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Mayr A, Ciper N, Wahl G, Wildenhof J, Frede S, Kirschneck C, Jäger A, Götz W, Beisel-Memmert S. Longitudinal analysis of microcirculatory parameters in gingival tissues after tooth extraction in patients with different risk profiles for wound healing disorders - a pilot study. Clin Oral Investig 2024; 28:303. [PMID: 38714559 PMCID: PMC11076346 DOI: 10.1007/s00784-024-05686-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/24/2024] [Indexed: 05/10/2024]
Abstract
OBJECTIVES We aimed to establish a risk profile for intraoral wound healing disorders based on measurements of microcirculation in gingival tissues. MATERIALS AND METHODS Oxygen saturation (SO2) and blood flow in gingival tissues were measured with tissue spectrometry and laser doppler spectroscopy in 37 patients before/after tooth extractions. Patients were assigned to four groups: anamnestically and periodontally healthy patients (n = 7), anamnestically healthy but suffering from periodontitis (n = 10), anamnestically healthy but smoking and suffering from periodontitis (n = 10) and suffering from diabetes and periodontitis (n = 10). Measurements were performed at three different time points: Baseline measurement (T0), one day post extractionem (p.e.) (T1) and seven days p.e. (T2). RESULTS Baseline SO2 values were higher in control patients (p = .038). This effect was most evident in comparison to smokers suffering from periodontitis (p = .042), followed by diabetics suffering from periodontitis (p = .09). An opposite trend was seen for blood flow. Patients suffering from periodontitis demonstrated higher blood flow values (p = .012). Five patients, which belonged to the group of smokers suffering from periodontitis, showed clinically a delayed wound healing. CONCLUSION Differences in SO2 and blood flow of gingival tissue could be detected in different groups of patients with existing periodontitis compared to control patients. CLINICAL RELEVANCE Lower baseline SO2 values could be a warning signal for possible wound healing disorders after oral surgery.
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Affiliation(s)
- Alexandra Mayr
- Department of Orthodontics, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Nadja Ciper
- Center for Dental, Oral and Maxillofacial Medicine, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Gerhard Wahl
- Center for Dental, Oral and Maxillofacial Medicine, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Jan Wildenhof
- Private Clinic Schloss Schellenstein, Olsberg, Germany
| | - Stilla Frede
- Department of Anaesthesiology, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Christian Kirschneck
- Department of Orthodontics, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Andreas Jäger
- Department of Orthodontics, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Werner Götz
- Department of Orthodontics, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Svenja Beisel-Memmert
- Department of Orthodontics, University Hospital Bonn, Medical Faculty, Bonn, Germany.
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Zdrada-Nowak J, Stolecka-Warzecha A, Odrzywołek W, Rusztowicz M, Błońska-Fajfrowska B, Wilczyński S. The assessment of moderate acne vulgaris face skin using blood perfusion and hyperspectral imaging-A pilot study. J Cosmet Dermatol 2023; 22:3143-3151. [PMID: 37248648 DOI: 10.1111/jocd.15811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/03/2023] [Accepted: 04/28/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Microcirculation is the flow of blood through the smallest vessels in the circulatory system. Capillaries respond to various pathologies much earlier than arteries and veins, the changes which indicate that the disease is already developing. Careful monitoring of the functioning of the capillary system often allows the detection of in vivo disorders at an early stage. AIMS The aim of the study was to evaluate the microcirculation within acne lesions. A noninvasive method of semi-quantitative blood perfusion measurement based on laser speckle contrast analysis (LASCA) and a quantitative assessment of the acne severity using the hyperspectral imaging method supported by image analysis and processing methods were used. PATIENTS/METHOD The acne lesion perfusion was compared to the healthy skin perfusion of the control group. The reflectance in the range from 400 to 1000 nm was also compared for acne lesions and healthy skin. A dedicated version of the algorithm based on the gray-level co-occurrence matrix was used to compare differences between acne lesions and healthy skin. RESULTS Blood perfusion in acne lesions is on average 117% higher than in healthy skin. The reflectance of acne lesions was lower in the range of 400-600 nm compared to the healthy skin. A statistically significant decrease in the reflectance of acne lesions was demonstrated for wavelengths: 434, 549, and 588 nm. CONCLUSIONS Increased blood perfusion in acne lesions compared to healthy skin suggests increased chemotaxis of inflammatory cells and wound healing. Decrease points in skin reflectance resemble the absorption peaks for hemoglobin and coproporphyrin III produced by Cutibacterium acnes. Thus, the proposed methods may serve not only for the early detection of acne lesions, before they manifest themselves clinically for the naked eye, but may also be a tool for quantifying the effectiveness of acne treatment.
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Affiliation(s)
- Julita Zdrada-Nowak
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Anna Stolecka-Warzecha
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Wiktoria Odrzywołek
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Monika Rusztowicz
- Department of Health Sciences, Institute of Health Sciences, University of Opole, Opole, Poland
| | - Barbara Błońska-Fajfrowska
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Sławomir Wilczyński
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
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Li Z, Zhang Q, Sun YY, Wu N. Effects of different dehydration methods on the preservation of aortic and renal glycocalyx structures in mice. Heliyon 2023; 9:e15197. [PMID: 37095921 PMCID: PMC10121396 DOI: 10.1016/j.heliyon.2023.e15197] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
Glycocalyx is located outside the vascular endothelial cells playing an important role in vascular homeostasis. However, lacking efficient detection methods is one of the biggest obstacles to study the glycocalyx. In this study, three dehydration methods were used to compare the preservation of HUVEC, aorta and kidney glycocalyx by transmission electron microscope. The chemical pre-fixation was performed by lanthanum nitrate staining, and the mice aorta and renal glycocalyx were prepared by different dehydration methods such as ethanol gradient, acetone gradient and low temperature dehydration. HUVEC glycocalyx was prepared by acetone gradient and low temperature dehydration. Low temperature dehydration method preserves HUVEC and mice aortic glycocalyx completely, which had a certain thickness and presented a needle-like structure. But for mice kidney, the acetone gradient dehydration preparation method could better preserve the glycocalyx integrity than other two methods. In conclusion, low temperature dehydration method is suitable for HUVEC and aortic glycocalyx preservation, acetone gradient dehydration method is more suitable for kidney glycocalyx preservation.
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Affiliation(s)
- Zhi Li
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao, China
- Department of Drugs and Bioproducts, Qingdao National Laboratory for Marine Science and Technology, Qingdao, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Quanbin Zhang
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao, China
- Department of Drugs and Bioproducts, Qingdao National Laboratory for Marine Science and Technology, Qingdao, China
| | - Yuan-yuan Sun
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao, China
- Corresponding author.
| | - Ning Wu
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao, China
- Department of Drugs and Bioproducts, Qingdao National Laboratory for Marine Science and Technology, Qingdao, China
- Nantong Zhongke Marine Science and Technology Research and Development Center, Nantong, China
- Corresponding author. Institute of Oceanology Chinese Academy of Sciences, China,
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Deep learning and computer vision techniques for microcirculation analysis: A review. PATTERNS (NEW YORK, N.Y.) 2022; 4:100641. [PMID: 36699745 PMCID: PMC9868679 DOI: 10.1016/j.patter.2022.100641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The analysis of microcirculation images has the potential to reveal early signs of life-threatening diseases such as sepsis. Quantifying the capillary density and the capillary distribution in microcirculation images can be used as a biological marker to assist critically ill patients. The quantification of these biological markers is labor intensive, time consuming, and subject to interobserver variability. Several computer vision techniques with varying performance can be used to automate the analysis of these microcirculation images in light of the stated challenges. In this paper, we present a survey of over 50 research papers and present the most relevant and promising computer vision algorithms to automate the analysis of microcirculation images. Furthermore, we present a survey of the methods currently used by other researchers to automate the analysis of microcirculation images. This survey is of high clinical relevance because it acts as a guidebook of techniques for other researchers to develop their microcirculation analysis systems and algorithms.
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Bol ME, Broddin BEK, Delhaas T, Sels JEM, van de Poll MCG. Variability of microcirculatory measurements in healthy volunteers. Sci Rep 2022; 12:19887. [PMID: 36400927 PMCID: PMC9674639 DOI: 10.1038/s41598-022-22947-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/21/2022] [Indexed: 11/19/2022] Open
Abstract
Reliable assessment of the microcirculation is important to investigate microcirculatory properties in various disease states. The GlycoCheck system automatically analyzes sublingual sidestream dark field images to determine the perfused boundary region (PBR; a measure of glycocalyx thickness), red blood cell filling percentage, and microvascular vessel density. Although GlycoCheck has been used to study the microcirculation in patients, little is known about the reproducibility of measurements in healthy volunteers. We assessed intra- and interobserver agreement by having two experienced observers perform three consecutive microcirculation measurements with the GlycoCheck system in 49 healthy volunteers. Intraobserver agreement of single measurements were poor (intraclass correlation coefficients (ICCs) < 0.4) for PBR, red blood cell filling percentage and microvascular vessel density. ICCs increased to values > 0.6 (indicating good reproducibility) for all parameters when performing and averaging three consecutive measurements. No systematic differences were observed between observers for any parameter. Interobserver variability was fair for PBR (ICC = 0.53) and red blood cell filling percentage (ICC = 0.58) and poor for perfused vessel density (ICC = 0.20). In conclusion, GlycoCheck software can be used with acceptable reliability and reproducibility for microcirculation measurements on a population level when averaging three consecutive measurements. Repeated measurements are preferably performed by the same observer.
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Affiliation(s)
- M. E. Bol
- grid.412966.e0000 0004 0480 1382Department of Intensive Care Medicine, Maastricht University Medical Center, MUMC+), Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - B. E. K. Broddin
- grid.412966.e0000 0004 0480 1382Department of Intensive Care Medicine, Maastricht University Medical Center, MUMC+), Maastricht, The Netherlands
| | - T. Delhaas
- grid.5012.60000 0001 0481 6099Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - J. E. M. Sels
- grid.412966.e0000 0004 0480 1382Department of Intensive Care Medicine, Maastricht University Medical Center, MUMC+), Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Cardiology, Maastricht University Medical Center, MUMC+), Maastricht, The Netherlands
| | - M. C. G. van de Poll
- grid.412966.e0000 0004 0480 1382Department of Intensive Care Medicine, Maastricht University Medical Center, MUMC+), Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Surgery, Maastricht University Medical Center, MUMC+), Maastricht, The Netherlands
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Sun Y, Cheng G, Du L, Gan Y, Li B, Yan S, Shao M, Jin H, Li S. Chuanzhitongluo capsule ameliorates microcirculatory dysfunction in rats: Efficacy evaluation and metabolic profiles. Front Pharmacol 2022; 13:1011333. [PMID: 36278210 PMCID: PMC9585327 DOI: 10.3389/fphar.2022.1011333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Ischemic stroke is a leading cause of mortality and disability worldwide. Microcirculatory dysfunction is the foremost hindrance for a good clinical prognosis in ischemic stroke patients. Clinical researches show that Chuanzhitongluo capsule (CZTL) has a curative effect during the recovery period of ischemic stroke, which contributes to a good prognosis. However, it is not known whether CZTL treats ischemic stroke by ameliorating microcirculation dysfunction. Objective: In this study, we investigated the influence of CZTL on microcirculation and its underlying mechanism. Methods: A rat model of acute microcirculatory dysfunction was established by stimuli of adrenaline and ice water. The microcirculatory damage in model rats and the efficacy of CZTL were assessed by detecting laser speckle contrast imaging, coagulation function, hemorheology, vasomotor factor and microcirculation function. The potential mechanism of CZTL action was explored by the untargeted metabolomic analysis based on ultra-performance liquid chromatography-quadrupole-time of flight-mass spectrometry. Results: Laser speckle contrast imaging showed that model rats suffered low perfusion in ears, feet and tails, and CZTL treatment increased microcirculatory blood flow. Coagulation function detection results showed that CZTL diminished the reduction of thrombin time, prothrombin time, activated partial thromboplastin time and the elevated fibrinogen level caused by acute microcirculatory dysfunction. Furthermore, CZTL could recover the increased blood viscosity as well as the abnormal vasomotor and microcirculation function in rats with acute microcirculatory dysfunction. Metabolomics analysis indicated that CZTL might regulate sphingolipid metabolism and arachidonic acid metabolism to exert protective effects on microcirculation. Conclusion: These results elucidated that CZTL was highly effective against microcirculatory dysfunction and its potential mechanisms related with the modulation of sphingolipid and arachidonic acid metabolic pathways. The present study provided a new perspective on the clinical application of CZTL, and it contribute to explore novel therapeutic drug against microcirculatory dysfunction.
