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BACKGROUND: The current paradigm of watchful waiting (WW) in people 65 years or older with an asymptomatic paraesophageal hernia (PEH) is based on a now 20-year-old Markov analysis. Recently, we have shown that elective laparoscopic hernia repair (ELHR) provides an increase in lifeyears (L-Ys) compared with WW in most healthy patients aged 40 to 90 years. However, elderly patients often have comorbid conditions and may have complications from their PEH such as Cameron lesions. The aim of this study was to determine the optimal strategy, ELHR or WW, in these patients. STUDY DESIGN: A Markov model with updated variables was used to compare L-Ys gained with ELHR vs WW in hypothetical people with any type of PEH and symptoms, Cameron lesions, and/or comorbid conditions. RESULTS: In men and women aged 40 to 90 years with PEH-related symptoms and/or Cameron lesions, ELHR led to an increase in L-Ys over WW. The presence of comorbid conditions impacted life expectancy overall, but ELHR remained the preferred approach in all but 90-year-old patients with symptoms but no Cameron lesions. CONCLUSIONS: Using a Markov model with updated values for key variables associated with management options for patients with a PEH, we showed that life expectancy was improved with ELHR in most men and women aged 40 to 90 years, particularly in the presence of symptoms and/or Cameron lesions. Comorbid conditions increase the risk for surgery, but ELHR remained the preferred strategy in the majority of symptomatic patients. This model can be used to provide individualized management guidance for patients with a PEH. [ABSTRACT FROM AUTHOR]

This study will explore the effectiveness of fish skin grafts (FSG) in ulcer healing in diabetic foot disease compared to standard of care (SOC). The systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. The electronic databases of PubMed, EMBASE, and Web of Science (WoS) internet were searched for the outcome rate of complete ulcer healing. The risk of bias assessment was conducted using the tool recommended by the Cochrane Collaboration. Statistical analysis included the individual and combined result of the studies, heterogeneity test, the effect size, sensitivity analysis, and publication bias tests. Five randomised controlled trials (RCTs) with a total of 411 patients were included in this study. This meta-analysis showed a higher rate of complete ulcer healing in groups receiving fish skin grafts (OR = 3.34, 95% CI 2.14–5.20, p < 0.01, I2 = 0%) compared to control groups. Fish skin grafts have been shown to be more effective for achieving complete ulcer healing compared to current conventional treatments in diabetic foot disease. • Foot complications are one of the leading causes of hospitalisation in patients with diabetes mellitus, demanding prolonged stays. • 15% of the diabetic population will develop diabetic foot disease during their disease, with 25% of them leading to lower limb amputation. • The current standard hospital treatments for patients with diabetic foot disease, do not guarantee success in their closure. • Fish skin grafts is a highly efficient treatment considering its cost and effectiveness in the ability to stimulate cell proliferation and differentiation. [ABSTRACT FROM AUTHOR]

Background: Oral traumatic ulcerative lesions (OTUL) are commonly encountered in clinical practice, yet there is limited research on their clinical characteristics and traumatic etiological factors. This retrospective study aimed to analyze the age, gender, clinical characteristics, and traumatic etiological factors in a large cohort of patients with OTUL and provide valuable insights for dental clinicians to optimize patient care and prevention strategies. Methods: A total of 1543 patients with OTUL were enrolled in this study. Age, gender, medical history, clinical characteristics and traumatic etiological factors were collected and analyzed. Logistic regression analysis was performed to determine the significance of age and gender as factors related to OTUL. Results: The study revealed significant variations in clinical characteristics and traumatic etiological factors among different age groups and between genders. Logistic regression analysis demonstrated that both age and gender were significant factors related to OTUL. Conclusion: The clinical characteristics of OTUL and traumatic etiological factors appear to be significantly different according to age and gender. More targeted prevention strategies should be implemented for all age and gender groups. [ABSTRACT FROM AUTHOR]

Introduction: Radiotherapy as an adjunct to cancer treatment causes a high incidence of radiation-induced tissue injury, ranging from radiation dermatitis to severe osteoradionecrosis. Currently, no gold standard exists in the management of radiation injury. Various strategies ranging from modern wound treatment to surgical management have been studied. CaseIllustration: Three women presented with varying degrees of ulceration in the chest during or shortly following radiotherapy. Each case followed different approaches to management. One case solely received wound treatment, another received wound treatment and a sequestrectomy, and the third required surgical reconstruction of the chest wall and defect. Discussion:Methods of wound treatment range from topical agents, barrier films and dressings, hydrogel and hydrocolloid dressings, miscellaneous treatments, and biodressings. Surgery is required in severe cases, particularly with osteoradionecrosis. This may include wound debridement, biopsy, chest wall stabilization, closure using various flaps, and potential breast reconstruction. Conclusion: Radiation-induced ulcers of the chest pose a complex issue. Understanding effective treatment methods and key surgical principles is important for ensuring better outcomes. Further studies are needed to provide a complete guide to treatment. [ABSTRACT FROM AUTHOR]

