Clinical Hemorheology and Microcirculation - Volume 77, issue 1

Authors: Brettner, Florian | Heitzer, Markus | Thiele, Friederike | Hulde, Nikolai | Nussbaum, Claudia | Achatz, Stefan | Jacob, Matthias | Becker, Bernhard F. | Conzen, Peter | Kilger, Erich | Chappell, Daniel

Article Type: Research Article

Abstract: BACKGROUND: Hypotension and bradycardia are known side effects of general anesthesia, while little is known about further macro- and microhemodynamic changes during induction. Intriguing is furthermore, why some patients require no vasopressor medication to uphold mean arterial pressure, while others need vasopressor support. OBJECTIVE: Determination of macro- and microhemodynamic changes during induction of general anesthesia. METHODS: We enrolled 150 female adults scheduled for gynaecological surgery into this prospective observational, single-blinded trial. Besides routinely measuring heart rate (HR) and mean arterial blood pressure (MAP), the non-invasive technique of thoracic electrical bioimpedance was applied to measure cardiac output …(CO), cardiac index (CI), stroke volume (SV), stroke volume variability (SVV) and index of myocardial contractility (ICON) before induction of anesthesia, 7 times during induction, and, finally, after surgery in the recovery room. Changes in microcirculation were assessed using sidestream dark field imaging to establish the perfused boundary region (PBR), a validated gauge of glycocalyx health. Comparisons were made with Friedman’s or Wilcoxon test for paired data, and with Mann-Whitney-U test for unpaired data, with post-hoc corrections for multiple measurements by the Holm-Bonferroni method. RESULTS: 83 patients did not need vasopressor support, whereas 67 patients required therapy (norepinephrine, atropine or cafedrine/theodrenaline) to elevate MAP values to ≥70mmHg during induction, 54 of these receiving norepinephrine (NE) alone. Pre-interventional (basal) values of CO, CI, ICON, SV and SVV were all significantly lower in the group of patients later requiring NE (p  < 0.04), whereas HR and MAP were identical for both groups. HR, MAP and CO decreased from baseline to 12 min after induction of general anesthesia in both the patients without and those with NE support. Heart rate decreased significantly by about 25% in both groups (–19 to –21 bpm). The median individual decrease of MAP amounted to –26.7% (19.7/33.3, p  < 0.001) and –26.1% (11.6/33.2, p  < 0.001), respectively, whereas for CO it was –40.7% (34.1/50.1, p  < 0.001) and –43.5% (34.8/48.7). While these relative changes did not differ between the two groups, in absolute values there were significantly greater decreases in CO, CI, SV and ICON in the group requiring NE. Noteably, NE did not restore ICON or the other cardiac parameters to levels approaching those of the group without NE. PBR was measured in a total of 84 patients compiled from both groups, there being no intergroup differences. It increased 6.4% (p  < 0.001) from pre-induction to the end of the operation, indicative of damage to microvascular glycocalyx. CONCLUSION: Non-invasive determination of CO provides additional hemodynamic information during anesthesia, showing that induction results in a significant decrease not only of MAP but also of CO and other cardiac factors at all timepoints compared to baseline values. The decrease of CO was greater than that of MAP and, in contrast to MAP, did not respond to NE. There was also no sign of a positive inotropic effect of NE in this situation. Support of MAP by NE must consequently result from an increase in peripheral arterial resistance, posing a risk for oxygen supply to tissue. In addition, general anesthesia and the operative stimulus lead to an impairment of the microcirculation. Show more

Keywords: Blood pressure, cardiac output, general anesthesia, heart rate, microcirculation

DOI: 10.3233/CH-190691

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 1, pp. 1-16, 2021

Authors: Loibl, Csaba | Rozanovic, Martin | Bogár, Lajos | Pankaczi, Andrea | Kovács, Patrícia | Miseta, Attila | Molnár, Tihamér | Csontos, Csaba

