Clinical Hemorheology and Microcirculation - Volume 77, issue 4

Authors: Peschel, G. | Jung, E.M. | Fisser, C. | Putz, F.J. | Wertheimer, T. | Sinner, B. | Lunz, D. | Jung, F. | Müller, M.

Article Type: Research Article

Abstract: BACKGROUND: Coronavirus disease 2019 (COVID-19) can cause acute respiratory distress syndrome (ARDS). OBJECTIVE: This single centre cross-section study aimed to grade the severity of pneumonia by bed-side lung ultrasound (LUS). METHODS: A scoring system discriminates 5 levels of lung opacities: A-lines (0 points),≥3 B-line (1 point), coalescent B-lines (2 points), marked pleural disruptions (3 points), consolidations (4 points). LUS (convex 1–5 MHz probe) was performed at 6 defined regions for each hemithorax either in supine or prone position. A lung aeration score (LAS, maximum 4 points) was allocated for each patient by calculating the arithmetic mean of …the examined lung areas. Score levels were correlated with ventilation parameters and laboratory markers. RESULTS: LAS of 20 patients with ARDS reached from 2.58 to 3.83 and was highest in the lateral right lobe (Mean 3.67). Ferritin levels (Mean 1885μg/l; r  = 0.467; p  = 0.051) showed moderate correlation in spearman roh calculation. PaCO2 level (Mean 46.75 mmHg; r  = 0.632; p  = 0.005) correlated significantly with LAS, while duration of ventilation, Horovitz index, CRP, LDH and IL-6 did not. CONCUSIONS: The proposed LAS describes severity of lung opacities in COVID-19 patients and correlates with CO2 retention in patients with ARDS. Show more

Keywords: COVID-19, lung ultrasound, scoring system, PaCO2

DOI: 10.3233/CH-200925

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 4, pp. 355-365, 2021

Authors: Braune, S. | Bäckemo, J. | Lau, S. | Heuchel, M. | Kratz, K. | Jung, F. | Reinthaler, M. | Lendlein, A.

Article Type: Research Article

Abstract: Nanoporous microparticles prepared from poly(ether imide) (PEI) are discussed as candidate adsorber materials for the removal of uremic toxins during apheresis. Polymers exhibiting such porosity can induce the formation of micro-gas/air pockets when exposed to fluids. Such air presenting material surfaces are reported to induce platelet activation and thrombus formation. Physical or chemical treatments prior to implantation are discussed to reduce the formation of such gas nuclei. Here, we report about the influence of different rewetting procedures – as chemical treatments with solvents – on the thrombogenicity of hydrophobic PEI microparticles and PEI microparticles hydrophilized by covalent attachment of poly(vinyl …pyrrolidone) (PVP) of two different chain lengths. Autoclaved dry PEI particles of all types with a diameter range of 200 – 250 μm and a porosity of about 84% ±2% were either rewetted directly with phosphate buffered saline (24 h) or after immersion in an ethanol-series. Thrombogenicity of the particles was studied in vitro upon contact with human sodium citrated whole blood for 60 min at 5 rpm vertical rotation. Numbers of non-adherent platelets were quantified, and adhesion of blood cells was qualitatively analyzed by bright field microscopy. Platelet activation (percentage of CD62P positive platelets and amounts of soluble P-Selectin) and platelet function (PFA100 closure times) were analysed. Retention of blood platelets on the particles was similar for all particle types and both rewetting procedures. Non-adherent platelets were less activated after contact with ethanol-treated particles of all types compared to those rewetted with phosphate buffered saline as assessed by a reduced number of CD62P-positive platelets and reduced amounts of secreted P-Selectin (P  < 0.05 each). Interestingly, the hydrophilic surfaces significantly increased the number of activated platelets compared to hydrophobic PEI regardless of the rewetting agent. This suggests that, apart from wettability, other material properties might be more important to regulate platelet activation. PFA100 closure times were reduced and within the reference ranges in the ethanol group, however, significantly increased in the saline group. No substantial difference was detected between the tested surface modifications. In summary, rewetting with ethanol resulted in a reduced thrombogenicity of all studied microparticles regardless of their wettability, most likely resulting from the evacuation of air from the nanoporous particles. Show more

