Improvement Of Microcirculation Research Articles

Diabetic peripheral angiopathy treatment using a multi-laser therapy device

Diabetic peripheral angiopathy treatment using a multi-laser therapy device

Clinical values of hemodynamics assessment by parametric color coding of digital subtraction angiography before and after endovascular therapy for critical limb ischaemia

To investigate the feasibility of parametric color coding of digital subtraction angiography (Syngo iFlow) for hemodynamics assessment in patients with critical limb ischemia in pre- and post-endovascular therapy. To explore the correlation between Syngo iFlow and the conventional techniques. from January 2013 to December 2014, Clinical data of 21 patients with TASC II type B and type C femoropopliteal arteriosclerotic occlusive disease who were treated by percutaneous transluminal angioplasty and/or primary stent implantation in Nanjing first hospital were analyzed retrospectively. Of these patients there were 10 males and 11 females with an average age of (72±6) years (range from 58-85 years). The treatment efficacy was assessed by the variation of a series of clinical symptoms indexes (such as pain score, cold sensation score and intermittent claudication score), ankle braehial index (ABI) and transcutaneous oxygen pressure (TcPO2). Angiography was performed with the same protocol before and after treatment and parametric color coding of digital subtraction angiography was created by Syngo iFlow software on a dedicated workstation. The time to peak (TTP) of artery and tissue perfusion selected at the same regions of foot and ankle were measured and analyzed to evaluate the improvement of microcirculation and hemodynamics of the ischemic limb. The correlations between Syngo iFlow and the traditional clinical evaluation methods were explored using the Spearman rank correlation test. All patients (21 limbs) underwent successful endovaseular therapy. The mean pain score, cold sensation score, intermittent claudication score, ABI and TcPO2 before treatment were (0.48±0.68), (2.71±0.72), (2.86±0.85), ABI (0.33±0.07), TcPO2 (26.83±3.41) mmHg. While 1 week after treatment all above indicators were (2.57±0.93), (0.33±0.48), (0.90±0.54), (0.69±0.11), TcPO2 (53.75±3.60) mmHg respectively. There were significant statistical differences between pre- and post-treatment (P<0.05). The pre- and post-operative TTP of artery and tissue perfusion were (14.07±1.77) vs (10.43±2.05) s, (18.75±2.72) vs (15.38±2.78) s. For assessment of hemodynamic changes during and after treatment, parametric color coding of digital subtraction angiography (Syngo iFlow) was assumed to show the limb blood flow and perfusion were improved and the differences were statistically significant. The Spearman rank correlation test showed the TTP of artery was positively correlated with ABI, TcPO2 (r=0.65, 0.73, P<0.05), the TTP of tissue perfusion was also positively correlated with ABI, TcPO2 (r=0.60, 0.60, P<0.05). Parametric color coding of digital subtraction angiography (Syngo iFlow) is a real-time, sensitive and quantitative tool that might provide additional support in the hemodynamics evaluation of endovascular treatment for patients with lower extremity peripheral arterial occlusion disease.

Endothelial Function Predicts New Hospitalization due to Heart Failure Following Cardiac Resynchronization Therapy.

Cardiac resynchronization therapy (CRT) has been established as a treatment for patients with chronic heart failure (HF). We tested the hypothesis that assessment of peripheral endothelial function is associated with the long-term outcome of CRT and its linkage to coronary flow reserve (CFR) was also investigated. From 2010, a total of 34 consecutive patients implanted with CRT for the treatment of advanced HF were evaluated at baseline (immediately before CRT) and 6-8 months after CRT. Endothelial function was evaluated by measurement of reactive hyperemia peripheral arterial tonometry (RH-PAT). In 24 of 34 patients, CFR was determined by transthoracic echocardiography. Based on the receiver-operating characteristic curves, depressed RH-PAT index (RHI) was defined as ≤1.5. Accurate follow-up information during the mean of 343 ± 120 days was obtained in 20 preserved RHI group (mean age 66 ± 1.8 years) and 14 depressed RHI group (71 ± 2.2 years). Kaplan-Meier survival analysis demonstrated that depressed RHI group had higher prevalence of new hospitalization due to HF progression (log-rank 5.40). Cox proportional hazards regression analysis revealed that the baseline log brain natriuretic peptide (hazard ratio 5.95) and the baseline RHI value (hazard ratio 0.066) were independently associated with the incidence of new hospitalization due to HF progression. The baseline RHI values were positively correlated with the 6-8 months change of CFR (R = 0.434, P = 0.0343). Our results suggest that the baseline peripheral endothelial function could predict the long-term outcome of CRT. The results also suggest that improvement of coronary microcirculation might be associated with the better baseline endothelial function.

