Clinical Hemorheology and Microcirculation - Volume 74, issue 4

Authors: Jung, F.

Article Type: Editorial

DOI: 10.3233/CH-209001

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 4, pp. 347-348, 2020

Authors: Wenzel, Folker

Article Type: Letter

DOI: 10.3233/CH-209002

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 4, pp. 349-352, 2020

Authors: Jung, E.M. | Stroszczynski, C. | Jung, F.

Article Type: Research Article

Abstract: In the hands of experienced examiners, the contrast enhanced sonography (CEUS) offers the possibility to analyze dynamic microcirculatory disturbances in real time dynamically without any risk for kidneys and thyroid gland even in severe progressing disease bedside. Based on severe COVID-19 infections, first experiences with abdominal CEUS examinations are presented. In the stage of an imminent organ failure with significantly reduced kidney and liver function, CEUS can be used to show a narrowing of the organ-supplying arteries, as well as a delayed capillary filling of vessels near the capsule, a regional reduced parenchymal perfusion or an inflammatory hyperemia with capillary …hypercirculation. It is possible to quickly rule out organ infarction and to dynamically record the mesenteric arterial and venous blood flow. Show more

Keywords: Corona virus, contrast enhanced ultrasound sonography (CEUS), COVID-19, liver, kidney

DOI: 10.3233/CH-209003

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 4, pp. 353-361, 2020

Authors: Jung, F. | Krieger, V. | Hufert, F.T. | Küpper, J.-H.

Article Type: Research Article

Abstract: BACKGROUND: In the early phase of the COVID-19 pandemic Germany missed to set up efficient containment measures. Consequently, the number of cases increased exponentially until a lockdown was implemented to suppress the spread of SARS-CoV-2. Fortunately, Germany has a high capability for coronavirus lab testing and more than 30,000 ICU beds. These capabilities and the lockdown turned out to be an advantage to combat the pandemic and to prevent a health-system overload. AIM: The aim was to predict the plateau day of SARS-CoV-2 infections or deaths. RESULTS: The effect on the viral spread of the German …measures taken and the impact on the peak of new infection cases is shown. By normalizing daily case numbers, the plateau day of the current outbreak in Germany could be calculated to be reached at April 12, 2020 (day 103 of 2020). CONCLUSION: Normalized case number curves are helpful to predict the time point at which no further new infections will occur if the epidemic situation remains stable. Upon reaching the plateau day during a lockdown phase, a residual time-period of about 2-3 weeks can be utilized to prepare a safe unlocking period. As can be learned from Asian countries such as South Korea and Taiwan there must be strict rules to keep the risk of infection low. Those include social distancing, face mask wearing in combination with digital contact tracing and serosurveillance studies. Following those rules, a safe dance around the infection curve allows to keep the population at a reduced infection rate. Show more

Keywords: Corona virus, SARS-CoV-2, COVID-19, herd immunity, hammer and dance strategy

DOI: 10.3233/CH-209004

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 4, pp. 363-372, 2020

Authors: Shi, You-Zhen | Jin, Yan | Zheng, Li

Article Type: Research Article

Abstract: OBJECTIVES: To identify the associated factors for malignancy in partially cystic thyroid nodules (PCTNs) on ultrasound (US). MATERIALS AND METHODS: This is a retrospective study. 338 PCTNs confirmed by surgery was included in this study. The US features of the nodules were reviewed and their significance in differential diagnosis was analyzed. RESULTS: In the 338 PCTNs, 50 were malignant and 288 were benign. Univariate analyses revealed that a taller-than-wide shape and spiculated or microlobulated margin were significantly associated with malignancy while the spongy form, an ovoid to round shape and smooth margin were significantly associated with …benign nature. In terms of the internal solid portion of the nodule, eccentric configuration, non-smooth margin, hypoechogenicity, and microcalcification were more frequently demonstrated in malignant nodules than in benign ones. In the multivariate logistic regression analysis, a taller than wide shape (OR: 13.357; 95% CIs: 3.457–28.797) was revealed to be the strongest independent predictor for malignancy, followed by microcalcification (OR: 11.578; 95% CIs: 3.142–29.563), spiculated or microlobulated margin (OR: 6.331; 95% CIs: 1.425–9.457), eccentric configuration (OR: 5.456; 95% CIs: 1.358–8.774), non-smooth rim of the internal solid portion (OR: 4.897; 95% CIs: 0.754–7.021), and hypoechogenicity of the internal solid portion (OR: 4.651; 95% CIs: 0.712–8.245). CONCLUSIONS: Understanding the ultrasound characteristics of malignant PCTNs is important to make a precise diagnosis of thyroid nodules. Show more

