Methylene blue mu bushakashatsi ku bisebe: ibipfuko, urumuri, n'ibipimo byo gukira

Igipfuko cyasizwe ibara ry’ubururu n’icupa rifite igikoresho cyo gutonyanga amazi y’ubururu bishobora gusa n’uburyo bumwe bwo kuvura. Mu bushakashatsi ku bisebe, si ko biri. Kimwe ni igipfuko cyakorewe mu ruganda gifite ingano y’irangi igenwe, kigeragezwa nk’igikoresho cyarangiye gukorwa. Ikindi ni umuti w’amazi usigwa n’intoki, aho ubukana bwawo, ingano y’amazi, n’igihe umara ku gisebe bihinduka buri gihe usizwe. Ubushakashatsi kuri ibyo byombi busubiza ibibazo bitandukanye, bityo n’ibipimo by’ibisubizo byabwo bikaba bitandukanye.

Iri sesengura ritandukanya ibyo byombi. Rigaragaza ibyo abashakashatsi bakoresheje, aho babikoresheje, n’ibyo bapimye: ubuso bw’igisebe, umuvuduko wo gufunga kwacyo, umubare wa bagiteri, cyangwa igipimo cyo muri laboratwari gihagararira gukira, nko gufunga umwanya washushanyijwe mu tugingo turi mu gasahani.

Uburyo butatu, busobanuwe neza

Ubushakashatsi ku bisebe bukoresha methylene blue buri mu buryo butatu. Buri buryo bufite ibisobanuro byabwo by’icyo irangi rikora.

Ubwa mbere, ibipfuko bya furo birimo amarangi. Ibicuruzwa nka furo ya polyvinyl alcohol yinjijwemo methylene blue na gentian violet (igurishwa nka furo irwanya bagiteri ya Hydrofera Blue) bigira ayo marangi afatiriye mu miterere y’igipfuko. Uburyo bivugwa ko bikora ni ukurwanya bagiteri bifitanye isano n’igipfuko, bigamije gufasha kugenzura ubwinshi bwa bagiteri mu gisebe mu gihe furo yakira amazi asohoka mu gisebe. Ibyemezo byo kuvura ukoresheje igicuruzwa nk’icyo bifatwa n’inzobere mu buvuzi ihitamo igipfuko cy’igisebe runaka; amabwiriza yo gukoresha icyo gipfuko ni yo agena igihe kigumaho n’inshuro gihindurwa, si uburyo rusange bwo gutegura irangi ry’ubururu.

Ubwa kabiri, ubuvuzi bukoresha methylene blue n’urumuri. Muri ubu buryo, umuti w’amazi wa methylene blue usigwa nk’ikinyabutabire gikangurwa n’urumuri, hanyuma ukamurikirwa, akenshi hakoreshejwe urumuri rutukura rufite uburebure bw’umuraba buri hafi y’aho irangi rinyunyuza urumuri cyane. Urumuri na ogisijeni bigira uruhare mu kurema ibinyabutabire byihutira kwitabira impinduka zangiza mikorobe. Iyi mikorere ya shimi itandukanye n’impamvu zo kurwanya okisidasiyo zikoreshwa mu kwamamaza ibicuruzwa byo kwita ku ruhu; inyandiko yacu isobanura methylene blue mu kwita ku ruhu na yo igaragaza iryo tandukaniro. Ubu buryo bugizwe n’irangi, ingano y’urumuri, na ogisijeni, kandi guhindura kimwe muri ibyo bitatu bihindura uburyo bwo kuvura.

Ubwa gatatu, methylene blue idakoreshejwe hamwe n’urumuri mu tugingo no mu nyamaswa. Aya magerageza abaza niba irangi ubwaryo rihindura imyitwarire y’utugingo twa fibroblast, poroteyine z’urusobe rushyigikira utugingo, cyangwa gufunga kw’ibisebe byakozwe mu igerageza. Ni ubushakashatsi ku buryo ibintu bikora, si amagerageza y’ibipfuko.

