Clinical Hemorheology and Microcirculation - Volume 75, issue 3

Authors: Astapenko, David | Ticha, Alena | Tomasova, Adela | Hyspler, Radomir | Zadak, Zdenek | Lehmann, Christian | Cerny, Vladimir

Article Type: Research Article

Abstract: BACKGROUND: Endothelial glycocalyx (EG) is a carbohydrate-rich gel-like mesh covering the apical surface of endothelial cells. It has been linked to the microvascular pathophysiology and tissue metabolism. However, little is known about its condition in young healthy adults. OBJECTIVE: We aimed to describe the condition of EG in young healthy adults by in vivo EG imaging and measurement of syndecan-1, a plasma marker of EG integrity in order to obtain reference values. METHODS: For in vivo EG studies we used Side-stream Dark Field imaging of the sublingual microcirculation. Recordings were analysed automatically by GlycoCheck …software providing the Perfused Boundary Region (PBR) as a marker of EG thickness. Levels of syndecan-1 were analysed in plasma samples by ELISA. RESULTS: 21 volunteers were included in the study. Median of the PBR value was 1.82 μm (interquartile range 1.69–2.01, 95% CI 1.79–1.97). Median concentration of syndecan-1 was 0.3 ng/ml (interquartile range 0.23–0.39, 95% CI 0.27–0.49). CONCLUSION: This study provides a comparison for cohorts of patients with a particular disease where the EG is presumably damaged. Our findings do not entirely comply with already published data in healthy individuals. Show more

Keywords: Endothelial glycocalyx, syndecan-1, healthy volunteers

DOI: 10.3233/CH-190581

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 3, pp. 257-265, 2020

Authors: Koch, Christoph | Taeger, Christian | Geis, Sebastian | Lonic, Daniel | Heidekrueger, Paul | Dolderer, Juergen | Bitzinger, Diane | Hirche, Christoph | Prantl, Lukas | Kehrer, Andreas

Article Type: Research Article

Abstract: BACKGROUND: Purpura fulminans (PF) is a distinct form of rare meningococcal septicaemia mostly in childhood which is characterized by high lethality, extensive necroses and mutilations of extremities. Other ethiologies are idiopathic forms or purpura neonatorum, which is marked by deficiency of Protein-C. PF is caused by micro-embolism of the vascular system, followed by quickly spreading necroses of skin and different organs. Modern concepts of intensive care treatment of the acute phase of this disease and early surgical intervention lead to a rising number of surviving patients requiring limb salvage. Aim of this study is to evaluate a possible lower morbidity …and the grade of lower loss of function because of early surgical intervention. PATIENTS AND METHODS: Between the years 1998 and 2017 eight cases of PF at two large centers for critical wound care, the department of plastic-, hand- and reconstructive surgery of the university hospital of Regensburg and the department of plastic-, hand- and reconstructive surgery of the BG-clinic Ludwigshafen were included into our study. We retrospectively examined patients with PF who were stabilized by intensive care medicine and received surgical interventions. After survival of the acute phase (10 days), patients received plastic surgical reconstructions. RESULTS: A total number of eight patients could be included into our study. All patients survived the initial phase (10 days). All patients required plastic-surgical interventions to address extensive skin and soft tissue defects. Flap operations were judged necessary in five cases. Hereby four defects could be reconstructed by free tissue transfer, one with a local flap. Flap survival was 100 percent. One flap required revision of the arterial anastomosis of the flap arteria. Another flap got partial necrosis. One patient died due to multiorgan failure. Early debridements with consequent fasciotomies and secondary plastic-surgical reconstruction achieved good functional results. Limb salvage was accomplished in three patients. One patient died due to fulminant progress of the disease. CONCLUSION: Management of PF requires a multidisciplinary approach and close communication between the different subspecialties. Early debridements with consequent fasciotomies showed good results in salvaging subfascial muscle tissue in the extremities with satisfying functional results. Early surgical intervention is an important factor for improved limb salvage and survival. Show more

