吉林192Ir放射事故患者局部急性放射损伤病理改变

目的观察一例大剂量全身极不均匀照射急性放射损伤患者数处局部病理改变。方法病理常规切片染色，光镜检查。结果吸收剂量右下肢为３７３８Ｇｙ，左手掌为８３０Ｇｙ，于照射后第８天行右下肢、左前臂截肢术。右手、左膝照射剂量相对较小但难以准确估计，红斑、水肿、水疱、溃疡出现相对较晚，于第５５天行右手指、左膝清创植皮术。镜下：右小腿局部皮肤和皮肤附属器官、皮下组织和骨胳肌广泛地坏死和弥漫性出血，但真皮中的立毛肌尚存；左手指、手掌皮肤表皮细胞空泡变性、坏死，并形成大小不一的囊泡，致使表皮与真皮分离，真皮弥漫性出血、中性粒细胞浸润，汗腺上皮细胞变性、坏死，皮下组织内弥漫性出血，少数脂肪细胞坏死。胫骨、腓骨上端和股骨、桡骨、尺骨下端处骨髓腔内造血组织各系细胞均消失。左膝、右手拇指、食指、中指皮肤示急性放射性溃疡。结论大剂量照射导致的急性放射损伤造成大面积、深达肌肉的软组织坏死及骨髓造血细胞消失。     

5-Hydroxytryptamine increases excitability of CA1 hippocampal pyramidal cells.

In the presence of spiperone to block the 5-HT1A-mediated inhibition of pyramidal cell activity, 5-hydroxytryptamine (serotonin, 5-HT) produces a rapid transient increase in amplitude of the extracellularly recorded population spike from area CA1 of the hippocampus. Intracellular recording techniques in area CA1 of rat hippocampal slices were used to identify the ionic mechanism and to characterize the 5-HT receptor mediating this excitatory response to 5-HT. Most of the experiments were conducted in the presence of spiperone to block the 5HT1A hyperpolarization. Since spiperone also has high affinity for 5-HT2 receptors, any response mediated by 5-HT2 receptors would also be blocked. Bath perfusion of the slice with 5-HT increased the rectification of pyramidal cells in the subthreshold region, increased the resistance, and increased the amplitude of subthreshold excitatory postsynaptic potentials (EPSPs) to initiate spike firing. The 5-HT2,1C-selective agonist DOI mimicked this effect of 5-HT, and the 5-HT2,1C antagonist ketanserin (1 microM) blocked the effect of DOI. There was no change in the amplitude of the slow afterhyperpolarization (sAHP) or the amplitude of evoked inhibitory postsynaptic potentials (IPSPs). The increase in rectification and EPSP amplitude by 5-HT occurred even in the presence of the 5-HT4-selective antagonist BRL 24924 to prevent the decrease in amplitude of the sAHP by 5-HT. We conclude that 5-HT produces a fast excitatory response by increasing subthreshold conductance in CA1 hippocampal pyramidal cells. The identity of the receptor mediating this response was not conclusively identified, but resembled the 5-HT1C receptor.     

Skin reactions to irritants assessed by non-invasive bioengineering methods

Pathophysiological components of irritant contact dermatitis caused by 3 chemically-different irritants were investigated. 20 healthy volunteers were patch tested with sodium lauryl sulphate, nonanoic acid and hydrochloric acid on the flexor side of the upper arm. The skin response was evaluated after 24, 48 and 96 h by visual scoring and measured by the following bioengineering methods: transepidermal water loss measurement, electrical conductance for measurement of skin hydration, laser Doppler flowmetry for measurement of cutaneous blood flow and 20 MHz ultrasound A-scan for measurement of skin thickness. In spite of homogeneous inflammatory responses, significant differences in the severity of the injury to the skin barrier function caused by the different irritants were found. Also significant differences between irritants were found in the time course of development of maximum irritant reactions. Bioengineering methods indicating inflammatory responses (measurement of blood flow and skin thickness) were helpful in quantifying the irritant response in general, while bioengineering methods indicating epidermal damage (measurement of TEWL and electrical conductance) were helpful in classifying the individual irritants.     

背部供皮区修复大面积皮肤缺损

目的探讨应用背部供皮区修复大面积皮肤缺损的优点。方法对Ⅲ°烧伤、巨大体表肿瘤切除、四肢皮肤撕脱伤及其他原因造成的大面积皮肤缺损的40例患者,根据缺损的部位和大小,用鼓式取皮机在患者背部切取相应的中厚皮片,移植修复缺损。结果术后随访患者1年,所有移植皮片均成活。背部供皮区愈合良好,瘢痕增生轻微,不影响外观。结论于背部取皮其供皮面积大、部位隐蔽,且背部真皮层较厚,取皮后愈合快,愈合后患者能自行平卧加压,避免瘢痕增生。是较理想的修复大面积皮肤缺损的手术方法。     

