Clinical Hemorheology and Microcirculation - Volume 70, issue 1

Authors: Kehrer, A. | Engelmann, S. | Ruewe, M. | Geis, S. | Taeger, C. | Kehrer, M. | Tamm, E.R. | Bleys, R.L.A.W. | Prantl, L. | Mandlik, V.

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVES: Early persistent facial paralysis is characterized by intact muscles of facial expression through maintained perfusion but lacking nerve supply. In facial reanimation procedures aiming at restoration of facial tone and dynamics, neurotization through a donor nerve is performed. Critical for reanimating target muscles is axonal capacity of both donor and recipient nerves. In cases of complete paralysis, the proximal stump of the extratemporal facial nerve trunk may be selected as a recipient site for coaptation. To further clarify the histological basis of this facial reanimation procedure we conducted a human cadaver study examining macro and micro anatomical …features of the facial nerve trunk including its axonal capacity in human cadavers. Axonal loads, morphology and morbidity of different donor nerves are discussed reviewing literature in context of nerve transfers. METHODS: From 6/2015 to 9/2016 in a group of 53 fresh frozen cadavers a total of 106 facial halves were dissected. Biopsies of the extratemporal facial nerve trunk (FN) were obtained at 1 cm distal to the stylomastoid foramen. After histological processing and digitalization of 99 specimens available, 97 were selected eligible for fascicle counts and 87 fulfilled quality criteria for a semi-automated computer-based axon quantification software using ImageJ/Fiji. RESULTS: An average of 3.82 fascicles (range, 1 to 9) were noted (n  = 97). 6684±1884 axons (range, 2655– 12457) were counted for the entire group (n  = 87). Right facial halves showed 6364±1904 axons (n  = 43). Left facial halves demonstrated 6996±1833 axons (n  = 44) with no significant difference (p  = 0.73). Female cadavers featured 6247±2230 (n  = 22), male showed 6769±1809 axons (n  = 40). No statistical difference was seen between genders (p  = 0.59). A comparison with different studies in literature is made. The nerve diameter in 82 of our specimens could be measured at 1933±424 μm (range, 975 to 3012). CONCLUSIONS: No donor nerve has been described to match axonal load or fascicle number of the extratemporal facial nerve main trunk. However, the masseteric nerve may be coapted for neurotization of facial muscles with a low complication rate and good clinical outcomes. Nerve transfer is indicated from 6 months after onset of facial paralysis if no recovery of facial nerve function is seen. Show more

Keywords: Facial nerve, zygomatic nerve branches, buccal nerve branches, facial paralysis, facial reanimation, facial anatomy, facial muscles, mimetic muscles, nerve transfer, cross-face-nerve grafts (CFNG), free muscle transplantation

DOI: 10.3233/CH-189905

Citation: Clinical Hemorheology and Microcirculation, vol. 70, no. 1, pp. 1-13, 2018

Authors: Al-Hindwan, Haitham Saleh Ali | Landmesser, Ulf | Stähli, Barbara | Alushi, Brunhilda | Curio, Jonathan | Neumann, Tim | Jung, Friedrich | Lendlein, Andreas | Jacobs, Stephan | Reinthaler, Markus

Article Type: Research Article

Abstract: INTRODUCTION: Concomitant mitral-regurgitation (MR) is frequently observed in patients undergoing trans-catheter aortic valve implantation (TAVI). The predictive value of MR etiology remains to be elucidated. METHODS: 600 patients with coincidental MR (≥moderate) undergoing TAVI were categorized according to a modified Carpentier classification [Groups: no/mild MR, n = 477; left atrial (LA) functional MR, n = 18; MR due to left ventricular dilatation, n = 29; degenerative MR, n = 50; MR with restricted leaflet motion n = 26]. MR improvement and patient outcome was compared among the groups in a retrospective analysis. …RESULTS: MR regression was most pronounced in patients with restricted leaflet motion after 6 months, although a significant improvement was observed in all subgroups. MR relief was predominantly observed within the first 30 days after TAVI. Only patients with restricted leaflet motion experienced further improvement thereafter. In the entire cohort a total of 15 strokes (2.5%) during the first 30 days after TAVI were observed, with the highest incidence in the LA functional cohort (3 events, 17%; p = 0.008). In multivariate analysis, organic etiology was associated with an increased 1-year mortality. In conclusion, despite significant MR regression in all MR groups, some individuals may require additional mitralvalve repair after TAVI. According to our data the timing of these procedures should be based on the underlying MR etiology. The Carpentier classification in patients with coincidental MR undergoing TAVI for severe AS may also have prognostic implications as we found an increased incidence of strokes in our LA functional cohort and a worse mortality rates in organic MR. Show more

