Clinical Hemorheology and Microcirculation - Volume 83, issue 2

Authors: Tazegul, Hatice | Ozen, Nur | Yildirim, Ahmet | Ulker, Pinar | Hadimioglu, Necmiye | Cakin, Ozlem | Yoldas, Sukran Burcak | Yilmaz, Murat | Cengiz, Melike

Article Type: Research Article

Abstract: BACKGROUND: Liver transplantation is a life-saving treatment in end-stage liver failure. Hemorheological features as blood fluidity and red blood cell aggregation may alter effective tissue perfusion, graft function and hemodynamic variables. OBJECTIVE: The aim of the study is to investigate effect of albumin infusion on red blood cell deformability and aggregation, blood viscosity and hemodynamics in liver transplant patients. METHODS: Seventeen live or cadaveric donors were included in this prospective study. Hemorheological and hemodynamic measurements were performed in order to evaluate the effects of albumin infusion in perioperative period. RESULTS: Erythrocyte aggregation was significantly …reduced 90 minutes after albumin infusion (p  < 0.01). Mean blood viscosity revealed significant decrease at 20 rpm and 50 rpm after 90 minutes of albumin infusion (p  < 0.05). Plasma viscosity decreased significantly compared to the value before albumin infusion at 20 rpm (p  < 0.05). Albumin replacement improved hemodynamic variables in patients with low blood pressure and cardiac index measurements (p  > 0.05). CONCLUSIONS: Human albumin infusion led to decrease in whole blood and plasma viscosities, red blood cell aggregation and induced blood pressure and cardiac index elevation in perioperative liver transplant patients. Determination of hemodynamic and hemorheological effects of human albumin replacement in various patient populations may serve beneficial clinical data. Show more

Keywords: Albumin, hemorheology, viscosity, aggregation, transplantation

DOI: 10.3233/CH-221473

Citation: Clinical Hemorheology and Microcirculation, vol. 83, no. 2, pp. 93-104, 2023

Authors: Hahn, Robert G.

Article Type: Research Article

Abstract: BACKGROUND: “Interstitial washdown” is an edema-preventing mechanism that implies a greater redistribution of interstitial albumin occurs whenever the capillary filtration is increased. OBJECTIVE: To study the effect of interstitial washdown on fluid distribution in normovolemic and hypovolemic volunteers. METHODS: Capillary filtration was increased by infusing 25 mL/kg Ringer’s acetate intravenously over 30 min 10 male just after withdrawal of 0, 450, and 900 mL of blood. Population volume kinetic analysis was used to assess the effects of washdown and hemorrhage on fluid distribution, using the difference in plasma dilution based on hemoglobin and albumin as biomarker of washdown. …RESULTS: Blood withdrawal during 10–15 min recruited 100–150 mL of fluid of high albumin content to the plasma, which was probably lymph. The albumin recruitment was temporarily reduced during the fluid loading but increased from 40 min post-infusion and was then greater when preceded by hemorrhage. Simulations suggested that interstitial washdown decreased the extravascular fluid volume by 200 mL over 3 h. The plasma volume and urinary excretion both increased by approximately half this amount. CONCLUSIONS: Blood loss without hypotension probably recruited lymph to the plasma, but interstitial washdown played no major role in determining the distribution of crystalloid fluid after hemorrhage. Show more

Keywords: Crystalloid solution, pharmacokinetics, extracellular space, physiology, lymphatic flow, pharmacokinetics

DOI: 10.3233/CH-221531

Citation: Clinical Hemorheology and Microcirculation, vol. 83, no. 2, pp. 105-116, 2023

Authors: Zheng, Ruiying | Ye, Jieyi | Zhang, Xiaoer | Zhou, Xiaoyu | Huang, Tongyi | Xu, Ming | Cong, Longfei | Xie, Xiaoyan | Huang, Guangliang

