Clinical Hemorheology and Microcirculation - Volume 55, issue 3

Authors: Liu, Huifang | Yang, Lin | He, Hongchen | Zhou, Jun | Liu, Ying | Wang, Chunyan | Wu, Yuanchao | He, Chengqi

Article Type: Research Article

Abstract: Apart from medications, pulsed electromagnetic fields (PEMFs) are used to treat osteoporosis nowadays. However studies on hemorheological safety of PEMFs were scarce. This randomized, placebo controlled clinical trial assessed whether PEMFs could lead to significant hemorheological changes. Fifty-five postmenopausal women were randomly assigned to receive placebo or PEMFs. Venous blood samples were collected at baseline and after treatment to measure 14 hemorheological determinants. Independent samples t-test, paired samples t-test and chi-squared tests were performed respectively. Relationships between variables were determined by Pearson correlation analysis. Multiple linear stepwise regression analysis was used to explore predictors of selected determinants. No significant differences …existed between the placebo and PEMFs groups for any of the 14 hemorheological determinants (P > 0.05) or the percentage of patients with hemorheological determinant within reference range (P > 0.05). Hematocrit was found to be correlated with BMI (P = 0.007). The most significant predictor of blood reduced viscosity at low shear rate was blood viscosity at low shear rate. And blood reduced viscosity at high shear rate was the most important predictor of plasma viscosity. These results showed, compared with placebo, PEMFs treatment of postmenopausal osteoporosis was not associated with adverse changes in hemorheological determinants, which may contribute to venous thromboembolism. Show more

Keywords: Pulsed electromagnetic fields, PEMFs, post-menopause, hemorheology, venous thromboembolism, randomized controlled trial

DOI: 10.3233/CH-2012-1619

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 3, pp. 285-295, 2013

Authors: Tabara, Yasuharu | Igase, Michiya | Saito, Isao | Nishida, Wataru | Kohara, Katsuhiko | Sakurai, Susumu | Kawamura, Ryoichi | Okada, Yoko | Hitsumoto, Shinichi | Onuma, Hiroshi | Nagai, Tokihisa | Takata, Yasunori | Uetani, Eri | Takita, Rie | Kido, Tomoko | Ochi, Namiko | Osawa, Haruhiko | Tanigawa, Takeshi | Miki, Tetsuro

Article Type: Research Article

Abstract: BACKGROUND: Elevated hematocrit levels have been suggested to be an independent determinant of insulin resistance and type 2 diabetes. To clarify the diagnostic significance of hematocrit level, we investigated the association with hemodynamic profiles, insulin resistance and insulin sensitivity, arterial properties, and asymptomatic cerebrovascular damage in a general Japanese population. METHODS: This study included 1,978 participants from two independent cohorts. Insulin sensitivity was assessed by the oral 75 g glucose tolerance test. Carotid ultrasonography was performed to evaluate atherosclerosis and wall shear stress. Periventricular hyperintensity and lacunar infarction were assessed by brain magnetic resonance imaging. RESULTS: Hematocrit quartile showed a …stepwise association with insulin sensitivity (Q1: 2.2 ± 0.7, Q2: 2.0 ± 0.7, Q3: 1.9 ± 0.7, Q4: 1.8 ± 0.6, p < 0.001) and insulin resistance (1.0 ± 0.6, 1.2 ± 0.7, 1.3 ± 0.8, 1.5 ± 1.0, p < 0.001). Multiple linear regression analysis adjusted for possible covariates identified hematocrit as an independent determinant of insulin sensitivity (β = −0.074, p = 0.019) and insulin resistance (β = 0.115, p < 0.001). However, this association was lost after further adjustment for visceral fat area and plasma alanine aminotransferase level. Further, no significant association was observed between hematocrit and carotid intima-media thickness (p = 0.306) where as wall shear stress was inversely associated with the carotid atherosclerosis (r = −0.250, p < 0.001). In contrast, a low hematocrit level was independently associated with periventricular hyperintensity (odds ratio 0.87 (95% CI 0.80–0.95), p = 0.001). CONCLUSION: Hematocrit was positively associated with insulin resistance and insulin sensitivity. This association was epiphenomenon of visceral and hepatic adiposity. Conversely, low hematocrit was a significant risk factor for periventricular hyperintensity independent of insulin resistance. Show more

