State Of Microcirculation Research Articles

About relationship of polymorphisms of the VEGFA 634C>G and MMP9 8202A>G genes with endothelial dysfunction markers and state of the microvasculature in diabetes mellitus

Introduction . Diabetes mellitus is one of the most common diseases in the world. In 4–25 % of patients with this pathology, diabetic foot syndrome develops, leading to a large number of amputations accompanied by postoperative mortality. Aim . To assess the relationship of polymorphisms of the VEGFA 634 C˃G and MMP9 8202 A˃G genes with markers of endothelial dysfunction and state of the microvasculature in diabetes mellitus. Materials and methods . In 198 people with uncomplicated diabetes mellitus and 199 people with diabetic feet, polymorphisms 634 C˃G of the VEGFA gene and 8202 A˃G of the MMP9 gene were studied by polymerase chain reaction. The content of endothelin 1, NO 2 and NO 2 – /NO 3 – , MMP 9 and state of microcirculation at three points were studied by laser Doppler flowmetry in 30 people from each group, comparable in frequency of the indicated gene polymorphisms. Results . The frequency of polymorphisms of genes VEGFA 634 C˃G, MMP9 8202 A>G did not differ in the groups of patients. In diabetic feet, a decrease in the total perfusion index by 1.4, 1.8 and 1.5 times was recorded at three points. At a point on the forearm with a diabetic foot, a 1.6-fold decrease in the temporal variability of perfusion was revealed; at the dorsum and first toe of the foot, a decrease in the coefficient of variation by 1.7 and 1.5 times was revealed. In patients with different variants of the course of diabetes mellitus, there were no differences in the levels of endothelin-1, NO 2 and NO 2 – / NO 3 – , MMP 9. Conclusion . Polymorphisms of the VEGFA 634 C˃G, MMP9 8202 A˃G genes in different variants of the course of3 – diabetes mellitus correlate with indicators of general state of the microvasculature. The parallelism of changes in the content of endothelin 1, MMP 9 and polymorphic variants of the MMP9 8202 A˃G gene indicates a deep remodeling of the vasculature, which may be an important link in the pathogenesis of the development of complications of diabetes mellitus.

Skin microcirculation in patients with arterial hypertension and in patients with a combination of arterial hypertension and type II diabetes mellitus

Introduction . Common combination of arterial hypertension (AH) with type 2 diabetes mellitus (DM2) which has a negative impact on the incidence and prognosis of coronary artery disease (CAD) imposes a requirement to study their interdependent effects, primarily at the microcirculation (MC) level. Aim. To study peculiarities of functional state of skin MC in patients with a combination of AH and DM2 compared to patients with AH. Materials and methods . Two groups of patients were examined: group 1 (n=66) – patients with a combination of AH and DM2, and group 2 (n=93) – patients with AH. Skin MC was assessed by laser Doppler flowmetry. Basal blood flow, amplitude-frequency spectrum of its oscillations, occlusion indicators, and incidence of various hemodynamic MC types were assessed. Results . In patients with a combination of AH and DM2, progressive deterioration of MC indicators was detected, compared to patients with AH without DM2. Statistically significant differences were revealed in more pronounced tone of the precapillary segment of the microvascular bed (myogenic tone 60.5 [37.4; 83.6] vs 49.1 [31.3; 61.0] units; р=0.014). Impaired function of active blood flow control mechanisms with increase in the role of passive regulation factors was found, as evidenced by lower modulation index (1.3 units in group 1 vs 2.8 units in group 2). In patients with a combination of AH and DM2, there were detected the strengthening of arterio-venous shunts bypassing the capillary bed and blood flow productivity reduction (increase in indicator of bypass grafting up to 1.6 [1.0; 2.1] units) compared to patients with AH and without DM2 up to 1.2 [0.8; 1.5] units; р=0.037), limitation of vasodilation blood flow reserve which amounted to 173.4 % [135.3; 195.4] vs 184.9 % [166.1; 231.3] (р=0.025). Conclusion . More significant changes in microhemocirculation were registered in patients with a combination of AH and DM2 compared to patients with AH. It was characterized by constriction of the microvascular bed precapillary segment with restriction of capillary blood flow, strengthening of arterio-venous shunts bypassing with formation of venous congestion, and reduction of MC reserve potential.

