增生性瘢痕内3种成纤维细胞生长因子及其受体基因的表达

目的 探讨成纤维细胞生长因子(FGF)-7、酸性FGF(aFGF)、碱性FGF(bFGF)及其受体(FGFR1、FGFR2)在不同形成时期的增生性瘢痕中的基因表达。方法用病理学技术检测增生性瘢痕和正常皮肤的结构特征后,提取16例不同发生时期的增生性瘢痕和8例正常皮肤的总RNA后,分离mRNA,用逆转录-聚合酶链反应(RT-PCR)方法检测这5种基因在不同组织中的表达。结果在正常皮肤中,FGF-7,bFGF,FGFR1和FGFR2基因表达水平较低,而在增殖期的瘢痕中,这4种基因转录本的灰密度值分别为正常皮肤的2.1、2.1、3.6和2.8倍,基因表达显著增强(P<0.05);在成熟期的瘢痕中,FGF-7,FGFR1和FGFR2基因的表达量都低于增殖期的瘢痕,而bFGF仍保持高水平的基因表达。在正常皮肤和增殖期的瘢痕中,aFGF基因呈低水平表达,而在成熟期的瘢痕中aFGF基因表达明显增强(P<0.05)。结论FGF-7、bFGF及其受体基因表达升高可能是增生性瘢痕形成的机制之一,而FGF-7、FGFR1和FGFR2基因表达降低,aFGF表达增强可能与增生性瘢痕达到相对稳定的成熟期有关。     

脂多糖刺激后人正常皮肤成纤维细胞基因表达谱的变化及其意义

目的：观察正常皮肤成纤维细胞经大肠杆菌内毒素（LPS）刺激后基因表达谱的变化,探讨LPS对后期瘢痕形成的影响及可能机制.方法：用0.1 μg/ml LPS刺激正常皮肤成纤维细胞并进行连续传代培养,选择第3代成纤维细胞,采用基因芯片技术检测成纤维细胞基因表达谱的变化,与自身正常皮肤成纤维细胞及自身增生性瘢痕组织成纤维细胞相关基因进行对比,挑选差异基因,采用逆转录一聚合酶链式反应（RT-PCR）方法进行验证.结果：LPS刺激后正常皮肤成纤维细胞基因表达谱发生改变,其中与胶原代谢相关的基因（Ⅰ型胶原、c-myc、TGF-β1mRNA）表达均上调;RT-PCR结果显示,这些基因表达与自身增生性瘢痕组织成纤维细胞表达量近似（P〉0.05）.结论：LPS可能诱导正常皮肤成纤维细胞转化为增生性瘢痕组织成纤维细胞,参与增生性瘢痕形成.     

碱性成纤维细胞生长因子和转化生长因子-β在溃疡与增生性瘢痕组织中的表达及其对创面修复的影响

目的研究碱性成纤维细胞生长因子(bFGF)与转化生长因子-β(TGF-β)在溃疡和增生性瘢痕组织中的表达特征以及与修复结果的关系.方法 21例标本包括体表慢性溃疡8例、增生性瘢痕8例和正常皮肤5例.用免疫组织化学法和常规病理技术确定两种生长因子在溃疡和增生性瘢痕的定位与表达量.结果 bFGF和TGF-β在正常皮肤中有少量表达,主要位于表皮基底细胞胞浆和细胞外基质.此外,bFGF还见于真皮毛细血管内皮细胞等.在溃疡组织bFGF与 TGF -β表达量明显增加,其中bFGF的阳性信号主要见于成纤维细胞和毛细血管内皮细胞,而TG F-β则仅见于炎性细胞.在增生性瘢痕TGF-β的表达为阴性,而bFGF则仍呈现出较高的表达量.结论在高浓度生长因子环境下创面修复延迟可能和生长因子与其受体结合障碍有关.研究结果还提示bFGF参与了瘢痕发生的全过程,TGF-β则主要作用于瘢痕形成早期.     

