I-methylene blue ocwaningweni lwamanxeba: izimbozo, ukukhanya, nemiphumela yokuphola

Ibhandeshi elinombala oluhlaza okwesibhakabhaka nebhodlela loketshezi oluluhlaza okwesibhakabhaka elinesiconsi kubukeka kuyindlela efanayo yokungenelela. Ocwaningweni lwamanxeba akufani. Okokuqala kuyisimbozo esikhiqiziwe esinenani ledayi elimisiwe, esihlolwe njengomkhiqizo ophelile. Okwesibili kuyisixazululo esigcotshwa ngesandla, lapho ukugxila, umthamo woketshezi, nesikhathi sokuthintana kushintsha njalo lapho sigcotshwa. Izifundo zalezi zinto ezimbili ziphendula imibuzo ehlukene, nemiphumela eziyilinganisayo iyahluka ngokufanayo.

Lokhu kubuyekezwa kugcina lezi zinto ezimbili zihlukene. Kubeka obala lokho abacwaningi abakusebenzisa, lokho abakusebenzisa kukho, nalokho abakulinganisayo: indawo yenxeba, izinga lokuvaleka, amanani amagciwane, noma isilinganiso saselabhorethri esimelela ukuphola, njengokuvaleka kwesikhala esiklwebhiwe esitsheni.

Izimo ezintathu, zichazwe ngokucacile

Ucwaningo lwamanxeba nge-methylene blue luwela ezimweni ezintathu. Ngasinye sinombono waso ngalokho idayi ekwenzayo.

Esokuqala, izimbozo zegwebu ezinedayi. Imikhiqizo efana negwebu le-polyvinyl alcohol elifakwe i-methylene blue ne-gentian violet (elithengiswa njengegwebu le-Hydrofera Blue elilwa namagciwane) ithwala odayi ababoshelwe esakhiweni sesimbozo. Indlela yokusebenza echaziwe iwukulwa namagciwane okuhlobene nesimbozo, okuhloswe ukusiza ukulawula ubuningi bamagciwane endaweni yenxeba kuyilapho igwebu limunca uketshezi oluphuma enxebeni. Izinqumo zokwelapha ngomkhiqizo onjalo zenziwa uchwepheshe wezempilo okhetha isimbozo senxeba elithile; imiyalelo yokusetshenziswa kwesimbozo ichaza ukuthi sigqokwa isikhathi esingakanani nokuthi sishintshwa kaningi kangakanani, hhayi indlela evamile yokulungisa idayi eluhlaza okwesibhakabhaka.

Esesibili, ukwelashwa kwe-photodynamic nge-methylene blue. Lapha kufakwa isixazululo se-methylene blue njengento esabela ekukhanyeni bese kukhanyiswa kuso, ngokuvamile ngokukhanya okubomvu okuseduze nebanga lapho idayi imunca khona ukukhanya kakhulu. Ukukhanya nomoya-mpilo kusiza ukukhiqiza izinhlobo zamakhemikhali asebenza ngamandla alimaza amagciwane. Le ndlela yamakhemikhali ihlukile encazelweni yokulwa nama-oxidant esetshenziswa ekukhangiseni ukunakekelwa kwesikhumba, umehluko esiwuchazayo nasemhlahlandleleni wethu we-methylene blue ekunakekelweni kwesikhumba. Ukungenelela kuyinhlanganisela yedayi, umthamo wokukhanya, nomoya-mpilo, futhi ukushintsha noma yikuphi kokuthathu kushintsha ukungenelela.

Esesithathu, i-methylene blue ngaphandle kokukhanya kumaseli nasezilwaneni. Lezi zivivinyo zibuza ukuthi ingabe idayi ngokwayo iyakushintsha yini ukuziphatha kwamaseli e-fibroblast, amaprotheni esakhiwo esizungeze amaseli, noma ukuvaleka kwamanxeba enziwe ngenhloso yokuhlola. Lezi yizifundo zezindlela zokusebenza, hhayi izivivinyo zezimbozo.

