Aim — the development of method for early diagnosis of microangiopathy in patients with type 1 diabetes mellitus (DM) by capillaroscopy with functional tests: the cuff occlusion of the upper extremity, tests with the cooling and heat exposures on the upper extremity.Material and methods. We investigated 54 patients with DM type I (mean age 24,1±3.2 years), who were divided into 2 groups: I group — 28 (51.6%) patients with duration DM <5 years; group II — 26 (48.4%) with duration DM >7 years. All the patients were underwent complex laboratory and instrumental examinations and also capillaroscopy and functional tests. Control group was consisting of 26 healthy people.Results. We revealed early stages of the diabetic microangiopathy even before the appearance of structural changes in patients with DM type at functional tests. We were identified the functional disorders: increasing recovery time of capillaroscopic parameters after carrying out functional tests to baseline versus control.Conclusion. We were to diagnose structural changes of microcirculation in diabetic patients with disease duration more than 7 years by capillaroscopy. In the early stages of the disease we were observed functional disorders which appearance before the structural changes using functional tests. It was lengthened recovery time of capillaroscopic dates after carrying out functional tests to baseline values in comparison with the control group. Recovery time may be used as early diagnostic criteria of diabetic microangiopathy when carrying out functional tests in patients with DM.

Целью данной работы явилось изучение взаимосвязи показателей капилляроскопии сосудов верхних конечностей с выраженностью нефропатии, ретинопатии, клиническими проявлениями ангиопатии нижних конечностей у больных сахарным диабетом 1-го типа.Методы исследования. Обследовано 53 больных сахарным диабетом 1-го типа: 30 лиц женского пола и 23 — мужского. Исследуемые были разделены на 3 группы. Всем больным выполнялась компьютерная капилляроскопия.Результаты исследования. Наибольшие изменения сосудов микроциркуляторного русла отмечены у больных III группы, имевших выраженные стадии микроангиопатий.Поражение сосудов микроциркуляторного русла верхних конечностей прогрессировало с развитием основного заболевания и проявлялось укорочением длины капилляров, снижением плотности капиллярной сети, увеличением диаметров переходных отделов капилляров. Показатель плотности капиллярной сети наиболее четко характеризовал состояние кровотока, а его снижение свидетельствовало о глубоких нарушениях микроциркуляции на периферии. Уменьшение плотности капиллярной сети имело прямую корреляционную взаимосвязь со скоростью клубочковой фильтрации (ρ = 0,601) и обратную корреляционную взаимосвязь с наличием белка в моче (ρ = –0,644).У пациентов с сахарным диабетом 1-го типа изменения структуры капилляров ногтевого ложа верхних конечностей прогрессировали синхронно стадиям ретинопатии и клиническим проявлениям ангиопатии нижних конечностей.

In recent years, ideas about the pathogenesis of urinary tract infections have been changed significantly. Various pathogenetic factors of microorganisms and new defense mechanisms against them have been discovered. A significant part of pathogens is inactivated by the first line of defense - innate immunity which includes epithelial barriers (mucous membranes), cellular (phagocytes, dendritic cells, NK-cells) and humoral (chemokines, cytokines, complement) components, as well as antimi­crobial proteins). The second and more specific line of defense is the acquired (adaptive) immune system - humoral (B-cells, antibodies) immunity and cellular (T-cells) immunity. However, epithelial cells play an important role in the immune response. These cells interact with the components of both innate immunity and acquired one. Antimicrobial proteins are one of the most ancient and primitive components of the immune system and they are very widely spread in nature. More than 800 antimicro­bial proteins have been described and more than 100 of them have been found in the human body. The mechanism of these proteins is mainly connected with the violation of the bacterial membrane integrity. Nevertheless, some proteins can inhibit protein and/or DNA synthesis. The most common protein in the urine is uromodulin (Tamm-Horsfall protein), synthesized in the thick ascending section of the Henle loop. Uromodulin does not have direct antimicrobial activity, but it is involved in the pathogenesis of many inflammatory kidney diseases. In addition, uromodulin acting through the TLR4 signaling pathway pro­motes the maturation of dendritic cells, thereby further activating innate and acquired immunity. Currently, the role of antimi­crobial proteins and dendritic cells in the pathogenesis of the infectious process is being actively studied. It will probably have a significant practical value. Thus, the development of urinary tract infections is the process of competing for the interaction of the uropathogenic and the macroorganism. The treatment of these diseases (especially chronic) should not be limited to the use of antibacterial drugs. An important component of the pathogen eradication is to increase the activity of its own protective mechanisms.

