Clinical Hemorheology and Microcirculation - Volume 67, issue 1

Authors: Kózka, Mariusz | Słoczyńska, Karolina | Szkaradek, Natalia | Waszkielewicz, Anna M. | Pękala, Elżbieta | Marona, Henryk

Article Type: Research Article

Abstract: This in vitro study was designed to examine the effect of some newly synthesized aminoalcanolic derivatives of xanthone (I, II) and aroxyalkyl derivatives of 2-methoxyphenylpiperazine (III, IV) having cardiovascular activity on the haemorheological parameters of RBCs from healthy individuals and patients with chronic venous disease. Additionally, the influence of compounds I-IV on some RBCs associated enzymes such as acetylcholinesterase (Ache), glucose-6-phosphate dehydrogenase (G6PD) and glutathione reductase (GR) as well as glutathione (GSH) content were determined in vitro in RBCs from healthy subjects. The study showed that compounds I, III and IV significantly increased RBCs deformability. Moreover, both xanthone …derivatives reduced RBCs aggregation and diminished RBCs aggregates strength in all RBCs groups. Compounds II and III significantly improved Ache activity, whereas compounds I and II increased G6PD and GR activity and GSH level. In conclusion, compounds I, III and IV, which significantly improved RBCs deformability in vitro , may facilitate the passage of blood in the vascular system. Additionally, compounds I and II which inhibit RBCs aggregates formation in vitro may contribute to more rapid degradation of red blood cell aggregates in circulating blood. Show more

Keywords: Erythrocyte aggregation, erythrocyte deformability, piperazine derivatives, red blood cells, xanthones

DOI: 10.3233/CH-16001A

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 1, pp. 1-14, 2017

Authors: Dumbarton, Tristan C. | Maxan, Alexander | Farah, Nizam | Sharawy, Nivin | Zhou, Juan | Nantais, Jordan | Lehmann, Christian

Article Type: Research Article

Abstract: BACKGROUND: Tetrahydrobiopterin (BH4), an endogenous nucleic acid derivative, acts as an important cofactor for several enzymes found within the vascular endothelium, which is deranged in sepsis. OBJECTIVE: We hypothesized that BH4 would improve capillary density and decrease inflammation within the intestinal microcirculation of septic rats. METHODS: We conducted a randomized, controlled trial using two previously validated models of sepsis in rats: 1) A fecal peritonitis model using a stent perforating the ascending colon, and 2) An endotoxemia model using lipopolysaccharide (LPS) toxin from E. coli . Experimental groups receiving BH4 (60 mg/kg) were compared to otherwise healthy …controls and to untreated groups with sepsis-like physiology. RESULTS: BH4 decreased leukocyte-endothelial adhesion by 55% and 58% (P  < 0.05) in the peritonitis model and endotoxemia models, respectively. In the endotoxemia model but not the peritonitis model, BH4 improved functional capillary density in capillary beds within the intestine (141.3 vs. 106.7 mm/cm2 , p  < 0.05). Macrohemodynamic parameters were no different between placebo treatment and BH4-treated groups. CONCLUSIONS: This study demonstrates that BH4 improves capillary density and inflammation in two separate models of sepsis. BH4 may represent a novel adjunct in the treatment of sepsis and septic shock in clinical practice. Further dose-finding studies and clinical trials are warranted. Show more

Keywords: Tetrahydrobiopterin, endotoxemia, peritonitis, sepsis, microcirculation, rat

DOI: 10.3233/CH-160207

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 1, pp. 15-24, 2017

Authors: Caimi, Gregorio | Canino, Baldassare | Lo Presti, Rosalia | Urso, Caterina | Hopps, Eugenia

Article Type: Research Article

Abstract: In this brief review, we have examined some clinical conditions that result to be associated to an altered hemorheological profile and at times accompanied by skin ulcers. This skin condition may be observed in patients with the following condtions, such as primary polycythemic hyperviscosity (polycythemia, thrombocytemia) treated with hydroxyurea, primary plasma hyperviscosity (multiple myeloma, cryoglobulinemia, cryofibrinogenemia, dysfibrinogenemia, and connective tissue diseases), primary sclerocythemic hyperviscosity (hereditary spherocytosis, thalassemia, and sickle cell disease). In addition, it may be present in patients with secondary hyperviscosity conditions such as diabetes mellitus, arterial hypertension, critical limb ischemia and chronic venous insufficiency.

