Mean Capillary Research Articles

Nailfold capillaroscopic assessment in pediatric patients with autoimmune uveitis: a case-control study.

Uveitis is a major cause of visual impairment. Most uveitis cases have autoimmune etiology. Pediatric autoimmune uveitis may be associated with systemic diseases such as juvenile idiopathic arthritis or may arise as an isolated disorder. It may be accompanied by retinal vasculitis due to retinal microcirculation involvement. Nailfold capillaroscopy, a digital microscope, is a non-invasive tool for systemic microcirculation evaluation. We aimed to evaluate systemic microcirculation abnormalities in pediatric autoimmune uveitis. Twenty-five patients with pediatric autoimmune uveitis and 21 healthy children underwent detailed capillaroscopic evaluation. We assessed capillary density/mm, capillary morphology, capillary dimensions, and the presence or absence of microhemorrhages and avascular areas. The mean age of the study and control groups was 11.24 ± 3.03 and 9.9 ± 4.17years, respectively. Most included patients had isolated uveitis and juvenile idiopathic arthritis (64% and 24%, respectively). The predominant uveitis subtype in the study was anterior uveitis (48%). A significant difference was found between cases and controls regarding mean capillary density (p-value = 0.0003) and the number of subjects having capillary density less than 7 (p-value = 0.002). Other capillaroscopic abnormalities did not show any significant difference between the studied groups. Mean capillary density did not correlate significantly with age, disease duration, or acute phase reactants. Children with autoimmune uveitis, whether isolated or asa part of systemic disease, may have systemic microcirculation involvement. Key Points • Idiopathic autoimmune uveitis is not always an isolated intraocular condition. • Systemic microcirculation involvement may occur in pediatric autoimmune uveitis, even in cases with isolated uveitis. • Nailfold capillaroscopy showed that capillary density in children with autoimmune uveitis is significantly reduced compared to healthy controls.

Nail fold capillaroscopy in leprosy: Unveiling the microvascular changes

BackgroundLeprosy, a chronic infectious disease, is associated with various nail changes. Its etiopathogenesis is multifaceted, with microvascular damage being crucial. Nail fold capillaroscopy (NFC) emerges as a novel tool for detecting early vascular deficits in leprosy. The study aimed to assess and provide a complete clinical characterization of NFC changes in leprosy patients. MethodsIt is an observational cross-sectional study, done over a period of 1.5 year (January 2021 to august 2022) in a tertiary care hospital, encompassing 60 patients diagnosed with leprosy (18–60 years). After obtaining informed consent; detailed history, complete cutaneous and neurological examinations were conducted. All fingernails and toenails were examined for clinical changes. Subsequently, onychoscopy was performed using USB type of video-dermatoscope (Model AM7115MZT Dino-lite), a non-invasive tool. This was followed by NFC which was done for all fingernails and images were recorded by single operator, which were then assessed for quantitative and qualitive changes and statistical analysis was conducted using SPSS v20, with mean capillary density compared using Student's t-test, morphological change frequencies assessed by proportions, and group comparisons made using Chi-square or Fischer exact tests, with a significance threshold of p < 0.05. ResultsAmong the 60 patients, 39 were in the lepromatous group, which included both borderline lepromatous (BL) and lepromatous leprosy (LL) patients, and 17 were in the tuberculoid group, which included borderline tuberculoid (BT) leprosy patients; 23.3 % had Type 1 reactions, and 18.3 % had Type 2 reactions. Nail fold capillaroscopy (NFC) showed microvasculature changes in 93.3 % of patients. The average capillary density was 6.8 ± 1.5 capillaries per mm, with the lepromatous group having a lower density (6.5 ± 1.09) compared to the tuberculoid group (7.0 ± 0.86). The most common NFC changes in the tuberculoid group were tortuous capillaries (70 %), capillary dropouts, and dilated capillaries (both 64.7 %). In the lepromatous group, capillary dropouts (82 %) were most frequent, followed by tortuous (69 %), receding (69 %), and dilated capillaries (66 %). A dilated and prominent subpapillary plexus was more common in the lepromatous group (35 %, p = 0.04). Patients with trophic changes in the lepromatous group had more capillary dropouts and bizarre capillaries. Capillary dropouts, dilated capillaries, and visible subpapillary venous plexus were more prevalent in patients with Type 2 reactions. ConclusionNFC changes are prevalent in both tuberculoid and lepromatous leprosy, which may be an indicator of peripheral vascular compromise and trophic changes, especially in lepromatous leprosy. NFC can be an auxiliary tool for detecting microvascular abnormalities in leprosy patients.

