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

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

Article Type: Editorial

DOI: 10.3233/CH-238110

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-5, 2023

Authors: Ren, Ling | Zhao, Yuzhuo | Xiao, Jing | Li, Miao | Zhang, Ying | Zhu, Lianhua | Luo, Yukun

Article Type: Research Article

Abstract: PURPOSE: Early assessment of the severity of acute kidney injury (AKI) is critical to the prognosis of patients. Renal microcirculation hemodynamic changes and inflammatory response are the essential links of AKI induced by ischemia-reperfusion injury (IRI). This study aims to explore the value of contrast-enhanced ultrasound (CEUS) based on vascular cell adhesion molecule-1 (VCAM-1) targeted microbubbles (TM) in evaluating the renal microcirculation hemodynamics and inflammatory response of different severity of AKI. METHODS: Eighteen male C57BL/6J mice were randomly divided into three groups (n  = 6): sham operation (sham) group, mild IRI-AKI (m-AKI) group, and severe IRI-AKI (s-AKI) group. CEUS …based on VCAM-1 TM was used to evaluate renal microcirculation perfusion and inflammatory response. Pearson’s correlation was used to analyze the correlation between ultrasonic variables and pro-inflammatory factors. RESULTS: Compared with the sham group, AUC in m-AKI and s-AKI groups was significantly decreased, and s-AKI group was lower than m-AKI group (P  <  0.05). NID of m-AKI and s-AKI groups was significantly higher than that of the sham group, and s-AKI group was higher than that of m-AKI group (P  <  0.05). There was a linear positive correlation between NID and VCAM-1 protein expression (r = 0.7384, P  <  0.05). NID and AUC were correlated with TNF-α and IL-6 levels (P  <  0.05). Compared with early AKI biomarkers, CEUS based on VCAM-1 TM has higher sensitivity in evaluating the severity of AKI. CONCLUSIONS: CEUS based on VCAM-1 TM can evaluate renal microcirculation perfusion and inflammatory response in mild and severe AKI, which may provide helpful information for assessing the severity of AKI. Show more

Keywords: Acute kidney injury, Ischemia-reperfusion injury, ultrasonography, microcirculation, inflammation

DOI: 10.3233/CH-231940

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-12, 2023

Authors: Jung, Friedrich | Prantl, Lukas

Article Type: Editorial

DOI: 10.3233/CH-238109

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-2, 2023

Authors: Chaloupka, Michael | Pyrgidis, Nikolaos | Ebner, Benedikt | Pfitzinger, Paulo | Volz, Yannic | Berg, Elena | Abrarova, Benazir | Atzler, Michael | Ivanova, Troya | Pfitzinger, Paulo | 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. Pre-press, no. Pre-press, pp. 1-8, 2023

Authors: Miao, Huanhuan | Zhong, Jingwen | Xing, Xuesha | Sun, Jiawei | Wu, Jiaqi | Wu, Chengwei | Yuan, Yan | Zhou, Xianli | Wang, Hongbo

Article Type: Research Article

Abstract: OBJECTIVE: The purpose of this study was to explore the risk factors of cervical lymph node metastasis(LNM) in papillary thyroid carcinoma(PTC) coexistent with Hashimoto’s thyroiditis(HT). METHODS: The clinical data of patients who underwent thyroid operation between November 2016 and January 2020 in our hospital were analyzed retrospectively. The association between sonographic features and the risk factors of cervical LNM in PTC coexistent with HT was analyzed and a nomogram based on the risk factors was built. RESULTS: Age, US features as calcification, blood flow type, distance between thyroid nodule and fibrous capsule were risk factors of …cervical LNM(P  <  0.05).Size, SWVmax and SWVmean of thyroid nodule, SWVratio between thyroid nodule and thyroid gland were higher in PTCs with LNM than those without LNM(P  <  0.05). The ROC curve showed that the cutoff value of SWVratio for predicting LNM was 1.29 (Sensitivity = 0.806, Specificity = 0.775, AUC = 0.823, P  <  0.001). Based on the risk factors above, a relevant nomogram prediction model was established. The model verification showed that the C-index of the modeling set was 0.814, indicating that the nomogram model had good predicted accuracy. CONCLUSION: Based on the risk factors above, a relevant nomogram prediction model was established. The model verification showed that the C-index of the modeling set was 0.814, indicating that the nomogram model had good predicted accuracy. The nomogram based on the risk factors above had good prediction ability, which could optimize thyroidectomy and cervical lymph node dissection and improving prognosis. Show more

Keywords: Hashimoto’s thyroiditis, papillary thyroid carcinoma, lymph node metastasis, ultrasound, nomogram

DOI: 10.3233/CH-221673

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-13, 2023

Authors: Vanessa, Hoesl | Johanna, Klepetko | Brochhausen, C. | Gleißner, S. | Prantl, L. | Kempa, S.

