help to differentiate between malignant and benign breast lesions <1 cm in diameter.
Abstract: OBJECTIVE: To evaluate the diagnostic performance of shear wave speed (SWS) within the lesion, fat-to-lesion speed ratio (FLR), and gland-to-lesion speed ratio (GLR) for differentiation between benign and malignant breast lesions using a novel SWS imaging technique. METHODS: From April 2016 to June 2016, 182 breast lesions were prospectively included in the study. For each lesion, SWS-lesion, FLR, and GLR were calculated. Pathological results were used as the reference standard. Receiver operating characteristic curves (ROC) were plotted to assess the diagnostic performance. RESULTS: Of the 182 lesions, 142 (78.0%) were benign and 40 (22.0%) were…malignant. Significant differences were found between benign and malignant lesions in SWS-lesion, FLR and GLR (2.12±0.64 m/s vs 3.87±1.45 m/s, 1.63±0.61 vs 2.60±1.04, and 1.33±0.39 vs 2.08±0.78, respectively. All P < 0.001). The optimal cut-off values of SWS-lesion, FLR, GLR were 2.88 m/s, 2.31 and 1.51, respectively. The diagnostic performance of SWS-lesion in terms of AUC was the highest (i.e. AUC = 0.845), in comparison with FLR and GLR alone or their combination. The associated sensitivity, specificity, and accuracy for SWS-lesion were 75.0%, 89.4%, and 86.3%, respectively. CONCLUSION: SWS-lesion is a valuable and sufficient method for differentiation between benign and malignant breast lesions.
Abstract: PURPOSE: To investigate the correlation between quantitative parameters on contrast-enhanced ultrasound (CEUS) and pathological prognostic factors in patients with breast invasive ductal carcinomas (IDCs). MATERIALS AND METHODS: 102 patients with pathologically proven IDCs were retrospectively enrolled and all were preoperatively evaluated by CEUS. Quantitative analysis was conducted using the SonoLiver® software. On the parametric imaging, the data of rise time (RT), time to peak (TTP), mean transit time (mTT) and maximum intensity (IMAX) were recorded. Pathological prognostic factors, including histological grade, tumor diameter, lymph node status, estrogen receptor (ER), progesterone receptor (PR), C-erb-B2 and Ki-67 expression…were evaluated. Correlation of enhancement parameters with pathological prognostic factors was analyzed. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance and operator consistency was evaluated. RESULTS: The RTs and TTPs for lower grade IDCs (grade I or II) and higher histological grade IDCs (grade III) were 9.3 s±3.9 vs. 11.4 s±5.4 (p = 0.016), 11.6 s±6.1 vs. 14.7 s±7.7 (p = 0.028), respectively. The RTs for positive-C-erbB-2 expression and negative-C-erbB-2 expression IDCs were 10.1 s±4.5 vs. 11.9 s±6.0 (p = 0.047). The IMAX showed statistical difference between IDCs with negative-ER and those with positive-ER (p = 0.003), as well as IDCs with negative-PR and those with positive-PR (p = 0.019). The ROC analysis showed that, for the differentiation ER expression, the cut-off point for IMAX was 648.8% with an Az value of 0.718 (95% CI: 0.599–0.836), and the sensitivity and specificity were 63.6% and 70.2% respectively. The intra-operator consistency of the RT, TTP, mTT and IMAX were excellent with an overall ICC of 0.893, 0.858, 0.984 and 0.800, respectively (all p < 0.001). CONCLUSIONS: Quantitative analysis of CEUS may be a useful and objective method in predicting pathological prognostic factors in breast IDCs.
