THE EFFECT OF MEBT/MEBO ON EPIDERMAL REGENERATIVE STEM CELLS

INTRODUCTION 　　As an innovative therapeutic system in burn therapy, Moist exposed burn therapy (MEBT) has been in wide clinical practiced in association with the topical drug of Moist Exposed Burn Ointment (MEBO). It successfully resolved four major clinical problems, i.e. pain, wound infection, progressive necrosis, and healing with scar formation of deep second-degree burn wound. Recently, a new progress, the regeneration and replication of skin tissue in the subcutaneous fat tis…     

Imaging and review of a large pre-auricular pilomatrixoma in a child

A 10-year-old girl presented with a mildly tender mass in the right preauricular region. The mass became larger, and the overlying skin turned purple. There was no clinical response to a course of either cephalexin or clarithromycin. The remainder of the head and neck examination was normal including normal facial nerve function. Lyme titers and a computed tomographic (CT) scan with contrast of the facial region were obtained. The CT scan demonstrated the lesion to be superficial to the parotid gland. The lyme titer was elevated and doxycycline was begun. The mass appeared to reduce in size after doxycycline treatment, but then grew and turned erythematous. The lesion was surgically excised and was vascular with calcification and cheesy inclusions. The mass was quite close to the skin and the clinical diagnosis at the time of surgery was a pilomatrixoma, which was corroborated on pathological evaluation.     

On the Principle of Treatment of Burn Wound

The article expounds the therapeutic features of the Moist Exposed Burn Therapy(MEBT)in the treatment of-burn injuries by means of experimental research data and clinical application experiences about MEBT and confirmsthat the principle and method of conventional dry therapy for burn injuries is contrary to burn pathogenesis,whileMEBT is an effective medical technique which is in conformity with burn pathogenesis at present.Histogical studies confirmed:microscopical examination of wound tissue treated with dry exposure therapyshowed that the granulation tissue was atrophic,in which the lobocytes exudated,collagenous fibers wereeosinophilous.An inanimate sign was emerged in the granulation tissue.The wound tissue treated with MEBT wasfull of vitality,fibroblasts proliferated actively and there were aboundant blood vessels.The comparison study be-tween amnion overlying therapy and MEBT in the treatment of superfcialⅢ°burnt wound confrmed that the latercould make the wound heal through epidermization.The     

Radiation sterilization of tissue allografts:A review

Tissue substitutes are required in a number of clinical conditions for treatment of injured and diseased tissues.Tissues like bone,skin,amniotic membrane and soft tissues obtained from human donor can be used for repair or reconstruction of the injured part of the body.Allograft tissues from human donor provide an excellent alternative to autografts.However,major concern with the use of allografts is the risk of infectious disease transmission.Therefore,tissue allografts should be sterilized to make them safe for clinical use.Gamma radiation has several advantages and is the most suitable method for sterilization of biological tissues.This review summarizes the use of gamma irradiation technology as an effective method for sterilization of biological tissues and ensuring safety of tissue allografts.     

Potential of (18)~F-FDG-PET as a valuable adjunct to clinical and response assessment in rheumatoid arthritis and seronegative spondyloarthropathies

