Cyanocobalamin absorption abnormality in alcoholics is improved by oral supplementation with a fermented papaya-derived antioxidant

BACKGROUND/AIMS: Thirty alcoholic patients and 24 teetotaler dyspeptic patients were considered and underwent baseline blood chemical evaluation and the Schilling test. METHODOLOGY: During gastroscopy, biopsy samples were taken to assay: routine histology, malonyldialdehyde, vitamin E and glutathione concentration and for testing vitamin B12-Intrinsic Factor binding. Examinations were repeated after 1-week supplementation with Bionormalizer. RESULTS: Plasma malonyldialdehyde level and lipid hydroperoxides concentration as well as either malonyldialdehyde and xanthine oxidase concentration in the gastric mucosa in alcoholics were significantly higher than in controls and despite unchanged alcohol consumption, significantly decreased after Bionormalizer supplementation. Gastric mucosal glutathione was markedly depressed in alcoholics and partly recovered after Bionormalizer supplementation. Although the alcoholics showed a normal intrinsic factor secretion in the gastric juice, they exhibited a markedly depressed intrinsic factor-cobalamin binding on the "ex vivo" study. Moreover, nearly 23% of them had an abnormal Schilling test. Both these impairments reverted to normal after Bio-normalizer supplementation. CONCLUSIONS: It can be postulated that the antioxidative action played by Bionormalizer, possibly due to its availability substrates for glutathione synthesis as well as to its effects on local oxidative burst from neutrophil, is able to recover a normal cobalamin absorption.     

青紫型先天性心脏病红细胞膜流动性及血液流变学

为探讨青紫型先天性心脏病红细胞膜性能的改变及其临床意义，应用荧光偏振法测定了３１例患儿红细胞膜微粘度及血液流变学指标。结果：患儿红细胞膜微粘度及全血粘度、血细胞比容、红细胞聚集指数、刚性指数均显著高于正常组（３０例）（Ｐ＜０．０１）；膜微粘度与全血粘度、红细胞刚性指数呈明显正相关（Ｐ＜０．０１）。研究表明，青紫型先天性心脏病红细胞膜微粘度增高，流动性降低，可能是引起红细胞变形性差，血液粘度增加较为重要的原因之一。     

Blood flow properties and walking performance in chronic arterial occlusive disease

Recent investigations suggest an interdependence between blood fluidity and walking performance in patients with peripheral arterial occlusive disease (PAOD). Therefore, various blood fluidity variables (erythrocyte aggregation, erythrocyte flexibility, plasma viscosity, plasma proteins) were studied in groups of healthy subjects and claudicants with severe PAOD (exhausted perfusion reserve) receiving intravenous treatment with Trental (600 mg Pentoxifylline b.i.d., 21 days). Erythrocyte flexibility (expressed by filterability through micropore filters), red cell aggregation and plasma viscosity deteriorate with progression of disease especially in Stage IIb and III Fontaine classification, with walking distance below 150 m. Trental treatment resulted in patients with advanced POAD stages in improvement of red cell filterability, red cell aggregation, decrease of plasma viscosity, increase in absolute walking distance and relief from rest pain, suggesting that such patients are accessible to conservative treatment with hemorheologically active agents.     

Blood rheology abnormalities in diabetes mellitus

The diabetic microangiopathy does not arrive accidentally. Since few years numerous hemorheological abnormalities have been described among diabetic patients. The results of these works are often contradictory. In diabetes mellitus, the red cell and whole blood filterability are decreased. The purpose of this work is to resume the works know today about the diabetes types (ID or NID), the diabetes seniority, the glucose control quality, arteriosclerotic complications (peripheral vascular disease, retinopathy, nephropathy), deformability of erythrocytes. The metabolic state of diabetic patients red cells is like premature ageing red cells (decreased level of red cell ATP concentration, increased of red cell 2, 3-DPG level). Other hemorheological parameters are disturbed: whole blood viscosity, plasma viscosity, platelet aggregation and adhesion. Insulin activity or level or "insulinisation" has a main part in opposition to glucose level.     

