Clinical Hemorheology and Microcirculation - Volume 69, issue 4

Authors: Martini, Romeo

Article Type: Research Article

Abstract: In this review 14 studies were identified reporting the treatment strategy in 4891 patients with Critical Limb Ischemia (CLI) with the aim to investigate if the strategy of treatment of the first episode of CLI has changed during the last 15–20 years. A computer research has been performed on PubMed and Scopus databases on November 2016. The used terms for the investigation about studies evaluating the strategy of treatment of CLI at the first-time presentation, have been “critical leg ischemia”, “critical limb ischemia”, “critical lower limb ischemia” along with the terms “placebo”, “medical treatment” and/or “conservative” revascularisation, surgical revascularisation, endovascular …revascularisation, hybrid revascularisation and primary amputation. Studies were included if they were either retrospective or prospective and reporting the rate of patients who underwent to any form of revascularization, conservative treatment and primary amputation. The one-year limb and life survival rates have been reported as major outcomes. The pooled rate of revascularization was 72.5% (95% CI 80-64.96) of which 54.5%, surgical, 38.3% endovascular and 7.1% hybrid. The bivariate regression of revascularisation procedures has been with not significant increase, from 68% in 1993 to 88% in 2015. The endovascular procedures have shown a significant increase of the trend, from 2% to more the 50% (p 0.007), while surgical and hybrid procedures have not. The pooled rate of conservative treatment was 18% (95% CI 11.6–24.5%) with a not significant increasing trend and primary amputation pooled rate was 8.7% (95% CI 12.0-5,4) with a significant decreasing trend (p 0.009). The one-year limb survival rate was 75,4% (95% CI 81.5-69.3%) and the life survival was 76%. (95% CI 85.4-66.1%) both with a not significant increasing trend. In conclusion, this review highlights how the treatment strategy of the first CLI manifestation has changed over the last 15–20 years. It has shown an increase of the rate of revascularization procedures, particularly for endovascular and a significant reduction of the rate of primary amputations. The rate of patients treated conservatively appears to be unchanged and maybe influencing the rate of limb and life survival, that have remained unchanged. Show more

Keywords: Critical limb ischemia (CLI), peripheral arterial disease (PAD)

DOI: 10.3233/CH-170352

Citation: Clinical Hemorheology and Microcirculation, vol. 69, no. 4, pp. 447-456, 2018

Authors: du Plooy, Jeanette N. | Bester, Janette | Pretorius, Etheresia

Article Type: Research Article

Abstract: BACKGROUND: Haemochromatosis is an iron-storage disease with different genetic mutations, characterized by an increased intestinal absorption of iron, resulting in a deposition of excessive amounts of iron in parenchymal cells. When the iron is released in the blood, it is left in an unliganded form, where it can participate in Haber-Weiss and Fenton reactions, creating hydroxyl radicals. Erythrocytes (RBCs) are particularly vulnerable to hydroxyl radical damage, which can result in eryptosis (programmed cell death similar to apoptosis). STUDY DESIGN AND METHODS: Here, we used flow cytometry to study the presence of eryptosis in the main genotypic variations of …HFE (heterozygous and homozygous C282Y; H63D; C282Y/H63D). We also viewed RBCs from the different mutations using super-resolution Airyscan confocal microscopy. RESULTS: Flow cytometry showed significant changes in membrane biochemistry, indicated by the presence of phosphatidylserine (PS) proteins on the outer leaflet of the membrane, as well as increased intracellular calpain. This was found in all of the studied mutations. Airyscan fluorescence revealed PS flip and also microparticles from RBCs. Such microparticles are known to be pro-inflammatory. CONCLUSION: We conclude that RBC pathology is present in all the studied HFE mutations, even in low penetrance mutations, and this might affect rheology in these individuals. Show more

Keywords: Haemochromatosis, erythrocyte membrane, flow cytometry, Airyscan confocal microscopy

