Clinical Hemorheology and Microcirculation - Volume 60, issue 3

Authors: Broz, Pavel | Aschwanden, Markus | Partovi, Sasan | Schulte, Anja-Carina | Benz, Daniela | Takes, Martin | Walker, Ulrich A. | Bilecen, Deniz | Jaeger, Kurt A. | Stephan Imfeld, | Staub, Daniel

Article Type: Research Article

Abstract: We assessed the cutaneous microcirculatory reactivity of a clinically unaffected skin region in patients with systemic sclerosis (SSc) compared to healthy controls by measuring transcutaneous oxygen saturation (TcPO2 ) and Laser Doppler flowmetry (LDF). Twelve consecutive patients with SSc and twelve healthy controls were subjected to TcPO2 monitoring and LDF during cuff-induced ischemia and reactive hyperemia in order to measure the skin oxygen tension and the microcirculatory blood flow. Mean minimal and maximal values of oxygen tension and blood flow, time to peak (TTP), and declining slopes after peaking (slope) were compared between patients with SSc and controls. …Compared to the controls, TcPO2 values in SSc were similar during ischemia and diminished during reactive hyperemia, with longer TTP, and a slower return to baseline (−60% vs. −58% , p  = 1.000, +76% vs. +210% , p  = 0.047, 137 s vs. 108 s, p  = 0.028, −0.009% /s vs. −0.019% /s, p  = 0.021, respectively). LDF values, however, did not differ significantly between patients with SSc and controls. Unaffected skin regions of SSc patients showed a significantly diminished postischemic vasodilatory reactivity when assessed by TcPO2 monitoring, but not by LDF, indicating that vasculopathy may represent an early mechanism in the onset of skin sclerosis. TcPO2 measurement may help to detect changes in the microcirculation in SSc with no skin affection. Show more

Keywords: Systemic sclerosis, transcutaneous oxygen saturation measurement, Laser Doppler flowmetry, microcirculation

DOI: 10.3233/CH-131676

Citation: Clinical Hemorheology and Microcirculation, vol. 60, no. 3, pp. 263-271, 2015

Authors: Tancer-Elci, Hazal | Isik-Balci, Yasemin | Bor-Kucukatay, Melek | Kilic-Toprak, Emine | Kilic-Erkek, Ozgen | Senol, Hande | Aybek, Hülya

Article Type: Research Article

Abstract: We aimed to investigate the effects of vitamin B12 deficiency on hemorheological parameters, and the changes in these parameters following vitamin B12 treatment. 33 patients (mean-age:7 ± 5.7 years) diagnosed as nutritional vitamin B12 deficiency, and 31 age and sex matched controls (mean-age:7.1 ± 5.2 years) were enrolled. Erythrocyte deformability and aggregation were determined by an ectacytometer, plasma and whole blood viscosities by a cone-plate rotational viscometer. The differences between patients and controls were compared. Hemorheological parameters were repeated in the patient group following vitamin B12 treatment, and the results were compared with the initial results. In vitamin B12 deficiency, …erythrocyte deformability and whole blood viscosity were found to be significantly decreased, eythrocyte aggregation was found to be significantly increased compared with the controls. Plasma viscosity was found to be decreased in deficiency but this decrease was not statistically significant. In patient group, erythrocyte deformability, whole blood and plasma viscosities were found to be significantly increased and erythrocyte aggregation was significantly decreased, after treatment. This study indicates that vitamin B12 deficiency has important effects on hemorheological parameters and adequate treatment of deficiency not only corrects the hematological parameters, but also by helping to normalize the hemorheological parameters, may contribute to the regulation of microvascular perfusion. Show more

Keywords: Vitamin B12 deficiency, erythrocyte deformability, erythrocyte aggregation, viscosity

DOI: 10.3233/CH-131740

Citation: Clinical Hemorheology and Microcirculation, vol. 60, no. 3, pp. 273-282, 2015

Authors: Martínez-Sales, Vicenta | Vila, Virtudes | Ricart, José M. | Vayá, Amparo | Todolí, José | Nńñez, Cornelio | Contreras, Teresa | Ballester, Carmén | Reganon, Edelmiro

