Impaired Microvascular Reactivity in Patients with Chronic Kidney Disease Submitted to Kidney Transplantation: A Prospective Observational Study.

INTRODUCTION: The effect of kidney transplantation on endothelial dysfunction and autonomic dysfunction in uremia remains controversial, and few studies have evaluated this question. Endothelial dysfunction and autonomic dysfunction, both, be assessed noninvasively using laser Doppler flowmetry (LDF). This study evaluated cutaneous microvascular blood flow and reactivity using LDF in patients undergoing kidney transplantation. METHODS: This prospective longitudinal cohort study involved 40 patients with chronic kidney disease (CKD) undergoing kidney transplantation, compared with 40 patients without kidney disease. Using LDF, post-occlusive reactive hyperemia (PORH) (resting flow [RF], peak flow, ratio between peak, and RF, hyperemic area, PORH index), and sympathetic constrictor response to inspiratory breath-hold (mean minimum inspiratory values) were evaluated. RESULTS: RF and sympathetic constrictor response to inspiratory breath-hold (mean minimum inspiratory values), were lower in the CKD group at 1 week and at 3 months after transplantation (p < 0.005). Mean minimum inspiratory values increase in the CKD group, 3 months after transplantation. CONCLUSION: Compared with controls with no CKD, in CKD patients undergoing kidney transplantation, microcirculation by LDF shows improvement after 3 months.

Case-control study analyzing the relationship between oral microcirculation and oral mucositis and pain in patients under antineoplastic therapy.

The study aimed to evaluate the relation between microcirculation of the genian region using laser Doppler flowmetry and oral mucositis (OM) and pain in individuals undergoing antineoplastic therapy. A case-control clinical study was conducted with the participants divided into three groups: chemotherapy (CTG), radiation therapy and chemotherapy group (RCTG), and control group (CG). Pain was assessed by visual analog scale; OM was classified by oral mucositis assessment and WHO scales. The blood flow was assessed by laser Doppler flowmetry. Kruskal-Wallis statistical test, Friedman test, and Spearman test were used for statistical analysis of this study. CTG (7 individuals/25.93%) showed the worst manifestations of OM between 2nd and 4th evaluations (OM-WHO: T2, p = 0.006; T3, p = 0.006; T4, p = 0.003; OM-OMAS: T2, p = 0.004; T3, p = 0.000; T4, p = 0.011), and increased blood flow over time, with the exception of the 3rd evaluation (p = 0.138). The RCTG (9 individuals/33.33%) showed the worst manifestations of oral mucositis on the 4th week (OM-WHO and OM-OMAS: p = 0.000) with a decrease in blood flow (p = 0.068). The decreased blood flow is associated with greater severity of oral mucositis and greater pain intensity.

Effects of exergaming on the microcirculation of adolescents with overweight or obesity-a clinical trial efficacy.

To assess the effect of exergaming on the microcirculation function of adolescents with overweight or obesity, this non-randomized clinical trial efficacy was conducted with 61 adolescents aged between 10 and 16 years. The intervention group (n = 31) performed exergaming three times per week for 8 weeks. Both groups received guidelines for a healthy diet and staying physically active. Microcirculation was assessed using a laser Doppler flowmetry (LDF) at baseline and after intervention. Primary outcomes derived from LDF assessment included resting flow, maximum flow, maximum/resting flow ratio, area under hyperemia, and post-occlusive reactive hyperemia (PORH). Secondary outcomes were body mass index and systemic blood pressure. Unpaired Student's t test compared intergroup analyses, and paired Student's t test compared intragroup analyses. The significance was set at 5%. Statistical analysis intergroup and intragroup was done by fitting a two-way mixed effects model. Microcirculation was similar between groups. Maximum flow (109.0 ± 38.3 versus 124.6 ± 43.0, P = 0.022), area under hyperemia (1614 ± 472 versus. 1755 ± 461, P = 0.023), and PORH (2.18 ± 0.49 versus 2.01 ± 0.52, P = 0.031) were statistically different after intervention. Body mass index decreased in intervention (24.5 ± 3.8-24.1 ± 4.0 kg/m2, P = 0.002) and control (25.2 ± 3.2-25.1 ± 3.3 kg/m2, P = 0.031) groups. Systolic blood pressure decreased significantly in the intervention group (110 ± 10-106 ± 9 mm Hg; P = 0.041) but not diastolic blood pressure (66.0 ± 7-68.8 ± 8 mm Hg; P = 0.089). Exergaming for 8 weeks led to improvements in the microcirculation function in adolescents with overweighed or obesity. Clinical trials: NTC03532659.

Non-invasive techniques to access in vivo the skin microcirculation in patients.

The microcirculation is composed of blood vessels with mean internal diameter smaller than 100 µm. This structure is responsible for survival of cells and in the last 50 years its study has become increasingly interesting because it often participates in the pathophysiology of several diseases or can determine better or worse prognosis for them. Due to the growing importance of knowing more about the microcirculation, several techniques have been developed and now it is possible to study its structure or function. In the last 25 years, the cutaneous microcirculation has emerged as an accessible and representative portion of generalized vascular bed allowing the examination of mechanisms of microcirculatory function and dysfunction. This mini review presents several techniques used for non-invasive access to skin microcirculation, such as Nailfold Videocapillaroscopy, Orthogonal Polarization Spectral Imaging, Sidestream Dark Field Imaging, Incident Dark field Illumination, Laser Doppler Flowmetry, and Laser Speckle Contrast Imaging applied. The techniques presented will describe which types of variables (structural or functional) can be evaluated, their limitations and potential uses.

