Clinical Hemorheology and Microcirculation - Volume 86, issue 1-2

Authors: Jung, Friedrich | Prantl, Lukas

Article Type: Editorial

DOI: 10.3233/CH-238109

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 1-2, 2024

Authors: Michael, Jung Ernst | Xiaoyan, Xie | Xiaoer, Zhang

Article Type: Editorial

DOI: 10.3233/CH-238110

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 3-7, 2024

Authors: Connes, Philippe

Article Type: Research Article

Abstract: Sickle cell disease (SCD) is an autosomal recessive disorder. Although the molecular mechanisms at the origin of SCD have been well characterized, its clinical expression is highly variable. SCD is characterized by blood rheological abnormalities, increased inflammation and oxidative stress, and vascular dysfunction. Individuals with only one copy of the mutated β-globin gene have sickle cell trait (SCT) and are usually asymptomatic. The first part of this review focuses on the biological responses of SCT carriers during exercise and on the effects of combined SCT and diabetes on vascular function, several biomarkers and clinical complications. The second part of the …review focuses on SCD and shows that the magnitude of red blood cell (RBC) rheological alterations is highly variable from one patient to another, and this variability reflects the clinical and hematological variability: patients with the less deformable RBCs have high hemolytic rate and severe anemia, and are prone to develop leg ulcers, priapism, cerebral vasculopathy, glomerulopathy or pulmonary hypertension. In contrast, SCD patients characterized by the presence of more deformable RBCs (but still rigid) are less anemic and may exhibit increased blood viscosity, which increases the risk for vaso-occlusive events. Several genetic and cellular factors may modulate RBC deformability in SCD: co-existence of α-thalassemia, fetal hemoglobin level, oxidative stress, the presence of residual mitochondria into mature RBCs, the activity of various non-selective cationic ion channels, etc. The last part of this review presents the effects of hydroxyurea and exercise training on RBC rheology and other biomarkers in SCD. Show more

Keywords: Sickle cell disease, red blood cell deformability, blood viscosity, microcirculation, vascular function

DOI: 10.3233/CH-238122

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 9-27, 2024

Authors: Jung, F.

Article Type: Research Article

Abstract:  This review spans a wide arc from the first observations of the early anatomists to the present day. William Harvey was the first to describe the heart as the centre of the large and small circulatory system. He thus replaced the previously valid system of Galenos, It was Marcello Malpighi who first described that the capillary system connects the arteries with the veins. In 1688 Antoni van Leeuwenhoek (1632–1686) confirmed these results with a paper on capillary perfusion in the caudal fin of the glass eel. It was then Hermann Boerhave (1668–1738, Leiden) who was the first to carry …out microcirculation tests on patients. He studied the microcirculation in the human bulbar conjunctiva. Even today, microcirculation studies in the conjunctiva bulbi of patients are carried out today. Until 1831, it was never quite clear whether the observations reported belonged mainly to the field of microcirculation, which had not yet been defined. This was done in Great Britain by Marshall Hall (1790–1857). Technical Improvements allowed increasingly sophisticated studies of the morphological structure of the terminal vasculature. According to Gustav Ricker (1870–1948, Vienna), the terminal vasculature comprises the functional unit of the smallest arteries, arterioles, capillaries and venules. In 1921 it was still thought that the blood circulation was the sole response to the pumping action of the heart. Even the classic work by Bayliss on the myogenic hypothesis (later referred to as “blood flow autoregulation”) initially received little attention. More strikingly, even the findings of August Krogh, for which he received the Nobel Prize in Medicine in 1920 (for his discovery of the mechanisms of capillary motor regulation), were ignored. During an outstanding autoregulation symposium held in 1963 a broad consensus was reached on active and passive mechanisms, which is more or less valid till today. The mechanisms of regulation of capillary blood flow are now largely understood, although not completely resolved. The development of video systems with recording capability and automated off-line recording of capillary erythrocyte velocities allowed the application of morphological and dynamic studies of cutaneous capillaries in humans. These reopened the field of physiological or pathophysiological questions again for many groups worldwide. Since 1955, many publications on “microcirculation (5423)” and “capillary microscopy (2195)” have been listed in pubmed. Show more

Keywords: Human, cutaneous, capillary circulation, microcirculation

DOI: 10.3233/CH-248001

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 29-50, 2024

Authors: Huang, Yun-Lin | Cheng, Juan | Wang, Ying | Xu, Xin-Liang | Wang, Shi-Wen | Wei, Li | Dong, Yi

