Capillaries play a critical role in cardiovascular function as the point of exchange of nutrients and waste products between tissues and circulation. A common problem for healthy volunteers examined during isolation, and for the patients suffering from heart failure is a quantitative estimation tissue oedema. Until now, objective assessment body fluids retention in tissues did not exist. Optical imaging of living capillaries is a challenging and medically important scientific problem.
Goal of the investigation was to study dynamic of microcriculation parameters including tissue oedema in healthy volunteers during extended isolation and relative hypokinesia as a model of mission to the International Space Station. The other aim was to study dynamic of microcirculation parameters including tissue oedema in patients suffering from heart failure under treatment.
Healthy volunteers and patients. We studied four healthy male subjects at the age of 41, 37, 40, and 48 before the experiment (June 1999), and during the 240-d isolation period starting from July3, 1999. Unique hermetic chambers with artidicial environmental parameters allowed performing this study with maximum similarity to real conditions in the International Space Station (ISS). With the regularity of 3 times a week at the same time, each subject recorded three video episodes with the total length of one-minute using the optical computerized capillaroscope for noninvasive measurement of the capillary diameters sizes, capillary blood velocity as well as the size of the perivascular zone. All this parameters of microcirculation determined during three weeks in 15 patients (10 male, 5 female, aged 62,2±8,8) suffering from heart failure under Furosemid 40 mg 2 times a week, as diuretic.
Results. About 1500 episodes recorded on laser disks and analyzed during this experiment. Every subject had wave-like variations of capillary blood velocity within the minute, week, and month ranges. It was found that the perivascular zone sizes rising during isolation correlate with body mass of subjects and probably depend on retention of body fluids in tissues. Computerized capillaroscopy provides a new opportunity for non-invasive quantitative estimation tissue oedema and suggests for exact management patients suffering from heart failure under diuretic treatment.
An automatic device for high-temporal resolution of the process of red blood sedimentation was designed. The position of the boundary between red blood and plasma may be registered each 30 sec in several pipettes simultaneously with +/- 10 mkm precision. Fractional rates of the boundary movement are deduced with high accuracy. Data are processed by a PC and presented as velocity-time curves and the curves describing time evolution of the boundary position. The results obtained with this equipment demonstrate non- monotonous character of the rate of red blood sedimentation and revealed several peculiarities of macroscopic stages and microkinetic of the process. Changes of biophysical-chemical state of blood related to changes in physiological state of a donor or under the action of different substances may result either in improving, or in worsening of studied parameters of blood sedimentation dynamics. A slight dilution of blood with saline in vitro leads as a rule to decreasing of sedimentation rate and improving of microkinetic parameters of the process of the red blood sedimentation. Adding of highly diluted hydrogen peroxide to blood samples of patients provides for the oxygenation of the system, and result in the improving of sedimentation dynamics: decreasing of average sedimentation rate and prolonging of macrokinetic states. The parameters of this reaction depend upon the metabolic potential of blood, the functional state of all its cellular and plasma elements, and in complex they reflect the physiological state of the individual Any changes in parameters of macro- and microkinetics may reflect the pattern of oxygen release- delivery-consumption in blood. ESR-graphy may give much more information in comparison to the routine ESR-test and allows to consider blood sedimentation not from the viewpoint of separate physico-chemical parameters, but treating it as a metabolically active system.
Goals of the investigation were to analyze the spectrum of microcirculation parameters and collection of baseline data healthy subjects during extended isolation and relative hypokinesia as a model of mission to the International space station. There were investigated four healthy volunteers at the age of 37, 40, 41 and 48 during the baseline 240-d isolation period starting from July 3, 1999. With the regularity of 3 times a week each subject made records at the same time between 1 and 2 pm. Optical computerized capillaroscope for noninvasive measurement of the capillary diameters, blood flow velocity as well as the size of the perivascular zone and the number of the blood aggregates was used. About 1500 episodes were recorded on laser disks and analyzed. Parameters of microcirculation were compared with other physiological parameters monitored in the experiment. All subjects had wave-like variations in the microcirculation parameters within the minute, week, and month ranges. Mean blood flow velocity in the baseline period was lower than in the period of isolation. Results of the daily body mass measurement were found to correlate with the perivascular zone size, that could be explained as retention of body fluids in tissues. Computerized capillaroscopy is easy to perform, noninvasive, highly sensitive and informative. It enables analysis of the character of rhythmic processes, adaptability of organism to long-term experiments and, therefore, can be proposed for use in extended space missions.