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Affiliation(s)
- Yuanfang Sun
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guoliang Cheng
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co.,Ltd, Linyi, China
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Lijing Du
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yu Gan
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bing Li
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co.,Ltd, Linyi, China
| | - Shikai Yan
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co.,Ltd, Linyi, China
| | - Mingguo Shao
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co.,Ltd, Linyi, China
- *Correspondence: Mingguo Shao, ; Shasha Li,
| | - Huizi Jin
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co.,Ltd, Linyi, China
| | - Shasha Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Mingguo Shao, ; Shasha Li,
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Machikhin AS, Volkov MV, Khokhlov DD, Lovchikova ED, Potemkin AV, Danilycheva IV, Dorofeeva IV, Shulzhenko AE. Exoscope-based videocapillaroscopy system for in vivo skin microcirculation imaging of various body areas. BIOMEDICAL OPTICS EXPRESS 2021; 12:4627-4636. [PMID: 34513213 PMCID: PMC8407810 DOI: 10.1364/boe.420786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
The capillary system immediately responds to many pathologies and environmental conditions. Accurate monitoring of its functioning often enables early detection of various diseases related to disorders in skin microcirculation. To expand the scope of capillaroscopy application, it is reasonable to visualize and assess blood microcirculation exactly in the areas of inflamed skin. Body vibrations, breathing, non-flat skin surface and other factors hamper the application of conventional capillaroscopes outside the nailfold area. In this paper, we propose an exoscope-based optical system for high-quality non-invasive computational imaging of capillary network in various areas of the body. Accurate image matching and tracking temporal intensity variations allow detecting the presence of blood pulsations, precise mapping of capillaries and photoplethysmogram acquisition. We have demonstrated the efficiency of the proposed approach experimentally by in vivo mapping and analysis of microvessels in wrist, forearm, upper-arm, breast and hip areas. We believe that the developed system will increase the diagnostic value of video capillaroscopy in clinical practice.
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Affiliation(s)
- Alexander S. Machikhin
- Laboratory of Acousto-optic Spectroscopy, Scientific and Technological Center of Unique Instrumentation, Russian Academy of Sciences, 15 Butlerova, 117342, Moscow, Russia
| | - Mikhail V. Volkov
- Faculty of Applied Optics, ITMO University, 49 Kronverksky, 197101, St. Petersburg, Russia
| | - Demid D. Khokhlov
- Laboratory of Acousto-optic Spectroscopy, Scientific and Technological Center of Unique Instrumentation, Russian Academy of Sciences, 15 Butlerova, 117342, Moscow, Russia
| | - Ekaterina D. Lovchikova
- Laboratory of Acousto-optic Spectroscopy, Scientific and Technological Center of Unique Instrumentation, Russian Academy of Sciences, 15 Butlerova, 117342, Moscow, Russia
| | - Andrey V. Potemkin
- Faculty of Applied Optics, ITMO University, 49 Kronverksky, 197101, St. Petersburg, Russia
| | - Inna V. Danilycheva
- Department of Allergology and Immunotherapy, Institute of Immunology, Federal Medical Biological Agency, 24 Kashirskoe, 115522, Moscow, Russia
| | - Irina V. Dorofeeva
- Department of Allergology and Immunotherapy, Institute of Immunology, Federal Medical Biological Agency, 24 Kashirskoe, 115522, Moscow, Russia
| | - Andrey E. Shulzhenko
- Department of Allergology and Immunotherapy, Institute of Immunology, Federal Medical Biological Agency, 24 Kashirskoe, 115522, Moscow, Russia
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Visualization of three-dimensional microcirculation of rodents' retina and choroid for studies of critical illness using optical coherence tomography angiography. Sci Rep 2021; 11:14302. [PMID: 34253747 PMCID: PMC8275781 DOI: 10.1038/s41598-021-93631-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/08/2021] [Indexed: 02/06/2023] Open
Abstract
We developed a method to measure the relative blood flow speed using optical coherence tomography angiography (OCTA) in retina and choroid, and investigated the feasibility of this method for assessing microcirculatory function in rat models of sepsis and hemorrhagic shock. Two sepsis models, 6-h severe sepsis without treatment and 30-h moderate sepsis maintaining mean arterial pressure, and volume controlled hemorrhagic shock and fluid resuscitation model were used to see the change of microcirculation. The blood flow index (BFI), which was calculated from the OCTA images to represent the average relative blood flow, was decreasing during the 6-h severe sepsis model. Its change is in parallel with the mean arterial blood pressure (MAP) and blood lactate levels. In the 30-h moderate sepsis model, the BFI was decreased while maintaining MAP, and lactate was increased. In the hemorrhagic shock model, the change of BFI is in line with MAP and lactate levels. In all models, BFI change is more sensitive in choroid than in retina. This study presents the OCTA-based retinal and choroidal microcirculatory blood flow monitoring method and shows its utility for assessment of critical illness.
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Watanabe K, Shiba T, Komatsu T, Sakuma K, Aimoto M, Nagasawa Y, Takahara A, Hori Y. The influence of hemorrhagic shock on ocular microcirculation by obtained by laser speckle flowgraphy in a white rabbit model. Microcirculation 2021; 28:e12716. [PMID: 34008269 DOI: 10.1111/micc.12716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/27/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To clarify the continuous changes in the retinal vessels' and choroid's microcirculation during hemorrhagic shock and resuscitation in a rabbit model. METHODS Hemorrhagic shock by the removal of blood (30 mL) and resuscitation by a blood-return technique was induced in anesthetized male New Zealand White rabbits (n = 10). We evaluated the retinal vessel blood flow (relative flow volume: RFV) and choroidal blood flow (mean blur rate in the choroid area: MBR-CH) by laser speckle flowgraphy (LSFG), with simultaneous measurements of systemic hemodynamics and laboratory parameters. RESULTS RFV and MBR-CH showed significant decreases immediately after the initiation of blood removal and recovered by blood return. The lactate concentration tended to increase from baseline by the blood-removal operation, and it was significantly higher at the end of observation period. The %RFV and %MBR-CH each showed a significant positive correlation with mean arterial blood pressure, cardiac output, carotid blood flow, and central venous pressure. %RFV showed a significant positive correlation with %central venous oxygen saturation and negatively correlated with %lactate. The %hemoglobin did not show a significant correlation with %RFV or %MBR-CH. CONCLUSION This rabbit hemorrhagic shock model confirmed that ocular microcirculation measurements by LSFG feasibly reflect variations in systemic hemodynamics during hemorrhagic shock and recovery.
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Affiliation(s)
- Kento Watanabe
- Department of Ophthalmology, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Tomoaki Shiba
- Department of Ophthalmology, Toho University Graduate School of Medicine, Tokyo, Japan.,Department of Ophthalmology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Tetsuya Komatsu
- Department of Ophthalmology, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Kiyoshi Sakuma
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Megumi Aimoto
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Yoshinobu Nagasawa
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Akira Takahara
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Yuichi Hori
- Department of Ophthalmology, Toho University Graduate School of Medicine, Tokyo, Japan
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Guerrero F, Lambrechts K, Wang Q, Mazur A, Théron M, Marroni A. Endothelial function may be enhanced in the cutaneous microcirculation after a single air dive. Diving Hyperb Med 2020; 50:214-219. [PMID: 32957122 DOI: 10.28920/dhm50.3.214-219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/17/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The effects of scuba diving on the vessel wall have been studied mainly at the level of large conduit arteries. Data regarding the microcirculation are scarce and indicate that these two vascular beds are affected differently by diving. METHODS We assessed the changes in cutaneous microcirculation before an air scuba dive, then 30 min and 24 h after surfacing. Endothelium-dependent and independent vasomotion were successively elicited by iontophoretic administration of acetylcholine and sodium nitroprusside respectively, and cutaneous blood flux was monitored by laser Doppler flowmetry. RESULTS The response to sodium nitroprusside was significantly lower 30 min after surfacing than before diving (50 (SEM 6)% of the pre-dive values, P = 0.0003) and returned to normal values 24 h post-dive (102 (29)% of the pre-dive values, P = 0.113). When compared to pre-dive values, acetylcholine elicited a hyperaemia which was not statistically different 30 min after surfacing (123 (17)% of the pre-dive values, P = 0.230), but significantly increased 24 h post-dive (148 (10)% of the pre-dive values, P = 0.005). CONCLUSION Microvascular smooth muscle function is transiently impaired after diving. On the contrary, microvascular endothelial function is enhanced for up to 24 h after diving. This further suggests that the microcirculation reacts differently than large conduit arteries to scuba diving. The impact of modifications occurring in the microvascular bed on the physiological effects of diving merits further study.
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Affiliation(s)
- François Guerrero
- Univ Brest, ORPHY EA4324, IBSAM, 6 avenue Le Gorgeu, 29200 Brest, France.,Corresponding author: François Guerrero, EA4324 ORPHY, 6 Av. Le Gorgeu CS 93837, 29238 BREST Cedex 3, France,
| | - Kate Lambrechts
- Univ Brest, ORPHY EA4324, IBSAM, 6 avenue Le Gorgeu, 29200 Brest, France
| | - Qiong Wang
- Univ Brest, ORPHY EA4324, IBSAM, 6 avenue Le Gorgeu, 29200 Brest, France
| | - Aleksandra Mazur
- Univ Brest, ORPHY EA4324, IBSAM, 6 avenue Le Gorgeu, 29200 Brest, France
| | - Michael Théron
- Univ Brest, ORPHY EA4324, IBSAM, 6 avenue Le Gorgeu, 29200 Brest, France
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Ma L, Han X, Gu J, Li J, Lou W, Jin C, Saiyin H. The physiological characteristics of the basal microvilli microvessels in pancreatic cancers. Cancer Med 2020; 9:5535-5545. [PMID: 32488986 PMCID: PMC7402840 DOI: 10.1002/cam4.3177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/17/2020] [Accepted: 05/08/2020] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer (PC) is a highly lethal tumor with controversial high glucose uptake and hypomicrovascularity, and the hypomicrovasculature, which is considered to have poor perfusion, blocks the delivery of drugs to tumors. The preferential existence of a novel endothelial projection with trafficking vesicles in PCs, referring to basal microvilli, was described previously. However, the perfusion and nutrients delivering status of the basal microvilli microvessels are unknown. Here, we used the perfusion of fluorescently labeled CD31 antibody, lectin, and 2‐NBDG to autochthonous PC‐bearing mice, immunostaining, probe‐based confocal laser endoscopy and three‐dimensional (3D) reconstruction to study the nutrient trafficking, and perfusion status of the basal microvilli microvasculature in PC. Our data showed that the coperfusion of lectin and CD31 is an efficient way to show the microcirculation in most healthy organs. However, coperfusion with lectin and CD31 is inefficient for showing the microcirculation in PCs compared with that in healthy organs and immunostaining. This method does not reflect the nutrient trafficking status in the microvessels, especially in basal microvilli microvessels of PCs. In basal microvilli microvessels that were poorly labeled by lectin, we observed large vesicle‐like structures with 2‐NBDG preferentially located at the base of the basal microvilli or in basal microvilli, and there were long filopodia on the luminal surface of the human PC microvasculature. Our observations suggest that the PC microvasculature, especially basal microvilli microvessels, is well perfused and might be highly efficient in the trafficking of glucose or other nutrients, indicating that macropinocytosis might participate in the nutrient trafficking.
