Linear Flow Velocity Research Articles

Comorbidity in patients with lobular panniculitis-lipodermatosclerosis

Lipodermatosclerosis (LDS) is one of the variants of lobular panniculitis. The onset of LDS falls on the age of 50–60 years, when many patients already have comorbid pathology requiring complex therapy, which affects the course, the choice of treatment and prognosis of LDS, as well as the quality of life.Objective: to study the structure and frequency of comorbid conditions in patients with LDS.Patients and methods. 53 patients (3 men and 50 women), 18–80 years old, with a verified diagnosis of LDS were included, all of them had an average follow up of 10 years (they were observed in the V.A. Nasonova Research Institute of Rheumatology). The duration of the disease ranged from 2 weeks to 20 years. During clinical examination, the localization, prevalence, color and number of affected skin areas and sub cutaneous fat were determined. The intensity of pain on palpation of the node was assessed using a visual analogue scale (VAS). Laboratory and instrumental research included: blood and urine tests, computed tomography of the chest and ultrasound Doppler of the lower extremities with registration of the linear blood flow velocity in the affected veins (femoral, popliteal, posterior tibial, foot veins). Clinical, laboratory and instrumental examination of patients was carried out 2 times a year. The CIRS and Charlson indices were used to assess the relationship between comorbid pathology and LDS.Results and discussion. Most patients (60.3%) were women with increased body weight (91.5±21.8 kg). Depending on the duration of the disease, the main variants of the LDS course were: acute (<3 months), subacute (3–6 months), and chronic (>6 months). Skin changes were associated with polyarthralgia (34%) and/or myalgia (22.6%), mainly on the side of the affected limb. In 16 patients, an increase in ESR, on average 23.8±7.8 mm per hour, was detected, in 7 patients, including 4 with an acute course of LDS, – more than a threefold increase in the level of CRP. No comorbid diseases had 17 patients, 64.7% of them were under 50 years and had an acute course of LDS (p=0.02). In 68% of patients, mainly with chronic LDS, the following concomitant diseases was recorded: chronic venous insufficiency (CVI; in 67.9%); exogenous constitutional obesity (in 60.3%); rheumatic diseases (45.2%), including osteoarthritis (75%), rheumatoid arthritis (17%), antiphospholipid syndrome (8%), and arterial hypertension (39.6%). Most patients had 1 concomitant disease, and almost one fifth of patients had 2 concomitant diseases. The proportion of patients with 3 comorbid pathologies was 11.1%, with 4 – 8.3% and with 5 – 5.5%. When assessing the Charlson index, a 10-year survival rate of >90% (index values from 0 to 2 points) was observed in 66% of patients, 53–77% (3–4 points) – in 26.4% and <21% (≥5 points) – in 7.5%. There was correlation between the comorbidity index and the age of patients (r=0.8, p<0.05); no association with the duration of LDS was found (r=0.3, p=0.2). Patients over 61 years had ≥1 comorbid disease. The average CIRS index for this group was 4.2±0.3 points (0–10), in most patients (45.2%) it was <5 points. Analysis of the Charlson and CIRS scales confirmed their statistically significant relationship (r=0.5, p=0.0000001).Conclusion. In patients with LDS, a high incidence of comorbid pathology was noted. Interdisciplinary approach with interaction between doctors of different specialties is required for treatment of these patients.

Informativity of blood flow distribution in the precerebral arteries for determining the hemodynamic significance of carotid stenosis

Introduction. Conventionally, hemodynamic significance of carotid stenosis is characterized with an increased peak systolic velocity up to 230 cm/s, which corresponds to 70 % carotid stenosis. This does not take into account changes of cerebral hemodynamics or collateral circulation, which can be determined by assessment of blood flow distribution in precerebral arteries. Aim – to evaluate blood flow redistribution in precerebral arteries in patients with critical carotid stenosis. Materials and methods. 40 patients (aged 49–80 y. o.) with critical carotid stenosis were studied (13 patients had 70–79 % stenosis, 11 patients – 80–89 %, and 16 patients – 90–99 % stenosis). Flow velocity index in precerebral arteries was determined with duplex scanning (Vivid e, USA), whereas linear blood flow velocity in intracranial arteries – with transcranial Doppler (MultiDop X, Germany). Results. In 60 % of patients, flow velocity index in ipsilateral carotid artery was reliably decreased (p<0.05). In 49 % of patients flow velocity index in contralateral carotid artery and blood flow velocity in contralateral anterior cerebral artery were reliably increased (p<0.05), as well as linear blood flow velocity in the contralateral anterior cerebral artery. Just in 39 % of patients flow velocity index in ipsilateral vertebral artery and linear blood flow velocity in ipsilateral posterior cerebral artery were increased (p<0.05). In 13 % of cases flow velocity index in the external carotid artery was increased (p<0.05). Conclusion. Thus, critical degree of carotid stenosis does not always indicate its hemodynamic significance. Flow velocity index distribution in precerebral arteries can be used as an additional criterion for assessing hemodynamic significance of carotid stenosis and, along with other indicators, should be taken into account when choosing treatment modality.

