Clinical Hemorheology and Microcirculation - Volume 84, issue 2

Authors: Wang, Jinlong | Song, Qianwen | Yang, Shuhe | Wang, Haofei | Meng, Shanshan | Huang, Lili | Li, Qing | Xu, Jingyuan | Xie, Jianfeng | Huang, Yingzi

Article Type: Research Article

Abstract: OBJECTIVE: To investigate the effects of hydrocortisone combined with vitamin C and vitamin B1 versus hydrocortisone on sublingual microcirculation in septic shock patients. METHODS: This pilot study enrolled septic shock patients admitted to the ICU of a tertiary teaching hospital from February 2019 to January 2020. We randomly assigned the enrolled patients to the treatment group (hydrocortisone combined with vitamin C and vitamin B1 added to standard care) and the control group (hydrocortisone alone added to standard care) in a 1 : 1 ratio. The primary outcome was perfused small vascular density (sPVD) monitored by a sublingual microcirculation imaging system …at 24 hours after treatment. RESULTS: Twelve patients in the treatment group and ten in the control group completed the study. The baseline characteristics were comparable between the groups. No statistically significant difference was found in the sPVD between the groups at baseline. The sPVD in the treatment group was significantly higher than that in the control group at 4 hours after treatment (mean difference, 7.042; 95% CI, 2.227-11.857; P  = 0.009) and 24 hours after treatment (mean difference, 7.075; 95% CI, 2.390-11.759; P  = 0.008). CONCLUSIONS: Compared with hydrocortisone, hydrocortisone combined with vitamin C and vitamin B1 significantly improves microcirculation in septic shock patients. Show more

Keywords: Septic shock, hydrocortisone, vitamin, microcirculation, critical care

DOI: 10.3233/CH-221444

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 2, pp. 111-123, 2023

Authors: Zhang, Tiancong | Huang, Xiaojing | Gao, Xuemei | Liu, Ling | Chen, Dan | Huan, Xuanrong | He, Cui | Li, Yuan

Article Type: Research Article

Abstract: Circulating platelets are sometimes exposed to high shear rate environments due to vascular stenosis, and the effect of transiently elevated pathological high shear rates on platelet activation and aggregation function has not been clarified. The aim of this study was to investigate the effect of pathological high shear rate (8302s-1 ) exposure time (3.16-25.3 ms) on platelet activation and aggregation function. In addition, by adding active ingredients of antiplatelet drugs such as ASA (an active ingredient of aspirin), Ticagrelor, Tirofiban and GP1BA (platelet membrane protein GPIb inhibitor) in vitro , we studied TXA2 , P2Y12 -ADP, GPIIb/IIIa-fibrinogen and GPIb /IX/V-vWF receptor …pathways to determine platelet activation function mediated by pathological high shear rate. In this study, we designed a set of microfluidic chips with stenosis lengths of 0.5 mm, 1 mm, 2 mm, 3 mm, and 4 mm, all with 80% stenosis, to generate pathological high shear forces that can act at different times. The whole blood flowing through the microchannels was collected by perfusion of sodium citrate anticoagulated whole blood at a physiological arterial shear rate (1500 s-1 ), and the expression levels of platelet surface activation markers (P-selectin and GP IIb/IIIa) and the degree of platelet aggregation were analyzed by flow cytometry; platelet aggregation patterns were observed by microscopic examination of blood smears. The results showed that shearing significantly increased platelet activation and aggregation levels compared to un-sheared whole blood, and the activation and aggregation levels increased with increasing duration of pathological high shear rate. In vitro inhibition studies showed that ASA barely inhibited the expression of P-selectin and PAC-1 on the platelet surface; Ticagrelor effectively inhibited the expression of both P-selectin and PAC-1; Tirofiban significantly inhibited the expression of PAC-1 on the platelet surface and slightly inhibited the expression of P-selectin; GP1BA significantly inhibited the expression of both. Our results suggest that transient pathological high shear rate (8302s-1 ) exposure can induce platelet activation in a time-dependent manner; however, the mechanism is more complex and may be due to the following reasons: transient elevated pathological high shear rate activates platelets through the GPIb/IX/V-vWF receptor pathway, and after platelet activation, its surface membrane protein GPIIb/IIIa receptors activate platelets through fibrinogen to form platelet-platelet aggregates, and further activation of active substances such as ADP and TXA2 released by platelet alpha particles, which contribute to the formation of irreversible platelet aggregation. Show more

