糖尿病大鼠深二度烫伤创面VEGF和bFGF的表达规律及其与创面微血管密度的关系

皮肤伤口愈合是一个复杂的生物学过程，通常认为是由进入伤口的成纤维细胞的增殖分化及其合成和分泌的细胞外基质的纤维化，新生血管长入伤口的血管化和表皮细胞增生覆盖创面的再上皮化等综合作用的结果。在愈合过程中产生的生长因子大多对皮肤伤口的纤维化、血管化和再上皮化有介导和调控作用。本实验采用糖尿病难愈创面的动     

糖尿病合并深Ⅱ度烫伤创面bFGF受体的表达

目的:观察糖尿病合并深Ⅱ度烫伤创面bFGF受体表达的改变,探讨糖尿病难愈创面形成和发展的机制。方法:将SD大鼠用链脲佐菌素(STZ)诱导成糖尿病大鼠模型,8周后经80℃ 5 s制成糖尿病合并30％深Ⅱ度烫伤动物模型,同时将对照组的正常SD大鼠30％深Ⅱ度烫伤,分别于伤后1、3、5、7、14和21 d取背部的创面组织。同时各设1组非烫伤组,脱毛后直接取大鼠背部的正常皮肤标本,作为O时相点。采用SP免疫组织化学方法、计算机图像扫描分析技术和逆转录一聚合酶链反应(RT—     

热休克蛋白70的研究

本系统地介绍了热休克蛋白的理论基础、相关研究和进展，为进行有关研究提供线索。     

创面修复中生长因子研究及临床干预新进展

创面修复是一个多因素参与的复杂而精细的生物学过程。创面局部生长因子及其受体活性下降和数量的相对和绝对缺乏是其难愈的重要病理生理基础。创面修复过程中生长因子不仅可以促进角质细胞增殖分化使创面再上皮化,还可改变细胞外基质,促进蛋白质、DNA和RNA的合成以及糖酵解,促进新生肉芽组织形成。因此,局部外用生长因子可以显著促进创面修复。在临床实践中,生长因子的应用方式也不断改善,同时与其相关的治疗方案也不断涌现,应用前景广泛。     

糖尿病真皮组织中细胞的增殖和凋亡状态

目的研究在未受到外源损伤时,糖尿病真皮组织中细胞的行为表现特征。方法以糖尿病患者(糖尿病组)和非糖尿病对照者(对照组)的皮肤组织标本作为研究对象,分别进行组织学观察,免疫组化检测PCNA、cyclin B1的表达,TUNEL法检测凋亡细胞,组织蛋白提取ELISA法测定p53、Bcl-2和Bax表达水平。结果与对照组相比,糖尿病组真皮组织胶原排列松散杂乱,纤细的浅层胶原范围广。两组真皮组织中PCNA、cyclin B1和Bax表达无明显差别;与对照组相比,糖尿病组真皮组织中凋亡细胞表达明显增加(P<0.01),p53水平增高而Bcl-2水平减低(均P<0.05)。结论无外源性损伤时,糖尿病真皮组织已有病理改变。凋亡细胞比例增加,相关的凋亡调控蛋白表达异常。提示糖尿病创面有一个异常的愈合起点。     

创面修复专科与社区医疗机构双向转诊现状及发展对策

2011年3-4月,笔者通过对大型综合医院医师、社区医疗机构医师、大型综合医院就诊的创面患者、社区医疗机构就诊的创面患者定性访谈,深入分析目前大型综合医院创面修复专科与社区医疗机构之间双向转诊现状及存在的问题.研究表明,目前创面疾病双向转诊过程中面临着“上转”和“下转”困难、双向转诊过程中政策不完善和操作规范不明确、大型综合医院和社区医疗机构间信息无法共享等问题.突破创面疾病双向转诊运行障碍的主要对策应包括:建立深层次的各级医院联动机制、建立药品对接通道、明确创面修复的双向转诊流程、建立医院间可共享的患者诊疗信息“数据库”等.     

Introduce法经皮胃造瘘术在上消化道狭窄肿瘤患者中的应用

目的: 总结Introduce法经皮胃造瘘术在上消化道狭窄肿瘤患者中的应用经验。方法: 对61例上消化道部分或完全梗阻肿瘤患者[男48例,女13例;年龄18~90岁,平均(60.02±9.88)岁],采用Introduce法经皮胃造瘘建立肠内营养管道,分析术前准备、胃腔充气膨胀方式、胃壁固定穿刺置管、术中及术后并发症等情况。结果: 61例患者中,造瘘成功60例,失败1例。鼻胃镜充气膨胀52例,超细管充气4例,腹腔穿刺针刺入充气5例,其中1例穿刺充气失败,原因是穿刺针滑入胃壁,造成胃黏膜下充气,形成夹层。鼻胃镜引导手术顺利,术后无并发症;CT引导下手术后1例伤口出血,止血处理后出院。结论: Introduce法经皮胃造瘘术是上消化道梗阻患者建立肠内营养途径的有效方法。鼻胃镜和CT均可引导胃造瘘,但前者可提供可视窗口,安全性较好;CT不能实时监控,需严格掌握适应证。     

