Clinical Hemorheology and Microcirculation - Volume 39, issue 1-4

Authors: Schenk, J.F. | Stephan, B. | Zewinger, S. | Speer, T. | Pindur, G.

Article Type: Research Article

Abstract: Genetic polymorphisms in plasminogen activator inhibitor-1 gene-675 4G/5G (PAI-1 4G/5G) are claimed to contribute to an increased risk of venous thromboembolism. Inherited thrombophilia, on the other hand, is associated with the occurrence of spontaneous abortions. The objective of this study was, to explore the significance of genetic polymorphisms of PAI-1 4G/5G with particular emphasis on 4G alleles in pregnant women suffering from venous thromboembolism or early spontaneous abortion, respectively. Therefore genetic PAI-1 4G/5G polymorphisms were studied in 108 pregnant females suffering from venous thromboembolism (n=69) or from spontaneous abortion (<20 week, n=39), respectively. Healthy volunteers (n=238) were taken as controls. …The frequencies of 4G alleles (4G/4G or 4G/5G genotypes) of PAI-1 were significantly higher in venous thromboembolism (OR: 3.40, p=0.0088) and slightly higher, but not significantly, in abortions (RR: 2.33; p=0.1162) compared to controls. The incidence of 4G-carriers in females with abortion was 0.68 (−32%) compared to women suffering from venous thromboembolism alone. We conclude from these data, that the occurrence of PAI-1 4G/4G or 4G/5G genotypes, respectively, is clinically significant for the pathogenesis of venous thromboembolism in pregnancy but not for early abortion. Show more

Keywords: Pregnancy, abortion, venous thromboembolism, genetic plasminogen-activator-inhibitor-1 4G/5G polymorphism

DOI: 10.3233/CH-2008-1098

Citation: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 329-332, 2008

Authors: Pongrácz, Endre | Andrikovics, Hajnalka | Bernát, Iván S. | Nagy, Zoltán

Article Type: Research Article

Abstract: Background: The phenotype caracteristic of blood clotting factors are well known, however few data has been documented about effects on haemorheology. The connection among genetic polymorphisms, haemorheological factors and vascular mortality is also studied poorly. Purpose: Our aim was: to study six genetic polymorphisms of blood clotting factors, which presents the role of platelet–plasmaprotein–endothel system in thrombotic course in controls and ischaemic stroke cohort. Second, to study the connection of genotypes and haemorheologic factors and both with five years vascular mortality in patients. Patients and methods: It was studied the genetic polymorhisms of GP IIb/IIIa Leu33Pro, prothrombin gene …G20210A, ACE I/D, fibrinogen gene-455 G/A, Leiden mutation and MTHFR C677T alleles or genotypes in blood samples of 433 ischaemic stroke patients and 173 controls by PCR. Haematocrit values, plasma fibrinogen (FIB) concentration, whole blood viscosity (WBV) at 90 s−1 and also the plasma viscosity (PV) were measured. Vascular mortality of patients were followed during five years and studied by curves Kaplan–Meier. Results: A higher plasma FIB concentration in non smoker patients, carrying A alleles of FIB gene could be observed as compared to wild types (p<0.05). Also a moderate WBV increasing in smoker patients with A alleles was found against wild types (p=0.11), at the same time we observed a significant WBV increasing in non smoker patients (p<0.05). The highest quartile of PV showed a connection with Leiden mutation in whole group of patients (p=0.01), in subgroup of young patients (<50 years) (p=0.03) and also in non smoker groups (p<0.05) as compared to patients having wild types. No association could be detected between different genetic polymorphisms and vascular mortality, however it was observed significant mortality increasing in patients having PV above 1.51 mPa s (p=0.03). Conclusion: Certain genetic polymorphisms of coagulation system could result unfavorable haemorheological changes, however non of them increases the mortality. The connection between higher mortality and PV focuses the attention for the necessity of PV measuring and correction in stroke patients. Show more

DOI: 10.3233/CH-2008-1099

Citation: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 333-341, 2008

Authors: Prantl, L. | Schreml, S. | Walter, M. | Kasprzak, P. | Stehr, A. | Nerlich, M. | Feurbach, S. | Jung, E.M.