Rate of Initial Optic Nerve Head Capillary Density Loss and Risk of Visual Field Progression

Rapid initial optic nerve head capillary density loss may be used to assess the risk of glaucoma visual field progression. To investigate the association between the rate of initial optic nerve head capillary density loss from optical coherence tomography angiography (OCTA) and visual field progression. This was a retrospective study of a longitudinal cohort at a glaucoma referral center. A total of 167 eyes (96 with primary open-angle glaucoma and 71 with glaucoma suspect) of 109 patients were monitored for a mean (SD) of 5.7 (1.4) years from January 2015 to December 2022. Data analysis was undertaken in April 2023. The rates of initial capillary density and average retinal nerve fiber layer loss were calculated from the first 3 optic nerve head OCTA and OCT scans, respectively, during the initial follow-up (mean [SD], 2.0 [1.0] years). Based on the median rate, eyes were categorized into fast and slow progressor groups. The association between initial capillary density change or retinal nerve fiber layer thinning and visual field progression was evaluated using linear-mixed and time-varying Cox models. A total of 167 eyes of 109 patients (mean [SD] age, 69.0 [11.1] years; 56 [51.4%] female and 53 [48.6%] male) were assessed. Eighty-three eyes were slow OCTA progressors, while 84 eyes were fast with mean capillary density loss of -0.45% per year and -1.17% per year, respectively (mean difference, -0.72%/year; 95% CI,-0.84 to -0.60; P < .001). Similarly, 83 eyes were slow OCT progressors, while 84 eyes were fast with mean retinal nerve fiber layer thinning of -0.09 μm per year and -0.60 μm per year, respectively (mean difference, -0.51 μm/year; 95% CI,-0.59 to -0.43; P < .001). The fast OCTA and OCT progressors were associated with more rapid visual field loss (mean difference, -0.18 dB/year; 95% CI,-0.30 to -0.06; P = .004 and -0.17 dB/year; 95% CI,-0.29 to -0.06; P = .002, respectively). Fast OCTA progressing eyes were more likely to have visual field progression (hazard ratio, 1.96; 95% CI, 1.04-3.69; P = .04). Seventeen of 52 eyes (32.7%; 95% CI, 32.5-32.8) with fast OCTA and OCT progression developed subsequent visual field likely progression. Rapid initial optic nerve head capillary density loss from OCTA was associated with a faster rate of visual field progression and a doubling of the risk of developing event progression in this study. These findings may support clinical use of OCTA and OCT optic nerve head measurements for risk assessment of glaucoma progression.

INDICES OF THE CAPILLARY DIAMETER IN NORMAL RETINA AT DIFFERENT TERMS OF EXPERIMENTAL OPIOID INFLUENCE AND IN THE SUBCHRONIC AND CHRONIC PERIODS OF THEIR CORRECTION

In Ukraine, according to the latest biobehavioral research, the estimated number of people who inject drugs was 317000 people (on the controlled territory of Ukraine), of which 200661 people (63.3% of the total number) use only opioids, 38674 people use stimulants (12.2% of the total number), 77665 people practiced mixed use of narcotic substances (24.5%). Increasingly, doctors of various specialties face the problem of treating various nosologies in people with opioid addiction. It dramatically complicates the process of correcting the main pathology due to the consequences arising from the chronic use of opioid drugs. One of these factors is the long-term use of opioid analgesics for therapeutic purposes, as well as the use of opioid drugs without medical indications by people belonging to the category of drug addicts. At present, the issue of structural reorganization in the layers of the retina and links of its hemomicrocirculatory bed during long-term use of opioid drugs and the possibility of correcting the resulting changes in the subchronic and chronic periods of experimental opioid exposure remains unclear. That is why we decided to supplement, expand and deepen information about these processes by conducting our own research in this direction.The purpose of the study is to find out the dynamics of changes in the diameter of the capillary link of the hemomicrocirculatory bed of the retina at different times of experimental opioid exposure and to establish the possibility of correcting these changes in the subchronic and chronic periods. Material and methods. The research material was sexually mature, outbred, white male rats, in number 125 animals weighing 160-270 g, aged 4.5-7.5 months. The initial dose of nalbuphine during the first 2 weeks was 0.212 mg/kg, the next 2 weeks (III-IV weeks) – 0.225 mg/kg, the next (V-VI weeks) – 0.252 mg/kg, the next (VII-VIII weeks ) – 0.260 mg/kg, the next (IX – X weeks) – 0.283 mg/kg, the next (XI – XII weeks) – 0.3 mg/kg, and during (XIII – XIV weeks) – 0.45 mg/ kg Correction was carried out in the early and late periods of opioid exposure, where the dose of pentoxifylline was 2.857 mg/kg. The morphometric study of the diameter of retinal capillaries in normal conditions at different times of experimental opioid exposure and during correction was performed using histological preparations according to generally accepted methods.Research results. With the help of our statistical analysis of the capillary component of the retina, we established the diameter parameters of the retinal capillaries, which were 5.9 [5.6; 6.1] μm., which made it possible to assess the degree of vascularization of the retina in the norm. When corrected at the subchronic period, we found that there was no significant difference between the average values of capillary diameters (p&gt;0.05) between the control group and the 14th subgroup (2 weeks of nalbuphine administration with withdrawal followed by 4 weeks of pentoxifylline administration). There was a significant increase in mean capillary diameter when comparing subgroup 10 (2 weeks of nalbuphine followed by 4 weeks withdrawal) (p&lt;0.05) with subgroup 12 (2 weeks of nalbuphine followed by 4 weeks of pentoxifylline) (p&lt;0.05). 0.001), compared to the data of the control group. Capillary diameters in subgroup 10 (2 weeks of nalbuphine administration followed by 4 weeks withdrawal) were increased by 18.7% (p&gt;0.05), compared to subgroup 5 (6 weeks of nalbuphine administration). The situation was significantly unfavorable in comparison with the previous results in subgroup 12 (2 weeks of nalbuphine administration with the addition of 4 weeks of pentoxifylline) - by 32%, compared to the diameters of capillaries in subgroup 14 (2 weeks of nalbuphine administration with withdrawal and followed by 4 weeks of pentoxifylline administration). When corrected for the chronic period, we found that, compared to the control group, capillary diameters increased the least in the 15 subgroup of 10 weeks (6 weeks of administration of nalbuphine with withdrawal and followed by 4 weeks of administration of pentoxifylline) (by 35%). Capillary diameters were significantly larger in the 11-week 10-week subgroup (6 weeks of nalbuphine followed by 4-week withdrawal) (by 49%), while in the group with ten weeks of experimental opioid exposure (by 57%). The most unfavorable situation was in the 13th subgroup of 10 weeks (6 weeks of administration of nalbuphine with the addition of pentoxifylline for 4 weeks) (by 63%).Conclusion. As a result of our research, we can conclude that in the subchronic and chronic periods of correction of opioid exposure, the situation was most unfavorable in the subgroups where correction was carried out with simultaneous administration of nalbuphine and pentoxifylline. From the above, it is possible to draw a clear conclusion that in no case can these drugs be combined during the medical correction of pathomorphological changes in the retina and links of its hemomicrocirculatory bed in experimental opioid retinopathy.

