Clinical Hemorheology and Microcirculation - Volume 71, issue 3

Authors: Rothenberger, Jens | Wittwer, Matthias | Tschumi, Christian | Constantinescu, Mihai A | Daigeler, Adrien | Olariu, Radu

Article Type: Research Article

Abstract: BACKGROUND: Improvement of skin microcirculation would be beneficial in transplanted tissues and thus, there is a demand for effective, reliable and harmless angiogenic treatments. The aim of this study was to assess the effect of capsaicin application (CA), the remote effect of capsaicin application (REC), the impact of remote ischemic conditioning (RIC), and the impact of combined remote ischemic conditioning with capsaicin application (Comb) on human skin microcirculation. METHODS: Perfusion changes were assessed using a laser Doppler device (easyLDI, Aimago Lausanne). 30 healthy volunteers were enrolled and divided into two groups: 1) CA and REC: perfusion was assessed …on both forearms after application of capsaicin cream on one forearm with an exposure time of 40 minutes. 2) RIC and Comb: perfusion of one forearm was assessed after four cycles of 5 min blood occlusion and 5 min reperfusion using a tourniquet on the contralateral upper arm and application of capsaicin on the ipsilateral forearm. Baseline skin perfusion measurements of both forearms were carried out initially and were used as intra-individual reference. RESULTS: 1) Skin perfusion significantly increased after capsaicin application (CA = +328.3% , p > 0.05). There was no remote skin perfusion change due to capsaicin (REC). 2) RIC significantly improves skin perfusion (RIC = +20.0% , p < 0.05). The combination of RIC and CA does not improve skin perfusion compared to CA alone (Comb). CONCLUSIONS: The conditioning techniques RIC and CA showed a significant increase in human skin perfusion, CA being superior to RIC. However, the combination of CA and RIC showed no additional improvement potential as compared to CA alone. Furthermore, a remote effect of capsaicin application could not be demonstrated. These results encourage to analyze if the conditioning treatments are also beneficial for transplanted tissue survival. Show more

Keywords: Remote ischemic conditioning, laser Doppler flowmetrie, capsaicin, ischemic conditioning

DOI: 10.3233/CH-180373

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 3, pp. 291-298, 2019

Authors: Lachmann, Vera | Heimann, Marc | Jung, Christian | Zeus, Tobias | Verde, Pablo Emilio | Kelm, Malte | Bönner, Florian

Article Type: Research Article

Abstract: AIM The study aims to test whether simultaneous measurement of fractional flow reserve (FFR), coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) is feasible, safe and effective during regadenoson-induced hyperemia. METHODS AND RESULTS FFR, CFR and IMR were measured simultaneously during regadenoson (Rapiscan 400 μg) -induced hyperemia in 50 patients with stable coronary artery disease with a SYNTAX score of <22. Simultaneous measurement of FFR, CFR and IMR was technically feasible in all cases (50/50). No side effects occurred and even patients fulfilling classical contraindications for the use of adenosine (10/50) could be included. Regadenoson-induced hyperemia remained …stable after maximal pressure drop for more than 35 sec as measured by systemic aortic and distal coronary pressure. There was a significant drop in transit mean time from baseline to hyperemia of more than 50% (1.0 ± 0.6 s vs. 0.4 ± 0.2 s, p  <  0.01). Patients‘ mean IMR value was 23.4, and IMR values above 75th percentile significantly correlated with metformin demanding diabetes mellitus with OR 21.76 and nicotine abuse with OR 10.28. CONCLUSION A single intravenous regadenoson bolus via peripheral line increases coronary blood flow without harmful systemic side effects enabling interventionists to simultaneously assess FFR, CFR and IMR in patients with stable coronary artery disease. Show more

Keywords: Coronary artery disease, regadenoson, coronary hyperemia, coronary blood flow

