金因肽联合复方磺胺粉治疗鼻咽癌III度放射性皮炎的疗效观察及护理

目的：探讨金因肽联合复方磺胺分治疗鼻咽癌II 度放射性皮炎的疗效及护理要点。方法将84例鼻咽癌I I度放射性皮炎患者随机分为金因肽治疗组、复方磺胺粉治疗组及金因肽联合复方磺胺粉治疗组，每组28例。观察三组患者的治疗效果。结果金因肽联合复方磺胺粉治疗组总有效率为100%，金因肽治疗组总有效率为74.5%，复方磺胺粉治疗有效率为35.2%。三组之间疗效比较，差异具有显著统计学意义(<0.05)。结论金因肽联合复方磺胺粉治疗鼻咽癌I I度放射性皮炎疗效显著，优于单独使用金因肽和复方磺胺粉，值得临床推广应用。     

磺胺嘧啶银霜的安全性试验

磺胺嘧啶银霜[1]为磺胺类抗菌药,具有磺胺嘧啶和银的盐的双重作用,临床用于预防和治疗小面积轻度烧烫伤直接涂于创面。为了确保用药安全,对磺胺嘧啶银霜进行皮肤刺激和皮肤过敏试验。观察家兔多次接触磺胺嘧啶银霜后所产生的刺激性反应情况以及在豚鼠皮肤重复接触磺胺嘧啶银霜后,观察机体免疫系统反应在皮肤上的表现,为临床安全用药提供科学依据。     

富林蜜与外用重组人粒细胞-巨噬细胞刺激因子凝胶联合应用治疗深Ⅱ度烧伤临床观察

目的 观察富林蜜与外用重组人粒细胞-巨噬细胞刺激因子（rhGM-CSF）凝胶联合应用治疗深Ⅱ度烧伤创面的临床疗效.方法 采用同体对照法,在56例患者身上分别选取两处面积相当的创面,随机分为两组,同步同法清创后,对照组部位涂抹安慰剂后用磺胺嘧啶银霜换药治疗,治疗组部位涂抹rhGM-CSF凝胶后用富林蜜换药治疗,观察比较两组创面的愈合时间、愈合百分率及细菌培养结果的差异,并检测受试者在用药期间有无化验检查结果异常及不良反应.结果 治疗组创面愈合时间（17.33±1.19）d较对照组（19.56±1.81）d缩短,差异有统计学意义（P＜0.05）.用药后的第14、17和20天,治疗组创面愈合率均显著高于试验组,且差异均有统计学意义（P＜0.05）.治疗组创面细菌培养阳性率为5.63%,对照组为3.57%,差异无统计学意义（P＞0.05）.用药期间全部受试者的血象及肝肾功能相关指标的差异与药物应用无明显相关,绝大多数患者无明显不适主诉.结论 富林蜜与rhGM-CSF凝胶联合应用治疗深Ⅱ度烧伤,能有效缩短创面愈合时间,提高创面愈合百分率,其抑菌效果与深Ⅱ度烧伤创面经典外用药物磺胺嘧啶银霜相比,无明显差异,而且在用药过程中绝大多数受试者无明显不良反应.     

湿润烧伤疗法治疗头面部烧伤的临床观察

目的探讨湿润暴露疗法治疗在头面部烧伤的疗效。方法将86例病例随即分成两组，分别行湿润暴露疗法和磺胺嘧啶银暴露疗法，观察两组治疗效果。结果湿润暴露疗法（MEBT组）于磺胺嘧啶银暴露疗法（SD—Ag组）相比，创面渗出天数少、15天创面愈合率高．瘢痕形成例数少。结论MEBT治疗头面部烧伤疗效优于SD—Ag疗法。     

磺胺嘧啶铈对糖尿病足创面的作用

目的研究磺胺嘧啶铈治疗糖尿病足创面的效果。方法将糖尿病足50例随机分为对照组和治疗组。对照组创面应用碘伏换药,治疗组创面以1%磺胺嘧啶铈霜纱布覆盖,每日换药1次,两组其他治疗相同。治疗6周后,观察两组细菌清除率、肉芽生长情况、创周炎症反应和创面愈合率。结果治疗组细菌清除率和创面愈合率明显高于对照组（P〈0.05）,肉芽生长评分显著好于对照组（P〈0.05）,治疗组创周炎症反应较对照组轻（P〈0.05）。结论磺胺嘧啶铈能抑制糖尿病足创面细菌生长,促进创面愈合。     

