Clinical Hemorheology and Microcirculation - Volume 77, issue 3

Authors: Jung, Friedrich | Connes, Philippe | Lehmann, Christian

Article Type: Editorial

DOI: 10.3233/CH-219001

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 3, pp. 245-246, 2021

Authors: Jung, Ernst | Hösl, Vanessa | von Fraunberg, Sarah | Jung, Friedrich | Prantl, Lukas

Article Type: Research Article

Abstract: BACKGROUND: Capsular contractures around breast implants usually develop leading to pain and aesthetically inadequate results and ultimately often requires the replacement of the implants. Textured silicone implants are the most commonly placed implant, but polyurethane-coated implants are increasingly being used in an attempt to ameliorate the long-term complications associated with implant insertion. AIM: Capsular contracture is traditionally classified using the Baker scale, a subjective classification system based upon clinical findings. Aim of this study was to evaluate the association between pain due capsular contraction, Baker score and different techniques of US elastography. MATERIAL AND METHODS: Patients …were contacted who had undergone an implant replacement due to capsular contracture. Inclusion criterion was the re-implantation of a PU-coated implant. In the third year after changing the implant a follow-up examination was performed in 16 patients with 23 implants. A conventional examination with anamnesis, tactile and visual findings to obtain a Baker score, and ultrasound examinations including shear wave elastography, ARFI and compound elastography were performed. In addition, pain was evaluated using a visual analogue scale (VAS). RESULTS: The pain data showed a significant improvement (before implant exchange: 4.1±2.8 score points) with significance in favor of the current state (1.7±1.0 pain score points; p  = 0.002). All patients suffered from less or no pain three years after exchange of the implant. Pain values and elastography (ARFI values) correlated well (r  = 0,873), with increasing Baker score the ARFI values increased. US elastography evaluations can locally determine tissue density but correlate only to a limited extent with the test findings according to Baker. US elastography values of mammary gland tissue without implant did not differ from mammary gland tissue around implants. CONCLUSION: Preoperative Baker scores prior to exchange and the current Baker scores at the follow-up showed significantly lower score points three years after exchange of the implants. Ultrasound elastography seems to be an objective classification of capsular fibrosis. These first results motivate to initiate a prospective multicenter investigation. Show more

Keywords: Capsular fibrosis, ultrasound examinations, elastography, ARFI, Baker score

DOI: 10.3233/CH-200875

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 3, pp. 247-257, 2021

Authors: Chen, Ji-Xiong | Huang, Xiao-Yan | Wang, Ping | Lin, Wen-Ting | Xu, Wen-Xing | Zeng, Min

Article Type: Research Article

Abstract: This study aimed to investigate the effects of arachidonic acid metabolite epoxyeicosatrienoic acid (EETs) in the apoptosis of endothelial cells induced by tumor necrosis factor-alpha (TNF-α ). After human umbilical vein endothelial cells were cultured, TNF-α /ActD, 14, 15-EET, and HMR-1098 were added, respectively, into the culture medium. The apoptosis level of endothelial cells was detected by flow cytometry. After TNF-α /ActD induced endothelial cell apoptosis, flow cytometry staining showed that endothelial cell apoptosis increased significantly, and the apoptotic cells were significantly reduced after the addition of 14, 15-EET. However, the apoptotic cells significantly increased after the addition of HMR-1098. …Western Blot results showed that the phosphorylation levels of LC3-II and AMPK were increased after TNF-α /ActD induction, and the increase was noticeable after the addition of 14, 15-EET. However, the phosphorylation levels of LC3-II and AMPK significantly decreased after the addition of HMR-1098. The activity of Caspase-8 and -9 decreased significantly after the addition of 14, 15-EET but increased after the addition of HMR-1098. Arachidonic acid can inhibit TNF-α induced endothelial cell apoptosis by upregulating autophagy. Show more

Keywords: Epoxyeicosatrienoic acid, autophagy, apoptosis, endothelial cell, TNF-α

DOI: 10.3233/CH-200946

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 3, pp. 259-265, 2021

Authors: Joly, Philippe | Bonello-Palot, Nathalie | Badens, Catherine | Pissard, Serge | Chamouine, Abdourahim | Bernaudin, Françoise | Bertrand, Yves | Connes, Philippe | Renoux, Céline

Article Type: Research Article

Abstract: Sickle cell anemia (SCA) is a disease characterized by abnormal red blood cell rheology. Because of their effects on HbS polymerization and red blood cell deformability, alpha-thalassemia and the residual HbF level are known genetic modifiers of the disease. The aim of our study was to determine if the number of HbF quantitative trait loci (QTL) would also favor a specific sub-phenotype of SCA as it is the case for alpha-thalassemia. Our results confirmed that alpha-thalassemia protected from cerebral vasculopathy but increased the risk for frequent painful vaso-occlusive crises. We also showed that more HbF-QTL may provide an additional and …specific protection against cerebral vasculopathy but only for children with alpha-thalassemia (-α /α α or -α /-α genotypes). Show more