Keywords: Pathological high shear, platelet activation and aggregation, microfluidics

DOI: 10.3233/CH-221567

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 2, pp. 125-139, 2023

Authors: Toprak, Kenan | Kaplangoray, Mustafa | Palice, Ali | İnanır, Mehmet | Memioğlu, Tolga | Kök, Zafer | Altıparmak, İbrahim Halil | Toprak, İbrahim Halil | Biçer, Asuman | Demirbağ, Recep

Article Type: Research Article

Abstract: BACKGROUND: Complete atrioventricular block is most commonly caused by age-related degeneration and fibrosis in the cardiac conduction system and is called primary idiopathic complete atrioventricular (iCAVB). Although many factors affect this situation, which increases with age in the cardiac conduction system, the relationship between whole blood viscosity (WBV) and iCAVB has not been clarified until now. In this study, we aim to reveal the relationship between iCAVB and WBV. METHODS AND RESULTS: 141 patients with dual-chamber permanent pacemaker implanted for iCAVB and 140 age- and sex-matched subjects were included in this study. The WBV values of the study …groups were compared in both high shear rate (HSR) and low shear rate (LSR). Both WBV at HSR and WBV at LSR were significantly higher in the iCAVB group compared to the control group (16.11 [15.14–16.89] vs 14.40 [13.62–15.58]; 39.82 [17.43–55.23] vs 1.38 [–13.14–26.73]; p  < 0.001, respectively). The patient population was followed up for an median of 38 months for all-cause mortality. Higher mortality rates were found in higher WBV at HSR and WBV at LSR (p  < 0.001,for both). CONCLUSIONS: In this study, WBV was found to be an independent predictor for iCAVB, and in these patients WBV was associated with poor clinical outcomes. Show more

Keywords: Primary idiopathic complete atrioventricular block, whole blood viscosity, high shear rate, low shear rate

DOI: 10.3233/CH-221596

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 2, pp. 141-151, 2023

Authors: Li, Chunxiao | Zhang, Huili | Chen, Jing | Shao, Sihui | Li, Xin | Yao, Minghua | Zheng, Yi | Wu, Rong | Shi, Jun

Article Type: Research Article

Abstract: OBJECTIVES: The purpose of our study is to present a method combining radiomics with deep learning and clinical data for improved differential diagnosis of sclerosing adenosis (SA)and breast cancer (BC). METHODS: A total of 97 patients with SA and 100 patients with BC were included in this study. The best model for classification was selected from among four different convolutional neural network (CNN) models, including Vgg16, Resnet18, Resnet50, and Desenet121. The intra-/inter-class correlation coefficient and least absolute shrinkage and selection operator method were used for radiomics feature selection. The clinical features selected were patient age and nodule size. …The overall accuracy, sensitivity, specificity, Youden index, positive predictive value, negative predictive value, and area under curve (AUC) value were calculated for comparison of diagnostic efficacy. RESULTS: All the CNN models combined with radiomics and clinical data were significantly superior to CNN models only. The Desenet121+radiomics+clinical data model showed the best classification performance with an accuracy of 86.80%, sensitivity of 87.60%, specificity of 86.20% and AUC of 0.915, which was better than that of the CNN model only, which had an accuracy of 85.23%, sensitivity of 85.48%, specificity of 85.02%, and AUC of 0.870. In comparison, the diagnostic accuracy, sensitivity, specificity, and AUC value for breast radiologists were 72.08%, 100%, 43.30%, and 0.716, respectively. CONCLUSIONS: A combination of the CNN-radiomics model and clinical data could be a helpful auxiliary diagnostic tool for distinguishing between SA and BC. Show more

