强骨胶囊对老年股骨头近段骨折延迟愈合患者血清BMP-2 及IGF-1水平的影响

目的:探究强骨胶囊对老年股骨头近段骨折延迟愈合患者血清骨形态发生蛋白-2(BMP-2)及胰岛素生长因子-1(IGF-1)水平的影响。方法:选择我院收治的股骨近端骨折延迟愈合的老年患者41例,随机分为实验组及对照组。对照组19例予钙片;实验组22例予强骨胶囊。对比两组的临床疗效及治疗前后血清BMP-2及IGF-1水平的改变。结果:实验组总有效率(95.5%)高于对照组(78.9%),差异具备统计学意义(P0.05)。两组血清BMP-2及IGF-1水平均较治疗前显著升高(P0.05),且实验组血清BMP-2和IGF-1水平较对照组高(P0.05)。治疗后,两组血浆粘度均下降、骨密度值(BMD)均升高(P0.05);与对照组相较,实验组血浆粘度降低、BMD较高(P0.05)。结论:强骨胶囊能够有效改善老年股骨头近段骨折延迟愈合,促进骨折断端的愈合,推测其机制与增加患者血清BMP-2及IGF-1水平有关。     

Comparison of donor-site healing under Xeroform and Jelonet dressings: unexpected findings

Split-thickness skin grafts remain central to the strategy of burn wound treatment. The dressing used to cover the donor wound site has a significant effect on healing parameters. The purpose of this study was to compare split-thickness skin graft donor site reepithelialization under Xeroform and Jelonet dressings. A dermatome was used to cut two consecutive strips of skin from 25 paired donor sites on the thigh, calf, or back of 19 participants. Standardization of the harvest method was achieved by using the same surgeon to harvest the compared skin graft strips, with attention to consistency of dermatome skin-thickness setting, downward pressure, and angle of dermatome approach. A strip of Xeroform or Jelonet was applied to one of each pair of wounds. Epidermal and dermal thickness was measured from biopsy specimens cut at the midpoint of each split-thickness graft strip. The day of final dressing separation was declared the day of complete donor reepithelialization (healing). The mean healing time for Xeroform and Jelonet was 10.4 +/- 2.6 days (n = 25) and 10.6 +/- 2.8 days (n = 25) (p = 0.76) at sites cut to a mean depth of 0.23 +/- 0.08 mm and 0.23 +/- 0.09 mm (p = 0.89), respectively. There was no correlation between graft thickness and healing time for sites dressed with Xeroform (r = 0.17) or Jelonet (r = 0.02). Donors sites reharvested 10 to 21 days after a prior harvest healed an average of 3.1 days earlier than virgin sites (8.4 +/- 1.6 versus 11.5 +/- 2.6 days, p < 0.001), although reharvested grafts were on average 0.05 mm thicker (p = 0.10). The mean thickness of reepithelialized donor-site epidermis (0.13 +/- 0.04 mm, n = 30) was found to be twice the thickness of virgin epidermis from the same sites (0.06 +/- 0.02 mm, n = 38, p < 0.001). Thirty-six grafts harvested with dermatomes set to cut 8/1000 inch (0.20 mm) deep ranged from 0.12 to 0.42 mm thick, with only eight of these grafts measuring within +/-10 percent of the desired thickness setting. Before donor dressing separation, Xeroform and Jelonet dressings were judged to be more comfortable by nine patients and one patient, respectively, whereas no difference was detected by six patients. The authors now use Xeroform as the preferred donor dressing.     

The regulation of IGF-1 by leptin in the pig is tissue specific and independent of changes in growth hormone

