死亡危重型手足口病临床特点分析

目的:探讨进入IV期危重型手足口病(Hand-mouth and foot disease, HFMD)死亡的临床特点、诊治经过及死亡分析,总结经验及教训。方法:采用回顾性分析方法对2009年1月至2014年12月昆明周边及地州转入我院救治19例危重型HFMD患儿的临床资料进行分析。结果:19例患儿来自农村,其中男性13例(68.42%),女性6例(31.58%),3岁以下16例,占84.21%,3岁以上3例,占15.79%。所有病例均有发热、惊跳、肢体抖动的表现。16例患儿入院时出现肺出血、呼吸循环衰竭的表现。17例患儿均出现白细胞总数及中性粒细胞、超敏C-反应蛋白升高,12例血糖升高。4例合并消化道出血,1例同时合并肾功能衰竭。病原学:18例EV71阳性,1例为其它未定型肠道病毒感染。结论:早期识别并及时治疗第2期HFMD病例,及时进行干预,避免进展为危重型HFMD,危重型HFMD主要由EV71病毒感染引起,致死率高,进入IV期危重型HFMD出现神经源性肺水肿、肺出血、呼吸循环衰竭、严重脑功能障碍等严重并发症,死亡率高。

Platelet-rich plasma accelerates skin wound healing by promoting re-epithelialization

Background:Autologous platelet-rich plasma(PRP)has been suggested to be effective for wound healing.However,evidence for its use in patients with acute and chronic wounds remains insufficient.The aims of this study were to comprehensively examine the effectiveness,synergy and possible mechanism of PRP-mediated improvement of acute skin wound repair.Methods:Full-thickness wounds were made on the back of C57/BL6 mice.PRP or saline solution as a control was administered to the wound area.Wound healing rate,local inflammation,angiogenesis,re-epithelialization and collagen deposition were measured at days 3,5,7 and 14 after skin injury.The biological character of epidermal stem cells(ESCs),which reflect the potential for re-epithelialization,was further evaluated in vitro and in vivo.Results:PRP strongly improved skin wound healing,which was associated with regulation of local inflammation,enhancement of angiogenesis and re-epithelialization.PRP treatment significantly reduced the production of inflammatory cytokines interleukin-17A and interleukin-1β.An increase in the local vessel intensity and enhancement of re-epithelialization were also observed in animals with PRP administration and were associated with enhanced secretion of growth factors such as vascular endothelial growth factor and insulin-like growth factor-1.Moreover,PRP treatment ameliorated the survival and activated the migration and proliferation of primary cultured ESCs,and these effects were accompanied by the differentiation of ESCs into adult cells following the changes of CD49f and keratin 10 and keratin 14.Conclusion:PRP improved skin wound healing by modulating inflammation and increasing angiogenesis and re-epithelialization.However,the underlying regulatory mechanism needs to be investigated in the future.Our data provide a preliminary theoretical foundation for the clinical administration of PRP in wound healing and skin regeneration.