RESUMEN
ETHNOPHARMACOLOGICAL RELEVANCE: The Chinese traditional medicine frankincense, which can promote blood circulation, is often used to treat skin lesions, including frostbite. AIM OF THE STUDY: To explore the properties of frankincense oil extract (FOE) and its active ingredients and their effect on frostbite wound recovery as an approach to understand the mechanism associated with microcirculation-improvement therapy. MATERIALS AND METHODS: The microcirculation-improving effects of FOE and its active ingredients were evaluated using liquid nitrogen-induced frostbite animal models. The rewarming capacity of FOE on the skin was determined through infrared detection, and frostbite wound healing was evaluated following haematoxylin and eosin (H&E) staining and fibre analysis. Moreover, related factors were examined to determine the anti-apoptotic, anti-inflammatory, and microcirculatory properties of FOE and its active ingredients on affected tissue in the context of frostbite. RESULTS: FOE and its active ingredients rapidly rewarmed wound tissue after frostbite by increasing the temperature. Moreover, these treatments improved wound healing and restored skin structure through collagen and elastin fibre remodelling. In addition, they exerted anti-apoptotic effects by decreasing the number of apoptotic cells, reducing caspase-3 expression, and eliciting anti-inflammatory effects by decreasing COX-2 and ß-catenin expression. They also improved microcirculatory disorders by decreasing HIF-1α expression and increasing CD31 expression. CONCLUSIONS: FOE and its active components can effectively treat frostbite by enhancing microcirculation, inhibiting the infiltration of inflammatory cells, decreasing cell apoptosis, and exerting antinociceptive effects. These findings highlight FOE as a new treatment option for frostbite, providing patients with an effective therapeutic strategy.
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Congelación de Extremidades , Microcirculación , Cicatrización de Heridas , Congelación de Extremidades/tratamiento farmacológico , Animales , Microcirculación/efectos de los fármacos , Masculino , Cicatrización de Heridas/efectos de los fármacos , Piel/efectos de los fármacos , Piel/irrigación sanguínea , Piel/patología , Apoptosis/efectos de los fármacos , Ratas , Modelos Animales de Enfermedad , Ratones , Administración Tópica , Ratas Sprague-Dawley , Aceites de Plantas/farmacología , Aceites de Plantas/uso terapéutico , Extractos Vegetales/farmacologíaRESUMEN
PURPOSE: This study aims to investigate whether contrast-enhanced ultrasound (CEUS) could be used to reveal the status of blood supply of the superficial flap of rat model in the early postoperative stage. METHODS: One viable and one ischemic random-pattern flap were prepared on the left and right back of the same rat respectively with a number of 40. CEUS examinations were applied within 12 h and 7 days postoperatively, and the quantitative measurements of microvascular blood volume (BV) of the base and the end of both flaps were expressed using acoustic intensity as a ratio to that of the healthy skin. RESULTS: Within 12 h post operation, there was a smaller BV value of the ischemic ends than that of both the ischemic bases and viable ends (p < 0.001), while no difference was indicated between ischemic bases and viable bases or between viable bases and viable ends. The same result was provided 7 days post operation. CONCLUSION: Microcirculation of superficial tissues such as random-pattern flaps in this rat model can be assessed quantitatively by CEUS. It could sensitively and accurately reveal the objective status of tissue perfusion in the early postoperative stage.
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Medios de Contraste , Microcirculación , Colgajos Quirúrgicos , Ultrasonografía , Animales , Colgajos Quirúrgicos/irrigación sanguínea , Microcirculación/fisiología , Masculino , Ratas Sprague-Dawley , Ratas , Isquemia/diagnóstico por imagen , Periodo Posoperatorio , Volumen SanguíneoRESUMEN
OBJECTIVE: To observe the effect of Wenyang Baidu Yin on early microcirculation indicators in patients with sepsis (syndrome of Yang deficiency and turbid toxin), analyze the specific therapeutic effect, and provide a new perspective for clinical treatment of microcirculation disorders in sepsis. METHODS: Sixty-four patients with sepsis admitted to the intensive care unit (ICU) of Shanxi Province Hospital of Integrated Traditional Chinese and Western Medicine from January 2022 to July 2023 were enrolled. Patients were divided into control group and observation group by randomly number table method, with 32 cases in each group. The control group received conventional Western medicine treatment. On the basis of conventional Western medicine treatment, the observation group was given Wenyang Baidu Yin 200 mL/d (100 mL each time, with