Clinical Hemorheology and Microcirculation - Volume 74, issue 3

Authors: Xu, Guang | Xiang, Lihua | Wu, Jian | Shao, Hongda | Liu, Hui | Ding, Shisi | Wu, Rong

Article Type: Research Article

Abstract: PURPOSE: Prostate cancer (PCa) is one of the most common cancers in elderly men worldwide. Systematic biopsy guided by transrectal ultrasound remains the standard for PCa diagnosis; however, the false negative rate is 10–20%. Multiparametric magnetic resonance imaging (mpMRI) allows PCa visualization with a more precise localization and a higher accuracy and specificity for the detection of PCa. The physician can mentally relocate the most appropriate area detected on the prebiopsy mpMRI, based on its zonal topography and anatomical landmarks, called cognitive fusion. Herein, we concentrated on the accuracy of PCa localization in cognitive fusion compared with MRI-TRUS fusion and …explored the applied scope of cognitive fusion. METHODS: Thirty-two eligible patients with 36 PCa lesions were recruited for our study. TRUS examinations and MRI-TRUS fusion procedures were performed by experienced operators. The cognitive fusion images were compared using the TRUS image in a MRI-TRUS fusion workstation. RESULTS: Using cognitive fusion imaging, 86.1% of the lesions were accurately located by the senior sonographer and 69.4% of the lesions were accurately located by the junior sonographer. The maximum diameter and PI-RADS score of the lesions were important factors that affected the accuracy of cognitive fusion (P  < 0.05). Furthermore, the lesions with high PI-RADS scores and the lesions with large diameters were more accurately located using cognitive fusion (P  < 0.05). CONCLUSIONS: Cognitive fusion is a reliable technique with dependency on working experience, and its accuracy of locating suspicious lesions is consistent with MRI-TRUS fusion in patients with high PI-RADS score and large lesions. Show more

Keywords: Prostate cancer, multiparametric magnetic resonance imaging, cognitive fusion

DOI: 10.3233/CH-180423

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 3, pp. 223-229, 2020

Authors: Ding, Xiaohu | Lu, Lin | Yang, Jing | Chen, Yijiao | Ma, Jin

Article Type: Research Article

Abstract: PURPOSE: To explore the peripapillary capillary density distribution and its correlation with nerve fibre layer in superficial and deep retinal layers of healthy Chinese. METHODS: Images of superficial and deep retinal capillary networks were obtained by optical coherence tomography angiography (OCTA) using a CIRRUS TM HD-OCT Model 5000 system and analyzed by Image-Pro Plus (Medical Cybernetics, Version 6.0). Peripapillary capillary density was defined as the mean optical density of the annular region between two concentric circles of 3.085 mm and 3.835 mm diameter. Parafoveal capillary density was defined as the mean optical density between the foveal avascular zone (FAZ) boarder …and a 2.5 mm diameter circle. Retinal nerve fibre layer (RNFL) thickness was also measured and the correlation with capillary density determined. RESULTS: Mean peripapillary capillary density was 4.16±1.06 in the superficial and 2.92±0.80 in the deep layer. Corresponding mean parafoveal densities were 2.65±0.55 and 2.51±0.55. Capillary densities were higher in the superficial layer of all quadrants for both peripapillary and parafoveal regions (P  < 0.001). A significant correlation between peripapillary capillary density and RNFL thickness was found in the superficial layer (r  = 0.305, P  < 0.05). A negative correlation between age and capillary density was found in both peripapillary and parafoveal regions (P  < 0.001). CONCLUSIONS: Peripapillary capillary density in the superficial layer highly correlated with RNFL thickness. Regional and age-related differences in peripapillary and parafoveal capillary density should be considered when diagnosing and monitoring individuals with diseases affecting retinal capillary density. Show more

Keywords: Capillary density, optical coherence tomography angiography (OCTA) angiogram, retinal nerve fibre layer

DOI: 10.3233/CH-180453

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 3, pp. 231-239, 2020

Authors: Zhang, Shupin | Wan, Jing | Liu, Hui | Yao, Minghua | Xiang, Lihua | Fang, Yan | Jia, Liqiong | Wu, Rong