Effects and Perspectives of Chinese Patent Medicines for Tonifying Qi and Promoting Blood Circulation on Patients with Cerebral Infarction.

Stroke is a disease with high morbidity, disability, and fatality. Since ischemic stroke is the most common kind of stroke, increasing attention has been paid to its prevention and treatment. Given the limitations of conventional medicine, there is growing interest in Chinese Medicine (CM), especially Chinese Patent Medicine (CPM) for its convenience and stability. Studies of CM show that Chinese Patent Medicines for Tonifying Qi and Promoting Blood Circulation (CPMs-TQPBC) are one of the most common and effective categories of all clinical CPMs in China. This review investigated and summarized the randomized controlled trials (RCT) of CPMs-TQPBC combined with conventional interventions in the last 10 years. Trial results demonstrated the potential in reducing the endpoints and improving neurologic impairments, body movements, Barthel index, quality of life, and certain biomarkers. Furthermore, certain CM syndromes were alleviated with rare adverse events. Advantages of interventions combined with CPMs-TQPBC for patients with cerebral infarction were discovered. Compared with the Chinese patent medicines for promoting blood circulation (CPMs-PBC) alone, CPMs for both tonifying qi and promoting blood circulation exhibited noticeably better effects. The underlying reasons could be related to the improvement of microcirculation in the brain, protection against ischemic reperfusion injury, generation of neuroprotective factors, and inhibition of apoptosis. Under the circumstances of qi deficiency and blood stasis syndrome (QDBSS) (Qixu-Xueyu Zheng), CPMs- TQPBC showed a substantial difference. More trials focusing on specific patient groups should be carried out to corroborate and expand the findings.

Update on the clinical pharmacology of Pycnogenol(R)

AbstractObjectives: Pycnogenol®, obtained from the bark of the French maritime pine, has attracted the interest of researchers world-wide, more than 300 publications in Medline reflect this scientific interest. This review is an up-date based on clinical findings.Methods: The update includes publications in scientific journals between 2010 and 2015.Results: Knowledge of the metabolism of PYC was expanded. Its active metabolite M1 is accumulated via active transport in blood cells and undergoes further intra-cellular metabolism. PYC exerts 4 basic functions: Inhibition of α-glucosidase, stimulation of synthesis of hyaluronic acid and collagen, stimulation of nitric oxide production, inhibition of inflammatory mediators. The effects of PYC in inhibiting inflammatory processes and stimulating endothelial function have been corroborated by new clinical studies. Further insight into the effects of PYC in chronic venous insufficiency and hemorrhoids resulted from ex-vivo experiments and clinical studies. The improvement of local microcirculation terminated tinnitus and Meniere’s disease in 87% of the patients vs 35% in controls. Inhibition of aromatase and growth factors by PYC was correlated with substantial amelioration of endometriosis, 90% of patients became pain free. The spectrum of contributions to women’s health has been broadened by new positive effects on sexual function, evaluated by the Female Sexual Function Index. Erectile function of infertile men, evaluated by the Int. Index of Erectile Function was improved from moderate to normal values. Concentration of sperms increased by 79% to normal levels by administration of combinations of PYC with aminoacids and roburin.The administration of PYC exerted a significant positive influence on cognitive functions as memory, learning and daily capabilities.Conclusions: The administration of PYC offers a multitude of health benefits. The improvements seen in vascular health need to be confirmed in further studies. New results regarding benefits in cognitive function may lead to new topics of research with PYC.