AIM: To evaluate the role of fluorine-18-labeled fluorodeoxyglucose positron emission tomography (18F-FDG PET) in various rheumatic diseases and its potential in the early assessment of treatment response in a limited number of patients. METHODS: This study involved 28 newly diagnosed patients, of these 17 had rheumatoid arthritis (RA) and 11 had seronegative spondyloarthropathy (SSA). In the SSA group, 7 patients had ankylosing spondylitis, 3 had psoriatic arthritis, and one had non-specific SSA. Patients with RA were selected as per the American College of Rheumatology criteria. One hour after FDG injection, a whole body PET scan was performed from the skull vertex to below the knee joints using a GE Advance dedicated PET scanner. Separate scans were acquired for both upper and lower limbs. Post-treatment scans were performed in 9 patients in the RA group (at 6-9 wk from baseline) and in 1 patient with psoriatic arthropathy. The pattern of FDG uptake was analysed visually and quantified as maximum standardized uptake value (SUVmax) in a standard region of interest. Metabolic response on the scan was assessed qualitatively and quantitatively and was correlated with clinical assessment. RESULTS: The qualitative FDG uptake was in agreement with the clinically involved joints, erythrocyte sedimentation rate, C-reactive protein values and the clinical assessment by the rheumatologist. All 17 patients in the RA group showed the highest FDG avidity in painful/swollen/tender joints. The uptake pattern was homogeneous, intense and poly-articular in distribution. Hypermetabolism in the regional nodes (axillary nodes in the case of upper limb joint involvement and inguinal nodes in lower limb joints) was a constant feature in patients with RA. Multiple other extra-articular lesions were also observed including thyroid glands (in associated thyroiditis) and in the subcutaneous nodules. Treatment response was better appreciated using SUVmax values than visual interpretation, when compared with clinical evaluation. Four patients showed a favourable response, while 3 had stable disease and 2 showed disease progression. The resolution of regional nodal uptake (axillary or inguinal nodes based on site of joint involvement) in RA following disease modifying anti-rheumatoid drugs was noteworthy, which could be regarded as an additional parameter for identifying responding patients. In the SSA group, uptake in the affected joint was heterogeneous, low grade and nonsymmetrical. In particular, there was intense tendon and muscular uptake corresponding to symptomatic joints. The patients with psoriatic arthritis showed intense FDG uptake in the joints and soft tissue. CONCLUSION: 18F-FDG PET accurately delineates the ongoing inflammatory activity in various rheumatic diseases (both at articular and extra-articular sites) and relates well to clinical symptoms. Different metabolic patterns on FDG-PET scanning in RA and SSA can have important implications for their diagnosis and management in the future with the support of larger studies. FDG-PET molecular imaging is also a sensitive tool in the early assessment of treatment response, especially when using quantitative information. With these benefits, FDG-PET could play a pivotal clinical role in the management of inflammatory joint disorders in the future.     

Novel eradicative high-dose rate brachytherapy for internal mammary lymph node metastasis from breast cancer

AIM:To develop a method of delivering an eradicative high radiotherapeutic dose safely preserving the surrounding skin in the treatment of internal mammary lymph node metastasis (IMLNM) of breast cancer. METHODS:We report a 38-year-old female patient with a solo IMLNM showing no response to 60 Gy in 2.5 Gy fractions of external beam radiotherapy. To eradicate this tumor, a boost brachytherapy plan was created after percutaneous insertion of an applicator needle into the IMLNM lesion avoiding the pleura and vessels under ultrasound monitoring. According to the dose distribution, the required thickness of a spacer between the skin and the tumor was determined, and hyaluronic gel was injected up to this thickness under ultrasound monitoring. We evaluated skin doses, target doses and clinical outcome. RESULTS:All procedures were performed easily. Sixteen Gy (34.7 Gy equivalent in 2 Gy fractions calculated by the linear quadratic model at α/β = 10:EQ 2, α/β = 10 , cumulative total was 101.9 Gy EQ 10) to 100% of the target volume was irradiated with cumulative maximum skin dose of 70 Gy EQ 2, α/β = 3 which was 98.7 Gy EQ 2, α/β = 3 without spacer. No procedure related-or late complications and no local recurrence at the treated site were observed for three years until expiration. CONCLUSION:We consider that this procedure will provide an eradicative high-dose irradiation to IMLNM of breast cancer, preserving skin from overdose complications.     

