Clinical Hemorheology and Microcirculation - Volume 75, issue 4

Authors: Inal, Jameel

Article Type: Letter

DOI: 10.3233/CH-200958

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 4, pp. 383-386, 2020

Authors: Wei, Linlin | Zeng, Kexue | Gai, Juanjuan | Zhou, Feixiong | Wei, Zhenglin | Bao, Qinghui

Article Type: Research Article

Abstract: OBJECTIVE: To study the effect of acupuncture on neurovascular units after cerebral infarction (CI) in rats through the phosphatidylinositol 3-hydroxy kinase/protein kinase B (PI3K/AKT) signaling pathway. METHODS: A total of 36 Sprague-Dawley rats were randomly divided into sham group (n  = 12), model group (n  = 12) and acupuncture group (n  = 12). The external carotid artery was only exposed in model group, while the post-CI ischemia-reperfusion model was established using the suture method in the other 2 groups. After modeling, the rats in sham group and model group were fixed and sampled, while those in acupuncture group were treated with …acupuncture intervention for 2 weeks and sampled. The neurological deficits of rats were evaluated using the Zea-Longa score, and the spatial learning and memory of rats were detected via water maze test. Moreover, the expressions of vascular endothelial growth factor (VEGF), growth associated protein-43 (GAP-43) and synuclein (SYN) in brain tissues were detected via immunohistochemistry, and the relative protein expressions of PI3K p85, PI3K p110 and p-AKT were detected via Western blotting. The messenger ribonucleic acid (mRNA) expressions of VEGF, GAP-43 and SYN were detected via quantitative polymerase chain reaction (qPCR). RESULTS: The Zea-Longa score was significantly increased in model group and acupuncture group compared with that in sham group (p  < 0.05), while it significantly declined in acupuncture group compared with that in model group (p  < 0.05). The escape latency was significantly prolonged and the times of crossing platform were significantly reduced in model group and acupuncture group compared with those in sham group (p  < 0.05), while the escape latency was significantly shortened and the times of crossing platform were significantly increased in acupuncture group compared with those in model group (p  < 0.05). The positive expressions of VEGF, GAP-43 and SYN were obviously increased in model group and acupuncture group compared with those in sham group (p  < 0.05), while they were obviously increased in acupuncture group compared with those in model group (p  < 0.05). Besides, model group and acupuncture group had significantly higher relative protein expressions of PI3K p85, PI3K p110 and p-AKT than sham group (p  < 0.05), while acupuncture group also had significantly higher relative protein expressions of PI3K p85, PI3K p110 and p-AKT than model group (p  < 0.05). The relative mRNA expressions of VEGF, GAP-43 and SYN were remarkably increased in model group and acupuncture group compared with those in sham group (p  < 0.05), while they were remarkably increased in acupuncture group compared with those in model group (p  < 0.05). CONCLUSION: Acupuncture promotes the repair of neurovascular units after CI in rats through activating the PI3K/AKT signaling pathway, thereby exerting a protective effect on neurovascular units. Show more

Keywords: Acupuncture, cerebral infarction, PI3K/AKT signaling pathway, neurovascular units

DOI: 10.3233/CH-190659

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 4, pp. 387-397, 2020

Authors: Strumwasser, Aaron | Cohan, Caitlin M. | Beattie, Genna | Chong, Vincent | Victorino, Gregory P.

Article Type: Research Article

Abstract: BACKGROUND: Autotaxin (ATX-secretory lysophospholipase D) is the primary lysophosphatidic acid (LPA) producing enzyme. LPA promotes endothelial hyper-permeability and microvascular dysfunction following cellular stress. OBJECTIVE: We sought to assess whether ATX inhibition would attenuate endothelial monolayer permeability after anoxia-reoxygenation (A-R) in vitro and attenuate the increase in hydraulic permeability observed after ischemia-reperfusion injury (IRI) in vivo . METHODS: A permeability assay assessed bovine endothelial monolayer permeability during anoxia-reoxygenation with/without administration of pipedimic acid, a specific inhibitor of ATX, administered either pre-anoxia or post-anoxia. Hydraulic permeability (Lp ) of rat mesenteric post-capillary venules was evaluated after IRI, …with and without ATX inhibition. Lastly, Lp was evaluated after the administration of ATX alone. RESULTS: Anoxia-reoxygenation increased monolayer permeability 4-fold (p  < 0.01). Monolayer permeability was reduced to baseline similarly in both the pre-anoxia and post-anoxia ATX inhibition groups (each p  < 0.01, respectively). Lp was attenuated by 24% with ATX inhibition (p  < 0.01). ATX increased Lp from baseline in a dose dependent manner (p  < 0.05). CONCLUSIONS: Autotaxin inhibition attenuated increases in endothelial monolayer permeability during A-R in vitro and hydraulic permeability during IRI in vivo . Targeting ATX may be especially beneficial by limiting its downstream mediators that contribute to mechanisms associated with endothelial permeability. ATX inhibitors may therefore have potential for pharmacotherapy during IRI. Show more

