Clinical Hemorheology and Microcirculation - Volume 80, issue 3

Authors: Li, Lei | Chen, Ling | Wang, Han | Li, Peiran | Wang, Dan | Zhang, Wei | Mi, Lai | Lin, Fang | Qin, Yuling | Zhou, Yuesu

Article Type: Research Article

Abstract: OBJECTIVE: This study aimed to explore the clinical detection and prognosis of coagulation function in patients with liver failure and sepsis. METHODS: The plasma fibrinogen (FIB), factor II, factor VII, factor V, factor IV, antithrombin III (ATIII), platelet (PLT), mean PLT volume (MPV), D-dimer, prothrombin activity (PTA), and fibrin degradation product (FDP) levels and thromboelastogram values were detected in patients with liver failure complicated with sepsis and compared with those in the liver failure and liver cirrhosis groups. The patients with liver failure complicated with sepsis were analyzed by univariate and multivariate logistic regression, and the regression equation …was established. RESULTS: The levels of FIB, factor II, factor VII, factor V, ATIII, PLT, MPV, D-dimer, and FDP in the patients with liver failure complicated with sepsis were compared with those in the control group patients, and the differences were statistically significant (p  < 0.05). Among the thromboelastography parameters in the patients with liver failure and sepsis, the differences in the K-value, R-value, angle, maximum amplitude, and coagulation index values compared with those of the control group were statistically significant (p  < 0.05). The logistic regression model obtained was as follows: p  = 1/(1 + e [–0.128×X1–0.058×X2 + 0.211×X3 + 0.2×X4 + 0.25]). The specificity, sensitivity, and accuracy values of the regression equation in determining the prognosis were 92%, 93.9%, and 92.8%, respectively. Among the 11 factors, factor VII, PLT, FDP, and D-dimer were included in the regression equation. CONCLUSION: Coagulation disorder is exacerbated in patients with liver failure and sepsis. Among the 11 coagulation-related factors, factor VII, PLT, FDP, and D-dimer may be the independent factors influencing the prognosis of patients with acute liver failure and sepsis. Show more

Keywords: Liver failure, coagulation disorders, sepsis, coagulation factor, prognosis

DOI: 10.3233/CH-211113

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 3, pp. 219-231, 2022

Authors: Güney, Tekin | Can, Ferda | Alkan, Afra | Akıncı, Sema | Dilek, İmdat

Article Type: Research Article

Abstract: INTRODUCTION: Essential thrombocythemia (ET) is an entity of classic Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs), characterized by thrombocytosis with megakaryocytic hyperplasia where in the thrombocytes are increased with abnormal function. Thrombotic events are seen frequently and represent the main cause of morbidity and mortality in patients with MPNs, mainly polycythemia vera and ET. This study has aimed to research the effects of clonally increased thrombocytes on plasma viscosity (PV) levels among patients with ET and the relationship between PV and thromboembolism history, according to the hypotheses about the effects of PV in thromboembolic events among patients with ET. METHODS: …A total of 55 patients were enrolled in the study group, 18 of who had been newly diagnosed with ET according to 2016 World Health Organization criteria and had not previously been treated. 37 of them had already been diagnosed with ET and had been treated. There were 47 healthy volunteers in the control group. 5 cc blood samples were taken from the patients into tubes including an anticoagulant to measure their PV levels. RESULTS: PV of the control group was found to be lower than in the study group and both each patient groups (p  < 0.05). No relationship was found between the patient groups in terms of PV (p  = 0.404). The mean PV levels of the 16 patients with a history of thromboembolism and the 39 patients with no such history were 2.42±0.17 cP and 2.33±0.20 cP, respectively. The mean PV levels were found to be similar according to their history of thromboembolism in all patient groups and in treated patients (p  = 0.572 vs p  = 0.991). CONCLUSION: We have found that PV levels were increased in clonally increased thrombocytes in patients with ET when compared with the control group. This is the first study in this field according to our knowledge. Show more