A combination of in vivo and in vitro experiments were performed to determine the extent to which exogenous leptin regulates serum growth hormone (GH) and insulin-like growth factor I (IGF-1) concentrations, and the abundance of IGF-1 mRNA in major peripheral tissues. Initially (Experiment 1), a recombinant human leptin analog was administered i.m. to young growing pigs (approximately 27 kg body weight) for 15 days at 0 (control), 0.003, 0.01 and 0.03 mg. kg(-1). day(-1). Although there was no sustained effect of leptin on serum GH, there was a reduction (P < 0.02) in serum IGF-1 at the intermediate dose that paralleled a decrease (P < 0.09) in hepatic IGF-1 expression. Leptin, at these doses, did not reduce feed intake (P > 0.57), nor was there an effect of leptin on dietary nitrogen retention (P > 0.97). In a second experiment, pigs were injected with vehicle or a higher dose of leptin (0.05 mg. kg(-1). day(-1)) for 14 days. A third treatment group was injected with vehicle and pair-fed to the intake of the group treated with leptin. In this study, exogenous leptin resulted in a sustained increase in serum leptin (P < 0.0001) and reduction in feed intake of approximately 30% (P < 0.0001). Serum IGF-1 was depressed in both the leptin-treated and pair-fed groups, relative to the group allowed ad-libitum intake (P < 0.01). Furthermore, there was no difference among treatments in the relative abundance of IGF-1 mRNA in skeletal muscle (P > 0.42) or adipose tissue (P > 0.26), and liver mRNA abundance was actually increased (P < 0.01) by leptin, despite the lower feed intake. Finally, to determine whether leptin altered the secretion of IGF-1 by isolated pig hepatocytes, primary cultures were incubated with leptin for 24 to 48 hr (Experiment 3). Leptin (100 nM) caused a sharp reduction (P < 0.0001) in dexamethasone-induced IGF-1 secretion at 24 hr (47% reduction) and at 48 hr (40% reduction). Collectively, these data indicate that leptin may regulate hepatic IGF-1 production in the pig, independent of GH, but that hepatocyte sensitivity to leptin may be depend on dose and in vitro vs. in vivo conditions.     

游离植皮联合负压封闭引流治疗骨科创面的临床研究

目的：观察游离植皮联合负压封闭引流（vacuumsealingdrainage,后文简称VSD）对骨科创面的疗效,并与植皮后传统加压包扎相比较,为临床实践提供更好的治疗方法。方法：对广州中医药大学第一附属医院创伤骨科2008年3月至2010年2月收治的65例感染创面病例采取手术清创后予VSD引流,合理应用抗生素,创面感染得到控制后,创面干净,肉芽生成良好,外露的肌腱、骨膜表面有新鲜的肉芽组织覆盖,达到植皮的要求后,随机分成两组,其中30例（实验组）采用游离植皮联合VSD法闭合创面,35例（对照组）采用游离植皮加压包扎植皮区,对两组术后的平均换药次数、创面平均愈合时间、植皮成活率情况、平均住院时间（植皮后）、平均抗生素应用次数（植皮后）进行统计学分析,采用t检验和卡方检验,对此两种方法进行评价。结果：植皮联合VSD组与植皮加压包扎组,在平均换药次数、创面平均愈合时间、植皮成活率、平均住院时间（植皮后）、平均抗生素应用次数（植皮后）的对比,有显著性差异（P〈0.05）。结论：创面达到游离植皮条件后,游离植皮联合VSD负压引流可以促使皮片黏附,保持创面洁净,避免皮下渗液积聚,有利于皮片的存活,与植皮加压包扎组相比,减少了平均换药次数,缩短创面平均愈合时间及平均住院时间（植皮后）,减少抗生素平均应用次数,提高了植皮成活率,说明游离植皮联合VSD组优于游离植皮加压包扎组,游离植皮联合VSD法治疗骨科创面有显著疗效。该手术方法操作简单,术后护理方便,是一种较理想的植皮后的固定方法,有利于创面的愈合,值得临床推广应用。     

Studies on the growth of the fetal guinea pig. The effects of nutritional manipulation on prenatal growth and plasma somatomedin activity and insulin-like growth factor concentrations