再生障碍性贫血对血粘度影响的初步研究

本文观测了42例慢性再障病人的血红蛋白(Hb)、红细胞滤过指数(EFI)和血粘度诸项指标,并与60例健康人对照。结果显示再障病人的全血比粘度、还原比粘度均显著低于正常人(P<0.01),其 EFI 显著高于对照组(P<0.05)。再障组的 Hb 和其全血比粘度、血浆比粘度均呈正相关(P<0.0001,P<0.001),Hb 和 EFI 则呈负相关(P<0.0001),其 EFI 与全血比粘度、血浆比粘度均呈负相关(P<0.05,P<0.05,)。本研究证实再障病人存在血粘度减低并有红细胞变形能力受损。     

Intermittent claudication, exercise, and blood rheology

Forty-two stable patients with claudication were assigned to two groups. Group I (n = 22) was submitted to regular, standardized treadmill exercise for 2 months. During this time the maximal and pain-free walking distances increased significantly (more than 100%). Group II (n = 20) patients did not exercise over the same period of time, and their walking distances remained essentially unchanged. No drugs or other forms of treatment were given in either group. The rheology of blood, as quantified by blood and plasma viscosity, hematocrit, blood filterability, and red cell aggregation, was initially abnormal in patients as compared with matched controls. Blood and plasma viscosity, blood cell filterability, and red cell aggregation normalized significantly in group I, but remained pathologic in group II. The hemorrheologic values of patients after 2 months of exercise did no longer differ significantly from those of healthy controls. The "fluidification" of blood induced by regular exercise was qualitatively and quantitatively similar to that obtainable by hemorrheologically active medications. The results confirm that physical training is clinically effective in patients suffering from claudication. They furthermore suggest that training may be looked on as a form of "hemorrheologic therapy" suitable for increasing the fluidity of blood in patients with ischemic diseases. Part of the benefits of regular exercise in stage II occlusive peripheral arterial disease may result from changes in hemorrheology; further studies are needed to define the mechanism.     

Blood rheology and aging

The flow properties of blood play significant roles in tissue perfusion by contributing to hydrodynamic resistance in blood vessels. These properties are influenced by pathophysiological processes, thereby increasing the clinical relevance of blood rheology information. There is well-established clinical evidence for impaired blood fluidity in humans of advanced age, including enhanced plasma and whole blood viscosity, impaired red blood cell (RBC) deformability and enhanced RBC aggregation. Increased plasma fibrinogen concentration is a common finding in many studies owing to the pro-inflammatory condition of aged individuals; this finding of increased fibrinogen concen-tration explains the higher plasma viscosity and RBC aggregation in elderly subjects. Enhanced oxidant stress in advanced age is also known to contribute to altered blood fluidity, with RBC deformability being an important determinant of blood viscosity. Several studies have shown that physical activity may improve the hemorheological picture in elderly subjects, yet well-designed observational and mechanistic studies are required to determine the specific effects of regular exercise on hemorheological parameters in healthy and older individuals.     

Haemorheological factors and myocardial reperfusion in patients with ST-elevation myocardial infarction undergoing primary coronary intervention

INTRODUCTION: The no-reperfusion phenomenon occurs in a considerable number of patients despite restoration of the infarct-related artery (IRA) patency. Factors responsible for this phenomenon include myocardial structural changes, whereas haemorheological parameters that significantly contribute to microvascular resistance, have not been studied so far. AIM: To determine the possible relationship between blood and plasma viscosity, red blood cell aggregation and their deformability, and myocardial reperfusion following effective mechanical intervention of IRA. METHODS: The analysis included 23 patients with myocardial infarction treated with primary coronary angioplasty with resultant TIMI (Thrombolysis in Myocardial Infarction) grade 3 flow. Myocardial reperfusion was found effective if myocardial perfusion grade (MPG) was 3. Blood and plasma viscosity were assessed using a Brookfield rotation viscometer. Red blood cell aggregation and deformability were measured with a Laser Optical Rotational Cell Analyzer (LORCA). Patients were divided into two groups with respect to obtained MPG: reperfusion group (14 subjects) and no-reperfusion group (9 patients). RESULTS: Corrected whole blood viscosity and plasma viscosity were significantly higher in the no-reperfusion group and exceeded the values obtained in the reperfused patients by 14% (p <0.05) and 10.5% (p <0.01), respectively. Red blood cell deformability index at shear stress ranging from 1.75 Pa to 60.03 Pa was significantly lower in the no-reperfusion group. Red blood cell aggregation index was significantly higher (by 14.3%, p <0.05), whereas aggregation halftime was significantly shorter (by 58%, p <0.05) in the no-reperfusion group. CONCLUSIONS: Our results indicate that haemorheological disturbances may be an important factor contributing to no-reperfusion after effective mechanical opening of IRA.     

