大鼠急性放射性皮肤溃疡愈合过程中血小板衍生生长因子B及其受体的表达

目的：观察血小板衍生生长因子(PDGF)-B及其受体(在急性放射性皮肤溃疡愈合过程中的动态表达,探讨急性放射性皮肤溃疡难愈合的机理。方法：应用50Gy~(60)Coγ射线单次照射大鼠制作急性放射性皮肤溃疡致伤模型,并制作皮肤全层切割伤模型作为对照;采用免疫组织化学及原位杂交等方法,动态观察大鼠急性放射性皮肤溃疡及皮肤全层切割伤创面内PDGF-B及其受体β的表达。结果：与皮肤全层切割伤比较,照射后14～28d,急性放射性皮肤溃疡内PDGF-B及其受体β的表达明显减弱;照射后35～55d,表达进一步减弱。结论：急性放射性皮肤溃疡内PDGF-B及其受体β的表达减弱可能是急性放射性皮肤溃疡难愈合的机理之一。     

烧伤后24小时内削痂对深Ⅱ度创面局部炎症反应的影响

目的探讨烧伤后24h内行削痂手术对深Ⅱ度创面局部炎症反应以及组织损害的影响。方法选择12例烧伤患者,伤后24h内对深Ⅱ度创面行削痂手术,将患者同一创面分为3个标本采集区,即手术前、手术后和未手术区。手术前标本取自削痂术前创面,手术后和未手术区创面标本于伤后5—7d获取。采用组织培养和比色法测定创面组织释放白细胞介素(IL)8、髓过氧化物酶(MPO)和丙二醛(MDA)的水平,通过HE和Masson染色对创面组织坏死程度进行形态学观察。结果削痂手术后,患者创面组织局部释放IL8、MPO、MDA的水平分别为(6.83±1.85)μg/L、(4.07±0.87)U/g、(8.94±5.66)μmol/g,与未手术创面比较明显降低(P<0.01)。形态学观察显示,手术前创面有凝固性坏死灶;未手术创面炎症反应明显,坏死组织范围扩大;削痂手术后创面局部的炎症反应得到改善,未见坏死组织范围扩大。结论伤后24h内行削痂手术,可以改善深Ⅱ度烧伤创面局部的炎症反应,防止创面进行性加深,有利于创面及早愈合。     

烧伤创面愈合的信号转导机制

After 50 years of development in science of bums care in China, we have basically solved coverage of deep wounds of burn trauma, as well as role of multiple growth factors and stem cell in wound healing, making great contribution to improving the treatment of patients with large area of deep bums. Surgeons are paying close attention to problems of wound healing, especially in the fields of starless healing and rehabilitation. To solve these problems, we need to do further investigation on multiple growth factors as well as proliferation/differentiation of stem cells in regulation of cell growth and differentiation in wound healing. Therefore ,we are facing a even more serious challenge.     

人羊膜间充质干细胞对小鼠全层皮肤缺损创面巨噬细胞表型和炎症因子的影响

目的 探讨人羊膜间充质干细胞(hAMSC)在体内外对小鼠全层皮肤缺损创面巨噬细胞表型的调控及对创面愈合相关炎症因子的影响. 方法 (1)取遵义医科大学附属医院妇产科5名足月分娩健康孕妇产后弃用的新鲜羊膜,酶消化法分离纯化培养hAMSC,取第3代细胞,经成骨、成脂诱导分化鉴定;取第4代细胞,经hAMSC表面标志物鉴定.取...     

人脂肪间充质干细胞外泌体对小鼠RAW264.7细胞的炎症反应和小鼠全层皮肤缺损创面愈合的影响

目的:探讨人脂肪间充质干细胞（ADSC）外泌体对小鼠RAW264.7细胞介导的炎症反应和小鼠全层皮肤缺损创面愈合的影响。方法:采用实验研究方法。取2020年6—9月于空军军医大学第一附属医院行腹部手术的3例女性患者（10~25岁）废弃脂肪组织,采用Ⅰ型胶原酶消化法提取ADSC,采用流式细胞术进行鉴定。使用差速超高速离心...     

