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Pillai S, Evans V, Davies G, Lawrence MJ, Whitley J, Battle CE, Williams PR, Morris K, Evans PA. A comparative study into the effects of venous and arterial blood on clot microstructure in critically unwell patients. Assessment of the diagnostic potential of a biomarker of haemostasis. J Intensive Care Soc 2023; 24:224-226. [PMID: 37260426 PMCID: PMC10227903 DOI: 10.1177/17511437211060154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Blood for coagulation analysis can be sampled from the arterial or venous system in intensive care units (ICU). The determination of clot microstructure and strength by fractal analysis (df) gives valuable information in a range of vascular haemostatic disease and sepsis. We aimed to determine if df could be measured equally and comparatively in arterial or venous blood, and 45 critically ill patients in an ICU were recruited. df was found to be readily measured in arterial blood with results comparable to those in venous blood and that add value of df as a potential marker of haemostasis in these patients.
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Affiliation(s)
- Suresh Pillai
- Welsh Centre for Emergency Medicine
Research, Emergency Department, Swansea Bay University Health Board, Swansea, UK
- Ed. Major Critical Care Unit, Morriston Hospital, Swansea, UK
- Medical School, Swansea University, Swansea, UK
| | - Vanessa Evans
- Welsh Centre for Emergency Medicine
Research, Emergency Department, Swansea Bay University Health Board, Swansea, UK
- Medical School, Swansea University, Swansea, UK
| | - Gareth Davies
- Welsh Centre for Emergency Medicine
Research, Emergency Department, Swansea Bay University Health Board, Swansea, UK
| | - Matthew J Lawrence
- Welsh Centre for Emergency Medicine
Research, Emergency Department, Swansea Bay University Health Board, Swansea, UK
- Medical School, Swansea University, Swansea, UK
| | - Janet Whitley
- Welsh Centre for Emergency Medicine
Research, Emergency Department, Swansea Bay University Health Board, Swansea, UK
- Medical School, Swansea University, Swansea, UK
| | - Ceri E Battle
- Welsh Centre for Emergency Medicine
Research, Emergency Department, Swansea Bay University Health Board, Swansea, UK
- Ed. Major Critical Care Unit, Morriston Hospital, Swansea, UK
| | | | - Keith Morris
- School of Applied Science, Cardiff Metropolitan University, Cardiff, UK
| | - Phillip A Evans
- Welsh Centre for Emergency Medicine
Research, Emergency Department, Swansea Bay University Health Board, Swansea, UK
- Medical School, Swansea University, Swansea, UK
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2
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de Vries JJ, Laan DM, Frey F, Koenderink GH, de Maat MPM. A systematic review and comparison of automated tools for quantification of fibrous networks. Acta Biomater 2023; 157:263-274. [PMID: 36509400 DOI: 10.1016/j.actbio.2022.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Fibrous networks are essential structural components of biological and engineered materials. Accordingly, many approaches have been developed to quantify their structural properties, which define their material properties. However, a comprehensive overview and comparison of methods is lacking. Therefore, we systematically searched for automated tools quantifying network characteristics in confocal, stimulated emission depletion (STED) or scanning electron microscopy (SEM) images and compared these tools by applying them to fibrin, a prototypical fibrous network in thrombi. Structural properties of fibrin such as fiber diameter and alignment are clinically relevant, since they influence the risk of thrombosis. Based on a systematic comparison of the automated tools with each other, manual measurements, and simulated networks, we provide guidance to choose appropriate tools for fibrous network quantification depending on imaging modality and structural parameter. These tools are often able to reliably measure relative changes in network characteristics, but absolute numbers should be interpreted with care. STATEMENT OF SIGNIFICANCE: Structural properties of fibrous networks define material properties of many biological and engineered materials. Many methods exist to automatically quantify structural properties, but an overview and comparison is lacking. In this work, we systematically searched for all publicly available automated analysis tools that can quantify structural properties of fibrous networks. Next, we compared them by applying them to microscopy images of fibrin networks. We also benchmarked the automated tools against manual measurements or synthetic images. As a result, we give advice on which automated analysis tools to use for specific structural properties. We anticipate that researchers from a large variety of fields, ranging from thrombosis and hemostasis to cancer research, and materials science, can benefit from our work.
