bluuebunny/crossref_metadata_2025 huggingface dataset:
Tissue reaction induced by implanted venous access ports in adult patients after infection of the implantation site
Authors: Hiebl B. , Hopperdietzel C. , Hünigen H. , Dietze K. , Jung F. , Niehues S.M.
Published: December 2019

Implantable long-term central venous port systems (CVPS) are widely used as a permanent means of accessing the vascular system for intravenous delivery of drugs, parenteral nutrition, blood transfusion, and blood sampling. These systems allow easy and repetitive puncture without causing much damage to the vessels. However, the body foreign surface of CVPS induces an inflammatory response with varying intensity (depending on the implant materials) that leads to formation of a fibrous tissue capsule around the implant. This study was designed to investigate the influence of bacterial infection on the tissue reaction induced by implanted CVPS in adult patients. 20 patients (9 women, 11 men, 58 ± 14 yrs of age) were included in this study. These patients received explantation of a polysulfone based CVPS (ChemoSite™, Covidien, Mansfield, USA) due to port related infections (patients with bacterial infections at the implantation site: group A, 5 men, 1 women) or to other reasons such as termination of treatment, thrombosis, or CVPS dysfunction (patients without bacterial infections, group B, 6 men, 8 women) 299.9 ± 261.2 days after CVPS implantation. A sample of the encapsulating tissue covering the CVPS together with surrounding tissue (at least 1 × 1 cm2) was placed in a small container with fixing agent, a buffered neutral 4% formalin solution (pH 7). Histological sections of the samples were prepared for light microscopic analysis after paraffin embedding. Sections of 3 μm were cut and stained with haematoxylin and eosin, Weigert's elastic stain, and Heidenhain's azan stain. There was no difference in thickness, collagen and elastin content, or cell and capillary density of the fibrous capsule between both groups. Due to the wound healing reaction involving angiogenesis and fibroblast activation cell density and number of capillaries in the capsule tissue of all patients showed a positive correlation (r = 0.45, p < 0.05). However, the study demonstrated that at the end of the foreign body reaction the artificial tissue layer which covers the CVPS after implantation due to foreign body reaction shows only low reactivity towards infections.
High resolution compression elastography and color doppler sonography in characterization of breast fibroadenoma
Authors: Rjosk-Dendorfer D. , Reu S. , Deak Z. , Hetterich H. , Kolben T. , Reiser M. , Clevert D.A.
Published: December 2019

PURPOSE: To evaluate the use of color Doppler sonography and free hand sonoelastography in the assessment of breast fibroadenomas according to their size and shape. MATERIALS AND METHODS: From December 2012 to March 2013 women with 16 solid breast masses, classified as BI-RADS category 3 or 4 were examined with B-mode ultrasound, sonoelastography and color Doppler sonography. Lesions were subdivided according to their shape in round, ovoid or macrolobulated and according to their size (<2.0 cm or ≥2.0 cm). Two readers assessed sonoelastographic findings at 12.5 MHz using the tsukuba elasticity score and results of Doppler sonography using a score of 0, 1 or 2, depending on the degree of perfusion. RESULTS: Among the 16 examined lesions 3 showed a round shape, 9 were ovoid and in 4 cases a macrolobulated appearance could be seen. No significant differences concerning Tsukuba-score depending on various shapes of fibroadenomas in B-mode sonography could be shown (p = 0.91) and also comparison of Tsukuba-scores and size of masses revealed no significant differences (p = 1.0). Sizes of fibroadenomas ≥2 cm were significantly associated with an increased vascularization of the lesions (p = 0.04) and a macrolobulated appearance in B-mode sonography (p = 0.04). CONCLUSION: The combination of color Doppler sonography and sonoelastography in addition to B-mode sonography leads to an increased accuracy in distinguishing benign from malignant breast masses and to an improvement in characterization of fibroadenomas independent of their shape or size.
Monitoring parotid gland tumors with a new perfusion software for contrast-enhanced ultrasound
Authors: Klotz Laura V. , Ingrisch Michael , Eichhorn Martin E. , Niemoeller Olivier , Siedek Vanessa , Gürkov Robert , Clevert Dirk-Andre
Published: December 2019

PURPOSE: Contrast enhanced ultrasound (CE-US) is a promising imaging modality for non-invasive analysis of functional vascularisation. Lesions of the parotid gland are associated with a vascularisation that differs from normal gland tissue. The aim of this clinical study was to further analyse the perfusion in parotid gland lesions with CE-US. The new quantification software VueBox (Bracco, Italy) was used to assess the perfusion, based on DICOM datasets of CE-US examination. MATERIALS AND METHODS: CE-US measurements were performed by intravenous application of a contrast agent (SonoVue, Bracco, Italy) before surgical tumor resection. From the analysis of a time sequence of 2D DICOM contrast images, area under time intensity curve (AUC), peak enhancement (PE), wash-in-rate (WiR) and wash-in-perfusion-index (WiPI) were calculated using VueBox. These were correlated with the histological analyses of the tumor tissue. RESULTS: Significant difference of area below intensity time curve (AUC), peak enhancement (PE), wash-in-rate (WiR) and wash-in perfusion index (WiPI) were observed in the malign lesions compared to benign tumors (p < 0,05) and in pleomorphic adenoma compared to cystadenolymphoma (p < 0,05). CONCLUSION: CE-US seems to be a quantitative and independent method for discriminating between malign and benign parotid gland tumors.
Value of high-resolution contrast-enhanced ultrasound in detection and characterisation of endoleaks after EVAR
Authors: Zimmermann H. , D'Anastasi M. , Rjosk-Dendorfer D. , Helck A. , Meimarakis G. , Reiser M. , Clevert D.A.
Published: December 2019

