The relevance of cold injury is due to its high specific weight in the structure of injuries, complexities of complex therapy, and unsatisfactory results of treatment. It is known that in the pathogenesis of local cold injury, the leading role belongs to endothelial dysfunction, which secretes a huge amount of biologically active substances, including matrix metalloproteinases.Aim: to determine the dynamics of the content of matrix metalloproteinases of the second subfamily (MMP-2, MMP-9) in the serum of patients with local cold injury.Materials and methods. The study included 80 patients (60 men, 20 women) with frostbite of the III–IV degree of the foot to the level of the lower third of the leg in the late reactive period and the period of granulation and epithelization.Results. In the late reactive period in patients with cryopreservation, the level of MMP-2 was 3.4 times higher relative to the control (p = 0.011), on day 30 MMP-2 values did not differ from the control parameters (p = 0.103). The level of collagenase B (MMP-9) in patients with local cold injury on day 5 was 14.5 times higher than the control parameters (p = 0.002), on day 30 – 12.5 times higher compared to the control group (p = 0.000094).Conclusion. During the analysis of the data obtained, we can think about the dual nature of collagenases during the processes of inflammation. In a situation of distress, collagenases prevent endothelial dysfunction by eliminating the cellular structures of the endothelium to ensure adequate metabolism in tissues. Their importance as markers of failure of adequate flow of reparative processes is not excluded.
Актуальность. В структуре общего травматизма местная холодовая травма имеет большой удельный вес. Выявление новых маркеров криоповреждения способствует более ранней диагностике глубины поражений тканей при обморожении, созданию новых подходов к хирургическому лечению и ускоренной реабилитации пострадавших. Цель исследования - изучение в динамике содержания оксида азота, асимметричного диметиларгинина и циркулирующих эндотелиальных клеток в сыворотке крови у пациентов с местной холодовой травмой. Методика. В исследование включено 80 пациентов с обморожениями нижних конечностей III-IV степени в позднем реактивном периоде и периоде гранулирования и эпителизации. Использован мультиплексный анализ сыворотки крови набором реагентов фирмы Biomedical (США), методом Hladovec (1978) и методом П.П. Голикова (2004) соответвенно. Результаты. У пациентов с криотравмой во всех исследуемых группах установлено снижение уровня оксида азота относительно контроля. У пострадавших с местной холодовой травмой на 5-е сут отмечено значительное снижение в крови уровня асимметричного диметиларгинина. на 30-е сут с момента криоповреждения уровень асимметричного диметиларгинина не отличался от показателей контрольной группы. При обморожении дистальных сегментов стоп концентрация асимметричного диметиларгинина в крови не менялась относительно контроля. У пациентов с тяжелыми обморожениями нижних конечностей уровень асимметричного диметиларгинина в крови снижался в 3,6 раза. У пациентов с местной холодовой травмой на 5-е сут установлено увеличение в крови уровня циркулирующих эндотелиальных клеток в 5,2 раза, на 30-е сут с момента криоповреждения уровень циркулирующих эндотелиальных клеток снижался, но, по-прежнему, превышал контрольные значения. У пострадавших с обморожением дистальных сегментов стоп содержание в крови циркулирующих эндотелиальных клеток увеличилось в 2,7 раза, с поражением проксимальных сегментов нижних конечностей - в 6,7 раза относительно здоровых добровольцев. У пациентов с наиболее тяжелыми обморожениями нижних конечностей уровень циркулирующих эндотелиальных клеток в крови повышался в 9 раз. The relevance of local cold injury remains high. In the structure of general injury prevalence, proportion of freeze burns is great. Identification of new markers of cold injury will help earlier determination of tissue lesion depth, development of new approaches in the surgical treatment of deep freeze burns of extremities, and promote rehabilitation of patients. The aim of this study was to elucidate the dynamics of the serum content of nitric oxide (NO), asymmetric dimethylarginine (ADMA), and circulating endothelial cells (CEC) in patients with local cold injury. Methods. The study included 80 patients with III-IV degree frostbite of the lower extremities in the late reactive period and the period of granulation and epithelization. Multiplex analyses of blood serum were performed with Biomedical (USA) reagent kits, according to methods by Hladovec (1978) and Golikov (2004). Results. In all groups of patients with frostbite, NO level was decreased compared to the control. Patients with local cold trauma displayed significant decreases in blood levels of ADMA on day 5; on day 30 after the cold trauma, the ADMA level did not differ from the control group. In patients with frostbite of the distal foot segments, the blood concentration of ADMA did not change from the control level. In patients with the most severe frostbite of the lower extremities, serum ADMA decreased 3.6 times. Patients with local cold trauma had a 5.2-fold increase in the blood level of CEC on day 5. On day 30 after the freeze burn, the amount of CEC was decreased but still remained above the control value. In patients with frostbite of the distal foot segments, the content of CEC increased 2.7 times compared to the control. In patients with lesions of more proximal segments of the lower extremities, the CEC index was increased 6.7 times compared to healthy volunteers. In patients with the most severe frostbite of the lower extremities, the blood content of CEC was 9 times increased.
