Clinical Hemorheology and Microcirculation - Volume 36, 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: Haemorheological changes in response to therapy have not been fully determined in pulmonary tuberculosis patients living in developing countries. This study was aimed at monitoring haemorheological parameters in newly diagnosed pulmonary tuberculosis patients undergoing therapy. Haemorheological parameters were studied in 40 tuberculosis patients (17 males and 23 females, mean age 33.4±1.4 years, range 23–45 years) undergoing treatment and 10 newly diagnosed patients (5 males and 5 females mean age 33.0±2.1 years) along with 50 apparently healthy controls age and sex matched. There were significantly lower packed cell volume (PCV), platelet count (PC), and total white blood cell count (p<0.0001). Whole…blood viscosity (WBV), plasma viscosity (PV), erythrocyte sedimentation rate (ESR), and plasma fibrinogen (PF) were significantly higher in pulmonary tuberculosis patients than controls (p<0.0001). The packed cell volume was significantly increased by the 8th week of therapy (p<0.01), there was a significant reduction in the erythrocyte sedimentation rate from the 4th week of therapy (p<0.0001). There was no significant change in blood viscosity by the 4th week of therapy (p>0.05), while the plasma fibrinogen showed significant reduction from the 4th week of therapy till 8th week of therapy (p<0.01 and p<0.0001 respectively). We conclude that thrombocytopaenia, stasis and hyperfibrinogenemia may predispose African PTB patients to bleeding and thrombotic disorders. Haemorheological parameters may be useful indices in assessing response to therapy and drug compliance in pulmonary tuberculosis patients living in developing countries.
Abstract: The activation of the coagulation system in the course of an inflammatory reaction impairs the function of the microcirculation. By means of intravital videomicroscopy the effect of the direct thrombin inhibitor melagatran on endotoxin-induced microvascular permeability and leukocyte adhesion to microvascular endothelium of rat mesentery was evaluated. Secondly, plasma concentrations of melagatran or interleukin-6 in response to endotoxin or after treatment with melagatran respectively, were determined. Male Sprague–Dawley rats (300–400 g bw) were infused with 0.5 mg/kg lipopolysaccharide (LPS) (E. coli O55:B5) over 80 minutes. Vascular leakage was detected with FITC-marked rat serum albumin by fluorescence microscopy and evaluated by…grey value analysis with a computer assisted image processing system. Light microscopy was used to evaluate the adherence of leukocytes to the vessel wall. Two treated groups received either 0.3 or 0.6 mg/kg bw melagatran iv in addition to LPS-infusion. The observation period was 3 hours after the beginning of LPS infusion. Groups of animals not infused with LPS or solely treated with melagatran (0.3 or 0.6 mg/kg) served as controls. Infusion of LPS led to a significant increase of microvascular permeability, leukocyte adherence and thrombin-antithrombin complex plasma concentration compared to unstimulated controls. These effects were significantly reduced by melagatran at both dosage levels. Elevated plasma concentrations of melagatran were observed in animals infused with endotoxin and higher plasma levels of interleukin-6 were found in endotoxemic animals treated with melagatran. The results indicate that thrombin is one of the most important clotting enzymes involved in inflammatory microvascular disturbance. Moreover, it should be clarified whether direct thrombin inhibitors themselves play a role within the immune response to endotoxin.