Влияние хирургической реконструкции внутренней сонной артерии на гемодинамику глаза у пациентов с хронической ишемической нейрооптикопатией

Purpose. To assess the effect of carotid endarterectomy (CE) on the hemodynamics of the eye, the neuroreceptor apparatus in patients with chronic ischemic neuroopticopathy (CIN) associated with hemodynamically significant atherosclerotic stenosis of the internal carotid artery (ICA). Material and methods. The study included 20 patients (20 eyes) with unilateral CIN. In all cases, Doppler ultrasound was used to assess the parameters of the linear blood flow velocity in patients after CE. Results. Surgical reconstruction of the ICA in all patients led to an improvement in blood flow in the vessels of the eye, in ⅔ of cases it stopped the process of neurodegeneration in the optic nerve (optic nerve) and contributed to an increase in the maximum corrected visual acuity at a follow-up of 1 year. Conclusion. Our studies indicate the advisability of performing ICA CE in patients with CIN associated with hemodynamically significant atherosclerotic ICA stenosis. The question of the use of pharmacological neuroprotection of the optic nerve in the postoperative period of CE remains relevant. Key words: chronic ischemic neuroopticopathy, ocular ischemic syndrome, internal carotid artery, carotid endarterectomy.

The influence of plant saponins on the elasticity parameters of the great arteries in patients with multifocal atherosclerosis

Background. Among the goals of pathogenetic therapy in patients with multifocal atherosclerosis, not only control of the intensity of atherogenesis, but also the elastic properties of the arterial system is becoming increasingly important, which opens up additional ways to reduce overall and cardiovascular mortality in this category of patients.
 Aim. To evaluate effectiveness of medication Vazosponin (ZAO Vifitekh, Russia), which is a source of plant saponins in a dosage 400 mg per day, on the indicators of the elasticity of the great arteries.
 Materials and methods. The study included 100 patients with multifocal atherosclerosis: those who had had myocardial infarction or percutaneous coronary intervention during the previous 2 1 2 months and who had stenosing atherosclerosis of peripheral arteries brachiocephalic arteries and/or arteries of the lower extremities. The main group MG (n=50) consisted of patients who received combined hypolipidemic treatment: atorvastatin in dosage 40 mg/day + Vazosponin 400 mg/day along with baseline treatment. The control group (CG) included 50 patients who received only atorvastatin in dosage 40 mg/day along with baseline treatment. The observation period for each patient was 90 days with 3 control points (on the 1st, 10th and 90th days of therapy), in which were evaluated the elasticity indicators of the main arteries pulse wave velocity, linear blood flow velocity, total peripheral vascular resistance, actual specific vascular resistance.
 Results. There was a decrease in pulse wave velocity in both groups by the 90th day of the study, with a significant advantage in the group of patients who received Vazosponin: in the CG the indicator decreased by 7.3% (p0.05), in the MG by 19.3% (p0.05). The decrease in linear blood flow velocity was 14.3% (p0.05), in the CG the indicator decreased by 5.7% (p0.05). The dynamics of peripheral vascular resistance indicators showed an obvious advantage in the group of patients who received plant saponins: in the MG of patients, a decrease in total peripheral vascular resistance was detected by an average of 11.0% (p=0.006) and actual specific vascular resistance by 39.3% (p=0.0008), while in the CG by 4.5% and 5.0%, respectively.
 Conclusion. The addition of Vazosponin to the basic therapy of patients with multifocal atherosclerosis made it possible to achieve an additional increase in the elasticity of the arterial system, a significant decrease in peripheral vascular resistance, and the elimination of the escape effect of basic therapy. The data presented make it possible to consider the possibility of using preparations of plant saponins in combination therapy of patients with multifocal atherosclerosis who have instrumentally verified violations of the elastic properties of the arterial system.

The influence of nicergoline on cerebral, systemic and cardiac hemodynamics in patients who have had an ischemic stroke

