Clinical Hemorheology and Microcirculation - Volume Pre-press, issue Pre-press

Authors: Ezer, Erzsebet | Schrick, Diana | Tőkés-Füzesi, Margit | Szapary, Laszlo | Bogar, Lajos | Molnar, Tihamer

Article Type: Research Article

Abstract: BACKGROUND: Elevated mean platelet volume (MPV) and immature platelet fraction (IPF) are predictive for vascular risk. Both can be associated with residual platelet reactivity. We aimed to explore associations among platelet characteristics and responder status in stroke patients on clopidogrel. METHODS: Blood samples from 46 patients and 15 healthy subjects were analyzed for platelet count, MPV, IPF, large cell ratio (LCR) and high-fluorsecent immature platelet fraction (H-IPF). As a novelty, not only whole blood, but upper and lower half blood samples after 1-hour gravity sedimentation were analyzed. Platelet aggregometry was used for the whole blood and separated samples …to explore area under the curve (AUC) in patients and controls. RESULTS: The AUC of the whole blood showed significant differences compared to the upper and lower samples separated after 1-hour sedimentation in patients and controls (p  < 0.001 and p  = 0.005 respectively). Remarkably, AUC measured in the upper samples in 59% of patients on clopidogrel were exceeding the therapeutic range suggesting that ascending platelets exert aggregation in the presence of ADP. This observation was associated with increased MPV and LCR in the upper samples (both p  = 0.04). Patients on clopidogrel were characterized as responders and non-responders and the percentage of H-IPF was significantly higher among non-responders compared to controls in the upper samples (p  = 0.04). CONCLUSIONS: The modified platelet function test may help to stratify patients with high residual platelet reactivity. Show more

Keywords: Immature platelet, clopidogrel, aggregometry, ischemic stroke

DOI: 10.3233/CH-190580

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-11, 2019

Authors: Islam, Sufia | Ahmed, Najneen | Rivu, Sanzana Fareen | Khalil, Marjana | Tanjia, Nafisa | Lehmann, Christian

Article Type: Research Article

Abstract: BACKGROUND: Microvascular dysfunction is a main contributor to morbidity and mortality worldwide. Sophisticated technical tools (e.g. miniaturizedhardware, automated software), along with skilled personnelare the prerequisite for quantitative observations of the microvasculature. OBJECTIVE: This review aimed to get anoverviewabout on-goingmicrocirculatory research in developing countries, particularly of the South-East Asia region for the last five years and to project the challenges faced in microcirculation research in developing countries. METHODS: Original research articles originating from 194 countries were searched in PubMed database on the field of microcirculation research for the last five years. RESULTS: Our findings showed …that around 1800 articles have been published from developing countries compared to more than 5000 from developed countries on different aspects of microcirculation. The overall publication per million populations for developing countries was found to be 0.36 where for developed countries it was 3.62. CONCLUSIONS: Initiation and executionof sophisticated research in microcirculation is a demand of the time. Such research, initially, may seem unmanageable in developing countries with limited resourcesand infrastructuresettings. Collaborativescientificprojectsmay aid in establishingnetworks for microvascular research in developing countries. Show more

Keywords: Microcirculation, infrastructure, developed countries, developing countries

DOI: 10.3233/CH-190611

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-9, 2019

Authors: Lerchbaumer, Markus Herbert | Auer, Timo Alexander | Marticorena, Garcia Stephan | Stephan, Carsten | Hamm, Bernd | Jung, Ernst-Michael | Fischer, Thomas

Article Type: Research Article

Abstract: BACKGROUND: Contrast-enhanced ultrasound (CEUS) has been used as an additional imaging technique in order to clarify testicular findings. CEUS is easy and fast to perform, overcomes the limitations of B-mode US. OBJECTIVE: To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the assessment of unclear testicular pathologies. METHODS: CEUS examinations of 45 patients with unclear testicular pathologies between 2012 and 2018 were analyzed retrospectively. Examinations were performed using B-mode, colour Doppler (CCDS) and CEUS after injection of contrast agent (SonoVue® , Bracco) and interpreted by an experienced radiologist (EFSUMB level 3). Reference standard was defined …as histopathological report and clinical course. RESULTS: Overall 19 patients presented with a neoplastic lesion, whereas 14 were malignant. Matched to the histopathological report and clinical follow up, CEUS represented a sensitivity of 93% (95% -CI, 69–99), a specificity of 94% (95% -CI, 80–98), a positive predictive value (PPV) of 87% (95% -CI, 62–96) and a negative predictive value (NPV) of 97% (95% -CI, 83–99). CONCLUSION: CEUS is an accurate additional tool to differentiate between testicular alterations when B-mode US and CCDS are uncertain. CEUS may provide additional information and detect early enhancement in small tumor lesions when CCDS comes to its limit. Show more

