Clinical Hemorheology and Microcirculation - Volume 87, issue 1

Authors: Rother, D. | Gehron, J. | Brenck, F. | Hudel, H. | Böning, A. | Wenzel, F.

Article Type: Research Article

Abstract: INTRODUCTION: COVID-19 causes a considerable degradation of pulmonary function to the point of an acute respiratory distress syndrome (ARDS). Over the course of the disease the gas exchange capability of the lung can get impaired to such an extent that extracorporeal membrane oxygenation (ECMO) is needed as a life-saving intervention. In patients COVID-19 as well as ECMO may cause severe coagulopathies which manifest themselves in micro and macro thrombosis. Previous studies established D-dimers as a marker for critical thrombosis of the ECMO system while on admission increased D-dimers are associated with a higher mortality in COIVD-19 patients. It is therefore …crucial to determine if COVID-19 poses an increased risk of early thrombosis of the vital ECMO system. METHODS: 40 patients who required ECMO support were enrolled in a retrospective analysis and assigned into 2 groups. The COVID group consist of 20 COVID-19 patients who required ECMO support (n  = 20), whereas 20 ECMO patients without COVID-19 were assigned to the control group. D-dimers, fibrinogen, antithrombin III (AT III), lactate dehydrogenase (LDH) and platelet count were analysed using locally weighted scatterplot smoothing and MANOVAs. RESULTS: The analysis of both groups shows highly significant differences in the dynamics of hemostasis. The increase in D-dimers that is associated with thrombosis of the ECMO systems occurs in COVID-19 patients around 2 days earlier (p  = 2,8115 10–11 ) while fibrinogen is consumed steadily. In the control group fibrinogen levels increase rapidly after ten days with a plateau phase of around five days (p  = 1,407 10–3 )  . Both groups experience a rapid increase in AT III after start of support by ECMO (p  = 5,96 10–15 ). In the COVID group platelet count decreased from 210 giga/l to 130 giga/l within eight days, while in the same time span in the control group platelets decreased from 180 giga/l to 105 giga/l (p  = 1,1 10–15 ). In both groups a marked increase in LDH beyond 5000 U/l occurs (p  = 3,0865 10–15 ). CONCLUSION: The early increase in D-dimers and decrease in fibrinogen suggests that COVID-19 patients bear an increased risk of early thrombosis of the ECMO system compared to other diseases treated with ECMO. Additionally, the control group shows signs of severe inflammation 10 days after the start of ECMO which were absent in COVID-19 patients. Show more

DOI: 10.3233/CH-229105

Citation: Clinical Hemorheology and Microcirculation, vol. 87, no. 1, pp. 1-11, 2024

Authors: Wang, Shengqiao | Xu, Xinliang | Cao, Siqi | Cheng, Juan | Wang, Ying | Dong, Yi

Article Type: Research Article

Abstract: BACKGROUND: Type 2 diabetes accelerates the loss of muscle mass and strength. Sarcopenia is also one of the chronic complications of diabetes. OBJECTIVE: To investigate the clinical value of B mode ultrasound (BMUS) and shear wave elastography (SWE) for predicting type 2 diabetic sarcopenia. METHODS: We recorded Skeletal Muscle Mass Index (ASMI), grip strength, muscle thickness (MT), pinna angle (PA), fascicle length (FL), and the difference of Young’s modulus in the relaxed states and tense states (Δ SWE). The correlations between clinical indicators and ultrasound characteristics were compared. A diagnostic model of sarcopenia was developed to …assess the independent correlates and evaluate the diagnostic efficacy of sarcopenia. RESULTS: ASMI was significantly and positively correlated with MT and Δ SWE (r  = 0.826, 0.765, P  < 0.01), and grip strength was significantly and positively correlated with MT and Δ SWE (r  = 0.797, 0.818, P  < 0.01). MT was the most significant predictor of sarcopenia (OR = 4.576, P  < 0.001), and the cut-off value of MT was 11.4 mm (AUC: 0.952). CONCLUSION: BMUS and SWE can quantitatively assess muscle mass and strength, and are effective methods to predict the occurrence of sarcopenia in elderly patients with type 2 diabetes. Show more