Features of infusions and tranfusions within the complex treatment in patients with multisystem trauma

Aim. To analyze features of infusions and transfusions within the complex treatment in patients with multisystem trauma.Methods. Features of infusions and transfusions were analyzed in 286 patients with multisystem trauma.Results. The first stage of infusions and transfusions is antishock. In cases of severe bleeding it is important to prevent the cardiac arrest of «empty» heart, to maintain the circulating blood volume, cardiac output and blood pressure at a safe level (systolic blood pressure BP 80-90 mm Hg). The second stage is emergency surgery and surgical hemostasis (abdominal surgery, removal of intracranial hematoma, the most sparing reposition methods). At surgery, anyway, there is an additional blood loss related to surgery itself, but it is possible to compensate the blood loss with patient’s own blood, using machine methods of reinfusion. Infusions and transfusions are performed at general anesthesia. The third stage is the period of treatment in the intensive care unit. Infusions and transfusions should eliminate multiple disorders: volemic, oxygen transport, ionic, toxic, immune, energy and plastic. The goal of infusions and transfusions is to maintain the water-electrolyte metabolism; to treat the anemia and to ensure the efficient oxygen transport; microcirculation improvement; detoxification and metabolites excretion.Conclusion. In multisystem trauma, the treatment success depends on the timely diagnosis, proper estimation of trauma severity, blood loss and general condition of the patient, infusions and transfusions depend on the treatment stage and injuries.

Correlation of post-stroke depression with stroke deficit scale and serum brain-derived neurotrophic factor levels in the elderly

Objective To explore the association of post-stroke depression (PSD) with the scale of stroke deficit and serum brain-derived neurotrophic factor levels in the elderly. Methods A total of 150 elderly stroke patients from the department of neurology of our hospital were recruited from August 2010 to September 2013. Patients were assessed by the Hamilton depression rating scale (HAMD), the National Institutes of Health Stroke Scale (NIHSS), and the Activities of Daily Living Scale (ADL). In addition, serum BDNF levels were determined by ELISA. Results 42.0% of the 150 elderly patients suffered depression after stroke (63/150). There were significant differences in neurological function impairment and ADL scores between the PSD group and the non-PSD group 〔(14.72±4.06) vs. (5.51±1.93) and (40.63±17.06) vs. (79.66±29.31), t=18.49 and 9.47, respectively, P<0.0001 for both〕. HAMD and NIHSS scores showed positive correlations with the degree of depression (r=0.998 and 0.962, P=0.0012 and 0.0375, respectively). ADL scores and serum BDNF levels decreased as the degree of depression increased, and were negatively correlated with the degree of depression (r=-0.985 and -0.995, P=0.0149 and 0.0049, respectively). Conclusions The degree of post-stoke depression is positively correlated with the scale of neurological dysfunction and negatively correlated with the activities of daily living scale and serum BDNF levels in the elderly. The primary disease should be properly treated, and improvement in brain metabolism and micro-circulation should be attempted to alleviate neurological dysfunction. In addition, rehabilitation therapy should be performed early in elderly stroke patients in order to improve physical activity and self-care ability, thus reducing the degree of disability and depression. Key words: Stoke; Depression; Cognition disorders; Brain-derived neurotrophic factor

Различные виды анестезии при операции «кесарево сечение» (обзор литературы)

The choice of anesthesia for Cesarean section is relevant in modern obstetrics, because an anesthesia should promote adequate protection of pregnant from operational stress and to create optimal conditions for the adaptation of the fetus in the perioperative and the neonatal period. In modern obstetrics, the anesthesiologist plays a significant role not only in the introduction of anesthesia for Caesarean section and to assist in the immediate postpartum period. A number of authors have noted the positive effect of segmental blocks on the vital functions at the comparison the general and regional anesthesia. In particular, hemo-rheological and stress-protective effects of regional anesthesia were identified in comparison with general anesthesia. Fewer thromboembolic complications were noted. The article discusses the various mechanisms that underlie these changes, namely, the activation of blood flow in the area of sympathetic blockade and activation of fibrinolysis, the decrease of the viscosity and aggregation properties of platelets prior to infusion therapy. The changes of hemostasis are associated with sympathetic blockade, peripheral vasodilatation, improvement of peripheral blood flow and microcirculation. According to some authors, the optimal method of modulation surgical stress is regional anesthesia, which allows to provide extensive sympathetic block during surgery and prolonged epidural analgesia.

