Microcirculation Index Research Articles

Changes in the penile microcirculation in the treatment of mixed erectile dysfunction on the background of arterial hypentension in locomotive team workers

BACKGROUND: Railway workers constantly experience stress in the workplace, associated with the need to maintain high attention and be ready for emergency action, which provokes a persistent increase in blood pressure. A significant number of such patients have erectile dysfunction. Most patients require complex therapy for stress-induced arterial hypertension and erectile dysfunction.
 AIM: To evaluate the dynamics of penile microcirculation indicators in the treatment of erectile dysfunction against the background of arterial hypotension in locomotive team workers.
 MATERIALS AND METHODS: A comprehensive examination and treatment of 65 young and middle-aged men from 30 to 55 years old (mean age 48.1 0.7 years), working as machinists or assistant machinists, was carried out. All observed patients complained of erectile dysfunction of varying severity and were registered with a general practitioner and (or) a cardiologist for controlled hypertension stage III. The patients were divided into three groups. Patients of the 1st group (n = 20) were prescribed basic treatment with antihypertensive drugs, as well as the drug Afalasa sublingually, 2 tablets 2 times a day. Patients of the 2nd group (n = 25) also received basic antihypertensive therapy, Afalasa (2 tablets 2 times a day sublingually) and the 5-PDE inhibitor tadalafil 5 mg once a day. Group 3 included 20 patients receiving basic antihypertensive therapy. The course of treatment for patients in each group was 4 months. The control 4th group consisted of 20 healthy men. In all patients before and after treatment and representatives of the control group, the state of microcirculation of the penis was assessed by laser Doppler flowmetry.
 RESULTS: According to the Doppler flowmetry technique, microcirculatory disorders of varying severity were detected in the penis before treatment. The most pronounced positive dynamic at 4 months after the start of treatment was noted in patients of the 2nd group who received complex treatment, which included antihypertensive therapy, a 5-PDE inhibitor, and Afalasa. In patients, the index of microcirculation significantly increased, the index of hypoxia and tissue ischemia decreased, an increase in the inert mechanism of blood flow regulation was noted, which was expressed in an increase in the index of microcirculation efficiency from 0.79 0.08 to 2.01 0.29 c.u. (p 0.05) and an increase in the bypass rate from 0.69 0.13 to 1.06 0.33 c.u. (p 0.05). The improvement in microcirculation was accompanied by an improvement in erectile function, most pronounced in patients of the 2nd group.
 CONCLUSIONS: Locomotive team workers with arterial hypertension have a mixed form of erectile dysfunction caused by a psychogenic factor and disruption of the vascular endothelium. The monitoring revealed significant violations of the penile microcirculation. The most pronounced improvement in penile hemodynamics and erectile function was noted with complex treatment, including basic antihypertensive therapy, a NO synthase activator, and a 5-PDE inhibitor.

Physiological Regulation of Pulmonary Microcirculation under Mechanical Ventilation at Different Cardiac Outputs and Positive End-Expiratory Pressures in a Porcine Model.

This study was performed to visualize the hemodynamic effects of pulmonary microcirculation and ventilation/perfusion (V/Q) matching after mechanical ventilation under different cardiac outputs and positive end-expiratory pressures (PEEPs). Ten experimental pigs were randomly divided into high and low tidal volume groups, and ventilation/perfusion were measured by electrical impedance tomography (EIT) at different PEEPs. Then, all the pigs were redivided into high cardiac output (CO) and low CO groups and measured by EIT at different PEEP levels with a low tidal volume. Additionally, sidestream dark field (SDF) was used to measure pulmonary microcirculation. Hemodynamic parameters and respiratory mechanics parameters were recorded. As PEEP increased at high tidal volume, blood flow was impaired at a higher PEEP (20 cmH2O) compared with low tidal volume (shunt: 30.01 ± 0.69% vs. 17.95 ± 0.72%; V/Q ratio: 65.12 ± 1.97% vs. 76.57 ± 1.25%, p < 0.01). Low tidal volume combined with an appropriate PEEP is the best option from the match between ventilation and pulmonary blood flow. Increasing PEEP can solve the problem of excessive shunt at high CO, and the V/Q ratio tends to match. At low CO, the increased dead space can reach as high as 64.64 ± 7.13% when PEEP = 20 cmH2O. With increasing PEEP, the microcirculation index deteriorates, including total vessel density (TVD), proportion of perfused vessel (PPV), perfused vessel density (PVD), and microcirculatory flow index (MFI). The periodic collapse of pulmonary capillaries or interruption of blood flow obviously occurred with high PEEP. The hemodynamic parameters indicated that the transpulmonary capillary wall pressure (Pcap) of the low CO group was negative at PEEP = 5 cmH2O, which determines the opening and closing of the pulmonary microcirculation and controls lung perfusion and the production of extravascular lung water. Therefore, it is essential to couple macrocirculation and pulmonary microcirculation during mechanical ventilation by improving shunting and optimizing Pcap.