Keywords: Contrast-enhanced ultrasound, CEUS, testis, testicular pathology

DOI: 10.3233/CH-190579

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-11, 2019

Authors: Rohm, Ilonka | Grün, Katja | Müller, Linda Marleen | Bäz, Laura | Förster, Martin | Schrepper, Andrea | Kretzschmar, Daniel | Pistulli, Rudin | Yilmaz, Atilla | Bauer, Reinhard | Jung, Christian | Berndt, Alexander | Schulze, P. Christian | Franz, Marcus

Article Type: Research Article

Abstract: Growing evidence suggests that inflammation is crucially involved in the pathogenesis of pulmonary hypertension (PH) and consecutive right heart failure. The present study analyzed the inflammatory response in lung and right ventricle in a rat model of PH and evaluated the effects of the dual endothelin receptor antagonist (ERA) Macitentan. PH was induced by monocrotalin (60 mg/kg body weight s.c.) in Sprague-Dawley rats (PH, n  = 10) and compared to healthy controls (CON, n  = 10) as well as monocrotalin-induced, macitentan-treated rats (THER, n  = 10). Detection of Dendritic cells (DCs), regulatory T cells (Tregs) and others as well as RT-PCR based inflammatory gene …expression analysis were performed. Circulating DCs and Tregs were quantified by flow cytometry in the rat model and in PH patients (n  = 70) compared to controls (n  = 52). Inflammatory cells were increased in lung and right ventricular tissue, whereas DCs and Tregs were decreased in blood. Expression of 17 genes in the lung and 20 genes in the right ventricle were relevantly (>2.0 fold) regulated in the PH group. These effects were, at least in part, attenuated in response to Macitentan treatment. In humans as well as rats, immune cells showed significant correlations to clinical, echocardiographic, and haemodynamic parameters. PH is accompanied by a distinct inflammatory response in lung and right but not left ventricular tissue attenuated by Macitentan. Correlations of circulating DCs as well as tissue resident immune cells with parameters reflecting right ventricular function raise the idea of both, promising biomarkers and novel treatment strategies. Show more

Keywords: pulmonary hypertension, right heart failure, inflammation, biomarker, dual endothelin receptor antagonist

DOI: 10.3233/CH-180529

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-26, 2019

Authors: Chen, Chao-Tsung | Hsu, Chung-Hua | Liu, Jyh-Rou | Wu, Hung-Bo | Chou, Yi-Sheng | Hsiu, Hsin

Article Type: Research Article

Abstract: This study tested the hypothesis that measuring and analyzing skin-surface blood flow dynamics can be used to noninvasively discriminate the different microcirculatory and physiological function states of breast-cancer patients with chemotherapy between receiving and not receiving Kuan-Sin-Yin (KSY) treatment. The 17 included patients were assigned randomly to 2 comparison groups: Group K (n  = 10) received KSY treatment, while Group NK (n  = 7) did not receive KSY treatment. Beat-to-beat, spectral, and approximate-entropy (ApEn) analyses were applied to the 20-minute laser-Doppler sequences. The self-reported quality of life and cancer-related symptoms of patients were also investigated. In posttests, Group NK had a significantly …larger ApEn ratio than that in Group K, significantly smaller values of laser-Doppler-flowmetry variability indices, and a slightly higher relative energy contribution of the neural-related frequency band compared to those in the pretests. Almost all cancer-related symptoms showed improvements in Group K compared to in Group NK. The present findings indicated that the present analysis can be used to detect the significantly different responses in the laser-Doppler indices between taking and not taking KSY. The KSY effect was also noted to be accompanied with improvement of EORTC QLQ-C30 scores. These could lead to a rapid, inexpensive, and objective technique for enhancing clinical applications in quality-of-life monitoring of breast cancer therapy. Show more

Keywords: Breast cancer, blood flow, laser Doppler, approximate entropy, spectral analysis

