毛发移植术中单株毛囊单位分离技术的培训研究

目的:探讨毛发移植术中单株毛囊分离的培训方法.提高毛发移植手术人员单株毛囊分离速度和精度.方法:首先对培训对象进行毛囊结构理论教学,要求学员掌握毛囊的基本结构;然后进入镜下分离,裸眼分离结合的培训阶段,使学员掌握正确的分离技术和分离出毛囊单位的标准;最后对头皮扩张器手术的剩余头皮中的毛发进行裸眼毛囊分离培训.分离基本过程为皮条分割、粗胚制作、细胚制作,单株分离.培训过程中考核学员的分离速度和分离出的毛囊合格率.结果:理论培训后结合显微分离,显著提高了术者分离的精度;裸眼分离可以明显提高单株毛囊制作速度;经过累计超过6h或>1000个毛囊单位的分离的培训,术者分离细毛胚的速度可以达到(8±3)根/min,合格率达92±1%.与培训前有统计学差异P<0.05,和熟练术者无统计学差异.结论:毛发移植术的制约点是毛发分离速度,经过毛囊结构理论学习和体式显微镜下分离的培训,术者对毛囊结构从理论和实际上有了明确的掌握,从而提高了术者的分离精度;经过累计6h的分离训练,多数学员可以达到(8±3)根/min的分离毛囊单位速度,这一结果极大的缓解了毛发移植的限速关键点,为提高毛囊的存活率提供了坚实的技术保障.     

离体角质形成细胞热损伤模型建立及细胞凋亡观察

Objective To reproduce a model of heat injured KC in vitro and explore its apoptosis rate of KC due to heat injury at different temperature. Methods Human KCs were cultured in vitro, and they were incubated at 37, 41, 43,45, 48, and 51 ℃ respectively for 10 mins in water bath. Trypan blue staining and Hoechst 33258 fluorescence staining were used respectively to determine necrosis and apoptosis of KC. Rates of apoptosis and necrosis of KC were analyzed quantitatively by flow cytometer. The prolifera-tion activity of KC after heat injury was detected by MTT test. Results The results of trypan blue stai-ning, Hoechst 33258 fluorescence staining, and flow cytometer demonstrated that number of apoptotic and necrotic KC increased gradually along with a rise of water bath temperature. The rates of apoptosis and necro-sis of KCwererespectively(12.3±3.2)% and (14.1±1.6)% at 45℃, (27.7±5.1)% and (58.0± 4.2)% at 48 ℃. Rate of KC necrosis reached up to (83.0±5.3)% at 51℃. Inhibition of KC growth reached a stationary phase when the injurious temperature reached 45 ℃ as observed with MTT test. Con-clusions Heat injury can induce apoptosis and growth inhibition of KC in vitro. Incubating KC at 45 ℃ for 10 mins is a good condition to reproduce a model of heat injured KC in vitro. This model may be used to study the biological character and apoptosis of KC after burn injury.     

系列矫形支具在烧伤后手功能恢复中的应用

目的 了解自制静态和动态手支具对烧伤后手功能恢复的作用.方法 在烧伤后不同治疗阶段,为32例患者的52只手制作不同类型支具,针对不同个体单独或联合使用,采用Car-roll上肢功能评定标准,对上肢及手的整体功能(包括粗动作及精细动作如抓、握、捏、夹及手臂旋前、旋后、取物、放置等)进行定量评定,比较使用支具治疗前后手部功能恢复情况.结果 按Carroll上肢功能评定标准.治疗前患手功能Ⅳ级7只、Ⅲ级15只、Ⅱ级23只、Ⅰ级7只.治疗3个月后重新评定.手功能Ⅵ级9只、Ⅴ级28只、Ⅳ级9只、Ⅲ级6只.28例患者46只手的对指、对掌、握、捏等功能恢复较好,可完成日常生活中的手部活动.结论 该自制手支具对预防和治疗手烧伤后瘢痕挛缩有良好的效果,可明显促进手功能的恢复.     

