Clinical Hemorheology and Microcirculation - Volume 88, issue 4

Authors: Jung, Ernst Michael | Wiesinger, Isabel | Kaiser, Ulrich | Jung, Friedrich

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: Modern ultrasound technology enables detailed tissue morphology analysis. A novel approach involves measuring viscoelasticity or viscosity. This pilot study investigates the potential of a novel high-end ultrasound system with dynamic quality indicators and the M-Ref tool. METHODS: Using a novel premium high-end ultrasound system (Resona A20/Mindray), comparative investigations were conducted on 52 patients, evaluating B-mode morphology, shear wave tissue elastography (STE), and viscosity (STVi) of the liver parenchyma. The study utilized a cohort of 25 healthy volunteers as a control group. The examinations were performed intercostally using a multifrequency convex probe SC7-1U (1–7 MHz) and breath-hold …technique, ensuring that at least the highest or second-highest score in the dynamic quality control (5 stars) was achieved. Measurements were made in a color-coded region with a maximum 2 cm diameter and a depth of no more than 2 cm, avoiding bile ducts or blood vessels, at a depth up 2 cm from the liver capsule. RESULTS: A minimum of 10 measurements were taken for each parameter: liver steatosis (based on acoustic attenuation coefficient, USAT), viscosity (STVi), and shear wave elastography (STE) with correlation to fibrosis grade. Reference values for the control group were <1.4 m/s and <5 kPa for STE, with cirrhosis criteria defined as values >2.6 m/s and >15 kPa. For steatosis, values up to 0.5 dB/cm/MHz were considered normal, while values >0.8 dB/cm/MHz indicated fatty liver. Viscosity values <1.7 Pa.s were deemed normal, with >3.6 Pa.s indicating significant abnormality. Major causes of increased viscosity included severe steatosis, active hepatitis, hepatic tumors, or post-ablative states. In all cases, a high-quality indicator score (>93%) was achieved with at least 4/5 top reference markers in green. CONCLUSIONS: This pilot study confirms the comprehensive capabilities of multimodal imaging for tissue characterization using B-mode, elastography, and new techniques for assessing viscoelasticity. However, extensive multicenter evaluations will be needed to definitively establish reference values specific to the type of transducer and equipment used. Show more

Keywords: Liver ultrasound, quality indicators, shear wave elastography, viscosity, multiparametric (M-Ref)

DOI: 10.3233/CH-248111

Citation: Clinical Hemorheology and Microcirculation, vol. 88, no. 4, pp. 419-427, 2024

Authors: Wang, Fang | Guo, Zhangmei | Yang, Guiqi | Yang, Fan | Zhou, Qi | Lv, Hongbin

Article Type: Research Article

Abstract: PURPOSE: Diabetic retinopathy (DR) is a serious retinal vascular disease that affects many individuals in their prime working years. The present research aimed at whether and how LOC681216 (LNC-216) is involved in retinal vascular dysfunction under diabetic conditions. METHODS: Rat retinal microvascular endothelial cells (RRMECs) treated with high glucose (HG) were used for functional analysis. Gene expression analysis was conducted using the Clariom D Affymetrix platform. The wound healing, transwell, and vascular tube formation assays were used to identify the migration, invasion, and tube formation capability of RRMECs. The dual-luciferase reporter confirmed the binding interaction between miR-143-5p and …LNC-216 or matrix metallopeptidase 2 (MMP2). RESULTS: Lnc-216 was upregulated in RRMECs treated with HG. Lnc-216 knockdown markedly suppressed the tube formation, cell migration, and wound healing of cultured RRMECs under HG conditions. Mechanistically, Lnc-216 acted as a miR-143-5p sponge to affect the biological activity of miR-143-5p, which led to increased expression of matrix metallopeptidase 2 (MMP2). CONCLUSIONS: Lnc-216 attenuates diabetic retinal vascular dysfunction through the miR-143-5p/MMP2 axis, providing a potential therapeutic strategy for DR. Show more

Keywords: Lnc-216, miR-143-5p, microarray, diabetic retinopathy, MMP2

DOI: 10.3233/CH-242163

Citation: Clinical Hemorheology and Microcirculation, vol. 88, no. 4, pp. 429-442, 2024

