Improvement Of Microcirculation Research Articles

Physiotherapy following cardiac surgery: Program comparison

The objective is to examine and compare the usability of two physiotherapy programmes, analyzing respiratory function in patients before and after cardiac surgery in hospital during seven postoperative days (POD). Quantitative randomized prospective study of 157 patients before and after the valve replacement surgery, coronary artery bypass graft and combined surgeries, who moved independently. Participants were randomized into two groups (1 and 2) with different physiotherapy programmes. The routine physiotherapy of breath-enhancing techniques, micro-circulation improvement were used for the first group, for the second group - modified physiotherapy – the improvement of inspiration muscles, mm. quadriceps. gluteus max strength. Anthropometric measurements were defined for both groups on the day before surgery and during spirography - dynamic indicators - forced vital capacity (FVC), forced expiratory volume in the 2nd second (FEV1), Tiffeneau index (FEV1 / VC (%)), peak expiratory flow (PEF), operation parameters. By comparing the postoperative respiratory parameters between the two groups and using independent samples t test, it was found out that the difference in FVC between groups is 1.71 [95% CI: −8.25 to 4.8] and it is not statistically significant (t (155) = −0.52; p = 0.60). Based on the Leuven test results FVC the distribution variance is not statistically notably different for group 1 and group 2 (F = 0.27, p=0.60). Using routine and modified physiotherapy and comparing postoperative dynamic respiratory performance of the two groups, there was no statistically significant difference, proving that the two models are equally effective.

Effect of etoksidol against sulfur-containing gas induced reduction in bone marrow microcirculation in different stages of ontogenesis in rats

Objective: To investigate the state of femoral red bone marrow microvasculature of nonlinear white male rats in the course of an acute experiment. Materials and Methods: The ontogenesis of experimental animals were between 36 and 730 days: Intact ones, those subjected to the action of subtoxic doses of sulfur-bearing gas, and those receiving a protector-drug “Etoksidol”. The data on microcirculation were obtained using laser Doppler flowmetry. The industrial sulfur-containing natural gas of the Astrakhan gas condensate field was used as a toxic agent. It was revealed that the reducing intensity of blood microcirculation in the red bone marrow of intact rats is statistically more significance in the presenile period of ontogenesis compared with the earlier periods. Results: The use of “Etoksidol” along with the influence of sulfur-containing pollutant on the experimental animals of different age groups led to improvement of microcirculation in the bone marrow at all the studied stages of ontogeny. However, such improvement was statistically highly significant (P < 0.01) in the mature age I, very close to significant in the mature age II, and was not statistically significant in the young and presenile age. Conclusions: As a result, the following findings were obtained: The toxic effect greatly reduces the intensity of the microcirculation in the bone marrow, which is most pronounced in younger animals; the experimental results suggest that the drug “Etoksidol,” with an antihypoxic and antioxidant action, has a positive effect on red bone marrow microvasculature.

Activation of ACE2/angiotensin (1–7) attenuates pancreatic β cell dedifferentiation in a high-fat-diet mouse model

ObjectiveAngiotensin-converting enzyme 2 (ACE2) has been identified in pancreatic islets and can preserve β cells. In this study, we aimed to examine the possible role of ACE2 and its end product, angiotensin 1–7 (A1–7), in reducing β cell dedifferentiation during metabolic stress. MethodsFirst, a lineage-tracing experiment was performed to track β cells in mice fed a high-fat diet (HFD). Second, the ACE2/A1–7 axis was evaluated in the HFD mouse model. Intraperitoneal glucose tolerance tests (IPGTTs) and intraperitoneal insulin tolerance tests (IPITTs) were conducted. Phenotypic changes in β cells were detected by immunohistochemistry and quantitative real-time PCR. Pancreatic sections were immunostained for vascular endothelial growth factor (VEGF) and inducible nitric oxide synthase (iNOS). Finally, the effects of the ACE2/A1–7 axis were explored in isolated mouse islets exposed to different concentrations of glucose. Glucose-stimulated insulin release and levels of insulin mRNA and OCT4 mRNA were measured. ResultsPancreatic β cell dedifferentiation occurred both in vitro and in vivo in response to metabolic stress and was accompanied by ACE2 reduction. HFD-induced insulin resistance and glucose intolerance were exacerbated in ACE2-knockout (ACE2KO) mice but were alleviated by exogenous A1–7 in C57BL/6J mice. Approximately 20% of β cells were dedifferentiated in ACE2KO mice fed a standard rodent chow diet (SD). A higher percentage of dedifferentiated β cells was detected in ACE2KO mice than in wild-type (WT) mice under HFD conditions. In contrast, the administration of A1–7 alleviated HFD-induced β cell dedifferentiation in C57BL/6J mice. Moreover, the exogenous injection of A1–7 improved microcirculation in islets and decreased the production of iNOS in islets of C57BL/6J mice fed an HFD. Additionally, ACE2 was found to be mainly expressed in α cells of mice, while Mas, the receptor of A1–7, was distributed in β cells. ConclusionsOverall, this study is the first to demonstrate that the ACE2/A1–7/Mas axis may be one of the intra-islet paracrine mechanisms of communication between α and β cells. Enhancing the ACE2/A1–7 axis exerts a protective effect by ameliorating β cell dedifferentiation, and this effect might be partially mediated through improvements in islet microcirculation and suppression of islet iNOS.