an interval of 12 hours) orally or by nasal feeding for 3 consecutive days. The central venous oxygen saturation (ScvO2), difference of central venous-to-arterial partial pressure of carbon dioxide (Pcv-aCO2), arterial lactic acid (Lac), pulse perfusion index (PI), capillary refill time (CRT), and skin mottling score (SMS) of two groups were detected before treatment and at 6, 12, 24, and 48 hours of treatment; simultaneously record the traditional Chinese medicine (TCM) syndrome score before treatment and at 72 hours of treatment, as well as the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) before treatment and at 24 hours and 72 hours of treatment. RESULTS: There were no statistically significant differences in gender, age, and various microcirculation indicators before treatment between the two groups, indicating consistent baseline characteristics. Compared with before treatment, the microcirculation indicators ScvO2, Pcv-aCO2, Lac, PI, CRT, and SMS in both groups showed significant improvement after treatment. Moreover, the observation group showed more significant improvements in Lac and PI compared to the control group at 24 hours and 48 hours of treatment [Lac (mmol/L): 2.45±0.92 vs. 3.07±1.07 at 24 hours, 2.06±0.87 vs. 2.59±1.01 at 48 hours; PI: 3.45±0.89 vs. 2.92±0.98 at 24 hours, 3.56±0.99 vs. 3.01±0.87 at 48 hours, all P < 0.05]. CRT and SMS showed more significant improvements compared to the control group at 48 hours of treatment [CRT (s): 2.04±1.08 vs. 2.62±0.99, SMS: 0.5 (0.0, 1.0) vs. 1.0 (1.0, 1.0), both P < 0.05], while there were no statistically significant differences in ScvO2 and Pcv-aCO2 at each time point between the two groups. After treatment, the APACHE score, SOFA score, and TCM syndrome score improved in both groups compared to before treatment, and the improvement degree of each score in the observation group was significantly higher than that in the control group [72 hours APACHE II score: 15.0 (12.2, 16.0) vs. 17.0 (13.5, 20.0), 72 hours SOFA score: 6.0 (6.0, 8.0) vs. 10.0 (8.0, 13.0), 72 hours TCM syndrome score: 10.13±3.73 vs. 14.63±5.55, all P < 0.05]. CONCLUSIONS: On the basis of conventional Western medicine treatment, the combination of Wenyang Baidu Yin can significantly improve microcirculation disorders in patients with sepsis (syndrome of Yang deficiency and turbid toxin) to a certain extent, thereby improving patient prognosis.
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Medicamentos Herbarios Chinos , Microcirculación , Sepsis , Deficiencia Yang , Humanos , Microcirculación/efectos de los fármacos , Sepsis/tratamiento farmacológico , Sepsis/fisiopatología , Medicamentos Herbarios Chinos/uso terapéutico , Deficiencia Yang/tratamiento farmacológico , Masculino , Femenino , Medicina Tradicional China/métodos , Unidades de Cuidados Intensivos , Persona de Mediana EdadRESUMEN
Approximately half of all coronary angiograms performed for angina do not show obstructive coronary artery disease, and many of these patients have coronary microvascular dysfunction (CMD). Invasive testing for CMD has increased with the advent and wider availability of thermodilution systems. We review CMD pathophysiology and invasive diagnostic testing using the Doppler and thermodilution systems. We report the results of a PubMed search of invasive microvascular testing and discuss limitations of current diagnostic algorithms in the diagnosis of CMD, including controversies regarding the optimal cutoff value for abnormal coronary flow reserve, use of microvascular resistance indices, and options for increasing sensitivity of testing.
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Microcirculación , Humanos , Microcirculación/fisiología , Angina de Pecho/fisiopatología , Angina de Pecho/diagnóstico , Angina de Pecho/etiología , Termodilución/métodos , Circulación Coronaria/fisiología , Vasos Coronarios/fisiopatología , Vasos Coronarios/diagnóstico por imagen , Angiografía Coronaria/métodos , Resistencia Vascular/fisiología , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/diagnósticoRESUMEN
The peripheral perfusion index (PI) is derived from pulse oximetry and is defined as the ratio of the pulse wave of the pulsatile portion (arteries) to the non-pulsatile portion (venous and other tissues). A growing number of clinical studies have supported the use of PI in various clinical scenarios, such as guiding hemodynamic management and serving as an indicator of outcome and organ function. In this review, we will introduce and discuss this traditional but neglected indicator of the peripheral microcirculatory perfusion. Further clinical trials are required to clarify the normal and critical values of PI for different monitoring devices in various clinical conditions, to establish different standards of PI-guided strategies, and to determine the effect of PI-guided therapy on outcome.