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Affiliation(s)
- Judith J de Vries
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daphne M Laan
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Felix Frey
- Department of Bionanoscience, Kavli Institute of Nanoscience, Delft University of Technology, Delft, the Netherlands
| | - Gijsje H Koenderink
- Department of Bionanoscience, Kavli Institute of Nanoscience, Delft University of Technology, Delft, the Netherlands
| | - Moniek P M de Maat
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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3
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Karri S, Aviel-Ronen S, Firer MA. Fractal and textural imaging identify new subgroups of patients with colorectal cancer based on biophysical properties of the cancer cells. Pathol Res Pract 2022; 238:154040. [PMID: 36057191 DOI: 10.1016/j.prp.2022.154040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 10/16/2022]
Abstract
Colorectal cancer (CRC) can been sub-divided, based on the generation of tertiary lymphoid structures (TLS), into CRC with a Crohn's like lymphoid reaction (CLR) representing de novo formation of TLSs or CRC lacking TLSs that show Diffuse Inflammatory infiltration (DII). The association between TLS, early treatment initiation and longer survival highlights the need for deeper patient stratification that could lead to more targeted therapies. We hypothesized that such stratification might be achieved by using digital image analyses. Here we retrospectively analyzed 35 CRC patient samples classified as CLR or DII by digital analysis, focusing on the parameters Fractal dimension, Lacunarity and the textural features Angular second momentum, Correlation, Inverse difference momentum and Entropy. Significant differences in the grades of these parameters between the two patient groups provided preliminary data that additional biophysical information can divide CRC into at least 3 subgroups which encompass CLR and DII. Additional studies are needed to test if this sub-classification aids in the selection of targeted therapy for patients with CRC.
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Affiliation(s)
- Sirish Karri
- Department of Chemical Engineering, Ariel University, Ariel 40700, Israel
| | | | - Michael A Firer
- Department of Chemical Engineering, Ariel University, Ariel 40700, Israel; Adelson School of Medicine, Ariel University, Ariel 40700, Israel; Ariel Center for Applied Cancer Research, Ariel University, Ariel 40700, Israel.
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4
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Lawrence MJ, Evans V, Whitley J, Pillai S, Williams PR, Coulson J, Krishnan M, Slade P, Power K, Morris RHK, Evans PA. The effects of apixaban on clot characteristics in atrial fibrillation: A novel pharmacodynamic biomarker. Pharmacol Res Perspect 2022; 10:e00937. [PMID: 35338612 PMCID: PMC8956932 DOI: 10.1002/prp2.937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 01/09/2023] Open
Abstract
Atrial fibrillation (AF) is a major risk factor for stroke. We aim to characterize AF patients and the effects of apixaban therapy in terms of clot microstructure using gel point analysis, a novel biomarker. Seventy-eight patients were included in the study, 50 Stroke with AF (AF-S), and 28 AF without stroke (AF). Pre- and post-anticoagulation samples were collected: gel point (GP) analysis was performed to obtain (i) TGP (the time taken to reach the GP or the clot formation time) and (ii) df , the fractal dimension of the clot, a quantification of clot fibrin microstructure at the GP. At baseline, the AF-S group had a df = 1.70 (±0.05) and TGP = 306 (±73 s). The AF group had a df = 1.70 ± 0.05 and TGP = 346 ± 78 s, showing a significantly shortened TGP in the stroke group (p = .008). For both groups, apixaban significantly prolonged TGP, p = .005, but resulted in no change in df. Apixaban prolonged clotting time while having no significant impact on the blood's ability to form stable clots (no change in df ). This indicates that apixaban provides protection from the formation of thrombi by reducing clotting kinetics.