Effects of four antiplatelet/statin combined strategies on immune and inflammatory responses in patients with acute myocardial infarction undergoing pharmacoinvasive strategy: Design and rationale of the B and T Types of Lymphocytes Evaluation in Acute Myocardial Infarction (BATTLE-AMI) study: study protocol for a randomized controlled trial

BackgroundEarly reperfusion of the occluded coronary artery during acute myocardial infarction is considered crucial for reduction of infarcted mass and recovery of ventricular function. Effective microcirculation and the balance between protective and harmful lymphocytes may have roles in reperfusion injury and may affect final ventricular remodeling.Methods/designBATTLE-AMI is an open-label, randomized trial comparing the effects of four therapeutic strategies (rosuvastatin/ticagrelor, rosuvastatin/clopidogrel, simvastatin plus ezetimibe/ticagrelor, or simvastatin plus ezetimibe/clopidogrel) on infarcted mass and left ventricular ejection fraction (LVEF) (blinded endpoints) in patients with ST-segment elevation myocardial infarction submitted to fibrinolytic therapy before coronary angiogram (pharmacoinvasive strategy). All patients (n = 300, 75 per arm) will be followed up for six months. The effects of treatment on subsets of B and T lymphocytes will be determined by flow-cytometry/ELISPOT and will be correlated with the infarcted mass, LVEF, and microcirculation perfusion obtained by cardiac magnetic resonance imaging. The primary hypothesis is that the combined rosuvastatin/ticagrelor therapy will be superior to other therapies (particularly for the comparison with simvastatin plus ezetimibe/clopidogrel) for the achievement of better LVEF at 30 days (primary endpoint) and smaller infarcted mass (secondary endpoint) at 30 days and six months. The trial will also evaluate the improvement in the immune/inflammatory responses mediated by B and T lymphocytes. Omics field (metabolomics and proteomics) will help to understand these responses by molecular events.DiscussionBATTLE-AMI is aimed to (1) evaluate the role of subsets of lymphocytes on microcirculation improvement and (2) show how the choice of statin/antiplatelet therapy may affect cardiac remodeling after acute myocardial infarction with ST elevation.Trial registrationClinicalTrials.gov, NCT02428374. Registered on 28 September 2014.

Effects of baicalin on the changes in hemorheology of acute respiratory distress syndrome in rats

Objective: To investigate the effect of baicalin on the changes in hemorheology and its mechanism during the development of Acute Respiratory Distress Syndrome(ARDS) induced by oleic acid (OA) in rats. Methods: Rats were randomized into 3 groups: control, ARDS (OA induction, 0.12 mg/kg) and ba-icalin-treated group (300 mg/kg). The blood samples were collected at 30 min, 1, 2, 3, 6, 12 and 6 h after OA injection. The whole blood viscosity, plasma viscosity, Maximum erythrocyte deformability index (DImax) were detected. Meanwhile, blood gas analysis and Routine blood test were also performed. Results: The level of arte-rial oxygen partial pressure and oxygenation index decreased (P<0.01 vs. control) and oxygenation index (178 mm Hg, 1 mm Hg=0.133 kPa) reached the diagnostic standard of ARDS at 2 h in ARDS group. In baicalin-treated group, the level of arterial oxygen partial pressure and oxygenation index increased versus the ARDS group. The platelet count (PLT) decreased in baicalin-treated and ARDS groups. Compared with the ARDS group, the level of PLT increased significantly in baicalin-treated group at 30min, 1, 2, and 3 h. Hematocrit (HCT) increased in baicalin-treated and ARDS groups. Compared with the ARDS group, the level of HCT de-creased significantly in baicalin-treated group at 2, 3, 6 and 12 h. Meanwhile, all the index of hemorheology improved in baicalin-treated group. Conclusion: Baicalin may improve hypoxemia of ARDS induced by OA in rats. It may be due to the Improvement of microcirculation of lung.