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Microcirculación , Oximetría , Humanos , Oximetría/métodos , Microcirculación/fisiología , Adulto , Índice de Perfusión/métodos , Hemodinámica/fisiologíaRESUMEN
Rationale: Azoospermia is a significant reproductive challenge. Differentiating between non-obstructive azoospermia (NOA) and obstructive azoospermia (OA) is crucial as each type requires distinct management strategies. Testicular microcirculation plays a profound role in spermatogenic functions. However, current diagnostic methods are limited in their ability to effectively elucidate this crucial connection. Methods: We employed ultrasound localization microscopy (ULM) to visualize testicular microcirculation in NOA and OA patients and quantified the testicular hemodynamic parameters. Pearson correlation analysis was conducted to investigate the inner connection between parameters of testicular microcirculation and clinical spermatogenic functions. We conducted multiple logistic regression analysis to establish a new diagnostic model that integrates follicle-stimulating hormone (FSH) and mean vascular diameter to distinguish NOA from OA. Results: Our findings demonstrated significant differences in vascular parameters between NOA and OA, with NOA characterized by lower mean vascular diameter (p < 0.001), vessel density (p < 0.001), and fractal number (p < 0.001). Testicular volume showed a moderate positive correlation with mean vascular diameter (r = 0.419, p < 0.01) and vessel density (r = 0.415, p < 0.01); Mean vascular diameter exhibited negative correlations with both FSH (r = -0.214, p < 0.05) and age (r = -0.240, p < 0.05); FSH (r = -0.202, p < 0.05) and luteinizing hormone (LH) (r = -0.235, p < 0.05) were negatively correlated with mean blood flow velocity. The diagnostic model demonstrated an area under the curve (AUC) of 0.968. We also reported a method to map the vascular pressure distribution derived from the blood flow velocity generated by ULM. Conclusions: ULM provides a non-invasive and detailed assessment of testicular microvascular dynamics. The ULM-derived vascular parameters are able to connect testicular microcirculation to spermatogenic functions. The combination of FSH and mean vascular diameter enhances diagnostic precision and holds potential for distinguishing NOA from OA.
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Azoospermia , Hormona Folículo Estimulante , Microcirculación , Espermatogénesis , Testículo , Masculino , Humanos , Testículo/irrigación sanguínea , Testículo/diagnóstico por imagen , Azoospermia/diagnóstico por imagen , Azoospermia/fisiopatología , Adulto , Hormona Folículo Estimulante/sangre , Ultrasonografía/métodos , Persona de Mediana Edad , Microscopía/métodosRESUMEN
Cocoa flavan-3-ols affect endothelium-dependent responses in resistance vessels and microcirculation has received little attention. We tested the effects of dark chocolate consumption (396 mg total flavanols/day for 3 days) in two Groups of 10 men (18-25 years; non-smokers) each comprising equal numbers of White European (WE) and South Asian (SA) ethnicity. In Group 1, dark chocolate did not affect reactive hyperaemia in forearm muscle, but augmented muscle dilatation evoked by acute mental stress, and reactive hyperaemia and acetylcholine (ACh)-evoked dilatation in cutaneous microcirculation. Conversely, in Group 2, chocolate did not affect cutaneous reactive hyperaemia or ACh-evoked dilatation, but these responses were blunted in Group 1 relative to Group 2. Further, when Groups 1 and 2 were combined, responses were blunted in SAs relative to WEs, augmented by chocolate in SAs only. In Group 2 individuals whose ACh-evoked dilatation was attenuated by nitric oxide synthase (NOS) inhibition, ACh-evoked dilatation was not altered after chocolate, but the attenuating effect of NOS inhibition was lost. Conversely, in Group 2 individuals whose ACh-evoked dilatation was enhanced by NOS inhibition, ACh-evoked dilatation was also augmented by chocolate. We propose that in resistance and microvessels of young men, cocoa flavan-3-ols preferentially augment endothelium-dependent dilator responses whose responses are depressed by familial and lifestyle factors more prevalent in SAs than Wes. Flavan-3-ols may facilitate the NOS pathway but also influence other endothelium-dependent dilators.
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Cacao , Chocolate , Estilo de Vida , Microcirculación , Humanos , Masculino , Adulto Joven , Adulto , Cacao/química , Microcirculación/efectos de los fármacos , Adolescente , Flavonoides/farmacología , Vasodilatación/efectos de los fármacos , Población Blanca , Hiperemia , Endotelio Vascular/efectos de los fármacos , Piel/irrigación sanguínea , Piel/efectos de los fármacos , Piel/metabolismo , Microvasos/efectos de los fármacos , Pueblo Asiatico , Antebrazo/irrigación sanguínea , Acetilcolina/farmacología , Estrés Psicológico , Óxido Nítrico Sintasa/metabolismo , Músculo Esquelético/efectos de los fármacos , Músculo Esquelético/metabolismoRESUMEN
BACKGROUND: Microcirculation abnormality in septic shock is closely associated with organ dysfunction and mortality rate. It was hypothesized that the arterial blood glucose and interstitial fluid (ISF) glucose difference (GA-I) as a marker for assessing the microcirculation status can effectively evaluate the severity of microcirculation disturbance in patients with septic shock. METHODS: The present observational study enrolled patients with septic shock admitted to and treated in the intensive care unit (ICU) of a tertiary teaching hospital. The parameters reflecting organ and tissue perfusion, including lactic acid (Lac), skin mottling score, capillary refill time (CRT), venous-to-arterial carbon dioxide difference (Pv-aCO2), urine volume, central venous oxygen saturation (ScvO2) and GA-I of each enrolled patient were recorded at the time of enrollment (H0), H2, H4, H6, and H8. With ICU mortality as the primary outcome measure, the ICU mortality rate at any GA-I interval was analyzed. RESULTS: A total of 43 septic shock patients were included, with median sequential organ failure assessment (SOFA) scores of 10.5 (6-16), and median Acute Physiology and Chronic Health Evaluation (APACHAE) II scores of 25.7 (9-40), of whom 18 died during ICU stay. The GA-I levels were negative correlation with CRT (r = 0.369, P < 0.001), Lac (r = -0.269, P < 0.001), skin mottling score (r=-0.223, P < 0.001), and were positively associated with urine volume (r = 0.135, P < 0.05). The ICU mortality rate of patients with septic shock presenting GA-I ≤ 0.30 mmol/L and ≥ 2.14 mmol/L was significantly higher than that of patients with GA-I at 0.30-2.14 mmol/L [65.2% vs. 15.0%, odds ratio (OR) = 10.625, 95% confidence interval (CI): 2.355-47.503]. CONCLUSION: GA-I was correlated with microcirculation parameters, and with differences in survival. Future studies are needed to further explore the potential impact of GA-I on microcirculation and clinical prognosis of septic shock, and the bedside monitoring of GA-I may be beneficial for clinicians to identify high-risk patients.