西罗莫司与未成熟树突状细胞延长小鼠皮肤移植存活时间的协同作用

目的 研究西罗莫司（SRL）对小鼠骨髓源树突状细胞（DC）分化及成熟的影响，观察西罗莫司与未成熟树突状细胞在延长小鼠皮肤移植存活时间中的协同作用。方法 （1）在诱导C57BL／6小鼠骨髓细胞定向分化为DC时加入SRL，通过流式细胞仪检测CD11c、CD86及MHCⅡ类分子表达情况，经脂多糖（LPS）刺激后，再检测各分子表达的变化。（2）通过单向混合淋巴细胞反应（MLR）观察经SRL处理的DC刺激同种异基因小鼠T细胞增殖情况。（3）以C57BL／6小鼠为供者，BALB／c小鼠为受者建立皮肤移植模型。观察皮肤移植前7d经尾静脉注射供者未成熟DC及经胃管连续灌注SRL7d的受者移植皮片存活情况及组织学变化。结果 （1）经SRL处理的DC表面CD11c表达仅有轻度降低，但CD86和MHCⅡ类分子表达明显减少。（2）MLR显示经SRL处理的DC刺激同种异基因小鼠T细胞增殖的能力降低。（3）受者皮肤移植术前联合应用供者未成熟DC和SRL，可减轻移植皮片炎症反应并延长其存活时间。结论 SRL对DC分化的影响不明显，但可抑制DC发育成熟。受者术前应用SRL和未成熟DC可延长皮肤移植的存活时间。     

湿性皮肤再生技术在皮肤擦伤的应用

目的:探导湿性皮肤再生技术治疗皮肤擦伤的疗效。方法:自2000年1月-2005年10月,治疗头面部、躯干和四肢急性皮肤擦伤共353例,其中采用湿润烧伤膏和暴露疗法治疗(新法组)185例,按传统疗法清创治疗(传统组)168例。结果:新法组7天内痊愈116例,占62．7％;14天内痊愈59例,占3713％;总有效率100％。传统组7天内痊愈82例,占48．8％;14天内痊愈58例,占34．5％;另外28例,占16．7％,发生不同程度的创面感染,痂下积脓,需作再次清创,碘伏湿敷或改用MEBO治疗,创面延期愈合,愈后瘢痕增生明显。结论:湿润烧伤膏和暴露疗法治疗皮肤擦伤与传统疗法比较,具有缩短创面愈合时间,愈后不留瘢痕等优点。     

Epidermolysis bullosa herpetiformis (Dowling-Meara type) exhibits ultrastructural derangement of tonofilaments and desmosomes

Ultrastructural and immunohistochemical studies of clinically intact skin obtained from three severe neonatal cases of epidermolysis bullosa herpetiformis (Dowling-Meara type) demonstrated disorders in the assembly of keratin intermediate filaments and desmosomes of the keratinocytes. During mitosis, K5- and K14-positive and K1- and K10-negative tonofilaments were disrupted and formed spherical bodies associated with intracytoplasmic desmosomes by invagination of the desmosomes and the adjacent plasma membrane. During the invagination process, destructive changes in the internalized membrane were noted. These were accompanied by gradual loss of reactivity with a monoclonal antibody ZK31, which detected plasma membrane adjacent to the attachment plaques of desmosomes. However, the reactivity of the attachment plaques of the internalized desmosomes for desmoplakins and desmoglein did not decline during the process of internalization. In the suprabasal layers of the epidermis, filamentous substructures and K1 and K10 appeared at the periphery of the spherical bodies. Simultaneously, the desmosomes that were sparsely located in the lower epidermis, increased in number as cell differentiation progressed. Thus, the keratinocytes attained an almost normal appearance with respect to tonofilaments and desmosomes by the time they reached the upper layer of the epidermis. These findings may be relevant to the mechanism responsible for the clinical appearance of the herpetiform blisters in epidermolysis bullosa herpetiformis, which are also characterized by spontaneous involution during childhood or when exposed to high ambient temperatures.Part of this work was presented at the annual meeting of the Japanese Society for Ultrastructural Cutaneous Biology, 12 May 1990, Tokushima, Japan, at the joint meeting of the Society for Cutaneous Ultrastructure Research and the Japanese Society for Ultrastructural Cutaneous Biology, 23–25 May 1991, Vienna, Austria, and at the sixth Conference on Disorders of Keratinization, 6 July 1991, Tokyo, Japan     

正常人体多毛部位皮肤雌激素受体的比较研究

应用直接荧光组化法对１０例正常男性头皮、眉部、胡须、腋部、阴部皮肤作比较研究。结果显示皮肤和附属器均有雌激素受体（ＥＲ）存在，而部位不同，含量各异。阻断对照：阻断率５０％～９０％。进一步证实皮肤是雌激素靶器官之一。