In guinea pigs between days 41-46 of pregnancy prenatal growth has been manipulated by alteration of nutritional state. Three methods were used. Uterine artery ligation at day 30 of pregnancy depressed fetal growth rate by greater than 50% and was associated with falls in plasma insulin, IGF-1, cortisol, thyroid hormone, glucose, acetate and free fatty acid concentrations and rises in that of IGF-2, glucagon and amino acids. Fetal plasma was inhibitory to sulphate incorporation into pig costal cartilage. Complete food withdrawal from pregnant guinea pigs for 2 days at days 43-44 of pregnancy caused mild fetal growth retardation and similar changes in plasma constituents, except in that plasma IGF-2 concentrations were now depressed and plasma was not inhibitory to sulphate incorporation into pig costal cartilage. Production of hypoglycaemia by 4-times-daily maternal injections of glucose between days 41-46 of pregnancy accelerated fetal growth rate. It also elevated fetal plasma concentrations of insulin, IGF-1, IGF-2, sulphation-promoting activity, thyroid hormones, glucose and free fatty acids and depressed that of glucagon and amino acids. Fetal growth rate during the experimental period showed a good correlation with plasma glucose, insulin and IGF-1 and, to a certain extent, with sulphation-promoting activity. It did not correlate closely with fetal plasma IGF-2 concentration. Hepatic glycogen concentrations showed a good correlation with plasma IGF-2 levels.     

重度烧伤患者应用重组人生长激素治疗的临床效果

目的:研究重组人生长激素对重度烧伤的应用治疗效果。方法:选取重度烧伤患者42例。根据随机数表法,将所有患者分为观察组(n=21)和对照组(n=21),观察组在对照组的基础上给予重组人生长激素治疗。结果:对照组术后24 h血红蛋白及总蛋白水平均低于实验组,差异无统计学意义(P0.05);对照组术后1周血红蛋白水平为(95.57±11.41)g/L,低于实验组的(137.91±14.29)g/L(t=3.726,P0.001);对照组术后2周血红蛋白水平为(80.89±11.38)g/L,低于实验组的(131.28±13.47)g/L(t=3.917,P0.001);实验组术后1周总蛋白水平为(61.47±5.19)g/L,高于对照组的(39.18±2.76)g/L(t=3.927,P0.001);实验组术后2周总蛋白水平为(55.78±6.38)g/L,高于对照组的(36.81±5.17)g/L(t=3.847,P0.001)。实验组术后24h的TNF-α和IL-6高于对照组,差异无统计学意义(P0.05);实验组术后2周的TNF-α、IL-6均明显低于对照组,差异有统计学意义(P0.001);实验组术后2周的TNF-α、IL-6均明显低于对照组,差异有统计学意义(P0.001);观察组的住院时长为(47.82±7.46)天,显著低于对照组的(79.36±8.10)天(t=4.275,P0.001);观察组的供皮区、植皮区、深Ⅱ度痂下愈合时间均显著低于对照组的,差异有统计学意义(P0.001)。结论:rh GH对重度烧伤的疗效非常显著,值得在临床中推广。     

重组人生长激素治疗儿童特发性矮小症的疗效及对血清Ghrelin和IGF-1水平的影响

目的:探讨重组人生长激素(rhGH)治疗儿童特发性矮小症(ISS)的疗效及对血清饥饿激素(Ghrelin)、胰岛素样生长因子-1(IGF-1)水平的影响。方法:选取2014年1月-2016年8月期间我院收治的ISS患儿114例为研究对象。按照随机数字表法分为实验组(n=57)与对照组(n=57)。其中对照组给予常规治疗,实验组在对照组基础上联合rhGH治疗,两组疗程均为12个月。比较两组患儿的临床疗效,同时观察并对比两组患儿治疗前后血清Ghrelin以及IGF-1水平。结果:治疗后两组患儿身高、生长速率均较治疗前升高,且实验组高于对照组,差异有统计学意义(P0.05);治疗后两组患儿体重、总甲状腺素、骨龄、空腹血糖水平较治疗前比较差异无统计学意义(P0.05)。治疗后两组患儿血清Ghrelin水平较治疗前降低,且实验组低于对照组,血清IGF-1水平较治疗前升高,且实验组高于对照组,差异均有统计学意义(P0.05)。实验组不良反应发生率为5.26%,与对照组的0.00%比较,差异无统计学意义(P0.05)。结论:ISS患儿应用rhGH治疗效果满意,可明显改善ISS患儿体内血清IGF-1、Ghrelin水平,安全无副作用,促进患儿健康成长。     

Free bone graft reconstruction of irradiated facial tissue: experimental effects of basic fibroblast growth factor stimulation

