Clinical Hemorheology and Microcirculation - Volume Preprint, issue Preprint
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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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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: Duchenne muscular dystrophy (DMD) consists of a lack in the expression of the subsarcolemmal protein dystrophin causing progressive muscle dysfunction. Among the widely applied animal models in DMD research is the C57BL/1010ScSn-Dmdmdx mouse, commonly referred to as the “mdx mouse”. The potential benefit of novel interventions in this model is often assessed by variables such as functional improvement, histological changes, and creatine kinase (CK) serum levels as an indicator for the extent of in situ muscle damage. OBJECTIVE: Our objective was to determine to what extent the serum CK-level serves a surrogate for muscle dysfunction. METHODS:…In this trial mdx mice were subjected to a four-limb wire-hanging test (WHT) to assess the physical performance as a reference for muscle function. As CK is a component of the muscle fiber cytosol, its serum activity is supposed to positively correlate with progressing muscle damage. Hence serum CK levels were measured to detect the degree of muscle impairment. The functional tests and the serum CK levels were analyzed for their specific correlation. RESULTS: Although physical performance decreased during the course of the experiment, latency to fall times in the WHT did not correlate with the CK level in mdx mice. CONCLUSION: Our data suggests that the serum CK activity might be a critical parameter to monitor the progression of muscle impairment in mdx mice. Further this study emphasizes the complexity of the DMD phenotype in the mdx mouse, and the care with which isolated parameters in this model should be interpreted.
Keywords: Duchenne muscular dystrophy, mdx mouse, muscle impairment, CK level, diagnostic methods, serum biomarker for muscle imparment
Abstract: BACKGROUND: In recent years, new measures of body adiposity have been introduced: lipid accumulation product (LAP), body adiposity index (BAI) and body shape index (ABSI). These indices have been demonstrated to better associate with cardiovascular disease than other measures of adiposity. OBJECTIVES: The aim of the present study was to evaluate if LAP or BAI better associate with blood viscosity than other measures of adiposity (body mass index, BMI; waist circumference, WC; waist-to-hip ratio, W/HR; waist-to-height ratio, W/HtR). METHODS: 344 subjects were recruited for the present investigation. Exclusion criteria were: diabetes, elevated triglycerides, smoking and…drug use. Blood lipids and glucose were measured by routine methods. Blood and plasma viscosity were measured by a cone-plate viscometer. Adiposity measures were computed as previously described. RESULTS: In simple correlation analyses, blood viscosity (BV) correlated with BMI, BAI, and LAP in males and with LAP in females. Correlations between plasma viscosity and adiposity indices were weak and not statistically significant. Other variables significantly related with BV were: gender, HDL- and LDL-Cholesterol, and triglycerides (p < 0.05). In multiple regression analysis only LAP was associated with BV. CONCLUSIONS: Our data suggest that LAP index is strongly associated to blood viscosity. This result, along with previous evidence, identifies LAP index as a potential cardiovascular risk marker.
Abstract: Growing evidence has shown that acute exercise impairs erythrocyte membrane structure and function as a consequence of increased physical and chemical stress. Erythrocyte-synthesized nitric oxide (NO) is known to modulate membrane fluidity, and its bioavailability depends on the balance between its production and scavenging by reactive oxygen species. Here, we investigated whether a maximal exercise test could affect erythrocyte NO bioavailability and oxidative stress. Twelve men (26±4 years old, V ̇ O2peak 44.1±4.3 mL·kg–1 ·min–1 ) performed a treadmill maximal cardiopulmonary exercise test. Blood was collected at rest and immediately after exercise for erythrocytes isolation. Maximal exercise caused an increase in…erythrocytes count, haemoglobin and haematocrit levels. There was no change in L-arginine influx into erythrocytes after exercise. Yet, nitric oxide synthase activity, and thus, NO production, was increased after maximal test, as well cyclic GMP levels. In relation to biomarkers of oxidative stress, maximal test resulted in increased levels of lipid peroxidation, and diminished superoxide dismutase activity. Neither glutathione peroxidase nor catalase activity was affected by maximal test. Our findings demonstrate that the increased erythrocyte membrane rigidity caused by an acute bout of exercise may be caused, in part, by an increased lipid oxidative damage caused by ROS produced exogenously.
