Clinical Hemorheology and Microcirculation - Volume 58, issue 4

Authors: Bor-Kucukatay, Melek | Colak, Ridvan | Erken, Gülten | Kilic-Toprak, Emine | Kucukatay, Vural

Article Type: Research Article

Abstract: Altitude training is frequently used by athletes to improve sea-level performance. However, the objective benefits of altitude training are controversial. This study aimed to investigate the possible alterations in hemorheological parameters in response to altitude training. Sprague Dawley rats, were divided into 6 groups: live low-train low (LLTL), live high–train high (LHTH), live high-train low (LHTL) and their controls live high and low (LHALC), live high (LHC), live low (LLC). LHC and LHTH groups were exposed to hypoxia (15% O2 , altitudes of 3000 m), 4 weeks. LHALC and LHTL were exposed to 12 hours hypoxia/normoxia per day, 4 weeks. …Hypoxia was maintained by a hypoxic tent. The training protocol corresponded to 60–70% of maximal exercise capacity. Rats of training groups ran on treadmill for 20–30 min/day, 4 days/week, 4 weeks. Erythrocyte deformability of LHC group was increased compared to LHALC and LLC. Deformability of LHTH group was higher than LHALC and LLTL groups. No statistically significant alteration in erythrocyte aggregation parameters was observed. There were no significant relationships between RBC deformability and exercise performance. The results of this study show that, living (LHC) and training at altitude (LHTH) seems more advantageous in hemorheological point of view. Show more

Keywords: Altitude training, exercise, RBC deformability, erythrocyte aggregation

DOI: 10.3233/CH-131711

Citation: Clinical Hemorheology and Microcirculation, vol. 58, no. 4, pp. 479-488, 2014

Authors: Spengler, M.I. | Svetaz, M.J. | Leroux, M.B. | Bertoluzzo, S.M. | Parente, F.M. | Bosch, P.

Article Type: Research Article

Abstract: Systemic lupus erythematosus (SLE) is an autoimmune, chronic inflammatory, non-organ specific disease with an important morbimortality affecting several organs and systems. Oxidative stress is a well documented mechanism of red blood cells (RBC) mechanical impairment. Free radicals could produced, through lipid peroxidation, physical and chemical alterations in the cellular membrane properties modifying its composition, packing and lipid distribution on the membrane erythrocyte. The aim of the present work is to study the lipid peroxidation in the RBC membrane in SLE patients (n = 42) affecting so far the lipid membrane fluidity and erythrocyte deformability in comparison with healthy controls (n …= 52). Malonildialdehyde (MDA) is a subrogate assesing lipidic peroxidation, rigidity index estimating erythrocyte deformability and the anisotropy coefficient estimating lipid membrane fluidity were used. Our results show that MDA values are increased, while erythrocyte deformability and membrane fluidity are significantly decreased in erythrocyte membrane from SLE patients in comparison with normal controls. The association of thiobarbituric acid reactive substances (TBARS) with membrane lipid fluidity and erythrocyte deformability confirms that the damage of membrane properties is produced by lipid peroxidation. Show more

Keywords: Systemic lupus erythematosus, lipid peroxidation, lipid membrane fluidity, erythrocyte deformability

DOI: 10.3233/CH-131716

Citation: Clinical Hemorheology and Microcirculation, vol. 58, no. 4, pp. 489-495, 2014

Authors: Vayá, Amparo | Collado, Susana | Dasí, Ma Angeles | Pérez, Ma Luz | Hernandez, Jose Luis | Barragán, Eva