Keywords: Biomaterial, polymer, microparticle, thrombogenicity, hemocompatibility, dynamic in-vitro test, rewetting

DOI: 10.3233/CH-201029

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 4, pp. 367-380, 2021

Authors: Zhao, Dan | Shao, Ya-Qin | Hu, Jun | Liu, Dan | Tang, Wei | He, Ning

Article Type: Research Article

Abstract: OBJECTIVE: To investigate the diagnostic value of core-needle biopsy (CNB) guided by contrast-enhanced ultrasound (CEUS) in cervical tuberculous lymphadenitis (CTL). METHODS: 178 patients with pathological confirmation of CTL were retrospectively enrolled. All of them had undergone CNB prior to the final surgery. According to the different ways of puncture guidance, they were divided into two groups: conventional ultrasound (US) group (n  = 81) and CEUS group (n  = 97). The comparison of diagnostic efficacy between two groups was compared and analyzed. RESULTS: Among the 178 patients, 146 were directly diagnosed as CTL by CNB, including 59 patients in …CEUS group and 87 patients in US group. The diagnostic accuracy were 89.7% (87/97) and 72.8% (59/81), respectively (P  < 0.01). For subgroup analyses, differences among diagnostic efficacy ascribed to the different guiding methods were significant in medium size group (>2.0 cm and ≤3.0 cm) and large size group (>3.0 cm), 91.7% for CEUS group vs. 69.0% for US group (P  < 0.05) and 84.4% for CEUS group vs. 57.7% for US group (P  < 0.05), respectively. CONCLUSIONS: In the diagnosis of CTL, compared with the US-guided CNB, CEUS-guided CNB have certain advantages, especially for larger lymph nodes. Show more

Keywords: Contrast-enhanced ultrasound, ultrasound, core-needle biopsy, tuberculous lymphadenitis, cervical

DOI: 10.3233/CH-201038

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 4, pp. 381-389, 2021

Authors: Boisson, Camille | Rab, Minke A.E. | Nader, Elie | Renoux, Céline | van Oirschot, Brigitte A. | Joly, Philippe | Fort, Romain | Stauffer, Emeric | van Beers, Eduard J. | Sheehan, Vivien A. | van Wijk, Richard | Connes, Philippe

Article Type: Research Article

Abstract: Sickle cell disease (SCD) is a genetic disorder characterized by the production of an abnormal hemoglobin (Hb), which, under deoxygenation, may polymerize and cause a mechanical distortion of red blood cell (RBC) into a crescent-like shape. Recently a method, using ektacytometry principle, has been developed to assess RBC deformability as a function of oxygen tension (pO2 ) and is called oxygen gradient ektacytometry (oxygenscan). However, standardization of this test is needed to properly assess the tendency of sickling of RBCs under deoxygenation and to allow comparisons between different laboratories. The study compared the oxygenscan responses during blood storage between distinct …populations of SCD patients. Blood from 40 non-transfused homozygous SCD patients (HbSS), 16 chronically transfused HbSS patients, and 14 individuals with compound heterozygous hemoglobin SC disease (HbSC) at steady-state was collected in EDTA tubes. Measurements were performed within 4 hours after collection and after 24 hours of storage at 4°C. We showed that storage affected the minimum RBC deformability reached during deoxygenation (EImin) in both non-transfused HbSS and HbSC patients and the maximum RBC deformability (EImax) measured before deoxygenation (i.e., in normoxia) in the three groups. In contrast, the tendency of RBCs to sickle under deoxygenation (i.e., the point of sickling; PoS) remained rather stable between the two time of measurements. Collectively, since the time between blood sampling and analysis affects some key oxygen gradient ektacytometry-derived parameters we recommend that each laboratory performs oxygenscan measurements at a standardized time point. Show more

Keywords: Oxygen gradient ektacytometry, sickle cell disease, red blood deformability, storage

DOI: 10.3233/CH-201037

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 4, pp. 391-394, 2021

Authors: Farber, Paulo L. | Dias, Ana | Freitas, Teresa | Pinho, Ana C. | Viggiano, Diego | Saldanha, Carlota | Silva-Herdade, Ana S.