Acute effects of normal saline and lactated Ringer’s with erythropoietin on microcirculatory perfusion, tissue bioenergetics, and gut permeability of the small intestine in a hemorrhagic shock and resuscitation rat model

Introduction: Erythropoietin (EPO) has acute hemodynamic and anti-inflammatory effects in addition to its erythropoietic action. We tested the hypothesis that recombinant human EPO (rHuEPO) given at the time of resuscitation with normal saline (NS) or lactated Ringer’s (LR) will improve capillary perfusion and tissue bioenergetics in a hemorrhagic shock and resuscitation (HS/R) rat model. Methods: Anesthetized rats’ ileal muscular layer was prepared for intra-vital microscopy. The rats were hemorrhaged 30 millitres per kilogram over 10 minutes with uncontrolled mean arterial pressure for 50 minutes. They were then randomized to one of four groups (NS, NS + rHuEPO, LR, and LR + rHuEPO; n = 6/group) and underwent a 60-minute resuscitation period. Intravenous rHuEPO (1,000 U/kg) was given at the start of fluid resuscitation. Gut microcirculation and nicotinamide adenine dinucleotide dehydrogenase (NADH) fluorescence were recorded for off-line analysis at baseline, 50 minutes of shock, and 60 minutes of resuscitation. In a separate HS/R experiment ( n = 10/group), gut permeability to fluorescein isothiocyanate dextran and endotoxin levels, tissue damage, and portal vein blood levels of interleukin (IL)-6 and tumour necrosis factor (TNF) were examined. Results: LR alone demonstrated better gut microcirculation and decreased gut injury than NS alone. NS + rHuEPO, compared with NS alone, improved functional capillary density (22.9 ± 0.6 Cap/mm and 20.2 ± 1.0 Cap/mm, respectively; p &lt; 0.01), red blood cell flow scores (2.1 ± 0.2 and 1.3 ± 0.2, respectively; p &lt; 0.01), and tissue NADH fluorescence (54.5 ± 0.3% and 59.7 ± 0.8%, respectively; p &lt; 0.01). Compared with LR, LR + rHuEPO did not result in significant improvement in microcirculation. Adding rHuEPO to NS improved gut permeability, inflammatory mediators (IL-6, TNF), and tissue injury, but adding it to LR did not. Discussion: LR improved tissue microcirculation, decreased permeability to macromolecules, and reduced mucosal injury in the ileum compared with NS alone. The beneficial effects of rHuEPO administration were mostly observed in the NS resuscitation group.

Evaluation of peripheral microcirculation improvement of foot after tarsal tunnel release in diabetic patients by transcutaneous oximetry.

According to recent studies, peripheral nerve decompression in diabetic patients seems to not only improve nerve function, but also to increase microcirculation; thus decreasing the incidence of diabetic foot wounds and amputations. However, while the postoperative improvement of nerve function is demonstrated, the changes in peripheral microcirculation have not been demonstrated yet. The aim of this study is to assess the degree of microcirculation improvement of foot after the tarsal tunnel release in the diabetic patients by using transcutaneous oximetry. Twenty diabetic male patients aged between 43 and 72 years old (mean age 61.2 years old) suffering from diabetic peripheral neuropathy with superimposed nerve compression underwent transcutaneous oximetry (PtcO2) before and after tarsal tunnel release by placing an electrode on the skin at the level of the dorsum of the foot. Eight lower extremities presented diabetic foot wound preoperatively. Thirty-six lower extremities underwent surgical release of the tibialis posterior nerve only, whereas four lower extremities underwent the combined release of common peroneal nerve, anterior tibialis nerve, and posterior tibialis nerve. Preoperative values of transcutaneous oximetry were below the critical threshold, that is, lower than 40 mmHg (29.1 ± 5.4 mmHg). PtcO2 values at one month after surgery (45.8 ± 6.4 mmHg) were significantly higher than the preoperative ones (P = 0.01). The results of postoperative increase in PtcO2 values demonstrate that the release of the tarsal tunnel determines a relevant increase in microcirculation in the feet of diabetic patients.