Article Type: Research Article

Abstract: Purpose: The aim of the prospective study was to evaluate the macro- and microcirculation in the center and periphery of free flaps with high resolution vascular ultrasound. Material: Fifteen patients with free parascapular flaps after lower limb trauma were examined six months postoperative. All ultrasound investigations were performed by one experienced examiner with a multi-frequency linear transducer (5–9 MHz, Logiq 9, GE). Flow evaluation was angle-optimized using digital image technology with the color coded Doppler sonography (CCDS) with measurement of the peak systolic, peak diastolic flow velocities and the resistance index (RI). Contrast harmonic imaging (CHI) with time …intensity curve (TIC) analysis was used for quantitative evaluation of the tissue perfusion. Through a peripheral cubital cannula, a first bolus injection was made of 2.4 ml Sonovue® to evaluate the perfusion near the flap center and the distal part of the flap. Results: The combined analysis of all 15 patients showed in the center and in the periphery of the flap a significant increase (p<0.01; Wilcoxon signed rank test) of the perfusion (relative units = RUs) in the period of 90–120 s after contrast medium application (center: baseline perfusion 2.23±0.31 RUs to 5.25±0.90 RUs after contrast medium; periphery: baseline perfusion 3.07±0.44 RUs to 5.80±0.57 RUs after contrast medium). The separate analysis of the non-bypass group (n=9) and bypass group (n=6) showed a clearly higher central flap perfusion after contrast medium application for the bypass group. The combined analysis of all patients showed RI-values amounting to 0.79±0.03. The RI-values of the bypass group were significantly higher than RI-values of the non-bypass group (p<0.05; t-test; p<0.05; Mann–Whitney rank sum test). Conclusion: The high-resolution ultrasound represents an ideal method for detection of the flow and patency of the bypass and the small vessels of the free flap. The patency of microvascular anastomosis as well as the perfusion and microcirculation in different flap territories and tissue layers can be investigated using dynamic contrast-enhanced ultrasound with subtraction modalities. Show more

Keywords: Free flap, femoral bypass, vascular ultrasound, contrast harmonic imaging (CHI), tissue perfusion

DOI: 10.3233/CH-2008-1100

Citation: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 343-350, 2008

Authors: Fehr, Martin | Galliard-Grigioni, Katja S. | Reinhart, Walter H.

Article Type: Research Article

Abstract: We have analysed the influence of acute alcohol exposure in vivo and in vitro on blood flow properties and platelet function. 12 healthy male volunteers drank either 4.36 ml red wine/kg body weight (=0.5 g ethanol/kg) or water at 06.00 p.m. under fasting conditions. Blood was drawn immediately before, and 1, 2, 4 and 13 h after alcohol ingestion. Alcohol had a detectable osmotic effect on erythrocytes; the mean cellular volume (MCV) was significantly smaller 1–4 h after ingestion. Whole blood viscosity remained unaffected, but blood viscosity at a standardized Hct of 45% measured at a high shear rate (94.5 …s−1 ) was increased 2 h after wine ingestion. In the morning, 13 h after wine drinking, platelet aggregation measured with a platelet function analyser PFA-100® was increased to a greater extent than after water drinking. In vitro, no effect was seen when blood was incubated with 0, 12.5, 25, 50 and 100 mmol/l ethanol for 1 h at 37°C. We conclude that an acute exposure to alcohol has only modest effects on hemorheological parameters and platelet aggregation in vivo and no effect in vitro, which suggests that other factors must be involved in both beneficial and harmful effects of wine drinking. Show more

DOI: 10.3233/CH-2008-1102

Citation: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 351-358, 2008

Authors: Schade, I. | Knaut, M. | Plötze, K. | Matschke, K.

