134
H. Schmid-Schönbein
constriction and shear-induced smooth muscle relaxation (NO-vasodilatation mechanism). In contrast, it is equally easy for any user of LDA or rPPG techniques to
provoke by simple cooling very powerful, aperiodically modulated and asymmetrically reacting attracting transient processes in the form of strong peripheral effects of
neurogenic vasoconstriction. Having performed both provocation tests, each user of
LDA and/or rPPG equipment will easily comprehend that that the “normal” mixtures
of reactions that are recorded at “normal temperature” are simply the reflection
rapidly changing quasi-attractors upon the “tone” of vascular smooth muscle. It is
well known, of course, that under the influence of phasically acting alpha adrenergic
(“activating“) and beta-adrenergic (“relaxing“) mechanisms, the fluctuating activity
of various spinal efferent sympathetic neurons can be detected. If fine graining of noninvasive microcirculatory measurements is further improved, even lymphomotoric
activity can, in principle, be measured in clinical settings, they are bound to exert an
effect on the “attractor configuration“(a situation not yet incorporated into the analysis of microcirculatory dynamics, but see Christ). In addition, there are other aperiodic influences that can modify the exact configuration and positioning of attractors
within the phase space. These include such parameters as hemorheological events,
endothelial leakage with hemoconcentration and, most importantly in many severe
clinical situations, a pressure effect that can be paraphrased as compartment symptomatology (compaction of tissue content and/or the sequelae of abnormal external
compression). It can be expected that in these, still other attractor combination dominate the picture, an aspiration born out by occasional applications of our measuring
devices to isolated cases of hyperviscosity, of chronic vasogenic and lymphogenic
edema and to the symptomatology found subsequent to crush injury and ulcerations.
As can be seen, the strategem we developed many years ago is beginning to yield
pragmatically relevant dividends: where all attempts to find “quantitative” abnormalities of microvascular perfusion in clinical settings have largely disappointed,
the potentials of the combined assessment of as many non-invasively obtainable data
as possible should be pursued. For many applications, the ingenious FINAPRESS
®
system (allowing to record phasically the arterial pressure in a “non-traumatising”
fashion) can be recommended. However, for the interpretation of discrete alterations
this method is wanting: owing to the unpleasant pain of the inflated cuff this method
does not really qualify as “non-invasive”.
7.6 Outlook
By a combination of physical, physiological and—most importantly—pathophysiological situations, we were able to overcome one of the most sterile attempts for
the comprehension of cardiovascular functions, namely the delineation of putatively
“chaotic” dynamics as derived from merely phenomenological interpretation of in the
non-stationary and nonlinearly regulated time series (e.g. ECG-recordings). During
the 1990s, a serious confoundation of “order” with “pathological stereotypes” had
occurred, and thence it had been concluded that it were “healthy to be chaotic”.
H. Schmid-Schönbein
constriction and shear-induced smooth muscle relaxation (NO-vasodilatation mechanism). In contrast, it is equally easy for any user of LDA or rPPG techniques to
provoke by simple cooling very powerful, aperiodically modulated and asymmetrically reacting attracting transient processes in the form of strong peripheral effects of
neurogenic vasoconstriction. Having performed both provocation tests, each user of
LDA and/or rPPG equipment will easily comprehend that that the “normal” mixtures
of reactions that are recorded at “normal temperature” are simply the reflection
rapidly changing quasi-attractors upon the “tone” of vascular smooth muscle. It is
well known, of course, that under the influence of phasically acting alpha adrenergic
(“activating“) and beta-adrenergic (“relaxing“) mechanisms, the fluctuating activity
of various spinal efferent sympathetic neurons can be detected. If fine graining of noninvasive microcirculatory measurements is further improved, even lymphomotoric
activity can, in principle, be measured in clinical settings, they are bound to exert an
effect on the “attractor configuration“(a situation not yet incorporated into the analysis of microcirculatory dynamics, but see Christ). In addition, there are other aperiodic influences that can modify the exact configuration and positioning of attractors
within the phase space. These include such parameters as hemorheological events,
endothelial leakage with hemoconcentration and, most importantly in many severe
clinical situations, a pressure effect that can be paraphrased as compartment symptomatology (compaction of tissue content and/or the sequelae of abnormal external
compression). It can be expected that in these, still other attractor combination dominate the picture, an aspiration born out by occasional applications of our measuring
devices to isolated cases of hyperviscosity, of chronic vasogenic and lymphogenic
edema and to the symptomatology found subsequent to crush injury and ulcerations.
As can be seen, the strategem we developed many years ago is beginning to yield
pragmatically relevant dividends: where all attempts to find “quantitative” abnormalities of microvascular perfusion in clinical settings have largely disappointed,
the potentials of the combined assessment of as many non-invasively obtainable data
as possible should be pursued. For many applications, the ingenious FINAPRESS
®
system (allowing to record phasically the arterial pressure in a “non-traumatising”
fashion) can be recommended. However, for the interpretation of discrete alterations
this method is wanting: owing to the unpleasant pain of the inflated cuff this method
does not really qualify as “non-invasive”.
7.6 Outlook
By a combination of physical, physiological and—most importantly—pathophysiological situations, we were able to overcome one of the most sterile attempts for
the comprehension of cardiovascular functions, namely the delineation of putatively
“chaotic” dynamics as derived from merely phenomenological interpretation of in the
non-stationary and nonlinearly regulated time series (e.g. ECG-recordings). During
the 1990s, a serious confoundation of “order” with “pathological stereotypes” had
occurred, and thence it had been concluded that it were “healthy to be chaotic”.