Local Cold Injury Research Articles

The Intensity of Degradation and Synthesis of the Dermal Intercellular Matrix in Rats after Local Cold Injury against the Background of Metabolic Syndrome

The Intensity of Degradation and Synthesis of the Dermal Intercellular Matrix in Rats after Local Cold Injury against the Background of Metabolic Syndrome

Особливості анестезіологічної допомоги хворим на холодову кропивницю (огляд літератури)

Cold urticaria (CU) is an allergic reaction that manifests itself as hives-like rashes or red spots in response to general or local cooling of the body. Th e disease can be acquired or hereditary, and in the cold season it can affect all segments of the population. Th is pathological condition, at first glance, does not seem to be a very dangerous variant of a local cold injury, but in persons who are prone to exposure to low temperatures, especially with a burdened cold history, it may be accompanied by chronicity of the process and complicated by neurovasculitis, obliterating endarteritis and secondary Raynaud’s syndrome, may decrease the quality of life of the victims and become a cause of disability. The pathophysiology of CU is largely unknown, but it is likely to be related to immunoglobulin E (IgE) and mast cell activation. Cooling has been reported to induce the release of neutrophilic and eosinophilic chemotactic factors, prostaglandin D2, and tumor necrosis factor (TNF-α). Less common immunologic fi ndings in patients with CU include cryoglobulinemia consisting of monoclonal IgG and mixed IgG/IgM and IgG/IgA cryoglobulin types. The mechanisms of development of CU are mainly determined by the formation of cryoglobulins (cold hemolysins) and subsequent degranulation of mast cells. Th e diagnosis of CU depends on the patient’s history and the results of cold provocation tests. Patients with CU are recommended first of all not to overcool, to take warm showers, to wear warm clothes and a hat, and not to consume cold food and drinks. Treatment options include second-generation H1 antihistamines and glucocorticosteroids. New promising option is omalizumab, a humanized monoclonal antibody derived from a recombinant DNA molecule that targets and selectively binds to circulating IgE and affects mast cells function. In patients with CU undergoing general anesthesia, premedication including antihistamines and corticosteroids is recommended, along with strict maintenance of perioperative normotermia.

Methods and pathophysiology of rewarming in case of local cold injury. Literature review

Nowadays, rewarming of the affected tissues is the primary method of treatment for patients with cold injuries. But the warming manipulation has its own characteristics and limitations, depending on specific circumstances. Untimely and incorrectly performed rewarming can lead to a significant increase in the level of dangerous complications, mortality, and disability. The rewarming strategy is implemented according to one of the two scenarios. If there is a risk of freezing again, the injured area is not actively rewarmed; it is just immobilized, and thermo‑insulating bandages are applied. Slow warming with body heat is also acceptable. If the frozen area can be warmed and kept warm without refreezing until the evacuation is completed, a quick warming with warm water or special heating blankets is preferable. Recommendations on the ideal water temperature significantly differ among authors and include a wide range between 37 °C and 43 °C. The extent of damage to the tissues becomes obvious only after thawing. The traditional classification system of local cold injuries distinguishes four degrees of frostbite. First‑degree frostbite presents with superficial damage to the skin; second‑degree frostbite involves deep skin damage; third‑degree frostbite results in full‑thickness skin damage, including the subcutaneous and surrounding tissues; and fourth‑degree frostbite causes deep necrosis of the subcutaneous structures. Depending on the extent of damage, patients may experience constant and severe pain during rewarming, so analgesics should be prescribed to relieve it. It is recommended to use topical agents (creams, gels, and ointments) to improve circulation and prevent and treat infection. Tissue necrosis with severe frostbite requires surgical treatment of wounds. The authors hope that the provided information will be useful to doctors‑of‑first‑ contact and in hospital conditions in order to optimize the treatment of local cold injuries.

Automated morphometric studies of collagen fibers as an auxiliary method for diagnosing cold injury

Background. Cold injury is one of the most significant problems for the northern regions of the Russian Federation. Frostbite is defined as a complex of changes caused by the action of low temperatures, which lead to morphological changes in damaged tissue structures. As a result, the skin with underlying tissues and the intercellular matrix, the components of which are collagen fibers, are damaged, which eventually leads to remodeling and a protracted course of the wound process. Morphometric studies in combination with quantitative analysis of microphotographs (histological specimens) using GIS technologies make it possible to distinguish altered collagen fibers under the influence of low temperatures from relatively healthy tissues. The aim of the study. To assess the possibility of using computer analysis of microphotographs in a complex of morphometric studies of collagen fibers in local cold injury. Materials and methods. The study included 84 patients with III and IV degree frostbite of the lower extremities. Morphological study of tissues and microphotography were performed using Leica DM2500 microscope (Leica, Germany). The thickness of collagen fibers was measured based on visual measurements of characteristic areas of the microphotograph. Computer analysis of tissue microphotographs of the zone of cryoinjury was performed using the ArcINFO software (Esri, USA). Statistical processing of the study results was carried out using the SPSS Statistics software package (IBM Corp., USA). Graphs and diagrams were constructed using MS Office Excel (Microsoft Corp., USA). Results. With frostbite, severe tissue damage occurs, accompanied by the destructive processes of the extracellular matrix components. Low temperatures contribute to changes in the width and orientation of collagen fibers in the damaged area. In this regard, a change in the texture of the histological specimen image leads to achange in the numerical characteristics of the standard deviation of the curvature coefficient in the studied area of the microphotograph. Thus, in the late reactive period, the described complex of morphometric studies makes it possible to classify particular microphotograph as having pathological signs or as a sample of healthy tissue.

