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[State of central and regional hemodynamics in riveters depending on the type of blood circulation].

Tetrapolar rheovasography was used to medically examine 54 riveters, of equal age and duration of work, who were exposed to the complex action of low-intensity vibration and noise. The central, cerebral and peripheral hemodynamic indices were assessed depending on the blood circulation type with dew account of the current views on the hemodynamic norms. Identified were differences in the absolute figures of most indices of central and cerebral hemodynamics depending on the blood circulation type. The 'levelling' of the peripheral blood circulation indices was performed by initial vibration disease pathologic developments in vascular tension. It can be concluded that the hypokinetic type of blood circulation is a risk factor which should be taken into account in selecting the occupational criteria for riveters.

Adult↗

[Significance of the arrest of pulmonary circulation in the genesis of postperfusion pulmonary complications in open heart surgery].

The purpose of the work is to elucidate the importance of pulmonary circulation arrest during extracorporeal circulation in the development of microcirculatory disorders in the pulmonary tissue. Experiments showed that temporary arrest of pulmonary circulation under conditions of extracorporeal circulation is attended by the development of ischemia of the respiratory pulmonary tissue. The systemic blood flow in the arterio-arterial anastomoses between the pulmonary and bronchial arteries is incapable of providing the pulmonary tissue with blood. Ischemia of the parenchyma leads to disorders in the microvessels of the organ, the manifestation of which in the ischemic and postischemic, periods is determined by the duration of the pathologic effect. The data gained indicate the importance of developing methods for the prevention and treatment of ischemic and postischemic pulmonary microcirculatory disorders and determining the safe terms of pulmonary artery ischemia.

Animals↗

[Role of "qi" in reaching affected area using acupuncture in "promoting blood circulation to remove blood stasis"].

In the present work, an experimental observation was carried out with the determination method of bioelectric impedance in 78 cases of chronic hepatitis, 58 cases of chronic obstructive pulmonary disease, 45 of obstructive thromboendarteritis and 65 of coronary heart disease, who were diagnosed definitely and possessed the symptoms and signs of blood stasis and produced change in hemodynamics. Yanglingquan (G. B. 34) and Zhangmen (Liv.13) acupoints on right side were needled and four indices of liver blood circulation were determined for chronic hepatitis. Bilateral Kongzui (Lu.6) acupoints were needled and seven indices of lung blood circulation were detected for chronic obstructive pulmonary disease. Acupoint along the pathway of channel were needled and six indices of blood circulation in the extremities were examined for obstructive thromboendarteritis. Bilateral Neiguan (P.6) acupoints were needled and four indices of the cardiovascular function were detected for coronary heart disease. Results showed 95 cases of the above four diseases having Qi reaching to affected area. 84 cases had propagated sensation along the channel. 67 cases had local sensation. Experimental results indicated that Qi reaching affected area produced obvious effects of dredging the meridian passage, and promoting blood circulation to remove blood stasis.

Acupuncture Therapy↗

Effect of collateral circulation on intestinal viability following segmental devascularization in the rat.

The collateral circulation in the rat small intestine was studied by evaluating the viability of an intestinal segment after its primary mesenteric vascular supply had been interrupted. After ligation of the main mesenteric branches of a 30-cm segment of either jejunum or ileum, viability was assessed immediately by the fluorescence pattern observed under ultraviolet illumination after the peripheral intravenous injection of sodium fluorescein. Viability was assessed again at 48 hours by the fluorescein technique and by gross and histologic examination. With the marginal vessels intact, the collateral circulation was able to sustain 10 per cent of the entire length of small intestine beyond the point of devascularization. On the other hand, when the marginal vessels had been ligated, this length of sustained intestine proved to be negligible. With respect to the above findings, there was no difference in the extent or pattern of collateral circulation at different levels along the small intestine, from proximal jejunum to jejuno-ileal junction to terminal ileum. Systemic infusion of a vasodilator, isoproterenol, was found to substantially decrease the length of small intestine maintained viable by collateral flow. This was associated with a greater decrease in systemic vascular resistance than in mesenteric vascular resistance, which resulted in a drop in mesenteric blood flow. In each of the above studies, the ultimate viability of the intestine by histologic section at 48 hours correlated closely with the fluorescein pattern immediately after devascularization. These studies demonstrate that the collateral circulation of the small intestine is extensive and sufficient to maintain viability in a substantial proportion of the length of the entire intestine.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[Relationship between myocardial contractility and collateral circulation in patients with ischemic heart disease].

