Nailfold capillaroscopy is a useful tool to diagnose endocrine, cardiovascular, neuropsychiatric, rheumatic and other diseases. Diagnoses are made on the presence or absence of certain types of capillary loops which are classified according to their shape. We have surveyed six clinicians, asking them to classify 217 capillary loops, in order to establish quantitative nailfold capillary loop classification criteria. The participating clinicians were not unanimous about the classification of any capillary, and there was no consensus about the class of 17% of the capillary loops. Some of the clinicians classified two occurrences of the same shape differently. This clearly demonstrates the need for well established classification criteria. Nailfold capillary loop classes can be divided into two major groups: Descriptive Classes (DC); "cuticulis", "open", "tortuous", "crossed", "bizarre" and "bushy", and Label Classes; "enlarged", "elongated" and "giant". Furthermore label classes can be divided into two groups, Width Anomaly Classes (WAC); "enlarged" and "giant", and Length Anomaly Class (LAC), "elongated". While descriptive classes give information about the shape of a loop, label classes emphasise dimensional anomalities of a loop. Assignment of a loop with one the descriptive or label classes causes information loss about the dimensions or shape, respectively. In order to preserve as much information as possible within a class, we propose a new class system that contains 17 classes which are the combination of WAC, LAC and DC. We propose quantitative classification criteria for commonly used classes: "cuticulis", "open", "tortuous", "elongated" and "giant". Although the class "enlarged" can be expressed quantitatively, inappropriate assignments of "enlarged" by the paricipating clinicians have not allowed us to set quantitative classification criteria. While definition of the class "crossed" is purely qualitative, a classification mechanism that is neither qualitative nor quantitative is proposed for "bizarre" and "bushy" loops. We propose the use of pattern recognition algorithms that are based on the evaluation of the capillary shape parameters such as loop length, loop width, limb width, the curvature, orientation, etc., to classify capillaries. By the use of mathematical morphology, skeletonization, topological relations, feature vectors, in an hierarchical structure, the software TANCCAS (The Automated Nailfold Capillary Classification and Analysis System) has been developed to calculate the shape parameters and to classify the capillary loops. These algorithms have been implemented on a Pentium PC and have resulted in an 88% accuracy level which is compared to participating clinicians' overall classifications of the test images.

Capillaroscopy is a non-invasive and safe tool which allows the evaluation of the morphology of the microcirculation. Since its recent incorporation in the 2013 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for systemic sclerosis together with its assessed role to monitor disease progression, capillaroscopy became a ‘mainstream’ investigation for rheumatologists. Given its increasing use by a variety of physicians internationally both in daily practice to differentiate primary from secondary Raynaud's phenomenon, as well as in research context to predict disease progression and monitor treatment effects, standardisation in capillaroscopic image acquisition and analysis seems paramount. To step forward to this need, experts in the field of capillaroscopy/microcirculation provide in this very consensus paper their view on image acquisition and analysis, different capillaroscopic techniques, normal and abnormal capillaroscopic characteristics and their meaning, scoring systems and reliability of image acquisition and interpretation. / Revisión por pares

Objetivos. Analisar prospectivamente os dados de capilaroscopiaperiungueal (CPU) em pacientes com dermatomiosite recém-diagnosticada (DM) e correlacioná-los com citocinas angiogênicas séricas e características clínicas e laboratoriais. Métodos. Vinte e três pacientes com DM com < 12 meses de sintomas foram incluídos no estudo. Para avaliar os níveis de citocinas séricas, os pacientes foram pareados 23 voluntários saudáveis por idade, sexo e etnia. As características da CPU e os parâmetros da atividade da DM foram analisados. Resultados. Foram observados níveis aumentados de angiogenina (ANG) e de fator de crescimento de endotélio vascular-1 (VEGF1) séricos de forma significativa em pacientes com DM em comparação com os controles saudáveis. Os níveis de ANG sérica correlacionaram-se positiva e negativamente, respectivamente, com a densidade capilar e as áreas avasculares. Além disso, a densidade capilar correlacionou-se inversamente com o número de capilares ectasiados, capilares gigantes e áreas avasculares. O número de capilares ectasiados correlacionou-se positivamente com a Escala Visual Analógica (EVA) do paciente e do médico, a presença de eritema facial, capilares gigantes e micro-hemorragias. Os capilares gigantes apresentaram correlação positiva com EVA do médico e da atividade cutânea, capilares ectasiados, áreas avasculares, micro-hemorragias e capilares em forma de arbustos e correlação negativa com a densidade capilar. Micro-hemorragias correlacionaram-se positivamente