Blood rheology in men with essential hypertension and capillary rarefaction

The pathophysiological significance of hyperviscosity and capillary rarefaction in untreated essential hypertension is unknown. Fifty untreated hypertensive men with capillary rarefaction (intravital capillaroscopy) and 20 age- and sex-matched normotensive controls underwent full haemorheological profiling (blood viscosity at high and low shear, haematocrit, platelet and leukocyte counts, fibrinogen and total protein concentrations, P-selectin levels, erythrocyte and leukocyte filterability rates and erythrocyte deformability and aggregation indexes). Subjects with skin capillary density below the group median had younger age, higher diastolic pressure, higher blood viscosity at low shear, higher P-selectin levels, higher erythrocyte and leukocyte filterability rates, and higher erythrocyte aggregation indexes (all P < 0.01). In contrast, patients with greater skin capillary density had a greater plasma viscosity (P < 0.05). The conclusions were that in untreated hypertensive men, capillary rarefaction and hyperviscosity are associated to an increased diastolic blood pressure and to an adverse haemorheological profile.     

Cardiovascular risk factors and hemorheology. Physical fitness, stress and obesity

To date there is little information about hemorheological data in the presence of secondary risk factors. Inter- and intraindividual comparisons of hemorheological parameters show that fitness has a significant influence on blood fluidity as quantified by ex vivo measurements of blood and plasma viscosity, red cell filterability and red cell aggregation. In fitter individuals blood is more fluid. Similar observations can be made with stress. Prolonged psychoemotional stress leads to a loss in blood fluidity and red cell filterability. Finally a comparison between excessively obese patients and healthy controls reveals a deterioration in hemorheological parameters in the obese group. These results, together with reports from the literature suggest that all accepted cardiovascular risk factors are associated with abnormalities in the flow properties of blood. It is proposed that partly the same phenomena are involved in the genesis of atherosclerotic lesions and influence rheological properties of blood.     

Techniques to evaluate erythrocyte deformability in diabetes mellitus

Abstract. Using several rheological techniques, we examined erythrocyte deformability in different groups of diabetic subjects. The macrorheological techniques used for this evaluation were respectively whole-blood filtration, filtration of erythrocyte suspensions, polyviscosimetry and diffractometry. Whole-blood filterability, at a negative pressure of 20 cm water, was decreased in type 2 diabetics; no difference was evident at a negative pressure of 10 cm water. The filtration of erythrocyte suspensions at low haematocrit (5%) did not show differences between normal and diabetic subjects. Polyviscosimetry, which explores the filterability of erythrocyte suspensions at high haematocrit (80%) through wide pores, demonstrated an impaired behaviour especially in type 2 diabetics. Diffractometry, which measures erythrocyte elongation induced by a defined shear stress through the diffraction pattern of a laser beam, showed an alteration in type 1 diabetic subjects. The microrheological methods employed for this evaluation were those based on fluorescence spectroscopy. Labeling intact red blood cells with fluorescent probes, we determined the membrane dynamic properties and using these techniques we found a reduction of erythrocyte membrane fluidity and a decrease of red cell membrane protein lateral mobility.     

Changes of hemorrheology in COPD patients with or without cor pulmonale

Parameters of hemorrheology such as whole blood viscosity, plasma viscosity, hematocrit and red blood cell electrophoretic time were measured in 34 COPD patients with or without cor pulmonale, and the pulmonary arterial pressure was simultaneously examined. The results showed that the whole blood viscosity and hematocrit in cor pulmonale group were obviously higher than COPD group which suggested the changes of hemorrheology was much obvious in patients with cor pulmonale than those in COPD patients. Meanwhile, a statistically significant correlation was obtained between whole blood viscosity and pulmonary arterial mean pressure. Thus, we suggest blood viscosity has a certain effect on the pulmonary arterial pressure.     

Influence of intravenous infusions of hydroxyethylstarch (HES) (MW 40,000 and 450,000) on the blood flow properties of healthy volunteers

Infusions of hydroxyethylstarch (HES) solutions as plasma substitutes and flow improvers play an increasing role in the treatment of various diseases. Little is known about the effect of HES solutions of different molecular weights on the flow properties of blood i.e. blood viscosity, plasma viscosity, erythrocyte aggregation and erythrocyte deformability (filtrability). In the present study the influence of 500 ml-infusions of a 6% solution of HES (MW 450,000) has been compared to that of 6% solutions of HES 40,000. Infusions of 500 ml of HES 450,000 into healthy persons induced a hemodilution with a subsequent decrease in whole blood viscosity whereas the plasma viscosity increased. Red cell aggregation increased as well, red cell deformability was slightly impaired. Infusions of 500 ml of HES 40,000 into healthy persons were followed by a hemodilution with a decrease in blood and plasma viscosity, a decrease in erythrocyte aggregation and a slight improvement of red cell deformability. The reason for this difference in behaviour and its therapeutical consequences are discussed.     

