The aim of the literature review was to present modern views on the possible mechanisms of the disturbances of capillary blood flow in severe brain injury (TBI). The critical analysis of the concept of secondary brain damage and possible mechanisms of the disturbances of cerebral microcirculation in TBI are presented. We also discuss modern methodologies for assessing capillary blood flow in patients with brain damage. The attention is focused on the causes of the disturbances of cerebral microcirculation in TBI, as well as in various forms of fat embolism in severe combined TBI. Possibilities of prevention and early correction of damaged capillary blood flow in brain injury, as well as the supposed reasons for the failure of some clinical trials, including the widely known CRASH, are analyzed. It is noted that an integrative approach to the assessment of cerebral microcirculation in conjunction with brain metabolism reflects not just the variability of cerebral blood flow and functional disorders of perfusion and metabolism coupling in traumatic brain injury. It is emphasized that ischemia is not the only cause of post-traumatic disorders of pial circulation. We highlight directions for future research of posttraumatic disturbances of cerebral microcirculation as a leading factor of secondary brain insults. The possibility of pharmacological and non-pharmacological correction of microcirculatory disorders in TBI is outlined.

The article describes the features of ultrasound diagnostics and central hemodynamics in patients with minor heart anomalies. In vivo visualization of these anomalies has become possible after the introduction of echocardiography. The working classification of minor heart anomalies, as well as the description of clinically significant syndromes and abnormalities are considered. The role of connective tissue dysplasia in the development of cardiac pathology is highlighted, and its place in the structure of connective tissue dysplasia syndrome of the heart and heritable disorders of connective tissue is described.

In clinical practice the combined atherosclerotic lesions of several arterial regions are observed twice often in comparison with the isolated lesions. About 25 % of cases of multifocal stenoses are significant (> 50 %) and demand surgical correction. For the purpose of definition of surgical tactics (staging and sequence of revascularization of each region), and tracking of results of treatment, high-informative, available and, as possible, noninvasive diagnostic methods are necessary. Ultrasonic visualization of the arteries is one of such methods. However, so far an X-ray angiography (AG) remains the conventional method of «the gold standard». The screening part is traditionally assigned to the ultrasonic duplex scanning (USDS). Recently several authors report about a successful application of USDS, in a combination with magnetic resonance imaging and/or computed tomography or independently, as a decisive method before operation. The purpose of the current study was to compare the USDS and AG of low extremity arteries in terms of their sensitivity and specificity in patients with multifocal atherosclerosis (MFA). By means of screening of 565 men at the age of 45-59 years, 64 patients with multifocal lesion of coronary, carotid and low extremity arteries were identified. The degree of stenosis had been defined both by USDS and AG. USDS provided best results compared with angiography which failed in detection of smaller grades of stenoses and abdominal aorta aneurysms. Sensitivity of duplex scanning was 90 vs. 75 % for angiography. Application of functional tests can further extend the possibilities of USDS. Thus, ultrasound assessment may be considered a useful method for detecting different characteristics of multifocal athero-sclerotic lesion and planning surgical tactics.

Relevance. Congenital pulmonary abnormalities are revealed considerably more often than it was supposed. In many children, they represent the main reason for development of inflammatory process or respiratory failure. The improvement of diagnostic methods resulted in the fact that congenital pulmonary malformations are diagnosed in children of early age and even in the neonatal period. For the correct choice of treatment tactics and timing in congenital pulmonary malformations in newborns, it is very important to differentiate among several types of malformations, including congenital cystic adenomatoid malformation, pulmonary sequestrations, bronchogenic and enterogenic cysts, and also bronchial atresia. Objective. To estimate possibilities of a chest computer tomographic angiography in the differential diagnosis of rare lung malformations in newborns. Materials and methods. The study included results of complex evaluation of 65 newborns, in which according to prenatal ultrasonic investigation, congenital cystic adenomatoid malformation were assumed. The utility of computer tomographic angiography in newborns, possibilities of a method in differentiation of congenital pulmonary malformations are defined. Results. In 27 patients, the postnatal computer tomography confirmed the diagnosis of congenital cystic adenomatoid malformations. In 38 patients, other malformations requiring surgical treatment were diagnosed. 61 children were subjected to surgical treatment. In 4 children, surgical treatment was not performed, and they were supervised by a pulmonologist. Questions of differential diagnostics of rare congenital pulmonary malformations in newborns as well as the comparison of our own results with the data of literature are considered. Conclusions. In the differential diagnosis of lung malformations in newborns, chest computer tomographic angiography can be used as the main method alternative to invasive procedures. Tactics of further surgical treatment of such patients in the newborn and later periods should be based on the results of chest computer tomographic angiography and depends on the identified lung malformation.

