Vascular screening technology

The monograph is devoted to the current problem of visualization and assessment of the severity of pathological vascular transformations in cardiovascular and cancer diseases. The signs of pathological neoangiooncogenesis at the micro- and macroangiological levels are analyzed in detail.

Review: Problems of effective correction and radical solving of cardiovascular disorders are not new. However, the statistic indexes of cardiovascular pathology are growing and they are considerably younger [1-6]; this testifies to lack of effective management strategy and tactics in fight against these diseases [7-13]. Today we can make a real estimation of achieved results: for the last 20-30 years many technologies are created for research of vascular system - USD of vessels, МRТ in angiomode; devices for correction of cardiac disorders are widely used - from numerous technologies for estimation of the heart structure to coronarography and coronarshunting; new fields of radical medicine are successfully implemented, such as cardiac surgery, angiosurgery, phlebology [14-16]. And at the same time, regardless of the most up-to-date technologies for vascular diagnostics and angiosurgery cardiovascular diseases gets top ranking regarding morbidity and death rate [6,9,17,18]. It can be explained by the fact that development and introduction in medical practice of modern vascular technologies are behind a steady tendency to progress and cardiovascular diseases strike younger people. This dissonance testifies to insufficient knowledge and analysis at the application of new technological potential of visualization of the cardiovascular system at structural (in vitro and in vivo) and functional level - in vivo [7,9,10,12,17]. Our 20-year-old experience of research of vascular disorders and successful attempts of their correction [19] has shown that 1) There is a huge layer of unexplored hemodynamic parameters, which are important in the personalized treatment processes. However, long neglecting biomechanics in medicine [20] resulted into excessive emphasis on endothelial dysfunction and cellular metamorphosis beneficial for promoting pharmacological business. As a result, doctors are not ready to think logically with categories of circulation mechanics and applied hydro- and hemodynamics [21]. 2) Physicians and medical staff don't have enough knowledge in angiology, hemodynamics, hydrodynamics, analytical angiocorrection, angiotherapy, treatment management on evidential basis. Without understanding the depth of hemodynamic laws and logics of pathological and sanogenic transformations in blood supply for organs and regional reservoirs as closed system of vascular tubes - vascular blood flow, it is impossible to perform personalized adequate treatment and predict positive outcomes [8,10]. 3) There is an urgent need in development of vascular monitoring technologies based on principles of evidential medicine [2,7,8,10]. Monitoring dynamic changes in any medical process management, doctors may correct on time the decline from sanogenic blood restoration in a particular regional reservoir and logic of blood redistribution in different vascular reservoirs in a patient's body. Keywords: Personalized treatment, Hemodynamics, Cardiovascular diseases, Angiocorrection, Hydrodynamic conflicts, Brain edema, Biomarkers, Angiomarkers, Intracranial hypertension, Vascular screening, Angiotherapy