寰枢椎后路三种组合固定技术治疗寰枢关节不稳的临床评估

Objective To assess clinical curative effect of three types of combined posterior atlantoaxial internal fixation techniques in treatment of atlantoaxial instability. Methods The study involved 68 patients with atlantoaxial instability treated with different fixation techniques from August 2002 to March 2008. ( 1 ) Transpedicular fixation was performed in 32 patients including 20 patients with Anderson Ⅱ odontoid fractures (seven with old odontoid fracture and 13 with fresh fractures), six with type Anderson Ⅲ fresh odontoid fractures, four with disrupt of transverse ligament of the atlas and two with congenital loose odontoid process combined with atlantoaxial instability. (2) Transpedicular internal fixation with screws of atlas incorporating C2 laminar screws was performed in 20 patients with upper cervical injury including eight with type Ⅱ odontoid process fractures combined with atlantoaxial backward dislocation,four with type Ⅱ odontoid process fractures combined with atlantoaxial forward dislocation, two with nonunion of odontoid process fractures, three with type Ⅲ odontoid process fractures combined with atlantoaxial unsteadiness and three with atlantoaxial dislocation combined with disrupt of transverse ligament of atlas. (3)A total of 16 patients with traumatic atlantoaxial instability, reducible atlantoaxial dislocation and irreducible atlantoaxial dislocation were treated with four-point internal fixation technique using autologous iliac bone grafts. Results (1) A total of 120 screws were implanted in 32 patients, with no spinal cord or vertebral artery injury after surgery. Atlas lateral mass fixation was adopted in three patients because of broken posterior arch of the atlas. Postoperative CT showed that two screws were inserted into the vertebral artery hole and that one screw was inserted medially into the spinal canal and caused medial correx rupture, but both with no clinical symptoms. All 32 patients were followed up for 6-42 months ( average 26 months), which showed solid fusion in all patients. The postoperative JOA scores ranged from 13.2 points to 16.8 points (average 14. 8 points). (2) Thirty-two screws were implanted in 20 patients,with no spinal cord or vertebral artery injury. The patients were followed up for mean six months ( range 6-14 months). Postoperative X-ray showed sound bone fusion, with no cervical instability, loosening or breakage of the screws. (3) The symptoms of all the patients were improved at different degrees, with no neurological deterioration or severe complications, such as nerve blood vessel injury. All 16 patients were followed up for 8-26 months ( average 16 months), which showed bony fusion in all patients at 3-6 months after surgery. The spinal cord function was improved markedly in five patients, good in eight, mild in two but unchanged in one. Conclusions Three types of combined posterior atlantoaxial internal fixation techniques have advantages of rigid, short-segmental and three-dimensional fixation and hence are effective methods for treatment of upper cervical injuries. The combination mode can be varied according to specific condition of the patients.     

寰枢椎后路三种组合固定技术治疗寰枢关节不稳的临床评估

Objective To assess clinical curative effect of three types of combined posterior atlantoaxial internal fixation techniques in treatment of atlantoaxial instability. Methods The study involved 68 patients with atlantoaxial instability treated with different fixation techniques from August 2002 to March 2008. ( 1 ) Transpedicular fixation was performed in 32 patients including 20 patients with Anderson Ⅱ odontoid fractures (seven with old odontoid fracture and 13 with fresh fractures), six with type Anderson Ⅲ fresh odontoid fractures, four with disrupt of transverse ligament of the atlas and two with congenital loose odontoid process combined with atlantoaxial instability. (2) Transpedicular internal fixation with screws of atlas incorporating C2 laminar screws was performed in 20 patients with upper cervical injury including eight with type Ⅱ odontoid process fractures combined with atlantoaxial backward dislocation,four with type Ⅱ odontoid process fractures combined with atlantoaxial forward dislocation, two with nonunion of odontoid process fractures, three with type Ⅲ odontoid process fractures combined with atlantoaxial unsteadiness and three with atlantoaxial dislocation combined with disrupt of transverse ligament of atlas. (3)A total of 16 patients with traumatic atlantoaxial instability, reducible atlantoaxial dislocation and irreducible atlantoaxial dislocation were treated with four-point internal fixation technique using autologous iliac bone grafts. Results (1) A total of 120 screws were implanted in 32 patients, with no spinal cord or vertebral artery injury after surgery. Atlas lateral mass fixation was adopted in three patients because of broken posterior arch of the atlas. Postoperative CT showed that two screws were inserted into the vertebral artery hole and that one screw was inserted medially into the spinal canal and caused medial correx rupture, but both with no clinical symptoms. All 32 patients were followed up for 6-42 months ( average 26 months), which showed solid fusion in all patients. The postoperative JOA scores ranged from 13.2 points to 16.8 points (average 14. 8 points). (2) Thirty-two screws were implanted in 20 patients,with no spinal cord or vertebral artery injury. The patients were followed up for mean six months ( range 6-14 months). Postoperative X-ray showed sound bone fusion, with no cervical instability, loosening or breakage of the screws. (3) The symptoms of all the patients were improved at different degrees, with no neurological deterioration or severe complications, such as nerve blood vessel injury. All 16 patients were followed up for 8-26 months ( average 16 months), which showed bony fusion in all patients at 3-6 months after surgery. The spinal cord function was improved markedly in five patients, good in eight, mild in two but unchanged in one. Conclusions Three types of combined posterior atlantoaxial internal fixation techniques have advantages of rigid, short-segmental and three-dimensional fixation and hence are effective methods for treatment of upper cervical injuries. The combination mode can be varied according to specific condition of the patients.     

