Burn Disease Research Articles

НАШ ОПЫТ ЛЕЧЕНИЯ БОЛЬНЫХ ТЕРМОИНГАЛЯЦИОННОЙ ТРАВМОЙ

According to the literature, a combination of skin burns with respiratory tract lesions occurs in 30% of patients with flame burns and there is a clear tendency to its growth. An analysis was made of 205 patients with thermo-inhalation lesions who were treated from 2009 to 2019. Studies have shown that all patients with severe burn injury flame have shown emergency fibrobronchoscopy at the earliest possible date. Timely objective assessment of the severity of TIT and the possibility of developing tracheobronchial and pulmonary complications is an important component in the diagnosis and treatment of patients with thermal injury, and helps to predict the course of burn disease and prescribe adequate intensive care

ОСОБЕННОСТИ ЦИТОКИНОВОГО ПРОФИЛЯ У ОЖОГОВЫХ ПАЦИЕНТОВ

Introduction. Currently, more and more attention is paid to burn injury as one of the most significant medical and social problems. Treatment of burn injury is performed by autotransplantation of the skin flap. The efficiency of using this method is from 70 to 90%. A significant reason for the failure of skin flap transplantation in burn disease is the lack of objective methods for assessing the patient's condition on the eve of free autodermoplasty surgery. Assessment of the levels of both Pro-and anti-inflammatory cytokines in burned patients is not included in the algorithm of examination and monitoring of the status of these patients. The aim of the study: to study the levels of pro — and anti-inflammatory cytokines to expand the algorithm of laboratory examination in preparing patients for free autodermoplasty.Materials and methods. The levels of IL-6, IL-8, and IL-10 in the peripheral blood of 50 patients with burn injury compared to healthy individuals were studied by enzyme immunoassay. Results. The serum content of all studied cytokines was significantly increased upon admission to the hospital in all burn patients compared to healthy individuals. A particularly pronounced increase was observed in patients with a fatal outcome. The results of autodermoplasty correlated with the severity of hyperproduction of proinflammatory cytokines on the eve of surgery. Conclusion. A justification for the addition of the algorithm for laboratory examination of burned patients by determining cytokines-interleukins 6, 8 and 10. Monitoring the level of cytokines in burn injury is appropriate for objectifying the choice of the timing of surgery, which will help reduce the mortality rate and increase the effectiveness of free autodermoplasty.

Erosive and ulcerative lesions of gastrointestinal tract in patients with burns

To analyze the incidence of erosive and ulcerative lesions of gastrointestinal tract in patients with burns, including those complicated by gastrointestinal bleeding, depending on severity of injury, complications of burn disease and treatment features. Medical records of 1833 patients were reviewed. We have retrospectively analyzed symptoms of disease and incidence of gastrointestinal bleeding depending on treatment strategy in patients with identified erosive and ulcerative lesions of gastrointestinal tract. Risk of gastrointestinal erosions and ulcers, including those complicated by gastrointestinal bleeding, correlates with area and depth of burn damage, especially in patients with thermo-inhalation injury and infectious complications of burn disease. Proton pump inhibitors intake in patients with burns of up to 50% of body surface area (BSA) and deep lesions up to 40% of BSA is followed by less incidence of gastrointestinal bleeding compared to H2-histamine receptor blockers. At the same time, severe burns of more than 50% of BSA ensure high risk of gastrointestinal bleeding regardless antisecretory therapy. Endoscopy upon admission is recommended in all patients with burns ≥30% of BSA or deep lesions ≥20% of BSA, as well as severe thermo-inhalation injury. This approach ensures timely diagnosis of gastrointestinal lesions and their adequate treatment.

Тhe use of corticosteroids in patients with severe burn injuries

Modern treatment of burns has led to a significant reduction in mortality in patients with burns whose injuries were fatal several years ago. However, along with improved survival, new problems arose in the treatment of burn patients. Systemic inflammatory response, capillary leak, sepsis top the list of the most common problems in both adults and children with severe thermal injury. Currently, new strategies are being developed and studied in the treatment of this category of patients. One of the ways to improve the results of treatment of patients with severe burn injury is to prescribe corticosteroids, both in the stage of burn shock and in the development of septic complications. Do corticosteroids reduce mortality and improve recovery in burn patients? The discussion about this has been going on for many years, but the opinion about their effectiveness remains controversial. An analysis of the literature shows that corticosteroids can play a significant role in the treatment of patients with severe burn injury and can be successfully used at any stage of a burn disease. The effect of reducing capillary leakage, increasing myocardial contractility, antiemetic, membrane-stabilizing effect of corticosteroids will be useful in the stage of burn shock. The anti-inflammatory, immunomodulatory effect of corticosteroids will play a role in any stage of a burn disease. With the aim of preventing and treating sepsis, corticosteroids may be useful in the stage of toxemia, septicotoxemia. It is also necessary to remember about adrenal insufficiency, which develops in burn patients. The article analyzes the literature, substantiates the use of corticosteroids in patients with severe burn injury in different periods of a burn disease.

