The unity of the organism and the ambient environment is realized by the nervous system and the humoral regulation. Based on this, all the variety of mechanisms for the functional activity regulation of the human body, experts traditionally classify into nervous and humoral processes, indicating that they are practically inseparable and constitute a united system. The advantages of one system compensate for possible shortcomings of the other, however, the vulnerability of the neuro-reflex mechanism of regulation is extremely high, and the state of knowledge of nervous regulation is higher, since it is amenable to registration by instrumental devices. At the same time, it is obvious that humoral regulation is one of the evolutionarily earliest mechanisms for regulating vital processes and, therefore, the most tested in practical use and, due to the preservation of this method of regulating homeostasis in the body, the most reliable and evolutionarily proven, but the study of humoral mechanisms regulation of the functions on the cellular and organ level is complicated by the vastness of subordinate tissues. Further painstaking research work is needed to study both the possibilities of humoral regulation in the human body and further study of the hemocirculatory system reactivity. This work can be the most important factor in the development of evidence-based medicine, validation of treatment policy for various pathological processes, objectification of control and estimated results of treatment.

Blood supply of bone tissue is one of the key factors in vital functions and reparative regeneration. The bloodstream supply nutrients and oxygen, remove toxic substances. Reparative regeneration is not impossible without the participation of the microvasculature of the bone tissue, mainly of the periosteum and feeding arterioles. Thus, the study of the microcirculation of bone tissue makes it possible to evaluate the physiological state of the bone tissue in normal and pathological conditions, as well as the dynamics of the consolidation of the bone fragments in fractures. Considering the morphological features of the bone tissue and its blood supply, there are certain obstacles in the study of microcirculation in real time and without surgery intervention. However, there are exist methods using near-infrared optical systems wich allow to realize a non-invasive examination of patients. This review discusses in detail the most well-known optical methods and also effective method of ultrasound dopplerography.

Introduction. Endothelial dysfunction (ED) makes a significant contribution to the pathogenesis of rheumatoid arthritis (RA). However, changes of vasomotor function (VF) in patients with a reduction in disease activity have not been studied enough. Objective – to study VF changes in patients with RA and a reduce in disease activity, to clarify the role of RA serological profile and the presence of arterial hypertension (AH) in the formation of vasomotor dysfunction.

Materials and methods. A total of 94 patients took part in the study (74 – the study group, 20 – the comparison group). The longitudinal study included 48 patients with 10 days interval between visits. RA activity reduced after prescribed anti-inflammatory therapy. All patients underwent laser Doppler flowmetry with functional tests (FT) to study VF. Also, the intensity of oxidative phosphorylation (IOP), levels of rheumatoid factor, antibodies to cyclic citrullinated peptide (ACCP) and antinuclear factor titer were assessed.

Results. Correlations of ACCP with endothelial (EС), neurogenic (NС) and cardiac (CC) components of the amplitude-frequency spectrum were revealed. With a decrease in RA activity, an increase in CC and a decrease in the total tone of resistive vessels (TTRV) were observed. There was a tendency to improve the parameters of post-occlusive hyperemia (not statistically significant). The duration and area of the reaction after acetylcholine iontophoresis increased and IOP decreased. The presence of AH reduced EС and NС, worsened post-occlusive hyperemia, and was associated with the presence of factors for RA unfavourable course.

Conclusion. The RA activity, the level of ACCP and the presence of AH make a significant contribution to the vasomotor dysfunction. At the same time, AH can be considered as a surrogate marker of an unfavourable course of RA. Endothelium-dependent regulation of blood flow, measured in FT, and IOP are closely related to disease activity. The reduce of RA activity was accompanied by a decrease in TTRV, confirming the leading role of the vasoconstriction in formation the ED pattern, the severity of ED will predominantly depend on the activity of the disease.

Introduction. The development of paraprosthetic regurgitation after transcatheter aortic valve implantation (TAVI) in patients with critical aortic stenosis is an actual problem, which predictors are not well understood. One of the main reasons is calcification of the aortic valve, which does not allow the aortic valve prosthesis to fully expand.

Objective – to identify a possible relationship between the severity of aortic valve calcification and the degree of paraprosthetic regurgitation after TAVI.

