Clinical Hemorheology and Microcirculation - Volume 85, issue 2

Authors: Wang, Kun | Dong, Yi | Han, Hong | Cao, Jiaying | Bao, Jingwen | Wang, Wen-Ping

Article Type: Research Article

Abstract: OBJECTIVE: This study aimed to evaluate the diagnostic performance of two-dimensional shear wave elastography (2D-SWE) with a propagation map in evaluating the degree of hepatic fibrosis in patients with liver tumors before resection. METHODS AND MATERIALS: From January 2020 to April 2021, 128 patients with liver tumors were prospectively enrolled, including 20 benign liver tumors and 108 malignant liver tumors. 2D-SWE with a propagation map technology was used to measure the stiffness of liver parenchyma 2 cm away from the tumor. The median value of five measurements was used in this study. The stage of hepatic fibrosis was …graded in accordance with Scheuer standard. Spearman correlation was used to analyze the correlation between liver fibrosis stage and the liver stiffness. Univariate and multivariate linear regression analyses were used to determine significant affecting factors for liver stiffness value. The diagnostic performance of 2D-SWE with a propagation map in predicting fibrosis stage was evaluated by receiver operating characteristic curve analysis. RESULTS: The median liver stiffness value in patients with benign liver tumors was lower than that in patients with malignant liver tumors (6.0 kPa vs. 9.4 kPa, p  < 0.05). The median liver stiffness values in patients with primary liver cancer were higher than that in patients with benign liver tumors and other types of malignant liver tumors (9.6 kPa vs. 6.0 kPa, p  < 0.05). The liver stiffness measured by 2D-SWE was highly correlated with the fibrosis stage confirmed by postoperative pathology (r  = 0.834, p  < 0.05). For the liver stiffness value, PLT,TB,ALB and fibrosis stage are significantly associated with liver stiffness. The median liver stiffness values in stages S0–S4 of fibrosis were 6.0, 7.2, 8.0, 9.4, and 12.6 kPa, respectively. The areas under the ROC curve of S ≥1, S ≥2, S ≥3, and S  = 4 as predicted by SWE were 0.932, 0.945, 0.945, and 0.916, respectively. According to the Youden index, the optimal critical values for predicting fibrosis S ≥1, S ≥2, S ≥3, and S  = 4 were 6.8 (sensitivity of 89.69% and specificity of 93.55%), 7.5 (sensitivity of 87.50 % and specificity of 95.00 %), 8.3 (sensitivity of 87.14 % and specificity of 87.93 %) and 9.8 (sensitivity of 79.55 % and specificity of 86.90 %) kPa. CONCLUSION: 2D-SWE with a propagation map could noninvasively and accurately predict the staging of liver fibrosis in patients with liver tumors before resection. Show more

Keywords: Shear wave elastography, liver fibrosis, ultrasound, propagation map

DOI: 10.3233/CH-221511

Citation: Clinical Hemorheology and Microcirculation, vol. 85, no. 2, pp. 93-104, 2023

Authors: Binneboessel, Stephan | Bruno, Raphael Romano | Wernly, Bernhard | Masyuk, Maryna | Flaatten, Hans | Fjølner, Jesper | Wolff, Georg | Kelm, Malte | Beil, Michael | Sviri, Sigal | Szczeklik, Wojciech | Leaver, Susannah | De Lange, Dylan W. | Guidet, Bertrand | Jung, Christian

Article Type: Research Article

Abstract: BACKGROUND: COVID-19 is associated with cytokine release in critical disease states. Thus, cytokine absorption has been proposed as a therapeutic option. This study investigated the influence of cytokine absorption on mortality in old critical patients with COVID-19 and renal failure admitted to intensive care units (ICU). METHODS: This retrospective analysis of a prospective international observation study (the COVIP study) analysed ICU patients≥70 years with COVID-19. Data on Sequential Organ Failure Assessment (SOFA) score, clinical frailty scale (CFS), ICU therapy details including renal replacement therapy (RRT) with/without cytokine absorption were collected. The cytokine absorption group was compared to patients …receiving RRT without cytokine absorption RESULTS: Among 3927 patients, 503 received RRT; among them 47 patients were treated with cytokine absorption. Mortality rates were high in both groups with increased rates in the cytokine group for ICU mortality and 30-day mortality, but not for 3-month mortality. Logistic regression analysis indicated that SOFA-score, but not cytokine absorption was associated with mortality. CONCLUSIONS: Critical COVID-19 patients with renal failure treated with cytokine absorption showed higher short term mortality rates when compared to patients with renal replacement therapy alone. Mortality is associated with disease severity, but not cytokine absorption in a multivariate analysis. Show more

