Microvascular changes on nailfold capillaroscopy in acute stage of Kawasaki disease: a new diagnostic paradigm for an enigmatic condition.

OBJECTIVES: Kawasaki disease (KD) is a medium vessel vasculitis with a predilection to involve coronary arteries. However, there is a paucity of literature on microvascular changes in patients with KD. METHODS: Children diagnosed with KD based on American Heart Association guidelines 2017 were enrolled prospectively. Demographic details and echocardiographic changes in coronaries were recorded. Nailfold capillaries were assessed using Optilia Video capillaroscopy and data were analysed using Optilia Optiflix Capillaroscopy software at acute (prior to IVIG administration) and subacute/convalescent phase. RESULTS: We enrolled 32 children with KD (17 boys) with a median age of 3 years. Nailfold capillaroscopy (NFC) was performed in 32 patients in the acute phase (compared with 32 controls) and in 17 during the subacute/convalescent phase at a median follow-up of 15 (15-90) days after IVIG treatment. The following findings were seen in NFC in the acute phase of KD: reduced capillary density (n = 12, 38.6%), dilated capillaries (n = 3, 9.3%), ramifications (n = 3, 9.3%) and capillary haemorrhages (n = 2, 6.2%). Capillary density was reduced significantly in the acute phase of KD (38.6%) as compared with the subacute/convalescent phase (25.4%) (P-value <0.001) and controls (0%) (P-value = 0.03). We observed no correlation between coronary artery involvement and mean capillary density (P = 0.870). CONCLUSION: Results show that patients with KD have significant nailfold capillary changes in the acute phase. These findings may provide a new diagnostic paradigm for KD and a window to predict coronary artery abnormalities.

Oral L-Arginine (5 g/day) for 14 Days Improves Microcirculatory Function in Healthy Young Women and Healthy and Type 2 Diabetes Mellitus Elderly Women.

OBJECTIVE: The aim of this study was to investigate the effect of oral supplementation with L-arginine on serum biochemical profile, blood pressure, microcirculation, and vasoreactivity/endothelial function in young controls, and elderly women with and without type 2 diabetes mellitus (T2DM). METHODS: Healthy young (n = 25), healthy elderly (n = 25), and elderly women with type 2 diabetes mellitus (T2DME, n = 23, glycated Hb ≥6.4% and mean of 7.7 years for duration of the disease), aged 18-30 and older than 65 years, respectively, were included in the study. All patients underwent biochemical analysis (fasting glycemia and lipidogram), arterial blood pressure, nailfold videocapillaroscopy (capillary diameters, functional capillary density [FCD], peak red blood cell velocity [RBCVmax] after 1 min ischemia, time to reach peak RBCV [TRBCVmax]), and venous occlusion plethysmography (vasoreactivity), before and after 14 days of oral supplementation with L-arginine (5 g/day). RESULTS: L-Arginine did not change fasting glycemia and lipidogram, but it decreased systolic, diastolic, and mean arterial pressure in elderly women, increased RBCVmax in all groups, and did not decrease TRBCVmax in T2DME. Capillary diameters and FCD remained unchanged in all groups. L-Arginine improved vasoreactivity during reactive hyperemia and after sublingual nitroglycerin (0.4 mg) in all groups. CONCLUSION: L-Arginine supplementation (5g/day during 14 days) was able to improve vascular/microvascular health in the elderly women with or without T2DM.

A Novel Whole Spectrum-Based Non-Invasive Screening Device for Neonatal Hyperbilirubinemia.

OBJECTIVE: Careful screening of bilirubin level in newborns is mandatory as per American Academy of Pediatrics (2004), to reduce incidents of kernicterus and acute bilirubin encephalopathy. Although, invasive capillary collection of blood and subsequent biochemical test is considered a gold standard for jaundice detection in neonates, transcutaneous bilirubin measurement using various non-invasive instruments is also used sporadically across the globe. The major aim of this study was to develop a non-invasive spectrometry-based technique for measurement of neonatal bilirubin level as an alternative of total serum bilirubin (TSB) test without limitations of other available bilirubinometers. METHODS: The instrument comprises of a light source and a spectroscopic detector. A light beam from source incident on the neonatal nail plate through optical fibers. The retro reflected light is acquired using the detector. An indigenously developed software is used to acquire and analyze the optical signal and to calculate the bilirubin value. The instrument was calibrated and validated in reference to TSB on 1033 subjects. MAJOR RESULTS: The result (r = 0.95 and P < 0.001) indicates a strong correlation between the bilirubin value obtained from our method and TSB. Time variant analysis of the subjects undergoing phototherapy provided a good correlation (r = 0.98). The repeatability test result shows the mean coefficient of variation is less than 5.0%. CONCLUSIONS: The indigenously developed non-invasive technique successfully detects the bilirubin level in newborns under various physiological conditions with high accuracy and precision.

