Clinical Hemorheology and Microcirculation - Volume 79, issue 3

Authors: Liu, Ju-Chi | Hsu, Yi-Ping | Zhu, Jia-Cheng | Hao, Wen-Rui | Yang, Tsung-Yeh | Sung, Li-Chun | Kao, Pai-Feng | Hwang, Jaulang | Hsiu, Hsin

Article Type: Research Article

Abstract: This study performed beat-to-beat and spectral analyses of 20-minute skin-surface laser-Doppler-flowmetry (LDF) and radial blood-pressure-waveform (BPW) signals in order to compare the blood-flow perfusion condition and regulatory mechanisms between essential-hypertension (EHT) patients and aged-matched control subjects. Beat-to-beat LDF analyses yielded the pulse width (PW), AC-to-DC ratio (AD), and their corresponding variability indices (coefficients of variation [CVs]). The relative energy contributions (RECs) of five characteristic frequency peaks (defined as FR1–FR5) were also calculated. Spectral BPW analysis obtained the amplitude proportion (Cn ) and phase angle (Pn ) of each harmonic component n . PW, AD, AD_CV, and …REC of FR2 were significantly smaller in the EHT group than in the control group. Regarding BPW indices, C 1 , C 2 , C 4 , and C 5 were significantly larger and P 2 –P 8 were significantly smaller in EHT patients than in controls. The present results indicate that BPW and LDF indices can be used to evaluate the blood-flow perfusion efficiency and microcirculatory regulatory activities in EHT. Sex differences were found, with the effects being more prominent in female patients. These findings may be partly attributable to impairment of endothelial and neural regulatory functions. The present findings might aid the development of new noninvasive methods for reducing the risk of EHT-induced damage. Show more

Keywords: Essential hypertension, laser Doppler, beat-to-beat, spectral analysis, pulse

DOI: 10.3233/CH-201056

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 3, pp. 365-379, 2021

Authors: Junqueira, Camillo L. C. | Ferreira, Esmeralci | Junqueira, Adriana S. M. | Cyrino, Fatima Z. G. A. | Maranhão, Priscila A. | Kraemer-Aguiar, Luiz Guilherme | Bottino, Daniel A. | de Souza, Maria das Graças C. | Bouskela, Eliete

Article Type: Research Article

Abstract: BACKGROUND: In patients with ischemia and no obstructive coronary artery disease (INOCA), coronary microvascular dysfunction is associated with higher rate of major adverse cardiovascular events. OBJECTIVE: To demonstrate if microvascular dysfunction present in coronary microcirculation of patients with INOCA may be detected noninvasively in their peripheral circulation. METHODS: 25 patients with INOCA and 25 apparently healthy individuals (controls) were subjected to nailfold videocapillaroscopy (NVC) and venous occlusion plethysmography (VOP) to evaluate peripheral microvascular function and blood collection for biomarkers analysis, including soluble vascular cell adhesion molecule-1 (sVCAM-1), endothelin-1 (ET-1) and C-reactive protein (CRP). RESULTS: …Red blood cell velocity (RBCV) before and after ischemia (RBCVmax ) were significantly lower in patients with INOCA (p  = 0.0001). Time to reach maximal red blood cell velocity (TRBCVmax ) was significantly longer in INOCA group (p  = 0.0004). Concerning VOP, maximal blood flow (p  = 0.004) and its relative increment were significantly lower in patients with INOCA (p  = 0.0004). RBCVmax showed significant correlations with sVCAM-1 (r  = –0.38, p  < 0.05), ET-1 (r  = –0.73, p  < 0.05) and CRP (r  = –0.33, p  < 0.05). Relative increment of maximal post-ischemic blood flow was significantly correlated with sVCAM-1 (r  = –0.42, p  < 0.05) and ET-1 (r  = –0.48, p  < 0.05). CONCLUSIONS: The impairment of microvascular function present in coronary microcirculation of patients with INOCA can be also detected in peripheral microcirculation. Show more

Keywords: Ischemia and no obstructive coronary artery disease, microvascular dysfunction, nailfold videocapillaroscopy, venous occlusion plethysmography