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Background: The MDR1 genotype and the CYP2C19 phenotype determine how much PPI is absorbed from the gut and how much is processed in the liver. Objective: To assess the impact of CYP2C19 and MDR1 C3435T gene polymorphisms on the efficiency of H. pylori eradication treatment with a 4-drug regimen of rabeprazole, bismuth, tetracycline, and tinidazole (RBTT) in patients with duodenal ulcers. Methods: The study was conducted at Can Tho University of Medicine and Pharmacy. Gene polymorphisms for CYP2C19 and MDR1 C3435T were detected through a blood test. The RBTT 4-drug regimen was used to eradicate H. pylori. Results: The success rate of the RBTT regimen for eradicating H. pylori in female patients with the CYP2C19 EM phenotype + MDR1 3435CC genotype was 20.0% lower than the rate of 91.7% for the group without both phenotype and genotype (p = 0.01, OR = 0.02, 95%CI: 0.00-0.45). Conclusion: Compared to the group lacking both phenotypes and genotypes, female patients with the CYP2C19 EM phenotype + MDR1 3435CC genotype had a lower rate of H. pylori eradication by RBTT regimen. [ABSTRACT FROM AUTHOR]

Objective: Intra-soft tissue and intramedullary antibiotic perfusion (iSAP and iMAP), which combine continuous administration of antibiotic solution to the wound and negative pressure wound therapy (NPWT), have been reported to be a useful management approach for hard-to-heal ulcers in the field of orthopaedic surgery. We report the efficacy of this treatment and discuss the key points. Method: The recipients of this treatment had contaminated fresh severe trauma with a high risk of infection, or hard-to-heal ulcers which were expected to be difficult to manage with conventional NPWT alone. Continuous administration of 1200µg/ml of gentamicin (GM) solution to the wound was performed along with NPWT. The GM solution was administered subcutaneously using a small catheter for iSAP, while intramedullary administration used a bone marrow needle for iMAP. Results: iSAP was employed in all 10 patients who took part, and iMAP in three of these patients. The average treatment time was 13.6 days with iSAP and 9.3 days with iMAP. The mean serum GM level during the therapy was 1.02µg/ml. Moderate GM-induced acute kidney injury was suspected in one case, but resolved spontaneously after GM administration was stopped. Favourable wound bed preparation was achieved in all cases without recurrence of infection. Conclusion: Combination with continuous suction by NPWT is able to keep the local concentration of antibiotic above the minimum inhibitory concentration of biofilm-coated bacteria within the wound. We have referred to this treatment as continuous local antibiotic perfusion. Further investigation of local pharmacodynamics in the wound and side-effects of this treatment are warranted. [ABSTRACT FROM AUTHOR]

Background: Little is currently known about HIV-related parameters that may increase the risk for oral ulcers during the COVID-19 pandemic. This study aimed to overcome this gap in research by assessing the associations between HIV viral load, antiretroviral adherence profile, co-morbidity status, SARS-CoV-2 infection and oral ulcers among people living with HIV (PLHIV). Methods: This was a secondary analysis of data generated from 21,206 to 18 years and above, recruited from 152 countries through an online survey between July and December 2020. Data were extracted for 874 people who reported living with HIV. The dependent variable was reporting having oral ulcer. The independent variables were the viral load, adherence to antiretroviral treatment and a history of SARS-CoV-2 infection. The confounding variables were age at last birthday and sex at birth. A multivariable logistic regression analysis was conducted to determine the associations between the dependent and independent variables after adjusting for the confounding variables. Results: Of the 874 participants, 99 (11.3%) reported having oral ulcers during the first wave of the COVID-19 pandemic. The odds of PLHIV having oral ulcers during the first wave of the COVID-19 pandemic was significantly higher for people who did not know their viral load than those who had undetectable viral load (AOR: 2.036; 95% CI: 1.204–3.443; p = 0.008); and people who did not adhere to the use of antiretroviral treatment than those who adhered (AOR: 4.113; 95% CI: 2.567–6.589; p < 0.001). Also, PLHIV who had SARS-CoV-2 infection had significantly higher odds of having oral ulcers than those who did not have the infection (AOR: 14.556; 95% CI: 4.500-47.078; p < 0.001). PLHIV who had co-morbidities had non-significantly higher odds of having oral ulcers than those without co-morbidities (AOR: 1.170; 95% CI: 0.656–2.085; p = 0.595). Conclusion: Oral ulcers may be an indicator of poor adherence to antiretroviral therapy and unsuppressed viral load among PLHIV. It may also be an indicator of SARS-CoV-2 infection and a signal to take prompt and critical care of affected individuals because of the risk for severe COVID-19 for these individuals. [ABSTRACT FROM AUTHOR]

Peptic ulcer disease has remained a global threat due to several complications such as perforation, gastrointestinal obstruction and organ penetration associated with the disease. This study evaluated the phytochemical composition and anti-ulcer activity of crude extract and fractions of Acanthus montanus on an indomethacin-induced ulcer in a mouse model. The plant was extracted using cold maceration in methanol and fractionated using solvents of varying polarities into their corresponding fractions. The phytochemical screening was conducted using a standard procedure. The acute toxicity test employed Lorke's method and the anti-ulcer activity was conducted using the indomethacin-induced method. The phytochemical composition revealed the abundance of tannins, saponins, steroids/terpenoids and flavonoids in the crude extract and fractions. An acute toxicity study showed that the extract is safe even at a high dose of 5000 mg/kg. The anti-ulcer study revealed that A. montanus extract and fractions elicited a dose-dependent activity against peptic ulcer with strong curative indices of 79, 93, and 71% for the 400 mg/kg doses of methanol extract aqueous, and n-hexane fractions respectively compared with 42% index of the control. There was a dose-dependent ulcer healing with 400 mg/kg doses eliciting higher curative indices than the 200 mg/kg doses. The 200 mg/kg doses of aqueous fraction and 400 mg/kg doses of methanol extract, aqueous, and n-hexane fractions elicited ulcer indices significantly different (p<0.05) from those of controls. The rich presence of biologically active constituents with antiulcerogenic properties in the methanol extract and fractions of A. montanus supports its use in ethnomedicine. [ABSTRACT FROM AUTHOR]