Abstract: OBJECTIVE: The purpose of this study was to comparatively evaluate the two different shear wave speed (SWS) imaging systems of Toshiba shear wave elastography (T-SWE) and SuperSonic SWE (S-SWE) in distinguishing malignant from benign thyroid nodules (TNs). MATERIALS AND METHODS: 140 patients with 140 focal TNs were enrolled and underwent T-SWE and S-SWE before fine-needle aspiration (FNA) biopsy or surgery. SWE indices of mean, standard deviation and maximum values (E- mean, E- SD and E- max) of elastic modulus in TNs were measured on a color-coded mapping. The receiver operating characteristic (ROC) curve was performed to assess…the diagnostic performance. RESULTS: Of the 140 nodules, 47 were thyroid carcinomas and 93 were benign. Areas under the receiver operating characteristic curve (AUC) were the highest with E- max among the three SWE parameters both for T-SWE and S-SWE (0.816 and 0.799). The most accurate cut-off values, sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were 26.6 kPa versus 42.9 kPa, 83.0% versus 63.8%, 68.8% versus 88.2, 72.9% versus 80.0%, 56.5% versus 73.2% and 88.7% versus 82.8% with E- max for T-SWE and S-SWE, respectively. Among these comparisons, the sensitivity in T-SWE was statistically higher than S-SWE (83.0% versus 63.8%, p = 0.022), whereas specificity was statistically lower than S-SWE (68.8% versus 88.2%, p < 0.001). CONCLUSION: T-SWE is equal to S-SWE with comparable and promising results for diagnosis of TNs. In clinical using, the selection of E- max should be recommended both for T-SWE and S-SWE.
Abstract: BACKGROUND: Red blood cell (RBC) aggregation influences blood flow properties, impacts blood microcirculation and consequently oxygen delivery. Different methods are established to determine RBC aggregation: under static conditions (i.e. the RBC adhesiveness/aggregation test (EAAT)) or under shear conditions (i.e. the laser-assisted optical rotational cell analyzer (LORCA)). OBJECTIVE: Comparison of these two different methods in detecting the RBC aggregation of patients with coronary artery disease (CAD) and of healthy controls. METHODS: RBC aggregation was quantified in peripheral venous blood of patients with CAD and healthy controls using EAAT and LORCA. RESULTS: Both methods detected…an increased RBC aggregation in patients with CAD compared to the healthy control group: the ratio of clot-free area to whole area (rCFA) detected with EAAT (15.65 vs. 11.30%), and aggregation index (66.33 vs. 53.90%), shear rate of disaggregation (SDA) (105.59 vs. 69.21 s–1 ), and upstroke/ttop (0.03 vs. 0.02 au/s) detected with LORCA device were increased, aggregation half time (detected with LORCA) was decreased (2.11 vs. 3.60 s). rCFA (EAAT) correlated with SDA (LORCA). CONCLUSIONS: Both methods determine an increased RBC aggregation in patients with CAD. However, only one measurement parameter of the LORCA seems to reflect the same RBC aggregation properties as the EAAT.