В ходе динамического исследования капиляров при функциональных пробах с вазоактивными средствами отмечено улучшение капиллярного кровотока и реологических свойств крови при назначении никотиновой кислоты, аспирина, пентоксифиллина. Исследования подтверждают возможность количественного определения агрегатов, состоящих из клеток крови, определения длительности стаза крови в капиллярах, что позволяет, в свою очередь, подбирать рациональные дозы прямых и непрямых антикоагулянтов, аспирина, не прибегая к инвазивным исследованиям (http://www.casmos.ru). Некоторые исследователи (http://www.casmos.ru) указывают на возможность не только изучения, но и контроля состояния микроциркуляторного звена в патогенезе сердечной недостаточности, а также оценки медикаментозной коррекции расстройств микроциркуляции у пациентов с разной степенью выраженности сердечной недостаточности. Так, у 14 пациентов, перенесших инфаркт миокарда, сопровождающего разной степенью сердечной недостаточности, определяли размер периваскулярной зоны. В начале лечения он составил в среднем 142,4±12,3 мкм. Использовались диуретики (арифон в дозе 2,5 мг ежедневно, фуросемид по 40 мг 2 раза в неделю). К исходу первой недели периваскулярная зона уменьшилась до 115±9,8 мкм. Спустя 2 недели после начала лечения периваскулярная зона составила до 106,6±8,7 мкм. Таким образом, исследование перпендикулярного размера периваскулярной зо-ны позволяет объективизировать диуретическую терапию у пациентов с сердечной недостаточностью. ВЫВОДЫ В процессе исследования микроциркуляции методами оптической и компьютерной капилляроскопии установлено, что компьютерная визуализация нарушений микроциркуляции является прогрессивным методом диагностики благодаря использованию современных электронно-компьютерных технологий и имеет целый ряд преимуществ над оптической капилляроскопией: 1. Позволяет значительно увеличить разрешающую способность капилляро-скопической картинки. 2. Отображение на мониторе дает возможность проводить консилиум врачей смежных специальностей, что благоприятствует уменьшению явлений субъ-ективизации в подходе к интерпретации полученных изображений. 3. Позволяет архивировать изображения, сравнивать их в динамике лечения и течения заболевания. 4. Факт мониторной визуализации нарушенного уровня микроциркуляции часто является для пациента фактором повышения доверия к врачу, осознанной необходимости лечения для устранения обнаруженных наруше-ний. 5. В отличие от цифровых параметров оценки уровня микроциркуляции в единице обьема, качественная картина визуализации нарушений кровообращения является более информативной и достоверной. 6. Разработка методик компьютерной обработки полученных капилляроскопических картинок позволит сформировать алгоритм качественно-количественного анализа уровня микроциркуляции, что в дальнейшем улучшит качество объективизации обнаруженных нарушений.

Численні дослідження, присвячені вивченню особливостей гемодинаміки в нормі та при патології, привели до виникнення спеціальной галузі науки – ангіології, в якій узагальнюються відомості про регіональну ангіоархітектоніку, про структуру й функції судинної системи людського організму, про його кровопостачання та кровообіг при різних станах. Нині проблема діагностики порушень структури та функціонування судинної системи набуває великого науково-практичного значення, оскільки сучасні діагностичні системи дають змогу по-новому – в динаміці, а не в статиці – візуалізувати функції тих чи інших судин, провести прижиттєве неінвазивне моделювання віявлених патологічних станів у живому організмі, зумовлених експериментально модельованими дизгеміями, індивідуально визначити фактори ризику й прогнозувати перебіг судинної патології. Індивідуальний підхід у діагностиці порушень кровообігу дає змогу оптимізувати подальшу тактику лікування з адекватним підбором доз і схем лікування під контролем сучасної апаратури. Дослідження судинної системи людського організму завжди паривертало увагу лікарів та біологів. Починаючи з пізнання таємниць функціонування судинного русла на рівні патанатомічного вивчення будови судинної системи часів Галена шляхом удосконалення цих знань за допомогою досліджень фізіології, топографічної анатомії, гідро- та гемодинаміки, функціонування окремих ланок судинної системи – макрогемодинаміки, системної і регіональної гемодинаміки та мікроциркуляції, сучасна медицина приходить до аналітичного узагальнення взаємного функціонування всіх ланок єдиного процесу – серцево-судинної системи з визначенням провідної ланки – серця чи венозної системи в забезпеченні руху крові. Не позбавлений підстав погляд деяких дослідників (Залманов А.С., 1958; Бердичевский М.Я., 1989), котрі акцентували увагу на домінуючій ролі венозного насоса в забезпеченні циркуляції крові. Поступово утверджується концепція венозної дисфункції у формуванні цереброваскулярної патології та відбувається визнання нозологічних термінів “венозна дизгемія” і “венозна дисциркуляторна енцефалопатія” (Холоденко М.И., 1963; Лесницкая В.Л. и соавт., 1970; Неймарк Е.З., 1975; Бердичевский М.Я., 1989; Лущик У.Б., 1998). Вищеназвані автори наполягають на необхідності всебічного вдосконалення й розширення досліджень венозної церебральної ланки. Але, на жаль, патофізіологія венозної системи мозку залишається не вивченою до кінця. Протягом останнього десятиріччя вивченню артеріовенозної церебральної рівноваги як прояву гідродинамічного та об’ємного дисбалансу у взаємозалежних артеріальній та венозній ланках судинної системи мозку присвячено одиничні роботи дослідників (Лущик У.Б., 1998; Шумилина М.В., 2002; Шумилина М.В. и др., 2002). Серед неінвазивних методик дослідження судинної системи на сьогоднішній день панують магнітно-резонансна томографія в ангіорежимі, ультразвукове ангіоскенування і допплерографія, офтальмоскопія і капіляроскопія. Оскільки капілярне кровопостачання здійснює основну функцію мікроциркуляторної системи – транскапілярний обмін, тобто обмін речовин між кров’ю і тканинами, стан мікроциркуляції може слугувати арбітром благополуччя системної гемодинаміки та відображенням збереженої артеріовенозної рівноваги в регіональних судинних басейнах. Тому погляди вчених і практикуючих лікарів знову звернені на стан мікроциркуляторної ланки. На сучасному етапі розвитку візуалізаційних технологій in vivo закономерний ренесанс давно забутої капіляроскопії. І знов актуальні слова О.С. Залманова 50-річної давності: “Порушення фізіології капілярів настільки поширені й так часто спостерігаються, що їх слід вважати не другорядним явищем, а, навпаки, одним з основних елементів органічних порушень у хворого, хоч би якою була хвороба”.

