“从无到有”到“铸就王牌”——记郑州市第一人民医院烧伤科的过去、现在和未来

郑州市第一人民医院烧伤科从1959年最初成立烧伤小组的12张床位发展至今,已有60余年历史,已经发展成为集医疗、教学、科研、整形、康复为一体,在省内领先,在国内具有一定影响力的综合性学科。笔者通过回顾本单位烧伤科的起步、发展、建设以及取得的成就,探讨未来学科发展方向,为我省烧伤医学事业的发展出谋划策。     

凝心聚力谋发展砥砺奋进谱新篇——献礼建党一百周年

2021年迎来建党一百周年,站在"2个一百年"奋斗目标历史交汇点,烧伤学科迎来了"十四五"开局,克难攻坚、再攀高峰.作为军事医学学科,陆军军医大学第一附属医院全军烧伤研究所伴随着国家、军队的建设、改革、发展及伟大实践逐步成长、壮大,坚持为党育人、为国育才的初心使命,不断提升政治判断力、领悟力、执行力,以立德救人为根本任...     

加强重症烧伤的学科建设和规范化烧伤重症加强治疗病房设置的思考

中国重症烧伤的救治起步于1958年。到20世纪80年代,在中国烧伤医务工作者的共同努力下,建立了具有鲜明中国特色的烧伤救治体系,治疗效果良好。近年来重症医学科的建立和飞速发展对烧伤重症治疗产生了重大而深远的影响。大型烧伤中心的烧伤监护室大多发展成为现代意义上的烧伤重症加强治疗病房(ICU)。烧伤工作者融合烧伤救治经验和重症医学的理论和实践,开展了大量烧伤重症理论研究与临床工作,取得了较好的救治效果。同时也有部分中小型烧伤科的烧伤监护室并未得到升级,重大事故的成批重症烧伤患者有时也会收入综合ICU进行救治。因此,促进重症烧伤的学科发展和进一步完善烧伤ICU的设置和管理成为热点问题。     

突发性成批烧伤急救亟需解决的三个问题

从2014年昆山"8·2"爆炸及2015年天津港"8·12"爆炸事件救治经验看,目前,突发性成批烧伤急救亟需建立符合我国国情的、完善的接近实战、衔接一线的突发性成批烧伤急救-研究-策略的教育体系,这是提高突发性成批烧伤救治成功率的基础;汲取烧伤学科历史和现实优势,与危重病等多学科磨合,研究危重创伤急救和修复的重大问题,提出突发性成批烧伤危重病救治策略,形成具有指导意义的中国烧伤危重病治疗强势力量;建立区域化救治网络,以提高突发公共卫生事件应急医疗救援水平。解决上述3个问题,以进一步提高突发性成批烧伤救治的成功率。     

烧伤医学中的“治未病”

"治未病"是祖国传统医学防病、治病的重要思想,其内涵主要包括"未病先防"和"既病防变"。对于已经烧伤的患者,树立既病防变的思想,在积极处理烧伤原发病的同时,还要密切观察患者的病情发展变化,积极预防烧伤并发症,做到对烧伤并发症的早预防、早发现、早治疗,防止或延缓烧伤后病情加重或恶化,以促进烧伤愈合和功能康复,提高烧伤救治成功率和救治水平。本文阐述了用"治未病"的观点预防和早期治疗烧伤并发休克、肾功能衰竭、血栓栓塞、水肿、骨代谢异常等并发症的理念。     

2009年第六届全国烧伤救治专题研讨会征文通知

由中华烧伤杂志编辑委员会及中华医学会烧伤外科学分会主办、第四军医大学西京医院承办的“第六届全国烧伤救治专题研讨会”（专题学术组稿会），定于2009年6月中旬在西安市召开。该会是《中华烧伤杂志》组织优秀稿件、保持期刊学术水平处于领先地位的有效途径，也是促进学术交流和学科发展的重要手段。     

不忘初心砥砺奋进在党的理论指引下推动烧伤学科更高质量发展——写于中国共产党建党一百周年之际

1958年是中国所有烧伤医学工作者都应当铭记的年份,在这一年,新中国终于有了属于自己的烧伤医学.经过半个多世纪的风雨兼程,经过几代烧伤医学工作者的刻苦钻研、顽强拼搏,中国烧伤医学事业取得一个又一个令人瞩目的突破,至今已岿然屹立于世界烧伤医学之巅.回顾这60多年的光辉历程,中国烧伤医学的学科发展和具体实践,中国烧伤医学的...     

