目的 探讨鞘氨醇激酶1(sphingosine kinase1,SphK1)和膜联蛋白A1(Annexin A1)在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)中的表达及相互关系.方法 收集PTC 81例、结节性甲状腺肿(nodular goiter,NG)30例、癌旁正常甲状腺组织(normal thyroid,NT)26例.应用免疫组化En Vision两步法检测各组中SphK1和Annexin A1的表达,并分析两者表达与PTC临床病理特征的关系.结果 SphK1和Annexin A1在PTC中的阳性率(60.5％和61.7％)高于NG组(33.3％和26.7％)以及NT组(30.8％和23.1％)(P均<0.017).Annexin A1和SphK1表达与PTC淋巴结转移和临床分期相关(P均<0.01),与患者性别、年龄、部位、肿瘤大小、TG-Ab值和TPO-Ab值无关(P均>0.05).SphK1与Annexin A1表达呈正相关(P<0.01).结论 SphK1与Annexin A1可能参与PTC的发生、发展和淋巴结转移,提示二者可能成为甲状腺肿瘤良恶性诊断和早期淋巴结转移风险评估的重要生物学因子.

目的 探讨整合素连接激酶(ILK)在大鼠烧伤创面中的表达及对创面愈合的影响.方法 建立大鼠烧伤模型,免疫组化法测定大鼠烧伤创面愈合过程ILK的表达情况,将烧伤大鼠分为ILK转染组、阴性对照组和空白对照组,ILK转染组大鼠创面注射ILK过表达慢病毒,阴性对照组大鼠创面注射空质粒慢病毒,空白对照组大鼠创面注射等量生理盐水;免疫组化法测定各组大鼠烧伤创面愈合过程ILK的表达情况,观察各组大鼠创面愈合时间和愈合率.结果 烧伤组烧伤后1 w和2 w后烧伤创面ILK的光密度值高于对照组(P<0.05),烧伤后3 w烧伤创面ILK光密度值和对照组比较差异无统计学意义(P>0.05).ILK转染创面后,荧光显微镜下见绿色荧光蛋白主要在皮肤基底层表达,部分毛囊中也可见绿色荧光蛋白表达.烧伤后1 w和2 w,ILK转染组创面组织ILK光密度值高于空白对照组和阴性对照组(P<0.05);烧伤后3 w,三组创面组织ILK光密度值比较差异无统计学意义(P>0.05).烧伤后1 w和2 w,ILK转染组创面愈合率高于空白对照组和阴性对照组(P<0.05);烧伤后3 w,三组创面愈合率比较差异无统计学意义(P>0.05);ILK转染组创面愈合时间短于空白对照组和阴性对照组(P<0.05).结论 大鼠烧伤创面中ILK表达量增加,大鼠烧伤创面转染ILK过表达慢病毒后创面中ILK表达量增加,并促进烧伤创面的愈合.

目的 研究负压引流联合重组人酸性成纤维细胞生长因子(recombinant human acidic fi-broblast growth factor,rh-aFGF)治疗糖尿病足Wagner3级创面的临床效果.②方法 选择2016年1~12月我院收治的糖尿病足Wagner3级创面患者60例,以入院病案号为编号,根据随机数字表,将患者随机分成观察组和对照组,各30例.观察组采用间歇性负压模式下负压引流联合rh-aFGF持续冲洗治疗,对照组除冲洗液为生理盐水外,其他操作同观察组.连续治疗7天,7天后拆除负压吸引装置.比较两组治疗前及治疗后第7天感染性实验室指标、创面肉眼观察、计算伤腔容积减少值及肉芽组织生长评分.③结果 治疗后第7天,创面感染性实验室指标(白细胞计数、血沉及C-反应蛋白)观察组改善优于对照组;观察组患者创面肉芽组织生长情况优于对照组;观察组和对照组伤腔容积减少值分别为(11.14±1.14)mL和(3.88±2.10)mL,前者优于后者(P<0.05);实验组和对照组肉芽组织生长评分分别为(1.39±0.66)分和(0.89±0.05)分,前者优于后者(P<0.05).④结论 负压引流联合rh-aFGF持续冲洗是促进糖尿病足Wagner3级创面快速愈合较为有效的方法 之一,值得推广.

糖尿病足是糖尿病患者最常见且最严重的慢性并发症之一,是非外伤性截肢的首要原因,具有发病率高、愈合时间长、治疗难度大及治愈后易复发等特点.因此越来越受到人们的广泛关注和重视,是创面修复领域亟待解决的难题之一.其中,清创是糖尿病足治疗中的首要和关键环节,及时清除影响愈合的失活或坏死组织、腐肉及异物等,并最大限度地保留有活性的组织,不但可以有效地控制创面感染,而且可以加速溃疡创面的愈合.近年来,随着现代医学的不断发展及创面治疗理念的不断更新,糖尿病足清创方法也在不断地丰富,这也使得人们将会面临更多的选择和挑战.本文就糖尿病足的生物清创、化学清创、物理清创、蚕食清创、中医中药清创及联合清创等方法予以综述.

