重组人酸性成纤维细胞生长因子（rh-aFGF）在激光治疗创面修复的效果评价

目的：对应用重组人酸性成纤维细胞生长因子(rh-aFGF)对接受激光治疗的患者实施创面修复治疗的临床效果进行研究。方法抽取该院于2013年11月-2014年11月收治的激光治疗患者82例,以就诊时间先后顺序分成对照组与治疗组,对照组采取百多邦与红霉素联合方式,观察组采取rh-aFGF方式,而后对这两组患者的治疗效果进行对比分析。结果治疗组患者创面愈合时间（5.10±1.67）d、创面皮肤外观复常时间（35.48±4.26）d、创面修复治疗计划实施总时间（10.32±3.65）d明显短于对照组(8.69±2.44）、（46.93±5.67）、（13.28±3.41）d;激光治疗创面修复治疗效果(总有效率92.7%)明显优于对照组（总有效率70.7%）;创面修复治疗期间出现水肿、渗出、红斑及疼痛灼烧的人数明显少于对照组。结论应用重组人酸性成纤维细胞生长因子(rh-aFGF)对接受激光治疗的患者实施创面修复治疗的临床效果非常明显。     

Episiotomy healing assessment: Redness,Oedema, Ecchymosis,Discharge, Approximation (REEDA) scale reliability

OBJECTIVE:

to analyse the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability when evaluating perineal healing after a normal delivery with a right mediolateral episiotomy.

METHOD:

observational study based on data from a clinical trial conducted with 54 randomly selected women, who had their perineal healing assessed at four time points, from 6 hours to 10 days after delivery, by nurses trained in the use of this scale. The kappa coefficient was used in the reliability analysis of the REEDA scale.

RESULTS:

the results indicate good agreement in the evaluation of the discharge item (0.75< Kappa ≥0.88), marginal and good agreement in the first three assessments of oedema (0.16< Kappa ≥0.46), marginal agreement in the evaluation of ecchymosis (0.25< Kappa ≥0.42) and good agreement regarding redness (0.46< Kappa ≥0.66). For the item coaptation, the agreement decreased from excellent in the first assessment to good in the last assessment. In the fourth evaluation, the assessment of all items displayed excellent or good agreement among the evaluators.

CONCLUSION:

the difference in the scores among the evaluators when applying the scale indicates that this tool must be improved to allow an accurate assessment of the episiotomy healing process.     

Scanning Electron Microscopic Characterization of Healing and Normal Rat Ligament Microstructure Under Slack and Loaded Conditions

The objective of this study was to observe and compare behavior of the collagen fiber microstructure in normal and healing ligaments, both in situ and ex vivo, in order to add insight into the structure-function relationship in normal and healing ligaments. Fifty-two ligaments from 26 male rats were investigated. Eleven animals underwent surgical transection of both medial collateral ligaments (MCLs) (22 ligaments), which were allowed to heal for a period of 2 weeks. An additional 15 animals (30 ligaments) were used as normals. Ligaments were placed into six groups: Slack ( n = 6 control, n = 6 healing), Reference ( n = 4 control, n = 4 healing), Loaded ( n = 4 control, n = 4 healing), 15° Flexion ( n = 4 control, n = 4 healing), 120° Flexion ( n = 4 control, n = 4 healing), and Tissue Strain vs. Flexion Angle ( n = 8 normals). All ligaments, except those in the Tissue Strain vs. Flexion Angle group, were prepared for scanning electron microscopy. Tissues were harvested, mounted in a load frame, and chemically fixed in one of five states: (1) slack, (2) reference (onset of loading), (3) loaded, (4) 15° knee flexion, or (5) 120° knee flexion. After fixation the tissues were prepared for electron microscopy (SEM). The micrographs from the slack, reference, and loaded groups show fiber straightening with loading in normal ligaments as well as in both scar and "retracted" regions of healing ligaments. Collagen fibers' diameter and crimp patterns were dramatically changed in the scar region of healing ligaments: Width decreased from 19.4 &#45 1.7 &#119 m to 6.5 &#45 2.1 &#119 m ( p < .000001), period from 51.4 &#45 15.1 &#119 m to 11.0 &#45 2.4 &#119 m ( p < .000001), and amplitude from 9.8 &#45 0.8 &#119 m to 3.9 &#45 0.8 &#119 m ( p < .000001). Normal ligaments fixed in situ show wavy regions at 120° but less so at 15° flexion. Healing ligaments fixed in situ show regions of fiber waviness in the scar region at 120° and also at 15° flexion, indicating ligament laxity persists toward both extremes of the range of motion. The data suggest that straightening of crimped fibers is a functionally relevant phenomenon, not only in normal but also in healing ligaments.     

