Procena angiogenih i anti-inflamatornih efekata ekstrakorporealne terapije zvučnim udarnim talasima na animalnom modelu ishemije kožnih režnjeva
Evaluation of angiogenic and anti-inflammatory effects of extracorporeal shockwave therapy in animal model of ischemic skin flaps
Author
Antonić, Vlado N.Mentor
Božić, BiljanaCommittee members
Stojadinović, AleksanderČolić, Miodrag
Novaković, Marijan
Metadata
Show full item recordAbstract
Skoro 30 godina terapija zvučnim udarnim talasima (engl. Extracorporeal Shock
Wave Therapy, ESWT) je u upotrebi u kliničkoj praksi kao efikasan tretman za razbijanje
kamena u urinarnom traktu. Ova tehnologija je kasnije razvijena i kao efikasan
neinvazivan tretman za različite indikacije u ortopediji i traumatologiji uključujući i
komplikovane rane koje ne zarastaju. Udarni zvučni talasi su tranzijentni, kratkotrajni
akustički pulsevi sa visokim pikom pritiska, koji se dostiže u veoma kratkom vremenu,
mereno nanosekunadama (jedan bilioniti deo sekunde). Udarni zvučni talasi koji se
koriste u medicini se generišu putem tri tipa generatora i fizičkih rešenja:
elektrohidraulički, piezoelektrični i elektromagnetni čiji je krajnji cilj da prenese fizičku
energiju do ciljnog tkiva.
Odloženo zarastanje, ili rane koje ne zarastaju predstavljaju veliki teret za svakog
pacijenta, značajno umanjujući njegov kvalitet života. Velika briga o pacijentu i rani je
neophodna u ovim slučajevima i ovo je ...veliki problem za društvo u smislu smanjene
produktivnosti ljudi kao i smislu velikih finansijskih izdataka za zdravstvo. Sa druge
strane, teške povrede kao one koje se viđaju u oružanim sukobima i saobraćajnim
nesrećama predstavljaju glavni uzrok smrti u mlađoj adultnoj populaciji. Tehnološki
napredak, i napredak u dostupnim terapeuticima, koji dovodi do inicijalnog povećanja
preživljavanja pacijenata nije praćen razvojem lekova koji su usmereni protiv moguće
prateće sistemske inflamacije, koja često progresira do sindroma sistemskog
inflamatornog odgovora i sindroma propadanja organskih sistema koji mogu dovesti i do
smrtnog ishoda. Zbog svega prethodno pomenutog, finansijski pristupačni, neinvazivni i
efikasni tretmani su neophodni da bi se postiglo ubrzavanje i potpuno zarastanje
problematičnih rana kao i redukovala cena lečenja. Zbog toga je neophodno utvrditi
potencijalnu primenljivost ESWT u relevantnim animalnim modelima i kod pacijenata, i
ispitati i razjasniti biološke mehanizme ove terapije.
Nekoliko eksperimentalnih i kliničkih studija je pokazalo efikasnost ESWT za
ubrzavanje opopravka ostećenog tkiva i regeneraciju različitih rana. Međutim, biološki mehanizmi kojima se ovi procesi ubrzavaju su ostali neobjašnjeni...
For almost 30 years,
extracorporeal shock wave therapy (ESWT) has been
implemented clinically and has proven to be an effective treatment for urinary stones.
This technology has also emerged as an efficacious non
-
invasive treatment modality for
several orthopedic and traumatic
indications including problematic soft tissue wounds.
Shock waves are produced as transient short
-
term acoustic pulses with high peak pressure
and a very rapid rise to peak pressure on the order of magnitude of nanoseconds (one
billionth of a second). Sho
ck waves for use in medicine can be generated using different
physical principles
-
electro
-
hydraulic, piezoelectric and electromagnetic
–
with the goal
of delivering physical energy to target tissue of interest in order to create a desired
biological effect. Delayed/non
-
healing or chronic wounds constitute a burden for each patient
affected, significantly impairing quality of life (QOL). Intensive multi
-
modality wound
care is required, a...nd this places an enormous burden on society in terms of lost
producti
vity and healthcare costs. Severe traumatic wounds seen in civilian and combat
related injuries are a major cause of death amongst the younger population.
Technological and therapeutic advances that lead to improved initial survival of patients
with life
-
t
hreatening injuries were unparalleled in therapeutics development to fight
concomitant systemic inflammation that accompanies these injuries. This systemic
inflammatory response to wounding often leads to development of a well
-
known
syndrome
-
systemic inf
lammatory response syndrome (SIRS)
-
and can progress to
multiple organ dysfunction syndrome (MODS) and death. Because of all of the
aforementioned, cost
-
effective, non
-
invasive, and efficacious treatments are imperative to
achieve both (accelerated and co
mplete) healing of problematic wounds and reduce
treatment
-
related costs to the human and the healthcare system. Therefore, the potential
of therapeutic shock wave application in relevant animal models and patients has to be
determined in addition to the e
lucidation of the biological mechanisms involved. 5
Several experimental and clinical studies have demonstrated efficacy of
extracorporeal shock wave therapy in terms of accelerating tissue repair and regenerating
various types of wounds. However, the bio
logical mechanism(s) by which this treatment
modality exerts its therapeutic effects remains unclear...