Article Type: Research Article

Abstract: OBJECTIVES: To explore the technical and clinical evaluation of ultrasound-derived fat fraction (UDFF) measurement in adult patients in whom fatty liver was suspected. MATERIALS AND METHODS: In this prospective study, 41 participants were initially enrolled in our hospital between October 2022 and December 2022 and received UDFF assessment using Siemens ACUSON Sequoia system equipped with DAX transducer. UDFF measurement was performed three times to obtain UDFF values from each imaging location (V hepatic segment and VIII hepatic segment) per participant, and the depth (skin-to-capsule distance) was automatically measured. The echogenicity of liver tissue in B mode …ultrasound (BMUS) was compared to the normal kidney tissue, and fatty liver was graded as mild (Grade 1), moderate (Grade 2), and severe (Grade 3). The median of the acquired overall median UDFF values was used for statistical analysis. All ultrasound examinations were performed by one of two radiologists (with 20 and 10 years of liver ultrasound imaging experience). RESULTS: Finally, UDFF measurement was successfully performed on 38 participants to obtain valid values, including 21 men with a median age of 40.0 years (interquartile range [IQR]: 23.0 – 58.5) and 17 women with a median age of 60.0 years (IQR: 29.5 – 67.0). Fatty liver was diagnosed by BMUS features in 47.4% (18/38) participants. Among all participants, the median UDFF value was 7.0% (IQR: 4.0 – 15.6). A significant difference in UDFF values was found between participants with fatty liver and without fatty liver (U  = 7.0, P  < 0.001), and UDFF values elevated as the grade of the fatty liver increased (P  < 0.001). The median UDFF values from the three UDFF measurements obtained during each ultrasound examination showed excellent agreement (ICC = 0.882 [95% confidence interval: 0.833 – 0.919]). The Spearman correlation of UDFF values in different depths was moderate, with a r s value of 0.546 (P  < 0.001). No significant differences in UDFF values were found between V hepatic segment and VIII hepatic segment (U  = 684.5, P  = 0.697). CONCLUSIONS: UDFF provides a novel non-invasive imaging tool for hepatic steatosis assessment with excellent feasibility. Show more

Keywords: Hepatic steatosis, ultrasound-derived fat fraction (UDFF), quantitative, feasibility, B mode ultrasound (BMUS)

DOI: 10.3233/CH-238102

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 51-61, 2024

Authors: Chaloupka, Michael | Pyrgidis, Nikolaos | Ebner, Benedikt | Pfitzinger, Paulo L. | Volz, Yannic | Berg, Elena | Enzinger, Benazir | Atzler, Michael | Ivanova, Troya | Pfitzinger, Paulo L. | Stief, Christian G. | Apfelbeck, Maria | Clevert, Dirk-André

Article Type: Research Article

Abstract: OBJECTIVE: Multiparametric magnetic resonance imaging (mpMRI) –Ultrasound- fusion guided biopsy of the prostate (FBx) is the new gold standard for the detection of prostate cancer. Hallmark studies showing superior detection rates of FBx over randomized biopsies routinely excluded patients≥75 years and information on outcome of FBx on this patient cohort is sparse. As a large referral center, we have performed FBx on a substantial number of patients this age. By evaluating outcome of FBx of patients over the age of 75 years we wanted to close the gap of knowledge on this patient cohort. MATERIALS AND METHODS: Between …2015 –2022, 1577 patients underwent FBx at our department and were considered for analysis. Clinical and histopathological parameters were recorded. Clinical data comprised age at FBx, serum level of Prostate-specific antigen (PSA), prostate volume, PSA-density, history of previous biopsies of the prostate, result of the digital rectal examination (DRE) and assessment of the indexlesion of mpMRI according to the Prostate Imaging and Reporting Data System (PI-RADS). Univariate analysis and multivariable logistic regression was used to identify age barrier of 75 years as a potential risk factor of detection of clinically significant prostate cancer by FBx. RESULTS: 379/1577 patients (24%) were≥75 years and 1198/1577 (76%) patients were < 75 years, respectively. Preoperative PSA was significantly higher in patients≥75 years compared to patients < 75 years (9.54 vs. 7.8, p  < 0.001). Patients≥75 years presented significantly more often with mpMRI target lesions classified as PI-RADS 5 compared to patients < 75 years (45% vs. 29%, p  < 0.001). Detection rate of clinically significant prostate cancer was significantly higher in patients≥75 years compared to patients < 75 years (63% vs. 43%, p  < 0.001). Aggressive prostate cancer grade ISUP 5 was significantly more often detected in patients≥75 years compared to patients < 75 years (13% vs. 8%, p  = 0.03). On multivariable logistic regression model adjusted for PSA and PI-RADS score, age barrier of 75 years was identified as a significant risk factor for the detection of clinically significant prostate cancer by FBx (OR: 1.77, 95% CI: 1.36 –2.31, p  < 0.001). CONCLUSION: After evaluation of a large patient cohort, we show that age≥75 years represents a significant risk factor for the detection of clinically significant prostate cancer. Further studies on mid- and long term outcome are necessary to draw conclusions for clinical decision making in this patient cohort. Show more

Keywords: Prostate biopsy, elderly patient, mpMRI

DOI: 10.3233/CH-238101

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 63-70, 2024

Authors: Brix, E. | Prantl, L. | Anker, A. | Klein, S. | Kehrer, A.

