Validation of haemodialysis recirculation and access blood flow measured by thermodilution.
BACKGROUND: Recirculation (R) and access blood flow (Qac) measurements are considered useful indicators of adequate delivery of haemodialysis. It was the purpose of this study to compare measurements of R and Qac obtained by two different techniques which are based on the same principle of indicator dilution, but which differ because of the characteristics of the injection and detection of the different indicators used. METHODS: Recirculation measured by a thermal dilution technique using temperature sensors (BTM, Fresenius Medical Care) was compared with recirculation measured by a validated saline dilution technique using ultrasonic transducers placed on arterial and venous segments of the extracorporeal circulation (HDM, Transonic Systems, Inc.). Calculated access flows were compared by Bland Altman analysis. Data are given as mean +/- SD. RESULTS: A total of 104 measurements obtained in 52 treatments (17 patients, 18 accesses) were compared. Recirculation measured with correct placement of blood lines and corrected for the effect of cardiopulmonary recirculation using the 'double recirculation technique' was -0.02 +/- 0.14% by the BTM technique and not different from the 0% measured by the HDM technique. Recirculation measured with reversed placement of blood lines and corrected for the effect of cardiopulmonary recirculation was 19.66 +/- 10.77% measured by the BTM technique compared with 20.87 +/- 11.64% measured by the HDM technique. The difference between techniques was small (-1.21 +/- 2.44%) albeit significant. Access flow calculated from BTM recirculation was 1328 +/- 627 ml/min compared with 1390 +/- 657 ml/min calculated by the HDM technique. There was no bias between techniques. CONCLUSION: BTM thermodilution yields results which are consistent with the HDM ultrasound dilution technique with regard to both recirculation and access flow measurement. (+info
Normal pregnancy is associated with enhanced endothelium-dependent flow-mediated vasodilation.
Normal pregnancy is characterized by reduced systemic vascular resistance, which may be mediated by nitric oxide (NO). We compared endothelial vasomotor function in 71 normal pregnant women (13 in first, 29 in middle, and 29 in last trimester) to 37 healthy age-matched controls. With external ultrasound, brachial artery diameter was measured at rest, during reactive hyperemia [with increased flow causing endothelium-dependent dilation (FMD)], and after sublingual nitroglycerin (causing endothelium-independent dilation). Compared with controls, resting flow and brachial artery diameter were significantly higher during the middle and last trimesters. Reactive hyperemia was reduced in all pregnant groups. FMD increased from the first trimester (by 26%), reaching the highest value in the last trimester (to 47% above nonpregnant values). FMD was significantly correlated to pregnancy status (nonpregnant or pregnant) and to vessel size. Nitroglycerin-induced dilation was similar in pregnant and nonpregnant women. A longitudinal study of eight women evaluated in the first, middle, and last trimesters confirmed an increase in FMD throughout pregnancy. The study supports the idea that basal and stimulated NO activity is enhanced in normal pregnancy and may contribute to the decrease in peripheral resistance. (+info
Neutrophils sense flow-generated stress and direct their migration through alphaVbeta3-integrin.
During inflammation neutrophils are recruited from the blood onto the surface of microvascular endothelial cells. In this milieu the presence of soluble chemotactic gradients is disallowed by blood flow. However, directional cues are still required for neutrophils to migrate to the junctions of endothelial cells where extravasation occurs. Shear forces generated by flowing blood provide a potential alternative guide. In our flow-based adhesion assay neutrophils preferentially migrated in the direction of flow when activated after attachment to platelet monolayers. Neutralizing alphaVbeta3-integrin with monoclonal antibodies or turning the flow off randomized the direction of migration without affecting migration velocity. Purified, immobilized alphaVbeta3-integrin ligands, CD31 and fibronectin, could both support flow-directed neutrophil migration in a concentration-dependent manner. Migration could be randomized by neutralizing alphaVbeta3-integrin interactions with the substrate using antibodies or Arg-Gly-Asp-containing peptide. These results exemplify mechanical signal transduction through integrin-ligand interactions and reveal a guidance system that was hitherto unknown in neutrophils. In more general terms, it demonstrates that cells can use integrin molecules to "sample" their physical microenvironment through adhesion and use this information to modulate their behavior. (+info
A vascular bed-specific pathway.
The endothelial nitric oxide synthase (eNOS) gene is induced by a variety of extracellular signals under both in vitro and in vivo conditions. To gain insight into the mechanisms underlying environmental regulation of eNos expression, transgenic mice were generated with the 1,600-bp 5' flanking region of the human eNos promoter coupled to the coding region of the LacZ gene. In multiple independent lines of mice, transgene expression was detected within the endothelium of the brain, heart, skeletal muscle, and aorta. beta-galactosidase activity was consistently absent in the vascular beds of the liver, kidney, and spleen. In stable transfection assays of murine endothelial progenitor cells, the 1,600-bp promoter region was selectively induced by conditioned media from cardiac myocytes, skeletal myocytes, and brain astrocytes. Cardiac myocyte-mediated induction was partly abrogated by neutralizing anti-platelet-derived growth factor (PDGF) antibodies. In addition, promoter activity was upregulated by PDGF-AB. Analysis of promoter deletions revealed that a PDGF response element lies between -744 and -1,600 relative to the start site of transcription, whereas a PDGF-independent cardiac myocyte response element is present within the first 166 bp of the 5' flanking region. Taken together, these results suggest that the eNos gene is regulated in the cardiac endothelium by both a PDGF-dependent and PDGF-independent microvascular bed-specific signaling pathway. (+info
Hypoxia inhibits baroreflex vagal bradycardia via a central action in anaesthetized rats.