目的 探讨斯钙素l(stanniocalcin 1,STC1)蛋白在甲状腺乳头状癌中的表达,分析其表达与临床病理特征的关系及意义.方法 采用免疫组化EnVision两步法检测甲状腺乳头状癌、结节性甲状腺肿和正常甲状腺组织中STC1的表达水平,应用Western blot法检测甲状腺组织中STC1蛋白的表达.结果 STC1在甲状腺乳头状癌组的表达(60.6％)显著高于结节性甲状腺肿组(30.0％,P ＜0.017)和正常甲状腺组(15.0％,P＜0.01).甲状腺乳头状癌中STC1蛋白表达与患者年龄、性别、肿瘤最大径无关(P＞0.05),与肿瘤淋巴结转移及临床分期相关(P＜0.05).甲状腺乳头状癌组中STC1蛋白的相对表达量(0.831±0.111)也显著高于结节性甲状腺肿组(0.583±0.013,P＜0.01)和正常甲状腺组(0.561±0.011,P＜0.01),结节性甲状腺肿组和正常甲状腺组比较差异无统计学意义(P＞0.05).结论 STC1在甲状腺乳头状癌中呈高表达,且与肿瘤淋巴结转移及临床分期存在相关性,可能在甲状腺肿瘤的恶性转化方面起重要作用,有望成为甲状腺乳头状癌诊断及判断预后的重要辅助参考指标.

目的 探讨线粒体丝氨酸蛋白酶(Omi/HtrA2)在甲状腺乳头状癌中的表达及其与临床病理的关系.方法 采用免疫组织化学方法和蛋白印迹法检测120例甲状腺乳头状癌、40例结节性甲状腺肿及40例正常甲状腺组织中Omi/HtrA2的表达水平,并分析其与甲状腺乳头状癌的临床病理特征的关系.结果 免疫组织化学结果表明,甲状腺乳头状癌组织中Omi/HtrA2蛋白阳性率(71.67％)较结节性甲状腺肿(30.00％)、正常甲状腺组织(32.50％)明显升高,差异有统计学意义(P＜0.05).蛋白印迹法检测结果表明,Omi/HtrA2蛋白在甲状腺乳头状癌组织中的表达量为(1.184±0.060),明显高于结节性甲状腺肿组织(0.599±0.096)和正常甲状腺组织(0.606±0.097),差异有统计学意义(P＜0.05).Omi/HtrA2蛋白的表达与甲状腺乳头状癌的包膜浸润、淋巴结转移、肿瘤临床分期及肿瘤分化有关(P＜0.05).结论 Omi/HtrA2蛋白的表达可能成为判断甲状腺乳头状癌恶化程度及预后的指标.

OBJECTIVE:To investigate the effects of botulinum toxin type A (BTXA) on the excessive expansion speed and blood supply of myocutaneous flap. METHODS:Seven adult Guizhou minipigs of clean grade were included, female or male and weighing 16-20 kg. The 2.4 mL BTXA solution (96 U) was injected in cutaneous muscle (24 points) of one side as experimental group (n = 7), the 2.4 mL saline in the other side as control group (n = 7). Two expanders (200 mL) were implanted beneath the cutaneous muscle on the bilateral flank of each pig symmetrically at 3 days after injection. One week later, the expanders were filled with saline every 4 days with an intracapsular pressure of 11.97 kPa, and accumulative total amounted to 400 mL for 3 weeks in control group and 5 weeks in experimental group. Then the expanders were taken out; the myocutaneous flaps formed and were sutured in situ. The myocutaneous flaps were cut for histological examination and capillary count. The expansion speed of the myocutaneous flap were recorded. The blood supply of the myocutaneous flap were observed by infrared thermography at 1 week after implantation expanders, before removing the expanders, and at 5 days after myocutaneous flap suture in situ. RESULTS:All the animals survived to the end of the experiment. The total expansion time was (54.0 +/- 3.1) days in experimental group and (67.0 +/- 3.9) days in control group, showing significant difference (t = -8.107, P = 0.000). All myocutaneous flaps survived after being sutured in situ. Infrared thermograph revealed that the temperature of the distal myocutaneous flap in experimental group was significantly higher than that in control group at 1 week after implantation of expanders (P < 0.05); at 5 days after myocutaneous flap suture in situ, the temperature of the central flap in experimental group was significantly higher than that in control group (P < 0.05); and there was no significant difference between 2 groups at the other time points (P > 0.05). The histological observation showed that the blood vessel density of the dermal layer and tissue between the capsule and the muscle layer in experimental group was significantly higher than those in control group (P < 0.05). CONCLUSION:When excessive expansion is performed, BTXA can accelerate the expansion rate and improve the blood supply of expanded myocutaneous flaps.

