Clinical Hemorheology and Microcirculation - Volume Preprint, issue Preprint
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Clinical Hemorheology and Microcirculation, a peer-reviewed international scientific journal, serves as an aid to understanding the flow properties of blood and the relationship to normal and abnormal physiology. The rapidly expanding science of hemorheology concerns blood, its components and the blood vessels with which blood interacts. It includes perihemorheology, i.e., the rheology of fluid and structures in the perivascular and interstitial spaces as well as the lymphatic system. The clinical aspects include pathogenesis, symptomatology and diagnostic methods, and the fields of prophylaxis and therapy in all branches of medicine and surgery, pharmacology and drug research.
The endeavour of the Editors-in-Chief and publishers of
Clinical Hemorheology and Microcirculation is to bring together contributions from those working in various fields related to blood flow all over the world. The editors of
Clinical Hemorheology and Microcirculation are from those countries in Europe, Asia, Australia and America where appreciable work in clinical hemorheology and microcirculation is being carried out. Each editor takes responsibility to decide on the acceptance of a manuscript. He is required to have the manuscript appraised by two referees and may be one of them himself. The executive editorial office, to which the manuscripts have been submitted, is responsible for rapid handling of the reviewing process.
Clinical Hemorheology and Microcirculation accepts original papers, brief communications, mini-reports and letters to the Editors-in-Chief. Review articles, providing general views and new insights into related subjects, are regularly invited by the Editors-in-Chief. Proceedings of international and national conferences on clinical hemorheology (in original form or as abstracts) complete the range of editorial features.
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Clinical Hemorheology and Microcirculation: medical practitioners in all fields including hematology, cardiology, geriatrics, angiology, surgery, obstetrics and gynecology, ophthalmology, otology, and neurology. Pharmacologists, clinical laboratories, blood transfusion centres, manufacturing firms producing diagnostic instruments, and the pharmaceutical industry will also benefit.
Important new topics will increasingly claim more pages of
Clinical Hemorheology and Microcirculation: the role of hemorheological and microcirculatory disturbances for epidemiology and prognosis, in particular regarding cardiovascular disorders, as well as its significance in the field of geriatrics. Authors and readers are invited to contact the editors for specific information or to make suggestions.
Abstract: BACKGROUND: Little is known about the effect of mean arterial blood pressure (MAP) augmentation on the microcirculation in cardiogenic-shock patients with peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) support. We investigated the effect of increasing MAP on the microcirculation in cardiogenic-shock patients with ECMO support. METHODS: A single-center prospective observational study under taken in ICU patients undergoing ECMO support for post-cardiotomy cardiogenic shock was carried out. Patients with MAP <60 mmHg treated with ECMO support were the study cohort. Inotropic and vasopressor agents (dopamine, dobutamine, norepinephrine or epinephrine) were administered to maintain the MAP at 60–90 mmHg. Hemodynamic and…microcirculatory data were obtained at a baseline MAP of <60 mmHg and 1 h after target MAP was reached. As parameters of microcirculation, we measured thenar eminence tissue oxygenation (StO2 ) and its change during the vessel obstruction test and cerebral tissue oxygenation (rSO2 ) with near-infrared spectroscopy. RESULTS: Seventeen patients were enrolled in the study. MAP of all patients increased and reached predefined therapeutic targets (52 [50–54.5] vs.74 [70–78.5] mmHg; p < 0.001). To obtain these targets, doses of inotropic agents were increased (inotrope score increased from 14 [15.5–28] μg/kg/min; p < 0.001). No obvious changes were observed in thenarmuscleStO2 and cerebral rSO2 . Thenar muscle StO2 desaturation slope and resaturation slopes during the vessel obstruction test were also unchanged. CONCLUSIONS: Increasing MAP from <60 mmHg to 60–90 mmHg did not affect microcirculation variables in cardiogenic-shock patients with ECMO support.