Article Type: Research Article

Abstract: BACKGROUND: Biocompatibility describes the influence of materials on their biological environment. Implant material in the human body can cause a foreign body reaction and the formation of a capsule around the foreign material. Since capsular formation is the most frequent issue after breast-implant insertion, knowledge and awareness of biocompatibility is crucial, especially since worldwide, breast augmentation continues to be the most popular plastic surgery, with over 1.6 million procedures performed in 2020, according to surveys by the International Society of Aesthetic Plastic Surgery (ISAPS). MATERIAL AND METHODS: This study includes 80 capsular samples of female patients who underwent …revision surgery after breast-implant insertion at the University Hospital Regensburg. Capsules of breast implants with different surface structures (smooth, textured and polyurethane-coated) and shapes (round-shaped, anatomically-shaped) were analyzed histologically after hematoxylin-eosin-staining in respect to capsular thickness and layer formation. RESULTS: Capsular thickness and layering showed a statistically significant difference between polyurethane-coated and smooth as well as polyurethane-coated and textured implants. Capsules around polyurethane-coated implants presented greater thickness. However, the difference between smooth and textured implants was not statistically significant. Furthermore, the shape of the implants also indicated a statistically significant difference in capsular thickness. Implants of anatomical shape resulted in a thinner capsule than round-shaped breast-implants. CONCLUSION: In conclusion, this study demonstrated a thicker capsule around polyurethane-coated breast implants and no difference in capsular thickness between smooth and textured breast implants. Anatomically shaped breast-implants presented a thinner capsule than round shaped breast-implants. Show more

Keywords: Breast implants, capsular fibrosis, histological examinations, polyurethane

DOI: 10.3233/CH-238113

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-9, 2023

Authors: Diesch, Sophia T. | Schiltz, Daniel | Kammermeier, Julian | Prantl, Lukas | Taeger, Christian D.

Article Type: Research Article

Abstract: CONTEXT: Global sales of compression garments have risen sharply in recent years. Due to the availability of a wide range of compression garments, this study aims to evaluate the effect of two types of compression garments and kinesio tape on edema formation and tissue perfusion in the lower extremities. Over-the-counter compression knee stockings and kinesio tape were compared with a prototype of high-end compression stockings that combine kinesio tape and a common knee bandage. The high-end compression stockings were designed by Cube with the aim of combining the positive effects of kinesio tape and compression garments on edema formation and …tissue perfusion. DESIGN: Clinical cross-over study METHODS: Before and after a 6-hour compression period, the knee regions on both, the treated and non-treated leg, of participants were examined using a 3-D scan to detect changes in volume. Also measured were local temperature (°C), oxygen saturation (SpO2), perfusion index (Pi), blood pressure (mmHg), compression pressure (mmHg), range of motion, body-mass-index (BMI) and limb-circumference (cm). Two different types of compression garments were examined: a novel high-end compression stocking (A) and a common compression stocking (B). In addition, kinesio tape was compared to compression garments (C). After each experimental day, a one-day break was taken to prevent an unwanted overlay effect. Male and female participants between the ages of 18 and 60 were randomly selected. RESULTS: The high-end compression garment (A) showed a statistically significant (P  = 0.009) reduction of edema intraindividually. Comparing the three treatment groups, compression (A) lead to a reduction of edema. However, the reduction was not statistically significant (P  = 0.585). The compression garment B and kinesio tape showed an increase in edema in the lower limb. There was a positive correlation between the highest compression pressure (A: 9.8 mmHg) and volume decrease over the period of 6 hours. Lighter compression (B: 8.2 mmHg) led to an increase in leg volume after compression application over 6 hours. There was no significant difference in tissue oxygen saturation with the two types of compression and kinesio tape. The tissue temperature below the compression garment was highest in the compression group A. Nevertheless, we could not demonstrate a statistically significant correlation between tissue temperature and volume difference. The range in motion of the lower limb decreased after 6 hours with both compression A and B and with kinesio tape. CONCLUSION: The novel bandage showed a statistically significant reduction in edema when compared intraindividually, but no statistically significant advantage was found when compared with the other compression garment B and kinesio tape. Despite the widespread use of kinesio tape, we did not find any improvement in the range of motion, edema prevention and circulation in the lower limb after application of kinesio tape. Show more