Materials and methods. The study included 23 patients with critical symptomatic aortic stenosis and high risk factors for EuroScore II and STS. The single center study is a retrospective analysis of aortic valve calcification measured by preoperative multislice computed tomography. Calcification (calcium index) of the aortic valve was quantified according to the Agatson method. Paraprosthetic regurgitation was evaluated by transthoracic echocardiography according to the ACC/AHA recommendations. The observation period was 12 months. Results. There female patients predominated in the study group (n=15, 65 %). The mean value of the calcium index (CI) of the aortic valve was 5179.7±2334.1 Agatson units. Intraoperatively, half of the patients (n=12, 52 %) after implantation of aortic valve prosthesis had paraprosthetic regurgitation of more than II degree, which required postdilation. The calcium index in this group of patients was significantly higher (6088.3±2274.4, p=0.049). After implantation of an aortal valve prosthesis, paraprosthetic regurgitation of I–II degrees was observed in 16 patients (70 %) with a CI of 5902.1±2191.9, in 7 patients (30 %) with a CI of 3528.7±1537.2 paraprosthetic regurgitation was absent (p=0.021). In the postoperative period (12 months), no lethal outcomes were detected in the study group. Paraprosthetic regurgitation of I–II degrees was detected in 14 patients with a CI of 5676.6±2275, paraprosthetic regurgitation was absent in 9 patients with a CI of 4406.9±2338.3 (p=0.21).

Conclusion. Patients with severe calcification of the aortic valve have an increased risk of developing significant paraprosthetic regurgitation and the use of more aggressive intervention techniques.

Introduction. Antioxidants deficiency with excess of endoperoxides leads to damage of intracellular structures, aggravating the course of most diseases, including cardiovascular pathology. Given the important role of antioxidants in the regulation of physiological processes in cells, the aim of this research was to study the effect of the antioxidant status of blood serum on the expression of pro-inflammatory and vasoactive molecules by blood cells, as well as markers of the metabolic syndrome in the aspect of clarifying possible mechanisms of the pathogenesis of arterial hypertension (AH). Materials and methods. As part of the cohort study, 60 patients of both sexes with hypertension from 45 to 55 years and 15 practically healthy individuals were examined. During the study, we determined in the blood serum the concentrations of insulin, glucagon, apoA1, apoB100, nitric oxide (NO), angiotensin-II (AT-II), E-selectin, P-selectin, intercellular adhesion molecule ICAM1, vascular adhesion molecule VCAM1, VE-cadherin, epinephrine, norepinephrine, endothelin-1, vasopressin, brain natriuretic peptide (BNP), antioxidants (AOS), urokinase-type plasminogen (uPA), plasma endoperoxides (OXY), antiotensin II receptor type 1 (AT-IIR ), plasminogen inhibitor type 1 (PAI1), C-reactive protein (CRP). Results. In patients with AH an increase in the concentration of the studied adhesion molecules was revealed, with significant decrease in the level of VE-cadherin. An increase in the level of vasopressors and decrease NO production was also found. These changes were accompanied by a decrease in the level of apoA1, an increase of the levels of apoB100, insulin, BNP, uPA, PAI1, and CRP. At the same time, an increase in the level of OXY was noted, with a reduced concentration of AOS. It has been established that AOX promote decreasing of the adhesion molecules expression, as well as the production of studied vasopressors, including AT-II, endothelin-1, BNP, insulin, AROB, CRP and stimulates the level of VE-cadherin. Conclusions. AH proceed with activation of vasopressor mechanisms and sympathetic regulation, accompanied by an increase in the adhesive activity of blood cells and endothelium, as well as metabolic disorders and activation of peroxide oxidation of lipids. These changes are associated with AOS deficiency. A correlation between AOS deficiency, laboratory manifestations of a subclinical intravascular inflammatory process, increased aggregation of blood cells, dyslipidemia and dysmetabolic manifestations, as well as dysfunction of the vascular endothelium and myocardium has been established. At the same time, a high level of AOS, in comparison with its low level, is associated with a lower expression of adhesion molecules, a lower level of vasopressor molecules, especially AT-II, a decrease in the level of apoB100 and insulin, as well as a higher expression of VE-cadherin.

Introduction. Varicose veins disease of the lower extremities is often accompanied by edema, which persists even after the elimination of the causes of venous insufficiency. Clinically, the etiopathogenesis of edema in such patients is not always possible to differentiate. Objective. To determine the role of the lower limb lymphatic vasculature stucture variants in the development of chronic venous edema in patients with varicose veins disease. Materials and methods. A retrospective analysis of the results of X-ray contrast lymphography and radionuclide lymphoscintigraphy of 257 patients with different stages of chronic venous insufficiency (CVI). Results. Pathognomonic patterns of the lymphatic vasculature structure at various stages of lymphedema in patients with C3-C5 CVI were discovered. We found that the increasing number of cases of persistent oedema could be associated with the lower limb lymphatic vasculature hypoplasia and higher classes of CVI: 43.95 % among the patients with C4 CVI and 88 % with C5 CVI. The majority (94,1 %) of patients with C3 CVI with a normal-like lymphatic system presented with transitory oedema. With CVI C5, the capacity of the groin lymph nodes was impaired in 64 %. In C4 CVI, weak contrasting was observed in 45.1 %. With C3 – in 35.1 % of cases. Conclusions. The progressing degree of chronic venous oedema could be associated with the lymphatic vasculature hypoplasia and the malfunction of the groin lymph nodes.