The state of microcirculation and identification of microcirculatory predictors of chronic pain in younger patients with functional disorders of the masticatory system affected by connective tissue dysplasia

Relevance. Occlusal splints, made for the patients with temporomandibular disorders (TMD), influence proprioceptive sensitivity, sensory characteristics of pain, parameters of microcirculation of the pulp and periodontium of the healthy teeth. Condition of the pulp and periodontium of the healthy teeth should be assessed in patients with TMD associated with connective tissue dysplasia (CTD).Materials and methods. The study examined 36 TMD patients aged 26.3 ± 1.3 лет (М ± m) with CTD (n = 20, main group) and without CTD (n = 16, control group); with natural teeth, without complaints of TMD, masticatory muscles and periodontal condition. Laser doppler flowmetry (LDF) helped to analyze blood flow parameters in the periodontium and pulp of the healthy teeth. Received results were statistically analyzed.Results. Wavelet analysis revealed different microcirculatory flowmotion: high-amplitude irregular type was in patients of the main group, low-amplitude regular type was in controls. In the main group, perfusion is supported by high values of flux and vasomotion, ergotropic sympathetic effects (controlled by catecholamines) prevail, myogenic tone is reduced, elevated microvascular tone reflects possible changes in rheologic blood properties, microcirculatory signs of pain syndrome and relatively elevated ischemic index in pulp microcirculation of healthy teeth.Conclusion. Sensory and regulatory mechanisms, reflected by the condition of periodontium and pulp blood flow, can be regarded as early signs of inflammation and chronic pain in the diagnosis of TMD in patients without complaints.

The Form of Erythrocytes and Laser Doppler Flowmetry of Skin with ACNE and Use of Medication FarGALS in its Comprehensive Treatment

Using the express method of a thick smear and morphometry, the state of erythrocytes obtained from theacne and finger region has been studied. Using laser Doppler flowmetry, the state of microcirculation of theskin of the finger and the acne location area has been studied.It has been found out that comprehensive treatment with the use of FarGALS promotes the reduction inblood of pathological forms of erythrocytes and the restoration of microcirculation parameters.

Possibilities of Laser-Doppler Flowmetry in assessment of functional state of microcirculation

Aim . In the present study we evaluate the amplitude-frequency spectrum patterns of the relatively healthy individuals using the laser Doppler flowmetry with simultaneous registration of micro-flow in five points and application of orthostatic sample. Materials and methods . 144 healthy volunteers (69 women, 45 men) from 18 to 40 years old (the average age is 26±6) in a good physical condition were included in the exploration. The mobile flowmeters LAZMA-PF (Russia) was used to record blood flow. All patients were carried out by laser Doppler flowmetry with the use of orthostatic test. Measurements were recorded at the same time in five points (medial overhead areas, inner surface of forearms, overhead area). Results . We observed typical patterns of amplitude-frequency spectrum in the regions of arcs of aorta and upper hollow vein, as well as descending aorta and lower hollow vein. The changes are due to the body position alteration. By the monitoring blood flow in the upper extremity and the supercilium regions the spectral harmonic of the myogenic range (0.047–0.145Hz) dominated in the clinostatic position and the harmonic of the neurogenic range (0.02–0.046 Hz) was less noticed. In the signal spectrum obtained from the lower limbs the harmonic of the neurogenic range (0.02–0.046 Hz) dominated and the harmonic of the myogenic range (0.047–0.145Hz) was less noticed. In the orthostatic position in the region of upper extremities and supercilium, the harmonic amplitude of the neurogenic range increased regarding to the amplitude of the myogenic spectrum, and in the region of lower extremities, the harmonic amplitude of the myogenic range increased regarding to the amplitude of the neurogenic range. Conclusions . Using of the several sensors in the different body parts by the same time is improving the technique relevance. The healthy volunteers showed the typical patterns of slow wave part of ACS in the upper and lower parts of the body in clinostatic and orthostatic positions. The body position changing is reversing the patterns in the upper and lower body parts. Getting the postural test allows to assess the integrity of regulation mechanisms of microcirculation. The method used and the results need further investigation to determine the possibility to detect the functional and pathological changes, as well as compensatory possibilities of microcirculation in normal and in pathology.

