Biomarker directed chronic wound therapy – A new treatment paradigm

AimTo develop a treatment paradigm for chronic leg ulcers that incorporates new biomarkers of wound healing with currently available therapies.MethodsRecently published data on GM-CSF and MMP-13 as biomarkers of venous leg ulcer (VLU) healing status with accuracies of 92% and 78% respectively, was reviewed along with the wound bed preparation (WBP) theoretical framework for treatment of chronic wounds. The broad categories of wound treatments that align with the WBP concepts were identified. These were then considered in a hierarchical order that initially improves the wound bed and subsequently incorporates more complex advanced wound therapies. Identification of the non-healing status of the wound is the driver to advance through the different treatments.ResultsA point of care test of wound healing status is the key to the systematic use of currently available therapies for chronic leg ulcers in a timely fashion. The different therapies address – debridement, moisture control, bacterial contamination, protease inhibition, formation of granulation tissue, application of growth factors, application of matrix constructs, and application of cellular components. Progression through this hierarchical order of therapies is directed by the leg ulcer remaining in a non-healing state with the previous therapies having been implemented.ConclusionCombining a validated point of care test of wound healing with a systematic approach to wound therapies, has the potential to create a new paradigm of chronic leg ulcer treatment - biomarker directed wound therapy.     

糖尿病对血管吻合口愈合规律影响的初步研究

目的研究糖尿病状态下血管吻合口愈合规律的特点及影响因素。方法将8周病程的糖尿病组和对照组SD大鼠各20只的双侧颈总动脉切断后行间断缝合,于吻合术后1d、3d、7d、14d分别取材,观察其通畅情况,并对血管吻合口行组织学、超微结构观察和图像分析。同时,各时间点检测血清TNF-α浓度变化。结果对照组吻合口血管内膜损伤小,管壁各层次结构清晰,炎症反应轻;糖尿病组血管内膜损伤重,管壁各层次结构紊乱,有断裂痕迹,管壁周围肉芽组织增生明显。吻合术后7d糖尿病组吻合口血管内膜平均再内皮化明显延迟(3745.18±1045.31μm2比1298.21±224.66μm2,p<0.01);吻合术后14d,糖尿病组血管吻合口内膜增生明显,I/M值达0.71±0.05。与对照组比较,血清TNFα浓度显著增加(术后7d:5.48±0.34ng/ml比0.73±0.09ng/ml,p<0.05;术后14d:5.15±0.12ng/ml比0.51±0.03ng/ml,p<0.05),血清TNF-α浓度与血管吻合口部位内膜增生程度呈正相关。结论糖尿病改变了血管吻合口正常的愈合规律,使正常的吻合口愈合过程转变为慢性炎性、纤维增殖过程,血管吻合口部位的重塑呈现病理性,其中TNF-α在糖尿病血管吻合口重塑过程中发挥了核心作用。     

多济敷对面部磨削创面愈合的临床疗效观察

目的：本研究采用多济敷外用于面部皮损磨削术后创面,观察其对创面愈合时间、皮肤色素沉着等的变化。方法：采用区域神经阻滞或局部浸润麻醉,对不同类型的面部皮损34例进行皮肤磨削治疗,术后创面应用多济敷或凡士林纱布作为底层敷料包扎创面,术后换药一次,保留底层敷料。结果：2001年8月至2003年9月间,通过自身对照,34例面部磨削术后采用多济敷治疗组较凡士林纱布组创面愈合时间缩短(P＜0．05),经过6个月至2年的随访,皮肤色素沉着也有明显改善。结论：多济敷有利于缩短面部磨削术后创面愈合时间,改善面部色素沉着,外观满意。     

无名异接骨冲剂对骨痂局部骨形态发生蛋白含量的影响

为探讨无名异接骨冲剂加速骨折愈合的作用机理，选用５５只新西兰大白兔，随机选择５只作为正常组；另５０只在无菌条件下造成双桡骨标准骨折模型。将５０只骨折兔随机平均分为实验组和对照组，实验组用无名异接骨冲剂每天４ｇ／ｋｇ溶于２０ｍｌ蒸馏水中分早晚两次灌胃；对照组用２０ｍｌ蒸馏水灌胃。于骨折后第１，２，３，４及５周用断颈法每次每组处死５只兔，取骨痂进行抗骨形态发生蛋白（ＢＭＰ）单克隆抗体免疫组化染色，并用ＣＭＩＡＳ型图像分析仪对ＢＭＰ含量进行定量分析。结果发现：实验组骨折局部ＢＭＰ含量明显高于正常组（Ｐ＜０．０１）；第１，２周实验组明显高于对照组（Ｐ＜０．０１）；实验组ＢＭＰ高峰出现在第２周，而对照组出现在第３周。认为，无名异接骨冲剂能促进成骨细胞合成ＢＭＰ，使ＢＭＰ峰值提前，从而加速骨折愈合。     

Arterial response to excimer and argon laser irradiation in the atherosclerotic swine