DOI: 10.3233/CH-201065

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 3, pp. 381-393, 2021

Authors: Hagn, Georg | Holbein, Bruce | Zhou, Juan | Lehmann, Christian

Article Type: Research Article

Abstract: BACKGROUND: Interstitial cystitis (IC) is a prevalent and debilitating chronic inflammatory disease of the urinary bladder. Currently there are no fully effective therapeutic agents available, in part due to the still obscure pathogenesis of IC. Lipopolysaccharide (LPS) also known as endotoxin from Gram negative bacteria elicits IC in mice and has formed the basis of model systems for investigation. Excess free iron plays an important role in inflammation through generation of reactive oxygen species (ROS). The novel iron chelator DIBI has been shown to sequester excess free iron and dampen excess inflammatory responses to systemic LPS administration and also to …Gram negative bacterial infections. OBJECTIVE: The overall objective of this study was to evaluate the effects of DIBI on LPS induced IC in mice. Leukocyte activation, endothelial adhesion and functional capillary density were assessed by intravital microscopy of the bladder microcirculation following a single intravesical LPS administration with or without intravesical DIBI treatment. Clinical IC symptoms were also assessed through behavioral and pain threshold force measurements. METHODS: Four groups of female BALB/c mice (n  = 5–6/group) were randomized in this study: control group, IC group without therapy, IC group with DIBI therapy and control group with DIBI therapy. The groups were examined using intravital microscopy (IVM) of the bladder for leukocyte-endothelial interactions (adherent leukocytes, temporarily interacting leukocytes) and functional capillary density (FCD). A modified behavioral score by Boucher et al. and Von-Frey-Aesthesiometry were used to evaluate key behavioral indices related to pain and visceral pain perception. RESULTS: LPS introduced intravesically induced an early (≤2h) inflammation of the bladder evidenced by leukocyte activation and adhesion to bladder capillary walls. Intravesical DIBI therapy of mice 30min following LPS administration and assessed after 1.5h treatment showed a significant decrease in the number of adherent leukocytes compared to IC animals without DIBI treatment. DIBI treated mice showed a significantly lowered increase in behavioral distress scores compared to IC mice without therapy. Untreated IC mice exhibited a significantly decreased threshold force value for evoked pain response and DIBI treatment improved the threshold pain response. A significant inverse correlation was found for the two pain and suffering evaluation methods results. CONCLUSION: DIBI reduced inflammatory endothelial leukocyte adhesion and key indices related to pain and suffering over those observed in untreated IC mice. Our findings suggest a potential therapeutic role for DIBI for IC treatment. Show more

Keywords: Interstitial cystitis, LPS, endotoxin, inflammation, iron chelator, microcirculation, DIBI

DOI: 10.3233/CH-201078

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 3, pp. 395-406, 2021

Authors: Kim, Yun-Hee | Choi, Sung-Uk | Youn, Jung-Min | Cha, Seung-Ha | Shin, Hyeon-Ju | Ko, Eun-Ji | Lim, Choon-Hak

Article Type: Research Article

Abstract: BACKGROUND: The prevention of rheologic alterations in erythrocytes may be important for reducing sepsis-associated morbidity and mortality. Remote ischemic preconditioning (RIPC) has been shown to prevent tissue damage caused by severe ischemia and mortality resulting from sepsis. However, the effect of RIPC on erythrocytes in sepsis is yet to be determined. OBJECTIVE: To investigate the effect of RIPC on rheologic alterations in erythrocytes in sepsis. METHODS: Thirty male Sprague-Dawley rats were used in this study. An endotoxin-induced sepsis model was established by intraperitoneally injecting 20 mg/kg LPS (LPS group). RIPC was induced in the right hind limb …using a tourniquet, with three 10-minute of ischemia and 10 min of reperfusion cycles immediately before the injection of LPS (RIPC/LPS group) or phosphate-buffered saline (RIPC group). The aggregation index (AI), time to half-maximal aggregation (T1/2), and maximal elongation index (EImax ) of the erythrocytes were measured 8 h after injection. RESULTS: The AI, T1/2, and EImax values in the LPS and RIPC/LPS groups differed significantly from those in the RIPC group, but there were no differences between the values in the LPS and RIPC/LPS groups. CONCLUSIONS: RIPC did not prevent rheologic alterations in erythrocytes in the rat model of LPS-induced endotoxemia. Show more

Keywords: Rat, red blood cell aggregation, red blood cell deformability, sepsis

DOI: 10.3233/CH-201084

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 3, pp. 407-415, 2021

Authors: Anžej Doma, Saša | Kristan, Aleša | Debeljak, Nataša | Preložnik Zupan, Irena

Article Type: Case Report

Abstract: Congenital erythrocytosis (CE) is an extremely rare disease and an infrequent cause of heamoglobin and haematocrit elevation. Genetic testing of CE is not widely available. Patients in whom a cause of erythrocytosis is not identified are classified as idiopathic erythrocytosis (IE) patients. In some types of CE thrombotic events have been reported but there is little hard evidence to advise on management in asymptomatic patients. Similarly is true for patients with IE. We describe a young patient who suffered several thromboembolic complications before the diagnosis of CE type 4 was established.