Kinetics of mucosal blood flow in 3D modeling of the gingival contour around dental implants after bone reconstruction of the alveolar ridge in the lateral part of the jaws

To study the kinetics of mucosal blood flow in 3D modeling of the gingival contour around dental implants after bone reconstruction of the alveolar ridge in the posterior jaw. The work was performed at the clinical base of the Department of Surgical Dentistry and Maxillofacial Surgery of the Institute of Dentistry of the Privolzhsky Research Medical University, Nizhny Novgorod, Russia with the participation of 87 patients who were divided into two groups depending on the chosen method of treatment and a control group. The method of laser Doppler flowmetry was carried out using a multifunctional laser diagnostic complex LAKK-02. The terms of observation were 7, 14, 28, 42 days. On the 7th postoperative day, the decrease in microcirculation index (MI) in the groups reflected moderately pronounced hemodynamic disorders with a predominance of a decrease in MI in the center (by 35.8%). The predominance of the stagnant-ischemic type of microcirculation disorders and low intensity of neoangiogenesis was established, especially in the central zone in group 1, and in group 2 signs of neoangiogenesis were noted by the 7th day. By the 14th day, there was a decrease in venous congestion and signs of arterial inflow. In the 2nd group there was a subsidence of inflammatory phenomena and an increase in the energy of the oscillatory process in the vessels. Gradually, by the 42nd day, the indicators in groups 1 and 2 approached in value to the control group and did not differ significantly. A previously unknown mechanism of interaction between two heterogeneous grafts (xenograft and thin free gingival graft) was revealed, which determined neoangiogenesis by the traditional method (from the center to the periphery), and by the proposed method (from the periphery to the center). Understanding the wound process is necessary for the purpose of further correction of the surgical technique for the best restoration of the vascular network and an increase in the success rate of operations.

Diagnosis of Skin Vascular Complications Revealed by Time-Frequency Analysis and Laser Doppler Spectrum Decomposition.

Nowadays, photonics-based techniques are used extensively in various applications, including functional clinical diagnosis, progress monitoring in treatment, and provision of metrological control. In fact, in the frame of practical implementation of optical methods, such as laser Doppler flowmetry (LDF), the qualitative interpretation and quantitative assessment of the detected signal remains vital and urgently required. In the conventional LDF approach, the key measured parameters, index of microcirculation and perfusion rate, are proportional to an averaged concentration of red blood cells (RBC) and their average velocity within a diagnostic volume. These quantities compose mixed signals from different vascular beds with a range of blood flow velocities and are typically expressed in relative units. In the current paper we introduce a new signal processing approach for the decomposition of LDF power spectra in terms of ranging blood flow distribution by frequency series. The developed approach was validated in standard occlusion tests conducted on healthy volunteers, and applied to investigate the influence of local pressure rendered by a probe on the surface of the skin. Finally, in limited clinical trials, we demonstrate that the approach can significantly improve the diagnostic accuracy of detection of microvascular changes in the skin of the feet in patients with Diabetes Mellitus type 2, as well as age-specific changes. The results obtained show that the developed approach of LDF signal decomposition provides essential new information about blood flow and blood microcirculation and has great potential in the diagnosis of vascular complications associated with various diseases.

Complex assessment of parameters of central hemodynamics and microcirculation in children of 6-7 years old

The paper presents the results of a comprehensive assessment of central hemodynamic and microcirculation indices in the skin of upper and lower limbs in 6–7-year-old children. 14 girls and 7 boys were examined using laser Doppler flowmetry methods (the LASMA-PF device, allowing simultaneous recording by four sensors) and the analysis of heart rate variability ("Varicard"). The parameters characterizing microcirculation in the limbs were determined and the signs of the appearing functional asymmetry of the upper limbs, as well as the differences in the mechanisms of modulation of cutaneous blood flow in boys and girls were revealed. The estimation of heart rate variability reveals the signs of girls' inclination to sympathotony and boys' inclination to vagotony at the given age. It was marked that central regulation mechanisms have the greater contribution to cardiac rhythm formation in girls. The data obtained testify to the fact that age-related changes at different levels of the cardiovascular system and regulation mechanisms occur somewhat earlier in girls than in boys.