Keywords: Type 2 diabetes, sarcopenia, B mode ultrasound, shear wave elastography

DOI: 10.3233/CH-231822

Citation: Clinical Hemorheology and Microcirculation, vol. 87, no. 1, pp. 13-26, 2024

Authors: Al-Smadi, Mohammad Walid | Fazekas, Laszlo Adam | Varga, Adam | Matrai, Adam Attila | Aslan, Siran | Beqain, Anas | Al-Khafaji, Mustafa Qais Muhsin | Bedocs-Barath, Barbara | Novak, Laszlo | Nemeth, Norbert

Article Type: Research Article

Abstract: BACKGROUND: Arteriovenous malformations (AVMs) are vascular anomalies characterized by abnormal shunting between arteries and veins. The progression of the AVMs and their hemodynamic and rheological relations are poorly studied, and there is a lack of a feasible experimental model. OBJECTIVE: To establish a model that cause only minimal micro-rheological alterations, compared to other AV models. METHODS: Sixteen female Sprague Dawley rats were randomly divided into control and AVM groups. End-to-end anastomoses were created between the saphenous veins and arteries to mimic AVM nidus. Hematological and hemorheological parameters were analyzed before surgery and on the 1st , …3rd , 5th , 7th , 9th , and 12th postoperative weeks. RESULTS: Compared to sham-operated Control group the AVM group did not show important alterations in hematological parameters nor in erythrocyte aggregation and deformability. However, slightly increased aggregation and moderately decreased deformability values were found, without significant differences. The changes normalized by the 12th postoperative week. CONCLUSIONS: The presented rat model of a small-caliber AVM created on saphenous vessels does not cause significant micro-rheological changes. The alterations found were most likely related to the acute phase reactions and not to the presence of a small-caliber shunt. The model seems to be suitable for further studies of AVM progression. Show more

Keywords: Arteriovenous malformation, experimental model, microsurgery, hemorheology

DOI: 10.3233/CH-231825

Citation: Clinical Hemorheology and Microcirculation, vol. 87, no. 1, pp. 27-37, 2024

Authors: Kokkinidou, D. | Kaliviotis, E. | Shammas, C. | Anayiotos, A. | Kapnisis, K.

Article Type: Research Article

Abstract: BACKGROUND: Even though cardiovascular stenting is widely used for the treatment of coronary artery disease, information on how it can affect the hematological and hemorheological profile is scarce in the literature. Most of the work on this issue is based on theoretical or computational fluid dynamics models, lacking in-depth in vitro and in vivo experimental verification. OBJECTIVE: This work investigates, in an in vivo setting, the effects of stenting and the implantation time-course on hematological and hemorheological parameters that could potentially compromise the device’s functionality and longevity. METHODS: Custom-made self-expanding nitinol stents were …implanted in the common carotid artery of male CD1 mice. Whole blood samples were collected from control (non-stented) and stented animals at 5 and 10 weeks post-implantation. Hematological measurements and blood viscosity, red blood cell aggregation, and deformability were performed using standard techniques. RESULTS: Implant-induced changes were observed in some of the hematological and hemorheological indices. Blood viscosity seems to have been negatively affected by an increased hematocrit and reduced RBC deformability, at 10 weeks post-implantation, despite a slight decrease in RBC aggregation. CONCLUSIONS: Although the alterations observed may be the result of the peri-implant inflammatory response, the physiological consequences due to hemorheological changes need to be further investigated. Show more

Keywords: Stents, mouse implantation model, hematology, red blood cell biomechanics, hemorheology

DOI: 10.3233/CH-231921

Citation: Clinical Hemorheology and Microcirculation, vol. 87, no. 1, pp. 39-53, 2024

Authors: Zhao, Qiannan | Ji, Zhengbiao | Chen, Yanling | Wang, Kun | Qiu, Yijie | Tian, Xiaofan | Zhu, Yuli | Qin, Hong | Han, Hong | Yuan, Haixia | Dong, Yi | Wang, Wenping

