Clinical Hemorheology and Microcirculation - Volume 80, issue 4

Authors: Yang, Daohui | Wang, Dansong | Qiu, Yijie | Tian, Xiaofan | Zuo, Dan | Dong, Yi | Lou, Wenhui | Wang, Wenping

Article Type: Research Article

Abstract: AIM: Preoperative suspicion of malignancy in nonfunctioning pancreatic neuroendocrine tumors (pNETs) is mostly based on tumor size. We retrospectively analyzed the contrast enhanced ultrasound (CEUS) features of a series of histopathologically proved nonfunctioning pNETs. METHODS: In this retrospective study, 37 surgery and histologically proved nonfunctioning pNETs were included. All pNETs lesions were incidentally detected by transabdominal ultrasound. B mode ultrasound (BMUS) and CEUS features were reviewed and analyzed. 52 histopathologically proved pancreatic ductal adenocarcinoma (PDACs) lesions were included as a control group. RESULTS: All nonfunctioning pNETs patients showed no typical clinical symptoms. No significant differences were …observed in size, echogenicity or internal color flow imaging signal between pNETs and PDAC patients (P  > 0.05). Most of nonfunctioning pNETs showed a well-defined tumor margin. The presence of pancreatic duct dilatation was less frequently observed in nonfunctioning pNETs patients (P  < 0.05). After injection of ultrasound contrast agents, homogeneous enhancement was more commonly observed in nonfunctioning pNETs group (P  < 0.05). During arterial phase of CEUS, most of nonfunctioning pNETs were hyper- or isoenhanced (32/37, 86.5%), whereas most of PDACs were hypoenhanced (34/52, 65.4%) (P  < 0.05). Nonenhanced necrosis area was more commonly detected in PDACs (P  = 0.012). CONCLUSIONS: CEUS features are helpful for preoperative non-invasive differential diagnosis of nonfunctioning pNETs, assisting further clinical decision-making process. Show more

Keywords: Contrast enhanced ultrasound (CEUS), nonfunctioning, pancreatic neuroendocrine tumors (pNETs), diagnosis, pancreatic ductal adenocarcinomas (PDACs), differential

DOI: 10.3233/CH-211269

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 4, pp. 343-352, 2022

Authors: Zhang, Jianbo | Shi, Qiyu | Hu, Yamin | Li, Xiaohong

Article Type: Research Article

Abstract: BACKGROUND: Diabetes mellitus (DM) abolishes the antithrombotic effect of Clopidogrel. Here, we investigated the synergistic effect of Silibinin on Clopidogrel-mediated atherosclerosis treatment in diabetic mice. METHODS: ApoE–/– mice were fed with high-fat diet (HFD) to establish the atherosclerotic model with diabetes. Animals were treated with Clopidogrel, Silibinin, or the combined to evaluate the protective effects on atherosclerosis and diabetes through Oil-red-O staining, qRT-PCR, Western blot, and metabolic measurements. Platelet activation and aggregation ex vivo assays were performed to detect the anti-thrombotic effect of different administrations. RESULTS: Silibinin significantly enhanced the inhibitory effect of Clopidogrel …on atherosclerosis in DM mice. Co-administration of Silibinin with Clopidogrel remarkedly reduced the aortic lesion, inflammation, and endothelial dysfunction in aorta roots, and diabetic symptoms were significantly improved by the Silibinin-Clopidogrel treatment in HFD-fed ApoE–/– mice. Interestingly, the anti-thrombotic effect of Clopidogrel was further augmented by the Silibinin treatment in atherosclerotic mice. CONCLUSION: In atherosclerotic mouse model, Silibinin significantly improves the effect of Clopidogrel on atherosclerosis. Show more

Keywords: Atherosclerosis, diabetes, Clopidogrel, Silibinin, platelet reactivity

DOI: 10.3233/CH-211279

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 4, pp. 353-361, 2022

Authors: Strauss, Catharina | Anker, Alexandra | Klein, Silvan | Kemper, Robert | Brebant, Vanessa | Prantl, Lukas | Geis, Sebastian