Aims : The most common postoperative complication when treating a pressure ulcer with a flap or primary closure is early wound dehiscence. In this study, we aimed to investigate the cause of early wound dehiscence and its associated risk factors. Early wound dehiscence was defined as the wound dehiscence within the post operation period where no weight or tension is applied to the wound. Methods : We conducted a retrospective study of 40 patients with pressure ulcers (69 sites). We calculated the significant difference in the incidence of wound dehiscence between the groups for the following 15 factors : age, obesity, emaciation, diabetes mellitus, smoking, ulcer site, musculocutaneous flap, methicillin-resistant Staphylococcus aureus, presence of two or more types of bacteria, albumin level, C-reactive protein level, white blood cell count, hemoglobin level, operative time, and ulcer size. Results : Bacteria were detected in all wounds with early dehiscence, which was found in 28 (40.6%) of the 69 cases. C-reactive protein level, albumin level, musculocutaneous flap, and operative time were found to be risk factors for early wound dehiscence using the χ² -test and t-test. (P = 0.011, 0.045, 0.018, and 0.003, respectively). Conclusion : The cause of dehiscence was considered to be surgical site infection. C-reactive protein level, albumin level, musculocutaneous flap, and operative time may be risk factors of the occurrence of early wound dehiscence. [ABSTRACT FROM AUTHOR]

Honey has been widely documented to have therapeutic benefits, especially on the healing of wounds, digestive disorders, and as an antimicrobial agent. It's known that stomach ulcers are one of the most prevalent diseases that affect humans with no effective treatment. The objective of this study was to investigate the gastroprotective effects of jujube honey against ethanol-induced gastric ulcer in mice and to explore possible mechanism of its action on the gastric mucosa. Stomach's tissues were examined for ulcerative lesions and white blood cell count (WBC), plasma C-reactive protein (CRP) and nitric oxide (NO) for clinical inflammation evaluation. The antioxidant enzyme activities were investigated using the measurement of superoxide dismutase (SOD) and catalase. Treatment with jujube honey reduced the ulcer index and preserved gastric tissue. It also decreased the inflammatory response by reducing WBC and plasma levels of CRP and NO in ulcerative group. In addition, jujube honey-treated group showed increased antioxidant enzyme activities of catalase and SOD. Furthermore, diluted jujube honey is more effective in preserving mucosal gastric integrity. In conclusion, these findings suggest that jujube honey, especially with dilution, may exert a protective effect against ethanol-induced gastric ulcer, through the improvement of antioxidant system and suppression of the inflammatory response via its bioactive compounds. [ABSTRACT FROM AUTHOR]

Background: Pressure ulcers occur due to prolonged pressure and friction in areas of bony prominences that result in tissue injury with varying depths. To date, there is no standardized wound dressing for these ulcers. From the review of the availability and affordability aspects, honey can be used as a wound dressing because it contains anti-oxidants, anti-inflammatory, and anti-bacterial properties. This article investigates the advantages of honey dressing over other modern dressings. Methods: Literature search from online databases using relevant keywords. A total of three articles were discussed in this review article. Results: All articles agreed that giving honey to pressure ulcer wounds reduced wound size and pain. Honey-soaked gauze provided quicker pain relief during treatment and reduced discomfort with each dressing change. Wound healing was proven to be four times faster with honey compared to other topical dressings. The anti-bacterial effect of honey could not be significantly confirmed in this study. Nonetheless, honey dressings succeeded in accelerating wound healing in patients with pressure ulcers. Conclusion: Honey can be a promising alternative to topical dressings in patients with pressure ulcers. [ABSTRACT FROM AUTHOR]

(1) Background: In Vietnam, H. pylori bacteria has a resistance rate of 63% to the antibiotic clarithromycin. The initial therapy of H. pylori eradication with a standard three-drug regimen has low efficacy. Objective: Assess the efficacy of H. pylori eradication therapy which uses a four-drug regimen of rabeprazole-bismuth-tetracycline-tinidazole in patients with duodenal ulcers. (2) Methods: We performed gastrointestinal endoscopy on patients with a diagnosis of duodenal ulcers, gastric mucosa biopsy for a rapid urease test, and histopathology to diagnose H. pylori bacteria before and after treatment. Treatment for eradication of H. pylori bacteria using a rabeprazole-bismuth-tetracycline- tinidazole regimen was prescribed for 14 days. (3) Results: The rate of successful H. pylori eradication treatment according to per protocol (PP) and intention to treat (ITT) was 91.3% (95%CI: 84.8-96.7) and 82.4% (95%CI: 74.5-89.2) respectively. The success rate of H. pylori eradication therapy in males was 96.0% (95%CI: 92-100), higher than in females, which was 70.6% (95%CI: 47.1-88.2), p < 0.01. (4) Conclusions: Treatment of H. pylori with rabeprazole-bismuth-tetracycline-tinidazole regimen is highly effective. Men had higher H. pylori eradication results than women. [ABSTRACT FROM AUTHOR]