Article Type: Research Article

Abstract: BACKGROUND: Hepatic sarcomatoid carcinoma (HSC) is a rare malignancy of the liver. The ultrasound and clinical features of HSC have not been determined. OBJECTIVE: To investigate and compare the ultrasound and clinical features of HSC and hepatocellular carcinoma (HCC), and to reveal the valuable features of HSC. METHODS: The ultrasound features and clinical data of pathologically proven HSC (n  = 37) were compared with HCC (n  = 92) in a matching ratio of 1:4 using the propensity score (age, gender and tumor size). RESULTS: The HSC patients were more likely to accompany with clinical symptoms and …vascular invasion than HCC patients (40.5% vs 17.4%, 24.3% vs 6.5%, P  < 0.05). The size of HSCs was significantly larger than that of HCCs (P  < 0.05). The proportion of patients with elevated alpha-fetoprotein was significantly lower in HSC (35.1% vs 54.3%, P  < 0.05). On gray-scale ultrasound images, the HSCs were more likely to demonstrate as indistinct margin and irregular shape lesions compared to HCCs (78.4% vs 48.8%; 70.3% vs 23.9%, P  < 0.05). Under color Doppler flow imaging (CDFI), the blood flow signals were more frequently detected in HSC lesions (75.7% vs 56.5%, P  < 0.05). Resistance index (RI) was higher in HSCs than in HCCs [0.78 (0.70,0.82) vs 0.70 (0.62,0.76), P  < 0.05]. On contrast-enhanced ultrasound (CEUS), HSCs mainly showed entirety heterogeneous hyper-enhancement (48.6%), entirety homogeneous enhancement (18.9%), peripheral and internal septal enhancement (18.9%). The incidence of non-enhanced areas inside HSC lesions was higher than that inside HCC lesions (56.8% vs 31.5%, P  < 0.05). During the portal venous and late phases, most of the lesions revealed hypo-enhancement in both groups, whereas earlier washout was observed in HSCs [43.0 s (30.5,58.0) vs 60.0 s (46.3,100.0), P  < 0.05]. CONCLUSIONS: CEUS features are useful in preoperative and non-invasive differentiation of hepatic sarcomatoid carcinoma and hepatocellular carcinoma. Show more

Keywords: Hepatic sarcomatoid carcinoma (HSC), hepatocellular carcinoma (HCC), gray-scale ultrasound, color Doppler flow imaging (CDFI), contrast-enhanced ultrasound (CEUS)

DOI: 10.3233/CH-231944

Citation: Clinical Hemorheology and Microcirculation, vol. 87, no. 1, pp. 55-65, 2024

Authors: Betz, Thomas | Pfister, Karin | Schierling, Wilma | Sachsamanis, Georgios | Radunski, Jörn | Nolte Ernsting, Claus | Stehr, Alexander

Article Type: Research Article

Abstract: BACKGROUND: The popliteal artery is highly exposed to biomechanical stress, which is the primary factor associated with stent failure. However, information on the optimal endovascular treatment for the popliteal artery is lacking. OBJECTIVE: To report the efficacy of the GORE® TIGRIS® Vascular Stent for the endovascular treatment of popliteal artery lesions. METHODS: Retrospective analysis of all patients with symptoms of peripheral artery occlusive disease (PAD) and popliteal artery lesions who underwent implantation of a GORE® TIGRIS® Vascular Stent between August 2012 and August 2014 at a tertiary vascular centre. RESULTS: …Between August 2012 and August 2014, 48 patients (32 men, aged 75±8 years) were treated with a GORE® TIGRIS® Vascular Stent. The technical success rate was 100%. At 12 months, the primary and secondary patency rates were 74% and 85%, respectively. During follow-up, no stent fracture was observed. No major amputations were performed. CONCLUSIONS: Our study showed that isolated popliteal artery lesions in patients with symptomatic PAD could easily be treated with the GORE® TIGRIS® Vascular Stent, as good short-term results were achieved at 12 months. Therefore, the discontinuation of this product removed a useful tool with a simple release mechanism from the endovascular armamentarium of vascular specialists. Show more