Is major burn injury associated with coagulopathy? The value of thrombelastometry in the detection of coagulopathy in major burn injury: A prospective observational study.

The coagulation status of burn patients is generally impaired and is a major factor of the deteriorating burn patients' overall situation. In trauma and other patient groups, the differential diagnosis of coagulation impairment has been largely improved by the use of rotational thromboelastometry (ROTEM®). The aim of this prospective observational study was the differentiated observation of coagulopathy in severely burned patients using standard parameters and ROTEM® thrombelastometry during the relevant stages of burn disease. Twelve patients that sustained at least 20% third degree burns of total body surface area (TBSA) were included in the study. Standard and ROTEM® coagulation analyses were performed on admission and then twice daily during the first 14 days following burn trauma. Although the initial assessment of DIC was similar for both standard labs and ROTEM® measurements, more patients were detected to be in a state of worsening coagulation status for a longer time in ROTEM® than in standard measurements. In addition, one patient was rated in to be in decompensated DIC for 3 days according to ROTEM® measurements, while no patient was rated to be in a decompensated DIC based on standard parameters. This study points towards a more complex picture and higher occurrence of DIC in burn patients when thrombelastometric measurements like ROTEM® are taken into account in addition to standard coagulation parameters.

Biomass burning and cardiovascular diseases in Mato Grosso State: a spatial approach

Environmental factors have influenced human health leading to illness due to cardiovascular diseases. This ecological and exploratory study analyzes the spatial distribution of burn outbreaks and rates of hospitalizations due to cardiovascular diseases in the municipalities of the State of Mato Grosso between the years of 2012 and 2015. Thematic and kernel maps were created for the outbreaks of fires and for hospitalizations for the years 2012 to 2015. Moran Global indices, were calculated for these variables. During the study period, 758023 outbreaks of fires and 57269 hospitalizations were identified; Moran index were significant for burn outbreaks, but for hospitalization rates, except for 2012, there was no significant spatial autocorrelation. Thematic and kernel maps show higher occurrences of fires in the north of the state, in the so-called arch of deforestation, and higher hospitalization rates in the southern region of the state, possibly due to the action of winds, displacing pollutants generated by the fires to the south of the state.

Features of morphological changes in the thyroid gland of white male rats 1 day after thermal trauma of the skin on the background of the introduction of 0.9 % NaCl solution

Despite the fact that the main pathogenetic factor in the development of burn disease is the alteration of the skin, the severity of the condition of patients in the acute period of the disease is due to systemic changes in the body caused by thermal factor. Being a powerful stress factor, severe burns are accompanied by activation of the hypothalamic-pituitary system. Although thyroid hormones are not considered typical "stress hormones", they also play a role in maintaining vasomotor function under stress. The question of thyroid dysfunction on the background of burn injury remains debatable, and scientific data on its morphological and ultramicroscopic changes are quite limited. The aim of the work is to establish microscopic and submicroscopic changes of the thyroid gland of experimental animals in the stage of shock after thermal trauma of the skin. Experimental studies were performed on 12 white adult male rats, which received a thermal burn of the skin of 2-3 degrees with a lesion area of 21-23 % of the skin. An infusion of 0.9 % NaCl solution at a dose of 10 ml/kg was performed into the inferior vena cava. Collection of material for histological and electron microscopic examinations was performed according to generally accepted methods. Histological specimens were examined using a MIKROmed SEO SCAN light microscope and photo-documented using a Vision CCD Camera with an image output system from histological specimens. Ultrathin sections made on an ultramicrotome UMPT-7 were contrasted with uranyl acetate, lead citrate according to the Reynolds method and studied under an electron microscope PEM-125K. Conducted micro- and submicroscopic studies of the structural components of the thyroid gland a day after the reproduction of thermal trauma to the skin on the background of the introduction of 0.9 % NaCl solution revealed reactive adjunctive-compensatory changes and initial manifestations of destruction. Vascular, stromal and parenchymal components of the organ in the stage of shock after burns correspond to the state of "stress" as a reaction to pathological exogenous exposure, and the intensification of metabolic processes in the affected organism of experimental animals.

