[PDF] Basic And Clinical Understanding Of Microcirculation eBook
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Microcirculation is key to providing enough nutrition and oxygen from head to toe. This is possible only through an extensive network of blood vessels spread around the body. Effect of microcirculation abnormalities stretch beyond one’s comprehension. The effects could be felt at any age, from the foetal life to the adulthood. The chapters present in this book describe how these abnormalities could lead to diseases such as atherosclerosis, thrombosis, diabetes, hypertension. Disorders of microcirculation could be related to the structural and/or functional damage to the inner lining of the blood vessels. Early identification of these disorders could benefit many ailments including cardiovascular and cerebrovascular diseases such as heart attack and stroke.
This e-book will review special features of the cerebral circulation and how they contribute to the physiology of the brain. It describes structural and functional properties of the cerebral circulation that are unique to the brain, an organ with high metabolic demands and the need for tight water and ion homeostasis. Autoregulation is pronounced in the brain, with myogenic, metabolic and neurogenic mechanisms contributing to maintain relatively constant blood flow during both increases and decreases in pressure. In addition, unlike peripheral organs where the majority of vascular resistance resides in small arteries and arterioles, large extracranial and intracranial arteries contribute significantly to vascular resistance in the brain. The prominent role of large arteries in cerebrovascular resistance helps maintain blood flow and protect downstream vessels during changes in perfusion pressure. The cerebral endothelium is also unique in that its barrier properties are in some way more like epithelium than endothelium in the periphery. The cerebral endothelium, known as the blood-brain barrier, has specialized tight junctions that do not allow ions to pass freely and has very low hydraulic conductivity and transcellular transport. This special configuration modifies Starling's forces in the brain microcirculation such that ions retained in the vascular lumen oppose water movement due to hydrostatic pressure. Tight water regulation is necessary in the brain because it has limited capacity for expansion within the skull. Increased intracranial pressure due to vasogenic edema can cause severe neurologic complications and death.
The microcirculation is highly responsive to, and a vital participant in, the inflammatory response. All segments of the microvasculature (arterioles, capillaries, and venules) exhibit characteristic phenotypic changes during inflammation that appear to be directed toward enhancing the delivery of inflammatory cells to the injured/infected tissue, isolating the region from healthy tissue and the systemic circulation, and setting the stage for tissue repair and regeneration. The best characterized responses of the microcirculation to inflammation include impaired vasomotor function, reduced capillary perfusion, adhesion of leukocytes and platelets, activation of the coagulation cascade, and enhanced thrombosis, increased vascular permeability, and an increase in the rate of proliferation of blood and lymphatic vessels. A variety of cells that normally circulate in blood (leukocytes, platelets) or reside within the vessel wall (endothelial cells, pericytes) or in the perivascular space (mast cells, macrophages) are activated in response to inflammation. The activation products and chemical mediators released from these cells act through different well-characterized signaling pathways to induce the phenotypic changes in microvessel function that accompany inflammation. Drugs that target a specific microvascular response to inflammation, such as leukocyte-endothelial cell adhesion or angiogenesis, have shown promise in both the preclinical and clinical studies of inflammatory disease. Future research efforts in this area will likely identify new avenues for therapeutic intervention in inflammation. Table of Contents: Introduction / Historical Perspectives / Anatomical Considerations / Impaired Vasomotor Responses / Capillary Perfusion / Angiogenesis / Leukocyte-Endothelial Cell Adhesion / Platelet-Vessel Wall Interactions / Coagulation and Thrombosis / Endothelial Barrier Dysfunction / Epilogue / References
This presentation describes various aspects of the regulation of tissue oxygenation, including the roles of the circulatory system, respiratory system, and blood, the carrier of oxygen within these components of the cardiorespiratory system. The respiratory system takes oxygen from the atmosphere and transports it by diffusion from the air in the alveoli to the blood flowing through the pulmonary capillaries. The cardiovascular system then moves the oxygenated blood from the heart to the microcirculation of the various organs by convection, where oxygen is released from hemoglobin in the red blood cells and moves to the parenchymal cells of each tissue by diffusion. Oxygen that has diffused into cells is then utilized in the mitochondria to produce adenosine triphosphate (ATP), the energy currency of all cells. The mitochondria are able to produce ATP until the oxygen tension or PO2 on the cell surface falls to a critical level of about 4–5 mm Hg. Thus, in order to meet the energetic needs of cells, it is important to maintain a continuous supply of oxygen to the mitochondria at or above the critical PO2 . In order to accomplish this desired outcome, the cardiorespiratory system, including the blood, must be capable of regulation to ensure survival of all tissues under a wide range of circumstances. The purpose of this presentation is to provide basic information about the operation and regulation of the cardiovascular and respiratory systems, as well as the properties of the blood and parenchymal cells, so that a fundamental understanding of the regulation of tissue oxygenation is achieved.