PURPOSE: To compare the value of high-resolution contrast-enhanced ultrasound in the detection and characterisation of endoleaks after EVAR. MATERIAL AND METHODS: In this retrospective study, a cohort of 80 patients underwent both standard examination using a curved array 5 MHz transducer and a second examination using a curved array 9 MHz transducer. The examination included B-mode, color Doppler and contrast-enhanced ultrasound using the Philips EPIQ 7 scanner. RESULTS: 80 patients were included in the study. CEUS was used as the preferred examination in determining the presence of an endoleak. The sensitivity and specificity for the detection of endoleak using the 5 MHz transducer was: CEUS (96.8%, 100%), Color Doppler (47.6%, 94.1%), B-mode (15.8%, 94.1%), while for the 9 MHz transducer: CEUS (100%, 100%), Color Doppler (39.7%, 94.1%), B-mode (23.8%, 24.1%). CONCLUSION: High resolution ultrasound (9 MHz) in detection and characterization of endoleaks after EVAR has some minor advantages in comparison to lower resolution ultrasound (5 MHz).
Haemorheological profile in patients with systemic sclerosis
Authors: Vayá Amparo , Todolí José , Calvo Javier , Romagnoli M. , Ricart Jose M.
Published: December 2019

The relationship between rheological alterations and systemic sclerosis (SSc) is not well established. We have determined in 27 patients with SSc (4 male, 21 female ) aged 59±14 years and in a well matched control group the whole rheological profile, i.e. blood viscosity (BV), plasma viscosity (PV), erythrocyte aggregation (EA), erythrocyte deformability (ED) along with fibrinogen (Fbg), C-reactive protein (CRP), lipids, and erythrocyte indices. Patients show higher Fbg, PV and EA (P<0.01) and lower ED (P<0.01). A negative significant correlation was found between ED and inflammation markers, both CRP (P<0.05) and Fbg (P<0.01), indicating that decreased ED seems to be related to inflammatory changes at microcirculatory levels. In addition, patients with anticentromere antibodies show significantly lower ED than those without (P<0.05). The clinical significance of this observation needs to be clarified, deserving further research.
Pathophysiology of polymorphonuclear leukocyte in arterial hypertension
Authors: Hopps Eugenia , Presti Rosalia Lo , Caimi Gregorio
Published: December 2019

This review shows how polymorphonuclear leukocytes (PMNs) play a pivotal role in the development of the organ injury that is associated with arterial hypertension. Elevated white blood cell count and higher levels of PMNs activation are risk factors for arterial hypertension and cardiovascular disease. Spontaneously activated PMNs release proinflammatory factors and reactive oxygen species, which have negative effects on vascular tone and on their adhesion to the endothelium. The oxidative stress in hypertensive PMNs is revealed by increased NADPH-oxidase production and lipid peroxidation and by decreased cytosolic and mitochondrial superoxide dismutase concentrations. The overexpression of adhesion molecules, such as β2-integrin, promotes PMNs rolling and leukocyte–endothelium interactions too. All these events underline how polymorphonuclear leukocytes may contribute to the vascular damage accompaining arterial hypertension.
Improvements in high resolution ultrasound for postoperative investigation of capillary microperfusion after free tissue transfer
Authors: Lamby P. , Prantl L. , Schreml S. , Pfister K. , Mueller M.P. , Clevert D.-A. , Jung E.M.
Published: December 2019

Introduction: High resolution ultrasound (US) techniques as implemented in the latest generation of US machines provide imminently better resolution compared to previous high resolution models. This improvement is based on advanced transducer technologies as well as updated post-processing procedures. Furthermore, matrix linear transducers providing frequencies from 6 to 15 MHz are now available. The aim of the study was the evaluation of these new techniques for the immediate postoperative investigation of microcirculation after free tissue transfer by supplemental use of Contrast-Enhanced Ultrasound Imaging (CEUS).

Patients and methods: To this end, we investigated 12 patients who underwent free tissue transfer in order to cover tissue defects in various body regions. We utilized the new GE Logiq E9 equipped with a linear 6–9 MHz and a matrix 6–15 MHz probe as well as the GE Logiq 9 with the previous version of the linear 6–9 MHz probe. Both machines provide the modalities of SRI®, Cross Beam® and THI®. The perfusion curves were quantitatively analyzed using digital cine sequences (Qontrast®, Bracco, Italy). Furthermore, two independent investigators evaluated the digitally recorded images with respect to the resolution of details based on a scale ranging from 0 to 5, and after application of 2.4 ml SonoVue® (Bracco, Italy), evaluated the image quality regarding the representation of tissue perfusion.

Results: None of the free flaps showed clinical or laboratory signs of flap failure during the hospital stay. Several flaps showed typical perfusion patterns relating to the flap type. The combination of SRI®, Cross Beam® and THI® allows, in most cases, a more exact differentiation of tissue graft outlines and tissue composition, in particular the tissue texture, compared to the use of B-scan only. In addition, the high resolution matrix technology combined with the broader spectrum of 6–15 MHz considerably improves the representation of image details compared to multifrequency probes with 6–9 MHz. The use of updated post-processing procedures as well as new transducer technologies in CEUS also results in improved resolution and thus achieves a higher score compared to previous models.

