The review discusses some of the most common methods of ocular microcirculation assessment in vascular lesions of the eye: color and power Doppler imaging, laser Doppler flowmetry, fluorescent and indocyanine green angiography, digital retinal photographs and measurement of retinal vascular caliber, pulsative ocular blood flow analyzer, OCT-angiography. These methods are used in diagnostic of impairment of blood flow in vessels of optic nerve and retina, which also are full informative in early diagnostic of vascular pathology of eye.

Control over angiogenesis is a source of interest and object of studies for medical professionals of various specialties. Angiogenesis is a key component of malignant growth pathogenesis. The inhibition of this process may be used in the treatment of malignant neoplasms and their metastases, as well as benign tumors. In spite of tumor cells unique ability to cope with hypoxia and nutrients deficiency, they are however sooner or later experiencing need in adequate oxygen and glucose supply. Evidently to overcome the limitations of diffusion range fast-growing neoplasm needs to boost production of various proangiogenic factors that induce and stimulate growth of new blood vessels in peritumorous area as well as in the tumor itself. In spite of a large volume of studies the use of anti-angiogenic drugs in Oncology till nowadays is limited and in most of the cases is of empiric nature. Some of the researchers point out target anti-angiogenic therapy low effectivity with simultaneous increase of chemiotherapy in case of some oncologic ailments, shrinking of relapse-free period and increase of neoplasms' development and their invasive and metastatic potential. These problems require more profound investigation. The nature of interrelations between the tumor and blood vessels is complicated and the activity of neoangiogenesis affects the tumor growth to the same extent as the tumor affects angiogenesis. Nowadays we continue to amass data on this problem as well as find new versions of its interpretation, therefore one should soon expect a breakthrough in comprehension of tumor-angiogenesis correlation principles.

Introduction and aim. In this study discrete plasmapheres method possibilities in the treatment of the patients with III stage of peripheral artery disease were investigated. The aim of current investigation was to find out the changes of the peripheral microcirculation. Materials and methods: microcirculation was investigated with Minimax-Doppler Ê device before and after treatment of 48 patients with intermittent claudication. Results and discussion. It was found that peripheral microcirculation data and spectral characteristics of Doppler flow changes and clinical status of the patients eventually improved after treatment by suggested method. In conclusion, treatment by suggested method of discrete plasmapheres is effective on one of the most complicated group of patients with III stage of ischemia according to Fontaine-Pokrovsky classification of atherosclerosis of the arteries of low extremities.

Introduction and purpose. Cerebral arterial compliance (CAC) is an important parameter of a microcirculation. The main function of CAC is to maintain the stiffness of vessels and protect downstream vessels when changing perfusion pressure. The aim of the study was to assess the CAC in severe polytrauma patients with and without intracranial hematomas (IH). Materials. We examined 75 polytrauma patients with severe traumatic brain injury (mean 32.2±11.6 years, 42 men, 33 women). The first group included 34 patients without IH and the second group included 36 patients with epidural (6), subdural (26) and multiple (4) hematomas. Perfusion computed tomography (PCT) was performed in 1-14 days after trauma in the first group and in 2-8 days after surgical evacuation of the hematoma in the second group. Mean arterial pressure was measured simultaneously with PCT. CAC was calculated by the formula modified by M. Czosnyka. Results. The CAC was significantly decreased (p<0.001) in both groups in comparison with normal values. The CAC in the group 2 was significantly lower than in the groupl, both on the side of the former hematoma (p=0.017). Conclusion. The results indicate severe dysregulation of cerebral capillary blood flow in polytrauma patients, which increases in the patients with polytrauma and traumatic IH.

The aim of our study was to assess of microcirculation using laser Doppler flowmetry (LDF) in patients with diabetic foot syndrome (DFS) caused by diabetes mellitus type 2. Materials and methods. The main group consisted of 16 patients with DFS. In the control group, 19 patients without diabetes mellitus were included. An LDF investigation was performed using Biopac LDF 100C system. Estimated glomerular filtration rate (eGFR) was determined using CKD-EPI formula. Results and discussion. According to LDF, patients with DFS had the severe form of microcirculatory failure, with abrupt worsening of venous drainage, caused by venous lesion during the diabetic microangiopathy. The marker LDF phenomena were decreasing of flaxmotion index, low- and high-frequency flaxmotions contribution and increasing of high-frequency flaxmotion contribution. During the eGFR decreasing in the main group a simultaneous decreasing of low-frequency flaxmotion contribution and flaxmotion index, also with increasing of high-frequency flaxmotions contribution and intravascular resistance shows to stazic form of microcirculatory disorder. Exposed correlations of LDF-indexes with eGFR can show that LDF has potential possibilities for diagnostics and progression assessment of microangiopathic changes. Summary. In patients with diabetes mellitus type 2, a progressive microcirculation failure takes place. With the development of the microangiopathy, a negative influence of venous stasis prevails over the ischemic events. The development of chronic kidney disease is an independent risk-factor of microangiopathic complications of diabetes mellitus type 2. Preclinical diagnostics of renal lesion is important for timely beginning of the protective therapy of severe microvascular complications.

