Clinical Hemorheology and Microcirculation - Volume 76, issue 3

Authors: Kiss, Rudolf | Farkas, Nelli | Jancso, Gabor | Kovacs, Krisztina | Lenard, Laszlo

Article Type: Research Article

Abstract: INTRODUCTION: With the aging of the population, the screening of frail patients, especially before high-risk surgery, come to the fore. The background of the frail state is not totally clear, most likely inflammatory processes are involved in the development. METHODS: Our survey of patients over age of 65 who were on cardiac surgery were performed with Edmonton Frail Scale (EFS). Patients’ demographic, perioperative data, incidence of complications and correlations of inflammatory laboratory parameters were studied with the severity of the frail state. RESULTS: On the basis of EFS, 313 patients were divided into non-frail (NF,163,52%), pre-frail …(PF,89,28.5%) and frail (F,61,19.5%) groups. Number of complications in the three groups were different (NF:0.67/patient, PF:0.76/patient, F:1.08/patient). We showed significant difference between NF and F in both intensive care and hospital stay, but there was no statistical difference between the groups in hospital deaths (NF:5/163, PF:3/89, F:5/61). We also found a significant difference between NF and F patients in preoperative fibrinogen-, CRP- and white blood cell count levels. CONCLUSIONS: We first present the incidence of frailty in patients with heart surgery in a Central-European population. According to our results, inflammatory processes are likely to play a role in the development of the frail state. Show more

Keywords: Frailty, frail state, CRP, fibrinogen, cardiac surgery

DOI: 10.3233/CH-190681

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 3, pp. 341-350, 2020

Authors: Huang, Hui | Li, Manying | Pan, Jiamin | Tong, Wenjuan | Cheng, Meiqing | Liang, Jinyu | Zheng, Yanling | Xie, Xiaoyan

Article Type: Research Article

Abstract: BACKGROUND: Primary hyperparathyroidism (PHPT) results from excessive secretion of parathyroid hormone from parathyroid tumors. Differentiating parathyroid tumors can be challenging before operation. OBJECTIVES: To differentiate parathyroid carcinoma from benign tumors in patients with PHPT by the application of ultrasound and biochemical parameters. METHODS: This study is a retrospective study. The study enrolled 17 patients with parathyroid carcinoma (PC) and 57 patients with parathyroid adenoma (PA), confirmed by postoperative pathology, between September 2010 and July 2017. This study retrospectively compared the ultrasonic features of the tumors included echotexture, maximum lesion diameter, shape, margin, blood flow inside the …mass, intralesional calcifications, cysts in the mass, and biochemical parameters included serum calcium, phosphorus, parathyroid hormone (PTH), alkaline phosphatase (ALP) levels, gender distribution and age of patients between patients with PC and those with PA. RESULTS: In the US images, the two groups showed significant differences in heterogeneity, the appearance of a taller-than-wide shape, irregular or lobulated margins, and intralesional calcifications (p  < #x003C;< #x200A;0.05). However, no significant difference was found in echogenicity, maximum lesion diameter, blood flow, and cystic components of the mass (p  > #x003E;> #x200A;0.05). The mean PTH levels were significantly different between the two groups (p  < #x003C;< #x200A;0.05). The PC and PA patients did not differ significantly in terms of mean serum calcium, mean serum phosphorus, and mean ALP levels (p  > #x003E;> #x200A;0.05). There were significant differences to distinguish PC from PA in calcifications in mass or/and taller-than-wide shape combine with PTH > #x003E;> #x200A;1000 pg/mL (p  < #x003C;< #x200A;0.05). Significant difference existed in the age between the two groups (p  < #x003C;< #x200A;0.001). No significant difference existed in the gender distribution between the two groups (p  > #x003E;> #x200A;0.05). CONCLUSION: Ultrasound features especially intralesional calcifications and taller-than-wide shape combine with an extremely high serum PTH (>1000 pg/mL) are helpful in differentiating between benign and parathyroid tumors in patients with PHPT. Show more

