Clinical Hemorheology and Microcirculation - Volume 86, issue 1-2

Authors: Jung, Friedrich | Prantl, Lukas

Article Type: Editorial

DOI: 10.3233/CH-238109

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 1-2, 2024

Authors: Michael, Jung Ernst | Xiaoyan, Xie | Xiaoer, Zhang

Article Type: Editorial

DOI: 10.3233/CH-238110

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 3-7, 2024

Authors: Connes, Philippe

Article Type: Research Article

Abstract: Sickle cell disease (SCD) is an autosomal recessive disorder. Although the molecular mechanisms at the origin of SCD have been well characterized, its clinical expression is highly variable. SCD is characterized by blood rheological abnormalities, increased inflammation and oxidative stress, and vascular dysfunction. Individuals with only one copy of the mutated β-globin gene have sickle cell trait (SCT) and are usually asymptomatic. The first part of this review focuses on the biological responses of SCT carriers during exercise and on the effects of combined SCT and diabetes on vascular function, several biomarkers and clinical complications. The second part of the …review focuses on SCD and shows that the magnitude of red blood cell (RBC) rheological alterations is highly variable from one patient to another, and this variability reflects the clinical and hematological variability: patients with the less deformable RBCs have high hemolytic rate and severe anemia, and are prone to develop leg ulcers, priapism, cerebral vasculopathy, glomerulopathy or pulmonary hypertension. In contrast, SCD patients characterized by the presence of more deformable RBCs (but still rigid) are less anemic and may exhibit increased blood viscosity, which increases the risk for vaso-occlusive events. Several genetic and cellular factors may modulate RBC deformability in SCD: co-existence of α-thalassemia, fetal hemoglobin level, oxidative stress, the presence of residual mitochondria into mature RBCs, the activity of various non-selective cationic ion channels, etc. The last part of this review presents the effects of hydroxyurea and exercise training on RBC rheology and other biomarkers in SCD. Show more

Keywords: Sickle cell disease, red blood cell deformability, blood viscosity, microcirculation, vascular function

DOI: 10.3233/CH-238122

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 9-27, 2024

Authors: Jung, F.

Article Type: Research Article

Abstract:  This review spans a wide arc from the first observations of the early anatomists to the present day. William Harvey was the first to describe the heart as the centre of the large and small circulatory system. He thus replaced the previously valid system of Galenos, It was Marcello Malpighi who first described that the capillary system connects the arteries with the veins. In 1688 Antoni van Leeuwenhoek (1632–1686) confirmed these results with a paper on capillary perfusion in the caudal fin of the glass eel. It was then Hermann Boerhave (1668–1738, Leiden) who was the first to carry …out microcirculation tests on patients. He studied the microcirculation in the human bulbar conjunctiva. Even today, microcirculation studies in the conjunctiva bulbi of patients are carried out today. Until 1831, it was never quite clear whether the observations reported belonged mainly to the field of microcirculation, which had not yet been defined. This was done in Great Britain by Marshall Hall (1790–1857). Technical Improvements allowed increasingly sophisticated studies of the morphological structure of the terminal vasculature. According to Gustav Ricker (1870–1948, Vienna), the terminal vasculature comprises the functional unit of the smallest arteries, arterioles, capillaries and venules. In 1921 it was still thought that the blood circulation was the sole response to the pumping action of the heart. Even the classic work by Bayliss on the myogenic hypothesis (later referred to as “blood flow autoregulation”) initially received little attention. More strikingly, even the findings of August Krogh, for which he received the Nobel Prize in Medicine in 1920 (for his discovery of the mechanisms of capillary motor regulation), were ignored. During an outstanding autoregulation symposium held in 1963 a broad consensus was reached on active and passive mechanisms, which is more or less valid till today. The mechanisms of regulation of capillary blood flow are now largely understood, although not completely resolved. The development of video systems with recording capability and automated off-line recording of capillary erythrocyte velocities allowed the application of morphological and dynamic studies of cutaneous capillaries in humans. These reopened the field of physiological or pathophysiological questions again for many groups worldwide. Since 1955, many publications on “microcirculation (5423)” and “capillary microscopy (2195)” have been listed in pubmed. Show more