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Glucemia , Líquido Extracelular , Unidades de Cuidados Intensivos , Microcirculación , Choque Séptico , Humanos , Choque Séptico/mortalidad , Choque Séptico/fisiopatología , Femenino , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Pronóstico , Anciano , Microcirculación/fisiología , Glucemia/análisis , Centros de Atención Terciaria , Adulto , Puntuaciones en la Disfunción de ÓrganosRESUMEN
Recent studies have shown that the extramuscular connective tissue (ECT) is thickened and stiffened in delayed onset muscle soreness (DOMS). However, contrarily to the normal population, severe DOMS is rare in athletes or highly trained individuals. The present randomized, controlled trial therefore aimed to investigate pain as well as microcirculation and stiffness of the ECT and the erector spinae muscle following submaximal eccentric trunk extension exercise not causing DOMS. The effect of manual treatment by a therapist (myofascial release; MFR) on these parameters was to be studied. Trained healthy participants (n = 21; 31.3 ± 9.6 years; > 4 h exercise per week) performed submaximal eccentric exercise of the trunk extensors. One group was manually treated (n = 11), while the other group (n = 10) received placebo treatment with sham laser therapy. Stiffness of the ECT and the erector spinae muscle (shear wave elastography), microcirculation (white light and laser Doppler spectroscopy), palpation pain (100 mm visual analogue scale, VAS) and pressure pain threshold (indentometry, PPT) were assessed before (t0), 24 h (t24) and 48 h (t48) after conditions. Erector spinae muscle stiffness increased after eccentric exercise from t0 to t24 (0.875 m/s) and from t0 to t48 (0.869 m/s). After MFR, erector spinae muscle stiffness decreased in contrast to placebo treatment at t24 (-0.66 m/s), while ECT stiffness remained unchanged. Oxygen saturation increased (17-20.93%) and relative haemoglobin decreased (-9.1 - -12.76 AU) after eccentric exercise and MFR differed from placebo treatment at t48 (-3.71 AU). PPT differed after MFR from placebo treatment at t48 (20.69 N/mm), while VAS remained unchanged. Multiple linear regression showed that ECT stiffness and group membership predicted erector spinae muscle stiffness. MFR could have a positive effect on pain, microcirculation and muscle stiffness after submaximal eccentric exercise, suggesting better recovery, which needs to be confirmed by future work.
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Ejercicio Físico , Microcirculación , Mialgia , Humanos , Microcirculación/fisiología , Adulto , Masculino , Femenino , Mialgia/terapia , Mialgia/fisiopatología , Ejercicio Físico/fisiología , Manipulaciones Musculoesqueléticas/métodos , Región Lumbosacra/irrigación sanguínea , Región Lumbosacra/fisiología , Adulto Joven , Músculo Esquelético/irrigación sanguínea , Músculo Esquelético/fisiología , Umbral del Dolor/fisiología , Torso/fisiología , Dimensión del Dolor , Músculos Paraespinales/fisiología , Músculos Paraespinales/diagnóstico por imagen , Músculos Paraespinales/irrigación sanguíneaAsunto(s)
Microcirculación , Valor Predictivo de las Pruebas , Resistencia Vascular , Humanos , Resultado del Tratamiento , Masculino , Persona de Mediana Edad , Femenino , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/fisiopatología , Angina de Pecho/fisiopatología , Angina de Pecho/terapia , Angina de Pecho/diagnóstico , Circulación Coronaria , Anciano , Isquemia Miocárdica/fisiopatología , Isquemia Miocárdica/terapia , Isquemia Miocárdica/diagnóstico por imagen , Vasodilatadores/uso terapéutico , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/terapia , Enfermedad de la Arteria Coronaria/fisiopatologíaRESUMEN
Systemic vasodilating agents like nitroglycerin (NG) or iloprost (Ilo) show beneficial effects on intestinal microcirculation during sepsis, which could be attenuated by activation of the sympathetic nervous system or systemic side effects of vasodilating agents. This exploratory study aimed to investigate the effects of topically administered vasodilators and the parasympathetic drug carbachol on colonic microcirculatory oxygenation (µHbO2), blood flow (µFlow) and mitochondrial respiration. A total of 120 male Wistar rats were randomly assigned to twelve groups and underwent either colon ascendens stent peritonitis (CASP) or sham surgery. After 24 h, animals received the following therapeutic regimes: (1) balanced full electrolyte solution, (2) carbachol, (3) NG, (4) Ilo, (5) NG + carbachol, and (6) Ilo + carbachol. Mitochondrial respiration was measured in colon homogenates by respirometry. In sham animals, NG (-13.1%*) and Ilo (-10.5%*) led to a decrease in µHbO2. Additional application of carbachol abolished this effect (NG + carbachol: -4.0%, non-significant; Ilo + carbachol: -1.4%, non-significant). In sepsis, carbachol reduced µHbO2 when applied alone (-10.5%*) or in combination with NG (-17.6%*). Thus, the direction and degree of this effect depend on the initial pathophysiologic condition.
