ObjectiveTo investigate the relationship between the nucleotide binding oligomerization domain like receptor protein 3 (NLRP3) inflammasome and inflammatory reaction of venous ulcer of lower extremity.MethodsTwenty-four patients with active venous ulcer of lower extremity (active ulcer group), 24 patients with non exudative venous ulcer of lower extremity as positive control (non-active ulcer group), and 24 patients with traumatic wound as negative control (traumatic-wound group) were enrolled. The clinical data of the three groups were compared, the tissue samples around the wound were harvested, and the expressions of NLRP3 protein were detected by immunohistochemistry among the three groups. Enzyme linked immunosorbent assay (ELISA) was used to detect the IL-1β and IL-18 protein levels, RT-PCR was used to detect the mRNA expressions of apoptosis associated speck like protein containing CARD (ASC), caspase-1, c-Jun N-terminal kinase (JNK), p38, nuclear factor (NF)-κB p65 and NF-κB inhibitor alpha (NF-κB IkBα), and Western blotting was performed to evaluate the level of NLRP3 inflammasome in wound tissues.ResultsThe inflammatory response in the non-active ulcer group and trauma-wound group were milder than that in the active ulcer group. The levels of IL-1β and IL-18 proteins in the active ulcer group were higher than those in the non-active ulcer group and the traumatic-wound group [IL-1β: (146.621±11.597) ng/L vs. (80.967±14.213) ng/L vs. (84.962±19.484) ng/L, F=136.200, P<0.001; IL-18: (119.814±12.788) ng/L vs. (72.899±17.220) ng/L vs. (48.131±10.407) ng/L, F=167.910, P<0.001]. The results of RT-PCR showed that the mRNA expressions of ASC [(0.030±0.012) ng/L vs. (0.021±0.005) ng/L vs. (0.016±0.004) ng/L, F=18.106, P<0.001], caspase-1 [(0.054±0.012) ng/L vs. (0.013±0.009) ng/L vs. (0.018±0.006) ng/L, F=130.372, P<0.001], NF-κB p65 [(0.093±0.015) ng/L vs. (0.038±0.013) ng/L vs. (0.043±0.014) ng/L, F=110.950, P<0.001], NF-κB IkB-α [(0.085±0.015) ng/L vs. (0.078±0.015) ng/L vs. (0.041±0.016) ng/L, F=53.070, P<0.001], and JNK [(0.075±0.018) ng/L vs. (0.042±0.013) ng/L vs. (0.039±0.014) ng/L, F=41.271, P<0.001] in the wound tissues of the active ulcer group were higher than those in the non-active ulcer group and the traumatic-wound group. And the mRNA expression of p38 in the wound tissues of the active ulcer group was lower than that in the non-active ulcer group [(0.050±0.008) ng/L vs. (0.064±0.014) ng/L, P<0.05]. The result of Western blotting showed that the relative expression level of NLRP3 protein in the wound tissues of the active ulcer group was higher than that in the trauma-wound group and non-active ulcer group (0.767±0.272 vs. 0.605±0.212 vs. 0.556±0.183, F=4.804, P=0.012).ConclusionNLRP3 inflammasome is closely related to the wound in venous ulcer of lower extremity and provides a new target to the therapy of venous ulcer of lower extremity.
The experience of the treatment of 5 thoracic ulcers and 1 large and deep neck ulcer was reported. Vascularized latissimus dorsi and rectus abdominis myocutaneous flaps were used to treat the ulcers with one failure. No recurrence was foundduring the followup from one to five years. In the early stage of acute inflammatory necrosis, treatment was focused on debridement. In order to remove the necrotic tissue and provide good drainage, it was not appropriate to cover the wound immediately. In the chronic stage, the radiation ulcers with their adjacent tissues should be excised. Island myocutaneous flap and axial pattern skin flap were selected to repair the wound. If the wound was too large, two flaps may be combined to cover it. No matter what kind of flap was chosen, the donor site should be far away from the ulcer.