Post-COVID syndrome and capillary bed abnormalities detected by videocapillaroscopy

Post-COVID syndrome (PCS) is a pressing problem in clinical practice. Dyspnea, along with neurologic and cardiovascular symptoms, is the most common symptom indicating low exercise capacity (EC) that reduces quality of life. The aim of this study was to investigate shortness of breath and the capillary bed abnormalities detected video capillaroscopy (VCS) in patients with PCS.Methods. The study included patients with PCS (n = 60) suffering from shortness of breath. Dyspnea was assessed using the 6-minute walk test (6-MWT). The capillary bed abnormality was diagnosed using VCS.Results. Patients with ACL walked an average of 79.5% of the predicted distance in the 6-MWT. They also had a decrease in pulse oximetry readings. The patients were divided into 2 groups: 1st – patients with desaturation, 2nd – patients without desaturation. Significant differences were observed between patients with and without desaturation, especially in the 6-MWT distance, pulse oximetry, and dyspnea before and after the 6-MWT. Patients with desaturation had a higher desaturation-to-distance ratio, a higher O2-GAP index, and higher cardiac effort levels, as well as a significant decrease in the proportion of perfused capillaries (PPC), mean capillary density, and a marked increase in the proportion of tortuous and branched capillaries. There was a direct correlation between PPC and diffusing lung capacity for carbon monoxide (DLCO), and carbon monoxide transfer coefficient (DLCO/Va), distance traveled during the 6-MWT and percentage (%) of predicted distance, inverse correlation between PPC and cardiac effort. There was a direct correlation between the percentage (%) of capillary recovery and 6-MWT distance and the percentage (%) of predicted distance, as well as an inverse correlation with the ratio of desaturation indicators and walking distance. Similarly, there was a direct correlation between mean capillary density and DLCO/Va, while the proportion (%) of tortuous capillaries was inversely correlated with DLCO, and the proportion (%) of branched capillaries was inversely correlated with DLCO/Va.Conclusion. The multifactorial nature of the mechanisms of dyspnea in patients with PCS was demonstrated, with the important role of vasculopathy. Continuous monitoring of pulse oximetry, heart rate and VCS are effective methods to screen and assess the condition of patients with PCS and dyspnea.

Risk factors for pancreatic necrosis in acute pancreatitis in obese patients

Background. Acute pancreatitis is an aseptic inflammation of the pancreas with diverse complications and further development of necrosis of the gland, parapancreatic tissue and possible addition of secondary infection. A significant number of biochemical markers that can be predictors of pancreatitis complications are still being researched. However, most of them are expensive and their indicators are increased only in the first 24–48 hours after the onset of the disease, so they are not used in daily clinical routine. The purpose of this study is to evaluate the factors that indicate an elevated risk of necrosis in acute severe pancreatitis. Materials and methods. A retrospective analysis of 80 patients with acute pancreatitis was performed via creation of a multivariate logistic regression model. Results. The dependence of the risk of pancreatic necrosis on the following factor signs was found: lipase at the onset of the disease (cut-off value = 599.6 U/l, area under the receiver operating characteristic curve (АUС) = 0.72 (95% confidence interval (СІ) 0.57–0.88)), severity of the disease, fibrinogen on day 3 of the disease (cut-off value = 9.7, АUС = 0.65 (95% СІ 0.48–0.81)), C-reactive protein (cut-off value = 175.7 mg/L, AUC = 0.70 (95% CI 0.54–0.86)), and intra-abdominal mean capillary perfusion pressure on the first day of the disease (cut-off value ≤ 63.3 mm Hg, АUС = 0.88 (95% СІ 0.77–0.99)). The autopsy results revealed the presence of necrosis and microthrombosis of the pancreas. Conclusions. Factors that may indicate an increased risk of pancreatic necrosis were high levels of lipase, fibrinogen on the third day of the disease, C-reactive protein, decreased intra-abdominal mean capillary perfusion pressure, severity of the disease, and the presence of portosplenomesentric thrombosis.