Abstract: BACKGROUND: Small rodent models are routinely used to evaluate the safety and efficacy of blood transfusions. Limited comprehensive literature exists about effect of different storage solutions in rat red blood cells (RBCs) characteristics. RBCs undergo time dependent biochemical and biophysical changes during storage known as hypothermic storage lesions (HSLs). OBJECTIVE: This study evaluates the effects of RBC additive solutions (AS) during storage of rat RBCs. METHODS: Blood was leukoreduced and stored as per manufacturer instructions at 4°C up to 42-days. Three solutions, CPDA-1; AS-1; and AS-7 (SOLX), were evaluated. Biochemical parameters measured included extracellular K +…, pH, hemolysis, 2,3-diphosphoglycerate (2,3-DPG), oxygen affinity, ATP, and lactate. Mechanical properties measured included RBC deformability, elongation index (EI), RBC membrane shear elastic modulus (SEM), mean corpuscular volume (MCV), viscosity, and aggregability. RESULTS: There were no differences in biochemical or mechanical parameters at baseline or after one week of storage. However, after two weeks, AS-7 preserved biochemical and mechanical properties as compared to CPDA-1 and AS-1. Changes were observed to be significant after 14-days of storage. AS-7 prevented extracellular K + increase, reduced acidosis, showed lower hemolysis, preserved ATP and 2,3-DPG levels (consequently oxygen affinity), and reduced lactate. AS-7, when compared to CPDA-1 and AS-1, prevented the reduction in RBC deformability and was found to preserve the EI at multiple shear stresses, the membrane SEM, the aggregability and viscosity. DISCUSSION: Rat RBCs stored with AS-7 presented reduced changes in biochemical and mechanical parameters, when compared with rat RBCs stored in CPDA-1 and AS-1, after as early as two weeks of storage.
Abstract: OBJECTIVE: To determine the value of combining conventional ultrasonography with virtual touch tissue imaging quantification (VTIQ) for differential diagnosis of breast lesions smaller than 10 mm. METHODS: A total of 98 breast lesions smaller than 10 mm were examined by conventional ultrasound and VTIQ using a Siemens ACUSON S3000 ultrasound machine. Pathologic diagnosis was established after surgery or fine needle biopsy. RESULTS: Malignant lesions were characterized by taller-than-wide shape, poorly circumscribed margin, and marked hypoechogenicity. The mean VTIQ shear wave velocity (SWV) value of malignant lesions was 4.88±1.87 m/s (range, 1.75–9.34 m/s), significantly higher than that of benign lesions…(2.68±1.02 m/s; range, 1.18–4.67 m/s). The optimal cutoff SWV value was 3.27 m/s, with sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 86.20%, 95.65%, 92.86%, 89.29%, and 94.29%, respectively. The combination of SWV >3.27 m/s plus the US feature of poorly circumscribed margin had the highest sensitivity (93.33%) and specificity (100%) for diagnosis of malignant breast lesions. CONCLUSION: Features such as taller-than-wide shape, poorly circumscribed margin, and marked hypoechogenicity on conventional US, and SWV >3.27 m/s on VTIQ, are indicators of malignancy in breast lesions with diameter <10 mm. The combination of poorly circumscribed margin and SWV >3.27 m/s provides the highest specificity and diagnostic accuracy.
Keywords: Conventional ultrasonography, virtual touch tissue imaging quantification, breast lesions
Abstract: BACKGROUND: Tetrahydrobiopterin (BH4), an endogenous nucleic acid derivative, acts as an important cofactor for several enzymes found within the vascular endothelium, which is deranged in sepsis. OBJECTIVE: We hypothesized that BH4 would improve capillary density and decrease inflammation within the intestinal microcirculation of septic rats. METHODS: We conducted a randomized, controlled trial using two previously validated models of sepsis in rats: 1) A fecal peritonitis model using a stent perforating the ascending colon, and 2) An endotoxemia model using lipopolysaccharide (LPS) toxin from E. coli . Experimental groups receiving BH4 (60 mg/kg) were compared to otherwise…healthy controls and to untreated groups with sepsis-like physiology. RESULTS: BH4 decreased leukocyte-endothelial adhesion by 55% and 58% (P < 0.05) in the peritonitis model and endotoxemia models, respectively. In the endotoxemia model but not the peritonitis model, BH4 improved functional capillary density in capillary beds within the intestine (141.3 vs. 106.7 mm/cm2 , p < 0.05). Macrohemodynamic parameters were no different between placebo treatment and BH4-treated groups. CONCLUSIONS: This study demonstrates that BH4 improves capillary density and inflammation in two separate models of sepsis. BH4 may represent a novel adjunct in the treatment of sepsis and septic shock in clinical practice. Further dose-finding studies and clinical trials are warranted.
Keywords: Tetrahydrobiopterin, endotoxemia, peritonitis, sepsis, microcirculation, rat