Clinical Hemorheology and Microcirculation - Volume 72, issue 3

Authors: Sheremet’ev, Yury A. | Popovicheva, Aleksandra N. | Rogozin, Methun M. | Levin, Grigory Ya.

Article Type: Research Article

Abstract: BACKGROUND: Diabetes mellitus is frequently associated with microcirculation pathology and hemorheological disorders. METHODS: 24 patients with diabetic foot and 22 healthy subjects were recruited. RBC aggregation, disaggregation and morphology of aggregates were determined in autologous plasma and serum. RESULTS: The RBC aggregation in patients with diabetic foot increased in autologous plasma and serum. Increased red blood cell aggregate strength in these patients was observed only in autologous plasma. Microscopic images of RBC aggregates of patients with diabetic foot show the formation of pathologic globular structures of aggregates in autologous plasma and serum. CONCLUSION: The …RBC aggregation in autologous plasma and autologous serum in patients with diabetic foot is significantly higher than in healthy subjects. Increase in strength of RBC aggregates in diabetic foot patients was observed only in autologous plasma. The microscopic images of RBC aggregates in patients with diabetic foot indicate the formation of globular (pathologic) structures of aggregates in autologous plasma and serum. The differences in the morphology of RBC aggregates in autologous plasma and serum between healthy subjects and diabetic foot patients, obtained by microscopic image analysis with high magnification light microscope, can be used as an additional diagnostic tool in medical practice. Show more

Keywords: Diabetic foot, red blood cell aggregation, disaggregation, aggregates morphology, autologous plasma, autologous serum

DOI: 10.3233/CH-180405

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 3, pp. 221-227, 2019

Authors: Sardinha, Joel | MacKinnon, Sean | Lehmann, Christian

Article Type: Research Article

Abstract: RATIONALE: Alterations in human microcirculation occur in many disease states leading to morbidity and mortality, however assessing the microcirculation is not standard clinical practice. Standard microcirculation analysis using semi-automated analysis is expensive, time consuming, and expertise dependent making it unfeasible. We proposed a novel visual scoring system (microVAS) for the analysis of microcirculation videos that can be performed at the patient bedside in real time. OBJECTIVE: Validate our microVAS score by training health professionals unfamiliar with the microcirculation field to use our microVAS score and compare their scores to the standard method of semi-automated analysis using …AVA3 software. METHODS: Using a prospective double-blind study design, we recruited and trained 20 participants to use our microVAS score. Participants scored 40 videos (from 22 healthy and 18 septic patients) for MFI and PPV. The same 40 videos were analysed by an expert using the gold standard semi-automated method of analysis. The results of the participants and the expert were analysed by Pearson’s linear regression. Krippendorff’s alpha was used to assess inter-rater reliability of the participants. RESULTS: Overall correlation of MFI was r = 0.33 (95% CI 0.27–0.39), p  < 0.05; overall correlation of PPV was r = –0.11 (95% CI –0.18 to –0.04), p  < 0.05. The Krippendorff’s alpha for MFI was 0.56 (healthy videos: α = 0.34, sepsis videos: α = 0.31). For PPV Krippendorff’s alpha was 0.43 (healthy videos: α = 0.56, sepsis videos: α = 0.17). CONCLUSIONS: Overall for both MFI and PPV, there was a small correlation between our microVAS score and AVA 3 scores. Regarding inter-rater reliability both MFI and PPV showed fair agreement between raters. Going forward multiple improvements to the microVAS scoring system as well as the training program are suggested to improve reliability and consistency. Show more

DOI: 10.3233/CH-180427

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 3, pp. 229-238, 2019

Authors: Gnasso, Agostino | Cacia, Michele | Cutruzzolà, Antonio | Minieri, Marilena | Carallo, Claudio | Cortese, Claudio | Irace, Concetta

