Резекционные операции на поджелудочной же-лезе (ПЖ) позволяют обеспечить существенное улуч-шение качества жизни пациентов с хроническим панкреатитом, выздоровление больных с доброкаче-ственными опухолями и продление жизни при раке ПЖ. Летальность после этих операций в специализи-рованных клиниках составляет 5%, а количество ос-ложнений в послеоперационном периоде может до-стигать 50% [8]. Первопричиной значительной части осложнений является послеоперационный панкреа-тит (ПП) как ответная реакция на операционную травму ПЖ [4]. В наиболее тяжелых случаях, когда развивается панкреонекроз и формируется панкреа-тический свищ, возникает реальная угроза аррозион-ного кровотечения. Именно эти осложнения лежат в основе танатогенеза летальных исходов.Факторы, предрасполагающие к возникнове-нию ПП, известны и многочисленны [11]. Опреде- Цель работы -улучшение результатов резекционных операций на поджелудочной железе за счет снижения частоты возникновения послеоперационного панкреатита (ПП). Материал и методы. Анализу подвергнуты результаты лечения 207 больных, которым выполнены резекционные радикальные операции по поводу различных опухолей поджелудочной железы (n=137) или хронического панкреатита (n=70). В ретроспективном исследовании у 112 больных изучено 22 фак-тора риска возникновения ПП. В проспективном исследовании у 95 больных изучена эффективность применения лорнок-сикама для профилактики ПП. Для оценки механизма действия лорноксикама изучено 68 показателей иммунного статуса пациентов, получавших препарат и леченных без его применения. Результаты. статистически достоверными факторами оказались: мягкая паренхима поджелудочной железы, опухолевый характер заболевания, диаметр панкреатического про-тока менее 3 мм, индекс панкреатического протока менее 0,2, индекс массы тела более 27 кг/м 2 . В случае сочетания двух факторов риска вероятность ПП составила 40,0%, трех -63,0%, сочетание четырех факторов приводило к ПП в 74,3%, пяти -в 88,9% наблюдений. Профилактическое использование лорноксикама позволило статистически достоверно (р=0,042) уменьшить частоту возникновения ПП, уменьшение частоты возникновения панкреатических свищей и арро-зионного кровотечения было статистически недостоверным из-за небольшого количества наблюдений. Выводы. оценка значимых факторов риска и использование медикаментозной профилактики ПП является одним из возможных способов уменьшения частоты его возникновения. Aim. to improve the results of pancreatic resections through decrease of postoperative pancreatitis incidence. Material and methods. it was analyzed 207 patients who underwent pancreatic surgery for pancreatic tumor (n=137) or chronic pancreatitis (n=70). 22 risk factors of postoperative pancreatitis were analyzed in 112 patients retrospectively. in prospective study of 95 patients the efficacy of lornoxicam to prevent postoperative pancreatitis was assessed. 68 parameters of immune state were studied to estimate effect of lornoxicam. Results. significant factors were mellow pancreatic parenchyma, tumoral disease, pancreatic duct diameter...
A classification of monocyte subpopulations developed in 2010 with coverage of the immunobiological properties of cells, their functional activity and participation in various pathological processes (inflammatory, cardiovascular diseases, strokes, myocardial infarctions, aortic aneurysms, surgical modification of heart valves, diabetes, burns, etc.). The diagnostic and prognostic aspects of the analysis of monocytic subpopulations are considered. The unique data obtained by the staff of the Gamaleya Institute of epidemiology and microbiology. They consist in the fact that various physical forms of unmodified native type 1 collagen are powder, i.e. crushed bundles of collagen fibers, a hydrogel or a solution of extracellular matrix peptides, as well as a suspension of collagen fibers obtained from a powder, when applied to the surface of acute and chronic and diabetic wounds, bedsores, trophic ulcers, etc., can provide a pronounced anti-inflammatory, reparative, remodulating and regenerative effect on condition of wounds, providing their accelerated healing due to the local accumulation of “regenerative” subpopulations of Mon3 monocytes, which can be most directly used in burn tissue lesions. In this case, the analysis of monocytic subpopulations is of paramount importance. Moreover, possible potentiating effects of additional use in burns under the control of the analysis of monocyte subpopulations of powerful modern pluripotent immunomodulators – polyoxidonium, galavit and their possible combination with local use of collagen preparations are discussed. Finally, we obtained preliminary data indicating the development in burned patients of a deficiency in the absolute and relative content of the most important “patrolling” non-classical subpopulation of CD14+CD16++ monocytes compared with healthy primary (non-professional) donors, which can be a very important finding in the diagnosis and prognosis and substantiation of new methods of treatment of burns.
