Clinical Hemorheology and Microcirculation - Volume 76, issue 1

Authors: Liu, Xiaojun | Wang, Gang | Zhang, Tao

Article Type: Research Article

Abstract: OBJECTIVE: To investigate the changes in the levels of plasm interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α ), C-reactive protein (CRP), matrix metalloproteinase-9 (MMP-9) and endotoxins in patients with acute aortic dissection (AAD). METHODS: 55 AAD patients who were admitted and scheduled to undergo emergency surgery in our hospital from January 2017 to July 2017 were selected and retrospectively analyzed. They were divided into the survival group (n  = 40) and the death group (n  = 15). The levels of plasma IL-6, TNF-α , CRP, MMP-9 and endotoxins at admission and at 6 h, 12 h and 24 h after admission (T0, T1, T2 …and T3) were measured, and the correlations of inflammatory cytokines with endotoxins were analyzed. RESULTS: At T1, T2 and T3, the levels of inflammatory cytokines and endotoxins were increased. The levels of plasma IL-6, TNF-α , CRP, MMP-9 and endotoxins in the death group were significantly higher than those in the survival group at each time point (p  < 0.05 in all comparisons). Neutrophil and platelet counts in the death group were higher than those in the survival group (p  < 0.05). Correlation analyses indicated that the levels of IL-6, TNF-α , CRP and MMP-9 were positively correlated with the level of endotoxin. CONCLUSION: Patients with AAD are often accompanied by systemic inflammatory responses, with inflammation-related cytokines (IL-6, TNF-α , CRP and MMP-9) and endotoxins levels significantly elevated. Combined monitoring of dynamic changes in inflammatory cytokines and endotoxins, as well as early interventions, has important clinical implications for evaluating the prognosis of AAD and reducing mortality. Show more

Keywords: Acute aortic dissection, IL-6, TNF-α, CRP, MMP-9

DOI: 10.3233/CH-190674

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 1, pp. 1-7, 2020

Authors: Bahrami, Saeed | Norouzi, Mahmood

Article Type: Research Article

Abstract: Cardiovascular disease is now under the influence of several factors that encourage researchers to investigate the flow of these vessels. Oscillation influences the blood circulation in the volume of red blood cells (RBC) strongly. Therefore, in this study, its effects have been considered on hemodynamic parameters in the elastic wall and coronary bifurcation. In this study, a 3D geometry of non-Newtonian and pulsatile blood circulation is considered in the left coronary artery bifurcation. The Casson model with various hematocrits is analyzed in elastic and rigid walls. The wall shear stress (WSS) cannot show the stenosis artery alone, therefore, the oscillatory …shear index (OSI) is represented as a hemodynamic parameter of WSS individually of time. The results are determined using two-way fluid-structure interaction (FSI) coupling method using an arbitrary Lagrangian-Eulerian method. The most prominent difference in velocity happened in the bifurcation and at hematocrit 30 with yield stress 6.59E-04 Pa. The backflow and vortex flow in the LCx branch grown with increasing shear rates. The likelihood of plaque generation at the ending of the LM branch is observed in hematocrits 10 and 20, while the WSS magnitude is normal in the hematocrit 60 with the greatest yield stress in the bifurcation. The shear stress among the rigid and elastic models is the highest at the ending of the LM branch. The wall shear stress magnitude among the models decreased at most of 24.49% by dividing the flow. Time-independent results for models showed that there is the highest value of OSI at the bifurcation, which then quickly dropped. Show more

Keywords: Fluid solid interaction, blood flow, hematocrit, Casson model, hemodynamic parameter

DOI: 10.3233/CH-200854

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 1, pp. 9-26, 2020

Authors: Zhang, Yan-Qun | Wen, Jie-Xian | Luo, Rong-Kui | Yuan, Hai-Xia | Wang, Wen-Ping

Article Type: Research Article

Abstract: Duodenal neuroendocrine tumors are rare neoplasms arising from endocrine cells. Here we present a case of 32-year-old woman with Duodenal neuroendocrine tumors, report the imaging and contrast-enhanced Ultrasound (CEUS) features and review previous literatures of neuroendocrine tumors, which may be valuable for the differential diagnosis of duodenal neoplasms.

