Pathogenetic and Prognostic Significance of Thrombocytopenia in Patients With Necrotizing Soft Tissue Infections

Necrotizing soft tissue infection (NSTI) is a severe surgical infection which can result in sepsis and septic shock when generalized.The aim of the study was to determine the frequency of thrombocytopenia in patients with generalized NSTI, the factors promoting its development, and its association with septic shock.Materials and Methods. We examined 129 patients with NSTI treated between 09.2015 and 12.2019 at St. George Hospital in St. Petersburg, Russia. Surgical treatment, hematological and biochemical examinations, and bacteriological analysis of blood and wound discharge were performed in each patient. The studied group included 22 patients with systemic inflammatory reaction syndrome, 63 patients with sepsis, and 44 patients with septic shock.Results. We found a decrease in platelet count in NSTI patients with septic shock as early as on the first day of the disease and its further decrease within the next 3 days, with the mean platelet volume (MPV) increasing during the same period and significantly exceeding that in patients with sepsis and systemic inflammatory response syndrome. In NSTI patients with thrombocytopenia on admission, we found a significant correlation between the platelet count and the percentage of segmented neutrophils (r=0.349; P<0.001; n=40). The maximum incidenсe of septic shock was observed in patients infected with Klebsiella pneumoniae (13 out of 19, 65%). These patients had the highest MPV but did not develop thrombocytopenia. Maximum frequency of thrombocytopenia and elevation of MPV and platelet distribution width (PDW) was found in patients with NSTI and underlying chronic viral hepatitis C. However, the relative frequency of septic shock in these patients was not increased.Conclusion. The development of septic shock in NSTI is associated with a specific platelet activation patter

Патогенетическое и прогностическое значение тромбоцитопении у пациентов с некротизирующими инфекциями мягких тканей

Necrotizing soft tissue infection (NSTI) is a severe surgical infection which can result in sepsis and septic shock when generalized.The aim of the study was to determine the frequency of thrombocytopenia in patients with generalized NSTI, the factors promoting its development, and its association with septic shock.Materials and Methods. We examined 129 patients with NSTI treated between 09.2015 and 12.2019 at St. George Hospital in St. Petersburg, Russia. Surgical treatment, hematological and biochemical examinations, and bacteriological analysis of blood and wound discharge were performed in each patient. The studied group included 22 patients with systemic inflammatory reaction syndrome, 63 patients with sepsis, and 44 patients with septic shock.Results. We found a decrease in platelet count in NSTI patients with septic shock as early as on the first day of the disease and its further decrease within the next 3 days, with the mean platelet volume (MPV) increasing during the same period and significantly exceeding that in patients with sepsis and systemic inflammatory response syndrome. In NSTI patients with thrombocytopenia on admission, we found a significant correlation between the platelet count and the percentage of segmented neutrophils (r=0.349; P<0.001; n=40). The maximum incidenсe of septic shock was observed in patients infected with Klebsiella pneumoniae (13 out of 19, 65%). These patients had the highest MPV but did not develop thrombocytopenia. Maximum frequency of thrombocytopenia and elevation of MPV and platelet distribution width (PDW) was found in patients with NSTI and underlying chronic viral hepatitis C. However, the relative frequency of septic shock in these patients was not increased.Conclusion. The development of septic shock in NSTI is associated with a specific platelet activation patternНекротизирующая инфекция мягких тканей (НИМТ) — тяжелая хирургическая инфекция, при генерализации которой часто развивается сепсис и септический шок.Цель исследования — определить частоту тромбоцитопении у больных с генерализованными формами НИМТ, факторы, способствующие ее развитию и связь с развитием септического шока.Материал и методы. Обследовали 129 больных c НИМТ, лечившихся с 09.2015 по 12.2019 гг. в больнице Св. Великомученика Георгия Санкт-Петербурга. Всем пациентам провели хирургическое лечение, лабораторное гематологическое и биохимическое обследование и бактериологическое исследование крови и отделяемого из раны. Всего больных с синдромом системной воспалительной реакции было 22, с сепсисом — 63, септическим шоком — 44 человека.Результаты. Выявили снижение количества тромбоцитов у больных НИМТ с септическим шоком уже в первые сутки заболевания и дальнейшее его снижение в течение 3-х дней, причем средний объем тромбоцитов (MPV) в эти же сроки возрастал и существенно превосходил таковой у больных с сепсисом и синдромом системной воспалительной реакции. У больных НИМТ, имевших при поступлении тромбоцитопению, выявили статистически значимую корреляцию количества тромбоцитов с долей сегментоядерных нейтрофилов (r=0,349; р<0,001; n=40). Максимальную частоту септического шока отметили у больных, инфицированных Klebsiella pneumoniaе (13 из 19, 65%). У этих больных тромбоциты имели наибольший MPV, однако тромбоцитопения не развивалась. Максимальную частоту тромбоцитопении, увеличение MPV и анизоцитоз (относительную ширину распределения тромбоцитов по объему — PDW) выявили у больных с развитием НИМТ на фоне хронического вирусного гепатита С. Однако, сравнительная частота развития септического шока у этих больных не была повышена.Заключение. Развитие септического шока при НИМТ обусловлено определенным типом активации тромбоцито

Essay: Transformation and Transfiguration in Gérard Grisey’s “Four Songs for Crossing the Threshold” Musical Composition: “Everyone Became a Trail” - Song Cycle in Five Movements for Soprano and Chamber Ensemble

My dissertation consists of two parts: 1. an essay presenting an analysis of Gérard Grisey’s seminal work Four Chants for Crossing the Threshold (1999) for soprano and ensemble, in regards to concepts of transformation and transfiguration, and 2. a musical composition entitled “Everyone became a Trail” - a five movement song cycle with original texts for soprano and chamber ensembleGrisey’s Chants is an outstanding masterpiece that conceptually explores aspects of ‘crossing the threshold’ by combining poetry about death with formal approaches that strategically explore the temporal structuring of musical processes. The content and structure of the texts become a propelling source for the formalization of the musical material. In each movement Grisey presents unique musical systems that evolve through methods of transformation that inevitably lead to significant formal points of transfiguration. By globally focusing on this evolution from transformation to transfiguration Grisey presents a musical work as a metaphor for the transition between life and death. It is an experience of how time affects the evolution and decay of musical systems. Each movement in the work presents a distinct method to formalize temporal procedures that gradually transform towards a climactic point of transfiguration which inevitably leads to its concluding decay