Imbonerahamwe y’ubushakashatsi n’uburyo bwabwo: icyageragejwe, aho cyageragejwe, n’icyahindutse

Koresha iyi mbonerahamwe nk’ikarita y’iyi nyandiko. Soma buri murongo uhereye ibumoso ujya iburyo: ibikoresho, uburyo bw’igerageza, n’igipimo cy’ibisubizo uwo murongo ushobora gushyigikira. Nta murongo ukoresha igipimo cy’undi.

Ibipfuko: igikoresho cyarangiye gukorwa, si uburyo bwo gutegura irangi

Ibipfuko bya furo byigwa mu kwita ku bisebe ni ibikoresho bikorerwa mu ruganda. Ubwoko bwa Hydrofera Blue busobanurwa ku rupapuro rw’ibicuruzwa rw’uruganda buhuza amarangi abiri muri furo itarimo mikorobe: ubwoko bwa CLASSIC bwa polyvinyl alcohol burimo bitarenze 0.00025 g bya buri rangi kuri garama ya furo, naho ubwoko bwa READY bwa polyurethane bukarimo bitarenze 0.00035 g kuri garama. Kubera ko amarangi ashyirwamo mu gihe cyo gukora igipfuko, buri gipfuko kiba gifite ingano izwi, kandi raporo z’ubuvuzi zisobanura igicuruzwa zivuga izina ryacyo, igihe kigumaho, na gahunda yo kugihindura.

Ibi ni ibikoresho by’ubuvuzi byahawe uruhushya, si imiti yemejwe. Igipfuko cy’umwimerere gifite uruhushya rwa FDA K013462 rwo mu 2002, ubwoko bwa Hydrofera Blue bwa polyurethane bufite uruhushya K130670 rwo mu 2014, naho ubwoko bwa READY bufite impande zifata bukagira uruhushya K190268 rwo mu 2019. Uruhushya rutangwa hakurikijwe inzira ya 510(k) rwemeza ko igikoresho gihwanye mu bintu by’ingenzi n’igikoresho cyakibanjirije; si ukwemeza ubushobozi bwacyo bwo kuvura. Ibivugwa ku kurwanya mikorobe mu nyandiko z’icyo gikoresho ahanini bishingiye ku mikorere iri imbere mu gipfuko no ku magerageza yo muri laboratwari. Ibyo ntibikwiye guhindurwamo ikivugwa ko igipfuko gikuraho mikorobe zose mu ngirangingo zanduye kigabanya umubare wazo ku gipimo runaka cya logaritimi.

Ibyatangajwe ku ikoreshwa ryabyo mu buvuzi ahanini ni uruhererekane ruto rw’abarwayi rudafite itsinda ryo kugereranya. Mu bushakashatsi bwa Woo na Heil bwakurikiranye ibisebe 29 bimaze igihe, aho Hydrofera Blue Classic yahindurwaga inshuro eshatu mu cyumweru mu gihe cy’ibyumweru bine, impuzandengo y’ubuso bw’igisebe yagabanutse iva kuri 21.4 igera kuri 12.3 cm² (igabanuka rya 42.5%), n’amanota ya PUSH agabanuka ava kuri 13.3 agera kuri 10.7. Uruhererekane rw’ibisebe 15 byo ku maguru rwakozwe na Coutts, Ryan na Sibbald rwagaragaje ko ubunini bw’igisebe bwagabanutse nyuma y’ibyumweru bine mu bisebe 8 muri 14 byashoboraga gusuzumwa, kandi bamwe mu barwayi bagize ububabare buke kurushaho, cyane cyane abafite ibisebe byo ku birenge bifitanye isano na diyabete. Ubushakashatsi bwasubiye mu makuru y’ibisebe 53, bwatangajwe na Lullove, bwahuje furo n’urusobe rwa kolajene ikomoka ku ntama, bityo impuzandengo y’igabanuka ry’ubuso rya 91.3% nyuma y’ibyumweru cumi na bibiri ntishobora kwitirirwa furo yonyine. Isesengura rinini rya gahunda, ryasubiye mu makuru y’igihe cyashize, ryakozwe na Hurd ryatangaje ko ibisebe byakiraga vuba kurushaho aho ibipfuko byakoreshwaga mu itsinda ry’ingamba zisanzwe zo kwita ku bisebe; na ryo rero ryagerageje izo ngamba zose hamwe aho kugerageza irangi.

