Microcirculatory Vessels Research Articles

Umbilical cord-derived mesenchymal stromal/stem cells enhance recovery of surgically induced skeletal muscle ischemia in a rat model.

This study delves into possible mechanisms underlying the stimulating influence of UC-MSCs transplantation on functional and structural recovery of ischemic skeletal muscles. Limb ischemia was created in Sprague-Dawley rats by excision of femoral and popliteal arteries. Allogeneic rat PKH26-labeled UC-MSCs were administered by direct intramuscular injection. Animals of experimental group responded to the transplantation by improvement in their locomotor function as assessed by the rotarod performance test on day 9 and 29 after transplantation. Histomorphometric analysis showed that relative area of the lesions in the experimental group was significantly smaller than in the control group at all time points during the observation. Calculated densities of microcirculation vessels within the lesions were significantly higher in the experimental group than in the control group on day 10 after transplantation. Only a part of the transplanted allogeneic UC-MSCs survived within the ischemic muscle tissue, and a considerable portion of these surviving cells were found alongside the VEGF-producing preserved muscle fibers. The PKH26 label was not found within the walls of capillaries or larger blood vessels. The administration of allogeneic UC-MSCs significantly increased the proportion of M2 macrophages, exhibiting proangiogenic and anti-inflammatory properties, for at least 10 days following the transplantation.

Investigation of cerebral circulation and peripheral microcirculation to passive postural orthostatic test

Cerebral hemodynamics and peripheral microcirculation was studied in 44 men during a passive postural orthostatic test. 7 people had poor orthostatic stability (OS). The study of cerebral hemodynamics (REG) showed that in individuals with good OS during the test, the blood filling of the brain is reliably increased (p<0.05), in a group with poor OS it practically does not change. The background dates of cerebral blood flow in the group with poor stability are significantly lower (p<0.001) relative to the parameters of the group with good tolerance of the test. In a group with good OS were stable blood flow in the microvasculature during the test. In a group with poor OS , vascular responses were expressed. The arterio-venular blood flow increases, the intensity of capillary blood flow is reduced. Blood flow indices are decrease - PI 2.7 times, RI 1.9 times, this is the dilution of microcirculation vessels.

Sodium nitrate affects myocardium in pregnant rats and their pups

The problem of pollution with nitrates and nitrites of the natural environment is very relevant nowadays. The purpose of this research was to study the morphological features of the myocardium in pregnant rats and their newborn pups exposed to chronic hemic hypoxia induced by sodium nitrite. The changes in the contractile apparatus of cardiomyocytes were atrophy and lysis of myofibrils which were most pronounced at the periphery of the cardiomyocytes, near the capillaries. A similar condition of the microcirculatory vessels accompanies absolutely all types of cardiomyopathies, regardless of the genesis of the disease. Cell-stromal relationships on the background of chronic myocardial ischemia cause destructive processes of myocardial remodeling. The final morphological outcome of prolonged hypoxic heart damage can be focal dystrophy of the myocardium, which leads to the development of chronic heart failure and the appearance of life-threatening arrhythmias.

EXPRESSION OF CELL ADHESION MOLECULES AND COMPLEMENT RECEPTORS IN DIAGNOSTICS OF TRANSPLANTED HEART REJECTION

Aim. Characterization of the changes in expression of cell adhesion molecules and complement receptors in the transplanted heart rejection using computer morphometry to improve the quality of endomyocardial biopsy diagnostics. Materials and methods. Endomyocardial biopsies of 20 patients undergoing cardiac transplantation were used. Histological sections were stained using a standard procedure with hematoxylin and eosin, as well as an indirect immunohistochemical method with the ABC detection system against CD21 and CD31. The area of the positive reaction was estimated with computer morphometry. Results. All biopsies are divided according to the degrees of rejection as follows: degree 0R – 8 samples, 1R – 10 samples, 2R – 7 samples, 3R – 4 samples. CD21 expression is 0.31% in samples with 0R, 1.09% at 1R, 2R rejection of 2.01%, and for 3R – 4.15%. The area occupied by CD31-positive cells is 3.49% in 0R, at 1R rejection this index decreases by 1.3 times, in biopsy samples with 2R this index is 1.8 times less, and for samples with 3R it decreases by 2.6 times. Conclusion. Evaluation of CD21-positive cells in the myocardium allows us to predict cardiosclerosis, as well as a tendency to a chronic clinical course of the rejection. Expression of CD31 makes it possible to assess condition of the microcirculatory vessels in the graft, which is also important for the heart failure prevention.