Keywords: Adenoma, biochemical findings, parathyroid carcinoma, primary hyperparathyroidism, ultrasonography

DOI: 10.3233/CH-200846

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 3, pp. 351-359, 2020

Authors: Zhao, Li | Wang, Hao | Li, Shan-Shan | Xin, Feng | Wu, Qi | Li, Zheng-Ye | Ma, Xian-Jun

Article Type: Research Article

Abstract: OBJECTIVE: This study aimed to retrospectively analyze the blood protective effect of autologous platelet separation in operations for acute aortic dissection. METHODS: A total of 130 patients with acute aortic dissection were enrolled into the present study. The average age of these patients was 52.962±10.5061 years old. These patients underwent the modified aortic arch replacement with the elephant trunk technique or endovascular aortic exclusion with covered stent. Among these patients, 68 patients who underwent autologous platelet separation were assigned to the platelet separation group, while the remaining patients were assigned to the control group. All operations were performed …under deep hypothermic circulatory arrest. After anesthesia, 1–2 therapeutic doses of autologous platelets were isolated from patients in the platelet separation group, and these platelets were quickly infused back to these patients after heparin was neutralized by protamine at the end of the cardiopulmonary bypass. The preoperative and postoperative indexes in these two groups were compared. RESULTS: There were no statistically significant differences in age, gender, smoking history, drinking history and hypertension history between these two groups. Compared with controls, the transfusion volume of allogeneic platelets in the perioperative period significantly decreased in the platelet separation group (1.919±1.6226 vs. 0.794±1.1789, P  < #x003C;< #x200A;0.05), and the use rate of allogeneic platelets also significantly decreased (74.19% vs. 45.59%, P  < #x003C;< #x200A;0.05). CONCLUSION: The intraoperative auto transfusion of platelets significantly reduced the volume of allogeneic platelet transfusion after the operation for aortic dissection, which has a significant blood protective effect. Show more

Keywords: Aortic dissection, autologous plateletpheresis, cardiopulmonary bypass, blood conservation, allogeneic platelet transfusions

DOI: 10.3233/CH-200871

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 3, pp. 361-366, 2020

Authors: Bizjak, Daniel A. | Grolle, Andreas | Urena, Javier Antonio Noriega | Bloch, Wilhelm | Deitenbeck, Robert | Grau, Marijke

Article Type: Research Article

Abstract: BACKGROUND: Autologous blood doping (ABD) is applied to improve performance capacity. ABD includes blood donation, red blood cell (RBC) storage at –80°C and re-infusion prior to or during competition. ABD is not directly detectable with current detection techniques. OBJECTIVE: Since cryopreservation is known to affect RBC physiology in vitro , the aim of the study was to examine whether these alterations are detectable in vivo . METHODS: Blood from six healthy male donors was transferred into conventional blood bags, cryopreserved, stored for 18 weeks at –80°C and re-infused with a RBC volume corresponding to ∼4% of …total blood volume into respective donor. RBC physiology parameters were measured before blood donation/re-infusion, and 0/1/2/6/24/48/72 h and 1 w post re-infusion. RESULTS: RBC parameters and age markers were unaffected during intervention. RBC deformability increased from pre-blood-sampling to pre-re-infusion while deformability and viscosity values remained unaltered post re-infusion. RBC nitric oxide associated analytes, metabolic parameters and electrolyte concentrations remained unaffected. CONCLUSIONS: The data of this pilot study indicate that the increase in RBC deformability might be related to neoformation of RBC after blood donation. The lack of changes in tested parameters might be related to the low re-infused RBC volume which might explain differences to in vitro results. Show more

Keywords: Anti-doping, hemorheology, transfusion, blood storage, autologous blood doping, blood boosting

DOI: 10.3233/CH-200887

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 3, pp. 367-379, 2020

Authors: Zhang, Wei-Bing | Li, Jing-Jing | Chen, Xiang-Yong | He, Bei-Li | Shen, Rong-Hua | Liu, Hua | Chen, Jian | He, Xiao-Fei