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Sistema Nervioso Autónomo , Carbacol , Microcirculación , Mitocondrias , Ratas Wistar , Sepsis , Vasodilatadores , Animales , Microcirculación/efectos de los fármacos , Sepsis/tratamiento farmacológico , Sepsis/fisiopatología , Masculino , Ratas , Vasodilatadores/farmacología , Mitocondrias/metabolismo , Mitocondrias/efectos de los fármacos , Sistema Nervioso Autónomo/efectos de los fármacos , Sistema Nervioso Autónomo/fisiopatología , Carbacol/farmacología , Colon/efectos de los fármacos , Colon/irrigación sanguínea , Colon/metabolismo , Nitroglicerina/farmacologíaRESUMEN
Cardiac surgery causes a series of disturbances in human physiology. The correction of systemic hemodynamic variables is frequently ineffective in improving microcirculatory perfusion and delivering oxygen to the tissues. We present the case of a 52-year-old male submitted to mitral valve replacement (metallic valve) and subaortic membrane resection. Sublingual microcirculatory density and perfusion were evaluated using a handheld CytoCam camera before surgery and in the early postoperative period. In this case, systemic hemodynamic variables were compromised despite an actual improvement in the microcirculatory parameters in comparison to the preoperative evaluation, possibly due to the correction of the structural cardiac defects.
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Microcirculación , Humanos , Masculino , Persona de Mediana Edad , Microcirculación/fisiología , Hemodinámica/fisiología , Implantación de Prótesis de Válvulas Cardíacas , Suelo de la Boca/irrigación sanguínea , Suelo de la Boca/cirugía , Periodo Posoperatorio , Procedimientos Quirúrgicos Cardíacos/métodos , Válvula Mitral/cirugíaRESUMEN
Cardiovascular disease is the predominant cause of mortality on a global scale. Research indicates that women exhibit a greater likelihood of presenting with non-obstructive coronary artery disease (CAD) when experiencing symptoms of myocardial ischemia in comparison to men. Additionally, women tend to experience a higher burden of symptoms relative to men, and despite the presence of ischemic heart disease, they are frequently reassured erroneously due to the absence of obstructive CAD. In cases of ischemic heart disease accompanied by symptoms of myocardial ischemia but lacking obstructive CAD, it is imperative to consider coronary microvascular dysfunction as a potential underlying cause. Coronary microvascular dysfunction, characterized by impaired coronary flow reserve resulting from functional and/or structural abnormalities in the microcirculation, is linked to adverse cardiovascular outcomes. Lifestyle modifications and the use of anti-atherosclerotic and anti-anginal medications may offer potential benefits, although further clinical trials are necessary to inform treatment strategies. This review aims to explore the prevalence, underlying mechanisms, diagnostic approaches, and therapeutic interventions for coronary microvascular dysfunction.
A doença cardiovascular é a causa predominante de mortalidade em escala global. A pesquisa indica que as mulheres, em comparação aos homens, apresentam maior probabilidade de apresentar doença arterial coronariana (DAC) não obstrutiva quando têm sintomas de isquemia miocárdica. Além disso, as mulheres tendem a apresentar uma maior carga de sintomas em relação aos homens e, apesar da presença de doença cardíaca isquêmica, são frequentemente tranquilizadas erroneamente devido à ausência de DAC obstrutiva. Nos casos de cardiopatia isquêmica acompanhada de sintomas de isquemia miocárdica, mas sem DAC obstrutiva, é imperativo considerar a disfunção microvascular coronariana como uma potencial causa subjacente. A disfunção microvascular coronariana, caracterizada por reserva de fluxo coronariano prejudicada resultante de anormalidades funcionais e/ou estruturais na microcirculação, está associada a desfechos cardiovasculares adversos. Modificações no estilo de vida e o uso de medicamentos antiateroscleróticos e antianginosos podem oferecer benefícios potenciais, embora sejam necessários mais ensaios clínicos para informar estratégias de tratamento. Esta revisão tem como objetivo explorar a prevalência, mecanismos subjacentes, abordagens diagnósticas e intervenções terapêuticas para disfunção microvascular coronariana.