The Intensity of Degradation and Synthesis of Derma Intercellular Matrix in Rats after Local Cold Injury in the Presence of Metabolic Syndrome

Studies of tissue regeneration processes in the post-cold period are currently in demand in connection with the development of the Arctic, which is characterized by extremely low temperatures. Metabolic or hormonal abnormalities based on insulin resistance and compensatory hyperinsulinemia, which can lead to the development of cardiovascular diseases, and, consequently, to microcirculation disorders, are aggravating factors that increase the consequences of cold injuries. In this work, we studied the processes of degradation and synthesis of the intercellular matrix of the dermis, as well as the concentration of sialic acids in the blood serum after a local cold injury of the third degree. It was revealed that the regenerative process after local cold damage began on day 3 and was characterized by an increase in the collagen content of the dermis and the thickness of collagen fibers. Regeneration in the case of metabolic syndrome was accompanied by a slowdown in tissue repair processes. The course of the recovery process was associated with a change in the content of sialic acids in the blood serum, while a distinctive feature of the dynamics of this indicator was an increase in the concentration of sialic acids in metabolic disorders on day 7 and a slow slight decrease throughout the experiment, reaching the control values by day 21.

Trench foot and other non-freezing cold injuries (literature review)

Non-freezing cold injury is a general term that includes trench foot and immersion foot and is characterized by damage to the soft tissues, nerves, and vessels of the distal extremities as a result of long stay (usually two to three days or longer) in wet, cold (but not freezing: typically 0 to 15 °C) conditions. Trench foot syndrome primarily affects military personnel, fishermen, agricultural workers, travelers, and other segments of the population. In wartime, the number of such local cold injuries increases several times. Unfortunately, in domestic medical developments, this problem is practically not given due attention. Based on data from foreign literary sources and their own clinical experience, the authors were able to highlight the main patterns of pathogenesis and clinical picture of this pathological condition with justification of treatment tactic and preventive measures.

Pernio — the least severe local cold injury (scientific literature review)

Local cold injury is a certain problem of peacetime and all-out military invasion. In modern guidelines, almost no attention is paid to the least severe local cold lesion of perniosis. However, such a variant of local cold injury should not be underestimated, although it can be a safe transient condition, since we cannot exclude its rather serious consequences and complications, which are sometimes accompanied by chronicity of the process and even disability.

A prospective study on local cold injuries in northern Sweden

ABSTRACT The study aimed to determine the prevalence and incidence proportion of local cold injuries in northern Sweden, and identify associated factors. It was based on prospective data from surveys in 2015 and 2021 sent to a population-based sample in northern Sweden. Multiple binary logistic regression was performed. The study included 5,017 subjects (response rate 44.4%). The prevalence of cold injuries in the hands was 11.4%, feet 12.6%, and face 19.9%, while the incidence proportion was 1.0%, 1.0%, and 0.9%, respectively. Male gender was associated with incident cold injuries in the hands (OR 1.69; 95% CI 1.31–1.28), feet (OR 1.34; 95% CI 1.04–1.73), and face (OR 1.53; 95% CI 1.15–2.03); mental stress with cold injuries in the hands (OR 1.55; 95% CI 1.16–2.05) and feet (OR 1.39; 95% CI 1.04–1.88); previous stroke with cold injuries in the hands (OR 2.64; 95% CI 1.09–6.40) and face (OR 3.09; 95% CI 1.26–7.56); and Raynaud’s phenomenon with cold injuries in the hands (OR 2.48; 95% CI 1.80–3.41) and feet (OR 2.07; 95% CI 1.50–2.87). We conclude that male gender, mental stress, previous stroke, and Raynaud’s phenomenon increased the probability of contracting local cold injuries.