On clinical models of infectious, somatic, malignant, and other diseases, the ability of immune responses to induce pathological processes due to competition, “pathogenicity”, hypersensitivity, and insufficiency has been shown. We are talking about the competitiveness of antibacterial and antiviral immunity, when the deployment of cellular and humoral immune responses weaken both defense mechanisms, competition of allergy and immune deficiency, which aggravates and modifies it, and antiviral immunity often induces a number of pathological conditions of the body. This is due to the inability of antiviral antibodies to completely inactivate the antireceptor structures of virions, interact with them without changing their function, and even stimulate a viral infection, induce autoimmune reactions. The protective system of interferons, which often cause side reactions, is also faulty. In the body, immunopathological reactions develop, manifested by immediate and delayed hypersensitivity, which have alternative properties – protective and damaging and autoimmune reactions, mainly with a negative effect. The mechanisms of the processes are discussed in detail in the review. The “inferiority” of immune reactions, respectively, cellular, humoral, phagocytic links, incomplete consistency of anticancer immunity, virus-induced immunodeficiencies are comprehensively covered. Such “alternativeness” of the considered immune reactions, at the same time, turns out to be a necessary condition for eliminating the emerging disorders of the organism’s reactivity. These include specificity and non-specificity, stimulation and suppression, variability and integration of immune responses. At the same time, immunoregulatory reactions are individual and interrelated, develop regionally and systemically and provide degradation of exogenous and endogenous objects and immune activation. All these aspects are discussed in detail in the review.
Introduction. Assessment of tissue regeneration, including that at the cellular and subcellular levels, appears to be one of the important trends in the complex treatment of patients with extensive burns. It is known that hematopoietic stem cells (HSCs) contribute to tissue restoration and regeneration through paracrine effects or direct cell differentiation, being a central component of post-burn anemia recovery and capable of forming not only blood cells, but also other types of cells. Notably, the role of these cells in burn injury has not been studied yet.The aim of the study was to investigate in dynamics the content of hematopoietic stem cells of different phenotypes in patients with extensive burns in the process of complex treatment. Methods. Hematopoietic stem cells and their subpopulations in peripheral blood samples were analyzed on a FACSCalibur flow cytometer (Becton Dickinson, USA) using the CellQuest program and CD45/CD34/CD38 and CD45/CD34/CD133 monoclonal antibody panels (BD, USA). The results obtained were statistically processed using the GraphPad Prism 7.0 program (USA), results were considered statistically significant at p0.05.Results. Hematopoietic stem cells and their subpopulations were studied at different stages of the complex treatment in 25 patients with a large burn area, more than 30% of the body surface. The comparison group consisted of 15 healthy volunteers. Upon admission to the Burn Center, a group of severely burned patients revealed a significant deep deficiency of both total HSCs CD45+34+ (p=0.0002) and their subpopulations CD45dim34+38+ (p=0.019), with predominantly early precursors of hematopoiesis CD45dim34+38- (p=0.0001) and CD45dim34+133+ (p=0.0002). In the course of the complex treatment, including surgical necrectomy and autodermoplasty of burn wounds, there was observed normalization of total HSCs CD45+34+ (0.050.012%, p=0.031) and a subpopulation of early HSCs CD45dim34+38- (0.0390.009%, p=0.016) in 20 days of treatment in the group of burn patients. There was a significant increase of mature CD45dim34+133- HSCs (p=0.0380) as a result of treatment, while the deficit of the more differentiated population of CD45dim34+38+ HSCs did not fully recover (p=0.272).Conclusion. The firstly detected modulations in the content of hematopoietic stem cells of different phenotypes in patients with extensive burns may reflect the state of compensatory-adaptive reactions of hematopoiesis in the course of the complex treatment. The data obtained may support the predictive use of HSC subcellular markers to assess the regenerative potential in burn wounds healing, including that during staged surgical treatment and autodermoplasty, and to predict the development of local and general complications of burn disease.
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