Amniotic membrane stimulates cell migration by modulating transforming growth factor‐β signalling

Keratinocyte migration is a mandatory aspect of wound healing. We have previously shown that amniotic membrane (AM) applied to chronic wounds assists healing through a process resulting in the overexpression of c‐Jun at the wound's leading edge. We have also demonstrated that AM modifies the genetic programme induced by transforming growth factor‐ß (TGF‐ß) in chronic wounds. Here we used a scratch assay of mink lung epithelial cells (Mv1Lu) and a spontaneously immortalized human keratinocyte cell line (HaCaT) cells to examine the influence of AM application on the underlying signalling during scratch closure. AM application induced c‐Jun phosphorylation at the leading edge of scratch wounds in a process dependent on MAPK and JNK signalling. Strikingly, when the TGF‐ß‐dependent Smad‐activation inhibitor SB431542 was used together with AM, migration improvement was partially restrained, whereas the addition of TGF‐ß had a synergistic effect on the AM‐induced cell migration. Moreover, antagonizing TGF‐ß with specific antibodies in both cell lines or knocking out TGF‐ß receptors in Mv1Lu cells had similar effects on cell migration as using SB431542. Furthermore, we found that AM was able to attenuate TGF‐ß‐Smad signalling specifically at the migrating edge; AM treatment abated Smad2 and Smad3 nuclear localization in response to TGF‐ß in a process dependent on mitogen‐activated protein kinase kinase 1 (MEK1) activation but independent of EGF receptor or JNK activation. The involvement of Smad signalling on AM effects on HaCaT keratinocytes was further corroborated by overexpression of either Smad2 or Smad3 and the use of Smad phosphorylation‐specific inhibitors, revealing a differential influence on AM‐induced migration for each Smad. Thus, AM TGF‐ß‐Smad signalling abating is essential for optimal cell migration and wound closure.     

Outpatient Care: Planning a Satellite Laboratory for Ambulatory Patient Care

Peripheral neuropathy is a common consequence of diabetes that often results in loss of protective sensation. Early identification of this loss is critical to minimize secondary complications. The authors’ purpose was to assess the behavior patterns of physical therapists as to their opinions and behaviors related to sensory testing for individuals with diabetes. A questionnaire was sent to physical therapists across the United States with the following results: a high level of agreement concerning the benefits of sensory testing, but with a far less agreement as to the actual performance of sensory testing by those same physical therapists.     

Hematopoietic Stem Cell Transplantation From Haploidentical Donors in Aplasia After Cladribine/Cytarabine Chemotherapy for Refractory Acute Myeloid Leukemia or Myelodysplastic Syndrome

IntroductionSurvival rate of patients with chemorefractory acute myeloid leukemia (AML) or myelodysplastic syndrome with excess blasts (MDS-EB) is poor. Allogeneic hematopoietic cell transplantation (HCT) is the only potentially curative therapy in these patients.Patients and MethodsWe report a retrospective analysis of outcomes of therapy of 24 patients with AML or MDS-EB refractory to high-dose salvage chemotherapy or who had failed previous HCT, who received T-cell–replete HLA haploidentical HCT in aplasia after cladribine/cytarabine-based chemotherapy followed by reduced intensity or myeloablative conditioning. All patients had active disease before commencement of the treatment.ResultsOf the patients, 91.7% achieved complete remission (CR), whereas 2 patients (8.2%) died in aplasia. One-year relapse rate was 49.3%. Cumulative incidence of nonrelapse mortality (NRM) was 25.6%. In a subgroup of patients with HCT–comorbidity index score ≤ 3, NRM was 15.4%. Two-year overall survival and relapse-free survival were 30.6% and 22.6%, respectively. Incidence of grade 3 and 4 acute graft versus host disease was 21.3% and 8.3, respectively.ConclusionWe found that sequential therapy with HCT in aplasia after cladribine/cytarabine chemotherapy is feasible, results in high CR rates, and has acceptable toxicity profile; however, posttransplant relapse is common in patients treated with active disease.     

慢性难愈性创面的治疗研究进展

慢性难愈性创面(Chronic Refractory Wounds，CRW)成为外科创面治疗的棘手问题，给患者生理心理和经济造成了极大的负担，CRW发生发展的最终转归因临床上治疗方法呈现多样化，临床上对慢性创面的治疗方法呈现多样化，现就中医和现代医学对慢性创面的治疗作一综述。     

伤口评估卡片联合电子照片在老年科护士伤口专科知识培训中的应用

[目的]探讨伤口评估卡片联合电子照片在老年科护士伤口专科知识培训中的应用效果。[方法]按照随机数字表法将老年科60名护士分为观察组和对照组各30例,对照组采用电子照片对护士伤口专科知识进行培训和指导,观察组采用自制伤口评估卡片联合电子照片对护士伤口专科知识进行培训和指导。比较两组护士伤口专科知识的掌握程度、护士记录伤口病人护理文书的记录质量及护士对伤口病人伤口转归的护理管理能力。[结果]观察组护士伤口专科知识的掌握程度、护士记录伤口病人护理文书的记录质量及护士对伤口病人伤口转归的护理管理能力均优于对照组(P<0.05)。[结论]在老年科护士伤口专科知识培训中应用伤口评估卡片联合电子照片效果显著。     

Gunshot wounds: A review of ballistics related to penetrating trauma

Civilian gunshot injuries from handgun and rifle ammunition vary in severity depending on the anatomic location involved and the different effects from the ballistic properties of the penetrating projectiles. Ballistic factors such as the impact velocity and energy should not be considered in isolation, as their specific effects are determined by the interaction between the projectile and tissues. Increased tissue damage can result from tumbling of non-deforming rifle bullets and deformation of expanding bullets. Both of these mechanisms increase substantially the energy transfer to the wound and its diameter, also producing a pulsating temporary cavity associated with pressure changes within tissue.