Histological picture in the skin of rats within a month after burn II-III degree against the background of the introduction for first 7 days 0.9% NaCl solution

Burn disease is a complex of pathological changes that occur in the body due to the action of a thermal agent and are life-threatening. The problem of skin burns still remains relevant today. Insufficiently studied features of pathogenesis and methods of treatment of thermal trauma are the cause of considerable interest of scientists in this problem. The aim is to study the features of microscopic changes in the skin of rats during the month after grade II-III burn on the background of the introduction of the first 7 days of 0.9% NaCL solution. The studies were performed on 360 laboratory white male rats weighing 155-160 g. During the experiment, the animals were divided into 4 groups: 1st, 2nd groups – rats without thermal trauma infused with 0.9% NaCl solution and HAES-LX-5% at a dose of 10 ml/kg. In the 3rd, 4th groups, rats were infused with 0.9% NaCl solution and HAES-LX-5% at a dose of 10 ml/kg after skin burns. Burning skin damage was caused by applying to the lateral surfaces of the trunk of rats for 10 seconds four copper plates, heated in water at a constant temperature of 100°C. Histological preparations were prepared by standard procedure and examined using an OLYMPUS BH-2 light microscope. Conducted microscopic studies of the skin of animals after thermal trauma under the conditions of application of 0.9% NaCl solution found that in the early stages of the experiment (1, 3, 7 days) compensatory and adaptive changes of its structural components are combined with signs of destructive disorders. In the later periods of thermal trauma (14, 21 and 30 days), the destructive changes of the structural components of the skin in the lesion area deepen, and the process becomes irreversible.

Features of immune status and immunocorrection in burn disease

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AGGREGATION AND SIZE OF PLATELETS IN CHILDREN WITH BURN DISEASE

Introduction. One of the main factors involved in the pathogenesis of burn disease consists in the disturbance of microcirculation and haemostasis, caused by increased platelet aggregation. Mechanisms underlying the enhancement of platelet aggregation are poorly understood. Main results were obtained for adult patients at the onset of the burn disease, with no similar data on paediatric patients being available. There is evidence of a relationship between the size of platelets (MPV) and their functionality.Aim. To undertake a study of spontaneous and ADP-induced platelet aggregation and their size in children with burn disease.Materials and methods. We studied the aggregation and size of platelets in children aged 3–17 years, in whom burn areas covered 10–70 % of the body surface at the onset of the disease and before discharge. Spontaneous platelet aggregation was analysed under conditions of induced shear flow, whereas ADP-induced aggregation was studied employing a turbidimetric method. The study of platelet sizes was carried out using a conductometric method.Results. Spontaneous platelet aggregation increases significantly in children with burn disease. The integrated optical density of the formed aggregates, their area and perimeter were estimated for the first time. These indicators remained elevated even after burn wounds had been completely closed. In burn disease, changes in ADP-induced platelet aggregation were multidirectional in nature. Mean platelet volume (MPV) was increased during the acute period of burn disease, decreased during the period of toxaemia, and normalised by the time of patients’ discharge. Changes in MPV did not affect the aggregation properties of platelets. There was no correlation between the degree of aggregation and the severity of hyperfibrinogenemia. The blood of burn patients contained a large number of activated platelets, which was the reason for the increase in their spontaneous aggregation, not requiring the participation of exogenous inducers.Conclusion. An increase in spontaneous platelet aggregation was observed in children after a thermal injury, which remained elevated until the burn wounds were completely closed. A significant increase in the number of activated platelets constituted the reason for the increase in spontaneous platelet aggregation.Conflict of interest: the authors declare no confl ict of interest.Financial disclosure: the study had no sponsorship.

Peculiarities of the wound healing process in the acute period of burn disease depending on the antiseptic used