Assesment of radiotherapy effects on the blood flow in gingiva and dental pulp - a laser Doppler flowmetry study

Abstract Objective This study aims to determine and compare the dental pulp and gingival blood flow in patients referred for oropharyngeal radiotherapy (RT) at three different time points: before the start, immediately after, and six months following the completion of RT. The aim is also to evaluate the dependence of the pulp and gingival blood flow on the radiation dose. Methodology A prospective study included 10 patients referred for intensity-modulated RT (IMRT) in the oropharyngeal region, with at least one intact tooth surrounded by a healthy gingiva. The dose received by each selected tooth and adjacent gingiva was determined according to the map of treatment planning and computer systems. The blood flow measurements were performed using the laser Doppler flowmetry (LDF) method. Results Comparing vascular flows at three different time points, the median blood flow in the dental pulp showed no statistically significant difference (p=0.325), contrary to gingiva (p=0.011). Immediately after RT completion, the gingival flow significantly increased compared to its starting point (p=0.012). The pulp flow correlated negatively with the radiation dose, whereas a strong correlation was noted 6 months following the RT completion. Conclusions RT caused a significant acute gingival blood flow increase, followed by a long-term (over six months) tendency to return to the starting levels. The dental pulp blood flow is differently affected by higher radiation doses (over 50Gy) in comparison to lower doses (below 50Gy). During RT planning, considering the possibility of protecting the teeth localized near the Gross Tumor Volume as a sensitive organ is recommended.

Effects of regular physical exercise on skin blood flow and cardiovascular risk factors in overweight and obese subjects / Efeitos do exercício físico regular sobre o fluxo sanguíneo da pele e nos fatores de risco cardiovascular em indivíduos com sobrepeso e obesidade

Objective: it is well known that low omentin levels and reduced bioavailability of nitric oxide (NO) are outgrowth of obesity. Besides, in obese subjects, microvascular dysfunction can be an initial stage of cardiovascular diseases. This situation can be evaluated with skin laser­Doppler flowmetry (LDF). Methods: in this study we investigated the effects of 12 weeks moderate physical exercise on microvascular reactivity and plasma levels of omentin and NO in 25 overweight and obese subjects. Control group was composed of 28 sedentary participants who were neither obese nor overweight. Microvascular reactivity was handled by measurement of skin blood flow from the ring finger of the right hand with LDF, which is a non­invasive method for evaluation. With this method, it was aimed to examine the post­occlusive reactive hyperemia response of the patients. None of the participants in both groups have never followed a regular exercise schedule in their life span. Results: with regular exercise, there was a statistically significant decrease in glucose (p=0.008), cholesterol (p=0.05), and triglyceride (p=0.048) levels, while body mass index, high­density lipoprotein, and low­density lipoprotein levels did not change significantly in overweight/obese group. Also, the omentin level significantly increased (p=0.01), but NO level did not change significantly. Moreover, the amount of change in omentin and NO levels measured before and after the physical exercise were significantly correlated (r=0.57). Considering the microcirculation, rest flow (p=0.001) and peak flow value of LDF (p=0.001) increased after the physical exercise. Conclusion: our study shows that moderate physical exercise affects microvascular reactivity and plasma levels of omentin in overweight and obese subjects.

Objetivo: sabe-se que níveis baixos de omentina e a reduzida biodisponibilidade de óxido nítrico (NO) são consequências da obesidade. Além disso, a disfunção microvascular pode ser um estágio inicial de doenças cardiovasculares em indivíduos obesos. Essa situação pode ser avaliada com a fluxometria de pele laser-Doppler (LDF). Métodos: foram investigados os efeitos do exercício físico moderado por 12 semanas na reatividade microvascular e nos níveis plasmáticos de omentina e NO em 25 indivíduos com sobrepeso e obesidade. O grupo controle foi composto por 28 participantes sedentários que não eram obesos nem com sobrepeso. A reatividade microvascular foi obtida pela medida do fluxo sanguíneo da pele do dedo anelar da mão direita com LDF, que é um método não invasivo de avaliação. Com este método, objetivou-se examinar a resposta da hiperemia reativa pós-oclusiva dos pacientes. Os participantes de ambos os grupos nunca seguiram um cronograma regular de exercícios em sua vida. Resultados: com o exercício regular houve diminuição estatisticamente significativa dos níveis de glicose (p=0,008), de colesterol (p=0,05) e de triglicerídeos (p=0,048), enquanto o índice de massa corporal e os níveis de lipoproteínas de alta e baixa densidade não se alteraram significativamente no grupo com sobrepeso/obesidade. Além disso, o nível de omentina aumentou significativamente (p=0,01), mas o nível de NO não apresentou modificações significas. Observou-se, também, que as modificações nos níveis de omentina e NO mensurados antes e após o exercício físico foram significativamente correlacionados (r=0,57). Em relação à microcirculação, os valores do fluxo de repouso (p=0,001) e do valor de fluxo de pico e da LDF (p=0,001) aumentaram após o exercício físico. Conclusão: nosso estudo mostra que o exercício físico moderado afeta a reatividade microvascular e os níveis plasmáticos de omentina em indivíduos com sobrepeso e obesidade.