磺胺嘧啶银脂质水胶敷料治疗小面积皮肤缺损并伤口感染:生物相容性评价

背景:磺胺嘧啶银脂质水胶敷料是两种抗菌药物的结合体,可以发挥局部广谱、强效、持久的抗菌作用,能有效控制并预防伤口感染。目的:观察磺胺嘧啶银脂质水胶敷料治疗皮肤缺损性感染伤口的效果及生物相容性。方法:将30例皮肤缺损合并感染伤口患者采用随机分组方法分为观察组和对照组,两组均常规清创、换药后,观察组用生理盐水冲洗伤口后使用磺胺嘧啶银脂质水胶敷料覆盖,再以纱布包扎;对照组使用凡士林纱布覆盖后再以纱布包扎。观察两组治疗0,1,2周换药时的目测类比评分、敷料与伤口粘连情况、创面愈合率及痊愈时间。结果与结论:观察组治疗1,2周换药时的目测类比评分显著低于对照组(P0.01),治疗1,2周换药时的创面愈合率显著高于对照组(P0.05);观察组换药时敷料与伤口粘连情况明显少于对照组(P0.01),创面愈合时间明显短于对照组(P0.05)。表明磺胺嘧啶银脂质水胶敷料治疗皮肤缺损合并感染伤口效果好,可减轻换药时疼痛,有效控制感染,促进伤口愈合。     

黄虎喷雾剂与好的快气雾剂在烧伤Ⅱ°创面和整形供皮区上的应用

目的观察黄虎喷雾剂与好的快气雾剂的疗效。方法黄虎喷雾剂与好的快气雾剂应用于32例Ⅱ°烧伤创面和整形供皮区,同期应用磺胺嘧啶银霜32例作为对照,两组病人的平均年龄、性别、烧伤和供皮区面积、深度无显著差异,用药方式均为暴露疗法。结果黄虎喷雾剂与好的快气雾剂能够显著促进创面愈合,缩短愈合时间。结论黄虎喷雾剂与好的快气雾剂是安全可靠、使用方便、效果理想的外用药物,对Ⅱ°烧伤创面可以替代磺胺嘧啶银霜的使用,能促进供皮区的愈合,减轻瘢痕。     

冷宁康敷料对烧伤创面疼痛的治疗

目的探讨新型烧伤敷料治疗Ⅱ度烧伤、减少患者疼痛、促进创面愈合方面的效果。方法对45例Ⅱ度烧伤创面分两组，应用冷宁康和磺胺嘧啶银锌治疗，观察两组创面疼痛情况及愈合时间。结果使用冷宁康组0～Ⅰ级疼痛占95．5％（43／45），对照组中0～Ⅰ级疼痛占17．3％（8／45），两组比较有统计学意义（P〈0．01）。与对照组比较，治疗组浅Ⅱ度创面平均愈合时间缩短2．48d，深Ⅱ度创面平均愈合时间缩短4．61d（P〈0.05）。结论冷宁康不但能促进创面愈合，而且是一种对烧伤创面具有良好止痛作用的外用烧伤敷料。     

纳米银敷料和磺胺嘧啶银霜治疗烧伤的对比研究

目的：对应用磺胺嘧啶银霜与纳米银敷料两种方式对患有烧伤疾病的患者实施治疗的临床效果进行对比研究。方法将我院收治的90例患有烧伤疾病的患者随机分为对照组和治疗组,平均每组45例。采用磺胺嘧啶银霜对对照组患者实施治疗;采用纳米银敷料对治疗组患者实施治疗。结果治疗组患者烧伤疾病治疗效果明显优于对照组;烧伤部位创面完全愈合时间和临床治疗方案实施总时间明显短于对照组;用药期间出现不良反应的人数明显少于对照组。结论应用纳米银敷料对患有烧伤疾病的患者实施治疗的临床效果非常明显。     