Keywords: Trans-catheter aortic valve implantation, TAVI, Carpentier classification, LA functional MR, functional mitral regurgitation, organic mitral regurgitation

DOI: 10.3233/CH-189906

Citation: Clinical Hemorheology and Microcirculation, vol. 70, no. 1, pp. 15-25, 2018

Authors: Du, Zhongtao | Jia, Zaishen | Wang, Jinhong | Xing, Zhichen | Jiang, Chunjing | Xu, Bo | Yang, Xiaofang | Yang, Feng | Miao, Na | Xing, Jialin | Wang, Hong | Jia, Ming | Hou, Xiaotong

Article Type: Research Article

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. Show more

Keywords: Cardiogenic shock, hemodynamics, extracorporeal membrane oxygenation, microcirculation, inotropic agents

DOI: 10.3233/CH-16156

Citation: Clinical Hemorheology and Microcirculation, vol. 70, no. 1, pp. 27-37, 2018

Authors: Zhao, Qing | Wang, Xiao-Lei | Sun, Jia-Wei | Jiang, Zhao-Peng | Tao, Lin | Zhou, Xian-Li

Article Type: Research Article

Abstract: OBJECTIVES: To compare the diagnostic performance of conventional strain elastography (CSE) and acoustic radiation force impulse (ARFI) induced SE for qualitative assessment of breast lesions and evaluate the additional value of the two techniques combined with Breast Imaging Reporting and Data System (BI-RADS) respectively for the differentiation of benign and malignant breast lesions. METHODS: In a cohort of 110 women, the conventional ultrasound (US) features and the elasticity scores of CSE and ARFI induced SE were recorded. The diagnostic performances of BI-RADS, elastography and BI-RADS plus elastography were evaluated, including the area under the receiver operating characteristic curve …(AUROC), sensitivity, specificity and accuracy. RESULTS: Pathologically, there were forty-eight malignant and sixty-two benign breast lesions in the final analysis. The AUCs for CSE and ARFI induced SE are similar (CSE, 0.807; ARFI induced SE, 0.846; p  > 0.05), however, the specificity of the latter method was significantly higher than that of CSE (83.9% vs. 58.1%, p  = 0.004) in differentiating breast lesions. The accuracy and specificity of BI-RADS plus ARFI induced SE (84.5%, 80.6%, respectively) were significantly higher than BI-RADS alone (73.6%, 54.8%, respectively) and BI-RADS plus conventional SE (72.7%, 56.5%, respectively), respectively (p  < 0.05) without loss of sensitivity. CONCLUSIONS: Our study showed that BI-RADS plus ARFI induced SE had a better diagnostic performance in the diagnosis of breast lesions in comparison with BI-RADS alone or BI-RADS plus CSE. Show more

Keywords: Breast cancer, elastography, ultrasound

DOI: 10.3233/CH-170364

Citation: Clinical Hemorheology and Microcirculation, vol. 70, no. 1, pp. 39-50, 2018

Authors: Lin, Hai-Peng | Zheng, Yan-Qing | Zhou, Zhi-Ping | Wang, Gao-Xiong | Guo, Ping-Fan