By analyzing coronary angiograms and ventriculograms of 61 patients with the narrowed lumen of one or several coronary vessels by 90-100%, the dependence of the contractile function of the myocardium on the development of the collateral circulation in the cardiac muscle was studied. The assessment of the segmentary contractility of the left ventricle served as a criterion of the efficiency of the collateral circulation. The segmentary contractility was shown to be dependent on the presence or absence of the collateral circulation and also on the number of damaged vessels. The collateral circulation was also demonstrated to contribute to the maintenance of the contractile function of the myocardium.

Adult↗

Pattern of coronary arterial circulation and anastomoses in post mortem angiographic studies of human hearts.

Hearts from 131 unselected medicolegal autopsies have been studied. The age of the subjects ranged from 5 to 80 years old. After the coronary arteries were injected with radio opaque dye in gelatin the hearts were dissected and angiograms taken. Depending upon the pattern of coronary artery circulation, the hearts, were categorised into 3 groups. Group I or right preponderant heart was found in 63% of cases, group II or heart with 'balanced circulation' was present in 25% of cases while group III or 'left preponderant' heart was seen in 12% of the cases. This pattern of circulation is similar to that observed in the western population. Coronary collateral circulation was seen in all hearts, of all age groups. However, mild degree of anastomoses were common in the first three decades of life while in the later decades anastomoses were often marked. Hearts with grade III and IV coronary occlusions showed moderate to marked anastomoses in 70% of the cases. Myocardial scars were seen in 24 hearts. Of these, 22 had grade III and IV occlusions in their coronary arteries while, only 2 hearts had grade II occlusive lesions. The anastomoses were moderate to marked in 67% of these hearts.

Adolescent↗

Variable responses of highly stenotic coronary arteries and collateral circulation to intracoronary injection of nitroglycerin in patients with chronic effort angina.

AIM: To assess the direct effects of nitroglycerin on coronary and collateral circulation, 31 consecutive patients with low exercise capacity resulting from chronic effort angina but who had not suffered previous myocardial infarction were investigated. METHODS: Rapid atrial pacing was used to induce myocardial ischemia, with the same pacing rate before and after an intracoronary injection of 50 micrograms nitroglycerin. Fifteen patients (group A) with an obstructed ischemia-related coronary artery (IRCA) (TIMI flow grade 0 or 1), were injected with nitroglycerin into a major donor artery of the well-developed collateral circulation. Sixteen patients with patent IRCAs (TIMI flow grade 2 or 3) were injected with nitroglycerin into the IRCA. These patients were subdivided according to the morphologic findings of the stenosis in the IRCA: group B, nine patients with eccentric elliptical residual lumens, and group C, seven patients with circular residual lumens. RESULTS: In group A, 0.21 +/- 0.08 mV of pacing-induced ST-segment depression was consistently ameliorated to 0.08 +/- 0.05 mV after pretreatment with nitroglycerin (P < 0.0001). In group B, the extent of ST-segment depression was markedly improved from a basal value of 0.21 +/- 0.05 mV to 0.05 +/- 0.03 mV with nitroglycerin (P < 0.001). In contrast, in group C ST-segment depression remained unchanged despite pretreatment with nitroglycerin (0.21 +/- 0.04 mV to 0.21 +/- 0.05 mV, P = NS). CONCLUSION: These results indicate that the contribution of the dynamic stenosis of the IRCA to effort angina differs greatly among patients and depends on the morphologic findings of the stenosis in the IRCA, and also that collateral circulation responds effectively to intracoronary injection of nitroglycerin in all patients with a well-developed collateral circulation.

Adult↗

Importance of the coronary collateral circulation for the distribution of anterograde and retrograde delivered cardioplegic solution in aortocoronary bypass surgery: a haemodynamic study.