rbbFGF凝胶联合高锰酸钾水疗治疗难愈性创面的临床研究

目的 探讨重组牛碱性成纤维细胞生长因子（rbbFGF）凝胶联合高锰酸钾水疗治疗难愈性创面的临床疗效。方法 选取2017年1月~2018年5月我院收治的难愈性创面患者40例,随机分为观察组和对照组,各20例。对照组创面清创后予以外用生理盐水冲洗,碘伏消毒,磺胺嘧啶银乳膏纱布覆盖,无菌敷料包扎。观察组清创后给予1∶5000高锰酸钾溶液（35℃）浸泡水疗30 min联合rbbFGF凝胶局部外用治疗,余操作同对照组一致。比较两组患者临床疗效、创面愈合时间、住院时间及不良反应情况。结果 治疗后,观察组愈合时间为（30.52±8.72）d,短于对照组的（40.42±15.81）d,差异有统计学意义（P＜0.05）;观察组创面缩小和肉芽生长结果均优于对照组,差异有统计学意义（P＜0.05）;观察组创面细菌转阴率为85.00%,高于对照组的50.00%,差异有统计学意义（P＜0.05）。两组不良反应比较,差异无统计学意义（P＞0.05）。结论 rbbFGF凝胶联合高锰酸钾水疗治疗难愈性创面能够促进创面缩小,加速创面肉芽增长,有明显的抗感染的作用,缩短创面愈合时间,具有较高的临床价值。     

Epidermal growth factor receptor: a novel biomarker for aggressive head and neck cutaneous squamous cell carcinoma

There is currently no prognostic tool that reliably predicts the risk of metastasis in cutaneous squamous cell carcinoma, most of which occur in the head and neck region. Epidermal growth factor receptor has received much interest in recent years with the advent of epidermal growth factor receptor-targeted molecular therapy in clinical oncology. We investigate the role of epidermal growth factor receptor as a biomarker for head and neck cutaneous squamous cell carcinoma. Using immunohistochemistry and fluorescence in situ hybridization, we assessed the epidermal growth factor receptor protein expression and gene copy in 3 groups of head and neck cutaneous squamous cell carcinoma: primary lesions not associated with metastasis (P), primary lesions associated with subsequent metastasis (PM), and metastatic nodal disease (M). Epidermal growth factor receptor overexpression was detected in 36% and 79% of P and PM cases, respectively. Epidermal growth factor receptor overexpression was significantly associated with PM (P = .03) and was found to be an independent prognostic factor for metastasis on multivariate analysis (P = .05). However, epidermal growth factor receptor overexpression was only maintained in 47% of cases in the M group. None of the 27 cases that overexpressed the epidermal growth factor receptor protein showed gene amplification: the results were uninterpretable in 2, and polysomy and balanced disomy were detected in 5 and 20 cases, respectively. These observations may have important prognostic and therapeutic implications for head and neck cutaneous squamous cell carcinoma.     

Is immunohistochemical epidermal growth factor receptor expression overestimated as a prognostic factor in head-neck squamous cell carcinoma? A retrospective analysis based on a tissue microarray of 365 carcinomas

Epidermal growth factor receptor is overexpressed in more than 80% of head-neck squamous cell carcinoma. Its role as an independent prognostic marker is discussed controversially. No standardized evaluation methods are reported. The aim of our study was to analyze the prognostic relevance of epidermal growth factor receptor expression, using a tissue microarray with more than 300 tumor samples. Epidermal growth factor receptor expression was analyzed by immunohistochemistry and fluorescence in situ hybridization based on a tissue microarray of 365 head-neck squamous cell carcinomas with complete clinicopathologic and follow-up data. Multiple independent observers blinded for clinical data evaluated epidermal growth factor receptor immunostaining semiquantitatively. Cut-off scores for positivity were determined systematically by receiver operating characteristic curve analysis and validated by resampling of the data. Epidermal growth factor receptor expression cut-off scores for loco-regional relapse and overall survival were determined to be 60%. No significant correlation with clinicopathologic data was found. Independent significant differences in loco-regional control and overall survival could not be distinguished by epidermal growth factor receptor expression. Epidermal growth factor receptor expression could not be confirmed as a significant independent prognostic marker in head-neck squamous cell carcinoma using a large tissue microarray with 365 head-neck squamous cell carcinomas with complete clinical data, an evaluation based on immunohistochemistry and fluorescence in situ hybridization by multiple independent observers and systematic determination of cut-off scores.     