Introduction. Thermal lesions represent a significant medical and social problem, they are characterized by the duration and high cost of treatment, a significant proportion of the limitation or disability. In Siberian region besides burn injuries, cold injury is common. The purpose of the work was to identify factors influencing the indicators of specialized medical care for patients with thermal injuries in the Siberian region. Materials and methods. The analysis of the reports of the main specialists of the subjects of the Siberian Federal District on the provision of specialized medical care to victims of thermal injuries in 2017 was carried out. Statistical processing was performed using the Microsoft Excel for Windows 10.0 program. Results. The average provision for victims of thermal trauma is 2.8 beds per 100,000 of the district’s population, the turnover rate per 100,000 of the population is 134, the mortality rate is 4.6%. The hospitalization rate for patients with burns per 100,000 populations is 39, with cold injury — 6.0. In the structure of adult patients, non-core patients hospitalized for a “burn” bed occupy 12%. The mortality rate in adults is 10 times higher than in children. For each specialized bed for a patient with thermal injuries, 6.4 beds intensive critical care are required. Over 12% of victims in intensive care units require mechanical ventilation. The rate of anesthetic management per patient varies in subjects by 6 times. Limitations. The study was conducted on the basis of available official statistical data, primary data were not used. Conclusion. Cold trauma has a significant impact on the performance of the medical care system in the Siberian Federal District for patients with the “combustiology” profile. The variability of a number of key parameters in the provision of specialized care for thermal trauma is due to different numbers and densities of the population, the degree of industrialization and the financial capabilities of the region. A significant proportion of those treated in burn hospitals are patients with another (without thermal injury) pathology.
The aim of the work is to evaluate microcirculation, innervation and intercellular interactions depending on the severity and timing of cold tissue lesions. Materials and methods. 50 patients with III–IV degree of lower extremities local cold injury, as well as their blood were explored. Patients were divided into two groups depending on the period of clinical course: 5 and 30 days of cold injury. At the same time, the patients were divided into 3 groups according to the level of the lesion. The 1 group patients had only fingers frostbitten. Group 2 – patients had lesion boundary extended to the metatarsals and metatarsals. Patients with cold trauma of the proximal segments of the lower extremities belonged to group 3, had the damage level limited by the lower third of the low leg in the most cases. Studies in these groups were carried out on the 5th day after the injury. The phenomenon of lymphocytic-platelet rosette formation and the amplitude of M-response were evaluated. Results. In patients with frostbite, the increased adhesive ability of blood platelets to lymphocytes, was significantly decreased by 30 days. By the day 5, the number of lymphocyte-platelet rosettes increased 2.2 times, and the degree of adhesion 1.7 times. By the day 5 of the injury, the value of the M-response was reduced by 1.7, and the detected changes were preserved for day 30. In patients with fingers frostbitten, the percentage of LTA increased by 1.3 times, and the degree of adhesion by 1.5 times. Registered ENMG potentials decreased by 1.7 times. In group 2, the ability of platelets to adhere to lymphocytes increased by 1.6 times, and the average number of plates participated in rosette formation increased by 2.1. The registered ENMG potentials decreased by 2.5 times. In patients with the maximum level of cold tissue damage, the adhesive ability of lymphocytes and platelets increased by 3 times, and the degree of adhesion increased by 3.5 times, the amplitude of the M-response decreased by 2.6 times. Conclusions. The patients with local cold injury have been demonstrated the increasing of the platelets ability to adhesion to lymphocytes. The increasing of the number and degree of LTA was proportional to the level of tissues damaged by cold. Also, patients with frostbite had a sharp decreasing of in the amplitude of the M-response (motor response), which was getting worse with the increasing of severity of tissue damage. In the case of local cold injury, the maximum activity deviations in the activity of lymphocytic-lamellar interactions and the m-response amplitude of the electroneuromyography were recorded in the early period of cold injury, with a tendency to restore the wound process on the 30th day.
The OBJECTIVE was to study the changes of bioelectric activity of muscles in patients with local cold injury of the feet.MATERIAL AND METHODS. Non-invasive method of cutaneous electroneuromyography was used to evaluate the bioelectrical activity of muscles. The study was conducted in 52 patients with local cold injury of III–IV degree of the lower extremities of the late reactive period and the period of granulation and epithelialization. M-response amplitude, residual latency and propagation velocity of the excitation were estimated.RESULTS. In patients with local cold injury, there was a decrease in the bioelectric activity of the limb muscles proximal to the affected area. M-response amplitude and the propagation velocity of the excitation decreased in the patients in the late reactive period, while the residual latency increased. In patients with frostbite limbs during granulation and epithelialization, there was a tendency to restore the level of bioelectrical activity of muscles relative to the late reactive period.CONCLUSION. The basis of the adverse effects of local cold injury was “chronic” endothelial dysfunction and local neuropathy.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.
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