EVALUATION OF DYNAMIC CHANGES IN THE MICROCIRCULATION OF THE MUCOSA IN THE ZONE OF DENTAL IMPLANTATION WITH IMMEDIATE INTRAOPERATIVE LOAD.

The aim: Study of the dynamics of changes in the average values of the index of mucosal microcirculation after dental implantation with immediate intraoperative prosthetics. Materials and methods: In clinical conditions, 55 patients aged from 29 to 60 years with a diagnosis of partial absence of teeth requiring orthopedic treatment using implants on the lower jaw were treated and examined. In the course of the latest achievements, the following methods were used: clinical protocol of immediate implantation with Solidum and Simplex implants of the «ART IMPLANT» system on the lower jaw by the one-stage implantation method, with immediate intraoperative loading and the manufacture of a temporary non-removable dental prosthesis, determination of the microcirculation index in dynamics using the laser Doppler method flowmetry, statistical analysis. Results: The obtained results indicate a pronounced reaction of microcirculation up to the 3rd day after surgery, an increase in blood perfusion of the mucous membrane by 2.7 times while maintaining vasomotor activity, which indicates adaptation to the injury and immediate loading of the denture in the postoperative period. 3 months after dental surgery and immediate intraoperative prosthetics, all indicators of microcirculation approach the initial values before surgery. Conclusions: With the help of laser Doppler flowmetry, the fact of a sharp restoration of microcirculation after dental implantation surgery with immediate intraoperative prosthetics is confirmed.

GENDER DIMORPHISM OF CHANGES IN THE SKIN MICROCIRCULATION OF RATS ON THE BACKGROUND OF ACUTE COLD TRAUMA

Gender factors play an important role in the prevention, preva- lence and specifics of the course of various pathological conditions, among which cold injury occupies an important place. The role of gender in its pathogenesis remains poorly understood. The aim. To assess sex-specific changes in the microcirculation of target organs exposed to extremely low temperatures during experimental acute cold trauma (ACT) in rats. Materials and methods. Experiments were performed on male and female sexually mature and castrated Wistar rats. Acute cold trauma (ACT) was modeled by keeping the animals at -180ºС for 2 hours. The microcirculation coefficients of the skin of the hind limbs, auricles, and tail of animals were determined using Biopas electrophysiological equipment (USA) non-invasively using a surface sensor. We compared the changes before and 30 minutes after the action of the cold factor. Statistical processing of the results was carried out using standard descriptive methods. The results. A 2-hour stay of animals under the influence of extremely low temperatures causes a significant drop in blood supply in animals of both sexes. The degree of changes has a clear sexual dimorphism with a predom- inance of pathological processes in male animals. In males, the coefficient of microcirculation of the lower limbs and auricles decreased by 72.2 and 55.3 %, and in the tail by 35.1 %, compared to this indicator before the effect of the cold factor (p < 0.05), on the other hand, in female rats changes in similar indicators were 66.5 and 44.3 % (lower limbs and auricles), and tail perfusion by 18.6 % (p < 0.05). ACT in castrated female rats caused more extensive hemoperfusion disorders compared to males: the microcirculation index of the tail, hind limbs, and auricle in male rats on the background of ACT decreased by 25.4, 66.4, and 40.7 %, respectively (p < 0.05), whereas in animals of the opposite sex – by 32.5, 78.8 and 47.4 %, respectively. Conclusion In sexually mature female rats without changes in hormonal status, a greater resistance to microcirculation disorders during experimental acute cold injury was found. The reason for these differences is the effect of sex hormones, since castration of males increases the resistance of the vascular system of animals to the action of a cold factor, while ovariectomy of females – on the contrary, increases the degree of microcirculatory lesions of the most vulnerable organs to the action of extremely low temperatures

Features of laser Doppler flowmetry in patients with bacterial and viral (covid-19) community-acquired pneumonia

