Capillaroscopic appearance of nailfold vasculature of diabetic nephropathy patients

ABSTRACT Objectives: Diabetic nephropathy is a microvascular complication of diabetes and the most common cause of end-stage renal failure throughout the world. Videocapillaroscopy is a simple and noninvasive method that can display capillaries in the nail bed at the micron level. A few studies have been conducted on detecting retinopathy, another important diabetic microvascular complication, with videocapillaroscopy; however, no comprehensive study has been performed on diabetic nephropathy. We aimed to determine the relationship between nephropathy and capillaroscopic changes. Subjects and methods: Capillaroscopic findings of 144 patients with type 2 diabetes and 88 healthy controls were assessed prospectively by nailfold videocapillaroscopy. Twelve capillaroscopic findings were evaluated in all subjects. Results: Patients with albuminuria had more capillary aneurysms (15.5%), more microhemorrhages (15.5%), greater tortuosity (76.3%), more neoformations (29.9%), more bizarre capillaries (49.5%) and more bushy capillaries (20.6%) than the control group. In logistic regression analysis, tortuosity was significantly correlated with albuminuria (OR: 2.451, p = 0.048). Conclusions: Our findings show that the application of nailfold videocapillaroscopy can detect microvascular abnormalities in the nail bed that occur in diabetes mellitus patients compared to healthy people. Although there was no difference in the microvascular changes among the stages of diabetic nephropathy, a relationship between tortuosity and albuminuria was identified by logistic regression analysis. Nailfold videocapillaroscopy may be a new application that can be used to screen the microvascular changes that occur in diabetes mellitus.

Relationship between pulmonary hypertension and serum uric acid level in patients with systemic sclerosis / 实用医学杂志

Objective To explore the relationship between serum uric acid and pulmonary hypertension (PH) in patients with systemic sclerosis (SSc). Methods The echocardiography, electrocardiogram, nailfold videocapillaroscopy and laboratory parameters of 62 patients with SSc were retrospectively analyzed . Patients were divided into two groups according to presence of PH . Statistical analysis was performed using SPSS 17 software . Results Compared to patients without PH , patients with PH had significantly higher serum uric acid levels ( P < 0 . 01 ) , systolic pulmonary arterial pressure ( P < 0 . 01 ) , abnormality of electrocardiogram (P < 0.01), abnormality of nailfold video capillaroscopy and lower serum albunin levels (P < 0.01). Systolic pulmonary arterial pressure had correlation with Serum UA ( r = 0 . 26 , P < 0 . 01 ) as well as serum ablumin (r = -0.28, P < 0.03). Moreover, the mean value of serum UA was significantly different in two ECG groups (P < 0.01) and two nailfold videocapillaroscopy groups (P < 0.01). At the cutoff level of 374 μmol/L, serum uric acid had reasonable accuracy for predicting the presence of PH in SSc patients ( sensitivity 66 . 7% and specificity 84 . 0%) . Conclusion The serum uric acid may be useful as a practicable marker for predict PH in patients with SSc .

Methods for the morphological and functional evaluation of microvascular damage in systemic sclerosis

Systemic sclerosis is a connective tissue disease characterized by alterations in microvascular structure and function. In these patients, numerous studies have demonstrated a relationship between capillary morphology and peripheral blood perfusion. Nailfold videocapillaroscopy reveals the peripheral microvascular morphology and thus allows classification and scoring of capillary abnormalities with respect to different microangiopathy patterns (early, active, and late). Laser Doppler flowmetry and laser speckle contrast analysis can be used to estimate cutaneous blood flow through microvessels and to assess and quantify blood perfusion at peripheral sites. These two methods are also used to identify changes in digital blood perfusion after the infusion of vasodilators.

The diagnostic significance of nailfold videocapillaroscopy in systemic sclerosis / 中华内科杂志

ObjectiveTo observe nailfold capillary changes in a cohort of conncctive tissue disease ( CTD ) with Raynaud's phenomenon (RP) and to explore the diagnostic value of nailfold videocapillaroscopy (NVC) in systemic sclerosis(SSc).MethodsSixty CTD patients with RP divided into SSc group (n =36) and non-SSc group ( n =24) were referred to an experienced operator for NVC.ResultsThe patients had decreased capillary loops in SSc group with the capillary diameter more enlarged in SSc group than nonSSc group.The number of patients in SSc group with giant capillaries was 14,while 3 in non-SSc group.There were 23 patients with haemorrhagcs in SSc group and 9 in non-SSc group.The number of patients with severe effusion was 15 in SSc group,while 2 in non-SSc group.By using the ROC curves,indexes with AUC at least 0.7 of the input capillary diameter,the output capillary diameter,the middle capillary diameter,blood color and effusion for the diagnostic cutoff points were 18.5 μm,24.5 μm,19.5μm,deep red and severe effusion.With at least 2 out of the top 3 indexes,the diagnostic sensitivity and specificity of SSc were higher.ConclusionsCTD Patients with RP of SSc have less capillary loops,more enlarged capillaries,more giant capillaries, moresevereeffusionandmorehaemorrhagesthannon-SScpatients. The characteristics of nailfold capillary changes in SSc patients with RP can be helpful tor the diagnosis and the differential diagnosis of SSc.

Organic grape juice intake improves functional capillary density and postocclusive reactive hyperemia in triathletes

OBJECTIVE: The aim of this study was to evaluate the effect of organic grape juice intake on biochemical variables and microcirculatory parameters in triathlon athletes. INTRODUCTION: The physiological stress that is imposed by a strenuous sport, such as a triathlon, together with an insufficient amount of antioxidants in the diet may cause oxidative imbalance and endothelial dysfunction. METHODS: Ten adult male triathletes participated in this study. A venous blood sample was drawn before (baseline) and after 20 days of organic grape juice intake (300 ml/day). Serum insulin, plasma glucose and uric acid levels, the total content of polyphenols, and the erythrocyte superoxide dismutase activity were determined. The functional microcirculatory parameters (the functional capillary density, red blood cell velocity at baseline and peak levels, and time required to reach the peak red blood cell velocity during postocclusive reactive hyperemia after a one-min arterial occlusion) were evaluated using nailfold videocapillaroscopy. RESULTS: Compared with baseline levels, the peak levels of serum insulin ( p = 0.02), plasma uric acid ( p = 0.04), the functional capillary density ( p = 0.003), and the red blood cell velocity (p < 0.001) increased, whereas the plasma glucose level (p,0.001), erythrocyte superoxide dismutase activity ( p = 0.04), and time required to reach red blood cell velocity during postocclusive reactive hyperemia ( p = 0.04) decreased after organic grape juice intake. CONCLUSION: Our data showed that organic grape juice intake improved glucose homeostasis, antioxidant capacity, and microvascular function, which may be due to its high concentration of polyphenols. These results indicate that organic grape juice has a positive effect in endurance athletes.