The Role of P-Selectin in Microvascular Hemodynamics and Cerebral Brain Volumes in Aging Sickle Cell Mice

Cerebral vasculopathy has been linked to the development of cognitive impairment in sickle cell disease (SCD). We have previously demonstrated that 13-month-old sickle cell mice recapitulate features of cerebral vasculopathy such as tortuous vessels, microthrombi, and hypoperfusion seen in adults with SCD. Histologically, we also showed these mice have increased cerebral microvascular deposition of P-selectin and more frequent and larger microinfarcts compared to matched controls. We further showed that these mice developed evidence of cognitive deficit compared to matched controls. Based on these observations, we hypothesized P-selectin may play a critical role in development of cerebral micro vasculopathy and downstream pathologic sequalae such as microinfarcts by enhancing leukocyte-endothelial interactions. Furthermore, abundant evidence from non-sickle mice shows that microinfarcts can exacerbate small vessel changes including gray matter volume loss. Building on our prior work, in this study, we examined the effect of P-selectin deficiency on cerebral microvascular hemodynamics and leukocyte-endothelial interaction and well as changes in cortical and subcortical gray matter volume in aged sickle mice. Male, P-selectin knockout (Psel KO) or intact (Psel WT) chimeric mice were generated by transplanting control (AA) or sickle (SS) bone marrow into P-selectin knockout (Psel -/-) or C57BL/6 (B6) recipients. To assess the impact of vasculopathy and brain gray matter volume changes longitudinally, male mice were assessed at 12-, 14- or 16-month post-transplant. Hemodynamics (mean velocity, red blood cell (RBC) flux, white blood cell stalls in capillaries as well as venules) were obtained from line-scan images acquired using in-vivo two-photon microscopy, using custom and validated MATLAB scripts. Gray matter volumes in 26 cortical and subcortical brain regions with relevance to cognitive function, were derived from parcellation of T2-weighted magnetic resonance imaging after non-linear registration to Allen brain atlas T1 anatomical space. Parcellation was accomplished by registering the Paxinos atlas to the mouse T2 now in Allen space. Brain volume analyses was accomplished using Analyze 12 software. After the completion of in-vivo studies, brains were extracted for immunohistochemistry analysis. Statistical analysis was performed using two-way ANOVA. The breakdown of the mice included in this study are; 14 B6 AA, 12 B6 SS, 12 Psel KO AA and 13 Psel KO SS. Given the high attrition rate in older mice, data from 12-, 14- and 16-month-old cohorts were combined. Mean age of B6 AA cohort was 13.1 months, 12.8 months for B6 SS, 13. 9 months for Psel KO AA and 13.6 months for Psel KO SS mice and were not statistically different. Psel KO sickle mice had a significantly lower mean capillary RBC velocity (1.733 mm/s vs 4.717 mm/s, p &amp;lt; 0.01) compared to Psel WT SS mice. In addition, Psel KO SS mice had relatively smaller (more normal) capillary diameter compared to Psel WT SS mice (6.248 um vs 8.613 um, p &amp;lt; 0.001). Interestingly, there was no statistically significant difference in RBC flux between Psel KO SS and Psel WT SS mice, however Psel KO SS mice show a lower red blood cell flux similar to that seen in Psel WT AA mice ( Figure 1). Of the 26 brain regions that were assessed, Psel KO SS mice had larger measured gray matter volume in the frontal association cortex (3.01 ± 0.77 vs 3.66± 0.33 mm 3, p= 0.0083), prelimbic cortex (1.72 ± 0.27 vs 1.95 ± 0.17 mm 3, p=0.0079), hippocampus (17.67 ± 1.56 vs 16.21± 1.97 mm 3, p=0.01)( Figure 1) including other regions such as lateral (2.12 ± 0.19 vs 1.88 ± 0.31 vs mm 3 p=0.0096) medial (1.84± 0.16 vs 1.64 ± 0.26 mm 3, p=0.01), and ventral orbital cortex( 1.95± 0.17 vs1.72 ± 0.27 mm 3, p=0.01) and dorsolateral olfactory tract (1.46 6± 0.13 vs 1.31 ± 0.20 mm 3, p=0.023 compared to the Psel WT SS mice (data not shown). In conclusion, non-hematopoetic P-selectin deficiency improves cerebral vasculopathy as demonstrated by normalization of hemodynamics in sickle mice. We also show that Psel KO SS mice had larger brain gray matter volume in regions involved in cognitive function. Additional studies are needed to identify the underlying mechanism of improvement in brain gray matter volume as well as whether P-selectin could be potential target for reducing SCD associated neurological complications.

Microvascular damage in autoimmune connective tissue diseases: a capillaroscopic analysis from 20 years of experience in a EULAR training and research referral centre for imaging

ObjectiveNailfold videocapillaroscopy (NVC) allows the detection of microvascular damage in autoimmune connective tissue diseases (CTDs). The prevalence of the morphological capillary findings was retrospectively evaluated in a wide cohort of...