烧伤后双侧乳房增生性瘢痕合并乳房肥大症一例矫治报告

1病例介绍患者,女,26岁,已婚,于2000年5月被电弧烧伤全身总面积90%,Ⅲ度占10%,伤愈后,双侧乳房上限增生性瘢痕。伤后康复期,体重由50kg增加至80kg;并且伴有月经不规律,3个月左右一次,双侧乳房逐渐肥大、下垂。于2001年2月要求行乳房缩小术。体检发现双侧乳房肥大,外侧达腋中线,下缘脐上5cm,双侧乳房上壁增生性瘢痕,右侧3cm×8cm,右侧6cm×10cm。如图1、2。     

背阔肌游离皮瓣修复面颈部瘢痕挛缩畸形

目的:研究背阔肌游离皮瓣在修复面颈部挛缩畸形中所起的重要作用。方法:10例面颈部瘢痕彻底松解后,采用游离的背阔肌肌皮瓣治疗,将胸背动静脉分别与面动静脉吻合,供瓣区采用中厚皮片移植,其中两例采用预扩张的背阔肌游离皮瓣进行修复。结果:9例背阔肌肌皮瓣游离移植后完全存活,1例背阔肌皮瓣远端部分坏死,术后患者的面颈部功能和外形得到明显的改善。结论:背阔肌游离皮瓣修复面颈部瘢痕挛缩畸形效果可靠。     

大鼠肾上腺内P物质神经的正常分布及烫伤后的改变

一、材料和方法1.动物模型及分组 :35只雄性ＳＤ大鼠分为烫伤组 (30只 )和正常对照组 (5只 )。烫伤组背部用电烫仪 (本室研制 )80℃恒温探头与皮肤接触 9ｓ ,造成 10 %～ 2 0 %ＴＢＳＡ深Ⅱ度烫伤。正常对照组探头温度为 2 0℃。于烫伤后 15ｍｉｎ ,6、12、2 4、4 8、96ｈ取肾上腺。2 .免疫组化染色及ＳＰ免疫反应阳性神经纤维和细胞半定量测量 :参照参考文献 [1 3]介绍的方法。3.统计学处理 :数据以ｘ±ｓ表示 ,行ｔ检验。二、结果1.正常大鼠肾上腺Ｐ物质 (ＳＰ)的分布 :正常大鼠肾上腺ＳＰ在被膜下皮质及髓质均有分布且极为密集。含ＳＰ神…     

严重烧伤早期血小板计数变化对预后的影响

严重烧伤早期血小板计数变化对预后的影响［朱雄翔，陈璧，徐明达．解放军医学杂志，１９９７；２２（１）：３０～３２］严重烧伤血小板（ＰＬＴ）计数下降的临床意义仍不甚明确．作者通过５年中住院治疗的死亡病例１６例进行临床病例对照研究，发现死亡组和存活组早期Ｐ...     

1 例营养不良性大疱性表皮松解症患者的护理

〔摘 要〕　营养不良性大疱性表皮松解症（DEB）是一种临床罕见异质性的遗传性疾病，其特点是皮肤和黏膜极其 脆弱，表现为不间断的皮肤水疱，并演变成慢性伤口、炎症和纤维化，严重者可继发手和脚畸形及上皮癌变，其治疗 难度大，护理难度高。南方医科大学深圳医院于 2021 年 9 月收治 1 例 DEB 患者，在清创手术、创面封闭式负压引流 术（VSD）及植皮术治疗的基础上，通过加强围手术期病室环境管理、管道护理、营养护理及皮肤护理等措施，现患 者已康复出院。由于该病临床罕见，其相应的护理经验在国内鲜有报道，现将护理体会总结如下，以期为同行提供该 病种患者围手术期护理的经验。     