MORPHOLOGICAL FEATURES OF INFLAMMATORY AND REACTIVE-DYSTROPHIC LESIONS OF THE MINOR SALIVARY GLANDS OF PATIENTS WITH DISEASES OF THE GASTROINTESTINAL TRACT

The authors conducted a histological study of biopsy a small salivary gland (SSG) in 12 patients with various diseases of the gastrointes-tinal tract. It was found that in SSG there were signs of chronic sialadenitis and sialadenosis, the latter being primarily expressed in parenchymal form. Sialadenosis and chronic sialadenitis had signs of dysfunction of sialocits, sclerosis and lipomatosis of the stroma and/or parenchyma, often with dilation of the ducts, lymphoid and lymphomacrophagal infiltration of the stroma and/or parenchyma. Noted that there was a pronounced of the plethora of microcirculatory vessels with edema of the stroma.

The no-reflow phenomenon: mechanisms and therapeutic targets

The phenomenon of «no-reflow» refers to a state of myocardial tissue hypoperfusion or absence of perfusion after eliminating the cause of the occlusion of the coronary artery. Two main pathogenetic mechanisms may contribute to the development of no-reflow phenomenon after primary percutaneous coronary intervention in patients with myocardial infarction: ischemic-reperfusion injury of the microcirculatory vessels and embolization of the distal arterial bed with fragments of thrombus and atherosclerotic plaque. In this review, we describe the pathophysiological mechanisms of no-reflow, risk factors for no-reflow phenomenon, the principles of diagnosis and therapeutic targets.

INDICATORS OF THE CARDIOMYOCYTES` CELLS CYCLE UNDER INFUSION OF BLOOD SUBSTITUTES AND IN THE CORRECTION OF EXPERIMENTAL BURN INJURY BY 0,9% NACL SOLUTION

According to the WHO, the thermal trauma is on the third place among other injuries. Burned injury is not only damage to the skin, but also the traumatization of all organs and systems of the body as a result of the stress response of the vascular system and the effects of toxic products coming from the area of burn injury. Firstly, such damages affect cardiomyocytes and the microcirculation vessels of the heart. The purpose of our study was to evaluate the changes in the cell cycle of myocardial cells in the left ventricle of rats under conditions of blood substitutes infusion and in the correction of experimental burn injury with a 0,9% solution of NaCl. The burn trauma was modeled using the Regas’ method and placed a catheter into the lower vena cava for intravenous infusion. The following solutions were used for infusion: 0,9% NaCl solution, lactoproteinum with sorbitol (Lactoproteinum-C) and colloidal-hyperosmolar HAES-LX-5% solution. Flow cytometry of the nuclear suspension of left ventricular cardiomyocytes was performed on the 1st, 3rd, and 7th days of the experiment. The statistical analysis of the results was carried out using the “STATISTICA 6.1” program package. The results of the performed study show a fairly stable picture of cell cycle parameters in myocardial cells of animals without burn injury with a predominance, on the one hand, of cells present in the G0G1 phase and the presence of a certain balance between the processes of creation of nuclear DNA synthesis and apoptosis. Changes in the phase of cardiac myocyte cell cycle against the background of the thermal injury of the skin throughout the observation time indicate a prolonged, uncorrected cell cycle disorder and a lack of effective normalization on the background of the physiological solution usage in the first 7 days after burning trauma of the skin. The protective effect of HAES-LX-5% prevents over-strain of cells, as evidenced by the lower synthetic activity of nuclei of cardiomyocytes at all times of the experiment.

A CASE OF DEVELOPMENT OF CARDIOGENIC SHOCK AFTER INTRA-ARTERIAL INJECTION OF PAPAVERINE DURING MEASURING OF FRACTIONAL FLOW RESERVE IN LEFT ANTERIOR DESCENDING ARTERY

Myocardial infarction complicated by cardiogenic shock is a rare but severe iatrogenic complication of invasive procedures. Damage of microcirculatory vessels; microcirculatory disorder, oedema of pericapillary tissues; embolization by microcrystals of contrast agent and platelet masses; inflammatory reaction in response to histamine release, dysfunctions of the heart’s autonomic nervous system cause “No-reflow” and “Slow-reflow” phenomena which leads to the development of pathological condition. In this case, a choice of interventions tactics depends on physician and is determined individually in each separate case, nevertheless the need of complete myocardial revascularization seems obvious.