Keywords: Hyperviscosity syndrome, blood viscosity, skin ulcers

DOI: 10.3233/CH-160218

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 1, pp. 25-34, 2017

Authors: Taeger, Christian D. | Klein, Konstantin | Horch, Raymund E. | Weyand, Michael | Beier, Justus P.

Article Type: Research Article

Abstract: BACKGROUND: Coronary bypass surgery using the internal mammary artery (IMA) is among the most commonly performed procedures in treatment of advanced coronary vessel disease. Further, bilateral harvesting of the IMA is associated with increased rates of sternal wound infections. OBJECTIVE: This study aimed to explore changes in sternal perfusion, following left internal mammary artery (LIMA) harvesting. METHODS: 60 patients were divided equally into intervention- and control cohorts and underwent assessment of oxygen saturation (sO2) and relative blood flow (RBF) by laser doppler flowmetry remission spectroscopy preoperatively, 24 h and 72 h postoperatively. RESULTS: 24 h postoperatively a …significant decrease of sO2 and RBF could be detected in LIMA harvest patients. After 72 h this difference disappeared. The side comparison within the groups 24 h postoperatively revealed a reduction of sO2 on the LIMA side within both groups. Regarding the 24 h RBF in side comparison, no significant differences could be detected within the groups. The 72 h side comparison showed an increased RBF for the non-LIMA side within the control group. CONCLUSIONS: The use of the LIMA may lead to significant decreases in local tissue oxygen saturation and RBF. This reduction is mostly distinct within the first 3 days postoperatively and may influence sternal wound infections. Show more

Keywords: Sternal wound infection, LIMA, sternal infection, sternum perfusion, tissue oxygenation, coronary bypass surgery

DOI: 10.3233/CH-170245

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 1, pp. 35-43, 2017

Authors: Jani, Vivek P. | Yalcin, Ozlem | Williams, Alexander T. | Popovsky, Mark A. | Cabrales, Pedro

Article Type: Research Article

Abstract: BACKGROUND: Small rodent models are routinely used to evaluate the safety and efficacy of blood transfusions. Limited comprehensive literature exists about effect of different storage solutions in rat red blood cells (RBCs) characteristics. RBCs undergo time dependent biochemical and biophysical changes during storage known as hypothermic storage lesions (HSLs). OBJECTIVE: This study evaluates the effects of RBC additive solutions (AS) during storage of rat RBCs. METHODS: Blood was leukoreduced and stored as per manufacturer instructions at 4°C up to 42-days. Three solutions, CPDA-1; AS-1; and AS-7 (SOLX), were evaluated. Biochemical parameters measured included extracellular K+ , …pH, hemolysis, 2,3-diphosphoglycerate (2,3-DPG), oxygen affinity, ATP, and lactate. Mechanical properties measured included RBC deformability, elongation index (EI), RBC membrane shear elastic modulus (SEM), mean corpuscular volume (MCV), viscosity, and aggregability. RESULTS: There were no differences in biochemical or mechanical parameters at baseline or after one week of storage. However, after two weeks, AS-7 preserved biochemical and mechanical properties as compared to CPDA-1 and AS-1. Changes were observed to be significant after 14-days of storage. AS-7 prevented extracellular K+ increase, reduced acidosis, showed lower hemolysis, preserved ATP and 2,3-DPG levels (consequently oxygen affinity), and reduced lactate. AS-7, when compared to CPDA-1 and AS-1, prevented the reduction in RBC deformability and was found to preserve the EI at multiple shear stresses, the membrane SEM, the aggregability and viscosity. DISCUSSION: Rat RBCs stored with AS-7 presented reduced changes in biochemical and mechanical parameters, when compared with rat RBCs stored in CPDA-1 and AS-1, after as early as two weeks of storage. Show more

Keywords: Banked blood, blood storage, deformability, storage lesions, blood transfusion

DOI: 10.3233/CH-170248

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 1, pp. 45-57, 2017

Authors: Zhang, Shu-Pin | Zeng, Zeng | Liu, Hui | Yao, Ming-Hua | Xu, Guang | Wu, Rong