Keywords: Autotaxin, anoxia-reoxygenation, ischemia-reperfusion, hydraulic permeability

DOI: 10.3233/CH-190732

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 4, pp. 399-407, 2020

Authors: Grambow, Eberhard | Klee, Gina | Klar, Ernst | Vollmar, Brigitte

Article Type: Research Article

Abstract: INTRODUCTION: Neointima formation is closely linked to vascular stenosis and occurs after endothelial damage. Hydrogen sulfide is an endogenous pleiotropic mediator with numerous positive effects on the cardio vascular system. OBJECTIVE: This study evaluates the effect of the slow releasing hydrogen sulfide donor GYY4137 (GYY) on neointimal formation in vivo . METHODS: The effect of GYY on neointimal formation in the carotid artery was studied in the FeCl3 injury model in GYY- or vehicle-treated mice. The carotid arteries were studied at days 7 and 21 after treatment by means of histology and immunohistochemistry for proliferating …cell nuclear antigen (PCNA) and alpha smooth muscle actin (α -SMA). RESULTS: GYY treatment significantly reduced the maximal diameter and the area of the newly formed neointima on both days 7 and 21 when compared to vehicle treatment. GYY additionally reduced the number of PCNA- and α -SMA-positive cells within the neointima on day 21 after FeCl3 injury of the carotid artery. CONCLUSIONS: Summarizing, single treatment with the slow releasing hydrogen sulfide donor GYY reduced the extent of the newly formed neointima by affecting the cellular proliferation at the site of vascular injury. Show more

Keywords: Pleiotropic mediator, gaseous transmitter, arterial stenosis, basic science, vascular disease

DOI: 10.3233/CH-190747

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 4, pp. 409-417, 2020

Authors: Lerchbaumer, Markus Herbert | Putz, Franz Josef | Rübenthaler, Johannes | Rogasch, Julian | Jung, Ernst-Michael | Clevert, Dirk-Andre | Hamm, Bernd | Makowski, Marcus | Fischer, Thomas

Article Type: Research Article

Abstract: PURPOSE: Contrast-enhanced-ultrasound (CEUS) has been frequently used in assessment of cystic renal lesions. OBJECTIVE: The aim of this study was to investigate the Bosniak classification in CEUS compared to CT and MRI in a multi-center setting. METHODS: Bosniak classification in CEUS examinations of cystic renal lesions were compared to imaging findings in computed-tomography (ceCT) and magnetic-resonance-imaging (ceMRI). Imaging results were correlated to histopathological reports. All examinations were performed by experts (EFSUMB level 3) using up-to-date CEUS examination-protocols. RESULTS: Overall, 173 cystic renal lesions were compared to subgroups CT (n  = 87) and MRI (n  = 86). …Using Bosniak-classification 64/87 renal cysts (73.6%) were rated equal compared to CT with upgrade of four lesions (4.6%) and downgrade of 19 lesions (21.8%) by CT (Intra-class-correlation [ICC] coefficient of 0.824 [p  < 0.001]). CEUS compared to MRI, presenting different scoring especially in classes Bosniak IIF (n  = 16/31) and Bosniak III (n  = 16/28) with an ICC coefficient of 0.651 (p  < 0.001). CONCLUSION: CEUS can visualize even finest septal and small nodular wall enhancement, which may result in an upgrade of cystic lesions into a higher Bosniak class compared to CT or MRI. Thus, a modification of the Bosniak classification on CEUS may reduce unnecessary biopsies and surgery. Show more

Keywords: Contrast-enhanced ultrasound, CEUS, Bosniak, renal cyst

DOI: 10.3233/CH-190764

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 4, pp. 419-429, 2020

Authors: Windberger, U. | Dibiasi, Ch. | Lotz, E.M. | Scharbert, G. | Reinbacher-Koestinger, A. | Ivanov, I. | Ploszczanski, L. | Antonova, N. | Lichtenegger, H.