Connective Tissue Growth Factor and Its Correlation to Other Growth Factors in Experimental Granulation Tissue

Connective tissue growth factor (CTGF) is upregulated in a variety of fibrotic disorders, probably secondary to the activation and production of transforming growth factor-beta (TGF- &#103 ). We have studied the expression of CTGF in a rat wound-healing model using Northern blot, in situ hybridization, and immunohistochemistry. The expression of CTGF mRNA in Northern blot and immunohistochemistry were correlated to the expression of TGF- &#103 1 and platelet-derived growth factor (PDGF). Northern hybridization showed the maximum expression of CTGF mRNA on day 14, whereas TGF- &#103 1 expression was maximal on days 7 and 14 and the time-related changes were smaller than for CTGF. PDGF A and PDGF B mRNA expressions were at maximum on day 14 and on day 21, respectively. In situ hybridization showed that fibroblast-like cells expressed CTGF most intensively, expression declining rapidly after day 14. CTGF mRNA and protein were found in blood vessel cells during the first week. In immunohistochemistry, all growth factors were expressed by fibroblast-like cells, macrophage-like cells, and blood vessels but CTGF-positive cells were fewer and were more restricted on days 5 and 7. These results demonstrate that CTGF expression together with TGF- &#103 and PDGF are upregulated in wound healing, and CTGF expression in blood vessels suggests that CTGF is involved in angiogenesis.     

Effects of Applied DC Electric Field on Ligament Fibroblast Migration and Wound Healing

Applied electric fields (static and pulsing) are widely used in orthopedic practices to treat nonunions and spine fusions and have been shown to improve ligament healing in vivo. Few studies, however, have addressed the effect of electric fields (EFs) on ligament fibroblast migration and biosynthesis. In the current study, we applied static and pulsing direct current (DC) EFs to calf anterior cruciate ligament (ACL) fibroblasts. ACL fibroblasts demonstrated enhanced migration speed and perpendicular alignment to the applied EFs. The motility of ligament fibroblasts was further modulated on type I collagen. In addition, type I collagen expression increased in ACL fibroblasts after exposure to pulsing EFs. In vitro wound-healing studies showed inhibitory effects of static EFs, which were alleviated with a pulsing EF. Our results demonstrate that applied EFs augment ACL fibroblast migration and biosynthesis and provide potential mechanisms by which EFs may be used for enhancing ligament healing and repair.     

湿润烧伤膏治疗剖宫产及会阴侧切术后切口愈合不良疗效观察

【摘要】 目的 观察湿润烧伤膏治疗剖宫产及会阴侧切术后切口愈合不良的临床疗效? 方法 选取 2017 年 6 月至 2019 年 12 月廊坊市第四人民医院收治的60例剖宫产及会阴侧切术后切口愈合不良产妇作为研究对象, 并按照随机数表法将其随机分为观察组与对照组, 每组 30 例, 观察组患者局部切口采用湿润烧伤膏换药治疗, 对照组患者局部切口采用常规碘伏消毒?生理盐水纱布或 1% 依沙吖啶纱布引流治疗, 对比两组患者切口愈合时间及切口疼痛程度? 结果 观察组患者切口愈合时间≤10 d 者 25 例? 10 ~ 20 d 之间者 5 例, 对照组患者切口愈合时间≤10 d 者 16 例? 10 ~ 20 d之间者10例? > 20 d 者4例, 观察组患者切口愈合时间明显短于对照组(Z = 2.628, P = 0.009)? 观察组患者中无明显疼痛不适 21例? 轻度疼痛8例?中度疼痛1例, 对照组患者中无明显疼痛不适5例?轻度疼痛 18 例? 中度疼痛5例?重度疼痛2例, 观察组患者切口疼痛程度明显低于对照组(Z =-4.203, P < 0.001)? 结论 湿润烧伤膏可有效减轻剖宫产及会阴侧切术后愈合不良切口的疼痛程度, 缩短切口愈合时间, 值得临床推广应用?     