The Aim of study was analysis of the effect of nicergoline on the cerebral, cardiac, systemic hemodynamics of patients after ischemic stroke, taking into account the hemispheric localization of the ischemic focus. Materials and methods. A comprehensive clinical and neurological examination was carried out in 38 elderly patients (mean age 64.3 ± 2.5 years) who had undergone atherothrombotic ischemic stroke in the carotid system (recovery period). There were 20 patients with left hemispheric stroke and 18 with right hemispheric stroke. All patients had arterial hypertension (AH). These were ACE inhibitors (enalapril 10-20 mg 1 tablet 2 times a day) and hydrochlorothiazide at a dose of 12.5 mg. Patients received nicergoline at a dose of 4 mg IV drip for 10 days. A comprehensive examination was carried out before and after treatment with nicergoline. The Results of the study allowed us to conclude that the course of nicergoline intake in patients after ischemic atherothrombotic stroke improves the subjective state and reduces the severity of neurological disorders, cerebral hemodynamics, increases linear systolic blood flow velocities (LBFVsys) and reduces peripheral resistance in individual extra- and intracranial vessels of the carotid and vertebro-basilar basins. In patients with right and left hemispheric localization of stroke under the influence of nicergoline, LBFVsys increases in the right and left ICA, PCA, and VA. In addition, LBFVsys increases in patients with right hemispheric stroke in the right MBA; in patients with left hemisphere - in two MBA and BA. In ischemic stroke patients, nicergoline affects systemic and cardiac hemodynamics: it reduces the systemic and cardiac hemodynamics, decreases the systemic vascular resistance and increases the ejection fraction, changes the structure of the relationship between systemic and cerebral hemodynamics, forming a positive relationship between blood pressure and hemodynamics in the vessels of the vertebro-basilar basin. Thus, the complex positive effect of nicergoline on various levels of cerebral, systemic and cardiac hemodynamics in ischemic stroke patients gives grounds to recommend the inclusion of this drug in the rehabilitation system of this category of patients.

Application of Narrow-band Optical Radiation and Kinesiotaping in Posterior Cervical Sympathetic Syndrome

Aim. To substantiate the application of the infrared range narrow-band optical radiation and kinesiotaping combined effect in the complex treatment of patients with posterior cervical sympathetic syndrome on the basis of clinical studies. Material and methods. The dynamics of complaints for dizziness in 60 patients of two groups were evaluated using the DHI (Dizziness Handicap Inventory) and VRBQ (Vestibular Rehabilitation Benefit Questionnaire) scales, headache and pain in the neck using the visual analog scale (VAS), tinnitus, visual defocusing, nausea, vomiting, palpitations, decreased concentration and attention using the International Classification of Functioning, Disability and Health (ICF). To assess the posture, the shoulder Aksenova index was used. A duplex scan of the brachycephalic arteries and an assessment of anxiety and depression on the Sheehan and Beck scales, respectively, were used to assess blood flow through the vertebral arteries. Results. Statistically reliable data (p <0.05) for reducing dizziness, headache, pain in the cervical region, reducing the severity of tinnitus, defocusing vision, nausea, and decreasing concentration and attention were obtained in the group using the combined effects of narrow-band infrared optical radiation and kinesiotherapy in comparison with the control group. Statistically reliable data (p <0.05) for improving linear velocity of blood flow Vm, Vps for the left vertebral artery at the extracranial level and statistically reliable data (p<0.05) for improving linear velocity of blood flow Vm, Vps for vertebral arteries were obtained at the intracranial level. Statistically reliable data (p<0.05) on the effectiveness of kinesiotaping for the correction of the upper cross syndrome were obtained. Conclusion. The application of the narrow-band infrared range optical radiation and kinesioteping combined exposure can be recommended in the complex treatment of patients with posterior cervical sympathetic syndrome as well as to increase the linear velocity of blood flow in the vertebral arteries, the use of kinesiotaping can be recommended for the correction of biomechanical disorders, correction of the upper cross syndrome.

Evaluation of microcirculation disorders in patients with severe COVID-19 by nail bed capillaroscopy

Microcirculation disorders caused by thrombosis are the most important factor determining the pathogenesis of organ damage in severe COVID-19 including the absence of obvious macrohemodynamic instability. However, there are very few publications demonstrating the results of intravital visualization of changes in the microcirculation system in this disease.The objective:to assess the state of microcirculation in patients with viral pneumonia associated with COVID-19 using nail bed microscopy.Subjects and methods.Eleven patients with COVID-19 were examined; they were admitted to the intensive care unit due to progressing acute respiratory failure. Vital microscopy of the microcirculatory bloodstream in the fingers’ nail bed was performed by admission and over time. When assessing microcirculation, the presence of aggregates in the lumen of capillaries and avascular zones, and the linear velocity of blood flow were taken into account. The results were summarized taking with the outcome consideration (6 people recovered, 5 died).Results.Microcirculation disorders were objectively confirmed in all patients. In 100% of cases, microaggregates were detected in the capillary lumen. The values of the mean linear velocity of capillary blood flow turned out to be extremely variable. However, the values of the maximum linear velocities of capillary blood flow in the patients who subsequently died were significantly lower versus survivors (190 μm/sec (135.5; 237) and 387 μm/sec (329.3; 407.5), p = 0.018). The irregularity of blood flow in the visualized field was revealed: when the value of the maximum linear velocity in some capillaries was less than 180 µm/sec, in others, disturbances in the form of pendulum-like movement were already noted. Further slowing down of the blood flow velocity led to the development of stasis and the formation of avascular zones.Conclusion.Impaired microcirculation (decreased blood flow rate in the capillaries, the presence of microaggregates and a lower number of perfused capillaries in the form of avascular zones) develops in all patients with severe COVID-19.