An annoucement of the conference attented by specially invited Chinese Members of ISBI

1 . Theoretical Basis of Defining the Therapy The existing general therapy for deep burn wound is formed along with the development, of surgical technique. It lays emphasis on preventing infections and Complications. Burn wounds are treated, at the early stage, either with dry exposed therapy, or baking therapy, or warm wind therapy, or eschar preserving medicinal therapy and later, immersion therapy, escharotorny and skin grafting are applied.     

CT patterns of nodal disease in pediatric chest tuberculosis

AIM:To highlight various patterns of nodal involvement and post treatment changes in pediatric chest tuberculosis based on contrast enhanced computed tomography(CECT) scans of chest.METHODS:This was a retrospective study consisting of 91 patients aged less than 17 years,who attended Paediatrics OPD of All India Institute of Medical Sciences with clinically diagnosed tuberculosis or with chest radiographs suggestive of chest tuberculosis.These patients had an initial chest radiograph as well as CECT of the chest and follow up imaging after 6 mo,and in some cases 9 mo,of completion of anti-tubercular treatment(ATT).CECT of these patients was reviewed for the location and extent of nodal involvement along with determination of site,size,enhancement pattern and calcification.RESULTS:Enlargement of mediastinal or hilar lymph nodes was found in 88/91 patients(96.7%),with the most common locations being paratracheal(84.1%),and subcarinal(76.1%).The most common pattern of enhancement was found to be inhomogenous.The nodes were conglomerate in 56.8% and discrete in 43.2%.In addition,perinodal fat was obscured in 84.1% of patients.In the post-treatment scan,there was 87.4% reduction in the size of the nodes.All nodes post-treatment were discrete and homogenous with perinodal fat present.Calcification was found both pre-and post-treatment,but there was an increase in incidence after treatment(41.7%).There was hence a reduction in size,change in enhancement pattern,and appearance of perinodal fat with treatment.CONCLUSION:Tubercular nodes have varied appearance and enhancement pattern.Conglomeration and obscuration of perinodal fat suggest activity.In residual nodes decision to continue ATT requires clinical correlation.     