An automatic device for high-temporal resolution of the process of erythrocytes sedimentation in blood was designed. The position of the boundary between red blood and plasma is registered each 30 sec in several pipettes simultaneously with +/- 10 mkm precision. Data are processed by a PC and presented as velocity-time curves (ESR-grams) and the curves describing time evolution of the boundary position. ESR-grams demonstrate non-monotonous character of erythrocytes sedimentation in blood. Blood of particular donor being in a stable physiological state taken on different days is characterized by similar ESR-grams. Pathological deviations from a normal physiological state are reflected in the shortening of duration of each process stage and increasing of average sedimentation rate. Intravenous infusion of some medical preparations may lead either to improving (prolonging of macrokinetic stages, decreasing of sedimentation rate), or to worsening of studied parameters depending on an individual. The low extent of blood dilution with saline in vitro lead as a rule to decreasing of sedimentation rate and improving of microkinetic parameters of the process. Adding of highly diluted hydrogen peroxide to blood samples of patients resulted in the improving of sedimentation kinetics. ESR-graphy may widen opportunities of practical medicine in diagnostics, prognostics and drug therapy.
There are correspondences between the number of lipid inclusions as detected with computerized capillaroscopy and the lipid parameters as determined using a routing blood test. The results have been obtained in the course of a study of two healthy volunteer groups (n equals 24) and three groups of patients: those suffering from ischemic heart disease with myocardial infarction in their past and heart failure (n equals 13), complicated insulin-independent diabetics (n equals 58), and patients with uncomplicated insulin-independent diabetes (n equals 27). Neither of the healthy volunteers had small lipid inclusions in the blood on an empty stomach. Moreover, lipid exchange parameters of every healthy volunteer as measured in a routine test were within the acceptable limits, while in patients with diabetes as well as in patients with coronary artery disease complicated by heart failure who had high cholesterol level, an elevated number of lipid inclusions was observed.
The interest to the non-invasive study of capillary blood flow in cardiological and diabetes patients is raised mainly by the explicit microcirculation disorder in such pathological patients. The interest to quantitative microcirculation parameters in the recent years has promoted the development of new technical facilities. In 1997, the Centre for Analysis of Substances in collaboration with a design team of the Space Device-Making Institute developed the computerized capillaroscope. This device consists of a high-resolution microscope with a magnification of up to 1000 and a color CCD camera that sends the image to a PC- based video processing station. An important merit of the instrument is the possibility of conducting non-invasive investigations, i.e. without damage to the skin or vessels and not causing any pain or unpleasant sensations. The sophisticated software provides for the possibility of accurately measuring capillary blood velocity as well as the size of the perivascular zone.
The aim of this work was to find out to which degree Tanakan affects the microcirculation parameters and the malonic dialdehyde level as a parameter of intense lipid peroxidation in insulin-independent diabetes patients with different disease durations. We used computerized capillaroscope GY-0.04 designed by the Centre for Analysis of Substances, Russia for the non-invasive measurement of capillary blood velocity as well as the size of the perivascular zone and density of blood aggregates and lipid inclusions. The microcirculation parameters were studied in two groups of insulin-independent diabetes patients. The basic group included 58 patients (61±9,0 years, disease duration 14,7±7,8 years). The patients had late diabetic complications as retinopathy and nephrophathy, neuropathy, confirmed by clinical and tool investigation. In this group we also studied the level of serum malonic dialdehyde, as a parameter of intense lipid peroxidation. The reference group included 31 patients (57±1,3 years, disease duration 3,6±0,6 years) with minimum diabetic complication. We show that Tanakan in daily dosage 120 mg for 2 months reduces the malonic dialdehyde level in the blood serum and the erythrocyte membranes of type II diabetes patients and improves the microcirculation parameters. There are correspondences between the density of lipid inclusions as determined with computerized capillaroscopy and the lipid exchange parameters as determined using a routing blood test. Thus, noninvasive blood lipid quantification is feasible and reliable.
