应用生长因子治疗深Ⅱ度烧伤创面疗效观察

目的:观察重组人表皮细胞生长因子(rhEGF)治疗深Ⅱ度烧伤创面的疗效。方法:深Ⅱ度烧伤98例,随机分为观察组56例及对照组42例,观察组创面应用rhEGF及磺胺嘧啶银治疗,对照组则单纯应用磺胺嘧啶银,分别观察创面50%、80%、100%的愈合时间。结果:深Ⅱ度创面50%愈合时间,观察组(15±1.5)天,对照组(16.1±1.7)天(P>0.05);90%愈合时间,观察组(20.0±1.7)天,对照组(26.0±2.4)天(P<0.01);100%愈合时间,观察组(22.0±1.5)天,对照组(28.0±1.9)天(P<0.01)。结论:rhEGF对深Ⅱ度烧伤创面的促进愈合作用显著,能明显缩短疗程。     

表皮细胞生长因子和碱性成纤维细胞生长因子促进烧伤创面愈合的疗效比较

目的　比较外源性重组人表皮细胞生长因子 (rhEGF)与重组人碱性成纤维细胞生长因子 (rhFGF)促进创面愈合的临床疗效。方法　选择浅Ⅱ度烧伤创面、深Ⅱ度烧伤创面和刃厚皮供皮区创面共 90例患者 2 70个创面为研究对象 ,所有创面分别为rhEGF治疗组、rhFGF治疗组和自身对照组 ,选择自体相应部位、相似深度创面进行对照。分别观察创面愈合时间和在不同时间内创面的愈合率。结果　rhEGF的促再上皮化作用明显 ,对浅Ⅱ度烧伤创面及刃厚皮供皮区创面比rhFGF组和对照组愈合时间缩短 (P <0 .0 1) ,rhEGF对深Ⅱ度烧伤创面与对照组愈合时间无明显差异 (P >0 .0 5 ) ;而rhFGF对肉芽组织生长有特殊的作用 ,rbFGF对深Ⅱ度烧伤创面比rhEGF组和对照组愈合时间明显缩短 (P <0 .0 1) ,对浅Ⅱ度烧伤创面及刃厚皮供皮区创面比对照组愈合时间无明显差异 (P >0 .0 5 ) ;动态愈合率在不同的烧伤创面也明显加快 ,组间具有显著性差异。结论　rhEGF和rhFGF修复创面效果的差异取决于它们不同的生物学特性以及作用机制 ,组织缺损较大 ,组织损伤层次深 ,早期需要内芽组织填充的创面使用rhFGF为宜 ,而浅度创面需要以再上皮化修复为主的则选择rhEGF为佳     

三种生物制剂复合应用对芥子气兔眼角膜损伤的治疗作用

目的 :观察角膜胶原膜 (CCS)及伍用纤连蛋白 (FN)、表皮生长因子 (EGF)对兔眼角膜芥子气损伤后的治疗作用 ,寻找芥子气眼损伤后眼睑水肿前救治的新方法、新技术和新药物。方法 :将2 4只兔左眼角膜芥子气染毒后 ,随机均分为A ,B ,C组 ,分别用PBS液、CCS及CCS +FN +EGF处理 ,于染毒后 2 ,8,16 ,2 4 ,36 ,4 8和 72h对角膜荧光素着色区拍照 ,计算其上皮愈合速率和上皮破损率。结果 :A ,B ,C三组的角膜上皮愈合速率分别为 (0 .879± 0 .139)mm2 /h、(1.2 2 3± 0 .16 6 )mm2 /h和 (1.543± 0 .2 2 4 )mm2 /h ,统计学处理发现角膜上皮愈合速率各组间差异均非常显著 (P <0 .0 1) ,三组的角膜上皮破损率分别为 71.6 %、57.3%和 4 4 .8% ,统计学差异也非常显著 (P <0 .0 1)。结论 :CCS能促进芥子气染毒引起的兔眼角膜损伤的上皮愈合 ,而伍用FN和EGF的效果更佳     

重组人表皮细胞生长因子治疗芥子气Ⅱ度皮肤损伤创面的临床观察

皮肤最易受到芥子气蒸气或液滴的侵袭产生损伤，因芥子气特殊的毒理作用，损伤的皮肤愈合较慢，往往遗留后遗症。Ⅱ度芥子气皮肤损伤创面能否尽快愈合，是影响芥子气中毒治疗效果的重要因素之一。重组人表皮细胞生长因子(rh-EGF)对Ⅱ度烧伤创面的愈合有促进作用，但可否用于芥子气皮肤损伤的治疗有待观察。笔者应用rh-EGF(金因肽，珠海亿胜生物制药有限公司生     