DOI: 10.3233/CH-170325

Citation: Clinical Hemorheology and Microcirculation, vol. 69, no. 4, pp. 457-469, 2018

Authors: Jariyapongskul, Amporn | Areebambud, Chonticha | Hideyuki, Niimi

Article Type: Research Article

Abstract: OBJECTIVE: This study was aimed to develop microhemodynamic indices to evaluate the effectiveness of herbal medicine in diabetic tissues. METHODS: Male Sprague-Dawley rats were divided into four groups: normal control rats (Control), type 2 diabetic rats without (DM2) and with supplementation of alpha mangostin (DM2-MG) or curcumin (DM2-CUR). Alpha-mangostin or curcumin (200 mg/kg BW) were fed followed by i.p. injection of streptozotocin (STZ). Mean arterial pressure (MAP) and retinal blood flow (RBF) were measured and retinal flow resistance (RFR) was calculated. Three indices were developed to evaluate the effectiveness of herbal medicines in RFR-MAP diagram based on experimental data …of MAP and RFR in type 2 diabetic rats. These indices are α, β, and γ where α is a ratio of reduction in MAP, β is a ratio of reduction in RFR increasing with MAP increase, and γ indicates a ratio of reduction in RFR. RESULTS: The elevated MAP and RFR and decreased RBF were observed in DM2 rats. Interestingly, alpha-mangostin or curcumin supplementation significantly increased RBF while decreased MAP and RFR. Using α, β and γ indices, it was found that alpha-mangostin is more effective than curcumin in type 2 diabetic retina. CONCLUSIONS: These microhemodynamic indices may be useful to compare various herbal medicines in different tissues. Show more

Keywords: Microhemodynamic indices, alpha-mangostin, curcumin, type 2 diabetes, retinal blood flow, retinal flow resistance

DOI: 10.3233/CH-170345

Citation: Clinical Hemorheology and Microcirculation, vol. 69, no. 4, pp. 471-480, 2018

Authors: Veres, Tünde Gyöngyvér | Takács, Ildikó | Nagy, Tibor | Jancsó, Gábor | Kondor, Ariella | Pótó, László | Vereczkei, András

Article Type: Research Article

Abstract: INTRODUCTION: Laparoscopy is more beneficial than the conventional open technique, however the pneumoperitoneum created may have an ischemic side effect. OBJECTIVE: Our aim was to evaluate the protective effects of preconditioning during laparoscopic cholecystectomies (LC). METHODS: 30 patients were randomized into 2 groups: I. PreC (preconditioning: 5 min. inflation, 5 min. deflation, followed by conventional LC), II: LC (conventional LC). Blood samples were taken before hospitalization (C = control), before surgery, after anaesthesia (B.S.), after surgery (A.S.) and 24 hours after the procedure (24 h). Measured parameters were: malondialdehyde (MDA), reduced glutathione (GSH), sulfhydril groups (-SH), superoxide-dismutase (SOD), catalase (CAT), myeloperoxidase …(MPO), length of hospitalization and pain (VAS = visual analogue scale). RESULTS: Compared to the BS levels, no significant changes were detected in SOD’s activity and MDA levels. GSH concentrations were significantly increased in the PreC group after operation. SH-, MPO, CAT and liver function enzymes were not significantly different. Hospitalization was shorter in the PreC group. Based on the VAS score patients had less pain in the PreC group. CONCLUSION: Significant differences concerning PreC group were found in GSH values. In the PreC group pain decreased by 2-2.5 units following the procedure, 24 h after surgery, and hospitalisation was also significantly shorter. In our pilot study the potential protective effect of preconditioning could be defined. Show more

Keywords: Laparoscopy, pneumoperitoneum, preconditioning, oxidative stress, ischemia-reperfusion

DOI: 10.3233/CH-170336

Citation: Clinical Hemorheology and Microcirculation, vol. 69, no. 4, pp. 481-488, 2018

Article Type: Other

Citation: Clinical Hemorheology and Microcirculation, vol. 69, no. 4, pp. 489-489, 2018