Conclusion: At present, these new US technologies combined with the updated 6–9 MHz probe provide the optimal assessment of perfusion in cutaneous, subcutaneous and deeper tissue layers. The additional use of new multifrequency 6–15 MHz matrix probes improves the resolution in the B-mode to an even higher degree.
Evaluation of Acoustic Radiation Force Impulse (ARFI) imaging and contrast-enhanced ultrasound in renal tumors of unknown etiology in comparison to histological findings
Authors: Clevert D.-A. , Stock K. , Klein B. , Slotta-Huspenina J. , Prantl L. , Heemann U. , Reiser M.
Published: December 2019

Purpose: It was the aim of our study to combine the findings of contrast-enhanced ultrasound and ARFI-imaging in the evaluation of renal masses in comparison to the histological findings.

Materials and methods: Fifteen patients with unclear kidney lesions were analyzed. We used a high-end ultrasound machine (Siemens ACUSON S2000™, Siemens Healthcare, Erlangen, Germany) with a multifrequency curved array 4 MHz or linear 9 MHz transducer. Contrast-enhanced ultrasound (bolus injection 1.6–2.4 ml SonoVue®) was carried out. We obtained fifteen ARFI measurements from each patient with at least five values for quantification. The ARFI-ROI (region of interest) was placed in the ventral margin of the kidney tumor and the whole ROI was covered by the tumor. The “reference-ROI” was placed in the ventral kidney parenchyma of the patient at a distance of at least two centimeters from the tumor. All renal tumors were surgically resected. In cases of complex renal cysts or anatomic variations mimicking renal tumors (“pseudo-tumors”), constant results of ultrasound examinations and additional MRI or multiphase CT over 6 months were required.

Results: Fifteen patients were included in the study and were examined using the diagnostic ultrasound tools of our study The kidney tumors of our patients had diameters ranging from 1.5 to 8 cm and were located at depths ranging from 2 to 5.5 cm. ARFI imaging was also performed in all patients. A field up to a depth of 10 cm could be visualized for diagnostic use. Performing ARFI quantification using Siemens Virtual Touch™ Tissue Quantification we obtained minimum and maximum tissue shear velocities ranging from 1.6 to 3.42 m/s. The reference tissue ROIs showed values from 1.31 to 4.4 m/s. 12 cases were accepted for surgical resection. The visualization of lesions with Virtual Touch™ Tissue Imaging confirmed the measurements of ARFI quantification and were able to depict the different areas of stiffness in the kidney tissue. No infiltration of kidney veins or vena cava was detected by contrast-enhanced ultrasound. Of the 12 cases two “complicated” renal cysts were examined, and both showed Bosniak-III findings.

Conclusion: ARFI imaging improves visualization of unclear renal masses in comparison to fundamental B-scan and adds new information about the tissue stiffness in a less time-consuming and more reproducible way. CEUS with SonoVue® allows an early evaluation of renal masses or complex cysts.
Quantitative assessment of bowel wall vascularisation in Crohn's disease with contrast-enhanced ultrasound and perfusion analysis
Authors: Girlich C. , Jung E.M. , Iesalnieks I. , Schreyer A.G. , Zorger N. , Strauch U. , Schacherer D.
Published: December 2019

Patients with inflammatory bowel disease (IBD) often undergo several radiologic imaging studies, which – with the exception of magnetic resonance imaging (MRI) and B-scan ultrasound (US) – subject patients to ionizing radiation. With contrast enhanced ultrasound microvascular imaging of the bowel is possible. Hence, the aim of our study was to assess the perfusion pattern of inflamed bowel walls in Crohn's disease compared with healthy volunteers quantitatively using a specific quantification software.

We evaluated 4 volunteers and 20 patients with proven Crohn's disease, who went through an active episode based on clinical symptoms and complementary imaging by MRI (19 patients) and computed tomography (1 patient), respectively, with dynamic contrast-enhanced ultrasound (CEUS) using a second generation contrast agent (SonoVue®, Bracco, Germany). Retrospectively, we applied the quantification software Qontrast® (Bracco, Italy) to obtain contrast-enhanced sonographic perfusion maps for each lesion.

Patients had significant higher peak values (median 46.86, lower quartile 37.91, upper quartile 53.20) and significant higher regional blood volume (median 2133.65, lower quartile 1202.90, upper quartile 2820.44) than volunteers.

Considering the very low peak value of the healthy, it is easy to understand that the time-to-peak was significantly shorter in the volunteers (median 4.45, lower quartile 1.82, upper quartile 6.88) than in the patients (median 12.15, lower quartile 9.18, upper quartile 15.74). Our study showed clear differences between inflamed and normal bowel wall vascularity regarding all perfusion parameters. These results show that a quantitative assessment of the bowel wall vascularisation and inflammation, respectively, is possible. The software used here enables us to collect data, not only in a semi-quantitative but also in a reproducible, quantitative manner which is comparable with the evaluation of CT or MRI generated data.
Capillary bleeding under oral anticoagulation
Authors: Leithäuser B. , Mrowietz C. , Hiebl B. , Pindur G. , Jung F.
Published: December 2019

Background: Oral anticoagulants are routinely used for prevention of thromboembolism in cardiac, arterial or venous diseases. Hemorrhages are serious treatment complications, frequently occurring under long-term and/or high-dose regiments. From animal experiments it is known that coumarin-type anticoagulants may cause capillary dilatation and increased permeability, red blood cell extravasation and punctate bleeding. Controlled human trials are lacking.