Article Type: Research Article

Abstract: BACKGROUND: Complex injuries of the hand frequently result in loss of essential functional features. Common reconstructive procedures for soft tissue defects of the thumb or phalanges are locoregional flaps like Moberg-, Foucher-, Cross-Finger- or Littler flaps. Microneurovascular toe (joint-) transfers complete the arsenal of operative reconstructive procedures and allow for most detailed reconstructions. Our experiences with free toe transplants are reported and diversely discussed regarding contending procedures. METHODS: From 2010 until 2019 14 patients who received emergency or elective partial or complete toe transfers were compared with a control group (n  = 12) treated with contending reconstructive procedures. Aim …of the reconstructions was to cover the defect with well-vascularized, sensate tissue, while preserving length and range of motion in a reliable manner. RESULTS: The Kapandji score showed a significant difference (p - value = 0.04) with a score of 9.8 in comparison to control group (Kapandji index = 8.0). CONCLUSION: In our heterogenic patient collective free toe transplants have proven to achieve comparable functional results for reconstruction of two and tripartite phalanxes as opposed to common local reconstructive procedures. Show more

Keywords: Amputations injuries, toe to hand transfer, free pulp flap, hand reconstruction by toe transfer after amputational injuries, wrap around flap great toe, toe joint transfer

DOI: 10.3233/CH-238114

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 71-88, 2024

Authors: Jung, Ernst Michael | Jung, Friedrich | Dong, Yi | Kaiser, Ulrich

Article Type: Research Article

Abstract: OBJECTIVE: To test and initially describe a new handheld wireless ultrasound technique (TE Air) for clinical use. METHODS: In this pilot study, the new ultrasound device TE Air from Mindray was used to examine the hepatic and renal vessels of healthy volunteers for first impressions. The probe has a sector transducer with a frequency range of 1.8–4.5 MHz. The B-mode and color-coded doppler sonography (CCDS) scanning methods were used. A high-end device from the same company (Resona 9, Mindray) was used as a reference. The results were evaluated using an image rating scale ranging from 0 to 5, …with 0 indicating not assessable and 5 indicating without limitations. RESULTS: Altogether, 61 participants (n  = 34 female [55.7%], n  = 27 male [44.3%]), age range 18–83 years, mean age 37.9±16.5 years) could be adequately studied using TE AIR and the high-end device. With one exception, the image quality score for TE Air never fell below 3 and had a mean/median scored of 4.97/5.00 for the B-mode, 4.92/5.00 for the color flow (CF) mode, and 4.89/5.00 for the pulse wave (PW) mode of the hepatic vein, 4.90/5.00 for the portal vein, 4.11/4.00 for the hepatic artery, and 4.57/5.00 for the renal segmental artery. A significant difference in the assessment of flow measurement of the hepatic artery and renal segmental arteries was found between TE AIR and the high-end device. CONCLUSIONS: TE Air represents a new dimension in point-of-care ultrasound via wireless handheld devices. Especially, its flow measurement ability offers a relevant advantage over other available handheld models. TE Air provides a formally sufficient image quality in terms of diagnostic significance. Show more

Keywords: Mindray, handheld ultrasound, TE Air, ultrasound, point-of-care ultrasound

DOI: 10.3233/CH-238100

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 89-97, 2024

Authors: Kempa, S. | Tessmann, V. | Prantl, L. | Schmid, S. | Müller, M. | Jung, E.-M. | Tews, H.C.

Article Type: Research Article

Abstract: BACKGROUND: Lipedema is a chronic disease marked by symmetric enlargement of painful nodular and fibrotic adipose tissue, predominantly affecting the limbs. Since there is no specific test or biomarker for this condition, years often pass before the diagnosis of lipedema is established for the first time, thereby causing psychosocial distress, including depression, eating disorders, and social isolation. Over the last few years several advanced Doppler–based technologies have been developed to visualize slow flow blood vessels and superficial microvascular architecture undetectable by traditional color Doppler flow imaging (CDFI). OBJECTIVE: The aim of this study was to evaluate …the superficial microvascular anatomy in lipedema patients compared to healthy controls and investigate the clinical significance of the Ultra Micro Angiography (UMA) technology in the diagnosis of lipedema. This new technique may contribute to reduce the diagnostic delay and, eventually, establish and guide treatment strategies toward a better therapeutic outcome in lipedema patients. METHODS: 25 patients with lipedema and ten healthy controls with no history of lipedema were included in this study. All ultrasound examinations were performed on a novel high-performance ultrasound system (Resona R9/Mindray) using CDFI and the UMA technique. RESULTS: In all of the patients, Ultra Micro Angiography achieved the excellent visualization of microvascular structures, revealing that most lipedema patients showed grade 3 (n  = 13) or grade 2 (n  = 8) flow. UMA was superior to CDFI for depicting the microvascular structures. CONCLUSIONS: Here we show that UMA imaging characterizes the subcutaneous microvasculature with an unprecedented accuracy. The method has the advantage of being sensitive to small, slow-flowing vessels. This allows for the assessment of the course of vessels and vascular pathologies in great detail. Thus, UMA as a non-invasive diagnostic method can improve diagnostic accuracy in lipedema. Show more

Keywords: Lipedema, diagnosis, ultrasound, ultra micro angiography, UMA

DOI: 10.3233/CH-238103

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 99-108, 2024

Authors: Río Bártulos, Carolina | Pirl, Lukas | Lier, Dennis | Planert, Mathis | Hohmann, Juliane | El Mountassir, Abdelouahed | El Anwar, Mohamed | Wiggermann, Philipp