Microcirculatory effects of systemic metabolic correction with reactive oxygen species: An experimental study

Introduction: The purpose of this study is to estimate microcirculation changes under systemic (intraperitoneal) administration of ozonized saline.
 Methods: For this study, we formed four equal groups of Wistar male rats (n = 10 per group). Rats of first (control) group was intraperitoneally injected with non-ozonized sterile saline solution (daily administration volume — 1 ml.) during 30 days. Animals of other groups (n = 10 for second, third and fourth groups) received 30 intraperitoneal infusions (1 ml/day) daily with ozonized saline solution (saturating ozone concentration for indicated groups — 3000, 10000 and 40000 mcg/l, ozone dose per procedure — 0.75, 2.5 and 10 mcg, respectively). Technology of the Laser Doppler Flowmetry (LDF) along with ``LAKK-02'' device (Moscow, Russia) was used for complex estimation of skin microcirculation state. This technology allows us to study blood flow intensity in skin microvessels at the first and thirty-first days of the experiment. We also can estimate regulatory mechanisms of microcirculation support and the presence of shunt paths of the microcirculation.
 Results: We studied the dose-dependent response of microcirculation on ozone infusions in chronic experiments. We found that long-lasting course (30 procedures) of intraperitoneal administration of ozonized sodium chloride solution provides an increase in the level of microcirculation index compared to that of the control (injections of nonozonized saline solution), regardless of the applied dose of ozone. At the same time, the level of the microcirculation response was directly determined by the introduced amount of ozone, and we fixed non-linear dependence on it. Our study allowed us to show that only low doses of ozone (0.75 mcg/day) have proadaptive effects on the microcirculatory bed. This was shown both in the dynamics of the microcirculation index and the state of regulatory mechanisms. Middle ozone dose (2.5 mcg/day) also caused the stimulation of blood flow in small vessels, though this was predominantly through other mechanisms (neurogenic components). The most negative reaction of microcirculation was observed for high ozone dose (8 mcg).
 Conclusion: Despite the activation of microcirculation observed in this case, we have identified that the mechanism was primarily through the respiratory component regulation and via formation of "steal syndrome" in the tissue.

CARDIORESPIRATORY SYSTEM AND ANTIHYPOXIC RESISTANCE STATE IN ELDER CORONARY HEART DISEASE PATIENTS

The aim of the study. Evaluation of cardiorespiratory system and microcirculation state in elder CHD patients with different resistance against hypoxia. Methods. The author has carried out a retrospective analysis of 103 CHD 60+-patients, their deaths have occurred due to cardiovascular events. Two patient groups have been formed including patients (68 persons) having kept their resistance to hypoxia (their blood SO2 level was never below 80 %) and patients (35 ones) with decreased resistance to hypoxia, their blood SO2 level having been dropped below 80 %. Results: The life span of patients with decreased hypoxia resistance is lower comparing to ones having kept such resistance. The patients with decreased hypoxia resistance demonstrate decreased ejection fraction, increased mass of left ventricle myocardium as well as increased left ventricle volumes. Such patients show also significant increase of mean daily values of systolic, diastolic, and mean arterial pressure. Generally, the micro-circulation state in patients with decreased anti-hypoxic resistance is lower comparing to persons having kept this resistance. Simultaneously, the endothelial function of persons with decreased anti-hypoxic resistance is significantly worse. The pulmonary ventilation system patency and bronchial patency in these persons are also lowered comparing to these indices in patients with kept anti-hypoxic resistance. Conclusions: The decrease of anti-hypoxic resistance leads to the shorter life span on elderly CHD patients. Such decreased resistance is accompanied by worsened potency of cardio-respiratory system, microcirculation, and endothelial system functioning.

