Vascular endothelial dysfunction in β-thalassemia occurs despite increased eNOS expression and preserved vascular smooth muscle cell reactivity to NO

Aims

The hereditary β-thalassemia major condition requires regular lifelong blood transfusions. Transfusion-related iron overloading has been associated with the onset of cardiovascular complications, including cardiac dysfunction and vascular anomalies. By using an untransfused murine model of β-thalassemia major, we tested the hypothesis that vascular endothelial dysfunction, alterations of arterial structure and of its mechanical properties would occur despite the absence of treatments.

Methods and Results

Vascular function and structure were evaluated ex vivo. Compared to the controls, endothelium-dependent vasodilation with acetylcholine was blunted in mesenteric resistance arteries of β-thalassemic mice while the endothelium-independent vasodilator (sodium nitroprusside) produced comparable vessel dilation, indicating endothelial cell impairment with preserved smooth muscle cell reactivity to nitric oxide (NO). While these findings suggest a decrease in NO bioavailability, Western blotting showed heightened expression of aortic endothelial NO synthase (eNOS) in β-thalassemia. Vascular remodeling of the common carotid arteries revealed increased medial elastin content. Under isobaric conditions, the carotid arteries of β-thalassemic mice exhibited decreased wall stress and softening due to structural changes of the vessel wall.

Conclusions

A complex vasculopathy was identified in untransfused β-thalassemic mice characterized by altered carotid artery structure and endothelial dysfunction of resistance arterioles, likely attributable to reduced NO bioavailability despite enhanced vascular eNOS expression.

Shear wave induced resonance elastography of spherical masses with polarized torsional waves

Shear Wave Induced Resonance (SWIR) is a technique for dynamic ultrasound elastography of confined mechanical inclusions. It was developed for breast tumor imaging and tissue characterization. This method relies on the polarization of torsional shear waves modeled with the Helmholtz equation in spherical coordinates. To validate modeling, an in vitro set-up was used to measure and image the first three eigenfrequencies and eigenmodes of a soft sphere. A preliminary in vivo SWIR measurement on a breast fibroadenoma is also reported. Results revealed the potential of SWIR elastography to detect and mechanically characterize breast lesions for early cancer detection.

Receptor tyrosine kinase Ephb6 regulates vascular smooth muscle contractility and modulates blood pressure in concert with sex hormones

Eph kinases constitute the largest receptor tyrosine kinase family, and their ligands, ephrins (Efns), are also cell surface molecules. Our study is the first to assess the role of Ephb6 in blood pressure (BP) regulation. We observed that EphB6 and all three of its Efnb ligands were expressed on vascular smooth muscle cells (VSMC) in mice. We discovered that small arteries from castrated Ephb6 gene KO males showed increased contractility, RhoA activation, and constitutive myosin light chain phosphorylation ex vivo compared with their WT counterparts. Consistent with this finding, castrated Ephb6 KO mice presented heightened BP compared with castrated WT controls. In vitro experiments in VSMC revealed that cross-linking Efnbs but not Ephb6 resulted in reduced VSMC contractions, suggesting that reverse signaling through Efnbs was responsible for the observed BP phenotype. The reverse signaling was mediated by an adaptor protein Grip1. Additional experiments demonstrated decreased 24-h urine catecholamines in male Ephb6 KO mice, probably as a compensatory feedback mechanism to keep their BP in the normal range. After castration, however, such compensation was abolished in Ephb6 KO mice and was likely the reason why BP increased overtly in these animals. It suggests that Ephb6 has a target in the nervous/endocrine system in addition to VSMC, regulating a testosterone-dependent catecholamine compensatory mechanism. Our study discloses that Ephs and Efns, in concert with testosterone, play a critical role in regulating small artery contractility and BP.

Forward problem study of an effective medium model for ultrasound blood characterization

The structure factor model (SFM) is a scattering model developed to simulate the backscattering coefficient (BSC) of aggregated red blood cells (RBCs). However, the SFM can hardly be implemented to estimate the structural aggregate parameters in the framework of an inverse problem formulation. A scattering model called the effective medium theory combined with the SFM (EMTSFM) is thus proposed to approximate the SFM. The EMTSFM assumes that aggregates of RBCs can be treated as individual homogeneous scatterers, which have effective properties determined by the acoustical characteristics and concentration of RBCs within aggregates. The EMTSFM parameterizes the BSC by three indices: the aggregate radius, the concentration of RBCs with- in aggregates (the aggregate compactness), and the systemic hematocrit. The goodness of fit of the EMTSFM approximation in comparison with the SFM was then examined. Based on a 2-D study, the EMTSFM was found to approximate the SFM with relative errors less than 30% for a product of the wavenumber times the mean aggregate radius krΛκ <; 1.32. The main contribution of this work is the parameterization of the BSC with the RBC aggregate compactness, which is of relevance in clinical hemorheology because it reflects the binding energy between RBCs.