Background. Burn injury, as one of the most common types of trauma, requires a comprehensive approach to treatment, including surgical and conservative treatment with effective post-burn wound protection. One of the main obstacles to wound healing is purulent-infectious complications, for prevention of which antiseptics are widely used.
 The aim is to study the microbiological, histological features of the wound healing course in the acute period of burn disease with the use of various antiseptics.
 Materials and methods. In the research there were involved 44 patients with burns (burn area 10–20 % of the body surface), treated in the Clinical Center for Thermal Injury and Plastic Surgery of Communal Non-Commercial Enterprise “Vinnytsia Regional Clinical Hospital named after M. I. Pirogov” (2018–2019). Depending on the antiseptic therapy, these patients were divided into three observation groups. Patients in the 1st study group (n = 15; mean age 48.07 ± 12.05 years) were treated with 2.0 % povidone-iodine during dressing. In the 2nd group (n = 15; mean age – 48.53 ± 14.76 years) antiseptic based on 0.02 % decamethoxin was used. In patients of the comparison group (n = 14; mean age – 47.71 ± 12.39 years) a solution of 10.0 % NaCl was administrated for topical wound management. Microbiological assessment of the condition of the wound surface (on 3, 7, 14, 21 days) and histological examination of tissue samples from the bottom of the wound (on 3, 7, 14 days) were carried out by means of standard methods.
 Results. Under the use of antiseptic agents based on 2.0 % povidone-iodine and 0.02 % decamethoxin during the treatment period in patients with burns up to 14 days, an effective reduction in the number of conditionally pathogenic microorganisms on the wound surface to lg (4.8 ± 0.4) and lg (3.06 ± 0.5) CFU/ml, respectively, was registered and it was significantly 1.5 times lower than that based on 10 % sodium chloride solution (p < 0.05). When applying decamethoxin for 14 days at the same time as the eradication of conditionally pathogenic microorganisms, moderate colonization of wounds was registered by representatives of normal skin microbiota (Corynebacterium spp., S. epidermidis). Histologically, there was found that with the use of 2.0 % povidone-iodine, the wound healing course was accompanied by a marked decrease in inflammation signs, as well as a pronounced inhibition of the formation of granulation tissue (10–14 days). The use of 0.02 % decamethoxin was accompanied by the formation of granulation tissue of sufficient maturity for atodermoplasty, in the presence of signs of inflammatory cellular reaction with the presence in the superficial parts of the bottom of the post-burn wounds of the fibrinoid layer, with signs of permanent formation of new hemocapillaries in it, surrounded by a thin argyrophilic mesh. When using a hypertonic sodium chloride solution before autodermoplasty, the granulation tissue had signs of uneven inflammatory cell infiltration. Signs of leukocyte-necrotic tissue changes, fibrinoid-leukocyte layers with fragments of tissue detritus, signs of resuscularization of granulation tissue were recorded.
 Conclusion. Microbiological data strongly suggest the efficacy of 0.02 % decamethoxin and 2.0 % povidone-iodine in reducing microbial wound colonization infection compared to 10.0 % NaCl. The use of antiseptics and hypertonic sodium chloride solution in the acute period of burn disease provides a marked reduction in histological signs of inflammation in the wound with a noticeable positive effect of decamethoxin and 10.0 % NaCl on the formation of granulations and their revascularization compared with povidone-iodine (p < 0.001).

STRUCTURAL CHANGES IN RENAL CORTEX IN EXPERIMENTAL SKIN BURN INJURY AND UNDER THE CONDITION OF INFUSION SOLUTIONSUSE

Aim of research is the establishment of structural features of the course of the adaptive-compensatory and regenerative processes in the cortical substance of the rat kidney in late terms after experimental burn skin injury and the use of HAES-LX-5 % is relevant for theoretical and practical medicine. Materials and methods.The article presents and analyzes the results of an experimental study on the structural changes of the cortical substance of the kidneys in rats in late terms after burn injury of the kidney with the condition of administration of intravenous infusion of 0.9 % NaCl solution and complex colloid-hyperosmolar solutions of lactoprotein with sorbitol and HAES-LX-5 %. Comparative analysis showed that functionally different cells of the nephrons under the infusion of detoxification solutions in the conditions of development of burn disease die by necrosis, apoptosis and anoikis. Also in epithelial cells of nephron tubules there weremitophagy and mitoptosis. Result. Mitoptosis in epithelial cells of rat nephron tubules with experimental burn skin injury was carried out in two ways, which are related to I – destruction of the outer mitochondrial membrane; II – preservation of the outer mitochondrial membrane and attachment of autophagic (mitophagic) mechanisms to release the cell from degraded mitochondrial material. In the first case, the mitochondria first condensed, after which its matrix swelled and the fragmentation of the cross occured due to the destruction of the cross compounds. Finally, the outer mitochondrial membrane broke and the remnants of the crystals (in the form of vesicles) went into the cytoplasm. In the second case, the mitochondria condensed, vesicular fragmentation of the sac occured, but the outer mitochondrial membrane retained its integrity and the mitochondria were absorbed by the autophagosome. Next, autophagosomes merged with lysosomes and formed autophagolysosomes, which, subject to effective content processing, were transformed into vacuoles. The latter were emptied by exocytosis and ensured the cell was free from degraded material. Conclusions. Only a lactoprotein with sorbitol has a membrane-plastic effect aimed at strengthening the mitochondrial membrane, in part of the mitochondria of epithelial cells of nephron tubules is ultrastructurally increased by the electron density and thickness of all components of the mitochondrial membrane. The maximal membrane effect of the action of lactoprotein with sorbitol on the mitochondria manifests itself fourteen days after the experimental burn skin injury and gradually (twenty-one and thirty days later) disappears, which coincides with the improvement of the overall clinical condition. There is every reason to believe that increased structuralization of mitochondria is a safeguard for the spread of mitoptosis and mitophagy, the excessive nature of which can lead to cell death.