DOI: 10.3233/CH-190569

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-11, 2019

Authors: Liu, Shui-Qing | Xie, Xiao | Liu, Yan-Ping | Ma, Yi-Bo | Zhang, Ling | Ge, Hong-Wei | Ding, Jiu-Le | Xing, Xiao-Xiao

Article Type: Research Article

Abstract:  Uterine arteriovenous malformation (AVM) is an extremely rare condition characterized by abnormal connections between veins and arteries. The atypical clinical manifestations and relatively low morbidity of AVM are conducive to missed diagnosis. The present study describes a case of a 47-year-old female patient with congenital uterine AVM followed by iatrogenic AVM. The diagnosis was established by contrast-enhanced ultrasound combined with contrast-enhanced CT (CECT). Because the symptom of vaginal bleeding was severe, trophoblastic disease or neoplasia could be preferred. The manifestations on various imaging examinations were carefully assessed, and the relevant literature was also reviewed.

Keywords: Uterine arteriovenous malformation, contrast-enhanced ultrasound, contrast-enhanced computed tomography, conventional ultrasound

DOI: 10.3233/CH-180489

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-6, 2019

Authors: Veres, T.Gy. | Petrovics, L. | Sárvári, K. | Vereczkei, A. | Jancsó, G. | Farkas, K. Borbásné | Takács, I.

Article Type: Research Article

Abstract: INTRODUCTION: Pneumoperitoneum, widely used in laparoscopic surgery increases the intraabdominal pressure, leading to hypoperfusion of the abdominal organs, and promoting the buildup of reactive oxygen species(ROS) and inflammatory cytokines which in turn impairs the body postoperatively. Aim of our investigation was to evaluate the potential protective effects of short ischemic episodes on ischemic damages. METHODS: 70 Wistar rats were used, divided into 7 groups: 1st group sham, 2nd group pneumoperitoneum with 5 mmHg, 3rd group preconditioning with 5 mmHg, 4th group: postconditioning with 5 mmHg, 5th group pneumoperitoneum with 10 mmHg, 6th group: preconditioning with 10 mmHg, 7th group postconditioning with 10 mmHg. Pneumoperitoneum …was created by Veres needle. Oxidative stress parameters: malondialdehyde (MDA) concentration, reduced glutathione (GSH), sulfhydril (SH-), myeloperoxidase (MPO) levels and superoxide-dismutase (SOD) activity were measured. We measured TNF-α and IL-6 concentrations. We monitored the activation of anti- and proapoptotic common signaling pathways (bax, bcl-2, p53) during the early phase of reperfusion. Histology was made from kidney samples. RESULTS: GSH concentrations were significantly reduced, MDA concentrations were significantly higher in each group compared to the Sham. SOD enzyme: a pressure of 10 mmHg elicited significantly greater damage than 5 mmHg. There was a significantly higher SOD activity in group 10 mmHg IPC compared to 10 mmHg. We found that the expression of bax was considerably higher in the none conditioned groups. Noticeably higher expression of anti-apoptotic bcl-2 level was measured in 10 mmHg IPC and 10 mmHg IPoC groups. In case of p53 expression: significant decrease could be seen in groups 10 mmHg IPC and 10 mmHg IPoC compared to the 10 mmHg group. CONCLUSION: Based on our results, the elevated intraabdominal pressure due to pneumoperitoneum induces oxidative stress, which is dependent on the applied pressure. Mostly precondiotioning – but also postconditioning – reduces surgical stress following laparoscopic procedures. In order to explore its mechanism it requires further investigations. Show more

Keywords: Laparoscopy, preconditioning, postconditioning, oxidative stress

DOI: 10.3233/CH-190572

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-13, 2019

Authors: Biran, Roni | Hadayer, Noa | Ramot, Yuval | Zlotogorski, Abraham | Yedgar, Saul | Barshtein, Gregory