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Enfermedad de la Arteria Coronaria , Circulación Coronaria , Microcirculación , Humanos , Microcirculación/fisiología , Circulación Coronaria/fisiología , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/terapia , Femenino , Masculino , Isquemia Miocárdica/fisiopatología , Isquemia Miocárdica/terapia , Factores Sexuales , Factores de RiesgoRESUMEN
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is estimated to affect approximately 25% of the global population. Both, coronary artery disease and NAFLD are linked to underlying insulin resistance and inflammation as drivers of the disease. Coronary flow reserve parameters, including coronary flow reserve velocity (CFRV), baseline diastolic peak flow velocity (DPFV), and hyperemic DPFV, are noninvasive markers of coronary microvascular circulation. The existing literature contains conflicting findings regarding these parameters in NAFLD patients. METHODS: A comprehensive systematic search was conducted on major electronic databases from inception until May 8, 2024, to identify relevant studies. We pooled the standardized mean differences (SMD) with 95% confidence intervals (CI) using the inverse-variance random-effects model. Statistical significance was set at Pâ <â .05. RESULTS: Four studies with 1139 participants (226 with NAFLD and 913 as controls) were included. NAFLD was associated with a significantly lower CFRV (SMD: -0.77; 95% CI: -1.19, -0.36; Pâ <â .0002) and hyperemic DPFV (SMD: -0.73; 95% CI: -1.03, -0.44; Pâ <â .00001) than the controls. NAFLD demonstrated a statistically insignificant trend toward a reduction in baseline DPFV (SMD: -0.09; 95% CI: -0.38, 0.19; Pâ =â .52) compared to healthy controls. CONCLUSION: Patients with NAFLD are at a higher risk of coronary microvascular dysfunction, as demonstrated by reduced CFRV and hyperemic DPFV. The presence of abnormal coronary flow reserve in patients with NAFLD provides insights into the higher rates of cardiovascular disease in these patients. Early aggressive targeted interventions for impaired coronary flow reserve in subjects with NAFLD may lead to improvement in clinical outcomes.
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Enfermedad de la Arteria Coronaria , Enfermedad del Hígado Graso no Alcohólico , Enfermedad del Hígado Graso no Alcohólico/fisiopatología , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Humanos , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/complicaciones , Circulación Coronaria/fisiología , Reserva del Flujo Fraccional Miocárdico/fisiología , Proyectos Piloto , Velocidad del Flujo Sanguíneo/fisiología , Microcirculación/fisiologíaRESUMEN
ETHNOPHARMACOLOGICAL RELEVANCE: Microcirculatory dysfunction is one of the main characteristics of sepsis. Shenfu Injection (SFI) as a traditional Chinese medicine is widely applied in clinical severe conditions. Recent studies have shown that SFI has the ability to ameliorate sepsis-induced inflammation and to improve microcirculation perfusion. AIM OF THE STUDY: This study aims to investigate the underlying mechanism of SFI for ameliorating sepsis-associated endothelial dysfunction and organ injury. MATERIALS AND METHODS: Side-stream dark-field (SDF) imaging was used to monitor the sublingual microcirculation of septic patients treated with or without SFI. Septic mouse model was used to evaluate the effects of SFI in vivo. Metabolomics and transcriptomics were performed on endothelial cells to identify the underlying mechanism for SFI-related protective effect on endothelial cells. RESULTS: SFI effectively abolished the disturbance and loss of sublingual microcirculation in septic patients. Twenty septic shock patients with or without SFI administration were enrolled and the data showed that SFI significantly improved the levels of total vessel density (TVD), perfused vessel density (PVD), microvascular flow index (MFI), and the proportion of perfused vessels (PPV). The administration of SFI significantly decreased the elevated plasma levels of Angiopoietin-2 (Ang2) and Syndecan-1, which are biomarkers indicative of endothelial damage in sepsis patients. In the mouse septic model in vivo, SFI inhibited the upregulation of endothelial adhesion molecules and Ly6G + neutrophil infiltration while restored the expression of VE-Cadherin in the vasculature of the lung, kidney, and liver tissue. Additionally, SFI reduced the plasma levels of Ang2, Monocyte Chemoattractant Protein-1(MCP1), and Interleukin-6 (IL6), and alleviated liver and kidney injury in septic mice. Moreover, SFI significantly inhibited the inflammatory activation and increased permeability of endothelial cells induced by endotoxins in vitro. By performing metabolomics and transcriptomics, we identified the activation of PI3K/Akt-mediated glycolysis as the underlying mechanism for SFI-related protective effect on endothelial cells. CONCLUSIONS: Our findings revealed that SFI may improve microcirculation perfusion and endothelial function in sepsis via inhibiting PI3K/Akt-mediated glycolysis, providing theoretical evidence for the clinical application of SFI.