Keywords: Partially cystic thyroid nodules, conventional ultrasound

DOI: 10.3233/CH-190582

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 4, pp. 373-381, 2020

Authors: Gao, Yan | Zhu, Xiaolong | Huang, Lining | Teng, Jinliang | Li, Fulong

Article Type: Research Article

Abstract: OBJECTIVE: This study aimed to investigate the effects of dexmedetomidine on cerebral oxygen saturation [Sct(O2 )] and postoperative cognitive function in elderly patients undergoing minimally invasive coronary artery bypass graft surgery. METHODS: Sixty elderly patients who received minimally invasive coronary artery bypass graft surgery were randomly equally divided into dexmedetomidine group (group D) and control group (group N). The patients in group D were pumped with 1 μg/kg dexmedetomidine for 15 min before incision, followed by continuous pumping at 0.3–0.5 μg/(kg·h) till the end of the operation. The patients in group N received same dose of normal saline during …the operation. Sct(O2 ) was monitored at pre-induction (T0), post-induction (T1), 30 min (T2) after single-lung ventilation, and after surgery (T3). Mini-mental state examination (MMSE) was used to assess the cognitive function at 1 day before, 72 hour and 7 days after surgery. RESULTS: Sct(O2 ) level in group D was significantly higher than that in group N at T2 (P  < 0.05). Sct(O2 ) level was statistically lower at T2 than that at T0, T1 and T3 in the same group N (P  < 0.05). At 72 h and 7d after operation, the incidence of cognitive dysfunction in group D was markedly lower than that in group N (P  < 0.05), the MMSE score in group D was markedly higher than those in group N, but was significantly lower than that before surgery (P  < 0.05). CONCLUSION: Dexmedetomidine can alleviate the decrease of Sct(O2 ) during single-lung ventilation, improve postoperative cognitive function, and reduce the incidence of POCD in elderly patients with minimally invasive coronary artery bypass surgery. Show more

Keywords: Dexmedetomidine, minimally invasive coronary artery bypass surgery, elderly, cognitive dysfunction

DOI: 10.3233/CH-190590

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 4, pp. 383-389, 2020

Authors: Liang, Ming | Ou, Bing | Wu, Jiayi | Xiao, Xiaoyun | Ruan, Jingliang | Tian, Jing | Xu, Xiaolin | Wang, Bin | Yang, Haiyun | Luo, Baoming

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate the combined use of strain elastography (SE) and superb microvascular imaging (SMI) with grayscale ultrasound (US) according to the Breast Imaging Reporting and Data System (BI-RADS) classification for differentiating benign from malignant breast masses. METHODS: In total, 166 patients with 177 breast masses categorized as BI-RADS 3–5 were included in the study between April 2016 to September 2017. US, SMI and SE were performed to evaluate each mass. The following outcome measures were compared between US and the combinations of US, SMI, and SE: area under the receiver operating characteristic curve (AUC), sensitivity, specificity. …RESULTS: The addition of SMI and SE to US increased the AUC from 0.816 to 0.948 (P  < .001); and the specificity from 43.7% to 80.8% (P  < .001), without a significant decrease in the sensitivity. Meanwhile, 66.1% (37 of 56) of the benign masses that were indicated for unnecessary biopsy were correctly changed to follow-up. CONCLUSIONS: The addition SMI and SE to US could improve the diagnostic performance in differentiating benign from malignant breast masses compared to US alone. When US was combined with SMI and SE, the specificity were increased, thus significantly reducing unnecessary biopsies. Show more