Authors: Zhu, Yi-Cheng | Zhou, Li | Zu, Dao-Ming | Deng, Shu-Hao | Zhang, Yuan | Shan, Jun | Shi, Xiu-Rong | Jiang, Quan

Article Type: Research Article

Abstract: BACKGROUND: Mesenteric lymphadenitis (ML) demonstrates a distinctive inclination for the pediatric and adolescent demographic and the diagnosis of ML in young children poses a substantial challenge. OBJECTIVE: This prospective study aimed to assess the diagnostic efficacy of Superb Microvascular Imaging (SMI) and Virtual Touch Tissue Imaging quantification (VTIQ) in distinguishing pediatric mesenteric lymphadentitis. METHODS: We examined 82 mesentric lymph node (MLN) in pediatric patients with mesenteric lymphadentitis and 50 MLN in a healthy group. SMI was utilized to evaluate vascularity within the MLN, while MLN stiffness, quantified as shear wave velocity (SWV) in meters per second …(m/s), was assessed using VTIQ. We compared the diagnostic performance of greyscale Ultrasound, US combined with SMI, US combined with VTIQ, and US combined with both SMI and VTIQ. RESULTS: SMI revealed a significant distinction between mesenteric lymphadentitis and normal MLN (p  < 0.001). MLN affected by mesenteric lymphadentis exhibited increased vascularity (marked vascularity: 13/82, 15.85%) compared to normal MLN (marked vascularity: 1/50, 2.00%). Statistically significant differences were observed in SWV values beween mesenteric lymphadentitis and normal MLN (all p -values <0.001). The mean and minimum SWV values for MLN with mesenteric lymphadentitis were 1.66±0.77 m/s and 1.51±0.53 m/s, respectively. Control group SWV values were approximately three times higher than those in the mesenteric lymphadenitis group. The highest area under the curve values were achieved with the combination of all three modalities (0.837, 95% confidence interval: 0.763– 0.896), followed by US + VTIQ (0.795, 0.716– 0.860), US + SMI (0.753, 0.670– 0.824) and US alone (0.642, 0.554– 0.724). CONCLUSION: SMI and VTIQ offer a promising noninvasive adjunct to grayscale ultrasound for identifying mesenteric lymphadentitis in pediatric patients. Show more

Keywords: Mesenteric lymphadenitis, pediatrics, Elastography, Doppler ultrasound

DOI: 10.3233/CH-242305

Citation: Clinical Hemorheology and Microcirculation, vol. 88, no. 4, pp. 443-454, 2024

Authors: Zhang, Lei-Guang | Li, Hui-Juan | Liu, Shuai | Liu, Jie-Yun

Article Type: Research Article

Abstract: OBJECTIVE: The aim of this study is to investigate the correlation between the triglyceride-glucose-body mass index (TyG-BMI) and the characteristics of various carotid plaques in middle-aged and elderly patients with acute myocardial infarction (AMI). METHODS: A retrospective study was conducted on 380 patients with AMI hospitalized in the Cardiology Department of Kaifeng Central Hospital. Based on carotid ultrasound results, patients were divided into the following two groups: the stable plaque group and the unstable plaque group. Additionally, a control group comprising 380 healthy individuals visiting the hospital’s physical examination center during the same timeframe was established. Fasting venous …blood samples were collected from all participants to measure blood glucose and triglyceride. The baseline TyG-BMI index was calculated using the formula Ln [fasting triglyceride (mg/dL)×fasting blood glucose (mg/dL)/2]×BMI. The correlation between different plaque groups and the TyG-BMI index was analyzed. RESULTS: The TyG-BMI index was significantly higher in the unstable plaque group compared to the stable plaque group, with values of 252.81±29.99 and 201.92±28.72, respectively (P  = 0.034). Spearman’s correlation analysis showed a positive correlation between the instability of carotid plaques and the TyG-BMI index in patients with AMI (r  = 0.521, P  = 0.003). Logistic regression analysis indicated that the TyG-BMI index was an important risk factor for unstable carotid plaques in patients with AMI (OR = 2.691, 95% CI: 1.169–4.123). CONCLUSION: The findings of this study suggest that an elevated TyG-BMI index significantly increases the risk of unstable carotid plaques in patients with AMI, making it an important risk factor for carotid plaque instability. Show more