Introduction. As a result of the coronavirus infection (COVID-19) pandemic, almost 74.9 thousand people died of pneumonia in Russia in 2021. Community-acquired pneumonia (CAP) is accompanied by a systemic re­sponse of the body to inflammation in the lung tissue and disorder of microhemocirculation. The method of laser Doppler flowmetry (LDF) allows assessing the general parameters of the microcirculatory bed and determining the state of various factors regulating the nutritive flow.Aim. To conduct a comparative analysis of LDF indices in patients with COVID-19- associated and bacterial CAP.Materials and methods. 140 patients were examined, 100 of them with non-severe CAP (main group), and 40 patients with extrapulmonary pathology (comparison group). The main group included 44 people with bacterial CAP and 56 people with COVID-19-associated CAP. Bacteriological studies of sputum were performed; detection of SARS-CoV-2 RNA in swabs from the oropharynx and nasopharynx by PCR, LDF to assess the state of pe­ripheral blood flow was carried out.Results. In patients with COVID-19-associated CAP, compared with patients with bacterial CAP, a decrease in the microcirculation index by 1.26 times (p<0.0005), an increase in the coefficient of variation by 1.11 times (p<0.0005) was found.Conclusion. In patients with COVID-19-associated CAP, compared with patients with bacterial CAP, more significant pathological changes in Dopplerograms were detected, which may indicate more pronounced disorders in the microcirculatory bed in COVID-19-associated CAP caused by exposure to the SARS-COV- 2 virus. Perhaps the established fact can lead to adverse outcomes of the course of the disease.

THE MORPHOLOGICAL AND FUNCTIONAL STATE OF THE VASCULAR COMPONENT OF HEMATOPOIESIS ORGANS IN DIFFERENT TIMES OF SIMULATED HYPOXIA IN THE EXPERIMENT

Under conditions of hypoxia, a change in the morphological and functional state of the components of the microvasculature bed will be accompanied by a change in the adequacy and usefulness of the immune response and hematopoiesis. The purpose of the study was to determine the morphofunctional state of the vascular component of the red bone marrow and spleen at various times of simulated hypoxia and to identify the degree of influence of CD68-positive cells on this state. Chronic hypoxia was modeled on 246 outbred male rats using special chambers containing natural gas from the Astrakhan gas field (Russia) at a concentration not exceeding the maximum allowable. The experiment was continued for 120 days, inhalation was carried out five days a week for four hours a day, the removal of animals from the experiment was carried out every 30 days. The functional activity of the vascular component of the red bone marrow was determined using the method of laser Doppler flowmetry. The degree of expression of inducible (iNOS) and endothelial (eNOS) NO synthases and the distribution of CD68-positive cells in the spleen structures were determined by immunohistochemical method. The study showed that as the duration of chronic simulated hypoxia increases, there is a decrease in the microcirculation index, an increase in myogenic tone and shunting index, which, taken together, indicates a deterioration of organ perfusion and confirms the formation of a hypoxic state. An analysis of the functional activity, carried out using an immunohistochemical study of the expression of iNOS and eNOS in the structures of the spleen, showed that as the duration of the experiment increased, the level of endothelial synthase decreased and the level of inducible synthase increased. Perhaps this is due to the influence of biologically active substances secreted by macrophages activated during hypoxia. This is supported by an increase in the presence of CD68-positive cells in the red pulp and along the connective tissue trabeculae as the experimental exposure increases.

The place of laser fluorescence spectroscopy, doppler flowmetry and ultrasound in the diagnosis and assessment of treatment efficacy for plaque scleroderma

According to modern ideas, a reasonable choice of an effective method of treating plaque scleroderma is based on the diagnosis of the pathological process prevailing in the tissues (inflammation-sclerosis). Therefore, an urgent problem of a personalized approach to dermatosis therapy is the possibility of an objective assessment of the prevailing process using non-invasive diagnostic methods. The article presents a clinical case of widespread plaque scleroderma in a 66-year-old patient, demonstrating the possibility of using laser fluorescence spectroscopy and laser Doppler flowmetry to determine the degree of activity of the focus and determine the leading pathological process.
 We selected three pathological skin foci localized in the abdomen and characterizing three clinical stages of the disease (inflammation, induration, sclerosis). The analysis of fluorescence and laser Doppler flowmetry data showed that in areas clinically defined as inflammation, there is an increase in the average values of the indices of tissue content of porphyrins, lipofuscin and microcirculation index compared with intact skin, while the intensity of collagen fluorescence does not differ significantly. In the induration zone, along with an increase in the fluorescence indices of lipofuscin and porphyrins, there is an increase in the average values of collagen fluorescence indices at effective registration waves. The data obtained by us indicate an active inflammatory process in these foci and the process of fibrosis in the induration zone. In the sclerosis zone, there is an increase in the average values of collagen fluorescence indices compared with intact skin, and the fluorescence of optical markers of inflammation (lipofuscin and porphyrins) do not differ significantly in comparison with the control intact skin. When analyzing the fluorescence spectra and laser Doppler flowmetry data after treatment, we found that in the zones of induration and inflammation, the average values of the fluorescence indices of porphyrins, lipofuscin, collagen and microcirculation index are reduced relative to the initial values (before treatment), but remain higher in comparison with intact skin. The data obtained may indicate that active inflammation in these foci persists at the time of the study. In the study of the focus of sclerosis, the obtained autofluorescence and microcirculation data in dynamics do not differ significantly from the initial values. The data for laser Doppler flowmetry and laser fluorescence spectroscopy are consistent with ultrasound examination of the skin.
 In our study, the potential possibility of using laser fluorescence spectroscopy and laser Doppler flowmetry methods to establish the degree of activity of the focus, determine the leading pathological process, as well as to evaluate the effectiveness of therapy was demonstrated for the first time.

