Estimation of the microcirculation state in cerebrovascular disorders using laser doppler flowmetry data and hemorheological parameters

The microcirculation state was assessed in the group of patients with ischemic stroke (n = 30) and the control group of healthy individuals (n = 27) using laser Doppler flowmetry and the wavelet analysis of the amplitude-frequency range of microvascular blood flow oscillations combined with absorption spectroscopy. The hemorheological parameters (blood and plasma viscosity, the degree of red blood cell aggregability and deformability) were assessed in both groups, as were their correlations with the microcirculation parameters. Decreased tissue perfusion (by 25%) and specific oxygen consumption (by 21%) were revealed in a cerebrovascular accident. Changes in the tone-forming regulatory mechanisms of microcirculation of vasodilating nature (decreased microvascular tone, activation of the secretory function of endothelium) may be regarded as a compensatory reaction aimed at maintaining the blood supply of organs and tissues in stroke. The blood viscosity increase in patients due to the plasma viscosity increase and increased red blood cell aggregability and their decreased deformability cause the blood flow to slow down and the wall shear stress to increase, which activates the endothelial secretory function and vasodilation of microvessels. Correlation between the rheological parameters and the passive (respiratory and cardiac) rhythm amplitudes was observed in the control group. In patients, the hemorheological parameters were correlated with the characteristics of the active factors of microvascular blood flow modulation (endothelial, neurogenic, and myogenic), which confirms the role of changed blood properties and regulatory tone-forming mechanisms in the maintenance of tissue perfusion in cerbrovascular accidents.     

Relation between microcirculation parameters and Pc3 geomagnetic pulsations

An individual analysis of long-term monitoring of microcirculation parameters of nine healthy volunteers showed that an increase in the geomagnetic activity led to an increase in tissue perfusion, variability of blood flow and growth of the amplitude of neurogenic and myogenic oscillations in four volunteers. It was found that the degree of microcirculation sensitivity to the level of geomagnetic activity varies with time and is proportional to its average level in the period of measurement. A comparison of frequency ranges of oscillations of blood flow and variations of the geomagnetic activity shows that neurogenic and myogenic oscillations showing the highest sensitivity to the geomagnetic activity have the same frequency as geomagnetic Pc3 pulsations. The pulsations of this frequency range are excited mainly during geomagnetic disturbances, which may explain the correlation between the microcirculation parameters and the K _p-index. The relation of the amplitude-frequency characteristics of Pc3-pulsations can explain the results obtained using Lednev’s model which treats the spins of hydrogen nuclei as a primary target of action for extremely weak alternating magnetic fields.     

Effect of penicillin G-induced epileptic seizures on hemorheological parameters in rats

Normally, cerebral blood flow (CBF) is quantitatively coupled to cerebral metabolic rate like other tissues and maintained basically by altering vascular geometry and appropriate perfusion pressure. However, the rheological properties of the blood are important factors for effective tissue perfusion. Although a lot of studies have reported that hemorheological parameters are affected by a wide range of pathophysiological conditions, to our knowledge no research related to the effects of epileptic seizures on hemorheological parameters has been carried out. Thus, the aim of this study was to explore possible changes in rheological parameters including red blood cell (RBC) deformability, rigidity and aggregation, whole blood and plasma viscosity during epileptic seizures induced by penicillin G in rats. Eighteen female albino rats were divided into three groups that included sham operated controls (Group S), epileptic group (Group E), intraperitoneal penicillin group (Group IPP). Epilepsy was induced by intracortical injections of penicillin G. Hemorheological studies had been carried out 3 h after the induction of epilepsy. Among the studied hemorheological parameters, only RBC deformability was found to be different in the E group compared to S group. Epileptic seizures led to an increase in RBC deformability in the E group. In conclusion, these results suggest that in addition to an increase in CBF, RBC deformability may also improve to better match brain metabolic demands during seizures.     