供皮区创面皮肤再生疗法的临床应用

目的:观察皮肤再生疗法对供皮区创面愈合的作用,寻找提高供皮区创面愈合质量和速度的理想方法。方法:选择供皮区创面刃厚皮28个,薄中厚皮26个,厚中厚皮18个,每个创面分成两个区域,分别随机应用MEBO药纱(实验组)和凡士林纱布(对照组),观察术后疼痛、出血及愈合时间等情况,术后6个月应用温哥华瘢痕评估量表评估上述供皮区瘢痕形成及增生程度,并进行随机自身对照研究。结果:实验组供皮区创面术后无疼痛、出血及瘢痕发生数较对照组少,平均愈合时间:刃厚皮5．3±1．1天,薄中厚皮7．5±3．4天,厚中厚皮13．6±4．9天,对照组分别为8．1±1．2天、10．4±3．2天、18．5±4．2天,组间比较具有非常显著差异(P＜0．01);术后随访6个月瘢痕评分值:中厚供皮区创面实验组低于对照组(P＜0．05)。结论:应用MEBO药纱处理供皮区创面效果优于凡士林纱布,具有止血、止痛、加快供皮区创面生理再生愈合的作用,无明显瘢痕增生,是提高供皮区特别中厚供皮区创面愈合质量和速度的理想方法。     

头部取皮创面处理方法的临床观察

目的比较湿润烧伤膏药纱与凡士林油纱在头部首次取皮创面的临床治疗效果.方法将40例头皮首次取皮深度相同的创面,随机分为观察组与对照组,每组各20例,观察组以湿润烧伤膏药纱作为内层敷料治疗,对照组用凡士林油纱治疗,观察创面愈合时间,创面渗出、疼痛程度及是否感染等并发症.结果观察组头部供皮区创面全部愈合,平均愈合时间5.7d±0.8d,无一例发生疼痛及感染等病症.药纱极易去除;对照组平均愈合时间7.2d±1.3d,创面有紧缩不适感,5例诉说创面干燥、疼痛,2例痂皮下感染,油纱去除困难,7例因去除凡士林油纱时导致头皮小面积再损伤,形成新创面,经统计学处理组间具有非常或显著性差异(P＜0.01或P＜0.05).结论湿润烧伤膏能促进头皮取皮创面愈合,缩短创面愈合时间,改善病人不适感.     

皮肤再生疗法治疗供皮区创面的疗效观察

目的观察再生疗法对供皮区创面愈合的远期效果.方法选择薄中厚供皮区创面21个,每个创面都用MEBO药纱布覆盖,术后72h采用半暴露疗法,术后1个月至1年对供皮区瘢痕及增生情况进行评估.结果运用MEBO药纱布处理的薄中厚供皮区创面平均愈合时间为11.26d±3.84d.术后1个月～3个月供皮区创面平整柔软,未见瘢痕增生,术后半年供皮区皮肤接近正常皮肤.结论应用MEBO药纱布处理供皮区创面可促进创面愈合.近期未见瘢痕增生.     

美宝湿润烧伤膏在中厚皮供皮区的应用

目的：观察美宝湿润烧伤膏在中厚皮供皮区的治疗作用。方法：在16例供皮区创面上采用美宝湿润烧伤膏与凡士林油纱进行自身对照治疗。结果：湿润烧伤膏治疗创面平均愈合时间16天，凡士林油纱治疗创面为25天，前者无瘢痕增生，后者瘢痕增生明显。结论：证实美宝湿润烧伤膏治疗部位愈合效果明显优于凡士林油纱治疗部位。     

皮肤再生医疗技术在供皮区的临床应用

目的 :探寻一种更利于供皮区创面修复的方法。方法 :应用皮肤再生医疗技术 (MEBT/MEBO)处理植皮手术供皮区创面 6 7例 (A组 ) ,与传统凡士林纱布处理供皮区 71例 (B组 ) ,在术后疼痛、愈合时间、愈合质量上进行比较分析。结果 :皮肤再生医疗技术治疗组在愈合时间、愈合质量与凡士林治疗组比较均有显著性差异 (P <0 0 1)。结论 :皮肤再生医疗技术能实现薄皮片和中厚皮片供皮区创面皮肤生理性再生修复、提高皮肤愈合质量、减少瘢痕增生等作用。     