Article Type: Research Article

Abstract: BACKGROUND: Major burn injury causes massive tissue destruction consequently enhanced platelet function and leukocyte-mediated inflammatory response. METHODS: In a prospective, observational study 23 consecutive patients with more than 20% body surface burn injury were followed for five days (T1–T5) after admission to a university intensive care (ICU). Platelet and leukocyte antisedimentation rate (PAR and LAR) was measured by one-hour gravity sedimentation. It detects the percentage of total platelet and leukocyte number crossed the half line of blood sample column, therefore, they can be regarded as cells of decreased specific gravity. We aimed to investigate the time course of …PAR and LAR after burn injury, as the trend of platelet and the leukocyte activation in the early post-burn period. RESULTS: Daily mean PAR and LAR values continuously increased in the observation period (T1 to T5). Daily mean PAR and LAR were lower in ICU non-survivors (n  = 7) compared to survivors (n  = 16) between T2 and T4 (p  < 0.05 and p  < 0.01). PAR values of septic patients (n  = 10) were lower than that of non-septic ones (n  = 13, p  < 0.01 at T5). CONCLUSIONS: Both PAR and LAR, as novel bedside test can predict septic complications and unfavorable outcome after major burn injury. Further studies with higher sample size are warranted. Show more

Keywords: Platelet activation, leukocyte activation, burns, sepsis after burns

DOI: 10.3233/CH-190779

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 1, pp. 17-26, 2021

Authors: Kükrek, Haydar | Aitzetmüller, Matthias | Vodiškar, Mateja | Moog, Philipp | Machens, Hans-Günther | Duscher, Dominik

Article Type: Research Article

Abstract: INTRODUCTION: Adipose derived Stem Cells (ASCs) have been proven to play a key role in tissue regeneration. However, exposure to large amounts of cigarette smoke can drastically diminish their function. Erythropoetin (EPO), can modulate cellular response to injury. Therefore, we investigated the ability of EPO to restore the regenerative function and differentiation capacity of ASCs. MATERIAL AND METHODS: Human ASCs were isolated from abdominoplasty samples using standard isolation procedures. Cell identity was established by means of Fluorescence Activated Cell Scanning. Subsequently, isolated ASCs were cultivated with cigarette smoke extract both with and without EPO. Parameters investigated included cellular …metabolic activity, adipogenic and osteogenic differentiation capacity, and in vitro wound closure capacity. For further enhancing wound closure, EPO was combined with Granulocyte Macrophage Colony Stimulating Factor (GM-CSF) or Stromal Derived Factor-1 alpha (SDF-1 a). RESULTS: Cigarette smoke reduces adipogenic differentiation, the osteogenic differentiation capacity as well as the in vitro wound healing ability of human derived ASCs. EPO did not change metabolic activity of ASCs significantly. The addition of EPO could partially restore their function. The combination of EPO with GM-CSF or SDF-1 did not result in a synergistic effect regarding wound healing ability. CONCLUSION: Exposure to cigarette smoke significantly reduced the regenerative potential of ASCs. Treatment of ASCs exposed to cigarette smoke with EPO has the potential to partially restore their function. Show more

Keywords: Mesenchymal stem cells, erythropoietin, cigarette smoke extract, wound healing, ASC

DOI: 10.3233/CH-200852

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 1, pp. 27-36, 2021

Authors: Wu, Yongjuan | Cheng, Guangyuan | Chen, Hui | Wang, Jingzhong | Wang, Jiangtao | Wang, Wanbi

