Clinical Hemorheology and Microcirculation - Volume 65, issue 4
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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: AIM: To evaluate hemorheological parameters in patients with fibromyalgia syndrome (FMS) in order to elucidate the etiology of the disease. METHODS: Twenty-three adult FMS patients and 20 healthy controls were enrolled in the study. Diabetics, hypertensives and those with any rheumatological disorder or use drugs or smoking cigarette were excluded from the study. Following parameters were analyzed in each subject; erythrocyte deformability, erythrocyte aggregation, plasma viscosity, complete blood count, fasting blood glucose, fibrinogen, albumin, globulin and lipid profile. RESULTS: Erythrocyte elongation indices indicating deformability of erythrocytes were higher in FMS patients (0.564±0.002 at 16.87 mPa and…0.605±0.002 at 30 mPa shear rate) than controls (0.558±0.001 at 16.87 mPa and 0.600±0.003 at 30 mPa shear rate). Erythrocyte aggregation speed was higher in FMS patients (2.1±0.1 s) than controls (2.3±0.2 s). Erythrocyte aggregation index was also higher in FMS patients (65.5±1.3) than controls (62.9±1.5). Erythrocyte aggregation amplitude and plasma viscosity values were similar in both groups (both p > 0.05). Among the complete blood count and biochemical parameters, only albumin levels were lower in the FM patients than controls (p < 0.05). CONCLUSION: Our results indicate higher erythrocyte deformability and quicker erythrocyte aggregation in FM patients.
Abstract: OBJECTIVE: Evaluating vascular autonomization of pedicled and microvascular free flaps for soft tissue reconstruction in the head and neck area by means of postoperative quantitative measurement of dynamic contrast values obtained with contrast-enhanced ultrasound. METHODS: 8/18 patients underwent lip reconstruction with a pedicle flap, 10 patients reconstruction of other parts of the head with a microvascular free transplant. Ultrasound examinations were conducted within the 1st postoperative week and 4 weeks after surgery. After the intravenous bolus of the ultrasound contrast agent, examinations were carried out for 30 sec without compression followed by 30 sec with compression of the vascular…pedicle in bolus and flash kinetics. Digital cine loops were analyzed off-line with a quantification software (VueBox™) to determine the Rise Time (RT) between flap tissue with and without compression. RESULTS: Measurements showed increasing autonomous perfusion, independent of the vascular pedicle. No transplant was lost, but 4/10 patients with a microvascular flap and 1/8 patients with a pedicle flap developed postoperative complications. RT values for the pedicled and microvascular flaps obtained under compression differed significantly between the 1st and the 4th week (p = 0.025). CONCLUSIONS: Reliable neovascularization was achieved 4 weeks postoperatively. CEUS showed to be a useful method for assessing the degree of autonomization of pedicle and microvascular free flaps.
Abstract: BACKGROUND: Duchenne muscular dystrophy (DMD) consists of a lack in the expression of the subsarcolemmal protein dystrophin causing progressive muscle dysfunction. Among the widely applied animal models in DMD research is the C57BL/1010ScSn-Dmdmdx mouse, commonly referred to as the “mdx mouse”. The potential benefit of novel interventions in this model is often assessed by variables such as functional improvement, histological changes, and creatine kinase (CK) serum levels as an indicator for the extent of in situ muscle damage. OBJECTIVE: Our objective was to determine to what extent the serum CK-level serves a surrogate for muscle dysfunction. METHODS:…In this trial mdx mice were subjected to a four-limb wire-hanging test (WHT) to assess the physical performance as a reference for muscle function. As CK is a component of the muscle fiber cytosol, its serum activity is supposed to positively correlate with progressing muscle damage. Hence serum CK levels were measured to detect the degree of muscle impairment. The functional tests and the serum CK levels were analyzed for their specific correlation. RESULTS: Although physical performance decreased during the course of the experiment, latency to fall times in the WHT did not correlate with the CK level in mdx mice. CONCLUSION: Our data suggests that the serum CK activity might be a critical parameter to monitor the progression of muscle impairment in mdx mice. Further this study emphasizes the complexity of the DMD phenotype in the mdx mouse, and the care with which isolated parameters in this model should be interpreted.