Article Type: Research Article

Abstract: INTRODUCTION: Psoriasis is a chronic pathology characterized by increased inflammation that can be associated with changes in the vascular endothelium. We quantified the levels of circulating endothelial cells (CECs) and microparticles (MPs) in patients with psoriasis in order to analyze their relationship with endothelial and inflammation markers, subclinical atherosclerosis and microcirculation. METHODS: We studied 20 patients and 20 controls. Circulating markers of endothelial damage (CEC, MPs and von Willebrand factor, vWF) and inflammation (E-selectin, E-sel; Interleukin-6, IL-6 and C-reactive protein, CRP) were determined. Subclinical atherosclerosis was assessed by carotid ultrasound to obtain intima-media thickness. Microcirculation …was evaluated by nailfold capillaroscopy. RESULTS: CECs, MPs, vWF, CRP and E-sel levels were significantly elevated in patients when compared with controls (p  <  0.05). Ninety-four and fifty-three percentage of patients had CEC and MP levels higher than 99th percentile in controls. Forty-seven percent of patients simultaneously showed increased CEC and MP levels. MPs correlate with the inflammatory markers and with the intima-media thickness. CECs correlate with the capillaries loops per mm (p  <  0.05). CONCLUSION: Psoriasis patients show elevated CECs and MPs, as a sign of endothelial dysfunction, which correlates with inflammatory markers as well as subclinical atherosclerosis and some capillaroscopy findings. Show more

Keywords: Psoriasis, circulating endothelial cells, microparticles, angiogenesis

DOI: 10.3233/CH-131766

Citation: Clinical Hemorheology and Microcirculation, vol. 60, no. 3, pp. 283-290, 2015

Authors: Tripolino, Cesare | Carallo, Claudio | Irace, Concetta | Scavelli, Faustina | De Franceschi, Maria Serena | Gnasso, Agostino

Article Type: Research Article

Abstract: OBJECTIVE: Peripheral artery occlusive disease (PAOD) is associated with increased cardiovascular risk (CVR). Recently it has been reported that also the increased stiffness of lower limb arteries is associated with increased CVR. In particular, subjects with poorly compressible arteries (PCA) appear to have a CVR even higher than that of subjects with PAOD. Limited data are available on the role of hemorheological factors in determining increase in arterial stiffness. Our study aimed to investigate possible association between blood and plasma viscosity and elevated ankle brachial index (ABI). METHODS: Subjects were free-living participants to a cardiovascular disease screening campaign. …Sixty-two subjects with ABI ranging 1.3-1.4, and 20 with ABI >1.4 were matched with 124 and 40 control subjects, respectively. Cardiovascular disease risk factors (blood pressure, blood lipids, glucose, cigarette smoking, obesity) were evaluated by routine methods. Blood and plasma viscosities were measured by a cone-plate viscometer. Ankle-brachial index was computed as measure of arterial stiffness. RESULTS: Compared with controls, who were carefully matched for age, sex and all cardiovascular risk factors, subjects with elevated ABI values had increased levels of plasma viscosity (1.42 ± 0.11 vs. 1.35 ± 0.10 cP, p  <  0.001, for subjects with ABI ranging 1.3-1.4, and 1.41 ± 0.10 vs. 1.33 ± 0.10 cP, p  <  0.01, for subjects with ABI >1.4). No difference in blood viscosity was observed. CONCLUSION: The present investigation provides evidence that plasma viscosity is increased in subjects with elevated ABI values, independently of other cardiovascular risk factors. This finding contributes to explain the high CVR of patients with PCA. Show more

DOI: 10.3233/CH-131834

Citation: Clinical Hemorheology and Microcirculation, vol. 60, no. 3, pp. 291-296, 2015

Authors: Carallo, Claudio | Loprete, Antonio | Mazza, Giuseppe | Bellotti, Giovanni | de Siena, Massimo | Serrao, Pietro | Vuoto, Elisa Stella | de Franceschi, Maria Serena | Irace, Concetta | Gnasso, Agostino

Article Type: Research Article

Abstract: OBJECTIVE: Heparin-induced Extracorporeal Low Density Lipoprotein Precipitation (HELP) Apheresis gives beneficial reductions in Low Density Lipoprotein (LDL) cholesterol levels; otherwise, extracorporeal circulation settings might elicit inflammation and platelet aggregation. The net effect of these variations on carotid hemodynamic has not been established. Aim of the present study was to investigate periprocedural variations of common carotid artery wall shear stress, circumferential wall tension, and Peterson’s elastic modulus. METHODS: Measurements were sequentially performed on 22 procedures: immediately before apheresis (T1), within one hour after (T2), after 24 (T3) and 48 hours (T4). In order to confirm acute …effects, in additional 30 procedures measurements were performed at T1 and T2. RESULTS: Mean shear stress was decreased at T2, with an improvement at T4. Mean circumferential wall tension showed an improvement at T4; arterial stiffness showed the same trend, but only close to statistical significance. The following 30 procedures, where measurements were performed at T1 and T2 only, confirmed previous results, showing a deep wall shear stress decrease at T2 (−21%). CONCLUSION: LDL apheresis seems to have a biphasic effect on common carotid hemodynamics: the acute worsening of shear stress, probably mediated by extracorporeal circulation, was followed by its improvement, possibly driven by LDL cholesterol reduction. Show more