便携式简易腋臭术后固定带对微创负压刮吸治疗腋臭术后伤口加压的效果

目的观察便携式简易腋臭术后固定带(简称腋臭带)在微创负压刮吸治疗腋臭术后伤口加压固定的应用效果。方法选取2017年9月至2019年9月在局部胀麻醉下行微创负压刮吸治疗双侧腋臭手术80例患者,按照术后伤口包扎加压方法不同,分为对照组和观察组,每组40例。对照组使用传统的无菌纱布垫和自粘性绷带包扎加压固定伤口;观察组使用腋臭带和无菌纱布垫加压固定伤口,2组使用时间均是术后至伤口拆线,手术方法及换药频率均相同。根据线性视觉模拟评分标尺评价,比较2组舒适度,患者术后换药的总费用。结果观察组和对照组患者的舒适度评分分别为(4.74±1.57)、(3.24±1.27)分,术后换药总费用分别为(450±20.16)、(690±20.14)元,观察组舒适程度高于对照组,术后换药成本低于对照组(P<0.05)。参与使用腋臭带的10名医生认为该工具使用方便、操作简单,可有效均匀加压固定术后伤口。结论腋臭带用于微创负压刮吸治疗腋臭术后,不仅可有效加压固定伤口,提高患者舒适度,还可降低患者术后换药的总费用。     

胰岛素对烧伤血清诱导血管内皮细胞核因子κB核移位的抑制作用

Objective To study the inhibitory effects of insulin on nuclear factor-kappa B (NF-κB) nuclear translocation of vascular endothelial cells induced by burn serum and its correlative mechanism. Methods Human umbilical vein endothelial cells (HUVECs) were cultured in vitro and divided into 5 groups: blank control group (BC, ordinary culture without any stimulation) , normal serum control group (NS, cultured with nutrient solution containing 20% healthy human serum) , burn serum stimulation group (BS, cultured with nutrient solution containing 20% burn human serum) , burn serum + insulin treatment group (BI, cultured with nutrient solution containing 20% burn human serum and 1 × 10-7 mol/L insulin) ,inhibitor pretreatment group [IP, pretreated with 50 μmol/L protein kinase B (Akt) specific inhibitor LY-294002, then cultured with the same medium as used in BI group 30 minutes later] according to the random number table. Six hours later, the injury and apoptosis of HUVECs was respectively observed by the scanning electron microscope and determined by the flow cytometry. Meanwhile, the phosphorylation of inhibitor kappa B-α (p-IκB-α) and Akt (p-Akt) in cytoplasm, and the content of NF-κB-p65 in nucleus were determined with Western blot. Results (1) Compared with those in BC group, HUVECs in BS group shrank obviously with irregular nuclear structure, and intercellular links jagged or vanished. Slight change was observed in HUVECs structure in NS and BI groups, with the cell ductility and nuclear structure much better than those in BS group. (2) The apoptosis rates of HUVECs in BS group [(28. 5 ± 2. 3) %] , BI group [(22. 3 ±1.8)%], and IP group [(29. 7 ± 2. 4) %] were all obviously higher than that in BC group [(15.7 ±2.2)% , F =14.288, P <0.05otP <0.01]. There was no significant statistical difference between NS group [(17. 0 ± 2. 5) %] and BC group in apoptosis rate (F = 14. 288 , P > 0. 05). The apoptosis rate of HUVECs in BI group was obviously lower than that in BS group (F = 14. 288 , P <0.05). (3)Compared with those in BC group, the protein expressions of p-IκB-α in cytoplasm and NF-κB-p65 in nucleus were up-regulated, and the protein expression of p-Akt in cytoplasm was down-regulated in BS and IP groups. The expression levels of the three proteins in NS and BI groups were close to those in BC group. Conclusions Insulin could inhibit the IκB phosphorylation, and then restrict NF-κB nuclear translocation and improve the vascular endothelial cells function accordingly through regulating phosphatidylinositol 3 ki-nase/Akt pathway.