Browsing by Author "Ince, Can"

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    Leukocyte-Endothelium Interaction in the Sublingual Microcirculation of Coronary Artery Bypass Grafting Patients
    (KARGER, 2020-01-01) Uz, Zuhre; Aykut, Guclu; Massey, Michael; Ince, Yasin; Ergin, Bulent; Shen, Lucinda; Toraman, Fevzi; van Gulik, Thomas M.; Ince, Can
    Objective: The aim of this study was to apply an innovative methodology to incident dark-field (IDF) imaging in coronary artery bypass grafting (CABG) patients for the identification and quantification of rolling leukocytes along the sublingual microcirculatory endothelium. Methods: This study was a post hoc analysis of a prospective study that evaluated the perioperative course of the sublingual microcirculation in CABG patients. Video images were captured using IDF imaging following the induction of anesthesia (T-0) and cardiopulmonary bypass (CPB) (T-1) in 10 patients. Rolling leukocytes were identified and quantified using frame averaging, which is a technique that was developed for correctly identifying leukocytes. Results: The number of rolling leukocytes increased significantly from T-0 (7.5 {[}6.4-9.1] leukocytes/capillary-postcapillary venule/4 s) to T-1 (14.8 {[}13.2-15.5] leukocytes/capillary-postcapillary venule/4 s) (p < 0.0001). A significant increase in systemic leukocyte count was also detected from 7.4 +/- 0.9 x 10(9)/L (preoperative) to 12.4 +/- 4.4 x 10(9)/L (postoperative) (p < 0.01). Conclusion: The ability to directly visualize leukocyte-endothelium interaction using IDF imaging facilitates the diagnosis of a systemic inflammatory response after CPB via the identification of rolling leukocytes. Integration of the frame averaging algorithm into the software of handheld vital microscopes may enable the use of microcirculatory leukocyte count as a real-time parameter at the bedside.
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    Microcirculatory Response to Blood vs. Crystalloid Cardioplegia During Coronary Artery BypassGrafting With Cardiopulmonary Bypass
    (FRONTIERS MEDIA SA, 2022-01-01) Aykut, Gueclue; Ulugoel, Halim; Aksu, Ugur; Akin, Sakir; Karabulut, Hasan; Alhan, Cem; Toraman, Fevzi; Ince, Can
    Background: Blood cardioplegia attenuates cardiopulmonary bypass (CPB)-induced systemic inflammatory response in patients undergoing cardiac surgery, which may favorably influence the microvascular system in this cohort. The aim of this study was to investigate whether blood cardioplegia would offer advantages over crystalloid cardioplegia in the preservation of microcirculation in patients undergoing coronary artery bypass grafting (CABG) with CPB.Methods: In this prospective observational cohort study, 20 patients who received crystalloid (n = 10) or blood cardioplegia (n = 10) were analyzed. The microcirculatory measurements were obtained sublingually using incident dark-field imaging at five time points ranging from the induction of anesthesia (T-0) to discontinuation of CPB (T-5).Results: In the both crystalloid {[}crystalloid cardioplegia group (CCG)] and blood cardioplegia {[}blood cardioplegia group (BCG)] groups, perfused vessel density (PVD), total vessel density (TVD), and proportion of perfused vessels (PPV) were reduced after the beginning of CPB. The observed reduction in microcirculatory parameters during CPB was only restored in patients who received blood cardioplegia and increased to baseline levels as demonstrated by the percentage changes from T-0 to T-5 (\%Delta)(T0-T5) in all the functional microcirculatory parameters {[}\%Delta TVDT0-T5(CCG): -10.86 +/- 2.323 vs. \%Delta TVDT0-T5(BCG): 0.0804 +/- 1.107, p < 0.001
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    MicroTools enables automated quantification of capillary density and red blood cell velocity in handheld vital microscopy
    (NATURE PORTFOLIO, 2019-01-01) Hilty, Matthias Peter; Guerci, Philippe; Ince, Yasin; Toraman, Fevzi; Ince, Can
    Direct assessment of capillary perfusion has been prioritized in hemodynamic management of critically ill patients in addition to optimizing blood flow on the global scale. Sublingual handheld vital microscopy has enabled online acquisition of moving image sequences of the microcirculation, including the flow of individual red blood cells in the capillary network. However, due to inherent content complexity, manual image sequence analysis remained gold standard, introducing inter-observer variability and precluding real-time image analysis for clinical therapy guidance. Here we introduce an advanced computer vision algorithm for instantaneous analysis and quantification of morphometric and kinetic information related to capillary blood flow in the sublingual microcirculation. We evaluated this technique in a porcine model of septic shock and resuscitation and cardiac surgery patients. This development is of high clinical relevance because it enables implementation of point-of-care goal-directed resuscitation procedures based on correction of microcirculatory perfusion in critically ill and perioperative patients.