Keywords: Atherosclerosis, acute myocardial infarction, carotid artery, TyG-BMI index, unstable plaques

DOI: 10.3233/CH-242354

Citation: Clinical Hemorheology and Microcirculation, vol. 88, no. 4, pp. 455-462, 2024

Authors: Ma, Yue | Du, Jin | Wang, Xin-Xin | Deng, Tong | Qi, Jia-Li | Cheng, Hong | Li, Lu

Article Type: Research Article

Abstract: OBJECTIVE: In this study, we developed an exercise training protocol for assessing both blood pressure dynamics and mRNA expression levels of purine receptors in various vascular tissues during physical activity. The objective is to assess the impact of exercise training on blood pressure regulation in spontaneously hypertensive rats (SHR) and purine receptors in vascular tissues. METHODS: Wistar Kyoto (WKY) and SHR rats were randomly allocated into sedentary (Sed) and exercise training (ExT) groups. Rats in the Sed groups were allowed unrestricted movement, whereas those in the ExT groups underwent a 16-week regimen of low- to moderate-intensity treadmill exercise. …Throughout the intervention period, blood pressure measurements and body weight recordings were conducted. Additionally, mRNA expressions of purine receptors P2X1, P2Y1, and P2Y2 in renal artery (RA), internal carotid artery (Int), thoracic aorta (Aor), and caudal artery (Cau) tissues were assessed. RESULTS: In the Sed group, body weight of SHR rats was observed to be lower compared to the three other groups. Over the course of the exercise regimen, blood pressure in the ExT group of SHR rats reduced gradually, converging towards levels similar to those observed in WKY rats by the conclusion of the exercise period. Regarding mRNA expression patterns of P2X1 receptors across the four blood vessels, WKY and SHR rats demonstrated similar sequences, consistently displaying the highest expression levels in the Cau. Conversely, mRNA expressions of P2Y1 and P2Y2 receptors exhibited distinct sequences across the four blood vessels in both WKY and SHR rats. Notably, compared to the Sed group of WKY rats, mRNA expression of P2X1 receptor in the Int of SHR rats revealed an increase, while expressions in the Aor of WKY rats and the Cau of SHR rats decreased following exercise. Expression of P2Y1 receptor mRNA decreased across all four types of blood vessels in SHR rats. Post-exercise, P2Y1 receptor mRNA expression increased in the Aor, decreased in the Cau of WKY rats, and increased in the Int and renal artery (RA) of SHR rats. Conversely, expressions of P2Y2 receptor mRNA decreased in the Int and Aor of SHR rats. Except for the Aor of WKY rats, expressions of P2Y2 receptor mRNA increased in the other arteries of both rat types following exercise. CONCLUSION: Differences in the distribution of purine receptor subtypes among distinct arterial segments in both WKY and SHR rats were observed. Exercise training was found to enhance mRNA expression levels of P2Y receptors in these rat models. This finding implies that exercise training might reduce hypertension in SHR rats by bolstering the purinergic relaxation response. Show more

Keywords: Blood vessels, exercise training, purine receptors, spontaneous hypertension rat

DOI: 10.3233/CH-242366

Citation: Clinical Hemorheology and Microcirculation, vol. 88, no. 4, pp. 463-474, 2024

Authors: Zhang, Wei-Bing | Deng, Wen-Fang | He, Bei-Li | Wei, Ying-Ying | Liu, Yu | Chen, Zhe | Xu, Ren-Yan