Keywords: Popliteal artery lesion, GORE® TIGRIS® vascular stent, endovascular therapy, self-expandable nitinol stent

DOI: 10.3233/CH-231993

Citation: Clinical Hemorheology and Microcirculation, vol. 87, no. 1, pp. 67-75, 2024

Authors: Zhang, Shen | Liu, Yunyun | Zhou, Bangguo | Xu, Huixiong

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate the efficacy and safety of percutaneous ultrasound-guided thermal ablation in the treatment of cervical metastatic lymph nodes (LNs) from papillary thyroid carcinoma (PTC). MATERIALS AND METHODS: A total of 77 patients with 79 LNs ablated by microwave ablation (MWA) or radiofrequency ablation (RFA) between September 2018 and October 2022 were enrolled in this study. After treatment, patients were followed up with measurement of diameters of LNs and serum thyroglobulin (s-Tg) at 1, 3, 6, and 12 months and annually thereafter. The paired t-test was used to compare the changes of s-Tg level, diameters of LNs …before and after ablation. RESULTS: There were no serious complications related to ablation while one case of incomplete ablation in MWA was found during follow-up. The mean longest and shortest diameter of the ablated LNs reduced from 11.6 ± 4.3 mm to 5.0 ± 4.1 mm (p  < 0.001), and from 6.1 ± 1.9 mm to 3.0 ± 2.5 mm (p  < 0.001) at the last follow-up visit. Besides, the final volume reduction rate (VRR) was 61.8 ± 56.4% (range, –67.0 –100%). The complete disappearance rate was 46.8%, but there were 4 (5.1%) LNs becoming bigger than before. The average s-Tg level was 9.2 ± 26.6 ng/mL, a data significantly decreased to 3.7 ± 7.0 ng/mL at the last follow-up, but no statistical difference was shown. CONCLUSION: Thermal ablation is an effective and safe modality for the treatment of metastatic LNs from PTC. Show more

Keywords: Ultrasound, thermal ablation, papillary thyroid carcinoma, lymph nodes

DOI: 10.3233/CH-231998

Citation: Clinical Hemorheology and Microcirculation, vol. 87, no. 1, pp. 77-87, 2024

Authors: Grynkiewicz, Michael | Wiewióra, Maciej

Article Type: Research Article

Abstract:  Recently diagnostic field in medicine was enriched by advances in ultrasonography (US) technology, which led to establishment of novel modalities, one of which is micro-ultrasound. Results demonstrated by early studies have been promising, simultaneously rising a question if those new modalities could become an alternative in diagnosis of prostatic carcinoma (PCa). To answer this question, several studies have been conducted where micro-ultrasound have been compared to standard diagnostic tools, such as conventional TRUS or mpMRI. Nevertheless, new technology presents with some limitations, which include inconsistent results, necessity for specialized equipment, need of training for investigators to understand the findings, and …external validation. In this publication, we have identified studies that provided evaluation of the accuracy and efficiency of the micro-ultrasound technology. Additionally, analysis of the results provided a better understanding of the novel imaging tool when compared standard modalities in diagnosis of PCa. Increasing number of studies demonstrated that micro-ultrasound carries high detection rate of PCa and clinically significant prostatic cancer (csPCa), suggesting a similar performance to mpMRI and even showing superiority over conventional TRUS. Recent studies have also showed that micro-ultrasound takes active role in improving the detection of csPCa and guidance for prostate biopsy (PBx) as well as further treatment. Moreover, certain practical aspects such as lower costs, decreased waiting time, real-time imaging and application of the imaging tool for patients that are not suitable for mpMRI (contrast allergy, prosthetics etc.) are significant advantages. Analysis of the results still does not provide clear answer whether micro-ultrasound outperforms mpMRI. Further studies are necessary in order to completely understand the potential of this new technology. Show more

Keywords: Prostate cancer, micro-ultrasound imaging, transrectal ultrasonography

DOI: 10.3233/CH-232024

Citation: Clinical Hemorheology and Microcirculation, vol. 87, no. 1, pp. 89-100, 2024

Authors: Chatlaong, Matthew A. | Stanford, Daphney M. | Miller, William M. | Davidson, Chance J. | Jessee, Matthew B.

