Background. One of the characteristics of a combat injury is the penetration of pathogenic microorganisms, pieces of dirty skin, clothes, dust, etc. into the depth of the wound. The combination of significant defects of bones and soft tissues, vessels and nerves of the affected segment of the limb (musculoskeletal system) causes a high percentage of unsatisfactory treatment results, as well as the development of infectious complications. Objective: to evaluate the nature of combat wounds in patients who had infectious complications in the musculoskeletal system during the war in Ukraine since 2014; to determine the features of the occurrence and development of such infectious complications. Materials and Methods. An analysis of case reports of patients with combat wounds with infectious complications (osteomyelitis, septic arthritis, surgical site infection (SSI), purulent- necrotic infection of soft tissues and wounds) who were treated at the Department of Bone- Purulent Surgery of the State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine” for the period from 2014 to mid-2022 was carried out. Results and Conclusions. Infectious complications in combat wounds mostly arise primarily as a result of the wound itself, taking into account the severity, extent of damage to structures and tissues, the type of weapon used to inflict the injury, and a wide spectrum of microorganisms, among which Staphylococcus aureus plays a leading role. In the control group, infectious complications occurred more often than SSI with further progression.
Background. Acute phase proteins – ceruloplasmin, haptoglobin, C-reactive protein (CRP) – are markers that characterize the inflammatory process. C-reactive protein is one of the major components of the acute phase (AF) and is a generally accepted indicator of inflammatory processes. Objective: to determine the level and specificity of acute-phase proteins (CRP, haptoglobin, ceruloplasmin), as well as procalcitonin in the modeling of infectious arthritis. Materials and Methods. Experimental studies were carried out on 31 white male Wistar rats. The model of infectious arthritis was created during three days by daily injection of 0.02 ml of S.aureus 108 No. 209 into the knee joint of a rat. The animals were divided into groups, of which group I was the vivarium control. The following model of drug administration was used for the experimental groups: a single daily injection of 0.02 ml of flosteron into the knee joint for three days (group II); daily single administration for three days of 0.02 ml of S.aureus 108 No. 209 (group III); daily one-time alternating (every other day) administration for three days of 0.02 ml of flosteron and 0.02 ml of S.aureus 108 No. 209 into the knee joint (group IV). The effectiveness of the drugs was observed 3 and 14 days after administration. Results. It was established that the concentration of haptoglobin probably increased in the blood serum of rats after 3 days only under the conditions of alternating three-time administration of flosterone and S.aureus 108 No. 209. After 14 days, when the inflammatory progress progressed, this indicator increased in all studied groups of animals, and most of all (by analogy with observations after three days) with the combined effect of flosterone and S.aureus 108 No. 209. The concentration of ceruloplasmin in blood serum increased in all experimental rats both after 3 days and after 14 days in the group after administration of flosterone. The content of C-reactive protein in blood serum increased in all studied groups of rats without exception, which proves its high specificity for detecting inflammatory processes of various severity. The concentration of procalcitonin in the experiment did not reliably change in the blood serum of rats of any experimental group after 3 days. However, significant changes occurred 14 days after the introduction of flosterone and with the combined effect of flosterone and S.aureus 108 No. 209. Conclusions. Determining the content of haptoglobin is not highly effective in early detection of the inflammatory process. At the same time, the synthesis of ceruloplasmin increases precisely during the first three days of the infectious process, which turns it into an effective marker for detecting early infectious complications. The dynamics of changes in the level of C-reactive protein in blood serum demonstrated the highest correlation with the activity of the infectious process, which proves its high specificity for detecting inflammatory processes of various severity. The greatest deviations were observed in rats, which were injected three times alternately (every other day) with flosterone and S. aureus 108 No. 209 into the knee joint. Such changes suggest that the hormonal drug flosteron contributed to the intensification of the inflammatory process.
Summary. We have developed a working classification of biotechnological products, defined the conceptual basis for their use in osteoarthritis and avascular necrosis of the hip and knee joints, and identified areas for further study and analysis of the results of the use of regenerative technologies in these diseases. The main conceptual principles of the use of regenerative technologies in osteoarthritis and avascular necrosis of the hip and knee joints include both the improvement of techniques for the introduction of biotechnological products and further study and improvement of biotechnological products used to treat these diseases, and a differentiated approach should combine the principles of evidence-based and personalized medicine.
The authors have carried out an experimental study for the purpose of determining a possibility of differentiating stem cells that are isolated from the adipose tissue according to the adipogenic orientation. The results of the research were indicative of the fact that the cells isolated from the adipose tissue are of specific differentiation, namely, an osteogenic, chondrogenic and, above all, adipogenic orientation that is an evidence of the multipotency of the stem mesenchymal cells of the adipose tissue. The adipose tissue is an alternative source to the bone marrow of multipotent mesenchymal stem cells that can be used as a protection of transplanted autologous adipose tissue from resorption by lipofilling.
Summary. Articular cartilage injuries are observed in 60% of arthroscopies. Degenerative changes of the articular cartilage (osteoarthritis) is the most common disease of all the joints, which affects at least 10-13% of the population over the age of 60 years. Significant progress has been made in the treatment of pain and inflammation, but the evidence base for improving the articular cartilage repair remains weak. Despite the seemingly positive results of a number of studies on the use of mesenchymal stem cells (MSCs) for the articular cartilage restoration, the question of the nature of their participation in this process remains controversial. Objective. The objective of the study was to determine the involvement of autologous mesenchymal bone marrow stem cells in reparative chondrogenesis. Materials and Methods. Experimental and morphological determination of the participation of undifferentiated autologous bone marrow MSCs in reparative chondrogenesis was carried out on fifteen rabbits. MSCs of bone marrow marked with a red fluorescent dye PKH-26 (Sigma, USA) was injected into the cavity of the injured joint on the 3rd day after the articular cartilage defect formation. The presence of the transplanted labeled autologous MSCs was examined in these animals on cryostat sections on the seventh, fourteenth and twenty-first days after implantation with fluorescence microscopy. The characteristic red glow was observed in case of the presence of labeled cells in the regenerated cartilage tissue. Results. The presence of transplanted labeled autologous MSCs on cryostat sections was determined in all studied animals. On the 7th day, the cells were arranged diffusely, without noticeable accumulations. On the 14th day, the labeled cells fluoresced in the red zone of the spectrum and created compact conglomerates mainly at the defect zone. On the 21th day, the labeled cells were found only in the regenerate zone. The data obtained indicate the direct participation of autologous MSCs in the processes of chondroreparation after the exogenous implantation into the joint cavity. Conclusions. The method of autologous bone marrow MSCs labeling using PKH-26 fluorescent dyes has shown that autologous bone marrow MSCs are directly involved in the processes of chondroreparation when they are injected intraarticularly.
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