Changing of «head – of – the bed» position is a routine method of positioning the patient to correct intracranial hypertension. In intensive care units, the «head – of – the bed» position vary from 0 to 60 °, and there is no consensus on which of them is most effective. The review of the major publications in the domestic and foreign literature about the problem of interrelation between positioning and changes of intracranial pressure, system and cerebral hemodynamic in patients with brain damage including databases eLibrary, PubMed, with the key words «hyperthermia», « positioning», «slope angle of the head of bed», «intracranial pressure», «cerebral perfusion pressure», «cerebral blood flow», «brain damage», and their combination. It is believed that the majority of patients with cerebral damage, regardless of the etiological factor, is preferable to 15–30° «head – of – the bed» position. In some cases manipulation of the head of the bed can lead to irreversible ischemic damage, due to the reduction of system and perfusion pressure, and cerebral blood flow. Thus, the selection of the optimal body position in acute cerebral pathology remains a debated issue. In this way, individual tactics of positioning in patients with cerebral damage allows choosing the correct intensive care and improving the treatment results.

Aim. To study the functional state of peripheral and microcirculatory blood flow in patients with pulmonary hypertension associated with systemic connective tissue diseases (PH-SCTD).

Material and methods. The study included 22 patients (50,1±14,7) with PH-SCTD I–III functional class. 18 patients had systemic scleroderma, 3 – systemic lupus erythematosus, and 1 patient suffered from rheumatoid arthritis. The control group (CG) comprised 25 healthy volunteers (39,3±10). The studies were performed using finger photoplethysmography (FPG), laser Doppler flowmetry (LDF), and capillaroscopy (CS).

Results. According to the FPG data, patients with PH-SCTD relative to CG have lower values of occlusion index in the amplitude of 1,51±0,37 and 2,28±0,46 respectively (<0.05). According to LDF data, signs of venular plethora are observed in patients with PH-SCTD, which is manifested by an increase in the amplitude of respiratory-induced fluctuations in blood flow to 0,17±0,11 (PU) versus 0,13±0,07 (PU) in CG (<0.05), an increase in the constrictor reaction in the cold test was 56,4±16,8 % and 42,1±17,9 % (<0.05) and a venous occlusion test was 56,8±18,7 % and 45,2±17,9 % (<0.05), respectively. According to CS data, patients with PH-SCTD have a noticeable increase in the degree of hydration of the interstitial space, which manifests itself in an increase in the size of the pericapillary space to 160,8±37,3 μm against 114,1±17,4 μm in the CG (<0.00001).

Conclusions. In patients with PH-SCTD, all regulatory mechanisms and structural components of microvessels, including endothelial and smooth muscle cells, are involved in the pathological process, which is manifested by an increase in the constrictor activity for all types of stimuli and a violation of the filtration-reabsorption mechanism of metabolism.

Aim of the study. To study the effect of therapy with prophylactic and supraphysiological doses of cholecalciferol on skin microcirculation (MC) indicators in patients with type 2 diabetes mellitus with diabetic peripheral neuropathy (T2DM with DPN).

Material and methods. The study included 62 participants with T2DM with DPN (according to the Neuropathy Disability Score (NDS) scale, more than 4 points). By the method of consecutive numbers, patients were randomized into two groups: Group I (n=31, 15 men/16 women, 52.4±5.7 years) and Group II (n=31, 16 men/15 women, 51.4±6.1 years). Antihyperglycemic treatment was stable during the study. For 24 weeks, cholecalciferol participants from Group I received once a week at a dose of 5,000 IU, and from Group II - once a week at a dose of 40,000 IU. Body mass index (BMI), serum levels of 25(OH)D (25-hydroxycalciferol) and serum glycated hemoglobin (HbA1c) were evaluated before and after 24 weeks of taking cholecalciferol. The method of laser Doppler flowmetry (LDF) compared the initial and final indicators of the baseline level of blood flow and microcirculation indicators against the background of functional tests (postural and occlusive). Control measurements of LDF parameters were performed on 16 subjects without revealed diabetes mellitus (8 men/8 women, 51.8±3.7 years).

Results. Patients from Group II, after 24 weeks of taking supraphysiological doses of cholecalciferol, against the background of 100% normalization of the serum 25(OH)D level, significantly improved the parameters of skin MC and functional tests, HbA1c and BMI decreased.