Abstract: Sepsis in different states of severity (sepsis, severe sepsis, septic shock and adult respiratory distress syndrome (ARDS)) is associated with microcirculatory blood flow abnormalities leading to decreased red blood cell's (RBC's) deformability, impaired oxygen delivery to tissues and organs failure. The main goal of the present study, was to first determine the values of RBC's deformability, in the course of patients treated in an Intensive Care Unit (ICU) for basically sepsis and then deteriorated states and secondly to establish the prognostic efficiency of the test. For this purpose a filtration method and the hemorheometer, was used to determine experimentally the…RBC's deformability, by measuring the RBC's Index of Rigidity (IR). Our results indicated that the IR was significantly increased in all patient groups and it was found to be approximately 51% higher in patients with sepsis, 229% in patients with severe sepsis, 1285% in patients with septic shock and 923% in patients with ARDS than in the healthy donors. The relationships between IR and Simplified Acute Physiology Score II (SAPS) and IR and Projected Mortality (PM) were found to be IR = 2.0237(SAPS) − 58.807 (r=0.731) and IR = 1.0671(PM) − 5.9829 (r=0.726) respectively. Our findings imply a significant impairment of the membrane's deformability possibly due to changes in its structure. It seems that the RBC's deformability is a useful mechanical parameter to estimate the prognosis and monitor patients suffering from different severity levels of sepsis.
Keywords: Deformability, hemorheometer, red blood cell, sepsis, septic shock, ARDS
Abstract: The concentrations of the acute phase proteins α1 -Acid Glycoprotein (AAG) and haptoglobin were determined in Sprague-Dawley-rats after implantation of a novel biodegradable multifunctional polymeric biomaterial for the reconstruction of a gastric wall defect (polymer group; n=42). For comparison, the concentrations of AAG and haptoglobin were measured as well after primary wound closure of the gastric wall defect without biomaterial implantation (control group; n=21) and in rats without any surgical procedure (baseline group; n=21). The implantation periods were 1 week, 4 weeks and 6 months. The concentrations of AAG and haptoglobin were measured by an ELISA assay. Gastrointestinal complications like…fistula, perforation or peritonitis did not occur in any of the animals. No statistically significant differences in the concentrations of AAG and haptoglobin were detected between the polymer and the control group. An adequate mechanical stability of the polymeric biomaterial was detectable under the extreme pathophysiological conditions of the stomach milieu. In further examinations the correlation between the intraperitoneal cytokine levels of the animals and the following systemic inflammatory markers should be analysed. Further investigations are needed to analyse the mechanisms of the tissue integration of a biomaterial as well as the process of the tissue remodeling and the influence of the immune system on these mechanisms. The knowledge of these processes is necessary to adapt the multifunctional biomaterial and prepare it thus for the use and implantation in different body locations and to develop novel therapeutical options in medicine.
Abstract: Renal cancer represents accounts for approximately 3% of all adult malignancies with a rising incidence. Incidental diagnosis is mostly based upon ultrasound (US). US and Computed tomography (CT) are the standard imaging modalities for detecting renal cell cancer (RCC). Differentiation between malignant and benign renal tumors is of utmost importance. Contrast enhanced ultrasound (CUS) seems to be a promising new diagnostic option for diagnosis and preoperative treatment planning for patients with renal cancer. It is an additional examination to baseline ultrasound and CT. We report a case of a 37-year-old woman with a papillary renal cell cancer in which CUS…helped to differentiate dignity of the tumor. CUS is an additional examination to baseline ultrasound and CT. It is a less invasive technique than contrast enhanced CT and shows even slight tumor blood flow. In addition it may allow a more rapid diagnosis, because of its bedside availability.
Abstract: Exercise and lactate usually change blood rheology, particularly red blood cell (RBC) deformability. The effect of lactate on RBC aggregation is unknown. The present study tested the in vivo effects of exercise on both lactate and RBC aggregation and the in vitro effects of lactate on RBC aggregation. Thirteen well trained athletes performed a progressive and maximal exercise test during which blood was sampled at rest, at 50% of maximal exercise, and at maximal exercise. RBC aggregation was assessed with the Myrenne aggregometer which gives two indexes of RBC aggregation: “M” (aggregation during stasis after shearing at 600 s−1 )…and “M1” (facilitated aggregation at low shear rate after shearing at 600 s−1 ). A part of the resting blood sample was also reserved to test the in vitro effects of three lactate concentrations (2, 4 and 10 mM). The lactate solutions were described in a previous study (P. Connes, D. Bouix, G. Py, C. Préfaut, J. Mercier, J.F. Brun and C. Caillaud, Opposite effects of in vitro lactate on erythrocyte deformability in athletes and untrained subjects, Clin. Hemorheol. Microcirc. 31 (2004), 311–318). The results demonstrated that M and M1 were unchanged with exercise and lactate. Therefore, lactate is able to change RBC deformability but not RBC aggregation.