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Affiliation(s)
- Lixiang Ma
- Department of Anatomy, Histology & Embryology, School of Medical Sciences, Fudan University, Shanghai, China
| | - Xu Han
- General Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jichun Gu
- Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Ji Li
- Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenhui Lou
- General Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chen Jin
- Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Hexige Saiyin
- The State Key Laboratory of Genetic Engineering, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
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12
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Wernly B, Pernow J, Kelm M, Jung C. The role of arginase in the microcirculation in cardiovascular disease. Clin Hemorheol Microcirc 2020; 74:79-92. [PMID: 31743994 DOI: 10.3233/ch-199237] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the microcirculation, the exchange of nutrients, water, gas, hormones, and waste takes place, and it is divided into the three main sections arterioles, capillaries, and venules. Disturbances in the microcirculation can be measured using surrogate parameters or be visualized either indirectly or directly.Arginase is a manganese metalloenzyme hydrolyzing L-arginine to urea and L-ornithine. It is located in different cell types, including vascular cells, but also in circulating cells such as red blood cells. A variety of pro-inflammatory factors, as well as interleukins, stimulate increased arginase expression. An increase in arginase activity consequently leads to a consumption of L-arginine needed for nitric oxide (NO) production by endothelial NO synthase. A vast body of evidence convincingly showed that increased arginase activity is associated with endothelial dysfunction in larger vessels of the vascular tree. Of note, arginase also influences the microcirculation. Arginase inhibition leads to an increase in the bioavailability of NO and reduces superoxide levels, resulting in improved endothelial function. Arginase inhibition might, therefore, be a potent treatment strategy in cardiovascular medicine. Recently, red blood cells emerged as an influential player in the development from increased arginase activity to endothelial dysfunction. As red blood cells directly interact with the microcirculation in gas exchange, this could constitute a potential link between arginase activity, endothelial dysfunction and microcirculatory disturbances.The aim of this review is to summarize recent findings revealing the role of arginase in regulating vascular function with particular emphasis on the microcirculation.
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Affiliation(s)
- Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - John Pernow
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
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13
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Beurskens DMH, Bol ME, Delhaas T, van de Poll MCG, Reutelingsperger CPM, Nicolaes GAF, Sels JWEM. Decreased endothelial glycocalyx thickness is an early predictor of mortality in sepsis. Anaesth Intensive Care 2020; 48:221-228. [PMID: 32486831 PMCID: PMC7328096 DOI: 10.1177/0310057x20916471] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Microcirculatory alterations play an important role in the early phase of sepsis. Shedding of the endothelial glycocalyx is regarded as a central pathophysiological mechanism causing microvascular dysfunction, contributing to multiple organ failure and death in sepsis. The objective of this study was to investigate whether endothelial glycocalyx thickness at an early stage in septic patients relates to clinical outcome. We measured the perfused boundary region (PBR), which is inversely proportional to glycocalyx thickness, of sublingual microvessels (5-25 µm) using sidestream dark field imaging. The PBR in 21 patients with sepsis was measured within 24 h of admission to the intensive care unit (ICU). In addition, we determined plasma markers of microcirculatory dysfunction and studied their correlation with PBR and mortality. Endothelial glycocalyx thickness in sepsis was significantly lower for non-survivors as compared with survivors, indicated by a higher PBR of 1.97 [1.85, 2.19]µm compared with 1.76 [1.59, 1.97] µm, P=0.03. Admission PBR was associated with hospital mortality with an area under the curve of 0.778 based on the receiver operating characteristic curve. Furthermore, PBR correlated positively with angiopoietin-2 (rho=0.532, P=0.03), indicative of impaired barrier function. PBR did not correlate with Acute Physiology and Chronic Health Evaluation IV (APACHE IV), Sequential Organ Failure Assessment score (SOFA score), lactate, syndecan-1, angiopoietin-1 or heparin-binding protein. An increased PBR within the first 24 h after ICU admission is associated with mortality in sepsis. Further research should be aimed at the pathophysiological importance of glycocalyx shedding in the development of multi-organ failure and at therapies attempting to preserve glycocalyx integrity.
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Affiliation(s)
- Daniëlle MH Beurskens
- Department of Biochemistry, Maastricht University, the
Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht
University, the Netherlands
| | - Martine E Bol
- Department of Intensive Care Medicine, Maastricht University
Medical Center, the Netherlands
- School of Nutrition and Translational Research in Metabolism,
Maastricht University, the Netherlands
| | - Tammo Delhaas
- Cardiovascular Research Institute Maastricht, Maastricht
University, the Netherlands
- Department of Biomedical Engineering, Maastricht University, the
Netherlands
| | - Marcel CG van de Poll
- Department of Intensive Care Medicine, Maastricht University
Medical Center, the Netherlands
- School of Nutrition and Translational Research in Metabolism,
Maastricht University, the Netherlands
- Department of Surgery, Maastricht University Medical Center, the
Netherlands
| | - Chris PM Reutelingsperger
- Department of Biochemistry, Maastricht University, the
Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht
University, the Netherlands
| | - Gerry AF Nicolaes
- Department of Biochemistry, Maastricht University, the
Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht
University, the Netherlands
| | - Jan-Willem EM Sels
- Department of Intensive Care Medicine, Maastricht University
Medical Center, the Netherlands
- Department of Cardiology, Maastricht University Medical Center,
the Netherlands
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14
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Hessler M, Nelis P, Ertmer C, Alnawaiseh M, Lehmann F, Schmidt C, Kampmeier TG, Rehberg SW, Arnemann PH, Rovas A. Optical coherence tomography angiography as a novel approach to contactless evaluation of sublingual microcirculation: A proof of principle study. Sci Rep 2020; 10:5408. [PMID: 32214141 PMCID: PMC7096522 DOI: 10.1038/s41598-020-62128-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 03/03/2020] [Indexed: 01/06/2023] Open
Abstract
Microcirculatory disorders are crucial in pathophysiology of organ dysfunction in critical illness. Evaluation of sublingual microcirculation is not routinely conducted in daily practice due to time-consuming analysis and susceptibility to artifacts. We investigated the suitability of optical coherence tomography angiography (OCTA) for contactless evaluation of sublingual microcirculation. Sublingual microcirculation was imaged in 10 healthy volunteers, using an OCTA device and an incident dark field (IDF) illumination microscopy (current gold standard). OCTA images were analyzed with regard to flow density and perfused vessel density (PVDbyOCTA). IDF videos were analyzed following current recommendations. Flow density was automatically extracted from OCTA images (whole en face 48.9% [43.2; 54.5]; central ring 52.6% [43.6; 60.6]). PVDbyOCTA did not differ from the PVD calculated from IDF videos (PVDbyOCTA 18.6 mm/mm² [18.0; 21.7]) vs. PVDbyIDF 21.0 mm/mm² [17.5; 22.9]; p = 0.430). Analysis according to Bland-Altman revealed a mean bias of 0.95 mm/mm² (95% Confidence interval −1.34 to 3.25) between PVDbyOCTA and PVDbyIDF with limits of agreement of −5.34 to 7.24 mm/mm². This study is the first to demonstrate the suitability of OCTA for evaluating sublingual microcirculation. Comparison of the perfused vessel density between methods showed a plausible level of agreement.
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Affiliation(s)
- Michael Hessler
- Department of Anesthesiology, Intensive Care, and Pain Therapy, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, Muenster, Germany
| | - Pieter Nelis
- Department of Ophthalmology, University Hospital Muenster, Domagkstraße 15, Muenster, Germany.,Department of Ophthalmology, University of Brussels (VUB), Laarbeeklaan 101, Jette, Belgium
| | - Christian Ertmer
- Department of Anesthesiology, Intensive Care, and Pain Therapy, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, Muenster, Germany.
| | - Maged Alnawaiseh
- Department of Ophthalmology, University Hospital Muenster, Domagkstraße 15, Muenster, Germany
| | - Florian Lehmann
- Department of Anesthesiology, Intensive Care, and Pain Therapy, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, Muenster, Germany
| | - Christina Schmidt
- Department of Anesthesiology, Intensive Care, and Pain Therapy, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, Muenster, Germany
| | - Tim-Gerald Kampmeier
- Department of Anesthesiology, Intensive Care, and Pain Therapy, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, Muenster, Germany
| | - Sebastian Willy Rehberg
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine and Pain Therapy, Protestant Hospital of the Bethel Foundation, Burgsteig, Bielefeld, Germany
| | - Philip-Helge Arnemann
- Department of Anesthesiology, Intensive Care, and Pain Therapy, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, Muenster, Germany
| | - Alexandros Rovas
- Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany
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15
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Kumar M, Suliburk JW, Veeraraghavan A, Sabharwal A. PulseCam: a camera-based, motion-robust and highly sensitive blood perfusion imaging modality. Sci Rep 2020; 10:4825. [PMID: 32179806 PMCID: PMC7075982 DOI: 10.1038/s41598-020-61576-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/27/2020] [Indexed: 11/08/2022] Open
Abstract
Blood carries oxygen and nutrients to the trillions of cells in our body to sustain vital life processes. Lack of blood perfusion can cause irreversible cell damage. Therefore, blood perfusion measurement has widespread clinical applications. In this paper, we develop PulseCam - a new camera-based, motion-robust, and highly sensitive blood perfusion imaging modality with 1 mm spatial resolution and 1 frame-per-second temporal resolution. Existing camera-only blood perfusion imaging modality suffers from two core challenges: (i) motion artifact, and (ii) small signal recovery in the presence of large surface reflection and measurement noise. PulseCam addresses these challenges by robustly combining the video recording from the camera with a pulse waveform measured using a conventional pulse oximeter to obtain reliable blood perfusion maps in the presence of motion artifacts and outliers in the video recordings. For video stabilization, we adopt a novel brightness-invariant optical flow algorithm that helps us reduce error in blood perfusion estimate below 10% in different motion scenarios compared to 20-30% error when using current approaches. PulseCam can detect subtle changes in blood perfusion below the skin with at least two times better sensitivity, three times better response time, and is significantly cheaper compared to infrared thermography. PulseCam can also detect venous or partial blood flow occlusion that is difficult to identify using existing modalities such as the perfusion index measured using a pulse oximeter. With the help of a pilot clinical study, we also demonstrate that PulseCam is robust and reliable in an operationally challenging surgery room setting. We anticipate that PulseCam will be used both at the bedside as well as a point-of-care blood perfusion imaging device to visualize and analyze blood perfusion in an easy-to-use and cost-effective manner.
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Affiliation(s)
- Mayank Kumar
- Electrical and Computer Engineering, Rice University, 6100 Main St, Houston, TX, 77005, USA
| | - James W Suliburk
- Division of General Surgery, Baylor College of Medicine, 6620 Main St, Houston, TX, 77030, USA
| | - Ashok Veeraraghavan
- Electrical and Computer Engineering, Rice University, 6100 Main St, Houston, TX, 77005, USA
| | - Ashutosh Sabharwal
- Electrical and Computer Engineering, Rice University, 6100 Main St, Houston, TX, 77005, USA.
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16
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Chioncel O, Mebazaa A. Microcirculatory Dysfunction in Acute Heart Failure. Microcirculation 2020. [DOI: 10.1007/978-3-030-28199-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Aykar SS, Reynolds DE, McNamara MC, Hashemi NN. Manufacturing of poly(ethylene glycol diacrylate)-based hollow microvessels using microfluidics. RSC Adv 2020; 10:4095-4102. [PMID: 35492659 PMCID: PMC9049053 DOI: 10.1039/c9ra10264g] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 01/10/2020] [Indexed: 12/27/2022] Open
Abstract
Biocompatible and self-standing poly(ethylene glycol diacrylate)-based hollow microvessels were fabricated from a microfluidic device using microfluidic principles.