Article Type: Research Article

Abstract: BACKGROUND: The relationship between blood viscosity (BV) and endothelial function is rather complex. An increase in BV causes an increase in blood flow resistance, with negative hemodynamic effects; on the other hand, a moderate increase in BV causes an increase in wall stress shear (WSS), and consequent beneficial effects. As a matter of fact, the effect of changes in BV on endothelial function is not yet clear. OBJECTIVES: Aim of the present study was to evaluate in-vivo the effects of the acute reduction in BV on endothelial function, in healthy male subjects. METHODS: Fourteen healthy …male blood donors were studied before and 48 hours after blood donation. Blood and plasma viscosity were measured at 37C° with a cone-plate viscometer. Endothelial function was evaluated through flow mediated vasodilation (FMD). RESULTS: Blood viscosity was reduced after blood donation (BV225 (cP) 4.53±0.59 vs.4.18±0.31, p  < 0.05). FMD 50 s after cuff deflation was unchanged: 6.23±3.84 vs. 6.62±4.81, p  = NS. The vasodilation, however, lasted longer and the area under the curve of FMD was significantly increased: 8.74±8.77 vs.16.14±8.65, p  < 0.005. CONCLUSIONS: The present results demonstrate that the acute reduction of BV prolongs vasodilation, without affecting the amount of vasodilatation, possibly as adaptive reaction allowing more time for oxygen release. Show more

Keywords: Blood viscosity, endothelial function, blood donation, hematocrit

DOI: 10.3233/CH-180446

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 3, pp. 239-245, 2019

Authors: Suker, Mustafa | Tovar Doncel, M. Sherezade | Pinto Lima, Alexandre A. | Ince, Can | van Eijck, Casper H.J

Article Type: Research Article

Abstract: Background: An observational cohort study was conducted to identify potential sublingual microcirculation parameters as a target for goal-directed fluid therapy. Methods: Patients that were scheduled for an open elective pancreatico-biliary surgery in Erasmus Medical Center were included. All patients underwent sublingual microcirculatory measurement at three time points: one day before surgery (T0), within the first 24 hours after surgery (T1) and on the fourth day after surgery (T2). The following parameters were obtained: microvascular flow index (MFI (AU)), Total vessels density (TVD (mm/mm2/)), Perfused vessels density (PVD (mm/mm2)), and proportion of perfused vessels (PPV (%)). Results: …Sixteen patients were included in the final analysis. The differences between the time points T1 and T0 in patients without clinical significant complication and in patients with these complications gave a significant difference for PVD small vessels (PVDs) (delta PVDs mean -0.1 vs -8.2, p=0.01) and PPV small vessels (PPVs) (delta PPVs median 7.0 % vs -15.5 %, p=0.01). Conclusion: The most significant microcirculatory parameter for a perioperative complicated course is the change of PVD and PPV. In the first 24 hours after surgery, if these parameters decrease there is a high chance of a complicated perioperative course. Show more

Keywords: Pancreatectomy, microcirculation, morbidity

DOI: 10.3233/CH-180448

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 3, pp. 247-257, 2019

Authors: Mizeva, Irina A. | Potapova, Elena V. | Dremin, Viktor V. | Zherebtsov, Evgeny A. | Mezentsev, Mikhail A. | Shuleptsov, Valery V. | Dunaev, Andrey V.

Article Type: Research Article

Abstract: The variation of blood flow characteristics caused by the probe pressure during noninvasive studies is of particular interest within the context of fundamental and applied research. It has been shown previously that the weak local pressure induces vasodilation, whereas the increased pressure is able to stop the blood flow in the compressed area, as well as to significantly change optical signals. The blood flow oscillations measured by laser Doppler flowmetry (LDF) characterize the functional state of the microvascular system and can be used for noninvasive diagnostics of its abnormality. This study was intended to identify the patterns of the …relationship between the oscillating components of blood flow registered by the LDF method under different levels of pressure applied to an optical fiber probe. For this purpose, we have developed an original optical probe capable of regulating the applied pressure. The developed protocol included six sequential records of the blood perfusion at a pressure within the 0 to 200 mmHg range with unloading at the last stage. Using wavelet analyses, we traced the variation of energy of oscillations for these records in five frequency bands associated with different vascular tone regulation mechanisms. Six young volunteers of the same age (three males and three females) were included in this preliminary study and the protocol was repeated five times in each volunteer. Accordingly, 30 LDF records were available for the analyses. As expected, the LDF signal increases at weak pressure (30 mmHg) and decreases at increased pressure. The statistically stable amplification of endothelial associated blood flow oscillations under the 90 mmHg pressure allowed us to put forward a hypothesis that the endothelial activity increases. The possible causes of this phenomenon are discussed. Show more

DOI: 10.3233/CH-180459

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 3, pp. 259-267, 2019

Authors: Iamaguchi, Raquel | Burgos, Felipe | Silva, Gustavo | Cho, Alvaro | Nakamoto, Hugo | Takemura, Renan | Wei, Teng | de Rezende, Marcelo | Mattar Jr, Rames