A study was undertaken to evaluate the potential utility of basic fibroblast growth factor in the induction of angiogenesis and osseous healing in bone previously exposed to high doses of irradiation. Thirty New Zealand rabbits were evaluated by introducing basic fibroblast growth factor into irradiated mandibular resection sites either prior to or simultaneous with reconstruction by corticocancellous autografts harvested from the ilium. The fate of the free bone grafts was then evaluated at 90 days postoperatively by microangiographic, histologic, and fluorochrome bone-labeling techniques. Sequestration, necrosis, and failure to heal to recipient osseous margins was observed both clinically and histologically in all nontreated irradiated graft sites as well as those receiving simultaneous angiogenic stimulation at the time of graft placement. No fluorescent activity was seen in these graft groups. In the recipient sites pretreated with basic fibroblast growth factor prior to placement of the graft, healing and reestablishment of mandibular contour occurred in nearly 50 percent of the animals. Active bone formation was evident at cortical margins adjacent to the recipient sites but was absent in the more central cancellous regions of the grafts.     

重组人生长激素对老年男性慢性心力衰竭患者血脂代谢影响的研究

目的：探讨重组人生长激素在治疗老年男性慢性心力衰竭时对血脂代谢的影响。方法：将对87例老年慢性心力衰竭患者随机分别进行常规心力衰竭治疗组（CHF对照组）（n=46）和常规治疗基础上加用生长激素治疗组（CHF实验组）（n=41）及正常对照组（n=10）;均连续治疗3个月,观察治疗前后生长激素（GH）、（胰岛素样生长因子-1（IGF-1）、总胆固醇（1℃）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-c）、高密度脂蛋白胆固醇（HDL-C）等各项指标的变化。结果：治疗前,各组之间GH、IGF-1水平无明显差异。治疗后,CHF实验组患者GH（0．71±0．34／350．96±0．48）、IGF-1（95．64±21．11 vs 111．64±23．14）水平较治疗前明显升高,CHF对照组治疗前后GH（0．81±0．32 vs 0．79±0．29）、IGF-1（97．82±19．74 vs 99．65±20．11）水平无明显差异。治疗后CHF实验组与CHF对照组相比GH（0．96±0．48 vs 0．79±0．29）、IGF-1（111．64±23．14 vs 99．65±20．11）水平显著升高（P〈0．05）。治疗前,3组患者血脂各项指标无明显差异（P〉0．05）,治疗后,CHF实验组LDL-C（2．11±0．82 vs 1．76±0．51）、TC（3．78±1．34 vs 3．21±1．17）水平较治疗前有所下降（P〈0．05）,而HDL-C（1．10±0．31 vs 0．99±0．28）、TG（1．89±1．07 vs 1．66±0．95）水平较治疗前无显著差异（P〉0．05）。然而,CHF对照组治疗前、后相比,LDL-C、HDL-C、TC、TG水平无显著差异（P〉0．05）。结论：应用重组人生长激素治疗老年慢性心力衰竭,GH参与了血脂代谢,可降低LDL-C、TC水平,但对HDL-C、TG水平无明显影响。故在长期应用生长激素时需要关注血脂代谢,及时调整血脂治疗。     

丹参酮IIA磺酸钠对烧伤植皮创面愈合及瘢痕形成的影响

目的:探讨丹参酮IIA磺酸钠注射液对烧伤患者植皮创面愈合及瘢痕形成情况的影响。方法:选取2014年3月至2014年12月我院收治的烧伤植皮患者62例,根据临床用药分为试验组(使用丹参酮IIA磺酸钠注射组)与对照组(未使用丹参酮IIA磺酸钠注射液)。比较两组创面愈合情况,术后植皮成活率及愈合后瘢痕形成情况。结果:1经治疗,两组创面均愈合,试验组患者植皮成活率为(97.12±1.89)%,高于对照组(89.96±1.86)%,差异具有统计学意义(P0.01);试验组愈合时间较对照组短,试验组创面愈合时间为10.1±1.9天,对照组为14.3±2.3天,两组比较差异具有统计学意义(P0.001);瘢痕形成评价试验组均优于对照组,差异具有统计学意义,其中血肿面积(1.50±0.03 vs.3.04±0.08,P0.01)、畸形率[2(6.45)vs.8(25.81),P0.05]、感染率[2(6.45)vs.9(29.03),P0.05]。结论:丹参酮IIA磺酸钠注射液对于烧伤植皮创面的患者,能够提高植皮成活率,促进创面愈合,减轻瘢痕形成,改善创面愈合质量。     

Influence of ghrelin on gastric and duodenal growth and expression of digestive enzymes in young mature rats.

