Clinical Hemorheology and Microcirculation - Volume 40, 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.
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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: A sufficient oxygen supply in skin grafts requires a functioning microcirculation. Venous occlusion impairs the microcirculation and is therefore a major threat of healing. Luminescence life time imaging (LLI) enables the non-invasive and two-dimensional assessment of the transcutaneous oxygen partial pressure (ptc O2 ). In the current trial this new device was applied for monitoring of venous congestion. A tourniquet on the upper arm was inflated up to 40–50 mmHg and released after 10 min in eight healthy volunteers. The ptc O2 was measured at the lower arm every minute prior to, during and up to 10 min…after cuff occlusion (40°C applied skin temperature) using LLI of platinum(II)-octaethyl-porphyrin immobilized in a polystyrene matrix. For validation the polarographic Clark electrode technique was applied in close proximity and measurement was performed simultaneously. ptc O2 measurements prior to (Clark: 50.68±5.69 mmHg vs. LLI: 50.89±4.96 mmHg) and at the end of the venous congestion (Clark: 16.41±4.54 mmHg vs. LLI: 23.82±3.23 mmHg) did not differ significantly using the Clark electrode vs. LLI. At the initial congestion respectively reperfusion phase the Clark electrode measured faster decreases respectively increase of ptc O2 due to oxygen consumption of this method. This experimental trial demonstrates the applicability of LLI to quantify the ptc O2 under changing venous blood flow. The use of planar transparent sensors allows the non-invasive generation of two-dimensional maps of surface pO2 what makes this method particular suitable for monitoring of skin grafts.
Keywords: Transcutaneous pO_2, luminescence life time imaging, Clark electrode
Abstract: Alpha macroglobulins (AM) are plasma proteins whose main function is to inactivate proteinases, protecting the tissues from the action of these enzymes. AM have influence on plasma viscosity (PV) and binds monofluorophosphate (MFP), which disturbs its homeostasis. The aim of this work was to evaluate whether the administration with MFP could modify blood viscosity. AM levels (μmol/l), PV (mPa·s), viscosity of red blood cells suspensions in NaCl 9 g/l (VES) and in autologue plasma (VEP) were measured in fifty-day old rats after a single dose of 80 μmol MFP or after 30 days of treatment with 80 μmol of MFP.…Relative viscosity (RV) was calculated as the ratio VEP/PV. AM and PV increased significantly after 30 min of an oral dose of MFP. Controls (n=6), AM: 19.65±0.85, PV: 1.39±0.01, treated (n=6), AM: 22.88±0.75 (p<0.05), PV: 1.76±0.14 (p<0.05). After 30 days of treatment with MFP, AM and PV increased significantly. Controls (n=6), AM: 10.76±1.33, PV: 1.19±0.04, treated (n=6), AM: 17.66±1.27 (p<0.05), PV: 1.38±0.03 (p<0.05). The treatment with MFP modifies neither the VEP nor the RV. These results would indicate that AM and/or MFP did not interact with erythrocyte membrane and did not modify erythrocyte deformability.
Abstract: Purpose: The purpose of this study was to compare color coded duplex sonography (CCDS), contrast-enhanced ultrasound (CEUS) and multislice computed tomography (MS-CT) angiography in pathological aortic lesions. Material and methods: 36 patients with a mean age of 71 years (range 51–87 yrs) with known or suspected treated and untreated aortic lesions detected by CTA were included in this prospective study. Standardized MS-CTA using a 16 or 64 row scanner (Somatom Sensation 16 or 64, Siemens Medical Systems, Forchheim, Germany) served as reference standard. The patients were examined with CCDS and CEUS (Logiq 9, General Electrics, Milwaukee, WI) using the…low MI technique with intravenous injection of 1.6–2.4 ml SonoVue (Bracco, Italy). Contrast enhanced ultrasound was performed in the arterial, venous and late venous phase. Results: In all patients CEUS resulted in a relevant diagnosis of an aortic pathology. In total, two covered ruptures, nine aortic dissections and five aortic aneurysms were detected. In the routine follow-up of 20 patients following endovascular repair (EVAR) of abdominal aortic aneurysm (AAA), one type 3 and three type 2 endoleaks after y-stent graft were detected. For presurgical planning, in addition to the perfused true and false lumen after dissection the perfusion of the renal arteries was examined. Conclusion: CEUS with SonoVue allows the evaluation of aortic lesions. It is an additional examination to CTA. It may allow a more rapid and noninvasive diagnosis, especially in critical patients from intensive care units because of its bedside availability. As the examination is dynamic, additional information about blood flow in the true and false lumen and about renal perfusion after dissections can be evaluated. Especially in patients with contraindications to CT contrast agents (e.g. due to renal failure or severe allergy), CEUS provides a good alternative to MS-CT.
