Plasmapheresis for hypertriglyceridemia: The association between blood viscosity and triglyceride clearance rate

Calculated whole blood viscosity in non-diabetic subjects with asymptomatic carotid atherosclerosis: How insulin resistance may affect blood viscosity

BACKGROUND AND OBJECTIVE

Asymptomatic atherosclerosis is an important early marker of vascular damage and, among its risk factors, hemorheological alterations play an important role.

PATIENTS AND METHODS

In a cohort of 85 non-diabetic subjects with asymptomatic carotid atherosclerosis (ACA), we have measured whole blood viscosity (cWBV) according to the haematocrit and plasma fibrinogen level. The cWBV distinguish the subgroup of ACA subjects with 3-5 cardiovascular risk factors (CRFs) from that with 1-2 CRFs and the same behavior is present for haematocrit and plasma fibrinogen level. Therefore, we divided the whole group of ACA subjects according to the medians of the four surrogate indexes with an insulin resistance degree of TG/HDL-C, TyG, VAI and LAP.

RESULTS

The analysis of the correlation between cWBV and each index of insulin resistance has shown that no correlation is present in the whole group and in the group of ACA subjects with 1-2 CRFs, while in the subgroup with 3-5 CRFs there is a positive correlation between cWBV with TG/HDL-C and TyG at a low degree of statistical significance.

CONCLUSIONS

The date underline that subjects with this clinical condition have an unaltered evaluation of the cWBV compared to the other indices.

The Synergistic Effects of Astragalus mongholicus and Salvia miltiorrhiza on Coronary Heart Disease Identified by Network Pharmacology and Experiment

BACKGROUND AND PURPOSE

Two Chinese herbal medicines Huang Qi (HQ, Astragalus mongholicus) and Dan Shen (DS, Salvia miltiorrhiza) are often combined to treat coronary heart disease (CHD). The purpose of this study was to identify the underlying synergistic effects and mechanisms of HQ and DS against CHD.

METHODS

The active components and targets of HQ and DS, CHD-related genes, and the biological progression were analysed by network pharmacology. The myocardial infarction (MI) rat model was established by ligating the left anterior descending coronary artery. Cardiac function was detected by ultrasonic electrocardiography. The MI size, fibrosis, cardiac hypertrophy, lipid metabolism, blood viscosity, and coagulation indexes were analysed by histological staining or chemical methods, respectively.

RESULTS

A total of 170 shared and specific seed genes of HQ and DS against CHD were identified. The shared and specific biological processes of HQ and DS against CHD were obtained. The LVEF and LVFS values significantly increased, the myocardium infarct size and fibrosis significantly decreased, the values of lipid metabolism indexes and blood viscosity indexes significantly reduced in the HQ + DS treatment group vs HQ or DS single treatment (P < 0.05); the LVEDd, LVEDs, and the CSA values significantly reduced in HQ single and HQ + DS treatment groups vs MI group (P < 0.05); the coagulation index (APTT, PT, TT, and FIB) values decreased significantly in the DS single and HQ + DS treatment groups vs MI group (P < 0.05).

CONCLUSION

In MI rats, HQ and DS exhibited synergistic effects on improving cardiac function, reducing MI size, fibrosis, regulating hyperlipidaemia, and maintaining circulatory system homeostasis; HQ had the specific advantage of alleviating cardiac remodelling; DS had the specific advantage of regulating hypercoagulability. This study revealed that HQ and DS not only exerted synergistic effects but also exhibited complementary effects on CHD.

Membrane-based therapeutic plasma exchange: Hemodynamics and operational characteristics leading to procedure failure

BACKGROUND AND OBJECTIVES

Therapeutic plasma exchange (TPE) is a blood purification treatment capable of removing large molecular weight substances from plasma. It is commonly used for the removal of circulating pathogenic immunoglobulins presumed to be the cause of many autoimmune diseases. TPE can be performed with a membrane-based system (mTPE) or a centrifugal-based system (cTPE). When plasma separation is performed with a membrane, filter clotting can lead to longer treatment time, higher cost and can negatively impact patient satisfaction. In this study, we examine the operational characteristics that might influence filter life.

DESIGN, SETTING, PARTICIPANTS, & MEASURES

We report on 24 patients, with a total of 135 mTPE treatments in a single tertiary care academic center using the NxStage machine. The study focuses on treatment specific parameters that may lead to procedure failure. The main parameters of interest were transmembrane pressure (TMP) and the filtration fraction as displayed on the machine (FFd) compared to the calculated filtration fraction (FFc). Primary outcome was to measure whether TMP, FFc, and FFd influenced filter survival. Secondary outcomes included factors that might have indirectly resulted in filter failure, including hematocrit (Hct), platelet count, heparin use, and intra-treatment calcium administration.