[Impacts of mild moxibustion on immune indices and nailfold microcirculation in the subhealthy group].

OBJECTIVE: To compare the difference in the clinical therapeutic effects of the regulation of subhealthy condition between the mild moxibustion on alternate days and Chinese herbal medicine. METHODS: Seventy-two participants of subhealthy condition were assigned into a mild moxibustion group (36 cases) and a medication group (36 cases) according to random number table. In the mild moxibustion group, the intervention of mild moxibustion with moxa stick was applied to Guanyuan (CV 4), Zusanli (ST 36) and Sanyinjiao (SP 6), once every other day. In the medication group, yupingfeng granules were prescribed for oral administration, three times a day. The treatment was continued for 2 months. Before and after treatment, the levels of IgA, IgM and IgG, SOD (superoxide dismutase), the total score of fatigue scale 14 (FS-14) and the score of nailfold microcirculation were observed separately. RESULTS: Compared with the results before treatment, the immune indices, the total score of FS-14 and the scores of nailfold microcirculation were all improved after treatment in the two groups, indicating the significant differences (P<0.05, P<0.01). In comparison between the two groups after treatment, the levels of immune globulin, e.g. IgM, IgG and SOD in the mild moxibustion group were higher in tendency than those in the medication group, but without significant differences (all P>0.05). The total score of FS-14 after treatment in the mild moxibustion group was lower than that in the medication group (P<0.05). After treatment, in the mild moxibustion group, for the nailfold microcirculation, the flow state score, the periloop score and the total score were all reduced more apparently as compared with those in the medication group (P<0.01, P<0.05). CONCLUSIONS: Mild moxibustion with moxa stick on alternate days apparently relieves fatigue state, immune dysfunction and microcirculatory impairment in the subhealthy group. The results are apparently superior to the treatment with yupingfeng granules.

Yerba mate (Ilex paraguariensis) improves microcirculation of volunteers with high blood viscosity: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Elevated blood viscosity is a risk factor for atherosclerosis, thrombosis and other cardiovascular events. Our previous studies have suggested that consumption of Yerba mate tea (Ilex paraguariensis) has strong antioxidant and lipid-lowering properties in animals. The in vivo effects of Yerba mate on blood viscosity in humans, however, have not been studied. OBJECTIVE: This study aims to investigate the effect of Yerba mate tea on the reduction of blood viscosity and the improvement of microcirculatory parameters commonly regarded as risk factors for serious cardio and cerebrovascular disorders. METHODS: 142 subjects with high blood viscosity were recruited in this randomized, double-blind, placebo-controlled study. Yerba mate tea or placebo (5 g/day) was administered to different groups for 6 weeks. After treatment, results of hemorheological indexes, nailfold microcirculation, 6-keto-PGF1α and TXB2 and lipid profiles of subjects in the Yerba mate tea group were compared with those in the placebo-receiving group. RESULTS: Parameters of blood viscosity and microcirculation were improved in the subjects from the Yerba mate tea group but not in placebo-receiving patients. After treatment, whole blood viscosity, plasma viscosity and the Equation K value of erythrocyte sedimentation rate (ESRK) decreased significantly in the Yerba mate group. Meanwhile, shape, flow state and nailfold microcirculation appeared positively changed. Specifically, blood flow speeds accelerated gradually and nailfold weighted integral values decreased significantly. Moreover, the vasodilator 6-keto PGF1α increased while the thromboxane TXB2 decreased in serum samples of subjects in the Yerba mate-receiving group. Overall, Yerba mate tea-receiving subjects saw nearly all measured values improve to levels comparable to those characteristic of patients with normal microcirculation. CONCLUSIONS: These results indicate the therapeutic capacity of Yerba mate tea in the treatment of high blood viscosity. Here, Yerba mate tea played a role in the regulation of various indexes of hemorheology, nailfold microcirculation, and the platelet aggregating factors 6-keto-PGF1a and TXB2. The regulation of these might be correlated with reduced blood viscosity and accelerating blood flow. Thus, Yerba mate tea may reduce some key risk-factors of cardiovascular disease. Daily consumption of Yerba mate tea may be a better-tolerated option for individuals with high blood viscosity and microcirculatory disturbance and as such, a novel preventative strategy for patients at-risk for vascular disease.