Keywords: Cytokine absorption, COVID-19, critically ill, ICU, mortality, srenal replacement therapy

DOI: 10.3233/CH-221579

Citation: Clinical Hemorheology and Microcirculation, vol. 85, no. 2, pp. 105-113, 2023

Authors: Yang, Lu | Mo, Liqun | Li, Fuyu | Zhu, Fuzu | Bai, Yiping

Article Type: Research Article

Abstract: BACKGROUND & OBJECTIVE: We aimed to evaluate the effect of sitaxentan on renal microvascular perfusion via application of ultrasound microbubble contrast. METHODS: Male beagles were randomly divided into: Sham, cardiopulmonary bypass (CPB) and sitaxentan-infused (Sit) groups (n  = 6). The ascending slope rate (ASR), area under the curve (AUC), derived peak intensity, and time to peak (TTP) were obtained via ultrasound microbubble contrast before CPB (T1 ), after 1 h CPB (T2 ), at end of CPB (T3 ), and 2 h after CPB (T4 ). RESULTS: Compared with the Sham group, the CPB group had lower ASR of …the renal cortex and medulla at T2 - 4 , higher AUC and TTP at T3 - 4 , and lower derived peak intensity at T4 . The ASR at T2 - 4 in the Sit group was lower, TTP was higher at T2 - 4 , and AUC was higher at T3 - 4 (P  < 0.05). Compared with the CPB group, the Sit group had higher ASR of the renal cortex and medulla at T3 - 4 and AUC and TTP at T3 - 4 (P  < 0.05). Compared with that at T1 , the ASR of the renal cortex and medulla at T2 - 4 in the CPB group was lower, and AUC and TTP were higher at T3 - 4 . The ASR of the renal cortex and medulla at T2 - 4 in the Sit group was lower, TTP was higher at T2 - 4 , and AUC was higher at T4 (P  < 0.05). CONCLUSIONS: Ultrasound microbubble contrast could be effectively used to evaluate renal microvascular perfusion peri-CPB in beagles, which was prone to decrease and could be improved via pretreatment with sitaxentan. Show more

Keywords: Ultrasound, kidney, microcirculation, cardiopulmonary bypass, endothelin receptor antagonist

DOI: 10.3233/CH-221600

Citation: Clinical Hemorheology and Microcirculation, vol. 85, no. 2, pp. 115-121, 2023

Authors: Lian, Kai-Mei | Lin, Teng

Article Type: Research Article

Abstract: PURPOSE: Many Thyroid Imaging Reporting and Data System (TI-RADS) category 3-4 nodules are benign. Our study aimed to add virtual touch tissue imaging (VTI) to TI-RADS using two methods, namely conservative and aggressive, and to explore which method had better diagnostic performance and which method avoided more unnecessary biopsies. METHODS: From January 2016 to December 2021, we included 121 thyroid nodules classified as TI-RADS category 3-4 in 115 consecutive patients in this retrospective study. This study used the reference standard for pathological diagnosis by surgical resection or biopsy. The diagnostic performance of the different methods was evaluated and …compared by receiver operating characteristic (ROC) and area under the ROC curve (AUC ). RESULTS: In this study, the aggressive approach had the best diagnostic performance among TI-RADS alone, the conservative approach, and the aggressive approach (AUC : 0.863 versus 0.598, P  = 0.0007; 0.863 versus 0.755, P  = 0.0067). When we used an aggressive approach, 75.44% (43/57) of the 57 false-positive nodes diagnosed by TI-RADS were appropriately downgraded from TI-RADS category 4 to category 3, avoiding unnecessary biopsies. CONCLUSION: VTI improves the diagnostic performance of TI-RADS. The aggressive approach of combining the TI-RADS with VTI would help reduce unnecessary biopsies. Show more

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

DOI: 10.3233/CH-231694

Citation: Clinical Hemorheology and Microcirculation, vol. 85, no. 2, pp. 123-134, 2023

Authors: Astapenko, David | Hyspler, Radomir | Ticha, Alena | Tomasova, Adela | Navratil, Pavel | Zrzavecky, Marek | Byreddy, Bhavya | Sedlacek, Petr | Radochova, Vera | Skulec, Roman | Hahn, Robert G. | Lehmann, Christian | Malbrain, Manu L.N.G. | Cerny, Vladimir