Identification of Gingival Microcirculation Using Laser Doppler Flowmetry in Patients with Orthodontic Treatment-A Longitudinal Pilot Study.

Background and Objectives: Orthodontic tooth movement is associated with inflammatory responses. The aim of this study was to identify gingival microcirculation using laser Doppler flowmetry in patients with orthodontic treatment. Materials and Methods: A longitudinal pilot study was performed. The participants were selected using a non-probability consecutive sampling. Of the twenty-five subjects, a total of six (four women and two men) complied with the criteria. Before and during the treatment, the oral hygiene index, gingival index, probing depth, level of epithelial attachment, and gingival microcirculation were evaluated with laser Doppler flowmetry (integrated parameters: 1. integrated primary basal flow (IPBF), 2. integrated total secondary real flow (ITSRF), and 3. difference between integration (DBI)) in all of the participants). Results: (a) An increase in gingival blood flow was identified at all time intervals with different arches during orthodontic treatment. (b) The IPBF and ITSRF (with treatment) identified after 20 min (treatment initial stage) were compared with the different time intervals, and we observed an increase in gingival perfusion at the 24th, 48th, and 72nd hours in some arches. (c) In the DBI, we found statistically significant differences (p < 0.005) in the Nitinol group of 0.016 inches among all the time intervals (24 h, 48 h, and 72 h) within the 30-day interval, observing a flow increase three times greater than the basal flow after 30 days. Conclusions: Healthcare professionals must identify the inflammatory processes in treatment to observe and discontinue use of harmful methods in clinical practice.

Guía de manejo obstétrico y del recién nacido en madre aloinmunizada / Guidelines for the obstetric management of an alloimmune mother and her newborn / Guia de manejo obstétrico e neonatal em mães aloimunizadas

Resumen: La aloinmunización es una respuesta biológica frente a la exposición de antígenos no propios. La gestación, las transfusiones de hemocomponentes, los trasplantes de órganos sólidos y células hematopoyéticas, así como el consumo de drogas intravenosas exponen a las pacientes al desarrollo de aloanticuerpos antieritrocitarios. El hallazgo de los mismos debe cumplir con las instancias diagnósticas para identificar la probabilidad de estar asociados a enfermedad hemolítica feto neonatal (EHFN) y su oportuna derivación a policlínica de alto riesgo obstétrico (ARO) para su correcto seguimiento. Es fundamental que sean los laboratorios de inmunohematología de los servicios de hemoterapia y medicina transfusional los encargados de los estudios diagnósticos de aloinmunización eritrocitaria(1). En este sentido hemos elaborado esta guía con el objetivo de protocolizar de manera multidisciplinaria el manejo de las embarazadas aloinmunizadas y sus recién nacidos.

Abstract: Alloimmunization is the biological response to exposure to non-HLA antigens. Pregnancy, transfusion of blood components, solid organ and hematopoietic cell transplantation, as well as intravenous drug use expose patients to the development of anti-erythrocyte antibodies. When the latter are found, they must match diagnostic criteria to identify the potential association to hemolytic disease of the fetus and newborn (HDFN) and its timely referral to the high-risk obstetric risk polyclinic for due follow-up. It is of the essence for erythrocyte alloimmunization diagnostic tests to be carried out by the immunohematology laboratories of the Hemotherapy and Transfusional Medicine services. To that end, we have prepared these guidelines with the purpose of providing a multidisciplinary protocol for the handling of maternal alloimmunization and alloimmunization of the newborn.

Resumo: A aloimunização é uma resposta biológica à exposição a antígenos não próprios. A gravidez, as transfusões de hemocomponentes, os transplantes de órgãos sólidos e células hematopoiéticas, bem como o uso de drogas intravenosas expõem os pacientes ao desenvolvimento de anticorpos antieritrocitários. O achado destes deve obedecer a critérios diagnósticos para identificar a doença e a probabilidade de estarem associados a doença hemolítica feto neonatal (DHPN) e seu encaminhamento oportuno para uma unidade de alto risco obstétrico para acompanhamento adequado. É fundamental que os laboratórios de imuno-hematologia dos serviços de Hemoterapia e Medicina Transfusional se encarreguem dos estudos diagnósticos da aloimunização eritrocitária. Elaboramos este guia com o objetivo de estabelecer um protocolo multidisciplinar para o manejo de gestantes aloimunizadas e seus recém-nascidos.

Ex vivo penetration analysis and anti-inflammatory efficacy of the association of ferulic acid and UV filters.

