负压封闭吸引对糖尿病溃疡愈合的促进作用

目的 在"创而床准备(WBP)"理论指导下,观察负压封闭吸引局部处理糖尿病溃疡的疗效.方法 收集2000年1月至2005年1月间收治的27例糖尿病溃疡患者作对照组,2005年1月至2007年6月的8例糖尿病溃疡患者为试验组.两组患者均经常规系统的治疗,试验组在创面的黑、黄期采用清创后负压吸引治疗.观察两组创而各分期间的演进情况.比较两组手术Ⅰ期修复率、入院首次及实施负压治疗后1、2、3周创面细菌学检查结果 .观察各期创面组织标本的HE染色和黄、红两期Ⅰ、Ⅲ型胶原纤维苦味酸-天狼猩红染色结果 及对其含量进行图像分析.结果 试验组患者创面各分期的演进速度、于术Ⅰ期修复率均优于以照组(100%比46%,P<0.05).治疗2周后试验组创面末检出致病菌,对照组检出率为66.7%(P<0.05).HE染色显示试验组各期间的演进类似于急性创面愈合过程,且试验组黄期Ⅰ、m型胶原总含量为12.28%,对照组为24.77%(P<0.01).结论 基于WBP方案的负压吸引治疗能促进糖尿病溃疡的创面愈合过程.     

增殖性瘢痕色度测量方法的研究

目的:临床评价增殖性瘢痕的颜色需要定量测量.本实验主要研究增殖性瘢痕色度的测量方法,实现瘢痕颜色的定量测量,为临床诊治提供量化依据.材料与方法:采用以光电积分式测量原理设计的色彩分析仪对增殖性瘢痕患者19人,共65个测试点按不同部位分为四组进行色度测量,并与正常组对照.用CIE-XYZ色度标准表达测量值,配合色度图直接观察瘢痕的疗效.结果:增殖性瘢痕各部位组的色度坐标值与相应的对照组比较均有显著性差异(P＜0.05).结论:本实验的测量方法是有效的,能准确、定量反映增殖性瘢痕颜色的变化.可用量化指标总结、分析、报告治疗结果.     

Report of the symposium

Summary The past decades have seen considerable shifts of emphasis in surgical care. The recognition that pus was not laudable, was followed by a realisation that not all complications were inevitable and that prophylaxis could effectively reduce the incidence of most common problems in the post-operative period. As anaesthesia has become safer, it has been possible to embark on more intricate and prolonged procedures and for sufficient time to be available to ensure adequate intraoperative care.These two phenomena have firstly increased the complexity of management in the post-operative period, and have brought this aspect of surgical care more obviously to the limelight. However, many separate disciplines are involved in the care of the patient post-operatively, and the Symposium was organised¹ to bring the different groups together to identify the areas of recent development in the different specialities and to integrate the overall care of the individual patient.Abbreviations ARDS adult respiratory distress syndrome - DIC disseminated intravascular clotting     

Bedeutung der Fibroblasten-Chemotaxis für Wundheilung und Tumorzellevasion

Summary Fibroblast are responsable for the synthesis of the structural proteins of the connective tissue. A further property of these cells, their migratory ability, could be analyzed in the last years. A special form of migration is chemotaxis, which can be quantitatively measured in a modified Boyden chamber in-vitro. Using this method chemoattractive substances could be characterized, which are able to stimulate fibroblasts and tumorcells to chemotactic migration. Furthermore it could be proved, that benign and transformed cell lines react in a different manner towards these chemoattractive substances. The in-vitro results allow some hypotheses about both fibroblast migration in wound healing or chronic inflammation, and the mechanisms of tumor cell evasion in the tumor surrounding tissue or the metastasizing process in other organs.