Keywords: Duchenne muscular dystrophy, mdx mouse, muscle impairment, CK level, diagnostic methods, serum biomarker for muscle imparment
Abstract: PURPOSE: To evaluate the combination of conventional ultrasound (US) and acoustic radiation force impulse (ARFI) elastography in predicting triple-negative breast cancer and the likelihood of lymphatic metastasis. MATERIALS AND METHODS: A total of 178 women presenting from May 2013 to September 2015 with pathologically proven triple-negative (n = 60) or hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer (n = 118) were reviewed. Conventional US and ARFI imaging including Virtual touch tissue image (VTI) and Virtual Touch tissue Quantification (VTQ), were performed for each breast nodule. Parameters collected included patient age, lymph node involvement, histological grade,…tumor subtype, appearance on conventional US, shear wave velocity (SWV) value, VTI score and the boundary on VTI. The ARFI findings were compared with the pathological findings. RESULTS: Younger age (P < 0.001), higher histological grade (P < 0.001), lymphatic metastasis (P < 0.001), more nodes involved (P = 0.001), larger tumor size (P = 0.008), regular shape (P = 0.032), high VTI score (P = 0.006), unclear VTI boundary (P = 0.033), SWV ≥3.51 m/s (P = 0.015) were significantly associated with triple-negative breast cancer. High VTI score (P = 0.004) and a high SWV ≥4.15 m/s (P = 0.002) were significantly associated with lymphatic metastasis. CONCLUSION: Conventional US combined with ARFI may be used to predict triple-negative breast cancer. Those cancers with higher SWV and the high VTI score have a higher likelihood of lymphatic metastasis.
Keywords: Conventional US, acoustic radiation force impulse (ARFI), triple-negative breast cancer, lymphatic metastasis
Abstract: OBJECTIVE: The purpose of this study was to comparatively evaluate the two different shear wave speed (SWS) imaging systems of Toshiba shear wave elastography (T-SWE) and SuperSonic SWE (S-SWE) in distinguishing malignant from benign thyroid nodules (TNs). MATERIALS AND METHODS: 140 patients with 140 focal TNs were enrolled and underwent T-SWE and S-SWE before fine-needle aspiration (FNA) biopsy or surgery. SWE indices of mean, standard deviation and maximum values (E- mean, E- SD and E- max) of elastic modulus in TNs were measured on a color-coded mapping. The receiver operating characteristic (ROC) curve was performed to assess…the diagnostic performance. RESULTS: Of the 140 nodules, 47 were thyroid carcinomas and 93 were benign. Areas under the receiver operating characteristic curve (AUC) were the highest with E- max among the three SWE parameters both for T-SWE and S-SWE (0.816 and 0.799). The most accurate cut-off values, sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were 26.6 kPa versus 42.9 kPa, 83.0% versus 63.8%, 68.8% versus 88.2%, 72.9% versus 80.0%, 56.5% versus 73.2% and 88.7% versus 82.8% with E- max for T-SWE and S-SWE, respectively. Among these comparisons, the sensitivity in T-SWE was statistically higher than S-SWE (83.0% versus 63.8%, p = 0.022), whereas specificity was statistically lower than S-SWE (68.8% versus 88.2%, p < 0.001). CONCLUSION: T-SWE is equal to S-SWE with comparable and promising results for diagnosis of TNs. In clinical using, the selection of E- max should be recommended both for T-SWE and S-SWE.
Abstract: BACKGROUND: Red blood cell (RBC) aggregation influences blood flow properties, impacts blood microcirculation and consequently oxygen delivery. Different methods are established to determine RBC aggregation: under static conditions (i.e. the RBC adhesiveness/aggregation test (EAAT)) or under shear conditions (i.e. the laser-assisted optical rotational cell analyzer (LORCA)). OBJECTIVE: Comparison of these two different methods in detecting the RBC aggregation of patients with coronary artery disease (CAD) and of healthy controls. METHODS: RBC aggregation was quantified in peripheral venous blood of patients with CAD and healthy controls using EAAT and LORCA. RESULTS: Both methods detected…an increased RBC aggregation in patients with CAD compared to the healthy control group: the ratio of clot-free area to whole area (rCFA) detected with EAAT (15.65 vs. 11.30%), and aggregation index (66.33 vs. 53.90%), shear rate of disaggregation (SDA) (105.59 vs. 69.21 s–1 ), and upstroke/ttop (0.03 vs. 0.02 au/s) detected with LORCA device were increased, aggregation half time (detected with LORCA) was decreased (2.11 vs. 3.60 s). rCFA (EAAT) correlated with SDA (LORCA). CONCLUSIONS: Both methods determine an increased RBC aggregation in patients with CAD. However, only one measurement parameter of the LORCA seems to reflect the same RBC aggregation properties as the EAAT.