EGFR and gastrointestinal stromal tumor: an immunohistochemical and FISH study of 82 cases.

Gastrointestinal stromal tumor is the most common mesenchymal neoplasm of the gastrointestinal tract. Mutually exclusive KIT or platelet-derived growth factor receptor-alpha mutations are key events in gastrointestinal stromal tumor pathogenesis, and specific treatment targeting KIT/platelet-derived growth factor receptor-alpha activation is available. Epidermal growth factor receptor plays an important role in cancer biology and also constitutes a promising molecular target of therapy. Very few reports have been published in the literature about the relationship between gastrointestinal stromal tumor and epidermal growth factor receptor. The aim of this study was to investigate epidermal growth factor receptor immunohistochemical expression and epidermal growth factor receptor gene amplification in 82 consecutive gastrointestinal stromal tumor cases using tissue microarray technique. Hematoxylin- and eosin-stained sections and clinical information were reviewed, and expression of CD117 (KIT), CD34 and epidermal growth factor receptor was investigated by immunohistochemistry. Epidermal growth factor receptor gene copy number was determined using fluorescence in situ hybridization. Immunohistochemistry revealed that CD117 and CD34 were expressed in 96 and 57% of tumors, respectively. Variable epidermal growth factor receptor protein immunohistochemical overexpression was detected in 96% of gastrointestinal stromal tumor cases, but none of the 75 cases with represented tumor tissue cores and countable fluorescence signals exhibited epidermal growth factor receptor gene amplification by fluorescence in situ hybridization. These results show that there is no correlation between epidermal growth factor receptor protein overexpression by immunohistochemistry and epidermal growth factor receptor gene amplification by fluorescence in situ hybridization. Considering that the mechanisms of epidermal growth factor receptor protein overexpression are not well understood and the possibility that anti-epidermal growth factor receptor therapy may be beneficial for patients with gastrointestinal stromal tumor that overexpresses epidermal growth factor receptor, additional studies are encouraged.     

自制羊膜载体复合物植入表皮细胞修复全层皮肤缺损

背景：利用组织工程和细胞培养技术研制的复合皮肤距理想的人工皮肤尚有一定的差距,如局部皮肤薄弱、抗拉及抗摩擦能力差、无皮肤附属器等。 目的：观察含碱性成纤维细胞生长因子和维生素C的羊膜载体复合物对皮肤缺损局部真皮组织的修复作用,寻找真皮组织修复重建促进表皮生长的最佳时期。 方法：取新西兰大耳白兔36只,在每只背部建立皮肤全层缺损模型3处,分别植入含有缓释碱性成纤维细胞生长因子和维生素C羊膜载体复合物、单纯羊膜载体复合物及油纱覆盖。随机分为3组,分别于术后21,14,7 d植入自体表皮细胞混合液,1周后行大体、组织学、免疫组织化学、墨汁灌注等观察。 结果与结论：术后21 d植入表皮细胞组皮肤缺损局部新生皮肤瘢痕轻、形态结构较满意,创面愈合速度和质量均优于术后14,7 d 植入表皮细胞组,并且植入含碱性成纤维细胞生长因子和维生素C羊膜载体复合物组创面皮肤新生真皮组织完全被新生的表皮覆盖,而且表皮几乎均变为复层,其生长速度及质量优于单纯羊膜载体复合物移植组和油纱覆盖组。说明含有碱性成纤维细胞生长因子和维生素C的羊膜载体复合物植入皮肤全层缺损后,能加速真皮的修复和重建;真皮组织修复增生晚期和重建初期为促进表皮生长的最佳时期。     

Epidermal growth factor receptor expression and gene copy number in fibrolamellar hepatocellular carcinoma