Article Type: Research Article

Abstract: BACKGROUND: Registration of three-dimensional contrast-enhanced ultrasound fusion imaging (3DCEUS-FI) is time-consuming to obtain high success rate. OBJECTIVE: To investigate the influence factors on registration success rate of 3DCEUS-FI. METHODS: Water tank phantoms were made to obtain mimicked pre- and post- radiofrequency ablation three-dimensional contrast-enhanced ultrasound (3DCEUS) and CT images. Orthogonal trials were designed according to factors including size, depth, enhancement level of mimicked tumor, diameter and number of mimicked adjacent vessels. Mimicked pre- and post-RFA 3DCEUS images of 72 trials were fused to assess ablative margin (AM) by two radiologists. With CT images as standard, 3DCEUS-FI …accuracy was considered as the consistency of AM evaluation. The inter-observer agreement and the influence factors on registration success rates were analyzed. RESULTS: The intraclass correlation coefficient (ICC) for the consistency of AM evaluation between CT and 3DCEUS-FI in x-axis, y-axis or z-axis was 0.840∼0.948 (P  < 0.001). The ICC for inter-observer agreement was 0.840∼0.948 (P  < 0.001). The success rates of registration within mimicked vessels with diameter of 2 mm were significantly lower than those with diameter of 3 mm and 4 mm. CONCLUSIONS: The mimicked AM measured by 3DCEUS-FI had high accuracy and inter-observer agreement. Diameter of the mimicked adjacent vessels was significantly related to success rate of registration. Show more

Keywords: Contrast-enhanced ultrasound, three-dimensional, fusion imaging, phantom, registration

DOI: 10.3233/CH-221573

Citation: Clinical Hemorheology and Microcirculation, vol. 83, no. 2, pp. 117-128, 2023

Authors: Zhong, Lichang | Xie, Juan | Shi, Lin | Gu, Liping | Bai, Wenkun

Article Type: Research Article

Abstract: OBJECTIVE: To establish a nomogram for predicting cervical lymph node metastasis (CLNM) based on the preoperative conventional ultrasound (US) and shear wave velocity (SWV) features of papillary thyroid carcinoma (PTC). METHODS: A total of 101 patients with pathologically confirmed thyroid nodules were enrolled. These patients were divided into the CLNM-positive (n  = 40) and CLNM-negative groups (n  = 61). All patients underwent the preoperative conventional US and shear wave elastography (SWE) evaluation, and the US parameters and SWV data were collected. The association between SWV ratio and CLNM was compared to assess the diagnostic efficacy of SWV ratio alone as …opposed to SWV ratio in combination with the conventional US for predicting CLNM. RESULTS: There were significant differences in shape, microcalcification, capsule contact, SWV mean, and SWV ratio between the CLNM-positive and CLNM-negative groups (P  < 0.05). Logistic regression analysis showed that taller-than-wide shape, microcalcification, capsule contact, and SWV ratio > 1.3 were risk factors for CLNM; Logistic(P)=-6.93 + 1.647 * (microcalcification)+1.138 * (taller-than-wide-shape)+1.612 * (capsule contact)+2.933 * (SWV ratio > 1.3). The area under the curve (AUC) of the receiver operating characteristic (ROC) of the model for CLNM prediction was 0.87, with 81.19% accuracy, 77.5% sensitivity, and 85.25% specificity. CONCLUSION: The nomogram based on conventional US imaging in combination with SWV ratio has the potential for preoperative CLNM risk assessment. This nomogram serves as a useful clinical tool for active surveillance and treatment decisions. Show more

Keywords: Nomogram, papillary thyroid carcinoma, central lymph node metastasis, shear wave velocity, conventional ultrasound

DOI: 10.3233/CH-221576

Citation: Clinical Hemorheology and Microcirculation, vol. 83, no. 2, pp. 129-136, 2023

Authors: Zlojutro, Biljana | Jandric, Milka | Momcicevic, Danica | Dragic, Sasa | Kovacevic, Tijana | Djajic, Vlado | Stojiljkovic, Milos P. | Skrbic, Ranko | Djuric, Dragan M. | Kovacevic, Pedja