重组人表皮细胞生长因子缓释微球治疗糖尿病大鼠溃疡

目的 制备重组人表皮细胞生长因子(rhEGF)缓释微球,并对其形貌、释药行为和在体外促进细胞增殖的能力进行评价;同时比较rhEGF缓释微球与rhEGF原液对糖尿病大鼠溃疡促愈作用的差异. 方法 (1)用改进的复乳法制备rhEGF缓释微球.透射电镜检测rhEGF微粒形貌表征,激光粒度仪/Zeta电位仪分析微球粒径分布,ELISA法测定rhEGF微球释药行为.(2)以小鼠成纤维细胞L929细胞系为对象,采用MTT法鉴定rhEGF缓释微球的生物学活性.(3)制备糖尿病大鼠溃疡模型,成模后采用随机数字表法将大鼠分为4组:rhEGF缓释微球组(A组)、rhEGF原液组(B组)、空白微球组(C组)、PBS溶媒对照组(D组),每天给药1次.分别于给药后3,7,14,21 d对溃疡创面照相计算创面愈合率.创缘皮肤取材,测定羟脯氨酸含量,免疫组化检测β1整合素和角蛋白-19并测量其阳性染色面积比. 结果 (1)rhEGF缓释微球平均粒径为193.5nm,粒径分布均匀,微球之间元粘连,分散性好.释药过程符合Higuchi释放动力学模型,释放时间长达24 h.(2)不同浓度rhEGF缓释微球均有促进小鼠成纤维细胞增殖的作用,其中以10μg/L浓度促小鼠成纤维细胞增殖的作用最强.(3)从治疗第7天开始,愈合率以A组最快,A组与其他三组比较,差异均有统计学意义(P<0.05).羟脯氨酸含量、β1整合素和角蛋白-19阳性染色面积比A组均高于B组. 结论 用改进的复乳法制备的rhEGF缓释微球,粒径大小分布均一,释放时间长达24 h.rhEGF缓释微球促进糖尿病大鼠溃疡创面愈合速度较rhEGF原液更快,溃疡创面愈合质量更高.     

重组人表皮细胞生长因子凝胶对家兔烫伤创面修复作用的研究

目的观察重组人表皮细胞生长因子(rhEGF)凝胶对家兔烫伤创面的修复作用。方法家兔12只,制备深II°烫伤模型,rhEGF凝胶分为3个剂量组(0.5、10.0、50.0μg.g-1),另设空白基质、生理氯化钠溶液和rhEGF水溶液对照组,每只动物6个创面,均采用自身对照试验。结果rhEGF凝胶治疗的创面愈合速度较对照组显著加快,并存在着一定的量效关系。组织病理学检查发现rhEGF凝胶治疗的创面肉芽组织中毛细血管生长与胶原沉积明显。结论rhEGF凝胶对家兔深II°烫伤创面有明显的促进愈合作用,并可提高创面愈合质量。     

39例芥子气皮肤损伤3年随访报告

目的 观察早期使用表皮细胞生长因子治疗、创面早期切痂植皮对芥子气皮肤损伤的疗效.方法 39例芥子气皮肤损伤患者随访3年,对皮肤愈合情况进行评估.结果 随访患者皮肤愈合良好,但遗留色素沉着,局部复发少.主诉皮肤损伤部位出现瘙痒、感觉异常较多,皮肤损伤后遗症目前尚难以预测.结论 早期使用表皮细胞生长因子、创面早期切痂植皮治疗芥子气皮肤损伤对创面愈合、改善预后有明显的效果.     

重组人表皮生长因子凝胶在Ⅲ期压疮护理中的应用研究

 目的 观察重组人表皮生长因子(recombinant human epidermal growth factor,rhEGF)凝胶在Ⅲ期压疮护理中的疗效.方法 38例Ⅲ期压疮入院患者随机分为治疗组和对照组.治疗组以rhEGF凝胶均匀涂布于创面;对照组仅以3%过氧化氢液冲洗.观察两组创面愈合率、组织学改变、创面羟脯氨酸(HYP)含量及Ⅰ型/Ⅲ型胶原比例.结果 治疗组的创面愈合速度较对照组明显加快,其Ⅲ期压疮平均愈合时间为(10±2.5)d,对照组为(35±8.7)d(P＜0.01).在治疗后第3、6、9天,治疗组可见创面肉芽组织灶明显增生,富含血管及细胞,同时创面中HYP含量增加,Ⅰ型/Ⅲ型胶原比例降低(P＜0.01).结论 rhEGF治疗Ⅲ期压疮可以缩短创面愈合时间,增加肉芽组织及HYP含量,降低Ⅰ/Ⅲ型胶原比例,明显促进压疮创面的修复.     