Article Type: Research Article

Abstract: BACKGROUND: Dynamic mechanical analysis of blood clots can be used to detect the coagulability of blood. OBJECTIVE: We investigated the kinetics of clot formation by changing several blood components, and we looked into the clot “signature” at its equilibrium state by using viscoelastic and dielectric protocols. METHODS: Oscillating shear rheometry, ROTEM, and a dielectro-rheological device was used. RESULTS: In fibrinogen- spiked samples we found the classical high clotting ability: shortened onset, faster rate of clotting, and higher plateau stiffness. Electron microscopy explained the gain of stiffness. Incorporated RBCs weakened the clots. Reduction of temperature …during the clotting process supported the development of high moduli by providing more time for fiber assembly. But at low HCT, clot firmness could be increased by elevating the temperature from 32 to 37°C. In contrast, when the fibrinogen concentration was modified, acceleration of clotting via temperature always reduced clot stiffness, whatever the initial fibrinogen concentration. Electrical resistance increased continuously during clotting; loss tangent (D) (relaxation frequency 249 kHz) decreased when clots became denser: fewer dipoles contributed to the relaxation process. The relaxation peak (Dmax) shifted to lower frequencies at higher platelet count. CONCLUSION: Increasing temperature accelerates clot formation but weakens clots. Rheometry and ROTEM correlate well. Show more

Keywords: Clot stiffness, kinetic, temperature, erythrocytes, fibrinogen, rheometry, thrombelastometry, dielectric test

DOI: 10.3233/CH-190799

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 4, pp. 431-445, 2020

Authors: Al-Hindwan, Haitham Saleh Ali | Silbernagel, Günther | Curio, Jonathan | Abulgasim, Kamal | Schröder, Mark | Wuerdemann, Imke | Kasner, Mario | Landmesser, Ulf | Reinthaler, Markus

Article Type: Research Article

Abstract: BACKGROUND: High surgical risk patients presenting with severe mitral valve regurgitation (MR) and concomitant aortic valve disease are frequently a challenge for the interdisciplinary heart team meeting. If open-heart surgery for severe MR is performed, aortic stenosis (AS) or regurgitation (AR) is corrected during the same procedure if at least moderate severity of AS or AR has been confirmed. In patients with prohibitive surgical risk, optimal management strategies in the light of available transcatheter interventions still needs to be established. METHODS AND RESULTS: In this retrospective single center study, we aimed to investigate the impact of coincident moderate …aortic valve disease on the outcome of patients undergoing MitraClip for severe MR. In 286 MitraClip procedures performed in our institution, 21 patients (7,3%) were identified to suffer from concomitant moderate AS and 28 patients had moderate AR (9,8%). Patients with AS were found to have a higher incidence of >moderate MR following the procedure when compared to patients without aortic valve disease (14,3% vs. 8,9%, p  = 0.001). No differences between the groups were found regarding a combined endpoint of all cause deaths and heart failure hospitalizations after 1 year follow up (no aortic-valve disease vs. moderate AS: 19% vs 18%; p  = 0,881 and no aortic valve disease vs moderate AR: 19% vs. 25%; p  = 0.477). However, mortality was significantly higher in patients with coincidental moderate AR (3.8% patients without aortic valve disease, 5% in patients with AS, 17,9% in patients with AR; p  = 0.006). CONCLUSION: According to our analysis coincidental Aortic valve stenosis may be associated with worse technical results regarding residual MR after MitraClip. Although our results regarding a combined endpoint of all-cause mortality and heart failure hospitalizations within one year of follow up were comparable between the groups, patients with moderate AR had significantly higher mortality rates. Due to the limited number of patients, our study is only hypothesis generating. Larger trials are necessary to confirm our result. Show more

Keywords: Mitral valve regurgitation, interventional mitral valve repair, MitraClip, aortic valve stenosis, aortic valve regurgitation, TAVI

DOI: 10.3233/CH-200818

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 4, pp. 447-455, 2020

Authors: Amoroso, Matteo | Apelgren, Peter | Elander, Anna | Säljö, Karin | Kölby, Lars