com o sinal de \"V do decote\" e EVA do médico. O VEGF1 sérico não mostrou relação com os parâmetros da CPU ou com características clínicas e laboratoriais relacionadas a DM. Além disso, 15 dos 23 pacientes foram avaliados prospectivamente após 3,21 anos. Todos os pacientes tiveram resposta clínica com melhora significativa em todos os parâmetros da CPU, exceto em relação a capilares ectasiados e número de capilares em forma de arbustos. Conclusões. A CPU pode ser uma ferramenta útil para avaliar a atividade da doença em DM de início recente e a sua correlação com a ANG sérica sugere a participação desta citocina na neoangiogênese da doença / Objectives. To prospectively analyze nailfold capillaroscopy (NC) findings in new-onset dermatomyositis (DM) and to correlate NC findings with serum angiogenic cytokines and DM clinical and laboratory features. Methods. Twenty-three patients with DM who experienced < 12 months of symptoms were included in the study. To assess serum cytokine levels, 23 age-, sexand ethnicity-matched healthy volunteers were used. NC characteristics and DM activity parameters were analyzed. Results. Significantly higher serum angiogenin (ANG) and vascular endothelial growth factor-1 (VEGF1) levels were observed in DM patients than in controls. Capillary density and avascular areas correlated positively and negatively, respectively, with serum levels of ANG. Moreover, the capillary density correlated inversely with the number of enlarged and giant capillaries and avascular areas. The number of enlarged capillaries correlated positively with patient and physician VAS, the presence of a facial rash, giant capillaries and microhemorrhages. Giant capillaries had a positive correlation with physician and cutaneous VAS, enlarged capillaries, avascular areas, microhemorrhages and bushy capillaries and a negative correlation with capillary density. Microhemorrhages correlated positively with the \"V-neck\" sign and physician VAS. VEGF1 showed no relationship with the NC parameters with DMrelated clinical and laboratory features. Additionally, 15 out of 23 patients were assessed prospectively after 3.21 years. All patients had a major clinical response with significant improvement in all NC parameters, except for enlarged and bushy capillaries. Conclusions. The NC may be a useful tool to assess disease activity in recent-onset DM, and it can also reinforce the role of ANG in the angiogenesis of this myopathy

Nailfold capillary microscopy is simple, non-invasive, no injuries and easy to observe human`s microcirculation and micro blood stream directly. Due to these advantages, it plays a significant role in diseases diagnoses, treatments and prognosis. The observation of microcirculation focuses on hand, foot naildfold, conjunctival, lingual surface and lips. Nailfold microcirculation is usually performed on the ring finger. However, when measuring the speed of blood flow, difficulty to stabilize the region of interest (ROI) is often encountered. This problem becomes more serious when the magnification of microscope increases. Fixture to stabilize finger will inevitably affect the speed of blood flow under observation. The Laser Doppler blood flow velocimetry method, is expensive, only can be used in bigger capillary or to measure the average flow velocity of lager observed area, lacking of diversified morphological features of capillary, it¡¦s precision is worse than microscopy image capture method, and because of the regular contraction and relaxation of arterioles it can only measure the local blood flow velocity, cannot describe whole details of capillary blood flow velocity, some important information of microcirculation will be ignored easily. This thesis employs computer vision technique to operate displacement compensation of microscopy image sequence to stabilize observed area and extract area of capillary. Then the morphological and hemodynamic pathology features will be derived and analyzed to evaluate the status of a person¡¦s health. Not only morphological features, e.g., length, density and color, but also hemodynamic features, e.g., blood flow velocity will be measured to assess the microcirculation in end capillary. The most significant characteristic of this project is to combine three-dimensional models reconstruction technology of computer graphic to reconstruct three-dimensional capillary models and perform the three-dimensional dynamic blood flow visualization. Thus, the capillary blood flow can be adjusted and observed in the desired orientation, magnification and viewpoint. A variety of pathologically significant features of nailfold microcirculation will be extracted in the project proposed. These features can be classified into morphological and hemodynamic features. The morphological features extracted include the number, width/height, density, arteriolar limb caliber, curved segment caliber, venular limb caliber, blood color, tortuosity, and width of the curved segment of capillaries. On the other hand, hemodynamic features including velocity, direction of blood flow will also be extracted. By integrating both morphological and hemodynamic features, the status of a person¡¦s health can be evaluated by the doctor. The novel system proposed is not only easy to operate, low-cost but also has the great potential to be utilized clinically.