Article Type: Research Article

Abstract: BACKGROUND: Calcium, vitamin D and insulin resistance are linked to osteoporosis and cardiovascular disease in menopause. OBJECTIVE: Determine if hemorheological parameters related to blood viscosity in microcirculation are linked to calcium metabolism and insulin resistance in menopause. METHODS: 25-Hydroxyvitamin D (25(OH)D)), 1, 25-dihydroxyvitamin D3 (1, 25(OH)2 D), parathyroid hormone, ionized calcium, glucose, insulin and hemoglobin A1c were measured in blood from 43 volunteers. Red blood cells (RBC) aggregation, RBC deformability and whole blood viscosity were also performed. RESULTS: 25(OH)D showed a positive correlation with RBC deformability 0.60 Pa. Subjects with 25(OH)D≤29.00 ng/mL had lower RBC …deformability 0.60 Pa, and higher RBC aggregation and higher HOMA-IR. Ionized calcium showed a negative correlation with RBC aggregation. Subjects with ionized calcium ≤1.24 mmol/L showed higher RBC aggregation. There was a positive correlation between HOMA-IR and RBC aggregation and HOMA-IR showed a negative correlation with RBC deformability 0.30 Pa. Subjects with HOMA-IR <1.80 showed lower RBC aggregation and higher RBC deformability at 0.30 Pa, 0.60 Pa, 1.20 Pa, 3.0 Pa and 6.0 Pa. CONCLUSION: Low 25(OH)D, low ionized calcium and high HOMA-IR are related to impaired hemorheology in menopause. RBC aggregation and deformability can be used as biomarkers of calcium metabolism and insulin resistance in menopause. Show more

Keywords: Hemorheology, calcium metabolism, osteoporosis, vitamin D, insulin resistance, cardiovascular diseases

DOI: 10.3233/CH-200956

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 4, pp. 395-410, 2021

Authors: Wang, Zheng-Dong | Li, Hao | Liu, Ming | Li, Ping | Chen, Jian | Liang, Xiang-Wen | Zhu, Xian-Zhang | Liao, Wang

Article Type: Research Article

Abstract: OBJECTIVE: The aim of the present study was to evaluate the effectiveness and safety of nicorandil in improving the area of myocardial infarction in patients with acute myocardial infarction (AMI). METHODS: One hundred and twenty patients with acute ST-segment elevation myocardial infarction (STEMI) admitted to our hospital between December 1, 2018 and December 31, 2019 were selected and randomly allocated to the experimental group (group A, n  = 60) and the control group (group B, n  = 60). In the experimental group, an infusion of nicorandil was given intravenously before the first balloon dilation or 1 minute before the stent …placement, and with the completion of the infusion, nicorandil maintenance infusion was given. In the control group, only balloon dilation and stent placement were undertaken. RESULTS: The postoperative peak levels of myoglobin, creatine kinase isoform and hypersensitive troponin T were significantly lower in group A than in group B (p  < 0.05). Moreover, the left ventricular ejection fraction (LVEF) on the 180th day post operation was substantially greater in group A than in group B (p  < 0.01), and the area of myocardial infarction was significantly smaller in patients in group A than those in group B on the 180th day post operation (p  < 0.01). In terms of the safety, there were no statistically significant differences in the incidence of slow flow/no reflow, malignant arrhythmias, and hypotension within 24 hours post operation between the two groups (p  > 0.05), and no major adverse cardiovascular event (MACE) occurred in either group during the postoperative follow-up period of 180 days (p  > 0.05). CONCLUSION: Intravenous administration of nicorandil in patients with STEMI during the perioperative percutaneous coronary intervention (PCI) period was effective in reducing the area of myocardial infarction and myocardial injury without increasing the incidence of malignant arrhythmias, hypotension, or composite cardiovascular events during the drug administration period. Show more