Nucleation and Crystallization Kinetics of Barium Sulfate in the Hydrodynamic Boundary Layer: An Explanation of Mineral Deposition

The initialization of barite deposition is believed to be mineral nucleation. The induction times characterizing the kinetics of nucleation have been widely studied to investigate the precipitation kinetics of barium sulfate and to estimate the risk of mineral deposition in the flowing tube. It is generally accepted that if the solution’s supersaturated solution’s induction time is longer than the pipe’s traveling time, barium sulfate will not precipitate inside the pipe. However, recent research shows that barium sulfate still deposits inside the flowing tube even though the predicted induction time is longer than the travel time. The results correlate to the field observations that the mineral scale deposition is found in the production well even at the condition that is predicted to be kinetically stable. The contradiction suggests that there is a missing step of mineral deposition in the flow. In this work, a hypothesis of nucleation in the boundary layer is proposed to explain the contradiction: the barium sulfate can nucleate inside the boundary layer at the surface where the linear flow velocity approaches zero. This slow-flow region offers enough time for the crystals to form without being flushed away. A series of experiments were conducted in the flowing tube and the microfluidic channels to support the hypothesis. The amounts of deposited barium sulfate in the pipes were measured and compared with the induction time prediction. The result shows that with barite SI (supersaturation index) = 0.5–0.9 at 120 °C, the barium sulfate can deposit all along the tube even when the predicted induction times are longer than the traveling time (311 s). On the other hand, the observed nucleation time in the microfluidic channels matches the previously reported nucleation time in the kinetic turbidity tests in beakers. This implies that the barium sulfate can stay and nucleate in the boundary layer at the surface, which further supports the proposed mechanism. To conclude, we combine the ideas of induction times, boundary layer, and precipitation kinetics to describe a new mechanism of barium sulfate deposition. Once the solution in the boundary layer reaches its induction time, the deposition begins.

Состояние мозгового кровообращения при нейросенсорной тугоухости в сочетании со стабильной стенокардией напряжения

The aim of this study was to study the state of cerebral circulation using duplex scanning of extra- and intracranial vessels in sensorineural hearing loss in combination with stable exertional angina. The study included 43 patients with diagnosed sensorineural hearing loss in combination with stable exertional angina at the age of 30 to 63 years, who had not previously received antianginal drugs. With the help of color duplex scanning, cerebral circulation in the extra- and intracranial vessels was studied. 19 people (44,2%) had the first degree, and 16 people (37,2%) had the second degree of hearing loss. In 9,3% of cases, the average air conduction rate in patients did not reach 26 dB. In 9,3% of patients, an increase in thresholds was observed only in the ultra-high-frequency zone (10 000–20 000 Hz). In patients with sensorineural hearing loss in combination with stable exertional angina, there was a change in the linear blood flow velocity in the extra- and intracranial vessels. In the common carotid and vertebral arteries, an increase in the linear blood flow velocity and the Gosling pulsative index was revealed. In the intracranial segment, a decrease in the linear velocity of blood flow in the vertebral and main arteries was found, which in 42% of patients was combined with a decrease in the anatomical reserve of blood vessels due to a disconnected variant of the structure of the circle of Willis and / or the presence of obstructed venous outflow.

Изменения макрогемодинамики при различных режимах ретропневмоперитонеума

Aim of the study. To study alterations in macrohaemodynamics in diff erent modes of retropneumoperitoneum during retroperitoneal surgery. Material and methods. A total of 58 patients aged 40-60, both male and female, with previous surgeries on renal cysts through retroperitoneal approach were studied aft er distribution between 2 groups. In the fi rst group, the pressure did not exceed 12 mm Hg. The RPP in the second group was observed to be 12-16 mm Hg. During the surgical intervention, analysis of the cardiovascular system values was carried out using the method of volume compression oscillometry. Results. Evaluation of macrohaemodynamics revealed significant deviation of the indices in patients with high RPP (group 2). Elevated true systolic pressure was revealed, as well as cardiac output decrease by 20 %, decrease of the cardiac index by 24 % and decrease of the stroke volume by 11 %. Th e patients treated with application of the highest gas pressure in the retroperitoneal space were revealed to have decrease in the linear velocity of blood fl ow by 17 % and elevation of total systemic vascular resistance (TSVR) by 12 %. Conclusion. Th erefore, the RPP value of 12-16 mm Hg exerts significant influence on the patient’s macrohaemodynamic status

