Clinical Hemorheology and Microcirculation - Volume 31, issue 4
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Clinical Hemorheology and Microcirculation, a peer-reviewed international scientific journal, serves as an aid to understanding the flow properties of blood and the relationship to normal and abnormal physiology. The rapidly expanding science of hemorheology concerns blood, its components and the blood vessels with which blood interacts. It includes perihemorheology, i.e., the rheology of fluid and structures in the perivascular and interstitial spaces as well as the lymphatic system. The clinical aspects include pathogenesis, symptomatology and diagnostic methods, and the fields of prophylaxis and therapy in all branches of medicine and surgery, pharmacology and drug research.
The endeavour of the Editors-in-Chief and publishers of
Clinical Hemorheology and Microcirculation is to bring together contributions from those working in various fields related to blood flow all over the world. The editors of
Clinical Hemorheology and Microcirculation are from those countries in Europe, Asia, Australia and America where appreciable work in clinical hemorheology and microcirculation is being carried out. Each editor takes responsibility to decide on the acceptance of a manuscript. He is required to have the manuscript appraised by two referees and may be one of them himself. The executive editorial office, to which the manuscripts have been submitted, is responsible for rapid handling of the reviewing process.
Clinical Hemorheology and Microcirculation accepts original papers, brief communications, mini-reports and letters to the Editors-in-Chief. Review articles, providing general views and new insights into related subjects, are regularly invited by the Editors-in-Chief. Proceedings of international and national conferences on clinical hemorheology (in original form or as abstracts) complete the range of editorial features.
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Clinical Hemorheology and Microcirculation: medical practitioners in all fields including hematology, cardiology, geriatrics, angiology, surgery, obstetrics and gynecology, ophthalmology, otology, and neurology. Pharmacologists, clinical laboratories, blood transfusion centres, manufacturing firms producing diagnostic instruments, and the pharmaceutical industry will also benefit.
Important new topics will increasingly claim more pages of
Clinical Hemorheology and Microcirculation: the role of hemorheological and microcirculatory disturbances for epidemiology and prognosis, in particular regarding cardiovascular disorders, as well as its significance in the field of geriatrics. Authors and readers are invited to contact the editors for specific information or to make suggestions.
Abstract: Influence of the change of red blood cell (RBC) concentration on the initiation time of blood coagulation was investigated with a damped oscillation rheometer. The blood samples from 40 volunteers were examined. After centrifuging some portion of each blood sample, an appropriate volume was taken from the lower RBC layer to add it to the autologous blood, making an artificially concentrated blood. Initiation time of coagulation of each sample from 20 males and 20 non‐pregnant females was shortened according to the increase of the RBC concentration, producing a significant difference at the boundary of 5.0×106 /mm3 (p<0.01). The results…suggest that RBC concentration may play an important role in accelerating the initial coagulation reaction of blood and that hemoconcentration could be a risk factor for thrombosis even within the normal range, especially beyond the boundary of 5.0×106 /mm3 of RBCs.
Abstract: This study was designed to examine changes of hemorheological parameters in patients with CHD and hypercholesterolaemia (wide range of plasma total cholesterol level from 5.6 to 9.8 mmol·l−1 ) subjected to lipid lowering therapy with statins (simvastatin, 10.0–20.0 mg/day, dosage was dependent on an initial level of total cholesterol). Twenty female subjects were enrolled in this research program. Both prior to and following drug treatment for eight weeks, hemorheological measurements included plasma viscosity, high and low shear whole blood viscosity, hematocrit, RBC aggregation and rigidity. Treatment with simvastatin significantly (p<0.05) reduced total cholesterol, total triglycerides and low‐density lipoprotein cholesterol (LDL‐C).…However, the hemorheological effects of lipid lowering therapy differed markedly between macro‐ and microrheological groups of parameters: plasma and whole blood viscosity were not significantly changed whereas RBC aggregation and its rigidity were decreased significantly after statin treatment. These results thus suggest that the rheologic effect of lipid lowering therapy concerned mainly the microrheological parameters: red cell aggregation and deformability.