BACKGROUND: Unprotected chronic exposure to ultraviolet (UV) radiation generates many harmful effects to human skin and sunscreens are essential to health, however, traditional products do not provide enough protection against cutaneous oxidative stress, a process amplified by UV radiation. Therefore, the development of multifunctional photoprotective formulations seems to be a more efficacious approach, since these enable the absorption/reflection of UV radiation and maintain the cutaneous homeostasis. OBJECTIVES: In the present study, ferulic acid (FA), a well-known antioxidant, has been combined with two UV filters, bemotrizinol and ethylhexyl triazone, and the safety and efficacy of this formulation has been assessed combining ex vivo and in vivo methods. METHODS: Skin permeation assays were performed by applying the formulation in the volar forearm of participants, after which consecutive samples of the stratum corneum were collected by tape stripping, and the quantification of FA, bemotrizinol and ethylhexyl triazone was performed by high-performance liquid chromatography (HPLC). Also, the FA anti-inflammatory action in combination with the UV filters was probed through a method employing Laser Doppler flowmetry to measure the vasodilatory response to methyl nicotinate topical application. RESULTS: Skin permeation assay was able to characterize the penetration depth of each substance. It should also be noted that a specific HPLC analytical method was developed in this study to enable the rapid simultaneous quantification of the three substances. Results from Laser Doppler flowmetry showed that the FA was able to mitigate the vasodilatory response. CONCLUSIONS: FA proved to be a valuable resource in a multifunction sunscreen, not only providing an increase in the SPF of sunscreens, previously published, but also decreasing the extent of inflammation.

Laser doppler flowmetry as a method of analysis for the evaluation of chemo - induced oral mucositis: a pilot study / Flujometría por láser doppler como método de análisis para la evaluación de la mucositis oral inducida por quimioterapia: un estudio piloto

Background: Oral mucositis (OM) is an inflammation of the oral mucosa due to cancer therapy that compromises the patient's quality of life. Laser Doppler flowmetry (LDF) is a non-invasive method to monitor microvascular blood flow (BF) in real-time. Purpose: Develop a method to evaluate BF in the genian region cheek in patients undergoing chemotherapy by LDF and compare the degrees of OM and pain with evaluation of BF. Material and methods: Evaluation of OM was performed using the World Health Organization (WHO) and Oral Mucositis Assessment Scale (OMAS) scales and the visual analog scale for pain evaluation. For flowmetry analysis, a laser Doppler flowmeter (moorVMSTM™, 780 nm wavelength and VP3 probe), fixed by an acrylic resin support was used; VP3 probe was positioned on the genian region and the patient's head was stabilized with a neck pillow for an accurate measurement. The Wilcoxon test was used to compare the flowmetry results at the studied times. The Pearson correlation coefficient was used to evaluate relationships between BF and the WHO, OMAS and visual analog scales. Results: Eleven patients of both sexes, aged between 30 and 78 years, with OM were included. An increase in cutaneous BF was observed at the initial times of OM, with progressive reduction during the chemotherapy cycle. There was a statistical difference (p<0.05) between time point T0 (first consultation) and time point T6 (last consultation). Conclusion: The method developed in this pilot study is effective, reliable, and reproducible, and allows the evaluation of BF dynamics in the genian region using LDF of patients undergoing chemotherapy at risk of developing OM.

Antecedentes: La mucositis oral (MO) es una inflamación de la mucosa oral debido a la terapia del cáncer, que compromete la calidad de vida del paciente. La flujometría láser Doppler (FLD) es un método no invasivo para monitorear el flujo sanguíneo microvascular (FS) en tiempo real. Objetivo: Desarrollar un método para evaluar la FS en la mejilla de la región geniana en pacientes sometidos a quimioterapia por FLD y comparar los grados de MO y dolor con la evaluación del FS. Material y Métodos: La evaluación de la MO se realizó utilizando las escalas de la Organización Mundial de la Salud (OMS) y la Escala de Evaluación de la Mucositis Oral (OMAS) y la escala analógica visual para la evaluación del dolor. Para el análisis de flujometría se utilizó un flujómetro láser Doppler (moorVMSTM™, longitud de onda de 780 nm y sonda VP3), fijado por un soporte de resina acrílica; La sonda VP3 se colocó en la región geniana y la cabeza del paciente se estabilizó con una almohada para el cuello para una medición precisa. Se utilizó la prueba de Wilcoxon para comparar los resultados de la flujometría en los tiempos estudiados. Se utilizó el coeficiente de correlación de Pearson para evaluar las relaciones entre FS y las escalas de la OMS, OMAS y analógicas visuales. Resultados: Se incluyeron 11 pacientes de ambos sexos, con edades comprendidas entre 30 y 78 años, con MO. Se observó un aumento del FS cutáneo en los momentos iniciales de la MO, con reducción progresiva durante el ciclo de quimioterapia. Hubo una diferencia estadística (p<0.05) entre el momento T0 (primera consulta) y el momento T6 (última consulta). Conclusión: El método desarrollado en este estudio piloto es efectivo, confiable y reproducible, y permite evaluar la dinámica del FS en la región geniana utilizando FLD de pacientes sometidos a quimioterapia con riesgo de desarrollar MO.