Article Type: Research Article

Abstract: BACKGROUND: The range of software available to radiologists has increased enormously with the advancement of AI. A good example of this is software to determine ASPECTS in the treatment of potential stroke patients. OBJECTIVE: In this study, two software packages (eASPECTS from Brainomix and VIA_ASPECTS from Siemens) were tested and compared for their performance in the daily clinical routine of a maximum care provider with a 24/7 stroke unit. METHODS: A total of 637 noncontrast CT images were obtained from consecutive patients with suspected stroke, of whom 73 were finally diagnosed with MCA …infarction. Differences in agreement and quantification of agreement were analysed, as well as the correlation and sensitivity, specificity and accuracy compared to raters. RESULTS: Compared to VIA_ASPECTS, eASPECTS shows good agreement and strong correlation with the raters. VIA_ASPECTS has lower accuracy and low specificity than eASPECTS but a higher sensitivity. CONCLUSION: Both software products have the potential to be decision support tools for radiologists. There are, however, differences between the two software products in terms of their intended use. Show more

Keywords: Acute ischaemic stroke, computed tomography, software comparison, artificial intelligence

DOI: 10.3233/CH-238105

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 109-119, 2024

Authors: Greiner, Barbara | Kaiser, Ulrich | Hammer, Simone | Platz Batista da Silva, Natascha | Stroszczynski, Christian | Jung, Ernst Michael

Article Type: Research Article

Abstract: AIM: To evaluate the usefulness of handheld ultrasound in comparison with high-end ultrasound for lesion evaluation before and after sclerotherapy in pediatric patients with venous malformations (VMs). MATERIAL AND METHODS: 10 pediatric patients prior to and after sclerotherapy were scanned by an experienced examiner using handheld ultrasound (Vscan AirTM ) and high-end ultrasound (LOGIQ E9/E10) as reference. Patients with associated venous thromboses and intralesional aneurysms had been excluded. Results were interpreted independently by two readers in consensus. RESULTS: 10 patients (4-17 years; 10.0±4.32 years; female n  = 6, male n  = 4) with 10 VMs …(4 of the head and neck region, 4 of the upper and 2 of the lower extremities) were examined. 7 phleboliths were detected. The average rating score achieved by the high-end device never was less than 4, by Vscan AirTM never less than 3. An exception was the assessment of AV fistulas. In comparison with the evaluation of variables examined, we found a significant difference between the high-end scanner and the handheld device regarding the achieved image quality. CONCLUSION: Vscan AirTM ultrasound device allows new possibilities for procedure planning and post-procedural control of pediatric patients with VMs. Show more

Keywords: Handheld ultrasound, Vscan Air, pediatric, venous malformations

DOI: 10.3233/CH-238106

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 121-131, 2024

Authors: Luderer, V. | Jung, F. | Brandenstein, M. | Stroszczynski, C. | Jung, E.M.

Article Type: Research Article

Abstract: AIM: First assessment of flow changes in the jugular veins using high resolution ultrasound vector flow. MATERIAL UND METHODS: 15 patients (8 males, 7 females) with an age range of 35 to 82 years (mean age 58.53±12.26 years) were examined by an experienced examiner using high power ultrasound equipment (Resona R9, Mindray) with probe technology (Mindray L9-3U Linear Array transducer, 2.5 to 9.0 MHz). This group was compared with five healthy subjects (mean age 35.4±13.79 years) as a reference. To assess flow changes, the color-coded duplex sonography and the novel vector flow technique were used. The evaluation was …performed of vector morphology changes, turbulence, and wall resistance measurements. RESULTS: There were changes after acute and chronic thrombosis in 9 cases, and venous compression in 7 cases. Turbulence was measurable from 0.01 % to 64.44 %, the average turbulence was 19.73±22.06 %. Wall resistance measurement showed values from 0.01 Pa to 3.14 Pa, depending on the age of the thrombosis or compression. The reference veins showed turbulence of 0.94±1.5 % and a mean wall resistance of 0.05±0.05 Pa. There are statistically significant differences between normal and thrombotic or compressed veins in terms of maximum wall stress (p  = 0.006) and mean degree of turbulence (p  = 0.012), while the difference in mean wall stress is not statistically significant (p  = 0.058). CONCLUSION: Despite still existing technical limitations, the combination of V-flow and wall stress measurements in jugular vein changes suggests a high diagnostic potential. Show more

Keywords: Thrombosis, vector-flow-imaging, high resolution ultrasound, color-coded duplex sonography

DOI: 10.3233/CH-238117

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 133-142, 2024

Authors: Strauss, Catharina | Fodor, Katharina J. | Anker, Alexandra | Kemper, Robert | Prantl, Lukas | Brébant, Vanessa | Bosselmann, Talia | Geis, Sebastian

