Clinical Hemorheology and Microcirculation - Volume 34, 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.
The following professionals and institutions will benefit most from subscribing to
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: Given that functional abnormalities of the microcirculation are one of the primary abnormalities in cardiovascular disease pathogenesis, various noninvasive clinical tools have been developed recently to assess the microvascular function, particularly at the skin. The common techniques used to assess cutaneous microvascular function in vivo include capillaroscopy, venous occlusion plethysmography, and laser-Doppler instruments (laser-Doppler fluximetry and laser-Doppler imaging). These noninvasive techniques can be used as an early measure of functional abnormalities within the microvascular tree, predominantly in population at high risk for cardiovascular events. This review discusses some underlying application principle of these techniques, including its clinical significance, method reproducibility…and limitations.
Keywords: Clinical significance, in vivo, limitation, noninvasive, reproducibility, skin, technique
Abstract: The relationship between the flexibility of atherosclerotic vessels and RBC deformability has been investigated. A significant difference of RBC deformability was found among the arterial stiffness groups classified by oscillometric measurement of blood pressure. The deformability was determined by direct microscopic observation of RBCs subjected to shear stress of 0.3 to 40.0 Pa with a rotating rheoscope. The deformability of stiffen group – abnormal pulse wave pattern group or moderate cardiovascular risk group – was found to be much higher than that of normal groups in wide shear stress region (3.0, 10.0, 30.0, and 40.0 Pa). We postulate that the…body adapts high shear stress in vivo by making RBCs more distensible, and therefore less likely to rupture under strain or microcirculatory alterations.
Keywords: RBC, deformability, arterial stiffness, rheoscope, in vivo
Abstract: Purpose: To investigate the dynamic value of contrast medium-enhanced ultrasonography with Optison® for appraisal of the vascularization of hepatic tumors using harmonic imaging, 3D-/power Doppler and B-flow. Materials/methods: 60 patients with a mean age of 56 years (range 35–76 years) with 93 liver tumors, including histopathologically proven hepatocellular carcinoma (HCC) [15 cases with 20 lesions], liver metastases of colorectal tumors [17 cases with 33 lesions], metastases of breast cancer [10 cases with 21 lesions] and hemangiomas [10 cases with 19 lesions] were prospectively investigated by means of multislice CT as well as native and contrast medium-enhanced ultrasound using a…multifrequency transducer (2.5–4 MHz, Logig 9, GE). B scan was performed with additional color and power Doppler, followed by a bolus injection of 0.5 ml Optison® . Tumor vascularization was evaluated with coded harmonic angio (CHA), pulse inversion imaging with power Doppler, 3D power Doppler and in the late phase (>5 min) with B-flow. In 15 cases with HCC, i.a. DSA was performed in addition. The results were also correlated with MRT and histological findings. Results: Compared to spiral-CT/MRT, only 72/93 (77%) of the lesions could be detected in the B scan, 75/93 (81%) with CHA and 93/93 (100%) in the pulse inversion mode. Tumor vascularization was detectable in 43/93 (46%) of lesions with native power Doppler, in 75/93 (81%) of lesions after administering contrast medium in the CHA mode, in 81/93 (87%) of lesions in the pulse inversion mode with power Doppler and in 77/93 (83%) of lesions with contrast-enhanced B-flow. Early arterial and capillary perfusion was best detected with CHA, particularly in 20/20 (100%) of the HCC lesions, allowing a 3D reconstruction. 3D power Doppler was especially useful in investigating the tumor margins. Up to 20 min after contrast medium injection, B-flow was capable of detecting increased metastatic tumor vascularization in 42/54 (78%) of cases and intratumoral perfusion in 17/20 (85%) of HCC cases. All 19 hemangiomas were correctly classified by phase inversion imaging. Conclusions: Contrast medium-enhanced ultrasound investigation of liver tumors with Optison® allowed reliable detection of tumor foci and, in most cases, appraisal of tumor vascularization. The time available for evaluation of tumor margin vascularization was substantially longer in B-flow.
Keywords: Liver tumors, vascularization, contrast medium-enhanced ultrasound, 3D imaging
Abstract: Obesity is associated with many comorbid pathologies that lead to increased morbidity and increased mortality. Hemorheological changes in obesity are currently investigated as one of the risk factors for many comorbid pathologies. It has been found that erythrocyte hyperaggregation and a decrease in erythrocyte filterability have also been well documented in obesity patients. The aim of this study is to present preliminary results of the influence of weight reduction after vertical banded gastroplasty (VBG) on aggregation of red cells and red blood cells deformability. We studied seven patients who underwent VBG, median age 46 years (range 35–52), median BMI 52.1…kg/m2 (range 36.6–66). Blood rheology changes and selected biochemical parameters were examinated before and 6 months after VBG. Erythrocyte elongation and red blood cells (RBC) aggregation were measured using the Laser-assisted Optical Rotational Cell Analyser (LORCA). The RBC aggregation index was significantly decreased, while the aggregation half-time (t1/2 ) significantly elongated after surgery. The syllectogram amplitude did not change. No differences in RBC deformability were observed in the postoperative period. Conclusion: We could conclude that among morbidly obese patients six months after VBG some beneficial changes of erythrocyte rheological parameters are observed. Further studies are necessary to confirm our preliminary results.