Increased expression of epidermal growth factor receptor (EGFR), a transmembrane tyrosine kinase, is associated with tumor progression in many carcinomas. Epidermal growth factor receptor inhibitors have shown promise in treating some of these tumors. Fibrolamellar hepatocellular carcinoma (FL-HCC) is an aggressive neoplasm that occurs in young patients with no history of cirrhosis. This study examines the expression and gene copy number of EGFR in FL-HCC. Formalin-fixed, paraffin-embedded FL-HCC (n = 13) sections were stained with a monoclonal antibody against EGFR. Fluorescence in situ hybridization analysis was performed using probes against EGFR gene and centromeric region of chromosome 7 (CEP 7). Epidermal growth factor receptor and CEP 7 signals were counted in 50 tumor nuclei per case as well as 300 normal hepatocyte nuclei. The EGFR to CEP 7 signal ratio was calculated for each case. Most (92%, 12/13) of FL-HCC showed strong and diffuse staining with anti-EGFR antibody. Fluorescence in situ hybridization was informative in 11 cases, 10 of which showed extra EGFR gene copy numbers (mean, 3.69; range, 3.13-5.0). Epidermal growth factor receptor was overexpressed in all these cases. The mean number of EGFR signals per cell in FL-HCC was double that of normal hepatocytes (3.69 versus 1.80); the mean EGFR/CEP 7 ratio in tumor cells was 1.05. In conclusion, EGFR is strongly overexpressed on the cell membrane in nearly all cases of FL-HCC. Similar gains of chromosome 7 are observed, indicating that the extra EGFR gene copies are due to polysomy rather than gene amplification. The strong expression of EGFR in FL-HCC tumors suggests that they may respond to treatment with EGFR antagonists.     

人工真皮复合自体薄皮移植治疗皮肤软组织缺损

背景：修复皮肤软组织缺损自体或异体植皮治疗,往往需要多次植皮。而国内临床上应用人工真皮较少,应用经验亦不足。 目的：评价人工真皮治疗皮肤软组织缺损的疗效。 方法：收集因皮肤软组织缺损,行人工真皮结合自体薄皮移植修复创面的22例患者,其中骨外露6例,肌腱外露2例,表皮肿瘤切除3例,其他11例。一期清创移植人工真皮,2~4周后局部肉芽组织生长良好,外露肌腱、骨组织被类真皮组织覆盖,二期移植自体薄层皮片。观察取皮部位、损伤部位、操作性能、密封性、不良反应情况,结合评价临床效果及综合评价。 结果与结论：20例患者人工真皮结合二期自体薄皮移植全部存活,至二期植皮所需时间(18.50±4.27) d,其中1例患者因感染再次手术,2例患者行人工真皮后未行二期植皮,而自动上皮化;随访至3个月,21例损伤部位表皮生长性、外观性均良好、无瘢痕增生,1例因感染而致瘢痕增生严重、外观不良,但生长性良好;20例患者取皮部位无明显的色素沉着及色素脱出,无严重增生性瘢痕,上皮形成时间为(15.35±4.67) d。说明人工真皮结合自体薄皮移植修复皮肤软组织缺损,操作简便,创面愈合质量高,供皮区损伤轻微,至二期植皮时间较长,总体临床效果良好。     

低频电磁场在基因修饰表皮干细胞移植修复创面中的作用

背景：烧伤、慢性创面等大面积皮肤缺损的创面修复是临床上亟待解决的难题。表皮干细胞和角质化细胞生长因子可为创面的治疗提供新的策略。低频电磁场作为一种非侵入性物理刺激在创面修复中已被认为较佳的方法。 目的：探讨低频电磁场在角质化细胞生长因子基因修饰的表皮干细胞移植促进小鼠皮肤全层缺损创面修复中的作用。 方法：体外分离培养SD乳鼠表皮干细胞,用5-溴脱氧尿核苷进行标记,成功转染角质化细胞生长因子基因腺病毒表达载体后,移植于昆明小鼠全层缺损创面。建立全层缺损创面小鼠模型,分别进行表皮干细胞移植,角质化细胞生长因子修饰的表皮干细胞移植,角质化细胞生长因子修饰的表皮干细胞移植外加低频电磁场干预。 结果与结论：移植后第9,16天,低频电磁场干预的角质化细胞生长因子基因修饰的表皮干细胞移植组创面收缩率优于其他各组(P < 0.05)。移植后第9天,免疫荧光染色法检测显示,各组组创面中均有5-溴脱氧尿核苷阳性细胞分布。移植后第16天,Western blot检测显示,低频电磁场干预的角质化细胞生长因子基因修饰的表皮干细胞移植组和角质化细胞生长因子基因修饰的表皮干细胞移植组创面组织中角质化细胞生长因子蛋白表达高于表皮干细胞移植组(P < 0.05);移植后第16,30天,苏木精-伊红染色结果显示,低频电磁场干预的角质化细胞生长因子基因修饰的表皮干细胞移植组的创面组织上皮化现象较明显。结果证实,低频电磁场有促进角质化细胞生长因子基因修饰的表皮干细胞移植修复小鼠皮肤全层缺损创面的作用。     