薰衣草精油涂膜剂治疗手部Ⅱ度烫伤疗效分析

目的 探讨薰衣草精油涂膜剂治疗手部Ⅱ度烫伤的临床疗效。方法 选取2017年4月至2020年2月沈阳医学院附属中心医院收治的168例手部Ⅱ度烫伤患者作为研究对象,根据治疗方法将其分为研究组84例、对照组84例,研究组患者采用薰衣草精油涂膜剂治疗,对照组患者采用京万红软膏治疗,对比观察两组患者创面无明显渗出时间、疼痛缓解时间以及创面愈合时间。结果 研究组患者的创面无明显渗出时间为（11.85±2.38）d、疼痛缓解时间为（5.93±0.52）d、创面愈合时间为（22.74±3.53）d,均明显短于对照组的创面无明显渗出时间（15.39±3.52）d、疼痛缓解时间（7.27±0.74）d、创面愈合时间（27.93±4.07）d（t=8.829、7.636、13.579,P均＜0.001）。结论 薰衣草精油涂膜剂有助于减轻手部Ⅱ度烫伤创面的疼痛程度,减少创面渗出,加快创面愈合。     

MEBO与rhEGF促进烧伤残余创面修复研究

目的 :探讨MEBO与重组人表皮细胞生长因子 (Recombinanthumanepidermalgrowth ,rhEGF)治疗烧伤残余创面 ,促进创面愈合的应用效益。方法 :2 0 0 2年 1月～ 2 0 0 4年 2月 ,30例深Ⅱ～Ⅲ度烧伤患者后期残余创面进行随机双盲试验 ,每例患者设A、B两个治疗区 ,A区为MEBO与rhEGF混合治疗区 ,MEBO一支和rhEGF 4 0u/cm ,混合涂在创面上 ,MEBO按 4小时更换新药 ,rhEGF每日一次 ;B区为对照区 ,10 %碘伏清洁创面后外用丁胺卡那霉素换药 ,每日一次。每例患者如A区先愈合 ,B区治疗停止并改为A区治疗方法 ,反之改为B区治疗方法。结果 :30例患者A区先愈合 ,愈合时间12 9± 1 2天 ,点状小创面 3天有上皮覆盖 ,B区无一例愈合 ,每例患者换药时有分泌物 ,创面有小脓点出现 ,残余创面扩大。结论 :MEBO与rhEGF联合使用是治疗残余创面最好方式 ,值得临床推广。     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Sexual homicide: Brief review of the literature and case report involving rape,genital mutilation and human arson

The objective of the current paper is to report a new case of sexual murder involving human arson and summarize the literature on the phenomenon of sexual homicide. The present case study is unprecedented in Greece and a rarity in international literature due to the fact that the victim suffered genital mutilation and incineration while still alive. The evaluation consisted of 176 articles; 53 were reviewed by the authors. The results revealed sparse, but significant, research findings. The authors discuss the limitations regarding research, incidence of the phenomenon, crime-scene patterns, offender characteristics (killing methods, motive inferences, sociodemographic data, classifications, psychopathology, modus operandi), and victim selection. The incidence of the phenomenon is unclear (1–4%) due to non-standardized criteria. It is an expression of displaced anger or sexual sadism and/or a way to elude detection (ancillary benefit). Most offenders (in their first kill) and victims were in their late 20s to early 30s and belong to Caucasian populations. Personal weapons were commonly used against women, strangulation is the prevalent killing method against children, and firearms against men. Most of the sexual homicide perpetrators are non-psychotic at the time of the attack, but experience personality pathology, primitive defenses, pathological object relations, and withdrawal into fantasy in order to deal with social isolation.     

Extension du modèle puissance–temps limite pour estimer la production d’énergie aérobie et anaérobie lors de l’exercice intense

Aim

Examine how the modelling of the relation between power and time to exhaustion can provide an estimation of the production of aerobic and anaerobic energy during intense exercise.