Article Type: Research Article

Abstract: BACKGROUND: The optimal number of veins to be anastomosed in perforator flaps for limb reconstruction and its influence on the results remain controversial. Venous thrombosis of microvascular anastomoses is a commonly recorded complication in soft tissue reconstruction. OBJECTIVE: To evaluate the effect of two venous anastomoses in the incidence of venous thrombosis for limb reconstruction using anterolateral thigh (ALT) microsurgical free flaps. METHODS: This was a cross-sectional study on patients undergoing limb reconstruction using ALT flap during 2014–2017. Perioperative information was recorded and patients were divided in two groups: group 1 (one venous anastomosis; 17 patients) …and group 2 (two venous anastomoses; 21 patients). Complications were investigated. RESULTS: Overall, 38 microsurgical flaps were included. The mean age was 33 years, and 32 patients were male. The most prevalent wounds were traumatic. Group 1 presented a higher complication rate than group 2 (47% vs. 24%; p  = 0.065), although the difference was not significant. Group 1 presented a higher rate of venous anastomotic thrombosis (p  = 0.032) than group 2. The overall success rate was 92%. CONCLUSION: For limb reconstruction using ALT microsurgical free flaps, two venous anastomoses are associated with a low rate of venous thrombosis in microvascular anastomoses. Show more

Keywords: Thrombosis, microcirculation, free tissue flaps, postoperative complication, thigh/surgery

DOI: 10.3233/CH-180467

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 3, pp. 269-277, 2019

Authors: Li, Xiang | Hou, Xiu-Juan | Du, Lin-Yao | Wu, Jia-Qi | Wang, Luo | Wang, Hong | Zhou, Xian-Li

Article Type: Research Article

Abstract: OBJECTIVE: This study was conducted to investigate the diagnostic performance of Virtual Touch Tissue Imaging and Quantification (VTIQ), combined with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) in differentiating malignant and benign thyroid nodules. METHODS: A total of 130 thyroid nodules in 128 patients were included. The diagnostic performance of conventional ultrasound (US), VTIQ, and the combination of these two techniques was calculated and compared according to the area under the receiver operating characteristic curve (AUROC), for sensitivity, specificity, and accuracy. RESULTS: The sensitivity and specificity for the ACR TI-RADS …were 98.6% (72/73) and 24.6% (14/57), respectively. There was a strong agreement with ACR TI-RADS categories of thyroid nodules (all ICCs > 0.60). With an optimal cutoff value of 2.46 m/s, the sensitivity and specificity of the minimal shear wave velocity (SWVmin ) were 87.7% (64/73) and 70.2% (40/57). By applying this value to downgrade or upgrade ACR TI-RADS, the specificity significantly increased from 24.6% (14/57) to 47.4% (27/57; P  < 0.05) and the sensitivity remained at 98.6% (72/73). CONCLUSIONS: VTIQ combined with ACR TI-RADS could improve the specificity of the differential diagnosis of thyroid nodules without a loss of sensitivity. Show more

Keywords: Ultrasound, elastography, thyroid nodule, thyroid imaging reporting and data system, virtual touch tissue imaging and quantification

DOI: 10.3233/CH-180477

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 3, pp. 279-291, 2019

Authors: Quan, Juan | Hong, Yurong | Zhang, Xu | Mei, Mei | You, Xiangdong | Huang, Pintong

Article Type: Research Article

Abstract: OBJECTIVE: To clarify the clinical role of contrast enhanced ultrasound (CEUS) in predicting BI-RADS 4 breast disease. METHODS: A total of 92 sites of BI-RADS 4 breast diseases were reassessed by routine ultrasound and CEUS. The main indicators of routine ultrasound, CEUS and the combination of the two modalities were picked up by binary logistic regression analysis, scoring 0 for benign and 1 for malignant characteristics with pathology as referential standard to generate corresponding score systems of them. Finally, the receiver operating characteristic curves (ROC) were applied to compare the diagnostic efficacy of the three score systems. …RESULTS: As pathological results showing, there were 43 malignant and 49 benign sites in total. Binary logistic regression analysis indicated that the margin, micro-calcification, and hyperechoic halo were main indicators for routine ultrasound score system. The scope expansion and pathological vessels in CEUS were main indicators for CEUS score system. The microcalcification, hyperechoic halo, the scope expansion and pathological vessels in CEUS were main indicators for the combination score system of the two modalities. The sensitivity, specificity and the area under ROC curve (AUC) of routine US, CEUS and the combination of the two modalities score systems were 74.4%, 91.8%, 0.885 and 88.4%, 87.8%, 0.901 and 86.0%, 95.9%, 0.937, respectively. CONCLUSION: In summary, CEUS is helpful for us to identify malignant disease and plays a supplementary role in predicting BI-RADS 4 breast disease in some extent. The scope expansion and pathological vessels in CEUS may be the most useful indicators. Show more