Purpose. Comparative evaluation of the functional reserves of microcirculation in in vivo produced additional integumentary tissues of the hand during longitudinal and transverse traction impact. Materials and methods. 20 patients with posttraumatic pathology of the hand were examined at the stages of treatment using the following techniques: ultrasound dopplerography (USDG) (Minimax-Doppler K, 20-MHz sensor, St. Petersburg), laser flowmetry (BLF21 Transonic Systems Inc., USA), transcutaneous polarography [Model 840 (VFD, USA) with Clark type electrode]. Local ischemic test with occlusion cuff placing on the forearm was used to study the mechanisms involved in tissue blood flow regulation. Main results. The dynamics of linear systolic velocity of linger artery blood flow is unidirectional in both groups of patients: 1.5-3.0-fold increase (p<0.05) relative to the values of the intact limb with an increase in the proportion of shunt blood flow in USDG spectrogram. The differences in the reactivity of precapillary unit vessels were revealed for transverse (when transverse forces are applied to soft-tissue component only) and longitudinal (when a distraction regenerated bone is formed) tissue traction. Hyperemic microcirculation type prevails in case of longitudinal tissue traction through vascular vasodilation, and normoreactive type prevails in case of transverse traction. The half recovery period of capillary blood flow (CBF) for longitudinal tissue traction was 2-fold increased, while for transverse traction it was 4-fold increased relative to the values of the intact limb. Conclusions. The differences in the reactivity of precapillary unit vessels have been revealed for transverse and longitudinal traction of the hand tissues. According to the LDF at the impact of mini-clamps traction on the background of clinical signs of tissue ischemia recorded of saving a reserve the possible of capillary bed, but significantly recovery of CBF - 25 to 40 seconds, and the duration of the reactive hyperemia to 2-3 minutes.

Introduction and aim. Minor heart anomalies (MHA) are the visceral form of connective tissue dysplasia (CTD) that lead to a deterioration in both systolic and diastolic function of the left ventricle (LV). Information about functional state of the myocardium of the right ventricle (RV) of patients with MHA is not available widely. The aim of the study is to evaluate the frequency of occurrence of different types of MHA and features of intracardiac hemodynamic using Tissue Doppler (TD) examination of patients with CTD. Materials and methods. Total were surveyed 1240 people, of which were selected 67 patients with SHD and control group of 27 healthy persons (average age 30.1±4.0 years). Evaluation of systolic and diastolic function of LV and RV was carried out based on results of pulse-wave tissue Doppler of lateral and medial parts of the mitral fibrous annulus (MFAlat, MFFm) and tricuspid fibrous annulus (TEA), including the calculation of the index Tei. Results and discussion. The incidence of SHD was 23 %. Patients of first and second groups both have significantly higher Tei index MFAlat, MFFm and TFA, and at the same time the maximum values of Tei index were observed of patients with multiple MHA (0.50±0.09; 0.56±0.08; 0.49±0.10 standard units respectively). Conclusions. Evaluation of central hemodynamics using TD is very useful to identify disorders of myocardial performance of both the left and right ventricle. Increased Tei index is an early marker of diastolic dysfunction of both ventricles.

The endothelial dysfunction (ED) in diabetic foot syndrome (DFS) is manifested in the imbalance between the formation of vasodilating and vasoconstrictive substances, not only in the affected area (lower limb), but in the other areas of the peripheral circulation (skin of dorsum of the hand). The aim of this study was the comparative evaluation of endothelial function in patients with neuropathic and neuroischemic forms of DFS in the remote skin tissue, that is, skin. Laser Doppler flowmetry (LDF) was used to assess skin perfusion. The study was conducted in patients with neuropathic and neuroischemic forms of diabetic foot receiving standard hospital treatment at the surgical ward of complicated forms of diabetic foot syndrome in the St. Petersburg's City Hospital 14. Control group comprised patients with proven absence of manifestations of diabetes mellitus and cardiovascular disease. In patients with neuropathic and neuroischemic forms of DFS the significant decrease in microcirculation in the skin was observed. Assessment of the functional state of endothelium in patients with neuropathic and neuroischemic forms of DFS was conducted using functional tests (cold test and iontophoresis of acetylcholine or nitroglycerine). We found significant decrease in endothelium-dependent and endothelium-independent vasodilatation, which was more prominent in neuroischemic forms of DFS.