Article Type: Research Article

Abstract: Rheological properties of homozygous sickle cell anaemia (SCA) show marked heterogeneity, which may be explained in part by the concomitance of alpha genotypes or beta haplotypes, along with hydroxurea (HU) treatment. To further clarify this issue, in 11 homozygous patients with SCA in the steady state and in 16 healthy controls, we analysed erythrocyte deformability (ED) in a Rheodyn SSD by means of the Elongation Index (EI) at 12, 30 and 60 Pa, and erythrocyte aggregation at stasis (EA0) and at 3 sec−1 (EA1) in a Myrenne aggregometer along with fibrinogen, biochemical and haematological parameters. When compared with controls, …homozygous (SS) patients showed a lower EI at all the shear stresses tested (p < 0.01) and higher EA0 (p < 0.014), but not higher EA1 (p = 0.076). Fibrinogen did not show statistical differences (p = 0.642). In the Spearman's correlation IE60 correlated inversely with Hb S (p < 0.05) and directly with MCV, MCH and Hb F levels (p < 0.01). EA0 correlated inversely with MCV, MCH, Hb F (p < 0.01) and directly with Hb S (p < 0.05). HU treatment improved EI and EA0, but not EA1. This paradoxical behaviour of HU on erythrocyte aggregation merits further research to be clarified. Show more

Keywords: Sickle cell disease, erythrocyte deformability, erythrocyte aggregation, hydroxyurea treatment

DOI: 10.3233/CH-131717

Citation: Clinical Hemorheology and Microcirculation, vol. 58, no. 4, pp. 497-505, 2014

Authors: Richards, P.D. | Richards, A.A. | McKoy, M.G. | Pepple, D.J.

Article Type: Research Article

Abstract: Fansidar® (sulfadoxine/pyrimethamine) and Coartem® (artemether/lumefantrine) are drugs that destroy malarial parasites and also produce free radicals which cause hemolysis of malaria-parasitized erythrocytes. This study investigated the effect of these drugs on the viscoelasticity of erythrocytes of ten healthy female subjects using the BioProfiler. The concentration for each of the two drugs were determined based on the therapeutic dose as normal, half the therapeutic dose as low and double the therapeutic dose as high. For Fansidar® , the concentrations were 0.15/0.01 mg/ml (low), 0.30/0.02 mg/ml (normal) and 0.60/0.04 mg/ml (high) based on the adult therapeutic dose of 1500/75 mg …of sulfadoxine/pyrimethamine in the drug combination. For Coartem® , the concentrations were 0.03/0.19 mg/ml (low), 0.06/0.38 mg/ml (normal) and 0.12/0.76 mg/ml (high) based on the adult therapeutic dose of 320/1920 mg of artermether/lumefantrine in the drug combination. There was a statistically significant (p < 0.05) decrease in viscosity, elasticity and relaxation time with Coartem® at normal and high doses. Fansidar® also showed significant (p < 0.05) reductions in these parameters only in the high dose. This suggests that Coartem® generated significant free radicals at normal and high doses, with Fansidar® only in the high dose, resulting in increased hemolysis and ultimately reduced viscoelasticity. Show more

Keywords: Sulfadoxine/pyrimethamine, artemether/lumefantrine, viscoelasticity, blood viscosity, relaxation time, free radicals

DOI: 10.3233/CH-131798

Citation: Clinical Hemorheology and Microcirculation, vol. 58, no. 4, pp. 507-514, 2014

Authors: Agha, Ayman | Hornung, Matthias | Schlitt, Hans J. | Stroszczynski, Christian | Jung, Ernst-Michael