Keywords: Neuroendocrine tumors, duodenal, contrast-enhanced ultrasound (CEUS), imaging features

DOI: 10.3233/CH-200816

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 1, pp. 27-32, 2020

Authors: Chung, Young Hak | Lee, Kyung Ah | Cho, Minhee | Shin, Sehyun | Lee, Byoung Kwon

Article Type: Research Article

Abstract: BACKGROUND: Analysis of responsiveness to antiplatelet therapy is crucial in the management of patients with cardiovascular diseases. OBJECTIVE: This study aimed to evaluate a new platelet function analysis system (Anysis-200) and to compare it with VerifyNow (Accumetrics, San Diego, CA, USA) in cardiology patients. METHODS: Overall, 125 citrated blood samples were collected from 85 cardiology patients referred for platelet function testing. In Anysis-200, platelet function was measured as blood migration distance (MD) until clogging of flow passage, which is comparable to aspirin resistance units obtained using VerifyNow. The two devices were simultaneously used and compared. …RESULTS: The MDs before and after taking aspirin were 175±51 and 247±27 mm, respectively (p  < 0.0001). Compared with VerifyNow (reference), the sensitivity and specificity of Anysis-200 was 91.5% and 75.5%, respectively (area under the curve, 0.829). Further, the true positive rate in patients newly taking aspirin was 85% for VerifyNow and 92.5% for Anysis-200, respectively. The Cohen’s kappa coefficient between the two devices was 0.682, indicating a relatively high agreement. CONCLUSIONS: Anysis-200, a novel system for assessing platelet aggregation, has accuracy and precision equivalent to that of, and significant agreement with, VerifyNow. Anysis-200 may be useful in screening patients with abnormal platelet reactivity and aspirin nonresponsiveness. Show more

Keywords: Platelet function, aspirin, Anysis-200 analyzer, VerifyNow

DOI: 10.3233/CH-200822

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 1, pp. 33-42, 2020

Authors: Meissner, Florian | Plötze, Katrin | Matschke, Klaus | Waldow, Thomas

Article Type: Research Article

Abstract: BACKGROUND: Tranexamic acid (TXA) reduces perioperative bleeding among patients undergoing heart surgery. It is uncertain whether its postoperative administration, after prior administration before cardiopulmonary bypass (CPB), has an additional benefit. OBJECTIVE: Our study aimed to evaluate whether the postoperative administration of TXA reduces the blood loss after heart surgery. METHODS: In a retrospective cohort study at the University Heart Center Dresden, patients who underwent on-pump open-heart surgery and received 1 g TXA before CPB were included. Patients with postoperative administration of 1 g TXA were compared to patients without. Primary endpoint was the postoperative blood loss …within 24 hours. RESULTS: Among 2,179 patients undergoing heart surgery between 1 July 2013 and 31 October 2014, 92 (4.2%) received TXA postoperatively. After matching, 71 patients with postoperative administration of TXA were compared to 71 without (n  = 142). Postoperative administration of TXA did not result in decreased blood loss (MD 146.7 mL; p  = 0.064). There was no evidence of an increased risk for thromboembolic complications. CONCLUSIONS: The postoperative administration of TXA did not reduce blood loss. The use of TXA was shown to be safe in terms of thromboembolic events and hospital mortality. Unless there is no clear evidence, the postoperative administration of TXA should be restricted to patients with massive blood loss and signs of hyperfibrinolysis only. Show more

Keywords: Tranexamic acid, antifibrinolytics, hyperfibrinolysis, blood loss, open-heart surgery, cardiac surgery

DOI: 10.3233/CH-200836

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 1, pp. 43-49, 2020

Authors: Zhang, Xin-Yue | Huang, Zheng | Li, Qing-Jie | Zhong, Guo-Qiang | Meng, Jian-Jun | Wang, Dong-Xiao | Tu, Rong-Hui | Hong-Wen,