Imephu yamamodeli ezifundo: yini eyahlolwa, yahlolwa kuphi, futhi yini eyashintsha

Sebenzisa leli thebula njengemephu yale ndatshana. Funda umugqa ngamunye ukusuka kwesobunxele uye kwesokudla: into esetshenzisiwe, imodeli, nomphumela lowo mugqa ongawusekela. Awukho umugqa oboleka umphumela womunye.

Izimbozo: umkhiqizo ophelile, hhayi indlela yokulungisa idayi

Izimbozo zegwebu ezifundwe ekunakekelweni kwamanxeba ziyimikhiqizo ekhiqiziwe. Uhlu lwe-Hydrofera Blue oluchazwe ekhasini lomkhiqizo lomkhiqizi luhlanganisa odayi ababili egwebini elingenamagciwane: uhlobo lwe-CLASSIC lwe-polyvinyl alcohol luthwala okungenani kungadluli ku-0.00025 g wedayi ngayinye ngegramu yegwebu, kanti uhlobo lwe-READY lwe-polyurethane luthwala okungadluli ku-0.00035 g ngegramu. Ngenxa yokuthi odayi bafakwa ngesikhathi sokukhiqiza, isimbozo ngasinye sithwala inani elaziwayo, futhi imibiko yezempilo ichaza umkhiqizo ngegama, isikhathi sokugqokwa, nohlelo lokushintshwa.

Lezi yimikhiqizo yezokwelapha evunyelwe ukuthengiswa, hhayi imithi egunyaziwe. Isimbozo sokuqala sinemvume ye-FDA engu-K013462 yango-2002, uhlobo lwe-Hydrofera Blue lwe-polyurethane lunemvume engu-K130670 yango-2014, kanti uhlobo lwe-READY olunomngcele lunemvume engu-K190268 yango-2019. Imvume ngomzila we-510(k) iqinisekisa ukufana okukhulu nomkhiqizo wangaphambili; akusona isigunyazo sokusebenza ngempumelelo. Izimangalo zokulwa namagciwane emibhalweni yomkhiqizo zisekelwe kakhulu ekusebenzeni ngaphakathi kwesimbozo nasekuhlolweni kwaselabhorethri, okungafanele kuhunyushwe kube isimangalo sokuthi isimbozo siqeda wonke amagciwane ezicutshini ezithelelekile ngokuncipha okuthile okushiwo ngesilinganiso se-log.

Imibiko eshicilelwe yokusetshenziswa emsebenzini wezempilo ngokuyinhloko iqukethe uchungechunge oluncane lwezigameko olungenawo amaqembu okuqhathanisa. Ocwaningweni luka-Woo no-Heil olwalulandelela amanxeba angama-29 angapholi isikhathi eside, lapho i-Hydrofera Blue Classic yashintshwa khona kathathu ngesonto amasonto amane, indawo yenxeba emaphakathi yehla isuka ku-21.4 yaya ku-12.3 cm² (ukuncipha ngo-42.5%) namaphuzu e-PUSH ehla esuka ku-13.3 aya ku-10.7. Uchungechunge luka-Coutts, Ryan no-Sibbald lwezigameko zamanxeba ayi-15 ezingxenyeni ezingezansi zemilenze lwathola ukuncipha kosayizi wenxeba emasontweni amane kumanxeba ayi-8 kwangama-14 ayengahlolwa, nokuncipha kobuhlungu kwezinye iziguli, ikakhulukazi lezo ezinezilonda zonyawo ezihlobene nesifo sikashukela. Ucwaningo lweqembu lwamanxeba angama-53 olwalubheka emuva olwabikwa u-Lullove lwahlanganisa igwebu nesakhiwo se-collagen esivela ezimvini, ngakho ukuncipha kwendawo okumaphakathi ngo-91.3% emasontweni ayishumi nambili akunakuthiwa kwabangelwa igwebu lodwa. Ukuhlaziywa okukhulu kohlelo okwakubheka emuva okwenziwa u-Hurd kwabika ukuphola ngokushesha lapho izimbozo zisetshenziswa ngaphakathi kwesethi yokunakekelwa esezingeni elimisiwe, nayo ehlola isethi kunokuba ihlole idayi.