Ghrelin, a nature ligand for the growth hormone secretagogue receptor (GHS-R), stimulates a release of growth hormone, prolactin and adrenocorticotropic hormone. Also, ghrelin increases food intake in adult rats and humans and exhibits gastroprotective effect against experimental ulcers induced by ethanol or stress. The aim of present study was to examine the influence of ghrelin administration on gastric and duodenal growth and expression of pepsin and enterokinase in young mature rats with intact or removed pituitary. METHODS: Two week after sham operation or hypophysectomy, eight week old Wistar male rats were treated with saline (control) or ghrelin (4, 8 or 16 nmol/kg/dose) i.p. twice a day for 4 days. Expression of pepsin in the stomach and enterokinase in the duodenum was evaluated by real-time PCR. RESULTS: In animals with intact pituitary, treatment with ghrelin increased food intake, body weight gain and serum level of growth hormone and insulin-like growth factor-1 (IGF-1). These effects were accompanied with stimulation of gastric and duodenal growth. It was recognized as the significant increase in gastric and duodenal weight and mucosal DNA synthesis. In both organs, ghrelin administered at the dose of 8 nmol/kg caused maximal growth-promoting effect. In contrast to these growth-promoting effects, administration of ghrelin reduced expression of mRNA for pepsin in the stomach and was without effect on expression of mRNA for enterokinase in the duodenum. Hypophysectomy alone lowered serum concentration of growth hormone under the detection limit and reduced serum level of IGF-1 by 90%. These effects were associated with reduction in daily food intake, body weight gain and gastroduodenal growth. In hypophysectomized rats, administration of ghrelin was without significant effect on food intake, body weight gain or growth of gastroduodenal mucosa. Also, serum concentration of growth hormone or IGF-1 was not affected by ghrelin administration in rats with removed pituitary. CONCLUSION: Administration of ghrelin stimulates gastric and duodenal growth in young mature rats with intact pituitary, but inhibits expression of mRNA for pepsin in the stomach. Growth hormone and insulin-like growth factor-1 play an essential role in growth-promoting effects of ghrelin in the stomach and duodenum.     

Study of effects of porcine skin and bovine dermis on the healing of split-skin graft donor sites in humans.

A study was undertaken of the effects of heterografts (lyophilized porcine skin or bovine dermis) on the healing of split-skin graft donor sites. When compared with a petrolatum gauze dressing, no advantages were found. Some disadvantages developed, however, which led us to discontinue their use.     

Changes in the blood chemistry of rainbow trout, Salmo gairdneri Rich, in relation to dietary protein level, and an anabolic steroid hormone, ethylestrenol

The effect of feeding isocaloric test diets containing 35, 45 and 55% protein, with and without inclusion of the anabolic steroid hormone, ethylestrenol, was studied in rainbow trout, Salmo gairdneri , in relation to blood chemistry. The control (no hormone) and experimental diets (hormone-supplemented), were fed for a total of 60 days, after which time all groups of fish were fed an identical commercial diet with no hormone for a further 30 days (withdrawal period). After 60 days, the body weights offish fed the 35 and 45% experimental diets were significantly greater than their respective controls, and after hormone withdrawal, increased growth was still apparent in the 35% experimental group.
No significant changes in serum amino acid nitrogen (AAN), protein, or glucose in relation to the dietary protein level, or inclusion of steroid, were observed after 30 days. Serum creatinine, however, increased with an increase in dietary protein, and was significantly higher in the 35% experimental group than the respective control. After 60 days, the most significant observation was the marked increase in serum glucose with an increase in dietary protein, but respective control and experimental values were not significantly different at this time. Following a 30-day withdrawal period, serum AAN in the 55% experimental group was significantly higher than the control, whereas serum protein, creatinine, and glucose stabilized to similar concentrations in all groups. Over the 90-day period of feeding, in both control and experimental groups, serum AAN and protein tended to increase, serum creatinine and glucose to decrease, whilst haematocrit remained constant. It is concluded that addition of ethylestrenol to trout diets has apparently little effect on serum metabolite concentrations and haematocrit, the most significant variations being related more to diet composition and duration of study.     