Keywords: Breast cancer, superb microvascular imaging, strain elastography, ultrasonography

DOI: 10.3233/CH-190693

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 4, pp. 391-403, 2020

Authors: Sun, Xianlei | Tung, Wingtai | Zou, Jie | Wang, Weiwei | Kratz, Karl | Ma, Nan | Lendlein, Andreas

Article Type: Research Article

Abstract: BACKGROUND: The behavior of endothelial cells is remarkably influenced by the physical and biochemical signals from their surrounding microenvironments. OBJECTIVE: Here, the elasticity of fiber meshes was studied as a design parameter of substrates for endothelial cells in order to modulate angiogenesis. METHODS: Human umbilical vein endothelial cells (HUVECs) were cultured on electrospun fiber meshes made from polyetheresterurethane (PEEU), differing in their elasticity. Cell morphology, proliferation, migration and angiogenesis of endothelial cells on the degradable substrate meshes were characterized. RESULTS: The aspect ratio of HUVECs cultured on the fiber meshes from PEEU materials increased …with increasing stiffness of the materials. HUVECs cultured on fiber meshes with high stiffness (Young’s modulus E  = 4.5±0.8 MPa) presented a higher proliferation rate and significantly faster migration velocity, as well as higher tube formation capability than the cells cultured on fiber meshes with low stiffness (E  = 2.6±0.8 MPa). CONCLUSIONS: These results suggested that tuning the fiber meshes’ elasticity might be a potential strategy for modulating the formation or regeneration of blood vessels. Show more

Keywords: Tensile E-modulus, HUVECs, electrospun fiber meshes, multiblock copolymers

DOI: 10.3233/CH-190696

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 4, pp. 405-415, 2020

Authors: Zhu, Jing | Kang, Jing | Li, Xiaochen | Wang, Mengmei | Shang, Min | Luo, Yuchuan | Xiong, Mengqing | Hu, Ke

Article Type: Research Article

Abstract: BACKGROUND AND AIM: Both chronic intermittent hypoxia (CIH) and chronic continuous hypoxia (CCH) are risk factors for cardiovascular disease, which are associated with cardiac systolic function and associated with dysfunction of endothelia and coagulation-fibrinolysis system in the vasculature. However, the different effects of these two hypoxic models are not fully understood. In our study, we systemically compared the effects of CIH and CCH on cardiac function and related factor levels in serum using rat model. METHODS: Forty-five male Sprague-Dawley rats were randomly divided into the normoxia control (NC), CIH and CCH groups. The rat CIH and CCH models …were established, then the blood and tissue samples were collected to analyze the function of endothelium and the coagulation-fibrinolysis system. Also, the ultrasound cardiogram was performed to directly assess myocardial contractility. RESULTS: Both CIH and CCH significantly decreased the NO, eNOS, P-eNOS and AT-III levels in the rat serum but significantly increased the levels of ET-1, vWF, COX-2, NF-κ B, FIB, FVIII and PAI-1 in the rat serum (P  < 0.05). The expression of ET-1, VWF and ICAM-1 in CIH group were higher than CCH group (P  < 0.05), however, the expression of CD62p was increased in CCH group but not in CIH group. The expression of t-PA in CIH group were lower than CCH group (P  < 0.05), but there were no significant differences in CCH group and NC group (P  > 0.05). Using transmission electron microscope, we found that the mitochondrial ultrastructure of thoracic aorta endothelial cells in CIH and CCH group were damaged. Moreover, the myocardial contractility in CIH and CCH group were significantly decreased compared with NC group. CONCLUSION: Our results suggested that CIH and CCH could cause endothelial dysfunction, dysfunction of the coagulation-fibrinolysis system and decreasing of myocardial contractility. Compared with CCH, CIH has greater effect on vasoconstriction and adhesion of vascular endothelial cells, and stronger procoagulant effect. Show more

Keywords: Chronic intermittent hypoxia, chronic continuous hypoxia, vascular endothelial function, myocardial contractility