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Affiliation(s)
- Saurabh S. Aykar
- Department of Mechanical Engineering
- Iowa State University
- Ames
- USA
| | | | | | - Nicole N. Hashemi
- Department of Mechanical Engineering
- Iowa State University
- Ames
- USA
- Department of Biomedical Sciences
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18
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Zhang Y, Zhu M, Zhang F, Zhang S, Du W, Xiao X. Integrating Pharmacokinetics Study, Network Analysis, and Experimental Validation to Uncover the Mechanism of Qiliqiangxin Capsule Against Chronic Heart Failure. Front Pharmacol 2019; 10:1046. [PMID: 31619994 PMCID: PMC6759796 DOI: 10.3389/fphar.2019.01046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/19/2019] [Indexed: 12/16/2022] Open
Abstract
Objectives: The purpose of this study was to propose an integrated strategy for investigating the mechanism of Qiliqiangxin capsule (QLQX) to treat chronic heart failure (CHF). Methods: Pharmacokinetics analysis was performed to screen the active components of QLQX using high-performance liquid chromatography-tandem mass spectrometry techniques. We then constructed the component-target network between the targets of active components in QLQX and CHF using Cytoscape. A network analysis, including topological parameters, clustering, and pathway enrichment, was established to identify the hub targets and pathways. Finally, some of the predicted hub targets were validated experimentally in human cardiac microvascular endothelial cell (HCMEC). Results: We identified 29 active components in QLQX, and 120 consensus potential targets were determined by the pharmacokinetics analysis and network pharmacology approach. Further network analysis indicated that 6 target genes, namely, VEGFA, CYP1A1, CYP2B6, ATP1A1, STAT3, and STAT4, and 10 predicted functional genes, namely, KDR, FLT1, NRP2, JAK2, EGFR, IL-6, AHR, ATP1B1, JAK1, and HIF1A, may be the primary targets regulated by QLQX for the treatment of CHF. Among these targets, VEGFA, IL-6, p-STAT3, and p-JAK2 were selected for validation in the HCMEC. The results indicated that QLQX may inhibit inflammatory processes and promote angiogenesis in CHF via the JAK/STAT signaling pathway. Conclusions: This study provides a strategy for understanding the mechanism of QLQX against CHF by combining pharmacokinetics study, network pharmacology, and experimental validation.
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Affiliation(s)
- Yu Zhang
- School of Graduate, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,The Second Affiliated Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Mingdan Zhu
- The Second Affiliated Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Fugeng Zhang
- Department of Pharmacy, Tianjin Huanhu Hospital, Tianjin, China
| | - Shaoqiang Zhang
- The Second Affiliated Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wuxun Du
- The Second Affiliated Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xuefeng Xiao
- School of Graduate, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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19
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Wijntjens GW, Fengler K, Fuernau G, Jung C, den Uil C, Akin S, van de Hoef TP, Šerpytis R, Diletti R, Henriques JP, Šerpytis P, Thiele H, Piek JJ. Prognostic implications of microcirculatory perfusion versus macrocirculatory perfusion in cardiogenic shock: a CULPRIT-SHOCK substudy. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 9:108-119. [PMID: 31517505 DOI: 10.1177/2048872619870035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND After early revascularisation, restoration of macrocirculatory perfusion parameters is the primary objective in the management of cardiogenic shock complicated acute myocardial infarction. Nevertheless, vital organ perfusion may be compromised at the systemic microcirculatory level, even in patients with preserved macrohaemodynamics. Microvascular perfusion was shown to have independent prognostic value for early mortality. The present study aims to compare the prognostic value of microcirculatory versus macrocirculatory perfusion parameters. METHODS This substudy of the culprit lesion-only percutaneous coronary intervention versus multivessel percutaneous coronary intervention in cardiogenic shock (CULPRIT-SHOCK) trial examined the sublingual capillary network using videomicroscopy post-percutaneous coronary intervention to determine the proportion of perfused capillaries (<20 µm) and perfused capillary density. Thirty-day follow-up was performed to obtain the occurrence of a combined clinical endpoint of all-cause death and renal replacement therapy. RESULTS Videomicroscopy measurements were performed in 66 patients. There was a significant adjusted association between microcirculatory perfusion parameters and the combined clinical endpoint (proportion of perfused capillaries: P=0.020; perfused capillary density: P=0.035), whereas there was no significant adjusted association between macrocirculatory perfusion parameters and the combined clinical endpoint (systolic blood pressure: P=0.205). Normotensive patients with compromised microcirculatory perfusion parameters had a higher risk of the combined clinical endpoint than normotensive patients with preserved microcirculatory perfusion parameters (proportion of perfused capillaries: Breslow P=0.014; perfused capillary density: Breslow P=0.076). CONCLUSIONS There is a significant and independent association between microcirculatory perfusion parameters perfused capillary density and proportion of perfused capillaries and the combined clinical endpoint of all-cause death and renal replacement therapy at 30 days follow-up. In patients with loss of haemodynamic coherence between microcirculatory and macrocirculatory perfusion parameters, microcirculatory perfusion parameters confer dominant prognostic value.
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Affiliation(s)
| | - Karl Fengler
- Department of Internal Medicine/Cardiology, University Hospital, Germany
| | - Georg Fuernau
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University of Luebeck, Germany
| | - Christian Jung
- Medical Faculty, University Hospital Düsseldorf, Germany
| | - Corstiaan den Uil
- Department of Intensive Care Medicine, Erasmus University Medical Center, The Netherlands.,Department of Cardiology, Erasmus University Medical Center, The Netherlands
| | - Sakir Akin
- Department of Cardiology, Erasmus University Medical Center, The Netherlands.,Department of Intensive Care, Haga Teaching Hospital, The Hague, The Netherlands
| | - Tim P van de Hoef
- Heart Center, Amsterdam Universitair Medische Centra, The Netherlands
| | - Rokas Šerpytis
- Clinic of Cardiac and Vascular Diseases, Vilnius University, Lithuania
| | - Roberto Diletti
- Department of Cardiology, Erasmus University Medical Center, The Netherlands
| | - José Ps Henriques
- Heart Center, Amsterdam Universitair Medische Centra, The Netherlands
| | - Pranas Šerpytis
- Clinic of Cardiac and Vascular Diseases, Vilnius University, Lithuania
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, University Hospital, Germany
| | - Jan J Piek
- Heart Center, Amsterdam Universitair Medische Centra, The Netherlands
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20
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Abstract
Aging is the progressive decline of physiological functions necessary for survival and reproduction. In gaining a better understanding of the inevitable aging process, the hope is to preserve, promote, or delay healthy aging through the treatment of common age-associated diseases. Although there are theories that try to explain the aging process, none of them seem to fully satisfy. Microcirculation describes blood flow through the capillaries in the circulatory system. The main functions of the microcirculation are the delivery of oxgen and nutrients and the removal of CO2, metabolic debris, and toxins. The microcirculatory impairment or dysfunction over time will result in the accumulation of toxic products and CO2 and loss of nutrition supplementation and O2 in corresponding tissue systems or internal organs, which eventually affect normal tissue and organ functions, leading to aging. Therefore, I propose a microcirculatory theory of aging: aging is the process of continuous impairment of microcirculation in the body.
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Affiliation(s)
- Kunlin Jin
- Department of Pharmacology & Neuroscience, University of North Texas Health Science Center, TX 76107, USA
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21
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Abstract
Despite our understanding that the microvasculature plays a multifaceted role in the development and progression of various conditions, we know little about the extent of this involvement. A need exists for non-invasive, clinically meaningful imaging modalities capable of elucidating microvascular information to aid in our understanding of disease, and to aid in the diagnosis/monitoring of disease for more patient-specific care. In this review article, a number of imaging techniques are summarized that have been utilized to investigate the microvasculature of skin, along with their advantages, disadvantages and future perspectives in preclinical and clinical settings. These techniques include dermoscopy, capillaroscopy, Doppler sonography, laser Doppler flowmetry (LDF) and perfusion imaging, laser speckle contrast imaging (LSCI), optical coherence tomography (OCT), including its Doppler and dynamic variant and the more recently developed OCT angiography (OCTA), photoacoustic imaging, and spatial frequency domain imaging (SFDI). Attention is largely, but not exclusively, placed on optical imaging modalities that use intrinsic optical signals to contrast the microvasculature. We conclude that whilst each imaging modality has been successful in filling a particular niche, there is no one, all-encompassing modality without inherent flaws. Therefore, the future of cutaneous microvascular imaging may lie in utilizing a multi-modal approach that will counter the disadvantages of individual systems to synergistically augment our imaging capabilities.
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Affiliation(s)
- Anthony J Deegan
- Department of Bioengineering, University of Washington, 3720 15th Ave. NE., Seattle, WA 98195, United States of America
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22
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van den Akker JPC, Bakker J, Groeneveld ABJ, den Uil CA. Risk indicators for acute kidney injury in cardiogenic shock. J Crit Care 2018; 50:11-16. [PMID: 30465893 DOI: 10.1016/j.jcrc.2018.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/30/2018] [Accepted: 11/09/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE In critical illness, the relation between the macrocirculation, microcirculation and organ dysfunction, such as acute kidney injury (AKI), is complex. This study aimed at identifying predictors for AKI in patients with cardiogenic shock. MATERIALS AND METHODS Thirty-nine adult cardiogenic shock patients, with an admission creatinine <200 μmol l-1, and whose microcirculation was measured within 48 h were enrolled. Patient data were analyzed if AKI stage ≥1 developed according to the Kidney Disease/Improving Outcomes classification within 48 h after admission. Variables with a p < .05 in the univariate analysis were considered for analysis with logistic regression. RESULTS Twenty-four patients (61.5%) developed AKI within 48 h. The group that developed AKI had higher central venous pressures (CVP), lower diastolic arterial blood pressures and mean perfusion pressures, higher maximum ventilator pressures as well as positive end expiratory pressures and were treated with higher dosages of dobutamine. There was no difference of the microcirculation. In the multivariate logistic regression analysis, CVP was the only independent predictor for AKI (OR 1.241; 95% CI 1.030-1.495; p = .023). CONCLUSIONS In this population of patients with cardiogenic shock, CVP was associated with the development of AKI.
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Affiliation(s)
- Johannes P C van den Akker
- Department of Intensive Care Adults, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015GD, Rotterdam, the Netherlands.
| | - Jan Bakker
- Department of Intensive Care Adults, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015GD, Rotterdam, the Netherlands; Division of Pulmonary, Allergy and Critical Care, Columbia University Medical Center, New York, NY, USA; Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone-Bellevue Hospital, New York, NY, USA; Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - A B J Groeneveld
- Department of Intensive Care Adults, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015GD, Rotterdam, the Netherlands
| | - C A den Uil
- Department of Intensive Care Adults, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015GD, Rotterdam, the Netherlands; Department of Cardiology, Erasmus MC, University Medical Center, s-Gravendijkwal 230, Rotterdam 3015, the Netherlands
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23
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Bimpong-Buta NY, Jirak P, Wernly B, Lichtenauer M, Masyuk M, Muessig JM, Braun K, Kaya S, Kelm M, Jung C. Analysis of human microcirculation in weightlessness: Study protocol and pre-study experiments. Clin Hemorheol Microcirc 2018; 70:119-127. [PMID: 29710687 DOI: 10.3233/ch-170366] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In weightlessness, alterations in organ systems have been reported. The microcirculation consists of a network of blood vessels with diameters of a few μm. It is considered the largest part of the circulatory system of the human body and essential for exchange of gas, nutrients and waste products. An investigation of the microcirculation in weightlessness seems warranted but has not yet been performed. OBJECTIVE In this paper, we outline a study in which we will investigate the possible interrelations between weightlessness and microcirculation. We will induce weightlessness in the course of parabolic flight maneuvers, which will be conducted during a parabolic flight campaign. In this study protocol also an evaluation of a possible influence of parabolic flight premedication on microcirculation will be described. METHODS The microcirculation will be investigated by sublingual intravital measurements applying sidestream darkfield microscopy. Parameters of macrocirculation such as heart rate, blood pressure and blood oxygenation will also be investigated. RESULTS In our pre-study experiments, neither dimenhydrinate nor scopolamine altered microcirculation. CONCLUSIONS As the application of motion sickness therapy did not alter microcirculation, it will be applied during the parabolic flight maneuvers of the campaign. Our results might deepen the understanding of microcirculation on space missions and on earth.
