Observational study of the microcirculation in patients with liver cirrhosis.

BACKGROUND AND AIM: Liver cirrhosis is associated with widespread microcirculatory dysfunction and hemodynamic derangement, which may play a role in the pathogenesis of multiple organ failure. Little is known, however, about the progression of microvascular alterations as the severity of liver disease worsens. Therefore, our aim is to quantify the peripheral systemic microcirculatory changes associated with increasing severity of liver cirrhosis. METHODS: Forty patients with liver cirrhosis were studied and divided into groups based on Child-Pugh classes A (n = 9), B (n = 18), and C (n = 13) for comparison. Incident dark field imaging was used to evaluate the sublingual microcirculation and near-infrared spectroscopy at the thenar eminence to assess microvascular reactivity and function. RESULTS: There was no difference in microcirculatory flow index (P = 0.655), heterogeneity index (P = 0.702), or vessel density (P = 0.923) between the different Child-Pugh groups. Microvascular reactivity did not change as the severity of liver disease worsened. CONCLUSIONS: This study showed no association between peripheral systemic microcirculatory alterations and the severity of liver disease. Further research with larger study cohorts are needed to clarify the relationship between microcirculatory abnormalities and disease progression and to establish if the peripheral microcirculation is affected by the pathophysiology of worsening cirrhosis.

Sustained vasomotor control of skin microcirculation in Sherpas versus altitude-naive lowlanders: Experimental evidence from Xtreme Everest 2.

NEW FINDINGS: What is the central question of this study? Do Sherpa highlanders, when exposed to graded hypobaric hypoxia, exhibit enhanced vasomotor and neurovascular control to maintain microcirculatory flux, and thus tissue oxygenation, when compared with altitude-naive lowlanders? What is the main finding and its importance? Sherpas, when exposed to hypobaric hypoxia at high altitude, demonstrated superior preservation of their peripheral microcirculatory perfusion, a greater oxygen unloading rate and sustained microvascular reactivity with enhanced vasomotion, when compared with altitude-naive lowlanders. These differences have not been reported previously and may improve our understanding of the multifactorial responses to sustained environmental hypoxia. ABSTRACT: Enhanced oxygen delivery, consequent to an increased microvascular perfusion, has been postulated to play a key role in the physiological adaptation of Tibetan highlanders to the hypobaric hypoxia encountered at high altitude. We tested the hypothesis that Sherpas, when exposed to graded hypobaric hypoxia, demonstrate enhanced vasomotor and neurovascular control to maintain microcirculatory flux, and thus tissue oxygenation, when compared with altitude-naive lowlanders. Eighty-three lowlanders [39 men and 44 women, 38.8 (13.1) years old; mean (SD)] and 61 Sherpas [28 men and 33 women, 27.9 (6.9) years old] were studied on ascent to Everest Base Camp over 11 days. Skin blood flux and tissue oxygen saturation were measured simultaneously using combined laser Doppler fluximetry and white light spectroscopy at baseline, 3500 and 5300 m. In both cohorts, ascent resulted in a decline in the sympathetically mediated microvascular constrictor response (P < 0.001), which was more marked in lowlanders than in Sherpas (P < 0.001). The microvascular dilator response evaluated by postocclusive reactive hyperaemia was significantly greater in Sherpas than in lowlanders at all sites (P < 0.002). Spectral analysis of the blood flux signals revealed enhanced myogenic (vasomotion) activity in Sherpas, which was unaffected by ascent to 5300 m. Although skin tissue oxygenation was lower in Sherpas than in lowlanders, the oxygen unloading rate was faster, and deoxyhaemoglobin levels higher, at all altitudes. Together, these data suggest that Sherpas, when exposed to hypobaric hypoxia, demonstrated superior preservation of peripheral microcirculatory perfusion compared with altitude-naive lowlanders. The physiological differences in local microvasculature vasomotor and neurovascular control may play a key role in Sherpa adaptation to high-altitude hypobaric hypoxia by sustaining local perfusion and tissue oxygenation.

Getting the most from venous occlusion plethysmography: proposed methods for the analysis of data with a rest/exercise protocol.

BACKGROUND: Venous occlusion plethysmography is a simple yet powerful technique for the non-invasive measurement of blood flow. It has been used extensively in both the experimental and clinical settings. The underlying rationale is that when venous outflow from an extremity is occluded, any immediate increase in volume of this compartment must originate from the on-going arterial inflow. Mercury-in-silastic strain gauges are typically used to measure these volume changes, the rates of which are directly proportional to blood flow. RESULTS: When using a simple rest/exercise protocol to provide a local or systemic metabolic stimulus to increase blood flow, current methods for analysing the data obtained are often rather simplistic, solely considering the mean increment in blood flow induced by exercise. Previous methodological considerations have focused mainly on issues of reproducibility and accuracy (for instance, by comparing unilateral and/or bilateral measurements) but rarely on what the recorded traces may actually mean. CONCLUSIONS: In this methodological manuscript, we suggest a more detailed approach to processing venous occlusion plethysmography data, one which could provide additional physiological information. Six parameters are described, all of which are easily derived from a simple and reproducible experimental rest/exercise venous occlusion plethysmography protocol.

Can primary care data be used to monitor regional smoking prevalence? An analysis of The Health Improvement Network primary care data.

BACKGROUND: Accurate and timely regional data on smoking trends allow tobacco control interventions to be targeted at the areas most in need and facilitate the evaluation of such interventions. Electronic primary care databases have the potential to provide a valuable source of such data due to their size, continuity and the availability of socio-demographic data. UK electronic primary care data on smoking prevalence from The Health Improvement Network (THIN) have previously been validated at the national level, but may be less representative at the regional level due to reduced sample sizes. We investigated whether this database provides valid regional data and whether it can be used to compare smoking prevalence in different UK regions. METHODS: Annual estimates of smoking prevalence by government office region (GOR) from THIN were compared with estimates of smoking prevalence from the General Lifestyle Survey (GLF) from 2000 to 2008. RESULTS: For all regions, THIN prevalence data were generally found to be highly comparable with GLF data from 2006 onwards. CONCLUSIONS: THIN primary care data could be used to monitor regional smoking prevalence and highlight regional differences in smoking in the UK.