It is known that arterial baroreflexes are suppressed in stressful conditions. The present study was designed to determine whether and how hypoxia affects arterial baroreflexes, especially the heart rate component, baroreflex vagal bradycardia. In chloralose-urethane-anaesthetized rats, baroreflex vagal bradycardia was evoked by electrical stimulation of the aortic depressor nerve, and the effect of 15 s inhalation of hypoxic gas (4% O2) was studied. Inhalation of hypoxic gas was found to inhibit baroreflex vagal bradycardia. The inhibition persisted after bilateral transection of the carotid sinus nerve. Cervical vagus nerves were cut bilaterally and their peripheral cut ends were stimulated to provoke vagal bradycardia of peripheral origin so as to determine whether hypoxia could inhibit vagal bradycardia by acting on a peripheral site. In contrast to baroreflex vagal bradycardia, the vagus-induced bradycardia was not affected by hypoxic gas inhalation. It is concluded that baroreflex vagal bradycardia is inhibited by hypoxia and the inhibition is largely mediated by its direct central action. (+info
On the validity of blood flow measurement using colored microspheres.
The aim of this study was 1) to investigate the validity of repeated estimations of blood flow using colored microspheres (CMS) and 2) to develop and validate a method that permits four consecutive estimations in the same animal using nonradiolabeled microspheres (NRMS). Several mixtures of different types of microspheres were injected in dogs, with each mixture containing the radiolabeled microspheres (RMS; labeled with 113Sn) with either three CMS, four CMS, or three CMS and one type of fluorescent (crimson labeled) microsphere (FMS). The blood flows estimated with the use of any of the injected microspheres were compared with those measured using the RMS as the "gold standard." The results were analyzed by 1) regression analysis, 2) variance analysis (ANOVA I), and 3) estimation of the limits of agreement between RMS and NRMS flow rates. The results indicate that simultaneous estimations of blood flow obtained with the use of more than three CMS lack accuracy and reliability. A combination of three types of CMS with crimson-labeled FMS, however, offers the possibility to estimate consecutively four different flow rates in the same animal in an accurate way and with relatively high precision. (+info
The effects of extracorporeal whole body hyperthermia on the functional and phenotypic features of canine peripheral blood mononuclear cells (PBMC).
In this study the effect of transient 42.3 degrees C whole body hyperthermia (WBH) on the distribution of PBMC phenotypes and in vitro blastogenic responsiveness was determined in dogs. Hyperthermia (n = 6) was induced by heating venous blood during extracorporeal circulation (venous perfusion WBH); perfused non-heated dogs (n = 4) were used as controls. Both euthermic and hyperthermic perfusion produced transient lymphopenia which normalized in controls after perfusion but persisted in hyperthermic animals throughout the 8-day post-perfusion observation interval. The transient lymphopenia in control dogs was non-selective. In contrast, WBH-associated lymphopenia was selective, in that CD5+ T lymphocytes were more sensitive to hyperthermia than sIg+ B cells and, within the T cell compartment, suppressor (CD8+) cells were more sensitive to hyperthermic stress than helper (CD4+) lymphocytes. Functional analyses showed that WBH caused persistent suppression of PBMC blastogenesis in response to T cell phytomitogens. Increased plasma cortisol levels were correlated to peak lymphopenia and hyporesponsiveness to phytomitogens. Despite these alterations, high grade WBH was well tolerated and there was no evidence of opportunistic infection. (+info
Mechanisms of selective leukocyte recruitment from whole blood on cytokine-activated endothelial cells under flow conditions.
Selective recruitment of eosinophils to sites of allergic and parasitic inflammation involves specific adhesion and activation signals expressed on or presented by stimulated endothelial cells. Here we examined leukocyte recruitment on cytokine-activated HUVEC under flow conditions. We perfused whole blood through a flow chamber to examine mechanisms of selective leukocyte recruitment. Although there was substantial recruitment of leukocytes on TNF-alpha-stimulated HUVEC, we found no selective accumulation of any particular leukocyte subpopulations. In contrast, fewer leukocytes were recruited to IL-4-stimulated HUVEC, but the recruitment was selective for eosinophils. We examined the role of adhesion molecules in these interactions and found that eosinophil recruitment was completely blocked with an alpha4 integrin mAb at the shear rates examined. A significant number of neutrophils were also recruited to IL-4-stimulated HUVEC, and these interactions required P-selectin and P-selectin glycoprotein ligand-1. Thus, whole blood perfusion over cytokine-activated endothelium revealed that IL-4-stimulated HUVEC support selective recruitment of eosinophils, whereas TNF-alpha-stimulated HUVEC lack selectivity for any leukocyte subclass. (+info