高级实践护士在烧伤领域的发展

半个多世纪以来中国烧伤在治疗方面已经取得了辉煌的成就,在国际上已经达到领先水平.烧伤专业护理有着较强的专业特点,集烧伤预防、临床护理、伤口护理、危重症护理、康复护理、心理护理等于一体,对护士提出更高的专业要求.本文对高级实践护士定义进行描述,并立足于烧伤护理,对烧伤专业高级护理实践的现状、发展烧伤高级护理实践的必要性、可行性和挑战性以及烧伤高级护理实践的内容等方面进行阐述.认为烧伤高级实践护士将对烧伤护理学科的发展起着举足轻重的位置,但这可能需要一段漫长的过程.需要进行相关的研究,对既有高学历,又有工作经验的护士进行培训,同时也需要行政部门的支持.     

一份出色的答卷——记上海交通大学医学院附属瑞金医院许伟石教授

本文作者在读过许伟石教授撰写的《我的学术轨迹》一文原稿后,深感以许教授为代表的一代烧伤开拓者为烧伤事业的开拓和发展做出了巨大贡献,更为他们淡泊名利、富于奉献的精神感动,因此,特撰写这篇关于许伟石教授的文章,以颂扬他们这代人为烧伤事业付出的毕生精力,他们是这个学科发展的脊梁和灵魂,是广大医务工作者的楷模。     

中医治疗烧伤的研究进展

目的 探讨中医中药治疗烧伤的研究进展.方法 通过文献检索方式检索中医对烧伤的认识和治疗烧伤的方法及剂型情况.结果 中医在治疗烧伤方面有一定的优势,临床应用广泛,取得了一定的疗效,无明显毒副作用,值得进一步研究,以徐荣祥为代表的烧伤湿性疗法使烧伤治疗带入了一个原位再生皮肤的器官再生治疗学新阶段,代表了现代烧伤治疗的研究发展方向和趋势.结论 中医对烧伤的治疗是以中医基本理论为基础,以辩证施治、理法方药为指导的治疗方法,取得了可喜的疗效,在现代中医治疗烧伤方面还有几个问题,这有待烧伤工作者继续不断的总结经验和进一步研究.     

Wade RS. 1998. Medical mummies: The history of the Burns collection. Anat Rec (New Anat) 253:158–161.

Wade RS. 1998. Medical Mummies: The History of the Burns Collection. Anat Rec (New Anat) 253:158–161. In the Historical Note “Medical Mummies: The History of the Burns Collection” by Ronald S. Wade, which appeared in our December 1998 issue [Anatomical Record (New Anat) 253, 158–161, 1998], credit should have been attributed to Mark Teske, R.B.P. for his expert photographic work. The author and editors apologize for this unintended omission. Mark H. Paalman Managing Editor, The New Anatomist © 1999 Wiley‐Liss, Inc.     

Psychological,situational, and gender predictors of cardiovascular reactivity to stress: A multivariate approach

This study examined whether relationships between anger expression, hostility, social evaluative anxiety, and a presumed mechanism for coronary heart disease development, cardiovascular reactivity (CVR) to stress, are moderated by stress situation and gender and whether such relationships are attenuated by inadequate assessments. Subjects (47 men, 47 women) were assigned randomly to either a Harassment or a Social Evaluation condition, under which they performed a reaction time task. SBP, DBP, and HR measures were recorded during baseline and task. Multiple regression analyses indicated that expressed anger was related to CVR only among men in the Harassment condition; that hostile men who express anger showed the most CVR across situations, and that the traits assessed here did not predict CVR among women. Results suggest that assessments of coronary-risk and interventions to reduce risk may need to take into account attitudes, styles of emotional expression, environmental factors, and gender.This research was supported in part by an NIMH predoctoral fellowship (F31MH09836) awarded to John W. Burns and by a grant from the American Heart Association (89-01-3G) awarded to Edward S. Katkin.     

Developmental trajectories, critical windows and phenotypic alteration during cardio-respiratory development

Embryo-environment interactions affecting cardio-respiratory development in vertebrates have been extensively studied, but an equally extensive conceptual framework for interpreting and interrelating these developmental events has lagged behind. In this review, we consider the conceptual constructs of "developmental plasticity", "critical windows", "developmental trajectory" and related concepts as they apply to both vertebrate and invertebrate development. Developmental plasticity and the related phenomenon of "heterokairy" are considered as a subset of phenotypic plasticity, and examples of cardiovascular, respiratory and metabolic plasticity illustrate the variable outcomes of embryo-environment interactions. The concept of the critical window is revealed to be overarching in cardio-respiratory development, and events originating within a critical window, potentially mitigated by "self-repair" capabilities of the embryo, are shown to result in modified developmental trajectories and, ultimately, modified adult phenotype. Finally, epigenetics, fetal programming and related phenomena are considered in the context of potentially life-long cardio-respiratory phenotypic modification resulting from embryo-environment interactions.     