The intravenous laser blood irradiation in chronic pain and fibromyalgia.

Intravenous laser blood irradiation was first introduced into therapy by the Soviet scientists EN.Meschalkin and VS.Sergiewski in 1981. Originally this method was developed for the treatment of cardiovascular diseases. Improvement of rheologic properties of the blood as well as improvement of microcirculation and reduction of the area of infarction has been proved. Further, reduction of dysrhythmia and sudden cardiac death was achieved. At first, only the Helium-Neon laser (632.8 nm) was used in this therapy. For that, a power of 1-3mW and a period of exposure of 20-60 minutes were applied. The treatments were carried out once or twice a day up to ten appointments in all1. In the years after, many, and for the most part Russian studies showed that helium-neon laser had various effects on many organs and on the hematologic and immunologic system. The studies were published mainly in Russian which were little known in the West because of decades of political separation, and were regarded with disapproval. Besides clinical research and application for patients, the cell biological basis was developed by the Estonian cell biologist Tiina Karu at the same time. An abstract is to be found in her work "The Science of Low-Power Laser-Therapy"

Dementia and Cognitive Impairment Reduction after Laser Transcatheter Treatment of Alzheimer’s Disease

Reduced cerebral perfusion and microcirculation are found among AD causes, which should be considered in the development of new treatments for the disease. 165 patients with AD were examined. The examination plan included clinical assessment of dementia severity (CDR), cognitive function assessment (MMSE), laboratory examination, cerebral scintigraphy (SG), rheoencephalography (REG), cerebral CT and MRI, morphometric AD stages assessment (TDR) and cerebral multi-gated angiography (MUGA). 89 patients aged 34 - 79 (average age 67) were selected for the treatment: 31 (34.83%) male, 58 (65.17%) female patients. According to their AD stage, the patients were divided into: TDR-0 (preclinical stage)—10 (11.24%) patients, TDR-1 (early stage with mild dementia, mild cognitive impairment)—28 (31.46%) patients, TDR-2 (medium stage with moderate dementia, cognitive impairment sufficiently persistent)—34 (38.20%) patients, TDR-3 (late stage with sufficiently severe dementia and cognitive impairment)—17 (19.10%) patients. Test Group—46 (51.68%) patients—had transcatheter treatment with low-energy lasers. Control Group—43 (48.31%)—had conservative treatment with Memantin and Rivastigmine. The Test Group had cerebral microcirculation improvement leading to permanent dementia reduction and cognitive recovery which allowed transferring the patients to a lighter TDR group or withdrawing them from the scale. Control Group patients with earlier AD stages (TDR-0, TDR-1, TDR-2) obtained stabilization for a period of 6 months-3 years, with subsequent growth of dementia and cognitive impairment; patients with late AD stage (TDR-3) showed further increase of cognitive impairment and dementia. Transcatheter treatment allows reducing the effects of dyscirculatory angiopathy of Alzheimer’s type (DAAT) improving cerebral microcirculation and metabolism, which leads to permanent dementia regression and cognitive impairment reduction. These data show that AD treatment should be comprehensive and aimed at both the recovery of cerebral microcirculation and blood supply and the normalization of amyloid beta metabolism in the cerebral tissue.