The importance of coronary collateral circulation for homogeneous distribution of anterograde and retrograde delivery of cardioplegia was evaluated in 36 patients undergoing myocardial revascularization. All patients had three-vessel coronary artery disease, with a stenosis of the right coronary artery of at least 80%. The patients were randomized into two groups: group A (n = 19) received anterograde delivered cardioplegic solution and group B (n = 17) received retrograde. Both groups were further subdivided depending on the pathology of the right coronary artery, as evaluated on preoperative coronary angiography. In group A1 (n = 8) and group B1 (n = 7) there was no visualization of collateral circulation from the left to the right coronary artery system, whereas in group A2 (n = 11) and group B2 (n = 10) there was retrograde filling of the right coronary artery by collateral circulation. Right atrial pressure increased significantly (P < 0.05) in group A1 and was elevated in group A2, but not significantly (P = 0.07). By contrast, right arterial pressure decreased in groups B1 and B2. Analysis of the individual differences in the right atrial filling pressure showed a statistical significance between the two subgroups (group B1-1.0(0.5) versus group B2-1.8(1.1), P < 0.05), although the individual decrease of the right ventricular stroke work index was not significant. It is concluded that collateral circulation is important for an adequate distribution of anterogradely delivered cardioplegia and is also beneficial in cases of retrograde delivery.

Adult↗

The effect of oscillating low intensity magnetic field on the Na+, K+, Ca++, and Mg++ concentrations in the maternal and fetal circulation of the dually perfused human placental cotyledon.

Dual-sided perfusions of the human placental cotyledon in vitro were used to study effects of low intensity magnetic fields (MFs) of 2 mT, 50 Hz (E1, 10 perfusions) and 5 mT, 50 Hz (E2, 10 perfusions). In the control group C (10 experiments) no field was used. Perfusions lasted 180 min each. Increased release of calcium ions from the placental cotyledon was found in the fetal circulation during perfusion when the 2 mT, 50 Hz MF was used. No changes in the release of sodium and magnesium ions were observed compared to the control group. The 5 mT, 50 Hz oscillating MF intensified the release of sodium ions from the perfused cotyledon both to the fetal and maternal circulation up to the 150th min of the experiment. Increased release of magnesium ions was observed only to the fetal circulation between 120 and 180 min and of calcium ions to the fetal circulation between 60 and 180 min. No significant differences in K concentrations were found between the control and MF exposed cotyledons under conditions of these experiments.

Calcium↗

Adiponectin produced in coronary circulation regulates coronary flow reserve in nondiabetic patients with angiographically normal coronary arteries.

BACKGROUND: Epicardial adipose tissue expresses adiponectin protein, and its expression is significantly lower in patients with severe coronary artery disease (CAD) than in those without CAD. Transcoronary adiponectin levels are significantly decreased in nondiabetic but not in diabetic patients with CAD. Adiponectin is also an important adipocytokine that is linked to insulin resistance and reduces coronary microvascular function. HYPOTHESIS: Adiponectin may play a significant role in the localized coronary circulation. The present study examines the local dynamics of adiponectin in the coronary circulation in nondiabetic individuals with normal coronary arteries and the relationship between adiponectin and coronary microvasculature function. METHODS: We examined 22 consecutive nondiabetic patients whose coronary arteries were angiographically normal. Plasma levels of adiponectin were measured in blood samples that were simultaneously collected from the orifice of the left coronary artery (LCA) and the great cardiac vein (GCV). To evaluate the function of the coronary microcirculation, we measured coronary flow velocity at maximal hyperemia using a Doppler wire. Coronary flow reserve (CFR) was obtained from the ratio of hyperemia to the baseline coronary flow velocity. RESULTS: Plasma adiponectin levels in the GCV (median 6.95 microg/ml) were significantly higher than those in the LCA (median 6.60 microg/ml, p < 0.0005). The difference in plasma adiponectin levels between GCV and LCA significantly correlated with CFR (R = 0.451, p < 0.05). CONCLUSIONS: Adiponectin is locally produced in the coronary circulation. This protein may participate in modulating the coronary circulation of nondiabetic patients with angiographically normal coronary arteries.

Adiponectin↗

Granulocyte- and monocyte-platelet adhesion index in coronary and peripheral blood after extracorporeal circulation and reperfusion.