DOI: 10.3233/CH-180495

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 3, pp. 293-303, 2019

Authors: Cao, Jiaying | Dong, Yi | Fan, Peili | Mao, Feng | Wang, Wenping

Article Type: Research Article

Abstract: BACKGROUND: Dynamic three-dimensional contrast-enhanced ultrasound (3D-CEUS) with quantitative analysis is updated in recent years. OBJECTIVE: To explore the feasibility of dynamic 3D-CEUS in evaluation of dynamic vascular patterns of focal liver lesions (FLL), and to analyze the correlation of time-intensity curve (TIC) parameters between dynamic 3D-CEUS and two-dimensional CEUS (2D-CEUS). METHODS: Dynamic 3D-CEUS and 2D-CEUS were both carried out in 106 FLL cases with SonoVue. Divided into arterial, portal and late phases, dynamic 3D-CEUS image quality of 106 FLLs were scored by 2 readers separately and graded according to the overall score. The 2D-CEUS and identical …3D-CEUS TIC parameters of the same FLL were compared and the correlation of these parameters were analyzed. RESULTS: A satisfactory correlation (0.953) and a good inter-observer agreement (0.700) of 2 readers were achieved by using five-point score scale to image quality in 3 phases of dynamic 3D-CEUS. The boundaries of FLLs were clearest in arterial phase on dynamic 3D-CEUS. The depth and vascularization of FLLs only had influence on its image quality in only arterial phase (P  = 0.002 and 0.000 respectively). The comparison of quantification between dynamic 3D-CEUS and 2D-CEUS of 56 FLLs were also underwent. Interclass correlation coefficient (ICC) of mean transit time (MTT) and time to peak (TP), were both 0.96, and Pearson correlation coefficients of all 5 TIC parameters were no less than 0.90 between dynamic 3D-CEUS and 2D-CEUS. CONCLUSION: Dynamic 3D-CEUS is technically feasible and can be used for clinical evaluation of the perfusion of FLL avoiding adverse factors of sampling. Quantitative 3D-CEUS parameters are stable and reliable, and have good correlation with those of 2D-CEUS. Show more

Keywords: Three-dimensional, contrast-enhanced ultrasound, two-dimensional, focal liver lesion

DOI: 10.3233/CH-180531

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 3, pp. 305-316, 2019

Authors: Zhao, Huaqun | Liu, Xueling | Lei, Bei | Cheng, Ping | Li, Jian | Wu, Yedong | Ma, Zhen

Article Type: Research Article

Abstract: OBJECTIVE: This study aimed to evaluate the impact of thyroid nodule sizes on the diagnostic performance of Korean thyroid imaging reporting and data system (TIRADS) and contrast-enhanced ultrasound (CEUS). METHODS: In total, 308 consecutive patients with 382 thyroid nodules underwent US-guided FNA or surgery were included in this retrospective study. The nodule size was classified into 3 categories: ≤10 mm (group A), 10–20 mm (group B), and ≥20 mm (group C). We compared the risk of malignancy in each subgroup, categorized according to the TIRADS and CEUS patterns. RESULTS: In group A, the differences in diagnostic value between TIRADS …and CEUS were significant (AUC: 0.804 vs 0.733, P  = 0.028, sensitivity: 81.8% vs 72.7%, P  = 0.013, specificity: 88.9% vs 79.4%, P  = 0.011). In group B, the AUC (0.897), sensitivity (88.1%) and specificity (91.9%) of CEUS were highest. In group C, the specificity of CEUS was significantly higher compared with TIRADS classification (90.8% vs 82.9%, P  = 0.023), while the sensitivity and AUC showed no significant difference between the two models (84.2% vs 81.5%, P  > 0.406, 0.848 vs 0.820, P  = 0.545). CONCLUSIONS: Nodule size influences the diagnostic accuracy of the two methods. TIRADS have best value in nodules ≤10 mm, while CEUS perform best for differentiating lesions >10 mm, especially in lesions ≥20 mm. Show more

Keywords: Thyroid ultrasound, nodule size, thyroid malignancy, contrast-enhanced ultrasound, TIRADS, Biopsy

DOI: 10.3233/CH-180545

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 3, pp. 317-326, 2019