Violations of protein metabolism in children in the acute period of burn disease

Introduction . Burn pathology is one of the most serious problems of pediatric surgery, which is associated with a high frequency of injuries, severe clinical course, due to the imperfection of adaptive capacity in children. Among the main target organs in burn disease a special place is occupied by the liver, one of the manifestations of it’s insufficiency are violations of protein metabolism. Purpose of the study. To evaluate the characteristics of protein status in burnt children in the acute period of burn disease. Materials and methods. Were examined in 22 children on 2–6 and 13–16 days after burn injury. The concentrations of total protein, albumin, prealbumin, C-reactive protein, urea, fibrinogen, prothrombin and antithrombin III activity were evaluated. Statistical data processing was performed using the program Statistica 6.1. Results. It is shown that the acute period of burn disease in children occurs on the background of hypo – and dysproteinemia. A decrease in the concentration of the albumin fraction (albumin, prealbumin) and globulins was revealed. The study of individual representatives of the globulin fraction showed an increased content of fibrinogen and C-reactive protein, almost unchanged activity of antithrombin III and a decrease in the average prothrombin activity. At the same time, it is noteworthy that the lowest values of antithrombin activity were observed in children with developed sepsis. The minimum value of prothrombin activity and content of prealbumin discovered in a patient with a fatal outcome. Conclusion. The obtained data indicate the possibility of using the parameters of the protein spectrum as markers of unfavorable (doubtful) prognosis of burn disease.

Methods for the effective treatment of animal burns

Burns (combustio) - tissue damage arising from thermal, chemical, electrical or radiation exposure. Burn disease – a complex violation of the organs and systems, developing due to extensive burns. The cause of burn disease is the loss of all types of the skin functions, loss of plasma, the collapse of red blood cells, as well as metabolic disorders. The probability of development, severity, and prognosis in this pathology are determined by the age of the patient, the General condition of his body and some other factors, but the leading role is played by the area of the lesion. 500 thousand animals are burned according to statistics in Russia for the year, and as a rule, mortality among burned animals is more than 11%. Treatment includes antibiotic therapy, infusion, and detoxification therapy, correction of all organs and systems. Treatment of burns of the first and second degree is most often limited to the local use of drugs that reduce pain sensitivity, promote faster tissue regeneration and help prevent infection, which leads to lengthening of healing processes and other complications. In the case of third and fourth-degree burns, regular thorough cleaning of the affected areas is also necessary, sometimes surgical intervention is required. Today, burns are widespread, so the search for effective treatments remains relevant. In this paper, we describe the etiology, pathogenesis of burns of small pets, the definition of the most effective and cost-effective method of treatment. The task of the research was also to determine the degree of burns and diagnosis of burns.

Submicroscopic changes of alveoli of respiratory department of lungs a day after experimental thermal trauma

Deep, large thermal burns are not limited to local lesions of tissues, they cause significant disruption of all systems and organs of the organism, change in metabolic processes. It is revealed that the primary links in the pathogenesis of burn disease are destruction of the skin, impaired neuroendocrine regulation and significant hemodynamic disorders. The reorganization of structures and impaired lung function, in response to a pathological process in the body, is attracting increasing attention of scientists. The aim of the study was to establish a submicroscopic rearrangement of the alveoli after a thermal lesion for 1 day after the experimental thermal trauma. Grade III burns were applied under ketamine anesthesia with copper plates heated in boiled water to a temperature of 97-1000С. The size of the lesion area was 18-20 % of the epilated surface of the body of rats. An experimental study of the structural components of lung alveoli after burn injury was performed on laboratory white male rats weighing 160-180 g. Euthanasia of rats was performed after ketamine anesthesia by decapitation. In the experiment, the study of the submicroscopic state of the walls of the alveoli of the lungs after thermal trauma was done. It is established that in the stage of shock after the application of burn injury – 1 day, in the alveoli of the respiratory department of the lung, there are adaptive compensatory and initial destructive changes of all structural components of the alveoli. Damage to the ultrastructure of the aerohematical barrier is manifested by intracellular edema and edema of the organelles of the endothelial cells, respiratory and secretory epitheliocytes, and the amount of heterochromatin increases in their deformed nuclei. The basement membrane also has signs of edema, sometimes homogeneous, fuzzy. The decrease in the number of vesicles and micropinocytotic vesicles in endothelial and respiratory epitheliocytes leads to impaired endothelial and alveolar metabolism. Numerous actively phagocytic alveolar macrophages with a well-expressed lysosomal apparatus are found in the alveoli. Initial alternative alterations of the ultrastructure of the components of the air-barrier barrier lead to disruption of gas exchange in the respiratory department of the lungs