Peculiarities of lymphocytes emigration from newborn thymus

Introduction. Mechanisms of mass lymphocytes’ emigration from thymus are still unclear. The process of lymphocytes migration and mechanisms, which provide it, form one of the important problems of immunomorphology.Aim of the work: to establish the peculiarities of newborn thymus structure and to reveal pathways and mechanisms which provide lymphocytes’ emigration from thymus.Materials and methods. Morphological, histological and histochemical analyses of 160 rats’ thymuses from birth up to the 7th day after birth were conducted and discussed. The animals were handled according to the European Commission Directive (86/609/EEC). The profound microscopic analysis of cell contents, lymphatic vessels morphology in morpho-functional areas of rats’ thymuses during the first week after birth in 4 hours interval was carried out. All quantitative results were estimated by the statistic methods.Results. It is settled that thymus specific density tightly depends on the quantity of degranulated mast cells, absolute quantity of microcirculatory vessels, especially of lymphatic ones. The index of specific density, lymphocyte-epithelial index change wavy during the first week after birth every 12 hours. These changes are followed by the changes of extracellular matrix structure, absolute quantity of small lymphocytes in thymic cortex and lymphocytes’ adhesive properties. The key periods are: from 0 till 2, from 12 till 16, and from 108 till 120 hours after birth. At that time discrete migration of lymphocytes from the thymus occurs through paravasal lymphatic vessels. After temporal edema reduction, lymphatic vessels turn to be empty, their quantity decreases.Conclusion. Therefore, emigration of lymphocytes from thymus takes place through lymphatic vessels on the top of periodical short-term local edema.

ХАРАКТЕРИСТИКА МЕТОДА АГРЕГАТОСКОПИИ ДЛЯ РЕГИСТРАЦИИ МИКРОРЕОЛОГИИ ЭРИТРОЦИТОВ

Введение. Две микрореологические характеристики определяют кровоток в системе сосудов микроциркуляции — агрегация и деформируемость эритроцитов. В подавляющем большинстве приборов для регистрации агрегации эритроцитов (АЭ) отсутствует визуализация процесса, и интерпретация данных основывается на его косвенных характеристиках. Материалы и методы. Проведено исследование АЭ на созданной установке — агрегатоскопе, получены данные регистрации картины АЭ с последующей обработкой изображения с помощью специальной программы для ЭВМ. Информативность полученных данных была проверена в сравнительных исследованиях с использованием агрегометра эритроцитов Myrenne M1 и теста СОЭ. Результаты. Получены значительные положительные корреляции (r=0,90 и r=0,86, соответственно). Показано, что агрегатоскоп дает четкую картину изменения АЭ (ее снижение) при инкубации эритроцитов с хелатором Са2+ (ЭДТА, верапамил, изобутилметилксантин, монафрам). В ответ на инкубацию с препаратами другой группы, известными как стимуляторы АЭ (CaCl2, ионофор А23187, фенилэфрин, простагландин F2α), был получен достоверный прирост агрегации. Заключение. Метод агрегатоскопии в сочетании с программной обработкой изображений является удобным и надежным инструментом оценки суспензионной стабильности крови и точным методом измерения важной микрореологической характеристики эритроцитов — их агрегации. Introduction. Aggregation and deformability of erythrocytes are two microrheological characteristics that determine the blood fl ow in microcirculation vessels. In large majority of devices for registration of erythrocyte aggregation (EA) there is no visualization of the process, and the interpretation of the data is based on its indirect characteristics. Materials and methods. EA investigation was carried out on the created unit — aggregatoscop. Data were obtained for registration of EA followed by image processing using a special computer program. Data informativeness was verified in comparative studies using erythrocyte aggregometer Myrenne M1 and erythrocyte sedimentation rate test. Results. Significant positive correlations were obtained (r=0,90 and r=0,86, respectively). It was shown that aggregatoscop gave a clear picture of EA changes (its reduction) during erythrocytes incubation with Са2+ chelator (EDTA, verapamil, isobutylmethylxanthine, monaphram). Reliable increasing of aggregation was obtained in response to incubation with other agents — EA stimulants (CaCl2, ionophore A23187, phenylephrine, prostaglandin F2α). Conclusion. Aggregoscopy method in combination with software image processing is a convenient and reliable tool for assessing of blood suspension stability and an accurate method for measuring of important microrheological characteristics of erythrocytes — their aggregation.