Radiotracer method: A nuclear tool for flowrate measurement in the pipeline

Experimental work has been carried out to demonstrate using the radiotracer method for flowrate measurement of water in a 3 inches diameter of the carbon-steel pipeline. The water was supplied from a water tank of a volume of approximately 5000 liters. The tank was connected to the pipeline through a flexible plastic hose. A ball valve was installed at the far end of the pipeline to adjust water discharge from the pipeline. None flow meters were installed on the pipeline. Iodine-131 (131I) radioisotope with a concentration of 1 mCi.mL−1 has been injected instantaneously through the injection point located at 15 meters from the water tank. Two radiation detectors (notified as D1 and D2) which had been set-up respectively at the distance of 4 m and 7 m from the injection point recorded residence time distribution (RTD) curves of the radiation intensities emitted from the injected radioisotope. During the experiment, the system was assumed time-invariant by keeping the tank was always containing full of water. The transit time calculated based on mean residence time (MRT) was 89.9 s, and the linear velocity of the water flow is 3.33 cm.s−1

Vascular effects of combined vacuum interferential therapy in patients with urolithiasis after extracorporeal shock wave lithotripsy

To study the combined vacuum-interference therapy effect on the renal blood flow in patients with urolithiasis after ECSWL. Forty patients aged 33 to 64 years old with urolithiasis after ECSWL were included in the study. Patients were assigned into two groups by simple randomization. Starting the second day after ECSWL, along with drug therapy, the patients of the main group (n=20) received vacuum-interference therapy with the carrier frequency of 5 kHz, frequency range 80-150 Hz, and the vacuum of 0.3-0.4 bar for 15 min daily, 6-8 procedures in total. Patients in the control group (n=20) received antibacterial and anti-inflammatory drug therapy, the same as the main group. To evaluate the severity of impaired renal blood flow due to nephrolithotripsy, we studied renal blood flow by the basic hemodynamic characteristics of renal ultrasound dopplerography (USDG): renal blood flow indices at the level of renal, segmental, interlobar, and arch arteries, including measurement of systolic linear blood flow velocity (Vps) and diastolic blood flow velocity (Vsd), as well as pulsatility index (PI) and resistance index (RI). The ultrasound examination prior to ECSWL revealed a statistically significant increase in all studied parameters. Thus, Vsd in renal arteries was increased by 32.7% (p<0.01) and 17.8% (p<0.05), respectively; in segmental arteries by 14.5% (p<0.05) and 29.5% (p<0.05), respectively; in interlobar arteries by 14.5% (p<0.05) and 29.5% (p<0.05), respectively, and in the arcus arteriosus by 10.7% (p<0.05) and 21.4% (p<0.05), respectively; the renal vein blood flow was within the reference range. When assessing PI in UL patients before lithotripsy, a statistically significant increase in all studied indices was also observed: in the renal arteries by 19.0% (p<0.05), in the segmental arteries by 12.5% (p<0.05), and in the interlobar and arch arteries by 11.6% (p<0.05) and 11.8% (p<0.05), respectively. After the treatment course, the most pronounced change was observed in the patients of the main group, in which all indices differed from the reference values only by 3.5-8.3%. It is important to note an increase in linear velocity in the renal vein by 21.4% (p<0.05), indicating a significant improvement of renal blood flow due to improved venous outflow and increased arterial inflow in the renal arteries. In the control group patients, statistically significant improvement was observed only for systolic and diastolic blood flow velocity, as well as the renal vein blood flow velocity, which increased by 22.1% (p<0.05), 6.3% and 17.8% (p<0.05), respectively; the other parameters remained unchanged. When assessing PI and RI values after the treatment course, the most marked improvement was also observed in the main group of patients, in which all indices were close to the reference values (p<0.05). In the control group patients, the indices were 11.6-14.0% higher than reference values (p<0.05). According to obtained data, it was concluded that vacuum interference therapy has a pronounced vascular effect that promotes an earlier recovery of blood flow and normalization of the kidney function in patients with urolithiasis after extracorporeal lithotripsy and can be recommended for routine clinical practice.

A system for assessing the functional state of blood flow in the skin surface layers by the speckle structure of multiply scattered optical radiation

Assessment of the parameters of skin microcirculation is an urgent and important task of modern medicine in the development of methods for diagnosing diseases of the nervous system. The system for assessing the functional state of blood flow in the skin surface layers in the wavelength range from 400 to 850 nm has been improved based on the use of an extended mathematical model of the propagation of optical radiation in human skin by taking into account additional parameters: optical anisotropy of the skin, diameter and shape of erythrocytes in the dermis layer, blood pressure in the brachial artery in the range from 90/60 to 195/130 mm·Hg, plasma protein concentration in the blood (α1, α2, β1, β2, γ-globulins and fibrinogen, g/l), rheological properties of blood flow with a diameter of blood vessels from 4.5 to 500 microns in the skin surface layers, skin temperature from +35 to +41 °C. The developed system makes it possible to determine the severity of microhemodynamic shifts in relation to metabolic disorders, improve diagnosis and evaluate the treatment efficacy of a number of neurological disorders; it also made it possible to reduce the patient examination time and increase the accuracy of measuring the blood flow microcirculation parameters by 10 % (linear and volumetric blood flow velocities) to detect blood flow disturbances in the surface layers of the skin in the normal and abnormal condition of the nervous system.