Keywords: Essential thrombocytosis, plasma viscosity, thrombosis

DOI: 10.3233/CH-211137

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 3, pp. 233-240, 2022

Authors: Zhang, Gang | Liu, Dandan

Article Type: Research Article

Abstract: BACKGROUND: To investigate the accuracy of contrast-enhanced ultrasonography, CT-enhancement and MRI in the diagnosis of liver-occupying lesions. METHODS: 176 patients with suspected liver lesions in our hospital were retrospectively studied from July 2014 to July 2016. All of the 176 patients were diagnosed by contrast-enhanced ultrasonography, enhanced CT and MRI, and the pathological examination was performed. The results of pathological examination were regarded as the results of the diagnosis. The diagnostic accuracywas then compared among contrast-enhanced ultrasound, enhanced CT and MRI of these patients. RESULTS: The results of contrast-enhanced ultrasonography showed that 164 of the 176 …patients had liver-occupying lesions, and the accuracy of the diagnosis was 95.35%, which was significantly higher than that of CT enhancement and MRI (80.23% 84.30%). The accuracy of contrast-enhanced ultrasonography, in the diagnosis of primary liver cancer was significantly higher than that of CT enhancement and MRI (P  < 0.05), and the difference was significant difference (P  < 0.05). CONCLUSIONS: The examination of contrast-enhanced ultrasonography is relatively simple, and the patients can get duplicateexamination, so we should choose the contrast-enhanced ultrasonography as the preferred method of diagnosis in liver mass, especially primary liver cancer. Show more

Keywords: Contrast-enhanced ultrasonography, CT enhancement, MRI, liver lesions

DOI: 10.3233/CH-211142

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 3, pp. 241-251, 2022

Authors: Chalkias, Athanasios | Papagiannakis, Nikolaos | Mavrovounis, Georgios | Kolonia, Konstantina | Mermiri, Maria | Pantazopoulos, Ioannis | Laou, Eleni | Arnaoutoglou, Eleni

Article Type: Research Article

Abstract: BACKGROUND: The incidence of postoperative microcirculatory flow alterations and their effect on outcome have not been studied extensively. OBJECTIVE: This systematic review and meta-analysis were designed to investigate the presence of sublingual microcirculatory flow alterations during the immediate and early postoperative period and their correlation with complications and survival. METHODS: A systematic search of PubMed, Scopus, Embase, PubMed Central, and Google Scholar was conducted for relevant articles from January 2000 to March 2021. Eligibility criteria were randomized controlled and non-randomized trials. Case reports, case series, review papers, animal studies and non-English literature were …excluded. The primary outcome was the assessment of sublingual microcirculatory alterations during the immediate and early postoperative period in adult patients undergoing surgery. Risk of bias was assessed with the Ottawa-Newcastle scale. Standard meta-analysis methods (random-effects models) were used to assess the difference in microcirculation variables. RESULTS: Thirteen studies were included. No statistically significant difference was found between preoperative and postoperative total vessel density (p  = 0.084; Standardized Mean Difference (SMD): –0.029; 95%CI: –0.31 to 0.26; I2  = 22.55%). Perfused vessel density significantly decreased postoperatively (p  = 0.035; SMD: 0.344; 95%CI: 0.02 to 0.66; I2  = 65.66%), while perfused boundary region significantly increased postoperatively (p  = 0.031; SMD: –0.415; 95%CI: –0.79 to –0.03; I2  = 37.21%). Microvascular flow index significantly decreased postoperatively (p  = 0.028; SMD: 0.587; 95%CI: 0.06 to 1.11; I2  = 86.09%), while no statistically significant difference was found between preoperative and postoperative proportion of perfused vessels (p  = 0.089; SMD: 0.53; 95%CI: –0.08 to 1.14; I2  = 70.71%). The results of the non-cardiac surgery post-hoc analysis were comparable except that no statistically significant difference in perfused vessel density was found (p  = 0.69; SMD: 0.07; 95%CI: –0.26 to 0.39; I2  = 0%). LIMITATIONS: The included studies investigate heterogeneous groups of surgical patients. There were no randomized controlled trials. CONCLUSIONS: Significant sublingual microcirculatory flow alterations are present during the immediate and early postoperative period. Further research is required to estimate the correlation of sublingual microcirculatory flow impairment with complications and survival. Show more