Article Type: Research Article

Abstract: BACKGROUND: Intracellular calcium overload has been implicated in various pathological conditions including ischemia reperfusion injury. This study aims to explore the effect and probable mechanism of dantrolene, a ryanodine receptor and intracellular calcium antagonist, on the skeletal muscle ischemia reperfusion injury. MATERIALS AND METHODS: SD rats were randomly divided into three groups: sham group which underwent anaesthesia and exposure of femoral vein, reperfusion group that received 2 h ischemia and the amount of diluent via femoral vein before 4 h reperfusion, dantrolene group that underwent 2 h ischemia and was given 2 mg/kg dantrolene via femoral vein before 4 h reperfusion. The parameters …measured at the end of reperfusion included serum maleic dialdehyde (MDA), tissue myeloperoxidase (MPO) and muscle histology, as well as serum TNF-α and IL-10. RESULTS: Levels of MDA, MPO and TNF-α increased in the reperfusion group, whereas the relevant expressions in the dantrolene group decreased significantly. Histological examination demonstrated significant improvements between the same both groups. IL-10 reflected the protection observed above with a significant up-regulation of expression after dantrolene administration. CONCLUSION: Ryanodine receptor antagonist dantrolene exerted a significant protective effect against the inflammatory injury of skeletal muscle ischemia reperfusion. The underlying molecular mechanism is probably related to the suppression of TNF-α levels and the increment of IL-10 expression. Show more

Keywords: Ischemia reperfusion, skeletal muscle, dantrolene, ryanodine receptor

DOI: 10.3233/CH-170276

Citation: Clinical Hemorheology and Microcirculation, vol. 70, no. 1, pp. 51-58, 2018

Authors: Shin, Dong Woo | Gu, Ja-Yoon | Kim, Jun Sik | Jung, Jae-Seol | Shin, Dong-Yeop | Koh, Youngil | Kim, Inho | Kim, Hyun Kyung

Article Type: Research Article

Abstract: BACKGROUND: Although hyperviscosity syndrome in plasma cell dyscrasia (PCD) and thrombosis in myeloproliferative neoplasm (MPN) are major causes of morbidity and mortality, blood viscosity measurements are often underutilized. OBJECTIVE: This study aimed to characterize whether whole blood viscosity (WBV) or plasma viscosity (PV) could be predictive of hyperviscosity syndrome in PCD and could be elevated in subgroups of MPN. METHODS: A total of 75 patients with hematologic diseases: PCD (n  = 26), MPN (n  = 25) including polycythemia vera (P. vera) and lymphoma (n  = 24) were enrolled along with 104 healthy controls. Both WBV and PV were measured …using a capillary tube viscometer. Hyperviscosity syndrome was defined as having 2 or more hyperviscosity symptoms. RESULTS: Patients with PCD showed significantly higher PVs at high and low shear rates when compared to healthy controls, especially in those with hyperviscosity syndrome. The sensitivity and specificity of WBV and PV in detecting hyperviscosity syndrome were 28.6% and 94.1%, and 71.4% and 66.7%, respectively. Patients with P. vera exhibited high WBV and RBC counts compared to healthy controls. CONCLUSION: PV is predictive of hyperviscosity syndrome in PCD and WBV is elevated in patients with P. vera. It suggests that hemorheologic disturbances exist in patients with PCD and MPN and that tests of viscosity may be helpful in detecting hemorheological disturbances. Show more

Keywords: Blood viscosity, plasma cell dyscrasia, myeloproliferative neoplasm, hyperviscosity syndrome

DOI: 10.3233/CH-170304

Citation: Clinical Hemorheology and Microcirculation, vol. 70, no. 1, pp. 59-67, 2018

Authors: Neumann, Jan | Schmaderer, Christoph | Finsterer, Sebastian | Zimmermann, Alexander | Steubl, Dominik | Helfen, Anne | Berninger, Markus | Lohöfer, Fabian | Rummeny, Ernst J. | Meier, Reinhard | Wildgruber, Moritz