Vascular pathologies constitute a significant part of human's diseases and their rate tends to increase. Numerous investigations of brain blood flow in a normal condition and in a pathological one has created a new branch of modern medicine -- angioneurology. It combines the information on brain angioarchitecture and on blood supply in a normal condition and in a pathological one. Investigations of a disease's development constitute an important problem of a modern medicine. Cerebrum blood supply is regulated by arterial inflow and venous outflow, but, unfortunately, in the literature available arterial and venous beds are considered separately. This causes an one-sided interpretation of atherosclerotical and discirculatory encefalopathies. As arterial inflow and venous outflow are interrelated, it seems to be expedient to perform a complex estimation of arteriovenous interactions, prove a correlation dependence connection between the beds and find a dependence in a form of mathematical function. The results will be observed clearly in the graphs. There were 139 patients aged from 2 up to 70 examined in the 'Istyna' Scientific Medical Ultrasound Center by means of a Logidop 2 apparatus manufactured by Kranzbuhler, Germany using a technique of cerebral arteries and veins ultrasound location (invented and patented by Ulyana Lushchyk, State Patent of Ukraine N10262 of 19/07/1995). A clinical interpretation of the results obtained was performed. With the help of this technique and ultrasound Dopplerography the blood flow in major head and cervical arteries was investigated. While performing a visual graphic analysis we paid attention to the changes of carotid artery (CA), internal jugular vein (IJV) and supratrochlear artery's (STA) hemodynamical parameters. Generally accepted blood flow parameters: FS -- maximal systolic frequency and FD -- minimal diastolic frequency were measured. The correlation between different combinations of parameters in the vessels mentioned above was investigated. Correlation analysis shows a significant (r equals 0.95) interdependence between different combination of hemodynamical parameters.

A device which is a new stage in the development of medical equipment has been developed. The device works as an ultrasound microscope in vivo and provides 4 up to 32 colored histological image. It gives possibility to estimate tissue acoustic density with the help of 4 up to 32 gradation coloring different tissues and enables tissue microcirculation visualization. With the help of the device a doctor can objectify fatty hepatitis and cirrhosis, edema of different organs and tissues as well as microcirculation in organs and tissues (e.g. muscles, myocard and bone system). New promising applications of ultrasound systems in diagnostics and for choosing individual treatment tactics, with pathogenesis being taken into account, may be developed with the help of the device.