Article Type: Research Article

Abstract: INTRODUCTION: This study was created to analyze dynamic alterations in coagulation, hematological and biochemical parameters and their association with mortality of COVID-19 patients. To identify the most sensitive biomarkers as predictors of mortality more research is required. METHODS: The present study was a prospective, one-year-long observational study conducted on all critically ill, COVID–19 patients with respiratory failure. The following data were collected: demographic and clinical characteristics of the study population, comorbidities, coagulation, biochemical and hematological parameters. The primary outcome was the proportion of patients who died. RESULTS: 91 patients with median age 60 (50–67), 76.9% male, …met the acute respiratory distress syndrome criteria. It was tested whether dynamic change (delta-Δ) of parameters that were found to be predictors of mortality is independently associated with poor outcome. Adjusted (multivariate) analysis was used, where tested parameters were corrected for basic and clinical patients characteristics. The only inflammatory parameter which dynamic change had statistically significant odds ratio was ΔCRP (p  < 0.005), while among coagulation parameters statistically significant OR was found for Δ fibrinogen (p  < 0.005) in predicting mortality. CONCLUSION: Monitoring of coagulation, hematological and biochemical parameters abnormalities and their dynamical changes can potentially improve management and predict mortality in critically ill COVID –19 patients. Show more

Keywords: COVID–19, crtically ill, cogulation, biochemical, hematological, mortality

DOI: 10.3233/CH-221583

Citation: Clinical Hemorheology and Microcirculation, vol. 83, no. 2, pp. 137-148, 2023

Authors: Kaiser, Ulrich | Herr, Wolfgang | Greiner, Barbara | Stroszczynski, Christian | Jung, Ernst-Michael

Article Type: Research Article

Abstract: OBJECTIVE: This study aimed to evaluate a new W-Lan-supported ultrasound mobile technology for the diagnosis of vascular peripheral thrombosis. MATERIAL and METHODS: Fifty patients were examined by an experienced reference sonographer using high-end technology and a W-Lan supported device (VScan Air) to evaluate its diagnostic capabilities for peripheral thrombosis. RESULTS: Fifty patients were examined (age, 25–88 years; male, n  = 27, female n  = 23). Thromboses were diagnosed in the neck (n  = 1), upper leg (n  = 7), lower leg (n  = 49), and muscle veins (n  = 25). VScan Air technique also allows the diagnosis of circumscribed deep vein thrombosis …with a sufficient diagnostic certainty. Moreover, for superficial thrombi that can be well-delineated, a maximum image quality is possible compared to high-end technology. CONCLUSION: The mobile VScan technology opens up new possibilities for near-patient and location-independent imaging in cases of deep vein thrombosis. Show more

Keywords: Deep vein thrombosis, mobile ultrasound, peripheral thrombosis, VScan Air

DOI: 10.3233/CH-221598

Citation: Clinical Hemorheology and Microcirculation, vol. 83, no. 2, pp. 149-161, 2023

Authors: Martocchia, Antonio | Piccoli, Cinzia | Notarangelo, Michele Fortunato | Bentivegna, Enrico | Sergi, Daniela | Luciani, Michelangelo | Barlattani, Michela | Sesti, Giorgio | Martelletti, Paolo

Article Type: Research Article

Abstract: BACKGROUND: The use of the ultrasound (US) bedside examination is increasing for the detailed evaluation of the hemodynamic parameters, allowing the physicians to set the appropriate therapeutic strategies with greater precision. OBJECTIVE: The aim of this study is to evaluate the hemodynamic parameters (the cardiac output or CO, the central venous pressure or CVP and the systemic vascular resistance or SVR) in the patients with sepsis, by using a bedside US approach. METHODS: We consecutively enrolled n.82 patients of S.Andrea Hospital (n.47 with sepsis and n.35 without sepsis), examining the hemodynamic parameters by a bedside US …evaluation. RESULTS: The incidence of sepsis was more than 50% of cases. The patients with sepsis presented higher comorbidity and polypharmacy (p  < 0.01, p  < 0.001), with increased creatinine (p < 0.001) and consequent esteemed glomerular filtration rate (p < 0.01), C-reactive protein (p  < 0.01), SOFA (Sepsis-related Organ Failure Assessment) score (p  < 1.58×10–7 ) and reduced SVR (p  < 0.05). The SOFA score was inversely related to the SVR (p  < 0.05). CONCLUSIONS: To our best knowledge, this is the first study with a bedside US protocol to measure SVR, beyond the abdominal and cardiac qualitative evaluation. Show more