Article Type: Research Article

Abstract: INTRODUCTION: Correct preoperative detection of parathyroid gland adenoma (PA) in the case of primary hyperparathyroidism (pHPT) is the requirement for unilateral cervical exploration associated with lower morbidity. We present our experience with contrast-enhanced ultrasonography (CEUS) as diagnostic tool for the preoperative localization of PA in pHPT in comparison to the 99m Technetium-sestamibi scintigraphy. METHODS: Between 8/2009–5/2013 143 patients with pHPT received surgical interventions in the Department of Surgery at the University Hospital of Regensburg. In all patients contrast-enhanced ultrasonography (CEUS) was performed as diagnostic tool for the localization of pathological parathyroid glands. By one experienced examiner CEUS was performed after …bolus injection of 1–2.4 ml contrast agent with storage of digital cine loops from the arterial phase (15–45 s) to the late phase (3 Min). Criteria for a parathyroid adenoma were marginal hypervascularisation in the arterial phase and wash out in the late phase. 74 patients received 99m Technetium-sestamibi scintigraphy. The sensitivity of both diagnostic tools was analyzed in comparison to the intraoperative and histological findings. RESULTS: CEUS revealed a sensitivity of 95.9% for the detection of pathological parathyroid glands and even of 97.1% for patients without scintigrapy in comparison to 60.8% for 99m Technetium-sestamibi scintigraphy. Sensitivity of CEUS in patients with negative scintigraphy was 96.3%. In multivariate regression analysis detection of small PA compared to scintigraphy was better by trend but did not reach significance (p = 0.019). Follow-up with a minimum of 8 weeks showed normal serum levels of calcium and parathyroid hormone in all patients except one. CONCLUSIONS: CEUS represents a new diagnostic method for the localization of parathyroid gland adenomas independent on findings in scintigraphy. In the present of appropriate expertise in CEUS no further diagnostic procedures are required. Show more

Keywords: Contrast-enhancend ultrasonography, $^{99m}$Technetium-sestamibi scintigraphy, diagnostic of primary hyperparathyroidism

DOI: 10.3233/CH-131800

Citation: Clinical Hemorheology and Microcirculation, vol. 58, no. 4, pp. 515-520, 2014

Authors: Prantl, L. | Englbrecht, M.A. | Schoeneich, M. | Kuehlmann, B. | Jung, E.M. | Kubale, R.

Article Type: Research Article

Abstract: BACKGROUND: To estimate the presence and severity of capsular contracture in patients after breast implants an objective measurement tool is necessary. PATIENTS AND METHODS: Eleven patients (range of age 37 to 53 years) who underwent cosmetic breast augmentation (seven patients with bilateral implants) or breast reconstruction by mammary asymmetry (four patients unilateral) with smooth silicone gel implants were included in this prospective study. In total seventeen implants were examined clinically and with the colour coded Ultrasound Elastography using a multifrequency probe (5–10 MHz Siemens Antares Premium VFX13-5). The grade of capsular contracture was assessed by two examiners with the palpation …method and classified according to the Baker score. The Ultrasound Elastography was performed by two radiologists specialized in breast imaging and was correlated with the Baker score, colour coded ultrasound elastography and a high resolution ultrasound B-scan score (0–5). RESULTS: The clinical examination proved following distribution of the Baker degree: 6 breast implants with Baker grade I and Baker grade II, 3 breast implants with Baker grade III and two breast implants with Baker grade IV. There was a high correlation between the Baker score and the objective scoring measured by Ultrasound Elastography (kappa 0.83–0.89). CONCLUSION: The new technology of Ultrasound Elastography represents a useful tool to evaluate the compressibility of the peri-implant capsule, the implant and the surrounding tissue. Show more

Keywords: Capsular contracture, mammary compliance, ultrasound elastography, baker's classification

DOI: 10.3233/CH-141812

Citation: Clinical Hemorheology and Microcirculation, vol. 58, no. 4, pp. 521-528, 2014

Authors: Ignee, Andre | Cui, Xinwu | Hirche, Tim | Demolo, Chiara | Barreiros, Ana P. | Schuessler, Gudrun | Dietrich, Christoph F.