精氨酸对烧伤创面愈合的影响

目的 探讨精氨酸对烧伤创面愈合的影响和量效关系。方法 通过大鼠深Ⅱ度烫伤模型,伤后肠道站充不同剂量精氨酸,观察烧伤创面愈合时间,测定烧伤创面愈合面积百分比,创面Ｉ型／Ⅲ型胶原比例,羟脯氨酸（ＯＨＰ）含量和真皮细胞增殖周期,结果 每天补充１００－４００ｍｇ／ｋｇ精氨酸可缩短烧伤创面愈合时间,增加烧伤创面中ＯＨＰ含量,降低烧伤创面Ｉ／Ⅲ型胶原比例,加速真皮细胞ＤＮＡ复制。比较喂不同剂量精氨酸各组,发现     

创面难愈机制研究——糖尿病皮肤的"微环境污染"

在创面修复中,糖尿病合并难愈创面是最值得重视的领域之一.其中糖尿病下肢溃疡特别是糖尿病足的发生率日渐升高,但治疗手段局限,预后较差.迄今认为,糖尿病足的发生基于血管神经病变,表现为伴有血供不足和感染的创面愈合延迟与溃疡形成[1],涉及组织细胞、细胞外基质、生长因子等诸多环节[2],但在此研究基础上衍生出来的治疗策略仍然不尽如人意.     

烧伤创面愈合的理论探索与临床实践

The basic and clinical research in wound healing have made great progress in China in the past 50 years. The method of " intermingle skin transplantation" which was first advocated by surgeons of Ruijin Hospital in 1966 greatly reduced the amount of autologous donor skin, thus making the coverage of an extensive burn wound possible. This method is al so known as " Chinese therapy". In 1986,doctors of Jishuitan Hospital reported successful coverage of an extensive burn wound with mieroautografts and allogeneic skin. The basic research of wound healing has been carried out since 1992,a series of studies showed the characteristics of biological behaviours of cells in concern, extracellular matrix and growth factor, the mechanism underlying progressive injury in deep second burn wound, the effect of " skin island" and the local immune tolerance induced by it (which are the key factors of intermingle transplantation).The induction of local immune tolerance has now become the re search hot subject of skin transplantation immunology. Stem cell research in the field of wound healing has been extensively car ried out. The theory of " dermal template defection" has been proposed as one of the mechanisms of scar formation. On the other hand, great progress has been achieved in the treatment of bums on the basis of clinical researches. Doctors of PLA 304 hospital found that excision of eschar on patients with extensive deep burn injury at early shock stage greatly decreased the occurrence of complications and mortality. Doctors of Ruijin Hospital reported that healing of deep second burn wound could be improved by tangential excision of burn eschar within 24 hours after burn injury. Doctors of Xiang ya Hospital reported patients suffering from deep bums of the hands got satisfied functional restoration when treated with tangential excision of eschar while degraded dermal tissue could be retained with transplantation of autoskin grafts.     

姜黄素对糖尿病创面的促愈合作用及其机制研究进展

糖尿病创面是糖尿病常见的并发症,目前的治疗效果仍然欠佳。姜黄素具有抗炎、抗氧化、抗微生物、抗癌以及改善胰岛素抵抗等多方面的药理作用。本文主要针对姜黄素促进糖尿病创面愈合的作用及其机制的研究进展进行综述。     