Article Type: Research Article

Abstract: BACKGROUND: Early detection and treatment of vascular complications in replanted digits is essential for the survival. The perfusion index (PI) represents a marker of peripheral perfusion as it shows the ratio of pulsatile to non-pulsatile blood flow. OBJECTIVE: To evaluate the feasibility and applicability of the PI as a monitoring tool for free flaps and replanted digits by measuring the inter- and intraindividual changes in PI. METHODS: Five patients were postoperatively monitored according to intern standards by hourly clinical evaluation. Additionally, a pulse oximeter with SET-technology® (Masimo Radial 7, Masimo Corporation, Irvine, USA) was added with …a LNCS® Red TFA-1 SpO2 sensor (Masimo Corporation, Irvine, USA) and respectively a LNCS® Neo-3 neonatal finger clip to evaluate the perfusion via PI and SpO2. RESULTS: All patients showed sufficient perfusion in clinical controls. There was no detectable vascular complication during follow-up. Mean perfusion index was 0.93 with a median of 0.44. The patients showed a mean SpO2 of 90.59%with a median of 89.21%. CONCLUSION: Our results show a great intra- and interindividual range of PI and SpO2. SpO2 provided an even greater range than PI. Trends in intraindividual PI changes may be a promising monitoring tool for free flaps and replanted digits. Show more

Keywords: Perfusion index, monitoring, free flap, replanted digits

DOI: 10.3233/CH-211295

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 4, pp. 363-371, 2022

Authors: Korolev, A.I. | Fedorovich, A.A. | Gorshkov, A.Yu. | Dadaeva, V.A. | Kim, O.T. | Omelyanenko, K.V. | Mikhaylova, M.A. | Vasilyev, D.K. | Dzhioeva, O.N. | Akasheva, D.U. | Drapkina, O.M.

Article Type: Research Article

Abstract: OBJECTIVE: To investigate structural and functional features of cutaneous microvasculature in men of working age with newly diagnosed arterial hypertension (AH). MATERIALS AND METHODS: The study included 161 apparently healthy men from 30 to 60 years, who underwent a comprehensive examination of cardiovascular system “from the heart to the capillaries”. Control group (CG) included 60 normotensive men. AH group included 101 men with elevated BP. RESULTS: There is no rarefaction of the capillary bed and latent fluid retention in the interstitial space in the skin in men with AH. No data were obtained for increased endothelial, …neurogenic and myogenic tone of resistive cutaneous precapillary arterioles in AH group, but a decrease in the perfusion efficiency of the endothelial and myogenic mechanisms of tissue perfusion modulation was noted. CONCLUSION: Obtained results allow making the assumption that metabolic disorders at the level of capillaries that are of a systemic nature prevail in men with the onset of AH. Show more

Keywords: Arterial hypertension, microcirculation, capillaroscopy, laser Doppler flowmetry, arteriole tone

DOI: 10.3233/CH-211292

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 4, pp. 373-387, 2022

Authors: Heine, Norbert | Eigenberger, Andreas | Brebant, Vanessa | Hoesl, Vanessa | Brix, Eva | Prantl, Lukas | Kempa, Sally

Article Type: Research Article

Abstract: BACKGROUND: Autologous fat grafting (AFG) has been established over the past two decades as an additive technique during and after breast reconstruction. Complete reconstruction of the breast mound with AFG alone represents an exceptional technique that has been published mostly in case reports or in studies with limited cases. The purpose of this study is to investigate the influence of three different techniques for breast reconstruction on the recovery of skin sensitivity at the reconstructed breast. METHODS: The study included 30 patients after mastectomy following breast cancer. Three groups were examined: A) breast reconstruction by autologous fat grafting …(AFG), B) breast reconstruction by deep inferior epigastric artery perforator flap (DIEP) and C) breast reconstruction by expander/implant (TE). Biometric data were compared; sensitivity tests were performed using Semmes-Weinstein monofilaments. The non-operated, healthy contralateral breasts of the patients were used as a reference. RESULTS: While the traditional reconstruction techniques by microsurgical anastomosed perforator flap or expander/implant showed a strongly decreased or completely missing sensitivity of the skin, the tests after reconstruction by AFG represented high values of sensory recovery, which came close to the reference group of non-operated breasts. CONCLUSION: To our knowledge, this is the first study to compare skin sensitivity after AFG-based reconstruction to established techniques for breast reconstruction. We could demonstrate in a limited group of patients, that breast reconstruction by autologous fat grafting can achieve higher values of skin sensitivity compared to traditional techniques. Show more

Keywords: Breast reconstruction, lipofilling, skin sensitivity, autologous fat grafting

DOI: 10.3233/CH-219203

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 4, pp. 389-397, 2022

Authors: Lu, Qianqian | Li, Ying | Lou, Jiaping | Li, Pingzhen | Gu, Yi | Wang, Xianghai