Kunomkhawulo owodwa kuzo zonke lezi zifundo: ubuningi bamagciwane buvela njengamaphuzu okuhlola ukutheleleka ngokwezempilo noma amasampula athathwe ngama-swab anikeza isilinganiso esingaphelele senani, hhayi njengokukhuliswa kwamagciwane ezicutshini ngokuphindaphindiwe ukuze kubalwe inani lawo. Isifinyezo esithembekile siwukuthi izifundo zegwebu elinodayi ababili zibika ukuncipha kwendawo, ukuthuthuka kwamaphuzu okuhlola isisekelo senxeba, ngezinye izikhathi nobuhlungu obuncane, ngaphandle kokuqinisekisa ukuhlobana komthamo nomphumela okuqondene ne-methylene blue noma izinga lokubulawa kwamagciwane elilinganisiwe ezicutshini. Futhi akukho ezifundweni zezimbozo okuqinisekisa ukuthi ukucwilisa i-gauze esixazululweni sebhodlela elinesiconsi kuyindlela elinganayo. Ukugxila, ukusabalala, izinga lokudedelwa kwedayi, ukungabi namagciwane, nesikhathi sokugqokwa konke kuyahluka.

Ukukhanya nedayi: izifundo zamanxeba ze-photodynamic

Ucwaningo lwamanxeba lwe-photodynamic lwengeza ukukhanyiswa ohlelweni lokwelapha. Ukugxila ezifundweni zabantu ngokuvamile kuphakathi kuka-0.01% no-1% we-methylene blue, ngokukhanya okubomvu okuseduze no-635 kuya ku-660 nm, namandla okukhanya afika endaweni esukela kuma-joule ambalwa ngesentimitha eliyisikwele kuya kwangaphezu kwekhulu. Amaqembu okuqhathanisa ayahluka: ezinye izifundo ziqhathanisa nokunakekelwa okujwayelekile, ezinye zibika amanani amagciwane ngaphambi nangemva kokwelashwa emanxebeni afanayo.

Okubonwa ngokungaguquguquki kakhulu kubantu kumayelana nesimo nendawo yenxeba kunamanani amagciwane. Ocwaningweni olulawulwayo luka-Carrinho nozakwabo lwezilonda eziyi-12 ezihlobene nesifo sikashukela, i-methylene blue engu-0.01% nokukhanya okungu-660 nm ngamandla angu-6 J/cm², kathathu ngesonto izikhathi eziyishumi, kwaveza ukuncipha kwendawo okukhulu ngokuphawulekayo kuneqembu lokuqhathanisa. Uchungechunge lwezigameko zamanxeba amahlanu athelelekile luka-Shen nozakwabo lwabika ukuphola okuphelele ngemva kwezikhathi ezine ngokwesilinganiso sokwelashwa ngedayi engu-1% nokukhanya okungu-635 nm, ngaphandle kwemiphumela yokubala amanani amagciwane. Isivivinyo esikhulu kunazo zonke esinokwabiwa kwamaqembu ngokungahleliwe kuze kube manje, isivivinyo luka-Chagas nozakwabo lwabahlanganyeli abangama-94 abanezilonda zonyawo ezihlobene nesifo sikashukela, lapho abahlanganyeli nabahloli babengazi ukwabiwa kwamaqembu, sathola ukuthuthuka kwamaphuzu amanxeba e-Bates-Jensen kusukela esikhathini sesithathu sokwelashwa kuya ekuhlolweni kokulandelela kwezinsuku ezingamashumi amathathu ngedayi engu-1% ne-laser engu-660 nm, ngaphandle kwezehlakalo ezimbi ezihlobene nokwelashwa, kodwa futhi ngaphandle komphumela wokubala ubuningi bamagciwane.