Indicators of the cell cycle in the thyroid gland in rats when using infusion of 0.9% NaCl solution on the background of thermal skin burns

Systemic damage of the organs, including the thyroid gland, is one of the key factors in the pathogenesis of burn disease due to thermal skin burns. The aim of this study was to investigate the indices of the cell cycle and DNA fragmentation of thyroid gland cells in rats with the use of infusion of 0.9% NaCl solution against the background of thermal skin burns. Experimental studies were conducted on 60 white male rats weighing 160-180 g, which was subjected to thermal burns of the skin of 2-3 degrees with a total area of 21-23% of the body surface. The first 7 days rats were infused with 0.9% NaCl solution into the inferior vena cava. Animals were removed from the experiment by decapitation (after 1, 3, 7, 14, 21, and 30 days). DNA content in the nuclei of the cells of the thyroid gland of rats was determined by flow cytometry. The statistical processing of the obtained results was carried out in the license package “STATISTICA 6.1” using nonparametric estimation methods. After 1 day after thermal skin damage and using 0.9% NaCl solution, lower (p<0.05) values of the S-phase index (0.234±0.094) were found compared to the control group without burn (0.652±0.134). The maximum decrease (p<0.01) of S-phase indicators (0.622±0.110 and 0.214±0.105, respectively) and a significant increase (p<0.01) of the SUB-G0G1 interval (5.288±0.840) compared to similar control group values (2.594±0.628) is observed after 3 days. The S-phase against the background of the introduction of 0.9% NaCl solution and thermal skin burn remained significantly lower than those of the similar control groups at 7 (p<0.01), 14 (p<0.05) and 21 days (p<0.05). At 14 days after thermal skin injury, the SUB-G0G1 interval (p<0.05) was lower than in the control group of rats. After 30 days, the G0G1 phase parameters were significantly lower (p<0.01), and the G2+M phase values were significantly (p<0.01) higher than those in the control group at the same time. Thus, it was found that 0.9% NaCl solution was not effective enough to correct cell division disorders during the entire observation period after skin burns.

Advantage of Early Tangential Necrectomy in Extensive Pediatric Burns

Background: An extensive burn is one of the most serious injuries. The modern treatment of pediatric burns is a logical exercise in resuscitation, infection control, surgical wound care, nutrition and psychologic and physical rehabilitation. The conventional methods of local therapy, especially in extensive and deep burns, cannot prevent infection. The fact is that the necrotic burn tissue always gives rise to infection and must therefore be excised. Tangential excision is a diagnostic procedure as well as a surgical preparation of a recipient bed for skin graft. Clinical parameters of sixty extensively burned children have been evaluated, divided into two groups (surgically and non-surgically treated) and in four subgroups (under and over the 25% TBSA). The following criteria have been used to compare the results: pain, fever, body weight, duration of the hospital stay, wound infenction, laboratory values.
 Aim of research: The aim of our research was to demonstrate the efficacy of early tangential necrectomy in the treatment of extensive burns in children as well as in preventing the burn diseases.
 Material and methods: Clinical parameters of sixty extensively burned children have been evaluated, divided into two groups (surgically and non-surgically treated) and in four subgroups (under and over the 25% TBSA). The following criteria have been used to compare the results: pain, fever, body weight, duration of the hospital stay, wound infection, laboratory values.
 Results: The boys comprised 58.3% of the respondents and the girls were 41,7% of the respondents. The most common cause was the hot liquid of 73.3%, open flame 23.3% and the contact with hot metal 3.3%. The body temperature was significantly higher in control group compared to the examined group (p <0.001) significantly lower hematocrit values in the control group compared to the examined group (p = 0.002). The results show that hospitalization lasted considerably longer in patients in the control group than in the examined group (p = 0.003).
 The incidence of bacterial infection of the burns is significantly higher in control compared to the examined group of patients (p = 0.007). The most commonly isolated bacteria in the study group was Staphylococcus aureus (15/30 or 50% of all subjects). Acinetobacter spp. was isolated in 9 patients (30% of respondents). Serratia spp. And Enterococcus Foecalis were isolated in 6 patients (20%). Pseudomonas aeruginosa was isolated in 3 patients (10%). Three patients (10%) did not isolate any bacteria during hospitalization
 Conclusions: The method of early tangential necrectomy of extensively burned children significantly reduce morbidity and mortality (it improves the general condition of the patient, improves clinical and laboratory parameters, reduces the possibility of infection of the wound, reduces the possibility of sepsis, reduces the length of hospitalization).The most optimal time to perform an early tangential necrectomy is the period between the 4th and the 6th day after the injury. In extensively burned children over 30% of the total body surface, an early tangential necrectomy should be performed on an area of about 20% of the total body surface as a prevention of blood loss due to necrectomy and autotransplantation. With extensively burned children over 40% of the total body surface, taking homotransplants from parents or close relatives reduces morbidity and mortality.