Prerenal kidney damage in patients with local cold injury

Introduction. Important links in the pathogenesis of cold alterations are vascular damage and powerful systemic alterations. The presence of premorbid pathology and the duration of the wound process negatively affects to the function of most organs and systems, including the kidneys. Renal insufficiency in patients with frostbite develops in the acute period of cold damage. This is indicated by a decrease in the amount of urine and an increase in creatinine levels in victims with frostbite. In this regard, the identification and analysis of the dynamics of new markers of renal dysfunction in patients with frostbite is promising both from a scientific and practical point of view.The aim. To investigate the dynamics of changes in serum creatinine, NGAL and cystatin C levels in patients with local cold trauma.Materials and methods. The study included 60 patients with frostbite of the III–IV degree of distal limb segments. The study was carried out depending on the volume of the lesion and the timing from the moment of cryoalteration.The results of the study. In patients with grade III–IV frostbite, an increase in the level of lipocalin and serum creatinine was detected in the blood. The concentration of lipocalin and serum creatinine is directly proportional to the volume of cold-affected tissues. Indicators of lipocalin and serum creatinine decrease in the late stages of cryopreservation. The level of cystatin C significantly decreases during all periods of frostbite; the concentration of the latter does not depend on the severity of cryopreservation.

Содержание клеток в зонах дермы крыс в норме и на фоне метаболического синдрома при восстановлении после холодовой травмы

Local cold injury is not uncommon in areas with unfavourable climatic conditions. The significance of this problem is associated with a large number of such injuries, complexity of their treatment, long period of disability and high level of disablement among the population. Aggravating factors of cold injuries include metabolic abnormalities that can lead to the development of cardiovascular diseases, and, consequently, to microcirculation disorders. The aim of this paper was to trace the dynamics of the cellular structures of the dermis in the process of recovery from local cold injury in rats with metabolic syndrome, compared with the recovery process in healthy rats. Materials and methods. The study was conducted on outbred rats. The development of obesity and metabolic disorders was modelled by including a 30 % sucrose solution in the diet instead of water, as well as saturated fats. Local cold injury was modelled by applying a metal weight 2.5 cm in diameter cooled in liquid nitrogen to the depilated skin of the animals’ backs. Cell dynamics was studied in the papillary and reticular dermis as well as in the reticular dermis on the border with the hypoderm of the damaged area and on its periphery using a morphometric grid. Results. The data obtained suggest that regenerative changes after local cold injury in rats are associated with accumulation of cells on the border of the reticular dermis and the hypoderm of the damaged area. In addition, we observed a later onset of the peak of the migration process and a larger number of cells involved in migration at metabolic syndrome than during regeneration of the wound surface in the absence of metabolic disorder. It is quite likely that all the dermal zones under study, especially the dermis on the border with the hypoderm, are involved in the regeneration process of the affected area, whereas on the periphery of the damaged area, it is mainly the dermal zone located on the border of the reticular dermis and the hypoderm that is involved.

Osmotic Resistance of Rat’s Erythrocytes After Local Cold Injury

The effect of local cold injury in rats on the osmotic resistance of erythrocytes in the early and late reactive terms was investigated. Cryoinfluence was performed by pressing the applicator to the skin on the lateral surface of the rat thigh for 30, 60 and 120 s. Afterwards, the blood was collected from the aorta of animals after 1 and 4 hours and after 24 and 48 hours (early and late reactive periods, respectively). The effect of hypotonic solutions on cells was used as a test for osmotic resistance of erythrocytes. It is shown that the osmotic resistance of erythrocytes in the early reactive term increases (compared with control cells). In the late reactive term, the indices of osmotic resistance of erythrocytes after 24 hours approached the control values and after 48 hours they reached the norm. Osmotic resistance of erythrocytes in both reactive terms after local cold injury does not depend on the duration of cryoinfluence (30, 60, 120 s). The findings are considered from the standpoint of adaptive reactions that have an allostatic nature.

Hypothermia and Cold Injury in Children.

Hypothermia and Cold Injury in Children.

Complications classification of local cold injury

The OBJECTIVE of this work was to develop a classification of complications of local cold injury.METHODS AND MATERIALS. The study is based on the results and analysis of the treatment of 132 patients with local cold injury of the II–IV degree of the lower extremities. The victims were hospitalized in the regional center for thermal trauma on the basis of the «City Clinical Hospital № 1» in the period from 2018 to 2019. Post-traumatic complications were detected in 54 patients (40.1 %), of which 32 developed early and 22 patients developed late complications. The remaining 78 patients after discharge from the hospital did not seek medical help again and were under the supervision of a polyclinic surgeon.RESULTS. In the course of the study, it was found that in 32 out of 132 patients in the early period of local cold injury of the lower extremities, sensitivity disorders, muscle weakness, convulsions, impaired coordination of movements, graft rejection, wound suppuration and suture failure, stump necrosis were detected in the affected segments of the extremities. 22 victims developed late complications of local cold injury: trophic ulcers of the stumps of the feet, osteomyelitis with the formation of sequesters, gangrene of the stumps of both feet. As a result of the study and pathogenetic interpretation of the consequences of cryoinjury, a new classification of complications of local cold injury was formed and the criteria for the forms of «cold extremity» were identified.CONCLUSION. Post-traumatic complications were detected in almost half of the victims with local cold injury (54 patients, 40.1 %). Thus, in the early stages of cryoinjury, 32 patients were found to have impaired sensitivity of the affected limb, muscle weakness, convulsions, and impaired coordination of movements; 4 (12.5 %) had treatment complicated by graft rejection; 5 (15.5 %) had wound suppuration and suture failure; 2 (6.25 %) had stump necrosis. In the late period, complications of local cold injury were registered in 22 patients. Of these, 12 (55 %) patients were found to have trophic disorders; osteomyelitis was detected in 8 (36 %) patients; in 2 (9 %) — gangrene of the distal segment of the affected limb.