Abstract: BACKGROUND: In patients with shock, inflammation and sepsis alterations in microcirculation are common problems. Although the pathophysiologic consequences are well understood, measurements of microcirculation have not entered clinical routine so far. OBJECTIVE: To characterize the requirements for clinical microcirculation measurement techniques and the barriers for implementation into routine practice. METHODS: Clinical review of reliability, reproducibility, validity, availability and usefulness of clinically available measurement techniques to be used in patients with sepsis or cardiac surgery with cardiopulmonary bypass. RESULTS: Few methods such as video microscopy are readily available at the bedside, but are hampered by…the high variability of measurements and the lack of reliable automated software analysis. The correlation of microcirculation impairment measured by in-vivo microscopy with fatal outcomes has been established, but no recommendations have been given which parameters should be targeted to improve outcomes. Measurement of regional brain tissue oxygenation has been recommended for cardiac surgery, but does not specifically target microcirculation. CONCLUSIONS: International guidelines for the management of sepsis or cardiac anesthesia do not recommend specific goals targeting the microcirculation directly, but global hemodynamics. The reason for this may be attributed to the lack of methods that fulfill the requirements necessary to be clinically acceptable. Once the validity, i.e. any improvement in patient’s outcomes attributable to microcirculation measurements, can be established, clinical measurement of microcirculation could become part of routine treatment of patients with sepsis, inflammation and shock. Until then, more clinical studies targeting microcirculation are urgently needed.
Abstract: BACKGROUND: The plantar fasciitis is a common disease with a high prevalence in public and a frequent cause of heel pain. OBJECTIVE: In our pilot study, we wanted to characterise the feasibility of shear-wave elastography and contrast-enhanced ultrasound (CEUS) in the assessment of the plantar fasciitis. METHODS: 23 cases of painful heels were examined by B-Mode ultrasound, Power Doppler (PD), shear wave elastography and contrast-enhanced ultrasound before anti-inflammatory radiation. Time-intensity-curves were analysed by the integrated software. The results for area-under-the-curve (AUC), peak, time-to-peak (TTP) and mean-transit-time (MTT) were compared between the plantar fascia and the surrounding…tissue. RESULTS: All cases showed thickening of the plantar fascia, in most cases with interstitial oedema (87.0%). Shear wave elastography showed inhomogeneous stiffness of the plantar fascia. 83.3% of cases showed a visible hyperperfusion in CEUS at the proximal plantar fascia in comparison to the surrounding tissue. This hyperperfusion could also be found in 75.0% of cases with no signs of vascularisation in PD. AUC (p = 0.0005) and peak (p = 0.037) were significantely higher in the plantar fascia than in the surrounding tissue. CONCLUSION: CEUS and shear wave elastography are new diagnostic tools in the assessment of plantar fasciitis and can provide quantitative parameters for monitoring therapy.
Abstract: PURPOSE: To compare the diagnostic performance of real-time maximum liver capacity (LiMAx) with dynamic contrast-enhanced ultrasound (CEUS)-based liver microcirculation. MATERIALS AND METHODS: 23 patients underwent liver function capacity (LiMAx) test and consecutive or previous CEUS examinations. A bolus injection of 1.4 ml sulfur hexafluoride microbubbles was administered for CEUS measurements (1–6 MHz) and quantitative perfusion analysis (TIC) was performed with an integrated perfusion software using stored cine-loops. Two perfusion-parameters, time to peak (TtoP) and area under the curve (Area), were evaluated in liver parenchyma and portal vein using TIC analysis. To compare quantification parameters, patients were classified in patients representing…a healthy population (LiMAx value >315 μg/kg/h) and those representing patients with liver disease (LiMAx value <315 μg/kg/h). RESULTS: Comparing perfusion parameters derived from portal vein measurements, TtoP and Area were higher in patients with normal liver function TtoP: 25.0±8.4 s, Area: 1483±920 a.u. compared to patients with impaired liver function TtoP: 22.4±14.0 s; Area 1351±1212 a.u. This difference however was not statistically significant (p = 0.52, p = 0.48). In parameters derived from measurements in liver parenchyma TtoP was higher (38.5±11.3 s) and Area was lower (999±632 a.u.) in patients with normal liver function compared to patients with impaired liver function (TtoP; 30.6±11.0 s, p = 0.156; Area: 1202±719 a.u.) (p = 0.16, p = 0.56). In a simple linear regression model, none of the perfusion parameters measured in portal vein (TtoPportal , Area portal) and liver parenchyma (TtoP liver, Area liver) correlated significantly with respective LiMAx values (p = 0.194–0.950). CONCLUSION: Within the framework of this study, CEUS-based perfusion parameters were not able to assess severity of liver disease, assessed with LiMAx- test.