DOI: 10.3233/CH-221613

Citation: Clinical Hemorheology and Microcirculation, vol. 83, no. 2, pp. 163-169, 2023

Authors: Jian, Zheng-Wei | Zhang, Xiao-Ming | Huang, Guan-Shen

Article Type: Research Article

Abstract: OBJECTIVE: To investigate the clinical value of platelet and inflammatory factor activation in vascular endothelial injury in hypertension. METHODS: A total of 120 hypertension patients diagnosed in our hospital from December 2019 to June 2021 were enrolled as study objects (Hypertension group); besides, another cohort of 60 healthy people undergoing physical examination at the same period were recruited as the controls (Control group). Next, the baseline clinical characteristics of subjects in the two groups were recorded and compared. Specifically, a hematology analyzer was adopt for detecting the mean platelet volume (MPV), platelet distribution width (PDW) and platelet hematocrit …(PCT); ELISA for the level of IL-6, IL-8 and TNF-α ; PHILIPS EPIQ 7 C (a device assessing endothelial vasodilator function in a non-invasive fashion) for reactive hyperemia index (RHI); univariate and multivariate regression analysis for risk factors triggering endothelial dysfunction; and Spearman correlation analysis for the correlation of platelet activation indicators and inflammatory factor level with vascular endothelial function. RESULTS: Compared with the Control group, the patients in the Hypertension group exhibited higher levels of MPV, PDW, PCT, inflammatory factors (IL-6, IL-8 and TNF-α ) and lower RHI. Moreover, Spearman correlation analysis showed a significant negative correlation of MPV, PDW, PCT, IL-6, IL-8 and TNF-α level with RHI level. In addition, univariate and multivariate regression analysis presented that MPV, PCT, IL-8 and TNF-α were risk factors for vascular endothelial dysfunction. CONCLUSION: The activation of platelet and inflammatory factor is closely related to vascular endothelial function injury in patients with hypertension. To be specifically, platelet and inflammatory factor activation can effectively reflect the vascular endothelial function injury in patients with hypertension and has high clinical value. Show more

Keywords: Platelet activation, inflammatory factors, hypertension, vascular endothelial injury, clinical value

DOI: 10.3233/CH-221638

Citation: Clinical Hemorheology and Microcirculation, vol. 83, no. 2, pp. 171-180, 2023

Authors: Jung, E.M. | Dong, Yi | Jung, F.

Article Type: Research Article

Abstract: Current ultrasound multifrequency probes allow both improved detail resolution and depth of penetration when examining the liver. Also, new developments in vascular diagnostics, elastography with fibrosis assessment, evaluation of possible steatosis, and parametric and time intensity curve (TIC) analysis of dynamic microvascularization of the liver with contrast-enhanced ultrasound sonography (CEUS) complement ultrasound-guided diagnostics. State-of-the-art high-resolution technology includes a high frame rate (HiFR) mode for CEUS, fast shear wave measurements with the sound touch quantify (STQ) mode, artifact-free flow detection using HR flow and glazing flow in combination with a special flow-adapted imaging (Ultra Micro Angiography, UMA) and additionally different assessments …of possible fatty liver (UltraSound ATtenuation Imaging Technology, USAT). In 50 cases with focal liver lesions, a multimodal liver diagnosis was performed with a still new high-performance ultrasound system as part of the clarification of questions from the university liver consultation and tumor outpatient clinic. Show more

Keywords: Contrast enhanced ultrasonography (CEUS), fibrosis, perfusion analysis, liver cancer

DOI: 10.3233/CH-239100

Citation: Clinical Hemorheology and Microcirculation, vol. 83, no. 2, pp. 181-193, 2023