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Medicamentos Herbarios Chinos , Glucólisis , Proteínas Proto-Oncogénicas c-akt , Animales , Medicamentos Herbarios Chinos/farmacología , Humanos , Masculino , Proteínas Proto-Oncogénicas c-akt/metabolismo , Ratones , Glucólisis/efectos de los fármacos , Microcirculación/efectos de los fármacos , Endotoxemia/tratamiento farmacológico , Ratones Endogámicos C57BL , Femenino , Fosfatidilinositol 3-Quinasas/metabolismo , Persona de Mediana Edad , Sepsis/tratamiento farmacológico , Sepsis/complicaciones , Modelos Animales de Enfermedad , Células Endoteliales/efectos de los fármacos , Células Endoteliales/metabolismo , Células Endoteliales de la Vena Umbilical Humana/efectos de los fármacos , Anciano , Transducción de Señal/efectos de los fármacosRESUMEN
Energy drinks are nonalcoholic beverages whose main ingredients are sugar, taurine, and caffeine. The consumption of energy drinks is increasing worldwide, but only a few conflicting studies have investigated the vascular effects of energy drinks in young adults. The aim of this study was to evaluate microvascular reactivity before and after energy drinks consumption in young healthy male volunteers. This was a cross-sectional prospective study. Microvascular reactivity signals were evaluated in the skin of the forearm using laser speckle contrast imaging with acetylcholine (ACh) iontophoresis before and 90 and 180 min after the randomized consumption of one ED or the same volume of water (control), followed by a postocclusive reactive hyperemia (PORH) test. Thirty-two volunteers were evaluated (age: 25.4±4.3 years). Energy drink consumption prevented the rest-induced reduction in cutaneous vascular conductance over time that was observed in the control group. In the control group, there were significant reductions in microvascular vasodilation at 90 and 180 min compared to baseline (P=0.004), but this was not the case in the energy drink group (P=0.76). Our results demonstrated that the reduction in microvascular conductance associated with prolonged immobility can be prevented by the consumption of one energy drink, highlighting the vasodilator effects of this beverage in young individuals at rest. The between-study variability in terms of the brand of energy drinks and the ingested volume, as well as the method of vascular evaluation and the inclusion criteria, may explain the discrepancies among previous studies on the vascular effects of energy drinks.
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Bebidas Energéticas , Humanos , Masculino , Adulto , Estudios Prospectivos , Estudios Transversales , Adulto Joven , Vasodilatación/efectos de los fármacos , Vasodilatación/fisiología , Descanso/fisiología , Antebrazo/irrigación sanguínea , Microcirculación/efectos de los fármacos , Microcirculación/fisiología , Piel/irrigación sanguínea , Piel/efectos de los fármacos , Hiperemia , Microvasos/efectos de los fármacos , Acetilcolina/administración & dosificación , Acetilcolina/farmacologíaAsunto(s)
Cardiomiopatía Hipertrófica , Proteínas Proto-Oncogénicas c-mdm2 , Transducción de Señal , Cardiomiopatía Hipertrófica/fisiopatología , Cardiomiopatía Hipertrófica/metabolismo , Humanos , Proteínas Proto-Oncogénicas c-mdm2/metabolismo , Proteínas Proto-Oncogénicas c-mdm2/genética , Animales , Microvasos/metabolismo , Microvasos/fisiopatología , Subunidad alfa del Factor 1 Inducible por Hipoxia/metabolismo , Subunidad alfa del Factor 1 Inducible por Hipoxia/genética , MicrocirculaciónRESUMEN
BACKGROUND: Chagas disease is a systemic illness with widespread microvascular involvement. Experimental and clinical studies suggest that functional and structural microcirculatory abnormalities might be relevant to the disease progression. OBJECTIVES: To show the presence of sublingual microcirculatory alterations in patients with chronic Chagas disease. METHODS: This was a cross-sectional study including adult patients with serologic diagnosis of Chagas disease (n = 41) and control volunteers with negative serology (n = 38), from an endemic rural population. Study participants underwent clinical, electrocardiographic, echocardiographic, and sublingual videomicroscopic assessment. Videos were acquired by a sidestream-dark-field (SDF) imaging device and evaluated by a software-assisted analysis (AVA 3.2 software). FINDINGS: Most of Chagas disease patients were in the indeterminate phase (n = 34) and had lower heart rate and more echocardiographic abnormalities than control group (50 vs. 26%, p = 0.03). They also exhibited higher small microvessels total and perfused vascular density (20.12 ± 2.33 vs. 19.05 ± 2.25 and 20.03 ± 2.28 vs. 19.01 ± 2.25 mm/mm2, p < 0.05 for both). Other microvascular variables did not differ between groups. MAIN CONCLUSIONS: Patients with chronic Chagas disease exhibited increases in sublingual total and perfused microvascular density. Angiogenesis might be the underlying mechanism. The videomicroscopic assessment of mucosal sublingual microcirculation might be an additional tool in the monitoring of Chagas disease.