Introduction. Oxidative stress (OS) is involved in the development of vascular inflammation and hemostasis. The aim. We hypothesized that GSH-dependent antioxidant defense system may be affected in paroxysmal nocturnal hemoglobinuria (PNH), causing exacerbation of inflammation and activation of intravascular coagulation and fibrinolysis (AIVCF). Methods. The study involved 63 patients with PNH and 75 healthy people. The concentration of GSH and the activity of glutathione peroxidase (GP), glutathione reductase (GR) and superoxide dismutase (SOD) have been determined in the erythrocytes. Results. We have demonstrated the inhibition of glutathione metabolism and signs of OS, expressed in a significant reduction in levels of GSH and decreased activity of antioxidant enzymes GP, GR and SOD in erythrocytes when compared PNH patients with healthy people. Spearman's test showed significant positive correlation between the activity of GR and GP (R = 0.376; p<0.01) in red blood cells, as well as a weak negative correlation (R = -0.338; p<0.05) between GP activity in erythrocytes and the concentration of D-dimer in the blood plasma in patients with PNH. A positive (R = 0.626; p<0.001) correlation was found between GSH in erythrocytes and plasma concentrations of CRP at CRP concentration values in the range of reference interval. Conclusion. The results are consistent with previously published data on disorders of glutathione metabolism in PNH. The indicators GSH and GP in erythrocytes can be considered as potential markers of AIVCF and vascular inflammation in PNH.

The aim of the study - to evaluate the effects of age and renal dysfunction on the myocardium and coronary vessels in young Wistar rats. Materials and methods. The study was performed on male Wistar rats aged ~ 2.5 months. 5/6 nephrectomy (NE) was performed stepwise at intervals of one week. The observation period was 2 or 4 months after NE or sham operation. For histological examination, the heart sections were stained with hematoxylin & eosin and by van Gieson. The histological changes were studied by light microscopy and quantitatively assessed by morphometry program Videotest 5.2. Results. At intact rats aged about 6.5 months as compared to animals at the age of 4.5 months there was a clear increase in the left ventricular mass index and moderate growth of connective tissue in the myocardium (including perivascular areas). These changes were accompanied by an extension of the lumen of the intramural coronary arteries, combined with a slight decrease in the thickness of the walls of these vessels. Two 2 months after 5/6 nephrectomy (NE) pronounced spasm and early signs of thickening of the coronary artery walls took place, along with an increase of the left ventricular mass index and myocardial fibroplastic manifestations. Longer postoperative observation periods (4 months) were associated with a significant expansion of the connective tissue, increasing of the vascular wall thickness and the diameter of the vascular lumen without increase of the index of left ventricular mass. Manifestations of myocardial and coronary vessel remodeling evoked by age and renal dysfunction are not unequivocally associated with an increase in blood pressure. Conclusion. In young Wistar rats both slight increase in age and nephron mass reduction result in significant independent effects on the myocardium and its vasculature.

Purpose. To reveal the correlation of blood flow in the artery supplying a fasciocutaneous flap with its engraftment quality. Materials and Methods. A flap of 18 cm² area was formed in 16 rats on the basis of the superficial inferior epigastric artery (SIEA) and replanted after 90-minute period of femoral artery clipping at the point of SIEA embranchment. The volume blood flow was registered immediately after the flap elevation, at the moment of the clip removal from the artery and for 10 minutes after the removal using T101 ultrasound flowmeter. 12 days later the animals were euthanized. True color digital images of the flap inner and outer surfaces were obtained by Sony Cyber-shot DSC-HX100V camera macro mode. Venous congestion severity of the flap and its subcutaneous fat necrosis were revealed using the semi-quantitative method of expert evaluations. The proportion of epidermis defects (in percentage of the flap area) was determined in the digital images of the flap external surface using the method of point-counting computer-assisted planimetry, and the proportion of vascular structures and extravasations was determined by analyzing the images of the inner surface. Results. Three variants of reperfusion were documented intraoperatively when analyzing the character and amount of the change in volume blood flow: hypoperfusion, moderate hyperperfusion, and severe transient hyperperfusion. In case of the second variant epidermis defects, the mean values of venous congestion severity and subcutaneous fat necrosis, as well as the proportions of extravasations were the lowest, while the percentage of vascular structures was the highest. The extent of venous congestion and the proportion of extravasations were reliably higher in the first variant in comparison with the second one. The severity of subcutaneous fat necrosis and the percentage of extravasations were higher in the third variant than in the second one. The most favorable rates of engraftment were observed for the second variant. Conclusion. The intraoperative study of volume blood flow in the artery supplying the flap allows to evaluate the risk of reperfusion injury of its vascular bed, venous congestion, and subcutaneous fat necrosis.