糖尿病大鼠皮肤伤口愈合过程中结缔组织生长因子的表达

背景：结缔组织生长因子表达在糖尿病伤口愈合过程中的变化及意义少见报道。 目的：观察链脲佐菌素诱导的糖尿病模型大鼠复合创伤修复过程中结缔组织生长因子表达的变化及意义。 方法：将Wistar大鼠随机分成正常对照组和模型组,3周后将各组动物复合背部1.3 cm2全厚皮切除形成伤口。 结果与结论：链脲佐菌素诱发的糖尿病模型大鼠伤口愈合明显延迟,创伤后第4,8,12 和16天创面愈合率明显低于正常对照组(P  < 0.01)。术后第8天,糖尿病组大鼠肉芽组织成熟度和新生血管形成指标得分均低于正常对照组(P < 0.01)。正常对照组的结缔组织生长因子蛋白表达呈时间递增趋势,而糖尿病组的结缔组织生长因子表达在整个创面愈合过程的后期(第12天后)均明显低于正常对照组(P < 0.01)。结果提示,糖尿病大鼠皮肤伤口愈合后期创面组织结缔组织生长因子表达相对正常对照组减少可能是导致创面愈合迟缓的重要原因之一。     

Nrf2 激动剂EGCG 对糖尿病伤口愈合障碍的治疗作用研究

目的:建立糖尿病及糖尿病伤口愈合障碍动物模型,研究EGCG对糖尿病伤口愈合障碍的治疗作用,探讨相关的免疫学机制和分子生物学机制。方法:腹腔注射STZ,检测空腹血糖,建立糖尿病小鼠模型。高糖高脂饮食长期饲养,使其处于稳定的糖尿病状态。人工制造皮肤创口,动态观察伤口愈合率,建立糖尿病伤口愈合障碍动物模型。期间,按照分组要求,应用EGCG进行药物治疗,根据伤口愈合率研究治疗效果。治疗期满,取创面皮肤进行相关指标检测。应用Western blot技术检测Nrf2、HO-1、NQO1、ICAM-1、VCAM-1和Caspase12等蛋白质相对表达量;免疫组化技术检测3-NT;对各检测指标进行统计学分析,阐述EGCG治疗糖尿病伤口愈合障碍的作用机制。结果:糖尿病组伤口愈合率明显低于正常对照组(P0.01),证明糖尿病伤口愈合障碍建模成功;糖尿病小鼠EGCG治疗组的伤口愈合率明显高于非治疗组(P0.05)。糖尿病组的Nrf2、HO-1和NQO1蛋白表达量均低于正常对照组(P0.05);ICAM-1、VCAM-1和Caspase12等蛋白表达量均高于正常对照组(P0.05)。糖尿病小鼠中,EGCG治疗组Nrf2、HO-1和NQO1蛋白表达量均高于其非治疗组(P0.05);ICAM-1、VCAM-1和Caspase12等蛋白表达量均低于其非治疗组(P0.05)。免疫组化实验检测3-NT结果显示,糖尿病组3-NT阳性率明显高于Control组,证明糖尿病机体皮肤伤口处于较高水平的氧化应激状态。糖尿病小鼠EGCG治疗组3-NT阳性率明显少于其非治疗组(P0.05)。结论:Nrf2是糖尿病并发症的关键保护性因子;上调机体Nrf2表达可有效减轻糖尿病并发症;EGCG作为Nrf2激动剂具有对抗糖尿病引起的氧化应激、炎症和细胞凋亡的作用,对DNHW有明显的治疗作用。     

