Experimental substantiation and clinical use of a combination of dermal matrix with allogenic or autologous cells for the treatment of extensive traumatic wounds.

We carried out a comparative experimental and clinical study of the efficiency of the combination of dermal matrix with autologous and allogenic cells for creation of an optimal biological wound coating. Experiments on outbred mice have demonstrated that the use of dermal matrix in combination with allogeneic or autologous cells shortens the inflammation phase and accelerated maturation of the granulation tissue. Clinical application of biological wound dressing based on dermal matrix in combination with autologous or allogeneic mesenchymal multipotent stromal cells prevented septic complications and shortened the time of preparing extensive traumatic wounds with skin defect to autodermoplasty.

Morphofunctional analysis of human platelets by vital staining.

We developed a method for differential staining of human platelets preserving their functional activity based on vital fl uorochrome stains trypafl avin and acridine orange. Platelets stained with trypafl avin and acridine orange exhibited under a fl uorescent microscope green fl uorescence of the cytoplasm and red-orange fl uorescence of the granules. Morphofunctional analysis of platelets was carried out on the cells from donor blood, donor concentrated platelets, and cells from hematological patients and patients with thromboembolic complications.

[Coagulation profiles during cardiac surgery].

Objective: To evaluate patients' hemostasis after cardiac surgery using thromboelastometric and impedance aggregometry.

Materials And Methods: 66 patients were examined intraoperatively. Comparison group included 45 blood donors.

[The morphologic evaluation of adhesive activity].

The morphologic evaluation of adhesive activity of human thrombocytes using both vital dye of cells and registration of adhesion process with fluorescent microscope is proposed. The regression dependence between adhesive activity of human thrombocytes and morpho-functional and aggregative activity of thrombocytes is established. The blood samples of 100 blood donors, 100 patients with hematologic pathology, 110 patients of traumatology, 50 patients with acute exogenous intoxications and 20 patients with chronic trophic ulcers were analyzed.

[Homeostasis changes during rehabilitation period after acute chemical poisoning].

The article deals with review of 78 patients of rehabilitation toxicological unit. The patients received resuscitation and detoxification. All patients were divided into three groups; 1st group--patients after poisoning with psychopharmaceuticals, 2nd group--patients after poisoning with cauterizing liquids and 3rd group--patients with encephalopathy after poisoning with neurotoxin (psychopharmaceuticals, narcotics and ethanol).

Effect of concentration of platelet-derived growth factor on proliferative activity of human fibroblasts.

Serum concentration of platelet-derived growth factor was measured in patients with trophic ulcers and proliferative activity of human fibroblasts was measured in wells with different content of added serum platelet-derived growth factor. In parallel, morphofunctional analysis of platelets from the whole blood of these patients was performed. A close correlation was found between morphofunctional parameters of blood platelets and serum concentration of platelet-derived growth factor.

[Mechanic reinfusion in emergency surgery].

The article highlights techniques and effects of intraoperative mechanic blood reinfusion in patients with trauma and intraabdominal bleeding in extend, exceeding the self circulating blood volume. The high efficacy of the self blood reinfusion during the emergency operation allowed the 2-fold decrease of the hospital and overall mortality. The mechanic blood reinfusion proved to be a safe and clinically effective method of the globular blood volume deficiency compensation, especially in emergency surgery.

[The intraoperative auto- and allohemotransfusion by massive bleeding in emergency abdominal surgery].

The results of intraoperative hemotransfusion of 112 patients with abdominal injuries, complicated with bleeding and the loss of more then 70% of the circulating blood. The aim of the study was to compare the efficacy of auto- and allohemotransfusion. The first method allowed to decrease both the overall lethality (p=0.

[Selective adsorption of endotoxin in the complex treatment of patients with severe sepsis].

Severe sepsis and septic shock remain the most serious problem of critical care medicine today with a mortality of 25-80%. Bacterial endotoxin is of considerable importance in the pathogenesis of sepsis. A selective hemosorbent in which endotoxin adsorption is accomplished via its binding to a synthetic peptide (LPS-A) has been recently designed in Sweden.