DOI: 10.3233/CH-180386

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 3, pp. 299-310, 2019

Authors: Wang, Qiao | Li, Xiao-Long | He, Ya-Ping | Alizad, Azra | Chen, Shigao | Zhao, Chong-Ke | Guo, Le-Hang | Bo, Xiao-Wan | Ren, Wei-Wei | Zhou, Bang-Guo | Xu, Hui-Xiong

Article Type: Research Article

Abstract: OBJECTIVES: To prospectively evaluate the diagnostic performance of three-dimensional (3D) shear wave elastography (SWE) for breast lesions with quantitative stiffness information from transverse, sagittal and coronal planes. METHODS: Conventional ultrasound (US), two-dimensional (2D)-SWE and 3D-SWE were performed for 122 consecutive patients with 122 breast lesions before biopsy or surgical excision. Maximum elasticity values of Young’s modulus (Emax ) were recorded on 2D-SWE and three planes of 3D-SWE. Area under the receiver operating characteristic curve (AUC), sensitivity and specificity of US, 2D-SWE and 3D-SWE were evaluated. Two combined sets (i.e., BI-RADS and 2D-SWE; BI-RADS and 3D-SWE) were compared in …AUC. Observer consistency was also evaluated. RESULTS: On 3D-SWE, the AUC and sensitivity of sagittal plane were significantly higher than those of transverse and coronal planes (both P < 0.05). Compared with BI-RADS alone, both combined sets had significantly (P < 0.05) higher AUCs and specificities, whereas, the two combined sets showed no significant difference in AUC (P > 0.05). However, the combined set of BI-RADS and sagittal plane of 3D-SWE had significantly higher sensitivity than the combined set of BI-RADS and 2D-SWE. CONCLUSIONS: The sagittal plane shows the best diagnostic performance among 3D-SWE. The combination of BI-RADS and 3D-SWE is a useful tool for predicting breast malignant lesions in comparison with BI-RADS alone. Show more

Keywords: Breast, ultrasound, three-dimensional, shear wave elastography, quantitative analysis

DOI: 10.3233/CH-180388

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 3, pp. 311-324, 2019

Authors: Ghanem, Souleiman | Somogyi, Viktoria | Tanczos, Bence | Szabo, Balazs | Deak, Adam | Nemeth, Norbert

Article Type: Research Article

Abstract: BACKGROUND: Arteriovenous fistula (AVF) may affect erythrocytes through many pathways (e.g., mechanical, inflammatory). However, these effects haven’t been elucidated completely yet. OBJECTIVE: To follow-up the hemorheological and the hematological changes in the presence of artificial carotid-jugular fistula in rats. METHODS: Female Wistar rats were subjected to sham-operated group (SG, n = 6) and to fistula group (FG, n = 10). Under general anesthesia, the right carotid artery and jugular vein were isolated via a neck incision, and in the FG carotid-jugular fistula was performed by microsurgical techniques. Hematological variables, red blood cell (RBC) deformability …and membrane (mechanical) stability parameters were determined before operation and on the 1st and 6th postoperative weeks. Density separated samples (‘young’ and ‘old’ RBCs) were also tested. RESULTS: In FG group hematocrit, RBC and platelet counts increased gradually to reach highly significant level of increment on the 6th postoperative week. RBC deformability significantly was impaired. The membrane stability test showed lower deformability values after applying mechanical shearing. No significant differences were observed between density separated RBC subpopulations. CONCLUSIONS: The presence of arteriovenous fistula may lead to an increment of RBC mass and impairment of RBC deformability. These changes could be one of the pathways through which the fistula influences the microcirculation. Show more

Keywords: Carotid-jugular fistula, hemorheology, hematology, red blood cell deformability, mechanical stability

DOI: 10.3233/CH-180411

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 3, pp. 325-335, 2019

Authors: Beral, Laurence | Lemonne, Nathalie | Romana, Marc | Charlot, Keyne | Billaud, Marie | Acomat, Malik | Zorobabel, Coralie | Nader, Elie | Etienne-Julan, Maryse | David, Thierry | Connes, Philippe