Assessment of the liver microcirculation by laserdoppler flowmetry after extended liver resection in the experiment

Purpose. To assess microcirculation and mechanisms of its regulation in the liver after its extended resection.Materials and methods. 10 Wistar rats of both sexes weighing 180–270 g which had median laparotomy under general anesthesia were taken in the trial. Microcirculation in the liver of rats was assessed with LAKK-02 Laser-Doppler flowmeter (Russia). A light guide for determining microcirculation was placed on the visceral surface of the right liver lobe; parameters of Laser-Doppler flowmetry (LDF-gram) were registered for 7 min. Then, ligatures were sequentially applied to the left lateral and median lobes of the liver followed by their cutting off; then, about 70 % of the organ were removed. After removal of both liver lobes, LDF-gram was recorded again for 7 minutes with a sensor placed on the visceral surface of the right liver lobe. Basic microcirculation parameters were registered before and after extended liver resection.Results. After the extended liver resection, average arithmetic parameters of microcirculation in the liver parenchyma decreased by 11.71 % (p < 0.05), which indicates the decrease in the microvasculature perfusion. At the same time, indicators of standard deviation of the microcirculation index and the coefficient of variation did not change statistically significantly. The median maximum amplitude of neurogenic oscillations after the resection increased by 2.3 points (p < 0.05). The amplitude of myogenic oscillations also increased after resection (p < 0.05); however, the degree of increase was less than that of the neurogenic rhythms. It was found that in 70 % of animals the maximum amplitude of endothelial oscillations increased in the liver microcirculation after the extended resection; however, in general, differences between the average endothelial oscillations before and after the resection were not statistically significant.Conclusion. In the experimental liver resection, the most informative and reliable LDF criteria on ischemia development in the liver stump were average arithmetic microcirculation indices as well as the amplitude of neurogenic and myogenic oscillations. The authors emphasize that the degree of changes in these indices may be a sign of ischemia severity in the liver stump after its resection and may have a prognostic value, although the results obtained require further research.

Microcirculation and blood pressure/heart rate response during exercise stress testing in hypertensive patients

Abstract Background/Purpose A hypertensive response during exercise has been associated with adverse cardiovascular outcomes in general population and hypertensive patients. On the other hand, microcirculation is the major site of control of vascular resistance and thus has a key role in the etiopathogenesis of hypertension. The aim of our study was to investigate the presence of a possible correlation between blood pressure and heart rate response during exercise with a microcirculation index (capillary rarefaction) in a cohort of hypertensive patients. Methods We studied 105 untreated patients with stage I-II essential hypertension (70% men, mean age: 59.5 years, mean office blood pressure: 150/92mmHg). Patients with diabetes mellitus, secondary hypertension, atherosclerotic cardiovascular disease, heart failure, significant chronic renal or pulmonary disease and any other systemic illness or orthopedic problems that would not allow maximal effort on a treadmill were excluded. All participants underwent maximal exercise testing, using the Bruce protocol, as well as nail-fold videocapillaroscopy assessment by using VideoCap 3.0 videomicroscope. Results A significant negative correlation between diastolic BP at minute-1 of the recovery phase and capillary density expressed in capillaries/mm was revealed (Pearson's r=−0.365, p=0.043). A significant negative correlation was also observed between capillary density and peak heart rate (Pearson's r=−0.364, p=0.024) as well as between heart rate increase from stage 1 to 2 and capillary density (Pearson's r=−0.746, p=0.013). Conclusions Our study shows that in a small cohort of hypertensive patients, capillary rarefaction was associated with a steeper increase in heart rate during exercise, as well as with a higher peak heart rate and higher diastolic blood pressure values during the recovery phase. These findings suggest that new indices such as capillary rarefaction may provide insights into possible autonomic dysfunction and could also be taken into account in the assessment of hypertensive patients. Funding Acknowledgement Type of funding sources: None.

