Clinical Hemorheology and Microcirculation - Volume 31, issue 3
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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: The hemorheological performance of mammals and human will change with the time after the blood is withdraw from the subject. The whole blood apparent viscosity, erythrocyte deformability and aggregation of some mammals and human were measured. Our results showed that the hemorheological characteristics of mice, rats, guinea pigs, dogs and human began to change respectively after the threshold time of 0.5, 1, 3, 7, 12 h when the blood were stored in vitro. Moreover there exist a relationship: t=3.18W0.32 between the threshold time (t) and the animal weight (W) and the related coefficient is 0.992.
Abstract: Both lipids and inflammation sensitive proteins have been reported to affect the aggregation of red blood cells yet their relative importance in this regard have not been determined. We have included high sensitive C‐reactive protein, erythrocyte sedimentation, fibrinogen concentrations as well as various serum lipid concentrations and the degree of erythrocyte adhesiveness/aggregation in the peripheral blood in a linear regression analysis. Partial Pearson correlation coefficients were included as well. In a group of 674 individuals with various atherosclerotic risk factors, low grade inflammation and moderately increased serum lipids, a relatively low correlation was noted between red blood cell adhesiveness/aggregation and…triglycerides concentrations. A negative correlation was noted for HDL cholesterol. None of the lipid variables turned significant in the regression analysis. In a group of individuals with atherosclerotic risk factors, low grade inflammation and moderately increased serum lipids, the degree of erythrocyte adhesiveness/aggregation in the peripheral blood correlates much better with the presence of inflammation sensitive proteins than with the presence of increased lipid concentrations.
Abstract: We report on the hemorheological profile of a 16 year old school girl in whom liver transplant was performed due to primary sclerosing cholangitis complicated by biliary stricture. This patient turned out to be of particular hemorheological interest, displaying pre‐transplant grossly increased hematocrit‐standardized (45%) blood viscosity due to hyperaggregation and elevated plasma viscosity, which is a reflection of elevated immunoglobulins (IgG, IgA and IgM) and alpha‐2‐macroglobulin. Post‐transplant values of rheological parameters were within the normal range for healthy controls.
Abstract: Endothelial dysfunction of precapillary arterioles impairs nutritional microcirculation at rest as well as during post‐ischemic reactive hyperemia. In this monocentric, prospective, double‐blind, placebo‐controlled, randomized cross‐over study we investigated the acute effect of 50 mg sildenafil, a selective PDE‐5 inhibitor, on resting and post‐ischemic capillary circulation in twenty patients with angiographically confirmed coronary artery disease not taking nitrates or NO‐donors. Mean erythrocyte velocity in digital nail‐fold capillaries was determined before and after sildenafil and placebo, both baseline and after a three‐minutes supra‐systolic occlusion of the upper arm. Primary efficacy parameter was the drug effect on peak velocity during reactive hyperemia (peak…velocity: Vmax ). Post ischemic maximal capillary erythrocyte velocity Vmax significantly increased by 47% one hour after 50 mg sildenafil (mean value±standard deviation: 0.85±0.42 mm/s vs. 0.58±0.18 mm/s at baseline, p=0.0023), whereas placebo had no effect (p=0.5248). The difference between sildenafil and placebo was significant (p=0.0129) and sildenafil's effect can be regarded as biometrically highly relevant with standardized difference according to Cohen of 0.81. In spite a small decrease of both systolic and diastolic blood pressure after sildenafil, sildenafil significantly increased capillary erythrocyte velocity at rest. Conclusion: A single oral dose of sildenafil significantly increased resting and post‐ischemic cutaneous capillary circulation in patients with coronary artery disease. Future studies should assess whether sildenafil also improves nutritional capillary blood flow in other organs and in other diseases with impaired endothelial function and microcirculation, for example in diabetic microangiopathy.
