Clinical Hemorheology and Microcirculation - Volume 62, issue 3

Authors: Zhou, H.M. | Xu, S.J. | Wang, L. | Shao, H.B. | Xie, B. | Feng, J.K. | Wang, C.J. | Bai, Y.Q. | Zhang, Q.F.

Article Type: Research Article

Abstract: This study was performed to investigate the effects of high-voltage electrical burns (HEB) on the pulmonary microcirculation in rabbits. Total of 120 rabbits were randomly divided into control and HEB group using a random number table. HEB model was developed with a voltage regulator and experimental transformer. Laser Doppler perfusion imager was utilized to monitor and quantify the blood perfusion in pulmonary microcirculation. The microvascular morphologic changes of the lung were observed using light microscopy and transmission electron microscope (TEM). The lung wet/dry weight ratio and the PaO2 were determined. The values of blood perfusion in rabbit pulmonary microcirculation …in the HEB group were decreased at 5 min, but increased at 1 h after burn (P  <  0.01) and then decreased gradually. Light microscopy reveals microthrombus formation in pulmonary venules and bleeding in venous capillaries in HEB group. We found the number of microvilli in the capillary endothelial cells decreased, the rough endoplasmic reticulum expanded and severe degranulation occurred, the mitochondrial cristae fused or disappeared, and severe edema surrounded the capillary endothelial cells by TEM. The values of lung wet/dry weight ratio were higher and the PaO2 were lower than that of before burn group (P  <  0.01). These results demonstrated that microcirculatory disorders play a major role in the development of progressive lung damage after high-voltage electrical burns. Show more

Keywords: Burn, electric injuries, lung, microcirculation

DOI: 10.3233/CH-141921

Citation: Clinical Hemorheology and Microcirculation, vol. 62, no. 3, pp. 193-203, 2016

Authors: Geis, S. | Prantl, L. | Schoeneich, M. | Lamby, P. | Klein, S. | Dolderer, J. | Mueller, S. | Jung, E.M.

Article Type: Research Article

Abstract: OBJECTIVE: Incidence of patients requiring complex soft tissue or osseous reconstruction has dramatically increased. However most of the monitoring systems have limitations in tissue penetration and are not able to detect microvascular complications after transplantation of so-called buried-flaps, that have no contact to the surface. Aim of the study was to assess contrast enhanced ultrasound (CEUS) as monitoring tool after buried flap transplantations. METHODS: 20 patients were examined after buried flap transplantation using CEUS. Quantitative perfusion analysis (TIC) was performed with an integrated perfusion software using stored cine-loops. Two perfusion-parameters, time to PEAK (TtoPk) and area under the …curve (Area), were evaluated using TIC analysis. RESULTS: Minor complications were observed in 3 patients. In these patients a delayed contrast agent wash-in and wash-out was observed. Additionally the perfusion values TtoPk (sec.) and Area (relative Units) were clearly different in the patients with minor complications: TtoPk: 32.0 sec; Area 425.5 rU (without complication), TtoPk: 38.6 sec.; Area: 18.3 rU (wound healing disturbance) and TtoPk: 14.4 sec.; Area: 105.9 rU (hematoma). CONCLUSION: As CEUS can assess microvascularization almost depth-independent, CEUS is an unique method to assess global flap perfusion after buried flap transplantation. Show more

Keywords: Microvascularization, flap monitoring, buried flap, contrast enhanced ultrasound, CEUS

DOI: 10.3233/CH-151964

Citation: Clinical Hemorheology and Microcirculation, vol. 62, no. 3, pp. 205-214, 2016

Authors: Kiss, Ferenc | Toth, Eniko | Miszti-Blasius, Kornel | Nemeth, Norbert

Article Type: Research Article

Abstract: Laboratory investigations often require centrifugation of blood samples for various erythrocyte tests. Although there is a lack of data about the effect of centrifugation at various g force levels on erythrocyte rheological properties. We aimed to investigate the effect of a 10-minute centrifugation at 500, 1000 or 1500 g at 15°C of rat, dog, pig and human venous (K3-EDTA, 1.5 mg/ml) blood samples. Hematological parameters, erythrocyte deformability, cell membrane stability, osmotic gradient ektacytometry (osmoscan) and erythrocyte aggregation were determined. Hematological and erythrocyte deformability parameters showed interspecies differences, centrifugation caused no significant alterations. Cell membrane stability for human erythrocytes centrifuged at higher g …level showed less decrease in deformability. Osmoscan O min parameter showed slight elevation in dog centrifuged aliquots. Erythrocyte aggregation parameters changed unexpectedly. Rat and dog erythrocyte aggregation indices significantly dropped in centrifuged aliquots. Pig erythrocyte aggregation indices increased significantly after centrifugation. Human erythrocyte aggregation was the most stable one among the investigated species. The used centrifugation protocols caused the largest alterations in erythrocyte aggregation in a controversial way among the investigated species. On the other hand, erythrocyte deformability parameters were stable, cell membrane stability and osmoscan data show minor shifts. Show more

Keywords: Red blood cell deformability, red blood cell aggregation, comparative hemorheology, sample preparation, mechanical stress