烧伤创面愈合后瘢痕组织成纤维细胞DNA甲基化初步研究

目的研究探讨烧伤创面愈合后不同时期瘢痕组织中成纤维细胞DNA甲基转移酶1(DNMT1)的表达及意义。方法收集烧伤创面愈合后不同时期的瘢痕组织标本(早期、增生期、消退期、成熟期)和正常皮肤组织标本作为研究对象,采用免疫组织化学方法检测瘢痕组织及正常皮肤组织中成纤维细胞内DNMT1的表达,并比较各组之间的差异;采用RT-PCR技术检测瘢痕组织及正常皮肤组织中成纤维细胞内DNMT1 mRNA的表达,并比较各组之间的差异。结果瘢痕组织形成早期,成纤维细胞内DNMT1的表达水平逐渐升高(免疫组化评分:8.57±1.83),并于增生期达到高峰(10.41±1.58),消退期(7.17±1.19)及成熟期(4.90±0.88)逐步降低,而正常皮肤组织中成纤维细胞的表达呈阴性或弱阳性(0.81±0.87),组间差异具有统计学意义(P=0.000,P0.01);RT-PCR技术检测的:DNMT1 mRNA的表达水平在各组中的差异与免疫组织化学方法的检测结果一致(P=0.000,P0.01)。结论成纤维细胞DNMT1在烧伤创面愈合后瘢痕组织的形成过程中发挥着重要作用,DNA甲基化可能参与了烧伤创面愈合后瘢痕的发展与演变。     

CT引导下骨水泥注入辅助人工虎骨粉修复骨质疏松性脊椎压缩性骨折:骨痂生长及骨愈合评价

背景:研究证实微创手术修复骨质疏松性脊椎压缩性骨折效果显著,能撑起椎体恢复高度和硬度,达到解除疼痛、早日活动的目的。但是患者术后长期卧床会导致较多的并发症,预后效果不理想。当前许多中药开始应用于骨质疏松性脊椎压缩性骨折的康复。目的:观察人工虎骨粉辅助CT引导下骨水泥注入微创修复骨质疏松性脊椎压缩性骨折患者的骨痂生长及骨折愈合情况。方法:选取85例骨质疏松性脊椎压缩性骨折患者为研究对象,随机将患者分为两组,观察组43例,对照组42例。观察组及对照组患者分别在CT引导下微创经皮椎体成形治疗的基础上配合服用人工虎骨粉及接骨七厘片,观察两组患者骨痂生长、骨折愈合情况以及疼痛缓解时间。结果与结论:观察组术后骨痂生长良好,多为Ⅲ级与Ⅳ级患者;显著优于对照组(P<0.05)。在疼痛缓解时间及骨折愈合时间上,观察组显著短于对照组,差异有显著性意义(P<0.05)。观察组患者的JOA评分优良率显著优于对照组(P<0.05)。提示微创经皮椎体成形联合辅助CT引导下骨水泥注入修复骨质疏松性椎体压缩性骨折效果显著,同时配合服用人工虎骨粉对骨折愈合有很好的促进作用。     

LISS钢板与髁钢板置入修复股骨远端骨折:骨愈合及膝关节功能预后差异性

背景：近年来随着对股骨远端骨折的深入研究,治疗方式已经从传统的保守治疗转变为积极的手术治疗。目前关于股骨远端骨折的各种内固定方案报道很多,但是系统的预后比较研究报道较少。
　　目的：对比股骨远端骨折患者分别采取LISS钢板与髁钢板置入内固定对其预后康复影响的差异,并为这类患者内固定方案的选择积累经验。
　　方法：选取2009年3月至2013年1月收治的78例股骨远端骨折患者,按随机数字表法分为两组,每组39例。LISS钢板组采用LISS钢板置入内固定方案,髁钢板组采用髁钢板置入内固定方案。记录两组患者术中及术后相关指标、出院后第12个月末Evanich评分及随访期间不良事件发生率。
　　结果与结论：LISS钢板组切口长度及骨折愈合时间短于髁钢板组(P <0.05)。出院后第12个月末,两组疼痛及稳定性评分差异无显著性意义(P >0.05);而LISS钢板组活动度、股四头肌力量评分及Evanich总分均高于髁钢板组(P <0.05),减分项目少于髁钢板组(P <0.05)。LISS钢板组随访期间不良事件发生率为5%(2/39),髁钢板组不良事件发生率为21%(8/39),两组差异有显著性意义(P <0.05)。提示相较于髁钢板,LISS钢板置入内固定修复股骨远端骨折能有效促进骨折愈合及膝关节功能恢复,并发症较少,是一种较为理想的骨科内固定方式。