Ecografía doppler de la arteria pulmonar como indicador de madurez pulmonar fetal, Cuenca ­ Ecuador / Doppler ultrasound of the pulmonary artery as fetal lung maturity indicator, Cuenca - Ecuador

Introducción: la flujometría de la arteria pulmonar en fetos sanos puede ser un estudio predictor de la madurez pulmonar, lo que conlleva a un impacto en la disminución de la mortalidad perinatal.Objetivo: establecer el índice de tiempo de aceleración/tiempo de eyección de la arteria pulmonar (TA/TE) como un indicador de madurez pulmonar fetal en gestantes entre 26 y 40 semanas de gestación (SG), usuarias del Hospital Especializado Fundación Humanitaria Pablo Jaramillo Crespo, periodo 2017.Métodos: estudio de validación de prueba diagnóstica. Se evaluó la flujometría de la arteria pulmonar por ecografía doppler en 300 fetos sanos de gestantes entre 15 y 45 años de edad. Para la recolección de datos se utilizó encuestas y para la determinación de la validez se usó los estadísticos sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Resultados: el valor del índice TA/TE de la arteria pulmonar fue 0.216 para las gestantes entre 26-28 SG; de 0.253 entre 29-31 SG; de 0.279 entre 32-34 SG; de 0.315 para las gestantes entre 35-37 SG y de 0.349 entre 38-40 SG. Las 37 SG en punto de corte fue de 0.320; el área ROC fue 0.98 con una S: 95.2%, E: 97.2%. VPP 93.0% y VPN 98.1%.Conclusiones: el índice TA/TE de la arteria pulmonar demostró correlación con la edad gestacional. Un índice TA/TE de 0.320, como punto de corte, predice madurez pulmonar fetal (AU);

Introduction: pulmonary artery flow metric in healthy fetuses can be a predictive study of lung maturity, which leads to an impact on the decrease in perinatal mortality.Objective: to establish the ratio of pulmonary artery acceleration time to ejection time (AT/ET) as an indicator of fetal lung maturity in pregnant women from 26 to 40 weeks of gestation (WG), users of the "Hospital Especializado Fundación Humanitaria Pablo Jaramillo Crespo", period 2017.Methods: A validity study of diagnostic tests was carried out. Pulmonary artery flow metric was evaluated by Doppler ultrasound in 300 healthy fetuses of pregnant women between 15 to 45 years old. Surveys were used to collect data. Sensitivity (S), specificity (E), positive predictive value (PPV) and negative predictive value (NPV) were used to determine validity.Results: the value of the TA / TE index of the pulmonary artery was 0.216 for pregnant women between 26-28 WG; of 0.253 between 29-31 WG; 0.279 between 32-34 WG; 0.315 for pregnant women between 35-37 WG and 0.349 between 38-40 WG. The 37 WG at the cut-off point was 0.320; the ROC area was 0.98 with a S: 95.2%, E: 97.2%. The PPV 93.0% and NPV 98.1%.Conclusions: the AT/ET ratio of pulmonary artery showed correlation with gestational age. An AT/ET ratio of 0.320, as a cut-off point, predicts fetal lung maturity (AU);

Microcirculation changes in gingival tissue after ultrasonic tooth preparation in beagle dogs

Abstract Ultrasonic wave technology is widely used during dental treatments. We previously demonstrated that this method protects the gingival tissue. However, the physiological change on the gingival microvasculature caused by this method remains unclear. Objective The aim of this study was to investigate the relationship between the morphological and physiological effects on gingival microcirculation when preparing teeth, using the conventional dental turbine or ultrasonic method. Methodology The lower premolar teeth of beagle dogs were prepared along the gingival margin by using a dental turbine or ultrasonic wave instrument. Gingival vasculature changes were investigated using scanning electron microscopy for corrosion resin casts. Gingival blood flow at the preparation site was determined simultaneously by laser Doppler flowmetry. These assessments were performed immediately (Day 0), at 7 days and 30 days after tooth preparation. Results At day 0, in the turbine group, blood vessels were destroyed and some resin leaked. Furthermore, gingival blood flow at the site was significantly increased. In contrast, the ultrasonic group demonstrated nearly normal vasculature and gingival blood flow similar to the non-prepared group for 30 days after preparation. No significant alterations occurred in gingival circulation 30 days after either preparation; however, the turbine group revealed obvious morphological changes. Conclusions Based on multiple approach analyses, this study demonstrated that ultrasonic waves are useful for microvascular protection in tooth preparation. Compared with a dental turbine, ultrasonic wave instruments caused minimal damage to gingival microcirculation. Tooth preparation using ultrasonic wave instruments could be valuable for protecting periodontal tissue.

Clinical parameters, histological analysis, and laser Doppler flowmetry of different subepithelial connective tissue grafts.

Subepithelial connective tissue graft (SCTG) presents favorable outcomes. However, the harvesting technique can influence the anatomical and histological composition of the SCTG. Within the limitations of a case report, the behavior of SCTGs removed by two techniques was evaluated bilaterally in one patient using double blade scalpel (DBS) and de-epithelialized graft (DE). Clinical parameters, laser Doppler flowmetry (LDF) and histological analysis were assessed. Complete root coverage was observed bilaterally, as well as improvement in width and thickness of keratinized tissue 2 years postoperatively. The LDF analysis demonstrated better revascularization in the DBS recipient area compared to DE. The histological evaluation showed differences in tissue composition and organization of collagen fibers. Similar clinical outcomes were observed bilaterally, nevertheless greater morbidity and aesthetic was reported in the DE harvesting area.