Article Type: Research Article

Abstract: OBJECTIVE: IL-17 is considered to be a cancer-promoting gene in hepatocellular carcinoma (HCC). Here, we explored the effect of IL-17 in predicting the therapeutic effect of transcatheter arterial chemoembolization (TACE) combined with apartinib in patients with HCC in this study. METHODS: Established of IL-17 knockdown SK-Hep1 cells for studying the effects of IL-17 expression on the invasion and migration of human HCC cells in vitro by transwell assay and tumor angiogenesis in nude mouse. Immunohistochemistry was used to detect the expression of IL-17, E-cadherin, Vimentin and CD34 protein in 175 cases of human HCC tumor tissues. Kaplan-Meier …was used to analyze the prognostic significance of TACE combined with apatinib treatment in HCC patients. RESULTS: n SK-Hep1 cells, IL-17 knockdown could increase E-cadherin protein expression, reduce vimentin protein expression, inhibit cell invasion and migration in vitro , and inhibit angiogenesis of tumor and decrease plasma VEGF level in nude mouse. In tumor tissues of HCC patients, IL-17 protein expression was negatively correlated with E-cadherin protein expression (r  = –0.622, P  < 0.001), positively correlated with Vimentin protein expression (r  = 0.540, P  < 0.001), and was positively correlated with MVD of HCC tumor tissues (r  = 0.564, P  < 0.001). Compared with adjuvant TACE alone, patients with low-expression of IL-17 treated combined with apatinib have a higher 5-year overall survival. However, additional apatinib treatment did not significantly improve 5-year overall survival in HCC patients with high IL-17 expression. CONCLUSION: IL-17 had a pivotal role in the invasion and angiogenesis of HCC and contribute to the selection of patients who may benefit from adjuvant TACE combined with apatinib. Show more

Keywords: IL-17, transcatheter arterial chemoembolization, hepatocellular carcinoma, overall survival

DOI: 10.3233/CH-200857

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 1, pp. 37-47, 2021

Authors: Fu, Tiantian | Ding, Hong | Xu, Chen | Zhu, Yuli | Xue, Liyun | Lin, Feng

Article Type: Research Article

Abstract: BACKGROUND: Fibrolamellar hepatocellular carcinoma (FLHCC) is an unusual variant of hepatocellular carcinoma (HCC). Revealing the imaging features is important to the diagnosis of FLHCC. OBJECTIVE: The aim of this study was to investigate the imaging characteristics of FLHCCs. METHODS: This retrospective study included 29 patients with histopathologically proved FLHCC and 96 patients proved HCC. All patients underwent an ultrasound examination pre-operation. RESULTS: The average maximum diameters of the FLHCC and HCC lesions were 7.4±4.1 cm and 4.1±3.0 cm, respectively. On the ultrasound, 79.3% of the FLHCCs and 12.3% of the HCCs showed the internal hyperechoic area; …48.3% of the FLHCCs and 3.3% of the HCCs displayed a strip-like attenuation. Calcification was noted in 20.7% of the FLHCCs, while none in HCCs. On the contrast-enhanced ultrasound (CEUS), all FLHCC lesions and 87.7% of the HCCs displayed hyperenhancement in the arterial phase. An internal, unenhanced central scar appeared in all FLHCCs, while none in HCCs. CONCLUSIONS: The ultrasonographic features of FLHCC lesions indicate that they are relatively large masses showing the internal hyperechoic area or strip-like attenuation or calcification on the US and hypervascularity with an unenhanced central scar on the CEUS as compared with conventional HCC lesions. Show more

Keywords: Carcinoma, hepatocellular, contrast media, ultrasonography, diagnosis

DOI: 10.3233/CH-200896

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 1, pp. 49-60, 2021

Authors: Xian, Meng-Fei | Pan, Kang-Ming | Zhang, Jian-Chao | Cheng, Mei-Qing | Huang, Hui | Chen, Li-Da | Zhao, Zhen-Xian | Wang, Wei

Article Type: Research Article

Abstract: Tumor-induced osteomalacia (TIO) is a vanishingly rare paraneoplastic syndrome which is usually caused by phosphaturic mesenchymal tumors (PMTs). The conventional treatment for PMTs is total resection, and ultrasound-guided radiofrequency ablation (RFA) can also be used for the treatment of PMTs patients, especially for patients in whom complete resection may lead to serious complications. We report two cases with PMT who presented syndrome with progressive musculoskeletal complaints and performed ultrasound-guided biopsy and RFA. Ultrasound-guided RFA, which is a safe and effective minimally invasive treatment option, appears to be a valuable alternative to surgery for patients presenting with PMT. We are the …first reported case of RFA guided by ultrasonography in the treatment of PMT. Show more

Keywords: Tumor-induced osteomalacia, oncogenic osteomalacia, phosphaturic mesenchymal tumor, radiofrequency ablation, ultrasound