Keywords: Complications, hemodynamics, microcirculation, perfusion, postoperative, surgery

DOI: 10.3233/CH-211214

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 3, pp. 253-265, 2022

Authors: Shi, Xian-Quan | Zhang, Huiming | Liu, Xi | Dong, Yunyun | Yang, Peipei | Qian, Linxue

Article Type: Research Article

Abstract: AIM: To assess the feasibility and efficiency of contrast-enhanced ultrasound (CEUS) real-time guided fine needle aspiration (FNA) for sentinel lymph node (SLN) of breast cancer. MATERIALS AND METHODS: This retrospective study reviewed 21 breast cancer patients who scheduled for surgical resection performed CEUS real-time guided SLN-FNA and intraoperative SLN biopsy (SLNB). The success rate of CEUS real-time guided SLN-FNA was analyzed. The FNA diagnostic efficiency of SLN metastasis was analyzed compared to SLNB. RESULTS: Twenty-six SLNs were detected by intradermal CEUS whereas 130 SLNs were detected by SLNB. The median SLNs detected by intradermal CEUS (n … = 1) and by SLNB (n  = 5) was significantly difference (p  < 0.001). All 26 CE-SLNs of 21 patients were successfully performed intradermal CEUS dual image real-time guided SLN-FNA including 5 SLNs of 4 patients which were difficult to distinguish in conventional ultrasound. Compared to SLNB, FNA found 2 of 5 cases of SLN metastasis, the diagnosis sensitivity, specificity, positive predictive value, negative predictive value, false negative rate, false positive rate and Yoden index were 40%, 100%, 100%, 84.2%, 60%, 0%and 40%, respectively. CONCLUSION: SLN-FNA real-time guided by dual CEUS image mode was technically feasible. Patients with a positive SLN-FNA should be advised to ALND without intraoperative SLNB according to Chinese surgeon and patients’ conservatism attitude. But a negative SLN-FNA did not obviate the need of conventional SLNB because of the high false negative rate. Show more

Keywords: Contrast-enhanced ultrasound, sentinel lymph node, fine-needle aspiration cytology, breast cancer

DOI: 10.3233/CH-211226

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 3, pp. 267-279, 2022

Authors: Fini, Elahe Malekyian | Salimian, Morteza | Ahmadizad, Sajad

Article Type: Research Article

Abstract: BACKGROUND: Diabetes mellitus is a common disorder with the risk of vascular injury. OBJECTIVE: The aim of this study was to compare the effects of low-intensity resistance exercise with blood flow restriction versus high-intensity resistance exercise on platelet CD markers and indices in patients with type 2 diabetes. METHODS: Fifteen female patients with type 2 diabetes (Mean±SD; age, 47.6±7.2 yrs) randomly completed two resistance exercise at an intensity corresponding to 20% and 80% of one-repetition maximum (1-RM), with and without blood flow restriction (REBFR and RE), respectively. We measured markers of platelet activation (P-selectin, GpIIb/IIIa, and …CD42) and platelet indices before and immediately after exercise, and after 30 min recovery. RESULTS: Platelet count (PLT) and plateletcrit (PCT) increased in response to REBFR more than the RE (p  < 0.05), though, no significant differences in PDW and MPV were observed (p  < 0.05). Although P-selectin (CD62P), CD61, CD41, and CD42 were reduced following resistance exercise in both trials, these reductions were non-significant (p  < 0.05). Besides, no significant between-group differences were found for platelet CD markers (p  < 0.05). CONCLUSIONS: It is concluded that REBFR induces thrombocytosis, but responses of platelet CD markers in patients with type 2 diabetes are similar following low-intensity REBFR and high-intensity RE. Show more