Impaired neurovascular reactivity in the microvasculature of pregnant women with preeclampsia.

INTRODUCTION: PE is associated with maternal vascular dysfunction, leading to serious cardiovascular risk both during and following pregnancy. OBJECTIVE: To assess microvascular reactivity in pregnant women with PE. METHODS: A cross-sectional study was performed in 36 pregnant women with PE and 36 normotensive pregnant women (C) in the third trimester. Skin microvascular blood flow was measured using LDF at rest (RF), during the maximum hyperemic response to brief arterial occlusion (MF) and during the sympathetically mediated constrictor response to deep IBH. RESULTS: In pregnant women with PE, RF was higher [C, 8.1 (4.6); PE, 12.0 (7.6), P<.001; PU perfusion units; median (IQR)] and MF/RF [C, 6.1 (3.7); PE, 3. 9 (4.9) P<.001] and peak CVC lower (P=.009) compared to normotensive controls. The constrictor response to IBH [C, 62.4% (27.9); PE, 33.0% (50.6), P=.008] was reduced in women with PE. In univariate analysis, MF/RF was associated with PE status (r=-.417, P=.0001), systolic (r=-.385, P=.001), and diastolic (r=-.388, P=.001) blood pressure, but not BMI (r=.077, P=.536). CONCLUSIONS: Women with PE are more than three times more likely to exhibit a reduced microvascular reactivity in the third trimester of pregnancy than normotensive pregnant controls. These differences may be attributable in part to an altered sympathetic neural microvascular tone in PE.

Avaliação da fluxometria laser doppler na região geniana em pacientes sob terapia antineoplásica / Laser doppler flowmetry evaluation in the genius region in patients undergoing antineoplastic therapy

A quimioterapia e a radioterapia são modalidades terapêuticas não cirúrgicas aplicadas a pacientes com neoplasias malignas. A mucosite oral (MO) é uma inflamação da mucosa oral decorrente destas terapias antineoplásicas, manifestando-se por atrofia, inchaço, eritema e úlcera, comprometendo a qualidade de vida. A patogênese da mucosite oral envolve uma cascata de eventos de natureza inflamatória que culminam em alterações no epitélio e no tecido conjuntivo. Dentre estas modificações destacam-se as alterações na microvascularização, as quais precedem as alterações epiteliais na mucosa oral induzida por radiação e pelos agentes quimioterápicos. A Fluxometria Laser Doppler é um método não invasivo que permite avaliar parâmetros clínicos da microcirculação através do monitoramento do fluxo continuamente, em tempo real. O objetivo deste estudo foi avaliar a fluxo sanguíneo na região geniana em pacientes sob radioterapia de cabeça e pescoço ou quimioterapia através da técnica de Fluxometria Laser Doppler e comparar a graduação de mucosite oral e dor com dados obtidos na avaliação do fluxo sanguíneo. Este estudo observacional e prospectivo teve uma amostra de 14 pacientes oncológicos que foram avaliados antes do início da terapia antineoplásica e durante a fase intensiva da radioterapia de cabeça e pescoço ou quimioterapia, em 7 momentos. Para esta avaliação foi utilizado o Fluxômetro Laser Doppler para o registro do fluxo sanguíneo; as escalas da OMS (Organização Mundial da Saúde) e OMAS (Oral Mucositis Assessment Scale) para a avaliação do grau de mucosite; e Escala Visual Analógica (EVA) para a avaliação da dor em mucosa oral. Ao se comparar o fluxo sanguíneo nos tempos T1, T2, T3, T4, T5 e T6 com o T0, para os pacientes submetidos a radioterapia de cabeça e pescoço, não houve diferença estatística (p>0,05). Para os pacientes sob quimioterapia, houve diferença estatística nos tempo T1 (p=0,033) e T6 (p=0,043). Houve correlação positiva fraca entre as escalas para avaliação de mucosite oral (OMS (p=0,031) e OMAS (p=0,009)) e o fluxo sanguíneo. Não houve grau de relação entre dor induzida por mucosite oral e fluxo sanguíneo (p>0,05). A Fluxometria Laser Doppler permitiu a observação da dinâmica microvascular da região geniana da face em pacientes sob terapia antineoplásica e com risco de desenvolvimento de mucosite oral. Nos pacientes sob quimioterapia, houve aumento de perfusão cutânea na face nos tempos iniciais da MO, com progressiva redução do fluxo no decorrer do ciclo de quimioterapia.(AU)

