应用皮肤切削术治疗胸背部巨痣临床分析

目的:观察应用皮肤切削术治疗胸背部巨痣的临床效果,探讨治疗巨痣较为有效的方式。方法:于巨痣部位以切削方式削除黑色素痣病变组织,继发创面以愈邦(纳米银抗菌医用敷料)覆盖,术后逐层揭去外层敷料,直至创面愈合,愈后综合抗瘢痕治疗。结果:胸背部巨痣可一次性手术完成,创面均Ⅰ期愈合,愈后无明显瘢痕增生或挛缩,皮肤色泽及弹性可。结论:应用皮肤切削术治疗胸背部巨痣手术次数少,无需植皮。     

表皮生长因子导入治疗在皮肤扩张器中的应用研究

目的:探讨使用导入仪导入重组人表皮生长因子(rhEGF)促进皮肤扩张的临床效果。方法:自2013年1月~2013年5月入选38例患者,共将76个扩张器进行埋置,按照随机原则,分为常规注水对照组(36个扩张器)与导入仪导入治疗组(36个扩张器)。治疗组的扩张器在每次注水扩张的第二天进行导入仪治疗,在被扩张的皮肤表面涂抹rhEGF并使用导入按摩仪进行按摩导入。对照组的扩张器仅进行常规的注水。测量两组扩张器扩张致额定容量所花费的时间、皮肤扩张比率及扩张皮肤即刻回缩比率,采用自身对照的方法进行比较分析。进行胶原含量,I/III型胶原比率(%)的测定和病理HE染色分析。结果:注水后第二天进行rhEGF导入治疗能使扩张器扩张致额定容量所花费的时间明显缩短,皮肤扩张比率则明显增加,扩张皮肤即刻回缩比率减少,有效减小皮辨的即时回缩率。治疗组胶原纤维束粗而密,I/III型胶原比例降低。结论:注水后第二天通过使用导入仪将rhEGF导入扩张皮肤治疗能缩短扩张时程,促进皮肤的面积增加,降低皮瓣回缩的比率,提高皮瓣质量,改善治疗效果。     

皮肤扩张法修复外伤性耳廓缺损

目的:探讨皮肤扩张结合自体肋软骨支架修复外伤性耳廓缺损的可行性和效果。方法:根据耳廓缺损面积的大小选择50~80ml扩张器置入缺损后乳突区筋膜下,注水扩张至70~100ml。Ⅱ期手术时取出扩张器切取对侧第7、8或7、8、9肋软骨制作耳支架,用皮瓣包裹修复缺损,3个月后进行支架与残耳衔接修整。结果:除1例患者支架表面皮肤0.5cm×0.5cm坏死换药后愈合外,其余病例创口Ⅰ期愈合无并发症,耳廓外形满意。结论:皮肤扩张结合自体肋软骨支架修复外伤性耳廓缺损能取得较好的手术效果。     

两种薄中厚皮片治疗皮肤撕脱伤临床效果对比研究

目的:对比研究撕脱皮肤反取薄中厚皮片与常规切取薄中厚皮片在治疗皮肤撕脱伤中的移植效果。方法:选取2008年6月~2012年6月就诊的52例四肢皮肤撕脱伤患者为研究对象,其中23例因撕脱皮肤毁损严重无法利用,只能采用常规切取薄中厚皮片游离移植修复撕脱伤创面,其余29例利用撕脱皮肤反取制备薄中厚皮片,全部薄中厚皮片打孔直径1cm,术后均采取加压包扎。结果:所有移植皮片均成活,常规切取薄中厚皮片移植的23例患者中,Ⅰ期愈合者21例,Ⅰ期愈合率为91.3%;撕脱皮肤反取薄中厚皮片的29例患者中,Ⅰ期愈合者24例,Ⅰ期愈合率为82.8%。结论:常规切取薄中厚皮片移植与撕脱皮肤反取薄中厚皮片移植的Ⅰ期愈合率相仿,临床应尽可能利用撕脱皮肤反取制备薄中厚皮片移植修复撕脱伤创面,如撕脱皮肤难以利用则应选用薄中厚皮片移植修复。     

急性生理学与慢性健康状况Ⅱ评分在亚低温脑复苏患者中的运用及回归模型建立

目的应用急性生理学与慢性健康状况Ⅱ（APACHEⅡ）评分评价亚低温脑复苏患者的病情危重程度并判断其预后,以评估其应用的有效性。方法连续收集入急诊重症监护室（ECIU）或重症监护室（mu）的亚低温脑复苏患者共34例,分别计算各自APACHEⅡ评分,并进行验证,建立回归模型。结果纳入的34例患者APACHEⅡ评分20—47（33．86±5．12）分。9例72h内存活者为（27．83±4．89）分,25例72h内死亡者为（35．56±7．12）分,两者比较差异有统计学意义（P〈0．01）。非条件Logistic回归分析显示,APACHEⅡ评分是亚低温脑复苏患者死亡的危险因素（P〈0．01）。结论APACHEⅡ评分可应用于亚低温脑复苏患者的病情危重程度及预后的评估,指导临床决策。     

Cyproterone acetate-loaded nanostructured lipid carriers: effect of particle size on skin penetration and follicular targeting

Cyproterone acetate (CPA) is used to treat various skin disorders such as acne, hirsutism, and alopecia. Due to the limited skin penetration of CPA, nanostructured lipid carriers (NLCs) with different size ranges were considered in this study in order to enhance skin penetration and to target hair follicles. Drug loading, drug release and morphological assessment were evaluated for each targeted size (100, 300, and 600?nm). Ex vivo skin penetration was also investigated using Franz diffusion cells. Finally, in vivo follicular targeting was evaluated using rhodamine B-loaded micro and nanoparticles. Results revealed that 60–85% of drug was slowly released from lipid nanoparticles within 72?h. CPA-NLC with average diameter of 600?nm had better penetration and deposition in dermis-epidermis layer, also CPA-NLC 100 and 300?nm significantly increased drug penetration in dermis-epidermis in comparison to free CPA. Follicular targeting results revealed that NLC 300?nm had the best accumulation capacity in hair follicles. CPA-NLC with average diameter of 300?nm could be a promising topical novel drug delivery system for specific targeting of hair follicles and sebaceous glands to treat androgenic skin disorders such as acne, hirsutism, and alopecia.     