Keywords: Percutaneous coronary intervention, acute ST-segment elevation myocardial infarction, nicorandil, myocardial infarction area, myocardial injury

DOI: 10.3233/CH-200998

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 4, pp. 411-423, 2021

Authors: Li, Bao-Hua | Fang, Kuai-Fa | Lin, Pei-Huan | Zhang, Yi-Hui | Huang, Yong-Xiang | Jie, Hai

Article Type: Research Article

Abstract: OBJECTIVE: The aim of the present study was to observe the effect of sacubitril valsartan on cardiac function and vascular endothelial function in patients with chronic heart failure with reduced ejection fraction (HFrEF). METHODS: A total of 80 patients with HFrEF were randomly divided into an observation group and a control group, with 40 patients in each group. Sacubitril valsartan was added to the conventional treatment in the observation group, and perindopril was added to the conventional treatment in the control group. Both groups were treated continuously for 12 weeks. The left ventricular ejection fraction (LVEF), left ventricular …end-diastolic diameter (LVEDD), flow-mediated vasodilatory function (FMD) of the brachial artery, and levels of plasma Ang II, endothelin 1 (ET-1), and calcitonin gene-related peptide (CGRP), together with the serum nitric oxide (NO) and NO synthase (NOS) were compared before and after treatment in the groups. RESULTS: Before the treatment, the levels of LVEF, LVEDD, FMD, Ang II, ET-1, CGRP, NO, and NOS in the observation group were not significantly different from those in the control group (P  > 0.05). However, the levels of LVEF, FMD, CGRP, NO, and NOS in both groups were significantly higher after the treatment than those before the treatment (P  < 0.05) and significantly higher in the observation group than those in the control group. The difference was statistically significant (P  < 0.05). Meanwhile, the levels of LVEDD, Ang II, and ET-1 in both groups decreased significantly after the treatment (P  < 0.05) and were significantly lower in the observation group than those in the control group. The difference was statistically significant (P  < 0.05). CONCLUSION: Sacubitril valsartan might improve endothelial function while increasing cardiac function in HFrEF patients. Show more

Keywords: Sacubitril valsartan, left ventricular ejection fraction, chronic heart failure, cardiac function, endothelial function

DOI: 10.3233/CH-201032

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 4, pp. 425-433, 2021

Authors: Sohn, Sung-Hwa | Kim, Tae Sik | Kim, Ji-Won | Yoo, Sung Mook | Jo, Won-Min

Article Type: Research Article

Abstract: BACKGROUND: Although the number of vascular surgeries performed is increasing, the incidence of complications associated with this surgery has not improved and re-operations are frequently required. Thrombosis in a vessel is the most hazardous postoperative complication. OBJECTIVE: The aim of this study was to evaluate the anti-thrombotic and anti-inflammatory effects of sulodexide compared to aspirin in a rat model. METHODS: We divided the animals into three groups (sham (saline), aspirin, and sulodexide). The abdominal aorta was surgically opened and closed, primarily with 8/0 Prolene sutures. Postoperatively, saline, aspirin, or sulodexide was administered by oral gavage for …14 days to the rats. The degree of neovascularization, thrombus, calcification, inflammatory infiltrates, and fibrosis were analyzed histopathologically by hematoxylin and eosin staining. RESULTS: There was no significant difference in the incidence of postoperative thrombogenesis, but less calcification and inflammatory infiltrates were observed in the sulodexide group compared to the aspirin group. Histopathologic score revealed less infiltration of inflammatory cells and mild calcification for the sulodexide group (0.17±0.41 and 1.33±0.52, respectively) compared to the aspirin group (0.67±0.52 and 1.67±0.52, respectively) at days 14. CONCLUSIONS: This study offers the possibility that sulodexide could be used as an aspirin substitute for the postoperative management of vascular patients, with low gastrointestinal discomfort. In addition, it may also offer reduced postoperative calcification and inflammation. Show more

Keywords: Sulodexide, aspirin, thrombogenesis, calcification, inflammation

DOI: 10.3233/CH-201043

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 4, pp. 435-442, 2021

Authors: de Souza, Maria das Graças C. | Cyrino, Fatima Z. G. A. | Sicuro, Fernando L. | Bouskela, Eliete