Authors: Brun, Jean-Frédéric | Windberger, Ursula

Article Type: Research Article

DOI: 10.3233/CH-189200

Citation: Clinical Hemorheology and Microcirculation, vol. 69, no. 4, pp. 491-492, 2018

Authors: Brun, Jean-Frédéric | Varlet-Marie, Emmanuelle | Richou, Marlène | Raynaud de Mauverger, Eric

Article Type: Research Article

Abstract: Hematocrit increases during exercise and is usually decreased after regular training. However the interpretation of these facts is ambiguous since hematocrit is both a determinant of oxygen supply and the major determinant of blood viscosity. Classically hematocrit was assumed to impair blood flow, but it has been evidenced to exert a biphasic effect on it. In order to cope with these two apparently opposite effects of hematocrit, hemorheologists have proposed the concept hematocrit/viscosity ratio (h/η ). This h/η ratio is related to tissue oxygenation in vascular diseases (eg, POAD) but not in healthy subjects. h/η displays a bell-shaped …curve as a function of hematocrit and the hematocrit value corresponding to the maximal h/η can be assumed to be a theoretically optimal hematocrit. We propose to analyse exercise-related alterations in hematocrit according to this theoretical approach, viscosity at high shear rate being reconstructed with Quemada’s equation from actual plasma viscosity and red cell rigidity at various hematocrit levels. While theoretical and actual h/η are fairly correlated in athletes both before and after exercise, actual hematocrit is lower at rest and higher after exercise compared to the theoretical one. The main statistic correlate of these discrepancies between actual and predicted hematocrit is red cell rigidity. Submaximal exercise acutely decreases the h/η ratio (despite increasing both hematocrit and viscosity). This change is well predicted by the model and there is a strong correlation between predicted and actual h/η ratio. Endurance training tends to increase h/η and to reduce the discrepancy between predicted and actual hematocrit. Accordingly trained athletes have a higher h/η (both model-predicted and actual) than sedentary subjects, and a lower hematocrit, this lowering being rather correlated to training volume than to fitness improvement. On the whole, this approach suggests that homeostatic “viscoregulation” in athletes results in a fine tuning of h/η which seems to be a closely regulated parameter. Hematocrit alterations in this context are an adaptation involved in this regulation. Show more

Keywords: Blood viscosity, hematocrit, exercise, hematocrit/viscosity ratio

DOI: 10.3233/CH-189201

Citation: Clinical Hemorheology and Microcirculation, vol. 69, no. 4, pp. 493-501, 2018

Authors: Tomschi, Fabian | Bizjak, Daniel | Bloch, Wilhelm | Latsch, Joachim | Predel, Hans Georg | Grau, Marijke

Article Type: Research Article

Abstract: BACKGROUND: Red blood cell (RBC) deformability and blood viscosity are essential to ensure optimal microcirculation and may contribute to athletic performance. OBJECTIVE: To investigate the acute responses of density fractionated young, middle old and old RBC, RBC viscosity (RBCV), plasma viscosity (PV) and hematological changes to two running modes (intensive and moderate). METHODS: 27 young and healthy men of different training status participated in this study and were grouped into three groups in accordance to their VO2 peak and conducted an intensive and moderate running test, respectively (crossover design). Pre and Post exercise, RBC were fractionated …via percoll density gradient centrifugation. RBC deformability of the entire RBC population and the fractionated RBC was determined. Viscosity, hematocrit and mean cellular volume were determined. RESULTS: Baseline results reveal that high trained subjects possess more young RBC and show increased deformability of un-fractioned RBC and middle aged RBC. Baseline PV, RBCV, hematocrit and mean cellular volume did not differ between groups. Applied running modes did not change RBC deformability of any sub-fractions. Viscosity only increased after intensive running. Hematological changes were observed after both exercises. CONCLUSIONS: Acute effects of exercise on RBC are marginal, but chronic differences can be observed in RBC function. Show more