Article Type: Research Article

Abstract: BACKGROUND: Myocardial inflammation mediated by toll-like receptor 4 (TLR4) plays an active role in myocardial ischemia/reperfusion (I/R) injury. Studies show that heat shock protein 90 (HSP90) is involved in ischemic postconditioning (IPostC) cardioprotection. This study investigates the roles of TLR4 and HSP90 in IPostC. METHODS: Rats were subjected to 30 min ischemia, then 2 h reperfusion. IPostC was applied by three cycles of 30 s reperfusion, then 30 s reocclusion at reperfusion onset. Sixty rats were randomly divided into four groups: sham, I/R, IPostC, and geldanamycin (GA, HSP90 inhibitor, 1 mg/kg) plus IPostC (IPostC + GA). RESULTS: IPostC significantly reduced I/R-induced infarct size …(40.2±2.1% versus 28.4±2.4%; P  < 0.05); the release of cardiac Troponin T, creatine kinase-MB, and lactate dehydrogenase (191.5±3.1 versus 140.6±3.3 pg/ml, 3394.6±132.7 versus 2880.7±125.5 pg/ml, 2686.2±98.6 versus 1848.8±90.1 pg/ml, respectively; P  < 0.05); and cardiomyocyte apoptosis (40.3±2.2% versus 27.0±1.6%; P  < 0.05). Further, local and circulating IL-1β , IL-6, TNF-α , and ICAM-1 levels decreased; TLR4 expression and nuclear factor-KB (NF-κ B) signaling decreased; and cardiac HSP90 expression increased. Blocking HSP90 function with GA inhibited IPostC protection and anti-inflammation, suggesting that IPostC has a HSP90-dependent anti-inflammatory effect. CONCLUSION: HSP90 may play a role in IPostC-mediated cardioprotection by inhibiting TLR4 activation, local and systemic inflammation, and NF-kB signaling. Show more

Keywords: Heat shock protein 90, ischemic postconditioning, toll-like receptor 4, nuclear factor-KB, inflammation

DOI: 10.3233/CH-200840

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 1, pp. 51-62, 2020

Authors: Zheng, Yi | Xia, Shujun | Ren, Xinping | Zhan, Weiwei | Zheng, Zhan | Chen, Zhijie

Article Type: Research Article

Abstract: PURPOSE: To evaluate the value of spleen shear-wave elastography (sound touch elastography [STE], sound touch quantification [STQ]) in indirect prediction of liver fibrosis in patients with chronic hepatitis B (CHB). METHODS: The Young’s modulus (kPa) of spleen STE, STQ and liver FibroScan were measured in 112 patients with CHB. The final diagnosis was according to histological results from liver biopsy based on Scheure G/S scoring system and liver FibroScan was considered as a reference index of prediction efficiency. Grouped by the stage of liver fibrosis, data were analyzed by Spearman correlation analysis, Mann-Whitney test and receiver operating characteristic …curve (ROC). RESULTS: Spleen STE was positively correlated with the degree of liver fibrosis, but spleen STQ was not. STEmean and STEmax of spleen were statistically different between the groups categorized by S = 2, S = 3 and S = 4 (all p  < 0.05), respectively. Spleen STEmean had the best predicting performance on staging liver fibrosis. The areas under the ROC (AUC) for spleen STEmean were 0.66 (95% confidence interval [CI], 0.56–0.76) for stage S = 2 or higher, 0.72 (95% CI, 0.60–0.83) for S = 3 or higher, 0.83 (95% CI, 0.74–0.92) for S = 4 (all P  < 0.01). The differences between the AUC for spleen STEmean and liver FibroScan in liver fibrosis staging were not statistically significant when the groups categorized by S = 2 and S = 4 (P  = 0.146 and P  = 0.052). But when categorized by S = 3, the evaluating performance of liver FibroScan was better (P  = 0.004). CONCLUSION: STEmean of spleen is applicable in indirect predicting fibrosis stage in patients with CHB. Show more

Keywords: Spleen elastography, shear-wave elastography, transient elastography, chronic hepatitis B, liver fibrosis

DOI: 10.3233/CH-200869

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 1, pp. 63-72, 2020

Authors: Arita, Takeshi | Maruyama, Toru | Yokoyama, Taku | Hieda, Michinari | Fukata, Mitsuhiro | Fujino, Takehiko | Mawatari, Shiro | Akashi, Koichi