深Ⅱ度烫伤大鼠创面基质金属蛋白酶-1,2及其抑制剂表达变化机制的探讨

目的　观察深Ⅱ度烫伤创面愈合过程中基质金属蛋白酶 1,2 (MMP 1,2 )与金属蛋白酶组织抑制因子 1,2 (TIMP 1,2 )的表达规律以及其变化机制。　方法　 150只Wistar大鼠 3 0 %深Ⅱ度烫伤后随机分为 5组 :(1)正常对照组 (n =6) ;(2 )单纯烫伤组 (n =3 6) ;(3 )激酶激活剂BDM组 (n =3 6) ;(4)蛋白激酶C制剂H7组 (n =3 6) ;(5)c fos抗体组 (n =3 6)。分别于伤后 3、6h和 1、3、7、14d采取创面皮肤标本 ,检测创面组织c fosmRNA与c fos蛋白的表达 ,以及MMP 1,2 /TIMP 1,2相应变化。　结果　伤后 3～ 6h ,c fosmRNA与c fos蛋白的表达明显增多 ,随后逐渐下降。MMP 1,2 /TIMP 1,2的表达滞后于前者 ,在伤后 3～ 7d表达较高 ,MMP 2 /TIMP 2的表达增加显著。使用BDM后 ,烫伤 3～6h组织c fosmRNA与c fos蛋白的表达增加 ,MMP 1,2 /TIMP 1,2的表达也增强。使用H7后 ,c fosmRNA与c fos蛋白的表达被抑制 ,MMP 1,2 /TIMP 1,2的表达随之减弱。c fos抗体中和内源性c fos蛋白表达后 ,MMP 1/TIMP 1,2的表达受抑制 ,MMP 2的变化不明显。　结论　创面愈合过程中 ,MMP 1,2和TIMP 1,2的表达与蛋白激酶信号途径的激活有密切关系 ,c fos调节MMP 1和TIMP 1和TIMP 2的含量 ,完成对愈合的调控。     

急性放射性皮肤溃疡中血小板源性生长因子及其受体的表达

目的观察不同创面血小板源性生长因子(PDGF)A及其受体(PDGFR)α的动态表达,探讨急性放射性皮肤溃疡难愈合的机制。方法应用γ射线单次照射Wistar大鼠,制作急性放射性皮肤溃疡模型(照射组,55只),以皮肤全层切割伤模型大鼠作为创伤对照(创伤组,55只),另取5只正常大鼠作为对照组。采用免疫组织化学及原位逆转录-聚合酶链反应(RT-PCR)等方法,观察不同时相点各组大鼠创面内PDGF-A、PDGFR-α和PDGF-AmRNA的表达。结果对照组大鼠皮肤中PDGF-A及PDGFR-α表达为阴性;创伤组大鼠炎症反应期及肉芽组织期(伤后3~9d)PDGF-A的积分吸光度(IA)值为20.0±1.6、28.3±1.0;照射组炎症反应期及肉芽组织期(伤后14~28d)其PDGF-A的IA值各为14.0±1.2、20.3±1.2,PDGF-A及PDGFR-α和PDGF-AmRNA的表达较创伤组明显减弱,至瘢痕形成期(伤后55d)时表达进一步减弱。结论急性放射性皮肤溃疡内PDGF-A及PDGFR-α的表达减弱,可能是创面难愈合的机制之一。     

Protection of sildenafil citrate hydrogel against radiation-induced skin wounds

Radiation induced skin wound/dermatitis is one of the common side effects of radiotherapy or interventional radiobiology. In order to combat impaired healing of radiation wounds, alternative therapy to use sildenafil citrate (SC) topical hydrogel as a therapeutic option was proposed that has known to enhance nitric oxide in wounds. Our aim was to develop a radiation induced skin wound model and to investigate the wound healing efficacy of 5% SC hydrogel formulation in Sprague-Dawley rats. In the present study, the radiation wound inducing dose was optimized using a multi-dose localized γ-radiation trail with 10−55 Gy range (15 Gy interval). Optimal irradiation dose for wound induction was selected based on radiation skin damage assessment criteria followed the relative change from <35 Gy or>55 Gy showed significant variation and median 45 Gy γ-dose was selected for studying acute effects of radiation on wound healing. Significant (p < 0.05) higher wound contraction (88 ± 1.02%), skin damage reduction (81 ± 0.82%), tensile strength (45 ± 1.61%), nitric oxide and protein recovery (53 ± 0.72%) at dermal level prove the wound healing efficacy of 5% SC hydrogel formulation as compared to Rad 45 Gy control. In addition, the dose modifying factor (DMF) for SC hydrogel treatment was found to be 1.83 and 1.57 with respect to total wound area contraction and skin damage reduction. Skin histopathology in treated tissues showed improved granulation tissue formation, less inflammatory infiltrates and mature collagen fibres in the dermis. Thus, the modality could help to improve delayed wound healing in irradiated skin tissues.     