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate the efficacies of conventional ultrasound (US), US elasticity imaging (EI), and acoustic radiation force impulse (ARFI) elastography in breast malignancy diagnosis. METHODS: We included 315 women (mean age, 44 years; range, 18–81 years) with 336 pathologically proven breast lesions in this retrospective study. All lesions underwent conventional US, EI, and ARFI (including virtual touch tissue imaging [VTI], virtual touch tissue quantification [VTQ], and virtual touch tissue imaging and quantification [VTIQ]) elastography. Multivariate logistic regression analysis was performed to assess 12 independent variables for malignancy prediction. Diagnostic performance was evaluated with receiver operating characteristic (ROC) curve …analysis. RESULTS: Irregular lesion shape was the strongest independent predictor for breast malignancy, followed by poorly defined margins, taller than wide dimensions, posterior echo attention, VTIQ, and VTI boundaries (P  < 0.05). Area under the ROC curve (AUC) for VTIQ was higher than other significant independent variables. With the best cut-off value of 3.74 m/s, the AUC, sensitivity, and specificity were 0.93 (95% CI: 0.90, 0.96), 90.1%, and 91.1%, respectively. CONCLUSIONS: ARFI elastography is a promising method in breast malignancy prediction, with good diagnostic performance. For patients requiring surgery, the combination of various methods can provide better diagnostic results and may help to reduce unnecessary biopsy or surgery. Show more

Keywords: Ultrasound, breast cancer, elastography, acoustic radiation force impulse imaging, virtual touch tissue imaging and quantification

DOI: 10.3233/CH-180527

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 3, pp. 241-253, 2020

Authors: Wu, Qiong | Li, Yi | Liu, Yilun | Shen, Jian | Wang, Yan | Yi, Xiaolei | Hu, Bing

Article Type: Research Article

Abstract: PURPOSE: The aim of this study was to evaluate the diagnostic value of conventional sonography and ultrasound elastography for thyroid nodules of each Bethesda category and to analyze their potential role in the corresponding management decision. METHODS: This retrospective study included 557 thyroid nodules diagnosed by conventional ultrasound (US) and real-time ultrasound elastography (RTE) before fine-needle aspiration (FNA) from 458 patients. The US, RTE, and cytological results were collected and analyzed according to different Bethesda categories. Differences in the distribution of sonographic features between groups were evaluated by the Chi-square test or Fisher exact test. The sensitivity, specificity, …positive predictive value, negative predictive value, and accuracy of conventional US and RTE for the diagnosis of malignant nodules in each category were then calculated and analyzed. RESULTS: The diagnostic accuracy of the comprehensive US diagnosis in all categories stayed at a relatively high level from 78.4% to 88.6%, and good specificities ranging from 77.3% to 100% were revealed in all Bethesda categories. As to RTE, the diagnostic accuracies in categories I–IV stayed at a relatively low level ranging from 44.6% to 65.6% except for better performance in categories V and VI (85.2%, 89.1%). Besides, the accuracies of comprehensive US (85.2%, 88.6%) and RTE (85.2%, 89.1%) is relatively low compared to the corresponding cytological diagnoses in categories V and VI. CONCLUSIONS: Conventional US is complementary to FNA for providing additional hints especially in categories I–IV for further clinical managements, while RTE failed to provide useful diagnostic information in general. Show more

Keywords: Thyroid nodules, fine-needle aspiration, conventional US, real-time ultrasound elastography, Bethesda category

DOI: 10.3233/CH-180533

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 3, pp. 255-266, 2020

Authors: Li, Guanhua | Zhang, Yu | Tang, Wei | Zheng, Junmeng

Article Type: Research Article

Abstract: BACKGROUND: Polyamidoamine (PAMAM) dendrimers have been investigated for decades and currently applied in various areas throughout nanomedicine, including gene therapy, drug delivery, anti-bacteria and imaging. It is therefore necessary to assess cytotoxicity of PAMAM dendrimers systematically. Because blood component is usually the initial step of contact with any therapeutic agent, comprehensive hemocompatibility study is needed. MATERIAL S AND METHODS: The triblock dendrimer: polyamidoamine-polyethylene glycol-cyclic RGD (PAMAM-PEG-cRGD), was successfully synthesized. Various in vitro assays to characterize hemocompatibility of both PAMAM (Generation 4.0) and PAMAM-PEG-cRGD were performed, including hemolytic assay, platelet activation examination, platelet counting, assessment of coagulating pathways …and evaluation of complement system activation. RESULTS: The hemolytic ratio of PAMAM-PEG-cRGD maintained below 5%. Surface engineering of PEG and cRGD to PAMAM attenuated hemolysis and RBC aggregation as compared with unmodified PAMAM. PAMAM (Generation 4.0) reduced platelet counting in a dose-dependent manner, and the platelet number dropped dramatically at a relatively low incubating dose (1 μM). Such surface modifications also alleviated platelet activation and platelet reduction mediated by PAMAM polycationicity. Finally, high concentration (10 μM) of PAMAM interfered the coagulation system, prolonging prothrombin time significantly. CONCLUSION: Surface modification of PEG and cRGD to PAMAM (Generation 4.0) improves hemocompatibility. Introduction of PEG and cRGD significantly mitigates hemolytic and RBC aggregation effects as compared with unmodified PAMAM. Similarly, these modifications alleviate platelet activation and platelet reduction mediated by PAMAM polycationicity. Show more

Keywords: Polyamidoamine (PAMAM), dendrimer, nanoparticle, hemocompatibility, surface modification