湿性与干燥疗法对供皮区创面治疗效果观察

目的:观察湿性半暴露疗法与传统的凡士林纱布治疗供皮区创面的疗效.方法:对我院4年内122例患者200处(整形或烧伤)手术的供皮区创面,采用同个体、同部位或同一个体的对称部位、年龄相似的病例,应用半暴露湿性疗法与半暴露干燥疗法治疗,观察其疼痛、愈合时间、感染、瘢痕增生情况.结果:湿性较干燥疗法愈合时间缩短4天～7天,创面疼痛轻微,尤其是换药时不疼痛,纱布下不积脓,不影响术后睡眠.愈后1年复诊:湿性组韧厚皮区色泽与周围皮肤无差异、薄中厚区色素沉着或脱失、中厚皮区扁平质软瘢痕,而干燥组病人剧痛需应用镇痛药、愈合时间较长、部分创面出现增生性瘢痕.结论:湿性半暴露疗法能缩短供皮区创面愈合时间,有良好的止痛和预防感染之作用,且能减少瘢痕增生,半暴露湿性疗法是供皮区创面的良好适应症.     

MEBO 治疗皮瓣切取创面游离植皮成活不良的疗效分析

目的湿润烧伤膏（MEBO）是目前治疗各种类型烧伤刨面的主要药物,但用其治疗各类皮瓣切取创面游离植皮成活不良的报道不多,本文旨在总结MEBO治疗皮瓣切取创面游离植皮成活不良的临床疗效。方法自2010年1月至2012年1月,采用MEBO治疗这类创面42例（处）,创面用碘伏消毒后生理盐水冲洗干净,拭干后外涂MEBO,厚1mm-2mm,均匀涂布整个创面。尔后外敷MEBO药纱．每13换药1次．．结果42例（处）患者全部治愈,平均愈合天数为33d。结论MEBO治疗皮瓣切取创面游离植皮成活不良,避免了二次植皮手术,减轻了患者的心理恐惧和经济负担,操作简便,易于取材,值得推广。     

深部脓肿切开引流术后的换药治疗

目的:探讨深部脓肿切开引流术后用湿润烧伤膏换药的疗效及机制。方法:将62例深部脓肿切开引流术后患者随机分成两组,比较两组分别用湿润烧伤膏纱条换药和凡士林纱条换药的疗效。结果:湿润烧伤膏组平均治愈时间9．5±2．7d,凡士林组平均治愈时间12．2±3．6d,两者比较有显著差异(P＜0．01)。结论:湿润烧伤膏纱条用于深部脓肿切开引流,术后换药效果好、疗程短,为目前首选药物。     

美宝湿润烧伤膏治疗痔结扎术后创面疗效观察

目的：对美宝湿润烧伤膏、凡士林油纱外用治疗痔结扎术后创面进行疗效分析,判断其优劣。方法：将2003年1月-2005年1月我院治疗的94例痔结扎术后患者随机分为治疗组和对照组,均采用相同的全身治疗,其中治疗组采用美宝湿润烧伤膏外用,对照组采用凡士林油纱外用。通过跟踪随访。在平均愈合时间、治愈率两方面进行判断分析,比较优劣。结果：治疗组平均愈合时间、治愈率两方面均优于对照组。结论：美宝湿润烧伤膏外用治疗痔结扎术后创面优于凡士林油纱外用,为治疗痔结扎术后创面较好的外用药。     

湿润烧伤膏治疗危重症患者肛周皮损的临床疗效

目的 观察湿润烧伤膏治疗大便失禁的危重症患者肛周皮损的临床疗效.方法 将92例患者按照大便失禁出现的时间顺序分为观察组57例和对照组35例,观察组外涂湿润烧伤膏换药治疗,对照组外涂凡士林软膏换药治疗,比较两组患者痊愈时间及愈合效果.结果 观察组的治愈率（80.7%）及总有效率（100%）均显著高于对照组（37.1%、65.7%）,P＜0.01;观察组的治愈时间4.9 d±1.6 d显著短于对照组7.7 d±2.8 d,P＜0.01.结论 湿润烧伤膏治疗大便失禁的危重症患者肛周皮损疗效显著,值得临床推广应用.