Abstract: In the Aachen study the prevalence of arterial disease was established in 346 out of a cohort of 2821 subjects between 45 and 65 years of age. Rheological variables and risk factor profile for patients with peripheral occlusive arterial disease (POAD), coronary heart disease (CHD) and cerebrovascular insufficiency (CI) in comparison to a control group are given. Significantly elevated are hematocrit in males, plasma viscosity, erythrocyte aggregation and fibrinogen. It is evident that plasma viscosity is the rheological parameter most often elevated in patients with arterial disease (70.8%). In patients with CI (80.6%) plasma viscosity is elevated about four times…more often than in healthy subjects. While 85.8% of healthy volunteers show no or only one elevated rheological parameter only 44.5% of the patients have this constellation. Risk factors are bundled in patients compared to healthy volunteers. 84.2% of the healthy volunteers have no or only one risk factor whereas patients with OAD show this constellation in only 30.9% (32.4% in POAD, 16.1% in CI and 32.4% in CHD).
Keywords: Occlusive arterial disease, blood fluidity, Aachen study
Abstract: Due to the previously therapeutic failure in treating eleven focal segmental glomerulosis (FSGS) nephrotic patients (group I) with prednisolone, cyclophosphamide and antihypertensive agents (reserpine, hydralazine or prazosin) who all entered end‐stage renal disease, we prospectively evaluate 18 FSGS nephrotic patients who have been treated with combined formula consisting of ACEI, AIIRA, CCB, antiplatelet±heparin; group II. All the patients were subject to renal function studies namely creatinine clearance, fractional excretion of magnesium (FE Mg) and intrarenal hemodynamics. Treatment outcome of patients in group II was comparatively assessed before and after therapy. Clinical profiles were comparatively matched between groups I and II.…The intrarenal hemodynamic study in all nephrotic patients revealed hemodynamic maladjustment characterized by preferential constriction at the efferent arteriole. Such constriction induced intraglomerular hypertension and exaggeratedly reduced peritubular capillary flow (PTCF). Following treatment with combined formula (group II), reductions in efferent arteriolar resistance and intraglomerular hydrostatic pressure were observed in conjunction with the increases in PTCF and glomerular filtration rate in all 18 patients. Correction of hemodynamic maladjustment with combined formula effectively restores renal function and thereby prevents the renal disease progression in FSGS nephrosis.
Abstract: Plasma proteins and lipid profile influence whole blood fluidity through changes in plasma viscosity, red cell aggregability and deformation. In diseases like Cushing syndrome (CS) and diabetes mellitus (DM) plasma concentrations of fibrinogen, cholesterol, and triglycerides are increased, and, thus, blood rheology might be affected. Our aim was to determine parameters of blood fluidity in 26 dogs with spontaneous CS and DM. Ten dogs (CS) and 16 dogs (DM) showed typical signs of the respective disease, and their blood was tested for whole blood viscosity (WBV, at 37°C, LS30, Contraves, Zurich, Switzerland) at two shear rates (WBV0.7 s−1 ; WBV94 s−1…), erythrocyte aggregation (AI, LS30), and plasma viscosity (PV, at 21°C, OCR‐D, Paar, Graz, Austria). Plasma fibrinogen, cholesterol, and triglyceride concentration was increased in both groups of patients, plasma total protein was elevated only in dogs with DM. Plasma viscosity and erythrocyte aggregation was increased markedly in all dogs, however, WBV0.7 s−1 was increased only in dogs with DM, whereas dogs with CS showed a decrease in WBV0.7 s−1 despite the rise in fibrinogen and erythrocyte aggregation. Hypertension and microvascular complications have been demonstrated in patients with CS and DM. These effects are multifactorial, and it seems possible that changes in blood rheology contribute to these disturbances.