Chemotherapy and radiotherapy are non surgical therapeutic modalities to malignancies. Oral mucositis is a inflammation of the oral mucosa due to these cancer therapy, typically manifesting as atrophy, swelling, erythema and ulceration compromising the quality of life. The pathogenesis of oral mucositis (OM) involves a cascade of inflammation events that result in changes in the epithelial layer and connective tissue, including microvascular modifications. These modifications precede epithelial changes induced by radiation therapy and chemotherapeutic agents, thereby modifications in blood flow may be a predictive factor of the severity of oral mucositis. Laser Doppler flowmetry (LDF) is a non invasive method enabling the monitoring of microvascular blood flow continuously in real time. The aim of this study was to evaluate the blood flow in the genius region in patients undergoing head and neck radiation and/or chemotherapy by Laser Doppler Flowmetry and compare the degree of oral mucositis and pain with data obtained in the evaluation of blood flow. This prospective observational study had a sample of 14 oncologic patients who were evaluated before and during the intensive phase of head and neck radiotherapy or chemotherapy in 7 times. For this evaluation, we used the Laser Doppler Flowmeter to measure blood flow; WHO scale (World Health Organization) and OMAS (Oral Mucositis Assessment Scale) for assessing the severity of mucositis; and Visual Analogue Scale (VAS) for pain assessment in oral mucosa. When we compare blood flow in T1, T2, T3,T4, T5 and T6 with T0, for patients undergoing radiotherapy for head and neck, there was no statistical difference (p> 0.05). For patients undergoing chemotherapy, there was a statistical difference in time T1 (p = 0.033) and T6 (p = 0.043). There was a weak positive correlation between the scale for assessing oral mucositis (WHO (p = 0.031) and OMAS (p = 0.009)) and blood flow. There was no relation degree pain induced oral mucositis and blood flow (p>0.05). Laser Doppler flowmetry allowed the observation of microvascular dynamics in the genian region of the face in patients undergoing antineoplastic therapy and risk of developing mucositis. In patients undergoing chemotherapy, there was an increase of skin perfusion in the face in the early days of the OM, with progressive reduction in flow during the course of chemotherapy.(AU)

Características ultrassonográficas mamárias e índices hemodinâmicos das artérias mamárias internas durante a gravidez normal / Breast ultrasonographic features and internal mammary artery hemodynamic indexes during normal pregnancy

OBJETIVO: Avaliar as características ultrassonográficas mamárias e os índices hemodinâmicos das artérias mamárias internas em grávidas normais, correlacionando-os com os períodos da gestação.MÉTODOS: Estudo epidemiológico, observacional e transversal, realizado entre agosto de 2013 e fevereiro de 2015, com 93 mulheres distribuídas em três grupos: primeiro trimestre, segundo trimestre e terceiro trimestre. As variáveis dependentes foram as espessuras da pele, do tecido celular subcutâneo, do tecido fibroglandular, do tecido adiposo retromamário, o diâmetro dos ductos, assim como os índices de pulsatilidade e resistência das artérias mamárias internas. As variáveis independentes foram os três períodos da gestação. Para a análise estatística, empregou-se o teste de Levene (variâncias uniformes entre os períodos da gestação), o teste ANOVA com medidas repetidas, o teste de Tukey de comparação múltipla e de contraste. O teste t de Student foi utilizado para avaliar a diferença entre nulíparas e não nulíparas, e o coeficiente de correlação de Pearson para a correlação entre as duas mamas. Foi considerado o nível de significância de 5%.RESULTADOS: A média de idade foi 26,6±4,6 anos, a qual não houve diferença significativa entre os grupos. A localização da mama (direita/esquerda) e o período gestacional não tiveram efeito significativo sobre as espessuras mamárias da pele, tecido celular subcutâneo e tecido adiposo retromamário, porém a espessura do tecido fibroglandular e o diâmetro dos ductos apresentaram diferença significativa em relação ao período gestacional (p<0,001) do primeiro para o terceiro e do segundo para o terceiro trimestres. A dopplerfluxometria das artérias mamárias internas revelou diferença entre as mamas e o período gestacional, ou seja, o lado direito apresentou medidas superiores ao lado esquerdo, e os valores foram decrescentes ao longo da gestação (p<0,001).CONCLUSÃO: A espessura média de tecido fibroglandular e o diâmetro dos ductos mostraram diferenças significativas do primeiro para o segundo e do primeiro para o terceiro trimestre, não sendo observadas diferenças entre as duas mamas. O índice de pulsatilidade e o índice de resistência das artérias mamárias internas foram progressivamente menores durante a gravidez.

PURPOSE: To evaluate breast ultrasonographic features and hemodynamic indexes of the internal mammary arteries in normal pregnant women, and their correlation with the gestational periods.METHODS: Observational and cross-sectional, epidemiological, study, conducted between August 2013 and February 2015, with 93 women divided into three groups: first trimester, second trimester and third trimester. The dependent variables were thickness of the skin, of subcutaneous tissue, fibroglandular tissue, and retrommamary adipose tissue, the diameter of the ducts, as well as the pulsatility and resistance indexes of the internal mammary arteries. Independent variables were the three periods of gestation. Repeated measures ANOVA with the multiple comparison Tukey test and a test of contrasts were used for statistical analysis. The Levene test was used to test the homogeneity of variances between periods of gestation. Student's t-test was used to evaluate the difference between nulliparous and non -nulliparous women, and Pearson's correlation coefficient was used for correlation analysis between the two breasts. The level of significance was set at 5%.RESULTS: Mean age was 26.6±4.6 years, with no significant difference among groups. Breast location (right/left) and gestational period had no significant effect on the thickness of the skin, of subcutaneous tissue and adipose retromammary tissue. However, the thickness of fibroglandular tissue and the diameter of the ducts showed a significant difference according to gestational period (p<0.001), i.e., from the first to the second and to the third trimesters. Doppler flowmetry of the internal mammary arteries showed a difference between breasts and between gestational periods, i.e., the measurements of the right breast were greater than those of the left, and these values decreased throughout pregnancy (p<0.001).CONCLUSION: The average thickness of fibroglandular tissue and the diameter of the ducts showed significant differences from the first to the second and to the third trimesters, with no differences being observed between the two breasts. The pulsatility and resistance indexes of the internal mammary arteries decreased progressively throughout pregnancy.