On the potential of ultrasound elastography for pressure ulcer early detection

PURPOSE

Pressure ulcers are areas of soft tissue breakdown induced by a sustained mechanical stress that damages the skin and underlying tissues. They represent a considerable burden to the society in terms of health care and cost. Yet, techniques for prevention and detection of pressure ulcers still remain very limited. In this article, the authors investigated the potential of ultrasound elastography for pressure ulcer early detection. Elastography is an imaging technique providing local information on biological tissue mechanical properties. It is relevant for pressure ulcer detection as this pathology is associated with a gradual stiffening of damaged tissues, beginning in the deeper tissues and progressing toward the skin surface.

METHODS

A 2D ultrasound elastography method was proposed and its ability in terms of pressure ulcer detection was validated through numerical simulations and physical acquisitions on pressure ulcer mimicking phantoms. In vivo experiments on a rat model are also reported. A maintained pressure was applied on the animal thigh, with a view to generate a pressure ulcer, and ultrasound data were acquired and processed before and after application of this pressure.

RESULTS

Numerical simulations demonstrated that a pressure ulcer can theoretically be detected at a very early stage with ultrasound elastography. Even when the ulcer region was characterized by a low stiffening (ratio of 1.8 relative to normal tissues), the corresponding elastogram clearly underlined the pathological area. This observation was confirmed by the results obtained on a physical phantom mimicking a pressure ulcer at an early stage. Computed elastograms showed strain differences between areas mimicking healthy and pathological tissues. Results corresponding to in vivo experiments revealed a difference in the way tissues behaved before and after the pressure was applied on the animal thigh, which strongly suggests the presence of a pathological area.

CONCLUSIONS

Experiments demonstrated that ultrasound elastography is a promising technique for pressure ulcer detection, especially at an early stage of the pathology, when the disease is still visually undetectable. In the absence of any gold standard method, this is also a first step toward the development of a quantitative technique.

Hyper-frequency viscoelastic spectroscopy of biomaterials

With the emergence of new biomaterials and elastography imaging techniques, there is a need for innovative instruments dedicated to viscoelasticity measurements. In this work, we introduce a novel hyper-frequency viscoelastic spectroscopy (HFVS) technique dedicated to characterize soft media subjected to mid-to-very-high frequency stress ranges (or, equivalently, to probe short-to-very-short relaxation times). HFVS, which has been implemented in an analytical instrument performing non-contact measurements in less than 1 s between 10 and 1000 Hz, is a suitable tool to study viscoelasticity for bio-applications. In this context, HFVS has been compared to classical oscillatory rheometry on several classes of soft materials currently encountered in tissue repair, bioengineering and elastography imaging on a frequency range between 10 and 100 Hz. After having demonstrated the good correspondence between HFVS and rheometry, this study has been completed by exploring the sensitivity of HFVS to physicochemically induced variations of viscoelasticity. HFVS opens promising perspectives in the challenging field of biomaterial science and for viscoelasticity-based quality control of materials.

Assessment of accuracy of the structure-factor-size-estimator method in determining red blood cell aggregate size from ultrasound spectral backscatter coefficient

A computer simulation study to produce ultrasonic backscatter coefficients (BSCs) from red blood cell (RBC) clusters is discussed. The simulation algorithm is suitable for generating non-overlapping, isotropic, and fairly identical RBC clusters. RBCs were stacked following the hexagonal close packing (HCP) structure to form a compact spherical aggregate. Such an aggregate was repeated and placed randomly under non-overlapping condition in the three-dimensional space to mimic an aggregated blood sample. BSCs were computed between 750 KHz and 200 MHz for samples of various cluster sizes at different hematocrits. Magnitudes of BSCs increased with mean aggregate sizes at low frequencies (<20 MHz). The accuracy of the structure-factor-size-estimator (SFSE) method in determining mean aggregate size and packing factor was also examined. A good correlation (R(2) ≥ 0.94) between the mean size of aggregates predicted by the SFSE and true size was found for each hematocrit. This study shows that for spherical aggregates there exists a region for each hematocrit where SFSE works most accurately. Typically, error of SFSE in estimating mean cluster size was <20% for dimensions between 14 and 17 μm at 40% hematocrit. This study suggests that the theoretical framework of SFSE is valid under the assumption of isotropic aggregates.

