medical simulator

The last step is amputation as soon as possible.

In fact, the amputation rate of less than [-]% according to [-] in [-] is already far beyond the data released by the World Health Organization. It is estimated that such amputation rates are extremely rare in hospitals around the world.

Zhou Cheng did not answer the question instead: "Professor Ning, the patient's current symptoms should not be the last step. The indications for amputation are carrion, necrosis, and gangrene."

"For this patient, if conventional medication, debridement, antibiotics, and even vascular revascularization have failed, Professor Ning thinks, is there any other way to think about it?"

Zhou Cheng heard that the volatility in his heart was not strong.

The plan he gave is naturally the best, and it can handle most of the diabetic feet. The perfect plan is naturally the case.

Of course, no solution can perfectly solve all patients, and the solution given by Zhou Cheng must be properly perfected and repaired.

This is a blank space that he deliberately left when he proposed the plan, and this is also something that Ning Ling can make further progress.

The next topic that Zhou Cheng will apply for is related to diabetic foot. The patient base of this disease is large, and the current treatment is indeed relatively limited.

It’s just that Zhou Cheng is definitely not easy to do it alone, and Zhou Cheng not only only wants to do this, he also hopes to do it with Ning Ling. The most motivating thing is to let Ning Ling propose it himself.

"Debridement, blood circulation, and nutrition have all been done to the best, and the anti-infection is also effective, and there is no infection. Microcirculation and other factors are the best factors. If such treatment measures still fail to achieve results, I am serious. have no idea."

"There are other ways." Ning Ling frowned.

Because according to the idea given by Zhou Cheng before, there is basically nowhere to hide from diabetic foot. Ning Ling himself has the technical foundation of hand surgery, so it is very easy to get started.

Ning Ling was very happy to be able to get rid of such a disease just after taking over it.

He thought he was already very good at it because of his previous accumulation, but this patient really baffled him.

Zhou Cheng knew that Ning Ling had thought of a lot of ways, so he added a little more: "Professor Ning, since all the preparations have been made, the blood circulation is smooth, and the nutrition is good, why can't the wound heal?"

"No infection, adequate nutrition."

"Do you think it's possible that the local pressure is higher because the nutrition is too rich and the blood supply is too rich?"

"In fact, regardless of any treatment measures, when targeting diabetic feet, the essence is to reduce local pressure."

"What is too high local pressure?" Zhou Cheng made a point.

Ning Ling was taken aback when he heard the words.

The occurrence of local ulcers in diabetic feet is local skin necrosis caused by excessive local pressure, but that is mostly due to poor blood supply or embolism in a hypercoagulable state.

Now that Zhou Cheng said so, could it be that the local blood supply is too rich and the nutritional status is good, so the local pressure is still increased, which is the factor for the wound not to heal?

Zhou Cheng saw Ning Ling and Ding Changle thinking, and Zhou Cheng suggested: "Mr. Ning, I think that when we can't find the missing disease, we can consider whether it is an excess."

"For example, some patients' high blood pressure is caused by heart problems, but some patients' high blood pressure is caused by kidney problems."

"For cardiac problems, we can properly reduce the pumping capacity of the heart, but for renal problems, we may not be able to solve them by reducing the pumping capacity of the heart!"

"After the structural foundation is completed, we will reduce the overall flow of the body and optimize the nutritional structure to make the local blood supply less sufficient. Try it, and it may also have a miraculous effect."

All treatment principles must grasp the core.

Ning Ling was slightly taken aback when he heard the words: "Doctor Zhou, what do you mean is that this part has been repaired too much, and the blood supply is too rich, which again led to an increase in local pressure, so the ulcer did not heal?"

"The possibility of this is not ruled out. I think this is a good way for us to study in depth, especially for some patients who have a relatively rich nutritional supply."

"After the local anatomical foundation is established, other aspects need to be considered..." Zhou Cheng promptly threw out his next step of clinical research ideas.

4 Forty chapters of professional academic crushing

"Doctor Zhou, this is what we are more curious about. What do you think, Doctor Zhou?" Ning Ling immediately began to ask for advice.

To learn, you need to know what it is, and you need to know why it is so that you can go further.

Although Zhou Cheng has given a sufficiently systematic treatment plan, it still has flaws and cannot have broad-spectrum applicability.

Zhou Cheng glanced at Professor Ding Changle. Professor Ding Changle did not speak, but also gave a listening statement.

Zhou Chengcheng began to say: "Professor Ding, Professor Ning, I will delay everyone's time a little, so I would like to talk about my thoughts on diabetic foot."