Морфологічні особливості кровоносних судин тимуса новонароджених телят

The blood vessels of thymus of newborn calves were studied by using a complex of histological methods and methods of injection of blood vessels. Calf thymus gland is an unpaired organ consisting of a pair of cervical, unpaired cervical and thoracic lobes. Radiating insertions (septa) extrude from the capsule, dividing organ on lobules. Stroma (6.53 ± 2.33%) consists of loose connective tissue. The base of the lobules is formed by a lymphoid tissue (epithelial with cells of the lymphoid series). The area of the parenchyma of the diurnal calves’ thymus is 80.57 ± 3.46%. The thymus lobes consist of cortex (57.97 ± 3.38%) and medulla (22.60 ± 2.71%). There are concentric, nest-like bodies called Hassall's corpuscles in the medulla. The blood vessels of the thymus are interlobular and intralobular. Interlobular arteries are a continuation of extraorganic arteries. The diameter, caliber and thickness of the wall of arteries and veins, as well as microcirculatory vessels are different, which is due to functional activity. Some blood vessels branch out in the interlobular stroma, while others penetrate into the lobules, where they branch into microcirculatory vessels. In the cortex the blood vessels are radially branched, and in the medulla they form polygonal plexuses. Blood vessels of the thymus are represented by arteries, veins and microcirculatory vessels. The parameters of the wall of intralobular vessels are less than interlobular. The total area of the blood vessels of the thoracic part of the thymus is 12.89 ± 0.97%, interlobular – 4.28 ± 0.61% and intralobular – 8.61 ± 0.54%. The area of interlobular arteries is 11.71 ± 0.41%, which is slightly smaller than the area of interlobular veins (19.09 ± 0.86%).Microcirculatory vessels occupy the smallest area – 2.33 ± 0.05%. The area of intralobular arteries (9.60± 0.83%) is less, and the veins (22.08 ± 0.45%) are larger than interlobular. Microcirculatory vessels occupy the largest area in the lobe – 35.14 ± 0.88%. The wall of arteries and veins consists of intima, media and adventitia. Microcirculatory vessels are represented by arterioles, precapillaries, capillaries, postcapillaries and venules. The wall of arterioles consists of an intima, which is formed by endotheliocytes on the basement membrane, a media, which is made up principally of smooth (involuntary) muscle cells and elastic fibers arranged in roughly spiral layers, and an adventitia. The structure of the precapillary wall is similar to such in arterioles, but only single smooth muscle cells are in the media. The wall of capillaries and venous section of microcirculatory vessels are formed by endotheliocytes and the basement membrane.

Hemodynamic effects of short-term hyperoxia after coronary artery bypass grafting

BackgroundAlthough oxygen is generally administered in a liberal manner in the perioperative setting, the effects of oxygen administration on dynamic cardiovascular parameters, filling status and cerebral perfusion have not been fully unraveled. Our aim was to study the acute hemodynamic and microcirculatory changes before, during and after arterial hyperoxia in mechanically ventilated patients after coronary artery bypass grafting (CABG) surgery.MethodsThis was a single-center physiological study in a tertiary care ICU in the Netherlands. Twenty-two patients scheduled for ICU admission after elective CABG were enrolled in the study between September 2014 and September 2015.In the ICU, patients were exposed to a fraction of inspired oxygen (FiO2) of 90% allowing a 15-min wash-in period. Various hemodynamic parameters were measured using direct pressure signals and continuous arterial waveform analysis at three sequential time points: before, during and after hyperoxia.ResultsDuring a 15-min exposure to a fraction of inspired oxygen (FiO2) of 90%, the partial pressure of arterial oxygen (PaO2) and arterial oxygen saturation (SaO2) were significantly higher. The systemic resistance increased (P < 0.0001), without altering the heart rate. Stroke volume variation and pulse pressure variation decreased slightly. The cardiac output did not significantly decrease (P = 0.08). Mean systemic filling pressure and arterial critical closing pressure increased (P < 0.01), whereas the percentage of perfused microcirculatory vessels decreased (P < 0.01). Other microcirculatory parameters and cerebral blood flow velocity showed only slight changes.ConclusionsWe found that short-term hyperoxia affects hemodynamics in ICU patients after CABG. This was translated in several changes in central circulatory variables, but had only slight effects on cardiac output, cerebral blood flow and the microcirculation.Clinical trial registration Netherlands Trial Register: NTR5064