Concluding causation from correlation: comment on Burns and Spangler (2000).

This commentary critiques the study conducted by D. D. Burns and D. Spangler (2000) in which the relationship between homework compliance and therapy outcome was estimated using structural equation modeling (SEM). Although the authors of the commentary advocate the use of SEM, they suggest greater caution in the indiscriminate endorsement of a causal relationship based on (a) correlational data and (b) retrospective accounts of the main predictor variable within a cross-sectional design. This discussion also highlights a need to address the issue of therapist competence in homework administration. The results of Burns and Spangler's report are consistent with existing empirical evidence suggesting that compliance with homework facilitates therapeutic outcome. However, the gold standard for determining causal inferences rests on prospective, experimental research rather than on retrospective, correlational models.     

Coping styles, homework compliance, and the effectiveness of cognitive-behavioral therapy

Factor analysis of the Self-Help Inventory (Burns, Shaw, & Crocker, 1987) in a group of 307 consecutive outpatients seeking cognitive-behavioral therapy (CBT) for affective disorders revealed 3 factors that assessed the frequency with which subjects used active coping strategies when depressed, the perceived helpfulness of these coping strategies, and their willingness to learn new coping strategies. The Frequency and Helpfulness scales did not predict patients' subsequent compliance with self-help assignments or their rate of improvement during the first 12 weeks of treatment. These findings suggest that very resourceful patients are not better candidates for CBT than other patients and that patients' expectations about the value of active coping strategies do not predict the response to CBT. In contrast, the Willingness scale was correlated with the degree of improvement during the first 12 weeks of treatment. The Willingness scale and compliance with self-help assignments made additive and separate contributions to clinical improvement. Further research on motivational factors may be indicated.     

真皮替代物的研究进展及临床应用

创面修复一直是临床面临的难题,真皮替代物作为一种新兴材料给临床提供了新的治疗方法。真皮替代物分为人工真皮替代物和天然真皮替代物两大类,目前已被广泛应用于临床各个领域,如烧伤整形外科、口腔颌面外科、腹壁外科、耳鼻喉科、泌尿妇产科等,效果显著,但真皮替代物的转归机制及在临床应用中出现的感染、并发症等问题仍有待进一步研究及解决,从而为其临床应用提供更好的前景。本文主要从真皮替代物的研究进展和临床应用两方面进行综述。     

Probiotics, immunity and pediatric health

Early bacterial stimulation of gut associated immune cells is essential for the development and maturation of the infant's immune response. This "microbial experience" has been affected due to a decrease in vaginal births (which are the first source of bacterial exposure for an infant), the substitution of breast feeding, in favor of almost sterile formulas, an increase use of antibiotics, and an increasingly "cleaner" environment. Increased hygienic measures and pasteurization perpetuate this decreased microbe-host interaction. These changes in environmental and gut microbiota are associated with an altered and inadequate development of immune response, with related health implications. The inadequate host response to infectious diseases, as well as the epidemic of immune related chronic conditions (such as allergy) can be explained in great measure by these changes. The consumption of certain probiotics (specific dietary bacteria that provide a benefit to the host) has positive effects on gut barrier function and immune response. Thus, probiotics are a means of improving host-microbe interactions for health maintenance, and for the management of a number of illnesses. This paper summarizes important aspects of these interactions as well as the role that probiotic bacteria can play in pediatric health.     

Retraining faculty for the problem-based curriculum at the University of Hawaii, 1989-1991.

The problem-based learning (PBL) curriculum, adopted by an increasing number of medical schools, requires retraining faculty for new roles as tutors with small groups of medical students. This study describes the procedures and results of four PBL training workshops (1989-1991) given at the University of Hawaii John A. Burns School of Medicine. Eighty-eight faculty volunteers each answered a 20-item multiple-choice questionnaire testing their knowledge of PBL both before and after they participated in a workshop. The posttest results were used to identify deficiencies in the tutors' knowledge and practice of both their role and their function. The authors conclude that these deficiencies, now identified, will be addressed in a systematic fashion in subsequent workshops.     