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Affiliation(s)
- Matthew J Lawrence
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board, Swansea, UK.,Medical School, Swansea University, Swansea, UK
| | - Vanessa Evans
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board, Swansea, UK.,Medical School, Swansea University, Swansea, UK
| | - Janet Whitley
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board, Swansea, UK.,Medical School, Swansea University, Swansea, UK
| | - Suresh Pillai
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board, Swansea, UK.,Medical School, Swansea University, Swansea, UK
| | | | | | - Manju Krishnan
- Stroke Unit, Swansea Bay University Health Board, Swansea, UK
| | - Peter Slade
- Stroke Unit, Swansea Bay University Health Board, Swansea, UK
| | - Kieron Power
- Pharmacy Department, Swansea Bay University Health Board, Swansea, UK
| | - Roger H K Morris
- School of Applied Science, Cardiff Metropolitan University, Cardiff, UK
| | - Phillip A Evans
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board, Swansea, UK.,Medical School, Swansea University, Swansea, UK
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5
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Styła M, Giżewski T. The Study of Usefulness of a Set of Fractal Parameters to Build Classes of Disease Units Based on Images of Pigmented Skin Lesions. Diagnostics (Basel) 2021; 11:1773. [PMID: 34679471 PMCID: PMC8535145 DOI: 10.3390/diagnostics11101773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/15/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022] Open
Abstract
Dermatoscopic images are also increasingly used to train artificial neural networks for the future to provide fully automatic diagnostic systems capable of determining the type of pigmented skin lesion. Therefore, fractal analysis was used in this study to measure the irregularity of pigmented skin lesion surfaces. This paper presents selected results from individual stages of preliminary processing of the dermatoscopic image on pigmented skin lesion, in which fractal analysis was used and referred to the effectiveness of classification by fuzzy or statistical methods. Classification of the first unsupervised stage was performed using the method of analysis of scatter graphs and the fuzzy method using the Kohonen network. The results of the Kohonen network learning process with an input vector consisting of eight elements prove that neuronal activation requires a larger learning set with greater differentiation. For the same training conditions, the final results are at a higher level and can be classified as weaker. Statistics of factor analysis were proposed, allowing for the reduction in variables, and the directions of further studies were indicated.
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Affiliation(s)
- Monika Styła
- Chair and Department of Biophysics, Medical University of Lublin, 20-090 Lublin, Poland
- Department of Electrical Engineering and Electrotechnologies, Faculty of Electrical Engineering and Computer Science, Lublin University of Technology, 20-618 Lublin, Poland;
| | - Tomasz Giżewski
- Department of Electrical Engineering and Electrotechnologies, Faculty of Electrical Engineering and Computer Science, Lublin University of Technology, 20-618 Lublin, Poland;
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6
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Pillai S, Davies G, Lawrence M, Whitley J, Stephens J, Williams PR, Morris K, Evans PA. The effect of diabetic ketoacidosis (DKA) and its treatment on clot microstructure: Are they thrombogenic? Clin Hemorheol Microcirc 2021; 77:183-194. [PMID: 32925001 DOI: 10.3233/ch-200957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is a medical emergency with a high mortality rate and is associated with severe metabolic acidosis and dehydration. DKA patients have an increased risk of arterial and venous thromboembolism, however little is known about this metabolic derangement in the first 24 hours of admission and to assess its effect on coagulation. We therefore utilised a novel functional marker of clot microstructure (fractal dimension - df) to assess these changes within the first 24 hours. METHODS Prospective single centre observational study to demonstrate whether the tendency of blood clot formation differs in DKA patients. RESULTS 15 DKA patients and 15 healthy matched controls were recruited. Mean df in the healthy control group was 1.74±0.03. An elevated df of 1.78±0.07 was observed in patients with DKA on admission. The mean pH on admission was 7.14±0.13 and the lactate was 3.6±2.0. df changed significantly in response to standard treatment and was significantly reduced to 1.68±0.09 (2-6& h) and to 1.66±0.08 at 24& h (p < 0.01 One-way ANOVA). df also correlated significantly with lactate and pH (Pearson correlation coefficient 0.479 and -0.675 respectively, p < 0.05). CONCLUSIONS DKA patients at presentation have a densely organising less permeable thrombogenic clot microstructure as evidenced by high df. These structural changes are due to a combination of dehydration and a profound metabolic acidosis, which was reversed with treatment. These changes were not mirrored in standard clinical markers of thromboge-nicity.