FEATURES OF CAPILLARY BLOOD FLOW IN PATIENTS WITH PATHOLOGY OF INTRANASAL STRUCTURES AND NASAL BREATHING DISORDERS

The investigation of the vascular microcirculation system is important for diagnosis, assessment of the severity and nature of pathological processes in human body, monitoring the effectiveness of treatment. Monitoring the state of microcirculation in impaired respiratory function of the nose helps to study the subtle mechanisms of regulation of vascular−tissue relations. To do this, there were used the biomicroscopic methods to study capillary blood flow, one of the most relevant and promising is optical capillaroscopy of the nail bed. This method makes it possible to identify at the evidence level the peculiarities of the functioning of the peripheral circulatory system by the state of the capillary system and to evaluate the effectiveness of treatment by the rheological properties of blood in hematological practice. There were examined 145 patients by means of computer capillaroscopy to study the rate of capillary circulation in the patients with pathology of intranasal structures and nasal breathing disorders. All patients underwent a complete clinical examination, routine instrumental examinations, and computer capillaroscopy using a video capillaroscope with a visual magnification of up to 550 times. The obtained images were stored and processed according to a special software. During the characterization of the capillaroscopic picture there were evaluated: pathological tortuosity, change in the caliber of arterioles and venules, disorganization of the capillary network, the number of functioning capillaries. Changes in the speed and nature of capillary blood flow (accelerated, slow, stasis) were observed. The optical capillaroscopy method allows not only to visually assess the condition of microvessels, but also to determine such an important parameter as blood circulation, actually, it can replace the study of laser Doppler. Such data will be important in the diagnosis of respiratory and olfactory disorders and the formation of adequate tactics for their treatment. Key words: microcirculation, microcirculatory tract, capillary circulation, nasal obstruction, nasal breathing disorders, pathology of intranasal structures, computer capillaroscopy.

Risk factors for the progression of chronic generalized periodontitis in women during menopause

Relevance. The global trend associated with increasing life expectancy leads to an augmentation of the frequency of diseases and conditions associated with the cessation of estrogen production. Hormonal changes in the female body, which lead to changes in the mineral density of bone tissue, microcirculation, and immune status, create prerequisites for the destruction of target organs, including periodontal tissues. The highest prevalence of periodontal pathology is observed against the background of estrogen deficiency, especially during menopause. The multifactorial nature of the Association of pathologies that develop against the background of estrogen deficiency requires further study. Purpose. Assessment of the contribution of various pathogenetic factors to the progression of oral pathology in women in the period of reproductive aging. Materials and methods . The paper uses the results obtained during the examination of 73 patients with chronic generalized periodontitis at various stages of menopause with an assessment of the level of reproductive hormones, endothelial dysfunction, major periodontogens, and local immunity. Results. An increase in the duration of menopause leads to the formation of endothelial dysfunction, increased destruction of periodontal bone tissue, and local immunosuppression. Conclusion. The progression of periodontal diseases in menopause depends on many factors, including estrogen deficiency, violations of local and general blood supply, immunity disorders and microbial flora.

Состояние микроциркуляторного русла у больных с ремиттирующим течением рассеянного склероза

Состояние микроциркуляторного русла у больных с ремиттирующим течением рассеянного склероза

Increasing Transcutaneous Oxygen Pressure in Patients With Neuroischemic Diabetic Foot Ulcers Treated With a Sucrose Octasulfate Dressing: A Pilot Study.

Regarding the positive clinical outcomes of sucrose octasulfate impregnated dressing documented in neuroischemic diabetic foot ulcers (DFUs), we aimed to evaluate the microcirculatory status in patients with neuroischemic DFU through the use of sucrose octasulfate dressing. Eleven patients with neuroischemic DFU were included in a prospective pilot study between July 2019 and March 2020. We evaluated the effect in transcutaneous oxygen pressure (TcPO2; mm Hg) values within the use of a sucrose octasulfate dressing in the course of the healing process of neuroischemic DFUs (UrgoStart Contact, Laboratoires Urgo Medical). TcPO2 values were assessed at day 0 and monthly until wound healing was achieved. Additionally, wound healing process was evaluated using the Wollina score system and wound area surface, at day 0 and monthly until 20 weeks of follow-up or wound healing first occurred. TcPO2 values showed a significant increase between day 0 (29.45 ± 7.38 mm Hg) and wound closure (46.54 ± 11.45 mm Hg, P = .016), after dressing application. Wollina wound scores showed a significant improvement (4.2 ± 1.7 at day 0 to 5.4 ± 1.3 at the end of the study; P = .004). Median wound area at day 0 was 1.30 cm2, interquartile range [1.60-1] cm2, and 0.5 cm2 at week 4, interquartile range [1.1-0.1], P < .001. Median healing time was 8 weeks, interquartile range [8-5]. Treating a neuroischemic DFU with a sucrose octasulfate dressing in the standard of care showed an increase in skin oxygen pressure.