Keywords: Coronary artery disease, measurement devices, red blood cell aggregation
Abstract: We aimed to evaluate hemodynamic parameters in the cutaneous microcirculation during recovery to graded dynamic exercise performed on a cycloergometer by using two distinctive methods: high-frequency ultrasound Doppler flowmetry (UDF) and laser Doppler fluxmetry (LDF). Regarding UDF, the medium linear blood flow velocity (Vam ) was estimated, expressed in absolute units (cm/s) whereas blood flow assessed by LDF was registered in arbitrary perfusion units (PU). We compared the corresponding perfusion values obtained by UDF and LDF, respectively, every 20 s during recovery period to physical exercise. Three types of microvascular blood flow dynamics were recorded: blood flow with an occasional paroxysm,…a pulsatile blood flow pattern, and a shunting-type blood flow pattern. In the first type, the reaction time of registration and the direction of changes of UDF and LDF values coincided in 77.7%, exhibiting high correlation (r = 0.77; p ≤0.001). In the second type, the direction of changes of UDF and LDF showed 85.0% similarity and a moderate correlation (r = 0.66; p = 0.0015), whereas in the third type, there was also a moderate correlation (r = 0.53, p = 0.0024). Our pilot experiments have shown that UDF could be regarded as a comparable substitutional method to LDF for studying skin microcirculation.
Abstract: BACKGROUND: Generalized restricted blood flow is hallmark of CHF of any etiology, but the extent of microcirculation restriction and the role of intrinsic blood properties in heart failure remains unknown. OBJECTIVE: The aim of this study was to estimate the microvascular blood flow and hemorheological properties in chronic heart failure to test the hypothesis that CHF patients have altered peripheral blood flow which contributes to the tissue perfusion disturbances. METHODS: Cutaneous microvascular blood flow was estimated by Laser Doppler and Optical Tissue Oximetry techniques. Whole blood and plasma viscosity were measured by capillary viscometer, red…blood cell aggregation was evaluated by direct microscopic method, erythrocyte deformability was assessed as elongation index in flow microchamber. Hematocrit-to-viscosity ratio was used as index of oxygen transport efficacy. RESULTS: Depression of the regulatory mechanisms of microvascular blood flow as well as decreased tissue perfusion indicated the restricted blood flow in microcirculatory network in CHF. Increased blood and plasma viscosity, enhanced red blood cell aggregation and decreased erythrocyte deformability were registered in CHF. CONCLUSIONS: Complex impairment of peripheral blood flow in CHF including restricted microcirculation, attenuated regulatory mechanisms and impaired hemorheological properties caused the reduced oxygen utilization contributing to symptoms and advance of heart failure.
Abstract: OBJECTIVE: To assess the factors associated with initial incomplete ablation (ICA) after radiofrequency ablation for benign thyroid nodules (BTNs). MATERIALS AND METHODS: 69 BTNs (mean volume 6.35±5.66 ml, range 1.00–25.04 ml) confirmed by fine-needle aspiration cytology (FNAC) in fifty-four patients were treated with ultrasound-guided percutaneous radiofrequency ablation (RFA) and the local treatment efficacy was immediately assessed by intra-procedural contrast-enhanced ultrasound (CEUS). The RFA was performed with a bipolar electrode (CelonProSurge 150–T20, output power: 20 W). CEUS was performed with a second generation contrast agent under low acoustic power (i.e. coded phase inversion, CPI). Characteristics of clinical factors, findings on conventional…gray-scale ultrasound, color-Doppler ultrasound, and CEUS were evaluated preoperatively. Factors associated with initial ICA and initial ICA patterns on CEUS were assessed. Volume reduction ratios (VRRs) of ICA nodules were compared with those with complete ablation (CA). RESULTS: The RFA procedures were accomplished with a mean ablation time and mean total energy deposition of 11.13±3.39 min (range, 5.38–22.13 min) and 12612±4466 J (range, 6310–26130 J) respectively. CEUS detected initial ICA in 21 of 69 (30.8%) BTNs and 16 (76.2%) of the 21 BTNs with initial ICA achieved CA after additional RFA, leading to a final CA rate of 92.8% (64/69). The factors associated with initial ICA were predominantly solid nodule, nodule close to danger triangle area, nodule close to carotid artery, and peripheral blood flow on color-Doppler ultrasound (all P < 0.05). The mean VRRs of all BTNs were 23.4%, 54.4% and 81.9% at the 1-, 3- and 6-month follow-up, respectively. All BTNs achieved therapeutic success in this series in that all had VRRs of >50% at the 6-month follow-up, among which 7 nodules (10.1%) had VRRs of >90%. There were significant differences in VRRs between ICA nodules and CA nodules at the 3- and 6-month follow-up (all P < 0.05). CONCLUSION: The factors associated with initial ICA after RFA for BTNs were predominantly solid nodules, nodule close to danger triangle area, nodule close to carotid artery, and peripheral blood flow on color-Doppler ultrasound. CEUS assists quick treatment response evaluation and facilitates subsequent additional RFA and final CA of the nodules. Nodules with CA achieve a better outcome in terms of VRR in comparison with those with ICA.