Keywords: Liver capacity, LiMAx, CEUS, microcirculation, liver function
Abstract: OBJECTIVE: To compare contrast-enhanced computed tomography (CT) and contrast-enhanced ultrasound (CEUS) for the quantitative evaluation of an ablation defect following radiofrequency ablation of malignant liver lesions in a prospective study. MATERIALS AND METHODS: 22 radiofrequency ablations of malignant liver tumors were performed. The ablation defects were then measured and evaluated by two independent examiners via contrast-enhanced computed tomography (CT) and contrast-enhanced ultrasound (CEUS) using a 1–5 MHz multifrequency convex ultrasound transducer (LOGIQ E9, GE) with respect to the short-axis diameter, the long-axis diameter, and the area. RESULTS: Quantitative evaluation of ablation defects is possible with both contrast-enhanced…CT and CEUS. The average long-axis diameter was 47.1 mm (±11.08;±23,5%) on CEUS and 56.48 mm (±14.14;±25,0%) on CT; the short-axis diameter was 39.72 mm (±11.14;±28,05%) on CEUS and 40.27 mm (±10.50;±26,07%) on CT; the area was 1439.82 mm2 (±678.57;±47,13%) on CEUS and 2392.68 mm2 (1147.67;±48,0%) on CT. On average, ablation defects are assessed to be larger on CT than on CEUS. A significant correlation between the modalities could not be achieved for all measurement axes. CONCLUSION: CEUS can be used for the postinterventional detection and evaluation of ablation defects. However, these are always assessed to be larger on contrast-enhanced CT than CEUS.
Abstract: OBJECTIVE: The interleukin-1 receptor antagonist (IL-1RA) contributes to tumor survival and progression in multiple cancer entities. IL-1RA polymorphisms influence IL-1RA expression patterns and function. A known polymorphism was correlated with clinical outcomes in melanoma patients with particularly aggressive disease. METHODS: DNA of 343 controls and 97 melanoma patients with poor prognostic indicators (time from diagnosis to death, nodal status, metastasis) was analyzed for a variable number of tandem repeat polymorphisms (VNTR) of the IL-1RA gene. Five alleles containing two (allele 2), three (allele 4), four (allele 1), five (allele 3) or six (allele 5) 86-bp repeats were targeted…via PCR amplification. RESULTS: Genotype 1/2 is less common in the melanoma patient group vs. the control (28.8% vs. 39.6%; p = 0.06). Significant was the stage of the melanoma in order to predict the survivability (p = 0.008). The 1/1 and 1/2 genotype appeared to have lower hazards ratios than the 2/2 genotype (p > 0.05). CONCLUSIONS: Compared to the general population, the distribution of alleles coding for IL-1RA is different in melanoma patients. This alteration and the potential impact on tumor protein function and systemic inflammatory response may warrant further investigation.
Abstract: Coronary scaffolds have been recently developed to address the long-term limitations of metallic drug eluting stents. Concerns have however been expressed on the safety of these devices, with evidence of both early and late scaffold thrombosis. While early thrombosis has been associated with incomplete scaffold expansion, leading to flow disturbances, blood recirculation, and platelet activation, the pathophysiology of late events remains less understood. Recent cases series have shown that malapposition and scaffold dismantling might play a role in this phenomenon, an observation that further confirms the importance of an accurate implantation. Further, the role of dual antiplatelet therapy, and whether…prolonging it may reduce event rates, remains to be elucidated. As well, the role of inflammatoryphenomena has been proposed but never demonstrated. This brief review summarizes the current evidence on these phenomena.