Abstract: Malaria due to Plasmodium vivax affects blood flow in cardiovascular system. The present work is aimed to determine the variability of erythrocyte deformability and aggregation in malaria patients in comparison with that of normal subjects. Blood samples of malaria patients (n=16), selected based on occurrence of parasitaemia, are categorized into low (LP), medium (MP) and high parasitaemia (HP), which represent increasing levels of the disease severity. For measurement of aggregation and deformability, by laser aggregometer and optical hemorheometer, the erythrocyte suspensions are prepared in plasma and physiological saline at hematocrit 5%. The results show that the erythrocyte deformability is significantly…reduced (p<0.001) with the increasing level of parasitaemia. Despite this decrease in deformability, the aggregation parameters are significantly increased, indicating the occurrence of hyper‐aggregation, particularly in MP and HP, due to involvement of various factors. These changes may partly be contributing in the observed changes in blood flow in the microcirculation.
Abstract: A persistent proteinuria is commonly observed in nephrotic patient with focal segmental glomerulosclerosis (FSGS) under treatment with prednisolone ± cyclophosphamide or with vasodilators (ACEI + AII receptor antagonist, calcium channel blocker and antiplatelet agent). Fourteen such patients with persistent proteinuria were subject to be treated with Ganoderma lucidum. Initial study revealed an enhanced endothelial cell cytotoxicity induced by patient's serum, and an altered immunocirculatory balance with predominant proinflammatory cytokine TNF alpha activity in the presence of defective anti‐inflammatory cytokine interleukin‐10. Treatment with Ganoderma lucidum suppressed endothelial cell cytotoxicity, restored immunocirculatory balance and successfully suppressed proteinuria in all of these 14…patients.
Abstract: The hemorheological and morphological changes in blood samples of diabetic patients, with varying levels of hyperglycemia but normal cholesterol concentration, are determined and are compared with healthy subjects. The shape analysis is carried out by shape descriptors based on projected area, perimeter and form factor, as measured by processing of images of erythrocytes. The aggregation and deformability of erythrocytes are measured by sequential variation of the transmitted laser light after passing through the erythrocytes suspension in plasma and passage of erythrocytes suspension in physiological saline through cellulose membrane, respectively. The results show that with the increase of glucose concentration the…erythrocytes aggregation is enhanced and deformability is reduced in diabetic patients compared to that of healthy subjects. The shape parameters, which quantify the changes in erythrocytes in diabetes, show significant deviation from the shape of normal cells. A significant increase in the perimeter to area ratio and form factor in hyperglycemia also corresponds to highly significant increase in filtration time (decrease in deformability).
Keywords: Diabetes mellitus, erythrocyte aggregation and deformability, morphological changes, normo‐cholesterolemia
Abstract: Objective: To examine the difference in clinical signs of peripheral vasculopathy in patients (pts) with limited (lcSSc) and diffuse cutaneus systemic sclerosis (dcSSc). Patients and methods: Ninety one patients with systemic sclerosis (39 with lcSSc and 52 with dcSSc) have been assessed for the presence of clinical signs of vascular injury: Raynaud's phenomenon, severity of capillary damage on capillaroscopy, presence or absence of finger‐tip ulcers or pitting scars, presence of telangiectasias and radiographic signs of finger‐tip osteolysis. Statistical significance of difference in clinical manifestations of peripheral vasculopathy in pts with lcSSc and dcSSc was assessed using the Mann–Whitney and X2…‐test. Results: Duration of Raynaud's phenomenon before manifestation of skin or internal organ damage, was significantly longer (z=−2.54, p=0.004) in patients with lcSSc (5.4 years) than in patients with dcSSc (1.9 years). Using the technique of nailfold capillaroscopy, we found normal capillaries or non‐specific capillary change in 10.2% pts with lcSSc and only in 2.0% pts with dcSSc. Enlarged capillaries without significant loss of capillaries were found in 38.5% pts with lcSSc, and 11.5% pts with dcSSc (p=0.05). But severe capillary damage, with significant loss of capillaries, was noticed more frequently in pts with dcSSc (dcSSc/lcSSc: 86.5%/51.3%, p=0.002). Pitting scars or digital ulcers were found in 46.2% pts with lcSSc and 67.3% pts with dcSSc (p=0.04). We did not notice significant difference in frequency of finger‐tip osteolysis (lcSSc/dcSSc: 23.1%/21.2%, p>0.05) and telangiectasias (lcSSc/dcSSc: 46.2%/53.8%, p>0.05). Conclusion: Severe capillary damage and digital ulcers are more common in patients with diffuse cutaneus systemic sclerosis, but finger‐tip osteolysis and telangiectasias are equally frequent in both form of disease.