O envelhecimento populacional é um fenômeno mundial, assim como o predomínio de mortes por doenças cardiovasculares. Estudos demonstram que o envelhecimento acarreta aumento da rigidez vascular e perturbações na reatividade macrovascular. O presente estudo comparou a microcirculação deste processo com adultos jovens através da pletismografia de oclusão venosa (POV) e da videocapilaroscopia do leito periungueal (VC). Para isto, desenvolveu-se um estudo transversal com dois grupos: idade entre 18 e 30 anos (n=16) e outro grupo com idade igual ou superior a 60 anos (n=21), além da subdivisão deste grupo em três subgrupos: idosas saudáveis (n=8), idosas em tratamento de hipertensão arterial (IDHAS,n=6) e idosas em tratamento de dislipidemia (IDDIS,n=6). Foram realizadas avaliações clínica, antropométrica, bioquímica e microcirculatória. Como resultados, a VC mostrou aumento dos diâmetros capilares aferente, apical e eferente e redução da relação velocidade máxima/ velocidade basal de deslocamento de hemácias para grupo de idosas e todos os subgrupos. A POV revelou diminuição da vasodilatação endotélio-dependente em todos os grupos estudados e a vasodilatação endotélio-independente alterou-se apenas em IDHAS e IDDIS. Como conclusões houve, no envelhecimento, alterações estruturais e funcionais da microcirculação assim como redução da vasodilatação endotélio-dependente. A vasodilatação endotélio-independente manteve-se inalterada, indicando que a célula muscular lisa da parede vascular permanece preservada, porém sofre alterações nos grupos IDHAS e IDDIS. / Population aging is a worldwide phenomenon, as well as the prevalence of deaths from cardiovascular diseases. Studies show that aging brings increased vascular stiffness and altered vascular reactivity. The present study compared the microcirculation of elderly people to young adults by venous occlusion plethysmography (POV) and nailfold videocapillaroscopy (NVC). For this, we developed a cross-sectional study with two groups: those aged between 18 and 30 years (n = 16) and another group aged over 60 years (n = 21), and the subdivision of this group into three subgroups: healthy elderly (n = 8), elderly women being treated for hypertension (IDHAS, n = 6) and older in the treatment of dyslipidemia (IDDIS, n = 6). Clinical, anthropometric, biochemical and microcirculatory parameters were evaluated. As results, NVC showed an increase of afferent, apical and efferent capillary diameters and a lower ratio maximum red blood cell velocity/ baseline red blood cell velocity for the older group and all subgroups. POV showed decreased endothelium-dependent vasodilation in all groups and the endothelium-independent vasodilation was altered only in IDHAS and IDDIS. In conclusion, in the aging, there were structural and functional changes of microcirculation as well as reduced endothelium-dependent vasodilation. The endothelium-independent vasodilation remained unchanged, indicating that smooth muscle cells of the vascular wall remains preserved, but show changes in the groups IDHAS and IDDIS.

O envelhecimento populacional é um fenômeno mundial, assim como o predomínio de mortes por doenças cardiovasculares. Estudos demonstram que o envelhecimento acarreta aumento da rigidez vascular e perturbações na reatividade macrovascular. O presente estudo comparou a microcirculação deste processo com adultos jovens através da pletismografia de oclusão venosa (POV) e da videocapilaroscopia do leito periungueal (VC). Para isto, desenvolveu-se um estudo transversal com dois grupos: idade entre 18 e 30 anos (n=16) e outro grupo com idade igual ou superior a 60 anos (n=21), além da subdivisão deste grupo em três subgrupos: idosas saudáveis (n=8), idosas em tratamento de hipertensão arterial (IDHAS,n=6) e idosas em tratamento de dislipidemia (IDDIS,n=6). Foram realizadas avaliações clínica, antropométrica, bioquímica e microcirculatória. Como resultados, a VC mostrou aumento dos diâmetros capilares aferente, apical e eferente e redução da relação velocidade máxima/ velocidade basal de deslocamento de hemácias para grupo de idosas e todos os subgrupos. A POV revelou diminuição da vasodilatação endotélio-dependente em todos os grupos estudados e a vasodilatação endotélio-independente alterou-se apenas em IDHAS e IDDIS. Como conclusões houve, no envelhecimento, alterações estruturais e funcionais da microcirculação assim como redução da vasodilatação endotélio-dependente. A vasodilatação endotélio-independente manteve-se inalterada, indicando que a célula muscular lisa da parede vascular permanece preservada, porém sofre alterações nos grupos IDHAS e IDDIS. / Population aging is a worldwide phenomenon, as well as the prevalence of deaths from cardiovascular diseases. Studies show that aging brings increased vascular stiffness and altered vascular reactivity. The present study compared the microcirculation of elderly people to young adults by venous occlusion plethysmography (POV) and nailfold videocapillaroscopy (NVC). For this, we developed a cross-sectional study with two groups: those aged between 18 and 30 years (n = 16) and another group aged over 60 years (n = 21), and the subdivision of this group into three subgroups: healthy elderly (n = 8), elderly women being treated for hypertension (IDHAS, n = 6) and older in the treatment of dyslipidemia (IDDIS, n = 6). Clinical, anthropometric, biochemical and microcirculatory parameters were evaluated. As results, NVC showed an increase of afferent, apical and efferent capillary diameters and a lower ratio maximum red blood cell velocity/ baseline red blood cell velocity for the older group and all subgroups. POV showed decreased endothelium-dependent vasodilation in all groups and the endothelium-independent vasodilation was altered only in IDHAS and IDDIS. In conclusion, in the aging, there were structural and functional changes of microcirculation as well as reduced endothelium-dependent vasodilation. The endothelium-independent vasodilation remained unchanged, indicating that smooth muscle cells of the vascular wall remains preserved, but show changes in the groups IDHAS and IDDIS.