Keywords: SCA, HbF quantitative trait loci, XmnI, BCL11A, HBS1L-MYB, cerebral vasculopathy, alpha-globin genotype

DOI: 10.3233/CH-200951

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 3, pp. 267-272, 2021

Authors: Zhou, Ya-Fang | Zhang, Yi-Feng | Fu, Hui-Jun | Yang, Wei-Ping | Zhao, Chong-Ke | Xu, Hui-Xiong

Article Type: Research Article

Abstract: PURPOSE: To propose a diagnostic algorithm for improving the diagnosis of atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) thyroid nodules. METHODS: This study retrospectively enrolled 77 consecutive patients with 81 AUS/FLUS nodules who underwent preoperative BRAFV600E mutation analysis. A new diagnostic algorithm was proposed that BRAFV600E mutation analysis for the Fine-needle aspiration cytology specimen was firstly carried out, in which positive BRAFV600E mutation indicated malignancy and classification of the nodules with negative BRAFV600E mutation was further performed based on ultrasound pattern-based risk stratification of American Thyroid Association Guidelines. The diagnostic …performance of the new diagnostic algorithm was evaluated. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the receiver operating characteristic curve (AUROC) of new diagnostic algorithm were 94.6%, 84.0%, 91.4%, 86.9%, 90.1%, and 0.893, respectively. The proposed diagnostic algorithm significantly increased the diagnostic performances (AUROC: 0.893 vs. 0.837 and 0.795), sensitivity (94.6% vs. 71.4% and 75.0%), and accuracy (90.1% vs. 79.0% and 77.8%) compared with BRAFV600E mutation analysis alone and ultrasound pattern-based risk stratification alone (all P  < 0.05). CONCLUSION: The proposed diagnostic algorithm is helpful for improving the diagnosis of AUS/FLUS nodules, which might be as a routine approach. Show more

Keywords: Thyroid nodules, fine-needle aspiration cytology, AUS/FLUS nodule, BRAF, V600E analysis, ultrasound pattern-based risk stratification

DOI: 10.3233/CH-200985

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 3, pp. 273-285, 2021

Authors: Liu, Qin | Wang, Zhengrong

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate the diagnostic value of real-time shear wave elastography (SWE) in children with chronic kidney disease (CKD). METHODS: Children with CKD diagnosed by the ultrasound-guided biopsy between January 2018 and May 2019 were enrolled as the case group. Age- and sex- matched healthy children were selected as the control group. The Young’s Modulus (YM) of the renal cortex was measured by SWE after the traditional ultrasound examination. Variance analysis was performed to compare the values of YM between the two groups. Receiver operating characteristic curve (ROC) analysis was used to compare the values of YM, and …explore the cut-offs of the YM. RESULTS: In the case group (n  = 60, 45% male, mean age of 9.2 years), the kidney YM modulus on the left side (16.8±4.8 kPa vs. 8.3±2.1 kPa) and the right side (16.0±4.7 kPa vs. 8.3±2.4 kPa) were both higher than the control group (all P values < 0.001). With the progress of CKD, the YM value of the left and right kidneys gradually increased. ROC analysis showed that when the left and right kidney YM value was 11.7 kPa and 11.0 kPa, the diagnostic sensitivity and specificity were the highest (left: respectively 93.3% and 95.0%; right: respectively 93.3 % and 91.7%). CONCLUSION: The increase of YM in CKD is related to the progression of renal dysfunction which may provide a new method for early diagnosis of CKD, dynamic monitoring of disease progression, and evaluation of curative effect and prognosis. Show more

Keywords: Shear wave elastography, chronic kidney disease, children

DOI: 10.3233/CH-200982

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 3, pp. 287-293, 2021

Authors: Lu, Dian Yuan | Liu, Lan | Shen, Li | Cai, Jian Rong | Xu, Li | Xiang, Li Hua