DOI: 10.3233/CH-151965

Citation: Clinical Hemorheology and Microcirculation, vol. 62, no. 3, pp. 215-227, 2016

Authors: Dong, Yi | Wang, Wen-Ping | Lin, Pan | Fan, Peili | Mao, Feng

Article Type: Research Article

Abstract: OBJECTIVE: We performed a prospective study to evaluate the value of contrast-enhanced ultrasound (CEUS) in quantitative evaluation of renal cortex perfusion in patients suspected of early diabetic nephropathies (DN), with the estimated GFR (MDRD equation) as the gold standard. METHODS: The study protocol was approved by the hospital review board; each patient gave written informed consent. Our study included 46 cases (21 males and 25 females, mean age 55.6 ± 4.14 years) of clinical confirmed early DN patients. After intravenous bolus injection of 1 ml sulfur hexafluoride microbubbles of ultrasound contrast agent, real time CEUS of renal cortex was …performed successively using a 2–5 MHz convex probe. Time-intensity curves (TICs) and quantitative indexes were created with Qlab software. Receiver operating characteristic (ROC) curves were used to predict the diagnostic criteria of CEUS quantitative indexes, and their diagnostic efficiencies were compared with resistance index (RI) and peak systolic velocity (PSV) of renal segmental arteries by chi square test. Our control group included forty-five healthy volunteers. Difference was considered statistically significant with P  <  0.05. RESULTS: Changes of area under curve (AUC), derived peak intensity (DPI) were statistically significant (P  <  0.05). DPI less than 12 and AUC greater than 1400 had high utility in DN, with 71.7% and 67.3% sensitivity, 77.8% and 80.0% specificity. These results were significantly better than those obtained with RI and PSV which had no significant difference in early stage of DN (P  > 0.05). CONCLUSIONS: CEUS might be helpful to improve early diagnosis of DN by quantitative analyses. AUC and DPI might be valuable quantitative indexes. Show more

Keywords: Contrast-enhanced ultrasound, color doppler flow imaging, diabetic nephropathies, time-intensity curve, quantitative index

DOI: 10.3233/CH-151967

Citation: Clinical Hemorheology and Microcirculation, vol. 62, no. 3, pp. 229-238, 2016

Authors: Caimi, G. | Lo Presti, R. | Canino, B. | Ferrera, E. | Hopps, E.

Article Type: Research Article

Abstract: In the last years the neutrophil to lymphocyte ratio (NLR) has been examined in cardiovascular disorders and in particular in coronary artery disease and acute myocardial infarction (AMI). Now we examined this parameter in subjects with juvenile myocardial infarction at the initial stage and after 3 and 12 months. We enrolled 123 young subjects (112 men and 11 women, mean age 39.4 ± 5.8 yrs) with AMI. The time interval between the AMI onset and the investigation was 13 ± 7 days. The mean value of NLR observed in young AMI subjects was significantly increased compared to normal controls (N … = 1.817 ± 0.711; young AMI subjects = 2.376 ± 0.873, p  <  0.0001). NLR does not discriminate STEMI (2.427 ± 0.878) and non STEMI (2.392 ± 0.868) or diabetics (2.604 ± 1.000) and non diabetics (2.324 ± 0.853), but it differentiates smokers (2.276 ± 0.853) and non smokers (2.837 ± 1.072). NLR at the initial stage is not correlated with the number of cardiovascular risk factors or with the extent of the coronary disease. In this study we found a significant decrease of neutrophil count at 3 and 12 months later AMI without any significant variation of lymphocyte and consequently we observed a decrease in NLR at these two intervals of time in comparison with the initial stage. Despite some limitations present in this study, it is interesting to underline that also in juvenile myocardial infarction this low-cost haematological marker may be considered together with other inflammatory indicators. Show more

Keywords: Juvenile myocardial infarction, leukocyte count, neutrophil/lymphocyte ratio

DOI: 10.3233/CH-151968

Citation: Clinical Hemorheology and Microcirculation, vol. 62, no. 3, pp. 239-247, 2016

Authors: Pfister, Karin | Schierling, Wilma | Jung, Ernst Michael | Apfelbeck, Hanna | Hennersperger, Christoph | Kasprzak, Piotr M.