Изучение динамики содержания клеток в зависимости от локализации в дерме после локального холодового повреждения

Изучение динамики содержания клеток в зависимости от локализации в дерме после локального холодового повреждения

Патогенетическое значение дисфункции эндотелия в формировании гипертонуса периферической сосудистой стенки при местной холодовой травме

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.

On the participation of eosinophils in tissue recovery after a local cold injury

The article studies the correlation of the content of peripheral blood and red bone marrow eosinophils with the level of secretion of fibroblast growth factor (FGF-21), insulin-like factor (IGF-1) and vasculoendothelial growth factor (VEGF-C) in blood serum during the formation of dermal collagen after local cold damage. Animals of the experimental group after the onset of narcotic sleep on the depilated skin of the back were simulated contact frostbite of the 3rd degree. On the 3rd, 7th, 14th and 21st day of the experiment, the concentrations of growth factors, % dermal collagen content, and also the content of eosinophils in peripheral blood and red bone marrow were determined in the blood serum. The research results showed that the development of eosinopenia after a local cold injury occurs due to the sequestration of eosinophils in the affected area. The presence of reactive changes after a local cold injury not only in peripheral blood, but also in the red bone marrow may indicate the participation of eosinophils in tissue repair processes after a local cold injury.

Dynamics of the Level of Myeloperoxidase and Serum Calprotectin in Local Cold Injury

Relevance. Cold injury is defined as a complex of pathophysiological and pathomorphological changes arising as a result of local or general cooling of the human body. Endothelial dysfunction provokes a powerful cascade of cellular interactions with expressed excretory activity, which ultimately leads to a pronounced remodeling of microcirculation and a protracted process of inflammation in the focus of alterations. Aim of the study. To establish the dynamics of the level of myeloperoxidase and calprotectin in the serum of patients with local cold injury. Materials and methods. The study included 80 patients with III–IV degree lesions in the late reactive period and the period of granulation and epithelialization. The average age of patients was 38 ± 8 years. The myeloperoxidase level was measured on the 5th and 30th days from the moment of cryopreservation using multiplex analysis of blood serum. Results. The level of myeloperoxidase and serum calprotectin increases. In late reactive period (day 5), MPO level in patients with frostbite is 7.25 times higher in comparison with control values, in the period of granulation and epithelialization (day 30), it remains elevated, but only 3.63 times higher than in the control group. In the late reactive period, the level of calprotectin in the blood serum of patients with local cold injury was 4.6 times higher in comparison with control values, and on the 30th day of cryopreservation, the value of calprotectin was 4.5 times higher than in the control group. Changes in the level of myeloperoxidase and serum calprotectin reflect the flow of destructive and reparative mechanisms in tissues during local cold trauma and can be used in predicting an unfavorable prolonged course of the wound process.

Features of disturbances of microcirculation and intercellular interactions in local cold injury

Theaimof 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 role of matrix metalloproteinases and their inhibitors in patients with local cold injury

The role of matrix metalloproteinases and their inhibitors in patients with local cold injury

The state of lipid peroxidation and antioxidant protection systems in patients with different of local cold injury of the extremities

The authors studied the state of lipid peroxidation systems and antioxidant protection in of the extremities in different periods. It was revealed that in patients with frostbite of the radical oxidation and the level of antioxidant protection depended on periods of cold 20 people were in the control group, 30 patients with local cold trauma in the early reactive late reactive period (LRP) there were 40 people, and in the granulation and epithelization period (GEP) there were 15 people. There was a persistent increase in the concentration of the early, late reactive periods and the period of granulation and epithelization. In red blood cells, the content of intermediate intermediates of free radical lipid oxidation increases. The catalase activity in erythrocytes of victims with frostbite of the extremities decreases, but does not change in the blood serum. The dynamics of the serum in patients at different times of local cold injury in comparison with healthy people is not observed.