碱性成纤维细胞生长因子拮抗转化生长因子-β1对人α1(Ⅰ)胶原基因的启动激活

目的探讨碱性成纤维细胞生长因子(bFGF)对人α1(Ⅰ)胶原基因启动子活性的影响,以及与转化生长因子-β1(TGF-β1)之间的相互作用,为防治增生性瘢痕提供依据. 方法正常皮肤及瘢痕成纤维细胞原代、传代培养.采用FuGENE转染试剂,分别瞬间转染含人α1(Ⅰ)胶原基因5'端序列-2.5 kb与报告基因氯霉素乙酰基转移酶(CAT)的重组体phCOL2.5至正常皮肤及瘢痕成纤维细胞.ELISA法测定bFGF及TGF-β1作用24小时后,转染phCOL2.5的两种成纤维细胞的报告基因CAT表达量. 结果 bFGF能抑制转染phCOL2.5重组体的正常皮肤及瘢痕成纤维细胞CAT表达量,且能拮抗TGF-β1对转染phCOL2.5重组体的两种成纤维细胞CAT表达的上调作用.与对照组相比有统计学意义(P＜0.05). 结论正常皮肤及瘢痕成纤维细胞中,bFGF均能抑制人α1(Ⅰ)胶原基因的启动转录,且能拮抗TGF-β1对人α1(Ⅰ)胶原基因启动活性的上调作用,bFGF抗纤维机制有望为增生性瘢痕的防治提供新思路.     

FGFR1在增生性瘢痕和正常皮肤中的表达

目的　研究FGFR1在增生性瘢痕和正常皮肤中表达的差异。方法　用免疫组织化学、Western -blot、流式细胞仪分析等方法检测FGFR1在增生性瘢痕和正常皮肤组织及相关细胞中的表达差异以及在成纤维细胞中的亚细胞分布状况。结果　FGFR1阳性细胞主要存在于角质形成细胞、汗腺、皮脂腺、血管内皮细胞及成纤维细胞等 ,细胞爬片观察到阳性颗粒主要位于细胞核 ,细胞浆中不如细胞核中明显。FGFR1在单个细胞中的表达量无明显差异。结论　FGFR1在增生性瘢痕和正常皮肤中表达无差异     

FGFR1在增生性瘢痕和正常皮肤中的表达

目的研究FGFR1在增生性瘢痕和正常皮肤中表达的差异.方法用免疫组织化学、Western-blot、流式细胞仪分析等方法检测FGFR1在增生性瘢痕和正常皮肤组织及相关细胞中的表达差异以及在成纤维细胞中的亚细胞分布状况.结果 FGFR1阳性细胞主要存在于角质形成细胞、汗腺、皮脂腺、血管内皮细胞及成纤维细胞等,细胞爬片观察到阳性颗粒主要位于细胞核,细胞浆中不如细胞核中明显.FGFR1在单个细胞中的表达量无明显差异.结论 FGFR1在增生性瘢痕和正常皮肤中表达无差异.     

FGFR1在增生性瘢痕和正常皮肤中的表达

目 的研究FGFR1在增生性瘢痕和正常皮肤中表达的差异。方法 用免疫组织化学、WesteRN—blot、流式细胞仪分析等方法检测FGFR1在增生性瘢痕和正常皮肤组织及相关细胞中的表达差异以及在成纤维细胞中的亚细胞分布状况。结果 FGFR1阳性细胞主要存在于角质形成细胞、汗腺、皮脂腺、血管内皮细胞及成纤维细胞等．细胞爬片观察到阳性颗粒主要位于细胞核，细胞浆中不如细胞核中明显。FGFR1在单个细胞中的表达量无明显差异。结论 FGFR1在增生性瘢痕和正常皮肤中表达无差异。     