Article Type: Research Article

Abstract: Circular RNAs (circRNAs) are associated with the pathogenesis of human diseases, including atherosclerosis. Here, we undertook to investigate the biological role and mechanism of circRNA E3 ubiquitin-protein ligase (circ-CHFR) in atherosclerosis. The expression levels of circ-CHFR, miR-214-3p, and pregnancy-associated plasma protein A (PAPPA) were measured by real-time quantitative polymerase chain reaction (RT-qPCR) and western blot in human aorta vascular smooth muscle cells (HA-VSMCs) exposed to oxidized low-density lipoprotein (ox-LDL). Cell proliferation, migration, and invasion capabilities were assessed by 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl-2H-tetrazol-3-ium bromide (MTT), and transwell assays, respectively. The relationship between miR-214-3p and circ-CHFR or PAPPA was confirmed by dual-luciferase reporter …and RNA immunoprecipitation (RIP) assays. Our data showed that circ-CHFR was upregulated in HA-VSMCs after stimulation with ox-LDL. Downregulation of circ-CHFR inhibited the proliferation, migration, and invasion of HA-VSMCs exposed to ox-LDL. Mechanistically, circ-CHFR acted as a miR-214-3p sponge, and miR-214-3p was a molecular mediator of circ-CHFR regulation in ox-LDL-stimulated HA-VSMCs. PAPPA was a miR-214-3p target, and circ-CHFR regulated the expression of PAPPA by sponging miR-214-3p. Moreover, overexpression of miR-214-3p repressed the proliferation, migration, and invasion of ox-LDL-induced HA-VSMCs by decreasing PAPPA expression. Our findings suggest that the circ-CHFR/miR-214-3p/PAPPA axis regulates ox-LDL-induced proliferation, migration, and invasion in HA-VSMCs. Show more

Keywords: CircRNA, circ-CHFR, miR-214-3p, PAPPA, ox-LDL, HA-VSMCs

DOI: 10.3233/CH-211288

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 4, pp. 399-412, 2022

Authors: Chen, Jing | Li, Chun-xiao | Shao, Si-hui | Yao, Ming-hua | Su, Yi-jin | Wu, Rong

Article Type: Research Article

Abstract: OBJECTIVE: To investigate the association between ultrasound appearances and pathological features in small breast cancer. MATERIALS AND METHODS: A total of 186 small breast cancers in 186 patients were analyzed in this retrospective study from January 2015 to December 2019 according to pathological results. Forty-seven cases of axillary lymph node metastasis were found. All patients underwent radical axillary surgery following conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) examinations. The association between ultrasound appearances and pathological features was analyzed using univariate distributions and multivariate analysis. Then, a logistic regression model was established using the pathological diagnosis of lymph node …metastasis and biochemical indicators as the dependent variable and the ultrasound appearances as independent variables. RESULTS: In small breast cancer, risk factors of axillary lymph node metastasis were crab claw-like enhancement on CEUS and abnormal axillary lymph nodes on US. The logistic regression model was established as follows: (axillary lymph node metastasis) = 1.100×(crab claw-like enhancement of CEUS) + 2.749×(abnormal axillary lymph nodes of US) –5.790. In addition, irregular shape on CEUS and posterior echo attenuation on US were risk factors for both positive estrogen receptor and progesterone receptor expression, whereas calcification on US was a risk factor for positive Her-2 expression. A specific relationship could be found using the following logistic models: (positive ER expression) = 1.367×(irregular shape of CEUS) + 1.441×(posterior echo attenuation of US) –5.668; (positive PR expression) = 1.265×(irregular shape of CEUS) + 1.136×(posterior echo attenuation of US) –4.320; (positive Her-2 expression) = 1.658×(calcification of US) –0.896. CONCLUSION: Logistic models were established to provide significant value for the prediction of pre-operative lymph node metastasis and positive biochemical indicators, which may guide clinical treatment. Show more

Keywords: Small breast cancer, logistic model, metastasis, contrast-enhanced ultrasound

DOI: 10.3233/CH-211291

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 4, pp. 413-422, 2022

Authors: Dong, Yi | Wang, Wen-Ping | Lee, Won Jae | Meloni, Maria Franca | Clevert, Dirk-Andre | Chammas, Maria Cristina | Tannapfel, Andrea | Forgione, Antonella | Piscaglia, Fabio | Dietrich, Christoph Frank

Article Type: Research Article

Abstract: Liver cirrhosis is an established high-risk factor for HCC and the majority of patients diagnosed with HCC have cirrhosis. However, HCC also arises in non-cirrhotic livers in approximately 20 %of all cases. HCC in non-cirrhotic patients is often clinically silent and surveillance is usually not recommended. HCC is often diagnosed at an advanced stage in these patients. Current information about HCC in patients with non-cirrhotic liver is limited. Here we review the current knowledge on epidemiology, clinical features and imaging features of those patiens.