Flowmetry/pelvic floor electromyographic findings in patients with detrusor overactivity

To evaluate different flowmetry/EMG patterns in patients with proven detrusor overactivity (DO) and compare them with that of a group of patients with lower urinary tract symptoms (LUTS) but without DO.

In-office bleaching effects on the pulp flow and tooth sensitivity – case series

Laser Doppler flowmetry (LDF) is a noninvasive method capable of evaluating variations in pulp blood flow (PBF) and pulp vitality. This method has thus far not been used to assess changes in blood flow after in-office bleaching. The aim of this case series report was to measure changes in PBF by LDF in the upper central incisor of three patients submitted to in-office bleaching. The buccal surfaces of the upper arch were bleached with a single session of 35% hydrogen peroxide gel with three 15-min applications. The color was recorded using a value-oriented Vita shade guide before in-office bleaching and one week after the procedure. The tooth sensitivity (TS) in a verbal scale was reported, and PBF was assessed by LDF before, immediately, and one week after the bleaching session. The lower arch was submitted to dental bleaching but not used for data assessment. A whitening degree of 3 to 4 shade guide units was detected. All participants experienced moderate to considerable TS after the procedure. The PBF readings reduced 20% to 40% immediately after bleaching. One week post-bleaching, TS and PBF were shown to be equal to baseline values. A reversible decrease of PBF was detected immediately after bleaching, which recovered to the baseline values or showed a slight increase sooner than one week post-bleaching. The LDF method allows detection of pulp blood changes in teeth submitted to in-office bleaching, but further studies are still required.

Doppler flowmetry of ophthalmic arteries for prediction of pre-eclampsia / Dopplerfluxometria de artérias oftálmicas para predição de pré-eclâmpsia

Background: central nervous system (CNS) hyperperfusion is one of the events that constitute the pathophysiological basis for the clinical manifestations and complications of pre-eclampsia (PE). Detecting the increased flow in the CNS through Doppler flowmetry of the ophthalmic artery might precede the clinical onset of PE and could be used as a marker for subsequent development of PE. Objective: to evaluate the ophthalmic artery resistive index (OARI) values in the second trimester of pregnancy for prediction of the clinical manifestations of PE. Objective: to evaluate the ophthalmic artery resistive index (OARI) values in the second trimester of pregnancy for prediction of the clinical manifestations of PE. Methods: a total of 73 patients with risk factors for the development of PE were selected from the prenatal service at the HC-UFMG. They were submitted to ophthalmic artery Doppler flowmetry between 24 and 28 weeks of pregnancy and monitored until the end of the pregnancy to verify the occurrence of PE. ROC curves were created to determine the predictive characteristics of the OARI. Results: fourteen of the patients selected developed PE and 59 remained normotensive until the postpartum period. Patients with subsequent development of PE presented OARI values lower than patients that remained normotensive (0.682±0.028 X 0.700±0.029, p=0.044). Considering the development of PE as an outcome, the area under the OARI curve was 0.694 (CI 0.543 to 0.845), with no points obtaining good values of sensitivity or specificity. Conclusion: Doppler flowmetry of ophthalmic arteries between 24 and 28 weeks of pregnancy did not present itself as a good exam for predicting PE. .

Introdução: a hiperperfusão do sistema nervoso central (SNC) é um dos eventos que constitui substrato fisiopatológico para as manifestações clínicas e complicações da pré-eclâmpsia (PE). O fluxo aumentado no SNC, detectado por meio da dopplerfluxometria de artérias oftálmicas, poderia anteceder as manifestações clínicas da PE e, consequentemente, ser utilizado como marcador de subsequente desenvolvimento de PE. Objectivo: avaliar os valores do índice de resistência das artérias oftálmicas (Irao) no segundo trimestre gestacional para a predição das manifestações clínicas da PE. Métodos: pacientes com fatores de risco para desenvolvimento de PE foram selecionadas no serviço de pré-natal do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG). Elas foram submetidas à dopplerfluxometria de artérias oftálmicas entre 24 e 28 semanas de gestação e acompanhadas até o final da gestação para averiguar a ocorrência de PE. Curvas ROC foram criadas para determinar as características preditivas do Irao. Resultados: das pacientes selecionadas, 14 desenvolveram PE e 59 mantiveram-se normotensas até o puerpério. Pacientes com subsequente desenvolvimento de PE apresentaram valores de Irao menores do que pacientes que se mantiveram normotensas (0,682±0,028 vs. 0,700±0,029, p=0,044). Ao considerar o desenvolvimento de PE como desfecho, a área sobre a curva do Irao foi de 0,694 (IC 0,543-0,845), sem pontos com bons valores de sensibilidade ou especificidade. Conclusão: a dopplerfluxometria de artérias oftálmicas entre 24 e 28 semanas de gestação não se demonstrou um bom exame para a predição de PE. .