Keywords: Human, cutaneous, capillary circulation, microcirculation

DOI: 10.3233/CH-248001

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 29-50, 2024

Authors: Huang, Yun-Lin | Cheng, Juan | Wang, Ying | Xu, Xin-Liang | Wang, Shi-Wen | Wei, Li | Dong, Yi

Article Type: Research Article

Abstract: OBJECTIVES: To explore the technical and clinical evaluation of ultrasound-derived fat fraction (UDFF) measurement in adult patients in whom fatty liver was suspected. MATERIALS AND METHODS: In this prospective study, 41 participants were initially enrolled in our hospital between October 2022 and December 2022 and received UDFF assessment using Siemens ACUSON Sequoia system equipped with DAX transducer. UDFF measurement was performed three times to obtain UDFF values from each imaging location (V hepatic segment and VIII hepatic segment) per participant, and the depth (skin-to-capsule distance) was automatically measured. The echogenicity of liver tissue in B mode …ultrasound (BMUS) was compared to the normal kidney tissue, and fatty liver was graded as mild (Grade 1), moderate (Grade 2), and severe (Grade 3). The median of the acquired overall median UDFF values was used for statistical analysis. All ultrasound examinations were performed by one of two radiologists (with 20 and 10 years of liver ultrasound imaging experience). RESULTS: Finally, UDFF measurement was successfully performed on 38 participants to obtain valid values, including 21 men with a median age of 40.0 years (interquartile range [IQR]: 23.0 – 58.5) and 17 women with a median age of 60.0 years (IQR: 29.5 – 67.0). Fatty liver was diagnosed by BMUS features in 47.4% (18/38) participants. Among all participants, the median UDFF value was 7.0% (IQR: 4.0 – 15.6). A significant difference in UDFF values was found between participants with fatty liver and without fatty liver (U  = 7.0, P  < 0.001), and UDFF values elevated as the grade of the fatty liver increased (P  < 0.001). The median UDFF values from the three UDFF measurements obtained during each ultrasound examination showed excellent agreement (ICC = 0.882 [95% confidence interval: 0.833 – 0.919]). The Spearman correlation of UDFF values in different depths was moderate, with a r s value of 0.546 (P  < 0.001). No significant differences in UDFF values were found between V hepatic segment and VIII hepatic segment (U  = 684.5, P  = 0.697). CONCLUSIONS: UDFF provides a novel non-invasive imaging tool for hepatic steatosis assessment with excellent feasibility. Show more

Keywords: Hepatic steatosis, ultrasound-derived fat fraction (UDFF), quantitative, feasibility, B mode ultrasound (BMUS)

DOI: 10.3233/CH-238102

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 51-61, 2024

Authors: Chaloupka, Michael | Pyrgidis, Nikolaos | Ebner, Benedikt | Pfitzinger, Paulo L. | Volz, Yannic | Berg, Elena | Enzinger, Benazir | Atzler, Michael | Ivanova, Troya | Pfitzinger, Paulo L. | Stief, Christian G. | Apfelbeck, Maria | Clevert, Dirk-André