Article Type: Research Article

Abstract: OBJECTIVE: Our study investigated the prevalence of retinopathy and maculopathy in sickle cell patients and tested the association between these two conditions. In addition, we tested whether hematological and hemorheological parameters, as well as genotype, were involved in the development of these two conditions. METHODS: Seventy sickle cell adult patients were recruited: 37 with sickle cell anemia (SCA) and 33 with sickle cell hemoglobin C disease (SCC). All patients underwent retinal examination and macular ocular coherence tomography. Blood was sampled for the measurements of hematological and hemorheological parameters. RESULTS: Twenty-six patients had maculopathy and 30 had …retinopathy with no significant difference between SCA and SCC patients. No association between the presence of retinopathy and maculopathy was detected. RBC aggregation was higher and RBC deformability lower at 3 Pa in SCA patients. Blood viscosity and hematocrit were higher in SCC than in SCA patients. However, no association was found between biological parameters and the ocular complications studied. CONCLUSIONS: Our study showed that retinopathy and maculopathy are common in sickle cell disease. Nevertheless, we found no association with hematological parameters, blood rheology or genotype. Show more

Keywords: Hematology, hemorheology, maculopathy, retinopathy, sickle cell disease

DOI: 10.3233/CH-180412

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 3, pp. 337-345, 2019

Authors: Wiewiora, Maciej | Mertas, Anna | Nowowiejska–Wiewiora, Alicja | Kozlowski, Andrzej | Czuba, Zenon | Piecuch, Jerzy

Article Type: Research Article

Abstract: BACKGROUND: It is known that obesity is associated with alterations in blood rheology and venous hemodynamics. Another recent study has confirmed that adipose tissue is actively involved in angiogenesis through secretion of biologically active substances. OBJECTIVE: The aim of this study was to investigate the impact on the venous haemodynamics of the femoral vein on angiogenesis status in morbidly obese patients. METHODS: We studied venous haemodynamics and angiogenesis in a prospective study of obese and non-obese individuals. The venous wall shear stress (WSS) was calculated from the blood viscosity and the shear rate was calculated assuming …Newton’s law. Angiogenesis was detected using Bio-Plex Pro Human Angiogenesis Multiplex Assays (Bio-Plex 200 Systems). RESULTS: The shear rate (P < 0.000005) and the wall shear stress (P < 0.01) were significantly lower in the obese patients compared with the control subjects. All angiogenesis biomarkers were significantly higher in obese patients compared to the control group. Multivariate analyses identified waist circumference as an independent predictor for PECAM-1 (β = – 0.69, P < 0.0001) and for VEGF (β = – 0.60, P < 0.001); analyses identified WSS as an independent predictor for follistatin (β = – 0.59, P < 0.001), for PECAM-1 (β = – 036, P < 0.05) and for VEGF (β = – 0.42, P < 0.05). For angiopoietin 2 (β = – 0.35, P = 0.064) and HGF (β = – 0.31, P = 0.074), WSS tended to be a significant predictor. CONCLUSIONS: The results indicated that obesity-associated decreases in shear stress of the venous system lead to upregulation of angiogenesis, expressed by increased levels of endogenous positive regulators of angiogenesis. Show more

Keywords: Obesity, angiogenesis, vascular disease

DOI: 10.3233/CH-180414

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 3, pp. 347-356, 2019

Authors: Bagno, Andrea | Martini, Romeo

Article Type: Research Article

Abstract: The words “Translational” and “Medicine” have been recently coupled to indicate a combination of disciplines, resources, expertise, and techniques aimed at enhancing prevention, diagnosis, and therapies. As stated in 2015 by the European Society for Translational Medicine, translational medicine is “an interdisciplinary branch of the biomedical field supported by three main pillars: benchside, bedside and community”. By definition, Translational Medicine is a highly interdisciplinary field, which gathers several specialties aimed at improving the global healthcare system. With regard to the assessment of the microcirculatory function, it is worthwhile to mention the growing interest from both basic research and clinical …practice. Microcirculation is where the exchange of substances between blood and tissues takes place. Thus, it plays a key role in the pathophysiology of many diseases. Nonetheless, a gap does exist between the theoretical analysis of the microcirculatory function and its clinical exploitation. This gap can be due to the weak dissemination of analytical methods and theoretical results within the clinical community, which also delays the establishment of specific operative guidelines. This paper aims at encouraging, and possibly accelerating, the translation of basic research outcomes on microcirculatory function assessment into clinical applications. Show more