急性放射性皮肤溃疡形成早期表皮生长因子的表达及意义

目的:探讨急性放射性皮肤溃疡形成早期表皮生长因子(EGF)的表达和意义。方法:以50Gy~(60)Coγ射线单次局部照射建立急性放射性皮肤溃疡动物模型,以手术方法建立单纯皮肤伤口动物模型,采用免疫组化、原位杂交等方法检测伤口及溃疡组织内EGF的表达。结果:创伤组伤后5～10d,肉芽组织内EGF表达呈强阳性;照射后21～28d,放射性溃疡肉芽组织内EGF表达呈弱阳性,较创伤后5～10d明显减弱。结论:辐射诱导的肉芽组织内EGF表达减弱与急性放射性皮肤溃疡愈合延迟有关。     

New model of radiation-induced skin ulcer in rats

Abstract

Our aim was to provide a new animal model for intractable skin ulcers in irradiated rats. Twenty-four rats were irradiated with total single radiographic irradiation doses of 10, 15, 20, and 30 Gy. The skin was observed for 6 months. In the 10-Gy group, there were no visible changes to the skin. In the 15-Gy group, epilation and depigmentation were seen about 2 weeks after irradiation. In the groups over 20-Gy, minor erosion or skin ulcers appeared in most rats. The wounds healed in the 20-Gy group, but many in the 30-Gy group could not be healed. A further 36 rats were irradiated with 20 Gy, and this was followed by the creation of cutaneous full-thickness defects at different periods. The size of the wounds was measured on days 0, 3, 5, 7, 10, and 14. Delayed wound healing was found in the irradiated groups compared with the unirradiated group (p = 0.01). There were no differences in the time of ulceration, except in the Day 7 group (p = 0.03).     

康复新联合赛肤润治疗大鼠急性放射性皮肤损伤效果观察

目的 观察康复新联合赛肤润治疗大鼠急性放射性皮肤损伤的疗效。方法 取40只SD大鼠,用放射性核素32P敷贴固定于大鼠背部皮肤以制备急性放射性皮肤损伤模型。建模后,将大鼠随机分为模型组、康复新组、赛肤润组、康复新联合赛肤润组（联合组）,各10只。模型组用生理盐水擦拭皮损处;康复新组用康复新涂抹皮损处;赛肤润组用赛肤润喷涂皮损处;联合组先涂抹康复新液,待干后喷涂赛肤润,2次/d。各组均在8：00及16:00固定时间涂抹药液。观察创面局部变化及愈合时间。治疗第2周、4周、8周时取皮损创面组织进行苏木精-伊红染色和Masson染色。结果 与模型组比较,康复新组、赛肤润组、联合组的愈合时间显著缩短（均P＜0.05）;联合组的愈合时间显著短于康复新组及赛肤润组（均P＜0.05）;组织病理学检测结果显示,联合组创面组织炎性细胞浸润、水肿程度显著低于其他组,新生毛细血管数量及胶原纤维含量显著高于其他组,胶原纤维排列更整齐,表皮结构更加完整。与模型组比较,治疗第2周、4周、8周时康复新组、赛肤润组、联合组的胶原纤维含量较高（均P＜0.05）;与康复新组、赛肤润组相比,联合组的胶原纤维含量较高（均P＜0.05）。结论 康复新联合赛肤润能够减轻放射性皮肤损伤创面早期炎症反应,促进创面血管新生与胶原纤维形成,缩短创面愈合时间,加快创面修复。     

Acticoat™ stimulates inflammation,but does not delay healing,in acute full‐thickness excisional wounds

Acticoat? has antimicrobial and anti‐inflammatory effects which aid wound healing. However, in vitro studies indicate that Acticoat? is cytotoxic and clinical and in vivo studies suggest that it may delay healing in acute wounds. Therefore, this study investigated the effects of Acticoat? on healing in acute full‐thickness excisional wounds. Using a porcine model, healing was assessed on days 3, 6, 9 and 15 post‐wounding. Five wounds dressed with Acticoat? and five wounds dressed with polyurethane film (control) were assessed per day (n = 40 wounds). The rate of healing, inflammatory response, restoration of the epithelium and blood vessel and collagen formation were evaluated. No difference was found in the rate of healing between wounds treated with Acticoat? and the control wounds. Inflammation was increased in Acticoat?‐treated wounds on day 3 post‐wounding compared to the control wounds. However, by day 15 post‐wounding, the epithelium of the Acticoat?‐treated wounds closely resembled normal epithelium. Acticoat?‐treated wounds also contained a higher proportion of mature blood vessels, and differences in collagen deposition were apparent. Despite inducing an inflammatory response, Acticoat? did not delay healing in acute wounds. Conversely, the improved quality of the epithelium and blood vessels within Acticoat?‐treated wounds indicates that Acticoat? has a beneficial effect on healing.     