Background. In recent years, pulse wave velocity (PWV) is recommended as additional test for the evaluation of cardiovascular risk in various patients. The most widely employed methods for evaluating pulse waveforms are those based on applanation tonometry; multi-channel pletysmography, sonography etc. The aim of our study was to assess the feasibility of using an approach to 24-hour pulse wave velocity (PWV) analysis with single-channel sphygmography in the management of patients with renal transplantation. Methods. Overall, 41 patients aged between 18 and 55 years who had end-stage renal disease resulting from glomerulopathy were recruited from the kidney transplant waiting list. All the measurements were performed before kidney transplantation and at 1 and 20 weeks after transplantation. The Pulse Time Index of Norm (PTIN) was calculated with the Vasotens technology for the estimation of the 24-hour PWV, defined as the percentage of the 24-hour period during which the PWV does not exceed 10 m/second. Results. Before kidney transplantation, the mean PTIN in the whole group was 56.3 (standard deviation, 18.4). Then, a week after the renal transplantation, a blood pressure increase and a decrease in the PTIN were observed in most cases, going to 27.6 (standard deviation, 11.1). After 20 weeks, the mean PTIN in the whole group increased again to 52.0 (standard deviation, 23.6). In our study, we found that the persistence of arterial stiffness disturbances after kidney transplantation appears to be relatively predictable. We determined the cutoff value of PTIN that could predict the two states of PTIN: a state of improvement or a state of decline/without change. The cutoff value of PTIN at 45 % had a sensitivity of 69 %, specificity of 76 %, and area under the curve of 0.65. The analysis of variance showed that in the group with an initial PTIN of 45 % or higher, the PTIN in the remote period after transplantation changed significantly (P < 0.05), whereas in the group with an initial PTIN lower than 45 %, there were no significant changes. Conclusion. Thus, the analysis of 24-hour pulse wave velocity in the management of patients with renal transplantation using PTIN is feasible in clinical practice.

Introduction. Methods of laser Doppler flowmetry (LDF), tissue reflectance oximetry (TRO) and pulse oximetry are used to diagnose the microcirculatory-tissue system (MTS) condition and evaluate the tissue respiration. Use of these techniques in conjunction with a variety of functional stress tests allow the assessment of MTS parameters, reveal disorders of hemodynamics and evaluate the response of MTS to the functional tests. However, the dynamics of microcirculatory changes, tissue respiration and possible disorders during the cold pressor test (CPT) have, till now, been little studied with the help of laser diagnostic techniques. The aim of this study was to evaluate the dynamics of changes in complex parameters of MTS during the CPT and to analyze the possible causes that affect these changes. Materials and methods. Using non-invasive optical methods of LDF, TRO and pulse oximetry, we investigated the dynamics of MTS parameter changes when using CPT in 32 healthy volunteers. Results. According to differences in the recovery rate of oxygen consumption during CPT, volunteers can be conditionally divided into 2 groups: 1 - displaying normal physiology and 2 - with a tendency to angiospasm and a lack of functional recovery of the MTS. To identify possible causes of angiospasm, we performed a detailed analysis of blood flow oscillations. This analysis revealed that the cause of angiospasm may be a disorder in the tone-shaping myogenic mechanisms regulating resistive microvessels, disturbances to the microcirculation of stagnant blood, or a combination of both of these factors. Conclusions. Use of the CPT for functional assessment of MTS allows us not only to estimate the reserve capabilities of the MTS, but also to identify - at a pre-clinical stage - propensity to angiospasm, which has practical value in the clinic.