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Abkürzungen PDGF platelet derived growth factor - LTB₄ Leukotrien B 4 Mit Unterstützung der Deutschen Forschungsgemeinschaft Me 766/1–3     

Hypertrophic scar formation is associated with an increased number of epidermal Langerhans cells

The exact pathogenesis of hypertrophic scar and keloid formation is still unknown and a good therapy to prevent or treat these scars is lacking. Because immunological processes seem to be important in excessive scar formation, immunological cells and parameters were studied in a standardized breast reduction wound-healing model in the present study. Standardized scar samples were taken from infra-mammary breast reduction scars, 3 and 12 months following surgery. The samples were investigated for their number of mast cells, Langerhans cells, T-lymphocytes, and macrophages, and the presence of interleukin-4 (IL-4) and counter-regulating interferon-gamma (gamma-IFN), in relation to the scar's clinical appearance--normal or hypertrophic. In this study, hypertrophic scar formation was significantly associated with an increased number of epidermal Langerhans cells (p=0.0001) and significantly (p<0.05) increased expression of epidermal IL-4. No relationship was found between mast cell, T-lymphocyte and macrophage numbers or gamma-IFN staining and the formation of normal or hypertrophic scars. These results, combined with previous observation of abnormal keratinocyte behaviour in this context, indicate that the epidermal immune barrier plays an important role in the development of hypertrophic scars.     

Mechanical and Cellular Changes During Compaction of a Collagen-Sponge-Based Corneal Stromal Equivalent

The need for corneas suitable for transplantation, combined with the decreasing supply, has fueled interest in the development of a corneal replacement. In this study, a collagen-sponge-based stromal equivalent, consisting of human corneal fibroblasts cultured on a type I collagen sponge, was maintained in culture for up to 21 days and characterized with respect to mechanical properties and cellular behavior. The Young's modulus of the stromal equivalent varied from 95 to 370 Pa, and its permeability varied from 5.3 x 10(-8) - 4.2 x 10(-7) m4 N(-1) s(-1). The greatest changes occurred during the first few days in culture, but the mechanical properties continued to change during the entire 21 days. Cell traction stress, determined from sponge compaction and DNA count, decreased during the compaction process with the maximum traction value the initial value of 6.6 +/- 2.9 x 10(-3) Pacm3 cell(-1). Microarray data showed that the expression level of fibronectin, decorin sulfate, collagenase, and gelatinase A was upregulated at day 14 in the sponge. This suggested that the repair fibroblast phenotype was being expressed by the fibroblasts. Additional analysis suggested that a subpopulation of cells expressed the myofibroblast phenotype.     

术前碳水化合物对瘢痕切除术后胰岛素抵抗的影响

目的观察术前口服碳水化合物及静脉输注葡萄糖对术后胰岛素抵抗程度的影响.方法择期瘢痕切除术病人60例,随机分为对照组、口服组和静注组,每组20例.术前对照组常规禁食禁饮;口服组口服12.5%碳水化合物的饮料（CHO）;静注组持续静脉输注10%葡萄糖液.分别于口服或静注前、术后6 h采血,测定血糖、血清胰岛素以及红细胞胰岛素受体.结果处理前各组血糖、血清胰岛素、胰岛素敏感指数及红细胞胰岛素高亲和力受体、低亲和力受体无明显差异;术后6 h口服组、静注组的血糖明显低于对照组,与处理前无显著差别;术后6 h各组血清胰岛素无显著差别,均显著高于处理前;胰岛素敏感指数、红细胞低亲和力受体三组均较处理前显著降低,但口服组、静注组明显高于对照组;术后6 h口服组、静注组红细胞高亲和力受体无明显降低;口服组与静注组间的血糖、胰岛素、胰岛素敏感指数及红细胞胰岛素受体无明显差别.结论术前静脉输注葡萄糖可缓解术后胰岛素抵抗的程度,术前饮用碳水化合物具有同样的效果,是一种简单有效的治疗方法.     