Article Type: Research Article

Abstract: BACKGROUND: Quantitative Imaging of microcirculatory disorders is challenging. OBJECTIVE: To investigate the feasibility of 2D Fluorescence Optical Imaging (FOI) for characterization and quantification of microcirculatory disorders in peripheral arterial occlusive disease (PAOD) of the upper extremity. METHODS: 9 patients with various clinical presentations of PAOD of the upper extremity were included. Quantitative analysis of both hands was performed by assessing the fluorescence intensity of Indocyanine Green (ICG) dynamically over a time period of 360 seconds. Analysis of the signal intensity within multiple regions of both hands was calculated and time-dependent perfusion curves for each region of …interest were plotted over time. RESULTS: Compared to the healthy, vascular non-impaired segments, pathological segments with an impaired tissue perfusion were identified through a decreased rate of early tissue enhancement (p  = 0.02) and increased signal intensity of the optical perfusion agent per second (p  < 0.001). The affected segments showed a decreased maximum signal intensity and a prolonged interval to reach the maximum signal intensity (time to peak). CONCLUSION: 2D FOI allows quantitative assessment of the peripheral microcirculation in various vascular pathophysiologies and is able to detect the impaired tissue perfusion in patients with vascular disorders of the upper extremity. Show more

Keywords: Fluorescence optical imaging, microcirculation, peripheral arterial occlusive disease, indocyanine green

DOI: 10.3233/CH-170321

Citation: Clinical Hemorheology and Microcirculation, vol. 70, no. 1, pp. 69-81, 2018

Authors: Akkoca, Muzaffer | Usanmaz, Suzan Emel | Tokgöz, Serhat | Köksoy, Cüneyt | Demirel-Yilmaz, Emine

Article Type: Research Article

Abstract: BACKGROUND: Intermittent ischemia in remote tissues can be applied before ischemic injury, during ischemic injury or at the beginning of reperfusion of an index organ ischemia. The aim of this study was to investigate the effect of Remote Ischemic Conditioning (RIC) of the leg on changes in ischemia-induced the microvascular functions of the arm. MATERIAL AND METHODS: Ischemic microvascular injury was induced by arm ischemia (20 min) and reperfusion in healthy, nonsmoker, male volunteers (ischemia group-ISC, n: 9). In another group of volunteers, to investigate the effects of remote organ ischemic conditioning 5 cycles of reperfusion followed by leg …ischemia (each lasting 60 seconds) were applied either before (preRIC, n:11), or during (perRIC, n:12) or immediately after (postRIC, n:9) 20 minutes of arm ischemia. The microvascular flow of arm was assessed before and after ischemia using iontophoresis of the endothelium-derived nitric oxide (NO) releaser acetylcholine (ACh) and the endothelium-independent NO donor sodium nitroprusside (SNP). Changes in microvascular blood flow were measured using Laser Doppler imaging. The plasma level of biomarkers related to endothelial function such as nitric oxide (NO), asymmetric dimethylarginine (ADMA), total antioxidant capacity (TAC) and hydrogen sulphide (H2 S) were measured. RESULTS: No difference was determined between the groups in terms of age, BMI or blood biochemicals reflecting cardiovascular status. ACh caused a rise in microvascular blood flow in a charge dependent manner. The ACh-induced flow increase was not significantly depressed by ischemia and not affected by any of the types of RIC in the study subjects. The increase in SNP-induced microvascular flow was significantly decreased in the ISC, perRIC and postRIC groups, but not in the preRIC group. Plasma levels of NO, ADMA, TAC and H2 S were not changed by ischemia and RIC. CONCLUSION: These results suggested that microvascular perfusion of human forearm skin was elevated by either endothelium or drug-derived NO. The effect of ischemia and RIC on NO-induced flow increase was affected differently by different applications in the healthy young individuals. These complicated results are taken into consideration in experimental and therapeutic interventions. Show more

Keywords: Ischemia-reperfusion, remote ischemic conditioning, microcirculation, endothelial dysfunction