Introduction. Changes in local microcirculation are essential in the treatment of infectious surgical diseases. Aim of the study to evaluate the features of microcirculation while comparing local treatment with aqueous dispersions of oxide nanostructures of metals, myelopide and chlorhexidine bigluconate in experimental conditions on animals.

Materials and methods. Experimental modeling was performed on white Wistar rats of both sexes. 6 groups were formed: 1 – withdrawn from the experiment on the 1st day; 2 – control group without treatment; 3 – treatment with an aqueous dispersion of metal oxide nanostructures (group 1); 4 – treatment with a solution of 300 µg of myelopide per 1 ml (group 2); 5 – treatment with a solution of 600 μg of myelopide per 1 ml (group 3); 6. treatment with an aqueous solution of chlorhexidine bigluconate 0.05 % (group 4). The study was carried out on the 1st and 7th days of treatment, determining the number of capillaries per 0.1 mm2 of biopsy specimens. The data were processed with the determination of the mean values (M±m), 1st and 3rd quartiles [Q1-Q3], standard deviation (σ), correlation coefficient (CV, %), coefficient of Student’s.

Results. On the first day, the animals had an average of 2.5±0.9 capillaries per 0.1 mm2 of wound area. On the 7th day, the lowest vascularization was in the control group 2.7±0.9 per 0.1 mm2 . The largest number of vessels was determined in the 1st observation group using aqueous dispersions of metal oxide nanostructures. The correlation coefficients were 40–56 %. On the 7th day, the values of neoangiogenesis during local immunocorrection using an aqueous solution of myelopide were similar.

Conclusions. The least vascularization was noted in the control group (2.7±0.9). The greatest changes were associated with the use of aqueous dispersions of metal oxide nanostructures (3.8±1.4). The differences in the healing dynamic were associated with neoangiogenesis and the multifactorial nature of local immunocorrection.

Introduction. In the last decade the pancreas surgery has undergone considerable development, connected with the introduction of modern interventional procedures for treatment tumors and acute pancreatitis. There are carried out active studies of the risks elimination while transplanting the pancreas, its success considerably depends on the surgeon’s knowledge of the variant anatomy of this organ.

The aim of this study is to show on corrosive preparations the main features of intraorganic arterial blood supply of the human pancreas body and tail.

Materials and methods. The investigation was made on 40 specimens of the human pancreas: 17 – corrosive preparations, 23 – fixed preparations of the pancreas with the parenchyma dissection. Pancreatic vessels were filled with latex of different colors to verify arteries and veins. The preparations were fixed in 10 % acid formalin for a week. After this period, a part of the preparations was dissected, another part was immersed in alkaline solution to obtain corrosive casts of vessels.

Results. The greatest number of cases of the gland vascularization (50.0 %) was of type II, which was characterized by mixed presence of long and short branches of the splenic artery in the arterial blood supply of the gland parenchyma. The variant with predominance of short branches (Type I) was the second most frequent (32.5 %). The variant with predominance of blood supply of the gland only due to long branches (Type III) was observed less frequently, in 17 % of cases. In the majority of cases there were numerous arterial anastomoses in the form of arcades in the gland parenchyma (88,2 % of cases). They usually continue large branches of the splenic artery (dorsal pancreatic artery and large pancreatic artery), whereas short branches usually supply only a small part of the gland.

Conclusion. The human pancreas has a marked anatomical variability of its arterial blood supply. The investigation showed that in most cases its parenchyma is vascularized by short and long branches of the splenic artery forming arcade-type anastomoses. In a several cases there was found a variant of blood supply with predominance of short branches dividing the gland into separate sections. The type of blood supply of the gland body and tail with predominance of long branches was found less often.

