Clinical Hemorheology and Microcirculation

Stroke is the leading cause of morbidity and mortality, and its management differs among ischemic stroke, hemorrhagic stroke, and stroke mimics. Non-contrast CT has limited sensitivity for early ischemia. This study compared blood and plasma viscosity across different stroke types and identified cutoff values for predicting stroke type.

A cross-sectional study at the Emergency Department of Dr. Cipto Mangunkusumo National Referral Hospital (March–June 2025). Blood and plasma viscosity were measured using the Neo Digital Microcapillary device then compared using appropriate statistic tests. A p-value < 0.05 was considered statistically significant.

Seventy of 97 suspect stroke patients were included (36 ischemic, 16 hemorrhagic, 18 mimics). There were significant differences of blood viscocity between ischemic and hemorrhagic stroke compared with stroke mimic (median 5.65 cP ischemic; 5.29 cP hemorrhagic; 4.84 cP mimic; p < 0.0001), whereas no significant difference was observed in plasma viscosity across the groups (p = 0.411). A blood viscosity cutoff of 5.17 cP yielded an AUC of 0.84 (p < 0.0001), 71.2% sensitivity, 94.4% specificity, 97.37% PPV, and 53.13% NPV for stroke prediction.

Blood viscosity shows potential as an adjunctive diagnostic tool for distinguishing stroke from stroke mimics with high specificity, aiding in predicting types of stroke.

of this study was to identify potential diagnostic markers of microcirculation disorders in patients with primary hypothyroidism.

This cross-sectional study included patients with overt (OH, n = 14) and subclinical (SH, n = 37) hypothyroidism, and healthy volunteers (HV, n = 50). Using laser Doppler flowmetry (LDF), mean cutaneous blood flow in the dorsal forearm was assessed at rest (M), during cooling to 10 °C (M_10°C), heating to 35 °C (M_35°C) and to 42 °C (M_42°C). The standard deviation (σ) and the coefficient of variation of cutaneous blood flow (Kv=σ/M) at rest were calculated. The amplitudes of microvascular blood flow oscillations in frequency ranges corresponding to the neurogenic, myogenic, respiratory, and pulse mechanisms of microcirculation modulation were also calculated (A_n, A_m, A_resp, A_card). Laboratory parameters were evaluated.

The OH group had reduced blood flow variability (σ) compared to the HV (p=0.025) and SH (p=0.037) groups. Kv was lower in OH compared to SH (p=0.041). Acard was decreased in the OH group compared to the HV (p=0.001) and SH (p=0.012) groups. M_42°C was reduced in OH compared to HV (p=0.014). Hypercholesterolemia and increased IL-6 were found in the OH and SH groups compared to HV. In OH, the red blood cell distribution width (RDW) was increased compared to HV (p=0.026).

Overt hypothyroidism is associated with decreased total and pulse variability of cutaneous microvascular blood flow, decreased cutaneous hyperemia during local heating to 42 °C, and increased RDW. These microcirculatory disorders are accompanied by hypercholesterolemia and increased IL-6 levels.

In this study, we investigated the effects of hydrogen sulfide (H₂S) and sonic hedgehog (SHH) on the proliferation, autophagy, and apoptosis of human microvascular endothelial cells (HCMEC/D3). We also explored the regulatory relationship between cystathionine-β-synthase (CBS) and the SHH pathway.

Human microglia cells (HMC3) were stimulated under hypoxia to secrete H₂S and SHH proteins, which were then co-cultured with HCMEC/D3 cells. The relationship between H₂S and SHH was investigated by inhibiting the CBS or SHH pathways. Vascular endothelial growth factor (VEGF) levels in the culture medium were detected using ELISA, while H₂S levels were detected via a micro method. The mRNA levels of hypoxia-inducible factor 1α (HIF-1 α), VEGF, Beclin-1, light chain 3 (LC3), and caspase-3 were detected using RT-PCR. Protein levels of CBS, SHH, extracellular regulated kinase 1/2 (ERK1/2), phospho-ERK1/2 (P-ERK1/2), Beclin-1, LC3, and Caspase-3 were determined by western blot.

The results indicated that HIF-1α expression increased in HMC3 under hypoxic conditions but did not change when either the SHH signaling pathway or CBS was suppressed. H₂S secretion of HMC3 increased during hypoxia, with both CBS and SHH proteins being up-regulated. The inhibition of CBS resulted in decreased levels of H₂S and SHH in HMC3. whereas SHH pathway is inhibited, the H₂S secretion level is not affected. H₂S and SHH proteins were found to enhance the expression of VEGF, P-EKR1/2, Beclin-1, and LC3, while decreasing the expression of caspase-3 in HCMEC/D3 cells.

H₂S secretion of HMC3 promotes the proliferation and regeneration of HCMEC/D3 by regulating SHH protein and alleviating hypoxic injury.

Cervical tuberculous lymphadenitis (CTBL) and cervical lymph node metastasis (CLNM) share similar imaging characteristics, making differentiation challenging. This study aims to evaluate the clinical utility of a multimodal radiomics model combining grayscale ultrasound (GUS), elastography ultrasound (EUS), and contrast-enhanced ultrasound (CEUS) for distinguishing CTBL from CLNM.

A high-quality dataset comprising 203 cases of CTBL was used to train and test the radiomics models. The performance of single-modal (GUS, EUS, CEUS) and combined models was compared using AUC, sensitivity, specificity, and accuracy metrics. An independent test set of 45 cases was included for validation.

The combined GUS + EUS + CEUS model outperformed single-modal models, achieving AUCs of 0.894, 0.832, and 0.919 in the training, validation, and test sets, respectively. Its diagnostic performance was comparable to a clinical model in validation and test sets, demonstrating superior generalizability and robustness. Wavelet features accounted for all selected features, enhancing the model's discrimination ability.

The integration of three ultrasound modalities captures multidimensional imaging features, reducing reliance on subjective interpretation. This multimodal radiomics approach provides a standardized diagnostic tool with significant clinical potential, particularly for less experienced physicians. Further validation with diverse datasets is needed to confirm its utility.