Methods of Assessing Nailfold Capillaroscopy Compared to Video Capillaroscopy in Patients with Systemic Sclerosis—A Critical Review of the Literature

Introduction: Nailfolds of patients with systemic sclerosis (SSc) provide an opportunity to directly visualize microvascular remodeling in SSc. Nailfold video capillaroscopy (NVC) remains the gold standard for assessing nailfold capillaroscopy (NFC). However, access to NVC is limited by expense and expertise. This review aims to synthesize current research on other NFC devices compared to NVC. Methods: The literature search included the primary research of adult patients with SSc as defined by the 2013 ACR/EULAR criteria. Methods of assessing NFC included stereomicroscopy/wide-field microscopy, ophthalmoscopy, dermatoscopy, smartphone devices, and digital USB microscopy. Primary outcomes included both qualitative (normal vs. abnormal nailfolds, overall pattern recognition, presence/absence of giant capillaries, hemorrhages, and abnormal morphology) and quantitative (capillary density and dimension) measures. Results: The search yielded 471 studies, of which 9 were included. Five studies compared NVC to dermatoscopy, two compared it to widefield/stereomicroscopy, one to smartphone attachments, and one to USB microscopy. In dermatoscopy studies, NVC had a higher percentage of images that were interpretable (63–77% vs. 100%), classifiable (70% vs. 84%), or gradable (70% vs. 79.3%) across three studies. Dermatoscopy had a lower sensitivity (60.2% vs. 81.6%) and higher specificity (92.5% vs. 84.6%) compared to NVC. One stereomicroscopy study found a significant difference between methods in capillary density in limited cutaneous SSc, while another found correlations in all parameters between stereomicroscopy and NVC. One smartphone lens had good agreement with NVC on abnormal capillary morphology and density. USB microscopy was able to differentiate between SSc and healthy controls using mean capillary width but not by capillary density. Discussion: A dermatoscope may serve as a more portable and affordable screening tool to identify a normal “scleroderma pattern”, and images that need further corroboration by NVC. NFC parameters reported are heterogenous and the standardization of these parameters is important, especially in non-gold-standard devices.

Microvascular changes on nailfold capillaroscopy in acute stage of Kawasaki disease: a new diagnostic paradigm for an enigmatic condition.

Kawasaki disease (KD) is a medium vessel vasculitis with a predilection to involve coronary arteries. However, there is a paucity of literature on microvascular changes in patients with KD. Children diagnosed with KD based on American Heart Association guidelines 2017 were enrolled prospectively. Demographic details and echocardiographic changes in coronaries were recorded. Nailfold capillaries were assessed using Optilia Video capillaroscopy and data were analysed using Optilia Optiflix Capillaroscopy software at acute (prior to IVIG administration) and subacute/convalescent phase. We enrolled 32 children with KD (17 boys) with a median age of 3 years. Nailfold capillaroscopy (NFC) was performed in 32 patients in the acute phase (compared with 32 controls) and in 17 during the subacute/convalescent phase at a median follow-up of 15 (15-90) days after IVIG treatment. The following findings were seen in NFC in the acute phase of KD: reduced capillary density (n = 12, 38.6%), dilated capillaries (n = 3, 9.3%), ramifications (n = 3, 9.3%) and capillary haemorrhages (n = 2, 6.2%). Capillary density was reduced significantly in the acute phase of KD (38.6%) as compared with the subacute/convalescent phase (25.4%) (P-value <0.001) and controls (0%) (P-value = 0.03). We observed no correlation between coronary artery involvement and mean capillary density (P = 0.870). Results show that patients with KD have significant nailfold capillary changes in the acute phase. These findings may provide a new diagnostic paradigm for KD and a window to predict coronary artery abnormalities.

Impact of Arterial Input Function and Pharmacokinetic Models on DCE-MRI Biomarkers for Detection of Vascular Effect Induced by Stroma-Directed Drug in an Orthotopic Mouse Model of Pancreatic Cancer.

We demonstrated earlier in mouse models of pancreatic ductal adenocarcinoma (PDA) that Ktrans derived from dynamic contrast-enhanced (DCE) MRI detected microvascular effect induced by PEGPH20, a hyaluronidase which removes stromal hyaluronan, leading to reduced interstitial fluid pressure in the tumor (Clinical Cancer Res (2019) 25: 2314-2322). How the choice of pharmacokinetic (PK) model and arterial input function (AIF) may impact DCE-derived markers for detecting such an effect is not known. Retrospective analyses of the DCE-MRI of the orthotopic PDA model are performed to examine the impact of individual versus group AIF combined with Tofts model (TM), extended-Tofts model (ETM), or shutter-speed model (SSM) on the ability to detect the microvascular changes induced by PEGPH20 treatment. Individual AIF exhibit a marked difference in peak gadolinium concentration. However, across all three PK models, kep values show a significant correlation between individual versus group-AIF (p < 0.01). Regardless individual or group AIF, when kep is obtained from fitting the DCE-MRI data using the SSM, kep shows a significant increase after PEGPH20 treatment (p < 0.05 compared to the baseline); %change of kep from baseline to post-treatment is also significantly different between PEGPH20 versus vehicle group (p < 0.05). In comparison, when kep is derived from the TM, only the use of individual AIF leads to a significant increase of kep after PEGPH20 treatment, whereas the %change of kep is not different between PEGPH20 versus vehicle group. Group AIF but not individual AIF allows detection of a significant increase of Vp (derived from the ETM) in PEGPH20 versus vehicle group (p < 0.05). Increase of Vp is consistent with a large increase of mean capillary lumen area estimated from immunostaining. Our results suggest that kep derived from SSM and Vp from ETM, both using group AIF, are optimal for the detection of microvascular changes induced by stroma-directed drug PEGPH20. These analyses provide insights in the choice of PK model and AIF for optimal DCE protocol design in mouse pancreatic cancer models.