Association of Urinary Albumin:Creatinine Ratio with Outcome of Children with Sepsis.

ABSTRACTObjectiveThe aim of the study was to investigate the association of urinary albumin:creatinine ratio (ACR) with regard to the outcome of sepsis patients and to study the trends of ACR with severity of disease, organ dysfunction, microcirculation status, the use of inotrope, and mechanical ventilation use, and length of pediatric intensive care unit (PICU) stay.Materials and methodsIn the prospective observational study, the patients with varying categories of sepsis admitted in the PICU with stay >24 hours were enrolled consecutively. Urine samples were collected at the time of admission (ACR1), 12 hours (ACR2), and 24 hours (ACR3).ResultsOne hundred and thirty-eight patients including 56 cases of sepsis, 31 of severe sepsis, 22 of septic shock, and 29 of multiorgan dysfunction syndrome (MODS) cases were analyzed. There were 29 (21%) deaths. ACR (median, IQR) was significantly higher in nonsurvivors [ACR1 198.9 (111.2–329.4) vs 124.5 (59.37–294.5), p 0.03], [ACR2 213.8 (112.5–350) vs 117.8 (62.6–211.9) p 0.008], [ACR3 231.8 (99.9–441.2 vs 114.4 (44.1–240.3), p 0.005]. The ACR is increased progressively with the increasing severity of sepsis (p < 0.001). The performance of ACR operative characteristics was compared with that of PRISM and PELOD scores. In deceased, ACR was significantly correlated with blood pH, lactate, and base deficit. A cutoff value of ACR 102.7 mg/g had sensitivity 86.2%, specificity 40.4%, positive predictive value 27.8%, and negative predictive value 91.7%. The use of inotropes, mechanical ventilation (>48 hours), and mortality was significantly higher in patients with ACR >102 mg/g. The probability of death varied from 17.6 to 19% in the first 24 hours of admission. ACR was significantly cheaper as compared to PRISM score and PELOD score estimations.ConclusionUrinary ACR, a cost-effective tool, correlates with the severity of sepsis and associated morbidity and mortality in children.How to cite this articleSachdev A, Raheja K, Gupta N, Chugh P. Association of Urinary Albumin:Creatinine Ratio with Outcome of Children with Sepsis. Indian J Crit Care Med 2020;24(6):465–472.

Effects of Systemic Hypothermia on Microcirculation in Conditions of Hemodynamic Stability and in Hemorrhagic Shock.

Although hypothermia is independently associated with an increased mortality in trauma patients, it might be an effective therapeutic approach for otherwise lethal hemorrhage. The effect of hypothermia on microcirculation, however, has been poorly studied in this setting. Our goal was to characterize the effects of hypothermia on microcirculation in normal conditions and in severe hemorrhagic shock. In anesthetized and mechanically ventilated sheep, we measured cardiac output (CO), renal blood flow (RBF), and systemic and renal O2 consumption (VO2). Cortical renal, intestinal villi, and sublingual microcirculation was assessed by IDF-videomicroscopy. After basal measurements, sheep were assigned to hypothermia (n = 12) and normothermia (n = 12) groups. Central temperature was reduced to ∼34°C and maintained at baseline in each group, respectively. Measurements were repeated after 1 h of hemodynamic stable conditions and 1 h of severe hemorrhagic shock. In conditions of hemodynamic stability, the hypothermia group showed lower CO, RBF, and systemic and renal VO2 than the normothermia group. Red blood cell velocity was also lower in renal, villi, and sublingual microvascular beds (836 ± 195 vs. 1,066 ± 162, 916 ± 105 vs. 1051 ± 41, and 970 ± 182 vs. 1,102 ± 49 μm/s, respectively; P < 0.0001 for all). In hemorrhagic shock, most of the microvascular variables were similarly compromised in both the groups. In hypo- and normothermia groups, the percentage of reduction in perfused vascular density was higher in renal than in intestinal and sublingual microcirculation (66 ± 31 vs. 31 ± 23 and 15 ± 15%, and 78 ± 26 vs. 32 ± 37 and 18 ± 21%, P < 0.01 for both). This is the first experimental study assessing the effect of systemic hypothermia on microcirculation in severe hemorrhagic shock. The main finding was that hypothermia did not hamper additionally the microcirculatory derangements induced by hemorrhagic shock. In addition, renal microcirculation was more susceptible to hemorrhagic shock than villi and sublingual microcirculation.

