Clinical Hemorheology and Microcirculation - Volume 41, issue 1
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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: Background: The indication of surgical treatment in lower limb compartment syndrome mostly depends on the clinical signs which can be often uncertain, resulting in delayed insufficient intervention. Aim: The aim of the study was to evaluate the progression of compartment syndrome by measuring of intracompartmental pressure and monitoring of decreased tissular oxygenation, indicating an insufficient secondary microcirculation. Materials and methods: 16 patients were examined in our study (12 males, 4 females, mean age: 62.7±9.5 years), who underwent acute lower limb revascularization surgery for a critical (lasting more than 4 hours) limb ischemia. The indications were: 5 iliac artery…embolizations and 11 femoral artery occlusions. After revascularization, on the second postoperative day, we detected significant lower limb edema and swelling of several grade. To monitor the elevated intracompartmental pressure (ICP) and to evaluate the extremital circulation, we used KODIAG pressure meter and the tissular oxygen saturation (StO2 ) was measured by near-infrared-spectroscopy. Results: In 12 cases the ICP exceeded the critical 40 mmHg. In these patients the average StO2 was 50–53%, in spite of complete recanalization. In these cases we made urgent, semi-open fasciotomy. In 4 cases, where the clinical aspect showed compartment syndrome, the measured parameters did not indicate a surgical intervention (ICP: 25–35 mmHg, StO2 : around normal). Summary: A novel approach in our examination is that, besides empirical therapeutic guidelines generally applied in clinical practice, we established an objective, parameter-based (“evidence based medicine”) surgical indication strategy for the lower limb compartment syndrome. Our parameter results produced by the above pressure and saturation measurements help the clinicians to decide between conservative and operative treatment of the disease.
Abstract: Venipuncture procedures are widely thought to influence biochemical, hematological or hemorheological measurements. In line with the preparation of the new Guidelines for the standardization of hemorheological measurement, we compared various blood rheological parameters (i.e., red blood cell deformability and aggregation indices) assessed in blood samples obtained after 5, 30, 60 and 90 s following the tourniquet removal and a blood sample obtained without applying a tourniquet (control sample). A slight but significant improvement in red blood cell (RBC) deformability after the removal of tourniquet compared to the control sample was observed. RBC deformability was maximal in the samples obtained 30…s after tourniquet removal and remained slightly higher than the control in the following samples (at 60 and 90 s after tourniquet removal). The aggregation index (AI) decreased with time after tourniquet removal reaching significantly lower values than the control at 90 s after tourniquet removal. This finding was supported by a greater half time for RBC aggregation in the samples obtained 60 and 90 s after tourniquet removal. In conclusion, this study revealed that RBC deformability and aggregation might be significantly altered in the samples obtained after the application and removal of a tourniquet, as a part of the blood sampling procedure. Recommendation “remove the tourniquet at least 5 s prior to the start of blood sampling” may need to be revised.
Keywords: Red blood cell deformability, red blood cell aggregation, methodology, venipuncture procedures, blood sampling
Abstract: The dry fruits of Hippophae rhamnoides (so-called “Saji” or “Sea buckthorn”) are used in China as a herbal medicine. The present work studied the effects on microvessels in the left ventricular wall, hematological parameters, cardiovascular performance and plasma constituents in spontaneously hypertensive stroke-prone rats (SHRSP/EZO) treated with Hippophae for 60 days. Analyses showed that the powder made of dry Hippophae fruits contains the vitamins C, B1 , B2 and E, provitamin A, rutin, serotonin, cytosterol, selenium and zinc, among other constituents. The experimental rats were fed ad libitum with blocks of rat chow supplemented with Hippophae powder at a…concentration of 0.7 g/kg in rat powder chow, while control rats were unsupplemented chow. The mean arterial blood pressure, heart rate, total plasma cholesterol, triglycerides, and glycated hemoglobin were significantly decreased by the Hippophae treatment. The arteriolar capillary portions of microvessels expressing alkaline phosphatase decreased, but there was a trend for an increase in the total capillary density. It was concluded that Hippophae fruits improved the metabolic processes accompanied by reduction of hypertensive stress on the ventricular microvessels.