Age-related differences in the dynamics of the skin blood flow oscillations during postocclusive reactive hyperemia

Age-related changes in peripheral microcirculation were studied using laser Doppler flowmetry in 60 apparently healthy subjects. The response of microcirculation to short-term ischemia was studied using the occlusion test. Changes in the amplitude of the peripheral blood flow oscillations were determined using time-amplitude analysis based on continuous adaptive wavelet filtration. The oscillation amplitude in the frequency range of the heart rate was found to reach the maximum with a delay after the removal of the occlusion, whereas in the range of the respiratory rhythm, no delay was observed. The hyperemic response to short-term ischemia is assumed to develop under the predominant influence of the arterial-arteriolar component, whereas the dynamics of amplitude oscillations in the range of the respiratory rhythm is a result of the devastation of the venular component after removal of occlusion. In response to short-term ischemia, the maximum oscillation amplitudes of myogenic, neurogenic, and endothelial rhythms decreased with age, which demonstrates the restriction of the regulatory control of the peripheral blood flow by the corresponding systems.     

Effect of parenteral or oral vinpocetine on the hemorheological parameters of patients with chronic cerebrovascular diseases

IntroductionHemorheological factors play an important role in the pathomechanism of ischemic cerebrovascular disorders. Abnormal rheological conditions in patients with chronic cerebrovascular disease predispose for recurrent strokes. Vinpocetine (VP), a synthetic ethyl esther of apovincamine, has successfully been used in the treatment of cerebrovascular diseases, in part because of its favourable rheological effects.Patients and methodsThe study investigates the hemorheological changes in 40 patients in the chronic stage of ischemic cardiovascular disease after administration of vinpocetine. All patients received a high dose of intravenous VP in doses gradually increased to l mg/kg/day. In addition, 20 patients (mean age: 61±8 years) received 30 mg VP orally for 3 months. The other 20 patients (mean age: 59±6 years), who received placebo tablets, served as controls. Hemorheological parameters (hematocrit, plasma fibrinogen, whole blood viscosity, red blood cell aggregation and deformability) were evaluated at 1 and 3 months.ResultsThe high-dose parenteral VP significantly decreased red blood cell aggregation, plasma and whole blood viscosity (p<0.05) compared to the initial values. In patients with additional oral treatment, plasma and whole blood viscosities were significantly lower compared to the placebo patients at 3 months (p<0.05).ConclusionOur results confirmed the beneficial rheological effects of high-dose parenteral VP (partially caused by hemodilution) observed previously, and also warrant its long-term oral admission to maintain the beneficial rheological changes.     

Assessment of the changes in regulatory systems of human's skin blood flow during local heating

The mechanisms of thermal regulation of skin blood flow during local heating to 35, 40 and 45 'C have been studied by the method of laser Doppler flowmetry in healthy volunteers. To estimate the state of microvascular bed the continuous wavelet-transform spectral analysis has been used. The amplitudes of fluxmotions in the range of blood flow active modulation significantly increase during local heating to 35 degrees C. The amplitudes of blood flow oscillations in the ranges of cardiorhythm and respiratory rhythm increase during local heating to 40 degrees C. The high amplitude oscillations in the range of myogenic activity are maintained. The amplitude of oscillations in the range of endothelial activity distinctly decreases and the oscillations in the range of neurogenic activity are inhibited. Local heating to 45 degrees C results in a significant decreasing of the oscillation amplitudes in the range of myogenic activity, and the amplitudes of cardio- and respiratory spectral components amount to their peak values among the temperatures of local heating under study.     

Contributions to biorheology during hemodialysis.

Thrombogenicity is the property of a foreign surface to induce clotting processes or formation of aggregates after contact with blood. Beside the sort of anticoagulation patient's prethrombotic state, rheological factors as well as physicochemical properties of foreign membranes decisively influence thrombogenicity. We examined the influence of chronic renal failure and different hemodialyzers and blood transfusion therapy during hemodialysis on hemorheological parameters. Different membranes cannot be discriminated by the used hemorheological parameters. We clearly could demonstrate the close relationship between the hemofiltration rate and an increase of viscosity. Blood transfusion therapy or elevated hematocrit in combination with increased hemofiltration rate have influence on the flow behaviour of blood, especially in disturbed microcirculation.     