INFLUENCE OF THE COMBINATION DRUG PRESTANS (PERINDOPRIL A, AMLODIPINE) ON MORPHO-FUNCTIONAL PARAMETERS OF ARTERIAL BED IN ESSENTIAL HYPERTENSION

Aim. Recently, the problem of endothelial dysfunction is in high interest. It was proved that microcirculatory disorders play main role in development and progression of target organ damage in essential arterial hypertension (EAH). Microcirculatory bed itself should be the target of EAH. Modern antihypertension drugs, despite of normalization of blood pressure (BP), should fulfill the prevention of target organ damage. In our study, the influence was evaluated, of treatment with the fixed combination of perindopril A and amlodipine (Prestans®, “Les Laboratoires Servier”, France) on structural and functional parameters of the heart and vessels. Material and methods . In the study, 30 patients with grade II-III EAH included, mean age 54,12±9,15 y.o., duration of EAH — 12,6 (4;21) years. For the assessment of endothelial function and structural and functional condition of capillary net of a finger skin, photopletysmography were applied and videocapillroscopy, respectively. Results . Therapy with Prestans® led to improvement of functioning of the middle sized vessels and microcirculatory vessels (MC) (increase of occlusion index on MC level from 1,5 to 1,8, p&lt;0,006); on the large vessels level led to phase shift from 6,0 to 10,3 (р&lt;0,00005). There was influence of Prestans® on the parameters characterizing vascular bed remodelling on the levels of cappilars: density of capillary net in the skin at rest (cap/mm 2 ) increased from 47 cap/mm 2 to 51 cap/mm 2 (р&lt;0,00005), and the density of capillar net after venous occlusion test — from 53 cap/mm 2 to 60 cap/mm 2 (р&lt;0,006). Conclusion. Prestans® is a medication of choice not only for AH treatment, but for prevention of target organs damage, that is based on correction of endothelial dysfunction and morphofunctional parameters at the level of MC.

МОРФОФУНКЦИОНАЛЬНЫЕ ИЗМЕНЕНИЯ СОСУДОВ МИКРОЦИРКУЛЯТОРНОГО РУСЛА МИОКАРДА ГИПЕРТЕНЗИВНЫХ КРЫС ПРИ СТРЕССЕ

МОРФОФУНКЦИОНАЛЬНЫЕ ИЗМЕНЕНИЯ СОСУДОВ МИКРОЦИРКУЛЯТОРНОГО РУСЛА МИОКАРДА ГИПЕРТЕНЗИВНЫХ КРЫС ПРИ СТРЕССЕ

ETIOLOGICAL STRUCTURE AND DIFFERENTIAL DIAGNOSTICS OF SALMONELLOSIS OF BIRDS

The article presents the results of a study of the etiological structure and differential diag-nostic signs of avian salmonellosis. When identifying bacteria isolated from 128 blood samples of chickens with the use of rapid test "Salmonella latex kit" established the dominance of cultures of the microorganisms Salmonella spp. - of 10.94% (14 samples); 10 strains (71,43%) were attributed to Salmonella gallinarum, 4 (of 28.57%) to Salmonella pullorum. The overall level of resistance of Salmonella to ampicillin - 57,58%; tetracycline - 60,61%; streptomycin - 66,67%; had to 57,58%; 60,61% and 66,67% are sensitivity to norfloxacin amounted to 69,70%, to ceftazidime - 78,79%, enrofloxacin - 57,58%, ciprofloxacin - 69,70% of the tested strains. At postmortem examination the most frequently detected signs of pericarditis, hemorrhagic pneumonia, aeroscout, catarrhal-hemorrhagic enteritis, perihepatitis, hyperplasia of the spleen. The most frequently detected signs of pericarditis, aeroscout, catarrhal-hemorrhagic gastroenterocolitis, perihepatitis, inflam-mation of the ovaries, hyperplasia of the spleen. Revealed signs of congestive hyperemia, macrophage reaction, hyperplasia and plasmocytomas of lymphocyte transformation, increase the permeability of microcirculatory vessels, lymphoid-cellular infil-tration of loose fibrous connective tissue, perivascular oedema, disseminated thrombosis, proliferation of lymphocytes from lymph nodes, spleen, liver, and pancreas. In violation of the porosity of the blood vessels of serous membranes of organs were observed extensive serous oedema, the output of the formed elements of blood and the loss of fibrinogen.