Article Type: Research Article

Abstract: BACKGROUND: Hydrogen is a potent antioxidant agent that can easily be administered by inhalation. The aim of the study was to evaluate whether hydrogen protects the endothelial glycocalyx layer after successful cardiopulmonary resuscitation (CPR). METHODS: Fourteen anesthetized pigs underwent CPR after induced ventricular fibrillation. During CPR and return of spontaneous circulation, 2% hydrogen gas was administered to seven pigs (hydrogen group) and seven constituted a control group. Biochemistry and sublingual microcirculation were assessed at baseline, during CPR, at the 15th , 30th , 60th , 120th minute. RESULTS: All seven subjects from the hydrogen group …and six subjects in the control group were successfully resuscitated after 6–10 minutes. At baseline, there were no statistically significant differences in examined variables. After the CPR, blood pH, base excess, and lactate showed significantly smaller deterioration in the hydrogen group than in the control group. By contrast, plasma syndecan-1 and the measured variables obtained via sublingual microcirculation did not change after the CPR; and were virtually identical between the two groups. CONCLUSION: In pigs, hydrogen gas inhalation during CPR and post-resuscitation care was associated with less pronounced metabolic acidosis compared to controls. However, we could not find evidence of injury to the endothelium or glycocalyx in any studied groups. Show more

Keywords: Hydrogen, sudden cardiac arrest, post-resuscitation care, microcirculation, endothelial glycocalyx

DOI: 10.3233/CH-231768

Citation: Clinical Hemorheology and Microcirculation, vol. 85, no. 2, pp. 135-146, 2023

Authors: Bai, Xiaofang | Wang, Yunyue | Song, Ruxi | Li, Shangan | Song, Yan | Wang, Huan | Tong, Xiaoning | Wei, Wei | Ruan, Litao | Zhao, Qiaoling

Article Type: Research Article

Abstract: OBJECTIVES: The goal of this study was to assess the clinicopathological and ultrasound (US) features of breast cancer for predicting the risk of axillary lymph node metastasis. METHODS: Patients with breast cancer were included in this retrospective, monocentric, observational study. Their preoperative ultrasound features, clinical data, laboratory results and postoperative pathologic results and immunophenotyping were collected. The association of these factors of breast cancer with axillary lymph node metastasis was evaluated by univariate and multivariate analysis. RESULTS: In this study, 471 patients diagnosed with breast cancer at the First Affiliated Hospital of Xi’an Jiaotong University between …July 2016 and September 2019 were collected, with a total of 471 nodules, of which 231(49.0%) had axillary lymph node metastasis, and 240(51.0%) did not. The parameters of hyperechoic halo, posterior acoustic decrease, microcalcification, carcinogenic embryonic antigen (CEA), cancer antigen-153 (CA153), CK5/6 (+), Ki67 (≥40%), AR (+) and histological grade (grade II and grade III) were significantly and independently associated with axillary lymph node metastasis (p < 0.05 for all). CONCLUSIONS: The combination of ultrasound features, tumor markers, pathology, and immunohistochemistry can predict axillary lymph node metastasis in breast cancer patients. Show more

Keywords: Breast cancer, ultrasound, axillary lymph node metastasis

DOI: 10.3233/CH-231777

Citation: Clinical Hemorheology and Microcirculation, vol. 85, no. 2, pp. 147-162, 2023

Authors: Krausova, Vlasta | Neumann, David | Kraus, Jaroslav | Dostalova, Vlasta | Dostal, Pavel

Article Type: Research Article

Abstract: BACKGROUND: The sidestream dark-field imaging method is used to study microcirculation. Normal values of sublingual microcirculation parameters in healthy children of different age and gender categories are unknown. OBJECTIVE: The study’s main goal was to determine normal values of selected parameters of sublingual microcirculation in healthy children of different age and gender categories. METHODS: 40 healthy children were measured, ten aged 3-5.9 years, ten aged 6-10.9 years, ten aged 11-14.9 years, and ten aged 15-18.9 years. After recording the basic anthropometric parameters and vital functions, each volunteer had their microcirculation measured using an SDF probe placed …sublingually. Three video clips were recorded and processed offline, and the three best and most stable parts of each were analyzed. RESULTS: Total vascular density, small vessel density, proportion of perfused small vessels, perfused vessel density, perfused small vessel density, and DeBacker’s score were significantly higher in females than in males. There were no differences between age groups in microcirculation parameters except MFI. CONCLUSIONS: Age does not influence normal values of microcirculatory parameters. Female gender was associated with higher vessel density, perfused vessel density, and DeBacker’s score. A suggestion of the normal range of microcirculatory parameters in healthy children is provided. Show more