Blood rheology and hemodynamics

Blood is a two-phase suspension of formed elements (i.e., red blood cells [RBCs], white blood cells [WBCs], platelets) suspended in an aqueous solution of organic molecules, proteins, and salts called plasma. The apparent viscosity of blood depends on the existing shear forces (i.e., blood behaves as a non-Newtonian fluid) and is determined by hematocrit, plasma viscosity, RBC aggregation, and the mechanical properties of RBCs. RBCs are highly deformable, and this physical property significantly contributes to aiding blood flow both under bulk flow conditions and in the microcirculation. The tendency of RBCs to undergo reversible aggregation is an important determinant of apparent viscosity because the size of RBC aggregates is inversely proportional to the magnitude of shear forces; the aggregates are dispersed with increasing shear forces, then reform under low-flow or static conditions. RBC aggregation also affects the in vivo fluidity of blood, especially in the low-shear regions of the circulatory system. Blood rheology has been reported to be altered in various physiopathological processes: (1) Alterations of hematocrit significantly contribute to hemorheological variations in diseases and in certain extreme physiological conditions; (2) RBC deformability is sensitive to local and general homeostasis, with RBC deformability affected by alterations of the properties and associations of membrane skeletal proteins, the ratio of RBC membrane surface area to cell volume, cell morphology, and cytoplasmic viscosity. Such alterations may result from genetic disorders or may be induced by such factors as abnormal local tissue metabolism, oxidant stress, and activated leukocytes; and (3) RBC aggregation is mainly determined by plasma protein composition and surface properties of RBCs, with increased plasma concentrations of acute phase reactants in inflammatory disorders a common cause of increased RBC aggregation. In addition, RBC aggregation tendency can be modified by alterations of RBC surface properties because of RBC in vivo aging, oxygen-free radicals, or proteolytic enzymes. Impairment of blood fluidity may significantly affect tissue perfusion and result in functional deteriorations, especially if disease processes also disturb vascular properties.     

Hemorheologic factors in the postacute phase of ischemic stroke

Clinical and hemorheologic data were recorded in a homogeneous group of 72 patients (age range sixty-one to seventy years), suffering from ischemic stroke with an onset of less than eight hours, confirmed clinically and by computerized tomography. A quantitative neurologic analysis and the following hemorheologic parameters were monitored for twenty weeks following the acute episode: fibrinogen, total proteins, albumin, hematocrit, leukocyte and platelet counts, whole blood filterability (WBF), red blood cell deformability (RBCD), and blood plasma, and serum viscosity. The results show a significant decrease in hematocrit values parallel to the clinical neurologic improvement and a significant increase in RBCD in the patients with the better clinical recovery. These data confirm the role of hemorheologic parameters in the clinical follow-up of cerebrovascular disorders.     

Decreased blood fluidity in progressive systemic scleroderma

The aim was to define blood rheology in progressive systemic scleroderma (PSS). 55 patients were compared to controls. Blood and plasma viscosity, hematocrit, red cell aggregation, and deformability were measured. Except for hematocrit, all these variables are significantly altered, indicating a loss of blood fluidity in PSS. Drugs had no obvious effect on blood rheology, but the clinical picture did. The loss of blood fluidity in PSS is suggested to play a pathophysiological role in the initiation of Raynaud phenomena, from which all patients suffered.     

Hemorheological disturbances in patients with chronic cerebrovascular diseases

Hemorheological disturbances may occur in more than 40% of patients with ischemic cerebrovascular diseases. In this study the changes of rheological factors--hematocrit, plasma fibrinogen concentration, whole blood and plasma viscosity, red blood cell aggregation and deformability were investigated in 297 patients (173 males, 124 females, mean age 60 +/- 11 years) with transient ischemic attack or chronic phase (> 3 months after onset) ischemic stroke, and in 73 healthy volunteers (35 males, 38 females, mean age 38 +/- 7 years). Hematocrit, plasma and whole blood viscosity were significantly (p < 0.0001) elevated in cerebrovascular patients compared to controls. Plasma fibrinogen concentration (p < 0.001), red blood cell aggregation (p < 0.05) and deformability (p < 0.01) were also impaired in stroke patients. Hemorheological disturbances were dominant in stroke patients with diabetes, hyperlipidemia and smoking habits. Hematocrit, plasma viscosity and red blood cell aggregation showed a significant (p < 0.025-0.001) correlation with the severity of carotid artery stenosis. We could not find any characteristic distribution of rheological parameters among the three subtypes of brain ischemia. Our results show that all of the measured rheological parameters are significantly impaired in chronic ischemic cerebrovascular disorders, especially in diabetic, smoking and alcoholic patients. They correlate with the severity of the carotid artery stenosis, but there is no association with the type of ischemic stroke.     