Abstract 13697: Glucagon-like Peptide-1 Analogue Liraglutide Does Not Improve Microvascular Myocardial Function in Patients With Type 2 Diabetes - a Randomized, Single-blinded Cross Over Trial

Background: Impaired coronary microcirculation is associated with a poor prognosis in patients with type 2 diabetes. In the absence of stenosis of major coronary arteries, coronary flow reserve (CFR) reflects coronary microcirculation. Studies have shown beneficial effects of glucagon-like peptide-1 (GLP-1) on the cardiovascular system. The aim of the study was to explore the short-term effect of GLP-1 treatment on coronary microcirculation estimated by CFR in patients with type 2 diabetes. Methods: Twenty patients with type 2 diabetes and no history of coronary artery disease were treated with the GLP-1 analogue Liraglutide for 10 weeks, in a randomized single-blinded crossover setup. The effect of GLP-1 on coronary microcirculation was evaluated using non-invasive trans-thoracic Doppler-flow echocardiography during dipyridamole induced stress. Data were analysed as two-sample t-test after ensuring no carry over effect. Results: A total of 20 patients (15 male; mean age 57 ± 9; mean BMI 33.1 ± 4.4, mean baseline CFR 2.35 ± 0.45) completed full protocol. There was a small increase in CFR following GLP-1 treatment (change 0.18, CI95% [-0.01; 0.36], p=0.06) but with no difference in effect compared with the no treatment group (0.16, CI95% [-0.08; 0.40], p=0.18). GLP-1 significantly reduced glycated haemoglobin (-10.1 mmol/mol CI95% [-13.9; -6.4], p=&lt;0.001) systolic blood pressure (-10 mmHg CI95% [-17; -3], p=0.01) and weight (-1.9 kg CI95% [-3.6; -0.2], p=0.03). Conclusion: Despite a significant weight-loss, reduction in HbA1c and systolic blood pressure, we did not find a significant improvement in coronary microcirculation after 10 weeks treatment with GLP-1. In our short-term treatment study, we therefore conclude that the GLP-1 analogue Liraglutide does not improve coronary microcirculation in patients with type 2 diabetes. Further long-term studies are needed to explore mechanisms to improve coronary microcirculation in patients with type 2 diabetes.

MICROCIRCULATORY CHANGES IN PERIODONTAL TISSUES AT PATIENTS WITH DIABETES MELLITUS TYPE I AT LOCAL APPLICATION OF CHITOSAN-ALGINATE-HYDROXYAPATITE COMPOSITION

The article shows the results of experimental and clinical research microcirculation status of periodontal tissue in patients with type I diabetes treated with a course of applications of chitosan-containing «CAH-BOL». Purpose : To evaluate the influence of the «CAH-BOL» on the state of periodontal microvasculature in type I diabetes mellitus. Objectives : To evaluate the morphological changes in the microvasculature of periodontal, assess the functional status microvasculature as a result of «CAH-BOL». Materials and Methods : A morphological study of periodontal tissue preparations of a rat with model of insulin-dependent diabetes mellitus and chronic generalized periodontitis, receiving applications «CAH-BOL»; laser Doppler flowmetry of periodontal tissues of patients with chronic generalized periodontitis and diabetes mellitus type I was conducted in a clinic. As a result of the morphological study was found that «CAH-BOL» helps to normalize the microvasculature due to creation of large numbers of blood angeuos, functional clinical study demonstrates an improvement of microcirculation and indicators of active regulation of blood flow in the periodontium after the course of applications of «CAH-BOL». Scope results: medicine, dentistry.

Effect of single tibial artery revascularization on microcirculation in the setting of critical limb ischemia.