Segmentation of plaques in sequences of ultrasonic B-mode images of carotid arteries based on motion estimation and a Bayesian model

The goal of this work is to perform a segmentation of atherosclerotic plaques in view of evaluating their burden and to provide boundaries for computing properties such as the plaque deformation and elasticity distribution (elastogram and modulogram). The echogenicity of a region of interest comprising the plaque, the vessel lumen, and the adventitia of the artery wall in an ultrasonic B-mode image was modeled by mixtures of three Nakagami distributions, which yielded the likelihood of a Bayesian segmentation model. The main contribution of this paper is the estimation of the motion field and its integration into the prior of the Bayesian model that included a local geometrical smoothness constraint, as well as an original spatiotemporal cohesion constraint. The Maximum A Posteriori (MAP) of the proposed model was computed with a variant of the Exploration/Selection (ES) algorithm. The starting point is a manual segmentation of the first frame. The proposed method was quantitatively compared with manual segmentations of all frames by an expert technician. Various measures were used for this evaluation, including the mean point-to-point distance and the Hausdorff distance. Results were evaluated on 94 sequences of 33 patients (for a total of 8988 images). We report a mean point-to- point distance of 0.24 ± 0.08 mm and a Hausdorff distance of 1.24 ± 0.40 mm. Our tests showed that the algorithm was not sensitive to the degree of stenosis or calcification.

A local increase in red blood cell aggregation can trigger deep vein thrombosis: evidence based on quantitative cellular ultrasound imaging

BACKGROUND

Recurrent deep vein thrombosis (DVT) risk factors include a first idiopathic DVT, strongly suggesting the existence of undiagnosed and/or unidentified prothrombotic abnormalities.

OBJECTIVES

To evaluate the impact of locally increased red blood cell (RBC) aggregation on DVT pathogenesis in a rabbit model.

METHODS

DVT presence, flow and aggregation were measured in situ with ultrasound. Greatly enhanced aggregation was achieved by covalent linkage of Pluronic F98 to the RBC surface; coating with Pluronic F68, which very mildly enhances aggregation, was used as a coating control. On day 1, endothelial damage and a partial stenosis were surgically created on the left femoral vein whereas the right femoral vein was not manipulated.

RESULTS

A thrombus was formed within 30 min in six out of seven left femoral veins of animals receiving a 30% volume blood exchange with F98-coated RBC, whereas a thrombus occurred in only one out of seven veins in F68-transfused controls. In vivo imaging using quantitative ultrasound confirmed increased aggregation in the thrombosed veins of the F98 group compared with the F68 group and the contralateral vessel. For each group, five animals were followed for 2 weeks before being killed. In F98-transfused animals, lysis of clots occurred and the presence of chronic thrombi totally occluding the vein in three out of five animals was confirmed by histology. Conversely, in the F68 group, a single disorganized blood clot was observed in one out of five animals.

CONCLUSIONS

A marked increase in RBC aggregation promotes thrombosis in rabbit femoral veins, confirming a pathophysiological role of locally altered hemorheology in the onset of DVT.

Tissue characterization of equine tendons with clinical B-scan images using a shock filter thinning algorithm

The fiber bundle density (FBD) calculated from ultrasound B-scan images of the equine superficial digital flexor tendon (SDFT) can serve as an objective measurement to characterize the three metacarpal sites of normal SDFTs, and also to discriminate a healthy SDFT from an injured one. In this paper, we propose a shock filter algorithm for the thinning of hyper-echoic structures observed in B-scan images of the SDFT. This algorithm is further enhanced by applying closing morphological operations on filtered images to facilitate extraction and quantification of fiber bundle fascicles. The mean FBD values were calculated from a clinical B-scan image dataset of eight normal and five injured SDFTs. The FBD values measured at three different tendon sites in normal cases show a highest density on the proximal site (five cases out of eight) and a lowest value on the distal part (seven cases out of eight). The mean FBD values measured on the entire tendon from the whole B-scan image dataset show a significant difference between normal and injured SDFTs: 51 (±9) for the normal SDFTs and 39 (±7) for the injured ones (p = 0.004) . This difference likely indicates disruption of some fiber fascicle bundles where lesions occurred. To conclude, the potential of this imaging technique is shown to be efficient for anatomical structural SDFT characterizations, and opens the way to clinically identifying the integrity of SDFTs.