Influence of protamine shell on nanoemulsions as a carrier for cyclosporine-A skin delivery

Novel protamine-based nanosystems have been studied for cyclosporine-A (CsA) skin delivery. Core-shell structure systems have been developed to this end. These vehicles have particles sizes of 200–300?nm, a low polydispersity index and a zeta potential which varies between ?16?mV and +35?mV. The resulting four nanosystems efficiently encapsulated CsA in their oily nucleus (60–80%) and released this drug in a controlled manner. These formulations have shown a high stability in aqueous suspension in storage conditions at 4?°C (for at least 21?months) and in acetate buffer at a physiological temperature of 37?°C (for at least 24?h). Ex vivo transdermal diffusion experiments using Franz diffusion cells and 2- to 3-day-old pig skin as a biological barrier were performed. All nanoformulations designed produced an increase in CsA transdermal delivery and two of these nanosystems presented a marked promoting effect; the more relevant parameters were smaller particle size (200?±?7?nm) and negative superficial charge. Finally, the ability of these nanosystems to enhance retention of CsA in the skin was also studied. The protamine disposition in the shell influenced CsA skin retention. Therefore, the incorporation of CsA into the nanosystems studied here makes them suitable vehicles for CsA transdermal administration.     

基于皮肤外燥模型小鼠的干燥皮肤综合评价及银耳多糖的干预研究

目的 制备皮肤外燥模型小鼠,对小鼠皮肤进行综合评价并研究银耳多糖内服、外用的干预作用。方法 10只KM小鼠置于人工气候箱内按“温度-湿度-风”综合条件建立皮肤外燥小鼠模型;另90只KM小鼠,除空白组常规饲养,其余各组按外燥造模条件饲养。银耳多糖的干预研究分为内服和外用,内服给药动物随机分为空白组、模型组（等量生理盐水）和银耳多糖组（400,200,100 mg·kg^-1）;外用给药动物分为经皮空白组、经皮模型组（等量生理盐水）、经皮银耳多糖组（银耳多糖10 mg·cm^-2）和阳性对照组[透明质酸（hyaluronic acid,HA）10 mg·cm^-2],每日1次,连续给药20 d。观测不同给药方式在银耳多糖干预下小鼠皮肤表观特征、含水量、组织结构、HA含量以及水通道蛋白3（aquaporin-3,AQP3）表达量的影响。结果 皮肤综合评价结果表明,外燥模型建立成功;在银耳多糖干预下,与空白组比较,内服与外用给药的模型组皮肤含水量、HA含量以及AQP3表达量降低（P<0.05）;与模型组相比,各给药组可显著提高皮肤含水量、HA含量以及AQP3表达量（P<0.05）,且内服以银耳多糖高剂量组效果最好（P<0.05）,外用经皮银耳多糖组效果优于阳性对照组（P<0.05）。各给药组较模型组皮肤恢复色泽,未见明显皮屑与裂纹,毛发可正常增长,皮肤组织结构相对完整,毛囊与皮脂腺数目增多。结论 外燥可致皮肤干燥的理论成立。银耳多糖对皮肤外燥模型小鼠内服外用具有延缓干燥的功效,其作用可能与银耳多糖调节皮肤HA和AQP3表达量相关。     

复方龙胆合剂对小鼠激光损伤后皮肤屏障功能修复的研究

目的 研究复方龙胆合剂对于小鼠皮肤激光损伤后屏障修复的作用。方法 选择40只BALB/c小鼠,将小鼠背部脱毛后随机选取10只为正常组,其他30只使用Q开关1064激光机,以5 Hz频率、3 mm光斑、6 J能量照射脱毛区,构建激光损伤皮肤模型。将激光损伤模型小鼠随机分为模型组、对照组、实验组。模型组小鼠不做处理,对照组小鼠单一使用基质涂抹,实验组小鼠在基质涂抹的基础上每日灌胃给药复方龙胆合剂。分别在干预后6,24,48 h,7,14 d测试小鼠皮肤含水量、经皮失水量、小鼠皮肤中增殖细胞核抗原染色,ELISA法检测皮肤组织中髓样分化因子88（myeloid differentiation factor 88,MyD88）、白细胞介素6（interleukin-6,IL-6）的蛋白表达,RT-QPCR检测皮肤中表皮抗菌肽S100a8、S100a9、MyD88以及IL-6的mRNA水平。结果 模型组和对照组在皮肤含水量和经皮失水量的比较中无显著统计学意义,而实验组皮肤含水量显著高于模型组、经皮失水量显著低于模型组（P<0.05）。实验组增殖细胞核抗原表达较强。模型组和对照组皮肤中MyD88、IL-6的蛋白水平以及S100a8、S100a9、MyD88以及IL-6的mRNA水平无统计学意义,但是显著高于正常组（P<0.05）,而实验组皮肤中MyD88、IL-6的蛋白水平,S100a8、S100a9、MyD88以及IL-6的mRNA水平显著低于模型组（P<0.05）。结论 复方龙胆合剂可以促进小鼠皮肤激光损伤后屏障功能的恢复,其作用和炎症抑制相关。