毛发生长周期对小鼠皮肤创伤愈合的影响

目的　探讨处于不同毛发生长周期的C57BL/6小鼠皮肤创伤愈合速度。 方法　制备小鼠皮肤创伤模型,计算术后0、3、7 d创面愈合率,愈合率=（原始创面面积－未愈合的创面面积）/原始创面面积×100%,比较毛发静止期（Hair telogen stages）小鼠和毛发生长期（Hair anagen stages）小鼠伤口愈合速度。采用HE染色比较伤口愈合的组织形态结构差异,利用BrdU检测伤口周围细胞增殖。 结果　毛发生长期的小鼠皮肤伤口愈合率显著高于毛发静止期的小鼠伤口愈合率。HE染色显示毛发生长期小鼠伤口周围表皮细胞层较多,且表皮细胞向伤口迁移增强;BrdU检测显示毛发生长期小鼠皮肤伤口周围表皮BrdU+ 细胞数多于毛发静止期小鼠。 结论　毛发生长期的小鼠皮肤创伤愈合率高于毛发静止期小鼠,这一结果为进一步探讨毛囊在创伤愈合过程中的作用提供研究基础,也为选择皮肤创伤愈合动物模型提供指导。     

Sonic hedgehog促1型糖尿病小鼠的伤口愈合

目的：研究sonic hedgehog（Shh）及其受体Ptc1在糖尿病小鼠伤口愈合中的作用。方法：分别在正常和链脲佐菌素（STZ）诱导的糖尿病小鼠建立皮肤损伤模型,Western印迹检测Shh和Ptc1的蛋白水平;观察外源性Shh或Ptc1抑制剂cyclopamine对伤口愈合的影响。结果：（1）正常小鼠损伤后皮肤组织中的Shh和Ptcl蛋白质表达明显升高;外源性Shh对伤口愈合无明显促进作用,但cyclopamine可以明显地抑制伤口愈合;（2）STZ诱导的糖尿病小鼠,其皮肤组织中内源性的Shh和Ptcl蛋白水平明显下调;（3）外源性Shh可显著促进糖尿病小鼠伤口的愈合,且呈浓度依赖性;Cyclopamine则明显地抑制糖尿病小鼠的伤口愈合。结论：Shh-Ptc1通路参与了皮肤伤口愈合,糖尿病伤口愈合延迟与Shh-Ptc1表达下调有关。     

EGCG上调Nrf2表达促进糖尿病小鼠创伤皮肤愈合

目的:研究表没食子儿茶素没食子酸酯(EGCG)对皮肤组织细胞中核因子相关因子2(Nrf2)的激活作用,基于Nrf2的作用通路从整体水平上探讨EGCG促进皮肤损伤愈合的作用机制,为寻找治疗糖尿病伤口愈合障碍的新药物奠定实验基础.方法:建立小鼠糖尿病模型进而构建糖尿病伤口愈合障碍动物模型.配制EGCG治疗药物,治疗小鼠创口...     

表皮干细胞：治疗难愈性皮肤创面的种子细胞

难愈性皮肤创面是指在期望的时间内不能正常愈合的皮肤组织创面。本文以表皮干细胞（ESC）为靶点,对其在难愈性皮肤创面愈合中的研究和应用进行综述。首先介绍ESC的解剖位置和对创面愈合的调节作用。其次,总结难愈性皮肤创面的特点及共同的病理学机制。最后,归纳ESC在难愈性皮肤创面愈合中的作用：直接修复损伤皮肤组织;作为组织工程学构建人工皮肤的种子细胞;以及其基因修饰治疗用于皮肤创面修复。     

羊膜负载表皮干细胞促进糖尿病大鼠创面的愈合

背景:表皮干细胞作为皮肤组织的特异性干细胞,具有强大增殖及多向分化潜能,与创面修复紧密相关。近期研究表明糖尿病皮肤创面愈合过程中表皮干细胞数量减少、活性降低是导致其创面难愈的重要原因。目的:观察表皮干细胞在糖尿病大鼠创面愈合中的作用。方法:分离培养及鉴定SD大鼠表皮干细胞,并以BrdU标记。建立糖尿病SD大鼠创面模型,抽签法随机分为3组:表皮干细胞组创面移植羊膜负载BrdU标记的表皮干细胞;羊膜组创面移植羊膜;空白对照组创面未给予干预。观察创面愈合情况、计算创面愈合率,苏木精-伊红及免疫组织化学SP法检测创面愈合组织中BrdU及增殖细胞核抗原表达。用图像分析软件测量阳性细胞积分吸光度平均值。结果与结论:表皮干细胞组治疗后7d创面缩小明显,治疗后14d创面基本愈合,创面愈合率明显高于羊膜组、空白对照组(P0.01)。表皮干细胞组创面及新生表皮中可见BrdU阳性细胞,而另两组皮肤创面组织中始终未见BrdU阳性细胞。各组创面组织中可见增殖细胞核抗原阳性细胞表达,但表皮干细胞组的阳性细胞积分吸光度平均值与羊膜组、空白对照组比较差异有显著性意义(P0.01)。结果证实糖尿病大鼠创面愈合过程中表皮干细胞与创缘表皮移行、创面的上皮化有直接关联,可有效促进其创面愈合。     