Characterization of blood clot viscoelasticity by dynamic ultrasound elastography and modeling of the rheological behavior

Dynamic elastography (DE) is a new tool to study mechanical behavior of soft tissues via their motion response to propagating shear waves. This technique characterized viscoelasticity of 9 porcine whole blood samples (3 animals) during coagulation for a shearing frequency of 70Hz, and after complete clot formation between 50 and 160Hz. Clot storage (G') and loss (G″) moduli were calculated from shear wave velocity and attenuation. Temporal evolutions of G' and G″ during coagulation were typified with 4 parameters: maximum change in elasticity (G' slope(max)), elasticity after 120min of coagulation (G'(max)), time occurrence of G″ maximum (t(e)) and G″ at the plateau (G″(plateau)). G' and G″ frequency dependence of completely formed blood clots was fitted with 5 standard rheological models: Maxwell, Kelvin-Voigt, Jeffrey, Zener and third-order generalized Maxwell. DE had sufficient sensitivity to follow the coagulation kinetics described by a progressive increase in G', while G″ transitory increased followed by a rapid stabilization. Inter- and intra-animal dispersions (InterAD and IntraAD) of G'(max) (InterAD=15.9%, IntraAD=9.1%) showed better reproducibility than G' slope(max) (InterAD=40.4%, IntraAD=21.9%), t(e) (InterAD=27.4%, IntraAD=18.7%) and G″(plateau) (InterAD=58.6%, IntraAD=40.2%). G' evolution within the considered range of frequency exhibited an increase, followed by stabilization to a plateau, whereas G″ presented little variations with convergence at a quasi-constant value at highest frequencies. Residues χ(⁎), describing the goodness of fit between models and experimental data, showed statistically (p<0.05) that the Kelvin-Voigt model was less in agreement with experimental data than other models. The Zener model is recommended to predict G' and G″ dispersion of coagulated blood over the explored frequency range.

On the potential of a new IVUS elasticity modulus imaging approach for detecting vulnerable atherosclerotic coronary plaques: in vitro vessel phantom study

Peak cap stress amplitude is recognized as a good indicator of vulnerable plaque (VP) rupture. However, such stress evaluation strongly relies on a precise, but still lacking, knowledge of the mechanical properties exhibited by the plaque components. As a first response to this limitation, our group recently developed, in a previous theoretical study, an original approach, called iMOD (imaging modulography), which reconstructs elasticity maps (or modulograms) of atheroma plaques from the estimation of strain fields. In the present in vitro experimental study, conducted on polyvinyl alcohol cryogel arterial phantoms, we investigate the benefit of coupling the iMOD procedure with the acquisition of intravascular ultrasound (IVUS) measurements for detection of VP. Our results show that the combined iMOD-IVUS strategy: (1) successfully detected and quantified soft inclusion contours with high positive predictive and sensitivity values of 89.7 ± 3.9% and 81.5 ± 8.8%, respectively, (2) estimated reasonably cap thicknesses larger than ∼300 µm, but underestimated thinner caps, and (3) quantified satisfactorily Young's modulus of hard medium (mean value of 109.7 ± 23.7 kPa instead of 145.4 ± 31.8 kPa), but overestimated the stiffness of soft inclusions (mean Young`s moduli of 31.4 ± 9.7 kPa instead of 17.6 ± 3.4 kPa). All together, these results demonstrate a promising benefit of the new iMOD-IVUS clinical imaging method for in vivo VP detection.

Ultrasound dynamic micro-elastography applied to the viscoelastic characterization of soft tissues and arterial walls