DOI: 10.3233/CH-190706

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 4, pp. 417-427, 2020

Authors: Pettersen, Erik Mulder | Avdal, Jørgen | Hisdal, Jonny | Torp, Hans | Seternes, Arne

Article Type: Research Article

Abstract: OBJECTIVE: In this proof-of-concept study we aim to validate a novel ultrasound Doppler monitoring device for evaluating microcirculation (earlybird) against LDF and pulsed Doppler. METHODS: In ten healthy subjects, we measured microcirculatory function at rest and during different autonomic tests (forced respiration, isometric exercise, Valsalva maneuver and cold pressor). Earlybird, LDF and pulsed Doppler were recorded simultaneously. We performed a ZNCC to determine correlation. RESULTS: The curves for earlybird and LDF or pulsed Doppler correlates visually well. Overall median ZNCC 0.87 (interquartile range 0.77 –0.91) between the LDF and earlybird measurements, and 0.90 (0.82 – 0.95) …for pulsed Doppler and earlybird. Median ZNCC for baseline and each provocation test for earlybird against LDF and pulsed Doppler were calculated; baseline: LDF 0.87 (0.73 – 0.97) pulsed Doppler 0.91 (0.81 – 0.94), forced respiration: LDF 0.87 (0.28 – 0.90) pulsed Doppler 0.90 (0.85 – 0.96), isometric exercise: LDF 0.82 (0.59 – 0.90) pulsed Doppler 0.87 (0.68 – 0.94), Valsalva maneuver: LDF 0.88 (0.82 – 0.91) pulsed Doppler 0.94 (0.92 – 0.97) and cold pressor: LDF 0.90 (0.85 – 0.95) pulsed Doppler 0.89 (0.65 – 0.94). CONCLUSION: Earlybird records vasoconstrictions in healthy subjects as well as LDF and pulsed Doppler. Show more

Keywords: Ultrasonography, Doppler, Laser-Doppler Flowmetry, peripheral arterial disease, inventions, microcirculation

DOI: 10.3233/CH-190707

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 4, pp. 429-440, 2020

Authors: Negrão de Figueiredo, G. | Mueller-Peltzer, K. | Schwarze, V. | Marschner, C. | Zhang, L. | Rübenthaler, J. | Siepmann, T. | Illigens, B.W. | Clevert, D.A.

Article Type: Research Article

Abstract: BACKGROUND: Focal nodular hyperplasia (FNH) is a hyperplastic mass of vascular abnormality and the second most common benign liver lesion. It can be discovered incidentally or during a surveillance examination in patients at risk for hepatic malignancy, mostly by conventional ultrasound. CEUS has been used as an additional alternative method for the rapid diagnosis of FNH. However, none of the previous studies compared the diagnostic performance of CEUS to MRI retrospectively in a 10-year observation. OBJECTIVE: The aim of this long-term retrospective study is to assess the diagnostic performance of CEUS in the imaging of FNH and compare …the results to MRI. MATERIAL AND METHODS: A single experienced physician performed CEUS examinations in 244 patients between 2009 and 2019 with suspected focal nodular hyperplasia after conventional ultrasound. A second-generation blood pool agent (SonoVue® , Bracco, Milan, Italy) was administered. Additional dynamic MRI with contrast agent was performed in a subgroup of 95 patients. RESULTS: Out of 244 patients, FNH could be displayed in 221 patients on CEUS. A subgroup of 95 patients had CEUS examinations and CEMRI for diagnosis comparison. In comparison with CEMRI, CEUS presented a sensitivity of 97%, a specificity of 76%, a positive predictive value of 93% and a negative predictive value of 89%. CONCLUSION: CEUS is a safe and feasible approach that assess the diagnosis of focal nodular hyperplasia equally to MRI. The focal lesion enhancement can be depicted in real-time in the arterial, venous and late phase facilitating the prompt diagnosis. Show more

Keywords: CEUS, focal nodular hyperplasia, MRI, long-term study

DOI: 10.3233/CH-190710

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 4, pp. 441-452, 2020

Authors: Qiu, Yijie | Yang, Daohui | Zhang, Qi | Chen, Kailing | Dong, Yi | Wang, Wen-Ping