Coexistence of osteopoikilosis with seronegative spondyloarthritis and Raynaud's phenomenon: first case report with evaluation of the nailfold capillary bed and literature review.

Osteopoikilosis (OPK) is a rare autosomal dominant bone disorder characterized by numerous hyperostotic areas that tend to localize in periarticular osseous regions. It is usually asymptomatic and is often diagnosed incidentally during X-rays. OPK may be an isolated finding or associated with other pathologies, e.g. skin manifestations, rheumatic and/or skeletal disorders. We report a literature review and, for the first time, the coexistence of OPK with seronegative spondyloarthritis and Raynaud's phenomenon in a 48-year old female. To the best of our knowledge, this is the first case of OPK studied by videocapillaroscopy, demonstrating the absence of specific microvascular abnormalities of nailfold capillaries.

Effects of hot and cold foods on signals of heart rate variability and nail fold microcirculation of healthy young humans: a pilot study.

In traditional Chinese medicine, hot- and cold-attribute of food ingredients are a major part of dietary therapy. The aim of this study was to establish a suitable scientific methodology to define the attributes of food ingredients by investigating the relationship between food attributes and the physiological signals produced in healthy young subjects with different constitutions. Thirty subjects were grouped into hot and cold constitutions by Chinese medical doctors. Every subject took water, aged ginger tea and coconut water, which are well recognized as having neutral-, hot- and cold-attribute, respectively, on different visits. The different physiological signals induced by the samples were observed using skin and axillary temperature sensors, a heart rate variability analyzer and a laser Doppler anemometer. We found that the capillary red blood cell (RBC) velocity in nail fold microcirculation (NFM) of the subjects with hot constitution accelerated significantly after taking the hot-attribute aged ginger tea, which might be the result of elevated vagal activity leading to arteriole dilation in these subjects. In contrast, in subjects with cold constitution, capillary RBC velocity decelerated significantly and skin temperature decreased markedly after taking the cold-attribute coconut water, which might have been induced by sympathetic nerve activation causing the arteriole to be constricted. Accordingly, the use of capillary RBC velocity of NFM measured by laser Doppler anemometer may be a promising way to classify attributes of food ingredients commonly used in Chinese medicine dietary therapy in accordance with different personal constitutions.

[Effect on blood pressure and microcirculation of nail fold in primary hypertension patients treated with acupuncture according to syndrome differentiation].

OBJECTIVE: To verify the efficacy of primary hypertension treated with acupuncture at acupoints selected according to syndrome differentiation and probe into the mechanism of acupuncture for primary hypertension. METHODS: One hundred and thirty-five cases of primary hypertension were randomized into an observation group (108 cases) and a control group (27 cases). In either group, Fengchi (GB 20), Quchi (LI 11), Zusanli (ST 36) and Sanyinjiao (SP 6) were selected conventionally. In observation group, on the basis of the acupoints selected above, the supplementary points were selected according to syndrome differentiation in Chinese medicine and the control group was selected main points only, once per day. After 15 days acupuncture, the efficacy and changes in microcirculation of nail fold were observed. RESULTS: The remarkable effective rate and the total effective rate were 29.6% (32/108) and 84.2% (91/108) in observation group respectively, which were superior to 18. 5% (5/27) and 70.4% (19/27) as compared with control group separately (both P < 0.05). After treatment, the microcirculation of nail fold was all improved in two groups, of which blood flow state integral, peripheral capillary loop state integral and the total integral were all improved obviously (all P < 0.05). The improvements in observation group were much more significant than those in control group (all P < 0.05). CONCLUSION: Acupuncture is effective significantly on primary hypertension and the point selection according to syndrome differentiation can improve the efficacy, which is probably relevant with the reduction in the peripheral vascular resistance due to the improvements of microcirculatory state in mechanism.