"Currently, there are several levels of cognition about the treatment of diabetic foot in the world."

"Strict control of blood sugar, infection control, wound debridement, patient's own rest, protection, nutritional support. Individualized treatment."

"My personal thinking is this way. The principle of treatment is an outline and an overall framework, which we can discover through analysis."

"Controlling blood sugar: control blood sugar through regular diet control, drug therapy or insulin injections, so as to avoid damage to nerves and blood vessels caused by high blood sugar. We have no way to go further, or we do not have enough basis to discover and Create new hypoglycemic drugs."

"The second point is infection control: For diabetic foot infections that have occurred, treatment measures such as antibiotics and surgery should be applied in a timely manner. Antimicrobial spectrum and antibiotics are also matters of the Department of Infectious Diseases and Pharmacology, and we have no way to improve them in a short time .”

"Wound debridement is a basic skill, and it is very difficult for us to improve the texture. Then, under such a major premise, we found that if we want to make a fuss about diabetic feet, we can only collect it first. Good current research progress!"

When Zhou Cheng said this, he saw that Ning Ling and Ding Changle began to signal their students to start taking notes. The following will be some ideas for Zhou Cheng to start a new project, which is very meaningful for learning.

Zhou Cheng has done a good job in both clinical and scientific research, so how to get a scientific research direction will be a very important part.

Zhou Chengcheng deliberately slowed down his speech, knowing that in addition to being a doctor, he also needs to learn to be a good teacher.

"Professor Ding, Professor Ning, do you mind if I write a little bit?"

Ding Changle immediately expressed his opinion after hearing the words: "Xiao Zhou, just do it, your teaching mode is based on you, and we are just the audience. Do whatever you like."

Zhou Cheng immediately began to say: "The treatment of diabetic foot has always been one of the clinical problems. With the continuous advancement of medical technology and the deepening of research, some new treatment options have been applied and promoted. The following are some research results of diabetic foot treatment. progress--"

"Cell therapy: In recent years, more and more studies have confirmed that the use of patients' own stem cells and hematopoietic stem cells can promote the healing of diabetic foot wounds, and has good safety and efficacy.

"Application of biomaterials: Some biomaterials, such as collagen, biofilm, etc., can be used for wound repair and healing. These materials can promote wound healing, reduce infection rates, and can be absorbed by their own tissues.

"Ultrasound therapy: Studies have shown that ultrasound therapy can promote wound healing, reduce inflammation, and improve the redox state of wounds.

"Gene therapy: In recent years, gene therapy has also been used in the treatment of diabetic feet, such as the use of gene transfection technology to treat diabetic foot wounds.

"Artificial intelligence technology: Some current studies have shown that the use of artificial intelligence technology can make more accurate judgments and choices for the diagnosis and treatment of diabetic foot, and improve the effect of treatment."

Zhou Cheng began to show his strong knowledge reserves and all the cognitive skills of a perfect skill. Just like that, he showed Zhou Cheng's reading documents, at least hundreds of them.Just so a few, you can write a review out.

When Ding Changle and Ning Ling heard this, they became flustered and confused.

Fortunately, it was Zhou Cheng who listed the outline, so when Ding Changle and Ning Ling walked to Zhou Cheng's side, they could probably get some direction of the outline.

"Biological materials and stem cells are the hottest spots, but it is a difficult process and takes a long time to apply materials directly to the clinic. Therefore, the next breakthrough point that we can directly apply and is simple is cell therapy." Zhou Cheng drew a circle while analyzing.

In terms of cell therapy, a skill tree was made:

"Stem cell therapy: Some studies have shown that using the patient's own stem cells, such as bone marrow stem cells, fat stem cells, etc., can promote the healing of diabetic foot wounds, and has good safety and efficacy. At the same time, stem cells can also differentiate into different types of Cells, such as osteoblasts, chondrocytes, myoblasts, etc., can promote tissue repair and regeneration."

"There are also many types of stem cells."

"Hematopoietic stem cell therapy: Studies have shown that using the patient's own hematopoietic stem cells can promote the healing of diabetic foot wounds, and can improve angiogenesis and blood perfusion, thereby promoting tissue regeneration.

"Mesenchymal stem cell therapy: Studies have shown that mesenchymal stem cells can differentiate into osteoblasts, chondrocytes, muscle cells, etc., which can promote tissue repair and regeneration. At the same time, mesenchymal stem cells can also secrete some growth factors, Such as vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), etc., can promote angiogenesis and tissue repair.