Microcirculation in open vs. minimally invasive dorsal stabilization of thoracolumbar fractures

Standard open and percutaneous minimally invasive surgical procedures co-exist in the treatment of fractures of the thoracolumbar spine. Shorter skin incisions just above the pedicles are used in minimally invasive procedures. Full-length skin incisions and invasive preparations are applied in the standard open approach. While both methods show equivalent rates of intraoperative surgical complications and comparable clinical and radiological outcomes, blood loss and operation time have shown to be decreased in minimally invasive treatment. However, no study so far has investigated differences in microcirculation. This study hypothesized less impairment of microcirculation in the minimally invasive approach compared to the open approach and an improvement of microcirculation over time. A prospective cohort study was conducted using non-invasive laser-Doppler spectrophotometry (an O2C “oxygen to see” device) for measurement of cutaneous and subcutaneous blood oxygenation (SO2), haemoglobin concentration (Hb), and blood flow at depths of 2, 8, and 15 mm at six locations on the skin. Measurements were performed before surgery, 8 and 24 h after surgery, and 2, 4, 7, 12 and 20 days after surgery, however the number of patients measured decreased towards the later time points. Forty patients were included in the study, 20 with each approach (18 females and 22 males). Pair-wise comparison of the types of surgical procedure for each measurement point revealed a significantly higher flow value in the minimally invasive group at one of the measurement points located between the incisions (P = .041). The point-wise analyses of SO2 and Hb did not show significant differences between the approaches. In conclusion, significantly albeit moderately higher flow values could be found in minimally invasive procedures compared to open operations of thoracolumbar fractures in the area of skin that is spared by the incisions.

Effect of remifentanil during cardiopulmonary bypass on incidence of acute kidney injury after cardiac surgery.

Acute kidney injury (AKI) after cardiopulmonary bypass (CPB) is a well-known postoperative complication. Remifentanil, which is a commonly used ultra-short-acting opioid, has antiinflammatory and sympatholytic effects with improvement of microcirculation. A retrospective study was conducted to clarify the effect of the use of remifentanil during CPB on the incidence of postoperative AKI. Patients who underwent valve surgery while under cardiopulmonary bypass between January 2012 and December 2014 in our hospital were enrolled in this study. The incidences of postoperative AKI were compared in patients who received remifentanil during CPB (group R) and those who did not (group N). Univariate and multivariate regression analyses were performed to determine risk factors for AKI. Eighty patients received remifentanil (group R) and 50 patients did not (group N). The incidences of AKI were not significantly different in group R and group N (51% vs. 36%, P=0.10). In multivariate regression analysis, age [adjusted odds ratio (OR) 1.048, 95% CI 1.008-1.089, P=0.017], male gender (adjusted OR 3.101, 95% CI 1.303-7.378, P=0.011), and use of preoperative calcium channel blockers (adjusted OR 3.240, 95% CI 1.302-8.063, P=0.011) and diuretics (adjusted OR 2.673, 95% CI 1.178-6.066, P=0.019) were associated with the incidence of AKI. The use of remifentanil was not associated with AKI (adjusted OR 2.321, 95% CI 0.997-5.402, P=0.051). The use of remifentanil during CPB did not decrease the incidence of postoperative AKI after cardiac surgery.

Transfusion of Red Blood Cells to Patients with Sepsis.

Sepsis is one of the major causes of death worldwide, and is the host response to infection which renders our organs malfunctioning. Insufficient tissue perfusion and oxygen delivery have been implicated in the pathogenesis of sepsis-related organ dysfunction, making transfusion of packed red blood cells (pRBCs) a reasonable treatment modality. However, clinical trials have generated controversial results. Even the notion that transfused pRBCs increase the oxygen-carrying capacity of blood has been challenged. Meanwhile, during sepsis, the ability of our tissues to utilize oxygen may also be reduced, and the increased blood concentrations of lactate may be the results of strong inflammation and excessive catecholamine release, rather than impaired cell respiration. Leukodepleted pRBCs more consistently demonstrated improvement in microcirculation, and the increase in blood viscosity brought about by pRBC transfusion helps maintain functional capillary density. A restrictive strategy of pRBC transfusion is recommended in treating septic patients.