Keywords: Hematocrit, insulin resistance, atherosclerosis, cerebrovascular disease

DOI: 10.3233/CH-2012-1634

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 3, pp. 297-311, 2013

Authors: Atici, Atilla Guven | Kayhan, Servet | Aydin, Davut | Yilmaz, Yasemin Ari

Article Type: Research Article

Abstract: Genetic and acquired thrombophilic risk factors may play role on developing venous thromboembolism (VTE). In many cases of pulmonary thromboembolism (PE) it can not be defined any explicit risk factor. In this study we aimed to identify the role of plasma viscosity level on PE. The investigation was planned prospectively and 33 patients with PE and 36 apparently healthy and nonsmoker volunteers as control group were enrolled in the study. The mean plasma viscosity levels were determined in patients with PE and in healthy volunteers as 1.42 ± 0.30 cP and 1.29 ± 0.22 cP respectively. The mean plasma viscosity …levels was found to be different between PE and healthy group (p = 0.009). The mean levels of triglyceride, fibrinogen and hematocrit were found different between patients with PE and control group (p < 0.05). Variables including sex, age, smoking habits, levels of hematocrit, fibrinogen, total cholesterol and triglyceride were not associated with plasma viscosity values in patients with PE. Plasma viscosity levels were found higher in patients with PE compared with healthy indivudials. But it is needed to further studies to define the interactions between factors effecting blood rheology and development of thrombosis. Show more

Keywords: Venous thromboembolism, pulmonary thromboembolism, plasma viscosity

DOI: 10.3233/CH-2012-1637

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 3, pp. 313-320, 2013

Authors: Cagienard, F. | Schulzki, T. | Furlong, P. | Reinhart, W.H.

Article Type: Research Article

Abstract: Severe side effects of cocaine consumption are vasoocclusive events such as myocardial infarction and stroke. We have hypothesized that cocaine could affect red blood cells (RBCs) and alter the rheological behaviour of blood. Heparinized blood from healthy volunteers was incubated with a final hematocrit of 45% with increasing cocaine concentrations: 0, 10, 100, 1000, and 10'000 μmol/L plasma. Time dependence of the shape change was tested in phosphate buffered saline containing cocaine. RBCs were fixed in 1% glutaraldehyde for morphological analysis. Blood viscosity was measured with a Couette Viscometer (Contraves LS 30) at 37°C and a shear rate of 69.5 …s−1 . RBC aggregation was assessed with a Myrenne aggregometer. Cocaine induced a dose-dependent stomatocytic shape transformation of RBCs, which was more pronounced in buffer than in plasma (plasma protein binding of the drug). Stomatocytosis occurs when a drug intercalates preferentially in the inner half of the membrane lipid bilayer. It was a time-dependent process with two components, an almost instant shape change occurring within 1 s, followed by a gradual further shape change during 10 min. Stomatocytosis was reversible by resuspension of the RBCs in cocaine-free buffer. This stomatocytic shape change increased whole blood viscosity at high shear rate from 5.69 ± 0.31 mPa.s to 6.39 ± 0.34 mPa.s for control and 10'000 μmol/L cocaine, respectively (p < 0.01). RBC aggregation was not affected by the shape change. These effects occurred at a cocaine concentration, which is several-fold above those measured in vivo. Therefore, it is unlikely that hemorheological factors are involved in vascular events after cocaine consumption. Show more

Keywords: Aggregation, cocaine, erythrocyte, hemorheology, stomatocytosis, viscosity

DOI: 10.3233/CH-2012-1638

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 3, pp. 321-329, 2013

Authors: Vayá, Amparo | Ricart, Jose M. | Andino, Belinda | Todoli, Jose | Nuñez, Cornelio | Calvo, Javier | Bautista, Daniel