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Affiliation(s)
- Nana-Yaw Bimpong-Buta
- Department of Internal Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Peter Jirak
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Austria
| | - Bernhard Wernly
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Austria
| | - Michael Lichtenauer
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Austria
| | - Maryna Masyuk
- Department of Internal Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Johanna Maria Muessig
- Department of Internal Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Kristina Braun
- Department of Internal Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Sema Kaya
- Department of Internal Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Department of Internal Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christian Jung
- Department of Internal Medicine, Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
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Rosenstein PG, Tennent-Brown BS, Hughes D. Clinical use of plasma lactate concentration. Part 1: Physiology, pathophysiology, and measurement. J Vet Emerg Crit Care (San Antonio) 2018. [PMID: 29533512 DOI: 10.1111/vec.12708] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review the current literature with respect to the physiology, pathophysiology, and measurement of lactate. DATA SOURCES Data were sourced from veterinary and human clinical trials, retrospective studies, experimental studies, and review articles. Articles were retrieved without date restrictions and were sourced primarily via PubMed, Scopus, and CAB Abstracts as well as by manual selection. HUMAN AND VETERINARY DATA SYNTHESIS Lactate is an important energy storage molecule, the production of which preserves cellular energy production and mitigates the acidosis from ATP hydrolysis. Although the most common cause of hyperlactatemia is inadequate tissue oxygen delivery, hyperlactatemia can, and does occur in the face of apparently adequate oxygen supply. At a cellular level, the pathogenesis of hyperlactatemia varies widely depending on the underlying cause. Microcirculatory dysfunction, mitochondrial dysfunction, and epinephrine-mediated stimulation of Na+ -K+ -ATPase pumps are likely important contributors to hyperlactatemia in critically ill patients. Ultimately, hyperlactatemia is a marker of altered cellular bioenergetics. CONCLUSION The etiology of hyperlactatemia is complex and multifactorial. Understanding the relevant pathophysiology is helpful when characterizing hyperlactatemia in clinical patients.
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Affiliation(s)
- Patricia G Rosenstein
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
| | - Brett S Tennent-Brown
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
| | - Dez Hughes
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
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Smirni S, MacDonald MP, Robertson CP, McNamara PM, O'Gorman S, Leahy MJ, Khan F. Application of cmOCT and continuous wavelet transform analysis to the assessment of skin microcirculation dynamics. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-13. [PMID: 29992798 DOI: 10.1117/1.jbo.23.7.076006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
Correlation mapping optical coherence tomography (cmOCT) is a powerful technique for the imaging of skin microvessels structure, based on the discrimination of the static and dynamic regions of the tissue. Although the suitability of cmOCT to visualize the microcirculation has been proved in humans and animal models, less evidence has been provided about its application to examine functional dynamics. Therefore, the goal of this research was validating the cmOCT method for the investigation into microvascular function and vasomotion. A spectral domain optical coherence tomography (SD-OCT) device was employed to image 90 sequential three-dimensional (3-D) OCT volumes from the forearm of 12 volunteers during a 25-min postocclusive reactive hyperemia (PORH) test. The volumes were processed using cmOCT to generate blood flow maps at selected cutaneous depths. The maps clearly trace flow variations during the PORH response for both capillaries and arterioles/venules microvascular layers. Continuous blood flow signals were reconstructed from cmOCT maps to study vasomotion by applying wavelet transform spectral analysis, which revealed fluctuations of flow during PORH, reflecting the regulation of microvascular tone mediated by endothelial cells and sympathetic nerves. The results clearly demonstrate that cmOCT allows the generation of functional information that may be used for diagnostic applications.
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Affiliation(s)
- Salvatore Smirni
- University of Dundee, School of Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - Michael P MacDonald
- University of Dundee, School of Medicine, Ninewells Hospital, Dundee, United Kingdom
- University of Dundee, School of Science and Engineering, Nethergate, Dundee, United Kingdom
| | - Catherine P Robertson
- University of Dundee, School of Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - Paul M McNamara
- National University of Ireland, Tissue Optics and Microcirculation Imaging Facility, Galway, Ireland
| | - Sean O'Gorman
- National University of Ireland, Tissue Optics and Microcirculation Imaging Facility, Galway, Ireland
| | - Martin J Leahy
- National University of Ireland, Tissue Optics and Microcirculation Imaging Facility, Galway, Ireland
- Royal College of Surgeons (RCSI), Dublin, Ireland
| | - Faisel Khan
- University of Dundee, School of Medicine, Ninewells Hospital, Dundee, United Kingdom
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Alnawaiseh M, Ertmer C, Seidel L, Arnemann PH, Lahme L, Kampmeier TG, Rehberg SW, Heiduschka P, Eter N, Hessler M. Feasibility of optical coherence tomography angiography to assess changes in retinal microcirculation in ovine haemorrhagic shock. Crit Care 2018; 22:138. [PMID: 29843760 PMCID: PMC5975442 DOI: 10.1186/s13054-018-2056-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/07/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This study aimed to investigate the feasibility of optical coherence tomography angiography (OCT-A) for quantitative analysis of flow density to assess changes in retinal perfusion in an experimental model of haemorrhagic shock. METHODS Haemorrhagic shock was induced in five healthy, anaesthetized sheep by stepwise blood withdrawal of 3 × 10 ml∙kg- 1 body weight. OCT-A imaging of retinal perfusion was performed using an OCT device. Incident dark-field illumination microscopy videos were obtained for the evaluation of conjunctival microcirculation. Haemodynamic variables and flow density data in the OCT angiogram were analysed before and during progressive haemorrhage resulting in haemorrhagic shock as well as after fluid resuscitation with 10 ml∙kg- 1 body weight of balanced hydroxyethyl starch solution (6% HES 130/0.4). Videos of the conjunctival microcirculation were recorded at baseline, in haemorrhagic shock, and after resuscitation. Data are presented as median with interquartile range. Comparisons between time points were made using Friedman's test and the degree of correlation between two variables was expressed as Spearman's rank correlation coefficient. RESULTS Mean arterial pressure and cardiac index (CI) decreased and lactate concentration increased after induction of shock, and haemodynamics recovered after resuscitation. The flow density in the superficial retinal OCT angiogram decreased significantly after shock induction (baseline 44.7% (40.3; 50.5) vs haemorrhagic shock 34.5% (32.8; 40.4); P = 0.027) and recovered after fluid resuscitation (46.9% (41.7; 50.7) vs haemorrhagic shock; P = 0.027). The proportion of perfused vessels of the conjunctival microcirculation showed similar changes. The flow density measured using OCT-A correlated with the conjunctival microcirculation (perfused vessel density: Spearman's rank correlation coefficient ρ = 0.750, P = 0.001) and haemodynamic parameters (CI: ρ = 0.693, P < 0.001). CONCLUSIONS Retinal flow density, measured using OCT-A, significantly decreased in shock and recovered after fluid therapy in an experimental model of haemorrhagic shock. OCT-A is feasible to assess changes in retinal perfusion in haemorrhagic shock and fluid resuscitation.
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Affiliation(s)
- Maged Alnawaiseh
- Department of Ophthalmology, University of Muenster Medical Centre, Domagkstraße 15, 48149 Muenster, Germany
| | - Christian Ertmer
- Department of Anaesthesiology, Intensive Care, and Pain Therapy, University of Muenster Medical Centre, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Laura Seidel
- Department of Anaesthesiology, Intensive Care, and Pain Therapy, University of Muenster Medical Centre, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Philip Helge Arnemann
- Department of Anaesthesiology, Intensive Care, and Pain Therapy, University of Muenster Medical Centre, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Larissa Lahme
- Department of Ophthalmology, University of Muenster Medical Centre, Domagkstraße 15, 48149 Muenster, Germany
| | - Tim-Gerald Kampmeier
- Department of Anaesthesiology, Intensive Care, and Pain Therapy, University of Muenster Medical Centre, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Sebastian Willy Rehberg
- Department of Anaesthesiology, University of Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Peter Heiduschka
- Department of Ophthalmology, University of Muenster Medical Centre, Domagkstraße 15, 48149 Muenster, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Centre, Domagkstraße 15, 48149 Muenster, Germany
| | - Michael Hessler
- Department of Anaesthesiology, Intensive Care, and Pain Therapy, University of Muenster Medical Centre, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
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Sepsis-Induced Cardiomyopathy: Oxidative Implications in the Initiation and Resolution of the Damage. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:7393525. [PMID: 29057035 PMCID: PMC5625757 DOI: 10.1155/2017/7393525] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/14/2017] [Accepted: 08/23/2017] [Indexed: 12/13/2022]
Abstract
Cardiac dysfunction may complicate the course of severe sepsis and septic shock with significant implications for patient's survival. The basic pathophysiologic mechanisms leading to septic cardiomyopathy have not been fully clarified until now. Disease-specific treatment is lacking, and care is still based on supportive modalities. Septic state causes destruction of redox balance in many cell types, cardiomyocytes included. The production of reactive oxygen and nitrogen species is increased, and natural antioxidant systems fail to counterbalance the overwhelming generation of free radicals. Reactive species interfere with many basic cell functions, mainly through destruction of protein, lipid, and nucleic acid integrity, compromising enzyme function, mitochondrial structure and performance, and intracellular signaling, all leading to cardiac contractile failure. Takotsubo cardiomyopathy may result from oxidative imbalance. This review will address the multiple aspects of cardiomyocyte bioenergetic failure in sepsis and discuss potential therapeutic interventions.
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Karbalaie A, Abtahi F, Fatemi A, Etehadtavakol M, Emrani Z, Erlandsson BE. Elliptical broken line method for calculating capillary density in nailfold capillaroscopy: Proposal and evaluation. Microvasc Res 2017; 113:1-8. [PMID: 28414021 DOI: 10.1016/j.mvr.2017.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 04/07/2017] [Accepted: 04/08/2017] [Indexed: 12/19/2022]
Abstract
Nailfold capillaroscopy is a practical method for identifying and obtaining morphological changes in capillaries which might reveal relevant information about diseases and health. Capillaroscopy is harmless, and seems simple and repeatable. However, there is lack of established guidelines and instructions for acquisition as well as the interpretation of the obtained images; which might lead to various ambiguities. In addition, assessment and interpretation of the acquired images are very subjective. In an attempt to overcome some of these problems, in this study a new modified technique for assessment of nailfold capillary density is introduced. The new method is named elliptic broken line (EBL) which is an extension of the two previously known methods by defining clear criteria for finding the apex of capillaries in different scenarios by using a fitted elliptic. A graphical user interface (GUI) is developed for pre-processing, manual assessment of capillary apexes and automatic correction of selected apexes based on 90° rule. Intra- and inter-observer reliability of EBL and corrected EBL is evaluated in this study. Four independent observers familiar with capillaroscopy performed the assessment for 200 nailfold videocapillaroscopy images, form healthy subject and systemic lupus erythematosus patients, in two different sessions. The results show elevation from moderate (ICC=0.691) and good (ICC=0.753) agreements to good (ICC=0.750) and good (ICC=0.801) for intra- and inter-observer reliability after automatic correction of EBL. This clearly shows the potential of this method to improve the reliability and repeatability of assessment which motivates us for further development of automatic tool for EBL method.
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Affiliation(s)
- Abdolamir Karbalaie
- School of Technology and Health, Royal Institute of Technology (KTH), SE-100 44, Stockholm, Sweden.
| | - Farhad Abtahi
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden; Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.
| | - Alimohammad Fatemi
- Department of Rheumatology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mahnaz Etehadtavakol
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Zahra Emrani
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Björn-Erik Erlandsson
- School of Technology and Health, Royal Institute of Technology (KTH), SE-100 44, Stockholm, Sweden.