Angiotensin-(1-7) Treatment Restores Pancreatic Microcirculation Profiles: A New Story in Acute Pancreatitis.

The aim of this study was to investigate the changes of pancreatic microvascular vasomotion and blood distribution pattern in acute pancreatitis (AP), and whether Angiotensin (Ang)-(1-7) treatment could restore pancreatic microcirculation profiles. Mice were randomly separated into control, AP, and Ang-(1-7)-treated AP (A-AP) group. Acute pancreatitis was induced in mice by intraperitoneal injection of cerulein and lipopolysaccharide. Pancreatitis was confirmed by histopathology, serum amylase, and high-sensitive C-reactive protein. Pancreatic microvascular vasomotion and blood distribution pattern in AP progression were assessed by laser Doppler. Meanwhile, ultrastructural changes of pancreatic microcirculation, including microvascular cavity and wall and endothelial mitochondria, were evaluated by transmission electron microscopy. Acute pancreatitis mice exhibited pathological pancreatic injuries with lower blood distribution pattern and decreased average blood perfusion, relative velocity, effective frequency, and amplitude of microvascular vasomotion. The pancreatic pathological injuries in Ang-(1-7)-treated mice were significantly alleviated. Consistently, Ang-(1-7) treatment led to a restoration in pancreatic microcirculation profiles. Furthermore, non-Ang-(1-7)-treated mice showed an irregular microvascular wall, narrow cavity, and swelling mitochondria, and these ultrastructural impairments were reversed by Ang-(1-7) administration. Pancreatic microcirculation profiles are abnormal in the progression of AP. Angiotensin-(1-7) administration could restore functional status of pancreatic microcirculation.

Possible Differential Diagnosis of the Degrees of Rheological Disturbances in Patients with Type 2 Diabetes Mellitus by Dielectrophoresis of Erythrocytes.

Hemorheological disorders in structural and functional parameters of erythrocytes are involved in the pathological process in type 2 diabetes mellitus (DM). Aim: to investigate the feasibility of differential diagnosis of the degrees of rheological disturbances in patients with type 2 DM by dielectrophoresis of erythrocytes. Methods: 62 subjects (58.7 ± 1.6 years) with type 2 DM diagnosed according to the criteria of the ADA were subdivided into two groups: medium (n = 47) and high (n = 15) risk of microcirculatory disturbances (EASD, 2013). Electric and viscoelastic parameters of erythrocytes were determined by dielectrophoresis using an electric optical system of cell detection. Results: the progression of rheological disturbances in the patients with type 2 DM was accompanied by significant decreases in deformation amplitude; dipole moment; polarizability; and membrane capacity; and increases in conductivity, viscosity, rigidity, hemolysis, and formation of aggregates (p < 0.05). Combined use of the parameters increased sensitivity (97.8%) and specificity (86.7%) for diagnosis of rheological disturbances in type 2 DM. Conclusion: the proposed experimental approach possesses low invasiveness, high productivity, shorter duration, vividness of the results. The method allows to evaluate not only local (renal and ocular) but also systemic status of microcirculation using more than 20 parameters of erythrocytes.

Herbal therapy treatment in thromboangiitis obliterans: a retrospective clinical study.