Article Type: Research Article

Abstract: BACKGROUND: Disturbed microcirculation is related to diabetic complications, and erythrocyte deformability is a critical factor regulating microcirculation. OBJECTIVES: To know the relationship between the impaired deformability and density profile in diabetic erythrocytes. METHODS: We recruited patients with type 2 diabetes (n  = 15, diabetic group) and age- and sex-matched non-diabetic subjects (n  = 15, control group). Erythrocyte density (ED) profile was obtained by the phthalate ester separation technique. ED distribution was fitted by sigmoidal curve, yielding specific gravity of phthalate ester allowing passage of half erythrocytes population (ED50 ) and slope factor. Erythrocyte deformability was estimated by our …specific filtration technique. RESULTS: Diabetic group showed significantly (p  < 0.001) higher HbA1c and fasting blood glucose concentration. Erythrocyte deformability in diabetic group was impaired as compared with that in control group (p  < 0.001) and proportional to HbA1c (p  = 0.009). However, ED50 and the slope factor in diabetic group did not differ from respective parameters in control group. CONCLUSIONS: This study demonstrated that erythrocyte deformability was impaired in diabetic patients even under treatment. HbA1c up to 7.5% is concluded not to alter the erythrocyte density but to impair the deformability, which might be a warning to clinicians for prevention of diabetic complications. Show more

Keywords: Deformability, density, diabetes, erythrocyte, hemoglobin

DOI: 10.3233/CH-200873

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 1, pp. 73-83, 2020

Authors: Tong, Wenjuan | Zhang, Xiaoling | Luo, Jia | Pan, Fushun | Liang, Jinyu | Huang, Hui | Li, Manying | Cheng, Meiqing | Pan, Jiamin | Zheng, Yanling | Xie, Xiaoyan

Article Type: Research Article

Abstract: PURPOSE: To assess the value of conventional ultrasound (US), contrast-enhanced ultrasound (CEUS) and mammography in the diagnosis of breast lesions with calcifications. METHODS: A total of 87 breast lesions with calcification were subjected to US, CEUS and mammography and divided into 3 groups: Group A (all cases), Group A1 (31 cases who underwent US and CEUS first followed by mammography), and Group A2 (56 cases who underwent mammography first followed by US and CEUS). A receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic efficacy of different methods in different groups. RESULTS: In …Group A, the area under the ROC curve (AUROC) of CEUS were 0.937, which were significantly higher than that of mammography (p  < 0.05). In Group A1, the AUROC of CEUS were 0.842, which were not significantly different from that of US and mammography (p  > 0.05). In Group A2, the AUROC of CEUS were 0.987, which were significantly higher than that of mammography and US (p  < 0.05). CONCLUSION: Based on the mammography results, the combination of US and CEUS might improve the diagnostic efficacy in breast lesions with calcification. Show more

Keywords: Breast, ultrasonography, mammography, diagnosis

DOI: 10.3233/CH-200877

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 1, pp. 85-98, 2020

Authors: Sun, Xiaoying | Kuang, Bin | Dai, Yan | Xiong, Chao | Li, Mingxing | Luo, Zhijian

Article Type: Research Article

Abstract: BACKGROUND: Renal ischemia-reperfusion (I/R) injury often occurs in various clinical events, and its incidence and mortality have been increasing. OBJECTIVE: To investigate the value of contrast enhanced ultrasonography (CEUS) in the monitoring of dexamethasone in the improvement of renal I/R injury in rats. METHODS: Eighteen healthy male Sprague-Dawley rats were randomly divided into sham-operated, I/R, and I/R surgery plus dexamethasone treatment (Dexa) groups. In the I/R group 45-minute renal ischemia with 24 h reperfusion period was monitored. Time-intensity curve (TIC)-derived parameters, which included peak value, time to peak (TP), area under the curve (AUC), and mean transit …time (MTT) were compared to the blood creatinine, urea, Caspase-1, and NLRP3 levels. RESULTS: The I/R group showed an increased peak value, prolonged TP and MTT, and greater AUC (P  < 0.05). The Dexa group showed shorter TP and MTT, and smaller AUC (P  < 0.05). Results show that the associations between (i) TP, AUC, and MTT and (ii) creatinine, urea, Caspase-1, and NLRP3 levels were significant (P  < 0.05). CONCLUSION: Dexamethasone can alleviate renal I/R injury in rats, which may be related to the inhibition of NLRP3 and caspase-1. CEUS can quantitatively measure this change, in which the changes in TP, AUC and MMT values have considerable reference values. Show more

Keywords: Kidney, renal ischemia-reperfusion injury, dexamethasone, time-intensity curve, NLRP3, Caspase-1

DOI: 10.3233/CH-200842

Citation: Clinical Hemorheology and Microcirculation, vol. 76, no. 1, pp. 99-110, 2020