"Neural Stem Cell Therapy: Studies have shown that the use of neural stem cells can promote nerve regeneration and repair in the diabetic foot, thereby improving sensory and motor function in the foot.

"According to current research, hematopoietic stem cells have the ability to self-renew and differentiate into various cell types, and can continuously renew and repair damaged tissues and organs. It is also the easiest type of stem cell for us to obtain."

"When we sorted out and collected the functions of hematopoietic stem cells, we found that they can promote the formation of new blood vessels and repair damaged blood vessels, improve the blood supply and oxygen supply of tissues, thereby promoting wound healing.

"Then when we inquire about the basic theory of the application of hematopoietic stem cells in diabetic foot, we can sort out these few points."

"Wang Huan: You focus on taking notes, and after you go back, check the relevant literature carefully, and do a repetition of the literature and materials—"

"Hematopoietic stem cells can secrete a variety of growth factors and cytokines, promote tissue regeneration and repair, and reduce tissue inflammation and fibrosis."

"The treatment of diabetic foot with hematopoietic stem cells can improve the function of the immune system, reduce the level of inflammation, reduce tissue damage and inflammatory response, and thus promote wound healing."

"The treatment of diabetic foot with hematopoietic stem cells can improve the body's self-repair ability, promote tissue regeneration and repair, and prevent complications such as tissue necrosis and infection."

"These are popular principles. Let's go deeper and get to the physiological principles. Because these are what we need to use when we communicate. Communication with peers is like what we just analyzed and exchanged ideas. level."

Zhou Cheng is now very proficient at the level of knowledge reserve, and his teaching level has reached a certain level, so when he is doing demonstrations, the knowledge reserve that can be released is extremely huge.

And this will be his first project at the Affiliated Hospital of Shonan University, and the first bid he will submit, so he must demonstrate his strong dominance.

Zhou Cheng has such energy now!No need to hide.

However, based on some existing research foundations in reality, go further and lead your own team.

Ning Ling came from hand surgery, Zhou Cheng must let him know that it is absolutely right to follow him, maybe others think Ning Ling is at a disadvantage, but Zhou Cheng wants Ning Ling to see that I may be young, but My ability is not the youth version.

"Here is the principle of physiology:"

"After sorting out the data, we found that hematopoietic stem cells can differentiate into various cell types, including endothelial cells and fibroblasts, and these cells can participate in wound healing and new blood vessel formation.

"Hematopoietic stem cells can secrete a variety of growth factors and cytokines, including vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP) and bone morphogenetic protein (BMP), which can promote angiogenesis and wound healing.

"Hematopoietic stem cells can regulate immune system function, reduce inflammation and fibrosis, and reduce the risk of wound infection.

"Through these few principles, we can find that the gene targets involved in the treatment of diabetic foot by hematopoietic stem cells mainly include the following aspects:"

Everyone began to think about it, like listening to the scriptures, they could only keep up with Zhou Cheng's thinking rhythm, they didn't know the details of the content, and they didn't know what Zhou Cheng said.

But fortunately, Zhou Cheng will make suggestions for each one, so that he can barely keep up:

"Angiogenesis-related gene targets, such as VEGF, BMP, etc. These genes can promote new angiogenesis and repair damaged blood vessels, improve tissue blood supply and oxygen supply, thereby promoting wound healing.

"Gene targets related to inflammatory response, such as IL-10, TNF-α, etc. These genes can regulate the function of the immune system, reduce inflammatory response and fibrosis, and reduce the risk of wound infection.

"Tissue repair and regeneration-related gene targets, such as MMP, TGF-β, etc. These genes can promote tissue regeneration and repair, and reduce tissue inflammation and fibrosis.

"Gene targets related to cell proliferation and differentiation, such as Wnt, Notch, etc. These genes can promote cell proliferation and differentiation, thereby accelerating wound healing and tissue regeneration."

"However, the above are just some of the initial regulatory mechanisms that we can get at the basic level of the laboratory. There are still more detailed contents for the regulation of these targets, which we need to discover and prove."

When Zhou Cheng said this, he drew a circle.

"If it is said on the Internet that all the knowledge systems are such a circle, then the treatment of diabetic foot has reached a critical point at the level of stem cell treatment. The following is what we want to continue to develop. "

"The treatment of diabetic foot with hematopoietic stem cells can promote angiogenesis and repair by up-regulating or down-regulating the expression of some vascular survival-related gene targets, thereby improving the symptoms of diabetic foot patients. The following are some of the gene targets involved and their upstream and downstream regulation:

"VEGF (vascular endothelial growth factor): VEGF is an important angiogenic factor that can promote the proliferation, migration and tube formation of endothelial cells. The transcription factors that can regulate the expression of VEGF include HIF-1α, SP1, AP- 1 etc. At the same time, the signaling pathway of VEGF also involves multiple pathways such as PI3K/AKT, MEK/ERK, JAK/STAT and so on.