Keywords: Congenital erythrocytosis, idiopathic erythrocytosis, thrombosis, DNA sequencing

DOI: 10.3233/CH-211120

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 3, pp. 417-421, 2021

Authors: Zhao, Yanan | Jiang, Tao | Lv, Kun | Pan, Minqiang | Wen, Qing | Huang, Pintong

Article Type: Research Article

Abstract: BACKGROUND: The aim was to retrospectively analyze the ultrasonographic and clinical characteristics of focal inflammatory masses and malignant masses of salivary gland by using B-mode ultrasound (US) and contrast-enhanced ultrasound (CEUS) for differential analysis. METHODS: The features of US and CEUS were retrospectively analyzed for 19 cases of focal salivary inflammatory masses and 45 cases of malignant salivary masses. All cases were confirmed by pathohistological examination. RESULTS: On B-mode US, the incidence of expansive growth patterns of malignant salivary masses (44.4%, 20/45) was significantly higher than that of focal salivary inflammatory masses (15.8%, 3/19) (p  = 0.029). …The rate of lymphadenopathy surrounding salivary glands of malignant salivary masses (42.2%, 19/45) was significantly higher than that of focal salivary inflammatory masses (15.8%, 3/19) (p  = 0.042). On CEUS, clear enhancement margins were more common in malignant salivary masses (44.4%, 20/45) compared to focal salivary inflammatory masses (15.8%, 3/19) (p  = 0.029); Rapid washout was more common in malignant salivary masses (82.2%, 37/45) than focal salivary inflammatory masses (31.6%, 6/19) (p  < 0.001). Rapid washout on CEUS and craniocaudal diameter were independent predictive factors in differentiating salivary inflammatory masses and malignant masses according to binary logistic regression analysis. US and CEUS achieved a sensitivity of 80.0%, a specificity of 78.9% and an accuracy of 80.0% for discrimination between salivary inflammatory masses and malignant masses. CONCLUSION: Therefore, a multimodal ultrasonographic pathway combining clinical manifestations, B-mode US and CEUS was needed to differentiate between salivary focal inflammatory masses and malignancies to avoid unnecessary biopsies. Show more

Keywords: Chronic sialadenitis, salivary mass, ultrasound (US), contrast-enhanced ultrasound (CEUS)

DOI: 10.3233/CH-211151

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 3, pp. 423-434, 2021

Authors: Zhu, Jing-E. | Zhang, Hui-Li | Yu, Song-Yuan | Xu, Hui-Xiong

Article Type: Research Article

Abstract: Hyperthyroidism is a common disease mainly manifested by hyperexcitability of multiple systems and hypermetabolism. Currently, antithyroid drugs (ATDs), radioiodine therapy (RIT), and surgery are mainly used in the clinical treatment for primary hyperthyroidism. We reported a case of a 28-year-old female who received a novel treatment for primary hyperthyroidism. This patient had poor control of thyroid function while taking ATD, and her oral Methimazole (MMI) dose varied repeatedly between 20 mg qd and 15 mg qd, failing to maintain a stable status. To minimize the possible complication and to achieve drug reduction or withdrawal, she refused RIT and surgery and showed up …in our department. The patient, diagnosed with Graves’ disease (GD) and met the surgical indication after systematic clinical evaluation, was subject to ultrasound-guided percutaneous microwave ablation (MWA) of the partial thyroid gland with continuous oral administration of 20 mg qd MMI. The post-ablation condition was stable and the patient was discharged 2 days after the operation. Thyroid ultrasound and serum thyroid function test were examined regularly after ablation and the MMI dosage was gradually reduced according to the results of the biochemical examination. Five weeks after the operation, the patient completely discontinued the medication. Ultrasound-guided percutaneous microwave ablation is minimally invasive, safe, and effective, and has potential to be an alternative treatment besides the 3 classical treatments of hyperthyroidism. Show more