Article Type: Research Article

Abstract: BACKGROUND: Monitoring replanted digits remains a challenging task in microsurgical units. Previous studies have indicated the perfusion index (PI), a parameter directly proportional to the blood flow, might be a useful tool. OBJECTIVE: The PI is evaluated as a monitoring tool in patients with replanted digits. METHODS: This prospective, non-interventional study includes 31 patients with revascularized or replanted digits. After successful revascularization or replantation, the PI and peripheral oxygen saturation of the affected finger and its contralateral equivalent were measured simultaneously. The values were detected by the device Radical-97® Pulse CO-Oximeter® (Masimo Corporation, 52 Discovery, Irvine, …CA 92618, USA). RESULTS: The median PI of affected fingers was 3.5±0.56 for revascularized and 2.2±0.8 for replanted fingers. The difference between the PI values of replanted digits and the healthy contralateral side was highly significant (p  < 0.0001). The area under the curve in the receiver operating characteristics was 0.92 for a PI difference > 80.49% and predicted a loss of replant with a specificity of 100% and a sensitivity of 75%. CONCLUSION: The assessment of the PI in patients with reperfusion of a vascular compromised digit is a useful tool to continuously monitor peripheral perfusion. The dynamic behavior of the PI is essential to detect perfusion disturbance. Show more

Keywords: Replanted digits, microsurgery, perfusion index, monitoring

DOI: 10.3233/CH-238120

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 143-152, 2024

Authors: Biermann, Niklas | Eschenbacher, Elisabeth | Brébant, Vanessa | Heine, Norbert | Brix, Eva | Prantl, Lukas | Anker, Alexandra M.

Article Type: Research Article

Abstract: BACKGROUND: The use of dyes like Indocyanine green (ICG) and Patent blue facilitates the identification of lymphatic vessels during lymphaticovenous anastomosis (LVA) surgery. However, some patients experience “staining failure”. In these cases, no stained lymphatic vessels can be detected, making supermicrosurgical LVA even more complex. OBJECTIVE: This study aims to investigate patient-related factors that may interfere with lymphatic vessel staining during LVA. METHODS: A retrospective study was conducted on 30 patient charts, focusing on patient characteristics and the staining quality of ICG and Patent blue dye. Statistical analyses were performed to identify correlations between variables. …RESULTS: Significant correlations were found between higher age and secondary lymphedema, longer duration of lymphedema in male patients until surgery and reoccurring cellulitis and Patent blue staining. Notably, recurrent infections to the lymphatic system resulted in inferior staining ability during LVA surgery. CONCLUSIONS: Due to staining failure the detection of functional lymphatic vessels remains challenging in LVA surgery. A more extensive preoperative workup is recommended for patients with recurrent cellulitis to optimize surgical feasibility and procedure quality in LVA treatment for lymphedema. Show more

Keywords: Lymphedema, lymphedema surgery, lymphaticovenous anastomosis, lymphaticovenous bypass, LVA, Indocyanine green, Patent blue dye, blue dye, lymphography

DOI: 10.3233/CH-238112

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 153-158, 2024

Authors: Kammerer, Sarah | Nowak, Elisabeth | Mantke, René | Jung, Friedrich | Küpper, Jan-Heiner

Article Type: Research Article

Abstract: BACKGROUND: Liver biotransformation is the major route for drug metabolism in humans, often catalysed by cytochrome P450 (CYP) enzymes. This first-pass effect can lead to hepatotoxicity and influences the bioavailability of drugs. OBJECTIVE: We aimed to establish in vitro culture systems simulating the liver first-pass to study effects of the proteasome inhibitor MG-132 simultaneously on hepatocytes and cancer cells. METHODS: The first-pass effect was simulated by conditioned medium transfer (CMT) from pre-treated HepG2 CYP3A4-overexpressing cells to either pancreatic cancer cell line PANC-1 or primary colon cancer cells, and by indirect co-culture (CC) …of liver and cancer cells in a shared medium compartment. Experimental proteasome inhibitor MG-132 was used as test substance as it is detoxified by CYP3A4. RESULTS: Cancer cells showed higher viabilities in the first-pass simulation by CMT and CC formats when compared to monocultures indicating effective detoxification of MG-132 by HepG2 CYP3A4-overexpressing cells. HepG2-CYP3A4 cells showed reduced viabilites after treatment with MG-132. CONCLUSIONS: We successfully established two different culture systems to simulate the liver first-pass effect in vitro . Such systems easily allow to study drug effects simultaneously on liver and on target cancer cells. They are of great value in pre-clinical cancer research, pharmaceutical research and drug development. Show more

Keywords: Liver biotransformation, first-pass effect, CYP3A4, MG-132, cancer cells, in vitro culture systems

DOI: 10.3233/CH-238108

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 159-168, 2024

Authors: Brébant, Vanessa | Eschenbacher, Elisabeth | Hitzenbichler, Florian | Pemmerl, Sylvia | Prantl, Lukas | Pawlik, Michael