Article Type: Research Article

Abstract: OBJECTIVES: To compare the diagnostic efficacy of shear wave elastography (SWE) comnined with ACR TI-RADS categories for malignancy risk stratification of thyroid nodules with interminate FNA cytology. METHODS: The clinical data, sonographic features, ACR TI-RADS grading and shear wave elastography images of 193 patients of surgical pathologically proven thyroid nodules with interminate FNA cytology were retrospectively analyzed. The diagnostic efficacy of ACR TI-RADS categories, the maximum Young’s modulus (Emax) of SWE and the combination of the two were calculated respectively. RESULTS: The ROC curves were drawn using surgical pathology results as the gold standard. The ROC …curves indicated that the cut-off value of ACR TI-RADS and Emax of SWE was TR5 and 41.2 kPa respectively, and the area under the ROC curve (AUC) was 0.864 (95% CI: 0.879–0.934) and 0.858 (95% CI: 0.796–0.920) respectively. The diagnostic sensitivity, specificity and accuracy of ACR TI-RADS was 81.4% (127/156), 84.8% (31/37), and 81.9% (158/193), respectively. That of SWE Emax was 80.8% (126/156), 78.4% (29/37), and 80.3% (155/193), respectively. After SWE combined with ACR TI-RADS, the sensitivity, specificity and accuracy was 94.2% (147/156), 75.7% (28/37), and 90.7% (175/193), respectively. CONCLUSIONS: ACR TI-RADS classification system and shear wave elastography had high diagnostic efficacy for thyroid nodules with interminate FNA cytology. The combination of the two could improve diagnostic sensitivity and accuracy, and could help to differentiate benign and malignant thyroid nodules with interminate FNA cytology. Show more

Keywords: Thyroid nodules, indeterminate, shear wave elastography, ACR TI-RADS

DOI: 10.3233/CH-200893

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 3, pp. 381-390, 2020

Authors: Chen, Kailing | Dong, Yi | Zhang, Weibin | Han, Hong | Mao, Feng | Zhang, Qi | Zheng, Zhu | He, Wanyuan | Wang, Wen-Ping

Article Type: Research Article

Abstract: OBJECTIVE: To explore the specific contrast-enhanced ultrasound (CEUS) features of hepatocellular adenomas (HCA) according to their pathological molecular classifications. METHODS & MATERIALS: In this retrospective study, fifty-three histopathologically proved HCA lesions (mean size, 39.7±24.9 mm) were included. Final histopathological diagnosis of HCA lesions were identified by surgical resection (n  = 51) or biopsy (n  = 2) specimens. CEUS imaging features were compared among four subgroups according to World Health Organization (WHO) 2019 pathological molecular classifications standards. Analysis of variance (ANOVA) were used for statistical analysis of continuous variables. Fisher’s exact test were used for categorical variables. The sensitivity (SE), specificity (SP), …and accuracy of CEUS feature in diagnosis of each HCA subtype were calculated and compared. RESULTS: Final histopathological diagnosis included HNF-1α inactivated HCAs (H-HCA, n  = 12), β -catenin activated HCAs (B-HCA, n  = 8), inflammatory HCAs (I-HCA, n  = 31), and unclassified HCAs (U-HCA, n  = 2). During arterial phase of CEUS, all HCAs were hyper-enhanced, 66.6% (8/12) of H-HCAs and 50% (4/8) of B-HCAs displayed complete hyperenhancement, whereas 58.0% (18/31) of I-HCAs showed centripetal filling hyperenhancement pattern (P  = 0.016). Hyper-enhanced subcapsular arteries could be detected in 64.5% (20/31) I-HCAs during early arterial phase. During portal venous and late phase, sustained hyper- or iso-enhancement were observed in 91.7% (11/12) of H-HCAs, while most of I-HCAs (61.3%, 19/31) and B-HCAs (7/8, 87.5%) were hypo-enhanced (P  = 0.000). Central unenhanced areas were most commonly observed in I-HCAs (29.0%, 9/31) (P  = 0.034). CONCLUSION: Depending on its unique imaging features including enhancement filling pattern, hyper-enhanced subcapsular artery and presence of washout, CEUS might provide helpful diagnostic information for preoperative prediction of various HCA molecular subtypes. Show more