Hari imbogamizi ihuriweho n’ubwo bushakashatsi bwose: ubwinshi bwa bagiteri bugaragazwa n’amanota y’ibimenyetso by’ubwandu cyangwa ibipimo by’ibyafashwe n’udupamba bitanga ingano igereranyijwe, aho kuba ibipimo bikurikirana umubare wa bagiteri worowe uvuye mu ngero z’ingirangingo. Incamake itabogamye ni uko ubushakashatsi ku bipfuko bya furo birimo amarangi abiri butangaza igabanuka ry’ubuso, kunozwa kw’amanota y’ahari igisebe, kandi rimwe na rimwe ububabare buke, ariko ntibugaragaze isano hagati y’ingano ya methylene blue n’ingaruka zayo bwite cyangwa igipimo cyo kwica bagiteri mu ngirangingo. Kandi nta kintu mu bushakashatsi ku bipfuko cyemeza ko gutosa gaze mu muti wo mu icupa ritonyanga bihwanye na byo. Ubukana, ikwirakwira, umuvuduko wo kurekura irangi, kutabamo mikorobe, n’igihe igipfuko kigumaho byose biratandukanye.

Urumuri n’irangi: ubushakashatsi ku bisebe bukoresha urumuri

Ubushakashatsi ku bisebe bukoresha irangi rikangurwa n’urumuri bwongeramo kumurika mu buryo bw’igerageza. Ubukana bwa methylene blue mu bushakashatsi ku bantu akenshi buri hagati ya 0.01% na 1%, hakoreshejwe urumuri rutukura ruri hafi ya 635 kugeza kuri 660 nm, ku ngufu kuri buri buso ziva kuri joule nkeya kuri santimetero kare zikagera hejuru y’ijana. Amatsinda yo kugereranya aratandukanye: ubushakashatsi bumwe bugereranya n’uburyo busanzwe bwo kwita ku bisebe, ubundi bugatangaza umubare wa bagiteri mbere na nyuma yo kuvura mu bisebe bimwe.

Ibimenyetso bihoraho kurushaho mu bantu bireba imiterere n’ubuso bw’igisebe aho kuba umubare wa bagiteri. Mu bushakashatsi bwa Carrinho na bagenzi be ku bisebe 12 bifitanye isano na diyabete, bufite itsinda ryo kugereranya, 0.01% ya methylene blue hamwe n’urumuri rwa 660 nm kuri 6 J/cm², inshuro eshatu mu cyumweru ku nshuro icumi zo kuvura, byatanze igabanuka ry’ubuso riruta iry’ubuvuzi bwo mu itsinda ryo kugereranya ku buryo bufite ubusobanuro mu mibare. Uruhererekane rw’ibisebe bitanu byanduye rwakozwe na Shen na bagenzi be rwatangaje gukira burundu nyuma y’impuzandengo y’inshuro enye zo kuvura hakoreshejwe irangi rya 1% n’urumuri rwa 635 nm, ariko rutagira ibipimo by’umubare wa bagiteri. Igerageza rinini kurusha ayandi kugeza ubu, igerageza rya Chagas na bagenzi be ku bantu 94 bafite ibisebe byo ku birenge bifitanye isano na diyabete, bashyizwe mu matsinda ku buryo bwa tombola kandi abitabiriye n’abasuzuma batazi itsinda buri wese arimo, ryasanze amanota y’igisebe ya Bates-Jensen atangira kugenda neza kuva ku nshuro ya gatatu yo kuvura kugeza mu ikurikirana ry’iminsi mirongo itatu, hakoreshejwe irangi rya 1% na lazeri ya 660 nm. Nta ngaruka mbi zifitanye isano n’ubuvuzi zabonetse, ariko na none nta gipimo cy’umubare wa bagiteri cyakoreshejwe.