Article Type: Other

DOI: 10.3233/CH-2008-1103

Citation: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 359-362, 2008

Authors: de Oliveira, Sofia | Silva-Herdade, Ana S. | Saldanha, Carlota

Article Type: Research Article

Abstract: The interactions between membrane, peripheral and cytoskeleton proteins are responsible for the maintenance of erythrocyte deformability (EEI) and some of these interactions are modulated by PKC activity. Protein band 3 of the erythrocyte membrane is phosphorylated by phosphotyrosine kinases (PTK) and dephosphorylated by phosphotyrosine phosphatase (PTP). It was previously described by us a signal transduction mechanism that describes a possible pathway connecting an erythrocyte external membrane protein, acetylcholinesterase (AChE), with protein band 3. So how does PKC activity modulate EEI when protein band 3 is phosphorylated or dephosphorylated in absence or presence of AChE effectors? To answer …this we used phorbol 12-myristate 13-acetate (PMA) as an activator and chelerythrine chloride as inhibitor of PKC and also band 3 modulators of band 3 phosphorylation degree, in presence and absence of AChE effectors in order to measure in whole blood samples EEI. Our results showed that erythrocyte deformability was significantly (i) decreased by inhibition of PKC, in absence and presence of AChE inhibitor velnacrine (ii) increased with PMA in absence and presence of ACh and (iii) decreased in presence of calpeptin in absence and presence of either chelerythrine or PMA. These results establish dependence between cytoskeleton proteins, PKC activity, band 3 phosphorylation degrees and EEI. Better understanding of those proteins interactions on transduction mechanisms might trigger possible targets for drug action that would modulate EEI. Show more

Keywords: Erythrocyte protein band 3, protein tyrosine kinases, phosphotyrosine phosphatase, acetylcholinesterase, cytoskeleton, protein kinase C

DOI: 10.3233/CH-2008-1101

Citation: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 363-373, 2008

Authors: Artoli, A.M. | Sequeira, A. | Silva-Herdade, A.S. | Saldanha, C.

Article Type: Research Article

Abstract: The recruitment of leukocytes to the endothelial walls is intensively investigated both experimentally and through three dimensional computer simulations. The shear dependent viscosity has been obtained from measured values in post-capillary venules of Wistar rats' cremaster muscle. Localized velocity fields and shear stresses on the surface of leukocytes and near vessel wall attachment points have been computed and discussed for a cluster of recruited leukocytes under generalized Newtonian blood flow with shear thinning viscosity. We have observed one region of maximum shear stress and two regions of minimum shear stress on the surface of the leukocytes close to the endothelial …wall. This suggests that the accumulation of selectins attains a minimum value in two regions, rather than in one region, on the surface of the leukocytes. We have also verified that the collective hemodynamic behavior of the cluster of recruited leukocytes establishes a strong motive for additional leukocyte recruitment. From this study we claim that the influence of the leukocytes rolling on the endothelial wall increases the shear stress on both the leukocyte and the endothelial wall which results in activating more signaling mediators during inflammation. Show more

Keywords: Leukocytes dynamics, intravital microscopy, computational hemorheology, leukocyte wall shear stress

DOI: 10.3233/CH-2008-1105

Citation: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 375-380, 2008

Authors: Stoeff, S. | Jovtchev, Sv. | Dikov, I. | Kolarov, D. | Galabova, T. | Trifonova, N. | Hadjieva, Sv. | Mladenova, A. | Lambreva, L. | Penev, M.

Article Type: Research Article

Abstract: Accepted methods of the ESR methodology (the Westergren mode and ZSR mode) and its alternative the plasma viscosity were tested for diagnostic utility in pregnancy induced hypertension and pre-eclampsia. The receiver-operating characteristic curve (ROC) analysis approved moderate diagnostic accuracy for the ESR methodology and supplied support for its preliminary estimated cutoff values but failed to indicate cogent discernment of pathology by values of plasma viscosity. Likely pathological whole blood alterations boost the erythrocyte aggregation while the concomitant depletion of macromolecules degrades plasma viscosity values.