Conclusions. Acceptance of high doses of cholecalciferol for 24 weeks has been associated with an improvement in the parameters of glycaemia and indicators of cutaneous MC in patients with T2DM with DPN.

Aim. To study strain and strain rate dynamics the left ventricle (LV) myocardium fibers in patients with ischemic heart disease after coronary artery bypass grafting (CABG) in the early and late periods.

Material and methods. The dynamics of strain (S) and strain rate (SR) of longitudinal, circular and radial fibers in 148 patients (in 2646 LV segments) before and on the 12th day after CABG was studied using Velocity Vector Imaging technology. In the long-term (6, 12 and 24 months) 40 patients (720 LV segments) were examined.

Results. A positive dynamics of SR longitudinal fibers (p = 0.0002) was on the 12th day after CABG. Weak and medium correlation was between S and SR radial (R = –0.56; R = –0.52) and circular fibers with LDG-1 and duration of aortic clamping. In the long term, patients with complaints showed a decrease in global deformation properties in the coronary artery areas. The stable result of improvement S and SR longitudinal and circular fibers and SR radial fibers was obtained in segments with initially low deformation properties.

Conclusions. The use of Velocity Vector Imaging technology allows to estimate the dynamics of LV fibers deformation parameters in early and long-term periods. In the early period after CABG was a positive dynamic only from the global SR longitudinal fibers. In the long-term global deformation parameters of longitudinal and circular fibers was decrease in in the area of the coronary arteries. In the long-term was a significant improvement of the deformation parameters of segments with initially low deformation properties.

Purpose – the study the functional asymmetry of oscillatory processes of microcirculatory bed at physical loads on the upper limbs.

Material and methods. Microcirculation parameters were measured in 5 healthy volunteers (men aged 50–55 years) by laser Doppler flowmetry (LDF). LDF signal sensors were fixed symmetrically on the lower parts of the right and left shoulders (3 cm above the elbow bend). Physical exercise consisted of machs left or right hand in the standing position for 1 min. Measurements were performed in 3 conditions: 1 – initial state, 2 – immediately after exercise, 3 – 5 min after load termination The changes in the mean perfusion value and the components of the amplitude-frequency spectrum of blood flow fluctuations (myogenic, neurogenic, respiratory and cardiac), as well as the correlation between the changes in all parameters of the right and left sides of the observation were evaluated.

Results. Asymmetry of changes in microcirculation parameters and correlations between them under the physical loads on the upper limbs was revealed. It is shown that both left and right machs change the microcirculation parameters of both the left and right sides, and the changes on the left are more pronounced than on the right. It is shown that after the left machs the blood flow on the left and right increases, and after the right machs – reduced. After loads the right side is recovering more slowly than the left.

Conclusions. Our results illustrate the specific regulation of blood flow in micro vessels of paired organs, which is associated with functional asymmetry. The physiological mechanisms for this asymmetry require further experimental and clinical studies.

Introduction. Despite an active study of the problem of ischemic mitral regurgitation, studies of its connections with the degree and localization of coronary artery lesions are contradictory.

Objective. Study the features of coronary artery lesions according to coronary angiography in patients with ischemic heart disease and ischemic mitral regurgitation and the connections between the severity of coronary artery lesions and the degree of ischemic mitral regurgitation.

Material and methods. A retrospective analysis of the results of the examination of 86 patients with various forms of ischemic heart disease in combination with ischemic mitral regurgitation, operated in the department of cardiovascular surgery of the P.V. Mandryka Central Military Hospital. Results. 89,5 % of patients showed multifocal atherosclerotic coronary artery lesions, requiring direct myocardial revascularization; the predominant type of coronary blood supply was right (82,6 %); the average number of affected main coronary arteries was 2,2±1,1, the average total degree of coronary artery lesion was 42,3±25,1 %.

Conclusion. 1. The connections between the degree of ischemic mitral regurgitation and the severity and localization of coronary artery lesions was not revealed. 2. The degree of ischemic mitral regurgitation determined primarily by the progression of ischemic remodeling of the left ventricle. 3. Coronary angiography data cannot be a criterion for determining the degree of ischemic mitral regurgitation, however, they are necessary for determining the surgical tactics of direct myocardial revascularization.

Introduction. Simultaneous correction of severe deformities of the feet may be accompanied by a negative effect on the trophism of the adjacent soft tissues. However, the literature does not pay enough attention to the analysis of the blood supply to soft-tissue structures in the field of surgical intervention in the correction of complex deformities of the feet. The aim of the study is to investigate condition of soft tissues blood supply in the area of surgery before and after simultaneous correction of severe feet deformities by triple arthrodesis in patients with cerebral palsy.