Article Type: Research Article

Abstract: OBJECTIVE: Multiparametric magnetic resonance imaging (mpMRI) –Ultrasound- fusion guided biopsy of the prostate (FBx) is the new gold standard for the detection of prostate cancer. Hallmark studies showing superior detection rates of FBx over randomized biopsies routinely excluded patients≥75 years and information on outcome of FBx on this patient cohort is sparse. As a large referral center, we have performed FBx on a substantial number of patients this age. By evaluating outcome of FBx of patients over the age of 75 years we wanted to close the gap of knowledge on this patient cohort. MATERIALS AND METHODS: Between …2015 –2022, 1577 patients underwent FBx at our department and were considered for analysis. Clinical and histopathological parameters were recorded. Clinical data comprised age at FBx, serum level of Prostate-specific antigen (PSA), prostate volume, PSA-density, history of previous biopsies of the prostate, result of the digital rectal examination (DRE) and assessment of the indexlesion of mpMRI according to the Prostate Imaging and Reporting Data System (PI-RADS). Univariate analysis and multivariable logistic regression was used to identify age barrier of 75 years as a potential risk factor of detection of clinically significant prostate cancer by FBx. RESULTS: 379/1577 patients (24%) were≥75 years and 1198/1577 (76%) patients were < 75 years, respectively. Preoperative PSA was significantly higher in patients≥75 years compared to patients < 75 years (9.54 vs. 7.8, p  < 0.001). Patients≥75 years presented significantly more often with mpMRI target lesions classified as PI-RADS 5 compared to patients < 75 years (45% vs. 29%, p  < 0.001). Detection rate of clinically significant prostate cancer was significantly higher in patients≥75 years compared to patients < 75 years (63% vs. 43%, p  < 0.001). Aggressive prostate cancer grade ISUP 5 was significantly more often detected in patients≥75 years compared to patients < 75 years (13% vs. 8%, p  = 0.03). On multivariable logistic regression model adjusted for PSA and PI-RADS score, age barrier of 75 years was identified as a significant risk factor for the detection of clinically significant prostate cancer by FBx (OR: 1.77, 95% CI: 1.36 –2.31, p  < 0.001). CONCLUSION: After evaluation of a large patient cohort, we show that age≥75 years represents a significant risk factor for the detection of clinically significant prostate cancer. Further studies on mid- and long term outcome are necessary to draw conclusions for clinical decision making in this patient cohort. Show more

Keywords: Prostate biopsy, elderly patient, mpMRI

DOI: 10.3233/CH-238101

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 63-70, 2024

Authors: Brix, E. | Prantl, L. | Anker, A. | Klein, S. | Kehrer, A.

Article Type: Research Article

Abstract: BACKGROUND: Complex injuries of the hand frequently result in loss of essential functional features. Common reconstructive procedures for soft tissue defects of the thumb or phalanges are locoregional flaps like Moberg-, Foucher-, Cross-Finger- or Littler flaps. Microneurovascular toe (joint-) transfers complete the arsenal of operative reconstructive procedures and allow for most detailed reconstructions. Our experiences with free toe transplants are reported and diversely discussed regarding contending procedures. METHODS: From 2010 until 2019 14 patients who received emergency or elective partial or complete toe transfers were compared with a control group (n  = 12) treated with contending reconstructive procedures. Aim …of the reconstructions was to cover the defect with well-vascularized, sensate tissue, while preserving length and range of motion in a reliable manner. RESULTS: The Kapandji score showed a significant difference (p - value = 0.04) with a score of 9.8 in comparison to control group (Kapandji index = 8.0). CONCLUSION: In our heterogenic patient collective free toe transplants have proven to achieve comparable functional results for reconstruction of two and tripartite phalanxes as opposed to common local reconstructive procedures. Show more

Keywords: Amputations injuries, toe to hand transfer, free pulp flap, hand reconstruction by toe transfer after amputational injuries, wrap around flap great toe, toe joint transfer

DOI: 10.3233/CH-238114

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 71-88, 2024

Authors: Jung, Ernst Michael | Jung, Friedrich | Dong, Yi | Kaiser, Ulrich

Article Type: Research Article

Abstract: OBJECTIVE: To test and initially describe a new handheld wireless ultrasound technique (TE Air) for clinical use. METHODS: In this pilot study, the new ultrasound device TE Air from Mindray was used to examine the hepatic and renal vessels of healthy volunteers for first impressions. The probe has a sector transducer with a frequency range of 1.8–4.5 MHz. The B-mode and color-coded doppler sonography (CCDS) scanning methods were used. A high-end device from the same company (Resona 9, Mindray) was used as a reference. The results were evaluated using an image rating scale ranging from 0 to 5, …with 0 indicating not assessable and 5 indicating without limitations. RESULTS: Altogether, 61 participants (n  = 34 female [55.7%], n  = 27 male [44.3%]), age range 18–83 years, mean age 37.9±16.5 years) could be adequately studied using TE AIR and the high-end device. With one exception, the image quality score for TE Air never fell below 3 and had a mean/median scored of 4.97/5.00 for the B-mode, 4.92/5.00 for the color flow (CF) mode, and 4.89/5.00 for the pulse wave (PW) mode of the hepatic vein, 4.90/5.00 for the portal vein, 4.11/4.00 for the hepatic artery, and 4.57/5.00 for the renal segmental artery. A significant difference in the assessment of flow measurement of the hepatic artery and renal segmental arteries was found between TE AIR and the high-end device. CONCLUSIONS: TE Air represents a new dimension in point-of-care ultrasound via wireless handheld devices. Especially, its flow measurement ability offers a relevant advantage over other available handheld models. TE Air provides a formally sufficient image quality in terms of diagnostic significance. Show more