The efficacy of mesenchymal stem cells for the improvement of cerebral microcirculation in spontaneously hypertensive rats

Elaboration of new methods of correction of microcirculatory disorder in the brain caused by persistent high blood pressure is a topical task both for medicine and for biology. We studied influence of intracerebral transplantation of human mesenchymal stem cells (MSCh) to cerebral microcirculation in young (4 months) and aged (12 months) spontaneously hypertensive rats (SHR). It was shown that transplantation MSCh promoted the rise of the density of microvascular network of young SHR ca. 1.6-fold; density of the arteriolar area of microvascular network of the pia mater increased ca. 1.9-fold. The density of microvascular network of aged SHR increased ca. 1.4—1.5-fold after transplantation MSCh. The perfusion and tissue saturation of sensorimotor cortex of young SHR increased to the level of young normotensive rats, and in aged SHR the perfusion and tissue saturation of sensorimotor cortex was not increased. Conclusion: the intracerebral transplantation MSCh almost completely leveled the pathological changes of the microcirculation in the sensorimotor cortex of the brain of young SHR and improved unimportantly microcirculation in aged SHR.

Management Of Patients With Stroke In Critical Care Units, Considering Osmotic Therapy And Hypothermia

Cytotoxic brain edema is an early complication of stroke which increases the possibility of secondary ischemia. Hypertonic solutions, mannitol and recently hypertonic saline (HS) has been considered for treatment of increased ICP. HS could decrease ICP especially in hypotensive patients with different mechanisms, direct effect on edema, decreasing inflammation which is mediated by attenuation of TNFa and IL-1b stimulation on Na-K-Cl cotransporter 1 and improvement of microcirculation. Improvement of microcirculation is so important for hypertonic solutions to be effective in ischemia especially focal ischemia. Based on the literature, hypertonic saline is more effective in decreasing cerebral edema than the equal volume of mannitol. The optimal dose and duration of therapy needs more trials. Caution should be performed with patients with moderate size hemispheric infarcts on presentation, race and genetic factors regarding osmotic therapy.Hypothermia has been rated as one of the most active modes of neuroprotection based on the results of different trials. Hypothermia in both ways, surface and intravascular, decreases cerebral metabolic rate of O2 and glucose and reduces brain oxygen consumption, inflammation and oxidative stress. Recent data continue to support consideration of therapeutic hypothermia for cerebral ischemia in larger clinical trials of acute ischemic stroke. By increasing the time window to therapy initiation and decreasing the treatment duration, selective intracarotid cold saline administration brings increased feasibility, potentially better outcomes and perhaps fewer complications compared with the whole body cooling. Hypothermia is now recommended as a targeted temperature management with defined protocol which should be started early; it may be performed pharmacologically in combination with other therapies. Applying hypothermia should be considered regarding its cost, using in awaked patients, re-warming protocol, incorporation of thrombolysis and its complications.

Efficacy on visual display terminal syndrome treated with jingjin therapy of Zhuang medicine

To observe the efficacy and explore the effect mechanism on visual display terminal syndrome treated with jingjin therapy of Zhuang medicine. Sixty-five patients of visual fatigue induced by the visual display terminal operation were treated with jingjin trigeminy therapy of Zhuang medicine, e.g. massage manipulation, acupuncture and cupping; acting on the specific stimulating areas in Zhuang medicine, relevant with orbit, temple, forehead, ear and Baihui (GV 20). Each treatment lasted 40 min, once every two or three days. Totally, 10 to 14 treatments were required. The scores of visual symptoms and the ocular hemodynamics before and after treatment were observed, and clinical effect were evaluated in the two groups. After treatment, the scores of visual symptoms were reduced apparently as compared with those before treatment (all P<0.05). The total effective rate was 84.6% (55/65). The peak systolic velocity (PSV), the end diastolic velocity (EDV) in anterior ciliary artery (ACA) and the central retinal artery (CRA) were improved obviously, indicating the significant differences before and after treatment (all P<0.05). The jingjin therapy of Zhuang medicine alleviates the visual symptoms in patients of visual fatigue and improves visual quality. The effects are related to the improvement of ocular microcirculation.

