PSYCHOSOCIAL, GENETIC, BIOLOGIC FACTORS IN WOUND HEALING

创面愈合是指损伤后组织恢复正常结构和功能的过程。不正常的愈合可导致感染率增加、瘢痕形成、受伤组织完整性改变和功能受损。当伤口是一种治疗性干预时，例如牙周手术或美容手术，当愈合受损时，有益的效果可能无法实现。个体有效愈合伤口的能力取决于其炎症反应的质量和数量，炎症反应可由神经内分泌和遗传因素调节。本研究计划的总体目的是确定社会心理和遗传因素改变口腔伤口愈合所需的炎症反应的机制。学术考试压力已被证明会使口腔伤口的愈合延迟40%，但这种压力源的相对影响存在相当大的个体差异。我们假设压力影响的大小是社会心理因素的功能，它改变了对压力的感知和压力的感知后果，以及控制促炎细胞因子基因表达水平的遗传多态性。实验口腔伤口将在检查和非应激时间放置，以确定心理和遗传因素在愈合过程中改变炎症反应的机制。以下具体目标将解决这些假设：确定1)检查压力改变伤口愈合过程中细胞募集和炎症反应的机制，以及它们是如何被个体的炎症基因型调节的；2)心理社会因素、神经内分泌介质与伤口延迟愈合的关系。了解延迟愈合的机制，将有助于确定那些风险最大的人，并制定个性化的干预措施，以改善压力的影响。

Wound healing is the process of re-establishment of the normal structure and function of a tissue after injury. Abnormal healing can result in increased rates of infection, scarring, altered integrity of the injured tissue, and impaired function. When the wound is a therapeutic intervention, e.g., periodontal surgery or cosmetic surgery, the beneficial effect may not be achievable when healing is impaired. An individual's ability to efficiently heal a wound depends upon the quality and quantity of their inflammatory response which can be modulated by neuroendocrine and genetic factors. The overall purpose of this research proposal is to determine the mechanisms by which psychosocial and genetic factors alter inflammatory responses required for oral wound healing. Academic examination stress has been shown to delay healing of oral wounds by 40%, but there is considerable individual variation as to the relative impact of this stressor. We hypothesize that the magnitude of the effect of stress is a function of psychosocial factors which alter the perception of stress and the perceived consequences of stress, and genetic polymorphisms that control the level of pro-inflammatory cytokine gene expression. Experimental oral wounds will be placed during examinations and nonstressed times to determine the mechanisms by which psychological and genetic factors alter inflammatory responses during healing. The following specific aims will address these hypotheses: To determine l) the mechanisms by which examination stress alters cellular recruitment and inflammatory responses during wound healing and how they are modulated by an individual's inflammatory genotype; 2) the relationship among psychosocial factors, neuroendocrine mediators, and delayed wound healing. Understanding the mechanisms of delayed healing, will help to determine those at greatest risk and to develop individualized interventions to ameliorate the effects of stress.