Article Type: Research Article

Abstract: BACKGROUND: Necrotizing fasciitis (NF) is a rare but life-threatening condition in which extensive soft tissue destruction can occur very quickly if left untreated. Therefore, timely broad-spectrum antibiotic administration is of prognostic importance in addition to radical surgical debridement. AIM: This study evaluates the cases of NF in our hospital during the last ten years retrospectively with respect to the pathogens involved and their antimicrobial resistance. This approach aims to provide guidance regarding the most targeted initial antibiotic therapy. METHODS: We performed a retrospective microbiological study evaluating pathogen detection and resistance patterns including susceptibility testing of 42 …patients with NF. RESULTS: Type 1 NF (polymicrobial infection) occurred in 45% of the patients; 31% presented type 2 NF (monomicrobial infection). The most common pathogens detected were E. coli, staphylococci such as Staphylococcus aureus and Staphylococcus epidermidis, Proteus mirabilis, enterococci, and streptococci such as Streptococcus pyogenes. Twelve percent presented an additional fungus infection (type 4). Ten percent showed no cultivation. Two percent (one patient) presented cocci without specification. CONCLUSION: Most pathogens were sensitive to antibiotics recommended by guidelines. This confirms the targeting accuracy of the guidelines. Further studies are necessary to identify risk factors associated with multidrug resistant infections requiring early vancomycin/meropenem administration. Show more

DOI: 10.3233/CH-238119

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 169-181, 2024

Authors: Unbehaun, P. | Prantl, L. | Langer, S. | Spindler, N.

Article Type: Research Article

Abstract: The choice of antibiotics and length of administration in the treatment of deep sternal wound infections (DSWI) is unclear. The reason for this is the lack of studies and local differences in resistance. An increase in resistance can be observed in gram-positive cocci, which are the most frequently detected in deep sternal infections. The duration of administration is often 2- 6 weeks or longer, although the benefit of prolonged antibiotic administration has not been confirmed by studies. We evaluated the antibiotic treatment during surgical treatment, consisting of surgical wound debridement and plastic chest reconstruction. METHODS: Retrospective analysis of …patients (n  = 260) who underwent reconstructive surgery in the Department of Plastic Surgery at Leipzig University Hospital from 01.05.2012 - 31.12.2020. The duration of intake, results of microbiological swabs and resistance were investigated. RESULTS: At the time of discharge, closed wound conditions were noted in 177 of 260 cases (68.1%). The largest proportion of patients (n  = 238) was treated with a latissimus dorsi flap (91.5%). Antibiotic treatment was conducted in 206 of 260 cases (79.2%). The mean duration of antibiotic administration was 21.4 days (±17.6). Prolonged treatment over 14 days did not alter outcome (p  = 0.226), in contrast, the number of multidrug resistances (p  < 0.001). There was no prove of resistance against linezolid which is effective against the most common found infectious agents Staphylococcus epidermidis (n  = 93; 24.0 %) & Staphylococcus aureus (n  = 47; 12.1 %). CONCLUSION: There is no evidence of benefit from antibiotic therapy over 14 days, whereas multidrug resistance increases with prolonged antibiotic use. In the absence of infectious agents or clinical signs of inflammation, surgical treatment without additional antibiotic treatment is effective. Linezolid is a suitable antibiotic in the treatment of gram-positive infections which are the most frequent in DSWI. Show more

Keywords: Deep sternal wound infections, DSWI, antibiotic treatment, surgical treatment

DOI: 10.3233/CH-238121

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 183-194, 2024

Authors: Tessmann, V. | Klepetko, J. | Brochhausen, C. | Gleißner, S. | Prantl, L. | Kempa, S.

Article Type: Research Article

Abstract: BACKGROUND: Biocompatibility describes the influence of materials on their biological environment. Implant material in the human body can cause a foreign body reaction and the formation of a capsule around the foreign material. Since capsular formation is the most frequent issue after breast-implant insertion, knowledge and awareness of biocompatibility is crucial, especially since worldwide, breast augmentation continues to be the most popular plastic surgery, with over 1.6 million procedures performed in 2020, according to surveys by the International Society of Aesthetic Plastic Surgery (ISAPS). MATERIAL AND METHODS: This study includes 80 capsular samples of female patients who underwent …revision surgery after breast-implant insertion at the University Hospital Regensburg. Capsules of breast implants with different surface structures (smooth, textured and polyurethane-coated) and shapes (round-shaped, anatomically-shaped) were analyzed histologically after hematoxylin-eosin-staining in respect to capsular thickness and layer formation. RESULTS: Capsular thickness and layering showed a statistically significant difference between polyurethane-coated and smooth as well as polyurethane-coated and textured implants. Capsules around polyurethane-coated implants presented greater thickness. However, the difference between smooth and textured implants was not statistically significant. Furthermore, the shape of the implants also indicated a statistically significant difference in capsular thickness. Implants of anatomical shape resulted in a thinner capsule than round-shaped breast-implants. CONCLUSION: In conclusion, this study demonstrated a thicker capsule around polyurethane-coated breast implants and no difference in capsular thickness between smooth and textured breast implants. Anatomically shaped breast-implants presented a thinner capsule than round shaped breast-implants. Show more

Keywords: Breast implants, capsular fibrosis, histological examinations, polyurethane

DOI: 10.3233/CH-238113

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 195-203, 2024

Authors: Nghinaunye, T. | Waldeck, P. | Jung, C.G.H. | Küpper, J.-H. | Jung, F. | Braune, S.