The sedimentation properties of blood of 13 ischemic heart disease patients and 2 healthy volunteers have been analyzed using a special computerized optical device for high temporal resolution tracing of red blood/plasma boundary movement rate (ESR-graphy). The kinetic curves of red blood sedimentation are substantially nonmonotonic and exhibit multiple accelerations, decelerations and even backwards movement of the red blood/plasma boundary. The intensity of blood sedimentation rate oscillations is significantly higher in the blood of patients and voluteers on days of enhanced geomagnetic activity than on quiet days. In healthy donors, blood oscillations were also observed on active geomagnetic days, however, their intensity was lower, the sedimentation rate started to oscillate after a longer time upon pipette installation, and the oscillation frequency was lower than in the patients' blood. Thus, blood is highly responsive to changes in geomagnetic field activity. Possibly oscillatory behavior mechanism of blood sedimentation rate and the diagnostic and prognostic merits of the ESR graphs are discussed.
To assess the microcirculation parameters of diabetes sufferers we used the method of computerized capillaroscopy that allows one to visualize non-invasively and measure at a high accuracy the size of the perivascular zone, the blood flow velocity in the capillaries and the presence and duration of stasis. The sludge phenomenon and lipid inclusions also we studied non-invasively.
Measurement of erythrocyte sedimentation rate (ESR) is one of the most widely used diagnosis techniques. It is believed that high ESR testifies to inflammatory conditions or decay in body tissues. However, standard ESR test data do not allow definitive determination of such conditions. ESR is currently determined manually. The ambiguity of standard ESR tests that have found general use in medicine raises the necessity of increasing their information merit without serious modification to the test method. The present device and method allow completely automatic hourly ESR measurement and determine several parameters of blood sedimentation dynamics (BSD). Analysis of BSD introduces a number of parameters that allow pathology to be detected in case of normal standard ESR test data and allow more efficient planning of medical treatment than is available with hourly ESR data. The results were used to elaborate and produce a pilot device for automatic clinical ESR testing to obtain BSD data. The device and BSD method are being clinically tested at the Intensive Care Unit of the Moscow Central Railway Hospital. All the technical solutions have been patented. BSD can be applied as a new powerful diagnostic tool, once large statistics has been obtained.
The blood flow in capillary vessels plays an important role in sustaining the vital activity of the human organism. The computerized capillaroscope is used for the investigations of nailfold (eponychium) capillary blood flow. An important advantage of the instrument is the possibility of performing non-invasive investigations, i.e., without damage to skin or vessels and causing no pain or unpleasant sensations. The high-class equipment and software allow direct observation of capillary blood flow dynamics on a computer screen at a 700 - 1300 times magnification. For the first time in the clinical practice, it has become possible to precisely measure the speed of capillary blood flow, as well as the frequency of aggregate formation (glued together in clots of blood particles). In addition, provision is made for automatic measurement of capillary size and wall thickness and automatic recording of blood aggregate images for further visual study, documentation, and electronic database management.
Detection of endogenous carbon monoxide content in breath with tunable diode lasers (TDL) was proposed for noninvasive monitoring of rapid blood pH variation. Applied approach is based on high sensitivity of the haemoglobin and myoglobin affinity for CO to blood pH value and an ability to detect rapidly small variations of CO content in expired air. Breath CO absorption in 4.7 micrometers spectral region was carefully measured using PbSSe tunable diode laser that can provide 1 ppb CO concentration sensitivity and 10 s time constant. Applied TDL gas analyzer was used to monitor expired air of studied persons in physiological tests including hyperventilation and physical load. Simultaneous blood tests were conducted to demonstrate correlation between blood and breath chemical parameters.
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