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Affiliation(s)
- Suresh Pillai
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK.,Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| | - Gareth Davies
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK
| | - Matthew Lawrence
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| | - Janet Whitley
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| | - Jeffrey Stephens
- Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
| | | | | | - Phillip Adrian Evans
- Welsh Centre for Emergency Medicine Research, Emergency Department, Morriston Hospital, Swansea, UK.,Morriston Hospital, Swansea, UK.,Swansea University, Swansea, UK
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7
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Sabra A, Lawrence MJ, Curtis D, Hawkins K, Williams PR, Evans PA. In vitro clot model to evaluate fibrin-thrombin effects on fractal dimension of incipient blood clot. Clin Hemorheol Microcirc 2019; -1:147-153. [PMID: 31381508 DOI: 10.3233/ch-190615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This aim of this study is to investigate the individual effects of varying concentrations of thrombin and fibrinogen on clot microstructure (characterised through the fractal dimension of the incipient clot network, df) and clot formation time (TGP) using a fibrin-thrombin clot model. df and TGP markers are measured using a haemorheological method that has already been investigated for whole blood. METHODS This is an in vitro study using three thrombin concentrations (0.1, 0.05 and 0.02 NIH/ml) and two fibrinogen concentrations (8 mg/ml and 12 mg/ml) to investigate a fibrin-thrombin clot model. The haemorheological changes were measured at the gel point using df and TGP. RESULTS Fractal dimension (df) increased with increasing concentrations of thrombin both at 8 mg/ml (1.60±0.024, 1.67±0.022, 1.74±0.079) and 12 mg/ml fibrinogen concentrations (1.63±0.02, 1.87±0.019, 1.95±0.014). On the other hand, TGP decreased for both 8 mg/ml (1089±265, 637±80, 223±22 seconds) and 12 mg/ml fibrinogen concentrations (2008±247, 776±20, 410±20 seconds). In contrast to previous studies investigating whole blood, TGP increased with higher fibrinogen levels. CONCLUSIONS The findings from this fibrin-thrombin clot model confirmed that df and TGP can detect changes in the incipient clot following manipulation of fibrinogen and thrombin concentration. df increases (indicating stronger clot) with higher concentrations of thrombin and fibrinogen. On the other hand, TGP decreased as expected with higher thrombin level but not with higher fibrinogen concentrations.
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Affiliation(s)
- Ahmed Sabra
- Welsh Centre for Emergency Medicine Research, Swansea University, Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK.,Morriston Cardiac Centre, Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | - Matthew J Lawrence
- Welsh Centre for Emergency Medicine Research, Swansea University, Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | - Dan Curtis
- College of Engineering, Swansea University, Swansea, UK
| | - Karl Hawkins
- College of Medicine, Swansea University, Swansea, UK
| | | | - Phillip A Evans
- Welsh Centre for Emergency Medicine Research, Swansea University, Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK.,Emergency Department, Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK
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8
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Dibiasi C, Plewka J, Ploszczanski L, Glanz V, Lichtenegger H, Windberger U. Viscoelasticity and structure of blood clots generated in-vitro by rheometry: A comparison between human, horse, rat, and camel. Clin Hemorheol Microcirc 2018; 69:515-531. [PMID: 29710696 DOI: 10.3233/ch-189203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Although the coagulation system is evolutionary well preserved, profound species differences exist in viscoelastic as well as in common laboratory tests of coagulation. OBJECTIVE Evaluating differences in clot formation and material characterisation of clots of four mammalian species on macro-, micro- and nanoscales by the means of rheometry, scanning electron microscopy (SEM) and small angle x-ray scattering (SAXS). METHODS Blood samples were collected from healthy human volunteers, laboratory rats (HL/LE inbred strain), warmblood horses and dromedary camels. Clot formation was observed by oscillating shear rheometry until plateau formation of the shear storage modulus G', at which point selected clots were prepared for scanning electron microscopy. SEM images were analysed for fibre diameter and fractal dimension. Additionally, scattering profiles for plasma and whole blood samples were obtained with SAXS. RESULTS Viscoelasticity of clots showed great interspecies variation: clots of rats and horses exhibited shorter clotting times and higher G' plateau values, when compared to human clots. Camel clots showed unique clotting characteristics with no G' plateau formation in the timeframe observed. Less differentiating features were found with SEM and SAXS, although the rat fibre network appears to be more convoluted and dense, which resulted in a higher fractal dimension. CONCLUSION Clotting kinetic differs between the species, which is not only of clinical interest, but could also be an important finding for animal models of blood coagulation.