Ibintu bibiri byo kwitondera bituma ibi bitabo by’ubushakashatsi bisobanurwa mu kuri. Icya mbere, igisubizo gikomeye ku guca ingingo rimwe na rimwe kivugwa gikuwe mu bushakashatsi bwa Tardivo na bagenzi be cyaturutse ku gukoresha methylene blue hamwe na toluidine blue, bityo ntigishobora kwitirirwa methylene blue yonyine. Icya kabiri, gukira nyuma yo kuvurwa hakoreshejwe urumuri ntibishobora guhita byitirirwa imikorere ya shimi iterwa n’urumuri irwanya mikorobe, kuko urumuri rutukura ubwaryo rushobora guhindura isanwa ry’ingirangingo. Mu igerageza rya Sperandio na bagenzi be ku bisebe by’imbeba ryari rifite amatsinda y’irangi ryonyine, urumuri rwonyine, byombi hamwe, n’itsinda ryo kugereranya, gukoresha lazeri yonyine byagize ingaruka ku gukira. Kwitirira igisubizo kwica bagiteri bisaba ibipimo bya mikorobe n’amatsinda akwiriye yo kugereranya. Ubushakashatsi ku nyamaswa burushaho kubigaragaza neza: mu buryo bwo kwiga igisebe cyanduye ku mbeba bwakoreshejwe na Pérez na bagenzi be, ubuvuzi bukoresha irangi n’urumuri bwatanze igisubizo cyiza kurusha ibindi ku gukira kugaragara, mu gihe mupirocin yagabanyije bagiteri cyane kurusha ibindi, bityo ibyo bipimo byombi biratandukana neza. Incamake yacu y’ibimenyetso kuri methylene blue n’urumuri rutukura ishyira ubu buryo bwo kuvura ibisebe iruhande rw’uburyo bwo gukoresha urumuri butareba ibisebe, kugira ngo imikorere ya shimi iterwa n’urumuri ihuriweho ititiranywa n’impamvu imwe yo kubukoresha mu buvuzi.

Utugingo n’ingero z’uruhu: aho ikimenyetso cyo gukira gitangirira

Intandaro yo muri laboratwari y’ibivugwa ku gukira kw’ibisebe ni ubushakashatsi bwo mu 2017 bwa Xiong na bagenzi be ku tugingo twa fibroblast two mu ruhu rw’abantu no ku ruhu rwongeye kubakwa. Utugingo twa fibroblast twavuye ku bantu babiri, twabanje gushyirwaho 100 nM ya methylene blue, twongeye kuzura umwanya washushanyijwe vuba kurusha utugingo tutayishyizweho, ku buryo bufite ubusobanuro mu mibare, nyuma y’amasaha 24. Mu ruhu rwongeye kubakwa rufite umubyimba wose, igihe kirekire cyo guhura n’irangi cyongereye amazi yapimwe mu ruhu n’umubyimba w’igice cy’imbere cy’uruhu, kandi mu mpinduka z’urusobe rushyigikira utugingo harimo ukwiyongera kw’ikorwa rya elastin na COL2A1.

Ibi ni ibipimo bifatika bifitanye isano n’ibisebe, kandi bireba uburyo bw’igerageza byakoreshejwemo. Igerageza ryo gushushanya umwanya hagati y’utugingo ripima uko utugingo twimuka hamwe twambuka uwo mwanya mu gasahani. Ntiharimo igisubizo cy’ubudahangarwa bw’umubiri, gutura kwa bagiteri, amazi asohoka mu gisebe, cyangwa igipfuko. Uruhu rwongeye kubakwa rwongeramo imiterere y’ingirangingo, ariko na rwo ntirugira itembera ry’amaraso n’uruhererekane rwose rw’ibikorwa byo gukira. Nta na bumwe muri ubwo buryo bugerageza igipfuko cya furo cyangwa uburyo bwo kuvura bukoresha irangi n’urumuri, kandi nta na bumwe butanga ubukana bw’umuti wo gusiga mu rugo.

