Clinical Hemorheology and Microcirculation - Volume 79, issue 4

Authors: Carlisi, Melania | Mancuso, Salvatrice | Caimi, Gregorio | Siragusa, Sergio

Article Type: Research Article

Abstract: The complement system is an essential component of the innate immune defence that, if overly activated, may damage organs and tissues. For this reason, there is a fine complement regulatory system. The complement modulation system includes two proteins with important regulatory activity, CD55 or decay accelerating factor (DAF) and CD59 or membrane inhibitor of reactive lysis (MIRL). The paroxysmal nocturnal hemoglobinuria (PNH) is a clonal and non-neoplastic disease characterized by intravascular haemolysis, occurrence of thrombosis and bone marrow failure. In clinical practice, in opposition to PNH, a variety of pathological conditions have been observed with an acquired and …non-genetic deficiency of the regulatory proteins CD55 and CD59. This abnormal, non-clonal, reduced expression of complement regulatory proteins configures what we may define as PNH-like phenotype. Similarly to PNH, even in the PNH-like phenotype diseases there has been a greater exposure to the mediated complement cellular lysis and, a likely increased risk of thromboembolic events. Therefore, the knowledge of the potential roles of the complement system becomes necessary for a deeper understanding of several pathological conditions and for an improved clinical management of the patients. Show more

Keywords: Paroxysmal nocturnal hemoglobinuria, complement system, CD55, CD59, thromboembolic risk

DOI: 10.3233/CH-190735

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 4, pp. 491-503, 2021

Authors: Curta, Adrian | Jaber, Ahmad | Rieber, Johannes | Hetterich, Holger

Article Type: Research Article

Abstract: INTRODUCTION: Endothelial shear stress (ESS) is a local hemodynamic factor that is dependent on vessel geometry and influences the process of atherogenesis. As in vivo measurements of ESS are not possible, it must be calculated using computational fluid dynamics (CFD). In this feasibility study we explore CFD-models generated from coronary CT-angiography (CCTA) using an individualised blood viscosity and a pulsatile flow profile derived from in vivo measurements. MATERIALS AND METHODS: We retrospectively recruited 25 consecutive patients who received a CCTA followed by a coronary angiography including intravascular ultrasound (IVUS) and generated 3D models of the …coronary arteries from the CT-datasets. We then performed CFD-simulations on these models. Hemodynamically non-relevant stenosis were identified in IVUS. They were isolated in the CFD-model and separated longitudinally into a half with atherosclerotic lesion (AL) and one without (NAL). ESS was measured and compared for both halves. RESULTS: After excluding vessels with no IVUS data or relevant stenosis we isolated 31 hemodynamically non-relevant excentric AL from a total of 14 vessels. AL segments showed consistently significantly lower ESS when compared to their corresponding NAL segments when regarding minimum (0.9 Pa, CI [0.6, 1.2] vs. 1.3 Pa, CI [0.9, 1.8]; p  = 0.004), mean (5.0 Pa, CI [3.4, 6.0] vs. 6.7 Pa, CI [5.5, 8.4]; p  = 0.008) and maximum ESS values (12.4 Pa, CI [8.6, 14.6] vs. 19.6 Pa, CI [12.4, 21.0]; p  = 0.005). Qualitatively ESS was lower on the inside of bifurcations and curvatures. CONCLUSION: CFD simulations of coronary arteries from CCTA with an individualised flow profile and blood viscosity are feasible and could provide further prognostic information and a better risk stratification in coronary artery disease. Further prospective studies are needed to investigate this claim. Show more

Keywords: Coronary artery disease, endothelial shear stress, computational flow dynamics, pulsatile flow, coronary computed tomography, hemodynamics

DOI: 10.3233/CH-201025

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 4, pp. 505-518, 2021

Authors: Zheng, Bo-wen | Yi, Shu-hong | Wu, Tao | Liao, Mei | Zhang, Ying-cai | Yuan, Lian-xiong | Zheng, Rong-qin | Yang, Yang | Ren, Jie