Benefits of 2-dimensional (2D) angiosome-oriented infrapopliteal revascularization remain controversial. The aim of this retrospective study was to clarify the effect of single tibial artery revascularization on the dorsal and plantar microcirculation of critically ischemic limbs based on skin perfusion pressure (SPP). Fifty-seven interventions that only involved either anterior tibial artery (ATA) or posterior tibial artery (PTA) revascularization were included in this study. SPP was measured on the dorsal side (theoretically ATA perfusion area) and the plantar side (theoretically PTA perfusion area) before and after the procedure. Dorsal and plantar SPP increased significantly, from 33 (IQR 23-40.5) to 52 (IQR 32.5-65) mm Hg (P<0.0001) and 31.6±16.1 to 44.8±19.2 mm Hg (P=0.001) after ATA revascularization, respectively, and from 29.3±14.0 to 42.4±19.7 mm Hg (P=0.003) and 29.3±9.8 to 43.5±15.9 mm Hg (P<0.001) after PTA revascularization, respectively. Both ATA and PTA revascularization were not associated with any significant differences in ΔSPP between the dorsal and the plantar regions of the foot. Only 64% and 58% of ATA revascularization cases showed higher post-SPP and ΔSPP on the dorsal side than on the plantar side, respectively. Also, only 47% and 40% of PTA revascularization cases showed higher post-SPP and ΔSPP on the plantar side than on the dorsal side, respectively. Single tibial artery revascularization, whether of the ATA or PTA, yielded comparable improvements in microcirculation of the dorsal and plantar foot. Approximately half of the feet revascularized had a change in microcirculation that was not consistent with the 2D angiosome theory.

Evaluation of the Activity and Tolerability of a Cosmetic Treatment for the Periocular Area on the Aging Face: Controlled Clinical and Instrumental Evaluation vs. Placebo

The aim of this study was to evaluate clinically and by non invasive instrumental evaluations the efficacy and tolerability of a cosmetic treatment containing an innovative active ingredient, ethyl ximenynate, in the prevention of dark circles under the eyes and blemishes of skin aging on the eye profile. Evaluations were performed at baseline and after 2 and 4 weeks of treatment on 22 volunteers; the study was planned as a double blind half-face trial. Data showed a trend towards a lifting of the eyelid skin; all investigator scores (eye puffiness, skin smoothness, roughness and dryness) decreased. In addition, profilometric results confirmed the anti-wrinkles efficacy of the active product and its lifting action, while those related to spectrophotometry underlined the decongestant effect on dark circles that appeared, at the end of the study, to be less marked. The improvement of skin microcirculation and capillary resistance and vascular tone in the eye area underlines a general mitigation of all relevant skin imperfections and blemishes of skin aging on the eye profile. The active ingredient was shown to be effective for the cosmetic treatment of the periocular area.

Improvement of facial scar appearance and microcirculation by autologous lipofilling

Autologous lipofilling has become a standard procedure for many indications in plastic surgery. Single-case studies have reported improvements in scars, especially in burn patients, after autologous lipofilling. Despite its widespread use, little is known about the mechanisms responsible for this improvement. It is hypothesized that the mesenchymal stem cells and numerous growth factors contained in the lipoaspirate contribute to the skin and scar remodeling. Between 2008 and 2012, 35 facial scars (n=35) on 26 patients (n=26) were treated by autologous lipofilling. The preoperative examinations and postoperative follow-up included use of the patient and observer scar assessment scale (POSAS), photo documentation, and laser Doppler spectrometry (O2C) measurements of tissue oxygen saturation, hemoglobin levels, and microcirculation on the second, seventh, and ninetieth postoperative days. The scar quality improved in all cases, leading to a high patient satisfaction rate at the final follow-up examination. The POSAS scores were significantly increased for pain (p=0.0331), color (p=0.0007), stiffness (p=0.0030), irregularity (p=0.0039), pigmentation (p=0.0282), and pliability (p=0.0404). In addition, we observed increased hemoglobin levels in the early postoperative period (second day) and a reduction in the microcirculation, which normalized to the preoperative values after 7-90 days. We demonstrated that autologous lipofilling represents a valuable technique for the treatment of facial scars. Further prospective observational studies are needed to better understand the mechanisms leading to scar enhancement and to make this procedure more reliable and predictable for patients.

Intensified insulin treatment is associated with improvement in skin microcirculation and ischaemic foot ulcer in patients with type 1 diabetes mellitus: a long-term follow-up study.