Article Type: Research Article

Abstract: Psoriasis is a systemic inflammatory disorder with increased cardiovascular risk which has been partly attributed to the increased prevalence of the metabolic syndrome (MS). However, the contribution of rheological alterations to cardiovascular risk has been scarcely investigated. In 91 psoriasis patients and in 101 healthy volunteers, we determined the rheological profile (fibrinogen, blood viscosity and erythrocyte aggregation), along with lipidic and inflammatory parameters. Patients showed statistically higher BMI, waist, triglycerides, insulin, c-reactive protein (CRP), neutrophils, lower HDL-cholesterol and a higher MS prevalence (p < 0.05). When subjects with MS were excluded from the study, patients with psoriasis still showed a …worse inflammatory, lipidic and rheological profile in the above-mentioned variables compared with controls without MS (p < 0.05). The logistic regression analysis revealed that abdominal obesity and fibrinogen >384 mg/dL were independent predictors of psoriasis (OR 3.75 95% CI 1.77–7.94, p < 0.001; OR 2.95 95% CI 1.14–7.64, p = 0.025), respectively. Patients on biologics, showed less inflammation and a better rheological profile than those not on biological treatment. In conclusion, patients with psoriasis show an altered rheological profile, which may contribute to increased cardiovascular risk. Although the presence of MS worsens this profile, psoriasis per se shows rheological alterations due to both inflammation and altered metabolic parameters. Anti TNF-α treatment markedly improves the rheological profile by mostly decreasing inflammation. Show more

Keywords: Psosiasis, hemorheolgy, metabolic syndrome

DOI: 10.3233/CH-2012-1639

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 3, pp. 331-339, 2013

Authors: Kim, C.B. | Shin, Sehyun | Song, Seok-Heung

Article Type: Research Article

Abstract: Lead is a ubiquitous, biohazardous, and toxic heavy metal that induces a broad range of physiological, biochemical, and behavioral dysfunctions. We investigated the effect of lead on hemorheological characteristics, including deformability and aggregation. We found that red blood cell (RBC) deformability was unaffected at low concentrations of lead-rich plasma, but showed a significant decrease at high concentrations even within 1 h of incubation. In addition, apparent alterations in RBC aggregation were observed with an increase in lead concentration and incubation time. These results highlight the influence of lead on hemorheology and microcirculation.

Keywords: Lead, toxicology, hemorheology, deformability, aggregation

DOI: 10.3233/CH-2012-1641

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 3, pp. 341-348, 2013

Authors: Napoleão, Patrícia | Selas, Mafalda | Freixo, Cláudia | Carmo, Miguel Mota | Viegas-Crespo, Ana Maria | Ferreira, Rui Cruz | Pinheiro, Teresa

Article Type: Research Article

Abstract: BACKGROUND: Auto-immune responses are associated with oxidized LDL (ox-LDL) release, a key factor in plaque destabilization. Data on the relationship between ox-LDL and T lymphocytes in human populations remains scarce. T cells also react with other molecules from the lesion and/or damage the myocardium. OBJECTIVE: The objective of the present study was to examine the relationship between circulating T lymphocytes, ox-LDL, markers of myocardial necrosis (cTnT), myocardial dysfunction (N-terminal pro-brain natriuretic peptide – NT-proBNP) and inflammation (C-reactive protein – CRP) in the setting of acute myocardial infarction. METHODS: A longitudinal study of 55 patients with ST-elevation myocardial infarction (STEMI) were …evaluated at three time points: admission, 2 and 40 days following admission, together with 30 patients with stable angina (SA) and 56 subjects without coronary artery disease serving as controls (CTR). RESULTS: STEMI patients had maximal ox-LDL values and minimal levels of CD3+ T lymphocytes at admission, which was normalized during the recovery period. The increasing trend of CD3+ T cells was positively associated with an ox-LDL decline over time. CRP and cTnT longitudinal variations were negatively associated with the CD3+ T-cell increasing trend. These associations were not found in SA patients or controls. CONCLUSIONS: The associations found between CD3+ T lymphocytes, ox-LDL and cTnT suggest a specificity of the immune response in AMI towards arterial and myocardial inflammation and remodelling. Show more

Keywords: T lymphocytes, oxidized LDL, cardiac troponin T, C-reactive protein, acute coronary syndromes, longitudinal study

DOI: 10.3233/CH-121644

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 3, pp. 349-358, 2013

Authors: Zheng, Shu-Guang | Xu, Hui-Xiong | Liu, Lin-Na | Lu, Ming-De | Xie, Xiao-Yan | Wang, Wen-Ping | Hu, Bing | Yan, Kun | Ding, Hong | Tang, Shao-Shan | Qian, Lin-Xue | Luo, Bao-Ming