Methods: 31 patients under oral anticoagulation were examined by video capillary microscopy. 52 patients with comparable diseases and treatment but without oral anticoagulation served as controls. Nailfold capillaries of four fingers of each hand were examined and analyzed off-line according to the following criteria: (1) numbers of capillaries investigated, (2) numbers of capillary bleedings, and (3) bleeding incidence (bleedings per 100 capillaries).

Results: In 23 out of 31 patients (74.2%) capillary bleedings were observed. The bleeding incidence ranged from 0.33 to 4.29 per 100 capillaries. In contrast, only 4 out of 52 controls were detected with capillary bleedings (2.1%, p<0.001). The bleeding incidence was 0.34–2.41. In patients on anticoagulation there was no correlation between the number of capillary bleedings and the INR or Quick values. During a two year follow-up of patients on oral anticoagulation no significant difference was found in terms of clinically obvious bleedings in patients with or without capillary bleedings.

Conclusion: This study shows that capillary bleedings can be demonstrated in patients on oral anticoagulation. Bleedings occur independent of the INR-value. Thus, other factors than the vitamin-k-dependent coagulation effect seem to be causal for the damage of microvessels. Further, the evidence of capillary bleedings is not a prognostic indicator for future hemorrhage.
Intravital microscopy of the capillary perfusion in the corium limbi of the third toe of the minipig
Authors: Hiebl B. , Mrowietz C. , Braune S. , Franke R.P. , Plendl J. , Jung F.
Published: December 2019

Several methods are available today for the investigation of microcirculation in animal models, but they can be invasive and time-consuming depending on the area investigated. In particular, non-invasive methods that can be conducted rapidly and without dye or tracer injections are in demand.

The cutaneous microcirculation can be easily studied in the dorsal corium limbi of the third toe of the porcine forelimb using intravital microscopy – analogous to nail fold capillary microscopy in humans. The capillary microscopy system consists of a reflected-light microscope with a cold light source, green and infrared filters and a video camera. The video sequences were recorded using the image capture system Framegrabber (Imagenation PXC-200) and a PC (with an Intel Core 2 Duo processor, 1024 MB RAM, 160 GB hard disk, Windows XP Pro), and stored via a DVD recorder (Panasonic LQ-MD800).

Quantification of capillary erythrocyte flow velocities was performed using the computer-assisted image analysis system Cap Image Version 8.5 which includes a movie tool as a video sequence storage medium. The method allows estimation of capillary density and tortuosity as well as capillary circulation in the anesthetized pig within a few minutes. First measurements were made after anesthesia induction followed by further measurements during anesthesia maintenance (3 minutes each). No differences in capillary circulation were found.

The present method is thus very well suited for long-term microcirculation measurements in pigs, e.g., to evaluate therapeutic interventions in the ischemic limb model.
The effect of carbon monoxide poisoning on hemorheological parameters in rats and the alterations in these parameters in response to three kinds of treatments
Authors: Bor-Kucukatay Melek , Atalay Habip , Karagenc Nedim , Erken Gulten , Kucukatay Vural
Published: December 2019

This study aimed to investigate the short term effects of carbon monoxide (CO) poisoning and three kinds of poisoning treatments; namely room air, normobaric and hyperbaric oxygen on hemorheological parameters such as red blood cell (RBC) deformability, aggregation, blood and plasma viscosity. 43 Wistar rats were divided into 5 groups. Poisoning was induced by exposure to 4000 ppm CO (1 h). The poisoning protocol was followed by 3 types of treatments; room air, normobaric 100% oxygen and hyperbaric oxygen for 1 h. RBC deformability and aggregation were determined using an ektacytometer (LORCA) and a cone-plate rotational viscometer was used for the viscosity measurements. RBC deformability of CO poisoned rats were found to be elevated and the treatments applied, caused decrement of this parameter. A no significant increment tendency was found in erythrocyte aggregation after CO exposure. Although room air and hyperbaric oxygen treatments caused further significant elevations in the amplitude of aggregation, normobaric oxygen therapy induced decrement in this parameter towards control levels. No significant alterations were observed in viscosity values among the groups. The results of this study demonstrate normobaric oxygen therapy as a better choice of treatment after CO poisoning in hemorheological point of view.
Does carbonyl stress cause increased blood viscosity during storage?
Authors: Li Guolin , He Hong , Yan Han , Zhao Qiong , Yin Dazhong
Published: December 2019

Background: The structural and biochemical changes to erythrocytes during storage, called ‘storage lesion’, are important factors that contribute to decreases in the efficacy and safety of blood transfusions. However, the biochemical mechanisms are only partly understood.

Study design and methods: Fresh whole blood in citrate phosphate dextrose anticoagulant was preserved in storage bags at 1–4°C for over 20 days. Aliquots of stored blood were withdrawn for analysis at the 1st, 5th, 10th, 15th and 20th day of storage. Whole blood viscosity, plasma reactive carbonyl species, erythrocyte membrane protein carbonylation, protein (tryptophan) fluorescence and the contents of thiols were quantified concurrently.

Results: There were significant increases in blood viscosity and plasma reactive carbonyl species level during storage. There were significant time-dependent increases in membrane protein carbonylation, increases in protein (tryptophan) fluorescence and a decrease in the content of thiols.