Article Type: Research Article

Abstract: OBJECTIVES: To investigate the diagnostic value of CEUS combined with C-TIRADS for indeterminate FNA cytological thyroid nodules. METHODS: The clinical data, ultrasonic images, C-TIRADS categories and CEUS images of 192 patients with indeterminate FNA cytological thyroid nodules confirmed by the surgical pathology were analyzed retrospectively. The diagnostic efficacy of CEUS, C-TIRADS and CEUS-TIRADS were calculated. RESULTS: The AUCs of CEUS, C-TIRADS and CEUS-TIRADS were 0.905 (95% CI: 0.862∼0.949), 0.881 (95% CI: 0.825∼0.938) and 0.954 (95% CI: 0.922∼0.986), respectively. The sensitivity, specificity, PPV, NPV, accuracy, LR– and LR+ were 84.7% (116/137), 85.5% (47/55), 93.5% (116/124), …69.1% (47/68), 84.9% (163/192), 0.179, 5.82 and 84.7% (116/137), 83.6% (46/55), 92.8% (116/125), 68.7% (46/67), 84.4% (162/192), 0.183, 5.17, 92.7% (127/137), 89.1% (49/55), 95.5% (127/133), 83.1% (49/59), 91.7% (176/192), 0.082, and 8.50, respectively. Compared with CEUS and C-TIRADS, CEUS-TIRADS had improved the AUC, sensitivity and accuracy (all P  < 0.05). CONCLUSIONS: CEUS and C-TIRADS had high diagnostic values in indeterminate FNA cytological thyroid nodules. CEUS-TIRADS improved AUC, diagnostic sensitivity and accuracy, and helped to distinguish indeterminate FNA cytological nodules. Show more

Keywords: Thyroid nodule, contrast enhanced ultrasound, Chinese thyroid imaging reporting and system

DOI: 10.3233/CH-242363

Citation: Clinical Hemorheology and Microcirculation, vol. 88, no. 4, pp. 475-483, 2024

Authors: Li, Chen | Jia, Yong-Rui | Gou, Qiao | Ju, Zhong-Jian

Article Type: Research Article

Abstract: OBJECTIVE: Our prior research has established that X-ray exposure induces pyroptosis in human umbilical vein endothelial cells (HUVECs), with Cx43 playing a regulatory role in this process. However, the precise mechanism by which Cx43 regulates pyroptosis remains unclear. The objective of this study is to assess the involvement of the calcium signaling pathway in Cx43-mediated regulation of X-ray-induced pyroptosis in HUVECs. METHODS: HUVECs were exposed to 10 Gy X-ray radiation either alone or combined with Cx43 overexpression or knockdown. Calcium ions (Ca2+ ) were stained using Fluo-4/AM and analyzed via flow cytometry and confocal microscopy. Pyroptosis was assessed through …flow cytometry by staining with FLICA (fluorescent-labeled inhibitor of caspase) and propidium iodide (PI). Calcium signaling was inhibited using BAPTA/AM, 2-APB, or nifedipine. Protein expression levels were assessed by western blotting. RESULTS: X-ray irradiation induced an increase in intracellular calcium levels in HUVECs in a dose- and time-dependent manner. The results demonstrated that regulating calcium release with BAPTA/AM, 2-APB, or nifedipine significantly reduced pyroptosis. Also, the overexpression of Cx43 significantly attenuated the increase in intracellular calcium. Conversely, Cx43 knockdown via siRNA significantly increased the intracellular calcium levels. Also, interfering with calcium signaling using BAPTA/AM, 2-APB, or nifedipine reduced the raised pyroptosis levels induced by Cx43 knockdown. CONCLUSION: Individual HUVECs exposed to high-dose X-ray irradiation exhibited an increase in intracellular calcium, leading to pyroptosis. Also, upregulating Cx43 expression reduced the pyroptosis levels by inhibiting intracellular calcium concentration. This study introduces new concepts for identifying targets for the prophylaxis and therapy of radiation-induced damage. Show more

Keywords: Calcium, Connexin43, pyroptosis, X-ray

DOI: 10.3233/CH-242381

Citation: Clinical Hemorheology and Microcirculation, vol. 88, no. 4, pp. 485-497, 2024

Authors: Kordi, Negin | Sanaei, Masoumeh | Akraminia, Peyman | Yavari, Sajad | Saydi, Ali | Abadi, Fatemeh Khamis | Heydari, Naser | Jung, Friedrich | Karami, Sajad