慢性难愈合创面住院患者回顾性调查

Objective To investigate cause of chronic wounds and related status of patients so as to provide strategy for study and treatment of chronic wounds and establish ment of health policy. Methods A total of twelve thousand one hundred and sixty-one cases hospitalized in our hospital in 2008 were enrolled in the study. A chronic wound was defined as skin tissue defect which could not heal after one month of treatment. Medical records were thus screened. Then a retrospective study was performed on patients with chronic wounds with analysis of age, gender, injury cause, therapy, and average length of hospital stay. Data were processed with chi-square test and one-way analysis of variance. Results Investigation showed:397 out of 12 161 cases ( accounting for 3.3% ) were recognized as having chronic wounds. ( 1 ) The main causes for chronic wound were burn, diabetes, and pressure ulcer, accounting for 59.9% (238/397),15.6% (62/397), 10.8% (43/397), respectively. The other causes were operative injury, infection,varicosity, etc. There was statistical difference among the numbers of patients with chronic wounds with regard to various causes of injury (x 2 = 136.21, P = 0. 001 ). (2) Among patients with chronic wound, the patients older than 70 years. There was significant difference in the numbers of patients with chronic wound among different age groups (x2 = 24.12, P =0. 025). There was statistical difference among the numbers of patients with chronic wound in different age groups with each cause of injury ( with x 2 values from 7.86 to 28.31, P values all below 0.05 ). ( 3 ) All patients with chronic wounds received traditional dressing. In 60. 5% (240/397) and 86.4% (343/397) of patients, operative treatment or antibiotics were given. (4)The average length of hospital stay in patients with chronic wound [( 38 ± 27 ) d] was longer as compared with that of all the inpatients in the same period [(15 ± 7) d, F = 22.82, P = 0. 012]. There was obvious difference in the average length of hospital stay among patients with chronic wound caused by different reasons ( F = 24.06, P = 0. 036) , in which burn injury resulted in the longest length of hospital stay [(47 ±27) d]. Conclusions Chronic wounds are mainly caused by diabetes and burn, and characterized by old age and longer length of hospital stay. It is necessary to strengthen translational research and related policy making, so that more rational treatment can be applied for patients with chronic wounds.     

中国人群体表慢性难愈合创面病原微生物学特征分析

目的:研究体表慢性难愈合创面病原微生物学特征,为选择正确的创面抗感染治疗方法提供依据.方法:采用多中心横断性病例回顾调查研究的方法,对2007-2008年我国17家医院中因体表慢性难愈合创面住院治疗患者的住院病历中有关细菌病原学特征进行记录,分析其规律.结果:共有1 488 201个病案被纳入观察对象,从中获得符合入选...     

糖尿病大鼠皮肤组织糖代谢紊乱与皮肤神经病变相关性研究

Objective To analyze the relationship between cutaneous glycometabolic disorders and cutaneous neuropathy in diabetic rats, and to look for the mechanism of neuropathy and impaired wound healing. Methods Eighty male SD rats were randomly divided into the normal control group (NC, n =20 ), diabetic group (D, n = 20 ), aminoguanidine-interfered group (AⅠ, n = 20 ), and insulin-interfered group ( Ⅱ, n = 20) by drawing lots. Diabetes was reproduced in rats of D, AⅠ, and Ⅱ groups with intraperoguanidine, while rats in Ⅱ group were subcutaneously injected with insulin for satisfactory control of blood glucose. Changes in mechanical and heat pain thresholds of pad of hind limb were measured at post injection week ( PIW ) 2, 4, 8. Skin specimens were collected during PIW 2-8 from pads for determination of contents of glucose, advanced glycation end product ( AGE), substance P ( SP), calcitonin gene-related peptide ( CGRP), and observation of distribution and ultrastructure of skin nerve fibers. Data were processed with t test. Results The mechanical and heat pain thresholds in D group at PIW 2 [(6.3 ± 1.5) g, (6.0 ±0.9) s, respectively] were obviously lower than those in NC group [(13.0 ±3.2) g, (10.3 ± 1.2) s,with t value respectively 2.71, 3.42, P values all below 0.05]. Contents of glucose and AGE in skin tissue in D group were significantly increased when compared with those in NC group, especially at PIW 8 [(2.85 ±0.33) mg/g, (31.7±3.2) U/mg of hydroxyproline vs. (0.82 ±0.22) mg/g, (22.2 ±1.9) U/mg of hydroxyproline, with t value respectively 1.65, 6.47, P values all below 0.01]. The myelinated nerve fibers were edematous and degenerated, with axons compressed, while the unmyelinated nerve fibers were vacuolated, with microfilament and microtubule disorderly arranged. Content of SP in skin tissue in D group was lower as compared with that in NC group, especially at PIW 2 [(16.8 ±3.4) pg/g vs. (28.5 ±5.0) pg/g,t = 2.42, P ＜ 0.01]. There was no obvious difference in content of CGRP between NC and D groups, and also in content of glucose in skin between D and AⅠ groups. Compared with those in D group, content of AGE in AⅠ group at PIW 8 was decreased markedly [(27.2 ± 1.4) U/mg of hydroxyproline, t = 3.38, P ＜0.05]; contents of glucose and AGE in Ⅱ group at PIW 8 were significantly decreased [( 1.42 ± 0.38 ) mg/g,(23.6 ± 1.3 ) U/mg of hydroxyproline, with t value respectively 1.74, 8.17, P ＜ 0.05 or P ＜ 0. 01].Compared with that in D group, contents of SP in AⅠ and Ⅱ groups were increased, with a delay in time of trough value. Content of CGRP showed no obvious difference among D, AⅠ, and Ⅱ groups. Conclusions High glucose and accumulation of AGE are key mediators of cutaneous neuropathy and impaired wound healing in diabetes mellitus, which confirms that diabetic wound takes an atypical footing during wound repairing. Aminoguanidine and insulin can reduce contents of glucose and AGE in diabetic skin tissue, and ameliorate diabetic cutaneous neuropathy.