Background. The adverse impact of chronic hyperglycaemia on vascular wall in diabetes mellitus includes endothelial dysfunction with subsequent development of diabetic microangiopathy. Microangiopathy can be corrected via adequate glycaemic control for establishing a target level of glycated haemoglobin. Considering a multiplex nature of metabolic and vascular regulation, a comprehensive approach is required for simultaneous correction of rheological disorders, hypercoagulation and endothelial dysfunction.Objectives. Estimation of vascular factors (von Willebrand factor, desquamated endothelium, antithrombin III, protein C, VEGF) and capillaroscopic patterns in therapy for type 1 diabetes with methylethylpyridinol in comparison with sulodexide.Methods. A total of 89 patients with type 1 diabetes were examined and separated by two cohorts: 42 patients receiving sulodexide (cohort 1) and 47 patients receiving methylethylpyridinol (cohort 2). Therapy duration was 14 days. Both cohorts were estimated pre- and post-treatment endothelial conditions (activity of von Willebrand factor, VEGF, desquamated endothelial cell count), anticoagulant indicators (activity of antithrombin III, protein C) and had capillaroscopy with functional test and oximetry.Results. Diabetes patients in pre-treatment exhibited signs of endothelial dysfunction, reduced blood anticoagulant protection and capillary constriction. Both cohorts in post-treatment showed the significantly reduced von Willebrand factor, VEGF activity and desquamated endothelial cell count. The anticoagulant system revealed positive dynamics; capillaroscopy reported limiting of the capillary transition zonal diameter and a certain improvement in functional performance.Conclusion. Patients with type 1 diabetes were revealed with endothelial dysfunction and an increased blood procoagulant activity. Both sulodexide and methylethylpyridinol treatments improved endothelial dysfunction and anticoagulant blood protection. Both preparations can be used for complex microangiopathy correction in patients with <10-years history of type 1 diabetes mellitus.

Background. The widespread prevalence of diabetes and the progressive deterioration of health against the background of this disease substantiate the need for the use of new methods for the early diagnosis of diabetic microangiopathies. The combined use of digital capillaroscopy and deep learning technologies will significantly improve the quality and speed of microvascular disorders diagnostics. Aim. Development of a system for assessing capillary images based on artificial neural networks, as well as its testing for the early diagnosis of microangiopathy in patients with diabetes mellitus. Material and methods. 136 patients (59 females and 77 males) with type 1 diabetes mellitus aged 25.826.05 years were examined and divided into two groups: the first group included 65 (47.8%) patients who had no symptoms of diabetic microangiopathies, the second group 71 (52.2%) patients who were diagnosed with one or more diabetic microangiopathies. The control group consisted of 30 practically healthy volunteers. All patients with diabetes melitus, as well as individuals from the control group, underwent сapillaroscopic examination. The resulting images were analyzed using the developed evaluation system based on artificial neural networks. Statistical data processing was performed using the Student and MannWhitney tests (U-test), logistic regression analysis, and ROC analysis. Results. In patients with diabetes mellitus, there was a decrease in the capillary network density in both groups and the diameter of the arterial sections in the second group. Capillaroscopy using the developed system showed a sufficient level of significance (2=21, p=0.000), high sensitivity (71.43%) and specificity (85.71%). This method can be used in the diagnosis of microangiopathy in diabetic patients. Conclusion. The combined use of capillaroscopy and neural networks allows to increase the speed and quality of the examination, as well as simplify the interpretation of the resulting images.