Keywords: Strength training, kaatsu, type 2 diabetes, thrombosis, platelet activation, P-selectin

DOI: 10.3233/CH-211229

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 3, pp. 281-289, 2022

Authors: Konschake, Wolfgang | Tembulatow, Movsar | Lutze, Stine | Arnold, Andreas | Jünger, Michael | Riebe, Helene

Article Type: Research Article

Abstract: BACKGROUND: In this paper, the method of steam vein occlusion for the treatment of the great/small saphenous vein (GSV/SSV) was analyzed in terms of a therapeutic influence on the dynamic parameters of global vein function, its effects on subjective symptoms based on chronic venous insufficiency (CVI) and the side effects of the steam vein sclerosis (SVS). It has been questioned whether the effects of this method lead to a recommendation for routine clinical practice. METHODS: The venous drainage and the venous refilling time (T0 ) of the leg treated were determined by photoplethysmography (Elcat, Wolfratshausen, Germany) …before, six weeks and one year after the intervention to examine the effects on global venous function. Further changes of clinical symptoms and findings were assessed by the Venous Clinical Severity Score (VCSS), preoperatively and after one year, and the complication rate at 6-week follow-up was monitored. RESULTS: The SVS was performed on 167 veins (GSV: 124; SSV: 43) in a total of 156 patients. Eight patients (5.1%) did not attend the 6-week follow-up, while 29 patients (18.6%) were lost in the 1-year follow-up. Patients were suffering from symptoms such as leg pain and leg edema, which resulted in a VCSS of 9.4 (cumulated mean score of all patients) preoperatively. The T0 was reduced to mean values of 20.6 s (GSV cohort) and 21 s (SSV cohort). The VCSS improved to 6.0 after one year. This correlated with the hemodynamic parameters. The T0 increased in the GSV cohort after six weeks to 31.8 s, p  < 0.001, and showed a nonsignificant improvement to 32.2 s, p  = 0.509, in the 1-year check. The T0 also increased in the SSV cohort significantly after 6 weeks to 30.1 s, p  < 0.001, and showed a nonsignificant reduction after one year, p  = 0.289. A total of 71%of the GSV and 69.8%of the SSV of the patients involved no complications following the treatment. Light complications (grade 1) occurred (reddening, hematoma, hyperpigmentation) in the majority: 24.2%of the GSV and 18.6%of the SSV. We noticed one grade 3 complication with thrombosis in the SSV cohort, which led to a pulmonary embolism. Forty-seven complete questionnaires were analyzed (responder rate: 28.1%); 40.4%of the patients had light complaints after the treatment, such as pain, warmth or local pressure sensations (Fig. 7 ); 63%of those patients noticed only slight pain at a maximum of 3 out of 10. The majority (91%) would recommend this procedure. CONCLUSION: The SVS revealed endoluminal catheter-based intervention to abolish venous reflux of the G/SSV as safe. As one therapeutic target is to eliminate venous reflux, effectiveness of a method cannot be based on sonographic data alone; one must further assess patients’ symptoms and dynamic venous function. This data shows an improvement of patients’ symptoms which correlated well with the improvement of the venous function in digital photoplethysmography. The SVS can be recommended as a catheter-based treatment in the future. Show more

Keywords: Steam vein occlusion, thermal ablation, chronic venous insufficiency, dynamic venous function, follow-up

DOI: 10.3233/CH-211239

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 3, pp. 291-305, 2022

Authors: Andorfer, K.E.C. | Seebauer, C.T. | Koller, M. | Zeman, F. | Berneburg, M. | Fischer, R. | Vielsmeier, V. | Bohr, C. | Kühnel, T.S.