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30
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Yu L, Da XW, Wu XL, He AD, Long D. Simvastatin prevents lipopolysaccharide-induced septic shock in rats. ACTA ACUST UNITED AC 2017; 37:226-230. [DOI: 10.1007/s11596-017-1719-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/16/2017] [Indexed: 12/11/2022]
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das Graças Coelho de Souza M, Kraemer-Aguiar LG, Bouskela E. Inflammation-induced microvascular dysfunction in obesity – A translational approach. Clin Hemorheol Microcirc 2017; 64:645-654. [DOI: 10.3233/ch-168018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maria das Graças Coelho de Souza
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular, Centro Biomédico, Universidade do Estado do Rio de Janeiro, RJ, Brazil
| | - Luiz Guilherme Kraemer-Aguiar
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular, Centro Biomédico, Universidade do Estado do Rio de Janeiro, RJ, Brazil
- Ambulatório de Obesidade, Policlínica Piquet Carneiro, Departamento de Medicina Interna, Faculdade de Ciências Médicas, Centro Biomédico, Universidade do Estado do Rio de Janeiro, RJ, Brazil
| | - Eliete Bouskela
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular, Centro Biomédico, Universidade do Estado do Rio de Janeiro, RJ, Brazil
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Kumar M, Suliburk J, Veeraraghavan A, Sabharwal A. PulseCam: high-resolution blood perfusion imaging using a camera and a pulse oximeter. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2016:3904-3909. [PMID: 28269139 DOI: 10.1109/embc.2016.7591581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Measuring blood perfusion is important in medical care as an indicator of injury and disease. However, currently available devices to measure blood perfusion like laser Doppler flowmetry are bulky, expensive, and cumbersome to use. An alternative low-cost and portable camera-based blood perfusion measurement system has recently been proposed, but such camera-only system produces noisy low-resolution blood perfusion maps. In this paper, we propose a new multi-sensor modality, named PulseCam, for measuring blood perfusion by combining a traditional pulse oximeter with a video camera in a unique way to provide low noise and high-resolution blood perfusion maps. Our proposed multi-sensor modality improves per pixel signal to noise ratio of measured perfusion map by up to 3 dB and improves the spatial resolution by 2 - 3 times compared to best known camera-only methods. Blood perfusion measured in the palm using our PulseCam setup during a post-occlusive reactive hyperemia (PORH) test replicates standard PORH response curve measured using laser Doppler flowmetry device but with much lower cost and a portable setup making it suitable for further development as a clinical device.
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Butler E, Chin M, Aneman A. Peripheral Near-Infrared Spectroscopy: Methodologic Aspects and a Systematic Review in Post-Cardiac Surgical Patients. J Cardiothorac Vasc Anesth 2016; 31:1407-1416. [PMID: 27876185 DOI: 10.1053/j.jvca.2016.07.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Ethan Butler
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Melissa Chin
- Intensive Care Unit, Liverpool Hospital, Sydney, Australia
| | - Anders Aneman
- Intensive Care Unit, Liverpool Hospital, Sydney, Australia; University of New South Wales, South Western Sydney Clinical School, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia.
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Abstract
Adequate monitoring of patients on intensive care units is of highest priority to provide optimal treatment and to detect patients at risk. Within recent years the microcirculation became more and more attention due to its central importance for the outcome of patients. Microcirculatory disorders may include capillary flow disturbances as well as changes in the density of perfused vessels. In the clinical setting, the most often used parameter to detect alterations in the microcirculation is serum lactate. Since this parameter is characterized by major limitations, other strategies including non-invasive methods to quantify microvascular perfusion have been developed. A successful surveillance of the microcirculation in the individual patient may guide diagnostic and treatment strategies in order to optimize organ perfusion and oxygenation, subsequently leading to an individualized therapy. Intravital microscopy has been used to stratify patients at risk and to predict patients' outcome. The aim of this review is to evaluate clinical correlates of microcirculatory disorders as well as giving an overview of newer diagnostic devices that may directly or indirectly evaluate the microcirculation and are available for use in critically ill patients.
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Jung C, Kelm M, Ferrari M. Beurteilung der Mikrozirkulation beim kritisch kranken Patienten. Med Klin Intensivmed Notfmed 2016; 111:605-609. [DOI: 10.1007/s00063-016-0169-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/02/2016] [Indexed: 01/30/2023]
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Townsend D, D’Aiuto F, Deanfield J. Vascular Fragility and the Endothelial Glycocalyx in the Tissues Lining the Healthy Gingival Crevice. J Periodontol 2016; 87:672-9. [DOI: 10.1902/jop.2016.150568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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O'Connor J, Day P, Mandal P, Revell A. Computational fluid dynamics in the microcirculation and microfluidics: what role can the lattice Boltzmann method play? Integr Biol (Camb) 2016; 8:589-602. [PMID: 27068565 DOI: 10.1039/c6ib00009f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Patient-specific simulations, efficient parametric analyses, and the study of complex processes that are otherwise experimentally intractable are facilitated through the use of Computational Fluid Dynamics (CFD) to study biological flows. This review discusses various CFD methodologies that have been applied across different biological scales, from cell to organ level. Through this discussion the lattice Boltzmann method (LBM) is highlighted as an emerging technique capable of efficiently simulating fluid problems across the midrange of scales; providing a practical analytical tool compared to methods more attuned to the extremities of scale. Furthermore, the merits of the LBM are highlighted through examples of previous applications and suggestions for future research are made. The review focusses on applications in the midrange bracket, such as cell-cell interactions, the microcirculation, and microfluidic devices; wherein the inherent mesoscale nature of the LBM renders it well suited to the incorporation of fluid-structure interaction effects, molecular/particle interactions and interfacial dynamics. The review demonstrates that the LBM has the potential to become a valuable tool across a range of emerging areas in bio-CFD, such as understanding and predicting disease, designing lab-on-a-chip devices, and elucidating complex biological processes.
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Affiliation(s)
- Joseph O'Connor
- School of Mechanical, Aerospace and Civil Engineering, The University of Manchester, Manchester, UKM13 9PL.
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Abstract
Functional components of the microcirculation provide oxygen and nutrients and remove waste products from the tissue beds of the body's organs. Shock states overwhelmingly stress functional capacity of the microcirculation, resulting in microcirculatory failure. In septic shock, inflammatory mediators contribute to hemodynamic instability. In nonseptic shock states, the microcirculation is better able to compensate for alterations in vascular resistance, cardiac output, and blood pressure. Therefore, global hemodynamic and oxygen delivery parameters are appropriate for assessing, monitoring, and guiding therapy in hypovolemic and cardiogenic shock but, alone, are inadequate for septic shock.
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Affiliation(s)
- Shannan K Hamlin
- Nursing Research and Evidence-Based Practice, Houston Methodist Hospital, MGJ 11-017, Houston, TX 77030, USA.
| | - C Lee Parmley
- Vanderbilt University Hospital, 1211 21st Avenue South, S3408 MCN, Nashville, TN 37212, USA; Department of Anesthesiology, Division of Critical Care, Vanderbilt University School of Medicine, 1211 21st Avenue South, S3408 MCN, Nashville, TN 37212, USA
| | - Sandra K Hanneman
- Center for Nursing Research, University of Texas Health Science Center at Houston School of Nursing, Room #594, 6901 Bertner Avenue, Houston, TX 77030, USA
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Kataoka H, Ushiyama A, Kawakami H, Akimoto Y, Matsubara S, Iijima T. Fluorescent imaging of endothelial glycocalyx layer with wheat germ agglutinin using intravital microscopy. Microsc Res Tech 2015; 79:31-7. [DOI: 10.1002/jemt.22602] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Hanae Kataoka
- Department of Perioperative Medicine, Division of Anesthesiology; Showa University, School of Dentistry; Tokyo Japan
| | - Akira Ushiyama
- Department of Environmental Health; National Institute of Public Health; Saitama Japan
| | - Hayato Kawakami
- Department of Anatomy; Kyorin University School of Medicine; Tokyo Japan
| | - Yoshihiro Akimoto
- Department of Anatomy; Kyorin University School of Medicine; Tokyo Japan
| | - Sachie Matsubara
- Laboratory for Electron Microscopy; Kyorin University School of Medicine; Tokyo Japan
| | - Takehiko Iijima
- Department of Perioperative Medicine, Division of Anesthesiology; Showa University, School of Dentistry; Tokyo Japan
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Lewejohann JC, Braasch H, Hansen M, Zimmermann C, Muhl E, Keck T. [Adequate fluid resuscitation in septic shock with high catecholamine doses]. Med Klin Intensivmed Notfmed 2015; 111:514-24. [PMID: 26555619 DOI: 10.1007/s00063-015-0111-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/02/2015] [Accepted: 09/04/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Appropriate fluid resuscitation is a fundamental aspect for the hemodynamic management of septic shock patients and should ideally be achieved before vasopressors and positive inotropic substances are administered. The development of hemodynamic monitoring has revealed that in some cases patients had been improperly treated with high-dose catecholamines for initially insufficient fluid resuscitation. The aim of this study was to show that in some cases it is possible to actively reduce catecholamines by a volume challenge adapted according to the individual patient needs. MATERIAL AND METHODS In this retrospective observational study 29 patients with septic shock in a surgical intensive care unit (ICU) at a university hospital (17 male, 12 female, mean age 71 ± 10 years) on high-dose catecholamines (median values norepinephrine 0.204 µg/kg body weight/min, dobutamine 3.876 µg/kg/min and epinephrine 0.025 µg/kg/min, ranging up to 0.810 µg/kg/min, 22.222 µg/kg/min and 0.407 µg/kg/min in 28, 20 and 17 patients, respectively) were analyzed. The extremities of the patients were initially cold with a mottled marbled appearance whereas the mean arterial pressure (MAP) was ≥ 65 mmHg. The median central venous pressure (CVP) was 17 mmHg (range 55-34 mmHg) and the mean lactate concentration was 2.78 mmol/l (range 0.93-10.67 mmol/l). The standard therapy concept consisted of a forced volume challenge combined with active reduction of catecholamines to achieve an adequate fluid loading status, guided by the passive leg raising test (PLR), clinical signs and in 19 cases by hemodynamic monitoring (pulmonary artery catheter Vigilance II(™) n = 10, FloTrac(™), Vigileo(™) n = 9 and PreSep(™) n = 5; Edwards Life Sciences). The forced volume challenge was stopped after clinical improvement with rewarmed extremities, increasing diuresis volumes and lack of improvement by PLR. RESULTS Catecholamine doses could be significantly reduced in all patients: norepinephrine to 0 µg/kg/min, dobutamine to 1.852 µg/kg/min and epinephrine to 0 µg/kg/min (up to 0.133 µg/kg/min, 6.289 µg/kg/min and 0.091 µg/kg/min, respectively, p < 0.05 Wilcoxon signed rank test). Volume challenge test: + 4,500 ml Ringer solution (range 0-24,000 ml) and 1,000 ml hydroxyethyl starch (range 0-2,500 ml) and mean fluid balance + 6,465 ml (range + 2,040 ml to + 27,255 ml). The median weaning time from catecholamines was 12 h (range 4-43 h). After treatment all patients showed rewarmed extremities and a decrease in mean lactate levels from 2.78 mmol/l (range 0.93-10.67 mmol/l) to 2.05 mmol/l (range 0.7-5.4 mmol/l). The measured hemodynamic constellations showed clear interindividual differences but no cardiac deterioration occurred. The median oxygenation index (paO2/FiO2) showed a statistically insignificant change from 264 mmHg (range 75-418 mmHg) to 250 mmHg (range 120-467 mmHg). Of the patients 20 survived and 9 died. CONCLUSION It is possible to wean a substantial proportion of septic shock patients from high-dose catecholamines in combination with a needs-adapted forced volume challenge test. The importance of appropriate fluid loading prior to the use of high catecholamine doses should be a main subject of discussion in patients with severe septic shock and was confirmed in this study. This should be oriented to clinical and if possible, hemodynamic parameters and should not be underestimated.