Keywords: Sidestream dark-field imaging, sublingual microcirculation, healthy child

DOI: 10.3233/CH-231851

Citation: Clinical Hemorheology and Microcirculation, vol. 85, no. 2, pp. 163-171, 2023

Authors: Zhang, Zhanshuai | Qin, Shaoqiang | Wang, Rui | Fang, Zhiqin | Wang, Yaling | Li, Fangjiang

Article Type: Research Article

Abstract: BACKGROUND: Circular RNAs (circRNAs) are involved in the progression of atherosclerosis (AS). The present study aimed to determine the functions and mechanism of circ_0003575 in AS. METHODS: Oxidized low-density lipoprotein (ox-LDL) was used to induce human aortic endothelial cells (HAECs) to establish an AS cell model. Cell Counting Kit-8 (CCK-8) assay and 5’-ethynyl-2’-deoxyuridine (EdU) assay were conducted to assess cell proliferation. Flow cytometry analysis was utilized to quantify cell apoptosis. Tube formation assay was performed to analyze angiogenesis ability. Enzyme linked immunosorbent assay (ELISA) was used to examine the concentrations of inflammatory factors. Quantitative real-time polymerase chain reaction …(qRT-PCR) and western blot were manipulated for the expression of circ_0003575, microRNA-637 (miR-637) and TNF receptor associated factor 6 (TRAF6). Dual-luciferase reporter assay and RNA immunoprecipitation (RIP) assay were adopted to estimate the downstream targets of circ_0003575. RESULTS: Ox-LDL treatment repressed the proliferation and angiogenesis and promoted the apoptosis and inflammation in HAECs. Circ_0003575 knockdown ameliorated ox-LDL-induced injury of HAECs. Circ_0003575 interacted with mi-R-637, which directly targeted TRAF6. Inhibition of miR-637 reversed the impacts of circ_0003575 knockdown on HAEC injury. Moreover, miR-637 overexpression promoted cell proliferation and angiogenesis and inhibited cell apoptosis and inflammation by targeting TRAF6 in ox-LDL-treated HAECs. Further, circ_0003575 silencing inhibited the activation of NF-κB pathway. CONCLUSION: Circ_0003575 knockdown alleviated ox-LDL-induced HAEC damage by regulating miR-637/TRAF6 and NF-κB pathways. Show more

Keywords: AS, HAECs, circ_0003575, miR-637, TRAF6

DOI: 10.3233/CH-231858

Citation: Clinical Hemorheology and Microcirculation, vol. 85, no. 2, pp. 173-187, 2023

Authors: Riaz, Asad | Ali, Hossam Tharwat | Ali, Fawad | Ali, Jawad

Article Type: Research Article

Abstract: Immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a platelet count of less than 100 x 109 /L, resulting from antibody-mediated platelet destruction. Treatment for ITP typically involves steroids, and intravenous immunoglobulins (IVIG) can be added. Splenectomy is performed in cases with refractory ITP. Rituximab can suppress immunity but has limited efficacy in ITP cases. Herein, we present a rare case of a 30-year-old female who was first diagnosed with ITP and underwent a splenectomy two years later. However, seven years after surgery, she was presented with symptoms of ITP. A splenic scan showed an accessory spleen …in the spleen bed, for which she underwent accessory spleen removal surgery. Her laboratory tests three days post-operation showed a rise in platelet count and hence was discharged a few days later. The patient had recurrent attacks of ITP even after the removal of the normal and accessory spleen, suggesting that accessory spleen removal may not always be an effective treatment for ITP. The patient eventually died. While splenectomy is a common treatment for ITP, it may not always be effective in all cases, and other treatments such as bone marrow transplantation may be necessary. Show more

Keywords: Immune thrombocytopenic purpura (ITP), intravenous immune globulins (IVIG), splenectomy, steroid, rituximab

DOI: 10.3233/CH-231881

Citation: Clinical Hemorheology and Microcirculation, vol. 85, no. 2, pp. 189-194, 2023