Keywords: Hepatocellular adenoma (HCA), contrast-enhanced ultrasound (CEUS), pathological molecular subtype, washout, differentiate

DOI: 10.3233/CH-200899

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 3, pp. 391-403, 2020

Authors: Martini, Romeo

Article Type: Research Article

Abstract: The most important and consulted guidelines dealing with not healing foot ulcers suggest the measurement of the foot perfusion (FP) to exclude the critical limb ischemia (CLI), because of the high risk of limb amputation. But the recommended cut-off values of FP fail to include all the heterogeneity of patients of the real-life with a not healing ulcer. Often these patients are diabetics with a moderate PAD but with a high level of infection. To meet this goal, in 2014, the Society for Vascular Surgery has published the “Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Infection, …and foot Ischemia (WIfI).” This new classification system has changed the criteria of assessment of limb amputation risk, replacing the single cut-off value role with a combination of a spectrum of perfusion values along with graded infection and dimension levels of skin ulcers. The impact of this new classification system was remarkable so to propose the substitution of the CLI definition, with the new Critical limb-threatening ischemia (CLTI), that seems to define the limb amputation risk more realistically Show more

Keywords: Foot perfusion, limb amputation risk, foot ulcers

DOI: 10.3233/CH-200901

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 3, pp. 405-412, 2020

Authors: Römer, Claudia | Fischer, Thomas | Haase, Oliver | Möckel, Martin | Hamm, Bernd | Lerchbaumer, Markus Herbert

Article Type: Research Article

Abstract: BACKGROUND: Median arcuate ligament syndrome (MALS) is a rare condition due to compression of the celiac artery (CA) by an anatomically abnormal median arcuate ligament. With ultrasonography (US) as first-line diagnostic modality in patients with unclear abdominal pain, there is limited data on its diagnostic performance in MALS. OBJECTIVE: To investigate the value of CA peak systolic velocity (PSV) in the workup of patients with suspected MALS. METHODS: Patients with diagnosis of MALS between 2009 and 2019 were referred by Department of Visceral Surgery after clinical and gastroenterological workup. Diagnosis was confirmed by surgery or further …cross-sectional imaging. B-mode US findings and PSV in the CA during various respiratory states were compared between patients with a final MALS diagnosis and patients not meeting the diagnostic criteria. RESULTS: Patients with proven MALS (n  = 10) had higher median CA PSV during normal inspiratory breath-hold (239 [IQR, 159–327] vs. 138 [IQR, 116–152] cm/s; p  < #x003C;< #x200A;0.001), and expiratory breath-hold (287 [IQR, 191–412] vs. 133 [IQR, 115–194] cm/s; p  < #x003C;< #x200A;0.001) compared to patients without MALS (n  = 26). CA PSV in both inspiratory breath-hold (AUC 0.88, 95% CI 0.77–1.00) and expiratory breath-hold (AUC 0.89, 95% CI 0.78–1.00) was of diagnostic value for confirming MALS. The best diagnostic performance (100% sensitivity, 80% specificity) was found for the combination of CA PSVexpiration  + 2.4 · PSVinspiration  > 550 cm/s . CONCLUSIONS: Since results on optimal cutoff values are inconsistent, a combination of CA PSVs during breathing maneuvers may help to diagnose or rule out MALS. Show more

Keywords: Median arcuate ligament syndrome, MALS, Dunbar syndrome, color-coded duplex sonography, coeliac artery compression syndrome