Keywords: Purpura fulminans, symptoms, surgical management, intensive care management, Idiopathic Thrombocytopenic Purpura, Disseminated Intravascular Coagulation, Acquired Protein C Deficiency, Sepsis, Neisseria meningitidis, Menigococcal sepsis, streptococcus pyogenes, herpes simplex virus

DOI: 10.3233/CH-190588

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 3, pp. 267-278, 2020

Authors: Liu, Xuanwei | Zhao, Na’na | Zeng, Kexue | Xiao, Peng | Sheng, Pengjie | Luo, Xun | Wang, Yulong

Article Type: Research Article

Abstract: OBJECTIVE: This study aims to investigate the effect of nimodipine combined with betahistine on the levels of CRP and other inflammatory cytokines, as well as vascular endothelial function in patients with hypertensive cerebral vasospasm. METHODS: A total of 80 patients with hypertensive cerebral vasospasm from March 2016 to September 2018 were enrolled and randomly equally divided into two groups. At 1 week before enrollment, the application of all antihypertensive drugs was stopped. Then amlodipine tablets were used in control group, based on which nimodipine tablets were applied in observation group. All the patients included were followed up for …1 month. The changes in the cerebral vasospasm index in the course of treatment as well as inflammatory cytokines and indicators related to vascular endothelial function at 1 month after treatment were measured and compared between the two groups. The correlations of the cerebral vasospasm index with the changes in inflammatory cytokines and vascular endothelial function-related factors in the body were analyzed. Finally, the effective rates of blood pressure regulation and cerebral vasospasm treatment were compared, while the adverse reactions and the overall clinical treatment effect of the two groups were evaluated. RESULTS: The cerebral vasospasm indexes in observation group were significantly lower than those in control group at 3 d, 1 week and 1 month after treatment (p  < 0.05). At 1 month after treatment, the levels of inflammatory cytokines such as high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α ) in observation group were significantly reduced compared to those in control group (p  < 0.05). As for vascular endothelial function-related indicators, the endothelin-1 (ET-1) level in observation group was markedly lower than that in control group, whereas the level of nitric oxide (NO) was statistically higher than that in control group (p  < 0.05). The cerebral vasospasm index was statistically positively correlated with changes in hs-CRP, IL-6, TNF-α and ET-1 (p  < 0.05), but negatively correlated with changes in NO (p  < 0.05). Besides, the effective rates of blood pressure regulation and cerebral vasospasm treatment in observation group were significantly higher than those in control group (p  < 0.05). The overall treatment effective rate in observation group was markedly higher than that in control group (p  < 0.05), and there were no significant differences of adverse reactions between the two groups (p  > 0.05). CONCLUSION: For the treatment of hypertensive cerebral vasospasm, combined application of betahistine on the basis of nimodipine can effectively reduce the body’s aseptic inflammatory responses, improve vascular endothelial function and increase the cerebral circulation blood flow, which offers a favorable strategy for clinical therapy. Show more

Keywords: Betahistine, hypertension, cerebral vasospasm, inflammatory cytokine, vascular endothelial function, nimodipine

DOI: 10.3233/CH-190589

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 3, pp. 279-289, 2020

Authors: Liu, Bo-Ji | Zhang, Yi-Feng | Zhao, Chong-Ke | Wang, Han-Xiang | Li, Ming-Xu | Xu, Hui-Xiong