Article Type: Research Article

Abstract: OBJECTIVE: Splenic lesions are rare and characterization is difficult. Secondary spread is more frequent than primary malignant lesions. Thus clinical circumstances are important in the general work-up. Contrast enhanced ultrasound (CEUS) had high accuracy in recent studies but the positive predictive value is low. Biopsy is considered dangerous. Recent studies have brought back this method into focus showing an excellent efficacy and safety. The aim of this study was to estimate the rate of relevant biopsy results in patients with splenic lesions concerning the clinical circumstances. DESIGN: Patients with unclear splenic lesions which appeared progressively hypoenhancing in the late phase …of CEUS with BR1 were included. Biopsy was performed with ultrasound guidance. Patients were sorted into 5 groups according to their clinical symptoms. RESULTS: 44 patients were enrolled, 59% had benign lesions. 73% were rated relevant. For the subgroups the rate was: patients with hints for hemato-oncological diseases 83%, patients without symptoms 38%, patients with infections of unknown origin 100%, patients with suspicion of metastases 33%, immunocompromised patients 100%. One bleeding could be managed conservatively, another bleeding was detected incidentally 2 weeks later. CONCLUSION: Percutaneous biopsy of unclear splenic lesions which appear hypoenhancing in the late phase of CEUS with BR1 results in a high rate of relevant lesions. The results should be tested in larger numbers of patients. Show more

Keywords: Contrast enhanced ultrasound, contrast agent BR1, splenic tumors, signs and symptoms

DOI: 10.3233/CH-141813

Citation: Clinical Hemorheology and Microcirculation, vol. 58, no. 4, pp. 529-541, 2014

Authors: Wiewiora, Maciej | Piecuch, Jerzy | Glûck, Marek | Slowinska-Lozynska, Ludmila | Sosada, Krystyn

Article Type: Research Article

Abstract: The aim of this study was to evaluate the effects of the obesity degree on red blood cell aggregation and deformability. We studied 56 obese patients before weight loss surgery who were divided into two groups: morbid obesity and super obesity. The aggregation and deformability of RBCs were evaluated using a Laser-assisted Optical Rotational Cell Analyzer (Mechatronics, the Netherlands). The following parameters specific to the aggregation process were estimated: aggregation index (AI), aggregation half-time (t1/2 ) and threshold shear rate (γthr ). RBC deformability was expressed as erythrocyte elongation (EI), which was measured at 18.49 Pa and 30.2 Pa shear …stresses. Super obese patients presented significantly higher AI (P < 0.05) and γthr (P < 0.05) and significantly lower t1/2 (P < 0.05) compared with morbidly obese individuals. Multivariate analyses showed that fibrinogen (β 0.46, P < 0.01 and β 0.98, P < 0.01) and hematocrit (β 0.38, P < 0.05 and β 1.01, P < 0.01) independently predicted the AI in morbidly obese and super obese patients. Fibrinogen (β −0.4, P < 0.05 and β −0.91, P < 0.05) and hematocrit (β −0.38, P < 0.05 and β −1.11, P < 0.01) were also independent predictors of the t1/2 in both obese groups. The triglyceride level (β 0.32, P < 0.05) was an independent predictor of the t1/2 in the morbidly obese group. No differences in EI were observed between obese subjects. Multivariate analyses showed that the triglyceride level independently predicted EI at 18.49 Pa (β −0.42, P < 0.05 and β −0.53, P < 0.05) and 30.2 Pa (β −0.44, P < 0.01 and β −0.49, P < 0.05) in both obese groups. This study indicated that the obesity degree of patients who qualify for bariatric surgery affects RBC aggregation properties, but it does not indicate the reasons for this difference. Further studies are needed to determine factors associated with hyperaggregation in super obesity. Show more

Keywords: Red blood cell aggregability and deformability, bariatric surgery

DOI: 10.3233/CH-141814

Citation: Clinical Hemorheology and Microcirculation, vol. 58, no. 4, pp. 543-550, 2014

Authors: Vayá, Amparo | Giménez, Cristina | Alis, Rafael | Murado, Julian | Fuster, Óscar

Article Type: Other

DOI: 10.3233/CH-141890

Citation: Clinical Hemorheology and Microcirculation, vol. 58, no. 4, pp. 551-553, 2014

Authors: Nemeth, Norbert | Kiss, Ferenc | Peto, Katalin | Miko, Iren | Furka, Istvan

Article Type: Other

DOI: 10.3233/CH-141905

Citation: Clinical Hemorheology and Microcirculation, vol. 58, no. 4, pp. 555-558, 2014