Treatment with mycophenolate mofetil is associated with improved nailfold vasculature in systemic sclerosis.

To investigate the evolution of nailfold capillary density in patients with SSc in relation to immunosuppressive treatment and autoantibodies. This was a prospective study cohort. Consecutive newly diagnosed SSc patients were included into this study who, in a retrospective review, had at least two nailfold capillary microscopy measurements performed during the first 48 months of follow-up. Capillary density per 3 mm was measured with widefield nailfold capillary microscopy. Improvement of capillary density per finger and mean capillary density were analysed. Longitudinal measurements of mean capillary density were analysed by generalized estimating equation. Eighty patients (68 women, 12 men) met the inclusion criteria. The median follow-up time was 27 months. Twenty-eight patients had an improved capillary density in per-finger analysis. MMF was associated with fewer numbers of fingers that had worsened in capillary density. Anti-topoisomerase antibodies were associated with low mean capillary density. Anti-RNA polymerase III antibodies were associated with improvement and anti-centromere antibodies with worsening of capillary density in per-finger analysis. MMF treatment was associated with less steep capillary density decline in a moderated generalized estimating equation model including presence of anti-topoisomerase antibodies and the interaction of MMF with follow-up time. Nailfold capillary density improved over time in a substantial proportion of SSc patients. MMF treatment had a positive impact on the evolution of capillary density in these patients. SSc autoantibody phenotype may affect the capillary density development. The data support previous hypotheses that early immunosuppression may favourably affect vascular regeneration in SSc.

Effects of Stromal Vascular Fraction and Platelet-Rich Plasma Treatment on Capillary Histopathology During Anal Trauma Healing in Rats: An in Vivo Study

INTRODUCTION: Anal traumas, such as blunt and penetrating injuries to the perineum, can disrupt the anal sphincter and cause considerable morbidity. Non-invasive anal trauma therapies have been widely developed, including growth factors administered as platelet-rich plasma (PRP) and stromal vascular fraction (SVFs) containing adipose[1]derived stem cells (ASCs) and limited growth factor. This study aimed to assess PRP and SVF effects on capillary histopathology in the anal trauma Wistar rat model. MATERIALS AND METHODS: This experimental study used a rat model. Rats were divided into three groups: Group A (n=12) was treated with PRP and SVFs; Group B (n=12) was treated with normal saline (placebo); Group C (n=4) was sacrificed on day 0 to obtain baseline capillary counts. Groups A and B were further divided into three subgroups, sacrificed on days 1, 7, and 14 post-treatment. RESULTS: Capillary counts significantly showed higher density between Groups A and B (p=0.037, analysis of variance). On day 7, there was a significant difference between Groups A and B (p=0.001). CONCLUSION: Mean capillary density significantly improved in anal trauma treated with a combination of PRP and SVFs compared to control. Our findings support the use of PRP and SVFs to aid recovery of patients with anal trauma.

Body Composition and Nutritional Status of the Spanish National Breaking Team Aspiring to the Paris 2024 Olympic Games

Breaking is a sports dance modality that will debut for the first time at the Paris 2024 Olympic Games. This dance form combines street dance steps with acrobatics and athletic elements. It complies with gender equality, maintains aesthetic appeal, and is practised indoors. The objective of this study is to assess the characteristics of body composition and nutritional status of the athletes that make up the Breaking national team. This national team was recruited, and they underwent an analysis of body composition using bioimpedance measurement and a nutritional interview status with the completion of a survey on the frequency of the consumption of sports supplements and ergogenic aids. In addition, they completed a consumption questionnaire for a series of food groups with specified protein, lipid, and carbohydrate content. After that, parameters were analyzed in relation to their nutritional status during a complete medical examination at the Endocrinology and Nutrition Service of the Sports Medicine Center of CSD. A descriptive analysis of the results obtained was carried out to find the mean values of the variables analyzed. The analytical parameters described an adequate nutritional status, except for the mean capillary determination of 25-OH-vitamin D3, which was 24.2 ng/dL (SD: 10.3). Bone mineral density values were higher than those of the general population. This is the first time that a study of these characteristics has been carried out on Breakers, so it is highly relevant to increase knowledge in this area in order to conduct nutritional interventions aimed at improving the sports performance of these athletes.

Diagnostic Utility of Nailfold Capillaroscopy using Hand-held Dermoscope in Systemic Sclerosis.