Article Type: Research Article

Abstract: OBJECTIVE: To determine the value of combining conventional ultrasonography with virtual touch tissue imaging quantification (VTIQ) for differential diagnosis of breast lesions smaller than 10 mm. METHODS: A total of 98 breast lesions smaller than 10 mm were examined by conventional ultrasound and VTIQ using a Siemens ACUSON S3000 ultrasound machine. Pathologic diagnosis was established after surgery or fine needle biopsy. RESULTS: Malignant lesions were characterized by taller-than-wide shape, poorly circumscribed margin, and marked hypoechogenicity. The mean VTIQ shear wave velocity (SWV) value of malignant lesions was 4.88±1.87 m/s (range, 1.75–9.34 m/s), significantly higher than that of benign lesions (2.68±1.02 m/s; …range, 1.18–4.67 m/s). The optimal cutoff SWV value was 3.27 m/s, with sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 86.20%, 95.65%, 92.86%, 89.29%, and 94.29%, respectively. The combination of SWV >3.27 m/s plus the US feature of poorly circumscribed margin had the highest sensitivity (93.33%) and specificity (100%) for diagnosis of malignant breast lesions. CONCLUSION: Features such as taller-than-wide shape, poorly circumscribed margin, and marked hypoechogenicity on conventional US, and SWV >3.27 m/s on VTIQ, are indicators of malignancy in breast lesions with diameter <10 mm. The combination of poorly circumscribed margin and SWV >3.27 m/s provides the highest specificity and diagnostic accuracy. Show more

Keywords: Conventional ultrasonography, virtual touch tissue imaging quantification, breast lesions

DOI: 10.3233/CH-170249

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 1, pp. 59-68, 2017

Authors: Xiang, Li-Hua | Yao, Ming-Hua | Xu, Guang | Pu, Huan | Liu, Hui | Fang, Yan | Wu, Rong

Article Type: Research Article

Abstract: BACKGROUND: Contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE) are used for diagnostic purposes. OBJECTIVE: Investigate the diagnostic value of CEUS and SWE for breast lesions of sub-centimeter diameter. METHODS: Sixty-two patients (mean age: 49.3±12.1 years) with 66 lesions (mean diameter, 8.1±1.5 mm) were analyzed. Conventional ultrasound (US), CEUS and SWE were undertaken. Pathologic specimens were obtained through biopsy or surgery. Lesions were measured in kilopascals. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were analyzed. RESULTS: For conventional US, the sensitivity was 92.31%, specificity 28.30%, PPV 24.00%, NPV 93.75%, and accuracy …40.90%, whereas those for SWE were 61.54%, 98.11%, 88.89%, 91.23%, and 90.91% (p  = 0.000) and CEUS were 92.31%, 60.38%, 36.37%, 96.97%, and 66.67% (p  = 0.001), respectively. For SWE + CEUS, the sensitivity was 61.54%, specificity 100.00%, PPV 100.00%, NPV 91.38%, and accuracy 92.42% (p  = 0.000). There was a significant difference between US and CEUS (p  = 0.004), but not for SWE or SWE + CEUS (p  = 0.568; p  = 0.205). For SWE + CEUS, there was a significant difference with SWE alone and CEUS alone (p  = 0.000; p  = 0.008). Between SWE and CEUS, the difference was significant (p  = 0.031). CONCLUSIONS: SWE and CEUS could help to differentiate between malignant and benign breast lesions <1 cm in diameter. Show more

Keywords: Shear-wave elastography, contrast-enhanced ultrasound, lesion, breast, diagnosis

DOI: 10.3233/CH-170250

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 1, pp. 69-80, 2017

Authors: Li, Xiao-Long | Ren, Wei-Wei | Fu, Hui-Jun | He, Ya-Ping | Wang, Qiao | Sun, Li-Ping | Guo, Le-Hang | Liu, Bo-Ji | Fang, Lin | Xu, Hui-Xiong

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate the diagnostic performance of shear wave speed (SWS) within the lesion, fat-to-lesion speed ratio (FLR), and gland-to-lesion speed ratio (GLR) for differentiation between benign and malignant breast lesions using a novel SWS imaging technique. METHODS: From April 2016 to June 2016, 182 breast lesions were prospectively included in the study. For each lesion, SWS-lesion, FLR, and GLR were calculated. Pathological results were used as the reference standard. Receiver operating characteristic curves (ROC) were plotted to assess the diagnostic performance. RESULTS: Of the 182 lesions, 142 (78.0%) were benign and 40 (22.0%) were malignant. …Significant differences were found between benign and malignant lesions in SWS-lesion, FLR and GLR (2.12±0.64 m/s vs 3.87±1.45 m/s, 1.63±0.61 vs 2.60±1.04, and 1.33±0.39 vs 2.08±0.78, respectively. All P  < 0.001). The optimal cut-off values of SWS-lesion, FLR, GLR were 2.88 m/s, 2.31 and 1.51, respectively. The diagnostic performance of SWS-lesion in terms of AUC was the highest (i.e. AUC = 0.845), in comparison with FLR and GLR alone or their combination. The associated sensitivity, specificity, and accuracy for SWS-lesion were 75.0%, 89.4%, and 86.3%, respectively. CONCLUSION: SWS-lesion is a valuable and sufficient method for differentiation between benign and malignant breast lesions. Show more