血流变学指标及血清学指标在骨折延迟愈合患者中的临床意义

目的:探讨血流变学和血清学指标在骨折延迟愈合患者中的变化及其临床意义。方法:随机选取2010年1月~2016年6月在我院进行手术治疗的骨折延迟愈合及骨折正常愈合患者各90例,分别为观察组与对照组,对比分析两组患者术后第1、8、12周时血清可溶性血管细胞黏附分子1(sVCAM-1)、胰岛素样生长因子1(IGF-1)、血小板衍生生长因子(PDGF)及人可溶性细胞间黏附分子1(sICAM-1)和红细胞刚性指数、红细胞聚集指数、血浆黏度的差异。结果:术后第1、8、12周两组血清学及血流变学各指标整体相比差异均具有统计学意义(均P0.05),且组内两两比较均具有统计学差异(均P0.05)。术后8、12周观察组血清s ICAM-1、sVCAM-1、红细胞刚性指数、红细胞聚集指数、血浆黏度均高于对照组,而血清PDGF、IGF-1均低于对照组,比较差异均具有统计学意义(均P0.05)。结论:骨折患者血清sICAM-1、PDGF、IGF-1、sVCAM-1及红细胞刚性指数、红细胞聚集指数、血浆黏度水平会随着病程进展发生变化,并且血清sICAM-1、sVCAM-1及红细胞刚性指数、红细胞聚集指数、血浆黏度水平的升高,血清PDGF、IGF-1水平的降低可能是引起骨折延迟愈合的重要因素,对于骨折患者的临床治疗具有重要临床意义。     

营养状况对幼年鲤鱼肝脏IGF-Ⅰ mRNA表达的影响

通过室外喂养观察3种营养状况对幼年鲤鱼生长、血清生长激素（GH）水平和组织胰岛素样生长因子－Ⅰ（IGF-Ⅰ）mRNA表达的影响。一组鱼喂含40％酪蛋白的饵料（H组）,一组鱼喂含20％酪蛋白的饵料（L组）,饵料的总能量相同;另一组鱼先饥饿32天再投喂含40％酪蛋白的饵料。禁食后饥饿组鲤鱼体重和体长的生长受阻,在第16天饥饿组鱼血清GH水平明显升高,到第32天达到H组的4倍;而肝组织IGF－Ⅰ mRNA水平在第16天无明显下降,但是到第32天已降到不到H组的一半。鲤鱼其它组织饥饿32天未发现IGF－Ⅰ mRNA表达有明显变化。饥饿32天后开始投喂含40％酪蛋白的饵料,鲤鱼生长、肝组织IGF－Ⅰ mRNA的表达水平逐渐恢复,再投喂16天皆与H组无明显差异。再投喂过程中,GH水平也逐渐下降,第16天恢复正常。实验结果提示鲤鱼营养对肝组织IGF－Ⅰ mRNA的表达有调节作用。营养缺乏将导致鲤鱼肝组织IGF－Ⅰ mRNA的表达水平也相应恢复正常,从而导致鲤鱼生长恢复。同时,实验结果也提示,鲤鱼肝以外的组织IGF－Ⅰ mRNA表达不受营养调节。L组鲤鱼在喂养过程中,体重和体长的增长比H组低,但即使喂养40天,两组鱼体重和体长并无显著差异。两组鱼血清生长激素水平和各组织IGF－Ⅰ mRNA的表达水平到实验第32天也未发现有明显差异。推测在鲤鱼含正常能量和20％酪蛋白的饵料已能维持正常IGF－Ⅰ mRNA的表达。L组和H组鱼肝IGF－Ⅰ mRNA在喂养1个月后仍无显著差异也可能与实验时间较短有关。     

