Clinical Hemorheology and Microcirculation - Volume 84, issue 4

Authors: Chen, Chao-Tsung | Huang, Tzu-Wei | Chou, Yi-Sheng | Cheng, Chi-Feng | Wu, Hung-Bo | Hsu, Chung-Hua | Hsiu, Hsin

Article Type: Research Article

Abstract: The vascular structure and function are potentially useful biomarkers for tumor detection. Treatment with chemotherapeutic agents may impair vascular function and increase the risk of cardiovascular disease. This study aimed to use noninvasive pulse waveform measurements to identify differences in the frequency-domain indices of the pulse waveform in breast-cancer patients following anthracycline chemotherapy between with (Group KSY) and without (Group NKSY) receiving Kuan-Sin-Yin (KSY) treatment. Radial blood pressure waveform (BPW) signals were measured noninvasively for 3 minutes in 31 patients, and the FACT-G, BFI-T, and EORTC QLQ-C30 questionnaires were administered. The following pulse indices were calculated for 10 harmonics: …the amplitude proportion and its coefficient of variation, and the phase angle and its standard deviation. The changes in spectral BPW indices were more prominent in Group NKSY than in Group KSY, especially for the decreases in BPW variability indices. Scores on the FACT-G, BFI-T, and EORTC QLQ-C30 questionnaires suggested that the quality of life following chemotherapy was better in Group KSY. The identified decreases in pulse variability indices could be related to the greater impairment of regulatory activities in Group NKSY. The present findings may be meaningful in developing techniques with advantages such as being noninvasive and time-saving to evaluate the blood supply and physiological conditions following chemotherapy or other treatment strategies in cancer patients. Show more

Keywords: Breast cancer, pulse, spectral analysis, Kuan-Sin-Yin, chemotherapy

DOI: 10.3233/CH-221602

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 4, pp. 345-358, 2023

Authors: Aswad, Mohamed Hussam | Kissova, Jarmila | Ovesna, Petra | Říhová, Lucie | Penka, Miroslav

Article Type: Research Article

Abstract: The clinical course of essential thrombocythemia (ET) is complicated with thrombosis which significantly impacts patients’ mortality. Studies have identified JAK2V617F mutation as an independent risk factor for thrombosis. Circulating extracellular vesicles (EVs) were evaluated in several studies regarding myeloproliferative neoplasms and thrombosis as potential biomarkers. The present study investigates the relationship between JAK2V617F mutation and EVs levels in 119 ET patients. Our analyses revealed that JAK2V617F -positive patients are at a significantly increased risk of thrombosis within five years before the ET diagnosis (hazard ratio [95% CI]: 11.9 [1.7–83.7], P  = 0.013), and that JAK2V617F mutation is an …independent risk factor for thrombosis at ET diagnosis or during the follow-up (hazard ratio [95% CI]: 3.56 [1.47–8.62], P  = 0.005). ET patients have higher levels of platelet-EVs, erythrocyte-EVs and procoagulant activity of EVs than the healthy population. Absolute and relative counts of platelet-EVs are increased in the presence of JAK2V617F mutation (P  = 0.018, P  = 0.024, respectively). In conclusion, our results support the role of JAK2V617F mutation in the pathogenesis of thrombosis in essential thrombocythemia through enhancing platelet activation. Show more

Keywords: Essential thrombocythemia, thrombosis, risk factor, JAK2V617F mutation, extracellular vesicles

DOI: 10.3233/CH-221678

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 4, pp. 359-368, 2023

Authors: Windberger, U. | Sparer, A. | Elsayad, K.

Article Type: Research Article

Abstract: BACKGROUND: Yielding and shear elasticity of blood are merely discussed within the context of hematocrit and erythrocyte aggregation. However, plasma might play a substantial role due its own viscoelasticity. OBJECTIVE: If only erythrocyte aggregation and hematocrit would determine yielding, blood of different species with comparable values would present comparable yield stresses. METHODS: rheometry (SAOS: amplitude and frequency sweep tests; flow curves) of hematocrit-matched samples at 37°C. Brillouin Light Scattering Spectroscopy at 38°C. RESULTS: Yield stress for pig: 20mPa, rat: 18mPa, and human blood: 9mPa. Cow and sheep blood were not in quasi-stationary state supporting …the role of erythrocyte aggregation for the development of elasticity and yielding. However, pig and human erythrocytes feature similar aggregability, but yield stress of porcine blood was double. Murine and ruminant erythrocytes both rarely aggregate, but their blood behavior was fundamentally different. Pig plasma was shear-thinning and murine plasma was platelet-enriched, supporting the role of plasma for triggering collective effects and gel-like properties. CONCLUSIONS: Blood behavior near zero shear flow is not based solely on erythrocyte aggregation and hematocrit, but includes the hydrodynamic interaction with plasma. The shear stress required to break down elasticity is not the critical shear stress for dispersing erythrocyte aggregates, but the shear stress required to fracture the entire assembly of blood cells within their intimate embedding. Show more