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Affiliation(s)
- Christoph Dibiasi
- Department of Biomedical Research, Decentralized Biomedical Facilities, Medical University of Vienna, Austria
| | - Jacek Plewka
- Department of Material Sciences and Process Engineering, Institute of Physics and Materials Science, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Leon Ploszczanski
- Department of Material Sciences and Process Engineering, Institute of Physics and Materials Science, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Veronika Glanz
- Department of Biomedical Research, Decentralized Biomedical Facilities, Medical University of Vienna, Austria
| | - Helga Lichtenegger
- Department of Material Sciences and Process Engineering, Institute of Physics and Materials Science, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Ursula Windberger
- Department of Biomedical Research, Decentralized Biomedical Facilities, Medical University of Vienna, Austria
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9
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Hood JE, Yesudasan S, Averett RD. Glucose Concentration Affects Fibrin Clot Structure and Morphology as Evidenced by Fluorescence Imaging and Molecular Simulations. Clin Appl Thromb Hemost 2018; 24:104S-116S. [PMID: 30114949 PMCID: PMC6714860 DOI: 10.1177/1076029618792304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Although in vivo studies have been conducted in the past to determine hyperglycemic effects and influence on clotting risk in patients with diabetes, the true extent of hyperglycemia on unstable and spontaneous clot formation remains highly debated. Factors such as increased glycation, elevated fibrinogen concentration, elevated prothrombin levels, and decreased plasminogen are known to influence fibrin conversion, clot morphology, and thrombus formation in these individuals. In this regard, the isolated effects of hyperglycemia on irregular fibrin clot formation were investigated in a controlled fibrinogen system. In this study, fibrin clot characteristic differences at 3 glucose concentrations were analyzed to determine the effects of glucose concentration on fibrinogen glycation and fibrin clot morphology using confocal microscopy, glycation quantification, molecular simulations, and image processing methods. Algorithms coupled with statistical analysis support in vivo findings that hyperglycemia increases fibrinogen glycation, with ensuing altered fibrin clot structure characteristics. Our experimental and molecular simulation results consistently show an increased glucose adsorption by fibrinogen with increased glucose concentration. Significant differences in clot structure characteristics were observed, and the results of this work can be used to further develop diagnostic tools for evaluating clotting risk in individuals with hypercoagulable and hyperglycemic conditions.