The pathogenesis in systemic sclerosis (SSc) mainly involves vascular injury, fibrosis, and immune activation. Visualization of these microvascular changes by nailfold capillaroscopy (NFC) can help in the early diagnosis of the disease. Even though the gold standard for NFC is a videodermoscope, the ease, practicality, and accessibility make the hand-held dermoscope a more versatile and suitable device in the hands of the dermatologists in the busy outpatient department. To study the pattern of nail fold capillaries using hand-held dermoscope in the patients of SSc and correlate the findings with disease severity. An observational, cross-sectional hospital-based study was carried out over a span of 2 years, from January 2020 till December 2021, in 50 patients of SSc. NFC using DermLite DL4 was performed in all the patients and distribution, morphology, density of capillaries, and nail fold capillary pattern were observed. Out of 50 patients, 38 patients had diffuse type of disease, and 12 had limited type of disease. The mean capillary density in our patients was 4.7 ± 0.81/mm. Dilated capillaries was the most common NFC finding (80%), whereas active scleroderma pattern was the most common pattern (56%). A significant association was found between the type of capillary pattern and duration of disease, type of disease, and cutaneous manifestations. Hand-held dermoscope is reliable, practical, and assessable tool that aids in early diagnosis of the disease and also helps in assessing the severity and prognosis of SSc.

Evaluation of the Oral Microcirculation in Patients Undergoing Anti COVID-19 Vaccination: A Preliminary Study.

Videocapillaroscopy allows the study of both the morphological and architectural structure of the microcirculation and its hemodynamic conditions; these parameters are directly involved in autoimmune and/or inflammatory pathologies. The purpose of this research, based on capillaroscopy, is to establish whether a patient who receives an anti-COVID 19 vaccine has any changes in their oral microcirculation. A complete capillaroscopic mapping of the oral cavity of the subjects examined was made; the investigated mucosa sites were the following: cheek, labial, chewing-gingival and back of the tongue. This study showed an increase in capillary density from the comparison between the mean labial capillary density of vaccinated patients and the reference mean capillary density value of the literature. The increase in capillary density is a sign that can be attributed to an increase in angiogenic activity. The EMA, GACVS and MHRA have reviewed the risk of thrombosis after vaccination, agreeing that the benefits outweigh the risks.

Deep Learning Approach to Nailfold Capillaroscopy Based Diabetes Mellitus Detection

Diabetes mellitus is a commonly occurring chronic metabolic disorder which has affected almost 400 million people around the world. It can lead to vascular structure alterations and various renal, cardiovascular, and neurologicalcomplications claiming several lives. Since diabetes mellitus results is vascular structure changes, NailfoldCapillaroscopy(NFC) based approach can be employed for the detection of diabetes. NFC is an inexpensive, non-invasive method which involves acquisition of images of capillaries in the nail bed region using a USB digital microscope. Qualitative parameters of the capillaries such as tortuosity, hemorrhages, angiogenesis, elongated capillariesand quantitative parameters like length, width and mean capillary density are considered for diabetes detection. About 600 capillary images of healthy and diabetic subjects were collected and further data augmentation was performed to increase this to 1018 images dataset. This paper focuses on using NFC to obtain capillary images and employdeep learning-based object detection algorithm to localize these capillary loops on the nailbed and differentiate them into five classes namely, normal, wide, elongated, tortuosity and hemorrhages. This classification is of prominent significance to medical practitioners as this helps in gauging the severity and progressionof the disorder.

Impact of O2 Availability on Convective and Diffusive O2 Transport and Skeletal Muscle Intracellular PO2 at VO2max