Abstract: Blood viscosity is one of the most important factors determining the blood flow. In this report we describe changes in whole blood viscosity in a group of patients after stroke measured as a function of the shear rate (flow curve) and also blood visco-elastic properties measured using oscillatory methods (dynamical mechanical analysis). The principle of the latter method is based on the measurement of the amplitude and phase of the sample oscillations driven by controlled harmonic strain. All measurements were performed by means of a rotary-oscillatory rheometer Contraves LS-40.
Abstract: The subject of this study was the effect of erythropoetin (Epoetin) treatment of anemic patients (n=30) with solid tumors on parameters of hemorheological profile. Both prior to and following Epoetin treatment (10,000 units subcutaneously thrice weekly) for four weeks hemorheological measurements included plasma and red blood cell (RBC) suspension viscosity; high and low shear whole blood viscosity; hematocrit (Hct), hemoglobin, RBC aggregation (RBCA) and deformation. It was found that the patients had reduced Hb up to 92.96±2.99 g/l, and the Hct – 28.2%. These parameters were significant increased after four weeks of Epoetin treatment: Hb by 28% (p<0.01) and Hct…by 31% (p<0.01). In macrorheological part of the profile, both the high shear blood viscosity, and the low one were increased by 23 and 27% (p<0.05), respectively. These changes were mainly associated with the Hct rise. As for microrheological part of profile after Epoetin treatment, RBCA was decreased by 25% (p<0.05). While the red cell rigidity index (Tk) was lowered only slightly (by 8%). RBC incubation with Epoetin (10.0 I.E./ml) was accompanied by 10% decrease of Tk. It is important to note that before Epoetin treatment incubation with it led to decrease of RBCA by 30% (p<0.05), whereas after four week of the treatment period a 27% (p<0.05) rise of aggregation was found in majority of patients. Thus these results suggest that Epoetin is an effective, safe and convenient therapy for the management of anaemia in patients with cancer. And this drug has a moderate positive hemorheological effect on RBC and on the microrheological properties in particular. These data suggested that Epoetin has an effect on the membrane properties regulating RBC aggregation and deformation and affects by the signal transduction system, including Ca2+ -dependant signaling pathway and tyrosine kinase and phosphotase activity change.
Abstract: Increase in erythrocyte aggregation (EA) is pathognomonic for rheumatoid arthritis (RA), and its estimation through erythrocyte sedimentation rate (ESR) is part of DAS 28-4 activity diagnosis, with low correlation with EA and that does not discriminate the contribution of cell factors that increase aggregation. Objective: To analyse cell and plasma factors that might be involved in EA increase, to understand how RA affects blood components, thus modifying blood fluid behavior. Methodology: One hundred women presenting active RA were compared with age-matched controls (C). EA was measured by transmitted light, obtaining two parameters: 2k2 n0 , characterizing the aggregation…process kinetics and s0 /n0 , estimating aggregates size. Cell factors assays: erythrocyte deformability, by filtration through nucleopore membranes, cell shape, by microscopy, and membrane fluidity by EPR. Plasma: total proteins and CRP, albumin, fibrinogen (Fb), by gravimetry, and IgG and IgM by single radial immuno-diffusion. Results: AR and C (x±SE). 2k2 n0 : 31.83±2.84, 23.75±1.91; s0 /n0 : 0.92±0.05, 0.87±0.04. Rigidity index (RI): 14.79±4.71, 6.92±1.31. Morphological index: 0.28±0.03, 0.30±0.05, n.s. Fb (mg/dl): 382±80, 299±70. IgG (mg/dl): 1580±219, 1296±158; IgM (mg/dl) 233±28, 183±23; albumin (g/dl) 3.84±0.44, 3.77±0.51 n.s. p<0.05 accepted. Correlations: 2k2 n0 vs. Fb r=0.66; s0 /n0 vs. Fb r=0.51; 2k2 n0 vs. Igs r=0.65; s0 /n0 vs. Igs r=0.56. 2k2 n0 vs. RI r=−0.59; s0 /n0 vs. RI=−0.52, p<0.05. Conclusions: Plasma factors, Igs and Fb increased aggregation, since RI is altered, this reduces the process efficiency regarding aggregation. Patients with active RA present an increased EA, with values modifications associated with the activity index DAS 28-4, thus becoming an RA activity indicator.