Microcirculation improvement after short-term infusion of vasopressin in septic shock is dependent on noradrenaline

OBJECTIVES:To assess the impact of vasopressin on the microcirculation and to develop a predictive model to estimate the probability of microcirculatory recruitment in patients with septic shock.METHODS:This prospective interventional study included patients with septic shock receiving noradrenaline for less than 48 hours. We infused vasopressin at 0.04 U/min for one hour. Hemodynamic measurements, including sidestream dark-field imaging, were obtained immediately before vasopressin infusion, 1 hour after vasopressin infusion and 1 hour after vasopressin withdrawal. We defined patients with more than a 10% increase in total vascular density and perfused vascular density as responders. ClinicalTrials.gov: NCT02053675.RESULTS:Eighteen patients were included, and nine (50%) showed improved microcirculation after infusion of vasopressin. The noradrenaline dose was significantly reduced after vasopressin (p=0.001) and was higher both at baseline and during vasopressin infusion in the responders than in the non-responders. The strongest predictor for a favorable microcirculatory response was the dose of noradrenaline at baseline (OR=4.5; 95% CI: 1.2-17.0; p=0.027). For patients using a noradrenaline dose higher than 0.38 mcg/kg/min, the probability that microcirculatory perfusion would be improved with vasopressin was 53% (sensitivity 78%, specificity 77%).CONCLUSIONS:In patients with septic shock for no longer than 48 h, administration of vasopressin is likely to result in an improvement in microcirculation when the baseline noradrenaline dose is higher than 0.38 mcg/kg/min.

Effect of Keishibukuryogan, a Japanese Traditional Kampo Prescription, on Improvement of Microcirculation and Oketsu and Induction of Endothelial Nitric Oxide: A Live Imaging Study.

Oketsu is a characteristic condition that plays an important role in Kampo, Japanese traditional medicine, and includes multiple aspects of hemodynamic disorders. This study aims to clarify the microcirculation of Oketsu and the pharmacological effect of Keishibukuryogan, an anti-Oketsu Kampo prescription, using live imaging techniques. Oral administration of Keishibukuryogan induced significant vasodilation of murine subcutaneous arterioles compared to the preadministration level. This vasodilatation peaked 60 min after administration and persisted for 90 min. The blood velocity in the subcutaneous capillary was also increased by Keishibukuryogan in generally the same manner. In rat mesenteric arterioles, Keishibukuryogan administration improved microhemodynamic parameters, including the resolution of erythrocyte congestion and the cell-free layer, which are representative of Oketsu pathology. Live imaging revealed an increase of diaminofluorescein-2 diacetate fluorescence, a nitric oxide (NO) specific reagent, in the arterial endothelium following Keishibukuryogan administration. This fluorescence was most remarkable at vascular bifurcations but was present throughout the mesenteric arterioles. This study demonstrates the successful imaging of Oketsu pathology with respect to microcirculation and the anti-Oketsu effects of Keishibukuryogan, namely, vasodilation of arterioles, increased blood velocity, and resolution of erythrocyte congestion. The anti-Oketsu effect of Keishibukuryogan is related to endothelial NO production.

CHANGES IN THE OCULAR MICROCIRCULATION AFTER VITREORETINAL SURGERIES FOR INTRAOCULAR HEMORRHAGE

Aim . To explore ocular microcirculation in patients with intraocular hemorrhage. Material and Methods. Microcirculation was investigated in 26 patients after subtotal posterior vitrectomy with the use of a laser blood analyzer LAK-01 and a computer program to carry out spectral analysis of the signal. Statistical processing of the results was performed using AnalystSoft software package, BioStat 2007. Results of the study. Ocular microcirculation in the control group was characterized by high levels of blood perfusion and metabolic activity, symmetrical distribution of arterial inflow and venous outflow. Evaluation of microcirculation parameters in patients with intraocular hemorrhage demonstrated a significant fall of these figures. Conclusion . Surgical removal of intraocular hemorrhage leads to a signficant improvement of ocular microcirculation.