DOI: 10.3233/CH-170337

Citation: Clinical Hemorheology and Microcirculation, vol. 70, no. 1, pp. 83-93, 2018

Authors: Dufu, Kobina | Patel, Mira | Oksenberg, Donna | Cabrales, Pedro

Article Type: Research Article

Abstract: BACKGROUND: In sickle cell disease (SCD), polymerization of hemoglobin S (HbS) leads to the formation of rigid, non-deformable sickled RBCs. Loss of RBC deformability, sickling and irreversible membrane damage causes abnormal blood rheology, and increases viscosity which contributes to vasoocclusion and other SCD pathophysiology. GBT440 (generic name voxelotor) is a novel anti-polymerization and anti-sickling agent currently undergoing clinical evaluation for the treatment of SCD. OBJECTIVE: The purpose of this study was to determine the effects of GBT440 on deformability of sickle RBCs (SS RBCs) and the hyperviscosity of sickle cell blood (SS blood). METHODS: The mechanical …and rheological properties of GBT440-treated SS RBCs were measured using micropipette and filtration techniques. The viscosity of sickle blood was measured using a Wells-Brookfield cone/plate viscometer. RESULTS: GBT440 restored movement of deoxygenated SS RBCs through a gel filtration column and reduced the pressure required to pass SS RBCs through a polycarbonate filter. Moreover, GBT440 decreased the membrane shear elastic modulus of SS RBCs assessed via micropipette aspiration and reduced the hyperviscosity of SS blood under deoxygenated conditions. CONCLUSIONS: GBT440 maintains SS RBC deformability and improves SS blood viscosity by inhibiting HbS polymerization under deoxygenated conditions. These results further support development of GBT440 as a disease-modifying agent in SCD patients. Show more

Keywords: Sickle cell disease, red blood cell deformability, sickling, viscosity

DOI: 10.3233/CH-170340

Citation: Clinical Hemorheology and Microcirculation, vol. 70, no. 1, pp. 95-105, 2018

Authors: Peto, Katalin | Nemeth, Norbert | Mester, Anita | Magyar, Zsuzsanna | Ghanem, Souleiman | Somogyi, Viktoria | Tanczos, Bence | Deak, Adam | Bidiga, Laszlo | Frecska, Ede | Nemes, Balazs

Article Type: Research Article

Abstract: BACKGROUND: Micro-rheological relations of renal ischemia-reperfusion (I/R) have not been completely elucidated yet. Concerning anti-inflammatory agents, it is supposed that sigma-1 receptor agonist N,N-dimethyl-tryptamin (DMT) can be useful to reduce I/R injury. OBJECTIVE: To investigate the micro-rheological and metabolic parameters, and the effects of DMT in renal I/R in rats. METHODS: In anesthetized rats from median laparotomy both kidneys were exposed. In Control group (n  = 6) no other intervention happened. In I/R group (n  = 10) the right renal vessels were ligated and after 60 minutes the organ was removed. The left renal vessels were clamped for …60 minutes followed by 120-minute reperfusion. In I/R+DMT group (n  = 10) DMT was administered 15 minutes before the ischemia. Blood samples were taken before/after ischemia and during the reperfusion for testing hematological, metabolic parameters, erythrocyte deformability and aggregation. RESULTS: Lactate concentration significantly increased and accompanied with decreased blood pH. Enhanced erythrocyte aggregation and impaired deformability were observed from the 30th minute of reperfusion. In I/R+DMT group we found diminished changes compared to the I/R group (lactate, pH, electrolytes, red blood cell deformability and aggregation). CONCLUSIONS: Metabolic and micro-rheological parameters impair during renal I/R. DMT could reduce but not completely prevent the changes in this rat model. Show more

Keywords: Kidney, ischemia-reperfusion, hemorheology, N, N-dimethyl-tryptamine

DOI: 10.3233/CH-170361

Citation: Clinical Hemorheology and Microcirculation, vol. 70, no. 1, pp. 107-117, 2018