A rapid development of modern computer technologies gave a powerful incentive to technical progress as a whole and to medical equipment in particular. A range of medical diagnostic computer-based systems has recently appeared. There are various fields these techniques are used in: roentgenology, ultrasound diagnostic, neurophysiology, angiology etc. The advantages of the use of computer interface are undoubted: it gives possibility to enhance the functioning of the system itself, speed up all technological processes, carry out a reliable and easy archivation and exchange the information obtained. But the most important advantage of using PC in diagnostic system lies in an unlimited freedom of use mathematical algorithms and flexible mathematical models for processing information obtained. On the other hand, the absence of clinical techniques for interpretation of the data obtained is an obstacle to the use of software at its full potential. As a result, a close connection of a scientific development of hardware with high-informative techniques for clinical interpretation of the instrumental data obtained has become topical as never before. We see an optimal solution in introducing the interpretation patterns in conjunction with purely numerical computations into mathematical simulations.© (2001) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

A rapid development of modern computer technologies gave a powerful incentive to technical progress as a whole and to medical equipment in particular. A range of medical diagnostic computer-based systems has recently appeared. There are various fields these techniques are used in: roentgenology, ultrasound diagnostic, neurophysiology, angiology etc. The advantages of the use of computer interface are undoubted: it gives possibility to enhance the functioning of the system itself, speed up all technological processes, carry out a reliable and easy archivation and exchange the information obtained. But the most important advantage of using PC in diagnostic system lies in an unlimited freedom of use mathematical algorithms and flexible mathematical models for processing information obtained. On the other hand, the absence of clinical techniques for interpretation of the data obtained is an obstacle to the use of software at its full potential. As a result, a close connection of a scientific development of hardware with high-informative techniques for clinical interpretation of the instrumental data obtained has become topical as never before. We see an optimal solution in introducing the interpretation patterns in conjunction with purely numerical computations into mathematical simulations.

The book is a brief review of two actual problems in modern diagnostics in the angiology such as 1 – diagnostics and estimation of the vascular system’s condition on the regional cerebral level, 2 – up-to-date potential of the in vivo non-invasive estimation of structure and function of capillaries on the microcirculatory level. Basics of modern investigating methods of the vascular system in the organism and interpretation of investigation’s results are performed in the comprehensible form. Possibilities of an integrated application of the ultrasound diagnostics of brain vessels, smart capillaroscopy together with magneto-resonance and radiopague angiography are described. The state of capillaries’ system as the more important link of the blood-carrying canal, which supply with all substances (required for vital activity) for organs and tissues, gives a lot of interesting extra information in diagnostics. Today the capillaroscopy, which enables to visualize disorders in microcirculation, has become one of progressive methods of diagnostics owing to application of modern electronic-computer technologies and a range of possibilities of its application is quite wide. The book contains a lot of schemes and colored illustrations The book is made for medical students, post-graduate students, doctors of general practice, neuropathologists, neurosurgeons, psychiatrists, angiologists and angiosurgeons, resuscitators, doctors of the functional and radial diagnosis, doctors of the intensive therapy departments, family physicians. Brief contents Macroangiology Color-coding of gray-scale scanned MRA- and USD-images. Ultrasound diagnostics of brain vessels. Elastic-tonic properties of a vascular wall. Investigation of a pumping function of the myocardium. Modern diagnostic methods of investigation of the vascular system in an aspect of creation of mathematical models. Theoretical models for hemodynamic processes. Conflict of calibers of the main and capillary vessels. Venous dyshemia. Arteriovenous cerebral disbalance. Arteriovenous cerebral pathological shunting. A phenomenon of reactive hyperemia after occlusion of the carotid artery. Application of modern methods of the vascular diagnostics under conditions of neuroresuscitation department (monitoring and correction of regional hemodynamics under critical states). Results of an integrated examination of patients in coma. Microangiology History of study of microcirculation: from pathomorphological investigations to intravital diagnostics. Theoretical basics of microcirculation regarding the pathomorphological investigations of capillaries. Microcirculation and statistics. Theoretical basics of functioning of the microcirculatory bed regarding problems of hemodynamics. Computed capillaroscopy: the new is a well-forgot old plus up-to-date potential of computed technologies. Method of examination of the capillary bed. History of issue of classification of disorders in microcirculation. Optic and computed capillaroscopy. Fields of application of the capillaroscopy. Possibility of application of the computed capillaroscopy in the clinical practice. Control of efficiency of treatment with the help of method of the computed capillaroscopy and a method of the clinical interpretation of obtained static and dynamic images.