水蛭素对皮肤增生性瘢痕成纤维细胞bFGF及TGFβ_1表达的影响

目的：检测水蛭素对人皮肤瘢痕成纤维细胞碱性成纤维细胞因子（basic fibroblast growth factor,bFGF）、转化生长因子β1（transforming growth factor beta 1,TGFβ1）表达的影响,探讨水蛭素抑制瘢痕形成的作用及机制。方法：体外培养并鉴定人皮肤瘢痕成纤维细胞,实时荧光定量RT-PCR和免疫细胞化学法分别检测不同浓度水蛭素作用人成纤维细胞24h后,bFGF、TGFβ1的mRNA和bFGF、TGFβ1蛋白表达水平。结果：浓度为0.156～2.5 U/L的水蛭素可下调瘢痕成纤维细胞TGFβ1mRNA、蛋白的表达,同时上调bFGF的mRNA、蛋白的表达,不同浓度组间比较,差异有统计学意义。水蛭素可抑制增生性瘢痕成纤维细胞分泌TGFβ1,促进其分泌bFGF。结论：水蛭素抑制瘢痕可调节bFGF、TGFβ1分泌,由此抑制成纤维细胞的生长、增殖并进一步抑制瘢痕形成。     

重组血管生成抑制因子-1对增生性瘢痕组织血管及其相关因子的影响

目的 研究基因转染血管生成抑制对兔耳增生性瘢痕组织血管及其相关因子表达的影响.方法 将基因重组血管抑制剂Ad-METH-1作用于兔耳增生性瘢痕,用微循环显微镜检、组织学染色、免疫组织化学染色等方法,研究Ad-METH-1对兔耳瘢痕组织增生、血管生成及血管内皮细胞生长因子(vascular endothelial cell growth factor,VEGF)、碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)表达的影响,探讨基因转染血管生成抑制对增生性瘢痕的影响.结果 Ad-METH-1注射后30 d,实验组瘢痕组织微血管计数为12.38±2.56,VEGF阳性细胞百分比为17.64%,bFGF阳性细胞为18.24%;对照组微血管计数为48.12±6.46,VEGF阳性细胞百分比为31.34%,bFGF阳性细胞为28.26%.结果 显示,实验组瘢痕组织微血管计数低于对照组,两组间差异有统计学意义(P＜0.01);实验组瘢痕组织VEGF及bFGF的阳性细胞百分比均低于对照组,两组间差异有统计学意义(P＜0.05).结论 Ad-METH-1对兔耳瘢痕组织增生、血管生成及VEGF、bFGF表达产生了明确的抑制作用,早期行血管抑制治疗可抑制增生性瘢痕的形成.基因转染血管抑制治疗有望成为一种有效的增生性瘢痕防治方法.     

P物质对大鼠成纤维细胞碱性成纤维细胞生长因子及其受体表达的影响

目的　探讨P物质 (SP)对大鼠肉芽组织成纤维细胞碱性成纤维细胞生长因子 (bF GF)及其受体 (FGFR 1)表达的影响。方法　采用成纤维细胞体外培养和逆转录 多聚酶链反应(RT PCR)技术 ,观察SP在不同浓度 ( 1× 10 - 9～ 1× 10 - 5mol L)及孵育时间 ( 0、3、6、12、2 4h)情况下刺激成纤维细胞后 ,其bFGF、FGFR 1mRNA表达情况。结果　SP可上调大鼠成纤维细胞bF GF、FGFR 1mRNA表达。SP对bFGF的量 效曲线呈双相分布 ,最大效应浓度为 1× 10 - 7mol L。但SP仅在高浓度 ( 1× 10 - 6 ～ 1× 10 - 5mol L)时促进FGFR 1表达。在最大效应浓度 ( 1× 10 - 7～ 1× 10 - 5mol L)时 ,SP对bFGF、FGFR 1表达的上调作用分别于刺激细胞后 3、12h达高峰。结论　SP对大鼠肉芽组织成纤维细胞bFGF、FGFR 1基因表达存在直接影响 ,其表现形式与SP的刺激浓度及孵育时间有关 ,这可能是SP在创伤修复中发挥作用的机制之一。     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.