Keywords: Pregnancy induced hypertension, ESR methodology, plasma viscosity, ROC analysis

DOI: 10.3233/CH-2008-1104

Citation: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 381-384, 2008

Authors: Vekasi, J. | Koltai, K. | Gaal, V. | Toth, A. | Juricskay, I. | Kesmarky, G.

Article Type: Research Article

Abstract: Hemorheological factors play an important role in the pathogenesis of severe complications of diabetes. The diabetic retinopathy is the leading cause of blindness in patients aged 20–65 years. In our study we investigated the effect of aspirin on the hemorheological parameters in patients with different diabetic retinopathies. Hemorheological parameters (hematocrit, fibrinogen, plasma and whole blood viscosity, red blood cell aggregation) of diabetic patients with non-proliferative (n=14, mean age: 66 years) and proliferative retinopathy (n=8, mean age: 48 years) were measured. The results between the two groups were compared: twelve patients were taking aspirin (group A), while ten patients were …not (group B). Hematocrit, fibrinogen, plasma and whole blood viscosity were significantly higher (p < 0.05–0.001) in patients with diabetic retinopathy who did not take aspirin than in those who took. No significant difference was observed in red blood cell aggregation parameters between the two groups. We could not find any significant difference in the measured parameters between patients with non-proliferative and proliferative diabetic retinopathy. According to our results, all the measured hemorheological parameters were in the pathological range, although aspirin treatment could decrease these factors and thus may help to prevent the progression of severe diabetic retinopathy and perhaps blindness. Show more

Keywords: Diabetic retinopathy, hemorheological parameters, aspirin treatment

DOI: 10.3233/CH-2008-1106

Citation: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 385-389, 2008

Authors: Velcheva, I. | Antonova, N. | Titianova, E. | Damianov, P. | Dimitrov, N. | Dimitrova, V.

Article Type: Research Article

Abstract: The aim of the study was to evaluate the possible relationship of the hemorheological disturbances with the clinical symptoms and some risk factors (RF) for cerebrovascular diseases (CVD). The study included 68 patients with CVD, 29 with transient ischemic attacks (TIA) and 39 with chronic unilateral cerebral infarctions (UCI) and 47 healthy control subjects. A questionnaire for RF for CVD was filled. Hemorheological variables: leucocytes, hemoglobin, hematocrit, fibrinogen (Fib), plasma (PV) and whole blood viscosity (WBV) at different shear rates by Couette rotational viscometer Contraves Low Shear 30 were investigated and the hemorheological indices of erythrocyte aggregation (IEA), erythrocyte deformability …(IED) and of oxygen transport to tissues (TO2 ) were calculated. The arterial hypertension was the most frequent RF in the examined patients'. The hemorheological investigation showed significant increase of Fib in the patients with TIA and of PV and WBV in both patients' groups. The comparative study of the hemorheological variables with the RF for CVD showed predominating significant correlations with blood pressure (systolic, diastolic and mean) values, with age, cholesterol, physical activity and the body mass index. Our study confirms the possibility the hemorheological variables to be accepted as RF for development of stroke and for its recurrences. Show more

Keywords: Cerebrovascular disease, hemorheological disturbances, risk factors

DOI: 10.3233/CH-2008-1107

Citation: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 391-396, 2008

Authors: Velcheva, I. | Nikolova, G.

