Development of a Wound Dressing Composed of a Hyaluronic Acid Sponge Containing Arginine

Spongy sheets composed of cross-linked high-molecular-weight (HMW) hyaluronic acid (HA) were prepared by freeze-drying an aqueous HMW-HA solution containing cross-linking agent (Group I). The Group I sheet was immersed into an aqueous low-molecular-weight (LMW) HA solution with or without L-arginine (Arg) and was then freeze-dried to prepare several types of spongy sheets (Groups II–V). The amount of Arg was 1.0 g, 0.5 g, 0.2 g and 0 g in Groups III, IV, V and II, respectively. In the first experiment, each spongy sheet was applied to a full-thickness skin defect with a diameter of 35 mm in the abdominal region of SD rats, with intact skin in the central area measuring 15 mm in diameter. Commercially available polyurethane film dressing was applied over each spongy sheet as a covering material. The control group was covered with polyurethane film dressing alone. All spongy sheets promoted epithelization, as well as angiogenesis, as compared with controls. These findings indicate that HA and Arg are essential for wound healing. Re-epithelizaion was particularly active in Groups IV and V. In the second experiment, each spongy sheet was applied to a full-thickness burn injury measuring 35 mm in diameter in the abdominal region of SD rats, after necrotic skin was surgically removed. Groups II–V showed decreased wound size when compared with Group I and controls. The present findings indicate that the release of LMW-HA and Arg from a cross-linked HMW-HA spongy sheet effectively stimulates wound healing.     

59例偶发分支杆菌皮肤感染的外科处理

目的　探讨皮肤软组织偶发分支杆菌感染的外科处理时机 ,指征和术式。方法　通过细菌学、组织病理、B超和临床观察 ,对 59例 76处病灶不同外科处理方法的效果作一回顾性分析。结果　45例 (52处病灶 )手术切除 ,其中除 8处创口有反复外 ,其余均一期愈合 ;扩创或切开引流 6例 ,5例愈合 ,1例新发病灶二次扩创清除后愈合 ;8例抽脓后注入阿米卡星 (AMK)未行切除 ,病灶均消失。 59例经综合治疗后全部治愈。结论　在全身给药有效治疗 6～ 8周后 ,局部病变得到控制 ,肉芽肿形成时为手术的最佳时机。术式以距病灶周边 1 .5～ 2 .0cm处完整切除为宜。     

Relationship of Helicobacterpylori CagA Status to Gastric Cell Proliferation and Apoptosis

Despite the fact that the association ofHelicobacter pylori with an increased risk of gastriccancer is well documented, the exact mechanisms of thisassociation have not been elucidated. Our aim was to shed some light on these mechanisms by studyingthe relationship of H. pylori CagA status to gastriccell proliferation and apoptosis, since both play animportant role in gastrointestinal epithelial cell turnover and carcinogenesis. We studied fiftypatients [32 men, 18 women, median age 39.5 years (range18-67)], referred for upper gastrointestinal endoscopy,from whom antral biopsies were taken. On biopsy specimens gastritis was estimated byscoring the severity of inflammatory infiltrate, and thepresence of atrophy and intestinal metaplasia were alsonoted. The gastric cell proliferation index (PI) was estimated by AgNOR staining, the epithelialapoptotic index (AI) was measured by special stainingfor apoptosis, and CagA status was determinedserologically by immunoblotting the sera of patientsagainst H. pylori antigens. Thirty-eight (76%) of the50 patients were H. pylori (positive) and 12 (24%) H.pylori (negative). Among the 38 H. pylori (+) patients,28 (73.6%) were CagA(+) and 10 (24.6%) CagA(-). In the H. pylori CagA(+) and CagA(-) groups,the PI values [median (ranges)] were 5 (4-7) and 3.7(3.5-5.5), respectively (P < 0.05). In addition thedifference in PI between the H. pylori CagA(+) and H. pylori (-) groups was highly significant (P< 0.001). Concerning apoptosis, in the H. pyloriCagA(+) and CagA(-) groups, the values for AI were 1(1-30) and 5.5 (1-35), respectively (P < 0.05). In addition, the difference in AI between theH. pylori CagA(-) and H. pylori (-) groups, wassignificant (P < 0.05). We conclude that H. pyloriCagA(+) strains induce increased gastric cellproliferation, which is not accompanied by a parallel increasein apoptosis. This might explain the increased risk forgastric carcinoma that is associated with infection byH. pylori CagA(+) strains.     