Article Type: Research Article

Abstract: BACKGROUND: Post-occlusive reactive hyperemia (PORH) typically requires caffeine abstinence. For habitual users, it is unknown if abstinence affects PORH. OBJECTIVE: Compare PORH after habitual users consume or abstain from caffeine. METHODS: On separate visits (within-subject), PORH was measured in 30 participants without abstinence from typical caffeine doses (CAFF) and with abstinence (ABS). Measurements included baseline and peak hyperemic velocity, tissue saturation index slopes during ischemia (Slope 1) and following cuff deflation (Slope 2), resting arterial occlusion pressure (AOP), heart rate (HR), systolic (SBP), and diastolic (DBP) blood pressure. All variables were compared using Bayesian paired t …-tests. BF10  = likelihood of alternative vs null. Results are mean±SD. RESULTS: Comparing baseline velocity (cm/s) between CAFF (9.3±4.8) and ABS (7.5±4.9) yielded anecdotal evidence (BF10  = 1.0). Peak hyperemic velocity (cm/s) was similar (CAFF = 77.3±16.7; ABS = 77.6±19.0, BF10  = 0.20). For slopes (TSI% /s), CAFF Slope 1 = –0.11±0.04 and Slope 2 = 1.9±0.46 were similar (both BF10 ≤0.20) to ABS Slope 1 = –0.12±0.03 and Slope 2 = 1.8±0.42. SBP and DBP (mmHg) were both similar (CAFF SBP = 116.0±9.8, DBP = 69.6±5.8; ABS SBP = 115.5±10.7, DBP = 69.5±5.4; both BF10 ≤0.22). Comparing AOP (mmHg) (CAFF = 146.6±15.0; ABS = 143.0±16.4) yielded anecdotal evidence (BF10  = 0.46). HR (bpm) was similar (CAFF = 66.5±12.3; ABS = 66.9±13.0; BF10  = 0.20). CONCLUSIONS: In habitual users, consuming or abstaining from typical caffeine doses does not appear to affect post-occlusive reactive hyperemia. Show more

Keywords: Blood velocity, tissue saturation index, methylxanthine, vascular, cardiovascular

DOI: 10.3233/CH-232036

Citation: Clinical Hemorheology and Microcirculation, vol. 87, no. 1, pp. 101-113, 2024

Authors: Men, Xingping | Hu, Aizhen | Xu, Tingting

Article Type: Research Article

Abstract: Atherosclerosis (AS) is a major chronic non-communicable disease and a primary cause of cardiovascular disease. Recent studies have shown that circRNAs are potential epigenetic factors that regulate vascular endothelial inflammatory responses and AS progression. Therefore, identification of the circRNAs that regulate ox-LDL levels is a critical step to understanding the pathology of AS. Our study is aim to investigate how circLZIC regulates atherosclerosis (AS) via the Micro-330-5p/NOTCH2 regulatory axis. The results showed that CircLZIC and NOTCH2 are highly expressed in human AS clinical samples, while Micro-330-5p is expressed locally. The CCK-8 experiment results showed that circLZIC promotes the proliferation of …HUVECS cells. Flow cytometry analysis showed that circLZIC act as an inhibitor of HUVEC cell apoptosis. The expression level of Micro-330-5p can be up-regulated by transfection of small interfering RNA against circLZIC. Further, Starbase predicted that Micro-330-5p could target and regulate NOTCH2. Next, we confirmed that overexpression of Micro-330-5p could significantly reduce the expression of fluorescein using the double Luciferase reporter assay. RIP-qRT-PCR experiment showed that Micro-330-5p and NOTCH2 mRNAs are effectively enriched by ago2 protein. Further, we found that knocking down circLZIC increases the expression of Micro-330-5p and promotes cell apoptosis, while inhibiting the expression of NOTCH2 and cell activity. On the other hand, co-transfection of Micro-330-5p inhibitor decreases Micro-330-5p expression and inhibit cell apoptosis, while increasing NOTCH2 expression and cell activity. In conclusion, CircLZIC regulates HUVEC cell activity by the Micro-330-5p/NOTCH2 signaling pathway, suggesting that circLZIC plays a key role in atherosclerosis development. Show more