Peripheral blood perfusion correlates with microvascular abnormalities in systemic sclerosis: a laser-Doppler and nailfold videocapillaroscopy study.

OBJECTIVE: To investigate possible correlations between fingertip blood perfusion (FBP) status, assessed by laser Doppler flowmetry (LDF), and morphological microvascular abnormalities, detected by nailfold videocapillaroscopy (NVC), in patients with systemic sclerosis (SSc). The effects on FBP of intravenous (IV) treatment with the prostacyclin analog iloprost were also investigated. METHODS: Thirty-four consecutive patients with SSc and 16 healthy subjects were evaluated. LDF was performed by analyzing blood perfusion at the fingertips in both hands. Patients with SSc were distributed into the appropriate NVC pattern of microangiopathy (early, active, and late). Iloprost was administered to inpatients with SSc by 24-hour IV infusion for 7 consecutive days (4 microg/h). RESULTS: FBP was significantly lower in patients with SSc (p < 0.05) compared to controls. Heating of the LDF probe at 36 degrees C induced a significant increase of FBP in all subjects (p < 0.001), but the slope of variation was significantly lower in patients with SSc compared to controls (p < 0.05). Patients with SSc showing the late NVC pattern of microangiopathy had significantly lower FBP than patients with the active and early NVC patterns (p < 0.05). A negative correlation was observed between FBP and NVC rating of the microvascular damage (p < 0.05). After iloprost treatment, a significant increase of FBP was observed in patients with SSc (p < 0.05). CONCLUSION: Patients with SSc show a decreased FBP partially reversible by local skin heating. The FBP correlated negatively with the extent of nailfold microvascular damage, and IV iloprost treatment increased the FBP.

Time course of changes in nail fold microcirculation induced by acupuncture stimulation at the Waiguan acupoints.

Acupuncture has been used widely to treat disease; however, the time course for acupuncture to have an effect remains unclear. Therefore, the aim of the present study was to investigate the time course of changes in nail fold microcirculation (NFM) induced by acupuncture stimulation (AS) at the right and left Waiguan acupoints (WAs). A total of 38 healthy female volunteers, age range from 21 to 33, were studied. We recorded NFM of the right middle finger before, and 5 min, 10 min, 15 min and 20 min after initiating AS; NFM was also recorded 5 min and 10 min after secessions of AS. Nitric oxide (NO) and endothelin-1 levels were measured from the left cubital vein, before AS and 10 min after stopping AS. The results indicated that capillary density of NFM increased 5 min after AS at the right Waiguan acupoint (WA); however, similar changes were not noted at the left WA. The capillary density decreased beginning 15 min after AS at the right and left WA. Capillary red blood cell velocity increased 5 min and 10 min after AS at the right and left WAs, but decreased 5 min and 10 min after stopping AS at the left WA. NO and endothein-1 levels were similar before AS and 10 min after stopping AS. Therefore, we suggest that a segmental effect of the spinal nerve contributes to the increasing capillary density of NFM induced by AS. The effect of acupuncture on NFM lasts about 10-15 min. The changes of balance between the sympathetic nerve activities and parasympathetic nerve activities may be induced by AS.

Effects of acupuncture on hemorheology, blood lipid content and nail fold microcirculation in multiple infarct dementia patients.

Forty-six cases of multiple infarct dementia (MID) in the treatment group were treated by acupuncture with the principle of supplementing the inferiority to clear the superiority and regulating spirit to invigorate intelligence. Changes of the blood lipid content, hemorheological indexes and nail fold microcirculation in the treatment group were compared with those in the randomly assigned control group. The data collected showed that the changes in the treatment group were remarkable, and part of them were superior to their counterparts obtained in the control group by statistical analysis. It is indicated that acupuncture can effectively regulate the affected hemodynamic state in MID.

[Clinical observation on treatment of vitiligo with xiaobai mixture].