Izixwayiso ezimbili zigcina le mibhalo yocwaningo ithembekile. Okokuqala, umphumela ophawulekayo wokunqunywa kwezitho ngezinye izikhathi ocashunwa ku-Tardivo nozakwabo wasebenzisa i-methylene blue ihlanganiswe ne-toluidine blue, ngakho awunakuthiwa wabangelwa i-methylene blue yodwa. Okwesibili, ukuphola ngemva kwesikhathi sokukhanyiswa akunakuthiwa ngokuzenzakalelayo kwabangelwa ukusabela kwamakhemikhali okuvuselelwa ukukhanya okulwa namagciwane, ngoba ukukhanya okubomvu ngokwakho kungakushintsha ukulungiswa kwezicubu. Esivivinyweni sika-Sperandio nozakwabo samanxeba amagundane esasineqembu ledayi yodwa, lokukhanya kuphela, lenhlanganisela, nelokuqhathanisa, i-laser yodwa yaba nomthelela ekupholeni. Ukuthi umphumela ubangelwe ukubulawa kwamagciwane kudinga ukuhlolwa kwamagciwane kanye namaqembu okuqhathanisa afanele. Ucwaningo lwezilwane lucace kakhudlwana kuleli phuzu: kumodeli yenxeba elithelelekile legundane elincane lika-Pérez nozakwabo, ukwelashwa kwe-photodynamic kwaveza umphumela omuhle kakhulu wokuphola obonakalayo kuyilapho i-mupirocin yehlisa amagciwane kakhulu, ihlukanisa le miphumela emibili ngokucacile. Ukubuka kwethu kabanzi ubufakazi be-methylene blue nokukhanya okubomvu kubeka lezi zinhlelo zamanxeba eceleni kwezimo zokusetshenziswa kokukhanya ezingahlobene namanxeba ukuze ukusabela okufanayo kwamakhemikhali ekukhanyeni kungaphanjaniswa nenhloso efanayo yokwelapha.

Amaseli namamodeli esikhumba: lapho uphawu lokuphola luqala khona

Isisekelo saselabhorethri sesimangalo sokuphola kwamanxeba ucwaningo lwango-2017 luka-Xiong nozakwabo lwamaseli abantu e-fibroblast ongqimba lwe-dermis nesikhumba esakhiwe kabusha. Amaseli e-fibroblast avela kubanikeli ababili, ayelashwe kusengaphambili nge-methylene blue engu-100 nM, agcwalisa kabusha isikhala esiklwebhiwe ngokushesha okukhulu ngokuphawulekayo kunamaseli angalashwanga emahoreni angama-24. Esikhunjeni esakhiwe kabusha esinazo zonke izingqimba, ukuchayeka isikhathi eside kwandisa umswakama olinganisiwe nokuqina kongqimba lwe-dermis, nokwanda kokukhiqizwa kwe-elastin ne-COL2A1 phakathi kwezinguquko esakhiweni esizungeze amaseli.

Lezi yimiphumela yangempela ehlobene namanxeba, futhi ingeyamamodeli yayo. Isivivinyo sesikhala esiklwebhiwe silinganisa ukuhamba kwamaseli ehlangene enqamula isikhala esitsheni. Asinakho ukusabela kwamasosha omzimba, akukho ukuzinza kwamagciwane, akukho uketshezi oluphuma enxebeni, futhi asikho isimbozo. Isikhumba esakhiwe kabusha sengeza ukwakheka kwezicubu kodwa sisantula ukujikeleza kwegazi nalo lonke uchungechunge lwezenzakalo zokuphola. Ayikho kulezi zimodeli ehlola isimbozo segwebu noma uhlelo lwe-photodynamic, futhi ayikho enikeza ukugxila okufanele kusetshenziswe ekhaya.

