Notoriously there is a great structural-functional difference between “central” adipose tissue, i.e. abdominal and visceral adipose tissue, and that “peripheral”, e.g. thigh. Insulin-resistance involves, as we clinically demonstrated, almost always central adipose tissue, we are here investigating, but not peripheral adipose tissue, e.g. tight. Biophysical-semeiotic preconditioning is the method of examination based on comparison of the parameters values of some reflexes, assessed in “quantitative” manner at rest (basal line) and then in a second evaluation, performed after exact 5 sec. of intervall from the first. From the technical clinical-microangiological point of view, by means of this clinical tool, doctor evaluates precisely both structure and function of local microvascular system, i.e. local Microcirculatory Functional Reserve (MFR) (4, 5). From technical view-point, at least it is necessary the knowledge of auscultatory percussion of stomach (Fig.1) (http://www.semeioticabiofisica.it, Technical Pages, N? 1).
Figure shows both the precise location of bell-piece of stethoscope and parallell and centripetal lines, on which digital percussion, directly and gently, must be applied in order to outlining properly the great curvature of stomach, or in practice only a small tract.
In an individual, psycho-physically relaxed and in supine position, cutaneous “lasting” pinching of the abdomen (lateral abdominal part at right and at left, or near to umbilicus) physiologically provokes gastric aspecific reflex (Fig. 1: in the stomach, both fundus and body are dilated, while antral-pyloric region contracts) after latency time (lt) 8 sec. In healthy, immediately after preconditioning lt rises to 10 sec. On the contrary, in subjects with dyslipidaemic constitution as well as obviously in dyslipidaemic patients, lt at basal line results 8 sec. and after preconditioning appears to be either the same or reduced, in inverse relation to the seriousness of underlying disorder. Without discussing patho-physiological mechanisms, the values of gastric aspecific reflex parameters are based on, it is enough to know that these behaviours are related to local Functional Microcirculatory Reserve (FMR), which in turn is strictly related to both anatomy and function of important microcirculatory structures, essential in direct capillary blood-flow, which parallel parenchimal alteration, both structural and functional. Among these really interesting structures we consider, later, only ubiquitarious Endoarteriolar Blocking Devices (EDB). According to our researches (See Bibliography in above-cited site and in http://diglander.libero.it/microangiologia), in fact, altered “genetic” information acts on both parechymal function-structure and local microvessels, that nowadays can be assessed clinically, thanks to Biophysical Semeiotics, which originated Clinical Microangiology.
Before going on, reader must remember that EBD, present in all tissues, are manifold microvascular structures, made up by smooth muscle cells, placed in different ways, and lined with endothelial cells. They are localized in two stations (first and second stations) along small arteries, according to Bucciante whose media is formed by 2 or more layers of smooth muscle cells (6, 7, 8). Their action mechanism (blood-flow direction toward the capillary bed) is obvious, in that their contraction brings about volume reduction, while the relaxation causes arteriolar lumen obstraction, evaluated as dilation of mean ureteral tract (Fig.2 and 3). EBD Clinical biophysical semeiotic evaluation represents practically the assessement of “mean” ureteral reflex (dilation of ureteral mean third), caused by cutaneous-sub-cutaneous lasting pinching, of average intensity of adipose tissue, we want examine. (See above) (Fig. 2).
!http://www.indmedica.com/cyberlecturespics/stagnaro_cl_biophysical_fig2.jpg"(In the figure the correct locations of the bell-piece)!
In the figure the correct locations of the bell-piece of stethoscope and the lines upon which auscultatory percussion, directly and gently, must be applied, in order to out-linig properly both kidneys and ureters, are clearly indicated.
After lt 3-4 sec., appears the dilation (1 cm.) of mean ureteral third or mean ureteral reflex, which in healthy lasts for 20 sec. exactly and, then, disappears for exact 6 sec. (Fig. 3). Interestengly, preconditioning lenghtens opening duration, which rises to about 22 sec., while reduces closure duration, that lowers to – 5 sec., in relation to the degree or severity ot underlying metabolic disorder.
On the contrary, in case of dyslipidaemic constitution as well as dyslipidaemia, of course reflex duration (EBD opening) results – 19 sec. (NN = 20), and its disappearing persists for 6-7 (NN = 6 sec. exactly).
Figure shows, in a very refined manner, a typical EDB with large installation base. (from S.B. Curri’s Le Microangiopatie, Ed. Inverni della Beffa).
Moreover, soon after preconditioning these values either are unchanged, i.e. identical to those at basal line, or EBD opening appears to be lessened in a statistically significant manner, and the EBD closure is greater than before (7-8 sec.), in relation once again to the seriouness of underlying lipidic dysmetabolism. In conclusion, the precise evaluation of microcirculation on “central” adipose tissue allows, in really easy way, to assess local MFR and, then, to recognize the dyslipidaemic constitution, starting from the first decades of life. A large variety of further biophysical-semeiotic evaluations, which require a staedy knowledge of the new physical semeiotics, permits doctor to gather a lot of information about local metabolic situation and consequently about responsiveness to various hormons, including insulin (9,10).
The precise evaluation of “central” adipose tissue microcirculation allows doctor to assess in an easy and rapid manner, clinically and on very large scale, the local function of MFR, and, therefore, starting from the first two individual’s life decades, to recognise the dyslipidemic constitution, since genetically-dependent alterations involve contemporaneously both the parenchyma and respective microcircle. A lot of other biophysical-semeiotic evaluations, apllicable by doctor skilled in the new physical semeiotics, allow to collect at the bed-side a large number of signs on microcirculation, which give information on local metabolic situation as well as on sensitivity of many receptors, e.g., insulin-receptors (9, 10). A long clinical experience permits us to state that the knowledge of dyslipidemic constitution is of paramount importance in day-to-day practice and research: rapid, early, easy, “quantitative” bed-side recognising individuals at real risk of dyslipidemia is unavoidable to primary prevention of a serious disease, that can bring about well-known severe macro- and micro-vacular complications, i.e., morbidity and mortality. As regards the clincal research, the dyslipidemic constitution has allowed us to suggest an hypothesis, biophysical-semeiotic in nature, of type 2 diabetes mellitus, enlightening its natural history (See the above-cited site, Practical Applications, Diabetes Mellitus, article N? 3: “From biophysical-semeiotic diabetic and dyslipidemic constitutions to type 2 diabetes mellitus”).