Comparative evaluation of instrumental methods for studying the state of endothelium in type II diabetes mellitus

Introduction . The method for assessing the flow-dependent vasodilation (FDV) and vasodilation induced by local iontophoresis of acetylcholine (Ach) is widely used, but has not yet been introduced into everyday clinical practice. Aim . Comparison of 2 ultrasound methods for assessing endothelial function in patients with diabetes mellitus (DM). Materials and methods . Effectiveness of reactive hyperemia tests of the brachial artery was compared using Vivid7pro ultrasound device, GE, with transducer 7.5 MHz. and the endothelium-dependent vasodilation and Ach iontophoresis in the microvasculature of the forearm were evaluated using a Minimax-Doppler-K ultrasound device with a 25 MHz transducer. After iontophoresis Ach, the linear blood flow velocity (%) was measured in comparison with the initial velocity. FDV is expressed as a % increase in arterial diameter in response to the test performed. Results . % of increase in blood flow velocity in the DM group was less than that in the control group for 2–6 minutes after the test and varied from 105.35 to 119.11 % in the DM group and from 130.0 to 270.0 % in healthy control subjects (p<0.05 for 2–6 min). After occlusion of the artery in reactive hyperemia test, as well as after 20, 40, and 180 sec, patients with DM had a lower % of increase in the diameter of the vessel, compared with healthy control subjects. When performing Celermaer test in 7 patients (43.75 %), in a number of measurements, an increase in the diameter of the vessel of more than 10 % was observed (which is characteristic of healthy control subjects). Conclusion . We associated the poor reproducibility of reactive hyperemia of the brachial artery with the difficulty in interpreting the results, which is probably due to the real-time resolution of the ultrasound method, and the Doppler method for assessing the linear blood flow velocity in the microvasculature turned to be less operator-dependent and more reproducible.

Analysis of the vascular abnormalities of the patients with ankle joint mild osteoarthritis

The vascular factor is one of the leading pathogenesis factors in the formation of ankle joint osteoarthritis. Dystrophic and sclerotic changes in the joint tissues develop as a result of blood flow decrease. These mechanisms understanding will allow to plan treatment and rehabilitation measures, as well as predict and prevent complications. The purpose of the work is to study hemodynamic parameters in the main lower leg arteries of the in patients in follow-up period of mild ankle joint osteoarthritis. Two groups of patients were examined. The first group - 82 patients with mild ankle joint osteoarthritis in the follow-up period (10 years) and the second group - control (healthy) group of 58 people without ankle joint osteoarthritis. Duplex scan of the main lower leg arteries was performed to all the patients. The state of arteries and hemodynamic parameters were evaluated. Excell and STATISTICA 10.0 programs were used for statistical data processing. In patients with follow-up of mild ankle joint osteoarthritis, the diameter of the arteries did not differ from the control group. In patients with mild ankle joint osteoarthritis the thickness of the Intima-media complex in the lower leg arteries and walls pulsation were significantly higher than those in patients of the control group (p &lt;0.05). Analysis of hemodynamic parameters in patients with ankle joint osteoarthritis revealed an increase in the linear velocity of blood flow with a further tendency to normalization and even decrease in the follow-up compared with the control group. Signs of perfusion difficulty that accompanied the development of high blood pressure syndrome in the lower leg arteries were observed in 122 (67.0%) patients, and the signs of perfusion difficulty were bilateral in most of the cases (86.9%). Stenosis, deformation and arteries tortuosity were noted in 22% of patients with ankle joint osteoarthritis. Thus, mild ankle joint osteoarthritis is accompanied by blood flow changes in the form of inadequate perfusion and high-pressure syndrome in the lower leg arteries, which can cause secondary injuries and requires higher attention when selecting treatment and rehabilitation actions.

Characteristics of heavy metal separation and determination of limiting current density in a pilot-scale electrodialysis process for plating wastewater treatment

Recent development in industry has led to increased water usage, while intensifying water shortage. Electrodialysis has been proposed as a technique for minimizing the generation of secondary environmental pollution problems and effectively treating harmful substances such as heavy metals in industrial wastewater. As electrodialysis is affected by several factors, it is crucial to provide necessary information about the operating elements. This study investigates the effect of linear flow velocity on the removal of heavy metals in an electrodialysis pilot plant. The results of the experiment showed that increasing the linear flow velocity from 0.6 to 5.1 cm/min increased the voltage from 17.3 to 40 V. In addition, the limiting current density (LCD) showed a linear relationship with the linear flow velocity, increasing from 1.4 to 5.9 A/m2 as the linear flow velocity increased proportionally in the same voltage range. The empirical correlation coefficients a and b for the mass transfer coefficient K, which can be expressed as a nonlinear function of the linear flow velocity, were estimated to be 1.8519 and 0.7016, respectively. In the batch operation, the ion-separation rate in the electrodialysis process was estimated with the shift order kinetics of the first-order and zero-order constants via regression analysis of experimental data. The ion separation rate in the diluate and the ion concentration rate in the concentrate decrease as the experiment number increase. This may be due to the reverse diffusion of ions transferring to the diluate owing to the high concentration of ions in the concentrate. Therefore, ion concentration in the concentrate has to be maintained at an appropriate level. Copper ions are deposited on the cathode electrode surface, although not uniformly.