重症急性胰腺炎合并深部真菌感染的预防和治疗

目的：探讨重症急性胰腺炎（SAP）合并深部真菌感染的预防和治疗措施。方法：将1998年7月－2002年6月收治的70例SAP病人随机分3组：大蒜素预防组、氟康唑（小剂量）预防组、对照组，比较各组的真菌感染发生率，治疗后真菌清除率及死亡率。结果：大蒜素组真菌感染率明显低于对照组（16％：30％，P＜0．05）及氟康唑组（9％：30％，P＜0．01）。真菌感染发生后，采用治疗剂量的氟康唑和两性霉素B对大蒜素组、对照组的真菌感染病人有效，而对氟康唑组真菌感染病人无效。结论：预防性应用大蒜素、小剂量氟康唑均可明显降低SAP的深部真菌感染发生率。真菌感染发生后，如氟康唑治疗无效，应及时改用两性霉素B。     

髓系细胞触发受体1在胆道感染患者中的表达

目的　了解胆道感染患者外周血髓系细胞触发受体 1(TREM 1)在转录水平上的表达规律及其意义。方法　收集 3 2例胆道感染患者 (研究组 )和 7例健康志愿者 (对照组 )外周血标本 ,以半定量RT PCR检测白细胞TREM 1mRNA表达水平 ;ELISA检测血清TNF α表达水平。结果　对照组TREM 1mRNA半定量比值为 0 .48± 0 .0 72 ,研究组 1,2 ,3 ,7天外周血TREM 1mRNA半定量比值分别为 0 .93± 0 .0 70 ,0 .90± 0 .0 60 ,0 .82± 0 .0 92和 0 .66± 0 .0 62 ;与对照组相比 ,差异有显著意义 (P<0 .0 5 )。急性重症胆管炎组患者第 1天和第 7天TREM 1mRNA半定量比值高于非重症胆管炎组 (P<0 .0 5 )。TREM 1与TNF α表达水平高度正相关 ( r =0 .75 2 ,P <0 .0 0 1)。结论　TREM 1表达上调可能在胆道感染脓毒症的发生中起重要作用。     

柳豆叶治疗开放性骨折感染性创面40例临床总结

应用单味中草药提取物—柳豆叶治疗开放性骨折感染创面的最大特色是快速促进创面微血管衍生肉芽组织生长,能在裸露的骨骼上长出“骨的肉茅岛”.是临床治疗合并骨骼裸露这一类复杂感染创面的简单实用、疗效显著、极富中医伤科特色的外用药物.经系列实验表明,该药的作用机理主要有:1.抑菌;2.增强机体非特异性免疫系统机能,尤其是巨噬细胞的功能有关。     

The immunology of tetanus

The results of measurements made in two cases of tetanus suggest that the level of tetanus antibody in the blood cannot be used as a diagnostic test for the disease. The investigation also indicated that an attack of tetanus does not result in a rise in tetanus antitoxin antibody levels. This confirms the opinion that tetanus is not an immunising disease. In the cases described, the pseudocholinesterase level was not of diagnostic value.     

Use of Gentamicin in the Treatment of Access-Port Infections

Background: A therapy concept for access-port infections is presented. Methods: Between January 2001 and May 2005, 556 adjustable gastric bands were placed laparoscopically, and access-port infection data were analyzed. 6 early infections and 1 late infection occurred. 2 early infections were treated successfully with placement of a PMMA-chain at the port-site – without port removal. 2 other early infections were treated successfully with port removal and later reconnection; however, infection recurred at the access-port soon after reconnection, so a PMMA-chain was positioned around the port. The last 2 early infections were treated successfully by port removal and later connection of a new access-port surrounded by a PMMA-chain. The late access-port infection appeared to be caused by gastric erosion. Results: Complete healing was achieved in all cases of early infection, and follow-up revealed no complications with subsequent band adjustments. The gastric erosion required removal of the entire banding system. Conclusion: For early port infection, the placement of a PMMA-chain around the subcutaneous port appears to be a safe and effective approach that is less invasive than the usual port removal under general anesthesia. Placing the PMMA-chain is a rapid and simple procedure that allows retention of the original access-port. Once local healing is complete, the port can then be accessed easily and safely for band inflation.     

Severe Intra-abdominal Infection due to Streptococcus <Emphasis Type="Italic">Milleri</Emphasis> Following Adjustable Gastric Banding

Background: Laparoscopic adjustable gastric banding represents a safe and effective bariatric surgical method. Nevertheless, complications such as intraabdominal infections are associated with high morbidity and mortality. Case Report: A 50-year old morbidly obese female patient underwent adjustable gastric banding with the Swedish band (SAGB). After an uneventful postoperative follow-up of 2 years, she developed band infection due to colon microperforation during endoscopic polypectomy. As the causative microorgansim, Streptococcus Milleri was revealed. Band removal was required, and recovery was quite prolonged. Conclusion: Intra-abdominal infection with Streptococcus Milleri can cause severe and life-threatening disease. Therefore, early diagnosis and surgical intervention combined with body weight adapted antibiotic therapy for a sufficiently long period of time seems necessary. In patients with intra-abdominal implanted devices such as the SAGB who undergo endoscopic polypectomy, antibiotic prophylaxis should therefore be considered.