Keywords: Coronary artery disease, measurement devices, red blood cell aggregation
Abstract: AIM: The purpose of this study was the application of a second derivative near infrared spectrophotometric (NIRS) technique to the human calf muscle in order to see if peripheral arterial disease (PAD) patients can be discriminated from control subjects, before, during and after a standard treadmill exercise test. METHODS: Three groups of human subjects were studied: group A consisted of 10 control subjects and groups B and C were formed by PAD patients classified as Fontaine’s stage 2a (5 patients) and 2b (10 patients), respectively. The measurement protocol for all groups was 9.75 minutes of standing up…(phase 1), 1 minute of exercise (phase 2) and 1 minute of rest (phase 3). Seven variables were defined at different times from the onset of the measurement protocol. RESULTS: All variables were significantly higher (p < 0.05) in group A in comparison to groups B and C. The level of significance was ten times higher (p < 0.005) at the onset (15 seconds) of the experiment and during phases 2 and 3. However, none of the variables in group B was significantly different from those in group C. CONCLUSIONS: It is shown for the first time that a second derivative NIRS technique can discriminate (p = 0.003) healthy subjects from PAD patients, in just 15 seconds of standing, with no exercise requirement. More experiments are required in order to uncover the full potential of the technique in the diagnosis of the PAD.
Keywords: Near infrared spectrophotometry (NIRS), second derivative, humans, calf muscle, peripheral arterial disease (PAD), claudication
Abstract: OBJECTIVE: To assess the factors associated with initial incomplete ablation (ICA) after radiofrequency ablation for benign thyroid nodules (BTNs). MATERIALS AND METHODS: 69 BTNs (mean volume 6.35±5.66 ml, range 1.00–25.04 ml) confirmed by fine-needle aspiration cytology (FNAC) in fifty-four patients were treated with ultrasound-guided percutaneous radiofrequency ablation (RFA) and the local treatment efficacy was immediately assessed by intra-procedural contrast-enhanced ultrasound (CEUS). The RFA was performed with a bipolar electrode (CelonProSurge 150–T20, output power: 20 W). CEUS was performed with a second generation contrast agent under low acoustic power (i.e. coded phase inversion, CPI). Characteristics of clinical factors, findings on conventional…gray-scale ultrasound, color-Doppler ultrasound, and CEUS were evaluated preoperatively. Factors associated with initial ICA and initial ICA patterns on CEUS were assessed. Volume reduction ratios (VRRs) of ICA nodules were compared with those with complete ablation (CA). RESULTS: The RFA procedures were accomplished with a mean ablation time and mean total energy deposition of 11.13±3.39 min (range, 5.38–22.13 min) and 12612±4466 J (range, 6310–26130 J) respectively. CEUS detected initial ICA in 21 of 69 (30.8%) BTNs and 16 (76.2%) of the 21 BTNs with initial ICA achieved CA after additional RFA, leading to a final CA rate of 92.8% (64/69). The factors associated with initial ICA were predominantly solid nodule, nodule close to danger triangle area, nodule close to carotid artery, and peripheral blood flow on color-Doppler ultrasound (all P < 0.05). The mean VRRs of all BTNs were 23.4%, 54.4%, 81.9% at the 1-, 3- and 6-month follow-up, respectively. All BTNs achieved therapeutic success in this series in that all had VRRs of >50% at the 6-month follow-up, among which 7 nodules (10.1%) had VRRs of >90%. There were significant differences in VRRs between ICA nodules and CA nodules at the 3- and 6-month follow-up (all P < 0.05). CONCLUSION: The factors associated with initial ICA after RFA for BTNs were predominantly solid nodules, nodule close to danger triangle area, nodule close to carotid artery, and peripheral blood flow on color-Doppler ultrasound. CEUS assists quick treatment response evaluation and facilitate subsequent additional RFA and final CA of the nodules. Nodules with CA achieve a better outcome in terms of VRR in comparison with those with ICA.