Conclusion: Reactive carbonyl species, by attacking the amino and/or sulfhydryl groups of erythrocyte membrane proteins, induce a series of structural alterations in erythrocytes. These lead to an increase in blood viscosity and reduce the efficacy and safety of storage and transfusion.
Effect of Ligaria cuneifolia catechin- and quercetin-enriched fractions on hemorheology and plasma cholesterol
Authors: Dominighini Alicia , Ferrero Mariana , Crosetti Diego , Alvarez María de Luján , Ronco María Teresa , Gonzálvez José , Wagner Marcelo , Gurni Alberto , Carnovale Cristina , Luquita Alejandra
Published: December 2019

We tested the in vivo and the in vitro effects of both Ligaria cuneifolia catechin- and quercetin-enriched fractions on erythrocyte shape and deformability, and on plasma cholesterol level. For in vivo studies, adult male Wistar rats were randomized in three experimental groups which received intraperitoneally, once a day, 3 days: Control: saline solution (C; n = 6); catechin from L. cuneifolia, 0.60 mg/100 g body weight (CLc; n = 6), or quercetin from L. cuneifolia, 2.3 mg/100 g body weight (QLc; n = 6). For in vitro studies, blood samples obtained from male Wistar rats were divided into three fractions, which were incubated with saline solution (C), catechin (CLc; n = 5) and quercetin (QLc; n = 5), in a concentration equivalent to 0.60 mg/100 g body weight, and 2.3 mg/100 g body weight, respectively. CLc significantly reduced the rigidity index due to a diminished mean concentration volume. QLc induced erythrocyte rigidization (less deformability), thus increasing blood viscosity. Neither of the two treatments produced any changes in plasmatic or biliary excretion of cholesterol. Opposite results were observed in rigidity index with CLc and QLc. In vitro studies showed an interaction of both CLc and QLc with the erythrocyte membrane, which induced changes in the erythrocyte shape from discocyte to stomatocyte.
Sickle cell disease: Selected aspects of pathophysiology
Authors: Alexy T. , Sangkatumvong S. , Connes P. , Pais E. , Tripette J. , Barthelemy J.C. , Fisher T.C. , Meiselman H.J. , Khoo M.C. , Coates T.D.
Published: December 2019

Sickle cell disease (SCD), a genetically-determined pathology due to an amino acid substitution (i.e., valine for glutamic acid) on the beta-chain of hemoglobin, is characterized by abnormal blood rheology and periods of painful vascular occlusive crises. Sickle cell trait (SCT) is a typically benign variant in which only one beta chain is affected by the mutation. Although both SCD and SCT have been the subject of numerous studies, information related to neurological function and transfusion therapy is still incomplete: an overview of these areas is presented. An initial section provides pertinent background information on the pathology and clinical significance of these diseases. The roles of three factors in the clinical manifestations of the diseases are then discussed: hypoxia, autonomic nervous system regulation and blood rheology. The possibility of a causal relationship between these three factors and sudden death is also examined. It is concluded that further studies in these specific areas are warranted. It is anticipated that the outcome of such research is likely to provide valuable insights into the pathophysiology of SCD and SCT and will lead to improved clinical management and enhanced quality of life.
Ultrasound-Arterioportography (US-AP): A new technical approach to perform detection of liver lesions
Authors: Zorger Niels , Jung Ernst-Michael , Schreyer Andreas G. , Heiss Peter , Mueller-Wille René , Wiest Reiner , Feuerbach Stefan , Rennert Janine
Published: December 2019

Purpose: To show the feasibility of a combination of the advantages of modern contrast enhanced ultrasound (CEUS) with the technique of arterioportography to achieve the highest sensitivity of all different modalities. Material and methods: Ten patients (9 m, 1 f, age 52–73 years) with suspected hepatocellular carcinoma (HCC) in liver cirrhosis (8 ethyl toxic, 2 hepatitis) were included before transarterial chemo-embolization (TACE). In all patients during a 6-week period a double enhanced MRI (Gd-DTPA and SPIO) was performed. Before TACE a bolus <2 mL ultrasound contrast agent (SonoVue®, Bracco, Milan, Italy) was injected over a selectively placed catheter in the superior mesenteric artery (SMA) and ultrasound of the liver (2.5–4 MHz, LOGIQ 9; GE Healthcare) was performed in arterioportographic phase (US-AP). Two independent readers evaluate number, size and localisation of detected lesion in MRI and US-AP. Additional diagnostic quality of both modalities was determined using a 4-point scale (1: excellent–4: not diagnostic). Differences were analysed for significance using a t-test. Interobserver variability was calculated (κ-value). Result: In all 10 patients (100 %) US-AP was feasible. Diagnostic quality was in all cases between 1–2 for both modalities and readers (MRI standard deviation (SD) −0.51, Sono-AP SD −0.421). US-AP detected with 33.5 vs. 24.5 lesions, significant more lesions than double enhanced MRI (p < 0.022). The interobserver variability was κ −0.965 for MRI and κ −0.898 for US-AP. Conclusion: US-AP for detection of liver lesions is feasible. Using this technique significantly more lesions in patients with hepatocellular carcinoma could be detected in comparison to MRI with liver-specific contrast agent.
Role of shear stress patterns in the TNF-α-induced atherogenic protein expression and monocytic cell adhesion to endothelium
Authors: Urschel Katharina , Wörner Anja , Daniel Werner G. , Garlichs Christoph D. , Cicha Iwona
Published: December 2019