Morphofunctional evaluation of the effect of collagen-1-based dressing on skin regeneration after burn trauma in mice of two genetic strains.

Morphofunctional evaluation of the effect of biological dressing with collagen-1 on healing of 3A degree burn wound in outbred and mutant Hr(hr)/Hr(hr)(hairless) mice was carried out by the histological method and optic radioautography. A pronounced stimulatory effect of the dressing on skin regeneration in mice was demonstrated. According to radioautography data, early dressing of the burn wounds in Hr(hr)/Hr(hr)mice led to active proliferation of epithelial cells in dermal cyst and vascular endotheliocytes.

[Apoptosis of mononuclear cells and dead leukocytes in venous blood of septic patients].

Apoptosis of mononuclear cells, dead leukocyte and CD95+ lymphocytes content in venous blood of 15 patients were evaluated by flow cytometry within 2-3 day after diagnosis of sepsis. The number of CD95+ lymphocytes increased in 40% of the cases and that of lymphocytes expressing Fas receptor decreased in 27%. The number of mononuclear cells in venous blood increased 7 times compared with physiological norm; this rise was a reliable predictor of the unfavourable outcome of the disease.

[Compensation for circulating blood volume in fatal blood loss].

Despite the extended potentials of modern medicine, noncompensated blood loss remains one of the leading causes of death in the able-bodied population all over the world. At present, there is no uniform policy of transfusion maintenance and intensive care in victims with severe decompensated blood loss. The purpose of the study was to assess the results of compensation for acute blood loss in victims with concomitant injury and wounds at various sites, which were attended by the loss of a circulating blood volume (CBV) with the use of new technologies.

[Evaluation of severity of immune disorders and prognosis of the development of pyo-septic complications in patients with emergency surgery pathology].

Any lesion in organism, causing the development of inflammation, is followed by changed work of the immune system that is extremely important for prognosis of the course of the pathological process. The adequate compensation-defense reaction was estimated using well-known immunological tests and normal reaction of the immune system was determined to be different from the pathological reaction, especially in patients in critical state. The adequate reaction of the immune system is characterized by mild leukocytosis, two-three fold increase of the spontaneous HCT test, normal or moderately pronounced indices of the cellular and humoral links of immunity.

[Immunomodulatory effect of extracorporeal hemocorrection in patients with surgical sepsis].

The study was undertaken to evaluate the immunomodulatory effects of various methods of extracorporeal hemocorrection in septic patients. Thirty-two patients in whom the course of the underlying disease was complicated by the development of sepsis were examined. A package of therapeutic measures involved debridement of an infection focus, de-escalation antibacterial therapy, nutritional support, and immunomodulatory therapy.

Stimulation of regeneration of hyaline cartilage in experimental osteochondral injury.

A model of osteochondral intra-articular defect in rats is presented. During spontaneous healing, the stage of formation of granulation tissue is followed by its replacement with bone and fibrous tissue. Chondroinductive properties of collagen 1 sponge used for defect filling manifested in the formation of fibrous cartilage with fields of hyaline cartilage.

[The level of dead blood leukocytes in sepsis and the significance of their elimination by extracorporeal hemocorrection techniques].

Sepsis with 18-to-33% mortality also remains the most serious problem of modem medicine today. Forty-five patients treated at the N. V.

The use of bioactive wound dressing, stimulating epithelial regeneration of IIIa-degree burn wounds.

Clinical and morphological comparison of wound healing after transplantation of living cultured allofibroblast on days 1-2 after the injury, collagen-1-based dressing with PDGF-BB, and traditional dressing with levomecol ointment showed that bioactive dressing accelerated wound epithelialization (5-7 days vs. 20-22 days with gauze dressing); the incidence of suppurative complications decreased, no crust formed, and epithelialization was not associated with the formation of a hypertrophic cicatrix. Biological dressing based on living cultured allofibroblasts and collagen-1 with PDGF-BB exhibited equal stimulatory effects on burn wound healing.