Current knowledge

The hyperbolic model made it possible to define the critical power corresponding to the maximal rate of energy renewed by aerobic metabolism. A new model distinguishing the critical power from the maximal aerobic power has been built to estimate more precisely the anaerobic contribution. Data from middle distance runners and subjects tested on cycle ergometer showed a relative contribution of anaerobic metabolism arising from critical power and increasing until around 10 % of total power when aerobic energy production reaches its maximum.

Prospects

Considering the slow component of oxygen uptake would provide a more precise analysis of energy production and transformation during exercise at high intensity.     

Beziehungen zwischen Aufprallgeschwindigkeit,Fahrzeugbeschädigungen,Frakturen und „Wurfweite” bei 50 tödlichen Fußgänger-PKW-Unfällen

Zusammenfassung Aus 160 Obduktionen von Fußgängern, die durch PKW getötet worden waren, sind 50 nach folgenden Gesichtspunkten ausgewählt worden:Auffahrunfälle Erwachsener mit gesicherten Angaben in den Gerichtsakten über Fahrzeugbeschädigungen, Zusammenstoßstellen, Endlage der Fußgänger und Bremsspuren. Aus diesen Daten wurden Ausgangs- und Aufprallgeschwindigkeiten berechnet sowie die Wurfweite der Fußgänger gemessen.Die Ausgangsgeschwindigkeiten, nach der Berechnung zwischen 32 und 95 km/h, lagen meistens etwas höher als die angegebenen Geschwindigkeiten. Zwischen Ausgangs- und Aufprallgeschwindigkeiten waren die Differenzen größer. Ab 12 km/h Aufprallgeschwindigkeit kam es bereits zu tödlichen Verletzungen. Auffallend ist die zweigipfelige Verteilung der Häufigkeit sowohl bei der Einteilung nach den Aufprallgeschwindigkeiten als auch nach den Deformationsarbeiten (Aufprallgeschwindigkeit: 26% bei 51–60 km/h und 22% bei 21 bis 30 km/h; Deformationsarbeit: 34% bei 39–200 kpm und 30% bei 701–1000 kpm).Bei Aufprallgeschwindigkeiten über 50 km/h wurden doppelt so viel Knochenbrüche an der Wirbelsäule und am Becken als bei Aufprallgeschwindigkeiten unter 50 km/h festgestellt.Bei 44 Fußgängerunfällen lag ein Drittel innerhalb der Erwartungsgrenze der Wurfweite nach Fiala, je ein Drittel aber darüber bzw, darunter.Das Beschädigungsbild und die Anstoßverletzungen geben Hinweise zur Ermittlung der Aufprallgeschwindigkeit, vor allem wenn weitere Berechnungsgrundlagen fehlen.

---

Summary Fifty cases were selected from 160 autopsies performed on pedestrians who were accidentally killed by private motorcars; the cases were selected according to the following criteria:The cases were confined to impact accidents involving adults in which reliable evidence could be gathered from the Court records in relation to damage to the car, the place of collision, the final position of the injured pedestrian and the extent of skidmarks. The initial and collision speeds of the cars were calculated from these facts and the distance of projection of the pedestrians were measured.The initial speeds, calculated between 32 and 95 km/h, were, in most cases, higher than the declared speeds. The differences between initial and collision speeds were larger. Fatal injuries could arise from a collision velocity of only 12 km/h. A striking feature of the analysis was the distribution of two peaks of frequency whether these were classified according to the collision speeds or according to the deformation of the vehicle (collision speed: 26% at the speed of 51 to 60 km/h and 22% at the speed of 21 to 30 km/h; deformation work: 34% at the deformation work of 39 to 200 kpm and 30% at the deformation work of 701 to 1,000 kpm).Twice as many fractures of the vertebral column and pelvis were sustained at collision speeds over 50 km/h as were sustained under 50 km/h.In one third of 44 pedestrian accidents, the distance of projection was within the expected range described by Fiala; in one third the distance was above and in one third below the expected range.If additional data for calculation were lacking, the patterns in injury arising from the impacts gave indications from which it was possible to estimate the collision speed.

Stipendiat der Alexander v. Humboldt-Stiftung, Dozent Dr. med. S. Kamiyama, Dept. of Legal Medicine, School of Medicine, Chiba University, 313 Inohanacho, Chiba, Japan.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.     

Hip and pelvic injuries in the elderly

Fractures of the hip and pelvis are frequent and serious injuries in elderly patients. Due to the aging population, their incidence should double by 2050. Therefore, the social and economical implications of these fractures are significant. Delay in diagnosis increases the associated morbidity and mortality. The purpose is to review the imaging features of these fractures, the imaging techniques (projections, CT) to depict them and their classification based on severity.