埃索美拉唑对幽门螺杆菌相关性十二指肠溃疡的疗效观察

目的分析埃索美拉唑治疗幽门螺杆菌（Hp）相关性十二指肠溃疡（DU）的临床疗效。方法收集48例Hp阳性DU患者，随机平分为两组，治疗纽（n=24）接受埃索荚拉唑、阿莫西林和克拉霉紊治疗，而对照纽患者（n=24）接受雷尼替丁、阿莫西林和克拉霉素治疗。治疗8周后观察临床症状情况，并通过内镜检查，观察溃疡愈合，Hp清除，并比较胃窦部炎症情况。结果经8周治疗后，发现埃索关拉唑组患者明显改善临床症状（如上腹部疼痛、上腹不适、嗳气），溃疡愈合率和HP清除率明显比对照组升高（P〈0．01），胃窦部炎症分级明显降低（P〈0．01）。结论埃索美拉唑可有效地缓解Hp相关性DU症状，加速溃疡愈合，清除HP感染，是治疗DU的一种有效方法。     

皮瓣修复糖尿病足合并慢性溃疡形成的临床体会

目的:总结糖尿病足合并慢性溃疡形成的临床治疗经验。方法:1994年7月~2007年7月,选择皮瓣修复治疗糖尿病足合并慢性溃疡形成创面56例。结果:应用皮瓣修复36例,对侧小腿交叉瓣修复11例,足弓和小腿中下段截肢9例。有7例皮瓣部分坏死,3例截肢断端部分皮瓣坏死,需再手术治疗后修复,3例皮瓣下有坏死组织流出,经换药1月后愈合,其余皮瓣及皮片移植成活。经随访2月~3年,外观和功能良好。结论:选择恰当的皮瓣修复,可以尽可能保留肢体功能和外观。     

Effect of low frequency pulsing electromagnetic fields on skin ulcers of venous origin in humans: a double-blind study

The effect of an electromagnetic field on the healing of skin ulcers of venous origin in humans has been investigated in a double-blind study. Forty-four patients have been admitted to the study; one-half were exposed to active stimulators (experimental group) and the remaining to dummy stimulators (control group). The stimulation was scheduled to last a maximum of 90 days. The success rate was significantly higher in the experimental group both at day 90 (p less than 0.02) and in the follow-up period (p less than 0.005). The data suggest that the effect of the electromagnetic field lasts even when the stimulation is over. No ulcers worsened in the experimental group, while four worsened in the control group. Twenty-five percent of the patients in the experimental group and 50% in the control group experienced recurrence of the ulcer. It is concluded that stimulation with an electromagnetic field is a useful adjunctive therapy in the management of these patients.     

p38丝裂原活化蛋白激酶在应激性溃疡发病中的作用

目的探讨p38丝裂原活化蛋白激酶(MAPK)在应激性溃疡发生中的作用。方法80只SD大鼠分成正常对照组(10只)、浸水-束缚(WIR)应激模型组(0.5、1、2、4和6h时间点各10只)和p38特异性抑制剂CNI1493处理组(低剂量和高剂量组各10只)。CNI1493处理组于应激前2h尾静脉注射1或10mg/kg的CNI1493。胃黏膜病变程度采用溃疡指数计分评价,磷酸化和总p38MAPK表达采用蛋白印迹法(Westernblot)检测,肿瘤坏死因子α(TNFα)和白细胞介素1β(IL1β)基因表达采用Northernblot方法检测。结果WIR应激后大鼠胃黏膜p38MAPK发生持续活化,其最大活化发生于应激后1h,为正常水平的(6.8±3.2)倍(P<0.01)。使用CNI1493阻断p38MAPK活化后,胃黏膜损伤程度显著减轻,同时促炎性细胞因子TNFα和IL1β基因表达也明显下调。结论p38MAPK活化在实验性应激性溃疡的发生中发挥了重要作用。     

Case series of use of Manuka honey in leg ulceration

Gethin G, Cowman S. Case series of use of Manuka honey in leg ulceration. Abstract The historical and current literature reports the successful use of honey to manage a diversity of wound aetiologies. However, only in the last 40 years is research on its mode of action and contribution to wound healing being investigated. The challenge of managing chronic non healing wounds generated interest in researching non standard therapies. The aims of the study were to gain insight into the practical use of Manuka honey in wound management. The objective was to test the feasibility of further rigorous research into the use of honey in the management of chronic wounds. Instrumental case series were used to examine the use of Manuka honey in eight cases of leg ulceration. To collect the necessary data, photographs, acetate tracings, data monitoring and patient comments and observations were used to add greater reliability and validity to the findings. The wounds were dressed weekly with Manuka honey. The results obtained showed three males and five females with ulceration of different aetiologies were studied. A mean initial wound size for all wounds of 5.62 cm(2) was obtained. At the end of four-week treatment period, the mean size was 2.25 cm(2). Odour was eliminated and pain reduced. The conclusions drawn were that the use of Manuka honey was associated with a positive wound-healing outcome in these eight cases. Arterial wounds showed minimal improvement only.     