Article Type: Research Article

Abstract: PURPOSE: To compare standardised 2D ultrasound (US) to the novel ultrasonographic imaging techniques 3D/4D US and image fusion (combined real-time display of B mode and CT scan) for routine measurement of aortic diameter in follow-up after endovascular aortic aneurysm repair (EVAR). METHOD AND MATERIALS: 300 measurements were performed on 20 patients after EVAR by one experienced sonographer (3rd degree of the German society of ultrasound (DEGUM)) with a high-end ultrasound machine and a convex probe (1–5 MHz). An internally standardized scanning protocol of the aortic aneurysm diameter in B mode used a so called leading-edge method. In summary, five …different US methods (2D, 3D free-hand, magnetic field tracked 3D - Curefab™, 4D volume sweep, image fusion), each including contrast-enhanced ultrasound (CEUS), were used for measurement of the maximum aortic aneurysm diameter. Standardized 2D sonography was the defined reference standard for statistical analysis. CEUS was used for endoleak detection. RESULTS: Technical success was 100%. In augmented transverse imaging the mean aortic anteroposterior (AP) diameter was 4.0±1.3 cm for 2D US, 4.0±1.2 cm for 3D Curefab™, and 3.9±1.3 cm for 4D US and 4.0±1.2 for image fusion. The mean differences were below 1 mm (0.2–0.9 mm). Concerning estimation of aneurysm growth, agreement was found between 2D, 3D and 4D US in 19 of the 20 patients (95%). Definitive decision could always be made by image fusion. CEUS was combined with all methods and detected two out of the 20 patients (10%) with an endoleak type II. In one case, endoleak feeding arteries remained unclear with 2D CEUS but could be clearly localized by 3D CEUS and image fusion. CONCLUSION: Standardized 2D US allows adequate routine follow-up of maximum aortic aneurysm diameter after EVAR. Image Fusion enables a definitive statement about aneurysm growth without the need for new CT imaging by combining the postoperative CT scan with real-time B mode in a dual image display. 3D/4D CEUS and image fusion can improve endoleak characterization in selected cases but are not mandatory for routine practice. Show more

Keywords: Aortic aneurysm diameter, EVAR surveillance, ultrasonographic imaging techniques, 3D ultrasound, 4Dultrasound, image fusion

DOI: 10.3233/CH-152012

Citation: Clinical Hemorheology and Microcirculation, vol. 62, no. 3, pp. 249-260, 2016

Authors: Hutchings, Sam | Watts, Sarah | Kirkman, Emrys

Article Type: Research Article

Abstract: We report a new microcirculatory assessment device, the Braedius Cytocam, an Incident Dark Field (IDF) video microscope, and compare it with a precursor device utilising side stream dark field (SDF) imaging. METHODS: Time matched measurements were made with both devices from the sublingual microcirculation of pigs subjected to traumatic injury and hemorrhagic shock at baseline and during a shock phase. Images were analysed for vessel density, microcirculatory flow and image quality. RESULTS: There were no differences in density or flow data recorded from the two devices at baseline [TVD IDF 14.2 ± 2.4/TVD SDF 13.2 ± 2.0, …p 0.17] [MFI IDF 3 (2.8–3.0)/MFI SDF 3 (2.9–3.0), p 0.36] or during the shock state [TVD IDF 11.64 ± 3.3/TVD SDF 11.4 ± 4.0 p  = 0.98] [MFI IDF 1.9 (0.6–2.7)/MFI SDF 1.7 (0.3–2.6) p 0.55]. Bland and Altman analysis showed no evidence of significant bias. Vessel contrast was significantly better with the IDF device for both capillaries [17.1 ± 3.9 (IDF) v 3.4 ± 3.6 (SDF), p  = 0.0006] and venules [36.1 ± 11.4 (IDF) v 26.4 ± 7.1 (SDF) p 0.014] CONCLUSION: The Braedius Cytocam showed comparable vessel detection to a precursor device during both baseline and low flow (shock) states. Show more

Keywords: Microcirculation, sidestream dark field imaging, incident dark field imaging, haemorrhagic shock

DOI: 10.3233/CH-152013

Citation: Clinical Hemorheology and Microcirculation, vol. 62, no. 3, pp. 261-271, 2016

Authors: Trottmann, M. | Marcon, J. | D’Anastasi, M. | Bruce, M.F. | Stief, C.G. | Reiser, M.F. | Buchner, A. | Clevert, D.A.

Article Type: Research Article

Abstract: PURPOSE: Real-time shear-wave elastography (SWE) is a newly developed technique for the sonographic quantification of tissue elasticity, which already is used in the assessment of breast and thyroid lesions. Due to limited overlying tissue, the testes are ideally suited for assessment using shear wave elastography. To our knowledge, no published data exist on real-time SWE of the testes. MATERIALS AND METHODS: Sixty six male volunteers (mean age 51.86±18.82, range 20–86) with no known testicular pathology underwent normal B-mode sonography and multi-frame shear-wave elastography of both testes using the Aixplorer ® ultrasound system (SuperSonic Imagine, Aix en Provence, France). …Three measurements were performed for each testis; one in the upper pole, in the middle portion and in the lower pole respectively. The results were statistically evaluated using multivariate analysis. RESULTS: Mean shear-wave velocity values were similar in the inferior and superior part of the testicle (1.15 m/s) and were significantly lower in the centre (0.90 m/s). These values were age-independent. Testicular stiffness was significantly lower in the upper pole than in the rest of the testis with increasing volume (p  = 0.007). CONCLUSION: Real-time shear-wave elastography proved to be feasible in the assessment of testicular stiffness. It is important to consider the measurement region as standard values differ between the centre and the testicular periphery. Further studies with more subjects may be required to define the normal range of values for each age group. Useful clinical applications could include the diagnostic work-up of patients with scrotal masses or male infertility. Show more

Keywords: Testis, three-dimensional-shear-wave elastography, ultrasonography

DOI: 10.3233/CH-162046

Citation: Clinical Hemorheology and Microcirculation, vol. 62, no. 3, pp. 273-281, 2016