Objective To explore the effect of laparoscopic highly selective vagotomy (Hill) on the treatment for acute perforating duodenal ulcer. Methods In 19 patients with acute perforating duodenal ulcers, laparoscopic repair of the perforation, laparoscopic freeing of the vagus, cutting off of posterior vagal trunk, and highly selective resection of anterior vagal trunk were performed. Results In all 19 cases the operation was successful. No patient was converted into open highly selective vagotomy. Ulcer symptoms of 17 patients disappeared after operation, and gastroscopy in follow up after 6 months showed that the ulcers had healed. The postoperative ulcer symptoms of 2 patients were markedly relieved and were easily controlled by medication. Conclusion The treatment of acute perforating duodenal ulcer by laparoscopic highly selective vagotomy (Hill) has the advantages of minor trauma, rapid postoperative recovery, and good results, it is a good procedure for the treatment of perforating duodenal ulcer.
ObjectiveTo investigate the effects of intermittent irrigation of insulin solution combined with continuous drainage of vacuum sealing drainage (VSD) in chronic diabetic lower limb ulcers. MethodsBetween January 2012 and December 2014, 45 patients with diabetic lower limb ulcer were treated with VSD (group A, n=15), with VSD combining irrigation of normal saline (group B, n=15), and with VSD combining irrigation of insulin solution (group C, n=15) after debridement. There was no significant difference in gender, age, course of ulcers, area and depth of wound, glycosylated hemoglobin, and Wagner grade among 3 groups (P>0.05), and the data were comparable. The levels of fasting blood glucose, 2-hour postprandial blood glucose, and random blood glucose were determined everyday during treatment. The contents of insulin growth factor 1 (IGF-1), tumor growth factor α (TNF-α), and nitric oxide (NO) in necrotic tissue after drainage were determined. The coverage rate and thickness of granulation tissue and clearance rate of bacteria in wound were calculated, the granulation tissue in the center of the wound was harvested for pathological observation with HE staining after 6 days of treatment. The second stage operation was performed according to the condition of wounds, and the time to the second stage operation and the method of the second stage operation were recorded and the survival rate of grafted skin or flap was calculated. ResultsThe pathological staining showed that there were a few new microvessels and fibroblasts in group A after treatment;more new microvessels and fibroblasts were observed in group B;and many new microvessels and fibroblasts were found in group C. There was no significant difference in levels of fasting blood glucose, 2-hour postprandial blood glucose, and random blood glucose among 3 groups during treatment (P>0.05). The coverage rate and thickness of granulation tissue and clearance rate of bacteria in group C were significantly higher than those in groups A and B after treatment (P<0.05). The contents of IGF-1 and NO were significantly increased and TNF-α was significantly decreased in group C when compared with those in group A (P<0.05). Compared with group B, IGF-1 and NO contents were significantly increased at 3-6 days and at 2-6 days respectively, and TNF-α content was significantly decreased at 3-6 days in group C (P<0.05). The method of the second stage operation showed no significant difference among 3 groups (χ2=2.920, P=0.230), but the time to the second stage operation in group C was significantly shorter than that in groups A and B (P<0.05), and the survival rate of grafted skin or flap in group C was significantly higher than that in groups A and B (P<0.05). ConclusionThe treatment of diabetic lower limb ulcers with intermittent irrigation of insulin solution combined with continuous drainage of VSD can reduce inflammatory reaction effectively, promote development of granulation tissue, improve recovery function of tissue, increase the rate and speed of wound healing obviously, but it has no effect on blood glucose levels.