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate the feasibility of vector flow imaging technique (V Flow) in measurement of wall shear stress (WSS) of common carotid arteries (CCA) in healthy adults and to provide the normal WSS values assessed by V Flow. METHODS & MATERIALS: This prospective study was approved by the Ethics Committee of our University. Eighty healthy adult volunteers were included (mean age 43.3 y, 47 females, 33 males). The volunteers were classified into three groups according to their age: group I (age 20 - 39 y), group II (age 40 - 59 y) and group III (age 60 - …80 y). Mindray Resona 8 ultrasound machine and a linear array transducer (3–9 MHz) was used, equipped with the updated V Flow function. Common carotid arteries of both sides were evaluated in three segments (initial segment, middle segment and near bifurcation segment). The WSS values of CCA were measured by two independent radiologists. The intraclass correlation coefficient (ICC) of observer reliability in WSS measurement was calculated. Inter-observer reproducibility was also evaluated with the 95% Bland-Altman limits of agreement (LOA). RESULTS: V Flow measurements were performed successfully in 79 volunteers (98.8 %, 79/80). The mean value of WSS in right CCA was (0.66±0.24) Pa, in left CCA was (0.66±0.18) Pa (P  > 0.05). Mean WSS value had a moderately negative correlation with age group (P  < 0.05). The mean WSS value of group I(mean±SD, 0.75±0.25 Pa) is larger than group II (mean±SD, 0.62±0.13 Pa) and group III (mean±SD, 0.49±0.11 Pa) (P  < 0.05). The ICC of observer reliability of group I, II and III was 0.96 (95% confidence interval (95% CI) 0.92–0.98), 0.94 (95% CI 0.88–0.97), 0.93 (95% CI 0.76–0.98) respectively. The Bland-Altman plots showed that the 95% LOA were –0.17–0.12 (Pa) for group I, –0.09–0.13 (Pa) for group II and –0.08–0.10 (Pa) for group III. CONCLUSION: V Flow measurement is a simple, rapid and feasible imaging method for the WSS assessment of CCA in healthy volunteers, which will probably be an important tool for assessing CCA function. Show more

Keywords: Vector flow imaging (V Flow), wall shear stress (WSS), common carotid artery (CCA), feasibility, normal value

DOI: 10.3233/CH-190719

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 4, pp. 453-462, 2020

Authors: Shao, Si-Hui | Li, Chun-Xiao | Yao, Ming-Hua | Li, Gang | Li, Xing | Wu, Rong

Article Type: Research Article

Abstract: OBJECTIVE: To identify the efficacy of contrast-enhanced ultrasound (CEUS) in re-evaluating masses with inconsistent Breast Imaging Reporting and Data System (BI-RADS) on mammography (MG) and conventional ultrasound (US). MATERIALS AND METHODS: A total of 637 breast lesions were evaluated with MG, US, and CEUS within 6 months and assessed as BI-RADS MG and US. CEUS was used as an additional screening to rerate BI-RADS US according to a five-point system. Lesions were divided into consistent or inconsistent group on the basis of BI-RADS MG and US assessment. The performance of MG, US, and CEUS in the overall and …inconsistent group as well as the clinicopathological differences between consistent and inconsistent group were compared using Z test, Mann–Whitney U test, and t -test. RESULTS: The respective AUCs of MG and US were 0.742, 0.843 for overall group and 0.412, 0.789 for inconsistent group. The corresponding values of rerated CEUS BI-RADS were 0.958 and 0.950, which were significantly prior to those of MG and US (p  < 0.001). Younger age, negative lymph node status, and dense breast were significantly associated with inconsistent group. CONCLUSION: Incorporation of CEUS to re-evaluate lesions can improve the diagnostic efficacy comparing to MG or US alone especially when disagreement occurred. Show more

Keywords: Contrast enhanced ultrasound, conventional ultrasound, inconsistent BI-RADS MG and BI-RADS US assessment

DOI: 10.3233/CH-190729

Citation: Clinical Hemorheology and Microcirculation, vol. 74, no. 4, pp. 463-473, 2020