Angiography derived index of microvascular resistance (IMR) in Takotsubo syndrome

Abstract Background and purpose Coronary microvascular dysfunction (CMD) has been proposed as a key driver in the etiopathogenesis of Takotsubo syndrome (TTS), likely related to an “adrenergic storm” upon a susceptible microvascular circulation. The aim of our manuscript was to assess and quantify CMD in patients with TTS through angiography-derived index of microcirculation (IMR) and evaluate its correlation with clinical presentation. Methods Coronary angiograms of 41 consecutive TTS patients were retrospectively offline analyzed to derive angiography-based indices of CMD. Three recently developed indices (NH-IMRangio, AngioIMR and A-IMR) were calculated and compared based on Quantitative Flow Reserve (QFR) analysis. CMD was defined as an IMRangio ≥25 units. The correlation between CMD and clinical presentation and outcomes was then assessed. Results Median age was 76 years, 85.7% were women and mean left ventricular ejection fraction (LVEF) at first echocardiogram was 41.2%. Angiography-derived IMR was higher in Left Anterior Descending artery (LAD) than Circumflex artery (LCX) and Right Coronary artery (RCA) with either NH-IMRangio (52.7 vs 35.3 vs 41.4), AngioIMR (47.2 vs 31.8 vs 37.3) or A-IMR (52.7 vs 36.1 vs 41.8). All patients presented CMD with angiography-derived IMR ≥25 in at least one territory with each formula. Angiography-derived IMR in LAD territory was significantly higher in patients presenting with LVEF impairment (≤40%) than in those with preserved ventricular global function (NH-IMRangio: 59.3 vs 46.3, p. value=0.030; AngioIMR: 52.9 vs 41.4, p-value=0.037; A-IMR: 59.2 vs 46.3, p-value=0.035). Conclusion CMD, assessed with angiography-derived IMR, is a common finding in TTS and it is inversely correlated with LV function. The available formulas have a substantial superimposable diagnostic performance in assessing coronary microvascular function. Funding Acknowledgement Type of funding sources: None.

RESPOSTA CARDIOVASCULAR EM CORREDORES DE MÉDIA E LONGA DISTÂNCIA SOB TREINAMENTO

ABSTRACT Introduction: Research on the effects of exercise on the cardiovascular system has a long history that has recently been expanded with echocardiography. Research using Doppler echocardiography has been increasing because of the safe and non-invasive method of examination to study cardiac morphology and function. However, few studies on functional cardiac changes in mid and long-distance runners under training are still few. Objective: Study the monitoring of cardiovascular response in middle and long-distance runners during training. Methods: The CFOCS-I cardiovascular function detector was used to observe 24 indices of cardiac pump function, vascular function, and microcirculation in 12 female middle-distance runners. Results: According to the test results, diastolic force, systolic force, systolic function, left ventricular ejection fraction increased during the proposed loading exercise. The mean systolic and mean pulse pressures increased significantly with exercise load (P<0.01). Conclusion: Mid and long-distance runners demonstrated significant cardiac changes in ventricular shape, size, and systolic function, accompanied by significant changes in diastolic function when subjected to intense exercise. Evidence Level II; Therapeutic Studies - Investigating the result.

ФУНКЦИОНАЛЬНОЕ СОСТОЯНИЕ СИСТЕМЫ МИКРОЦИРКУЛЯТОРНОГО РУСЛА В ТКАНЯХ ПАРОДОНТА У ЛИЦ МОЛОДОГО ВОЗРАСТА ПРИ РАЗЛИЧНЫХ ВИДАХ КУРЕНИЯ