I-methylene blue elungiselelwe ibe umkhiqizo nayo ihlolwe emanxebeni ezilwane eziququdayo. Ijeli yama-niosome engu-0.005% eyafundwa u-Farmoudeh nozakwabo yasheshisa ukuvaleka kokuqala kwamanxeba amagundane enziwe ngokusikwa kukhishwe izicubu, uma iqhathaniswa nedayi engafakwanga kule ndlela yokulungiselela kanye nesisekelo sejeli esingenadayi, ngokubonakala kwezicubu ngaphansi kwesibonakhulu kanye nezilinganiso zokucindezeleka kwe-oxidative okuhle kakhulu. I-nanoemulsion engu-0.1 mg/mL eyafundwa u-Gao nozakwabo kumagundane amancane anesifo sikashukela yasheshisa ukuvaleka, yandisa izinkomba zokwakheka kwemithambo yegazi emisha futhi yehlisa izimpawu ze-oxidative nokufa kwamaseli okuhleliwe. Indlela yokulungiselela ibalulekile kuzo zombili izimo; awukho kule miphumela odluliseka ngokuzenzakalelayo kudayi nje encibilikiswe emanzini.

Futhi umthelela awuhambi ngendlela efanayo kuzo zonke izimo. Esivivinyweni sika-Dinc nozakwabo sokuxhunywa kwamathumbu emagundaneni, i-methylene blue engu-1% eyafakwa ngaphakathi kwesisu yehlisa umfutho odingekayo ukuze kuqhume indawo yokuxhuma kanye ne-hydroxyproline ngosuku lwesithathu, ikhombisa ukwehla kwamandla okuphola kokuqala kulowo mthamo nakuleyo ndlela yokufaka. Ukugxila, izicubu, indlela yokulungiselela, nendlela yokufaka kunquma umphumela.

Imibuzo okufanele ibuzwe nganoma yisiphi isimangalo samanxeba

Zonke izimangalo zamanxeba nge-methylene blue kufanele zikwazi ukuphendula imibuzo emine. Okokuqala, yini ngempela eyasetshenziswa: isimbozo esikhiqiziwe esinegama elithile, uhlelo oluchaziwe lwento esabela ekukhanyeni kanye nokukhanya, noma isixazululo esingachaziwe? Okwesibili, yasetshenziswa kuphi: kumaseli, enxebeni lesilwane, noma emanxebeni abantu ohlobo olushiwo? Okwesithathu, yaqhathaniswa nani, futhi isikhathi esingakanani? Okwesine, ngamuphi umphumela olinganisiwe: ukushintsha kwendawo, ukuvaleka, amanani amagciwane, noma isilinganiso saselabhorethri esimelela ukuphola?

Izimangalo ezifiphaza umbuzo wokuqala yizona ezivame ukuphambuka kakhulu. Umphumela otholwe ngegwebu elinedayi awuqinisekisi ukufaneleka kokupenda inxeba libe luhlaza okwesibhakabhaka, futhi uphawu lokulwa namagciwane ngemva kwesikhathi sokwelashwa kwe-photodynamic aluqinisekisi ukufaneleka kokuthintisa isixazululo ngaphandle kokukhanya. Umhlahlandlela ozayo wokufunda izimangalo ze-methylene blue zamanxeba uzonikeza lolu hlu lokuhlola indawo yaphakade enezibonelo ezichaziwe; kuze kube yileso sikhathi, ithebula elingenhla liyimephu.

Amanxeba ajulile, asabalalayo, anephunga elibi, ahambisana nomkhuhlane, noma angathuthuki adinga ukuhlolwa uchwepheshe wezempilo kunedayi. Ucwaningo olubuyekezwe lapha lufanele ukulandelwa ngenxa yokuthi lucacisa izinto ezisetshenzisiwe, amamodeli, nezilinganiso. Gcina lezi zinto ezintathu zihambisana nesimangalo ngasinye, futhi lo mkhakha uqondakala ngokucacile.