Abstract: The lipoprotein lipase deficient (LPL–/–) mice and high fat-diet (HFD) induced hypertriglyceridemic mice were used to investigate the effects of cardiotonic pill (CP) on RBC rheologic abnormalities. Mice were randomly divided into the following five groups: the control group; the untreated HFD group; the untreated LPL–/– group; the treated HFD group; and the treated LPL–/– group, and the treated HFD and LPL–/– mice were administered with CP twice a day (400 mg/kg/day) orally for four weeks. Then, plasma triglyceride (TG), RBC deformation index (DI), orientation index (DI)or and RBC electrophoretic time (EPT) were measured. Compared with the untreated HFD…mice, TG level and EPT reduced and DI and (DI)or increased markedly in the treated HFD mice (P<0.05). However, compared with the untreated LPL–/– mice, these parameters in the treated LPL–/– mice had no statistically significant changes (P>0.05). Our data show that CP can lower plasma TG level and ameliorate RBC rheologic abnormalities in the HFD-induced hypertriglyceridemic mice, but it losses its capacity in the LPL deficient animals. The results indicate that LPL may be one of the important targets for CP regulating lipometabolism and rheologic abnormalities.
Abstract: There are conflicting results regarding the erythrocyte membrane cholesterol and phospholipid content in patients with primary hypercholesterolemia (PHC), due to methodological problems in obtaining haemoglobin-free ghosts. At the same time, the different units used and the fact that the cholesterol and phospholipids are not expressed in relation with integral protein membrane content, produces contradictory results. We have analysed in 33 patients with PHC (12 male, 31 female) aged 43±12 years and in 33 healthy normolipaemic volunteers (9 male, 24 female) aged 43±13 years plasma lipids, along with, erythrocyte membrane cholesterol, phospholipids and integral proteins. PHC patients showed increased erythrocyte membrane…cholesterol: 0.36±0.15 mg/mg when compared with controls: 0.29±0.75 mg/mg; p=0.018. Phospholipid membrane content, although higher in the cases, did not reach statistical significance (PHC patients: 0.38±0.15 mg/mg vs. 0.33±0.72 mg/mg; p=0.098). The cholesterol/phospholipids ratio (Chol/Ph) was 0.99±0.22 in PHC patients versus 0.92±0.28 in controls; p=0.127. Our results suggest that there is a slight increase in erythrocyte membrane cholesterol in patients with PHC. Given the increasing importance of erythrocyte membrane cholesterol in the stability of the atheroma plaque due its possible contribution to the clinical signs of ischaemic heart disease, it seems relevant to determine this parameter in risk populations. Therefore, a simple and reproducible method needs to be standardised which would enable comparisons between laboratories and facilitate further studies aimed to it as a marker of acute coronary syndromes.
Abstract: In our present study we investigated the association between platelet aggregation in patients treated with the most widely used antiplatelet agents (100 and 300–325 mg acetylsalicylic acid (ASA), 75 mg clopidogrel, 500 mg ticlopidine and the combination of 100 mg aspirin and 75 mg clopidogrel), fibrinogen levels and aging. Between 2001 and 2005 we measured in vitro platelet aggregation in 5026 vascular patients according to the method of Born. Platelet aggregation was tested with 5 and 10 μM adenosine-diphosphate, 2 μg/ml collagen and 10 μM epinephrine stimulants. Fibrinogen level was simultaneously measured in a subgroup of 3243 patients. The subjects…were divided by age into decades. Platelet aggregation increased significantly with advancing age in the case of 100 and 300–325 mg ASA-treated patients (p<0.001). In aspirin-treated patients also fibrinogen levels increased with aging (p<0.001). There was no association between platelet aggregation or fibrinogen levels and aging either in patients treated with 75 mg clopidogrel or with 500 mg ticlopidine. Thienopyridine-treated patients exhibited significantly lower fibrinogen levels than ASA-treated individuals (p<0.001). Our results suggest that advancing age is associated with elevated platelet aggregability in widely used antiplatelet regimens that might contribute to higher risk of cardiovascular events in the elderly.