Objectif : Déterminer la prévalence de la Sclérose systémique (SSc) chez les patients atteints de cirrhose biliaire primitive (CBP) et décrire les caractéristiques cliniques, pronostiques, immunologiques et capillaroscopiques chez les patients avec et sans SSc. Méthode : Étude descriptive de 100 patients avec CBP naïfs de SSc référés par les gastroentérologues. Un examen physique ainsi qu’un prélèvement sanguin et une capillaroscopie ont été réalisés. Résultats : Parmi les 22 patients diagnostiqués avec SSc, 13 n’avaient pas d’atteinte cutanée. Trente-neuf patients présentaient un phénomène de Raynaud. Dix-neuf étaient anticentromères (ACAs) positifs dont 18 avaient une SSc. Le groupe de CBP avec SSc avait un score Mayo meilleur et une atteinte histologique moins sévère. Une capillaroscopie anormale était retrouvée chez 29/100 patients. Les patients sans ACAs avaient une hypertension portale légèrement plus fréquente 14/81 (17,28%, p= 0,876) et une atteinte histologique hépatique plus sévère (89,5%, p=0,125). Le score Mayo était globalement meilleur dans le groupe des ACAs positifs. La sensibilité et la spécificité du test immunologique sont 95,45% et 93,59% respectivement. La capillaroscopie a une sensibilité de 78% et une spécificité de 94% pour le diagnostic de la SSc dans la population de CBP.   Conclusion : La SSc est fréquente dans la CBP, d’où l’intérêt de rechercher systématiquement les signes cliniques subtiles de la SSc, notamment le phénomène de Raynaud, et de demander une sérologie spécifique et une capillaroscopie pour identifier une SSc débutante. / Objective : To determine the prevalence of systemic scleroderma (SSc) in patients with primary biliary cirrhosis (PBC) and to describe the clinical, prognostic, immunologic and nailfold capillaropscopy characteristics in patients with and without SSc. Study design : In this descriptive cohort study, 100 patients with PBC who were unknown for any connective tissue disease, in particular for SSc, were referred by their gastroenterologist. Physical examination with collection of serum samples and nailfold capillaroscopy examination were performed. Results : Twenty-two patients had been diagnosed with SSc of which 13 had no cutaneous manifestations of scleroderma. Thirty-Nine patients had Raynaud’s phenomenon. Of the 19 patients with anticentromères antibodies (ACAs), 18 had SSc. Patients with PBC and SSc had a better Mayo score and less severe liver damage. Twenty-nine patients had abnormal nailfold capillaroscopy. More frequent portal hypertension 14/81 (17,28%, p= 0,876) and severe liver tissue damage (89.5%, p=0.125) seen in patients with positive ACAs. Mayo score was better in patients with positives ACAs. The sensitivity and specificity of the immunologic tests were 95,45% and 93,59% respectively. The sensitivity of nailfold capillaroscopy was 78% and specificity was 94% for the diagnosis of SSc in patients with PBC.   Conclusion : SSc is more prevalent in PBC. This study highlights the importance of screening for subtle clinical signs of SSc in patients with PBC, in particular Raynaud’s phenomenon, hence requiring immunologic tests and nailfold capillaroscopy to diagnose scleroderma at earlier stages.