Material and methods. The article is based on the results of study of 21 cerebral palsy patients with multicomponent feet deformities. All patients underwent simultaneous correction of foot deformities with usage of internal fixation. Patients were examined for the soft tissues blood supply (skin, subcutaneous fat, muscles) in the area of surgery using laser and high-frequency Doppler flowmetry before and after performing all phases of foot surgery.

Results. Capillary skin blood flow after performing all stages of operation, removing tourniquet and suturing tended to increase in all areas of measurement, but significantly increased on the dorsum of the foot, at points 1 (by 53.3 %, p <0.05), 4 (by 69.0 %, p<0.05), and at point 6 (53.9 %, p <0.05). Indicators of blood flow of subcutaneous fat and muscle tissue after performing all stages of operation and removal of tourniquet did not significantly differ from the preoperative level. In the long-term follow-up period, all examined patients showed good clinical results in 81 % of cases, satisfactory – in 19 % of patients who noted periodic moderate pain in the feet after a long walk. There were no unsatisfactory results.

Conclusion. After simultaneous intraoperative correction of severe feet deformities by triple arthrodesis in the area of operative wound in patients with cerebral palsy, there is no decrease in the microcirculatory blood flow in soft tissuesin the surgical intervention area. There is either stabilization or an increase in the perfusion of these structures.

Introduction. Ischemic postconditioning (IPostC) of the brain can be considered as a promising approach to limit reperfusion injury in the ischemic area of the brain. Objective – to study the effect of IPostC after global cerebral ischemia on the level of immunoreactivity to PECAM-1/CD31 in the structures of layers II, III and V of the neocortex of rats at different periods of the reperfusion period.

Material and methods. In male Wistar rats, a 10-minute global cerebral ischemia was modeled followed by IPostC in the form of reperfusion-ischemia at 15sec/15sec. In the early (2 days) and late (7 days) reperfusion periods after damaging ischemia, the number of morphologically unchanged neurons and the level of immunoreactivity to PECAM-1/CD31 in the structures of layers II, III and V of the neocortex were estimated.

Results. It is shown that the use of IPostC by 2 days of reperfusion contributed to the increase in the number of unchanged neurons in layers II and III of 25.8 and 28.2 % (P<0.05), which was not accompanied by changes in the level of immunoreactivity to PECAM-1/CD31, to 7 days of reperfusion there was an increase in the number of unchanged neurons in layers II, III and V of 19.2, 22,1, 21,4 % (P<0.05) was observed a decrease in the level of immunoreactivity to PECAM-1/CD31 in the structures of these layers of 27.4, 39.4, and 16.7 % (P<0.05), respectively, when compared with similar indicators in groups without the use of IPostC.

Conlusions. In the mechanisms of physiological reaction formed in the application of ischemic postconditioning after cerebral ischemia and leading to the preservation of the number of unchanged neurons in the late reperfusion period involved PECAM-1/CD31, which suggests that the protective potential of the phenomenon is realized by possible inhibiting the migration of neutrophils, monocytes and lymphocytes and extravasation of leukocytes from the systemic blood flow into the damaged area of the brain, i.e. through suppression of inflammatory response.

Introduction. According to WHO data, stroke and its consequences rank second in mortality after coronary heart disease. Hundreds of clinical trials have yielded only one tool that can be used – intravenous administration of recombinant plasminogen activator, i.e. recanalization agent. The means for effective neuroprotection, despite the huge number of studies, remain not found.

The aim of the work was in vivo study of neuroprotective effect of creatine amide (AC-PfA) on neurological and cognitive impairment in a model of ischemic stroke in rats.

Material and methods. The model of stroke (FCI) was reproduced by occlusion of middle cerebral artery proximal segment. Neurological deficits were assessed by the latency of movement initiation (LMI), cognitive impairments – by a spatial version of Morris water maze. Four groups of animals were used: (1) negative control (FCI with administration of saline), (2) positive control (FCI with controlled hypothermia), (3) test substance (FCI with administration of AC-PfA) and (4) sham-operated animals.