Keywords: Deep learning, radiomics, breast cancer, sclerosing adenosis

DOI: 10.3233/CH-221608

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 2, pp. 153-163, 2023

Authors: Yang, Daopeng | Zhuang, Bowen | Zheng, Yanling | Xu, Ming | Lin, Jinhua | Zhang, Xiaoer | Wang, Changxi | Xie, Xiaoyan | Huang, Gang | Xie, Xiaohua | Wang, Yan

Article Type: Research Article

Abstract: OBJECTIVES: To investigate the influencing factors of the image quality of shear wave elastography (SWE) performed using a high-frequency probe and its reproducibility for renal allografts. METHODS: A total of 211 patients with transplanted kidneys who underwent SWE examination performed using high-frequency or low-frequency probes were recruited for the study. The reproducibility of inter- and intraobserver agreements were analysed by using the intraclass correlation coefficient (ICC). According to the colour filling of the area of interest and imaging noise when conducting SWE, the image quality was classified as three grades: “good”, “common”, and “poor”. A logistic regression was …used to analyse the independent factors for SWE quality. RESULTS: In the comparative analysis, high frequency, transection measurement and middle pole were selected as the appropriate measurement methods. Regarding reproducibility, the ICCs) of the intra- and interobserver agreements were 0.85 and 0.77, respectively. Multivariate analysis indicated that only the skin allograft distance and kidney width were independent variables for SWE quality. In the subgroup analysis of the skin-allograft distance, the “good” and “common” rates of images decreased as the distance increased, but the CV (coefficients of variation) showed the opposite trend. The SWE quality of kidney width <5.4 cm was significantly better than that of kidney width ≥5.4 cm. CONCLUSIONS: High-frequency SWE can be used in the evaluation of transplanted kidneys due to its good repeatability and high successful measurement rate, but we should pay attention to the influence of the skin-allograft distance and kidney width on SWE quality. Show more

Keywords: Shear wave elastography, renal allograft, image quality, repeatability, high-frequency probe

DOI: 10.3233/CH-221668

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 2, pp. 165-176, 2023

Authors: Wang, Yang | Wu, Size

Article Type: Research Article

Abstract: Focal liver lesions (FFLs) evaluated using contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) may have the same or similar findings or substantial discrepant findings. Such phenomenon can be found in two performances of CEUS that the second performance of CEUS conducted shortly following the initial performance of CEUS. Discrepancy of two performances of CEUS for FFLs occurring in the same patient at a short internal has not been well addressed, which raises challenge for CEUS for the evaluation of FFLs. In this case study, such phenomenon is illustrated and implication is obtained.

Keywords: Keywords, Liver, focal liver lesion (FFL), contrast-enhanced ultrasound (CEUS)

DOI: 10.3233/CH-231721

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 2, pp. 177-184, 2023

Authors: Mantskava, Maia | Jung, Frederich | Sanikidze, Tamar | Momtselidze, Nana

Article Type: Research Article

Abstract: BACKGROUND: Ischemic heart disease is a pathological chronic and acute condition, which is provoked by insufficient blood supply or its complete cessation. To reduce the number of patients, all approaches and studies that can positively affect the prevention and treatment of the disease are important. This is very important in monitoring and treating diseases of all systems and organs, especially in diseases of the cardiovascular system. The aim of our work was to elucidate the relationship between the rheological status of blood, vascular changes and intracardiac hemodynamics in heart failure in coronary artery disease patients with different functional classes. …OBJECTIVES: The aim of our work was to elucidate the relationship between the rheological status of blood, vascular changes and intracardiac hemodynamics in heart failure in coronary artery disease patients with different functionalclasses. METHODS: We examined 76 men and women patients with coronary artery disease - I–IV functional class (by New York Heart Association Functional Classification NYHA)), mean age - 59.2±4 years. The control group consisted of 20 apparently healthy volunteers (Woman: Man –1:1), whose average age was 52±3 years. Representatives of the control group did not take any medication during the study period and were apparently healthy. The electrocardiogram of the subjects in the control group corresponded to the norm. All subjects underwent clinical and laboratory studies in a standard way: to describe the rheological status of blood, the erythrocyte aggregability index (EAI), erythrocyte deformability index (EDI), and plasma viscosity were determined; to assess vascular changes - resistance index of resistive arteries (RIRA); to study intracardiac hemodynamics, echocardiology was performed according to the recommendations proposed by the American Association of Physicians. RESULTS: Rheological changes are present from the very beginning of the disease and progress along with the severity of the disease. Therefore, it is possible to assess the severity of the disease based on rheological disorders, which can precede the onset of ischemic heart disease. The vascular status resistance index increases in the early stages of the disease, with I functional class - RIRA increased by 46%. The cardiac index, which determines the adequacy of the global perfusion pressure, is the main indicator of hemodynamics and is negatively related to the increase in erythrocyte aggregation, although this indicator turned out to be statistically unreliable. CONCLUSION: The interpretation of our data will allow us to better understand the pathogenesis of heart failure, as well as recommend a list of tests, and methods that were discussed in the article to assess the clinical condition of patients. Continuing research in the same direction, we believe that we will be able to make adjustments to research methods and to the algorithm for drug therapy Show more

