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Uz Z, van Gulik TM, Aydemirli MD, Guerci P, Ince Y, Cuppen D, Ergin B, Aksu U, de Mol BA, Ince C. Identification and quantification of human microcirculatory leukocytes using handheld video microscopes at the bedside. J Appl Physiol (1985) 2018. [PMID: 29517420 DOI: 10.1152/japplphysiol.00962.2017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Leukocyte recruitment and adhesion to the endothelium are hallmarks of systemic inflammation that manifest in a wide range of diseases. At present, no method is available to directly measure leukocyte kinetics at the bedside. In this study, we validate a new method to identify and quantify microcirculatory leukocytes observed by handheld vital microscopy (HVM) using space-time diagram (STD) analysis. Video clips ( n = 59) containing one capillary-postcapillary venule unit where leukocytes could be observed emanating from a capillary into a venule in cardiac surgery patients ( n = 20) were included. STD analysis and manual counting were used to quantify the number of leukocytes (total, rolling, and nonrolling). Pearson's correlation and Bland-Altman analysis were used to determine agreement between the STDs and manual counting. For reproducibility, intra- and interobserver coefficients of variation (CVs) were assessed. Leukocyte (rolling and nonrolling) and red blood cell velocities were assessed. The STDs and manual counting procedures for the quantification of rolling leukocytes showed good agreement ( r = 0.8197, P < 0.0001), with a Bland-Altman analysis mean difference of -0.0 (-6.56; 6.56). The overall intraobserver CV for the STD method was 1.5%. The overall interobserver CVs for the STD and the manual method were 5.6% and 9.4%, respectively. The nonrolling velocity was significantly higher than the rolling velocity (812 ± 519 µm/s vs. 201 ± 149 µm/s, P = 0.001). STD results agreed with the manual counting procedure results, had a better reproducibility, and could assess the leukocyte velocity. STD analysis using bedside HVM imaging presented a new methodology for quantifying leukocyte kinetics and functions in the microcirculation. NEW & NOTEWORTHY In this study, we introduce space-time diagram analysis of sublingual microcirculation imaging using handheld vital microscopy to identify and quantify the presence and kinetics of human microcirculatory leukocytes. We validated the methodology by choosing anatomical units consisting of a capillary connected to a venule, which allowed precise identification of leukocytes.
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Affiliation(s)
- Zühre Uz
- Department of Translational Physiology, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.,Department of Experimental Surgery, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Thomas M van Gulik
- Department of Experimental Surgery, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Mehtap D Aydemirli
- Department of Translational Physiology, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Philippe Guerci
- Department of Translational Physiology, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Yasin Ince
- Department of Translational Physiology, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Diede Cuppen
- Department of Translational Physiology, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Bulent Ergin
- Department of Translational Physiology, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.,Department of Intensive Care, Erasmus MC University Hospital Rotterdam , Rotterdam , The Netherlands
| | - Ugur Aksu
- Department of Translational Physiology, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.,Department of Biology, The University of Istanbul , Istanbul , Turkey
| | - Bas A de Mol
- Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Can Ince
- Department of Translational Physiology, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.,Department of Intensive Care, Erasmus MC University Hospital Rotterdam , Rotterdam , The Netherlands
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Boeckh-Behrens T, Schubert M, Förschler A, Prothmann S, Kreiser K, Zimmer C, Riegger J, Bauer J, Neff F, Kehl V, Pelisek J, Schirmer L, Mehr M, Poppert H. The Impact of Histological Clot Composition in Embolic Stroke. Clin Neuroradiol 2016; 26:189-97. [PMID: 25261075 DOI: 10.1007/s00062-014-0347-x] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/08/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Thrombus composition has been suggested to have a decisive impact on the outcome of patients treated by mechanical thrombectomy because of embolic stroke. The recent development of stent retrievers allows collection and, hence, histopathological analysis of fresh thrombus material. Against this background, the aim of this prospective study was to assess the impact of thrombus composition on mechanical recanalization, clinical outcome and stroke etiology. METHODS Thirty-four patients suffering from acute ischemic stroke due to occlusion of the distal internal carotid artery/carotid-T, anterior cerebral artery, or middle cerebral arteries were mechanically recanalized, and thrombus material was obtained. Histological thrombus composition was compared with imaging, clinical, and neurointerventional data. RESULTS The main findings were that a higher percentage of white blood cells (WBCs) in the thrombus was associated with (i) cardioembolic etiology, (ii) extended mechanical recanalization time, and (iii) less favorable recanalization (Thrombolysis in Cerebral Infarction score) and clinical outcome (National Institute of Health Stroke Scale). CONCLUSION Our results suggest that thrombi with a high WBC fraction are related to more organized thrombi of cardioembolic origin associated with less favorable recanalization and clinical outcome in acute ischemic anterior circulation stroke. WBC-mediated immunological and coagulatory processes may play a key role in thrombus formation and pathogenesis of stroke warranting further investigation.
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