We investigated skin microcirculation and its association with HbA1c and the incidence of ischaemic foot ulcer in patients with type 1 diabetes formerly randomised (1982-1984) to intensified conventional treatment (ICT) or standard treatment (ST) with insulin for a mean of 7.5years. We re-determined the skin microcirculation of 72 patients (ICT 35 vs ST 37) from the original Stockholm Diabetes Intervention Study with iontophoresis topically applied with the following vasoactive stimuli: acetylcholine (ACh) (endothelial-dependent vasodilatation), sodium nitroprusside (SNP) (endothelial-independent vasodilatation), and capsaicin (C-nociceptive-dependent vasodilatation). HbA1c levels (mean of 14 values/patient) were prospectively collected between 1990 and 1995 and tested for association with skin microcirculation. The patients were followed until first hospitalisation for an ischaemic foot ulcer or until 2011. During the median 28years of follow-up, three patients developed ischaemic foot ulcers in the ICT group compared with ten in the ST group (logrank, p = 0.035). At the time of iontophoresis, HbA1c was lower in the ICT group (median 57mmol/mol [minimum-maximum 40-79mmol/mol]) compared with the ST group (68mmol/mol [41-96mmol/mol], p < 0.01) (DCCT: ICT 7.4% [5.8-9.4%] vs ST 8.4% [5.9-10.9%]). Stimulated blood flow was higher in the ICT vs ST group with significantly increased perfusion units (PU) for: ACh (8.1 PU [4.6-24.7 PU] vs 5.3 PU [1.7-21.4 PU], p < 0.01); SNP (8.1 PU [2.2-20.1 PU] vs 5.6 PU [2.3-19.2 PU], p = 0.03); and capsaicin (5.0 PU [1.7-22.9 PU] vs 3.4 PU [1.5-8.4 PU], p < 0.01). HbA1c was associated with vasodilatation induced by ACh (b = -0.02, p < 0.01) and capsaicin (b = -0.02, p = 0.03). HbA1c was independently associated with ACh (b = -1.48, p < 0.01) and capsaicin-induced vasodilatation (b = -1.45, p < 0.01). Improved glycaemic control in patients with type 1 diabetes is associated with an improvement in skin microcirculation and with a lower incidence of ischaemic foot ulcers. ClinicalTrials.gov NCT01957930.

Perioperative management of diabetic foot.

Perioperative management of diabetic foot.

Omega-3 polyunsaturated fatty acids enhance cerebral angiogenesis and provide long-term protection after stroke

Stroke is a devastating neurological disorder and one of the leading causes of death and serious disability. After cerebral ischemia, revascularization in the ischemic boundary zone provides nutritive blood flow as well as various growth factors to promote the survival and activity of neurons and neural progenitor cells. Enhancement of angiogenesis and the resulting improvement of cerebral microcirculation are key restorative mechanisms and represent an important therapeutic strategy for ischemic stroke. In the present study, we tested the hypothesis that post-stroke angiogenesis would be enhanced by omega-3 polyunsaturated fatty acids (n−3 PUFAs), a major component of dietary fish oil. To this end, we found that transgenic fat-1 mice that overproduce n−3 PUFAs exhibited long-term behavioral and histological protection against transient focal cerebral ischemia (tFCI). Importantly, fat-1 transgenic mice also exhibited robust improvements in revascularization and angiogenesis compared to wild type littermates, suggesting a potential role for n−3 fatty acids in post-stroke cerebrovascular remodeling. Mechanistically, n−3 PUFAs induced upregulation of angiopoietin 2 (Ang 2) in astrocytes after tFCI and stimulated extracellular Ang 2 release from cultured astrocytes after oxygen and glucose deprivation. Ang 2 facilitated endothelial proliferation and barrier formation in vitro by potentiating the effects of VEGF on phospholipase Cγ1 and Src signaling. Consistent with these findings, blockade of Src activity in post-stroke fat-1 mice impaired n−3 PUFA-induced angiogenesis and exacerbated long-term neurological outcomes. Taken together, our findings strongly suggest that n−3 PUFA supplementation is a potential angiogenic treatment capable of augmenting brain repair and improving long-term functional recovery after cerebral ischemia.