Keywords: RBC, aggregation, deformation, viscosity, resistance arteries

DOI: 10.3233/CH-231744

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 2, pp. 185-192, 2023

Authors: Chigogidze, Maia | Mantskava, Maia | Sanikidze, Tamar | Pagava, Zurab | Urdulashvili, Tamar | Tsimakuridze, Marina | Momtselidze, Nana | Sharashidze, Nino

Article Type: Research Article

Abstract: BACKGROUND: In coronary artery disease (CAD), an alternative way of improvement of blood circulation in the ischemic area of the myocardium is coronary collateral circulation. Our study aimed to investigate the rheological parameters of blood and nitric oxide (NO) content in patients with various degrees of collateral development and the likelihood of the influence of blood fluidity on collateral angiogenesis. METHODS: We studied patients with stable CAD who underwent elective coronary angiography and a control group with the same mean age. We investigated patients with different degrees of developing collaterals and those without them. In studied patients, the …blood plasma viscosity, aggregability, and deformability of erythrocytes, as the main indicators of blood rheology. We recorded content of stable metabolic end products of nitric oxide (NOx). RESULTS: Results of the studies showed that in the blood of studied patients with CAD erythrocyte aggregation was increased and NO content decreased compared to the control level; NO content was as lower, as less was the number of developed collaterals was recorded. CONCLUSION: In this work, the role of the aggregation ability of erythrocytes and the endothelial origin of NO in the direct and feedback regulatory mechanism of angiogenesis in patients with CAD are discussed. Show more

Keywords: Rheology, blood flow, collaterals

DOI: 10.3233/CH-231745

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 2, pp. 193-203, 2023

Authors: Shi, Xia | Liu, Jianjian | Pu, Xujuan | Huang, Chen | Ma, Xin | Jin, Yingpeng

Article Type: Research Article

Abstract: OBJECTIVES: To establish the prediction model of liver fibrosis by combining ultrasound elastography and platelet count and evaluates its clinical value. METHODS: 146 patients with chronic liver diseases(CLD) admitted to our hospital from July 2020 to July 2022 were collected for liver biopsy pathological examination, and the results of ultrasound elastography (liver hardness value) and serological indicators were collected. Based on the results of Spearman correlation test and multiple linear regression model, the prediction model of liver fibrosis using ultrasound elastography combined with platelet count was constructed and verified. RESULTS: The AUC of transient elastography combined …with platelet count model (FSP) in the diagnosis of S2, S3 and S4 phases of liver fibrosis was 0.665, 0.835 and 0.909, with specificity of 81.5%, 90.0% and 100%. The AUC of sound touch elastography combined with platelet count model (STEP) in diagnosing S2, S3 and S4 phases of liver fibrosis was 0.685, 0.810 and 0884, with specificity of 96.3%, 90.0% and 83.3%, which are higher than APRI, FIB-4, FORNS, AAR and other models. CONCLUSION: Ultrasound elastography combined with platelet count model has good diagnostic efficacy for liver fibrosis. Show more

Keywords: Liver fibrosis, Transient elastography (Fibroscan), Sound touch elastography (STE), Platelet count (PLT)

DOI: 10.3233/CH-231766

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 2, pp. 205-214, 2023

Authors: Koutsiaris, Aristotle G. | Riri, Konstantina | Boutlas, Stylianos | Daniil, Zoe | Tsironi, Evangelia E.