Principles of management: the diabetic foot

Diabetes mellitus affects 5-10% of the US population at some point in their lives. Hyperglycemia produces serious chronic complications. Peripheral neuropathy is one of the most serious of these. Peripheral neuropathy, in the lower extremities, leads to plantar foot ulceration. Secondary infection of these ulcers is by far the leading cause of major amputations of feet and legs. Proper preventative care will dramatically reduce ulcer formation and costs related to this complication.     

Methylphenidate effects on activity-stress gastric lesions and regional brain noradrenaline metabolism in rats

Methylphenidate (5, 10, or 20 mg/kg/day) or saline were administered to rats in the activity-stress ulcer paradigm. Running-wheel activity and food consumption did not differ among groups. Methylphenidate produced dose-related increases in gastric ulcer severity, decreases in hypothalamic noradrenaline (NA) and increases in 3-methoxy-4-hydroxy-phenylethyleneglycol sulfate (MHPG-SO4) in the hypothalamus, amygdala, hippocampus and thalamus. These results differ markedly from the effects seen with a related substance, d-amphetamine, and suggest different mechanisms of action for these drugs.     

Urinary 8-hydroxydeoxyguanosine excretion in children before and after therapy for eradication of Helicobacter pylori infection

Aim: A number of reports have implicated oxygen free radicals in the pathogenesis of Helicobacter pylori (H. pylori)-associated disease. 8-hydroxydeoxyguanosine (8-OHdG) has recently been accepted as a sensitive marker for reflecting the oxidative DNA damage. However, there have been no previous studies comparing the changes in urinary 8-OHdG excretions before and after therapy for eradication of H. pylori infection, or to examine 8-OHdG excretions in children with H. pylori infection. The aim of this study was therefore to examine the DNA damage in gastric mucosal cells in children with H. pylori infection. Methods: Urinary 8-OHdG excretions were measured before and after therapy for eradication of H. pylori infection in 15 children diagnosed with the H. pylori infection and 13 parents who were also suffering from the same infection. Results: In both the children and their parents, no significant differences were found in urinary 8-OHdG excretions either before or after the eradication therapy. Furthermore, there was no significant difference in urinary 8-OHdG excretions between 8 children with peptic ulcers and 7 children without ulcers, either before or after the therapy.

Conclusion: These results suggest that measurement of urinary 8-OHdG levels is not useful for evaluation of the DNA damage in H. pylori-infected gastric mucosa in children.     

Buccal mucosal ulcer healing effect of rhEGF/Eudispert hv hydrogel

We have studied the effect of rhEGF on the buccal mucosal ulcer healing. rhEGF was rapidly degraded upon incubation with the hamster buccal mucosal homogenates; The degradation of rhEGF was significantly inhibited by sodium lauryl sulfate (SLS). Eudispert hv hydrogel and Polycarbophil 974P hydrogel were prepared for rhEGF delivery and their mucoadhesiveness was measured by the Instron method. The mucoadhesive force of Eudispert hv was significantly greater than that of Polycarbophil 974P. Moreover, rhEGF in Eudispert hv hydrogel remained stable for about 2 months. To evaluate the ulcer healing effect of rhEGF, the buccal mucosal ulcer was induced in golden hamsters using acetic acid. At 24 h after administration of rhEGF/Eudispert hv hydrogel, the ulcerous area was decreased compared with rhEGF solution and, as a result, the curative ratio was 36.8 +/- 5.68%. By the addition of SLS (0.5%) to Eudispert hv hydrogel, the curative ratio increased 1.5 times. The mechanism of the action was probably due to a combination of protection of the drug against proteases present in mucosa and prolongation of the release of rhEGF from the formulation at the site of action.     

Pioglitazone,a specific ligand of peroxisome proliferator-activated receptor-gamma,accelerates gastric ulcer healing in rat

The peroxisome proliferator-activated receptor-gamma (PPAR-gamma) is a member of the nuclear hormone receptor superfamily that is involved in the control of inflammation and carcinogenesis. We determined the effect of the specific PPAR-gamma ligand, pioglitazone (5-40 mg/kg intragastrically), on the healing of acetic-acid gastric ulcers in rats. At day 8 after ulcer induction, the ulcer area, the gastric blood flow and mucosal expression of proinflammatory cytokines such as interleukin-1beta, tumour necrosis factor alpha (TNF-alpha) and cyclooxygenase-1, cyclooxygenase-2, constitutive nitric oxide synthase (cNOS), inducible nitric oxide synthase (iNOS) and heat shock protein 70 (HSP70) was determined. Pioglitazone reduced the area of gastric ulcers and raised significantly the gastric blood flow at the ulcer margin and downregulated the mRNA for interleukin-1beta, TNF-alpha, cyclooxygenase-2 and iNOS while cyclooxygenase-1 mRNA was not affected. The expression of PPAR-gamma mRNA was increased in the ulcerated gastric mucosa. We conclude that pioglitazone accelerates the healing of preexisting gastric ulcers due to the hyperemia at ulcer margin and the anti-inflammatory action including suppression of interleukin-1beta, TNF-alpha, cyclooxygenase-2 and iNOS and by an overexpression of HSP70.