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Affiliation(s)
- J C Lewejohann
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - H Braasch
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - M Hansen
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - C Zimmermann
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - E Muhl
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - T Keck
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
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Marín-Corral J, Claverias L, Bodí M, Pascual S, Dubin A, Gea J, Rodriguez A. Prognostic value of brachioradialis muscle oxygen saturation index and vascular occlusion test in septic shock patients. Med Intensiva 2015; 40:208-15. [PMID: 26394682 DOI: 10.1016/j.medin.2015.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/26/2015] [Accepted: 07/09/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare rSO2 (muscle oxygen saturation index) static and dynamic variables obtained by NIRS (Near Infrared Spectroscopy) in brachioradialis muscle of septic shock patients and its prognostic implications. DESIGN Prospective and observational study. SETTING Intensive care unit. SUBJECTS Septic shock patients and healthy volunteers. INTERVENTIONS The probe of a NIRS device (INVOS 5100) was placed on the brachioradialis muscle during a vascular occlusion test (VOT). VARIABLES Baseline, minimum and maximum rSO2 values, deoxygenation rate (DeOx), reoxygenation slope (ReOx) and delta value. RESULTS Septic shock patients (n=35) had lower baseline rSO2 (63.8±12.2 vs. 69.3±3.3%, p<0.05), slower DeOx (-0.54±0.31 vs. -0.91±0.35%/s, p=0.001), slower ReOx (2.67±2.17 vs. 9.46±3.5%/s, p<0.001) and lower delta (3.25±5.71 vs. 15.1±3.9%, p<0.001) when compared to healthy subjects (n=20). Among septic shock patients, non-survivors showed lower baseline rSO2 (57.0±9.6 vs. 69.8±11.3%, p=0.001), lower minimum rSO2 (36.0±12.8 vs. 51.3±14.8%, p<0.01) and lower maximum rSO2 values (60.6±10.6 vs. 73.3±11.2%, p<0.01). Baseline rSO2 was a good mortality predictor (AUC 0.79; 95%CI: 0.63-0.94, p<0.01). Dynamic parameters obtained with VOT did not improve the results. CONCLUSION Septic shock patients present an important alteration of microcirculation that can be evaluated by NIRS with prognostic implications. Monitoring microvascular reactivity in the brachioradialis muscle using VOT with our device does not seem to improve the prognostic value of baseline rSO2.
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Affiliation(s)
- J Marín-Corral
- Critical Care Department - University Joan XXIII Hospital - IISPV-URV, Tarragona, Spain.
| | - L Claverias
- Critical Care Department - University Joan XXIII Hospital - IISPV-URV, Tarragona, Spain
| | - M Bodí
- Critical Care Department - University Joan XXIII Hospital - IISPV-URV, Tarragona, Spain; CIBERES (CIBER Enfermedades Respiratorias), ISC III, Bunyola, Palma de Mallorca, Spain
| | - S Pascual
- Respiratory Department - Hospital del Mar - IMIM. Department CEXS, UPF, Barcelona, Spain; CIBERES (CIBER Enfermedades Respiratorias), ISC III, Bunyola, Palma de Mallorca, Spain
| | - A Dubin
- Sanatorio Otamendi y Miroli, Servicio de Terapia Intensiva, Buenos Aires, Argentina; Cátedra de Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - J Gea
- Respiratory Department - Hospital del Mar - IMIM. Department CEXS, UPF, Barcelona, Spain; CIBERES (CIBER Enfermedades Respiratorias), ISC III, Bunyola, Palma de Mallorca, Spain
| | - A Rodriguez
- Critical Care Department - University Joan XXIII Hospital - IISPV-URV, Tarragona, Spain; CIBERES (CIBER Enfermedades Respiratorias), ISC III, Bunyola, Palma de Mallorca, Spain
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Wecht JM, La Fountaine MF, Handrakis JP, West CR, Phillips A, Ditor DS, Sharif H, Bauman WA, Krassioukov AV. Autonomic Nervous System Dysfunction Following Spinal Cord Injury: Cardiovascular, Cerebrovascular, and Thermoregulatory Effects. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0093-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Gilbert-Kawai E, Sheperdigian A, Adams T, Mitchell K, Feelisch M, Murray A, Peters M, Gilbert-Kawai G, Montgomery H, Levett D, Kumar R, Mythen M, Grocott M, Martin D. Design and conduct of Xtreme Everest 2: An observational cohort study of Sherpa and lowlander responses to graduated hypobaric hypoxia. F1000Res 2015; 4:90. [PMID: 26064476 PMCID: PMC4448741 DOI: 10.12688/f1000research.6297.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 11/20/2022] Open
Abstract
Objective: Oxygen availability falls with ascent to altitude and also as a consequence of critical illness. Because cellular sequelae and adaptive processes may be shared in both circumstances, high altitude exposure (‘physiological hypoxia’) assists in the exploration of the response to pathological hypoxia. We therefore studied the response of healthy participants to progressive hypobaric hypoxia at altitude. The primary objective of the study was to identify differences between high altitude inhabitants (Sherpas) and lowland comparators. Methods: We performed an observational cohort study of human responses to progressive hypobaric hypoxia (during ascent) and subsequent normoxia (following descent) comparing Sherpas with lowlanders. Studies were conducted in London (35m), Kathmandu (1300m), Namche Bazaar (3500m) and Everest Base Camp (5300m). Of 180 healthy volunteers departing from Kathmandu, 64 were Sherpas and 116 were lowlanders. Physiological, biochemical, genetic and epigenetic data were collected. Core studies focused on nitric oxide metabolism, microcirculatory blood flow and exercise performance. Additional studies performed in nested subgroups examined mitochondrial and metabolic function, and ventilatory and cardiac variables. Of the 180 healthy participants who left Kathmandu, 178 (99%) completed the planned trek. Overall, more than 90% of planned testing was completed. Forty-four study protocols were successfully completed at altitudes up to and including 5300m. A subgroup of identical twins (all lowlanders) was also studied in detail. Conclusion: This programme of study (Xtreme Everest 2) will provide a rich dataset relating to human adaptation to hypoxia, and the responses seen on re-exposure to normoxia. It is the largest comprehensive high altitude study of Sherpas yet performed. Translational data generated from this study will be of relevance to diseases in which oxygenation is a major factor.
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Affiliation(s)
- Edward Gilbert-Kawai
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, W1T 7HA, UK
| | - Adam Sheperdigian
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, W1T 7HA, UK
| | - Thomas Adams
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, W1T 7HA, UK
| | - Kay Mitchell
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, W1T 7HA, UK ; Integrative Physiology and Critical Illness Group, Faculty of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK ; Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK ; NIHR Southampton Respiratory Biomedical Research Unit, Southampton, CB2 3EG, UK
| | - Martin Feelisch
- Integrative Physiology and Critical Illness Group, Faculty of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK ; NIHR Southampton Respiratory Biomedical Research Unit, Southampton, CB2 3EG, UK
| | - Andrew Murray
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, W1T 7HA, UK ; Department of Physiology, Development & Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
| | - Mark Peters
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, W1T 7HA, UK ; Critical Care Group Portex Unit, UCL, Institute of Child Health, London, WC1N 1EH, UK
| | - Grace Gilbert-Kawai
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, W1T 7HA, UK
| | - Hugh Montgomery
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, W1T 7HA, UK
| | - Denny Levett
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, W1T 7HA, UK
| | - Rajendra Kumar
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, W1T 7HA, UK ; Nepal Health Research Council, Kathmandu, Nepal
| | - Michael Mythen
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, W1T 7HA, UK
| | - Michael Grocott
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, W1T 7HA, UK ; Integrative Physiology and Critical Illness Group, Faculty of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK ; Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK ; NIHR Southampton Respiratory Biomedical Research Unit, Southampton, CB2 3EG, UK
| | - Daniel Martin
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, W1T 7HA, UK
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Gu YM, Wang S, Zhang L, Liu YP, Thijs L, Petit T, Zhang Z, Wei FF, Kang YY, Huang QF, Sheng CS, Struijker-Boudier HAJ, Kuznetsova T, Verhamme P, Li Y, Staessen JA. Characteristics and determinants of the sublingual microcirculation in populations of different ethnicity. Hypertension 2015; 65:993-1001. [PMID: 25712718 DOI: 10.1161/hypertensionaha.114.05119] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/06/2015] [Indexed: 12/25/2022]
Abstract
No previous population study assessed sublingual capillary density (CD) or perfused boundary region (PBR). Lower PBR indicates greater glycocalyx width. In 252 Han and 220 She Chinese and 254 Flemish people (mean age, 51.1 years; 54.7% women), representing random population samples, we measured total and perfused CD and PBR in the sublingual capillary bed, using oblique profiled epi-illumination, and cardiovascular risk factors. In multivariable analyses, we modeled ethnicity as random effect. Significance level was α ≤ 0.05. Compared with Chinese, Flemish had lower total (577 versus 546 n°/mm(2)) and perfused (338 versus 320 n°/mm(2)) CD, but similar perfused-to-total CD ratio (mean, 0.59). Perfused-to-total CD ratio increased with age (effect size per 1-SD increase, +0.015 per year), body mass index (+0.008 per kg/m(2)), total cholesterol (+0.012 per mmol/L), and Framingham risk score (+0.018 per point) with no ethnic differences in these associations. For age and Framingham risk score, associations with perfused-to-total CD ratio were driven by positive relationships with perfused CD, whereas associations with total CD were nonsignificant. Chinese when compared with Flemish had higher hematocrit (43.0 versus 41.1%), PBR (2010 versus 1876 nm), and pulse rate (72.6 versus 63.3 bpm). PBR standardized for hematocrit, perfused CD, and pulse rate decreased with body mass index (-26.7 nm/kg/m2), mean arterial pressure (-30.6 nm/mm Hg), and diastolic pressure (-28.5 nm/mm Hg) with no ethnic differences in these associations. In conclusion, a higher cardiovascular risk profile is associated with functional recruitment of capillaries with preserved glycocalyx that protects the endothelial lining.