Article Type: Research Article

Abstract: OBJECTIVE: To investigate prostate cancer detection rate of different biopsy protocols in different PSA value groups in rural China. METHODS: A total of 186 patients underwent contrast-enhanced ultrasound (CEUS) in order to determine the puncture target prior to biopsy were enrolled in this retrospective study. All patients underwent 12-core SB combined with CEUS-TB. The biopsy results of different biopsy protocols were compared in patients with stratification by PSA value. RESULTS: Among the 186 patients underwent prostate biopsy, the histopathologic results revealed prostate cancer (PCa) in 117 cases (62.9%) and benign lesions in 69 cases (37.1%). The …PCa detection rate between 8-core SB and 12-core SB showed no significant difference in PSA 4–10 ng/ml group, while the 12-core SB was significantly higher than CEUS-TB (44.9% versus 32.7%, P  = 0.01). In PSA 10–20 ng/ml group, the significant difference was not seen between SB and CEUS-TB (50.0% versus 45.7%, P  = 0.15). As for PSA greater than 20 ng/ml group, the PCa detection rate by SB was higher than CEUS-TB, but showed no statistically significance (79.1% versus 76.9%, P  = 0.15). In the overall patients, the biopsy core positive rate of CEUS-TB was significantly higher than SB (97% versus 55.5% and 28.5%, P  = 0.0001). CONCLUSION: The flexible use of SB combined with CEUS-TB can reduce the number of biopsy cores in higher PSA groups. It has clinical importance in the detection of PCa in different PSA value groups in rural China. Show more

Keywords: PSA value, contrast-enhanced ultrasound, systematic biopsy, CEUS-targeted biopsy, prostate cancer

DOI: 10.3233/CH-200993

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 3, pp. 295-301, 2021

Authors: Jung, Ernst Michael | Engel, Martin | Wiggermann, Philipp | Schicho, Andreas | Lerchbaumer, Markus | Stroszczynski, Christian | Fischer, Thomas | Wiesinger, Isabel

Article Type: Research Article

Abstract: AIM: The aim of this study was to assess the success of irreversible electroporation (IRE) in prostate cancer and to differentiate between reactive changes and tumor. MATERIAL AND METHODS: This is a retrospective pilot study of 50 patients after irreversible electroporation (IRE) in prostate cancer between 50–79 years (mean age 65 years). Each patient received a transabdominal sonography using a 1–6 MHz convex matrix probe. Contrast-enhanced ultrasound (CEUS) was performed after i.v. bolus injection of 2.0 ml sulphur hexafluoride microbubbles. DICOM loops were continuously stored up to one minute. Parametric images were calculated by integrated perfusion analysis software. A …comparison was drawn to a follow-up MRI six months after ablation. RESULTS: While 13 patients showed local recurrence, 37 patients were successfully treated, meaning no local recurrence within six months after ablation. 18 patients showed signs of prostatitis after IRE. Tumorous changes were visually characterized by dynamic early nodular hypervascularization with fast and high wash-in. Correspondingly, nodular red and yellow shades were seen in parametric imaging. All patients with remaining tumor were correctly identified with CEUS and parametric imaging. After IRE there is a relevant decrease in tumor microcirculation in all patients, as seen in more purple shades of the prostate. The sensitivity for detecting residual tumor with CEUS compared to MRI was 76%, the specificity was 81%. The corresponding positive predictive value (PPV) was 73% and the negative predictive value (NPV) was 83%. CONCLUSION: CEUS and parametric imaging enable a critical analysis of post-ablation defects after IRE for prostate cancer even with a transabdominal approach. Remaining tumor can be detected with the help of pseudo-colors. Show more

Keywords: Parametric imaging, CEUS, prostate cancer, IRE

DOI: 10.3233/CH-201000

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 3, pp. 303-310, 2021

Authors: Alzoughool, Foad | Alanagreh, Lo’ai | Abumweis, Suhad | Atoum, Manar

Article Type: Research Article

Abstract: The emerging coronavirus disease (COVID-19) swept the world, affecting more than 200 countries and territories. As of August 22, 2020, the pandemic infected more than 23,329,752 including 807,054 patients who have died. Although the main clinical features of the pandemic disease are respiratory, cerebrovascular comorbidities emerged as one of the leading causes of death associated with COVID-19. Different case reports have indicated that C-reactive protein (CRP) and D-dimer (pro-inflammatory biomarkers) were elevated in COVID-19 patients, which can significantly increase the risk of ischemic stroke. Available data on cerebrovascular complications in COVID-19 patients were collected and a meta-analysis was designed and …carried out to evaluate the risk of severity and mortality associated with high levels of CRP and D-dimer levels in COVID-19 patients. In addition, we aimed to describe the overall event rate of pre-existing cerebrovascular disease in COVID-19 patients. In our analysis, 5,614 cases have been studied, out of these patients 164 cases have developed cerebrovascular comorbities. Cerebrovascular comorbidity increased the risk of disease severity (odd ratio = 4.4; 95% CI: 1.48 to 12.84) and mortality (odd ratio = 7.0; 95% CI: 2.56 to 18.99). Statistical analyses showed that CRP and D-dimer serum levels were elevated by six-folds in the severe cases of COVID-19 patients. This significant increase in these two proteins levels can serve as a vital indicator for COVID-19 patients who are at increased risk of severe COVID-19 cerebrovascular complications, such as stroke. Show more