Introduction. In transplantology, there has always been a problem of organ donor shortage, especially hearts. One of the possible ways to increase the pool of donor hearts is to use donors with circulatory arrest, however irreversible changes in the myocardium after circulatory arrest progress rapidly, which significantly complicates the use of a heart removed from an asystolic donor for transplantation. Objective. To evaluate the effectiveness of hypothermic perfusion of visceral cavities (HPVC) as a method of prolonging the viability of the myocardium of the donor heart during asystole. Materials and methods. The experiments were performed on male rats weighing 200–250 g. The animals were divided into 5 groups, deepening on the duration of HPVC, carried out after a 10-minute period of normothermal asystole: control – 0 min. HPVC and groups with HPVC lasting 30, 60, 90 and 120 min. After complete of perfusion of the heart cavities, they were connected to a Langendorff apparatus to evaluate functional parameters and then determine the volume of necrosis. Results. By the tenth minute of the asystole, the core temperature of the rats’ body was 37.2 ± 0.3 °C. The size of necrosis in the control group was 4.1± 0.6 %. In the groups with a duration of HPVC of 30, 60, and 90 minutes, the size of necrosis was significantly higher than in the control (p<0.05), and was 13.4±3.6 %, 10.3±4.4 % and 14.1±3.4 %, respectively, but there were no difference between these groups. There was a significant increase of the necrosis size in the group with HPVC lasting 120 min compared with the HPVC lasting 90 minutes (24.2±7.1 %, p><0.05). Conclusions. Cold perfusion of the visceral cavities of an asystolic donor, initiated 10 minutes after circulatory arrest, can significantly slow the progression of irreversible myocardial damage in up to 90 minutes, which can expand the potential for the use of hearts from asystolic donors.>< 0.05), and was 13.4±3.6 %, 10.3±4.4 % and 14.1±3.4 %, respectively, but there were no difference between these groups. There was a significant increase of the necrosis size in the group with HPVC lasting 120 min compared with the HPVC lasting 90 minutes (24.2±7.1 %, p< 0.05). Conclusions. Cold perfusion of the visceral cavities of an asystolic donor, initiated 10 minutes after circulatory arrest, can significantly slow the progression of irreversible myocardial damage in up to 90 minutes, which can expand the potential for the use of hearts from asystolic donors.

Introduction. One of the promising directions of studying liver microcirculation is searching for age-related features of its hemodynamics and early markers of pathological changes. Objective – to study the parameters of microcirculation in the liver of animals of different sex and age during a load test. Materials and methods. The study was conducted on 60 mongrel rats of both sexes weighing 120–270 g, divided into three age groups. The first group included 20 rats aged 1 month, the second – 20 rats aged 6–12 months and the third – 20 rats aged more than 18–24 months. The study of microcirculation was performed using a laser Doppler flowmeter LAKK-02 (Russia) under zoletil-xylazine anesthesia. Then, the rats were injected per os with mixture for enteral nutrition Nutridrink (Nutricia) in a ratio of 5 mg/kg of body weight. After 15 minutes the microcirculation parameters were determined again. Digital data were processed by methods of variation statistics. Results. In the liver of rats, the basic parameters of microcirculation were slightly higher in females compared to males: by 8.22 % (R=0.31) in the I, by 8.66 % (R= 0.05) in the II and by 1.19 % (R=0.48) in the III age group. With an increase in the age of the animals, the microcirculation indicators decreased. After the load test, an increase in microcirculation indexes was noted in the liver of rats in all age groups: by 45.13 % (R=0.82) in the I, by 27.99 % (R=0.64) in the II and by 15.88 % (R=0.91) in the III age group. Conclusion. There was no statistically significant dependence of the parameters of microcirculation in the liver of rats on the sex of the animals. With an increase in the rat’s age, the microcirculation rates decreased. After a food load test in the liver of rats, a statistically significant increase of the parameters of microcirculation was noted in all age groups. With an increase in the age of animals, the increase in microcirculation rates after a food load test significantly decreased.

Despite the success of conservative and surgical treatment of vascular diseases, the prevention of arterial and venous thrombosis remains extremely actual. For more than a hundred years, the so-called «Virchow’s triad» has been used to explain the mechanism of thrombosis: 1–slowing of blood flow; 2–hypercoagulation; 3 – damage to the vascular wall. However, the combination of these factors is fully applicable only for venous thrombosis and limited for arterial thrombosis. The generally accepted strategy for the prevention of venous thrombosis is the use of anticoagulants, while for arterial thrombosis – antiaggregants. In recent years the mechanisms of blood clot formation at high blood flow rates in the areas of arterial stenosis, as well as the role of platelets and von Willebrand factor in this process, were investigated. In the presented review, the details of the mechanisms of thrombosis in the arteries are analyzed and the concept of «arterial triad» is introduced. Arterial triad includes: 1 – arterial stenosis (increase in shear rate); 2 – platelets (their activation and interaction with von Willebrand factor); 3 – damage of the vascular wall. The arterial triad describes the mechanisms of thrombosis in the presence of artery stenosis (usually due to atherosclerosis). Understanding similarities and differences between Virchow’s and arterial triads, will allow us to estimate the risk factors in patients with cardiovascular pathology and develop optimal methods of their prevention.

Trachea is one of the most difficult organs for transplantation because of its segmental blood supply is provided by vessels which are too small for microvascular anastomosis. An effective vascular supply and, respectively, microcirculation is fundamental for successful transplantation of this organ. The possibility of using bioprosthesis for tracheal replacement is under investigation. Only few groups of researchers over the world have developed their own techniques of tracheal transplantation, but at present time the problem is not resolved. This review describes past and current researches in the field of tracheal transplantation and reconstruction.