Article Type: Research Article

Abstract: BACKGROUND: Biliary ischaemia is an important factor in the pathogenesis of non-anastomotic biliary stricture (NAS) after liver transplantation (LT). Contrast-enhanced ultrasound (CEUS) can be used to detect biliary ischaemia, but no study has examined the utility of CEUS in predicting NAS. OBJECTIVE: To evaluate whether repeated CEUS as a non-invasive method of biliary ischaemia can identify NAS. METHODS: Consecutive LT patients who underwent CEUS examinations at 1–4 weeks after LT from September 2012 to December 2015 at our institution were included. The CEUS images and clinical data were analysed. RESULTS: Among 116 eligible LT …patients, 39 (33.6%) were diagnosed with NAS within 1 year after LT. The patients with NAS had a significantly higher CEUS score at weeks 2–4 (all P  < 0.05) and a higher slope of CEUS score progression (0.480 vs –0.044, P  < 0.001). The accuracy of CEUS in identifying NAS improved over time after LT, reaching its maximum at week 4, with a sensitivity of 66.7%, a specificity of 87.9%, a positive predictive value (PPV) of 75.9%, a negative predictive value (NPV) of 82.3%, and an accuracy of 80.2%in the full cohort when a CEUS score≥3 was used as the cut-off. Multivariate analysis identified gamma-glutamyl transpeptidase (GGT), alanine transaminase (ALT) and the CEUS score at week 4 as independent predictors of NAS. In the task of identifying NAS, an NAS score combining the above 3 variables at week 4 showed areas under the receiver operating characteristic curve of 0.88 (95%CI, 0.78–0.99) in the estimation group (n  = 60) and 0.82 (95%CI, 0.69–0.96) in the validation group (n  = 56). An NAS score cut-off of 0.396 identified 87.2%of NAS cases in the estimation group, with a PPV of 93.3%; and 75.0%of NAS cases in the validation group, with a PPV of 58.8%. CONCLUSIONS: CEUS examination during the first 4 weeks is useful in assessing the risk of NAS within 1 year after LT. In particular, an NAS score combining the CEUS score, GGT level, and ALT level at week 4 can be used to accurately predict the risk of NAS in LT patients. Show more

Keywords: Ultrasonography, contrast agent BR1, liver transplantation, microcirculation, ischemia, biliary tract diseases

DOI: 10.3233/CH-211097

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 4, pp. 519-530, 2021

Authors: Cirillo, Michela | Attanasio, Monica | Paniccia, Rita | Rizzello, Francesca | Coccia, Maria Elisabetta | Fatini, Cinzia

Article Type: Research Article

Abstract: BACKGROUND: Hormonal fertility treatments are associated with increased coagulation factors inducing procoagulant milieu and possibly thrombotic risk. OBJECTIVE: To assess coagulation by ROTEM and coagulation tests in apparently healthy infertile women before oocyte donation procedure. METHODS: We enrolled 51 women (Assisted Reproductive Technology Centre, Florence). ROTEM and coagulation parameters were assessed before the start of infertility treatment. RESULTS: We divided women in 3 groups according to the number of cardiovascular risk factors: Group A (n  = 10), Group B (n  = 16), and Group C (n  = 25). By considering ROTEM Extem test, a significantly increased of …MCF, TPI, and G were observed in groups B (p  = 0.005, p  = 0.03, and p  = 0.007) and C (p  = 0.01, p  = 0.05, and p  = 0.005) in comparison to group A. As regards ROTEM Intem test, the TPI and G values were significantly higher in groups B and C in comparison to group A (p  < 0.01). MCF by Fibtem test significantly increased in groups B and C than in group A (p  = 0.004 and p  = 0.002, respectively). FVIII, vWF:Ag and D-dimer values significantly increase according to the presence of≥2 risk factors. CONCLUSIONS: Data from coagulative assessment permit to sensitively identify women with potentially procoagulable state, which represents a risk factor of thromboembolic event during hormone treatment. Show more

Keywords: Oocyte donation, assisted reproductive techniques, blood coagulation tests, hemostasis, women’s health