DOI: 10.3233/CH-200921

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 1, pp. 61-69, 2021

Authors: Kanda, Hideaki | Yamakuchi, Munekazu | Matsumoto, Kazuhisa | Mukaihara, Kosuke | Shigehisa, Yoshiya | Tachioka, Shuji | Okawa, Masashi | Takenouchi, Kazunori | Oyama, Yoko | Hashiguchi, Teruto | Imoto, Yutaka

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: Turbulent blood flow in patients with aortic valve stenosis (AS) results in morphological and functional changes in platelets and coagulation factors. The aim of this study is to determine how shear stress affects platelets and coagulation factors. METHODS: We retrospectively evaluated data from 78 patients who underwent AVR to treat AS between March 2008 and July 2017 at Kagoshima University Hospital. RESULTS: Platelet (PLT) count obviously decreased at three days after AVR, and increased above preoperative levels at the time of discharge. In contrast, platelet distribution width (PDW), mean platelet volume (MPV), and …platelet large cell ratio (P-LCR) increased three days after AVR, then decreased to below preoperative levels. No differences were evident between groups with higher (HPPG > 100 mmHg) and lower (LPPG < 100 mmHg) peak pressure gradients (PPG) before AVR, whereas PLT count, PDW, MPV and P-LCR improved more in the HPPG group. Plateletcrit (PCT), which represents the total volume of platelets, increased after AVR due to decreased shear stress. High increasing rate of PCT was associated with lower PLT count, higher PDW and lower fibrinogen. CONCLUSION: Shear stress affects PLT count, PDW, and fibrinogen in patients with AS. Show more

Keywords: Aortic valve stenosis, platelet, plateletcrit, shear stress, pressure gradient

DOI: 10.3233/CH-200928

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 1, pp. 71-81, 2021

Authors: Tian, Bing | Li, Wenzheng | Wu, Zheng | Gong, Minglian | Liu, Jinghua

Article Type: Research Article

Abstract: OBJECTIVE: This study applied pressure measurement to measure the hemodynamic changes in right coronary artery (RCA) donor vessels before and after the opening of the vessel in patients with left anterior descending chronic total occlusion (LAD-CTO) interventional therapy. METHODS: A total of 45 patients with LAD-CTO were divided into two groups of percutaneous coronary intervention (PCI) to observe the hemodynamic changes (fractional flow reserve [FFR] and instantaneous wave-free ratio [iFR]) before and after opening the chronic total occlusion (CTO), in order to provide collateral circulating donor vessels to the CTO, and observe the changes in iFR and FFR. …The results of these two measures were compared to determine the significance of the donor vascular function. RESULTS: A total of 45 patients with LAD-CTO successfully underwent LAD-CTO interventional therapy, and were immediately measured for FFR and iFR of the donor vessels. The FFR changes before right coronary artery flow reserve (RCAFR) was 0.73±0.083, and after the operation, this was 0.77±0.073. The iFR changes before RCAFR was 0.90±0.048, and after the operation, this was 0.93±0.034. Before and after the opening of the RCA, the FFR change (Δ FFR) and iFR change (Δ iFR) were also correlated with r  = 0.033 (0.041–0.568: P  < 0.05). A total of 19 cases had a FFR value of <0.75 before the operation, and the average FFR before and after the PCI was 0.65±0.048 and 0.72±0.057, respectively. Furthermore, the Δ FFR was 0.076±0.057 (n  = 19), and FFR was >0.75 in 26 cases. The Δ FFR was 0.017±0.0088 (n  = 26). These two groups were compared, P  = 0.0032 (P  < 0.05). CONCLUSION: The FFR and iFR results were the same in terms of RCA hemodynamic changes, after the LAD-CTO was opened. For the RCA with a preoperative FFR of <0.75, the increase in RCAFR after LAD-CTO PCI was more obvious. Show more

Keywords: Coronary artery diseas, coronary blood flow, CTO, fractional flow reserve, percutaneous coronary intervention