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Affiliation(s)
- Jacob E Hood
- School of Chemical, Materials, and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA
| | - Sumith Yesudasan
- School of Chemical, Materials, and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA
| | - Rodney D Averett
- School of Chemical, Materials, and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA
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10
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Lawrence MJ, Davies G, Nyberg M, Whitley J, Evans V, Williams R, Hellsten Y, Evans PA. The effect of tyramine infusion and exercise on blood flow, coagulation and clot microstructure in healthy individuals. Thromb Res 2018; 170:32-37. [PMID: 30098458 DOI: 10.1016/j.thromres.2018.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/19/2018] [Accepted: 07/24/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The long term benefits of exercise on the cardiovascular status of a patient have been proven, however, their benefit/risk relationship with exercise intensity is unclear. Furthermore, many thromboembolic diseases such as myocardial infarction and ischaemic stroke are associated with profound catecholamine release. In this study we explore the relationship between catecholamine release and hemodynamic changes and their effect on coagulation. MATERIALS AND METHODS Twelve healthy recreationally active males were recruited. Local anesthesia was given and catheters were placed under aseptic conditions, in the femoral artery and vein of the experimental leg. The first experiment involved tyramine infusion into the femoral artery at a dose of 1.0 μmol·min-1·L leg volume-1. The second experiment involved single leg knee-extensor exercise performed at 30 W for 15 min. Venous blood was collected at each time point to assess clot microstructure using the df biomarker. RESULTS AND CONCLUSIONS Tyramine infusion causes a local noradrenaline release in the leg. The increase in noradrenaline was associated with a significant increase in clot microstructure formation (df increased from 1.692 ± 0.029 to 1.722 ± 0.047, p = 0.016). Additionally moderate intensity single leg knee extensor exercise, which minimally alters sympathetic activity, also induced an increases in df (from 1.688 ± 0.025 to 1.723 ± 0.023, p = 0.001). This suggests that exercise can alter clot microstructure formation both via an increase in catecholeamine levels and by factors related to muscle activity per se, such as increased blood flow and consequent shear. These findings have implications for recommendations of exercise in patients at risk of cardiovascular events.
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Affiliation(s)
- Matthew J Lawrence
- Haemostasis Biomedical Research Unit, Welsh Centre in Emergency Medicine Research, Morriston Hospital, ABMU Health Board, Swansea, UK; College of Medicine, Swansea University, Swansea, UK
| | - Gareth Davies
- Haemostasis Biomedical Research Unit, Welsh Centre in Emergency Medicine Research, Morriston Hospital, ABMU Health Board, Swansea, UK; College of Medicine, Swansea University, Swansea, UK
| | - Michael Nyberg
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Janet Whitley
- Haemostasis Biomedical Research Unit, Welsh Centre in Emergency Medicine Research, Morriston Hospital, ABMU Health Board, Swansea, UK; College of Medicine, Swansea University, Swansea, UK
| | - Vanessa Evans
- Haemostasis Biomedical Research Unit, Welsh Centre in Emergency Medicine Research, Morriston Hospital, ABMU Health Board, Swansea, UK; College of Medicine, Swansea University, Swansea, UK
| | - Rhodri Williams
- Haemostasis Biomedical Research Unit, Welsh Centre in Emergency Medicine Research, Morriston Hospital, ABMU Health Board, Swansea, UK; College of Engineering, Swansea University, Swansea, UK
| | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Phillip A Evans
- Haemostasis Biomedical Research Unit, Welsh Centre in Emergency Medicine Research, Morriston Hospital, ABMU Health Board, Swansea, UK; College of Medicine, Swansea University, Swansea, UK.