Background: Atherosclerotic plaques develop at arterial regions subjected to non-uniform shear stress, and are initiated by increased leukocyte-endothelial interactions. In this study, we investigated the effects of distinct shear stress patterns on endothelial recruitment of monocytic cells. Methods: Human umbilical vein endothelial cells (ECs) were exposed to laminar or non-uniform shear stress in bifurcating flow-through slides, followed by 2 h stimulation with TNF-α. To study cell adhesion, ECs were perfused with medium containing THP-1 monocytic cells for 1 h. Endothelial protein expression was determined by immunofluorescence. Results: Exposure to non-uniform shear stress and TNF-α lead to progressive induction of adhesion molecules and increase in monocytic cell adhesion observed over 0.5–3 h. To investigate the relative role of the shear stress patterns in monocytic cell recruitment, ECs were exposed to reduced levels of shear stress, resulting in a reduced gradient steepness in the non-uniform shear stress regions. Lowering the shear stress from 10 to 5 and 2 dyne/cm2 resulted in increased monocytic cell adhesion under laminar shear stress. However, in these conditions, adherent monocytic cells under non-uniform shear stress were strongly reduced. Moreover, in the region exposed to shear stress gradient parallel to flow direction, monocytic cell adhesion was significantly lower than in the region of non-uniform shear stress, characterized by transversal gradient. Conclusion: Exposure to non-uniform shear stress results in progressive induction of adhesion molecules and monocytic cell recruitment in response to circulating TNF-α. Enhanced monocytic cell recruitment at bifurcations is affected not only by the magnitude and steepness of shear stress gradient, but also by its direction in relation to the flow.
Interaction of thrombocytes with poly(ether imide): The influence of processing
Authors: Braune S. , Lange M. , Richau K. , Lützow K. , Weigel T. , Jung F. , Lendlein A.
Published: December 2019

The processing of polymers for blood contacting devices can have a major influence on surface properties. In this study, we fabricated poly(ether imide) (PEI) membranes and films to investigate the effects of the processing on physicochemical surface properties by atomic force microscopy (AFM), scanning electron microscopy, contact angle as well as zeta potential measurements. A static platelet adhesion test was performed to analyze the thrombogenicity of both devices. While contact angle measurements showed similar levels of hydrophobicity and zeta potential values were equivalent, mean surface roughness as well as surface energies in the dispersive part were found to be increased for the PEI membrane. The static platelet adhesion test showed a significantly decreased number of adherent platelets per surface area on the PEI film (178.98 ± 102.70/45000 μm2) compared to the PEI membrane (504 ± 314.27/45000μm2) and, consequently, revealed evidence for higher thrombogenicity of the PEI membrane. This study shows that processing can have a significant effect on platelet adhesion to biomaterials, even though, molar weight was identical. Thrombogenicity of polymer-based cardiovascular devices, therefore, have to be evaluated at the final product level, following the entire processing procedure.
The value of contrast enhanced ultrasound (CEUS) in the characterisation of patients with renal masses
Authors: Ignee Andre , Straub Bernd , Brix David , Schuessler Gudrun , Ott Michaela , Dietrich Christoph F.
Published: December 2019

Renal masses are frequently incidentally found on ultrasound. Contrast enhanced computed tomography (CECT) is regarded as the method of choice. Contrast enhanced ultrasound (CEUS) has a high impact for characterisation of hepatic lesions. Its use in renal masses has been less comprehensively studied. Two hundred and one patients referred for surgical treatment of a renal mass, 143 patients fulfilling inclusion criteria (histology and reference method). Baseline ultrasound and CEUS with BR1, histology obtained by surgery (89%) or biopsy (11%). Eighty-eight percent of the patients had renal lesions which were malignant and 12% benign lesions. Eighty percent had renal cell carcinoma (RCC). Seven percent of the lesions were cystic. Two patients were upgraded by CEUS from CECT Bosniak II into CEUS Bosniak III resp. IV. CEUS could predict malignancy with a sensitivity, specificity, positive, negative predictive value and accuracy in 97%, 45%, 91%, 75%, and 90%. The correct staging was diagnosed by CEUS (CECT) in 83% (69%). CEUS was superior to CECT in the staging and characterisation of RCC, also in the subgroup of patients with cystic lesions. CEUS can replace CECT e.g. in patients with allergies or contraindications against CECT. Multicentre studies are necessary to confirm the findings.
Erythrocyte deformability in morbid obesity before bariatric surgery. Influence of abdominal obesity
Authors: Vayá Amparo , Cámara Rosa , Hernádez-Mijares Antonio , Romagnoli Marco , Solá Eva , Corella Dolores , Laiz Begoña
Published: December 2019