DOI: 10.3233/CH-211108

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 4, pp. 531-539, 2021

Authors: Peschel, Georg | Grimm, Jonathan | Buechler, Christa | Gunckel, Manuela | Pollinger, Kirstin | Aschenbrenner, Elisabeth | Kammerer, Sylvia | Jung, Ernst-Michael | Haimerl, Michael | Werner, Jens | Müller, Martina | Weigand, Kilian

Article Type: Research Article

Abstract: BACKGROUND: A rapid decline of liver stiffness (LS) was detected by non-invasive methods in patients with chronic hepatitis C (HCV) infection during treatment with direct-acting antivirals (DAA). OBJECTIVE: To investigate the influence of inflammation on LS. METHODS: We prospectively examined LS by sonographic shear-wave elastography in 217 patients during DAA therapy from treatment initiation (BL) to 12 weeks after end of therapy (SVR12). Demographic data, laboratory findings and serum levels of cytokines were determined. RESULTS: Values of LS decreased from 1.86 m/s to 1.68 m/s (p  = 0.01) which was most pronounced in patients who had F4 …fibrosis at BL (3.27 m/s to 2.37 m/s; p  < 0.001). Initially elevated values of aminotransferases, ferritin, IgG (p  < 0.001 each) and international normalized ratio (p  < 0.003) declined, thrombocyte count (p  = 0.007) increased. Correlations of these laboratory parameters with BL levels of LS measurement (LSM) were most apparent in patients with F1-F3 fibrosis. Tumor necrosis factor (TNF)-α (p  = 0.031), interleukin (IL)-10 (p  = 0.005) and interferon y inducible protein (IP)-10 (p  < 0.001) decreased in parallel with LSM under DAA therapy and corelated with BL values. CONCLUSION: Decrease of systemic inflammatory parameters correlated with LSM under DAA therapy. We conclude that regression of LSM is attributable to the decline of inflammation rather than reflecting fibrosis. Show more

Keywords: HCV, shear-wave elastography, inflammation, fibrosis

DOI: 10.3233/CH-211193

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 4, pp. 541-555, 2021

Authors: Turchanyi, Bela | Korei, Csaba | Somogyi, Viktoria | Kiss, Ferenc | Peto, Katalin | Nemeth, Norbert

Article Type: Research Article

Abstract: BACKGROUND: Ischemia-reperfusion (I/R) may worsen blood rheology that has been demonstrated by clinical and experimental data. It is also known that anti-inflammatory agents and preconditioning methods may reduce I/R injury. OBJECTIVE: We aimed to analyze hemorheological alterations in elective knee operations and the effects of intraoperative nonsteroidal anti-inflammatory drug (NSAID) administration and application of ischemic preconditioning. METHODS: Hemorheological variables of 17 patients with total knee replacement or anterior crucial ligament replacement were analyzed. The ischemic (tourniquet) time was 92±15 minutes. Seven patients did not receive NSAID (Control group), 5 patients got i.v. sodium-diclophenac 10 minutes before …and 6 hours after reperfusion. Five patients had ischemic preconditioning (3×15 minutes). Blood samples were collected before the ischemia, 10 minutes after reperfusion, on the 1st and 2nd p.o. day. RESULTS: Whole blood viscosity didn’t show notable inter-group differences, except for a slight decrease in the preconditioning group. RBC deformability decreased, erythrocyte aggregation enhanced by the 1st and 2nd p.o. days in Control group. In NSAID and preconditioning groups the changes were moderate, aggregation values significantly lowered compared to the Control group. CONCLUSION: Intraoperatively administered diclophenac or ischemic preconditioning could moderate the deterioration in micro-rheological parameters caused by I/R in patients. Show more

Keywords: Limb operation, ischemia-reperfusion, hemorheology, NSAIDs, ischemic preconditioning

DOI: 10.3233/CH-211200

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 4, pp. 557-565, 2021

Authors: Xu, Chen | Wu, Min | Wang, Zhaodong | Liu, Yajun | Zhou, Pinghui | Guan, Jianzhong