Article Type: Research Article

Abstract: BACKGROUND: Protective effects of Ruscus extract on macromolecular permeability depend on its capacity to stimulate muscarinic receptors on endothelial cells and induce the release of endothelium derived relaxing factors (EDRFs). OBJECTIVE: To investigate if these effects depend only on activation of muscarinic receptors or if EDRFs release are also necessary. We have also investigated the participation of Ruscus extract on muscarinic-induced release of EDRFs on microvascular diameters. METHODS: Hamsters were treated daily during two weeks with Ruscus extract (50, 150 and 450 mg/kg/day) and then macromolecular permeability induced by histamine and …arteriolar and venular diameters after cyclooxygenase (COX) and nitric oxide synthase (NOS) inhibitors: indomethacin and Nω-Nitro-L-arginine (LNA), respectively applied topically at 10–8 M, 10–6 M and 10–4 M were observed on the cheek pouch preparation. RESULTS: Ruscus extract decreased macromolecular permeability in a dose-dependent fashion and did not affect microvascular diameters. NOS and COX inhibitors enhanced its effect on microvascular permeability. NOS inhibition reduced arteriolar diameter and COX blocking decreased arteriolar and venular diameters at the lowest dose and increased them at higher doses of Ruscus extract. CONCLUSION: The protective effect of Ruscus extract on macromolecular permeability seems to be mediated only via muscarinic receptors. Muscarinic activation attenuated vasoconstrictive tone through cyclooxygenase-independent endothelium derived relaxing factors. Show more

Keywords: Ruscus extract, muscarinic receptors, endothelium derived relaxing factors, macromolecular permeability, microvascular diameter, cyclooxygenase, nitric oxide synthase, hamster cheek pouch preparation

DOI: 10.3233/CH-201019

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 4, pp. 443-459, 2021

Authors: Dong, Yi | Qiu, Yijie | Yang, Daohui | Yu, Lingyun | Zuo, Dan | Zhang, Qi | Tian, Xiaofan | Wang, Wen-Ping | Jung, Ernst Michael

Article Type: Research Article

Abstract: OBJECTIVE: To investigate the clinical value of dynamic contrast enhanced ultrasound (D-CEUS) in predicting the microvascular invasion (MVI) of hepatocellular carcinoma (HCC). PATIENTS AND METHODS: In this retrospective study, 16 patients with surgery and histopathologically proved HCC lesions were included. Patients were classified according to the presence of MVI: MVI positive group (n  = 6) and MVI negative group (n  = 10). Contrast enhanced ultrasound (CEUS) examinations were performed within a week before surgery. Dynamic analysis was performed by VueBox® software (Bracco, Italy). Three regions of interests (ROIs) were set in the center of HCC lesions, at the margin …of HCC lesions and in the surrounding liver parenchyma accordingly. Time intensity curves (TICs) were generated and quantitative perfusion parameters including WiR (wash-in rate), WoR (wash-out rate), WiAUC (wash-in area under the curve), WoAUC (wash-out area under the curve) and WiPi (wash-in perfusion index) were obtained and analyzed. RESULTS: All of HCC lesions showed arterial hyperenhancement (100 %) and at the late phase as hypoenhancement (75%) in CEUS. Among all CEUS quantitative parameters, the WiAUC and WoAUC were higher in MVI positive group than in MVI negative group in the center HCC lesions (P  < 0.05), WiAUC, WoAUC and WiPI were higher in MVI positive group than in MVI negative group at the margin of HCC lesions. WiR and WoR were significant higher in MVI positive group. CONCLUSIONS: D-CEUS with quantitative perfusion analysis has potential clinical value in predicting the existence of MVI in HCC lesions. Show more

Keywords: Dynamic contrast enhanced ultrasound (D-CEUS), hepatocellular carcinoma (HCC), microvascular invasion (MVI), time intensity curves (TICs), prediction

DOI: 10.3233/CH-201085

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 4, pp. 461-469, 2021