RESULTS

In this study, we demonstrated that machine displayed filtration fractions (FFd) were lower than FFc and this difference was significantly larger in TPE sessions that experienced a clotting event (7.58 vs 6.22, P = .031). TPE sessions that clotted had a higher mean TMP (57.48 mmHg vs 44.43 mmHg, P = .001) and clotting events tended to have a lower mean blood flow rate (175.83 mL/min vs 189.55 mL/min, P = .002). In TPE sessions that received prefilter calcium administration, a higher mean dose of calcium gluconate was found in the sessions that experienced clotting (3.27 g vs 2.70 g, P = .013). Patients who experienced at least one clotting event were noted to be heavier than those patients without any clotting events (91.52 kg vs 72.15 kg, P = .040). Prefilter heparin administration was not associated with a lower incidence of filter clotting. We did not find a statistically significant difference in clotting events based upon type of intravenous access, pretreatment hematocrit, or pretreatment platelet counts.

CONCLUSION

Among patients undergoing mTPE, machine FFd on the NxStage system are consistently lower than FFc. Treatments where there was a greater difference between displayed and FFc had a greater likelihood of filter clotting. Treatments with higher TMP were associated with failed treatments. Prefilter calcium administration during treatment was associated with increased filter clotting. Lower blood flow rates and higher patient weight were also associated with increased filter clotting. Prefilter heparin administration did not reduce the incidence of filter clotting.

Comparison between whole blood viscosity measured and calculated in subjects with monoclonal gammopathy of undetermined significance and in patients with multiple myeloma: Re-evaluation of our survey

BACKGROUND

in this study, with a re-evaluation of the hemorheological determinants previously described in MGUS subjects and in MM patients, we have detected the calculated whole blood viscosity, according whether to the hematocrit and total plasma protein concentration (de Simone formula) or to the haematocrit and plasma fibrinogen level (Merrill formula), and a marker of the erythrocyte aggregation (albumin/fibrinogen level).

METHODS

data were expressed as means±standard deviation. Student's t test for unpaired data was used to compare MGUS subjects and MM patients. The correlation coefficient between mean erythrocyte aggregation (MEA) and hematocrit (Ht) was evaluated in MGUS, MM and MGUS + MM groups using the Spearman test.

RESULTS

the comparison between MGUS and MM shows that the measured blood viscosity and calculated blood viscosity based on hematocrit and total plasma protein, but not which estimated in relation to the hematocrit and plasma fibrinogen, differentiate the two groups. A difference between the two groups also regards the measured erythrocyte aggregation and its surrogate marker. In addition, the measured plasma viscosity at low shear rate (0.51 s-1) and, in particular, the ratio between plasma viscosity at low (0.51 s-1) and high (450 s-1) shear rates distinguish MGUS and MM.

CONCLUSIONS

calculated blood viscosity (de Simone formula and other formulas) and the surrogate marker of erythrocyte aggregation disclose an alike trend with the corresponding hemorheological determinants obtained by using their direct measurement.

Plasmapheresis for hypertriglyceridemia: The association between blood viscosity and triglyceride clearance rate

OBJECTIVES

Several factors in double filtration plasmapheresis (DFPP) were associated with triglyceride (TG) clearance rate. This study examines whether baseline whole blood viscosity was a predictor for efficient TG removal.

METHODS

Adult subjects who receiving DFPP for hyperlipidemia in Taoyuan General Hospital from January 2015 to March 2018 were classified into efficient and inefficient TG removal according to TG removal rate ≥50% vs <50%. TG removal rate was defined as following formula: (pre-apheresis TG- post-apheresis TG)/pre-apheresis TG. Whole blood viscosity (WBV) was estimated by following equation: WBV = 0.12 × hematocrit +0.17 × (total protein -2.07). Univariate linear regression was used to assess the association between TG removal rate and WBV. Odds ratios (ORs) and 95% confidence interval (95%CI) for associations between variables and efficient TG removal were evaluated by logistic regression model to including univariate and multivariate adjustment.

RESULTS

From a total of 66 subjects receiving DFPP, 37 subjects reached efficient TG removal. The difference in pre-apheresis TG levels, hematocrit, and WBV between efficient vs. inefficient TG removal groups was 4.1 vs 6.7 mmol/L; 43.1% vs 39.5%; and 6.0cP vs 5.cP (Ps <0.05). After multivariate adjustment, WBC was a significant predictor for efficient TG removal (ORs and 95% CI were 3.192 (1.300-7.838), P < 0.05). The correlation between WBV and extraction of TG was significant (r = -0.255, P = 0.039).

CONCLUSION

Hyperviscosity reduced the efficiency of TG removal in those receiving DFPP.