Abstract: Increased activated circulating endothelial cells, enhanced von Willebrand factor (vWF:Ag) and adhesion molecules (sVCAM‐1) are observed in patients with beta‐thalassemia/hemoglobin E. Such evidences of endothelial cell injury are associated with altered intrarenal hemodynamics with a significant reduction in renal plasma flow. Altered renal functions (namely depleted creatinine clearance) and abnormal tubular function test, which is reflected by abnormally increased fractional excretion of magnesium (FE Mg), are also delineated. The increased FE Mg implies tubulointerstitial injury which may relate to the microvascular endothelial injury and chronic ischemia.
Abstract: Aim: The aim of the study was to determine the role of some erythrocyte patterns (Red Blood Cell deformability, aggregability, cytosolic calcium concentration) in normal tension glaucoma (NTG), compared with primary open angle glaucoma (POAG) and normal subjects. Material and methods: Ninety patients entered the study, divided in three groups: age and sex‐matched, otherwise normal subjects (30 patients), POAG (30 patients) and NTG patients (30 patients). Hemorheological parameters (elongation index [EI] and aggregability half time [At½] were detected using a laser diffractometer system (Laser‐assisted Optical Rotational Cell Analyzer [LORCA]). Cytosolic calcium levels were measured using spectrofluorimetry. Results: No significant difference…in systemic variables and refractive error was found. Mean hematocrit level, cell volume, plasma protein level and coagulation factors did not show any statistical difference among groups and resulted to be in the range of normality. A significant decrease in EI measurements was demonstrated in the NTG group (p<0.001) only. Similarly, A‐t½ measurements were significantly smaller in the NTG group than in the other groups (p<0.001). Cytosolic calcium levels were significantly higher in the NTG group than in the other groups (p<0.001) and they were correlated to the elongation index for each group and overall (r=−0.756, p<0.001). Conclusions: A significant decrease of erythrocyte deformability and increase in aggregability was found in NTG patients. These alterations seem to be inversely related to the intracytosolic calcium levels and they were not found in POAG patients and controls. Those results may contribute to understand the pathogenesis of normal tension glaucoma, suggesting a possible role played by red blood cells.
Abstract: Spectral analysis of skin laser Doppler (LD) signal was performed using Fourier transformation in twelve healthy subjects in order to compare post‐ischemic hyperemia and acetylcholine (ACh) iontophoresis tests for the exploration of cutaneous microcirculatory endothelial function. Within the frequency range studied of 0.009–1.6 Hz, five different frequency intervals were considered, arising from local (endothelial and myogenic) and central (neural, respiratory and cardiac) regulatory mechanisms. The power density (PD) for each of the five frequency intervals considered was measured in perfusion units (PU)/Hz, in each subject, before and in response to ischemia and to ACh iontophoresis, using a dedicated software. The…relative contribution of each frequency interval was calculated as per cent rate between each PD and the sum of the PD of the five frequency interval considered. PD of LD signals in response to ischemia and Ach iontophoresis significantly increased for all the five frequency intervals considered. A significant increase (from 25.0±6.3 to 48.3±17.8; p<0.01) in the relative contribution of 0.009–0.02 frequency interval, referred to endothelium activity, was observed only in response to ACh iontophoresis. No significant increase in the relative power contribution was observed in response to ischemia for any of the five frequency intervals considered. These data suggest that ACh iontophoresis test is more adequate than post‐ischemic hyperemia test in exploring the skin microcirculatory endothelial function in normal subjects.
Abstract: Exercise transiently increases blood viscosity: however data on red cell deformability in this process remain inconsistent, since studies report either impairment (proportional to blood lactate accumulation), a lack of effect, or even in some cases an improvement. To test whether these inconsistencies may be due to physiological differences among populations studied, we compared the effects of in vitro lactate (2 mM, 4 mM and 10 mM) on erythrocyte rigidity in venous blood drawn at rest in 10 untrained vs 10 aerobically‐trained subjects. After adjustment of osmolality and pH and incubation at 37°C during 2 minutes, viscometric measurements were performed at…1000 s−1 with the MT90 (falling ball) viscometer and Dintenfass's ‘Tk’ was calculated. While at baseline there was no significant difference in Tk between the two groups, it decreased in the aerobically‐trained subjects between 2 and 10 mM lactate concentrations (p<0.05) and increased in the untrained group between 2 and 4 mM (p<0.05). Thus, it seems that endurance training influences erythrocyte response to lactate. Lactate impaired erythrocyte deformability in untrained subjects but it (unexpectedly) improved it in trained subjects. This difference may be due to training‐induced adaptations in erythrocyte metabolism, possibly including transmembrane transfer via monocarboxylate transporters.
Keywords: Red blood cell, deformability, endurance, lactate