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11
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Sabra A, Lawrence MJ, Aubrey R, Obaid D, Chase A, Smith D, Thomas P, Storton S, Davies GR, Hawkins K, Williams PR, Morris K, Evans PA. Characterisation of clot microstructure properties in stable coronary artery disease. Open Heart 2017; 4:e000562. [PMID: 28761676 PMCID: PMC5515126 DOI: 10.1136/openhrt-2016-000562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/20/2017] [Accepted: 04/04/2017] [Indexed: 01/18/2023] Open
Abstract
Background Coronary artery disease (CAD) is associated with an increased prothrombotic tendency and is also linked to unfavourably altered clot microstructure. We have previously described a biomarker of clot microstructure (df) that is unfavourably altered in acute myocardial infarction. The df biomarker assesses whether the blood will form denser or looser microstructures when it clots. In this study we assessed in patients with stable chest pain whether df can differentiate between obstructed and unobstructed CAD. Methods A blood sample prior to angiography was obtained from 251 consecutive patients undergoing diagnostic coronary angiography. Patients were categorised based on angiographic findings as presence or absence of obstructive CAD (stenosis ≥50%). The blood sample was assessed using the df biomarker, standard laboratory markers and platelet aggregometry (Multiplate). Results A significant difference (p=0.028) in df was observed between obstructive CAD (1.748±0.057, n=83) and unobstructive CAD (1.732±0.052, n=168), where patients with significant CAD produce denser, more tightly packed clots. df was also raised in men with obstructive CAD compared with women (1.745±0.055 vs 1.723±0.052, p=0.007). Additionally df significantly correlated with the platelets response to arachidonic acid as measured by the ASPItest area under the curve readings from platelet aggregometry (correlation coefficient=0.166, p=0.008), a low value of the ASPItest indicating effective aspirin use was associated with looser, less dense clots. Conclusions For the first time, we characterise clot microstructure, as measured by df, in patients with stable CAD. df can potentially be used to risk-stratify patients with stable CAD and assess the efficacy of therapeutic interventions by measuring changes in clot microstructure.
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Affiliation(s)
- Ahmed Sabra
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, ABMU Health Board, Swansea, UK.,NISCHR Haemostasis Biomedical Research Unit, College of Medicine, Swansea University, Swansea, UK.,Department of Cardiology, Princess of Wales Hospital, ABMU Health Board, Bridgend, UK
| | - Matthew James Lawrence
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, ABMU Health Board, Swansea, UK.,NISCHR Haemostasis Biomedical Research Unit, College of Medicine, Swansea University, Swansea, UK
| | - Robert Aubrey
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, ABMU Health Board, Swansea, UK
| | - Daniel Obaid
- Cardiac Centre, Morriston Hospital, ABMU Health Board, Swansea, UK
| | - Alexander Chase
- Cardiac Centre, Morriston Hospital, ABMU Health Board, Swansea, UK
| | - Dave Smith
- Cardiac Centre, Morriston Hospital, ABMU Health Board, Swansea, UK
| | - Phillip Thomas
- Cardiac Centre, Morriston Hospital, ABMU Health Board, Swansea, UK
| | - Sharon Storton
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, ABMU Health Board, Swansea, UK.,NISCHR Haemostasis Biomedical Research Unit, College of Medicine, Swansea University, Swansea, UK
| | - Gareth R Davies
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, ABMU Health Board, Swansea, UK.,NISCHR Haemostasis Biomedical Research Unit, College of Medicine, Swansea University, Swansea, UK
| | - Karl Hawkins
- NISCHR Haemostasis Biomedical Research Unit, College of Medicine, Swansea University, Swansea, UK
| | | | - Keith Morris
- School of Applied Science, Cardiff Metropolitan University, Cardiff, UK
| | - Phillip Adrian Evans
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, ABMU Health Board, Swansea, UK.,NISCHR Haemostasis Biomedical Research Unit, College of Medicine, Swansea University, Swansea, UK.,Department of Emergency Medicine, Morriston Hospital, ABMU Health Board, Swansea, UK
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Knowles RB, Lawrence MJ, Ferreira PM, Hayman MA, D’Silva LA, Stanford SN, Sabra A, Tucker AT, Hawkins KM, Williams PR, Warner TD, Evans PA. Platelet reactivity influences clot structure as assessed by fractal analysis of viscoelastic properties. Platelets 2017; 29:162-170. [DOI: 10.1080/09537104.2017.1306039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Rebecca B. Knowles
- William Harvey Research Institute, Barts & the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Matthew J. Lawrence