DOI: 10.3233/CH-190641

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 3, pp. 267-279, 2020

Authors: Sirufo, Maria Maddalena | Ginaldi, Lia | De Martinis, Massimo

Article Type: Research Article

Abstract: Volleyball players are exposed to the possibility of several well recognized injuries, among which microvascular abnormalities are the less described and studied, although they could diminish their ability and performance. Capillaroscopy is a simple, non-invasive method to diagnose vascular abnormalities in athletes suffering for the consequences of repeated application of pressure by local trauma on the fingertips. The detected capillaroscopic picture will be the base for the follow-up and will indicate the possible need for further investigations aimed at excluding other occulted conditions. At our knowledge, this is the first report describing and documenting the related microvascular abnormalities in a …volleyball player. This case emphasizes the fact that volleyball players among other athletes, whose hands are exposed to repeated fingertips trauma may suffer from microcirculation damage, for which reason they should be able to access an effective health surveillance program able to detect the first signs and offer the most appropriate clinical support. Show more

Keywords: Volleyball, athletes, sport, capillaroscopy, hand, injury, microcirculation, translational medicine

DOI: 10.3233/CH-190667

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 3, pp. 281-285, 2020

Authors: Bakker, Nathalie | Schoorl, Marianne | Stoutjesdijk, Eline | Houdijk, Alexander P.J.

Article Type: Research Article

Abstract: BACKGROUND: An adequate erythrocyte function is vital for tissue oxygenation and wound healing. The erythrocyte membrane phospholipid composition plays an important role in erythrocyte function and administration of omega-3 fatty acids may provide a means to improve it. OBJECTIVE: To investigate peri-operative erythrocyte function and effects of omega-3 fatty acids METHODS: Forty-four patients undergoing elective laparoscopic colon resection for non-metastasized cancer were randomized between intravenous omega-3 poly-unsaturated fatty acids (n-3 PUFAs) or placebo (saline). Peri-operative blood samples were analyzed with a Lorrca MaxSIS Ektacytometer and erythrocyte membrane phospholipids were determined with gas chromatography. RESULTS: …Patient and operation characteristics were equal between groups. There was a significant increase in erythrocyte membrane eicosapentaenoic acid (EPA) but not docosahexaenoic acid (DHA) in the n-PUFA group. There were no significant differences in erythrocyte deformability but the aggregation index (AI) was significantly lower and the aggregation half time (T½) was significantly higher in the n-3 PUFA group. CONCLUSION: This study confirms rapid changes in erythrocyte membrane phospholipid composition after administration of intravenous n-3 PUFAs. Erythrocyte deformability parameters were not affected but erythrocyte aggregability was decreased in the n-3 PUFA group. Further investigation is necessary to gain more insights in the effects of n-3 PUFA and the postoperative inflammatory response on erythrocyte function. Show more

Keywords: Erythrocytes, deformability, aggregability, colon cancer surgery, omega-3 fatty acids

DOI: 10.3233/CH-190687

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 3, pp. 287-297, 2020

Authors: Caimi, Gregorio | Hopps, Eugenia | Montana, Maria | Carollo, Caterina | Calandrino, Vincenzo | Gallà, Eleonora | Canino, Baldassare | Lo Presti, Rosalia

Article Type: Research Article

Abstract: Protein carbonylation is a marker of oxidative protein damage, that is likely involved in the pathogenesis of several diseases. The aim of this study was to evaluate the protein carbonyl (PC) groups in different clinical conditions. It included different groups of subjects: 81 trained subjects; 23 subjects with mild essential hypertension; 31 middle-aged subjects with metabolic syndrome (MS); 106 subjects with MS not selected for age (subdivided into two subgroups, with and without diabetes mellitus); 91 obese adults subdivided in two subgroups (BMI 30–35 Kg/m2 and BMI > 35 kg/m2 ); 48 subjects with obstructive sleep apnea syndrome (OSAS) subdivided in …accordance with the apnea/hypopnea index (AHI); 27 subjects with chronic kidney disease (CKD) on conservative therapy; 31 subjects with CKD on haemodialysis treatment; and 50 subjects with juvenile myocardial infarction. PC groups were reduced in trained subjects in comparison with sedentary controls, while no variation was observed in mild essential hypertension. PC groups were increased in MS subjects and in adult obese subjects. In MS subjects the PC groups were not influenced by the presence of diabetes mellitus and in adult obese subjects were not influenced by the obesity degree. In OSAS subjects only those with AHI > 30 showed an increase of PC groups. PC groups increased in CKD subjects undergoing conservative treatment and haemodialysis therapy. In dialyzed subjects, after a standard dialysis session, there was a marked increase in PC groups. In juvenile myocardial infarction PC groups were higher than in controls; there was no difference between STEMI and NSTEMI and their concentration was unaffected by the number of cardiovascular risk factors or stenosed coronary vessels. Show more