Article Type: Research Article

Abstract: OBJECTIVE: To assess the value of contrast-enhanced ultrasound (CEUS) in the diagnosis of polypoid lesions of gallbladder (PLGs). METHODS: CEUS was performed to 116 patients (mean age, 49.6 years; range, 21–80 years) with PLGs from 8 university hospitals. 9 cases of biliary sludge were proven by surgery and the remaining 107 cases were confirmed by histopathological examination. The confidence level, diagnostic performance, inter-observer agreement of two independent readers with different experience was assessed. The readers were blind to the imaging and clinical results of the patients. RESULTS: There were significant differences between benign and malignant PLGs in patient age, gender, …lesion size, echogenicity, stalk, time-to-peak, vascularity on CEUS, enhancement pattern, and wall destruction. The confidence levels increased significantly and the interobserver agreement increased from 0.425 to 0.601 after CEUS. The sensitivity increased from 22.2 to 77.8% after CEUS in the staff radiologist, and from 22.2 to 66.7% in the resident radiologist. The correctly characterized lesions were 64.7% before versus 87.1% after CEUS (P = 0.125) for the staff radiologist, and 57.8% versus 70.7% for the resident radiologist (P = 0.007). No significance was found in the subgroup of lesions ≤1.0 cm before and after CEUS for the two radiologists. CONCLUSIONS: CEUS using convex multifrequency probes could detect the dynamic microvascularization of PLGs greater than 1.0 cm and facilitate the differentiation between benign and malignant tumors. Show more

Keywords: Contrast-enhanced ultrasound, gallbladder, polypoid lesion, differential diagnosis

DOI: 10.3233/CH-121651

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 3, pp. 359-374, 2013

Authors: Zheng, Shu-Guang | Xu, Hui-Xiong | Liu, Lin-Na | Wang, Yan | Zhang, Yi-Feng | Guo, Le-Hang | Liu, Chang | Xu, Jun-Mei | Sun, Li-Ping | Wu, Jian

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate whether parametric imaging with contrast-enhanced ultrasound (CEUS) is equal to experienced radiologists after review of CEUS in differentiating hepatocellular carcinoma (HCC) from focal nodular hyperplasia (FNH). METHODS: An image processing software was used to quantitatively analyze the CEUS clips of 30 HCCs (mean diameter, 3.4 ± 0.9 cm; range, 1.8–5.0 cm) and 30 FNHs (mean diameter, 3.0 ± 1.1 cm; range, 1.1–5.0 cm). Low mechanical index contrast specific imaging modes and contrast agent of SonoVue® were applied for CEUS. Fourteen HCCs were pathologically diagnosed and 16 were clinically diagnosed, whereas all the FNHs were confirmed by …pathological examination. Quantitative parameters of HCC and FNH were compared. The diagnostic performance between parametric imaging and two experienced readers was compared using the receiver operating characteristic (ROC) curve analysis. RESULTS: On parametric imaging, the rise time, time to peak and mean transit time for HCC and FNH were 16.7 ± 11.1 s vs. 21.9 ± 9.0 s (P = 0.052), 29.9 ± 14.1 s vs. 33.2 ± 11.1 s (P = 0.322), 115.0 ± 90.9 s vs. 271.5 ± 147.6 s (P < 0.001), respectively. The ROC analysis showed that, for the differentiation between HCC and FNH, the cut-off point for mTT was 107.93 s with the Az value of 0.817 (95% CI: 0.703–0.931), and the Az value was 0.834 (95%CI: 0.728–0.941) for two experienced readers (P = 0.417 compared with mTT). The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were 96.7%, 66.7%, 81.7%, 74.4%, and 95.2%, respectively, for parametric imaging, and 86.7%, 76.7%, 81.7%, 78.8%, and 85.2%, respectively, for two experienced readers (all P > 0.05 compared with parametric imaging). CONCLUSION: Parametric imaging with CEUS is helpful for characterization the typical dynamic effects of microvascularization of HCC and FHH and is equal to experienced readers in the differential diagnosis between HCC and FNH. Show more

Keywords: Parametric imaging, contrast-enhanced ultrasound, differential diagnosis, hepatocellular carcinoma, focal nodular hyperplasia

DOI: 10.3233/CH-121652

Citation: Clinical Hemorheology and Microcirculation, vol. 55, no. 3, pp. 375-389, 2013