Subject. Tobacco smoking is one of the risk factors of periodontal disease development; therefore, special attention should be paid to this group of patients in periodontal treatment management. Any pathological process in periodontium is directly or indirectly connected with microcirculatory disturbances. Therefore, the correction of these disturbances will promote the normalization of the periodontal morphofunctional status.
 Objectives. To study functional state of the microcirculatory channel system in the periodontal tissues of the young patients with different types of smoking.
 Matodology. Clinical examination of 240 patients was carried out with subsequent division into subgroups depending on the smoking type: smoking cigarettes, electronic cigarettes with liquids, tobacco heating systems and hookah with further division into subgroups depending on the smoking experience: up to 1 year, from 1 to 5 years, more than 5 years. Subsequently indices were determined: simplified index of oral hygiene according to Green–Vermillion (OHI-s, 1964), papillary-marginal-alveolar index (PMA modified by Parma, 1960), bleeding index SBI (Muehlemann modified by Cowell, 1975). For objective assessment of microcirculation in periodontal tissues we used high-frequency ultrasonic Dopplerography device "Minimax-Doppler-K" (LLC "SP-Minimax", St. Petersburg) with subsequent determination of average linear blood flow rate (Vas) and Gosling (PI) and Purcelo (RI) indices. Microcirculatory channel dynamics in periodontal tissues of the studied groups was studied in the state of physiological rest, immediately after smoking, in 15 minutes, in 30 minutes and in 60 minutes. 
 Results. On the basis of the carried out research the distinctive indices of microcirculation in the periodontal tissues before and after different kinds of smoking as well as the functional state of the vascular architectonics were determined. 
 Conclusions. The given research allows to understand at which types of smoking the smallest and the largest changes of microcirculation in periodontal tissues are observed and that also should be taken into account in daily clinical practice when seeing young periodontal patients who smoke.

Evaluation of clinical results of combined correction of age-related skin changes using fractional microneedle therapy and platelet-rich plasma activated by autologous thrombin.

Background. Involutive processes in the human body are often accompanied by the only visible manifestation - a change in appearance. Against this background, the search for new treatment methods that will focus on timely and rational correction of age-related skin changes and combine the possibility of complex effects on the mechanisms of skin aging is relevant. Hardware physiotherapy technologies and innovative autologous cellular preparations have a powerful regenerative potential, trigger and support physiological tissue regeneration. Despite the substantial amount of data on combined aesthetic correction protocols, there were only isolated data in the domestic and foreign literature on the combined use of fractional needle radiofrequency therapy and platelet-rich plasma activated by autologous thrombin. This was the basis for this study.
 Aims. To evaluate the results of a combined method for correcting age-related skin changes based on a combination of hardware fractional needle radiofrequency exposure and injection therapy with platelet-rich plasma activated by autologous thrombin, comparing to monotherapy the same methods.
 Materials and methods. Fractional microneedle radiofrequency therapy was carried out three times with an interval between procedures of 3 weeks with the use of a high-frequency electrosurgical device Scarlet RF. Therapy with autologous plasma rich in platelets activated by autologous thrombin (PRP therapy) was performed three times with an interval between procedures of 3 weeks without the use of preliminary topical anesthesia. Combination therapy combined the use of the above methods. Regression of clinical signs of skin aging was evaluated according to digital dermatoscopy and regression of the total value of the dermatological index of the quality of life of patients, as well as improvement of qualitative and functional parameters of the skin. A statistical analysis was carried out.
 Results. A comparative analysis of the influence of various methods of correction of involutive changes in the skin of the face showed that the use of combination therapy provides the development of the most significant clinical effect in relation to all the assessed signs of skin aging. Combination therapy was accompanied by a significant increase in the integral index of microcirculation, regardless of age. The reconstructive effect on the morphological structures of the skin according to ultrasonography also turned out to be significantly higher for the combined method of treatment in comparison with radiofrequency therapy.
 Conclusions. The combined use of fractional microneedle radiofrequency therapy and PRP therapy provides a more effective and prolonged correction of age-related skin changes compared to the monotherapy.

The Clinical Effects of Metronidazole Vaginal Effervescent Tablets Combined with Kushen Suppository in the Treatment of Trichomonas Vaginitis.