Background. Oral ulcer (OU) is a common oral mucosal disease manifested with obvious pain. In some studies, the efficacy of acupuncture in OU has been confirmed, but systematic reviews and meta-analyses for them are lacking. Our aim is to evaluate the efficacy of acupuncture in the treatment of OU. Methods. We searched the literature from eight databases from their inception to December 2021. We included randomized controlled trials of acupuncture for the treatment of oral ulcer. The meta-analysis was carried out using Review Manager 5.3 and Stata 16.0. The main outcomes were the effective rate and the recurrence rate, the secondary outcomes were the visual analogue score (VAS) and the ulcer healing time. Results. Totally, 18 studies were finally included in the meta-analysis, including 1,422 patients. In meta-analyses, we found that in comparison with Western medicine, acupuncture can improve effective rate (OR = 5.40, 95% CI: 3.40 to 8.58), reduce the ulcer recurrence rate (OR = 0.21, 95% CI: 0.13 to 0.33), and relieve the ulcer pain (MD = −2.26, 95% CI: −4.27to−0.24). In addition, compared with Western medicine, acupuncture plus Western medicine also can improve effective rate (OR = 2.95, 95% CI: 1.48 to 5.85). Compared with the Chinese medicine, the acupuncture plus Chinese medicine can improve the effective rate (OR = 8.26, 95% CI: 3.61 to 18.88) and relieve the ulcer pain (MD = −1.85, 95% CI: −2.51 to −1.19). Conclusion. Acupuncture may be more effective than Western medicine in terms of efficacy rate, and acupuncture combined with Western or Chinese medicine may have the potential to reduce the recurrence of ulcer and relieve the ulcer pain. However, due to limited evidence, higher quality and more rigorously designed clinical trials with larger sample sizes will be needed to further confirm our findings. [ABSTRACT FROM AUTHOR]

Context: Chronic non-healing ulcer causes significant morbidity, high cost and reduced quality of life. Aims: To compare autologous platelet-rich fibrin matrix and transplantation of autologous non-cultured epidermal cell suspension in the treatment of chronic non-healing ulcers. Methods: The study was single-centre, prospective, randomised comparative study conducted in a tertiary care center in North India. Patients with chronic non-healing ulcer were included and randomly divided into two treatment groups- Group 1: Platelet-rich fibrin matrix (PRFM) procedure was done every 2 weeks with maximum three sittings and in Group 2: Transplantation of autologous noncultured epidermal cell suspension (NCES) procedure was done once. Follow-up was done every 2 weeks for 8 weeks then monthly for up to 5 months to evaluate the healing of the ulcer. The data were analysed by statistical package for social science (SPSS) trial version 22. To find out a significant difference in mean value between groups, the Chi-square test, student's t-test, and Mann–Whitney U test were used. Results: A total of 41 patients were included in the study. Complete healing of ulcers occurred in 89.5% of the patients in the PRFM group and 93.8% of the patients in the NCES group at the end of 5 months (P = 0.33). The mean duration of complete healing in PRFM was 1.7 months and in NCES was 2.13 months (P = 0.20). Conclusions: Both procedures were effective, and there was no significant difference between the two procedures. [ABSTRACT FROM AUTHOR]

Introduction Band ligation plays an important role in the management of esophageal varices (EV), but banding ligation carries a risk of band slippage, postbanding esophageal ulcer formation, and postbanding bleeding. Aim The predisposing factors and frequency of esophageal ulcer after banding ligation of EV were assessed. Patients and methods A total of 130 cirrhotic patients with EV were subjected to therapeutic or prophylactic banding ligation, and then the patients were observed for 14 days for detection of incidence of esophageal ulcer bleeding after postbanding ligation. This was a prospective study done to compare the cirrhotic patients without endoscopic variceal ligation (EVL)-induced esophageal ulcer as a complication (nonbleeder group, n==118) with bleeding patients after EVL owing to postbanding ulcer (bleeder group, n = 12). Full present and past medical history taking for all patients, physical examination, laboratory investigation, ultrasonography of abdomen and/or triphasic computed tomography abdomen, upper endoscopy, and EVL, were done. Re-endoscopy was done if rebleeding happens after EVL. Results After EVL, the incidence of esophageal ulcer bleeding in cirrhotic patients was 9.2%, and the mortality within the 2-week follow-up was 16.7%. The risk factors of postbanding ulcer bleeding were esophageal reflux, increased aspartate transaminase to platelet ratio index score, and focal hepatic lesion. Conclusion Bleeding of esophageal ulcer after EVL is not a rare complication of EVL, which is most commonly detected within 14 days after EVL. Reflux esophagitis, increase in aspartate transaminase to platelet ratio index score, and presence of focal hepatic lesion are predisposing factors for postbanding esophageal ulcer bleeding. [ABSTRACT FROM AUTHOR]

Synthesis of gold nanoparticles exhibition wide range of bioactivities and was conventionally used for the remedy of numerous disorders. Our study aims to measure the gastroprotective effect of synthesized gold nanoparticles on absolute ethanol-induced stomach ulceration in rats. The rats were noticeably administered with two doses of gold nanoparticles (175 ppm and 350 ppm) with absolute alcohol and showed a significant improvement in the adverse effect of ethanol-produced stomach damage as confirmed by decreasing ulcer index and raising % of ulcer prevention. Increased mucus pH of stomach content reduced ulcerated portion, condensed or nonappearance of edema, and white blood cells permeation subcutaneous layer. In gastric tissue homogenate, synthesized gold nanoparticles presented a substantial increase in superoxide dismutase (SOD), catalase (CAT) actions, and a substantial lessening of malondialdehyde (MDA) amount. Besides, gold nanoparticle increases the intensity of periodic acid Schiff stained (PAS) of the gastric epithelium of the stomach. Gold nanoparticles confirmed gastro-protective effects which might be qualified to its antioxidant, increase mucus secretion, increase endogenous enzymes (SOD and CAT), and reduce MDA quantity. [ABSTRACT FROM AUTHOR]