Objective To assess the clinical efficacy and safety of proton pump inhibitor （PPI） and H2RA for stress ulcer bleeding in stroke patients. Methods Randomized controlled trials （RCT） were identified from MEDLINE （ 1966- Oct. 2005 ） ,EMBASE （ 1984- Oct. 2005 ）, The Cochrane Library （ Issue 4,2005 ）, CBMdisc （ 1980- Oct. 2005 ） and VIP（ 1980- Oct. 2005 ）. We handsearched the related published and unpublished data and their references. The quality of included trials was evaluated. Data were extracted by two reviewers independently with a designed extraction form. RevMan 4. 2.7 software was used for data analysis. Results Twenty RCT were included with 2 624 patients. The results of meta-analysis were listed as follows： （1） stress ulcer bleeding （SUB） ： PPI （ OR 0.14,95% CI 0.08 to 0.24, NNT = 3 ） and H2RA （OR 0.24,95% CI 0.15 to 0.39, NNT =5） significantly reduced the incidence of SUB in comparison with control group. PPI significantly reduced the incidence of SUB compared with H2R.A（P 〈0. 00001 ）. （2） Mortality： PPI （OR 0.22,95% CI 0. 11 to 0.47, NNT =8） and H2RA （OR 0.53,95% CI 0. 34 to 0.81, NNT =16） significantly decreased the mortality compared with non-prophylaxis group. PPI significantly decreased the mortality compared with H2RA （OR 0.28,95% CI 0.09 to 0. 89）. （3） Adverse effect： There were not evident adverse effects in both PPI and H2RA groups. Conclusions PPI and H2RA may reduce the incidence and mortality of SUB in stroke patients, and PPls are better in reducing incidence of SUB than H2RA.
Object ive To explore the ef fect s of di f ferent surgical methods on plantar ulcer s in leprosy. Methods The cl inical data of 71 patients with leprosy plantar ulcers and treated with different surgical methods between October 1950 and October 2006 were analyzed retrospectively. In group A, 34 cases underwent debridement, including 26 males and 8 females aged 53-88 years old (average 72.4 years old); the course of ulcer averaged 29.0 years; the size of ulcer ranged from 5 cm × 3 cm × 2 cm to 11 cm × 7 cm × 3 cm; the disabil ity degrees of the affected foot was mild in 25 cases andsevere in 9 cases according to the self-designed evaluation system. In group B, 22 cases received foot pressure rebuilding surgery, including 19 males and 3 females aged 48-83 years old (average 69.8 years old); the course of ulcer averaged 33.5 years; the size of ulcer ranged from 5 cm × 3 cm × 2 cm to 12 cm × 7 cm × 3 cm; the disabil ity degrees of the affected foot was mild in 12 cases and severe in 10 cases. In group C, 15 cases were repaired with the transposition of toe flap, foot arch flap, acrotarsium flap, or medial tibia flap, including 11 males and 4 females aged 43-73 years old (average 64.6 years old); the course of ulcer averaged 29.3 years; the size of ulcer ranged from 6 cm × 3 cm × 2 cm to 11 cm × 5 cm × 3 cm; the disabil ity degrees of the affected foot was mild in 9 cases and severe in 6 cases. No significant differences were evident among three groups in terms of the general information (P gt; 0.05), except for the difference between group A and group C on age (P lt; 0.05). Results Group A: 19 out of 34 cases healed and the average heal ing time was 46.8 days; all patients were followed up for 2-45 years (average 17.2 years); the rate of ulcer heal ing 1 year after operation was 55.9% (19/34); 12 healed ulcer patients relapsed at average 1.5 years after operation; the rate ofulcer heal ing at last follow-up was 20.6% (7/34). Group B: 18 out of 22 cases healed and the average heal ing time was 29.2 days; all patients were followed up for 2-50 years (average 13.3 years); the rate of ulcer heal ing 1 year after operation was 81.8% (18/22); 7 healed ulcer patients relapsed at average 3.3 years after operation; the rate of ulcer heal ing at last follow-up was 50.0% (11/22). Group C: 14 out of 15 cases healed and the average heal ing time was 27.1 days; all patients were followed up for 3-12 years (average 8.8 years). The rate of ulcer heal ing 1 year after operation was 93.3% (14/15); 7 healed ulcer patients relapsed at average 4 years after operation; the rate of ulcer heal ing at final follow-up was 46.7% (7/15). For the rate of ulcer heal ing 1 year after operation, there was a significant difference between group A and group B, and between group A and group C (P lt; 0.05), but no significant difference was evident between group B and group C (P gt; 0.05). For the rate of ulcer heal ing at the final follow-up visit, there was a significant difference between group A and group B (P lt; 0.05), but no significant difference was evident between group A and group C, and between group B and group C (P gt; 0.05). Conclusion The surgical treatment of plantar ulcers in leprosy should include the alleviation of the plantar high-pressure zone and the transposition of the flaps, providing good short-term and long-term therapeutic effect.