DYNAMICS OF MICROCIRCULATION OF PERIODONTA TISSUES DURING THE RECONSTRACTION OF MA[ILLARY SINUS BOTTOM USING OSTEOPLASTIC MATERIAL BIO-GENE

The rapid implementation in practice of the method of intraosseous implantation greatly exacerbated the problem of bone tissue restoration after damage inflicted by dentists and put the choice of a reliable method of eliminating the existing bone defects. When jawbones atrophy observed morphological changes in the microcirculation vein, leading to disruption of metabolic processes in tissues and reduced their viability. As a result of conducted research we found that osteoplastic material Bio-Gene for reconstraction of the maxillary sinus bottom shows improvement of microcirculation that allows recommending it in broad dental practice, as well as laser doppler floumetry for full information in clinical conditions on the status of microcirculation in tissues of parodentium noninvasive technique.

Danshensu, a major water-soluble component of Salvia miltiorrhiza, enhances the radioresponse for Lewis Lung Carcinoma xenografts in mice.

The molecule 3-(3,4-dihydroxyphenyl)-2-hydroxypropanoic acid (danshensu), a herbal preparation used in traditional Chinese medicine, has been found to possess potential antitumor and anti-angiogenesis effects. The aim of the present study was to investigate the efficacy of the combination of radiation therapy (RT) with danshensu in the treatment of Lewis lung carcinoma (LLC) xenografts, whilst exploring and evaluating the mechanism involved. In total, 8-week old female C57BL/6J mice were randomly assigned into 3 groups to receive: RT, RT + cisplatin and RT + danshensu, respectively, when LLC reached 100–150 mm3. Each group was divided into 7 subgroups according to the different irradiation doses that were administered. Tumor growth curves were created and the sensitization enhancement ratios of the drugs were calculated. The experiment was then repeated, and the 4 groups of tumor-bearing mice were treated with natural saline, danshensu, RT + danshensu and RT, respectively. The mice were sacrificed on day 7, and tumor tissue and blood were collected to determine microvessel density, the expression of proangiogenic factors, and the levels of blood thromboxane B2 and 6-keto-prostaglandin-F1α. Tumor hypoxia was also detected using in vivo fluorescence imaging. With respect to LLC xenografts, treatment with danshensu + RT significantly enhanced the effects of tumor growth inhibition (P<0.05). Furthermore, tumor vasculature was remodeled and microcirculation was improved, which significantly reduced tumor hypoxia (P<0.05). The present study demonstrated that danshensu significantly enhanced the radioresponse of LLC xenografts in mice. The mechanism involved may be associated with the alleviation of tumor cell hypoxia following treatment with danshensu + RT, caused by the improvement of tumor microcirculation and the remodeling of tumor vasculature.

Treatment for Gynura segetum caused hepatic vein occlusive disease: a single-center retrospective study

Objective To explore the effects of different treatments on prognosis of patients with Gynura segetum caused hepatic vein occlusion disease (HVOD). Methods From July 2008 to January 2016, 85 patients with Gynura segetum caused HVOD were enrolled and received treatment of liver function protection and microcirculation improvement. According to different treatment options, patients were divided into non-anticoagulation group, non-anticoagulation transfered to transjugular intrahepatic portosystem stent-shunt (TIPS) group, anticoagulation group, anticoagulation transfered to TIPS group and anticoagulation-TIPS step-by-step treatment group. The efficacy of each group was observed. Chi-square test was performed for statistical analysis. Results Among 22 patients who received non-anticoagulation treatment, six (27.3%) patients were cured and 14(63.6%) patients died during the treatment period; besides two (9.1%) patients received TIPS because of ineffective treatment and achieved long-term survival. Among 63 patients treated with combination of low-molecular-weight heparin and warfarin, six (9.5%) patients died and 36(57.1%) patients were cured. The cure rate was higher than that of non-anticoagulation group (χ2=5.820, P=0.016). Other 21 patients received TIPS treatment, achieved long-term survival except one patient died from surgical complications. The cure rate of anticoagulation-TIPS step treatment group was 88.9% (56/63) which was higher than that of non-anticoagulation group, and the difference was statistically significant (χ2=31.350, P<0.01). Conclusions Compared to conventional liver function protection treatment and symptomatic treatment, anticoagulation therapy significantly increases the cure rate of patients with Gynura segetum caused HVOD. Anticoagulation-TIPS step-by-step treatment further improves the cure rate. Key words: Gynura segetum; Hepatic veno-occlusive disease; Heparin, low-molecular-weight; Warfarin; Portasystemic shunt, transjugular intrahepatic

A new scaffold containing small intestinal submucosa and mesenchymal stem cells improves pancreatic islet function and survival invitro and invivo.