DOI: 10.3233/CH-200885

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 1, pp. 83-89, 2021

Authors: Yang, Juesheng | Hu, Shan | Huang, Li | Zhou, Jianliang | Xiang, Haiyan | Yang, Heng | Cheng, Hongzhang | Tang, Yanhua

Article Type: Research Article

Abstract: BACKGROUND: Transient receptor potential channel 7 (TRPM7) plays an important role in maintaining intracellular ion concentration and osmotic pressure. OBJECTIVE: The purpose of this study was to investigate the role and mechanism of inhibiting the expression of TRPM7 in the treatment of distal myocardial ischemia. METHODS: H9C2 cells were treated with hypoxia post-treatment and reperfusion, respectively, detect the expression of HIF-1α and TRPM7, the concentration of Ca2+ and the degree of apoptosis in the H9C2 cells. The relevant miRNAs targeting TRPM7 were searched, the TRPM7 interference vectors were constructed, and the interference of different …interference vectors on TRPM7 in H9C2 cells was detected. RESULTS: The results showed that hypoxia post-treatment treatment would lead to increased expression of miR-22-3p which directly targeting TRPM7, decreased expression of TRPM7, increased expression of HIF-α and increased intracellular Ca2+ concentration. While reperfusion can increase the expression of HIF-1α and TRPM7 in H9C2 cells and increase the degree of apoptosis. CONCLUSION: Knockdown of TRPM7 can significantly reduce reperfusion injury in H9C2 cells, reduce the degree of apoptosis, and the TRPM7 interference vector can inhibit the expression of TRPM7 and have a certain protective effect on the reperfusion injury of H9C2 cells. Show more

Keywords: TRPM7, hypoxia post-treatment, protective effect, H9C2 cardiomyocytes

DOI: 10.3233/CH-200934

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 1, pp. 91-105, 2021

Authors: Zhang, Hong-jun | Zheng, Bo-wen | Gu, Shi-jie | Wu, Tao | Wu, Li-li | Lian, Yu-fan | Tong, Ge | Yi, Shu-hong | Ren, Jie

Article Type: Research Article

Abstract: BACKGROUND: Broad hemodynamic changes, is believed to have a profoundly damaging effect on donor livers after brain death (DBD) or cardiac death (DCD). It remains unclear whether Doppler ultrasonography (DUS) and contrast-enhanced ultrasonography (CEUS), the imaging modalities to evaluate perfusion, could provide more information of liver discarded. OBJECTIVE: To evaluate the ability of DUS and CEUS to predict the risk of DBD or DCD liver discarded. METHODS: The consecutive DBD or DCD donors with DUS/CEUS examinations before surgical procurement from February 2016 to June 2018 at our institution were included. The US and CEUS images of …each donor liver were analyzed and the parameters were recorded. RESULTS: Among the 67 eligible donor livers, 15 (22.4%) were discarded and 52 (77.6%) were used. The discarded livers showed prolonged SAT of hepatic artery (0.08s vs 0.06s, OR = 2.169, P  = 0.008) on DUS, less cases with homogeneous enhancement (40.0% vs 73.1%, OR = 0.243, P  = 0.028) on CEUS, more cases with decreased enhancement (53.3% vs 19.2%, OR = 4.800, P = 0.009), and less difference of the peak time between portal vein and liver parenchymal (0.5s vs 6.7s, OR = 0.917, P = 0.034). The multivariable analysis showed that donor liver with prolonged SAT of hepatic artery (OR = 7.304, 95% CI: 1.195–44.655, P  = 0.031) and decreased enhancement (OR = 2.588, 95% CI: 1.234–5.426, P  = 0.012) were independent factors of liver discarded. CONCLUSIONS: DUS/CEUS could be applied as a promising predictive tool to screen high-risk liver donors. The prolonged SAT of hepatic artery on DUS and the decrease of liver donor in enhancement on CEUS, indicating hemodynamic changes in DBD and DCD donor livers, were risk factors of liver discarded. Show more

Keywords: Ultrasonography, Doppler, liver transplantation, tissue and organ procurement, donor selection

DOI: 10.3233/CH-200950

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 1, pp. 107-114, 2021