OBJECTIVE: To observe the therapeutic effect of Xiaobai Mixture (XBM) in treating vitiligo. METHODS: Seventy-four patients with vitiligo were randomly divided into the XBM group treated with XBM and the control group treated with 8-MOP. The therapeutic effect, nail-fold microcirculation, plasma endothelin-1, serum immunoglobulin were observed and compared. RESULTS: The therapeutic effect of XBM was better than that of 8-MOP (P < 0.05). XBM could also obviously improve the nail-fold microcirculation, elevate the plasma endothelin-1 level and lower the serum IgG (P < 0.01). CONCLUSION: XBM has superiority in treating vitiligo.

The effects of Chinese medicines on micro-circulation of nail folds and blood flow velocity of limbs in the patients with arteriosclerotic obliteration.

The effects of Chinese medicines on micro-circulation and blood flow velocity in arteries of the lower limbs were observed in 33 patients with arteriosclerotic obliteration (ASO). The results showed that the integral values of micro-circulation after treatment were obviously higher than those before treatment (P < 0.05 or P < 0.01). Blood flow velocity in arteries of the lower limbs determined with the color Doppler ultrasound detecting method after treatment were also obviously higher than those before treatment (P < 0.05 or P < 0.01). In this series of 33 ASO patients, the markedly effective rate was 36.36%, and the total effective rate was 63.64%. The observation indicates that the recipe prescribed according to the principle of supplementing qi and activating blood circulation can effectively improve micro-circulation in ASO patients, and accelerate blood flow in arteries of the lower limbs.

[Acrocyanosis: changing concepts and nosological limitations]. / Acrocyanose, évolution des concepts et limites nosologiques.

Acrocyanosis is undoubtedly the most commonplace acrosyndrome, both in terms of pathogenesis and prognosis. Patients experience functional impairment and an esthetic prejudice that must not be neglected. Adopting the nosological classifications described for Raynaud's syndrome, primary acrocyanosis must be distinguished from exceptional secondary phenomena that have a radically different clinical course. Primary acrocyanosis is generally observed in a young woman who appears thin or has recently lost weight. No paroxysmal episode (syncope, cyanosis, suspicious event involving the fingers) is found. The physical examination is negative and no complementary explorations are needed. Current pathophysiological hypotheses remain insufficient but suggest that vasospasticity rather than hemorheology is involved. The hypothesis that a thermoregulation disorder could be associated with weight loss deserves further study. Symptomatic care relies on dietary and hygiene counseling, emphasizing the importance of warm clothing. The psychological element must also be considered even in the most common forms.

TCM stage differentiation treatment of diabetic gangrene--an observation on microcirculatory changes.

Microcirculatory changes and therapeutic effects in 39 non-insulin dependent diabetes mellitus (NIDDM) cases were evaluated. Under the same basic treatment in both groups, the treatment group (21 cases) was treated with TCM drugs according to its stages and compared with the control group (18 cases, treated with 654-2). The results showed that the microcirculatory cumulative scores were significantly decreased in both groups (P < 0.05), but the decrease in the treatment group was more marked (P < 0.05). In the treatment group, 15 cases were cured, 3 markedly effective, 2 effective and 1 ineffective; while in the control group, 13 cases were cured, 1 markedly effective and 4 ineffective. Statistically, there is no significant difference between the 2 groups (P > 0.05) in therapeutic effects.

[A treatment combined Chinese with Western medicine for microcirculation diseases in tongue].

OBJECTIVE: Glossodynia is a common oral disease. The purpose of the investigation is to analyse the mechanism of microcirculation disorder in glossodynia, and find a new effective treatment. METHODS: 18 cases with microcirculation disorder in tongue were studied by histopathology, hemorrheology and nail microcirculation, treated by intravenous injection of angelica for promoting blood circulation and removing blood stasis. RESULTS: Hyper-viscosity of blood was found in this group of patients. Abnormal micro-vessels were observed in microcirculation examination, though vasculitis wasn't detected in tongue tissue. CONCLUSION: Microcirculation disorder may play an important role in the cause of glossodynia. For elderly patients, cardiovascular and mental diseases should be considered. According to the theory of the blood stasis in chinese medicine, these studies show that a treatment combined chinese with western medicine can be applied for the patients, and injection of angelica can improve microcirculation.