Keywords: Blood yielding, rheometry, SAOS, plasma viscoelasticity, rat, sheep, cow, pig

DOI: 10.3233/CH-231701

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 4, pp. 369-383, 2023

Authors: Veith, Sarah Berger | Nickl, Rosa | Rössel, Thomas | Lachmann, Björn | Koch, Thea | Richter, Torsten

Article Type: Research Article

Abstract: OBJECTIVE: Currently, there are limited data on the effect of macrocirculatory hemodynamic changes on human microcirculation, especially during the induction of general anesthesia (GA). METHODS: We performed a non-randomized observational trial on patients receiving GA for elective surgery. In the control group (CG), for GA induction sufentanil, propofol, and rocuronium was administered. Patients assigned to the esketamine group (EG) received additional esketamine for GA induction. Invasive blood pressure (IBP) and pulse contour cardiac output (CO) measurement were performed continuously. Microcirculation was assessed using cutaneous Laser Doppler Flowmetry (forehead and sternum LDF), peripheral and central Capillary Refill Time (pCRT, …cCRT), as well as brachial temperature gradient (Tskin-diff ) at baseline, 5, 10 and 15 minutes after induction of GA. RESULTS: 42 patients were included in the analysis (CG n  = 22, EG n  = 20). pCRT, cCRT, Tskin-diff , forehead and sternum LDF decreased following GA induction in both groups. IBP and CO were significantly more stable in esketamine group. However, the changes in the microcirculatory parameters were not significantly different between the groups. CONCLUSIONS: The addition of esketamine for GA induction warranted better hemodynamic stability for the first five minutes, but had no significant effect on any of the cutaneous microcirculatory parameters measured. Show more

Keywords: Microcirculation, induction, hemodynamic coherence, capillary refill time, pulse contour analysis, laser doppler flowmetry, esketamine

DOI: 10.3233/CH-231711

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 4, pp. 385-398, 2023

Authors: Dong, Xue-Ying | Li, Qiang-Mei | Xue, Wei-Li | Sun, Jia-Wei | Zhou, Hang | Han, Ye | Zhou, Xian-Li | Hou, Xiu-Juan

Article Type: Research Article

Abstract: OBJECTIVE: This study aims to analyze the performance of endorectal ultrasound (ERUS) combined with shear wave elastography (SWE) for rectal tumor staging. METHODS: Forty patients with rectal tumors who had surgery were enrolled. They underwent ERUS and SWE examinations before surgery. Pathological results were used as the gold standard for tumor staging. The stiffness values of the rectal tumor, peritumoral fat, distal normal intestinal wall, and distal perirectal fat were analyzed. The diagnostic accuracy of ERUS stage, tumor SWE stage, ERUS combined with tumor SWE stage, and ERUS combined with peritumoral fat SWE stage were compared and evaluated …by receiver operating characteristic (ROC) curve to select the best staging index. RESULTS: From T1 to T3 stage, the maximum elasticity (Emax) of the rectal tumor increased gradually (p  < 0.05). The cut-off values of adenoma/T1 and T2, T2 and T3 tumors were 36.75 and 85.15kPa, respectively. The diagnostic coincidence rate of tumor SWE stage was higher than that of ERUS stage. Overall diagnostic accuracy of ERUS combined with peritumoral fat SWE Emax restaging was significantly higher than that of ERUS. CONCLUSIONS: ERUS combined with peritumoral fat SWE Emax for tumor restaging can effectively distinguish between stage T2 and T3 rectal tumors, which provides an effective imaging basis for clinical decisions. Show more

Keywords: Endorectal ultrasound, shear wave elastography, rectal tumor, peritumoral fat, diagnostic performance

DOI: 10.3233/CH-231716

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 4, pp. 399-411, 2023

Authors: Meitner-Schellhaas, Barbara | Jesper, Daniel | Goertz, Rüdiger Stephan | Zundler, Sebastian | Strobel, Deike