Keywords: Morbid obesity, vertical banded gastroplasty, red blood cell aggregation, red blood cell deformability
Abstract: The present study was to investigate the protective effects of salvianolic acids (SA) on deformability of red blood cells (RBCs) and its mechanism during the development of acute lung injury (ALI) induced by oleic acid (OA) in rabbits. 32 rabbits were randomized into four groups, normal control group, OA-treated group (0.15 ml/kg), SA-treated group and OA+SA treated group. The blood samples were collected at 0, 10, 30, 60, 90, 120 and 180 min after OA injection. The RBC deformation index, Orientation index and small deformation index were measured by ektacytometry. The concentration of malondialdehyde (MDA) in RBCs was detected by…the assay kit. Meanwhile, the pulmonary pathological examination and the blood gas analysis were also performed. The results showed that the deformation index, orientation index and small deformation index decreased during the early phase of ALI, while the concentration of MDA in RBCs increased during the course. Pre-treatment with SA increased the deformability and orientability of RBC significantly and decreased the concentration of MDA in RBCs compared with OA group. Meanwhile, the hypoxia and pulmonary pathological damage were much improved. These results suggest that there were erythrocyte deformability changes in the early phase of ALI. SA has the protective effects on erythrocyte deformability during the development of ALI induced by OA, which might be due to its antioxidant effect. These results are valid in rabbits and in a model of ARDS, it would be interesting to see the effects of SA in patients.
Abstract: Introduction: Peritubular renal microcirculation has not been directly visualized in acute ureteral obstruction. Therefore, we used epiilluminescence intravital microscopy and an animal model for the assessment of microvascular perfusion. Materials and methods: In group 1 (n=5) the left kidney of Wistar rats was exteriorized and placed on a heatable stage for microcirculatory analysis. FITC-dextran was injected for plasma staining. Microcirculatory stability of the model was assessed by a repeated intravital microscopy at baseline, 60, and 120 minutes. In detail, the functional peritubular vessel density (FVD, total vessel length per area in cm/cm2 ), the red blood cell velocities and diameters…in/of arterioles and peritubular capillaries and the perfusion index were measured. In group 2 (n=7) the left ureter was obstructed after baseline microscopy. In a third group (n=6) the influence of the antidiuretic and vasoconstrictive peptide gastrin releasing peptide on peritubular microcirculation of the obstructed kidney was measured. Results: Repeated intravital microscopy did not induce major microcirculatory disturbances in group 1. Acute ureteral obstruction significantly decreased the index of peritubular perfusion. Moreover, FVD was found decreased at 120 minutes after a small rise at 60 minutes. Whereas blood cell velocities were not changed, arteriolar diameters were decreased after 120 minutes. GRP infusion lowered intrapelvic pressures at 60 and at 120 minutes. The transient increase of FVD (group 2) was not observed. The calculated peritubular flow remained nearly constant compared to a decrease in group 2. Histological assessment did not reveal any microscopy induced renal damage nor any differences between the groups. Conclusions: (1) The model is stable for a time period of at least 120 minutes and allows for the direct visualization of the renal peritubular vessels. (2) Peritubular microcirculation shows a significant deterioration during ureteral obstruction. (3) Infusion of GRP may be beneficial for the microcirculation of the acutely obstructed kidney.
Abstract: Objectives: The aim of this study is to clarify whether increased aggregation of red blood cells (RBCs) of multiple myeloma (MM) patients is caused by changes in plasma chemical composition or is associated with alterations in RBC properties and in addition, to suggest an approach to revert the enhanced aggregation in MM toward normal. Materials and methods: 40 blood samples of MM patients and suspensions of control RBCs in MM plasma were examined. In addition, RBC aggregation in MM blood was studied in the presence of dextrans with mean molecular weights of 9.6 and 40 kDa (D9.6 and D40). A…method based on electrical and dielectric properties of cellular suspensions was used to study RBC aggregation. In this method, a lower aggregation index demonstrates a higher aggregability. Results: The mean values of aggregation index for whole blood of healthy individuals, control cells in MM plasma and MM blood sample are 19.0, 7.2 and 3.2%, respectively. The kinetics of RBC aggregation slow down with the decrease in the fraction of MM plasma. No correlation was found between RBC aggregation and the immunoglobulin plasma level. Addition of D9.6 to MM blood reverts the enhanced aggregation toward normal. Discussion: The findings that RBC aggregation changes in the following order: MM blood > normal RBCs in MM plasma > control blood sample, suggest that surface-active plasma molecules play a role in enhanced aggregation in MM. The surface concentration of these molecules and hence RBC aggregability is reduced in the presence of dextrans due to their competitive adsorption onto RBC membrane. Because the end-to-end distance of D40 is quite comparable with the Debye length, the effect of this particular dextran on RBC aggregation is negligible.