The influence of the sympathetic innervation on the skin microvascular tone and blood flow oscillations

The influence of the sympathetic innervation on the tone of resistive vessels and blood flow oscillations was studied using laser Doppler flowmetry and skin thermography in 18 healthy subjects (before and after reflex cold and heat tests and local thermal testing), 42 patients with denervation syndromes caused by median nerve damage, and 10 patients with an acute stage of aseptic inflammation after radius fracture. The blood flow oscillations in the range of neurogenic sympathetic influences (0.02–0.052 Hz) supported by low-frequency sympathetic rhythms are an essential component of neurovascular interrelations. The importance of these oscillations is determined by their contribution to an increase in tissue perfusion owing to a decrease in the peripheral resistance and also by the leveling of drastic changes in blood flow and stabilization of microhemodynamics upon pronounced changes in the stationary tone. The high-and low-frequency (tonic and oscillatory, respectively) sympathetic rhythmic activities are expressed in two ways: (1) a synchronous increase or decrease in their amplitudes and (2) frequency dominance. The reactivity of the vessel smooth muscles is an important factor in maintaining the blood flow oscillations. Denervation decreases the oscillation amplitude in the neurogenic range. Under the conditions of local “inflammatory sympatholysis,” reflex tonic effects, rather than oscillatory ones, of the sympathetic impulses are mainly suppressed. An isolated evaluation of the blood flow oscillations in the neurogenic sympathetic range cannot be a measure of sympathetic activity. In studies on its functional state and evaluation of the neurogenic tone (NT) of resistive vessels, it is necessary to take into account the parameters of both stationary and oscillatory components of the NT.     

Decreased Hematocrit-To-Viscosity Ratio and Increased Lactate Dehydrogenase Level in Patients with Sickle Cell Anemia and Recurrent Leg Ulcers

Leg ulcer is a disabling complication in patients with sickle cell anemia (SCA) but the exact pathophysiological mechanisms are unknown. The aim of this study was to identify the hematological and hemorheological alterations associated with recurrent leg ulcers. Sixty-two SCA patients who never experienced leg ulcers (ULC-) and 13 SCA patients with a positive history of recurrent leg ulcers (ULC+) - but with no leg ulcers at the time of the study – were recruited. All patients were in steady state condition. Blood was sampled to perform hematological, biochemical (hemolytic markers) and hemorheological analyses (blood viscosity, red blood cell deformability and aggregation properties). The hematocrit-to-viscosity ratio (HVR), which reflects the red blood cell oxygen transport efficiency, was calculated for each subject. Patients from the ULC+ group were older than patients from the ULC- group. Anemia (red blood cell count, hematocrit and hemoglobin levels) was more pronounced in the ULC+ group. Lactate dehydrogenase level was higher in the ULC+ group than in the ULC- group. Neither blood viscosity, nor RBC aggregation properties differed between the two groups. HVR was lower and RBC deformability tended to be reduced in the ULC+ group. Our study confirmed increased hemolytic rate and anemia in SCA patients with leg ulcers recurrence. Furthermore, our data suggest that although systemic blood viscosity is not a major factor involved in the pathophysiology of this complication, decreased red blood cell oxygen transport efficiency (i.e., low hematocrit/viscosity ratio) may play a role.     

Normal Muscle Oxygen Consumption and Fatigability in Sickle Cell Patients Despite Reduced Microvascular Oxygenation and Hemorheological Abnormalities

Background/Aim

Although it has been hypothesized that muscle metabolism and fatigability could be impaired in sickle cell patients, no study has addressed this issue.

Methods

We compared muscle metabolism and function (muscle microvascular oxygenation, microvascular blood flow, muscle oxygen consumption and muscle microvascular oxygenation variability, which reflects vasomotion activity, maximal muscle force and local muscle fatigability) and the hemorheological profile at rest between 16 healthy subjects (AA), 20 sickle cell-hemoglobin C disease (SC) patients and 16 sickle cell anemia (SS) patients.

Results

Muscle microvascular oxygenation was reduced in SS patients compared to the SC and AA groups and this reduction was not related to hemorhelogical abnormalities. No difference was observed between the three groups for oxygen consumption and vasomotion activity. Muscle microvascular blood flow was higher in SS patients compared to the AA group, and tended to be higher compared to the SC group. Multivariate analysis revealed that muscle oxygen consumption was independently associated with muscle microvascular blood flow in the two sickle cell groups (SC and SS). Finally, despite reduced muscle force in sickle cell patients, their local muscle fatigability was similar to that of the healthy subjects.