Article Type: Research Article

Abstract: BACKGROUND: Acute normovolemic hemodilution (ANH) has been proposed as a microsurgical technique to improve blood flow in free flaps. OBJECTIVE: Here, we present the first systematic review of clinical and experimental studies on the effect of ANH. METHODS: We performed a systematic literature search of PubMed, Medline, the Cochrane Library, Google Scholar, and ClinicalTrials.gov using search strategies and a review process in agreement with the PRISMA statement and the Cochrane Handbook for systematic reviews of interventions. PICO criteria were defined before bibliometric processing of the retrieved articles, which were analyzed with the SYRCLE RoB tool for …risk of bias and the GRADE scale for level of evidence. RESULTS: We retrieved 74 articles from the literature search, and after processing according to PICO criteria, only four articles remained, all of which were experimental. The rating for risk of bias was uncertain according to SYRCLE RoB results, and the level of evidence was low according to GRADE evaluation. CONCLUSIONS: There is no clinical evidence for the effect of ANH on microcirculation in free flaps, and experimental studies provide weak evidence supporting the use of hemodilution in reconstructive microsurgery. Show more

Keywords: Acute normovolemic hemodilution, free flap, blood flow, systematic review, reconstructive surgery

DOI: 10.3233/CH-200832

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 4, pp. 457-466, 2020

Authors: Ahmadizad, Sajad | Rahmani, Hiwa | Khosravi, Nikoo | Falakdin, Zahra | Connes, Philippe | Daraei, Ali

Article Type: Research Article

Abstract: BACKGROUND: Platelet activation is associated with abdominal obesity and exercise training is an important modulator of body weight. OBJECTIVE: We investigated the effects of two high intensity interval exercise (HIIE) protocols of different intensity and duration on platelet indices and platelet aggregation in overweight men. METHODS: Ten overweight men performed 6 intervals of 30s exercise at 110% of peak power output (PPO) interspersed by 3 : 30 min active recovery (1/7 protocol) at 40% of PPO and 6 intervals of 2 min exercise at 85% of PPO interspersed by 2 min active recovery (1/1 protocol) at 30% of …PPO in two separate sessions. Platelet indices and platelet aggregation were measured before and immediately after both HIIEs. RESULTS: Platelet indices increased significantly following HIIE (P  < 0.05), though, significant differences between the two protocols were only detected for platelet count, which was markedly increased following 1/1 protocol. Platelet aggregation increased significantly (P  < 0.05) in response to the two HIIE protocols, with no significant difference being observed between the two protocols (P  > 0.05). CONCLUSIONS: It is concluded that HIIE leads to transient increases in markers of thrombus formation and that work to rest ratio is an important factor when investigating the changes in thrombocytosis following HIIE. Show more

Keywords: Interval exercise, exercise intensity, platelet function, thrombocytosis, thrombus

DOI: 10.3233/CH-200848

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 4, pp. 467-474, 2020

Authors: Bruno, Raphael Romano | Masyuk, Maryna | Muessig, Johanna M. | Binneboessel, Stephan | Bernhard, Michael | Bäz, Laura | Franz, Marcus | Kelm, Malte | Jung, Christian

Article Type: Research Article

Abstract: BACKGROUND: Dehydration occurs frequently in older patients and constitutes a significant clinical problem. OBJECTIVE: This proof-of-concept study examines whether 1) sublingual measurement in dehydrated old patients is feasible, 2) frailty and incompliance in old, awake patients affects video-quality, 3) dehydration impacts microcirculation METHODS: This prospective observational study included clinically dehydrated patients aged ≥65 years immediately after admission. Dehydration was assessed clinically. A sidestream dark field camera (SDF) was used for measurement. Video-quality was evaluated with MIQS (microcirculation image quality score). Both AVA 4.3C- and AVA POEM-software analyzed the videos. Seventeen patients ≥65 years not showing dehydration …served as control. RESULTS: Thirteen patients (8 female) were included. The average age was 83±8 years. The mini-mental test was 17±15 points, the Clinical Frailty Scale 4±3, the Barthel-Index 59±39. None of these parameters correlated with MIQS (3.4±4.2 SD (“acceptable”)). Dehydrated patients had a slightly impaired microcirculation, with a significantly lower percentage of perfused small vessels compared to control (83.1±7.7% versus 88.0±6.0%, P  < 0.05). After rehydration, there was acute improvement in the microcirculation. CONCLUSIONS: Sublingual microcirculatory SDF-measurement is both, safe and valid for dehydrated old patients - regardless of frailty, age or cognitive performance. Dehydration leads to an impaired microcirculation. Show more

Keywords: Microcirculation, elderly, dehydration, older, rehydration, cognitive impairment, SDF-measurement.

DOI: 10.3233/CH-200859

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 4, pp. 475-487, 2020