Abstract: We evaluated blood flow parameters in the cutaneous with the help of high-frequency ultrasound Doppler flowmetry (UDF) and laser Doppler fluxmetry (LDF) after submaximal physical exercises on cycloergometer. During investigation by means of UDF medium linear speed of blood flow was estimated in absolute values (Vam) in cm/s. The level of perfusion in the volume of tissue in a unit of time was registered in perfusion units (PU) with the help of LDF. Comparison of values of Vam and PU was made every 20 s during recovery period of every patient. Three types of blood flow reaction to physical exercises in…the system of microcirculation were recorded during investigation: blood flow with occasional paroxysm, pulsatile blood flow and shunting blood flow. In the first type of reaction time of registration and direction of changes of Vam and PU values coincided in 77.7%. Degree of manifestation of these changes demonstrated high correlation (r = 0.77; p = 0.000032). In the second type was 85.0%, degree of manifestation showed moderate correlation (r = 0.66; p = 0.001495). In the third type correlation was moderate too (r = 0.53, p = 0.00235). In the process of investigation a good comparability of results received during UDF and LDF methods.
Keywords: System of microcirculation, high-frequency Doppler sonography, ultrasound Doppler flowmetry, laser Doppler fluxmetry, physical exercise
Abstract: BACKGROUND: Little is known about the effect of mean arterial blood pressure (MAP) augmentation on the microcirculation in cardiogenic-shock patients with peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) support. We investigated the effect of increasing MAP on the microcirculation in cardiogenic-shock patients with ECMO support. METHODS: A single-center prospective observational study under taken in ICU patients undergoing ECMO support for post-cardiotomy cardiogenic shock was carried out. Patients with MAP <60 mmHg treated with ECMO support were the study cohort. Inotropic and vasopressor agents (dopamine, dobutamine, norepinephrine or epinephrine) were administered to maintain the MAP at 60–90 mmHg. Hemodynamic and…microcirculatory data were obtained at a baseline MAP of <60 mmHg and 1 h after target MAP was reached. As parameters of microcirculation, we measured thenar eminence tissue oxygenation (StO2 ) and its change during the vessel obstruction test and cerebral tissue oxygenation (rSO2 ) with near-infrared spectroscopy. RESULTS: Seventeen patients were enrolled in the study. MAP of all patients increased and reached predefined therapeutic targets (52 [50–54.5] vs.74 [70–78.5] mmHg; p < 0.001). To obtain these targets, doses of inotropic agents were increased (inotrope score increased from 14 [15.5–28] μg/kg/min; p < 0.001). No obvious changes were observed in thenarmuscleStO2 and cerebral rSO2 . Thenar muscle StO2 desaturation slope and resaturation slopes during the vessel obstruction test were also unchanged. CONCLUSIONS: Increasing MAP from <60 mmHg to 60–90 mmHg did not affect microcirculation variables in cardiogenic-shock patients with ECMO support.
Abstract: AIMS: We studied the new anti-inflammatory effects of non-specific phosphodiesterase (PDE) inhibitor pentoxifylline (PTX) on ischaemia-reperfusion injury and postconditioning of the lower extremities. We aimed to examine the oxidative stress parameters (OSP), the inflammatory response and the changes in structure of skeletal muscle after revascularization surgery. METHODS: 50 Wistar rats in five groups underwent a 60 min infrarenal aortic cross clamping. After the ischaemia in IR+PC group ischemic postconditioning was performed, intermittent 15 seconds reperfusion, 15 seconds ischaemic periods were applied four times. The ischemic phase was followed by a 120 min of reperfusion. In IR+PTX group the animals…were treated with PTX. In IR+PC+PTX group both ischemic postconditioning and PTX treatment were performed. Blood samples and biopsy from quadriceps muscle were collected. Plasma malondialdehyde, reduced glutathione, -SH-groups, TNF-alpha, IL-6 concentrations and superoxide dismutase enzyme activity were measured. RESULTS: The levels of OSP and the inflammatory proteins were significantly higher in the IR group. PTX treatment and PC could significantly decrease the levels of OSP and inflammatory proteins. When the animals were co-treated with PTX and PC the results were even better. CONCLUSIONS: Inhibition of PDE by PTX could markedly decrease the inflammatory response and moderate the ischaemia-reperfusion damages after lower limb ischemia and reperfusion. Administration of PTX could potentiate the beneficial effects of PC.