Article Type: Research Article

Abstract: BACKGROUND: Application of tranexamic acid (TXA) in the treatment of acetabular fractures could reduce intraoperative and postoperative blood loss. OBJECTIVE: To investigate the effect of single and repeated intravenous infusion of TXA on blood loss of acetabular fractures. METHODS: 120 patients with acetabular fractures admitted to our hospital from January 2017 to September 2020 were retrospectively divided into three groups: Patients accepted 1g TXA at preoperative 30 minutes were defined as single TXA group (n  = 40); Patients accepted 1g TXA at preoperative 30 minutes and 1g TXA at 3 hours after the start of surgery were …defined as repeated TXA group (n  = 40); Patients accepted normal saline at preoperative 30 minutes were defined as control group (n  = 40). RESULTS: The total blood loss in single TXA group and repeated TXA group were significantly lower than control group, and the total blood loss in the repeated TXA group was significantly lower than single TXA group (P  < 0.05). The hidden blood loss from surgery to postoperative 1 day in repeated TXA group was significantly lower than single TXA group and the control group(P  < 0.05). No significant differences were observed in the operative time, postoperative transfusion rate and thrombosis rate among the three groups (P  >  0.05). CONCLUSION: Repeated TXA is more recommended during acetabular fracture surgery since it can reduce the total blood loss without increasing the operative time, postoperative transfusion rate and thrombosis rate compared with single TXA. Show more

Keywords: Tranexamic acid, acetabular fracture, single TXA infusion, repeated TXA infusion, total blood loss, thrombosis rate

DOI: 10.3233/CH-211203

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 4, pp. 567-573, 2021

Authors: Li, Yan | Ma, Jianbing | Li, Baoqi | Zhu, Xiaoli | Wang, Jingping

Article Type: Research Article

Abstract: BACKGROUND: Acoustic Radiation Force Impulse (ARFI), Fibrosis-4(FIB-4) and Aspartate transaminase to platelet ratio index (APRI) are valuable non-invasive methods to evaluate fibrosis in hepatitis virus. Yet, they are rarely used in Wilson’s disease. OBJECTIVE: Evaluate the diagnostic efficacy of ARFI, FIB-4, APRI, combined detection in cirrhosis with WD, and speculate the optimal high, low cutoff. METHODS: This retrospective study was authorized by hospital ethics Committee (number:2021MCZQ02). 102 patients with WD completed ARFI and laboratory examination on the same day. The intraclass correlation coeffcient (ICC) of ARFI among three sonographers was 0.896 (95%CI:0.859–0.925, p  = 0.000). The stage …of liver involvement was classified into 5 categories according to clinical manifestations, laboratory examination, and liver morphologic characteristics: I, normal; II, biochemical abnormal only; III, abnormal liver morphologic features without sighs of cirrhosis; IV, clinical and imaging sighs of compensateded cirrhosis (Child-Pugh A); V, decompensated cirrhosis (Child-Pugh B and C). This stage system served as the reference standard. The diagnostic efficacy was analyzed by Logistic regression, ROC curve. The optimal low cut-off with high sensitivity (SE) and low negative likelihood ratio (NLR) and high cut-off with high specificity (SP) and positive likelihood ratio (PLR) were derived. RESULTS: The diagnostic value of ARFI (0.85, 95%CI:0.77–0.92, p  = 0.000) in distiguishing cirrhosis with WD was higher than FIB-4 (0.59, 95%CI: 0.47–0.70, p  = 0.127), APRI (0.70, 95%CI: 0.59–0.81, p  = 0.000). The low, high cut-off of ARFI for excluding, diagnosing cirrhosis with WD was 1.47 m/s(SE: 98%, NLR:0.09), 2.11 m/s(SP:98%, PLR:27.4), 37 (36%) patients could be spared a liver biopsy. When ARFI was 1.47∼2.11 m/s, liver biopsy was recommended. After combined with ARFI, the AUROC of FIB-4, APRI were increased respectively (p  < 0.001), there were not different between ARFI and combined detection(p  >  0.05). CONCLUSION: ARFI could replace some unnecessary liver biopsy according to high diagnostic efficacy for identifying cirrhosis of WD. The combined detection can also be used as an important model to predict cirrhosis in WD. Show more