负压封闭引流技术对颈部及躯干深度烧伤植皮修复患儿生活质量和血清炎症因子的影响

摘要 目的：观察负压封闭引流技术（VSD）对颈部及躯干深度烧伤植皮修复患儿生活质量和血清炎症因子的影响。方法：选取2016年4月~2020年12月期间我院接收的颈部及躯干深度烧伤患儿70例,采用计算机系统随机编号的方式将患儿分为2组,分别为对照组35例和实验组35例。对照组患儿进行游离植皮后常规包扎处理,实验组患儿进行游离植皮后在VSD下进行包扎处理。考察两组患儿疗效指标。术前、出院后30 d采用36项健康调查简表（SF-36）评估所有患儿的生活质量。术前、术后7d观察两组炎症因子水平变化。记录两组患儿并发症发生率。结果：实验组术后7 d植皮成功率高于对照组,术后住院天数、术后创面愈合时间短于对照组,术后换药次数少于对照组（P<0.05）。出院后30 d,两组患儿生理功能(PF)、总体健康 (GH)、生理职能(RP)、活力 (VT)、躯体疼痛(BP)、情感职能 (RE)、社会功能(SF)及精神健康(MH)评分均较术前升高,且实验组高于对照组（P<0.05）。术后7 d,两组患儿血清白介素-6（IL-6）、C 反应蛋白（CRP）和降钙素原（PCT）水平均较术前降低,且实验组低于对照组（P<0.05）。实验组的并发症总发生率低于对照组（P<0.05）。结论：针对颈部及躯干深度烧伤植皮修复患儿,在VSD下进行包扎处理,可提高植皮成功率,缩短住院天数及创面愈合时间,减少换药次数,降低并发症发生率,还可提高患儿生活质量及减轻机体炎性反应,值得临床借鉴。     

An alternative method to minimize pain in the split-thickness skin graft donor site

In the art of plastic surgery, the reconstruction of tissue defects to obtain cosmetic and functional recovery is the major concern. Skin grafting is the most frequently used procedure for reconstructing defects of various size and anatomical localizations. On the other hand, donor-site problems associated with this invaluable procedure are inevitable. Various methods are used in the postoperative management of the partial-thickness donor site created during the harvest of a split-thickness skin graft. Each technique has the potential for complications of fluid loss, excessive pain, prolonged period of healing and immobilization, hypertrophic scarring, and undesirable pigmentation. Donor-site pain is probably the most disturbing complication in the early postoperative period. The aim of this article is to point out the significance of donor-site pain, which has not been emphasized thoroughly in the literature, and to introduce flap skin as a potential graft donor site for patients in whom reduction of donor-site morbidity is of primary concern. The principal goal of the technique described in this article is to eliminate donor-site pain by harvesting the graft from the flap that is insensate after the elevation. In 15 patients, the overlying skin of the flap that had been used for reconstructive purposes was used as the donor site (group I). In the remaining 23 patients, the posterolateral thigh was used as the donor site (group II). Donor-site discomfort was recorded during the first 8 days postoperatively using a visual analogue scale. To analyze the data, we used the Friedman test, Dunn's multiple comparison test, and Mann-Whitney U test. It was observed that the visual analogue scale of both of the groups showed a significant decrease within days (group I, p < 0.0001; group II, p < 0.0001). The mean pain scores were significantly lower in group I than in group II (p < 0.0001). When donor-site pain is of primary concern, this procedure provides uneventful and comfortable healing while avoiding postoperative pain in the donor site. For that reason, this technique might be used in appropriate cases to minimize donor-site pain.     