[Treatment of IIIa grade burns with the biologic band].

The biologic band is created on the base of type I collagen and platelet derived growth factor. It was applied for extensive burns of IIIa grade at 1-2nd day after a trauma, which led to epidermis reconstruction at 5-7th day. Authors assume that the effect of the band is determined by the time of its use--1-2nd day, when stimulating exudation qualities combine with healing properties of the bandage.

[Immunological aspects of the early application of extracorporeal hemocorrection techniques in the complex therapy of purulent mediastinitis].

Acute purulent mediastinitis (APM) is one of the most complicated forms of surgical infection, showing a high incidence of sepsis--from 45 to 100%, mortality rates of 17 to 80%. Sixty-eight patients with APM admitted to the N. V.

[Clinical assessment of immune parameters at surgical patients with syndrome of systemic inflammatory reaction].

Results of immunological examination of 423 patients with syndrome of systemic inflammatory reaction of different ethiology (mediastinitis--78 patients, peritonitis--85, severe acute pancreatitis--91, trauma of thorax and abdomen complicated with massive hemorrhage--111, severe burn trauma--40 patients) are analyzed. For complex and objective assessment of immune reaction the system of scores has been developed. This scale permitted to detect the immune disorders, to diagnose the degree of immune insufficiency at early stages of disease, to predict the purulent complications and to start timely immune therapy.

[Assessment of bactericidal and growth-inhibiting activity of blood serum using flow cytometry and photometry].

Method of measurement of biological fluids bactericidal activity against Staphylococcus aureus using laser flow cytometry has been developed and proposed for clinical use. Overall bactericidal activity of sera of healthy donors has been assessed by this method. Strong positive correlation between bactericidal activity measured by flow cytometry and ability of the sera of healthy donors to inhibit bacterial growth assessed by photometric method was determined.

[Complex of immunological characteristics for the diagnostics of pancreatogenic immunodeficiency].

The results of the immunological study of blood in 89 patients with severe acute pancreatitis (SAP) were analyzed. Immune reactions in SAP were characterized by the presence of moderate leukocytosis, an increase in the phagocytic and metabolic activity of neutrophils, relative lymphopenia, a decrease in the number of B-lymphocytes. The average values of the parameters of the immunogram of patients with the favorable course of the disease on days 2 - 3 were analogous to the average population values in 89 examinees.

[Immunological estimation of the degree and prognosis of acute pancreatitis].

An analysis of data of immunological investigation of blood of 89 patients with a severe acute pancreatitis (SAP) on the 2-3 day of the disease has revealed changes in immunogram characteristic also of other pathological conditions and pointing to a systemic inflammatory reaction. Among the patients who did not have purulent complications against the background of therapy of SAP, the character and degree of changes in immunogram were in line with average values, and so they could be considered as "a norm of pathology". A system of scores of impairments of the immune response to the destructive process was developed for an objective evaluation of the immune status of patients with SAP.

[Aerobic metabolism of leucocytes, and acute phase proteins in early post-hemorrhagic period in patients with penetrating thoracal and abdominal wounds].

The subjects of the study were 82 patients with penetrating gunshot (17 cases) and stab-and-cut (65 cases) thoracal and abdominal wounds, complicated by an acute blood loss of 600 to 4500 ml. Aerobic metabolism of neutrophiles was studied using spontaneous and activated HCT test and chemoluminescent analysis; the concentration of acute phase proteins (fibronectin, ceruloplasmin, C-reactive protein, and haptoglobin) during the first two days after surgery was measured. The study revealed that bigger blood loss was associated with more pronounced increase of the number of spontaneously activated neutrophiles with low bactericidal potential, decrease of fibronectin and ceruloplasmin concentrations, and increase of C-reactive protein and haptoglobin concentrations.