Quantitative noninvasive methods that provide in vivo assessment of mechanical characterization of living tissues, organs and artery walls are of interest because information on their viscoelastic properties in the presence of disease can affect diagnosis and treatment options. This article proposes the dynamic micro-elastography (DME) method to characterize viscoelasticity of small homogeneous soft tissues, as well as the adaptation of the method for vascular applications [vascular dynamic micro-elastography (VDME)]. The technique is based on the generation of relatively high-frequency (240-1100 Hz) monochromatic or transient plane shear waves within the medium and the tracking of these waves from radio-frequency (RF) echoes acquired at 25 MHz with an ultrasound biomicroscope (Vevo 770, Visualsonics). By employing a dedicated shear wave gated strategy during signal acquisition, postprocessed RF sequences could achieve a very high frame rate (16,000 images per s). The proposed technique successfully reconstructed shear wave displacement maps at very high axial (60 mum) and lateral (250 mum) spatial resolutions for motions as low as a few mum. An inverse problem formulated as a least-square minimization, involving analytical simulations (for homogenous and vascular geometries) and experimental measurements were performed to retrieve storage (G') and loss (G'') moduli as a function of the shearing frequency. Viscoelasticity measurements of agar-gelatin materials and of a small rat liver were proven feasible. Results on a very thin wall (3 mm thickness) mimicking artery enabled to validate the feasibility and the reliability of the vascular inverse problem formulation. Subsequently, the G' and G'' of a porcine aorta showed that both parameters are strongly dependent on frequency, suggesting that the vascular wall is mechanically governed by complex viscoelastic laws.

Impact of supplementation with bicarbonate on lower-extremity muscle performance in older men and women

This study describes the impact of bicarbonate treatment for 3 months on net acid excretion (NAE), nitrogen excretion, and muscle performance in older men and women. Bicarbonate reduced NAE, and the decrement was associated with a decrease in nitrogen excretion. Treatment also improved muscle power and endurance in the women.

INTRODUCTION

Bicarbonate enhances muscle performance during strenuous exercise, but its effect on performance during normal activity in older subjects is unknown.

METHODS

In this trial, healthy subjects age 50 and older were randomized to 67.5 mmol of bicarbonate or to no bicarbonate daily for 3 months. Changes in lower-extremity muscle power, endurance, urinary nitrogen, and NAE were compared across treatment groups in the 162 participants included in the analyses.

RESULTS

In the men and the women, bicarbonate was well tolerated, and as expected, it significantly decreased NAE. The change in NAE correlated with change in nitrogen excretion in women (r = 0.32, P = 0.002) with a similar trend in men (r = 0.23, P = 0.052). In the women, bicarbonate increased double leg press power at 70% one repetition maximum by 13% (P = 0.003) compared with no bicarbonate and improved other performance measures. Treatment with bicarbonate had no significant effect on muscle performance in the men.

CONCLUSIONS

Ingestion of bicarbonate decreased nitrogen excretion and improved muscle performance in healthy postmenopausal women. The bicarbonate-induced decline in NAE was associated with reduced nitrogen excretion in both men and women. These findings suggest that bicarbonate merits further evaluation as a safe, low-cost intervention that may attenuate age-related loss of muscle performance and mass in the elderly.

A critical review and uniformized representation of statistical distributions modeling the ultrasound echo envelope

In ultrasound imaging, various statistical distributions have been proposed to model the first-order statistics of the amplitude of the echo envelope. We present an overview of these distributions based on their compound representation, which comprises three aspects: the modulated distribution (Rice or Nakagami); the modulating distribution (gamma, inverse Gaussian or even generalized inverse Gaussian); and the modulated parameters (the diffuse signal power with or without the coherent signal component or the coherent signal power). This unifying point of view makes the comparison of the various models conceptually easier. In particular, we discuss the implications of the modulated parameters on the mean intensity and the signal-to-noise ratio of the intensity in the case of a vanishing diffuse signal. We conclude that the homodyned K-distribution is the only model among the literature for which the parameters have a physical meaning that is consistent with the limiting case, although the other distributions may fit real data.

Ultrasound characterization of red blood cell aggregation with intervening attenuating tissue-mimicking phantoms

The analysis of the ultrasonic frequency-dependent backscatter coefficient of aggregating red blood cells reveals information about blood structural properties. The difficulty in applying this technique in vivo is due to the frequency-dependent attenuation caused by intervening tissue layers that distorts the spectral content of signals backscattered by blood. An optimization method is proposed to simultaneously estimate tissue attenuation and blood structure properties, and was termed the structure factor size and attenuation estimator (SFSAE). An ultrasound scanner equipped with a wide-band 25 MHz probe was used to insonify porcine blood sheared in both Couette and tubular flow devices. Since skin is one of the most attenuating tissue layers during in vivo scanning, four skin-mimicking phantoms with different attenuation coefficients were introduced between the transducer and the blood flow. The SFSAE gave estimates with relative errors below 25% for attenuations between 0.115 and 0.411 dBMHz and kR<2.08 (k being the wave number and R the aggregate radius). The SFSAE can be useful to examine in vivo and in situ abnormal blood conditions suspected to promote pathophysiological cardiovascular consequences.