Article Type: Research Article

Abstract: The aim of the study was to follow the relationship of the hemorheological variables with the cognitive functions in patients with ischemic cerebrovascular disease (CVD). The patient material comprised 117 patients with CVD, distributed in two main groups: 44 with transient ischemic attacks (TIAs) and 73 with chronic cerebral infarctions (CCI), 48 of them being unilateral (UCI) and 25 bilateral (BCI). Additional relative distribution according to the mean arterial blood pressure (MABP) values or to the presence of pathological asymmetries of the hemispheric cerebral blood flow (CBF) was made. The main hemorheological variables: hematocrit (Ht), fibrinogen (Fib) and plasma viscosity …(PV) were examined. The cognitive functions were assessed with a psychological test battery for evaluation of the general cognitive state, the nonverbal intellect, the episodic memory, the selective attention and the executive functions. The hemorheological investigation revealed predomonant increase of PV. The results of all neuropsychological tests showed significant impairment in the patients with CCI in comparison to TIAs. Fibrinogen correlated best with the psychological parameters. Its increase was associated with disturbance of the nonverbal intellect and the general cognitive capacity in the patients with CCI and BCI. In the presence of lower MABP or lack of pathological asymmetries the correlations of Fib and PV with the psychological scores predominated. The results of our study reveal distinct association between the blood rheological properties and the cognitive functions in the patients with ischemic CVD, which is probably based not only on vascular but also on other nonvascular mechanisms. Show more

Keywords: Cerebrovascular disease, cognitive functions, hemorheological variables

DOI: 10.3233/CH-2008-1108

Citation: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 397-402, 2008

Authors: Weinrich, Malte | Stephan, Bernhard | Weiss, Christel | Windischmann, Stefanie | Kopp, Berit | Pindur, Gerhard | Schilling, Martin K.

Article Type: Research Article

Abstract: Introduction: To reduce intraoperative blood loss in liver resections surgical bleeding control is often performed by a complete inflow obstruction of the liver called Pringle manoeuvre leading to a portal venous stasis. Platelet aggregability may be affected by this circulatory stasis. Materials and methods: A study population of 11 patients (37–67 years old, 7 females and 4 males) with hepatic tumours underwent elective liver resection. Pringle manoeuvre of up to 50 min duration was used in 4 patients. The other 7 patients were operated using selective vascular clamping. Platelets were aggregated before and after liver resection with adenosine diphosphate, …collagen and ristocetin (according to Born). Results: Mean maximal amplitudes of platelet aggregation were comparable before and after liver resection. Statistic analysis did not detect a significant difference between the values before and after liver resection as well as between Pringle manoeuvre and selective vascular clamping. Conclusion: Induced platelet aggregability is not affected by the method of surgical bleeding control used in liver resection. Platelet aggregability seems to be resistant even to portal venous stasis of up to 50 min during Pringle manoeuvre. Show more

Keywords: Induced platelet aggregation, Pringle manoeuvre, selective vascular clamping

DOI: 10.3233/CH-2008-1110

Citation: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 403-408, 2008

Authors: Weinrich, Malte | Scheingraber, Stefan | Stephan, Bernhard | Weiss, Christel | Kayser, Anna | Kopp, Berit | Schilling, Martin K.

Article Type: Research Article

Abstract: Introduction: Measurement of central venous oxygen saturation has become a surrogate parameter for fluid administration, blood transfusions and treatment with catecholamines in (early) goal directed therapy in the treatment of acute septic patients. These strategies are not easily transferred to the postoperative management of abdominal surgery due to the different conditions in surgical patients. Materials and methods: A study population of 15 patients (8 females/7 males) underwent elective major abdominal surgery: 6 gastrectomies, 5 major liver resections and 4 lower anterior rectum resections. Surgery was performed for primary or secondary malignancy. The patients' age was 65.4±12.7 (mean±standard deviation, range …44–84, median 62) years. Blood samples were taken intraoperatively from indwelling central venous lines as well as from draining veins at the surgical site. Blood gas analyses to determine the oxygen saturations were performed immediately. All patients were operated in standardized general anesthesia including epidural analgesia and in a balanced volume status. Results: Central venous oxygen saturations and oxygen saturations in blood from the draining veins of the surgical site showed a wide range with high intra- and interindividual differences intraoperatively. Overall, at most time points no correlation between the two oxygen saturations could be detected in three operation types. A significant correlation was only observed at one time point during liver resections. Conclusion: Our results show a lack of correlation between central venous oxygen saturations and oxygen saturations in the draining veins of the surgical site during major abdominal surgery. Measurement of central venous oxygen saturations does not seem to be a good surrogate for the local oxygen supply in the field of interest in major abdominal surgery even under standardized conditions. Show more