Abstract: Platelet–leukocyte conjugates are increased in cardiovascular disease, but exercise is also able to trigger platelet–leukocyte formation in healthy subjects. The aim was to investigate the heterogeneity of platelet–leukocyte conjugate formations triggered by short term exercise. 18 healthy non‐smokers underwent a 90 second maximal test on a SRM™ cycle ergometry system and a control experiment. Blood samples were taken after 30 min rest, immediately before and after, 15 min and 1 h after exercise. The different platelet–leukocyte conjugates were detected by flow cytometry via CD45, CD14, CD16, CD41, together with CD62P antibodies for the investigation of platelet activation in the conjugates.…In addition, a stimulation of conjugate formation in vitro with 8 μM TRAP‐6 was initiated. Immediately after exercise platelet–granulocyte (+24%), and –lymphocyte (+17%) conjugates were increased (p<0.01), while the platelet–monocyte conjugates (+40%) were enhanced (p<0.05) 15 min after exercise. The differentiation after stimulation showed that the regular (CD14+ 16− ; +32%) and mature (CD14+ 16+ ; +35%) monocytes were both increased after exercise (p<0.01) but the regular monocytes were preferred (p<0.001) in platelet–monocyte conjugate formation. In addition, these conjugates revealed the highest CD62P expression. Maximal short term exercise is useful for the investigation of platelet–leukocyte formation; e.g., it could be shown, that regular monocytes may be preferred in conjugate formation and that these conjugates revealed the highest CD62P expression.
Abstract: PGE1 or PGI2 acutely increase total skin perfusion in healthy volunteers. This study investigated whether skin nutritive perfusion and capillary pressure were increased by acute infusion of PGE1 . In a double blind randomised placebo controlled study the effect of Alprostadil (PGE1 , Prostavasin® , intra‐venous, infusion rate: 0.38 μg/h/kg,) on skin nailfold capillary blood pressure (CP) and capillary red blood cell velocity (CBV) was investigated in 16 healthy volunteers (placebo: 5 male, 3 female, age: 27.7, range: 22–29 years; Alprostadil: 5 m, 3 f, age 27.1, 22–38 y), using the electrical impedance servo nulling technique and…spatial shift alignment method, respectively. Initial finger tip temperature, systemic blood pressure, heart rate, CP, capillary pulse pressure amplitude (CPPA) and CBV showed no significant differences between the two groups (placebo: 23.6±3.0°C, 123±13/83±5 mmHg, 63±11 beats/min, 15.6±3.9 mmHg, 1.5±1.8 mmHg, and 425 μm/s (290–800); Alprostadil: 23.4±2.7°C, 121±9/82±10 mmHg, 65±9 beats/min, 14.4±3.7 mmHg, 1.8±1.3 mmHg, and 680 (140–1090 μm/s)). Twenty minute infusion with either Alprostadil or placebo had no significant effect on any of the parameters measured. Thus, in healthy volunteers, skin capillary blood pressure, capillary pulse pressure amplitude and capillary blood velocity are unaltered by acute administration of PGE1 at ambient temperatures.
Abstract: Glucose‐6‐phosphate dehydrogenase (G6PD) activity, red blood cell (RBC) lipid peroxidation and deformability were investigated in hemizygous and heterozygous G6PD deficient subjects and compared with normal individuals. None of the subjects were in acute hemolytic crises. G6PD activity was assessed based on the spectrophotometric determination of generated NADPH. Lipid peroxidation was measured as thiobarbutiric acid reactive substances (TBARS). RBC deformability was analyzed by ektacytometry. RBC lipid peroxidation was found to be significantly higher in hemizygous subjects compared to control and heterozygous subjects, while RBC deformability was found to be significantly impaired. However, although lipid peroxidation was higher than control, RBC deformability…was not significantly different from control in heterozygous individuals, characterized by significantly lower RBC G6PD activity. There were no significant correlations between these three parameters when the three groups were analyzed separately, but a significant negative correlation was found to exist between G6PD activity and TBARS when the pooled data from the three groups were used for the analysis. This was also true for the relationship between RBC deformability and G6PD activity. It has been concluded that G6PD activity is not a good predictor of oxidative damage resulting in mechanical impairment in heterozygous individuals.