Comparative evaluation of anesthesia methods for reconstructive carotid surgery

The objective: to assess the impact of total intravenous and combined anesthesia (consisting of regional block and inhalation anesthesia with sevoflurane) on higher mental functions, frequency and nature of postoperative complications in carotid endarterectomy.Subjects and methods. A total of 190 patients with ipsilateral carotid stenosis exceeding 70%, or with the unstable atheromatous plaque were examined. CE was performed in 140 (73.6%) patients, while 50 (26.4%) patients underwent plasty with the autovenous patch. 60 patients had total intravenous anesthesia. The other 60 patients had combination anesthesia (cervical plexus block as per A. Yu. Paschuk + non-inhalation anesthesia with thiopental sodium). In 70 patients, low-flow inhalation anesthesia with sevoran and potentiation of the analgesic effect by bolus administration of fentanyl was performed. The parameters of central hemodynamics, cerebral blood flow, markers of cerebral damage, and state of higher mental functions were assessed.Results. Inhalation anesthesia with sevoflurane was characterized by decrease of total peripheral resistance index by 20% (p = 0.002) and SBP by 13% (p = 0.004) compared to baseline values. Moderate reduction of afterload was accompanied by normalization of cardiac and stroke indices. Optimization of the central hemodynamic parameters led to high levels of the linear velocity of cerebral blood flow and cerebral perfusion pressure which at the main stages of the operation did not differ from the control values. At the end of the operation, a statistically significant insignificant increase in intracranial pressure was noted (on average, by 4 mm Hg exceeded values at the previous stages, p = 0.014) and levels of markers of ischemic neuronal damage: the levels of antibodies to protein S-100 increased by 14% (p = 0.043), and NSE – by 2.8 μg/L. During inhalation anesthesia with sevoflurane, the lowest number of postoperative neurological and cardiac complications was recorded; they developed only in 6 (8.6%) patients and distributed equally. However, more pronounced postoperative cognitive dysfunction was noted when this method of anesthesia was used.Conclusion. Each method of anesthesia provided an unequal level of cerebral protection from ischemic damage which was manifested by a difference in the severity of disorders of higher mental functions, the number and nature of postoperative neurological complications.

Effect of testosterone on lipid metabolism and endothelium in men with type 2 diabetes mellitus and hypogonadism

Abstract Background To date, knowledge about the effects of testosterone (T) on the cardiovascular system of men remains controversial and requires additional research. Especially the putative impact of T replacement therapy (TRT) on lipid metabolism and endothelial dysfunction as a starting mechanism for the development of cardiovascular pathology in men with type 2 diabetes mellitus (T2DM) presenting with T deficiency has to be elucidated. The aim of this work was to evaluate the effect of T replacement therapy on lipid metabolism and function of endothelium in men with T2DM and hypogonadism. Methods The study included 95 men (mean age 55,3±2,4 years) with T2DM and late onset hypogonadism, established according to EAU 2015 criteria. Parameters of carbohydrate and lipid metabolism, as well as ultrasound assessment of flow-mediated dilatation of the brachial artery (FMD-BA) and intima-media thickness (IMT) of brachial arteries were performed at baseline and after 9 months. Patients were randomized into 2 groups: 1 - 45 men receiving TRT, using 1% transdermal T-gel and 2 (control group) - 50 men, who were not assigned to TRT. Statistical analysis was carried out using the Wilcoxon - test for repeated measurements (STATISTICA 10 software package). Results During the treatment period no serious adverse events were registered. The study revealed a significant decrease in HbA1c (p&amp;lt;0.001), total cholesterol (p=0.009), triglycerides (p=0.004) and LDL (p=0.01) levels as well as an increase in HDL level (p=0.001) in the 1st group vs baseline and compared to the 2nd one. There was a decrease in IMT (from 1.0 [0.8; 1.1] to 0.7 [0.6; 0.9] mm, p=0.002) in the 1st group compared to the 2nd (p&amp;lt;0.001). The endothelium-dependent FMD-BA increased 1.5 - fold in men applying T-Gel vs baseline as well as compared to the control group at the time point of follow- up (p&amp;lt;0.001). At the same time TRT leaded to acceleration of the time until maximal vasodilation – it became twice faster (from 120 [90; 120] to 60 [60; 90] sec, p&amp;lt;0.001) compared to baseline and the 2nd group (p&amp;lt;0.001). Linear blood flow velocity increased markedly in the 1st group compared to the 2nd at the time point of follow-up (p=0.03). Conclusion TRT in men with T2DM and T deficiency leads to an improvement in carbohydrate and lipid metabolism together with a significant decrease in IMT and enhancement of endothelium vasomotor function, seems to facilitate a reduction in cardiovascular risk. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Russian Science Foundation