Results. Compared with negative control group, animals восtreated with AC-PfA showed lower latency of movement initiation a day after FCI, what indicates a better functional state of the basal ganglia and associative areas of the cortex. Hypothermia during FCI completely eliminated the effect of increasing LMI. In Morris water maze, animals treated with AC-PfA, in contrast to the negative control group, showed a decrease in platform search time during training, and in a probe trial differed statistically significantly in peripheral searching time and the number of crossings of the platform localization site. Hypothermia was not so effective, although not statistically significantly differs from the group with AC-PfA.

Conclusions. A new derivative of creatine has a pronounced therapeutic efficacy in relation to cognitive impairment, and improves the functional state of the systems, controlling the motor activity of animals. At the same time, it exceeds or approaches the effects of hypothermia, known as an effective neuroprotective technique.

Introduction. Micro- and macroangiopathies significantly reduce the duration and quality of life for diabetes mellitus (DM) patients, which determines the relevance of developing new ways to treat them, including non-drug ones. One of such methods is the autotransplantation of full-thickness skin flap providing a distant stimulating effect on microcirculation.

The aim of the study was to investigate the influence of skin flap autotransplantation on microcirculation at alloxan insulin deficiency in white rats.

Material and methods. The studies were carried out on 60 male scrub rats divided into the following groups: the control group, the comparison group (alloxan diabetes rats), the experimental group consisting of alloxan diabetes animals which had skin flap autotransplantations performed on them. Skin microcirculation (MC) of the dorsum of the feet was studied by laser Doppler flowmetry.

Results. Alloxan insulin deficiency caused a violation of the MC in rats which manifested by a decrease in perfusion of the skin of the dorsum of the foot in association with a decrease in the amplitudes of endothelial and neurogenic oscillations. On the 42nd day of the experiment in alloxan diabetes animals which had skin flap autotransplantations performed on them the statistically significant increase (p=0.000001) in the perfusion index by 43 % was observed attesting to microcirculation improvment. This was accompanied by an increase in the normalized amplitudes value of endothelial (by 44 %, р=0.000047) and neurogenic (by 20 %, р=0.019515) perfusion fluctuations relative to rats of the comparison group.

Conclusions. It can be concluded that skin flap autotransplantation has a positive effect on the state of MC in the feet in experimental diabetes rats due to the improvement of tissue perfusion and modulation of its activity.

Introduction. One of the promising methods of treating oncological diseases is high-frequency focused ultrasound (HIFU). The high-frequency acoustic field generated by the emitters induces mechanothermal effects whose significance has not yet been fully assessed and their study will change the tactics of therapy. To analyze their role, we selected cellular perivascular regulators of local blood flow – mast cells (MCs). Changes in the microcirculation (MCT) allow us to judge the morphofunctional state of the MC. The aim of the study is to assess the state of the rat’s skin periphocal tissue blood flow and MCs morphofunctional properties after HIFU-exposure.

Material and methods. Adult male Wistar rats were used. Animals were divided into 3 groups: control, non-contact local heating of the skin and HIFU-induced exposure. For HIFU, an experimental setting was used, consisting of a concave emitter H-148 S / N 010 with a central oscillation frequency of 1.4 MHz. In the averaged interference spot, the radiation intensity was 8.2 kW/cm2. The exposure duration from 150 to 700 ms. Depth of focus is about 1 mm. To assess the MCT, a laser doppler flowmeter was used. Material for the manufacture of film preparations of MCs was taken at the site of exposure and according to the standard method. MCs calculation was carried out using the software «Multimedia Catalog» taking into account their morphofunctional characteristics.

Results. HIFU exposure led to a significant increase in blood flow in rat’s skin at an exposure time of 250 ms or more (p<0.01). The maximum increase in perfusion was noted at 400 ms. The highest increase in tissue blood flow with local heating was observed at 45°C (p<0.001). HIFU-exposure led to a significant decrease in the density of MCs in the subcutaneous fat tissue of rat’s skin compared with the control at an exposure time of 250 ms or more (p<0.05) and a significant decrease in the relative number of type I cells, and an increase in type II and III, which indicates degranulation (p<0.05). Similar changes in the amount and morphofunctional characteristics of MCs were observed in a series of experiments with local heating, but the changes were not so significant.

Conclusions. With HIFU-induced exposure, increased MCT in the peripheral zones is observed, accompanied by processes of morphofunctional rearrangement of the MCs, which indicates a combined mechanothermal disturbance in the focus zone, which forms the spatiotemporal continuum of the thermal field.