Keywords: Familial hypercholesterolemia, LDL-cholesterol, HELP apheresis, carotid artery, extracorporeal circulation, shear stress

DOI: 10.3233/CH-141840

Citation: Clinical Hemorheology and Microcirculation, vol. 60, no. 3, pp. 297-307, 2015

Authors: Caimi, G. | Ferrara, F. | Montana, M. | Muratori, I. | Amato, C. | Canino, B. | Lo Presti , R. | Hopps, E.

Article Type: Research Article

Abstract: Venous leg ulcers are common in subjects with chronic venous insufficiency. The increased intraluminal pressure causes alteration of the skin microcirculation, leukocyte activation and release of proteolytic enzymes leading to ulceration. An impaired expression and activity of matrix metalloproteases (MMPs) and their tissue inhibitors (TIMPs) might influence extracellular matrix degradation and deposition in chronic venous ulcers with the failure of the healing process. Our aim was to evaluate plasma concentration of gelatinases (MMP-2 and MMP-9) and their inhibitors (TIMP-1 and TIMP-2) in subjects with venous leg ulcers before and after the compression therapy. We enrolled 36 subjects (12 men and …24 women, mean age 67.38 ± 12.7 yrs) with non-infected venous leg ulcers (CEAP C6), which underwent a color Duplex scan examination of the veins and arteries of the inferior limbs and were treated with a multi-layer bandaging system. The ulcer healing was obtained in 23 subjects only (9 men and 14 women). We evaluated, on fasting venous blood, the plasma levels of MMP-2, MMP-9, TIMP-1 and TIMP-2 using ELISA kit, before and after the treatment. We observed a significant increase in plasma concentration of gelatinases and their inhibitors and in MMP-2/TIMP-2 ratio in subjects with leg ulcers in comparison with normal controls. In subjects with healed ulcers we found a decrease in MMP-9 and TIMP-1 levels and in MMP-2/TIMP-2 ratio compared to the baseline values, although higher levels of all the examined parameters in comparison with normal controls. In conclusion, plasma MMPs profile is impaired in subjects with venous leg ulcers and it improves after the healing, persisting anyway altered in respect to healthy controls. Show more

Keywords: Venous leg ulcers, MMP-2, MMP-9, TIMP-1, TIMP-2

DOI: 10.3233/CH-141863

Citation: Clinical Hemorheology and Microcirculation, vol. 60, no. 3, pp. 309-316, 2015

Authors: Dominighini, Alicia | Ferrero, Mariana | Crosetti, Diego | Ronco, María Teresa | Gonzálvez, José | Urli, Leda | Wagner, Marcelo | Gurni, Alberto | Carnovale, Cristina E. | Luquita, Alejandra

Article Type: Research Article

Abstract: It was demonstrated that Ligaria cuneifolia (Lc ) crude extract increased blood viscosity and decreased plasma cholesterol in rats. In the present study, we analyzed the Lc proanthocyanidin enriched fraction (PLc ) to determine if it is capable of altering the hemorheological parameters while diminishing the plasma cholesterol. In vivo studies in adult male Wistar rats, randomized in three groups (n  = 6 each one) were performed: 1. Control: saline intraperitoneal (i.p.); 2. PLc 0.6 mg/100 g body weight (b.w.) i.p. and 3. PLc 3 mg/100 g b.w. i.p., every 24 hours during 3 days. In vitro studies: with …blood obtained by cardiac puncture, separated in aliquots and incubated with: 1. Saline solution (Control); 2. PLc 0.1 mg/mL, and 3. PLc 1.0 mg/mL, equivalent to doses in vivo experiments. The results demonstrated that in vivo PLc 0.6 and PLc 3 reduced plasma cholesterol (Cho) and LDL-Cho. Neither blood nor plasma viscosity was altered. Decrease of plasma cholesterol could be due to an increase of cholesterol and bile salts excretion leading to an increase of bile flow. In vitro experiments showed a direct interaction of PLc , at high concentration, with the erythrocyte membrane, inducing a switch from discocyte to stomatocyte. Only, PLc without hepatic metabolism produces hemorheological changes. Thus, PLc in vivo might be a pharmacological agent capable of decreasing plasma cholesterol. Show more