It is unknown whether a scaffold containing both small intestinal submucosa (SIS) and mesenchymal stem cells (MSCs) for transplantation may improve pancreatic islet function and survival. In this study, we examined the effects of a SIS-MSC scaffold on islet function and survival in vitro and in vivo. MSCs and pancreatic islets were isolated from Sprague-Dawley rats, and SIS was isolated from Bamei pigs. The islets were apportioned among 3 experimental groups as follows: SIS-islets, SIS-MSC-islets and control-islets. In vitro, islet function was measured by a glucose-stimulated insulin secretion test; cytokines in cultured supernatants were assessed by enzyme-linked immunosorbent assay; and gene expression was analyzed by reverse transcription-quantitative PCR. In vivo, islet transplantation was performed in rats, and graft function and survival were monitored by measuring the blood glucose levels. In vitro, the SIS-MSC scaffold was associated with improved islet viability and enhanced insulin secretion compared with the controls, as well as with the increased the expression of insulin 1 (Ins1), pancreatic and duodenal homeobox 1 (Pdx1), platelet endothelial cell adhesion molecule 1 [Pecam1; also known as cluster of differentiation 31 (CD31)] and vascular endothelial growth factor A (Vegfa) in the islets, increased growth factor secretion, and decreased tumor necrosis factor (TNF) secretion. In vivo, the SIS-MSC scaffold was associated with improved islet function and graft survival compared with the SIS and control groups. On the whole, our findings demonstrate that the SIS-MSC scaffold significantly improved pancreatic islet function and survival in vitro and in vivo. This improvement may be associated with the upregulation of insulin expression, the improvement of islet microcirculation and the secretion of cytokines.

Microcirculation Evaluated by Intraoperative Fluorescence Angiography after Tibial Bypass Surgery

Intact microperfusion of the foot in the critical ischemic limb remains a crucial condition for ulcer healing. Aim of this clinical study was to evaluate the immediate effect of tibial bypass surgery on the microcirculation by usage of fluorescence angiography. Prospective analysis of 33 patients presenting with critical limb ischemia (Rutherford IV-VI) undergoing tibial bypass surgery was performed. Macroperfusion was investigated by measurement of ankle-brachial index. For assessment of microperfusion, intraoperative fluorescence angiography (SPY Elite, NOVADAQ) was undertaken during general anesthesia immediately before and after operation. For each investigation, a fluorescence dye (Indocyanine green) with an amount of 0.1mg/kg was administered intravenously. Follow-up investigations were performed to assess the clinical outcome. The mean follow-up time was 8.28 (±4.46) months. The parameters Ingress (IN) and Ingress rate (InR) of the fluorescence dye representing the microcirculation showed a significant improvement to preoperative values and correlated with the ankle-brachial index significantly. Furthermore, a significant difference between the individual improvement of the microcirculation parameters (preoperative-postoperative) between patients with postoperative clinical improvement (wound healing, absence of rest pain) and those without could be demonstrated (InR: P = 0.039, IN: P = 0.036). The parameters IN and InR significantly reproduced the postoperative improvement of the microcirculation. An increased ankle-brachial index significantly correlated with increased microcirculation parameters. A better clinical outcome was found in those patients who had a higher relative improvement of microcirculation postoperatively.

Haemodynamic coherence in haemorrhagic shock.

In case of haemorrhage, a combination of low volume fluid resuscitation and permissive hypotension is used to avoid theadverse effects of early aggressive fluid resuscitation. Duringthis phase, occult microvascular hypoperfusion can possibly develop over time. After controlling the bleeding, it is expected that optimization of macrocirculation will result in an improvement in microcirculation. However, this is the case only without alterations in microcirculation regulation. Haemodynamic coherence must be maintained to expect the restoration of microcirculation through systemic haemodynamic-driven resuscitation. However, haemorrhagic shock, reperfusion, traumatic injury and inflammation can damage microcirculation and thus lead to a loss of haemodynamic coherence. In these cases, a systemic haemodynamic-driven resuscitation would notbe effective in restoring microcirculation and tissue oxygenation. A real-time technique enabling microcirculation monitoring can create an opportunity for microcirculatory haemodynamic-driven resuscitation to become the gold standard in the future.