Article Type: Research Article

Abstract: A usual practice in medicine is to search for “biomarkers” which are measurable quantities of a normal or abnormal biological process. Biomarkers can be biochemical or physical quantities of the body and although commonly used statistically in clinical settings, it is not usual for them to be connected to basic physiological models or equations. In this work, a normative blood velocity model framework for the exchange microvessels was introduced, combining the velocity-diffusion (V-J) equation and statistics, in order to define the normative range (NR) and normative area (NA) diagrams for discriminating normal (normemic) from abnormal (hyperemic or underemic) states, taking …into account the microvessel diameter D. This is different from the usual statistical processing since there is a basis on the well-known physiological principle of the flow diffusion equation. The discriminative power of the average axial velocity model was successfully tested using a group of healthy individuals (Control Group) and a group of post COVID-19 patients (COVID-19 Group). Show more

Keywords: Model, exchange microvessels, capillaries, postcapillary venules, biomarker, axial velocity, velocity-diffusion equation, ES diagram, NR diagram, NA diagram, normative, hyperemic, underemic, COVID-19

DOI: 10.3233/CH-231780

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 2, pp. 215-226, 2023

Authors: Jung, E.M. | Stroszczynski, C. | Jung, F.

Article Type: Research Article

Abstract:  Goal of the study was the assessment of AI-assisted diagnosis of solid thyroid foci with multimodal modern ultrasound imaging. 50 patients (26–81 years, 54.7±13.1 years) were included in the study. Multimodal ultrasound imaging by means of B-mode with linear probe (4–12 MHz) with option of automated documentation of findings by means of AI, with supplementary Ultra MicroAngiography (UMA) was used. Macrovascularisation was assessed by dynamic contrast ultrasonography (CEUS) with parametric evaluation and perfusion analysis, and microvascularization was assessed by combined strain and shear wave elastography on a novel high-performance ultrasound system (Resona R9/Mindray) by an experienced examiner with independent reading. The …evaluation was performed according to TI-RADS III-V. The volume of the thyroid lobes on both sides averaged 39 ml±5 ml (27 to 69 ml). The 13 cases of histologically confirmed thyroid carcinomas (8 papillary, 2 medullary, 2 microfollicular, 1 anaplastic CA) with a mean size of 15 mm±6 mm (9–21 mm) were correctly evaluated by TI-RADS V on the basis of irregular shape, induration > 2.5 m/s or > 30kPA and striking wash-out kinetics. Tumor lymph nodes could only be correctly detected preoperatively in one case of medullary carcinoma according to the surgical findings, based on irregular vascularization with UMA in roundish shape with cortex > 4 mm, transverse diameter up to 11 mm. In 25 cases of inhomogeneous nodular goiter an evaluation with TI-RADS III was performed in 31 cases, in 4 cases with incomplete marginal contour, partial marginal vascularization with UMA and partial wash out with indurations up to 2.5 m/s 30 kPA an evaluation with TI-RADS IV and surgical excision for nodular goiter. In 12 cases regressive nodular changes without relevant malignancy criteria resulted in nodular goiter, with focal changes up to 1.5 cm in diameter, classified as requiring control with TI-RADS III. There were no relevant changes in findings in the controls after 6 months. From the AI tool, the 20/25 goiter nodes were assessed as TI-RADS III, 7/12 adenomas, 5 goiter nodes, and 5 adenomas as TI-RADS IV, 5/13 carcinomas as TI-RADS IV, and 8/13 carcinomas as TI-RADS V. Multimodal ultrasound diagnostics supported by AI has a high diagnostic potential for the evaluation of solid thyroid lesions and standardizes the reporting with digital representative image documentation. CEUS perfusion and modern elastography techniques allow targeted follow-up of TI-RADS III findings. Show more

Keywords: Thyroid lesions, multimodal ultrasound, artificial intelligence (AI), UMA-elastography, contrast enhanced ultrasonography (CEUS), parametric-perfusion analysis

DOI: 10.3233/CH-239102

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 2, pp. 227-236, 2023