Article Type: Research Article

Abstract: The purpose of the study was to explore the differences of conventional ultrasound characteristics, thyroid imaging reporting and data system (TI-RADS) category and shear wave speed (SWS) measurement between follicular adenoma (FA) and follicular thyroid carcinoma (FTC). Twenty-eight FTCs and 67 FAs proven by surgery were retrospectively included for analysis. Conventional ultrasound and point-shear wave elastography (p-SWE) were performed in all of the included patients. The ultrasound features, American Thyroid Association (ATA) TI-RADS category and American College of Radiology (ACR) TI-RADS category, SWS measurement were compared between the two groups. Receiver operating characteristic (ROC) curve was performed and area under …ROC curve (AUC) was obtained for significant features. There were no statistical differences in mean age (46.9±15.7years vs. 48.6±13.6years, P  = 0.639), gender (9 males, 32.1% vs. 18 males, 29.0%, P  = 0.766) and mean diameter (28.3±16.2 mm vs. 33.8±11.9 mm, P  = 0.077) between FTCs and FAs. Hypoechogenicity, lobulated or irregular margin, macrocalcification were more common in FTCs than FAs (all P  < 0.05). Mean SWS of FTCs (2.29±0.64 m/s) was slightly higher than that of FAs (1.94±0.68 m/s) (P  = 0.023). The AUCs were 0.655, 0.744, and 0.744 with the cut-off SWS≥1.89 m/s, ACR TI-RADS category 4 and intermediate suspicion of ATA TI-RADS category. The sensitivity and AUC were 82.1% and 0.812 with combined ultrasound features of hypoechogenicity, lobulated or irregular margin and macrocalcification. In Conclusion, SWS measurement and TI-RADS categories were useful for the identification of FTCs from FAs. Show more

Keywords: Follicular thyroid carcinoma (FTC), follicular adenoma (FA), ultrasound, TI-RADS category, Shear wave speed

DOI: 10.3233/CH-190750

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 3, pp. 291-301, 2020

Authors: Bakker, Nathalie | Schoorl, Marianne | Demirkiran, Ahmet | Cense, Huib A. | Houdijk, Alexander P.J.

Article Type: Research Article

Abstract: BACKGROUND: An adequate erythrocyte function is vital for tissue oxygenation and wound healing. The erythrocyte membrane phospholipid composition plays an important role in erythrocyte function and administration of omega-3 fatty acids may provide a means to improve it. OBJECTIVE: To investigate peri-operative erythrocyte function and effects of oral omega-3 fatty acids in morbidly obese women undergoing gastric bypass surgery METHODS: Fifty-six morbidly obese women undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery were randomized between a low calorie diet (LCD) during 2 weeks or oral omega-3 poly-unsaturated fatty acids (n-3 PUFAs) and a normal diet during 4 …weeks. Peri-operative blood samples were analyzed with the Lorrca MaxSIS Ektacytometer for erythrocyte deformability and aggregability. RESULTS: There were no significant differences in erythrocyte function between the groups at any time point. Only erythrocyte aggregability parameters were affected by surgery. At six month follow-up, aggregation index (AI) and cholesterol, glucose and insulin were significantly improved. CONCLUSIONS: In this study, oral Omega-3 supplementation did not affect erythrocyte function compared to a LCD. Six months after surgery a significant improvement in AI and metabolic parameters was observed in both groups, contributing to a reduction in the risk at thromboembolic and cardiovascular complications. Show more

Keywords: Erythrocytes, deformability, aggregability, morbid obesity, laparoscopic gastric bypass surgery, omega-3 fatty acids

DOI: 10.3233/CH-190777

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 3, pp. 303-311, 2020

Authors: Pang, Mengru | Lei, Xiaoxuan | Yao, Zexin | Chen, Caihong | Cheng, Biao

Article Type: Research Article

Abstract: It has been reported that the beta-adrenergic receptor blocker (propranolol) and the a-adrenergic receptor (AR) blocker (phentolamine) both can inhibit human endothelial cell (EC) angiogenesis in vitro . However, it is unknown whether this inhibition also acts on pericytes. The present study aimed to determine how pericytes react to treatment with an a-/β- AR blocker. In the study, cell proliferation assays and scratch assay were performed to assess the effect of phentolamine or propranolol on cell proliferation and migration. Western blot and ELISA were employed to determine changes in VEGF-A and Ang-1 expression levels. The results indicated that the nonselective …a-/β- AR blocker inhibited the proliferation, migration, and secretion of pericytes. The use of the nonselective a-/β- AR blocker might have an impact on vascularization and vascular maturation. Our research suggests the rational use of nonselective a-/β- AR blockers to treat angiogenesis-dependent diseases. Show more