Article Type: Research Article

Abstract: Regulated cell death, including pyroptosis, apoptosis, and necroptosis, is vital for the body’s defense system. Recent research suggests that these three types of cell death are interconnected, giving rise to a new concept called PANoptosis. PANoptosis has been linked to various diseases, making it crucial to comprehend its mechanism for effective treatments. PANoptosis is controlled by upstream receptors and molecular signals, which form polymeric complexes known as PANoptosomes. Cell death combines necroptosis, apoptosis, and pyroptosis and cannot be fully explained by any of these processes alone. Understanding pyroptosis, apoptosis, and necroptosis is essential for understanding PANoptosis. Physical exercise has been …shown to suppress pyroptotic, apoptotic, and necroptotic signaling pathways by reducing inflammatory factors, proapoptotic factors, and necroptotic factors such as caspases and TNF-alpha. This ultimately leads to a decrease in cardiac structural remodeling. The beneficial effects of exercise on cardiovascular health may be attributed to its ability to inhibit these cell death pathways. Show more

Keywords: PANoptosis, pyroptosis, apoptosis, necroptosis, activity, training

DOI: 10.3233/CH-242396

Citation: Clinical Hemorheology and Microcirculation, vol. 88, no. 4, pp. 499-512, 2024

Authors: Tang, Ding-Zhong | Wang, Wei-Wei | Chen, Xin-Xin | Yin, Song-He | Zhang, Lei | Liang, Xue-Lin | Luo, Guo-Jun | Yu, Chun-Li

Article Type: Research Article

Abstract: OBJECTIVE: This study aimed to evaluate the prognostic significance of serum inflammatory factor levels in patients with acute ischemic stroke undergoing revascularization therapy. METHODS: The study included 94 patients with acute ischemic stroke who underwent revascularization therapy at our hospital. The primary outcome was the modified Rankin scale (mRS) score assessed three months post-treatment. Patients were categorized into two groups: those with a poor prognosis (mRS score > 2) and those with a good prognosis (mRS score≤2). The patients were divided into two groups based on the type of revascularization treatment received: thrombus extraction or intravenous thrombolysis. Logistic regression analysis …was used to identify independent risk factors associated with the prognosis of patients treated with recanalization for acute ischemic stroke. RESULTS: Among the 94 patients, 59 had a good prognosis, and 35 had a poor prognosis. At admission, the patients in the good prognosis group exhibited lower NIHSS scores, shorter hospital stays, fewer previous cardiac events, lower LDL levels, fasting glucose, IL-6, and TNF-a compared to those in the poor prognosis group (all P  < 0.05). Logistic regression analysis identified TNF-a (odd ratio (OD), 1.623; 95% confidence interval (CI), 1.282–1.933; P  = 0.035) and IL-6 (OD, 1.055; 95% CI, 1.024–1.088, P  = 0.023) as independent risk factors for poor prognosis in patients after revascularization. Additionally, pre-hospital NIHSS scores, IL-6, and TNF-a levels were significantly lower in the good prognosis group compared to the poor prognosis group, with these differences being statistically significant. CONCLUSION: IL-6 and TNF-α may serve as prognostic markers for outcomes following revascularization therapy in patients with acute ischemic stroke, including those receiving intravenous thrombolysis. Show more

Keywords: IL-6, prognosis, revascularization therapy, risk factors, TNF-a

DOI: 10.3233/CH-242435

Citation: Clinical Hemorheology and Microcirculation, vol. 88, no. 4, pp. 513-522, 2024

Authors: Li, Lisha | Wang, Hongjun | Pan, Yalong | Liu, Kun

Article Type: Research Article

Abstract: BACKGROUND: This article reviews the latest research results of the use of ultrasound technology in the perioperative period of carotid endarterectomy and carotid stenting and discusses the role of ultrasound technology in accurately evaluating carotid stenosis and plaque stability, assisting in selecting the most suitable surgical method, and providing optimal perioperative imaging to guide carotid endarterectomy (CEA) and carotid artery stenting (CAS) to reduce the occurrence and progression of stroke. METHODS: The research published in recent years on the application of ultrasound in the perioperative period of CEA and CAS was reviewed through the databases of CNKI, Pubmed, …and Web of Science. RESULTS: Ultrasound has high clinical value in preoperative screening for indications, assessing the degree of carotid artery stenosis and the nature of plaque; monitoring hemodynamic changes intraoperatively to prevent cerebral ischemia or overperfusion; and evaluating surgical outcomes postoperatively and in late follow-up review. CONCLUSION: Ultrasound is currently widely used perioperatively in CEA and CAS and has even become the preferred choice of clinicians to evaluate the efficacy of surgery and follow-up. The presence of vulnerable plaque is an important risk factor for ischemic stroke. Contrast-enhanced ultrasound is an excellent tool to assess plaque stability. In most studies, ultrasound has been used only in a short follow-up period after CEA and CAS, and data from longer follow-ups are needed to provide more reliable evidence. Show more