Methylene blue yateguwe mu mvange na yo yageragejwe ku bisebe by’inyamaswa zo mu itsinda ry’imbeba. Jeli ya 0.005% irimo methylene blue ifungiye mu duhitse twa niosome, yizwe na Farmoudeh na bagenzi be, yihutishije gufunga kw’ibisebe by’imbeba byakozwe hakuwemo igice cy’ingirangingo mu ntangiriro, ugereranyije n’irangi ritafungiye muri utwo duhitse n’uruvange rutwara irangi rutayirimo, kandi isuzuma ry’ingirangingo n’ibipimo by’umutwaro wa okisidasiyo byagaragaje ibisubizo byiza kurushaho. Imvange y’amavuta n’amazi igizwe n’udutonyanga duto cyane, ifite 0.1 mg/mL, yizwe na Gao na bagenzi be mu mbeba zifite diyabete, yihutishije gufunga kw’ibisebe, ijyana n’ukwiyongera kw’ibimenyetso byo kuremwa kw’imitsi mishya y’amaraso n’igabanuka ry’ibimenyetso bya okisidasiyo n’urupfu rw’utugingo rugenzurwa n’umubiri. Uburyo imvange iteguwe bufite akamaro muri ubwo bushakashatsi bwombi; nta gisubizo na kimwe gihita gikoreshwa no ku irangi riri mu mazi gusa.

Kandi ingaruka ntizigana mu cyerekezo kimwe muri buri gihe. Mu igerageza rya Dinc na bagenzi be ku guhuza ibice by’amara mu mbeba, methylene blue ya 1% yashyizwe imbere mu nda yagabanyije umuvuduko ukenewe kugira ngo aho amara yahujwe haturike na hydroxyproline ku munsi wa gatatu. Ibyo byagaragaje ko gukomera kw’aho gukira mu ntangiriro kwagabanutse kuri iyo ngano n’ubwo buryo bwo kuyikoresha. Ubukana, ingirangingo, imiterere y’imvange, n’inzira yo kuyikoresha ni byo bigena igisubizo.

Ibyo kubaza ku kintu cyose kivugwa ku bisebe

Ikintu cyose kivugwa kuri methylene blue ku bisebe kigomba gusubiza ibibazo bine. Icya mbere, ni iki nyirizina cyakoreshejwe: igipfuko cyakorewe mu ruganda gifite izina rizwi, uburyo bwagenwe bwo gukoresha ikinyabutabire gikangurwa n’urumuri hamwe n’urumuri, cyangwa umuti w’amazi utasobanuwe? Icya kabiri, cyakoreshejwe he: mu tugingo, ku gisebe cy’inyamaswa, cyangwa ku bisebe by’abantu by’ubwoko bwavuzwe? Icya gatatu, cyagereranyijwe n’iki, kandi mu gihe kingana iki? Icya kane, hakoreshejwe ikihe gipimo cy’ibisubizo: ihinduka ry’ubuso, gufunga, umubare wa bagiteri, cyangwa igipimo cyo muri laboratwari gihagararira gukira?

Ibivugwa bituma igisubizo cy’ikibazo cya mbere kitumvikana neza ni byo bikunze guteza ikosa. Igisubizo cyabonetse hakoreshejwe furo irimo irangi nticyemeza gusiga igisebe ubururu, kandi ikimenyetso cyo kurwanya mikorobe nyuma yo kuvurwa hakoreshejwe irangi n’urumuri nticyemeza gusiga umuti w’amazi udakoreshejwe hamwe n’urumuri. Inyandiko iri gutegurwa yo gusoma no gusuzuma ibivugwa kuri methylene blue ku bisebe izaha uru rutonde rw’ibibazo ahantu hahoraho, harimo n’ingero zisobanuwe; kugeza icyo gihe, imbonerahamwe iri hejuru ni yo ikora nk’ikarita.

Ibisebe byimbitse, bigenda byaguka, binuka nabi, bijyana n’umuriro, cyangwa bitagenda bikira bikeneye gusuzumwa n’inzobere mu buvuzi aho gukoresha irangi. Ubushakashatsi bwasesenguwe hano bukwiriye gukurikiranwa neza kuko busobanura mu buryo bwihariye ibikoresho, uburyo bw’igerageza, n’ibipimo. Komeza guhuza ibyo bitatu n’ikintu cyose kivugwa, maze uru rwego rw’ubushakashatsi rusobanuke neza.