Article Type: Research Article

Abstract: BACKGROUND: Alternations in erythrocyte deformability (ED), namley, the ability of erythrocytes to change shape under flow in the microcirculation, can contribute to cardiovascular diseases. Psoriasis, a systemic inflammatory skin disorder, is associated with an increased cardiovascular risk. The effect of psoriasis and psoriasis treatment on ED was only scarcely evaluated. OBJECTIVE: To evaluate ED changes in psoriasis patients following narrow band-ultraviolet B (NB-UVB) treatment. METHODS: Erythrocyte deformability was determined using a computerized cell flow properties analyzer in 9 patients with psoriasis before and after a course of Goeckerman regimen. ED was quantified using two parameters: average …elongation ratio (AER) in the cell population, and the fraction of low deformable cells (% LDFC). RESULTS: All 9 patients showed decreased ED (i.e. impaired deformability) following NB-UVB treatment. There was a significant (p  = 0.003) decrease in AER after treatment (AER±SD; 1.58±0.06) compared to the starting values (1.69±0.1). Additionally, there was a significant (p  = 0.002) increase in the fraction of low deformable cells (% LDFC±SD; 60.00±9.05) compared to their fraction before treatment (34.86±11.44). CONCLUSIONS: The decreased ED observed following phototherapy could have clinical influences on psoriasis patients, and may partially explain why phototherapy does not decrease the cardiovascular risk in psoriasis compared to other treatments. Show more

Keywords: Psoriasis, phototherapy, erythrocytes, deformability, comorbidities, cardiovascular disease

DOI: 10.3233/CH-180424

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-8, 2019

Authors: Han, Hong | Ji, Zhengbiao | Ding, Hong | Zhang, Weibin | Zhang, Ronghui | Wang, Wenping

Article Type: Research Article

Abstract: PURPOSE: To evaluate micro-flow imaging (MFI) in depicting the vascular architecture of hepatocellular carcinoma (HCC) and other focal liver lesions. MATERIALS AND METHODS: A total of 81 hepatic lesions were enrolled in this study. Each patient underwent CDFI, MFI, and CEUS examinations. The blood flow was first graded into three types (grade 1, 2 and 3) based on its richness with Adeler classification method. The differences in the grade of blood flow in liver tumors were compared between CDFI and MFI. With respect to the presented morphology, the blood flow was further classified into five types (Type I, …II, III, IV and V). The morphological differences in blood flow shown by MFI between malignant and benign hepatic tumors were then analyzed. RESULTS: For the total 81 lesions, MFI detected 61 lesion cases (75.31%) with blood flow grade 2 and 3, which obviously outperformed CDFI which detected 28 cases (34.57%) of grade 2 and 3 (χ 2 = 35.27, P  = 0.000). The MFI also showed that the most common blood flow morphology of HCC is Type-III (21/48, 43.75%) while the hepatic hemangioma (HEM) is mostly presented as Type V (5/10, 50%). Moreover, the grade of blood flow in MFI varied with different pathological subtypes of HCC (χ 2 = 5.610, P  = 0.018). CONCLUSIONS: Compared with traditional CDFI, MFI reveals more blood vessels in liver lesions with clearer view of blood flow distribution. Besides, MFI technology can demonstrate grade of blood flow for various differentiation stages of malignant liver tumors. Show more

Keywords: Micro-flow imaging (MFI), liver, tumor, vascular, color Doppler flow imaging

DOI: 10.3233/CH-180532

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-10, 2019

Authors: Martínez-Quintana, Efrén | Rodríguez-Hernández, Juan Lizandro | Riaño-Ruiz, Marta | Rodríguez-González, Fayna

Article Type: Research Article

Abstract: BACKGROUND: Platelet activation is linked with thrombosis, inflammation or heart failure. OBJECTIVE: To establish clinical and analytical factors that may favor high mean platelet volume (MPV) and to determine if MPV levels favor major adverse cardiovascular events (MACE). METHODS: Stable CHD patients and a control population matched for age, sex and cardiovascular factors. RESULTS: 658 CHD patients and 2092 controls were studied. Median age in CHD patients was 33 (25–41) year old with 56% of them being male. No significant differences were seen between MPV values and cardiac complexity (p  = 0.308) nor between MPV …values in the CHD and control groups (p  = 0.911). CHD patients had significant lower platelet count and MPV levels than patients in the control group. In the binary logistic regression analysis NT-pro-BNP levels above 125 pg/ml, thrombocytopenia and having atrial fibrillation/flutter reached statistical significance as predictors of MPV levels above 11 fL. The Kaplan-Meier survival analysis showed no significance between MPV levels higher than 11 fL and MACE, cardiovascular mortality and thrombotic events in a median time follow-up of 6.7(1.5–10.6) years. CONCLUSIONS: Atrial fibrillation/flutter, heart failure and thrombocytopenia are predictors of high MPV levels. A MPV above 11 fL is not associated with MACE at a median follow-up time. Show more

Keywords: Mean platelet volume, inflammation, heart failure, congenital heart disease

DOI: 10.3233/CH-180471

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-11, 2019