Keywords: Contrasted-enhanced ultrasound, hyperthyroidism, microwave ablation

DOI: 10.3233/CH-211180

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 3, pp. 435-444, 2021

Authors: Piao, Jinxiang | Yoo, Chaeyoung | Kim, SunYoung | Whang, Youn-Wha | Choi, Cheol Ung | Shin, Sehyun

Article Type: Research Article

Abstract: BACKGROUND: Assessment of platelet function is important in the management of patients who are subject to operation as well as at potential risk of hemorrhagic complications. OBJECTIVE: This study aimed to evaluate a new platelet assays (Anysis-Epinephrine, Anysis-ADP) and to compare them with PFA-200 in cardiology visiting patients and inpatients. METHODS: Citrated blood samples were collected from 184 patients for ADP test and 163 patients for EPI test, who visited Korea University Guro Hospital with written consent. The PFA-200 assay gives a test result the closure time (CT) until the blood flow rate decreases to 10% …of the initial value, whereas Anysis-200 assay does a blood flow migration distance (MD) until blood flow completely stops. According to the results of PFA closure time (CT), the tested samples were classified as either negative control or positive group. The measurements were simultaneously conducted with two devices and compared. RESULTS: The sensitivity and specificity of Anysis-200 C/EPI kit in comparison to PFA-200 C/EPI kit was 87.5% and 85.7%, respectively. Regarding C/ADP kit, the sensitivity and specificity of Anysis-200 was 96.9% and 87.5%, respectively. In addition, the sums of sensitivity and specificity are greater than 150% for both of EPI and ADP. Also, it was found that likelihood ratio and odd ratio for each assay provide useful additional information. Since the Cohen’s kappa coefficients value between the two devices was relatively high, the equivalence between the two devices was confirmed. CONCLUSIONS: Anysis-200, a novel platelet function analyzer has showed excellent agreements with PFA-200 with high agreement rates and precision. Anysis-200 assay would be useful in assessing bleeding risk management as well as abnormal platelet reactivity at point of care. Show more

Keywords: Platelet function, epinephrine, ADP, anysis-200 analyzer, PFA-200

DOI: 10.3233/CH-211185

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 3, pp. 445-454, 2021

Authors: Rother, Ulrich | Theune, Mona | Lang, Werner | Meyer, Alexander

Article Type: Research Article

Abstract: BACKGROUND: Negative pressure wound therapy (NPWT) has been established over years for treatment of chronic and complex wounds. OBJECTIVE: Aim of this study was to investigate the effect NPWT on the microperfusion. METHODS: Prospective single centre analysis of patients treated with NPWT due to acute (ACUTE) wounds after fasciotomy or patients with chronic wounds (CHRONIC) due to a chronic limb threatening ischemia was performed. NPWT was conducted through a three days sequence with a negative pressure of –120 mmHg. Before after and during the entire period of therapy the microperfusion was assessed (O2C™, LEA Medizintechnik). …RESULTS: Comparison of the perfusion values of 28 patients (CHRONIC/ACUTE 5/23, women/men 8/20) before and after the NPWT sequence showed a non-significant improvement in the CHRONIC group (supine position: p  = 0.144, elevated position p  = 0.068) and a significant decrease in the ACUTE group (supine position p  = 0.012, elevated position p  = 0.034). This effect could also been demonstrated during the NPWT over time (CHRONIC: supine position: p  = 0.320, elevated position: p  = 0.053, ACUTE: supine position: p  = 0.021, elevated position: p  = 0.012). CONCLUSION: Microperfusion measurements showed alterations and differences in wound bed perfusion of acute and chronic wounds; acute wounds tended to a decrease of blood flow, whereas this effect was not seen in chronic wounds in peripheral artery disease. Show more

Keywords: Negative pressure therapy, microperfusion, CLTI, fasciotomy, O2C

DOI: 10.3233/CH-211189

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 3, pp. 455-462, 2021

Authors: Jung, E.M. | Dinkel, J. | Verloh, N. | Brandenstein, M. | Stroszczynski, C. | Jung, F. | Rennert, J.