NO-ERGIC SYSTEM IN RENAL TISSUE DURING BURN DISEASE

This research aimed at studying the state of the NO-ergic system in renal tissue of rats in modelled burn disease. Materials and methods. The series of experiments were carried out on pubescent male rats. Burn disease was modeled according to the Dovgansky method: the shaved and depilated area of a hind limb of test animals was dipped into hot water (t = 70 – 75 0С) under ethereal anesthesia for 7 sec. The size of the site damaged was determined depending on the area of ​​the skin, which averaged 12-15% of the animal’s body surface. The area of the skin damaged was calculated using the special Kochetygov’s table. Histological study of the damaged skin showed that under the above conditions there was a burn of IIIA-B degree that, according to modern conceptions, is considered as a standard model of the development of burn disease in the experiment. The rats were decapitated under ethereal anesthesia in 1, 7, 14, 21 days that in accordance with the modern ideas is commensurate with shock phases, early and late toxemia, and septicotoxemia. To evaluate the status of NO-ergic system, we assessed the NO-synthase activity and the nitrites content in the renal tissues. Results. Depending on the stage of burn disease, the NO-ergic system changed its characteristics. On the 1st day, at the stage of burn shock, the activity of NOS in renal tissues increased to its maximal level, while the peak increase in the content of nitrites was observed on the 7th day, at the stage of early toxemia. Conclusions. Thus, during the course of long-term burn disease, there is an increase in the activity of the NO-ergic system in kidney of rats. This can be explained by the enhancement of inflammatory processes in the kidneys under burn disease and by NO2– accumulation of in the renal tissues.

Comparative analysis of the effects of various detoxification solutions on the structure of the kidneys in experimental burn disease in rats

The use of existing infusion solutions, as well as the development, scientific substantiation and implementation of the latest nephroprotective detoxification solutions, remain an urgent problem for combustiologists. The aim of this work is to compare the effects of various detoxification solutions (0.9 % NaCl solution and complex colloid-hyperosmolar solutions – lactoprotein with sorbitol and the newly developed HAES-LX-5 % solution) on the kidney structure in experimental burn disease in rats. The experimental rats were divided into seven groups (fifteen animals each): the first group was intact rats; the second, third and fourth groups were rats without reproduction of experimental burn disease, which had a separate intravenous infusion of 0.9 % NaCl solution, lactoprotein with sorbitol and HAES-LX-5 % at a dose of 10 ml/kg; the fifth, sixth and seventh groups were rats with experimental burn disease (by causing burn injury of the skin with an area of 21-23 % of the body surface), which under the same scheme had an intravenous infusion of the investigated solutions. All studies and the removal of rats from the experiment were performed under deep thiopental intraperitoneal anesthesia. Histological preparations of the renal cortex of the rat were stained with hematoxylin-eosin and examined on an Olympus BX51 microscope. Using ultramicrotome LKB-3 (Sweden) obtained semi-thin sections which were stained with toluidine blue and methylene blue – Azur II; and ultrathin sections were counterstained with uranyl acetate and lead citrate according to Reynolds and examined using a PEM-125K electron microscope. Morphometric measurements (estimation of the area of the vascular glomeruli, the area of the urinary lumen of the capsule of the renal corpuscles; the area of the renal tubules of the nephrons and the area of their lumens, the area of the renal corpuscles, the area of cytoplasm and nuclei of epithelial cells of tubules, and also their nuclear-cytoplasmic ratio) was carried out using the VideoTest-5.0, KAARA Image Base and Microsoft Excel on a personal computer. Statistical analysis of the obtained quantitative indicators was performed using the ІВМ SPSS v. 22.0. for Windows. Functionally different cells of nephrons have been found to die by necrosis, apoptosis and anoikis when infused with detoxification solutions during the development of burn disease; in epithelial cells of nephron tubules, mitophagy and mitoptosis occur. Mitoptosis in epithelial cells of rat tubules of nephrons with experimental burn skin injury is carried out in two ways related to: 1) destruction of the outer mitochondrial membrane; 2) preservation of the outer mitochondrial membrane and involvement of autophagic (mitophagic) mechanisms to release the cell from degraded mitochondrial material. In the first case, the mitochondria first condense, after which its matrix swells and the fragmentation of the cristae occurs due to the destruction of the junction of the cristae. Finally, the outer mitochondrial membrane breaks and the remnants of the cristae (in the form of vesicles) go into the cytoplasm. In the second case, the mitochondria condense, vesicular fragmentation of the cristae occurs, but the rupture of the outer mitochondrial membrane does not occur and the mitochondria are absorbed by the autophagosome (or transformed into the autophagosome). Next is the merger of autophagosomes with lysosomes and the formation of autophagolysosomes, which, under the conditions of effective digestion of the contents, are transformed into vacuoles. The latter are emptied by exocytosis and ensure the release of cells from degraded material. Only lactoprotein with sorbitol has a membrane-plastic effect on the strengthening (enhancement of structuring) of the mitochondrial membrane in part of the mitochondria of epithelial cells of nephron tubules, which is ultrastructurally manifested by an increase in the electron density and thickness of all components of the mitochondria. The maximum membrane effect of lactoprotein with sorbitol against mitochondria manifests itself fourteen days after the experimental burn skin injury and gradually (after twenty-one and thirty days) disappears, which is correlated with an improvement in the overall clinical condition and an improvement in the structural changes in the kidney of animals with burn disease. There is every reason to believe that increased structuration of mitochondria is a preventer of the spread of mitoptosis and mitophagy, the excess of which can lead to cell death.