Critical limb ischemia in patients with thromboangiitis obliterans (TAO, Buerger's disease) is associated with refractory rest pain, gangrene, and increased rates of amputation. Tuoju lotion was prepared by the Pharmacy Department of Dongfang Hospital. The focus of the study is to elicit the efficacy of the addition of Herbal therapy treatment to conventional treatment in TAO patients with severe extremity pain and to assess any statistically significant benefits in patient's pain control at rest. We fund that the addition of herbal therapy treatment can augment conventional treatments in TAO patients by improving or eliminating intermittent claudication symptoms, prolonging claudication distance, and reducing total blood viscosity. At the same time, Tuoju lotion can improve microcirculation status in the short term. The purpose of this study was to investigate the effect of topical Herbal therapy treatment on patient outcomes in patients with TAO. Seventy patients with TAO treated between January 2009 and July 2019 were included in a retrospective analysis of a single university hospital vascular center. Forty patients received topical herbal treatment in addition to conventional therapy and were compared to a control group who received standard treatment alone (n=30). Patients in both, the experimental and control group, were matched according to age and gender. There was no significant difference in course of disease and past medical history between the two groups. The mean ankle brachial index (ABI), toe pressure, and blood viscosity were also similar in both groups. Rest pain score (baseline VAS 4.76±2.87, post-treatment 3.32±1.29) and walking distance (baseline 169.7±23.6 m, post-treatment 284.5±32.3 m) significantly improved in the herbal treatment group. ABI values improved and total blood viscosity decreased in both groups with no significant difference between the herbal and conservative treatment arms. However, the arterial blood pressure ratio in the lower extremity stage showed no difference between the superficial femoral artery and the popliteal artery. The addition of Herbal therapy treatment to conventional treatment in TAO patients with severe extremity pain was associated with a reduction of rest pain and intermittent claudication.

Elevated Venous to Arterial Carbon Dioxide Gap and Anion Gap Are Associated with Poor Outcome in Cardiogenic Shock Requiring Extracorporeal Membrane Oxygenation Support

Optimal management of cardiogenic shock requiring extracorporeal membrane oxygenation (ECMO) is still an evolving area in which assessment and optimization of the microcirculation may be critically important. We hypothesized that the venous arterial carbon dioxide gap (P(v-a)CO2 gap); the ratio of this gap to arterio-venous oxygen content (P(v-a)CO2/C(a-v)O2 ratio) and the anion gap would be early indicators of microcirculatory status and useful parameters for outcome prediction during ECMO support. We retrospectively reviewed 31 cardiogenic shock patients requiring veno-arterial ECMO, calculating P(v-a)CO2 gap and P(v-a)CO2/C(a-v)O2 ratios in the first 36 hours and the final 24 hours of ECMO support. Sixteen patients (52%) survived and 15 (48%) died. After 24 hours of ECMO support, the P(v-a)CO2 gap (4.9 ± 1.5 vs. 6.8 ± 1.9 mm Hg; p = 0.004) and anion gap (5.2 ± 1.8 vs. 8.7 ± 2.7 mmol/L; p < 0.001) were significantly higher in non-survivors. In the final 24 hours of ECMO support, the P(v-a)CO2 gap (3.5 ± 1.6 vs. 10.5 ± 3.2 mm Hg; p < 0.001), P(v-a)CO2/C(a-v)O2 ratio (1.1 ± 0.5 vs. 2.7 ± 1.0; p < 0.001), anion gap (5.1 ± 3.0 vs. 9.3 ± 5.9 mmol/L; p = 0.02), and lactate (median 1.0 [interquartile range {IQR}: 0.7-1.5] vs. 2.8 [IQR: 1.7-7.7] mmol/L; p = <0.001) were all significantly lower in survivors. Increasing P(v-a)CO2 gap and increasing anion gap were significantly associated with increased risk of mortality. Optimum cut-points for prediction of mortality were 6 mm Hg for P(v-a)CO2 gap in combination with an anion gap above 6 mmol/L in the first 24 hours of ECMO in patients with cardiogenic shock requiring ECMO.

Flowmotion Monitored by Flow Mediated Skin Fluorescence (FMSF): A Tool for Characterization of Microcirculatory Status.