Abstract: We investigated in patients with chronic venous insufficiency (CVI) and after compression therapy the fluxmotion within characteristic frequency bands, which were described earlier by Bračič and Stefanovska (Bull. Math. Biol. 60 (1998), 919–935). Therefore, the frequency spectra of laser Doppler flux data of the 36 patient's legs were compared with 41 legs of healthy subjects. In addition, 14 patients with CVI wore a compression stocking (interface pressure: 25–32 mmHg) or compression bandages and were measured after 4 weeks therapy. Data were analyzed by means of a Wavelet packet transformation (a combination of the Daubechies filter of order 4 and…the Haar filter). We found significant differences between the patients and the healthy subjects in the frequency intervals of myogenic 0.06–0.16 Hz, respiratory 0.16–0.6 Hz and heart activity 0.6–1.6 Hz (p<0.05, Mann–Whitney U test). Furthermore, the main energy peak height in these frequency intervals increased with the severity of venous disease and was highest in patients with venous leg ulceration. Compression therapy had a significant influence in myogenic vessel activity, which has been proved by a positive frequency shift of 20% (p=0.007, one-sided by the exact Wilcoxon test). In venous disease fluxmotion was increased. Compression therapy over a period of 4 weeks improved myogenic vessel activity.
Abstract: It is not established whether there is an association between erythrocyte aggregation and AB0 blood type, as glycophorins carry sialic acid which is responsible for the negative erythrocyte surface charge and the antigenicity for AB0 blood groups. We have determined erythrocyte aggregation by means of the Myrenne aggregometer in 114 healthy volunteers, along with plasma lipids, fibrinogen and AB0 blood groups. No differences in erythrocyte aggregation (EA0 and EA1 ) were observed when subjects with 0 (n=45) and non-0 (n=69) blood group were compared (P=0.624 and P=0.838, respectively). Fibrinogen was statistically lower in 0 group compared with non-0 group…(P=0.012). Erythrocyte aggregation (EA0 and EA1 ) correlated significantly with both lipids and fibrinogen (P<0.01). When erythrocyte aggregation was dichotomized as EA1 ≥8, no association was found with 0 and non-0 blood groups (P>0.05) but it was associated with high lipid levels: T-Chol > 220 mg/dl, TG > 175 mg/dl and high fibrinogen levels > 300 mg/dl (P=0.035; P=0.030; P=0.010, respectively). Erythrocyte aggregation does not seem to be associated with blood groups, but rather with plasma lipids and fibrinogen.
Keywords: Erythrocyte aggregability, AB0 blood groups
Abstract: Does controlled vascular training influence plasmaviscosity and the pain free walking distance in patients with peripheral arterial occlusive disease (paod) Fontaine stage II? 37 patients, 24 men and 13 women with a mean age of 64.5 years SD 8.5 took part in ambulant vascular training over a period of 12 months. Before, after 6 months and after 12 months, pain free (pfwd) and maximum walking distance (mwd) was measured using a standardized treadmill program. Also ankle-brachials systolic pressure index (a-bspi), transcutaneous oxygen tension (tcPO2) and plasmaviscosity (pv) were measured. Pfwd increased from 212 SD 143 m to…371 SD 249 m (p<0.02). TcPO2 increased during training, but without statistically significance. A-bspi increased between the first 6 months of training statistically significant. Before training pv was 1.31 mPa s SD 0.10, after training period of 6 months it was 1.27 mPa s SD 0.11 (p=0.06) and 12 months later it was 1.28 SD 0.11 mPa s (p=0.35). The improvement of pfwd and the decrease of pv correlates (r=−0.39, p=0.05). In most patients, arterial vascular training improves pfwd and mwd. Simultaneously to the increase of the walking distances plasmaviscosity decreases and crurobrachial indexes increases. We found a coupling between improvement of pfwd and pv. Pv seems to participate in improvement of leg hemodynamics in patients with paod.