Peripheral circulation indicators in veteran trail runners.

[Purpose] Competitive sport places strict demands on the cardiovascular systems of veteran trail runners. Our research objective was to evaluate the dynamics of microcirculation parameters of veteran runners in hypoxic and mid-altitude conditions. [Subjects and Methods] Seven male runners from Russia and Italy between the ages of 50 and 60 years were examined whilst competing at mid-altitude (1,500–2,000 m above sea level). The same runners were examined in a simulated mid-altitude hypoxic environment, which was a hypoxic chamber with 16% oxygen concentration, for 720 minutes. Under both conditions, peripheral circulation was studied using a laser Doppler flowmeter attached to the distal phalange of the second finger of the subject’s right hand. All subjects had a microcirculation parameter assessed, which was the standard deviation of the erythrocytes flow vibration in peripheral circulation, under both conditions. In order to assess the intensity of vasomotor reactions of the microcirculatory vessels, the coefficient of variation was used. [Results] In the hypoxic environment, a decrease in the microcirculation parameter was noted in the short-term (360 minutes), with a subsequent compensatory increase in the long-term (720 minutes). However, the coefficient of variation showed a reverse trend with an increase in the vasomotor activity of microvessels from 12.4% to 18.2% at the stage of maximum training load within one month in the mid-altitude in the hypoxic environment, with a consequent reduction in preparation for the start. [Conclusion] In the hypoxic environment, the subjects demonstrated a two-stage change in the dynamics of the microcirculation parameter: an initial fall and a subsequent increase reaching the initial values. Similar changes were found when subjects were competing at mid-altitude. Our results show that the assessment of the peripheral circulation in a simulated mid-altitude hypoxic environment can be used to determine the readiness of veteran sportsmen for long-term trail running in mid-altitude conditions.

Peculiarities of Reparative Osteogenesis of Injured Thoracic and Lumbar Vertebral Bodies at Different Terms after Trauma

The analysis of the results of morphologic examination of vertebral body bone tissue obtained intraoperatively from 43 patients (20 - 67 years) with thoracic and lumbar spine injuries at different terms after trauma was performed. All patients were operated on via anterior approach to create ventral fusion. In the examined serial samples of vertebral body structures the quality and regeneration potential of bone tissue were assessed. It was shown that cell differentiation during the osteogenesis process was closely associated with angiogenesis. In the zones with active growth of microcirculatory bed vessels the normal cycle of osteoblast and osteocytes took place while hypoxia and acidosis resulted in pathologic osteogenesis. In patients under 50 years, both males and females) the full value consolidation time averaged 5 months. In patients over 50 years, independently of the gender, the decrease of spongy structures volume and bone mineral density was observed. The recommendations on surgical treatment tactics of patients with thoracic and lumbar vertebral body injuries were given.

Peculiarities of Reparative Osteogenesis of Injured Thoracic and Lumbar Vertebral Bodies at Different Terms after Trauma

The analysis of the results of morphologic examination of vertebral body bone tissue obtained intraoperatively from 43 patients (20 - 67 years) with thoracic and lumbar spine injuries at different terms after trauma was performed. All patients were operated on via anterior approach to create ventral fusion. In the examined serial samples of vertebral body structures the quality and regeneration potential of bone tissue were assessed. It was shown that cell differentiation during the osteogenesis process was closely associated with angiogenesis. In the zones with active growth of microcirculatory bed vessels the normal cycle of osteoblast and osteocytes took place while hypoxia and acidosis resulted in pathologic osteogenesis. In patients under 50 years, both males and females) the full value consolidation time averaged 5 months. In patients over 50 years, independently of the gender, the decrease of spongy structures volume and bone mineral density was observed. The recommendations on surgical treatment tactics of patients with thoracic and lumbar vertebral body injuries were given.