Purpose of this investigation: to determine the early signs of the typological disturbances of coronary and cerebral blood circulation with the arterial hypertonia of the I stage. Materials and the methods. Is carried out a study of cardio-cerebrovascular system in 147 men in the age of 30-59 years with the arterial hypertonia of the I stage, control group they composed 37 clinically healthy men at the age from 29 to 42 years. Results and their consideration. Substantial changes in the coronary and cerebral blood flow with the I stage of arterial hypertonia to the development of the clinical manifestations of the defeat of the vessels of heart and brain are revealed. Is carried out daily monitoring arterial pressure and electrocardiogram, rhythmocardiography, bicycle ergometry, echocardiography, transcranial dopplerography, ultrasonic diagnostics of the main arteries of head and neck. Statistical processing of the results of a study is carried out by the standard methods within the framework of software Statistica for Windows, version 6 and recommended in the management on the biomedical statistics. Obtained by us data give grounds for expanding the criteria, which characterize the defeat of the target organs at the early stage arterial hypertonia. To these criteria we carried the clinical signs of the initial manifestations of the insufficiency of the blood supply of brain and discirculatory encephalopathy of the I stage, and also painless ischemia of the myocardium in the absence of stenocardia and its equivalents, presence of the minimum signs of the disturbance extra and intracranial blood flow (high-speed indices and the asymmetry of blood flow, the index of cerebrovascular reactivity and the presence of microembolic signals). Conclusions. The clinico-functional heterogeneity of changes in the coronary and cerebral blood circulation with the arterial hypertonia of the I stage requires the revision of the standards of the inspection of patients with the development of the increased numbers of arterial pressure, and also start of the new criteria of the early defeat of heart and brain in clinical recommendations.

Introduction and aim of the study. Ischemic stroke develops in conjunction with interruption of blood flow in microvessels that depends on rheological blood properties. There is a lack of knowledge in hemorheological features of experimental stroke making more difficult to value the relevance of stroke models. The study aims investigation of microhemorheological parameters in two experimental stroke models - thromboembolic model and middle cerebral artery (MCA) ligation model. Methods. Male Wistar rats were subjected to focal brain ischemia in MCA ligation stroke model or thromboembolic stroke model. The neurological deficit, the size of ischemic brain lesion and hemorheological parameters (hematocrit, kinetics of red blood cells (RBC) (dis)aggregation and RBC deformability) were evaluated. Results. The neurological deficit was correlated with the size of brain ischemic lesion. The increased rate of RBC aggregate formation was detected in both stroke models. At the same time, the strength of RBC aggregates changed in a model-dependent manner, namely, it raised sharply in the MCA ligation stroke model, but was somewhat decreased in thromboembolic stroke model. Conclusion. The focal stroke models produce repeatable and neurologically significant lesions of brain followed with fundamental changes in the hemorheological parameters. The way of ischemia producing can be crucial for the direction of hemorheological changes.

The purpose of the study. The estimation of skin microcirculatory changes appearing in rats after subcutaneous implantation of polycaprolactone (PCL) scaffolds. Materials and methods. The experiments were conducted on 3 groups of rats: comparison group - the animals exposed to surgical intervention to the extent equivalent to matrix implantation, negative control group - animals subcutaneously implanted with non-biocompatible matrix; and experimental - rats subcutaneously implanted by PCL-scaffold. Skin microcirculation was analyzed by Lazer Doppler flowmetry (LDF) on the 7th, 14th and 21st day of the experiment. Morphological analysis of soft tissue complex and matrix samples was carried out on the 21st day of the experiment for scaffold biocompatibility verification. Results. It has been found that moderate increase in skin perfusion of animals in the comparison group over the surgical intervention area is not accompanied by the changes of active mechanisms of blood flow modulation and is completely resolved by the 21st day of the experiment. In negative control group, skin perfusion over the implantation area is 2 times higher than in controls in the period from 7th to 21st day of the experiment and this is accompanied by the significant increase of neurogenic and myogenic blood flow oscillation amplitudes. In the course of morphological analysis, these animals have demonstrated active inflammatory response. In the experimental group, perfusion changes are comparable with those in the comparison group and they resolve completely by the 21st day of the experiment. Morphological analysis suggests that by the 21st day of the experiment PLC-scaffold is evenly colonized by connective tissue cells and is vascularized. At the same time, reactive changes of adjacent tissues have not been detected. Conclusion. Skin microcirculatory changes over the scaffold implantation area correspond to the morphological pattern of tissue reactions which allows using LDF for dynamic estimation of scaffold biocompatibility in the course of subcutaneous implantation tests. This data suggest good PLC-scaffold biocompatibility which proves the prospects of its practical application in the tissue engineering.