BACKGROUND: Neutrophil-granulocyte and mononuclear-cell functional changes occur during cardiopulmonary bypass and cardiovascular surgery. In particular, leukocyte-platelet interaction, leading to generation of heterotypic coaggregates, represents an amplification mechanism of the local inflammatory response and tissue damage. METHODS: Samples of 20 patients were drawn from venous coronary sinus before cardioplegic arrest and immediately after reperfusion, as well as from peripheral blood at 5 and 24 h postoperatively. The granulocyte and monocyte surface expression of CD162, CD15s, CD18, and CD11b were quantified by flow cytometry at the different times. Parallel variations of circulating leukocyte-platelet conjugates (percentages) and a derived (cell number-normalized) leukocyte-platelet adhesion index were measured using a combination of antibodies against CD45, CD14, and CD41a. The evaluation of platelet functional state was carried out using antibodies against CD62P (P-selectin) and PAC-1. RESULTS: Monocyte and granulocyte cell number increased markedly in coronary blood at reperfusion and in peripheral blood postoperatively when compared with measurements done before cardioplegia. A very different course characterized the changes of the leukocyte-platelet adhesion index with respect to the variations of circulating leukocyte-platelet coaggregates (percentages). Leukocyte molecules expression showed no significant variations for CD15s on both the leukocyte subsets, while a significant up-modulation for CD162 was observed on monocytes at 24 h after extracorporeal circulation (P = 0.0002), and for CD11b on granulocytes at 5 h postoperatively (P = 0.033). A loss of CD162 expression was observed in coronary blood at reperfusion (P = 0.0038) on granulocytes, associated to a down-modulation of CD18 (P = 0.0033) and CD11b (P = 0.0184) in peripheral blood at 24 h postoperatively. No significant up-regulation of platelet activatory molecules expression was found at coronary reperfusion, as well as postoperatively in the peripheral blood, when compared with the before-cardioplegia derived data. CONCLUSIONS: The over time variations of a normalized leukocyte-platelet adhesion index seem to reflect the cumulative leukocyte-platelet functional interaction more accurately than the parallel measurements of cellular conjugates. The absence of platelet activation suggests that the leukocyte membrane modifications play a main role in controlling the formation and stability of heterotypic leukocyte-platelet coaggregates after cardiac surgery with extracorporeal circulation.

Adult↗

Lipoic acid prevents development of the hyperdynamic circulation in anesthetized rats with biliary cirrhosis.

Chronic bile duct ligation is associated with the development of oxidant injury, biliary cirrhosis, portal hypertension, and a hyperdynamic circulation. We have previously demonstrated that the hyperdynamic circulation in the partial portal vein-ligated rat can be prevented by the administration of N-acetylcysteine. To extend these findings, we have examined the effect of lipoic acid, a thiol-containing antioxidant, on hemodynamics, oxidative stress, and nitric oxide (NO) production in bile duct-ligated (BDL) cirrhotic rats. Lipoic acid was given continuously in drinking water to normal and BDL rats; control rats received ordinary drinking water, and animals were studied at 24 days following surgery. Lipoic acid prevented the development of the hyperdynamic circulation (cardiac index [CI]: 15.7 +/- 2.0 vs. 29.5 +/- 2.1 mL x min-1 x 100 g-1; P <. 05) and significantly attenuated the rise in portal pressure (PP) (12.7 +/- 0.8 vs. 15.2 +/- 0.5 mm Hg; P <.05). Hepatic nitric oxide synthase (NOS) activity and plasma nitrite/nitrate concentration increased significantly following bile duct ligation, and both of these were prevented by lipoic acid. Lipoic acid had no effect on the biochemical or histological parameters of liver function in the cirrhotic group. We conclude that lipoic acid prevents the development of the hyperdynamic circulation in the rat model of biliary cirrhosis, and that this is associated with decreased synthesis of NO.

Animals↗

Development of a membrane array-based multimarker assay for detection of circulating cancer cells in patients with non-small cell lung cancer.