Keywords: Cerebrovascular disease, COVID-19, stroke, C-reactive protein, D-dimer

DOI: 10.3233/CH-201002

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 3, pp. 311-322, 2021

Authors: Zuo, Dan | Feng, Yi | Zhang, Qi | Qiu, Yi-Jie | Tian, Xiao-Fan | Shi, Shuai-Nan | Dong, Yi | Liu, Tian-Shu | Wang, Wen-Ping

Article Type: Research Article

Abstract: PURPOSE: To evaluate the feasibility of dynamic contrast enhanced ultrasound (DCE-US) in predicting treatment response of high-intensity focused ultrasound (HIFU) in patients with locally advanced pancreatic cancer (LAPC) lesions. PATIENTS AND METHODS: In this prospective study, 10 patients with pathologically confirmed LAPC lesions (7 men, 3 women; average age, 61.13±5.80 years) were prospectively enrolled. All patients received HIFU treatment with peak intensity at 12000 W/cm2 . Contrast enhanced ultrasound (CEUS) was performed with an ACUSON Oxana 2 ultrasound equipment and a 6 C-1 transducer (1–6 Hz). A dose of 2.4 ml SonoVue was injected for each examination. Time intensity curves (TICs) …were generated and quantitative analyses were performed by SonoLiver software. B mode ultrasound (BMUS) features, CEUS enhancement patterns, TICs, CEUS quantitative parameters and serum carcinoma antigen 19-9 (CA19-9) levels were compared before and 4 weeks after HIFU treatment. Statistical analyses were performed with SPSS Version 20.0 and GraphPad Prism 5. RESULTS: While comparing before and after HIFU, no significant difference was obtained on mean size of lesion, BMUS or CEUS features. After HIFU treatment, TICs showed decreased and delayed enhancement. Among all CEUS quantitative parameters, significant decrease could be found in maximum intensity (MI) (60.66±23.95% vs 41.31±26.74%) and mean transit time (mTT) (76.66±47.61 s vs 38.42±28.35 s). CA19-9 level decreased significantly after HIFU (2747.92±4237.41 U/ml vs 715.08±1773.90 U/ml) (P  = 0.05). CONCLUSION: DCE-US combining with quantitative analysis might be a useful imaging method for early treatment response evaluation of HIFU in LAPC lesions. Show more

Keywords: Dynamic contrast enhanced ultrasound (DCE-US), locally advanced pancreatic cancer (LAPC), high-intensity focused ultrasound (HIFU), therapeutic response, blood perfusion

DOI: 10.3233/CH-201020

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 3, pp. 323-333, 2021

Authors: Krüger-Genge, A. | Tondera, C. | Hauser, S. | Braune, S. | Görs, J. | Roch, T. | Klopfleisch, R. | Neffe, A.T. | Lendlein, A. | Pietzsch, J. | Jung, F.

Article Type: Research Article

Abstract: Immunocompatibility and non-thrombogenicity are important requirements for biomedical applications such as vascular grafts. Here, gelatin-based hydrogels formed by reaction of porcine gelatin with increasing amounts of lysine diisocyanate ethyl ester were investigated in vitro in this regard. In addition, potential adverse effects of the hydrogels were determined using the “Hen’s egg test on chorioallantoic membrane” (HET-CAM) test and a mouse model. The study revealed that the hydrogels were immunocompatible, since complement activation was absent and a substantial induction of reactive oxygen species generating monocytes and neutrophils could not be observed in whole human blood. The density as well …as the activation state of adherent thrombocytes was comparable to medical grade polydimethylsiloxane, which was used as reference material. The HET-CAM test confirmed the compatibility of the hydrogels with vessel functionality since no bleedings, thrombotic events, or vessel destructions were observed. Only for the samples synthesized with the highest LDI amount the number of growing blood vessels in the CAM was comparable to controls and significantly higher than for the softer materials. Implantation into mice showed the absence of adverse or toxic effects in spleen, liver, or kidney, and only a mild lymphocytic activation in the form of a follicular hyperplasia in draining lymph nodes (slightly increased after the implantation of the material prepared with the lowest LDI content). These results imply that candidate materials prepared with mid to high amounts of LDI are suitable for the coating of the blood contacting surface of cardiovascular implants. Show more

Keywords: Gelatin-based hydrogels, immune cells, platelets, in vitro testing, mouse model

DOI: 10.3233/CH-201028

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 3, pp. 335-350, 2021

Authors: Bachour, Yara

Article Type: Article Commentary

DOI: 10.3233/CH-201012

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 3, pp. 351-352, 2021

Authors: Hoesl, V.

Article Type: Article Commentary

DOI: 10.3233/CH-201023

Citation: Clinical Hemorheology and Microcirculation, vol. 77, no. 3, pp. 353-354, 2021