Purpose of article The cardiovascular system is an essential component for the human health as the background level of functioning of nearly all organs and systems depends on the blood supply level. Today, occupying first place by spreading cardiovascular diseases cause more than a half of all deaths and one third of disability, mainly due to uncompensated cardiovascular conditions – heart attacks and strokes (according to WHO statistics and Ukrainian Ministry of Health). Despite of considerable scientists’ efforts, today there is not any tendency to decreasing of morbidity and mortality indexes of cardiovascular diseases. This says that several factors were not included in basic and applied research in previous years. Very dynamic CVS examination, which takes into account interconnections between the segments, must reach a principally new stage of intellectual processing of results from different local instrumental examinations with general conclusion within the entire vascular system in the organism. The time requires creation of a single technological complex for integral life-time dynamic diagnostics of CVS in a patient in one-moment on various regional and systemic levels with an output of analytically processed results for clinical interpretation and assessment of CVS reconstructions in norm and in pathological states by a physician.

Despite great efforts in treatments of cardiovascular diseases, the field requires innovative strategies because of high rates of morbidity, mortality and disability, indicating evident deficits in predictive vascular diagnosis and individualized treatment approaches. Talking about the vascular system, currently, physicians are not provided with integrated medical approaches to diagnose and treat vascular diseases. Only an individual global approach to the analysis of all segments in the vascular system of a patient allows finding the optimal way for vascular disease treatment. As for the existing methodology, there is a dominance of static methods such as X-ray contrast angiography and magnetic resonance imaging in angiomode. Taking into account the world experience, this article deals with innovative strategies, aiming at predictive diagnosis in vascular system, personalization of the biomedical treatment approaches, and targeted prevention of individual patient cohorts. Clinical examples illustrate the advances in corresponding healthcare sectors. Recommendations are provided to promote the field.

Purpose of article Origin of any vascular pathology is associated primarily with the circulation disorders in the smallest blood vessels, capillaries. If the capillaries are filled with blood evenly it is an evidence for correct functioning of the system heart – arteries- capillaries- veins- heart. Problems in the capillary functioning can cause circulatory disorders, leading to stagnation of the circulation and metabolic processes derangement. And as a result - reducing of immunity, exacerbation of chronic diseases and the development of new ones. Therefore, detection of any microcirculation problems at early stages is so important for forecasting the development of a cardiovascular disease, and for effective treatment. Research methodology A doctor requires only 5 minutes receiving prior diagnosis of presence or absence of any pathology in the cardiovascular system with smart capillaroscope. Any reconstructions in the vascular system occur first on the microcirculatory level therefore monitoring of the capillary changes is the most informative in assessment of efficiency of a prescribed treatment. Practical implications Regular capillaroscopic examination enables to diagnose microcirculation disturbances, to control non-invasively efficiency of prescription of an anti-aggregate therapy for patients with ischemic disease of heart, pancreatic diabetes etc. and also to study the dynamics of microstructures’ and materials’ reactions.