Oscillations in the microcirculation, known as flowmotion, are a well-recognized characteristic of cutaneous blood flow. Since flowmotion reflects the microcirculatory status of the vascular system, which is very often impaired in many diseases and disorders, a quantitative assessment of skin flowmotion could potentially be used to screen for early symptoms of such conditions. In this study, skin flowmotion was monitored using the Flow Mediated Skin Fluorescence (FMSF) technique. The flowmotion parameter was used for quantitative assessment of basal flowmotion both at rest (FM) and during reperfusion [FM(R)] following the post-occlusive reactive hyperemia (PORH). The study population was composed of healthy volunteers between the ages of 30 and 72 (n = 75). The FM parameter showed an inverse dependence relative to age, while the FM(R) parameter was inversely correlated to blood pressure. The FM(R) parameter reflects the strong effect of hypoxia on flowmotion, which is mainly due to increased myogenic activity in the vessels. The FMSF technique appears to be uniquely suited for the analysis of basal flowmotion and the hypoxia response, and may be used for the characterization of microcirculatory status.

ОЦЕНКА ХАРАКТЕРА МИКРОЦИРКУЛЯТОРНОГО ОТВЕТА НА ЭКСПЕРИМЕНТАЛЬНУЮ ТЕРМИЧЕСКУЮ ТРАВМУ

Burn disease affects the functioning of almost all functional systems, having a negative effect on them due to the development of endotoxicosis and vascular disorders. At the same time, the greatest attention is paid to the shifts that form in the systemic hemodynamics, primarily in the coronary and pulmonary blood flow, which can cause the development and progression of life-threatening conditions. At the same time, the microcirculatory system is also undergoing changes, but these changes have been studied in much less detail. The aim of this research was to study the state of skin microcirculation in healthy and burned rats. The experiment was carried out on 20 adult male Wistar rats divided into two equal groups. The first group of animals (n=10) was a control group (intact), with its representatives there were not any manipulations, except for a single study of the state of microcirculation. Rats of the second (main) group (n=10) were simulated contact thermal burn using their own patented method. The assessment of microcirculation parameters in the main group of animals was carried out by laser Doppler flowmetry on the device "LAKK-M" on the 1st day (2-3 hours after the injury), on the third and tenth days after the burn period. It was found that thermal injury has a negative impact on the microcirculation system, which is seen in a decrease in the intensity of blood flow through small-diameter vessels. This is achieved by reflex vasospasm, reducing the release of nitrogen oxide by endothelial cells and activating precapillary sphincters, and simultaneously activating the shunting ways of cardiac shunt from the arterial directly to the venous channel, bypassing the capillaries. Thus, in the post-thermal period, a compensatory "robbing phenomenon" is realized in the border zone of the burn, which requires pathogenetic correction.

Experimental approbation of methodological and hardware-software speck-visualization in diagnosis of microcirculation of human surface biological tissues

In modern clinical practice, the assessment of the state of blood microcirculation and the diagnosis of microcirculatory disorders are extremely relevant in a variety of diseases: in cardiology, diabetology, oncology, dermatology, dentistry, surgery and resuscitation. Microcirculatory disorders are very diverse both in their pathogenesis and in clinical manifestations. Therefore, in the pattern of various diseases and extreme conditions, as well as in the correction of microcirculatory disorders the methods are needed for both operative assessment of the state of blood flow at tissue level and for its long-term monitoring. The interest in the study of the microvascular bed of the circulatory system is sparked by the significant role of capillaries in the implementation of the basic processes of the body's vital activity, in the trophic support of organs and their direct participation in tissue and cellular respiration. The health and life expectancy of a person depend on the coordinated work of the heart, large blood lines, and microcirculation vessels. The authors have studied modern optical methods for diagnosing microcirculation. The feasibility of using the speckle imaging method for noninvasive rapid assessment of the state of the microvasculature of human surface biological tissues has been substantiated. To implement the speckle-visualization method, methodological and software have been developed. The processing parameters that are most optimal from the point of view of the ratio of spatiotemporal resolution and computation time have been experimentally substantiated. The purpose of this work is the experimental testing of the developed methodological and hardware speckle imaging for the diagnosis of microcirculation of human surface biological tissues. The authors have carried out the studies of the state of microcirculation in the superficial blood vessels of the skin during physiotherapeutic procedures and in the imitation of pathology. The results of the studies have proved the feasibility of using the developed software for a high-quality diagnosis of the state of microcirculation of human surface biological tissues: primary changes in microcirculation are revealed, further changes to occur during physiotherapeutic procedures are visualized.