Cross‐sectional evidence suggests that maximal O2 uptake (VO2max) is the consequence of well‐matched O2 supply and demand in untrained skeletal muscle (symmorphosis) and in trained skeletal muscle is limited, not by mitochondrial O2 capacity, but, by convective and diffusive O2 transport (dysmorphosis). However, it is unknown if, longitudinally, aerobic exercise training transitions skeletal muscle VO2max from a sym‐ to a dys‐morphosis of O2 transport and utilization capacities. The purpose of this study was to test the hypothesis that, compared to normoxia, hyperoxia would increase skeletal muscle mean capillary PO2 (capPO2) and intracellular PO2 (iPO2) both pre‐ and post‐training, but would only increase VO2max post‐training. We tested this in 5 healthy sedentary males (mean±SD; age: 27±5 yrs, height: 175±6 cm, mass: 73±7 kg, cycle VO2max: 33±4 ml/kg/min) using the unique combination of human quadriceps single‐leg knee‐extensor exercise (KE), directly measured arterial and femoral PO2, thermodilution measured leg blood flow (LBF), and 1H nuclear magnetic resonance spectroscopy measurement of myoglobin (Mb) desaturation at 100% maximal work rate in randomized conditions of hypoxia, normoxia, and hyperoxia (12, 21, and 100 % O2, respectively). Mb desaturation was converted to iPO2 using an O2 half‐saturation pressure of 3.2 mmHg. All measurements were made pre‐ and post‐training, which consisted of eight weeks of KE (1 hour/visit, 3 visits/week). Pre‐training, increasing inspired O2 increased capPO2 (33.0±4.8, 41.4±4.1, and 49.6±8.7 mmHg, all p&lt;0.019), Mb desaturation decreased from hypoxia to normoxia (46±4 and 31±4 %, p=0.004), but not from normoxia to hyperoxia (29±14 %, p=0.79), iPO2 increased from hypoxia to normoxia (3.8±0.6 and 7.2±1.4 mmHg, p=0.009), but not from normoxia to hyperoxia (10.0±6.6 mmHg, p=0.375), and VO2max was not altered by inspired O2 (0.47±0.10, 0.52±0.13, and 0.54±.01 l/min, all p&gt;0.285). Post‐training, increasing inspired O2 increased capPO2 (32.8±2.6, 39.6±2.8, and 47.5±6.1 mmHg, all p&lt;0.010), did not decrease Mb desaturation (79±20, 53±11, and 53±8 %, all p&gt;0.050), iPO2 increased from hypoxia to normoxia (1.1±1.2 and 3.1±1.1 mmHg, p=0.019), but not from normoxia to hyperoxia (3.0±1.1 mmHg, p=0.954), and VO2max increased with greater inspired O2(0.59±0.11, 0.68±0.11, and 0.76±0.09 l/min, all p&lt;0.044). There was a pre‐ to post‐training difference within all three inspired O2 conditions for VO2max (all p&lt;0.010) and in hypoxia and normoxia for both Mb desaturation (both p&lt;0.020) and iPO2 (both p&lt;0.011). When untrained, the concomitant increase in capPO2 and iPO2, with no change in VO2max, from normoxia to hyperoxia infers a mitochondrial O2 capacity limited skeletal muscle VO2max. In trained skeletal muscle, the concomitant increase in capPO2 and VO2max, with minimal changes in iPO2, from normoxia to hyperoxia infers an O2 transport limited VO2max.

Nailfold Videocapillaroscopy in Patients with COVID-19-associated Pneumonia in Intensive Care Units

To compare patients with COVID-19 in intensive care units (ICUs) to healthy controls using nailfold videocapillaroscopy (NVC), offering standardised findings about micro-circulation. A descriptive, cross-sectional study. Medical Intensive Care Unit, Kayseri City Education and Research Hospital, Kayseri, Turkey between January and May 2021. The NVC parameters-capillary morphology, loop diameter, capillary density, dilated capillaries, giant capillaries, avascular areas, microaneurysms, and micro-hemorrhages of 32 patients with COVID-19 and 29 controls were recorded. The most common capillary morphology in the COVID-19 group (18/32, 56.2%) was serpentine, which also characterised some (6/29, 20.7%) patients in the non-COVID-19 group (p <0.001). The median capillary loop diameter was 77.78 ± 3.63 µm in the COVID-19 group and 71.67 ± 2.19 µm in the non-COVID-19 group (p=0.030). Mean capillary density was 6.41 ± 1.21/1 mm in the COVID-19 group and 8.55 ± 1.12/1 mm in the non-COVID-19 group (p <0.001). The COVID-19 group had significantly more enlarged capillaries (p = 0.001), giant capillaries (p = 0.025), avascular areas (p = 0.028), micro-aneurysms (p <0.001), and micro-hemorrhages (p = 0.011). Mean capillary density was 5.50 ± 0.19/1 mm among deceased patients with COVID-19, but 6.71 ± 0.25/1 mm among survivors (p = 0.011). NVC findings differed between patients with COVID-19 and controls, and capillary density was less among deceased patients with COVID-19 than survivors. Capillaries, COVID-19, İntensive care unit, Micro-circulation, Nailfold videocapillaroscopy.

Nailfold Capillaroscopy of Healthy Individuals - An Observational Study.

Background:Nailfold capillaroscopy (NFC) is a noninvasive quick method to visualize capillaries in the nailfold. There is paucity of these studies in healthy individuals in skin of color.Aim:To evaluate the morphological characteristics and density of nailfold capillaries in healthy individuals.Settings and Design:This observational cross-sectional study was conducted in the Department of Dermatology at a tertiary care hospital. About 150 healthy individuals by consecutive sampling were included in the study.Materials and Methods:A total of 150 healthy individuals aged between 20 and 60 years were enrolled from January 2021 to September 2021 after consenting to the study protocol and qualifying the inclusion and exclusion criteria. NFC was performed for various morphological parameters and mean capillary density was also calculated. Comparison was done in male vs female, age group 20–40 vs 41–60, and body mass index (BMI) <24.9 vs >25.Statistical Analysis:Different morphological parameters and capillary density were recorded and analyzed. The Mann–Whitney and Pearson’s chi square was used according to type of data.Results:The study observed tortuous capillaries (45.33%), meandering capillaries (44.66%), neoangiogenesis (38.66%), plexus visibility (36.66%), dilated capillaries (33.33%), receding capillaries (31.33%), angulated capillaries (14.66%), and ramified capillaries (6.6%). The study found significantly decreased plexus visibility in those with BMI > 25.Tortuous and receding capillaries were significantly increased in age group >40 years.Conclusion:Various capillary morphological findings can be present in normal individuals but their presence in more number of fingers should be considered to be pathological. This data on normal morphology and capillary density add to the physiological NFC findings and thus aid in identifying the abnormalities.