Keywords: Tissue perfusion, edema, microcirculation, sport medicine, rehabilitation, sports rehabilitation imaging

DOI: 10.3233/CH-238111

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-9, 2023

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. Pre-press, no. Pre-press, pp. 1-10, 2023

Authors: Senk, Karin | Rio Bartulos, Carolina | Wilcke, Juliane | Einspieler, Ingo | Lürken, Lukas | Baeumler, Wolf | Stroszczynski, Christian | Wiggermann, Philipp

Article Type: Research Article

Abstract: BACKGROUND: Local ablation is an important treatment for liver cancer in cases of cirrhosis. Liver failure may occur after ablation, especially in advanced liver diseases. Currently, there is no standardization for peri-interventional risk assessment. The liver maximum capacity test (LiMAx) is used to assess functional liver capacity, but there is a lack of exploration of its use in this context. OBJECTIVE: The aim of this study was to retrospectively evaluate the usefulness of peri-interventional LiMAx measurements in patients with primary or secondary liver cancer who underwent ablation treatment. METHODS: A LiMAx test was …performed at 24 hours pre- and postablation in 49 patients. Blood parameters were collected to determine liver function using MELD and ALBI scores. The results of the LiMAx test were related with these scores and to critical postintervention LiMAx values. RESULTS: LiMAx values correlated strongly with MELD and ALBI scores before the intervention and reflected the change in liver function, as shown by an increase in scores after the intervention. Notably, LiMAx values decreased during the intervention. AUC analysis for patients at risk of reaching a critical liver level after the intervention showed a cutoff value of 186μg/kg/h. CONCLUSIONS: The LiMAx test may be a valuable tool in liver ablation for both peri-interventional monitoring of liver function and preintervention risk assessment. Show more

Keywords: Liver function, ablation, liver maximum capacity test (LiMAx), Hepatocellular carcinoma, ALBI, MELD

DOI: 10.3233/CH-238107

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-12, 2023

Authors: Li, Nana | Dong, Tiantian | Wang, Peihua | Li, Qi | Nie, Fang

Article Type: Research Article

Abstract: OBJECTIVE: Glypican-3 (GPC3) has emerged as a significant marker for the diagnosis and prognosis of hepatocellular carcinoma (HCC) and has garnered considerable attention as an immunotherapeutic target. In this study, we propose a combination of preoperative contrast-enhanced ultrasound (CEUS) imaging features and clinical factors to predict the positive expression of GPC3 in HCC patients. METHODS: We retrospectively included 30 cases of GPC3-negative HCC and 115 cases of GPC3-positive HCC patients who underwent conventional ultrasound and CEUS evaluation. We assessed and compared the clinical characteristics, conventional ultrasound features, and CEUS features between the two groups of HCC …patients. Based on the clinical and ultrasound features between the two groups, we developed a binary logistic regression model for predicting GPC3-positive HCC. RESULTS: A total of 145 HCC patients were included in this study. Binary logistic regression analysis showed that AFP >  20 ng/mL (OR = 4.047; 95% CI: 1.467-11.16; p  = 0.007), arterial phase hyperenhancement (APHE) (OR = 12.557; 95% CI: 3.608-43.706; p  <  0.001), and asynchronous perfusion (OR = 4.209; 95% CI: 1.206-14.691; p  = 0.024) were predictive factors for GPC3-positive HCC. Receiver operating characteristic (ROC) analysis was conducted to predict GPC3-positive expression. The model combining the three independent predictive factors showed good predictive performance (AUC 0.817, 95% CI: 0.731-0.902, sensitivity: 91.3%, specificity: 60.0%). This combined model demonstrated excellent discriminatory ability to predict GPC3-positive HCC. CONCLUSION: Preoperative integration of CEUS features and clinical factors can non-invasively and effectively identify GPC3-positive HCC patients, providing valuable assistance in making personalized treatment decisions. Show more

Keywords: Hepatocellular carcinoma, glypican-3, contrast-enhanced ultrasound

DOI: 10.3233/CH-231912

Citation: Clinical Hemorheology and Microcirculation, vol. Pre-press, no. Pre-press, pp. 1-14, 2023