Keywords: Carotid artery stent implantation, carotid artery ultrasound, carotid endarterectomy, ischemic stroke, neovascularization

DOI: 10.3233/CH-242412

Citation: Clinical Hemorheology and Microcirculation, vol. 88, no. 4, pp. 523-536, 2024

Authors: Wu, Zehong | Li, Huajuan | Chen, Zihao | Zhou, Honglian | Liang, Xin | Huang, Xing | Wang, Jiexin | Chen, Ting | Xu, Xiaohong | Yang, Yuping

Article Type: Research Article

Abstract: OBJECTIVE: To investigate the conventional ultrasound (US), contrast-enhanced ultrasound (CEUS) manifestations and the corresponding histopathological characteristics of patients diagnosed with breast encapsulated papillary carcinoma (EPC) and to explore the value of CEUS in diagnosis of EPC. METHODS: The clinical, pathological, US, and CEUS features of 16 patients (17 lesions) with EPC confirmed by postoperative histopathology were retrospectively analyzed. RESULTS: EPC was prevalent in the postmenopausal women. The majority of conventional US images of EPC showed complex cystic and solid masses with circumscribed margins (70.6%), enhanced posterior echo (94.1%), no sonographic calcification (88.2%), rich blood flow in …the solid components within lesions (70.6%) on Color Doppler flow imaging, and high resistance index of blood flow (94.1%). Moreover, CEUS showed mainly centripetal hyperenhancement of the solid components within the lesions with irregular outline, and the enhancement area of the whole masses was essentially the same as the B-mode US area. CONCLUSIONS: EPC typically presents as a complex cystic and solid mass. CEUS is helpful to clarify the extent of the solid component and facilitate preoperative core-needle biopsy. A comprehensive evaluation by CEUS is valuable for diagnosing EPC and combining it with clinical features are helpful to further improve the diagnosis of this rare kind of breast cancer. Show more

Keywords: Breast tumor, encapsulated papillary carcinoma of the breast, ultrasound features, contrast-enhanced ultrasound, pathology

DOI: 10.3233/CH-242263

Citation: Clinical Hemorheology and Microcirculation, vol. 88, no. 4, pp. 537-549, 2024

Authors: Liu, Jinming | Jiao, Wei | Li, Fang | Xie, Yanan | Meng, Mingjie | Hao, Jie

Article Type: Research Article

Abstract: OBJECTIVE: This study intends to explore the effects of Rosuvastatin on ox-LDL induced platelet activation and its molecular mechanism. METHODS: Platelet aggregation rate was detected by aggregometer. ELISA kit was used to detect the levels of cAMP. Immunofluorescence staining was used to detect the platelet adhesion. The expression levels of platelet surface markers CD62p and PAC-1 were detected by flow cytometry. The protein levels of p-p38, p-IKKa and p-IKKB in platelets were detected by western blot. RESULTS: We found that rosuvastatin significantly inhibited platelet aggregation and increased the level of cAMP in a dose-dependent manner. Immunofluorescence …staining results showed that rosuvastatin could inhibit platelet adhesion. Flow cytometry results showed that rosuvastatin could reduce the expression of platelet activation markers. Western blot results showed that rosuvastatin could down-regulate the expression levels of p-p38, p-IKKa and p-IKKb. CONCLUSION: Our study revealed the rosuvastatin could inhibit the aggregation, adhesion and activation of platelet induced by ox-LDL, its mechanism may be related to inhibition of p38/MAPK signal pathway. Show more

Keywords: Rosuvastatin, platelet, aggregation, adhesion, p38/MAPK

DOI: 10.3233/CH-242359

Citation: Clinical Hemorheology and Microcirculation, vol. 88, no. 4, pp. 551-560, 2024