Keratinocytes derived from embryonic stem cells induce wound healing in mice

The skin plays an important role in defending the body against the environment. Treatments for burns and skin injuries that use autologous or allogenic skin grafts derived from adult or embryonic stem cells are promising. Embryonic stem cells are candidates for regenerative and reparative medicine. We investigated the utility of keratinocyte-like cells, which are differentiated from mouse embryonic stem cells, for wound healing using a mouse surgical wound model. Mice were allocated to the following groups: experimental, in which dressing and differentiated cells were applied after the surgical wound was created; control, in which only the surgical wound was created; sham, in which only the dressing was applied after the surgical wound was created; and untreated animal controls with healthy skin. Biopsies were taken from each group on days 3, 5 and 7 after cell transfer. Samples were fixed in formalin, then stained with Masson’s trichrome and primary antibodies to interleukin-8 (IL-8), fibroblast growth factor-2 (FGF-2), monocyte chemoattractant protein-1 (MCP-1), collagen-1 and epidermal growth factor (EGF) using the indirect immunoperoxidase technique for light microscopy. Wound healing was faster in the experimental group compared to the sham and control groups. The experimental group exhibited increased expression of IL-8, FGF-2 and MCP-1 during early stages of wound healing (inflammation) and collagen-1 and EGF expression during late stages of wound healing (proliferation and remodeling). Keratinocytes derived from embryonic stem cells improved wound healing and influenced the wound healing stages.     

An experimental model of partial insulin-like growth factor-1 deficiency in mice

Insulin-like growth factor-1 (IGF-1) is responsible for many systemic growth hormone (GH) functions although it has an extensive number of inherent activities (anabolic, cytoprotective, and anti-inflammatory). The potential options for IGF-1 therapy arise as a promising strategy in a wide list of human diseases. However, deeper studies are needed from a suitable animal model. All human conditions of IGF-1 deficiency consist in partially decreased IGF-1 levels since total absence of this hormone is hardly compatible with life. The aim of this work was to confirm that heterozygous Igf-1 ^+/? mice (Hz) may be considered as an appropriate animal model to study conditions of IGF-1 deficiency, focusing on early ages. Heterozygous Igf-1 ^+/? mice were compared to homozygous Igf-1 ^+/+ by assessing gene expression by quantitative PCR, serum circulating levels by ELISA, and tissue staining. Compared to controls, Hz mice (25 days old) showed a partial but significant reduction of IGF-1 circulating levels, correlating with a reduced body weight and diminished serum IGFBP-3 levels. Hz mice presented a significant decrease of IGF-1 gene expression in related organs (liver, bone, testicles, and brain) while IGF-1 receptor showed a normal expression. However, gene expression of growth hormone receptor (GHR) was increased in the liver but reduced in the bone, testicles, and brain. In addition, a significant reduction of cortical bone thickness and histopathological alterations in the testicles were found in Hz mice when compared to controls. Finally, the lifelong evolution of IGF-1 serum levels showed significant differences throughout life until aging in mice. Results in this paper provide evidence for considering heterozygous mice as a suitable experimental model, from early stages, to get more insight into the mechanisms of the beneficial actions induced by IGF-1 replacement therapy.     

糖尿病对大鼠骨折愈合影响的实验研究

目的:观察糖尿病大鼠的骨折愈合过程,探讨糖尿病影响大鼠骨折愈合的可能的机制,为临床实践提供理论依据。方法:雄性Wister大鼠140只,随机分成二组,每组70只,A组为糖尿病骨折组;B组为非糖尿病骨折组。建立糖尿病动物模型后,无菌条件下在各组大鼠胫骨中点用手术方法制成骨折模型。术后1周、2周、4周、6周、8周各时间点进行X线检查,观察骨折愈合情况。术后1周、2周、3周、4周、6周、8周分别用ELISA法检测血清中IGF-1含量。分别在1、2、4、6、8周各时间点观察5只大鼠骨痂生长情况并取骨折断端组织行HE染色光镜观察。术后4周、6周、8周每组处死10只大鼠留取双侧胫骨标本,冷冻保存后集中进行生物力学检测。结果:1、大体标本观察结果:各时间点A组骨痂生长减缓延迟。2、X线结果:A组骨折愈合质量在各时间点均明显低于B组。3、生物力学测定结果:4周、6周、8周个时间点A组骨折处骨痂的机械强度均明显低于B组。4、组织学染色显示:术后各时间点1、2、4、6、8周A组与B组相比骨折处局部骨痂成熟延迟并且软骨细胞肥大。5、血清IGF-1含量测定:A组大鼠血清中IGF-1含量低于B组,且高峰延迟1周。结论:1.患有糖尿病后大鼠骨折愈合质量差,比较容易出现愈合延迟甚至不愈合;2.患有糖尿病的大鼠骨折后血清中的IGF-1表达明显低于对照组,且高峰推迟1周。