Keywords: Mindray, handheld ultrasound, TE Air, ultrasound, point-of-care ultrasound

DOI: 10.3233/CH-238100

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 89-97, 2024

Authors: Kempa, S. | Tessmann, V. | Prantl, L. | Schmid, S. | Müller, M. | Jung, E.-M. | Tews, H.C.

Article Type: Research Article

Abstract: BACKGROUND: Lipedema is a chronic disease marked by symmetric enlargement of painful nodular and fibrotic adipose tissue, predominantly affecting the limbs. Since there is no specific test or biomarker for this condition, years often pass before the diagnosis of lipedema is established for the first time, thereby causing psychosocial distress, including depression, eating disorders, and social isolation. Over the last few years several advanced Doppler–based technologies have been developed to visualize slow flow blood vessels and superficial microvascular architecture undetectable by traditional color Doppler flow imaging (CDFI). OBJECTIVE: The aim of this study was to evaluate …the superficial microvascular anatomy in lipedema patients compared to healthy controls and investigate the clinical significance of the Ultra Micro Angiography (UMA) technology in the diagnosis of lipedema. This new technique may contribute to reduce the diagnostic delay and, eventually, establish and guide treatment strategies toward a better therapeutic outcome in lipedema patients. METHODS: 25 patients with lipedema and ten healthy controls with no history of lipedema were included in this study. All ultrasound examinations were performed on a novel high-performance ultrasound system (Resona R9/Mindray) using CDFI and the UMA technique. RESULTS: In all of the patients, Ultra Micro Angiography achieved the excellent visualization of microvascular structures, revealing that most lipedema patients showed grade 3 (n  = 13) or grade 2 (n  = 8) flow. UMA was superior to CDFI for depicting the microvascular structures. CONCLUSIONS: Here we show that UMA imaging characterizes the subcutaneous microvasculature with an unprecedented accuracy. The method has the advantage of being sensitive to small, slow-flowing vessels. This allows for the assessment of the course of vessels and vascular pathologies in great detail. Thus, UMA as a non-invasive diagnostic method can improve diagnostic accuracy in lipedema. Show more

Keywords: Lipedema, diagnosis, ultrasound, ultra micro angiography, UMA

DOI: 10.3233/CH-238103

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 99-108, 2024

Authors: Río Bártulos, Carolina | Pirl, Lukas | Lier, Dennis | Planert, Mathis | Hohmann, Juliane | El Mountassir, Abdelouahed | El Anwar, Mohamed | Wiggermann, Philipp

Article Type: Research Article

Abstract: BACKGROUND: The range of software available to radiologists has increased enormously with the advancement of AI. A good example of this is software to determine ASPECTS in the treatment of potential stroke patients. OBJECTIVE: In this study, two software packages (eASPECTS from Brainomix and VIA_ASPECTS from Siemens) were tested and compared for their performance in the daily clinical routine of a maximum care provider with a 24/7 stroke unit. METHODS: A total of 637 noncontrast CT images were obtained from consecutive patients with suspected stroke, of whom 73 were finally diagnosed with MCA …infarction. Differences in agreement and quantification of agreement were analysed, as well as the correlation and sensitivity, specificity and accuracy compared to raters. RESULTS: Compared to VIA_ASPECTS, eASPECTS shows good agreement and strong correlation with the raters. VIA_ASPECTS has lower accuracy and low specificity than eASPECTS but a higher sensitivity. CONCLUSION: Both software products have the potential to be decision support tools for radiologists. There are, however, differences between the two software products in terms of their intended use. Show more

Keywords: Acute ischaemic stroke, computed tomography, software comparison, artificial intelligence

DOI: 10.3233/CH-238105

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 109-119, 2024