Age and Sex Differences in Cerebral Circulation in Patients with Cerebral Atherosclerosis and Diabetes mellitus

Cerebrovascular pathology and metabolic disorders are problems of modern health care, which are of colossal medical and social significance. A high percentage of not only mortality, but also disability determines the extreme urgency of studying their various aspects, and the presence of combined pathology requires the development of a personalized approach to the tactics of managing such patients.The objective: was to determine sex and age differences in the structural and functional state of the vessels of the carotid and vertebro-basilar basins in patients with stage I–III cerebral atherosclerosis (CA) and type 2 diabetes mellitus.Materials and methods. A comprehensive clinical and instrumental study involved 229 patients with stageI–IIICA and type 2 diabetes mellitus. The patients were divided into 2 groups: I – the general group of patients who had an ischemic atherothrombotic stroke in the middle cerebral artery basin – CA III; II – with CA I–II stages. All patients underwent conventional clinical, laboratory and instrumental studies (Doppler ultrasound of the vessels of the head and neck – study of cerebral blood flow in the extra- and intracranial sections of the main arteries of the head and neck using the Aplio XG device (Toshiba).Results. In patients of group I, there were no age or sex differences in the linear systolic blood flow velocity (LSBFV) of the vessels of the carotid and vertebro-basilar basins. In group II patients over 60 years of age, the LSBFV in both internal carotid arteries was statistically significantly higher than in middle-aged patients, while the LSBFV in the left vertebral, posterior cerebral arteries and the basilar artery was statistically significantly higher in middle-aged patients than in the elderly. In our opinion, these differences can be explained by statistically significant differences in fasting blood glucose levels. It is important to note that statistically significant sex differences were found only for LSBFV in both common carotid arteries: in women with CA stages I-II, the rate of cerebral blood flow was higher than in men.Conclusions. For patients with stage III CA and T2DM, age and sex differences in the parameters of cerebral circulation both in the vessels of the carotid and in the vessels of the vertebro-basilar basins have not been established. Elderly patients with stage I–II CA and T2DM, in comparison with middle-aged patients, are characterized by a statistically significantly higher LSBFV in the vessels of the carotid basin and lower in the vessels of the vertebro-basilar basin. The rate of cerebral blood flow in female patients with stage I–II CA and diabetes mellitus is statistically significantly higher in both common carotid arteries, in contrast to the corresponding LSBFV indicators in male patients.

THE EFFECTIVENESS OF TREATMENT OF CERVICAL SPINE PATHOLOGIES ASSOCIATED WITH UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA IN CHILDREN

Introduction. The article background a necessity to timely perform conservative treatment of cervical spine pathologies associated with undifferentiated connective tissue dysplasia in children. Their treatment should consider all structural features of the cervical spine, its blood supply and concomitant pathologies which may be identified by diagnostic algorithms of multidisciplinary approach. Material and methods. In 2018-2020, 177 children with cervical spine pathologies associated with undifferentiated connective tissue dysplasia were conservatively treated in Morozovskaya Children’s City Clinical Hospital. All children were randomized into 3 groups which were prescribed different treatment modalities. In Group I, patients had standard treatment (exercise therapy, isometric gymnastics, massage, apparatus therapy); in Group II, head holders were added to standard treatment; in Group III, medicamentous therapy was added to standard treatment and head holders (magnesium lactate dihydrate and pyridoxine hydrochloride, levocarnitine). The instrumental examination revealed that all studied children had phenotypic signs of syndromes of undifferentiated connective tissue dysplasia and signs of pathology in the cervical spine. The average follow-up period was 24 months (6 months - 2 years). The average age of patients was 10 ± 3 years (5-17 years). Results and discussion. In order to assess the effectiveness of treatment, a comparative analysis of findings obtained at objective examinations was made before treatment and in 6 and 12 months after it. The examinations included: measurements of linear blood flow velocity in the vertebral arteries with ultrasound Doppler of the brachycephalic vessels; X-ray measurements of the cervical spine (Cruvelier joint and various displacements in vertebrae). The analysis performed has shown that the best results were registered in Group III. Conclusion. Findings obtained after catamnestic and instrumental examinations have showed that the complex treatment of cervical spine pathology, associated with undifferentiated connective tissue dysplasia in children, should include not only standard treatment (physical exercise trainings, massage, apparatus therapy) but also cervical orthoses and medicamentous therapy. Such a combined treatment has more pronounced therapeutic effect.