Topical steroids for chronic wounds displaying abnormal inflammation

Introduction

Chronic, non-healing wounds are often characterised by an excessive, and detrimental, inflammatory response. We review our experience of using a combined topical steroid, antibiotic and antifungal preparation in the treatment of chronic wounds displaying abnormal and excessive inflammation.

Methods

A retrospective review was undertaken of all patients being treated with a topical preparation containing a steroid (clobetasone butyrate 0.05%), antibiotic and antifungal at a tertiary wound healing centre over a ten-year period. Patients were selected as the primary treating physician felt the wounds were displaying excessive inflammation. Healing rates were calculated for before and during this treatment period for each patient. Changes in symptom burden (pain, odour and exudate levels) following topical application were also calculated.

Results

Overall, 34 ulcers were identified from 25 individual patients (mean age: 65 years, range: 37–97 years) and 331 clinic visits were analysed, spanning a total time of 14,670 days (7,721 days ‘before treatment’ time, 6,949 days ‘during treatment’ time). Following treatment, 24 ulcers demonstrated faster rates of healing, 3 ulcers showed no significant change in healing rates and 7 were healing more slowly (p=0.0006). Treatment generally reduced the burden of pain and exudate, without affecting odour.

Conclusions

In normal wound healing, inflammation represents a transient but essential phase of tissue repair. In selected cases, direct application of a steroid containing agent has been shown to improve healing rates, presumably by curtailing this phase. Further evaluation is required to establish the role of preparations containing topical steroids without antimicrobials in the management of chronic wounds.     

Gammadelta T-cells: potential regulators of the post-burn inflammatory response

Severe burn induces an immunopathological response that contributes to the development of a systemic inflammatory response (SIRS) and subsequent multiple organ failure. While, multiple immune cells type (T-cells, macrophages, neutrophils) are involved in this response, recent evidence suggests that a unique T-cell subset, gammadelta T-cells are central in the response to injury. While gammadelta T-cells represent only a small percentage of the total T-cell population, they display specific functional characteristics that uniquely position them in the immune/inflammatory axis to influence a number of important aspects of the body's response to burn. This review will focus on the potential regulator role of gammadelta T-cells in immunopathological response following burn and thereby their potential as therapeutic targets for affecting inflammation and healing.     

rhPDGF对糖尿病鼠全层皮肤缺损创面微血管形成的影响和意义

目的:观察外源性重组人血小板源性生长因子(rhPDGF)对全层皮肤缺损的糖尿病鼠创面愈合过程中微血管形成的影响及促创面愈合的作用。方法:利用大鼠全层皮肤缺损创面愈合模型,将26只非糖尿病鼠52个创面分为3组:①A组为糖尿病大鼠创伤自然愈合组;②B组为接受rhPDGF治疗的糖尿病大鼠创伤愈合组;③C组为赋性剂组。于伤后3 d、7 d和14 d采取创面皮肤标本,用组织病理HE和血管Ⅷ因子抗体免疫组织化学染色技术检测创面肉芽再生与再血管化情况进行观察,同时观察创面的愈合情况。结果:全层皮肤缺损糖尿病鼠创面肉芽组织中微血管的形成数量少,采用赋性剂对照组与糖尿病鼠自然愈合组无显著差别。但外源性使用rhPDGF后,肉芽组织的形成量明显增多,内含的微小血管数量显著增加,愈合能力明显增强。结论:糖尿病大鼠微血管形成障碍可能是其创面愈合延迟的重要因素。而应用外源性的PDGF有助于微血管的形成,可以改善糖尿病鼠的创面愈合能力。