A new family with hereditary choreo-acanthocytosis

We describe a new family with hereditary choreo-acanthocytosis. Two members of this family were affected; neither of them suffered from anaemia or signs of haemolysis. The acanthocytes showed an impaired deformability with an increase in whole blood viscosity. The composition of the plasma and erythrocyte membrane lipids was normal, as was the fatty acid composition of the erythrocyte ghost membranes. The only alteration found was a decrease in the fluidity of the erythrocytic membrane.     

Haemorheological effects of losartan and enalapril in patients with renal parenchymal disease and hypertension

The objective of this study was to compare the effects of the angiotensin II (ang II) antagonist, losartan and the angiotensin-converting enzyme inhibitor (ACEI), enalapril on haemorheology. Twenty-nine patients with renal parenchymal disease and hypertension were enrolled in the prospective, open, parallel study that involved a 14-day washout period followed by a 120-day treatment period. Patients were allocated randomly to receive either losartan 50-100 mg/day (n = 15) or enalapril 2.5-10 mg/day (n = 14) to achieve blood pressure control <140/90 mm Hg. Blood pressure, haemorheology profile and plasma fibrinogen concentration were measured after the washout phase and after 2, 10, 60, and 120 days of treatment. The data were analysed using ANOVA with repeated measures. Twenty-seven patients completed the study. Treatment with both losartan and enalapril was associated with a significant decrease (P < 0.05) in relative high shear rate whole blood viscosity, indicating an increase in blood cell deformability. In patients taking losartan, the increase in blood cell deformability did not result in a decrease in mean whole blood viscosity due to a concomitant, significant increase in mean plasma viscosity (P < 0. 01). In contrast, the improved cell deformability in patients treated with enalapril resulted in a small and statistically insignificant decrease in mean whole blood viscosity (P = 0.06; mean change = -0.15 mPa sec). The mechanism of the increase in blood cell deformability and the rise in plasma viscosity associated with losartan remain unclear. It is possible but unproven that the improvement in intrinsic blood cell rheology with losartan and enalapril may be the result of changes in cation transport systems and/or the consequence of the protective antioxidant properties of drug metabolites.     

Low blood selenium levels in alcoholics with and without advanced liver disease

Selenium deficiency has been implicated as a cause of hepatic injury, possibly from accentuated lipoperoxidation due to decreased activity of the selenoenzyme, glutathione peroxidase. Because of possible clinical and biochemical links between selenium and alcohol, we performed nutritional assessment and assayed red blood cell, plasma, and whole blood selenium by spectrofluorometry in 27 normals (group I), 30 asymptomatic alcoholics on admission to a detoxification unit, (group II) and 16 alcoholics with severe liver disease (group III). We found a mean (+/- SD) whole blood selenium of 0.109 micrograms/ml +/- 0.014 for group I vs 0.076 +/- 0.010 for group II (P less than 0.001), and 0.047 +/- 0.006 for group III (P less than 0.001 vs group I and II). For plasma, the mean (+/- SD) selenium was 0.095 micrograms/ml +/- 0.016 for group I versus 0.065 micrograms/ml +/- 0.012 in group II and 0.038 micrograms/ml +/- 0.007 in group III (All P less than 0.001). Calculated red blood selenium levels were also significantly reduced in alcoholics versus controls. Whole blood and plasma selenium correlated directly with serum albumin. For whole blood selenium versus albumin, r = 0.73 (P less than 0.01), and for plasma selenium versus albumin, r = 0.71 (P less than 0.01). A significant inverse correlation was noted between whole blood selenium and the height of the total serum bilirubin (r = -0.46), alkaline phosphatase (r = -0.50), and AST (r = -0.51) (P less than 0.01 for all). Among alcoholics admitted for detoxification, selenium was diminished despite the absence of severe malnutrition, as determined by standard nutrition assessment parameters.(ABSTRACT TRUNCATED AT 250 WORDS)