Keywords: Training, running, erythrocyte, viscosity, mean cellular volume, hematocrit, VO2peak

DOI: 10.3233/CH-189202

Citation: Clinical Hemorheology and Microcirculation, vol. 69, no. 4, pp. 503-514, 2018

Authors: Dibiasi, Christoph | Plewka, Jacek | Ploszczanski, Leon | Glanz, Veronika | Lichtenegger, Helga | Windberger, Ursula

Article Type: Research Article

Abstract: BACKGROUND: Although the coagulation system is evolutionary well preserved, profound species differences exist in viscoelastic as well as in common laboratory tests of coagulation. OBJECTIVE: Evaluating differences in clot formation and material characterisation of clots of four mammalian species on macro-, micro- and nanoscales by the means of rheometry, scanning electron microscopy (SEM) and small angle x-ray scattering (SAXS). METHODS: Blood samples were collected from healthy human volunteers, laboratory rats (HL/LE inbred strain), warmblood horses and dromedary camels. Clot formation was observed by oscillating shear rheometry until plateau formation of the shear storage modulus G’, at …which point selected clots were prepared for scanning electron microscopy. SEM images were analysed for fibre diameter and fractal dimension. Additionally, scattering profiles for plasma and whole blood samples were obtained with SAXS. RESULTS: Viscoelasticity of clots showed great interspecies variation: clots of rats and horses exhibited shorter clotting times and higher G’ plateau values, when compared to human clots. Camel clots showed unique clotting characteristics with no G’ plateau formation in the timeframe observed. Less differentiating features were found with SEM and SAXS, although the rat fibre network appears to be more convoluted and dense, which resulted in a higher fractal dimension. CONCLUSION: Clotting kinetic differs between the species, which is not only of clinical interest, but could also be an important finding for animal models of blood coagulation. Show more

Keywords: Blood coagulation, rheometry, ROTEM, SEM, SAXS, comparative hemorheology

DOI: 10.3233/CH-189203

Citation: Clinical Hemorheology and Microcirculation, vol. 69, no. 4, pp. 515-531, 2018

Authors: Windberger, Ursula | Auer, Roland | Plasenzotti, Roberto | Eloff, Stephanie | Skidmore, Julian A.

Article Type: Research Article

Keywords: Oryx antelope, dromedary camel, red blood cells, deformability, aggregability, blood viscosity, temperature

DOI: 10.3233/CH-189204

Citation: Clinical Hemorheology and Microcirculation, vol. 69, no. 4, pp. 533-543, 2018

Authors: Pretorius, E.

Article Type: Research Article

Abstract: OBJECTIVE: This review focusses on the erythrocytes (RBCs) and their structural changes during inflammation and impaired blood rheology. We discuss systemic inflammation and the effects of dysregulated inflammatory molecules. These pro-inflammatory molecules directly affect the haematological system, and particularly the RBCs, platelets and plasma proteins. We focus on the three main changes; increased RBC eryptosis (programmed cell death, similar to apoptosis) and pathological deformability, platelet hyperreactivity and anomalous blood clotting, due to pathological changes to fibrin(ogen) protein structure. This pro-inflammatory haematological system directly affects blood rheology. In turn, hemorheological parameters such as RBC deformability are important parameters in hypercoagulation, which …is a hallmark of inflammation. For RBC deformation to happen during blood flow, the RBC membrane needs to be elastic to elongate sufficiently to squeeze through small capillaries. However, of greater importance is that the cell must return to its original biconcave shape after exiting the small diameter capillaries. CONCLUSION: Hemorheological parameters such as RBC deformability are of great importance clinically, to both identify the presence and extent of inflammation, and to study these parameters during intervention therapies. RBC rheology and deformability may therefore be a useful cell model for pharmaceutical testing. Show more

Keywords: Infalmmation, eryptosis, erythrocytes, rheology

DOI: 10.3233/CH-189205

Citation: Clinical Hemorheology and Microcirculation, vol. 69, no. 4, pp. 545-550, 2018