Article Type: Research Article

Abstract: The growth of cyanobacteria can vary considerably depending on the ambient temperature. Since the optimal growth temperature for Arthrospira platensis (strain SAG21.99) is not yet known, this was investigated in the present study. The study revealed that a process temperature of 30 °C seems to be optimal for the Arthrospira strain SAG21.99 cultivation in terms of a maximum biomass productivity. This was also true for the phycocyanin content which was at 30 °C significantly higher than at 20 or 40 °C.

Keywords: Arthrospira platensis, growth, temperature, bioreactor

DOI: 10.3233/CH-238104

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 205-211, 2024

Authors: Senk, Karin | Rio Bartulos, Carolina | Wilcke, Juliane | Einspieler, Ingo | Luerken, Lukas | Baeumler, Wolf | Stroszczynski, Christian | Wiggermann, Philipp

Article Type: Research Article

Abstract: BACKGROUND: Local ablation is an important treatment for liver cancer in cases of cirrhosis. Liver failure may occur after ablation, especially in advanced liver diseases. Currently, there is no standardization for peri-interventional risk assessment. The liver maximum capacity test (LiMAx) is used to assess functional liver capacity, but there is a lack of exploration of its use in this context. OBJECTIVE: The aim of this study was to retrospectively evaluate the usefulness of peri-interventional LiMAx measurements in patients with primary or secondary liver cancer who underwent ablation treatment. METHODS: A LiMAx test was …performed at 24 hours pre- and postablation in 49 patients. Blood parameters were collected to determine liver function using MELD and ALBI scores. The results of the LiMAx test were related with these scores and to critical postintervention LiMAx values. RESULTS: LiMAx values correlated strongly with MELD and ALBI scores before the intervention and reflected the change in liver function, as shown by an increase in scores after the intervention. Notably, LiMAx values decreased during the intervention. AUC analysis for patients at risk of reaching a critical liver level after the intervention showed a cutoff value of 186μg/kg/h. CONCLUSIONS: The LiMAx test may be a valuable tool in liver ablation for both peri-interventional monitoring of liver function and preintervention risk assessment. Show more

Keywords: Liver function, ablation, liver maximum capacity test (LiMAx), Hepatocellular carcinoma, ALBI, MELD

DOI: 10.3233/CH-238107

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 213-224, 2024

Authors: Ernert, Carsten | Kielstein, Heike | Azatyan, Argine | Prantl, Lukas | Kehrer, Andreas

Article Type: Research Article

Abstract: BACKGROUND: Deep sternal wound infections (DSWI) following cardiothoracic surgery represent a life quality endangering sequelae and may lead to sternal osteomyelitis. Radical debridement followed by Negative Pressure Wound Therapy (NPWT) may achieve infection control, provide angiogenesis, and improve respiratory function. When stable wound conditions have been established a sustainable plastic surgical flap reconstruction should be undertaken. OBJECTIVE: This study analyses a method to simplify defect coverage with a single Latissimus Dorsi Myocutaneous Flap (LDMF). METHODS: Preparation of 20 LDMF in ten fresh frozen cadavers was conducted. Surgical steps to increase pedicle length were evaluated. The common …surgical preparation of LDMF was compared with additional transection of the Circumflex Scapular Artery (CSA). RESULTS: Alteration of the surgical preparation of LDMF by sacrificing the CSA may provide highly valuable well-vascularized muscle tissue above the sensitive area of the Xiphisternum. All defects could be completely reconstructed with a single LDMF. The gain in length of flap tissue in the inferior third of the sternum was 3.86±0.9 cm (range 2.2 to 8 cm). CONCLUSIONS: By sacrificing the CSA in harvesting the LDMF a promising gain in length, perfusion and volume may be achieved to cover big sternal defects with a single flap. Show more

Keywords: Latissimus dorsi myocutaneous flap, deep sternal wound infection, circumflex scapular artery, microsurgery, single flap reconstruction, sternal reconstruction, sternal defect

DOI: 10.3233/CH-238115

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 225-236, 2024

Authors: Diesch, Sophia T. | Prantl, Lukas | Anders, Marvin | Eigenberger, Andreas | Wiesmeier, Anna | Brix, Eva | Griesbeck, Theresa | Brébant, Vanessa

Article Type: Research Article

Abstract: BACKGROUND: Asymmetry and scar formation of the nipple-areola complex (NAC) after reduction mammoplasty with periareolar suture are common complications and can significantly affect patient satisfaction. OBJECTIVE: The aim of this study was to investigate possible procedure-specific influencing factors on asymmetry and shape disturbances of the nipple-areola complex to optimize postoperative outcome and thus improve patient satisfaction. METHODS: 78 patients were followed-up after a 5-year period as part of a retrospective cohort study. Objective parameters as areolar diameter, symmetry, scar patterns, dimensions of the breast, and anthropometric measurements were recorded. All patients underwent surgery according to an …established treatment algorithm depending on the preoperative measurements. Follow up was 1 week, 6 week, 6 months and 3 years postoperatively. RESULTS: The periareolar suture-technique significantly influenced the symmetry and shape of the NAC. Compared to the intraoperative determined diameter and the postoperative diameter, the net-suture technique showed the highest NAC symmetry and minimal divergence. Patients who underwent Hall-Findlay mammoplasty showed significantly higher rates of asymmetry and deformity of the NAC with teardrop formation in comparison to Lejour mammoplasty. Scar formation was affected by periareolar ruffle formation especially after purse string suture. CONCLUSIONS: Regardless of what reduction mammoplasty techniques and periareolar suturing-technique are used, a tension-free suture of the NAC is crucial for shape, symmetry and scar formation. The net suture technique resulted in significantly higher symmetry of the NAC. Show more