Combination of multiple mRNA markers has been largely investigated for detection of circulating cancer cells. However, current PCR-based methods are relatively expensive and time consuming. The aim of this study was to develop a membrane array-based multimarker assay for detection of circulating cancer cells in nonsmall cell lung cancer (NSCLC) patients. At first, we selected 22 candidate genes by means of suppression subtractive hybridization and Northern blot analysis. The diagnostic value of each candidate gene was then preliminarily evaluated in 50 pairs of blood samples by membrane array method. Accordingly, 17 genes with area under the ROC curve (AUC) > or = 0.8 were selected as target genes to reconstruct the diagnostic membrane array, which was then used to test peripheral blood samples from 100 NSCLC patients and 147 control subjects. ROC curve analysis demonstrated that the optimal threshold number of overexpressed markers on membrane array for discrimination between NSCLC patients and control subjects was 12. As a result, the diagnostic membrane array could detect circulating cancer cells in 90 (90%) of 100 NSCLC patients and in 14 (9.5%) of 147 control subjects (including 6 of 100 normal persons, 3 of 20 breast cancer patients, 3 of 15 colorectal cancer patients and 2 of 12 gastric cancer patients). Moreover, the detection rate was significantly correlated with NSCLC patients' metastatic status and overall stage (p = 0.028 and 0.014, respectively). These results suggested that our blood-based membrane array assay for molecular detection of circulating lung cancer cells has great potential for clinical applications.

Adult↗

Mathematical analysis of coronary autoregulation and vascular reserve in closed-loop circulation.

The autoregulatory capacity of the coronary circulation has traditionally been studied in open-loop animal models where the coronary circulation was decoupled from the systemic circulation. In the closed-loop circulation, changes in arterial pressure alter coronary flow. Pressure variations can be caused by changes in cardiac contractility, preload, afterload, and heart rate. These changes also affect myocardial oxygen consumption. To maintain equilibrium between oxygen supply and consumption, coronary flow is altered by the autoregulation mechanism. Coronary resistance must change to produce the required change in coronary flow. The direction of change in coronary resistance is not directly predictable. Increased arterial pressure may result in either increased or decreased coronary resistance. To study the changes in coronary resistance in response to changes in arterial pressure that are produced by circulatory parameters, we used mathematical models. Coronary resistance was calculated to obtain equilibrium between ventricular oxygen consumption and supply for different values of contractility, preload, afterload, and heart rate. Maximum coronary resistance, indicating largest coronary vascular reserve and highest efficiency of arterial pressure generation, was defined as an optimal condition. The model predicted that the optimal value of cardiac contractility is its resting value. Minimizing end-diastolic volume and heart rate and maximizing peripheral resistance were shown to improve ventricular coronary vascular reserve. These observations suggest that afterload reduction therapy may not be beneficial for improving myocardial oxygen balance while venous vasodilatation and heart rate reduction result in greater coronary reserve.

Algorithms↗

Histophysiology of the circulating platelet.

The role of platelets in hemostasis and thrombosis has been well established since Eberth's and Schimmelbusch's pioneering intravital microscopic experiments. A century ago the distinct features of the circulating "smooth disc" and the activated "spiny sphere" were described. Since then the underlying cell-biological processes transforming a harmless floating platelet into a sticky corpuscle, ready to release its stores of thrombogenic and atherogenic substances have been unveiled. However, its life-threatening capabilities have evolved from the necessity of preventing equally dangerous blood losses from a pressurized circulation system. As circulation depends on the liquid state of blood, the platelets and the molecules of the plasmatic coagulation system must circulate in an inactive state, to become activated at the site of "demand" to transform the liquid into a solid hemostatic plug. As in nucleated cells the plasma membrane, made up of a phospholipid bilayer with integrated glycoproteins, is the structure signalling environmental information to the platelet interior. Many of the receptors for stimulatory or inhibitory mediators elicit a cell-biological response via G-proteins and subsequent Ca2+ mobilization by IP3, or stimulation/inhibition of adenylate cyclase followed by changes in cytoplasmic levels of cyclic AMP. The supposed intracellular Ca2+ store of the platelets, the dense tubular system, also appears as the site of Ca2(+)-activated prostaglandin synthesis. Raised cytoplasmic Ca2+ levels promote the polymerization of G-actin to F-actin involved in the extension of pseudopodia in the course of "external shape change." Ca2(+)-activated myosin light-chain kinase phosphorylates myosin which becomes associated with F-actin, with the resulting acto-myosin complex providing the contractile force for "internal shape change," i.e., the centralization of organelles and for clot retraction later in hemostasis. More than by the three-dimensional actin cytoskeleton proper, the discoid shape typical of the nonstimulated platelet appears to be secured by a two-dimensional membrane skeleton of actin filaments anchored to membrane glycoproteins via actin-binding protein or spectrin and ankyrin. Although the microtubule coil has been confirmed as the main determinant of the mechanical stiffness of the platelet with biophysical techniques, its hitherto assumed role for the maintenance of the disc shape no longer appears tenable. The morphological phenomenon of the shape change comprises an alteration of membrane glycoproteins resulting in binding of "adhesive" molecules like fibrinogen.(ABSTRACT TRUNCATED AT 400 WORDS)