Keywords: CircLZIC, atherosclerosis, Micro-330-5p/NOTCH2, proliferation, apoptosis

DOI: 10.3233/CH-232063

Citation: Clinical Hemorheology and Microcirculation, vol. 87, no. 1, pp. 115-127, 2024

Authors: Zou, Xiuli | Li, Ying | Yang, Jilan | Miao, Juan | Li, Yuan | Ling, Wenwu

Article Type: Case Report

Abstract: BACKGROUND: Acute stroke poses a serious threat to people’s health. The occurrence of a thrombus following the rupture of vulnerable plaques in the carotid artery is a significant contributor to the development of stroke. In previous case reports, it has been challenging to visualize tiny ulcerations within carotid artery plaques using computed tomography angiography (CTA) and digital subtraction angiography (DSA), even when the rupture of the plaque leads to the formation of a free-floating thrombus (FFT). However, in this particular case, contrast-enhanced ultrasound (CEUS) was able to overcome this limitation and provide a more precise assessment, confirming that the FFT …formation was indeed a result of plaque rupture rather than any other potential causes. Cases that utilize CEUS to visualize the formation of ulcers and FFT resulting from plaque rupture are even more rare. As such, we present this case to shed light on this infrequent phenomenon. CASE SUMMARY: In this case study, we present a 65-year-old male patient who was admitted to the hospital due to headache and abnormal mental behavior for one day. During the routine cervical artery ultrasound examination upon admission, we detected the presence of plaque in the right internal carotid artery of the patient, resulting in luminal stenosis. Additionally, we observed suspected hypoechoic material at the distal end of the plaque. After undergoing CEUS examination, it was definitively determined that an ulcer had formed and a FFT had developed due to the rupture of carotid artery plaque. Subsequent CTA and DSA examinations further confirmed the presence of the FFT. The magnetic resonance imaging (MRI) reveals an acute lacunar infarction in the head of the right caput nuclei caudate, which strengthens the potential link between the patient’s neurological and psychiatric symptoms observed during admission. The patient received prompt antiplatelet therapy and underwent cervical artery stenting surgery with the assistance of a distal embolic protection device. Following the procedure, the patient was discharged on the fourth day and experienced a complete recovery. CONCLUSION: CEUS is a valuable tool for visualizing FFT resulting from the rupture of vulnerable plaques in the carotid artery. Show more

Keywords: Contrast-enhanced ultrasound, vulnerable plaque, rupture, plaque ulceration, free-floating thrombus, stroke

DOI: 10.3233/CH-232037

Citation: Clinical Hemorheology and Microcirculation, vol. 87, no. 1, pp. 129-136, 2024

Authors: Wu, Lilu | Wang, Xiaogang | Zhou, Panpan | Luo, Jieli

Article Type: Case Report

Abstract: INTRODUCTION: It is rare for intraductal papilloma (IDP), a benign papillary tumor, to occur in the sublingual gland (SLG). CASE SUMMARY: A 55-year-old man incidentally found a painless mass in his left submandibular region (SMR). He had a history of two surgeries for bilateral SLG cyst. Contrast enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) were performed. The patient received trans-cervical excision of left residual SLG in combination with excision of left submandibular gland (SMG). The postoperative course was uneventful and no signs of recurrence during 5 months of follow-up. DISCUSSION: For a SMR mass, extraoral …type of IDP in SLG should be considered in the differential diagnosis. Show more

Keywords: Intraductal papilloma, sublingual gland, submandibular region, case report

DOI: 10.3233/CH-231717

Citation: Clinical Hemorheology and Microcirculation, vol. 87, no. 1, pp. 137-139, 2024