This reference is a volume in the Handbook of Physiology, co-published with The American Physiological Society. Growth in knowledge about the microcirculation has been explosive with the field becoming fragmented into numerous subdisciplines and subspecialties. This volume pulls all of the critical information into one volume. Meticulously edited and reviewed. Benefit: Provides investigators a unique tool to explore the significance of their findings in the context of other aspects of the microcirculation. In this way, the updated edition has a direct role in helping to develop new pathways of research and scholarship Highlights the explosive growth in knowledge about the microcirculation including the biology of nitric oxide synthase (NOS), endothelial cell signaling, angiogenesis, cell adhesion molecules, lymphocyte trafficking, ion channels and receptors, and propagated vasomotor responses. Benefit: Microcirculatory biology has become fragmented into numerous sub-disciplines and subspecialties, and these reference reintegrates the information in one volume
The book provides a comprehensive overview of selected topics in microcirculation, from physiology to pathophysiology including molecular mechanisms and clinical aspects. It contains 10 chapters written by reputed authors, which comprehensively sum up the current knowledge and some interesting new insights in the field of microcirculation. It will be useful to a broad range of audience, from students to highly profiled experts, helping them to expand their knowledge on microcirculation and opening up additional questions for further investigation.
This book offers an extensive review of the most recent data on the pathophysiological role of structural and functional alterations in the microcirculation, particularly focusing on hypertension and diabetes. It covers several relevant and innovative aspects, including the possible mechanisms involved in the development of microvascular remodeling and rarefaction, the technical approaches available for the detection of microvascular alterations, including non-invasive evaluations, the prognostic role of changes in small resistance artery structure, the possibility of preventing or regressing such alterations with appropriate treatment, and the potential clinical advantages of such intervention. A number of innovative areas of research are considered, including the role of the immune system, inflammation and oxidative stress in the development of microvascular alterations. Lastly, it examines the availability of recent non-invasive methods for the evaluation of small resistance artery morphology in the retina, which in the near future may provide a useful tool for the stratification of cardiovascular risk and even for clinical decisions regarding drug treatment, thus providing physicians with a clinically relevant instrument for improving and optimizing the management of hypertensive and diabetic patients. The book provides valuable, clinically relevant information for specialists (cardiology, internal medicine, and endocrinology) and general practitioners, and also offers novel and stimulating data to basic and clinical researchers.
In the past two decades a number of studies have shown that abnormalities in the function and structure of coronary microcirculation can be detected in several cardiovascular diseases. On the basis of the clinical setting in which it occurs, coronary microvascular dysfunction (CMD) can be classified into four types: CMD in the absence of any other cardiac disease; CMD in myocardial diseases; CMD in obstructive epicardial coronary artery disease; and iatrogenic CMD. In some instances CMD represents an epiphenomenon, whereas in others it represents an important marker of risk or may contribute to the pathogenesis of myocardial ischemia, thus becoming a possible therapeutic target. This book provides an update on coronary physiology and a systematic assessment of microvascular abnormalities in cardiovascular diseases, in the hope that it will assist clinicians in prevention, detection and management of CMD in their everyday activity.
This book presents recent progress in microvascular disorders including cerebral, myocardial and peripheral tissue ischemia, multiple organ failure and gastroenterological disorders. Knowledge of microcirculation is essential in order to understand thoroughly the mechanism of organ disorders. This book successfully elucidates the pathophysiologic significance of microcirculation in ischemia and other diseases. It is useful for basic researchers and clinicians who are interested in the early diagnosis and prevention of cardiovascular diseases as well as in the mechanism of circulatory disorders.
First published in 1995: Clinically Applied Microcirculation Research combines state-of-the-art microcirculation technology with present and potential applications in clinical medicine. This comprehensive guide unites the expertise of clinicians and basic researchers from around the world. Many of the chapters are authored by scientist/physician teams. The book provides a broad overview of how microcirculation is involved in clinical research. This is also a valuable reference source for both the history of and latest developments in microcirculation research.