Article Type: Research Article

Abstract: BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) is an inherited orphan disease, in which the absence of capillary beds between arterioles and venules lead to arteriovenous shunts. Epistaxis is the core symptom. Several case reports have described the nonselective beta-adrenergic receptor antagonist timolol as a successful treatment method of nosebleeds due in HHT patients. OBJECTIVE: TIM-HHT is a single-site, prospective, randomized, placebo-controlled, double-blind, cross-over study to investigate whether the efficacy of standard laser treatment of epistaxis in HHT patients can be increased by the additional use of timolol nasal spray (1 mg/d). METHODS: Twenty patients will …be randomly allocated to one of two treatment sequences. Primary outcome is the severity of epistaxis determined by the Epistaxis Severity Score (ESS). Secondary outcomes are subjective satisfaction, quality of life, as well as the hemoglobin, ferritin, and transferrin levels of the participating patients. Safety outcome is assessed by means of pulse, blood pressure, and adverse events. CONCLUSION: TIM-HHT will evaluate the efficacy and safety of timolol as an additional treatment of epistaxis in HHT patients in a three-month trial period. Benzalkonium chloride is used as a placebo, which has no documented positive effect on the nasal mucosa and hence on epistaxis in HHT patients (in contrast to saline). TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00020994. Registered on 10 March 2020 Show more

Keywords: Timolol, nasal sprays, HHT, hereditary hemorrhagic telangiectasia, Osler, rare disease, epistaxis

DOI: 10.3233/CH-211253

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 3, pp. 307-315, 2022

Authors: Lin, Jia | Lin, Wenqiang | Xu, Liang | Lin, Teng

Article Type: Research Article

Abstract: BACKGROUND: Tumor angiogenesis plays a critical role in the growth and metastasis of breast cancer. Evaluating the added value of vascular features to Breast Imaging Reporting and Data System (BI-RADS) in differentiating malignant masses from benign ones is essential. Micro-flow Imaging (MFI) is a promising noninvasive diagnostic method for the microvessels in breast tumors, but its precise value is still uncertain. OBJECTIVES: Understanding whether malignant tumor vascular characteristics by MFI are associated with breast cancer and whether the diagnostic efficiency varies by age. MATERIALS AND METHODS: B-mode ultrasound and MFI were performed for 153 solid breast …lesions. The vessels images by MFI were reviewed and assessed by two investigators, respectively. Then the diagnostic efficacy of different vascular features combined with BI-RADS was evaluated in different age groups. RESULTS: The mean size of lesions is 19.4 (range 18–78) mm. There were 94 breast masses in benign, while 59 breast masses in malignant by pathology. III Adler classification, penetrating vessels, and complex flow pattern showed a positive association with a high risk of malignant breast lesions (p  < 0.05). BI-RADS combined with vessel characteristics show better improvement of diagnostic performance of breast lesions in the elderly group than in the young group. CONCLUSIONS: Vascular features by MFI contribute to malignant breast masses’ diagnosis, and the association might be modified by age. Show more

Keywords: Breast, micro-flow imaging, tumor, ultrasound, vascular

DOI: 10.3233/CH-211258

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 3, pp. 317-325, 2022

Authors: Ullah, Imram | Wang, Weiwei | Ma, Nan | Lendlein, Andreas

Article Type: Research Article

Abstract: Multiblock copolymers type PDC are polyetheresterurethanes composed of poly(ɛ -caprolactone) and poly(p -dioxanone) segments. They were designed as degradadable shape-memory polymers for medical devices, which can be implanted minimally-invasively. While providing structural support in the initial phase after implantation, they are capable to modulate soft tissue regeneration while degradation. In this perspective, we elucidate cell-material interactions, compatibility both in-vitro and in-vivo and biofunctionality of PDC, which represents a promising candidate biomaterial family especially for cardiovascular applications.

Keywords: Multiblock copolymers PDC, biofunctionality, soft tissue regeneration

DOI: 10.3233/CH-211264

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 3, pp. 327-341, 2022