Article Type: Research Article

Abstract: AIM: To evaluate the diagnostic reliability of a new generation wireless point-of care ultrasound device for abdominal and thoracic findings. MATERIAL AND METHODS: 40 patients (16 females, 24 males 19 –80 years, on average 56.1 years) were scanned by an experienced examiner using the new wireless Vscan Air device for abdominal and thoracic findings. The probe frequencies were 2–5 MHz (convex probe) and 3–12 MHz for the linear probe. As a reference standard, all patients were also examined using high-end ultrasound (LOGIQ E9/LOGIQ E10). Results were interpreted independently by two examiners in consensus, also with regard to the image quality …(0–4, from not assessable = 0, to excellent 4). RESULTS: In all 40 patients (100%) examination with conventional high-end ultrasound and the Vscan Air ultrasound device was feasible. Sensitivity, specificity, positive and negative predictive value for the diagnosis of abdominal and thoracic findings were 63.3%, 100%, 100%, and 40%, respectively. Most main diagnostic findings were detected using the mobile device compared to the high-end ultrasound. Limitations were found regarding characterization and classification of hepatic and renal tumorous lesions. Image quality revealed mostly minor diagnostic limitations for the mobile device, mean 2.9 (SD ± 0.300) and was excellent or with only minor diagnostic limitations for conventional high-end ultrasound, mean 3.25 (SD ± 0.438). CONCLUSION: Due to its easy application and its high diagnostic reliability, point-of-care ultrasound systems of the latest generation represent a valuable imaging method for the primary assessment of abdominal and thoracic findings, especially in patients on intensive care units or in emergency situations. Show more

Keywords: Point-of-care ultrasound, Vscan Air, high-end ultrasound

DOI: 10.3233/CH-211197

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 3, pp. 463-474, 2021

Authors: Carlisi, Melania | Mancuso, Salvatrice | Lo Presti, Rosalia | Siragusa, Sergio | Caimi, Gregorio

Article Type: Research Article

Abstract: BACKGROUND: in this study, with a re-evaluation of the hemorheological determinants previously described in MGUS subjects and in MM patients, we have detected the calculated whole blood viscosity, according whether to the hematocrit and total plasma protein concentration (de Simone formula) or to the haematocrit and plasma fibrinogen level (Merrill formula), and a marker of the erythrocyte aggregation (albumin/fibrinogen level). METHODS: data were expressed as means±standard deviation. Student’s t test for unpaired data was used to compare MGUS subjects and MM patients. The correlation coefficient between mean erythrocyte aggregation (MEA) and hematocrit (Ht) was evaluated in MGUS, …MM and MGUS + MM groups using the Spearman test. RESULTS: the comparison between MGUS and MM shows that the measured blood viscosity and calculated blood viscosity based on hematocrit and total plasma protein, but not which estimated in relation to the hematocrit and plasma fibrinogen, differentiate the two groups. A difference between the two groups also regards the measured erythrocyte aggregation and its surrogate marker. In addition, the measured plasma viscosity at low shear rate (0.51 s–1 ) and, in particular, the ratio between plasma viscosity at low (0.51 s–1 ) and high (450 s–1 ) shear rates distinguish MGUS and MM. CONCLUSIONS: calculated blood viscosity (de Simone formula and other formulas) and the surrogate marker of erythrocyte aggregation disclose an alike trend with the corresponding hemorheological determinants obtained by using their direct measurement. Show more

Keywords: Calculated whole blood viscosity, measured whole blood viscosity, hematocrit, total plasma protein, albumin, fibrinogen

DOI: 10.3233/CH-211198

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 3, pp. 475-483, 2021

Authors: Pantos, Constantinos | Apostolaki, Vassiliki | Kokkinos, Leonidas | Trikas, Athanassios | Mourouzis, Iordanis

Article Type: Research Article

Abstract: Sepsis and septic shock result in impaired microcirculation and red blood cell rheology which lead to tissue hypoxia and multi-organ failure. Early administration of triiodothyronine prevents tissue hypoxia in experimental sepsis. In this context, a clinical trial was initiated to test the efficacy of acute triiodothyronine administration to combat tissue hypoxia in critically ill COVID19 patients. Here, we provide preliminary data from interim analysis of this study showing a novel acute effect of triiodothyronine on erythrocyte sedimentation rate which may have an important therapeutic impact on red blood cell rheology and tissue hypoxia in sepsis and particular in COVID19 critical …illness. Trial registration: ClinicalTrials.gov, NCT04348513. Registered 16 April 2020, https://clinicaltrials.gov/ct2/show/NCT04348513 Show more

Keywords: Thyroid hormone, hypoxia, erythrocyte sedimentation rate, COVID19, microcirculation, hemorheology

DOI: 10.3233/CH-211215

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 3, pp. 485-488, 2021

Article Type: Correction

DOI: 10.3233/CH-219902

Citation: Clinical Hemorheology and Microcirculation, vol. 79, no. 3, pp. 489-489, 2021