Objective The aim of this study was to explore the clinical effects of metronidazole vaginal effervescent tablets combined with Kushen suppository in the treatment of Trichomonas vaginitis. Methods Ninety patients with trichomoniasis admitted to our hospital from January 2019 to January 2020 were prospectively analyzed and randomly divided into a control group (n = 45) treated with metronidazole vaginal effervescent tablets and an experimental group (n = 45) treated with Kushen suppository on top of the control group using the random number table method. The clinical effects, inflammatory factors, and microcirculation indexes were compared. We assessed patient's vaginal health by Vaginal Health Score Scale (VHS) before and after treatment and estimated their quality of life according to Generic Quality of Life Inventory-74 (GQOLI-74). A follow-up visit was conducted to compare patient's recurrence 3 months after treatment. Results Distinctly higher total clinical effective of the experimental group compared with that of the control group was obtained (P < 0.05); the serum level of inflammatory factors of the experimental group was dramatically lower than that of the control group after treatment (P < 0.001); the experimental group experienced a favorable microcirculation index in comparison with the control group (P < 0.001); superior VHS (P < 0.001) and GQOLI-74 (P < 0.05) scores of the experimental group after treatment compared to those of the control group were observed; the recurrence rate of the experimental group 3 months after treatment was significantly decreased in comparison with that of the control group (P < 0.05). Conclusion Metronidazole vaginal effervescent tablets combined with Kushen suppository can effectively improve the clinical symptoms of patients with trichomonas vaginitis, abate patient's inflammatory reaction, and raise their quality of life, which is worthy of promotion.

Regression Analysis and Mathematical Modeling of Fluctuations in Microcirculation Indices in Symmetrical Regions of the Human Upper Limbs

Regression Analysis and Mathematical Modeling of Fluctuations in Microcirculation Indices in Symmetrical Regions of the Human Upper Limbs

THE ROLE OF MICROCIRCULATION ON BLOOD PRESSURE AND HEART RATE RESPONSE DURING EXERCISE STRESS TESTING IN HYPERTENSIVE PATIENTS

Objective: Exercise stress testing is regularly used to assess cardiovascular risk and a hypertensive response during exercise has been associated with adverse cardiovascular outcomes. On the other hand, the microcirculation is the major site of control of vascular resistance and thus has a key role in the etiopathogenesis of hypertension. The aim of our study was to investigate the presence of a possible correlation between blood pressure and heart rate response during exercise with a microcirculation index (capillary rarefaction) in a cohort of hypertensive patients. Design and method: We studied 105 untreated patients with stage I-II essential hypertension (70% men, mean age: 59.5 years, mean office blood pressure: 150/92mmHg). Patients with diabetes mellitus, secondary hypertension, atherosclerotic cardiovascular disease, heart failure, significant chronic renal or pulmonary disease and any other systemic illness or orthopedic problems that would not allow maximal effort on a treadmill were excluded. All participants underwent maximal exercise testing, using the Bruce protocol, as well as nail-fold videocapillaroscopy assessment by using VideoCap 3.0 videomicroscope. Results: A significant negative correlation between diastolic BP at minute-1 of the recovery phase and capillary density expressed in capillaries/mm was revealed (Pearson’s r = -0.365, p = 0.043). A significant negative correlation was also observed between capillary density and peak heart rate (Pearson’s r = -0.364, p = 0.024) as well as between heart rate increase from stage 1 to 2 and capillary density (Pearson’s r = -0.746, p = 0.013). Our study shows that in a small cohort of hypertensive patients, capillary rarefaction was associated with a steeper increase in heart rate during exercise, as well as with a higher peak heart rate and higher diastolic blood pressure values during the recovery phase. Conclusions: These findings could imply that new indices such as capillary rarefaction may provide insights into possible autonomic dysfunction and could also be taken into account in the assessment of hypertensive patients.

Coronary microvascular dysfunction: mechanisms and clinical outcome

A large percentage of patients, predominantly female, who undergo coronary angiography for typical chest pain do not have significant coronary stenosis. Many of these patients with microvascular myocardial disease have left ventricular hypertrophy, cardiomyopathies, valve disease, or other clinical conditions. The definition of microvascular angina is based on (i) symptoms of myocardial ischemia, (ii) absence of obstructive coronary artery disease (<50% stenosis on coronary angiography or coronary computed tomography scan), (iii) objective evidence of myocardial ischemia (ischemic electrocardiographic abnormalities during episodes of chest pain and/or myocardial perfusion defects or regional contractility abnormalities), and (iv) pathological indices of microcirculation (index of microcirculatory resistance >25, coronary flow reserve <2.0) and/or microvascular spasm (TIMI flow <2) during intracoronary vasoreactivity tests. The basic mechanisms and the diagnostic tests of microvascular dysfunction are reported in detail.From a clinical standpoint, while the crucial role of microcirculation in determining short- and long-term prognosis is evident, efforts to date to improve clinical outcomes in patients with microvascular obstruction have had limited success, most likely because microvascular dysfunction is a multifactorial process with several interdependent underlying pathophysiological mechanisms. Therefore, further studies are needed to develop effective therapeutic strategies for microvascular myocardial disease.