Keywords: Oxidative stress, arterial hypertension, metabolic syndrome, juvenile myocardial infarction, chronic kidney failure

DOI: 10.3233/CH-190689

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 3, pp. 299-313, 2020

Authors: Dong, Yi | Xu, Benhua | Cao, Qiong | Zhang, Qi | Qiu, Yijie | Yang, Daohui | Yu, Lingyun | Wang, Wen-Ping

Article Type: Research Article

Abstract: AIM: To investigate the value of contrast enhanced ultrasound with high resolution linear transducers (HF-CEUS) for differential diagnosis of focal fundal gallbladder (GB) wall thickening. METHODS: A total of 32 patients with incidentally detected focal fundal GB wall thickening were included. After conventional B mode ultrasound (BMUS) examinations, HF-CEUS were performed with a 7.5–12 MHz 9L4 linear transducer (S2000 HELX OXANA unit, Siemens). Two radiologists independently reviewed the HF-CEUS enhancement patterns to determine the differential features between malignancy and benignity with a five-point confidence scale. The diagnostic accuracy of BMUS and HF-CEUS for GB wall thickening was compared. The …final gold standard was surgery with histological examination. RESULTS: Final diagnoses included GB adenocarcinoma (n  = 16), adenomyomatosis (n  = 12), Xanthogranulomatous (n  = 2) and cholecystitis (n  = 2). HF-CEUS features associated with GB adenocarcinoma including arterial phase inhomogeneous hyperenhancement, venous phase hypoenhancement and disruption of GB wall layer structure (P  < 0.05). Two small (5 mm) liver metastasis were confirmed by HF-CEUS during the late phase liver sweep as hypoenhanced lesions. Nonenhanced Rokitansky-Aschoff sinuses were clearly observed in 83.3% focal adenomyomatosis. Overall sensitivity, specificity and accuracy for differentiation between malignant and benign focal fundal GB wall thickening of HF-CEUS and BMUS were 84.3% vs 53.1%, 90.6% vs 59.3% and 87.5% vs 56.2% (P  < 0.005). CONCLUSIONS: CEUS performed with high frequency linear transducers could be a useful alternative in the differential diagnosis of focal fundal GB wall thickening on conventional ultrasound. Show more

Keywords: Gallbladder, contrast enhanced ultrasound (CEUS), linear transducer, differential diagnosis, focal wall thickening

DOI: 10.3233/CH-190697

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 3, pp. 315-325, 2020

Authors: Auer, Timo Alexander | Fischer, Thomas | Garcia, Stephan Rodrigo Marticorena | Penzkofer, Tobias | Jung, Ernst-Michael | Hamm, Bernd | Lerchbaumer, Markus Herbert

Article Type: Research Article

Abstract: BACKGROUND: Contrast-enhanced ultrasound (CEUS) has been used as an additional imaging technique in order to evaluate focal liver lesions. CEUS is easy and fast to perform, overcomes the limitations of B-mode US. OBJECTIVE: To evaluate the diagnostic potential of contrast-enhanced ultrasound (CEUS) in focal liver lesions (FLL) with unclear findings on computed tomography (CT) or magnetic resonance imaging (MRI). METHODS: In this single-center retrospective study, 146 patients with at least one FLL underwent additional CEUS of the liver to clarify inconclusive cross-sectional imaging findings. Ultrasonography was performed using B-mode imaging and CEUS after injection of sulphur …hexafluoride microbubbles (second-generation contrast agent) within two months after ceMRI or ceCT and interpreted by an experienced radiologist (EFSUMB level 3). Histopathological reports, long-term follow-up or clinical course served as reference standard. RESULTS: Thirty-eight of the 146 patients had malignant and 108 benign FLL. Overall, CEUS had 92% sensitivity (95% -CI, 79–97) and 98% specificity (95% -CI, 93–99) with an AUC of 0.95 in correctly characterizing the lesion as malignant or benign. Sensitivity increased to 98% (95% -CI, 96–100) for benign lesions and decreased to 92% (95% -CI, 78–98) for malignant lesions. CEUS showed the highest diagnostical accuracy in lesion <1 cm with an AUC of 1.000, while the lowest accuracy was achieved in lesions >2 cm with an AUC of 0.924 due to a decreasing specificity of 86% (95% -CI, 87–100). CONCLUSION: CEUS correctly distinguished malignant from benign FLL in cases with inconclusive cross-sectional imaging findings and achieved high levels of diagnostic accuracy. CEUS has added diagnostic value especially in small lesions ≤1 cm while specificity remains limited in larger lesions. Show more

Keywords: CEUS, focal liver lesions, sonography, contrast-enhanced ultrasound, liver ultrasound

DOI: 10.3233/CH-190718

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 3, pp. 327-339, 2020