湿性敷料治疗皮肤Ⅱ度烧伤的比较

背景：已有基础实验证明,伤口在湿性环境下的愈合效果优于干性环境,湿性敷料的研究是皮肤创面愈合研究的重点。 目的：观察湿性敷料对皮肤Ⅱ度烧伤创面的治疗效果。 方法：选取在海南省人民医院门诊接受治疗的38例Ⅱ度烧伤患者,采用自身对照法将创面分为治疗组和对照组,治疗组采用湿性敷料覆盖治疗烧伤创面,对照组采用碘伏纱布或凡士林纱布覆盖,治疗后分别观察两种不同处理方法对创面的愈合效果及对疼痛程度的影响。 结果与结论：所有患者均纳入结果分析,治疗组患者烧伤创面的平均愈合时间为(9.8±3.1) d,对照组创面平均愈合时间为(13.1±2.2) d,两者比较差异有显著性意义(P < 0.01)。治疗组创面疼痛程度明显低于对照组(P < 0.01)。使用湿性敷料(美皮贴或美皮康)治疗Ⅱ度烧伤,可以使创面愈合时间缩短,创面疼痛程度明显降低。     

负压创面治疗技术在糖尿病足溃疡中的应用及护理

目的 探讨负压创面治疗技术（NPWT）在治疗糖尿病足溃疡中的应用及护理要点.方法 2012年8月至2013年4月对9例糖尿病足wagner分级为3～4级的糖尿病足患者在糖尿病足病灶清除术后使用NPWT治疗,2～3周后植皮或换药,观察创面愈合效果及加强术后负压引流的护理、伤口的护理及基础护理.结果 应用NPWT治疗糖尿病足溃疡创面,术后创面肉芽组织生长良好,骨外露基本覆盖,为后期治疗创造良好治疗条件,9例糖尿病足患者的溃疡全部愈合.结论 应用NPWT、术后负压引流的护理、伤口的护理及基础护理是保障NPWT治疗糖尿病足的关键环节.     

局部转染组织因子促进糖尿病小鼠的伤口愈合

目的为证实组织因子（TF）在启动新血管生成、促进伤口愈合中有一定的作用。方法我们以伤口愈合迟缓的糖尿病小鼠为研究对象,应用免疫组化,RT-PCR及伤口局部组织因子转染等方法,研究了组织因子在伤口愈合中的作用。结果正常小鼠未创伤皮肤几乎检测不到TF的表达,但创伤时TF的表达明显增高。和正常健康鼠比较,糖尿病鼠伤口处TF、血管内皮细胞生长因子（VEGF）、α平滑肌肌动蛋白（α-SMA）的表达不足,新血管生成迟缓,伤口处血管密度和血流明显减少伴随着伤口愈合的迟缓。以克隆有TF cDNA的真核表达质粒局部转染糖尿病小鼠的皮肤伤口,转染后伤口部位的TF表达明显增高,并明显促进了伤口局部新血管的形成,加速了伤口的愈合。同时促进了VEGF和α-SMA的表达。结论糖尿病鼠伤口愈合迟缓与伤口愈合初期阶段组织因子（TF）的合成不足有关,转染TF基因可以明显改善伤口愈合,其促进伤口愈合与其诱导血管内皮生长因子和α-平滑肌肌动蛋白的合成有关。     