Article Type: Research Article

Abstract: BACKGROUND: Non-invasive diagnosis of hepatocellular carcinoma (HCC) in contrast-enhanced ultrasound (CEUS) is based on the combination of arterial phase hyperenhancement (APHE) and subsequent late (>60 seconds) and mild contrast washout (WO). Whereas APHE is seen in the majority of HCC, wash-out pattern may vary in onset and intensity. In some HCC lesions, even no washout is seen at all. OBJECTIVE: Our prospective multicentre DEGUM HCC CEUS study aimed at identifying typical and atypical washout appearance of HCC in a real-life setting. METHODS: High-risked patients for HCC with focal liver lesions upon B-mode ultrasound were recruited prospectively. …In a multicentre real-life setting, a standardised CEUS examination including an extended late phase up to 6 minutes was performed. CEUS patterns of HCC were recorded, and onset and intensity of washout appearance were assessed with respect to patient and tumour characteristics. Histological findings served as reference standard. RESULTS: In 230/316 HCC (72.8%), a CEUS pattern of APHE followed by WO was observed. In 158 cases (68.7%), WO was typical (onset > 60 seconds, mild intensity). 72 cases (31.3%) showed marked and / or early WO, whereas in 41 HCCs (13%), APHE was followed by sustained isoenhancement. Atypical WO upon CEUS was associated with macroinvasion of the liver vessels, portal vein thrombosis and diffuse growth pattern, but not tumour size and histological grading. CONCLUSIONS: In a prospective multicentre real-life setting, APHE is followed by atypical washout appearance or no washout at all in almost half of the HCCs with APHE. The examiner has to bear in mind that in spite of a characteristic APHE in HCCs, washout appearance can be atypical in CEUS, especially in HCCs with macrovascular invasion or diffuse growth pattern. Show more

Keywords: Hepatocellular carcinoma, contrast-enhanced ultrasound (CEUS), standardized ultrasound examination, liver cirrhosis, prospective multicentre study, ESCULAP (Erlanger Synopsis for Contrast-enhanced Ultrasound for Liver lesion Assessment in Patients at risk), CEUS LI-RADS® (Contrast Enhanced UltraSound Liver Imaging Reporting And Data System)

DOI: 10.3233/CH-231740

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 4, pp. 413-424, 2023

Authors: Fu, Lan | Guan, Lin-Na

Article Type: Research Article

Abstract: OBJECTIVE: This study was designed to summarize the changes of cerebral blood flow (CBF) in the bilateral hippocampal CA1 region of the hemorrhagic shock reperfusion (HSR) model of rats and their correlation with anxiety-like behavior and inflammation. METHODS: Rats were randomly divided into the HSR group and the Sham group. 30 rats in each group were subdivided into 5 time points (1 w, 2 w, 4 w, 8 w, and 12 w) for examination. 3D-arterial spin labeling (3D-ASL) was performed. Long period anxiety-like behaviors were analyzed through the open field test. Histopathology was used to detect astrocytic activation in bilateral hippocampus. The concentrations …of pro-inflammatory cytokines were analyzed by ELISA. RESULTS: At 1, 2, 4, and 8 weeks, CBF in bilateral hippocampus CA1 area of the rats in the Sham group was significantly higher than the rats in the HSR group. The rats in the HSR group had significantly shorter total traveled distance, lower velocity, and less rearing counts than those in the Sham group at 1, 2, 4, 8, and 12 weeks after the surgery. The CBF at 1, 2, 4, 8, and 12 weeks after the surgery had positive correlation with the total traveled distance, velocity, and rearing counts in the open field test. The rats in the HSR group had significantly higher GFAP intensity and the concentrations of IL-6, IL-1β, and TNF-α than those in the Sham group at 1, 2, 4, 8, and 12 weeks after the surgery. The CBF at 1, 2, 4, 8 and 12 weeks after the surgery had significantly negative correlation with the GFAP intensity and the concentrations of IL-6, IL-1β, and TNF-α. CONCLUSION: In conclusion, CBF in bilateral hippocampus CA1 area, spatial exploration ability in rats with HSR were decreased while the astrocyte activation was enhanced. During the long period after the induction of HSR, the value of CBF in bilateral hippocampus CA1 area was proved to have significant correlation with anxiety-like behaviors and astrocyte activation. Show more

Keywords: Cerebral ischemia reperfusion, cerebral blood flow, anxiety-like behavior, astrocyte activation, inflammation