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Enfermedad de Chagas , Microcirculación , Suelo de la Boca , Población Rural , Humanos , Microcirculación/fisiología , Estudios Transversales , Masculino , Femenino , Enfermedad de Chagas/fisiopatología , Adulto , Persona de Mediana Edad , Suelo de la Boca/irrigación sanguínea , Estudios de Casos y Controles , Enfermedad Crónica , Enfermedades EndémicasRESUMEN
BACKGROUND: Diabetes mellitus (DM) and coronary microvascular dysfunction (CMD) increase the risk of adverse cardiac events in patients with non-ST-segment elevation myocardial infarction (NSTEMI). This study aimed to evaluate the combined risk estimates of DM and CMD, assessed by the angiography-derived index of microcirculatory resistance (angio-IMR), in patients with NSTEMI. METHODS: A total of 2212 patients with NSTEMI who underwent successful percutaneous coronary intervention (PCI) were retrospectively enrolled from three centers. The primary outcome was a composite of cardiac death or readmission for heart failure at a 2-year follow-up. RESULTS: Post-PCI angio-IMR did not significantly differ between the DM group and the non-DM group (20.13 [17.91-22.70] vs. 20.19 [18.14-22.77], P = 0.530). DM patients exhibited a notably higher risk of cardiac death or readmission for heart failure at 2 years compared to non-DM patients (9.5% vs. 5.4%, P < 0.001). NSTEMI patients with both DM and CMD experienced the highest cumulative incidence of cardiac death or readmission for heart failure at 2 years (24.0%, P < 0.001). The combination of DM and CMD in NSTEMI patients were identified as the most powerful independent predictor for cardiac death or readmission for heart failure at 2 years (adjusted HR: 7.894, [95% CI, 4.251-14.659], p < 0.001). CONCLUSIONS: In patients with NSTEMI, the combination of DM and CMD is an independent predictor of cardiac death or readmission for heart failure. Angio-IMR could be used as an additional evaluation tool for the management of NSTEMI patients with DM. TRIAL REGISTRATION: URL: https://www. CLINICALTRIALS: gov ; Unique identifier: NCT05696379.
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Angiografía Coronaria , Circulación Coronaria , Diabetes Mellitus , Microcirculación , Infarto del Miocardio sin Elevación del ST , Readmisión del Paciente , Intervención Coronaria Percutánea , Valor Predictivo de las Pruebas , Resistencia Vascular , Humanos , Masculino , Femenino , Persona de Mediana Edad , Infarto del Miocardio sin Elevación del ST/diagnóstico por imagen , Infarto del Miocardio sin Elevación del ST/mortalidad , Infarto del Miocardio sin Elevación del ST/terapia , Infarto del Miocardio sin Elevación del ST/fisiopatología , Anciano , Medición de Riesgo , Estudios Retrospectivos , Intervención Coronaria Percutánea/efectos adversos , Factores de Riesgo , Factores de Tiempo , Diabetes Mellitus/epidemiología , Diabetes Mellitus/diagnóstico , Resultado del Tratamiento , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/terapia , Insuficiencia Cardíaca/epidemiología , China/epidemiologíaRESUMEN
BACKGROUND: Obesity is associated with resistance to the metabolic (glucose uptake) and vascular (nitric-oxide mediated dilation and microvascular recruitment) actions of insulin. These vascular effects contribute to insulin sensitivity by increasing tissue delivery of glucose. Studies by us and others suggest that sympathetic activation contributes to insulin resistance to glucose uptake. Here we tested the hypothesis that sympathetic activation contributes to impaired insulin-mediated vasodilation in adult subjects with obesity. METHODS AND RESULTS: In a randomized crossover study, we used a euglycemic hyperinsulinemic clamp in 12 subjects with obesity to induce forearm arterial vasodilation (forearm blood flow) and microvascular recruitment (contrast-enhanced ultrasonography) during an intrabrachial infusion of saline (control) or phentolamine (sympathetic blockade). Insulin increased forearm blood flow on both study days (from 2.21±1.22 to 4.89±4.21 mL/100 mL per min, P=0.003 and from 2.42±0.89 to 7.19±3.35 mL/100 mL per min, P=0.002 for the intact and blocked day, respectively). Sympathetic blockade with phentolamine resulted in a significantly greater increase in microvascular flow velocity (∆microvascular flow velocity: 0.23±0.65 versus 2.51±3.01 arbitrary intensity units (AIU/s) for saline and phentolamine respectively, P=0.005), microvascular blood volume (∆microvascular blood volume: 1.69±2.45 versus 3.76±2.93 AIU, respectively, P=0.05), and microvascular blood flow (∆microvascular blood flow: 0.28±0.653 versus 2.51±3.01 AIU2/s, respectively, P=0.0161). To evaluate if this effect was not due to nonspecific vasodilation, we replicated the study in 6 subjects with obesity comparing intrabrachial infusion of phentolamine to sodium nitroprusside. At doses that produced similar increases in forearm blood flow, insulin-induced changes in microvascular flow velocity were greater during phentolamine than sodium nitroprusside (%microvascular flow velocity=58% versus 29%, respectively, P=0.031). CONCLUSIONS: We conclude that sympathetic activation impairs insulin-mediated microvascular recruitment in adult subjects with obesity.