Keywords: Central venous oxygen saturation, venous oxygen saturation at the surgical site, local venous oxygen saturation, major abdominal surgery

DOI: 10.3233/CH-2008-1111

Citation: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 409-415, 2008

Authors: Wenzel, F. | Baertl, A. | Zimmermann, N. | Hohlfeld, Th. | Giers, G. | Oldenburg, J. | Assert, R.

Article Type: Research Article

Abstract: Introduction: Biomarkers reflecting an inflammatory or immunological response are increasingly offered to improve the risk stratification of patients. For example, current evidence suggests that soluble CD40 ligand (sCD40L) is elevated in patients with acute coronary syndrome. But only a few data are available to evaluate the influence of preanalytic conditions on sCD40L values. Methods: Blood samples of seven healthy blood donors were collected in tubes without additives and in EDTA- or citrate-filled tubes at various storage conditions. Platelet count was modified by serum dilution, and sCD40L was measured in platelet-rich-plasma and in whole blood. sCD40L levels were determined by …an commercially available ELISA-Kit. Results: Immediately after blood sample assessment, sCD40L levels in serum samples were elevated (1258±820 pg/ml) compared to EDTA (64±32 pg/ml) and citrate (60±8.5 pg/ml) values. Additionally, sCD40L levels were dependent on storage duration. After platelet activation, sCD40L levels were significantly increased to 8278±2453 pg/ml and were significantly correlated to platelet count (r=0.96). Conclusions: Soluble CD40L levels were clearly influenced by preanalytical conditions and were dependent on storage duration, sample technique and platelet count. These influences should be considered by the determination and evaluation of sCD40L concentrations. Show more

Keywords: Soluble CD40L, preanalytical conditions, platelet count, serum samples

DOI: 10.3233/CH-2008-1112

Citation: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 417-422, 2008

Authors: Yerer, Mükerrem Betül | Aydoğan, Sami | Çomu, Faruk Metin

Article Type: Research Article

Abstract: Alterations in erythrocyte mechanical activities under the influence of anesthesia have been observed and discussed among the responsible factors for the deterioration of tissue and organ perfusion related to anesthetic procedures. 21 female and 17 male Swiss Albino rats were used. Female (f) and male (m) rats were divided into 3 groups; control (f (n=7); m (n=5)), sevoflurane treated group (f (n=7); m (n=5)), desflurane treated group (f (n=7); m (n=7)). 2% of sevoflurane or 6% desflurane were applied to the rats with inhalation in an adjustable cage for one hour. The deformability indexes of the erythrocytes were measured …by a laser diffractometer (Myrenne Rheodyne SSD). Sevoflurane anesthesia has improved the deformability of erythrocytes in male rats (p<0.05) whereas there were not any significant changes in female rats. Desflurane has improved the deformability of erythrocytes in both gender significantly (p<0.05). Volatil anesthetic agents sevofluran and desflurane has improved the mechanical properties of the erythrocytes in male rats compared to their controls. However, these changes were not significant with sevoflurane in females. The results in male rats may be due to the effects of testosterone on the flexibility of the erythrocytes leading them to tolerate to the environmental changes. These results reveal that the inhalation anesthetics like sevoflurane and desflurane are appropriate anesthetics which can improve the deformability of erythrocytes during surgery. Show more

Keywords: Sevoflurane, desflurane, anesthesia, erythrocyte deformability, rats

DOI: 10.3233/CH-2008-1113

Citation: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 423-427, 2008

Article Type: Other

Citation: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 429-435, 2008