DOI: 10.3233/CH-200903

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 3, pp. 413-423, 2020

Authors: Zhang, Xifeng | Yang, Likun | Xu, Guixia

Article Type: Research Article

Abstract: OBJECTIVE: Acute myeloid leukemia (AML) is a hematological malignancy. This study was attempted to uncover the effects of long noncoding RNA taurine-upregulated gene1 (TUG1) on the viability and apoptosis of AML cells. METHODS: QRT-PCR was implemented to examine the expression of TUG1, miR-221-3p and KIT in AML. The correlation between TUG1 and clinicopathological features of AML patients was evaluated. The effect of TUG1 on AML cells were studied by RNA interference approach. AML cells were transfected with miR-221-3p mimic and miR-221-3p inhibitor, respectively. Then the viability and apoptosis of AML cells were examined by MTT and flow cytometry …assay, respectively. Additionally, dual-luciferase reporter assay was used to confirm the interactions among TUG1, miR-221-3p and KIT. Western blot was applied to analyze protein expression of KIT. RESULTS: The expression of TUG1 and KIT was up-regulated in AML, but miR-221-3p was down-regulated. TUG1 expression had obviously correlation with World Health Organization (WHO) grade in AML patients. The functional experiment stated that TUG1 silencing suppressed the viability and accelerated the apoptosis of AML cells. Moreover, the mechanical experiment demonstrated that TUG1 and KIT were both targeted by miR-221-3p with the complementary binding sites at 3’UTR. Up-regulation of miR-221-3p inhibited the protein expression of KIT. Furthermore, in the feedback experiment, miR-221-3p inhibition or KIT overexpression reversed the repression of tumor behavior induced by TUG1 silencing. CONCLUSIONS: TUG1 silencing retarded viability and promoted apoptosis of AML cells via regulating miR-221-3p/KIT axis, providing a potential therapeutic target for AML. Show more

Keywords: Acute myeloid leukemia, long noncoding RNA TUG1, microRNA-221-3p, KIT, viability

DOI: 10.3233/CH-200906

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 3, pp. 425-437, 2020

Authors: Varga, Gabor | Ghanem, Souleiman | Szabo, Balazs | Nagy, Kitti | Pal, Noemi | Tanczos, Bence | Somogyi, Viktoria | Barath, Barbara | Deak, Adam | Matolay, Orsolya | Bidiga, Laszlo | Peto, Katalin | Nemeth, Norbert

Article Type: Research Article

Abstract: BACKGROUND: The optimal timing of remote ischemic preconditioning (RIPC) in renal ischemia-reperfusion (I/R) injury is still unclear. We aimed to compare early- and delayed-effect RIPC with hematological, microcirculatory and histomorphological parameters. METHODS: In anesthetized male CrI:WI Control rats (n  = 7) laparotomy and femoral artery cannulation were performed. In I/R group (n  = 7) additionally a 45-minute unilateral renal ischemia with 120-minute reperfusion was induced. The right hind-limb was strangulated for 3×10 minutes (10-minute intermittent reperfusion) 1 hour (RIPC-1 group, n  = 7) or 24 hour (RIPC-24 group, n  = 6) prior to the I/R. Hemodynamic, hematological parameters and organs’ surface microcirculation …were measured. RESULTS: Control and I/R group had the highest heart rate (p  < 0.05 vs base), while the lowest mean arterial pressure (p  < 0.05 vs RIPC-1) were found in the RIPC-24 group. The highest microcirculation values were measured in the I/R group (liver: p  < 0.05 vs Control). The leukocyte count increased in I/R group (base: p  < 0.05 vs Control), also this group’s histological score was the highest (p  < 0.05 vs Control). The RIPC-24 group had a significantly lower score than the RIPC-1 (p  = 0.0025 vs RIPC-1). CONCLUSION: Renal I/R caused significant functional and morphological, also in the RIPC groups. According to the histological examination the delayed-effect RIPC method was more effective. Show more

Keywords: Acute kidney injury, ischemia-reperfusion, remote ischemic preconditioning, microcirculation, histopathology

DOI: 10.3233/CH-200916

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 3, pp. 439-451, 2020