Abstract: This in vitro study was designed to examine changes of red cell microrheological parameters (red cell aggregation and their suspension viscosity) after cell incubation with some drugs having phosphodiesterase (PDE) inhibitory activity (pentoxifylline – 25.0 μg/ml; drotaverine – 10.0 μg/ml; vinpocetine – 5.0 μg/ml; papaverine – 10.0 μg/ml; caffeine – 25.0 μg/ml; 3-isobutyl-1-methylxanthine [IBMX] – 10.0 μg/ml). Concentrations of used drugs for in vitro red cell microrheology study were the similar with those which it could be possible in blood of patient after intravenous therapeutic infusion. Red blood cells were separated from the blood by centrifugation at 1400g for 15…min and washed 3 times with phosphate buffered saline (PBS). The washed RBCs were then resuspended in PBS at a hematocrit of approximately 40%. In each of the research sessions these RBC suspensions were divided into two aliquots and exposed to: one of the drug at 37°C for 15 min; remaining aliquot (red cell suspension with PBS) was kept at 37°C for 15 min and served as the control. It was found that all of used drugs decreased red cell aggregation and their suspension viscosity significantly. Since IBMX and vinpocetine are the specific inhibitor PDE activity it might be suppose that cellular PDE is molecular target in RBCs for this class of drugs. The obtained data reveals evidence that drugs, acting as PDE inhibitors, might be considered as microrheologically positive remedies.
Keywords: Red cell aggregation, red cell suspension viscosity, phosphodiesterase (PDE), drugs with PDE inhibitory effect
Abstract: Characteristic parameters of erythrocyte aggregation/disaggregation kinetics in blood samples of 200 healthy donors at native and standard hematocrit were studied. Average aggregation parameters for men and women at native hematocrit significantly differed, but these differences disappeared after hematocrit standardization, only maximal amplitude of aggregation (I0 ) at standard hematocrit in women was still less than in men (p<0.001). Though index of strength of largest aggregates (Ia 2.5 ) depended both on sex and age, no significant influence of IgG and IgM concentrations on this parameter was noticed. The obtained results show that suggested method can be used for diagnostics of…rheological disorders.
Abstract: Studies carried out on sheep's have suggested possible effects of hematological parameters on coronary flow reserve (CFR). However, there is no study published investigating possible effects of hematological parameters and blood viscosity on coronary haemorheology and CFR in humans. We investigated the possible effects of hematological parameters on CFR using transthoracic echocardiography. Methods: This study was conducted on 142 healthy subjects free of known cardiovascular risk factors between ages of 18–50 years. Hematological parameters were measured using an automated blood analyzer. Transthoracic echocardiographic examination including CFR measurement was performed on each subject using an Acuson Sequoia C256® Echocardiography System.…Results: The study group (142 subject) was divided into two according to the mean CFR values as the group with lower than mean CFR value and the group with upper than mean CFR value. Hematocrit (42.21±3.86 vs 40.27±3.97, P=0.004), LDL cholesterol, hsCRP values differed between the lower CFR and higher CFR groups. The other hematological parameters including hemoglobin value were similar between the two groups. hsCRP (β=−0.334, P=0.001), mitral E/A ratio (β=0.119, P=0.024), and haematocrit (β=−0.161, P=0.064) values were the independent predictors of CFR. In women's subgroup, age, hemoglobin, hematocrit, and hsCRP values tended to differ between the lower CFR and the higher CFR subgroups. In men's subgroup systolic blood pressure, hsCRP, and mitral E velocity were different between the two groups. Conclusion: In addition to the coronary endothelial and coronary microvascular functions, hematocrit and blood viscosity might have some effect on coronary haemorheology and CFR.