BACKGROUND:Studies regarding matrix metalloproteinase 13 (MMP-13) and transforming growth factor-β1 (TGF-β1) signaling pathways in pathological scars are mainly focused on in vitro culture of fibroblasts;however,the correlation studies are rare on tissue of operation.OBJECTIVE:To observe the expressions of MMP-13 and TGF-β1 in keloid and hypertrophic scars.METHODS:Experimental samples were obtained from the patients,who underwent burn and plastic surgery at the Department of Burn and Plastic Surgery,Workers' Hospital of Tangshan,from June 2004 to June 2008,including 54 patients with keloid,and 42 patients with hypertrophic scars.Normal scar from additional 45 cases were served as control group,normal skins from additional 40 cases were served as normal controls.The expressions of MMP-13 and TGF-β1 protein in keloid,hypertrophic scars,normal scar and normal skin were examined by flow cytometry.RESULTS:The expression of TGF-β1 was obviously greater in the experimental group (keloid and hypertrophic scars) than the control group (normal scar and normal skin) (P < 0.05).The expression of MMP-13 was obviously lower in the experimental group (keloid and hypertrophic scars) than the control group (normal scar and normal skin) (P < 0.05),but the difference between keloid and hypertrophic scars had no significance (P > 0.05).There was a negative correlation between MMP-13 and TGF-β1 in keloid,hypertrophic scars and normal scars (r=0.47,r=0.43,r=0.45;P < 0.05).No notable correlation was found between MMP-13 and TGF-β1 in normal skins (P > 0.05).It is indicated that the expressions of MMP-13 and TGF-β1 are changed,and the synergism of MMP-13 and TGF-β1 may promote the development in pathological scars.

To investigate the roles of MMP-13 protein in scar formation,we constructed MMP-13 eukaryotic recombinant vector and detected its expression in HaCat cells.MMP-13 gene was cloned into eukaryotic expression vector pcDNA3.1(+) by RT-PCR to construct eukaryotic expression plasmid pcDNA3.1(+) / MMP-13,then confirmed by gene sequencing.The recombinant vector was transfected into HaCat cell with Lipofectamine 2000.RT-PCR demonstrated that MMP-13 mRNA expressed abundantly in the HaCat cells,while indirect immunofluorescence reaction and Western blot confirmed the MMP-13 protein expression in the transformed HaCat cells.Zymography and MTT assay showed the expressed MMP-13 protein is competent and can inhibit cell proliferation HaCat.All the results indicate that active MMP-13 protein can be expressed in HaCat cells and can inhibit the cell proliferation of HaCat cells,which laid a basis for studying the protein's role in scar formation,so as to provide an effective scar treatment target.

上腰椎(或胸腰段椎体)肿瘤经侧前方入路可同时完成病变切除、减压、植骨、固定及重建脊柱稳定性,下腰椎手术因受腹主动脉、腔静脉影响,病椎切除后无法同时自侧前方固定脊柱而做到即刻稳定.自2006年1月以来,我们采用后路固定侧前方切除术治疗L3椎体肿瘤12例,效果满意.现报告如下.

<正>上腰椎(或胸腰段椎体)肿瘤经侧前方入路可同时完成病变切除、减压、植骨、固定及重建脊柱稳定性,下腰椎手术因受腹主动脉、腔静脉影响,病椎切除后无法同时自侧前方固定脊柱而做到即刻稳定。自2006年1月以来,我们采用后路固定侧前方切除术治疗L_3椎体肿瘤12例,效果满意。现报告如下。临床资料:本组12例L_3椎体肿瘤患者,男7例,女5例;年龄40～65岁。其中单发转移瘤6例,骨巨细胞瘤5例,多发性骨髓瘤1例;术前脊髓神经功能按FRANKLE分级A级

2003年7月～2005年6月,我们以刘氏烧伤敷料(LBD)辅助治疗Ⅱ°烧伤30例,效果满意.现报告如下.

选择严重烧伤后6 h内入院患者20例,随机分为血浆置换(plasma exchange,PE)组和对照组,每组10例,均进行抗休克、抗感染等常规治疗.置换组患者年龄(28±7)岁,男7例、女3例,烧伤总面积(64±25)%、Ⅲ度(38±9)%TBSA.伤后16～20 h行PE治疗:采用离心式血细胞分离机,抽吸速度20～30 ml/min,枸橼酸抗凝,置换液为新鲜冰冻血浆,置换量为全血量的60%[1],置换时间为2～4 h.对照组年龄(27±6)岁,男9例、女1例,烧伤总面积(53±12)%、Ⅲ度(33±8)%TBSA,不进行PE治疗.

回顾大面积深度烧伤创面处理的历史,大体经历了由保守到积极的发展历程.从第二次世界大战期间采用的包扎疗法以来,Ⅲ°烧伤创面的治疗是在坏死组织溶脱后,培育肉芽组织,以点状或邮票状植皮来封闭创面,但无法解决大面积Ⅲ°创面,大面积深度烧伤的治愈率在很长一段时间都处在停滞不前的状态.