Keywords: Wilson’s disease, ARFI, APRI, FIB-4

DOI: 10.3233/CH-211219

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 4, pp. 575-585, 2021

Authors: Li, Ya | Wu, Size

Article Type: Research Article

Abstract: BACKGROUND: Two-dimensional shear-wave elastography (2D-SWE) has been used for years for liver assessment of patients with chronic hepatitis B (CHB), but its effectiveness remains unclear in different populations and using different ultrasound systems. OBJECTIVE: This study investigated the effectiveness of 2D-SWE in evaluating liver fibrosis in patients with CHB. METHODS: A prospective investigation was conducted after approval by the institutional ethics committee, with 116 out of 133 patients with CHB referred for liver biopsy included and 50 patients with healthy livers selected as controls. Assessment with 2D-SWE of liver stiffness measurement (LSM) was compared with histopathological …results. Cutoff values for LSM were set to determine the degree of fibrosis, and area under the receiver operating characteristic (AUROC) curve, sensitivity, and specificity were calculated. RESULTS: The optimal LSM cutoff for differentiating healthy livers from livers with CHB and any liver fibrosis was 6.485 kPa, with an AUROC of 0.927, sensitivity of 94%, and specificity of 19.8%. The optimal LSM cutoff values for F1, F2, F3, and F4 were 6.19 kPa, 6.485 kPa, 7.46 kPa, and 9.62 kPa, respectively, with corresponding AUROCs of 0.516, 0.625, 0.779, and 0.881, respectively. Comparisons of AUROCs between F1 and F3, F1 and F4, F2 and F3, and F2 and F4 were all significantly different (P  = 0.0001, P  < 0.0001, P  = 0.0139, and P  = 0.0003, respectively); comparisons of AUROCs between F1 and F2 and between F3 and F4 were not significantly different (P  = 0.1232 and P  = 0.2462, respectively). Comparisons of LSMs between healthy livers and F0 and between healthy livers and a combination of F0 and F1 were significantly different (P  = 0.002 and P  = 0.001, respectively). Comparisons of LSMs between F1 and F2 and between F3 and F4 were not significantly different (P  = 0.233 and P  = 0.072, respectively). Other comparisons between fibrosis score groups were significantly different (F1 and F3, P  = 0.003; F1 and F4, P  = 0.007; F2 and F3, P  = 0.013; F2 and F4, P  = 0.015). CONCLUSION: 2D-SWE using a specific diagnostic ultrasound system is effective for the assessment of severe liver fibrosis and cirrhosis, but is limited in diagnosing mild liver fibrosis. Show more

Keywords: Chronic hepatitis B, liver fibrosis, two-dimensional shear wave elastography (2D-SWE)

DOI: 10.3233/CH-211223

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 4, pp. 587-596, 2021

Authors: Zhou, Shuo | Xu, Xun | Ma, Nan | Jung, Friedrich | Lendlein, Andreas

Article Type: Research Article

Abstract: Sulfated biomolecules are known to influence numerous biological processes in all living organisms. Particularly, they contribute to prevent and inhibit the hypercoagulation condition. The failure of polymeric implants and blood contacting devices is often related to hypercoagulation and microbial contamination. Here, bioactive sulfated biomacromolecules are mimicked by sulfation of poly(glycerol glycidyl ether) (polyGGE) films. Autoclaving, gamma-ray irradiation and ethylene oxide (EtO) gas sterilization techniques were applied to functionalized materials. The sulfate group density and hydrophilicity of sulfated polymers were decreased while chain mobility and thermal degradation were enhanced post autoclaving when compared to those after EtO sterilization. These results suggest …that a quality control after sterilization is mandatory to ensure the amount and functionality of functionalized groups are retained. Show more

Keywords: Sulfated polymer, sulfation, sterilization, ethylene oxide

DOI: 10.3233/CH-211241

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 4, pp. 597-608, 2021