- Medical School, Swansea University, Swansea, UK
- NISCHR Hemostasis Biomedical Research Unit, ABMU Health Board, Swansea, UK
| | - Plinio M. Ferreira
- William Harvey Research Institute, Barts & the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Melissa A. Hayman
- William Harvey Research Institute, Barts & the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Lindsay A. D’Silva
- Medical School, Swansea University, Swansea, UK
- NISCHR Hemostasis Biomedical Research Unit, ABMU Health Board, Swansea, UK
| | - Sophie N. Stanford
- Medical School, Swansea University, Swansea, UK
- NISCHR Hemostasis Biomedical Research Unit, ABMU Health Board, Swansea, UK
| | - Ahmed Sabra
- Medical School, Swansea University, Swansea, UK
- NISCHR Hemostasis Biomedical Research Unit, ABMU Health Board, Swansea, UK
| | - Arthur T. Tucker
- William Harvey Research Institute, Barts & the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Karl M. Hawkins
- Medical School, Swansea University, Swansea, UK
- NISCHR Hemostasis Biomedical Research Unit, ABMU Health Board, Swansea, UK
| | | | - Timothy D. Warner
- William Harvey Research Institute, Barts & the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Phillip A. Evans
- Medical School, Swansea University, Swansea, UK
- NISCHR Hemostasis Biomedical Research Unit, ABMU Health Board, Swansea, UK
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13
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The effect of sepsis and its inflammatory response on mechanical clot characteristics: a prospective observational study. Intensive Care Med 2016; 42:1990-1998. [DOI: 10.1007/s00134-016-4496-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/08/2016] [Indexed: 11/27/2022]
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Davies N, Llwyd O, Brugniaux J, Davies G, Marley C, Hodson D, Lawrence M, D'Silva L, Morris R, Hawkins K, Williams P, Bailey D, Evans P. Effects of exercise intensity on clot microstructure and mechanical properties in healthy individuals. Thromb Res 2016; 143:130-6. [DOI: 10.1016/j.thromres.2016.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/11/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
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Davies NA, Harrison NK, Morris RHK, Noble S, Lawrence MJ, D'Silva LA, Broome L, Brown MR, Hawkins KM, Williams PR, Davidson S, Evans PA. Fractal dimension (df) as a new structural biomarker of clot microstructure in different stages of lung cancer. Thromb Haemost 2015; 114:1251-9. [PMID: 26293709 DOI: 10.1160/th15-04-0357] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/28/2015] [Indexed: 12/21/2022]
Abstract
Venous thromboembolism (VTE) is common in cancer patients, and is the second commonest cause of death associated with the disease. Patients with chronic inflammation, such as cancer, have been shown to have pathological clot structures with modulated mechanical properties. Fractal dimension (df) is a new technique which has been shown to act as a marker of the microstructure and mechanical properties of blood clots, and can be performed more readily than current methods such as scanning electron microscopy (SEM). We measured df in 87 consecutive patients with newly diagnosed lung cancer prior to treatment and 47 matched-controls. Mean group values were compared for all patients with lung cancer vs controls and for limited disease vs extensive disease. Results were compared with conventional markers of coagulation, fibrinolysis and SEM images. Significantly higher values of df were observed in lung cancer patients compared with controls and patients with extensive disease had higher values than those with limited disease (p< 0.05), whilst conventional markers failed to distinguish between these groups. The relationship between df of the incipient clot and mature clot microstructure was confirmed by SEM and computational modelling: higher df was associated with highly dense clots formed of smaller fibrin fibres in lung cancer patients compared to controls. This study demonstrates that df is a sensitive technique which quantifies the structure and mechanical properties of blood clots in patients with lung cancer. Our data suggests that df has the potential to identify patients with an abnormal clot microstructure and greatest VTE risk.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Phillip Adrian Evans
- Prof. Phillip Adrian Evans, Director, NISCHR Haemostasis Biomedical Research Unit, Abertawe Bro Morgannwg University Health Board, NISCHR Haemostasis Biomedical Research Unit, Emergency Department, Morriston Hospital Abertawe Bro Morgannwg University Health Board, Swansea, UK, SA6 6NL, Tel.: +44 1792 703418, E-mail:
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