Keywords: Microcirculation, laser doppler fluxmetry, wavelet analysis, translational medicine

DOI: 10.3233/CH-180415

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 3, pp. 357-363, 2019

Authors: Akbudak, Ismail Hakki | Kucukatay, Vural | Kilic-Erkek, Ozgen | Ozdemir, Yasin | Bor-Kucukatay, Melek

Article Type: Research Article

Abstract: BACKGROUND: Ozone is used intensively worldwide in treatment and research of various pathologies due to its healing effects. OBJECTIVE: The aim of this study is to investigate the effect of major ozone autohemotherapy on erythrocyte deformability and aggregation. METHODS: 10 and 50μ g/ml doses of ozone was applied for 20 minute to venous blood samples obtained from 10 healthy male volunteers. Erythrocyte aggregation, deformability were measured by an ektacytometer. Total oxidant status, total antioxidant status were measured via a commercial kit. The oxidative stress index was calculated. RESULTS: Ozone at 10 and 50μ g/ml …doses did not alter erythrocyte aggregation. 50μ g/ml ozone increased red blood cell (RBC) deformability measured at 0.53 Pa. Compared with the Control value, there was a significant increase in TOS, TAS for the doses of 10 and 50μ g/ml. The increase in TAS was found to be more significant at 10μ g/ml dose. The most obvious increase in OSI value was observed at 50μ g/ml. CONCLUSION: Our results demonstrate that although 10μ g/ml ozone has no effect on hemorheology, 50μ g/ml ozone concentration has positive effects on RBC deformability, thus circulation at 0.53 Pa corresponding to the shear stress encountered during venous circulation. Show more

Keywords: Ozone therapy, RBC deformability, erythrocyte aggregation, oxidative stress

DOI: 10.3233/CH-180417

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 3, pp. 365-372, 2019

Authors: Yu, Sebastian | Hu, Stephen Chu-Sung | Yu, Hsin-Su | Chin, Yi-Ying | Cheng, Yang-Chun | Lee, Chih-Hung

Article Type: Research Article

Abstract: Background: Skin physiology measurement is receiving more attention for detecting vasculopathy in systemic sclerosis (SSc). Laser Doppler flowmetry (LDF) is a widely used physiological measurement to assess cutaneous microcirculation. However, findings of LDF may be subtle during early stage of microangiopathy in SSc. Objective: We hypothesized that cold stress test combined with LDF could detect early-stage microangiopathy in patients with SSc. Methods: A 67-year-old male came with multiple ulcerations on his fingers for one year. After excluding diseases such as diabetes mellitus-related peripheral arterial occlusive disease and smoking-related Buerger’s disease, the diagnosis of SSc was made …according to the 2013 ACR/EULAR criteria. We performed LDF and angiography for a patient with SSc and compared the results. Results: Although occlusions of right ulnar and digital arteries were obvious in angiography, the baseline skin temperature and perfusion unit on right fingers remained within normal limits. While the microcirculatory abnormalities measured by LDF alone are subtle, LDF combined with cold stress test detected a significant slow recovery of skin blood flow 40 minutes after cold immersion. Conclusions: In conclusion, there may be discordance between macrovasculopathy and baseline microcirculatory blood flow in SSc. In such a case, cold immersion test is essential to measure the dynamic change and slow recovery of blood flow. Show more

Keywords: Angiography, capillaroscopy, laser Doppler flowmetry, systemic sclerosis, vasculopathy

DOI: 10.3233/CH-180419

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 3, pp. 373-378, 2019