ObjectiveTo enhance nurses'awareness of pressure ulcer management and reduce the incidence of pressure ulcers by using the risk early warning management idea. MethodsWe analyzed the data of patients with pressure ulcers and patients at high risk of pressure ulcers reported through nursing software between January 2009 and December 2011.Then,we timely and actively gave instructions and formulated corrective measures for the weak points in order to optimize pressure ulcer management process. ResultsNurses'awareness of prevention of pressure ulcers was improved,and the number of patients at high risk of pressure ulcers reported was increased year by year.From 2009 to 2011,the ratio of extremely high-risk and high-risk patients to all discharged patients was respectively 0.76%,1.01% and 0.76%;while from 2009 to 2011,the rate of in-hospital pressure ulcers hard to avoid was respectively 0.06%,0.06% and 0.02%. ConclusionBased on pressure ulcers wound team management,training nurses'early warning management idea,assigning corresponding responsibilities and management goals can help to standardize the management of pressure ulcers and raise the discipline level unceasingly.
【Abstract】 Objective To discuss the role of leukocyte activation and inflammatory processes in the disease of chronic venous insufficiency （CVI）. Methods The relevant literatures about the role of leukocyte activation and inflammatory reaction in CVI were reviewed. Results The role of inflammatory reaction in occurrence and development of venous diseases has been studied a lot in recent years. It was found that the leukocyte activation and inflammatory reaction are involved in the structural remodeling of venous valves and walls, leading to valvular incompetence and formation of varicose veins. Conclusion Leukocyte activation and inflammatory processes take important roles in the occurrence and progression of CVI.
Eight cases of gastric remnant carcinoma are reported and its possible etiology, course of disease, prevention and treatmant are discussed together with literature review. Duodenal ulcer, except with serious complications, should be treated conservatively. For benign gastric ulcer gastrectomy may be considered in individual case, but the operative indication can be controlled by its lesions. Regular follow-up study should be performed on patients who had gastrectomy for more than five years.
ObjectiveTo evaluate whether laparoscopic repair for perforated peptic ulcer o ers elderly patients an improved outcome compared with conventional open surgery. MethodsFrom May 2008 to December 2013, clinical data of 163 elderly patients ( ≥ 60 years) who underwent laparoscopic or open repair of perforated peptic ulcer disease were analyzed retrospectively in our hospital. Ninety-one patients received laparoscopic repair and 72 received conventional open repair. The primary end points that were evaluated were total operative time, searching time, nasogastric tube utilization, intravenous fluid requirement, total time of abdominal drainage and urinary catheter usage, time taken to return to normal gastrointestinal motility, percentage of intravenous/intramuscular opiate use, off-bed time, and total in-patient hospital stay. The second end points were morbidity. ResultsThere was a significant diTherence in total operative time in patients who had undergone laparoscopic repair and open repair [(67.9±3.6) minutes vs. (97.8±5.2) minutes]. There was a significant decrease in the time that the nasogastric tube (2.1 days vs. 3.1 days), urinary catheter (2.3 days vs. 3.7 days) and abdominal drain (2.2 days vs. 3.8 days) were required during the postoperative period. Patients who had undergone laparoscopic repair also required less intravenous fluids (2.4 days vs. 4.1 days) and returned to normal gastrointestinal motility [(32.1±1.5) hours vs. (58.4±4.8) hours] and off-bed time significantly earlier than those who had undergone open repair (2.1 days vs. 3.5 days). There was significantly less requirement for intravenous/intramuscular opiate analgesia in patients who had undergone laparoscopic repair (4.7% vs. 45.6%). In addition, patients who had undergone laparoscopic repair required a shorter in-patient hospital stay (4.1 days vs. 5.3 days). Moreover, morbidity of laparoscopic repair was much lower than open repair (3.3% vs. 16.7%). ConclusionLaparoscopic repair is a viable and safe surgical option for elderly patients with perforated peptic ulcer disease and should be considered for all patients.