Abstract: This article presents our experience in managing peripheral vascular malformations over a 4-years period in a series of 46 patients treated in our Interdisciplinary Center of Vascular Anomalies at University of Regensburg. The patients presented vascular malformations of upper and lower extremity and were selected from our prospective vascular anomalies file archive from 2012 to 2016. The purpose of this study was to review combined embolotherapy, sclerotherapy (embolo/sclerotherapy), and surgical procedures (surgical excision and soft tissue reconstruction) to manage vascular malformations. Treatments were principally induced to reduce pain, daily physical limitations, reduce social discomfort and recover tegument continuity after…ulceration. The 46 patients were first examined with noninvasive radiological procedures. After diagnosis was posed, embolo/sclerotherapy, surgical procedures and clinically as well as radiological follow-ups were coordinated and established by the multidisciplinary team. Retrospectively all vascular malformations were categorized according to the classification approved at the April 2014 General Assembly of International Society for the Study of Vascular Anomalies (ISSVA) in Melbourne, Australia. Arteriovenous malformations (AVMs) were further classified following the Cho-Do and Schobinger classification. Embolo/sclerotherapy shows to be the most appropriate procedure in vascular malformations treatment. Nevertheless was found that in case of complications, a following partial or complete surgical excision and immediate soft tissue reconstruction seems to be the gold-standard treatment. In addition, the precise clinical and radiological diagnosis as well as an intensive postoperative patient care have a significant positive influence on the clinical outcome and patient satisfaction while decreasing morbidity and recurrence during early and late follow-up. Vascular malformations require a multidisciplinary approach and individual treatment after complex excision and indispensable reconstruction.
Abstract: OBJECTIVES: Irreversible electroporation (IRE) is a novel focal ablation technique applicable for treatment of prostate cancer (PCa). We aim to evaluate imaging findings of T1-weighted contrast-enhanced MRI after percutaneous IRE of low-risk PCa. METHODS: A total of 13 male patients underwent IRE of focal low-risk PCa and were included in this analysis. Prostate IRE was conducted using 2–4 electrodes being placed under CT-fluoroscopy guidance. Dynamic contrast-enhanced 3D isotropic fat-saturated T1-weighted MRI (DCE-MRI) was performed 24–72 hours before and 24–72 hours after ablation. RESULTS: Ablated prostate was either homogeneously (8/13 [62%]) or heterogeneously (5/13 [38%]) hypo attenuating.…Peripheral contrast enhancement manifesting as a hyper attenuating margin was observed during the arterial (60 sec) (3/13 [23%]) and venous (240 sec) (10/13 [77%]) phase. The ablation defect showed a sharp (8/13 [62%]) or blurry (5/13 [38%]) margin. CONCLUSIONS: The results show a venous peripheral rim enhancement in most of the cases, indicating reactive hyperaemia. The heterogeneous appearance of the defect zone in some cases may be secondary to sustained vascularization.
Abstract: Cell-based therapies often face the challenge of low cell retention and viability upon transplantation. Hence, biomaterials, which can immobilize transplanted cells, while at the same time support cell viability, are essential for successful clinical application. Noteworthy, biomaterials in the micrometer range such as microcapsules have the advantage of a minimally invasive introduction into tissue. Hence, we established an approach to generate gelatin-based cell carriers in the form of microspherical hydrogels. Fibroblasts were microencapsulated in glycidylmethacrylate (GMA)-functionalized gelatin by photopolymerization. While the degree of GMA-functionalization was kept constant, the hydrogel cross-linking density was adjusted by varying the time of irradiation,…or the average gelatin-chain length. Stable microcapsules could be achieved with 10 wt% GMA-gelatin solutions for all irradiation periods tested (0.5 –2 min). Evaluation of cell viability revealed that microgels with the same weight content of biopolymer but with decreased cross-linking densities and thus decreasing storage, and E moduli resulted in best cell support. Noteworthy, encapsulated cells partially migrated out of the microcapsules and attached to the spherical surface. 10 wt% GMA-gelatin-based hydrogels with E moduli properties comparable to the native cellular niche proved to be a promising biomaterial suitable for the production of cell-laden microcapsules and shall be evaluated further for biomedical application.