Injury associated with laser-induced tissue ablation may be reduced by using pulsed energy delivery at low repetition rates, as opposed to using continuous wave energy delivery. This study was designed to examine the similarities and differences between these two systems as regards the healing process, and to examine whether one is superior to the other. In order to test this postulate, the healing response of normal and atherosclerotic aorta were examined after exposure in vivo to argon and excimer (XeCl 308 nm) laser radiation in hypercholesterolemic swine. Swine were fed hyperlipidemic diets for eight months following balloon denudation of the descending aorta. Following general anaesthetic, the descending aorta was isolated and laser burns were made on both normal and atherosclerotic intima using a continuous wave argon laser delivered through a 50 diameter quartz fibre, and a XeCl excimer laser carried through a 1 mm diameter fibre. Energy levels of 3 to 5 J were applied with the argon laser. The pulse duration for the excimer laser was 30 ns and craters were produced using 10 to 60 pulses at a repetition rate of 20 Hz and an energy density of 2 J cm^–2.Forty-eight hours after laser application, craters created by both lasers were filled with thrombus material. Argon burns were surrounded by thermal and acoustic injury which was not seen with excimer burns. Three weeks after laser application all crater surfaces were reconstituted. Unlike the excimer burns, argon craters demonstrated necrosis well beyond the crater margins and were characterized by multinucleate giant-cell reaction surrounding char debris. By nine weeks both excimer and argon laser burns were covered by fibrous tissue but could be distinguished by the fact that char debris and subjacent tissue injury arose with the argon burns.The results suggest that both lasers can be used to remove focal atherosclerotic plaque from arteries without inducing excessive thrombogenicity. Rapid healing is observed with both; however, damage to surrounding tissue is significantly greater with a continuous energy delivery laser as opposed to pulsed energy delivery.Work supported in part by: Heart and Stroke Foundation of Ontario, Grant-in-Aid No. 5-17     

膝关节韧带的生物力学研究进展

膝关节韧带的生物力学是近年来研究的热点之一,力学刺激对调控韧带功能、韧带组织愈合和重建有着重要的作用,作者从膝关节韧带的结构、力学与生化特点、愈合与重建、施加应力与制动对韧带的影响、应力对韧带细胞分化的影响和前交叉韧带与内侧副韧带的对比研究等方面综述了近年来的一些研究进展。     

环境温度和接骨Ⅱ号对小鼠尾椎实验性骨折修复的影响

本实验以手术方法造成146只未成年的LACA小鼠第十二尾椎实验性骨折,以组织学改变的情况评价了不同环境温度和"接骨Ⅱ号"对骨折修复的影响以及肥大细胞与骨痂形成的关系.结果表明:选择小鼠尾椎为骨折部位建立动物模型有许多优点,环境温度为33℃时骨折愈合明显比8～14.5℃时快,但"接骨Ⅱ号"无明显的加快骨折愈合的作用,肥大细胞参于了骨痂的形成.     

Anastomotic false aneurysms with aortic Dacron graft after twenty-five years

One of the early diamond crimped knitted polyester (Dacron) grafts was surgically excised after implantation for 25 years in the aorto-billiac position because of false aneurysm formation at the three anastomotic sites. The sutures were no longer visible. While the areas around the false aneurysm were poorly incorporated, the graft limbs were well encapsulated with some endothelial-like cells on the luminal surface. The integrity of the graft was well preserved despite mild fraying and the disruption of one stitch.     

医院建筑户外疗愈景观设计策略研究

针对医院建筑户外景观的发展现状,阐述了疗愈概念在医院户外景观设计中的必要性以及医院疗愈景观的设计原则,并总结了当前我国医院户外景观环境中存在的一些问题,提出针对性的疗愈景观优化设计策略,为未来的医院景观环境建设提供一定的参考。     

Squat and smile assessment in predicting healing of lower limb fractures fixed with a SIGN nail

BackgroundIrrespective of the treatment method, union is the ultimate goal of any fracture treatment. However, nowadays, rather than the physician-based clinico-radiological methods, the patient-reported outcome measurements assessing their quality of life and function are gaining much popularity. This is specifically true in the part of the world where the patient needs almost complete degree of hip/knee flexion – for social, cultural, religious or occupational reason(s). The ability to squat can assess the mobility and stability of joints and thus the quality of squatting is a proxy reflection of the functional outcome after fixation of lower limb fracture. Thus, we studied to determine the inter-observer and intra-observer reliability of Radiographic Union Score for Tibia (RUST) and Squat and Smile (S & S) test in clinical photograph. We further calculated the sensitivity and specificity of S & S test in predicting healing of lower limb fracture fixed by intramedullary interlocking nail considering RUST as the gold standard.MethodsThis was a retrospective study of prospectively collected data of solid Surgical Implant Generation Network (SIGN) intramedullary interlocking nailing from a single, university-based, high volume tertiary center where 56 consecutive adults with either tibial or femoral shaft fractures fixed with a SIGN nail within one year and not requiring any surgery till minimum of eighteen-month follow-up were included. Cases without either Anterior-Posterior (AP) view and/or Lateral (Lat.) view follow-up x-ray(s) or proper S & S clinical photograph (at least 1.5-year post fixation) were excluded. The x-rays (RUST criteria) and clinical photograph (S & S grading) were scored by two independent and blinded observers each and repeated after 1 month.ResultsThe overall intra-observer reliability was from 0.773 to 0.825 and inter-observer reliability from 0.635 to 0.757 for RUST scoring which was from 0.687 to 0.785 and from 0.301 to 0.650 respectively for S & S scoring. The sensitivity and specificity of S & S in predicting fracture healing were up to 82.22% and 63.64% respectively.ConclusionThe S & S test is reliable to predict the healing of lower limb fracture fixed with an intramedullary nail. The test is more useful to determine healed fractures than to determine non-healed ones. (sensitivity being higher than specificity)