Keywords: Adrenergic receptor blocker, phentolamine, propranolol, pericytes, angiogenesis

DOI: 10.3233/CH-190780

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 3, pp. 313-323, 2020

Authors: Zhang, Qi | Wu, Lili | Yang, Daohui | Qiu, Yijie | Yu, Lingyun | Dong, Yi | Wang, Wen-Ping

Article Type: Research Article

Abstract: OBJECTIVES: To investigate the value of dynamic contrast enhanced ultrasound (D-CEUS) in monitoring the chemoradiotherapy (CRT) therapeutic response of local advanced pancreatic ductal adenocarcinoma (LAPC). PATIENTS AND METHODS: From October 2017 to December 2018, 11 patients diagnosed as LAPC were included (7 men, 4 women; mean age: 61.1±8.6 years). The algorithm of CRT was as following: the radiotherapy dose was 50.4 Gy/28Fx with S-1 40 mg bid orally taken in radiotherapy day. Conventional ultrasound scan and CEUS were performed before and 4 weeks after CRT. All ultrasound examinations were performed by an ACUSON Oxana 2 ultrasound equipment (Siemens Medical Solutions, …Germany) with a C 6-1 convex array transducer (1–6 MHz). Time intensity curves (TICs) were generated in the region of interests (ROIs) both in LAPC lesions and in its surrounding pancreas parenchyma by SonoLiver software (TOMTEC Imaging Systems). Quantitative perfusion parameters including maximum intensity (MI), rise time (RT), mean transit time (mTT) and time to peak (TTP) were analyzed and compared before and after CRT. RESULTS: No significant difference could be found by conventional B mode ultrasound scan after CRT. TICs of CEUS showed lower ascending and descending slopes rate after CRT. Among all perfusion quantitative parameters, MI decreased significantly after CRT (42.1±18.8% vs 27.8±17.2%, P  < 0.05). CONCLUSIONS: Depending on its unique advantages as non-radiation, effective and convenient, D-CEUS analysis and quantitative parameters, particularly MI, has potential application value in following up of the CRT treatment response in LAPC patients. Show more

Keywords: Dynamic contrast enhanced ultrasound (D-CEUS), locally advanced pancreatic ductal adenocarcinoma (LAPC), chemoradiotherapy (CRT), therapeutic response, blood perfusion

DOI: 10.3233/CH-190786

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 3, pp. 325-334, 2020

Authors: Liu, Ying | Huang, Zhen-Li | Gong, Lin | Zhang, Zhen | Zhang, Shuang-Chuan | Zhou, Yu-Xin

Article Type: Research Article

Abstract: Background: N-terminal pro-B-type natriuretic peptide (NTproBNP) appears to be a useful tool for diagnosing hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants. However, a consensus for its application has not been reached. Objective: The present study aims to evaluate the role of NTproBNP in predicting hsPDA in preterm infants, and explore the optimal cutoff value and testing-time. Methods: A prospective blind study of 120 preterm infants with birth weights of < 1,500 g was conducted at the NICU of Peking University Shenzhen Hospital. Blood samples were successively collected on the first three days after birth for NTproBNP analysis. …Echocardiographies were performed on day three of life to confirm the status of the ductus arteriosus. A receiver operating characteristic curve (ROC) analysis was performed to determine the ability of NTproBNP to recognize hsPDA. Results: NTproBNP was significantly higher in infants with hsPDA, than in infants in the control group, on both day two (P  < 0.001) and day three (P  < 0.001). On day two, a NTproBNP cutoff value of 3,689.0 pmol/L offered an optimal predictive value for hsPDA, while on day three, the optimal cut-off value for hsPDA was 2,331.5 pmol/L. The investigators proposes day three of life (48–72 hours) as the optimal testing time. Conclusion: The NTproBNP biomarker during the early neonatal period can be a useful tool for screening and assessing hsPDA in premature infants, especially on day three of life. Show more