Conclusions

Sickle cell patients have normal resting muscle oxygen consumption and fatigability despite hemorheological alterations and, for SS patients only, reduced muscle microvascular oxygenation and increased microvascular blood flow. Two alternative mechanisms can be proposed for SS patients: 1) the increased muscle microvascular blood flow is a way to compensate for the lower muscle microvascular oxygenation to maintain muscle oxygen consumption to normal values or 2) the reduced microvascular oxygenation coupled with a normal resting muscle oxygen consumption could indicate that there is slight hypoxia within the muscle which is not sufficient to limit mitochondrial respiration but increases muscle microvascular blood flow.     

Rheological Properties of Blood in Athletes

Rheological properties of blood were studied in subjects with high physical activity (athletes). It was found that the whole blood viscosity decreased under conditions of relative rest. The use of the concept of hemorheological profiles made it possible to reveal different profiles in subjects exposed to different courses of training exercise. The relationship between the rheological properties of blood and the total work capacity in humans was established. The typical parameter of profiles in subjects with high physical activity was high erythrocyte deformability associated mainly with erythrocyte form and viscoelastic properties of its membrane.     

Blood filterability in cerebral vascular disease

The aim of this paper is to test whether an alteration of blood flow in microcirculation and in particular of red cell deformability is present in cerebrovascular insufficiency. To this end we determined by the method proposed by Reid and Dormandy (J. Clin. Pharmacol. 1976, 29, 855) whole-blood filterability in 31 patients with cerebrovascular disease, in 15 clinically healthy subjects and in 99 subjects without clinical evidence of ischemic pathology displaying one or more vascular risk factors. Blood filterability turned out to be significantly lower in cases of cerebrovascular disease than in the controls (p less than 0,001), while data about presence of risk factors in cerebrovascular insufficiency and in controls are almost overlapping. Reduction of blood filterability in cerebrovascular disease may therefore be attributed directly to the risk factors associated to the disease, which can significantly reduce red cell deformability. Further we didn't find any significant correlation between blood filterability and levels of fibrinogen, platelets, triglycerides and cholesterol in blood.     

The functional state of microcirculation and autonomic regulation in young subjects with different levels of subjectively experienced psychological stress

A comprehensive comparative analysis of hemodynamics, microcirculation (the method of laser Doppler flowmetry with an occlusion test and the optical tissue oxymetry), blood circulation neurohumoral regulation (analysis of heart rate variability, HRV) in apparently healthy young subjects with different levels of subjectively experienced emotional stress has been performed. Depending on the degree of everyday stress (acute and/or chronic), the character of the autonomic regulation of blood circulation, as well as the state of the microcirculation and its regulation substantially vary. Moderate stress is accompanied by coactivation of sympathetic-parasympathetic regulatory mechanisms with augmented HRV baroreflex regulation circuits, which compensates for hemodynamic changes and is not accompanied by hypotensive reactions. An increase in the activity of neurogenic and myogenic tones of microhemodynamics in the subjects with moderate stress, which determines a high probability of blood shunting in tested tissue and decrease in relative oxygen extraction, has been discovered. Moderate levels of stress are also associated with an increase in the latency of postocclusive vasoreactive hyperemia, which is considered to be an early sign of the endothelium-mediated dysfunction of microcirculation.     

Characteristic features of microvascular responses of healthy humans to simulated emotional stress

Characteristic features of microvascular responses of healthy humans to simulated emotional stress (ES) were studied using computer-aided laser Doppler flowmetry. It was shown that, in ES, responses of individual regions of the microvasculature are relatively autonomous and different. In the nail bed, where the arteriolar and the arteriolovenular shunt tone depends on the neurogenic sympathoadrenal regulation, the responses are more pronounced than in the lower arm microvessels. The rearrangements of the nail bed and lower arm microvasculature in response to a simulated situation of ES are different, which is likely to be determined by both their different vascular architecture and other factors (the pressure gradient, metabolic requirements of tissues, etc.). It was established that the ES level determines an increase in the contributions of the neurogenic, myogenic, respiratory, and cardiac components to the modulation of the intensity of microcirculation, increasing the shunt value and the blood flow in microvessels.     