Chitosan-based dressings loaded with neurotensin—an efficient strategy to improve early diabetic wound healing

One important complication of diabetes mellitus is chronic, non-healing diabetic foot ulcers (DFUs). This study aims to develop and use dressings based on chitosan derivatives for the sustained delivery of neurotensin (NT), a neuropeptide that acts as an inflammatory modulator in wound healing. Three different derivatives, namely N-carboxymethyl chitosan, 5-methyl pyrrolidinone chitosan (MPC) and N-succinyl chitosan, are presented as potential biomaterials for wound healing applications. Our results show that MPC has the best fluid handling capacity and delivery profile, also being non-toxic to Raw 264.7 and HaCaT cells. NT-loaded and non-loaded MPC dressings were applied to control/diabetic wounds to evaluate their in vitro/in vivo performance. The results show that the former induced more rapid healing (50% wound area reduction) in the early phases of wound healing in diabetic mice. A NT-loaded MPC foam also reduced expression of the inflammatory cytokine TNF-α (P < 0.001) and decreased the amount of inflammatory infiltrate on day 3. On day 10 MMP-9 was reduced in diabetic skin (P < 0.001), significantly increasing fibroblast migration and collagen (COL1A1, COL1A2 and COL3A1) expression and deposition. These results suggest that MPC-based dressings may work as an effective support for sustained NT release to reduce DFUs.     

Effect of chitosan film containing basic fibroblast growth factor on wound healing in genetically diabetic mice

Basic fibroblast growth factor (bFGF) has been shown to stimulate wound healing. However, consistent delivery of bFGF has been problematic. We studied the stability of bFGF incorporated into a chitosan film as a delivery vehicle for providing sustained release of bFGF. The therapeutic effect of this system on wound healing in genetically diabetic mice was determined as a model for treating clinically impaired wound healing. A chitosan film was prepared by freeze-drying hydroxypropylchitosan (a water-soluble derivative of chitosan) acetate buffer solution. Growth factor was incorporated into films before drying by mixing bFGF solution with the hydroxypropylchitosan solution. bFGF activity remained stable for 21 days at 5 degrees C, and 86.2% of activity remained with storage at 25 degrees C. Full-thickness wounds were created on the backs of diabetic mice, and chitosan film or bFGF-chitosan film was applied to the wound. The wound was smaller in after 5 days in both groups, but the wound was smaller on day 20 only in the bFGF-chitosan group. Proliferation of fibroblasts and an increase in the number of capillaries were observed in both groups, but granulation tissue was more abundant in the bFGF-chitosan group. These results suggest that chitosan itself facilitates wound repair and that bFGF incorporated into chitosan film is a stabile delivery vehicle for accelerating wound healing.     

循环纤维细胞与慢性创面愈合

背景：循环纤维细胞是近些年来在外周血液发现的具有成纤维细胞特性的一种白细胞亚群,由于具有合成多种细胞外基质蛋白、细胞因子以及递呈抗原、收缩创面、促进新生血管形成的能力,因此被认为可以促进创伤的修复。但其促进慢性创面修复的潜在作用研究尚少。 目的：通过文献检索,对循环纤维细胞的生物学特性及其在慢性创面修复中的潜在作用进行文献综述。 方法：分别以“循环纤维细胞、慢性创面、糖尿病足、创面愈合、细胞治疗”和“circulating fibrocytes、An-healing wounds、diabetic foot ulcer、wound healing、cell therapy”为关键词进行检索,CNKI数据库的检索时限为2000至2014年,PubMed数据库的检索时限为1994至2015年,西文生物医学期刊文献数据的检索时限为2000至2015年,检索内容为循环纤维细胞、慢性创面的难愈机制以及细胞治疗在慢性创面愈合中的应用。保留符合纳入标准的54篇文献进行总结分析。 结果与结论：循环纤维细胞因其安全、有效并能较好的发挥促进创面愈合的作用,细胞治疗已开始应用于创面修复。循环纤维细胞是在外周血发现的具有成纤维细胞特性的一个新型白细胞亚群,具有合成多种细胞外基质蛋白、细胞因子以及递呈抗原、收缩创面、促进新生血管形成的能力并在伤后早期进入损伤部位,在创伤修复过程中发挥着积极作用。动物研究证实,应用循环纤维细胞可改善慢性创面尤其是糖尿病慢性创面的修复。   中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