Leprosy is a neglected disease caused by Mycobacterium leprae and Mycobacterium lepromatosis, and is related to significant disabilities resulting from the neural damage generated by this mycobacteria. Neuropathic ulcers—lesions that can appear at the plantar and extra-plantar levels—are one such disability, and diagnosis requires an adequate dermatological, neurological and microbiological evaluation. The treatment of these lesions is based on a multidisciplinary approach that includes debridement of the necrotic tissue, controlling infections, reducing pressure areas, optimising blood flow, and nerve decompression. This review aims to describe the clinical features, diagnostic methods and treatment of neuropathic ulcers in leprosy. The diagnostic methods and medical management used in leprosy ulcers are based on those used for diabetic foot. This requires radical change as these diseases are immunologically and physiologically very different. [ABSTRACT FROM AUTHOR]

This study aims at evaluating the efficacy and safety of ozone therapy for chronic wounds. The Cochrane Library, PubMed, Ovid Embase, Web of Science, and Chinese Biomedical Literature Database were searched. Randomised controlled trials (RCTs) about participants with chronic wounds were included. Risk of bias assessment was performed by the Cochrane risk‐of‐bias tool. A randomised‐effects model was applied to pool results according to the types of wounds or ulcers. Among 12 included studies, ozone was implemented by topical application (ozone gas bath, ozonated oil, ozone water flushing) and systematic applications including autologous blood immunomodulation and rectal insufflation. The results indicated compared with standard control therapy for diabetic foot ulcers, ozone therapy regardless of monotherapy or combined control treatment markedly accelerated the improvement of the wound area(standardised mean difference(SMD) = 66.54%, 95% confidence interval (CI) = [46.18,86.90], P <.00001) and reduced the amputation rate (risk ration (RR) = 0.36, 95% CI = [0.24,0.54], P <.00001). But there is no improvement in the proportion of participants with completely healed wounds and length of hospital stay. No adverse events associated with ozone treatment have been reported. And the efficacy of ozone therapy for other wound types is still uncertain because of no sufficient studies. More high‐quality randomised controlled trials are needed to confirm the efficacy and safety of ozone therapy for chronic wounds or ulcers. [ABSTRACT FROM AUTHOR]

The Dayak community is known to use Eleutherine palmifolia as a wound and ulcer treatment. However, according to published research, other species of Eleutherine possess wound healing properties. In addition, the active compound components of species Eleutherine induce antibacterial and antioxidant bioactivity which can aid the healing process. As a result, the aim of this research is to identify active components in an ethanol extract of Eleutherine sp bulb obtained through maceration with 70% ethanol as the solvent. Chemical compounds were analyzed using GC-MS, while the mass spectra of compounds found in extracts was compared to those contained in the National Institute of Standards and Technology (NIST) library. Preliminary phytochemical screening revealed the presence of bioactive compounds such as triterpenoids, steroids, and tannins. The mass spectral measurements revealed 13 peaks, indicating the existence of that number of active phytochemical components including 1H-Indene, 2-butyl-5-hexyloctahydro; Benzene, 1,2,3-trimethyl; and Phenol, 2,5-bis (1,1-dimethyl ethyl). It is intended that the findings of this study will provide more information about the active compound components of Eleutherine sp. which promote biological activity that aids wound healing. [ABSTRACT FROM AUTHOR]

Involvement of blood vessels in the form of Raynaud's phenomenon and microcirculatory dysfunction as well as accompanying skin lesions of the fingers in patients with systemic sclerosis lead to easy skin damage and difficult-to-heal ulcers. Patient education regarding, among other things, the avoidance of injuries, exposure to cold or smoking and pharmacological treatment are becoming important. The choice of drugs listed in current recommendations depends on the clinical manifestation, i.e. the presence and severity of Raynaud's phenomenon, the treatment or prevention of ulceration and the response to previous treatment. The paper presents a case of a 79-year-old woman with advanced necrotic lesions of the fingers in the course of systemic sclerosis diagnosed late in life. Due to the advancement of the lesions and the lack of improvement after first-line oral medications, the patient required intravenous prostaglandin. Six months of effective therapy and additional surgical treatment led to complete healing and inhibition of new ulcer formation. Intravenous prostaglandin is an effective alternative for the treatment of difficult-to-heal ulcers in the course of systemic sclerosis while preventing the formation of new lesions. [ABSTRACT FROM AUTHOR]