Although there are several studies dealing with erythrocyte deformability (ED) in obese patients, research on this topic in morbidly obese subjects is scarce. In these studies ED seems to be decreased, although the cause remains unknown. A case-control study in 76 morbid obese subjects (23 women and 53 men, aged 44 ± 13 years) and in 79 normal-weight controls (30 women and 49 men, aged 43 ± 13 years) was undertaken. ED has been determined by ektacytometric techniques in a Rheodyn SSD, by means of the elongation index (EI) at 12, 30 and 60 Pascals, along with anthropometric, lipidic, metabolic and inflammatory parameters. EI was statistically lower in morbidly obese subjects than in controls at all the shear stresses tested (EI12: 47.3 ± 2.14 vs. 47.9 ± 2.07; p = 0.047, EI30: 52.16 ± 2.1 vs. 53.12 ± 1.4; p = 0.007, EI60: 53.9 ± 2.4 vs. 55.2 ± 2.50; p = 0.001) as were anthropometric lipidic and inflammatory parameters (p < 0.001). In the bivariate correlation EI60 correlated negatively with most anthropometric, lipidic and inflammatory parameters. However, in the multivariate analysis, the case-control status was not significantly associated with EI60 and only triglycerides, glucose, hs-CRP and waist circumference were independently associated with EI60, constituting independent predictors of altered ED although, waist circumference, showed the highest statistical significance (p = 0.007). ED is decreased in morbidly obese subjects associated with insulin resistance and inflammation parameters although abdominal obesity seems to be of paramount importance in altering this rheological parameter.
A comparison of capillary and venous blood sampling methods for the use in haemorheology studies
Authors: Simmonds Michael J. , Baskurt Oguz K. , Meiselman Herbert J. , Marshall-Gradisnik Sonya M.
Published: December 2019

There is accumulating evidence that exercise may improve disturbed haemorheological parameters that are typically observed in various chronic diseases, thus there is a growing interest in exploring the influence of various exercise models for the improvement of haemorheology. Blood sampling using venipuncture, however, can be limiting during exercise and/or in field settings. The purpose of the present study was to investigate whether venous and capillary blood samples yield comparable red blood cell (RBC) deformability and aggregation indices. Twelve healthy volunteers (6 males and 6 females; age 30 ± 9 yrs; body mass index 24.9 ± 2.8 kgm−2) provided blood samples that were collected simultaneously from: i) a prominent forearm vein by venipuncture; ii) the earlobe using a lancet; iii) the middle finger using a lancet. Haematocrit, RBC deformability (Rheoscan-D, Sewon Meditech Inc., Korea) and RBC aggregation (Myrenne GmbH, Roetgen, Germany) were measured for each sample. Haematocrit and RBC deformability were not different between the three sampling sites, and the group averages of RBC aggregation parameters were not different between the three sampling methods. The time course of RBC aggregation was slower when using blood sampled from the earlobe, and there was stronger agreement between RBC aggregation parameters measured using venous and capillary finger samples compared with venous and earlobe. It is suggested that capillary blood sampling from the finger may provide a reliable alternative to venous blood sampling in clinical and field settings.
Prediction of RBC aggregability and deformability by whole body bioimpedance measurements analyzed according to Hanai's mixture conductivity theory
Authors: Varlet-Marie Emmanuelle , Brun Jean-Frédéric
Published: December 2019

Bioelectrical impedancemetry (BIA) has been used to evaluate hemorheological parameters in vitro, and whole body impedance measurements are also correlated to some hemorheologic factors, due to their close relationship with determinants of electric properties of blood. In previous studies, we have determined a set of predictive equations for hematocrit, whole blood viscosity and plasma viscosity in both sedentary and trained individuals. Recent developments of the interpretation of BIA analysis based on Hanai's mixture conductivity theory allows a more interpretative analysis of the relationships between these electric measurements and body composition. Impedance can be analyzed in terms of resistance and resistivity of the whole body and even more, assuming some simplifications, resistance R and resistivity ρ of total body water (TBW), extracellular water (ECW) and intracellular water (ICW). In this study we thus investigated relationships between blood rheology and these calculations of R and ρ in a sample of 83 subjects (age: 9–64 yr; BMI: 17–44 kg/m2). BIA was performed with a multifrequency bioelectrical impedancemeter using low intensity at the following frequencies: 1, 5, 10, 50 and 100 kHz. Viscometric measurements were done with a falling ball viscometer. Hematocrit was measured with microcentrifuge. We found a new prediction of Quemada's viscometric index of RBC rigidity “k” which was positively correlated to the resistance of ECW (Re) and even more if it was related to this volume: k = 0.005809 Re/ECW + 1.1784 (r = 0.487; Bland-Altman mean difference: 0.0124; range: −0.00481 to 0.00296). A new finding was that red blood cells (RBC) aggregability, that in the previous studies was not related to whole body impedance, despite its in vitro measurability with such measurements, was correlated to extracellular resistance and resistivity. The Myrenne index “M” was negatively correlated to the resistivity of the extracellular fluid ρe and is predicted by: M = −27.4755 ρe + 1121.57029 (r = 0.463; Bland-Altman mean difference: 0.00194; range: −0.842 to 0.842). Furthermore, the SEFAM index “S10” is correlated to the ρe and is predicted by S10 = −59.38579 (ρe−40) + 63.083 (r = 0.761; Bland-Altman mean difference: 0.000722; range: −1.77 to 1.77). Therefore, a more in-depth analysis of electric properties of the body provides a closer approach of RBC rheology, although, of course, most remains to be understood in this intriguing domain.
Joint preventive effects of swimming and Shenlian extract on rat atherosclerosis
Authors: You Yun , Liu Weihong , Li Yujie , Zhang Yi , Li Defeng , Li Wen , Yin Xiaojie , Liao Fulong , Zhu Xiaoxin , Liu Chifeng
Published: December 2019