Keywords: Hepatocellular carcinoma (HCC), non-cirrhotic liver, diagnosis, imaging, guideline

DOI: 10.3233/CH-211309

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 4, pp. 423-436, 2022

Authors: Zhu, Jing-E | Chen, Yun-Chao | Yu, Song-Yuan | Xu, Hui-Xiong

Article Type: Case Report

Abstract: Schwannoma is a benign tumor that originates from Schwann cells in the nerve sheathing of cranial, other peripheral, or autonomic nerves. Patients often present with painless mass as the chief complaint. The main symptoms of this tumor are related to its size and specific nerve origin. At present, the pretreatment diagnosis is mainly made by ultrasound, CT, MR, or biopsy, and the main treatment is surgical resection. We reported a new treatment method for cervical schwannoma in a 65-year-old woman with a history of non-small cell lung cancer (NSCLC). When the patient’s neck mass was initially found with hoarseness and …severe cough, it was considered as cervical lymph node metastasis of lung cancer due to her medical history. And she was diagnosed with schwannoma by core-needle biopsy after chemotherapy failed and the tumor shrank after the radiotherapy with no improvement of the clinical symptoms. After considering the physical condition, the patients were treated in our department for minimal invasiveness treatment. The patient was definitively diagnosed with cervical vagus schwannoma and was treated with ultrasound-guided microwave ablation of schwannoma under general anesthesia with systematic evaluation and improved preoperative examination. Her condition was stable, and the symptoms of severe cough disappeared after anesthesia resuscitation and the ablation. The tumor continued to shrink after the operation with no recurrence of cough symptoms. Ultrasound-guided percutaneous microwave ablation (MWA) for cervical vagus schwannomas might be a minimally invasive, effective, and relatively safe alternative to conventional treatment for those patients with severe symptoms. Show more

Keywords: Extracranial schwannoma, cervical vagus nerve, microwave ablation

DOI: 10.3233/CH-211301

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 4, pp. 437-446, 2022

Authors: Fan, Pei-Li | Ji, Zheng-Biao | Cao, Jia-Ying | Xu, Chen | Dong, Yi | Wang, Wen-Ping

Article Type: Research Article

Abstract: BACKGROUND: Recurrence or metastasis after surgery had been reported in hepatic epithelioid angiomylipoma (epi-AML). Most hepatic epi-AMLs were misdiagnosed with hepatocellular carcinoma or other hepatic tumors before surgery. OBJECTIVE: To describe the baseline and contrast-enhanced ultrasound (CEUS) features of hepatic epi-AMLs and to explore the potential ultrasonic features for prognosis. METHODS: The retrospective study enrolled 67 patients (56 females, 11 males) with 67 pathologically confirmed hepatic epi-AML lesions. All the lesions were examined by baseline ultrasound and 42 lesions were examined using CEUS with SonoVue (Bracco, Milan, Italy) before surgery. RESULTS: …Baseline ultrasound features of hepatic epi-AMLs included heterogeneous echo (86.6%), well-defined border (68.7%), hypoecho (64.2%), regular morphology (62.7%), peripheral-tumor arc-shaped or ring-like vessels (53.7%), and low value of resistive index (0.51±0.08). CEUS features of hepatic epi-AMLs included arterial phase hyper-enhancement with smooth and well-defined margin (100%), peripheral-tumor ring-like vessels (57.1%), and intra-tumor vessels (52.4%). Some CEUS features, including arterial phase heterogeneously tortuous filling, intra-tumor vessels and peripheral-tumor ring-like vessels were more commonly found in hepatic epi-AMLs of uncertain malignant potential/malignant than in benign hepatic epi-AMLs (p  < 0.05). CONCLUSIONS: Baseline ultrasound and CEUS features may be useful in diagnosis of hepatic epi-AML, and some CEUS features may be indicative of its malignant potential. Show more

Keywords: Angiomylipoma, epithelioid, ultrasound, contrast agent, liver

DOI: 10.3233/CH-211305

Citation: Clinical Hemorheology and Microcirculation, vol. 80, no. 4, pp. 447-461, 2022