慷舒灵治疗糖尿病足及下肢慢性创面疗效观察

目的探讨慷舒灵敷料治疗糖尿病足及下肢慢性创面的疗效。方法选择常规治疗四周以上无效的糖尿病足及下肢慢性创面患者16例，使用慷舒灵敷料治疗，视创面渗出的情况每3～5d换药1次，1周为一观察周期。结果5周愈合1例、6周愈合5例、7周愈合6例、10周愈合1例，11周愈合2例，有1例于12周行需要行自体皮片移植后创面愈合。慷舒灵全组总有效率为100％，8周愈合率为75％。结论慷舒灵敷料可有效治疗糖尿病足及下肢慢性创面，提高慢性创面愈合率，并可减少患者创面处理的痛苦。     

皮肤发育相关的miRNAs及其在糖尿病创面愈合中的作用*

微小核糖核酸（microRNA/miRNA）作为一类进化上保守的非编码小分子RNA,参与基因转录后的表达与 调控,其表达模式有一定的时间性和空间性,体现在不同的miRNAs在不同组织、不同发育阶段的表达水平差异。 某些miRNAs能够促进创面愈合,在创面愈合的炎症期抑制炎性介质的表达;某些miRNAs能够促进增生期创面 细胞的增殖、迁移,有利于创面的快速修复;在创面重塑期,某些miRNAs又能够通过抑制无痕愈合信号通路的 相关蛋白质来促使瘢痕修复。糖尿病创面通常伴随糖尿病周围神经病变、糖尿病血管病变和感染。部分miRNAs 通过调控特定基因的表达水平,激活或抑制不同且特定的信号通路,一定程度上促进了糖尿病创面的愈合。本文 主要综述了miRNA在创面愈合过程不同阶段的调控研究进展,以及miRNAs促进、抑制糖尿病创面愈合的机制, 以期为后续研究开拓新的思路。     

Effect of animal products and extracts on wound healing promotion in topical applications: a review

Wound healing is a natural process of body reaction to repair itself after injury. Nonetheless, many internal and external factors such as aging, comorbidity, stress, smoking, alcohol drinking, infections, malnutrition, or wound environment significantly affect the quality and speed of wound healing. The unsuitable conditions may delay wound healing process and cause chronic wound or scar formation. Therefore, many researches have attempted to search for agents that can accelerate wound healing with safety and biocompatibility to human body. Widely studied wound healing agents are those derived from either natural sources including plants and animals or chemical synthesis. The natural products seem to be safer and more biocompatible to human tissue. This review paper demonstrated various kinds of the animal-derived products including chitosan, collagen, honey, anabolic steroids, silk sericin, peptides, and proteoglycan in term of mechanisms of action, advantages, and disadvantages when applied as wound healing accelerator. The benefits of these animal-derived products are wound healing promotion, anti-inflammatory, antimicrobial activity, moisturizing effect, biocompatibility, and safety. However, the drawbacks such as allergy, low stability, batch-to-batch variability, and high extraction and purification costs could not be avoided in some products.     

Pseudomonas aeruginosa biofilms perturb wound resolution and antibiotic tolerance in diabetic mice