干扰素a-2b对增生性瘢痕HLA-DR和CD1a分子的影响

目的:探讨干扰素a-2b对增生性瘢痕HLA-DR和CD1α。分子的作用。方法 利用免疫组织化学方法检测6例增生性瘢痕（HS）和6例正常皮肤HLA-DR和CD1α分子的分布及密度,观察干扰素a-2b治疗后HS HLA-DR和CD1α分子的变化。结果:（1）HS组织表皮HLA-DR LC的数量806.67±101.72个//mm2和表皮CD1α LC的数量700.00±108.82个/mm2明显高于正常皮肤510.00±45.07个/mm2,521.24±57.87个/mm（P<0.05）。（2）HS组织HLA-DR分子在角质形成细胞和成纤维细胞中异常出现。（3）于扰素a-2b治疗3d时HS表皮HLA-DR LC及CD1α LC的数量分别为283.34±73.12个/mm2,220.00±83.92个/mm2,7d时516±49.67个/mm2,589.10±108.82个/mm2,干扰素a-2b治疗后HS表皮HLA-DR LC及CD1αLC的数量明显降低（P<0.05）。结论:（1）HLA-DR和CD1α分子数量的增加提示HS和K局部组织可能处于高兔疫应答状态;（2）干扰素a-2b可能通过抑制HLA-DR和CD1α分子降低HS高免疫应答的状态。     

慢性创伤伤口智能问诊系统的研制

目的:研发一种在收集微信端即可对慢性创伤伤口进行智能问诊的系统软件,以规范化慢性创伤伤口采集的规范化及合理化。方法:采用目前普及度最为广泛的微信端口收集数据,搭建云平台存储数据,将慢性创伤伤口按照规范化方式收集数据。结果:问诊系统规范了慢性创伤伤口治疗,使案例收集更为模式化,加强了医生和护士对创伤伤口处理的方式方法的选择准确性。结论:慢性创伤伤口智能问诊系统可对伤口进行规范化评估,根据数据分析明确治疗方案的选择;详细化的对患者建立电子病例档案,便于后期资料查询、病历统计、后期随访和管理;利于临床医疗、教学和科学研究。     

超声清创联合重组人表皮生长因子治疗肛周脓肿合并感染的效果

目的探讨超声清创联合重组人表皮生长因子对肛周脓肿合并感染患者表皮细胞生长因子(Epidermal growth factor,EGF)、激活素A(Activin A,ACTA)水平及创面血流量的影响。方法选取2018年2月-2020年1月承德医学院附属医院肛周脓肿合并感染患者117例,依据随机数字表法分为对照A组(n=39)、对照B组(n=39)、联合组(n=39)。常规干预基础上对照A组采取超声清创,对照B组采取重组人表皮生长因子,联合组采取超声清创及重组人表皮生长因子。统计三组治疗情况、治疗前后疼痛程度评分、创面血流量及经皮氧分压、EGF、转化生长因子-β(Transforming growth factor-β,TGF-β)、ACTA、C-反应蛋白(C-reactive protein,CRP)水平及临床疗效。结果联合组创面愈合时间、感染控制时间、住院时间分别为(12.39±2.01)d、(5.22±1.56)d、(13.91±2.51)d短于对照A组、对照B组,创面细菌清除率为(89.13±4.64)%高于对照A组、对照B组(P<0.001);治疗后1 d、3 d、7 d、14 d三组VAS评分较治疗前降低,且联合组低于对照A组、对照B组(P<0.05);治疗后1 d联合组创面血流量及经皮氧分压分别为(0.92±0.25)PU、(35.69±3.20)mmHg大于对照A组、对照B组(P<0.05);治疗后1 d联合组血清EGF、TGF-β分别为(0.70±0.11)μg/L、(0.68±0.12)μg/L高于对照A组、对照B组(P<0.05);治疗后1 d联合组血清ACTA、CRP分别为(9.45±3.58)μg/L、(5.71±2.68)mg/L低于对照A组、对照B组(P<0.05);联合组疗效优于A组和B组(P<0.05)。结论联合采取超声清创及重组人表皮生长因子治疗肛周脓肿合并感染,可改善创面愈合及感染控制情况,缓解疼痛程度,增加创面血流量及经皮氧分压,调节EGF、ACTA等水平,提高整体治疗效果。