Abstract: Sickle cell disease is characterized by altered blood rheology due to a reduced haematocrit and a resulting lowered viscosity. Oxygen carriage, and consequently oxygen delivery, may be deleteriously affected if the haematocrit reduction is such as to limit oxygen uptake from the lungs and delivery to the tissues. The present study seeks to determine and compare the oxygen delivery index (ODI) in subjects with normal and abnormal haemoglobin genotypes. Thirty four apparently healthy subjects having normal haemoglobin genotype (AA), 27 with sickle cell trait (AS) and 50 with homozygous sickle cell disease (SS) were recruited into the study. Whole blood…viscosity was measured at low and high shear rates of 23 s−1 and 230 s−1 , respectively, using a Wells Brookfield Cone and Plate Viscometer. Haematocrit was determined using an AC.Tron Coulter Counter. The oxygen delivery index was calculated as the ratio of the haematocrit to whole blood viscosity. There was a statistically significant difference in the ODI in the SS group compared with both the AA and AS groups. There was no statistical significance in the ODI between the AA and AS groups. The ODI may be considered as a useful assessment of oxygen delivery in subjects with sickle cell disease.
Abstract: Extracorporeal membrane oxygenation (ECMO) provides pulmonary and circulatory support in critically ill patients (Cardiopulmonary Resuscitation, Acute Respiratory Distress Syndrome, or low output syndrome). Hemodynamic parameters are used for evaluation of the macrocirculation, while the microcirculation is monitored by blood-lactate as a surrogate parameter. We evaluated the microcirculation by orthogonal polarization spectral imaging in a patient during ECMO support. This method was initially proposed to quantify changes of microcirculation in patients with septic shock. However, we were able to non-invasively monitor microcirculatory changes at the bedside during temporary intentional arrest of ECMO due to an exchange of the oxygenator. Using a…computerized analyzation model, the flow after ECMO stop in vessels (10–100 μm) in the sublingual mucosa was acutely absent or intermittent, respectively. 120 s after restart, microflow was improved with new ECMO settings compared to baseline, while macrocirculation with a mean arterial pressure of 75 mmHg was present after 60 s. The application of orthogonal polarization spectral imaging might be a valuable technique for evaluation of the microcirculation during extracorporeal circulation. It is rapidly implementable, can be used in vivo, and no invasive probes are required. A supplementary movie is available at: http://www2.uni-jena.de/kim3/seiten/microcirc/.
Keywords: Microcirculation, ECMO, OPS, intensive care, rheology
Abstract: Irradiation has been shown to induce biochemical changes in stored red blood cells (RBCs) and to generate reactive oxygen species (ROS). This study evaluated the hemorheological properties, the degree of lipid peroxidation and the oxidative susceptibility of irradiated RBCs. Furthermore, we investigated the radioprotective role of N-t-butyl hydroxylamine (NtBHA) against gamma-ray exposure of RBCs. RBC concentrates were irradiated with a minimum dose of 25 Gy, and were exposed to FeSO4 to examine the oxidative susceptibility. RBC deformability was evaluated by the use of a microfluidic ektacytometer, in relation to the hematological and biochemical properties. The deformability of the irradiated…RBCs was significantly lower than that of control. Exposure to gamma rays significantly increased the mean corpuscular volume (MCV) and lipid peroxidation. Changes in RBC deformability were more prominent in irradiated RBCs than in non-irradiated RBCs also under conditions of oxidative stress. The deformability of NtBHA treated RBCs prior to irradiation was not altered as compared with irradiated RBCs not treated with NtBHA. In conclusion, irradiation reduces RBC deformability during storage and the irradiated RBCs seem susceptible to oxidative stress. NtBHA may not have a protective role against the effects of gamma-ray exposure in RBCs but further evaluation of NtBHA or another radioprotective compound is required.