Reactive and destructive changes of Peyer’s patches in rats with experimental burn disease under infusion of detoxification solutions

The pathogenesis of burn immune dysfunction and burn enteropathy needs further clarification given that the cellular lesions of lymphoid tissue associated with mucous membranes are the least studied. The purpose of the study was to establish reactive and destructive changes in Peyer’s patches of rats after burn injury of the skin with the use of intravenous infusion of isotonic sodium chloride solution and combined colloid-hyperosmolar solutions. White male rats weighing 160-200 g at 6 months of age were divided into 4 groups (18 animals in each group): I, II, III – rats with burn skin injury (grade II-III burn with an area of 23% of body surface area and the development of moderate-severity shock state) which was administered a separate intravenous infusion once a day for the first 7 days of the experiment with isotonic sodium chloride, lactoprotein with sorbitol and HAES-LX-5%, in each case at a dose of 10 ml/kg; IV – intact animals. The material was collected from rats under deep thiopental intraperitoneal anesthesia after 1, 3, 7, 14, 21 and 30 days after burn injury. Biopsies from Peyer’s patches for histological and electron microscopic examination were processed using conventional methods. Investigation of histological preparations stained with hematoxylin-eosin was performed on an Olympus BX51 microscope. Ultrathin sections were contrasted on copper support meshes with uranyl acetate and lead citrate according to Reynolds and studied using a PEM-125K electron microscope. Electron and light microscopy data indicate that intravenous infusion of colloidal-hyperosmolar solutions (lactoprotein with sorbitol and HAES-LX-5%) promotes suppression of inflammatory response, inhibits necrosis, and optimizes lymphoid apoptosis at Peyer’s patches of rats with experimental burn disease caused by burn injury to the skin of 21-23% of the body surface. Apoptotic lymphocytes and their apoptotic bodies are effectively phagocytosed by macrophages and are digestible in heterophagolysosomes. The apoptotic altered dendritic cells in Peyer’s patches are characterized by osmiophilic cytoplasm and a nucleus with high electron density amorphous nucleoplasm. In the cytoplasm are located mitochondria with enlightened matrix and destroyed cristae, irregularly expanded tubules of variable configuration of a granular endoplasmic reticulum with electronically transparent content and numerous derivatives of their vacuole transformation, which are sharply darkened. The fusion of vacuoles leads to the formation of large electron-luminous cavities filled with various residues of compacted degraded cellular structures. Vacualization promotes site segmentation of condensed cytoplasm of apoptotic dendritic cells and formation of apoptotic blebs, which are subject to entrapment and subsequent sequential degradation with the participation of neighboring macrophages. The structural changes of the organelles of the protein-synthesizing apparatus found in Peyer’s plaque cells in rats with experimental burn disease can be regarded as a manifestation caused by functional overload of the granular endoplasmic reticulum (ER-stress). The consequence of optimal development of ER-stress and subsequent unfolded protein response is the apoptotic degradation of the corresponding cell, the course of which is modified by the use of colloid-hyperosmolar solutions.