Introduction: When the pressure ulcer does not respond to established standard care, then international guidelines recommend the use of alternative forms of therapy such as electrical stimulation, negative pressure wound treatment, ultraviolet radiation, electromagnetic field therapy or ultrasound. Low and high frequency ultrasound is used to treat various types of chronic ulcers including venous, diabetic and pressure ulcers. Aim: The aim of the present systematic review was to investigate the effectiveness of ultrasound in promoting the healing of pressure ulcers. Method and Material: A systematic review was carried out in the electronic databases PubMed and Cochrane Library. Inclusion criteria were primary and secondary studies, whose sample were patients with pressure ulcers, regardless of age, published in English language of the last decade (2008-2018). Results: The review revealed 5 articles that met the inclusion criteria. The results of these studies showed an advantage in the use of ultrasound for the treatment of pressure ulcers in relation to the standard wound care only. Conclusions: The use of ultrasound seems to be a process which improves and accelerates the healing of pressure ulcers. The method of low and high frequency ultrasound in the treatment of chronic wounds, presents many advantages. It appears to be easy to use, painless, less stressful and better accepted by patients. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Considering the relatively high prevalence of oral mucosal ulcers, their fast healing is of significance. Purpose: This study aimed to histopathologically compare the effects of 810 nm and 940 nm diode laser on the healing of iatrogenic oral ulcers in rabbits. Materials and Method: In this single-blind experimental study, mucosal ulcers measuring 3mm in diameter and 1mm in depth were bilaterally created in the buccal mucosa of 18 rabbits using a biopsy punch. The defects were irradiated with 810 nm diode laser on the right side and 940 nm diode laser on the left side. Biopsy samples of the same depth were obtained from the ulcers on days 3 and 7 followed by histopathological analysis. The intensity of inflammation was determined on hematoxylin-eosin-stained sections using a fourpoint scale. Data were analyzed employing the Wilcoxon signed rank test. Results: The degree of inflammation was not significantly different between the 810nm and 940nm diode laser groups on day 3; but on day 7, animals receiving 810 nm experienced a significantly lower degree of inflammation compared to those treated with 940 nm laser (p= 0.028). Conclusion: When comparing 810- and 940-nm diode lasers, 810 nm irradiation significantly decreased the severity of inflammation in oral wounds created on the buccal mucosa of rabbits in a time-dependent manner. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the efficacy and safety of cold atmospheric plasma (CAP) as a novel therapy for diabetic foot ulcers. This was an investigator‐blinded, randomized controlled trial of 14 weeks (6 weeks of treatment and 8 weeks of follow‐up). Twenty patients with diabetic foot ulcers were divided into two groups: the control group receiving standard wound care and the plasma group, which received CAP twice a week for six consecutive weeks in addition to standard wound care. The ulcer size, amount of exudate, and wound grading were determined weekly. Cold plasma was produced by applying a high voltage (4.5 kV) and a high frequency (22 kHz) to helium gas. Exudate from wounds treated with CAP showed a significant reduction in the third week after complete treatment (p = 0.039). The wound grading of the ulcers improved by the sixth week (p = 0.019), and the sizes of ulcers significantly decreased in the plasma group at the end of the treatment period (p = 0.007). In this randomized clinical trial, CAP was an effective treatment option for diabetic foot ulcers in terms of wound surface reduction and antibacterial effects. [ABSTRACT FROM AUTHOR]

Context: A non-healing ulcer occurs due to multiple causes and possesses a great impact on the quality of life. Autologous platelet-rich fibrin and the application of a triple combination paste (zinc oxide, phenytoin, and mupirocin ointment) have emerged with a good response in the treatment of non-healing ulcers. Aims: To compare the therapeutic efficacy of autologous platelet-rich fibrin matrix versus the triple combination paste (zinc oxide, phenytoin, and mupirocin ointment) in non-healing ulcers. Settings and Design: Hospital-based interventional comparative study. Materials and Method: Twenty-four patients with non-healing ulcers were randomly divided into two groups. One group received platelet-rich fibrin (PRF) therapy every week for up to 5 weeks and the second group applied triple combination paste (zinc oxide, phenytoin, and mupirocin ointment) again for 5 weeks. In the end, the ulcer area was measured. Statistical Analysis Used: Student's paired t-test was used to evaluate the correlations between variables. A P-value of < 0.05 was considered significant. Results: Group A showed a mean reduction in the ulcer area by 8.26 mm2 (75.99%). Group B showed a mean reduction in the ulcer area by 4.799 mm2 (47.75%), which was statistically significant with a P-value of 0.004. Conclusion: We conclude that autologous platelet-rich fibrin matrix is much more effective than the triple combination paste (zinc oxide, phenytoin, and mupirocin ointment) in the treatment of non-healing ulcers. [ABSTRACT FROM AUTHOR]

Background/Aim: Gastric mucosal injury induced by several agents such as ethanol, stress or nonsteroidal anti-inflammatory drugs (NSAIDs) is a common severe disorder. Hydrogen sulfide (H2S), carbon monoxide (CO) and nitric oxide (NO) are gaseous autacoids that are endogenously produced in mammalian tissues. Recently, several studies confirmed that H2S, CO and NO play a role in gastroprotection. Our work aimed to evaluate and compared the gastroprotective effects of H2S, CO and NO on ethanol-, indomethacin- and stress-induced rat ulcer models. Methods: The effects of NaHS (5 mg/kg), CORM-2 (5 mg/kg) and L-arginine (100 mg/kg) were investigated on gastric ulcer models induced by ethanol (1 ml 96% i.g.), stress (cold+immobility) and indomethacin (40 mg/kg i.g.). The ulcer index, gastric mucus secretion, free and total acidity, and levels of TNF-α, PGE2, MDA GSH, COX-1, COX-2 were measured. Results: NaHS and CORM-2 decreased the increased TNF-α and MDA levels in ethanol-induced ulcer. L-arginine reduced mucin secretion, TNF-α and GSH levels in stress-induced gastric ulcer. Conclusion: The present study showed that H2S and CO may have gastroprotective activity against ethanol-induced ulcers and NO may be gastroprotective against stress-induced ulcers. [ABSTRACT FROM AUTHOR]