碱性成纤维细胞生长因子与小儿烧伤创面的愈合

背景：皮肤创面愈合是一个复杂的病理过程,对于创伤和创伤后感染等引起皮肤难愈合的研究一直是临床创面修复的难题,对于碱性成纤维细胞生长因子促进皮肤创面愈合的基础研究相对较多,临床应用研究较少。 目的：对碱性成纤维细胞生长因子促进皮肤创面愈合研究的文献资料趋势进行多层次分析,探讨在小儿烧伤创面愈合中的应用疗效。 方法：以电子检索方式对CNKI数据库学术期刊2002-01/2011-12收录有关碱性成纤维细胞生长因子促进皮肤创面愈合研究的文献进行分析,采用检索词为“碱性成纤维细胞生长因子;创面愈合”,运用数据库的分析功能和Excel软件图表的功能分析数据特征。 结果与结论：CNKI数据库学术期刊2002/2011收录碱性成纤维细胞生长因子促进皮肤创面愈合研究的文献共228篇,文献数量处于平稳发展趋势。《中国组织工程研究与临床康复》杂志收录的文献数量最多为26篇。解放军第304医院产出的文献最多。碱性成纤维细胞生长因子促进皮肤创面愈合研究文献的基金资助项目有16项,基金资助项目的文献共76篇,以国家重点基础研究发展计划(973)项目和国家自然科学基金资助项目的文献最多。碱性成纤维细胞生长因子在小儿烧伤创面愈合中应用的文献虽然较少,但实验结果均显示治疗效果较好,有促进小儿Ⅱ度烧伤创面愈合的作用,而且无不良反应出现。     

结直肠癌靶向治疗的研究进展

结直肠癌是临床上最常见的恶性肿瘤之一。21世纪以来,靶向药物联合传统化学药物治疗中、晚期结直肠癌是临床研究的热点,但仍存在诸多争议。表皮生长因子受体和血管内皮生长因子是目前研究得较多的结直肠癌分子靶点。靶向基因一病毒治疗已显示出令人鼓舞的初步结果;肿瘤干细胞将会是一种很有前景的肿瘤治疗策略。     

Transgenic mice provide new insights into the role of TGF-alpha during epidermal development and differentiation.

Transforming growth factor-alpha (TGF-alpha) is thought to be the major autocrine factor controlling growth in epidermal cells. To explore further the role of TGF-alpha in epidermal growth and differentiation, we used a human keratin K14 promoter to target expression of rat TGF-alpha cDNA to the stratified squamous epithelia of transgenic mice. Unexpectedly, the only regions of epidermis especially responsive to TGF-alpha overexpression were those that were normally thick and where hair follicle density was typically low. This included most, if not all, body skin from 2-day- to 2-week-old mice, and ear, footpad, tail, and scrotum skin in adult mice. In these regions, excess TGF-alpha resulted in thicker epidermis and more stunted hair growth. Epidermal thickening was attributed both to cell hypertrophy and to a proportional increase in the number of basal, spinous, granular, and stratum corneum cells. During both postnatal development and epidermal differentiation, responsiveness to elevated TGF-alpha seemed to correlate with existing epidermal growth factor (EGF) receptor levels, and we saw no evidence for TGF-alpha-mediated control of EGF receptor (EGFR) expression. In adults, no squamous cell carcinomas were detected, but benign papillomas were common, developing primarily in regions of mechanical irritation or wounding. In addition, adult transgenic skin that was still both sensitive to TGF-alpha and subject to mild irritation displayed localized regions of leukocytic infiltration and granular layer loss, characteristics frequently seen in psoriasis in humans. These unusual regional and developmental effects of TGF-alpha suggest a natural role for the growth factor in (1) controlling epidermal thickness during development and differentiation, (2) involvement in papilloma formation, presumably in conjunction with TGF-beta, and (3) involvement in psoriasis, in conjunction with some as yet unidentified secondary stimulus stemming from mild mechanical irritation/bacterial infection.