The Importance of Perfusion Assessment for Determination of Functional Sufficiency of Myocardium

Myocardial vascular bed is represented by a network of arterial and venous vessels as well as microcirculatory vessels including arterioles, precapillaries, capillaries, postcapillaries, venules, and arteriolo-venular anastomoses. Myocardial capillaries are an exchange link providing perfusion of the myocardium with nutrients therefore sufficiency of the capillary circulation ensures the adequacy of metabolic processes in the cells of the heart muscle. There is no consensus among physicians of various specialties on the methodology of assessing coronary blood flow and blood supply to the myocardial tissue. The lack of universality and unity on measuring units, methods, and classification results in contradictions, both in defining approach to treatment strategy and to assessment of treatment effects. Currently, it is necessary to develop a common approach to assessment of coronary perfusion, which would allow to unify the criteria of sufficiency of blood supply to the heart and activity of metabolic processes in the myocardium. It is necessary to determine parameters of studying changes of myocardial vascular bed, closely related to metabolic processes in muscle tissue of the heart.

The Treatment of Infected Femoral Artery Pseudoaneurysms Secondary to Drug Abuse: 11 Years of Experience at a Single Institution

The purpose of our study is to analyze the methods of treating infected femoral artery pseudoaneurysms (IFAPs), and also to identify the most appropriate method, especially for patients with a long history of drug abuse. A retrospective chart review of 88 consecutive IFAPs secondary to drug abuse between 2003 and 2014 was performed. Outpatient clinic charts were reviewed, as well as inpatient and anesthesia records. All patients had undergone a computer tomography angiography or contrast computer tomography to confirm their diagnosis. Routine blood tests were performed. The treatment methods included common femoral artery ligation (CFA) along with local debridement and drainage, direct oversewing, and amputation. A clamping test of the distal external iliac artery (EIA) or the common femoral artery was performed after vessel isolation, during which the oxygen saturation of the blood at the end of the affected limb was examined with a continuous pulse oximeter. Skin samples from affected limbs were tested with hematoxylin and eosin (HE) stain. There were a total of 88 patients, of which 79 and 9 came from emergency and outpatient, respectively. Acute hemorrhage at the injection site, pulsatile mass, septic syndrome, and necrosis were present in 65, 14, 8, and 1 patients, respectively. All patients experienced groin pain. Thigh or leg swelling was present in 63 patients. The drug injection history was a mean 6.9±4.1years. Seventy-four patients presented with anemia and 75 patients presented with hypoproteinemia. Hepatitis B, hepatitis C, syphilis, and HIV were found in 42, 57, 12, and 2 patients, respectively. One patient gave up the treatment. One patient was treated by amputation along with CFA ligation and local debridement because the limb was necrotic on admission. Three patients with short drug injection abuse history and local slight infection were treated by direct oversewing. Eighty-three patients, of which 27 had a drug injection history shorter than 5 years and 56 patients longer than 5 years, were treated by CFA ligation and local debridement. All patients' oxygen saturation of the affected limbs was higher than 90% after distal EIA clamping test and ligation, except the amputation patient. None of these required amputation. One patient, whose injection history was only half a year, underwent an operation for acute ischemic performance. Forty patients had differing degrees of lymph extravasations and were treated by injecting 70% methylated amine diatrizoate. HE stain showed that there were an abundant of microcirculation vessels in IFAP patients. The mean follow-up period was mean (26±14) months from 3 months to 61months. In the group with a history shorter than 5 years, 10 patients had mild claudication in the first 3 months and then relieved from 6 months. However, in patients with a history longer than 5 years, no case presented claudication. Many of them admitted to drug abuse after surgery and rehabilitation. The appropriate and tolerated treatment for most IFAP is arterial ligation, particularly in patients with an injected drug history longer than 5 years. Primary repair may be adopted for special IFAP patients with short drug injection history and limit infection to avoid severe ischemia complication. Medical staff should take strict precautions and protection measures.