Pressure ulcers (PU) are deep scars on the skin that cause pain, infections and severe health complications. Most movement-impaired subjects are vulnerable to PU, leading to permanent and irreversible skin damage. The system proposed in this paper aims to prevent PU formation with the design and implementation of a wirelessly controlled device that predicts PUs before their occurrence and attempts to prevent it using therapeutic feedback. A flexible pad that consists of multiple types of sensors is used, theses sensors continuously and non-invasively monitor ulcer-related vital signs in vulnerable areas, and uses these data to predict PU with a decision-making process. When PU is detected an electrical stimulation (ES) unit is automatically activated. Stimulation prevents PU formation by increasing local blood flow to the simulated area and eliminating the main factor that leads to PU formation. The system successfully monitored and predicted PU; tests were performed on three healthy volunteers and one volunteer with sacral ulcers. Results including readings of blood oxygenation, force, humidity and temperature were recorded as graphs to monitor decay/increase in values more efficiently. [ABSTRACT FROM AUTHOR]

Background: Impaired wound healing is a major cause of morbidity in diabetic patients by causing chronic ulcers. This study aimed to investigate the safety and outcomes after intralesional allogeneic adipose-derived mesenchymal stem cells injection in chronic diabetic foot ulcers.Methods: Twenty patients (12 male and eight female) were involved in the study. We randomized the patients into two groups of 10 patients each. The study group was treated with allogeneic adipose-derived mesenchymal stem cells injection with standard diabetic wound care. The control group received only standard diabetic wound care. Patient demographics, wound characteristics, wound closure time, amputation rates and clinical scores were evaluated.Results: The mean age was 57.3 ± 6.6 years. The mean follow-up duration was 48.0 (range, 26-50) months. Wound closure was achieved in 17 of 20 lesions (study group, 9 lesions; control group, 8 lesions; respectively). The mean time to wound closure was 31.0 ± 10.7 (range, 22-55) days in the study group, 54.8 + 15.0 (range, 30-78) days in the control group (p = 0.002). In three patients, minor amputations were performed (one patient in study group; two patients in the control group, p = 0.531). There was a significant difference between groups in terms of postoperative Short Form 36- physical functioning (p = 0.017) and Short Form 36-general health (p = 0.010).Conclusion: Allogeneic adipose-derived mesenchymal stem cells injection was found to be a safe and effective method with a positive contribution to wound-healing time in the treatment of chronic diabetic foot ulcers. [ABSTRACT FROM AUTHOR]

Background: Infected diabetic foot ulcers (DFU) complicated with calcaneal osteomyelitis are a real challenge for limb preservation. Very few alternatives to amputation are available, mainly the resection of a part or the totality of the calcaneal bone. Calcanectomies were advanced as limb-sparing procedures in patients with heel osteomyelitis. However, there is a lack of pooled quantitative evidence on their efficacy and complications.Objectives: The present systematic review and meta-analysis was conducted to determine the primary outcome of healing rates following partial (PC) and total calcanectomies (TC) in treating calcaneal osteomyelitis due to diabetic heel ulcers. Additionally, secondary outcomes such as secondary TC following PC, secondary below knee amputation (BKA), mortality and the change in the ambulation status were analyzed.Methods: Medline, Scopus, Web of science, Cochrane Library and Google Scholar were searched since inception. All types of study design were included. Single case report studies and studies reporting osteomyelitis due to other etiologies than DFU were excluded.Results: Twenty studies met the inclusion criteria comprising 295 patients with 300 calcanectomies (270 PC and 30 TC). With a mean follow-up period of 29.3±17.7 months, the weighted results were as follows: a) the osteomyelitis healing rate was of 80% (95% CI=0.728 to 0.861, I2=48.3%), b) the rate of secondary total calcanectomy was of 5.4% (95% CI=0.022 to 0.097, I2=7.5%), c) the rate of secondary BKA was of 17.1% (95% CI=0.111 to 0.241, I2=50.6%) with no difference between subgroups of TC and PC, and d) the combined mortality rate of both calcanectomies was of 13.4% (95% CI=0.064 to 0.224, I2=73.6%); however, significant higher mortality was found following TC compared to PC (p<0.0001).Conclusion: Partial and total calcanectomies were found to yield very good healing rates with acceptable complication frequencies. When compared to the reported outcomes of below and above-knee amputations in the literature, calcanectomies could be fairly considered as good alternatives to above ankle amputations. [ABSTRACT FROM AUTHOR]

In consultation with academia and the Pharmaceuticals and Medical Devices Agency (PMDA), we have developed guidance for drafting protocols for clinical trials concerning medical devices for the healing of hard-to-heal wounds without ischaemia. The guidance summarises the validity of single-arm trials for hard-to-heal wounds, the definition of hard-to-heal wounds without ischaemia, methods of patient enrolment and clinical endpoints. This review focuses on the logical thinking process that was used when establishing the guidance for improving the efficiency of clinical trials concerning medical devices for hard-to-heal wounds. We particularly focused on the feasibility of conducting single-arm trials and also tried to clarify the definition of hard-to-heal wounds. If the feasibility of randomised control trials is low, conducting single-arm trials should be considered for the benefit of patients. In addition, hard-to-heal wounds were defined as meeting the following two conditions: wounds with a wound area reduction <50% at four weeks despite appropriate standards of care; and wounds which cannot be closed by a relatively simple procedure (for example, suture, skin graft and small flaps). Medical devices for hard-to-heal wound healing are classified into two types: (1) devices for promoting re-epithelialisation; and (2) devices for improving the wound bed. For medical devices for promoting re-epithelialisation, we suggest setting complete wound closure, percent wound area reduction or distance moved by the wound edge as the primary endpoint in single-arm trials for hard-to-heal wounds. For medical devices for improving the wound bed, we suggest setting the period in which wounds can be closed by secondary intention or a simple procedure, such as the primary endpoint. Declaration of interest: The authors have no conflicts of interest directly relevant to the content of this article. The authors' views expressed in the present article do not necessarily reflect the official views of the Pharmaceuticals and Medical Devices Agency. [ABSTRACT FROM AUTHOR]