Stromal Androgen Receptor Roles in the Development of Normal Prostate,Benign Prostate Hyperplasia,and Prostate Cancer

The prostate is an androgen-sensitive organ that needs proper androgen/androgen receptor (AR) signals for normal development. The progression of prostate diseases, including benign prostate hyperplasia (BPH) and prostate cancer (PCa), also needs proper androgen/AR signals. Tissue recombination studies report that stromal, but not epithelial, AR plays more critical roles via the mesenchymal-epithelial interactions to influence the early process of prostate development. However, in BPH and PCa, much more attention has been focused on epithelial AR roles. However, accumulating evidence indicates that stromal AR is also irreplaceable and plays critical roles in prostate disease progression. Herein, we summarize the roles of stromal AR in the development of normal prostate, BPH, and PCa, with evidence from the recent results of in vitro cell line studies, tissue recombination experiments, and AR knockout animal models. Current evidence suggests that stromal AR may play positive roles to promote BPH and PCa progression, and targeting stromal AR selectively with AR degradation enhancer, ASC-J9, may allow development of better therapies with fewer adverse effects to battle BPH and PCa.The prostate contains mainly the stromal cells and epithelial cells that are separated by base members and merged in extracellular matrix. Stromal cells include fibroblasts, smooth muscle cells (SMCs), and other minor inflammatory cells, nerve cells, and endothelial cells.The prostate is developed from the endodermal urogenital sinus¹ that contains an outer layer of embryonic connective tissue urogenital sinus mesenchyme (UGM) and an inner layer of urogenital sinus epithelium (UGE).¹ The initial step of prostate development in UGM involves the differentiation of fibroblasts and SMCs,¹ and in response to the UGM androgen/androgen receptor (AR) signals, UGE can grow into the surrounding stromal cells and develop into the prostate epithelial cells as part of the normal prostate development.The ability of the UGM to induce epithelial development and the developed epithelial cells, in return, to direct UGM to undergo differentiation, suggesting that the reciprocal developmental interactions between UGM and UGE might be governed by androgen/AR signals, which are essential for the development of normal prostate, benign prostate hyperplasia (BPH), and prostate cancer (PCa). Prostate development factors, including its proliferation, differentiation, morphogenesis, and functional maintenance, are all influenced by androgen/AR signals.² Androgen/AR signals also play vital roles in the initiation and progression of BPH and PCa,^3,4 which may require the proper interaction with various AR coregulators.²AR is a member of the nuclear receptor superfamily that can be activated and translocated from cytoplasm to nucleus after binding the testosterone or dihydrotestosterone.^5–7 In prostate, AR is expressed in both epithelial and stromal tissues. The transactivated AR in nucleus may then function through modulation of various downstream target genes to influence the development and maintenance of the prostate. In addition to influencing cell growth directly, epithelial AR and stromal AR can also function through epithelial-mesenchymal transition (EMT) to influence prostate development. EMT is a process by which epithelial cells lose their cell-cell adhesion and gain migratory properties to become mesenchymal-like and/or mesenchymal stem cells. These potent mesenchymal cells may then differentiate into different cell types to influence the progression of BHP⁸ and PCa.⁹This review will focus on the discussion of the roles of stromal AR in the development of normal prostate and prostate diseases.     

When health makes the headlines. Press, elite complicities and health globalisation in Bamako, Mali

To overcome the socio-medical failures observed in Africa's health services, researchers and practitioners of public health often mention the necessity to resort to counter-powers. But, what are precisely these counter-powers? To analyse the problem, we describe the treatment of health issues in the Bamako press during one year. The analysis of various processes (external references, lack of training, insufficient deontological standards, "elite" complicity among journalists and health directors) allows us to underline the complexity of the links between the press and health. The economic flows related to the economy of development "projects" in particular with AIDS, encourage the journalists to see themselves as "educationalists" of populations rather than spokesmen for their claims or difficulties. Two consequences follow. First of all the press counter-power has to be developed in the case one wishes to see it as the expression of "the voice of the voiceless" and a good help to make an "informal" evaluation of the quality of health cares by users. But, more generally within this context of globalisation of health, instead of encouraging the expression of a "popular" criticism, newspapers work out a system of mutual legitimacies and social connivances among local "elites". Far from contributing to the improvement of the health system by looking actively into the problem leading to a modernity under control, health journalism disconnects the discourse from its referent and contributes to discredit "political" language. This journalistic construction of the insignificance is one of the principal political effects of this medical journalism instrumentalized by institutions of development.