This work is to investigate the joint effect of extract from Shenlian (SL, the Chinese abbreviation for Radix Salviae miltiorrhizae and Andrographis paniculata) and swimming on atherosclerosis prevention and treatment. Atherosclerotic rat model was established by combining low shear stress by partial ligation of common carotid artery with afterwards feeding of a hyperlipotic diet. Sprague-Dawley rats after partial ligation of common carotid artery were allotted to a 3 × 3 factorial design with three levels of swimming (0, 1, and 2 hr per day) and three levels of SL extract (0, 2.56, and 5.12 g/kg once daily p.o.) for a total of 9 treatment groups. Then, the feeding of the hyperlipotic diet and the intervention of swimming and SL started at the same time, and lasted for 8 weeks. By the end, blood samples were collected to determine blood viscosity, hematocrit, blood lipids, MCP-1, NF-κB and NO levels. The common carotid arteries of the rats were harvested to investigate pathological changes. The animal model showed early sign of atherosclerosis according to the pathological findings. Joint effects of SL extract and swimming on preventing atherosclerosis appeared significantly: The combination of 1 hour swimming with 2.56 g/kg SL extract showed to be effective for lowering hematocrit, blood viscosity (at 10 s−1 and 200 s−1) and low-density-lipoprotein (p < 0.001). Combined treatment of 2.56 g/kg SL extract with 2 hr swimming led to a synergistic decrease in serum level of MCP-1. As a single factor, SL extract (2.56 g/kg) alone could decrease serum levels of NF-κB significantly (p = 0.003). Swimming alone could decrease cholesterol, triacylglycerols level and increase high-density-lipoprotein. The study demonstrates the combined therapy of oral SL extract with swimming on inhibiting inflammatory factors, improving hemorheological parameters and lipoproteins in rat model of atherosclerosis. It highlights the promising effects of the drugs and shear stress of blood flow, the biomechenopharmacological means, for prevention of atherosclerosis.
Hemorheological changes in patients with living-donor renal transplantation
Authors: Du Yuan , Yao Weijuan , Qian Yeyong , Han Mengxia , Wen Zongyao , Ma Lulin
Published: December 2019

Living-donor renal transplantation is the preferred treatment for patients with end stage renal disease since it affords earlier transplantation and better graft for long term survival. The aim of the present study was to explore the hemorheological changes in patients undergone living-donor renal transplantation. We investigated the dynamic changes in the hemorheological properties of blood taken from the patients before renal transplantation and at 1 week, 2 week, 3 week and >1 month after the operation. As compared with pre-operation, the whole blood viscosity at different shear rates decreased significantly; the erythrocyte aggregation index decreased; the erythrocyte deformation index (DI) and integrated deformation index (IDI) had a remarkable improvement; the erythrocyte electrophoresis rate was rasied. We also found that the osmotic fragility of RBCs at 145 mOsm/kg was greatly decreased after renal transplantation. Importantly, the ratio of erythrocyte membrane protein 4.1 a to 4.1 b decreased, which may explain the changes in DI, IDI, and osmotic fragility. Our results suggest that these hemorheological changes may greatly improve the organ microcirculation, which would play a critical role in reduce the ischemia-reperfusion injury in the graft.
Endurance running trial in tropical environment: A blood rheological study
Authors: Tripette Julien , Hardy-Dessources Marie-Dominique , Beltan Eric , Sanouiller Alain , Bangou Jacqueline , Chalabi Tawfik , Chout Roger , Hedreville Mona , Broquere Cédric , Nebor Danitza , Dotzis Grégory , Hue Olivier , Connes Philippe
Published: December 2019

Purpose: The aim of this study was to clarify whether exercising in a tropical climate induces blood rheology alterations despite ad libitum hydration. Methods: Hematological, biochemical and hemorheological changes were investigated in young healthy adults (N = 9 men, 20.7 ± 0.8 yrs) after a 10-km race in hot and humid conditions. Subjects' maximal aerobic abilities were tested using a maximal ramp exercise. Blood was sampled at rest (TR), at the end of the race (TEx), and after 24 hours of recovery (T24). Ad libitum hydration was allowed during the race. Blood viscosity (ηb), red blood cell deformability (EI), aggregation (AI) and disaggregation shear rate (γ) were measured. Results: Hematocrit, hemoglobin and plasma concentration of chlorine, sodium and potassium did not change in response to exercise. No functional consequence was observed on RBC deformability since EI remained unchanged. Percentages of echinocytes, schizocytes and stomatocytes remained in the subclinical range at all times. AI, γ and ηb did not present change. Conclusion: Running exercise in tropical climate with ad libitum hydration does not alter the main rheological properties of blood.
Measurement of red blood cell aggregation in disposable capillary tubes
Authors: Baskurt Oguz K. , Uyuklu Mehmet , Ozdem Sebahat , Meiselman Herbert J.
Published: December 2019

A new method is described in this paper that allows measurement of red blood cell (RBC) aggregation indexes in disposable glass tubes within minutes. Light transmission through the RBC suspension filled into a microhematocrit capillary at stasis is recorded during RBC aggregation; a novel method assures an initial dispersion of aggregates in the capillary. The resulting light transmittance-time data are analyzed to calculate various parameters. Measurement of erythrocyte sedimentation rate (ESR) and RBC aggregation using well established methods and the newly developed capillary tube aggregometer in blood samples with a wide range of RBC aggregation indicated significant correlations between these parameters. Additionally, light transmittance during complete disaggregation allows estimating hematocrit, thereby enabling hematocrit correction of the measured and calculated parameters. The newly developed capillary tube RBC aggregometer is suitable for use as a method to rapidly monitor disease activity and the acute phase response, especially at the point-of-care (e.g., health care facilities, physician's office) and for field studies.