Influence of sensory peptidergic innervation on human skin blood flow oscillations in the range 0.047–0.069 Hz

Thirty-six healthy subjects and 65 patients with neurogenic inflammation (complex regional pain syndrome of the hand) or denervation syndromes (after median and ulnar nerve injuries or transplantation of denervated vascularized musculocutaneous autografts), as well as after thoracoscopic sympathectomy, underwent laser Doppler flowmetry with spectral wavelet analysis of the blood flow oscillations in cutaneous microvessels and thermography. It was shown that, along with maintenance of the blood flow oscillations of endothelial genesis, peptidergic sensory nerve fibers (SPFs) are involved in activating independent, including high-amplitude, oscillations in the myogenic range 0.047–0.069 Hz (an average of three to four oscillations per minute). The above-mentioned oscillations were recorded against the background of neurogenic inflammation and nociceptive activation of C afferents after nerve injuries, as well as in the course of functional tests in healthy subjects (the forearm skin electrostimulation test, capsaicin application). Sympathectomy and hyposympathicotonia contributed to their manifestation; they were not detected under the conditions of severe sensory-trophic skin denervation. The appearance of high-amplitude blood flow oscillations in human skin microvessels at a frequency of 0.047–0.069 Hz may serve as an objective criterion of SPF activation.     

Changes in red cell oxygen release capacity in diabetes mellitus.

Studies are summarized to indicate that diabetes is associated with a fluctuating disturbance in the oxygen release capacity of the erythrocytes. This disorder, present from the onset of the disease, is a consequence of excess hemoglobin AIc, and absolute or relative hypophosphatemia and acidosis that interfere with formation of the red cell metabolite 2,3-diphosphoglycerate. As a result frequent increases in hemoglobin--oxygen affinity are produced. Available evidence suggests that transient decreases in red cell oxygen delivery lead to dilatation of the venous part of the microcirculation associated with increased transcapillary plasma permeation. Combined with microrheologic alterations (increased red cell aggregation, increased blood viscosity, and decreased red cell deformability) these functional changes may over the years participate in the pathogenesis of the microvascular disease in diabetes.     

Evaluation of the parameters of total,nutritive, and shunt blood flows in the skin microvasculature using laser Doppler flowmetry

Examination of 28 healthy subjects and 66 patients was performed using laser Doppler flowmetry (LDF) of the skin of fingers in the red and infrared ranges and wavelet analysis of microvascular blood flow oscillations. Formulas were suggested for the total (TF), nutritive (NF), and shunt (SF) local blood flows. TF = MI × A_c × A_n /(P_m × ), where MI is the microcirculation index in perfusion units (PU), A_n and A_c are the averaged maximum amplitudes of the neurogenic and cardiac rhythms (in PU), P_m is the mean arterial pressure (in mm Hg), and is the mean square deviation of the amplitude of blood flow oscillations (in PU). NF = TF/SP, where SP is the shunting parameter. SP = A_n/A_m, where A_m is the averaged maximum amplitude of the myogenic rhythm (in PU). SF = TF - NF. Significant positive relationships between the skin oxygenation and NF (red), temperature and TF (red), and blood flow measured by hydrogen clearance and TF (infrared) were revealed by comparison of the LDF parameters with polarographic and thermographic data. The advantages of the LDF parameters compared with the MI were shown, especially in skin denervation syndromes. The TF decreased in the case of complete anatomic rupture of the median nerve and increased in reflex sympathetic dystrophy, with both cases being accompanied by a deficit of the NF (red).Translated from Fiziologiya Cheloveka, Vol. 31, No. 1, 2005, pp. 114–119.Original Russian Text Copyright © 2005 by Krupatkin.     