Keywords: Ligaria cuneifolia, proanthocyanidin, blood viscosity, plasma cholesterol, erythrocyte deformability, biliary excretion

DOI: 10.3233/CH-141870

Citation: Clinical Hemorheology and Microcirculation, vol. 60, no. 3, pp. 317-325, 2015

Authors: Vayá, Amparo | Rivera, Leonor | Hernández-Mijares, Antonio | Bautista, Daniel | Solá, Eva | Romagnoli, Marco | Alis, Rafael | Laiz, Begoña

Article Type: Research Article

Abstract: Several studies have found an association between hyperuricemia and metabolic syndrome (MS), although there are discrepancies as to which MS components play a pivotal role in this association. We aimed to investigate the association between serum uric acid (SUA) levels and MS in a Mediterranean population (eastern Spain). We performed a case-control study of 71 patients with MS and 122 healthy controls. MS was defined according to the revised National Cholesterol Education Program Adult Treatment Panel III modified criteria. Hyperuricemia was defined as SUA levels >6.55 mg/dL. We determined biochemical, lipidic and inflammatory parameters along with uric acid. Patients with MS …showed a higher risk of hyperuricemia than those without MS (OR: 2.87 95% CI: 1.48– 5.55; p  = 0.002). In turn, the unadjusted logistic regression analysis showed that hyperuricemia is associated with a higher risk of presenting all the MS components, except hypertension; i.e., hypertriglyceridemia, low HDL-cholesterol, abdominal obesity and glucose intolerance were predictors for hyperuricemia (OR: 3.15, 95% CI: 1.61– 6.15, p  = 0.001; OR: 4.07, 95% CI: 1.77– 9.33, p  = 0.001; OR: 2.81, 95% CI: 1.41– 5.58, p  = 0.003 and OR: 2.82, 95% CI: 1.46– 5.45, p  = 0.002 respectively). The adjusted logistic regression analysis revealed that only low HDL-cholesterol and glucose intolerance were independent predictors for hyperuricemia (OR: 2.71, 95% CI 1.06– 6.97, p  = 0.038; OR: 2.14, 95% CI 1.01– 4.56, p  = 0.049, respectively). In our geographical area, the patients with MS showed a nearly 3-fold risk of hyperuricemia than those without. Among all the MS components, low-HDL-cholesterol and high glucose independently increased more than twice the risk of hyperuricemia, and are the pivotal components involved in hyperuricemia. Show more

Keywords: Hyperuricemia, metabolic syndrome, mediterranean population, low HDL-cholesterol, high glucose levels

DOI: 10.3233/CH-141887

Citation: Clinical Hemorheology and Microcirculation, vol. 60, no. 3, pp. 327-334, 2015

Authors: Goedeke, Jan | Apelt, Nadja | Kamler, Markus

Article Type: Research Article

Abstract: Hypothermia is increasingly used as a therapeutic strategy in a diversity of clinical scenarios. Its impact on mammalian physiology, particularly on the microcirculatory changes of critical organ systems, are, however, incompletely understood. Close examination of the literature reveals a marked paucity of small animal models of rapid systemic hypothermia. All published models introduce important microvascular confounders by investigating either local cooling processes or using anaesthetised animals. Here we present the first rapid systemic hypothermia model in an awake hamster. We developed a waterstream cooled copper tube system for standardized systemic temperature control. With this novel system core body temperature (Tc …) in 14 awake animals could be precisely stabilised at temperatures of 30°C and 18°C (7 animals, respectively) within 10–20 min. Rewarming was achieved over 10–15 min. Tolerance of the procedure was excellent. Hamsters did not show any behavioural changes in the mild hypothermia group. In the deep hypothermia group 6 of 7 animals regained normal behaviour within 2–11 hs. As hypothermia was induced in dorsal skinfold chamber bearing animals this model seems suitable for investigation of microcirculatory purposes. Advantages over previously established experimental hypothermia models are significant. Amongst these, the possibility of visualization of microcirculation, the lack of microcirculation confounding factors such as anaesthetic drugs, the ability for precise Tc control and rapid induction of hypothermia are prominent. Show more

Keywords: Hypothermia, cooling tube, microcirculation, awake animal model, Syrian Golden Hamster

DOI: 10.3233/CH-141854

Citation: Clinical Hemorheology and Microcirculation, vol. 60, no. 3, pp. 335-346, 2015