"Ang-1 (angiopoietin-1): Ang-1 is a factor closely related to angiogenesis and stability, which can promote the interaction between endothelial cells and smooth muscle cells and maintain the integrity of blood vessels. The expression of Ang-1 can Regulated by TGF-β, Notch and other signaling pathways.

"HGF (hepatocyte growth factor): HGF is a factor that promotes angiogenesis and repair, can promote the proliferation and migration of endothelial cells, and promote the interaction between vascular endothelial cells and smooth muscle cells. The expression of HGF can be controlled by transcription factors such as HIF- 1α, AP-1 and other regulation.

"CXCR4 (C-X-C chemokine receptor type 4): CXCR4 is a G protein-coupled receptor that can participate in the migration and directional differentiation of hematopoietic stem cells. The expression of CXCR4 can be regulated by factors such as VEGF and HGF.

"EPO (erythropoietin): EPO is a factor that promotes erythropoiesis, and can also promote angiogenesis and repair. The expression of EPO can be regulated by factors such as HIF-1α."

"For now, if we target the first of the above different pathways, the VEGF pathway, then the VEGF pathway has the following points..."

"Expression: VEGF is a protein produced by a variety of cells, including endothelial cells, fibroblasts, smooth muscle cells, macrophages, T lymphocytes, etc. Under stimulation such as ischemia and hypoxia, the expression of VEGF will increase significantly.

"Receptor: VEGF mainly conducts signal transduction through its receptor VEGFR (VEGF receptor). VEGFR includes three types: VEGFR-1, VEGFR-2 and VEGFR-3, among which VEGFR-2 is the main receptor of VEGF signal transduction .

"Transduced downstream molecules: After VEGF binds to its receptor VEGFR, it promotes angiogenesis and angiogenesis by activating downstream molecules. Downstream molecules include Ras, Raf, MEK, ERK, PI3K, AKT, etc. After activation, these molecules can promote endothelial Cell proliferation, migration and lumen formation, thereby promoting the formation and maturation of new blood vessels.

"Negative regulation of the VEGF pathway: Overactivation of the VEGF signaling pathway can lead to adverse consequences, so negative regulatory mechanisms are required to control its activity. For example, VEGF's soluble receptor sVEGFR can bind VEGF, thereby inhibiting its activation of VEGFR, thereby controlling The strength and duration of its signaling...

"..."

"..."

Time flies, half an hour has passed.

In the entire shift room, there was no sound, and Zhou Cheng was the only one performing.

"Let me analyze the production of this hematopoietic stem cell and the conditional reserve we have."

"The preparation process of hematopoietic stem cells for the treatment of diabetic foot includes the following steps:

"Collection of hematopoietic stem cells source: hematopoietic stem cells can be collected from bone marrow, peripheral blood or umbilical cord blood.

"Isolation and enrichment of hematopoietic stem cells: Use cell separation technology or negative selection technology to separate and enrich hematopoietic stem cells from other cells.

"Culture and Expansion of Hematopoietic Stem Cells: The isolated hematopoietic stem cells are cultured and expanded to obtain sufficient numbers of cells for treatment.

"Identification and screening of cells: identification and screening of the expanded hematopoietic stem cells to ensure that the purity and function of the cells meet the therapeutic requirements.

"Cryopreservation and preservation of cells: cryopreservation and preservation of cells needed for treatment for subsequent use.

"Cell infusion: infusion of the cells required for treatment, usually through intravenous injection, to deliver the cells to the patient's body to treat diseases such as diabetic foot.

"In our hospital, there is no shortage of equipment, laboratories, or personnel in the experimental group. We just lack people who do this part and spend time."

"And I generally estimate that within half a year, we can perfect this topic, and then sort out the upstream regulation of the first therapeutic target of hematopoietic stem cells in the treatment of diabetic foot."

"Wang Huan, what do you think?" Zhou Cheng didn't dare to ask Ning Ling and Ding Changle.

Confused, Wang Huan nodded, then shook his head again.

But after shaking his head like this, Wang Huan noticed that Zhou Cheng's brows were wrinkled, and he nodded quickly again, completely stunned.