An Experimental-Computational Approach to Quantify Blood Rheology in Sickle Cell Disease

In sickle cell disease, aberrant blood flow due to oxygen-dependent changes in red cell biomechanics is a key driver of pathology. Most studies to date have focused on the potential role of altered red cell deformability and blood rheology in precipitating vaso-occlusive crises. Numerous studies, however, have shown that sickle blood flow is affected even at high oxygen tensions, suggesting a potentially systemic role for altered blood flow in driving pathologies, including endothelial dysfunction, ischemia, and stroke. In this study, we applied a combined experimental-computation approach that leveraged an experimental platform that quantifies sickle blood velocity fields under a range of oxygen tensions and shear rates. We computationally fitted a continuum model to our experimental data to generate physics-based parameters that capture patient-specific rheological alterations. Our results suggest that sickle blood flow is altered systemically, from the arterial to the venous circulation. We also demonstrated the application of this approach as a tool to design patient-specific transfusion regimens. Finally, we demonstrated that patient-specific rheological parameters can be combined with patient-derived vascular models to identify patients who are at higher risk for cerebrovascular complications such as aneurysm and stroke. Overall, this study highlights that sickle blood flow is altered systemically, which can drive numerous pathologies, and this study demonstrates the potential utility of an experimentally parameterized continuum model as a predictive tool for patient-specific care.     

杜仲绿原酸对高脂小鼠血液流变学作用研究

旨以研究杜仲绿原酸对高脂高胆固醇诱导的高血脂模型小鼠血液流变学的影响,以昆明小鼠为实验动物,随机分成5组:阴性对照组,模型对照组和低剂量(25 mg/kg BW)、中剂量(50 mg/kg BW)、高剂量(100 mg/kg BW)杜仲绿原酸组,每组10只.后4组饲以高脂饲粮,同时小鼠灌胃杜仲绿原酸4周,实验结束,分别测定各组小鼠血液流变学参数、血清和肝脏的抗氧化酶活性和脂质过氧化产物MDA含量及其总抗氧化能力和羟自由基清除率.高脂血症小鼠的全血粘度、血浆粘度、红细胞压积、血沉、纤维蛋白原、红细胞刚性指数和聚集指数显著降低(P＜0.05),红细胞变形指数显著提高(P＜0.05),小鼠血清和肝脏SOD、GSH-Px水平、总抗氧化能力和羟自由基清除能力均显著升高(P＜0.05),MDA水平显著降低(P＜0.05).在高脂膳食条件下,杜仲绿原酸能有效提高血液的抗氧化防御功能(包括抗氧化力、抗氧化酶活性)、改变血液流变学参数等,降低血液粘度、红细胞刚性和聚集,增强变形能力,使细胞膜的流动性增高,其中以中剂量效果相对较好.     

Analysis of the Relationship Between Hemorheologic Parameters,Aluminum, Manganese,and Selenium in Smokers

Smoking is a significant risk factor in fatal pathologies including cardio-cerebrovascular and respiratory diseases. Aluminum (Al) is a toxic element without known biological function, but with recognized toxic effects. Manganese (Mn) and selenium (Se) are essential trace elements involved in cellular antioxidant defense mechanisms. Al, Mn, and Se carry out their metabolic activities via blood flow and tissue oxygenation. The structure and number of red blood cells (RBC) play important role in tissue oxygenation throughout blood flow. Increased hematocrit (Hct) as a result of probable hypoxia induces disturbed blood flow, RBC aggregation (RBC Agg), RBC deformability index (Tk), and oxygen delivery index (ODI). Therefore, we aimed to investigate the effects of altered Al, Mn, and Se levels on number, structure, and function of RBCs (Hct, blood and plasma viscosity (BV and PV, respectively), RBC Agg, Tk, ODI) in smokers without diagnosis of chronic obstructive pulmonary disease (COPD) in a study group (n = 128) categorized as ex-smokers (ES), smokers (S), and healthy controls (HC). Elements were analyzed in serum using ICP-OES. BV and PV were measured via Brookfield and Harkness viscometers at 37 °C, respectively. Smokers had statistically higher serum Al and Mn levels, BV, RBC, Hgb, Hct, PV, fibrinogen, RBC Agg, Tk₄₅, and pulmonary blood flow rate, but lower serum Se levels and ODI₄₅ values versus HC. In conclusion, increased Al, Mn, and hemorheological parameters and decreased Se and ODI₄₅ might result from inflammatory response in defense mechanism in smokers without diagnosis of COPD. Our results point out that serum Al, Mn, and Se with hemorheological parameters may be beneficial markers of tissue oxygenation and defense mechanism before the clinic onset of COPD in smokers.