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Affiliation(s)
- Yu-Mei Gu
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-M.G., Y.-P.L., L.T., T.P., Z.Z., T.K., J.A.S.) and Center for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (S.W., L.Z., F.-F.W., Y.-Y.K., Q.-F.H.,C.-S.S.,Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and VitaK Research and Development (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Shuai Wang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-M.G., Y.-P.L., L.T., T.P., Z.Z., T.K., J.A.S.) and Center for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (S.W., L.Z., F.-F.W., Y.-Y.K., Q.-F.H.,C.-S.S.,Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and VitaK Research and Development (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Lu Zhang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-M.G., Y.-P.L., L.T., T.P., Z.Z., T.K., J.A.S.) and Center for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (S.W., L.Z., F.-F.W., Y.-Y.K., Q.-F.H.,C.-S.S.,Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and VitaK Research and Development (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Yan-Ping Liu
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-M.G., Y.-P.L., L.T., T.P., Z.Z., T.K., J.A.S.) and Center for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (S.W., L.Z., F.-F.W., Y.-Y.K., Q.-F.H.,C.-S.S.,Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and VitaK Research and Development (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Lutgarde Thijs
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-M.G., Y.-P.L., L.T., T.P., Z.Z., T.K., J.A.S.) and Center for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (S.W., L.Z., F.-F.W., Y.-Y.K., Q.-F.H.,C.-S.S.,Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and VitaK Research and Development (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Thibault Petit
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-M.G., Y.-P.L., L.T., T.P., Z.Z., T.K., J.A.S.) and Center for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (S.W., L.Z., F.-F.W., Y.-Y.K., Q.-F.H.,C.-S.S.,Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and VitaK Research and Development (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Zhenyu Zhang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-M.G., Y.-P.L., L.T., T.P., Z.Z., T.K., J.A.S.) and Center for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (S.W., L.Z., F.-F.W., Y.-Y.K., Q.-F.H.,C.-S.S.,Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and VitaK Research and Development (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Fang-Fei Wei
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-M.G., Y.-P.L., L.T., T.P., Z.Z., T.K., J.A.S.) and Center for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (S.W., L.Z., F.-F.W., Y.-Y.K., Q.-F.H.,C.-S.S.,Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and VitaK Research and Development (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Yuan-Yuan Kang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-M.G., Y.-P.L., L.T., T.P., Z.Z., T.K., J.A.S.) and Center for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (S.W., L.Z., F.-F.W., Y.-Y.K., Q.-F.H.,C.-S.S.,Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and VitaK Research and Development (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Qi-Fang Huang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-M.G., Y.-P.L., L.T., T.P., Z.Z., T.K., J.A.S.) and Center for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (S.W., L.Z., F.-F.W., Y.-Y.K., Q.-F.H.,C.-S.S.,Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and VitaK Research and Development (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Chang-Sheng Sheng
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-M.G., Y.-P.L., L.T., T.P., Z.Z., T.K., J.A.S.) and Center for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (S.W., L.Z., F.-F.W., Y.-Y.K., Q.-F.H.,C.-S.S.,Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and VitaK Research and Development (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Harry A J Struijker-Boudier
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-M.G., Y.-P.L., L.T., T.P., Z.Z., T.K., J.A.S.) and Center for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (S.W., L.Z., F.-F.W., Y.-Y.K., Q.-F.H.,C.-S.S.,Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and VitaK Research and Development (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Tatiana Kuznetsova
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-M.G., Y.-P.L., L.T., T.P., Z.Z., T.K., J.A.S.) and Center for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (S.W., L.Z., F.-F.W., Y.-Y.K., Q.-F.H.,C.-S.S.,Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and VitaK Research and Development (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Peter Verhamme
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-M.G., Y.-P.L., L.T., T.P., Z.Z., T.K., J.A.S.) and Center for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (S.W., L.Z., F.-F.W., Y.-Y.K., Q.-F.H.,C.-S.S.,Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and VitaK Research and Development (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Yan Li
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-M.G., Y.-P.L., L.T., T.P., Z.Z., T.K., J.A.S.) and Center for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (S.W., L.Z., F.-F.W., Y.-Y.K., Q.-F.H.,C.-S.S.,Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and VitaK Research and Development (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Jan A Staessen
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-M.G., Y.-P.L., L.T., T.P., Z.Z., T.K., J.A.S.) and Center for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (S.W., L.Z., F.-F.W., Y.-Y.K., Q.-F.H.,C.-S.S.,Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and VitaK Research and Development (J.A.S.), Maastricht University, Maastricht, The Netherlands.
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Sasse M, Dziuba F, Jack T, Köditz H, Kaussen T, Bertram H, Beerbaum P, Boehne M. In-line Filtration Decreases Systemic Inflammatory Response Syndrome, Renal and Hematologic Dysfunction in Pediatric Cardiac Intensive Care Patients. Pediatr Cardiol 2015; 36:1270-8. [PMID: 25845941 PMCID: PMC4495711 DOI: 10.1007/s00246-015-1157-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/24/2015] [Indexed: 11/25/2022]
Abstract
Cardiac surgery with cardiopulmonary bypass (CPB) frequently leads to systemic inflammatory response syndrome (SIRS) with concomitant organ malfunction. Infused particles may exacerbate inflammatory syndromes since they activate the coagulation cascade and alter inflammatory response or microvascular perfusion. In a randomized, controlled, prospective trial, we have previously shown that particle-retentive in-line filtration prevented major complications in critically ill children. Now, we investigated the effect of in-line filtration on major complications in the subgroup of cardiac patients. Children admitted to tertiary pediatric intensive care unit were randomized to either control or filter group obtaining in-line filtration throughout complete infusion therapy. Risk differences and 95 % confidence intervals (CI) of several complications such as SIRS, sepsis, mortality, various organ failure and dysfunction were compared between both groups using the Wald method. 305 children (n = 150 control, n = 155 filter group) with cardiac diseases were finally analyzed. The majority was admitted after cardiac surgery with CPB. Risk of SIRS (-11.3 %; 95 % CI -21.8 to -0.5 %), renal (-10.0 %; 95 % CI -17.0 to -3.0 %) and hematologic (-8.1 %; 95 % CI -14.2 to -0.2 %) dysfunction were significantly decreased within the filter group. No risk differences were demonstrated for occurrence of sepsis, any other organ failure or dysfunctions between both groups. Infused particles might aggravate a systemic hypercoagulability and inflammation with subsequent organ malfunction in pediatric cardiac intensive care patients. Particle-retentive in-line filtration might be effective in preventing SIRS and maintaining renal and hematologic function. In-line filtration offers a novel therapeutic option to decrease morbidity in cardiac intensive care.
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Affiliation(s)
- Michael Sasse
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Friederike Dziuba
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Thomas Jack
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Harald Köditz
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Torsten Kaussen
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Harald Bertram
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Martin Boehne
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
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Koning NJ, Atasever B, Vonk AB, Boer C. Changes in Microcirculatory Perfusion and Oxygenation During Cardiac Surgery With or Without Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2014; 28:1331-40. [DOI: 10.1053/j.jvca.2013.04.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Indexed: 12/19/2022]
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den Uil CA, Lagrand WK, van der Ent M, Nieman K, Struijs A, Jewbali LSD, Constantinescu AA, Spronk PE, Simoons ML. Conventional hemodynamic resuscitation may fail to optimize tissue perfusion: an observational study on the effects of dobutamine, enoximone, and norepinephrine in patients with acute myocardial infarction complicated by cardiogenic shock. PLoS One 2014; 9:e103978. [PMID: 25084171 PMCID: PMC4118994 DOI: 10.1371/journal.pone.0103978] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 07/09/2014] [Indexed: 11/19/2022] Open
Abstract
AIM To investigate the effects of inotropic agents on parameters of tissue perfusion in patients with cardiogenic shock. METHODS AND RESULTS Thirty patients with cardiogenic shock were included. Patients received dobutamine, enoximone, or norepinephrine. We performed hemodynamic measurements at baseline and after titration of the inotropic agent until cardiac index (CI) ≥ 2.5 L.min-1.m(-2) or mixed-venous oxygen saturation (SvO2) ≥ 70% (dobutamine or enoximone), and mean arterial pressure (MAP) ≥ 70 mmHg (norepinephrine). As parameters of tissue perfusion, we measured central-peripheral temperature gradient (delta-T) and sublingual perfused capillary density (PCD). All patients reached predefined therapeutic targets. The inotropes did not significantly change delta-T. Dobutamine did not change PCD. Enoximone increased PCD (9.1 [8.9-10.2] vs. 11.4 [8.4-13.9] mm.mm(-2); p<0.05), and norepinephrine tended to decrease PCD (9.8 [8.5-11.9] vs. 8.8 [8.2-9.6] mm.mm-2, p = 0.08). Fifteen patients (50%) died within 30 days after admission. Patients who had low final PCD (≤ 10.3 mm.mm-2; 64%) were more likely to die than patients who had preserved PCD (>10.3 mm.mm(-2); mortality 72% vs. 17%, p = 0.003). CONCLUSION This study demonstrates the effects of commonly used inotropic agents on parameters of tissue perfusion in patients with cardiogenic shock. Despite hemodynamic optimization, tissue perfusion was not sufficiently restored in most patients. In these patients, mortality was high. Interventions directed at improving microcirculation may eventually help bridging the gap between improved hemodynamics and dismal patient outcome in cardiogenic shock.
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Affiliation(s)
- Corstiaan A. den Uil
- Thoraxcenter, Erasmus Medical Center, Departments of Cardiology and Intensive Care Medicine, Rotterdam, the Netherlands
| | - Wim K. Lagrand
- Academic Medical Center, Department of Intensive Care Medicine, Amsterdam, the Netherlands
| | | | - Koen Nieman
- Thoraxcenter, Erasmus Medical Center, Departments of Cardiology and Intensive Care Medicine, Rotterdam, the Netherlands
| | - Ard Struijs
- Thoraxcenter, Erasmus Medical Center, Departments of Cardiology and Intensive Care Medicine, Rotterdam, the Netherlands
| | - Lucia S. D. Jewbali
- Thoraxcenter, Erasmus Medical Center, Departments of Cardiology and Intensive Care Medicine, Rotterdam, the Netherlands
| | - Alina A. Constantinescu
- Thoraxcenter, Erasmus Medical Center, Departments of Cardiology and Intensive Care Medicine, Rotterdam, the Netherlands
| | - Peter E. Spronk
- Gelre Hospitals, Department of Intensive Care Medicine, Apeldoorn, the Netherlands
| | - Maarten L. Simoons
- Thoraxcenter, Erasmus Medical Center, Departments of Cardiology and Intensive Care Medicine, Rotterdam, the Netherlands
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New insights into the pathophysiology of cardiogenic shock: the role of the microcirculation. Curr Opin Crit Care 2014; 19:381-6. [PMID: 23995131 DOI: 10.1097/mcc.0b013e328364d7c8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The ultimate goal of therapy for cardiogenic shock is to restore microcirculatory function and thereby restore the oxygen supply to sustain cellular function. Therapeutic measures mainly focus on improving pressure-derived macrocirculatory parameters. However, it is increasingly clear that to achieve significant progress in treatment, microcirculatory physiopathological mechanisms must be considered. RECENT FINDINGS Microcirculatory function deteriorated during cardiogenic shock and improved after treatment. Postcardiogenic shock microcirculatory disturbances, both myocardial and peripheral, were a prognostic factor for the long-term outcome. Hypothermia, whether pharmacologically or physically induced, improved postresuscitation myocardial and cerebral function, an effect associated with improved postresuscitation microcirculation. The impact of cardiogenic shock on cerebral and myocardial microcirculation could be evaluated with MRI. In severe heart failure, pharmacological interventions improved microcirculation. An assessment of the microcirculation was often performed using handheld video microscopy for direct observation of the sublingual microcirculation, which proved to be useful for evaluating the effects of interventions during cardiogenic shock. A large multicenter study on critically ill patients is now being conducted using this technique. SUMMARY Cardiogenic shock induces microcirculatory disorders that can be monitored and influenced in various manners, both pharmacologically and physically. In addition to global hemodynamic optimization, interventions must also ameliorate the microcirculation.
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Modulation of endothelial glycocalyx structure under inflammatory conditions. Mediators Inflamm 2014; 2014:694312. [PMID: 24803742 PMCID: PMC3997148 DOI: 10.1155/2014/694312] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 03/03/2014] [Indexed: 01/08/2023] Open
Abstract
The glycocalyx of the endothelium is an intravascular compartment that creates a barrier between circulating blood and the vessel wall. The glycocalyx is suggested to play an important role in numerous physiological processes including the regulation of vascular permeability, the prevention of the margination of blood cells to the vessel wall, and the transmission of shear stress. Various theoretical models and experimental approaches provide data about changes to the structure and functions of the glycocalyx under various types of inflammatory conditions. These alterations are suggested to promote inflammatory processes in vessels and contribute to the pathogenesis of number of diseases. In this review we summarize current knowledge about the modulation of the glycocalyx under inflammatory conditions and the consequences for the course of inflammation in vessels. The structure and functions of endothelial glycocalyx are briefly discussed in the context of methodological approaches regarding the determination of endothelial glycocalyx and the uncertainty and challenges involved in glycocalyx structure determination. In addition, the modulation of glycocalyx structure under inflammatory conditions and the possible consequences for pathogenesis of selected diseases and medical conditions (in particular, diabetes, atherosclerosis, ischemia/reperfusion, and sepsis) are summarized. Finally, therapeutic strategies to ameliorate glycocalyx dysfunction suggested by various authors are discussed.
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Maksimenko AV, Turashev AD. Endothelial glycocalyx of blood circulation system. I. Detection, components, and structural organization. RUSSIAN JOURNAL OF BIOORGANIC CHEMISTRY 2014; 40:131-41. [DOI: 10.1134/s1068162014020113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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