DOI: 10.3233/CH-231770

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 4, pp. 425-434, 2023

Authors: Li, Cang-Tuo | Jiang, Xia | He, Xin-Qi | Li, Dong-Yun | Chen, Shi-Hao | Yao, Shao-Xin | Zhang, Lei | Zhao, Zeng-Ren

Article Type: Research Article

Abstract: OBJECTIVE: To assess the potential use of plasma microRNAs (miRNAs) in diagnosis of acute venous thromboembolism (VTE). METHODS: Using BGISEQ-500 sequencing technology, we analyzed the miRNA profile of paired plasma samples from the acute and chronic phases of four patients with unprovoked VTE. Using real-time quantitative polymerase chain reaction (RT-qPCR), we verified nine upregulated named miRNAs in the acute phase in the plasma samples of 54 patients with acute VTE and 39 controls. We then compared the relative expression of the 9 candidate miRNAs between the acute VTE and control group, and plotted the receiver operating characteristic (ROC) …curves of the differentially expressed miRNAs. We chose the miRNA with the greatest area under curve (AUC) to evaluate the effect of miRNA on coagulation and platelet function in the plasma samples of 5 healthy volunteers. RESULTS: The plasma levels of miR-374b-3p, miR-660-5p, miR-378a-3p, miR-425-5p, miR-3613-5p, miR-130b-3p, miR-183-5p, and miR-103b were higher in patients with acute VTE than in the controls, with AUCs of 0.6776, 0.6614, 0.6648, 0.6885, 0.8048, 0.6871, 0.7298, and 0.7498, respectively, and P values of 0.0036, 0.0081, 0.0069, 0.0020,<0.0001, 0.0022, 0.0002, and < 0.0001, respectively. There were no significant differences in miR-193b-5p level between the acute VTE group and the control group. Fibrinogen (Fib), thrombin– antithrombin complex (TAT), tissue plasminogen activator-inhibitor complex (t-PAIC), and TAT/plasmin-α2-plasmin inhibitor complex (PIC) were decreased in the miR-3613-5p group when compared with the control group (P < 0.05) and the mean platelet aggregation rate was increased in the miR-3613 group (P < 0.05). CONCLUSION: miRNAs can be potential biomarkers for diagnosing acute VTE, and miR-3613-5p may be involved in the formation, coagulation, and platelet functions in acute VTE. Show more

Keywords: Acute venous thromboembolism, biomarker, diagnosis, miRNAs

DOI: 10.3233/CH-231820

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 4, pp. 435-448, 2023

Authors: Binneboessel, Stephan | Masyuk, Maryna | Piayda, Kerstin | Bruno, Raphael Romano | Wernly, Bernhard | Jirak, Peter | Wolff, Georg | Gerdes, Norbert | Baldia, Philipp Heinrich | Kelm, Malte | Nienhaus, Fabian | Lang, Alexander | Winkels, Holger | Geerling, Gerd | Guthoff, Rainer | Kaya, Sema | Flossmann, Gerald | Riemer, Thomas | Baertschi, Michael | Jung, Christian

Article Type: Research Article

Abstract: BACKGROUND: “Spaceflight associated neuro-ocular syndrome” (SANS) represents a challenging health condition in modern space medicine. Forty-eight percent of astronauts are diagnosed with SANS after long-term space missions. The pathophysiological mechanism seems to be multifactorial, and yet remains unknown. In this proof-of-concept study we plan to investigate retinal microcirculatory changes in weightlessness and aim to identify their role in the development of SANS. METHODS AND DESIGN: Healthy individuals will take part in a parabolic flight campaign, which recreates fractioned total weightlessness periods. The airplane is specifically equipped, and designed for the execution of parabolic flight maneuvers and scientific research …in microgravity. Retinal microcirculation will be assessed with a modified fundus camera, which allows dynamic vessel analysis. We will additionally measure intra-ocular pressure and hemodynamic changes during each phase of the flight. Blood samples will be analyzed at baseline, one hour and 24 hours after exposure to weightlessness. CONCLUSIONS: This pilot study aims to investigate the feasibility of retinal microcirculation assessment during varying gravity. Results of this study may generate insights whether venous stasis in the eye, surrogated by the dilatation of retinal vessels and increase in intraocular pressure as signs of venous insufficiency, may potentially contribute to the development of SANS. Show more

Keywords: Microgravity, parabolic flight campaign, retinal microcirculation, dynamic vessel analyzer, spaceflight associated neuro-ocular syndrome

DOI: 10.3233/CH-221691

Citation: Clinical Hemorheology and Microcirculation, vol. 84, no. 4, pp. 449-457, 2023