Arteriosclerosis↗

Effects of DTIC, DM-COOK and ICRF-159 on the number of circulating Lewis lung carcinoma cells detected by flow cytometry.

Circulating tumor cells can be detected by means of flow cytometry in the blood of mice bearing i.m. Lewis lung carcinoma. This technique can be applied in the case of aneuploid tumors and does not require either concentration of nucleated cells or other processing of the blood samples. It offers the advantages of simplicity and speed and allows quantitative measurement of the number of circulating tumor cells. It can be applied to the study of the effects of drug treatment on the number of circulating tumor cells, for those drugs which do not cause alterations in the nuclear DNA content of normal diploid blood cells. The number of circulating tumor cells determined by flow cytometry is markedly reduced by treatment with ICRF-159, by dimethyltriazene DM-COOK, and also by its clinically used analog, DTIC.

Animals↗

[Significance of functional and nutritive pulmonary circulation for vital reactions in the form of embolisms].

The functional and nutritive circulation in the lungs is connected by anastomoses between the pulmonary and bronchial arteries. The anastomoses have the structure of blocked arteries from which arteriovenous anastomoses proceed to the peribronchial plexus. The pulmonary artery is provided with a flow impulse by the anastomoses, and oxygen-containing blood is admixed with the venous blood, thus forming an "aortalization" in the lungs. By diverting the bloodstream, venous blood can reach the bronchial artery. The peculiarities of the lung circulation are important for vital reactions in the form of macro- and microembolisms. Macroembolisms prove the functionality of the system if branches of the pulmonary artery are closed before the arteries are blocked. A hemorrhagic infarction either arises or does not arise, and the hemorrhagic infarction cannot exceed a certain limit. A microembolism is over and above the anastomoses. If the microembolism is greater, pressure in the arteria pulmonaris can cause blood from the pulmonary artery to overflow into the bronchial artery. Because arteriovenous anastomoses arise from the blocked arteries, microemboli can now reach the systemic circulation. Thus, the system described can explain the passage of microemboli into the systemic circulation, avoiding the capillaries of the lungs; on the other hand, larger microembolisms can prove the functionality of the system.

Energy Metabolism↗

Modeling the circulation with three-terminal electrical networks containing special nonlinear capacitors.

Development, first of analog and later of digital computers, as well as algorithms for analysis of electrical circuits, stimulated the use of electrical circuits for modeling the circulation. The networks used as building blocks for electrical models can provide accurate representation of the hydrodynamic equations relating the inflow and outflow of individual segments of the circulation. These networks, however, can contain connections in which voltages and currents have no analogues in the circulation. Problems arise because (a) electrical current must flow in closed loops, whereas no such constraints exist for hydraulic models; and (b) electrical capacitors have a number of characteristics that are not analogous to those of hydraulic compliant chambers. Disregarding these differences can lead to erroneous results and misinterpretation of phenomena. To ensure against these errors, we introduce an imaginary electrical element, the nonlinear residual-charge capacitor (NRCC), with characteristics equivalent to those of a compliant chamber. If one uses appropriate circuit connections and incorporates the residual-charge capacitor, then all voltages and currents in the model are proper analogues of pressures and flows in the circulation. It is shown that the capacitive current represents the rate of change of volume of blood inside the vessel, as well as the rate of the corresponding displacement of volume of the surrounding tissue.

Blood Circulation↗