Diabetic patients are more susceptible to the development of chronic wounds than non-diabetics. The impaired healing properties of these wounds, which often develop debilitating bacterial infections, significantly increase the rate of lower extremity amputation in diabetic patients. We hypothesize that bacterial biofilms, or sessile communities of bacteria that reside in a complex matrix of exopolymeric material, contribute to the severity of diabetic wounds. To test this hypothesis, we developed an in vivo chronic wound, diabetic mouse model to determine the ability of the opportunistic pathogen, Pseudomonas aeruginosa, to cause biofilm-associated infections. Utilizing this model, we observed that diabetic mice with P. aeruginosa-infected chronic wounds displayed impaired bacterial clearing and wound closure in comparison with their non-diabetic littermates. While treating diabetic mice with insulin improved their overall health, it did not restore their ability to resolve P. aeruginosa wound infections or speed healing. In fact, the prevalence of biofilms and the tolerance of P. aeruginosa to gentamicin treatment increased when diabetic mice were treated with insulin. Insulin treatment was observed to directly affect the ability of P. aeruginosa to form biofilms in vitro. These data demonstrate that the chronically wounded diabetic mouse appears to be a useful model to study wound healing and biofilm infection dynamics, and suggest that the diabetic wound environment may promote the formation of biofilms. Further, this model provides for the elucidation of mechanistic factors, such as the ability of insulin to influence antimicrobial effectiveness, which may be relevant to the formation of biofilms in diabetic wounds.     

Accelerating effects of chitosan for healing at early phase of experimental open wound in dogs.

Chitosan is a polymeric beta(1 --> 4) glucosamine (2-amino-2-deoxy-D-glucose) and N-acetyl-D-glucosamine (2-acetamido-2-deoxy-D-glucose) which has been reported as a wound healing accelerator. In order to evaluate the efficacy of chitosan as an accelerator of wound healing, experimental open skin wounds were made on the dorsal side in three normal beagles. Cottonfiber-type chitosan (degree of acetylation = 18%) was applied for 15 days, and the process of wound healing was evaluated histologically and immunohistochemically. On day 3 postwounding, the chitosan-treated wounds showed histologically severe infiltration of polymorphonuclear (PMN) cells and an increase in effusion compared with that in the control. Granulation was more pronounced by the chitosan treatment on day 9 and 15 postwounding. Immunohistochemical typing of collagen I, III and IV showed increase of the production of type III collagen in the chitosan group. The appearance of mitotic cells occurred numerously in the control on postwounding day 3, and in the chitosan group on postwounding day 6. These results suggest chitosan to be having a function in the acceleration of infiltration of PMN cells at the early stage of wound healing, followed by the production of collagen by fibroblasts.     

微小核糖核酸对糖尿病足溃疡的作用机制研究及应用进展

糖尿病足溃疡是糖尿病最常见的并发症之一，目前缺乏有效的治疗手段。微小核糖核酸(miRNA)是调节创面愈合的核心因子，通过与靶基因相互作用，参与了糖尿病足溃疡愈合过程中关键细胞(内皮细胞、成纤维细胞、角质形成细胞)的病理反应。本文就这些与糖尿病足溃疡相关的miRNA对关键细胞的作用机制作一综述，并总结了目前通过人工合成特异性miRNA来促进创面愈合的相关实验研究，为临床治疗糖尿病足溃疡提供了新的思路和方法。     

The use of wound healing assessment methods in psychological studies: A review and recommendations

Purpose. To provide a critical review of methods used to assess human wound healing in psychological research and related disciplines, in order to guide future research into psychological influences on wound healing. Methods. Acute wound models (skin blister, tape stripping, skin biopsy, oral palate biopsy, expanded polytetrafluoroethylene tubing), surgical wound healing assessment methods (wound drains, wound scoring), and chronic wound assessment techniques (surface area, volumetric measurements, wound composition, and assessment tools/scoring systems) are summarized, including merits, limitations, and recommendations. Results. Several dermal and mucosal tissue acute wound models have been established to assess the effects of psychological stress on the inflammatory, proliferative, and repair phases of wound healing in humans, including material‐based models developed to evaluate factors influencing post‐surgical recovery. There is a paucity of research published on psychological factors influencing chronic wound healing. There are many assessment techniques available to study the progression of chronic wound healing but many difficulties inherent to long‐term clinical studies. Conclusions. Researchers need to consider several design‐related issues when conducting studies into the effects of psychological stress on wound healing, including the study aims, type of wound, tissue type, setting, sample characteristics and accessibility, costs, timeframe, and facilities available. Researchers should consider combining multiple wound assessment methods to increase the reliability and validity of results and to further understand mechanisms that link stress and wound healing.