Keywords: Breast, ultrasound, elastography, shear wave speed imaging, fat-to-lesion speed ratio, gland-to-lesion speed ratio

DOI: 10.3233/CH-170253

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 1, pp. 81-90, 2017

Authors: Miko, Iren | Nemeth, Norbert | Peto, Katalin | Furka, Andrea | Toth, Laszlo | Furka, Istvan

Article Type: Research Article

Abstract: BACKGROUND: Decrease or loss in splenic filtration function may influence the hemorheological state. OBJECTIVE: To follow-up the long-term effects of splenectomy, spleen autotransplantation and spleen resections on red blood cell aggregation in a canine model. METHODS: Beagle dogs were subjected to control (n  = 6), splenectomy (SE, n  = 4), spleen autotransplantation (AU, Furka’s spleen-chip method, n  = 8) or partial and subtotal spleen resection (n  = 4/each) groups, and followed-up for 18 postoperative (p.o.) months. Erythrocyte aggregation was determined in parallel by light-transmittance aggregometry (Myrenne MA-1 aggregometer) and syllectometry (LoRRca). RESULTS: Erythrocyte aggregation decreased three months after …splenectomy, with lower aggregation index and elongated aggregation time. It was more or less associated with relatively lower hematocrit and fibrinogen concentration. However, in autotransplantated animals a relatively higher fibrinogen did not increase the aggregation markedly. Spleen resection resulted in the most controversial red blood cell aggregation findings, and it seems, that the degree of the resection is an influencing factor. CONCLUSIONS: Splenectomy alters erythrocyte aggregation, spleen autotransplantation can be useful to preserve filtration function. However, the degree of restoration shows individual differences with a kind of ‘functional periodicity’. Spleen resection controversially influences erythrocyte aggregation parameters. The subtotal resection is supposed to be worse than spleen autotransplantation. Show more

Keywords: Spleen filtration function, splenectomy, spleen autotransplantation, spleen partial or subtotal resection, red blood cell aggregation

DOI: 10.3233/CH-170264

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 1, pp. 91-100, 2017

Authors: Lichtenauer, Michael | Goebel, Bjoern | Paar, Vera | Wernly, Bernhard | Gecks, Thomas | Rohm, Ilonka | Förster, Martin | Betge, Stefan | Figulla, Hans R. | Hoppe, Uta C. | Kelm, Malte | Franz, Marcus | Jung, Christian

Article Type: Research Article

Abstract: BACKGROUND: Endothelial dysfunction is accompanied by the release of microparticles (MP). OBJECTIVE: We sought to investigate the effect of moderate hypoxia on circulatory levels of microparticles, biomarkers of cardiovascular function and inflammation and on echocardiographic parameters in healthy volunteers staying at an altitude of 2978 m. METHODS: Eighteen healthy volunteers were subjected to moderate hypoxia by staying at 2978 m above sea level for three days. Blood samples were evaluated for MP using flow cytometry. ELISA analysis was performed for sST2, H-FABP, suPAR and GDF-15. Moreover, the effect of dual endothelin-receptor blockade was investigated. RESULTS: Oxygen …saturation decreased to 93%. A significant decrease of endothelial and platelet MP levels was found. These results were corroborated by a similar response in sST2 and suPAR plasma concentration. Endothelin-receptor blockade by macitentan only had a marginal influence on MP, sST2, H-FABP, suPAR and GDF-15 levels, though it led to a significant amelioration of echocardiographic parameters of right heart function. CONCLUSIONS: These experimental results show that moderate hypoxia due to altitude exposition led to a reduction in parameters of endothelial dysfunction as shown by a decrease in endothelial and platelet MP, sST2 and suPAR levels. A slight increase in pulmonary pressure at moderate altitude was decreased by dual endothelin receptor blockade. Show more

Keywords: Endothelial dysfunction, microparticles, biomarkers, sST2, H-FABP, suPAR, GDF-15, endothelin, hypoxia, moderate altitude

DOI: 10.3233/CH-170273

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 1, pp. 101-113, 2017