Keywords: HsPDA, NTproBNP, preterm infants, very low birth weight infants

DOI: 10.3233/CH-190803

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 3, pp. 335-347, 2020

Authors: Huang, Yunqian | Liu, Qi | Xu, Junmei | Zhu, Wenqian | Jiang, Jianwei | Tang, Lei | Chen, Man

Article Type: Research Article

Abstract: BACKGROUND: Early identification of vulnerable plaques at risk of rupture could help prevent cerebral ischemic stroke in patients with carotid artery disease. OBJECTIVE: To investigate the correlation between contrast-enhanced ultrasound (CEUS) perfusion patterns and serum lipid signatures of carotid artery plaques with the degree of carotid stenosis. METHODS: A total of 80 patients with carotid artery plaques who underwent CEUS were included. All patients underwent CEUS, computed tomography angiography or digital subtraction angiography, and serum lipid testing. RESULTS: The contrast agent enhancement levels and the CEUS perfusion patterns in the plaques were associated with …the degree of carotid stenosis (P  < 0.05). Serum free fatty acid (FFA) was associated with the contrast agent enhancement levels (P  < 0.05), but did not correlate with the degree of stenosis (P  > 0.05). There was no significant difference in total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides with respect to contrast agent enhancement levels (P  > 0.05) or the degree of stenosis (P  > 0.05). CONCLUSION: A high level of CEUS perfusion and increased serum FFA levels are indicative of vulnerable carotid plaques, which may be useful for the prediction of stroke in patients with carotid artery disease. Show more

Keywords: Carotid plaque, contrast-enhanced ultrasound perfusion patterns, stenosis, free fatty acid, stroke

DOI: 10.3233/CH-190804

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 3, pp. 349-359, 2020

Authors: Kim, Yu Kyung | Lim, Young Tae | Suh, Jang Soo | Hah, Jeong Ok | Lee, Jae Min

Article Type: Research Article

Abstract: BACKGROUND: Previously, hemorheology studies using Rheoscan mainly focused on chronic kidney disease, cardiovascular disease, and endocrine disease in adults. The study using LORCA focused on erythrocyte disease. There were no studies using Rheoscan in children. OBJECTIVE: We aimed to investigate erythrocyte deformability among various hematologic diseases occurring in children, namely, iron deficiency anemia (IDA), hereditary spherocytosis (HS), immune thrombocytopenia (ITP), and aplastic anemia (AA). METHODS: Differences between those with HS, IDA, ITP, AA and healthy controls were compared among 43 patients, comprising 7 patients with HS, 8 patients with IDA, 6 patients with AA, 9 patients …with ITP, and 13 healthy controls. Erythrocyte deformability was measured using a microfluidic ektacytometer (RheoScan-D, RheoMeditech, Seoul, Korea). The erythrocyte elongation index (EI) was defined as (L – W)/(L  + W), where L and W are the major and minor axes of the ellipse, respectively. RESULTS: The EI values of IDA, HS and AA were significantly decreased compared with healthy controls, but those of ITP were similar to healthy controls. CONCLUSIONS: This study showed that erythrocyte deformability differed among various hematologic diseases. Further study concerning correlation in relation to the diagnostic and prognostic significance of erythrocyte deformability in hematologic disease is needed. Show more

Keywords: RBC deformability, children, hereditary spherocytosis, iron deficiency anemia, aplastic anemia, immune thrombocytopenia

DOI: 10.3233/CH-200817

Citation: Clinical Hemorheology and Microcirculation, vol. 75, no. 3, pp. 361-367, 2020