Keywords: Nipple-areola complex symmetry, reduction Mammoplasty, postoperative symmetry NAC, NAC symmetry, operative influence factors

DOI: 10.3233/CH-238116

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 237-243, 2024

Authors: Brun, Jean-Frédéric | Varlet-Marie, Emmanuelle | Myzia, Justine | Vachoud, Laurent | Marion, Bénédicte | Roques, Céline | Raynaud de Mauverger, Eric | Mercier, Jacques

Article Type: Research Article

Abstract: The size of body compartments is a determinant of several factors of blood viscosity. Red cell aggregation is proportional to fat mass while hematocrit is proportional to both fat-free mass and abdominal adiposity, but which parts of these body components are involved in this relationship is not known. Segmental bioelectrical impedance analysis (sBIA) provides a possibility to delineate the relationships more precisely between various subdivisions of the body and blood viscosity factors, going farther than preceding studies using non segmental BIA. In this study we investigated in 38 subjects undergoing a standardized breakfast test with mathematical modelling of glucose …homeostasis and a segmental bioelectrical impedance analysis (sBIA) the relationships between the various compartments of the body and viscosity factors. Blood and plasma viscosity were measured with the Anton Paar rheometer and analyzed with Quemada’s model. The parameters better correlated to hematocrit are fat free mass (r  = 0.562) and its two components muscle mass (r  = 0.516) and non-muscular fat-free mass (r  = 0.452), and also trunk fat mass (r  = 0.383) and waist-to hip ratio (r  = 0.394). Red cell aggregation measurements were correlated with both truncal and appendicular fat mass (r ranging between 0.603 and 0.728). Weaker correlations of M and M1 are found with waist circumference and hip circumference. This study shows that the correlation between lean mass and hematocrit involves both muscle and non-muscle moieties of lean mass, and that both central and appendicular fat are determinants of red cell aggregation. Show more

Keywords: Fat mass, fat-free mass, muscle, red cell, viscosity, hemorheology

DOI: 10.3233/CH-238118

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 245-252, 2024

Authors: Diesch, Sophia T. | Schiltz, Daniel | Kammermeier, Julian | Prantl, Lukas | Taeger, Christian D.

Article Type: Research Article

Abstract: CONTEXT: Global sales of compression garments have risen sharply in recent years. Due to the availability of a wide range of compression garments, this study aims to evaluate the effect of two types of compression garments and kinesio tape on edema formation and tissue perfusion in the lower extremities. Over-the-counter compression knee stockings and kinesio tape were compared with a prototype of high-end compression stockings that combine kinesio tape and a common knee bandage. The high-end compression stockings were designed by Cube with the aim of combining the positive effects of kinesio tape and compression garments on edema formation and …tissue perfusion. DESIGN: Clinical cross-over study. METHODS: Before and after a 6-hour compression period, the knee regions on both, the treated and non-treated leg, of participants were examined using a 3-D scan to detect changes in volume. Also measured were local temperature (°C), oxygen saturation (SpO2), perfusion index (Pi), blood pressure (mmHg), compression pressure (mmHg), range of motion, body-mass-index (BMI) and limb-circumference (cm). Two different types of compression garments were examined: a novel high-end compression stocking (A) and a common compression stocking (B). In addition, kinesio tape was compared to compression garments (C). After each experimental day, a one-day break was taken to prevent an unwanted overlay effect. Male and female participants between the ages of 18 and 60 were randomly selected. RESULTS: The high-end compression garment (A) showed a statistically significant (P  = 0.009) reduction of edema intraindividually. Comparing the three treatment groups, compression (A) lead to a reduction of edema. However, the reduction was not statistically significant (P  = 0.585). The compression garment B and kinesio tape showed an increase in edema in the lower limb. There was a positive correlation between the highest compression pressure (A: 9.8 mmHg) and volume decrease over the period of 6 hours. Lighter compression (B: 8.2 mmHg) led to an increase in leg volume after compression application over 6 hours. There was no significant difference in tissue oxygen saturation with the two types of compression and kinesio tape. The tissue temperature below the compression garment was highest in the compression group A. Nevertheless, we could not demonstrate a statistically significant correlation between tissue temperature and volume difference. The range in motion of the lower limb decreased after 6 hours with both compression A and B and with kinesio tape. CONCLUSION: The novel bandage showed a statistically significant reduction in edema when compared intraindividually, but no statistically significant advantage was found when compared with the other compression garment B and kinesio tape. Despite the widespread use of kinesio tape, we did not find any improvement in the range of motion, edema prevention and circulation in the lower limb after application of kinesio tape. Show more

Keywords: Tissue perfusion, edema, microcirculation, sport medicine, rehabilitation, sports rehabilitation imaging

DOI: 10.3233/CH-238111

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 253-261, 2024