Scientific objectives Some important aspects in evidence-based medicine have not been included in basic and applied research. The current level of examination of the cardiovascular system requires new analytical approaches for the pre-vention of cardiovascular diseases, insults and infarc-tions in people of different age, and diminishing of disability and mortality of vascular critical states. Technological approaches The technology of vascular screening enables not only to make accurate diagnoses but also to treat efficiently that reduces financial burden of a patient and his rela-tives. The medical technology will be useful in prophy-lactic and preventive medicine of the world for the health improvement of CVD patients. Results interpretation Regular vascular screening enables to perform diagnos-tics of microcirculatory disorders, to control efficiency of the therapy almost for every patient non-invasively (psychoneurological, therapeutic, angiological, endocri-nological, and cancer neovascularization profiles for the assessment of congenital and acquired vascular anoma-lies) and during prophylactic exanimations of healthy people who are under influence of external factors, resuscitation departments, insurance medicine and sports medicine.

Ulyana B Lushchyk1*, Viktor V Novytskyy2, Igor P Babii3, Nadiya G Lushchyk4, Lyudmyla S Riabets5, Ivanna I Legka6, Ulyana B Lushchyk1* *Corresponding author Email: u.lushchyk@gmail.com Viktor V Novytskyy2 Email: v.novytskyy@gmail.com Igor P Babii3 Email: chiefdoctor@istyna.kiev.ua Nadiya G Lushchyk4 Email: umi2012T@gmail.com Lyudmyla S Riabets5 Email: l.riabets@itmed.com.ua Ivanna I Legka6, Email: IvannaLegka2015@gmail.com 1Istyna-Veritas Research Center, Kyiv, Ukraine 2Institute of Mathematics of NAS of Ukraine, Kyiv, Ukraine 3Clinic of Healthy Vessels, Kyiv, Ukraine 4Medical center “Ukrainian medical innovations”, Ternopil, Ukraine 5Veritas IT Med Center for Innovative Medical Technologies, 4 Williams Str., Kyiv,03191, Ukraine 6Specialized clinic “Vessels, brain, neurorehabilitation”, Muscat, Oman Keywords Travel medicine, angiotherapy, meteo-dependence, vascular screening Scientific objectives Statistics shows that more than half of world population is dependent on meteorological factors, another half suffers stroke or heart attack, and 13% of cases have unexpected death. The organism’s reaction to sudden change of meteo-situation is one of the first signs of early dyshemia. Vascular disorders as system problems in the organism result in disbalance inside the organism, which is not able quickly to adapt to sudden meteorological changes. The research objectives are to find new personalized algorithms to predict negative influences of meteorological factors on the organism and create corresponding complex with feedback to control feeling and rapid reacting [1-3]. Technological approaches This research has established a number of regularities of physiology and pathological changes in hydro- and hemodynamic parameters in the human organism depending on influence of changes of meteo-factors, namely atmospheric pressure, air humidity, air temperature, wind velocity and direction, magnetic vibrations. Results interpretation The research results were put into basis of experimental samples of portable and stationary meteo-station with the feed-back effect for a certain patient. The developed meteo-stations are an integral complex for providing necessary data and parameters in departments of reanimation, psychoneurological and cardiologic departments. Outlook and Expert recommendations There is an urgent need in the timely informing of meteo-dependant people about threat of critical conditions for the organism and individual recommendations to improve the feeling. Reference 1. Lushchyk et al.: Monitoring brain functioning with evident based IT-technologies with feedback control. EPMA Journal 2014 5(Suppl 1):A100. 2. Lushchyk et al.: Screening of vascular pathologies – evidence-based monitoring of prevention efficiency. EPMA Journal 2014 5(Suppl 1):A91. 3. Lushchyk et al.: IT- technology for vascular monitoring as an evidential base in prevention and prediction of a vascular pathology. EPMA Journal 2014 5(Suppl 1):A64.

Psychological problems, brain exhaustions have a risk to be accumulated and pass to chronic psychosomatic and psychomuscular fixed vascular disorders, which can become a trigger for pathological stress vascular reactions as the Flammer-syndrome. A problem of early diagnosis and correction of vascular dysfunctions in the brain becomes extremely important both in childhood and to save manpower efficiency. Capillary microscopy, which can detect early changes in CVS and thus can prevent serious disorders due to biomarker technology of vascular screening.