Background: Foot ulcers are a common complication in diabetic patients. Mild callus formation due to a plantar pressure can lead to an ulcer formation with potentially hazardous sequelae. Eliminating the pressure from the ulcer is essential for a proper healing process. Proximal derotation phalangeal osteotomy is a relatively simple procedure that can redistribute the planter pressure points over the hallux. Methods: Thirteen patients underwent proximal derotation phalangeal osteotomy to relieve the bony pressure causing an ulcer in the first toe, which was refractory to non-operative treatment. Twelve patients had diabetes type 2 and one had Charcot-Marie-Tooth disease. Results: Ulcers were completely resolved in all 13 patients in an average time of 4.3 (range 2–8) weeks. Four patients (31%) had mild complications that resolved well. No further surgery was required at 1-year follow-up. Conclusion: Proximal derotation phalangeal osteotomy enabled ulcer healing in refractory cases. Level of Evidence: Level III retrospective study. [ABSTRACT FROM AUTHOR]

Objective: To explore the mechanism of Radix Astragali-Lithospermum Erythrorhizon on the treatment of diabetic ulcer through the method of network pharmacology. Methods: This study included 32 compounds and 81 key targets. 100 GO functional items and 116 KEGG signal pathways were obtained by enrichment analysis. Quercetin, kaempferol, isorhamnetin, mononetin, sitosterol, ivy sapogenin and other components of astragalus-purple herb play a key role in the targets of interleukin-6, cystatin 3, vascular endothelial growth factor, epidermal growth factor receptor and mitogen-activated protein kinase 8 in diabetic ulcer, and are mainly concentrated in AGE-RAGE, TNF and other signal pathways. Results: There were 32 compounds and 81 key targets. 100 GO functional items and 116 KEGG signal pathways were obtained by enrichment analysis. Quercetin, kaempferol, isorhamnetin, mononetin, sitosterol, ivy sapogenin and other components of astragalus-purple herb play a key role in the targets of interleukin-6, cystatin 3, vascular endothelial growth factor, epidermal growth factor receptor and mitogen-activated protein kinase 8 in diabetic ulcer, and are mainly concentrated in AGE-RAGE, TNF and other signal pathways. Conclusion: Radix Astragali-Lithospermum Erythrorhizon may play the role of inhibiting inflammation, anti-apoptosis, promoting cell proliferation, angiogenesis and immune regulation through multi-components and multitargets, and play a role in the treatment of diabetic ulcer. [ABSTRACT FROM AUTHOR]

This study will explore the effectiveness of autologous platelet-rich plasma in the treatment of diabetic foot disease compared to conventional treatments, based on the ulcer healing rate. The electronic databases of PubMed, EMBASE, and WOS internet were searched. Evaluated outcome rate of complete ulcer healing. Statistical analysis was performed with RevMan 5.0 software and SPSS 25.0. Eleven RCTs with 828 patients were included in this study. The meta-analysis showed a higher complete ulcer healing rate (OR = 3.69, 95 % CI 2.62 to 5.20, P < 0.01, I2 = 0 %) in growth factors based in autologous platelech-rich plasma (aPRP) group compared with control. Mixed evidence was seen for publication bias, but analyses by using the trim-and-fill method did not appreciably alter results. Autologous platelet-rich plasma can improve the complete healing rate of the ulcer compared to current conventional treatments in diabetic foot ulcer patients. • Foot complications in diabetic patients are a major cause of extended hospital stays. • 15% of diabetics will develop foot disease, with 25% of cases resulting in lower limb amputation. • The current standard hospital treatments for patients with diabetic foot disease, do not guarantee success in their closure. • Using aPRP is a cost-effective and highly efficient treatment that effectively stimulates cell proliferation and differentiation. [ABSTRACT FROM AUTHOR]

Toll-like receptor (TLRs) is one of the important recognition receptors in the innate immune defense system, which plays a key role in mediating inflammatory response and related signal transduction. In the TLRs family, TLR2/4 has been widely studied because of its close relationship with the occurrence and defense of digestive diseases, and studies have shown that the synergism between TLR2/4 is the basis of mediating inflammatory response and immune response. This article summarizes the research on the correlation of TLR2/4 in digestive system diseases, in order to provide ideas for the clinical treatment and research of digestive system diseases. [ABSTRACT FROM AUTHOR]

Allantoin (ALL) is a phytochemical possessing an impressive array of biological activities. Nonetheless, developing a nanostructured delivery system targeted to augment the gastric antiulcerogenic activity of ALL has not been so far investigated. Consequently, in this survey, ALL-loaded chitosan/sodium tripolyphosphate nanoparticles (ALL-loaded CS/STPP NPs) were prepared by ionotropic gelation technique and thoroughly characterized. A full 24 factorial design was adopted using four independently controlled parameters (ICPs). Comprehensive characterization, in vitro evaluations as well as antiulcerogenic activity study against ethanol-induced gastric ulcer in rats of the optimized NPs formula were conducted. The optimized NPs formula, (CS (1.5% w/v), STPP (0.3% w/v), CS:STPP volume ratio (5:1), ALL amount (13 mg)), was the most convenient one with drug content of 6.26 mg, drug entrapment efficiency % of 48.12%, particle size of 508.3 nm, polydispersity index 0.29 and ζ-potential of + 35.70 mV. It displayed a sustained in vitro release profile and mucoadhesive strength of 45.55%. ALL-loaded CS/STPP NPs (F-9) provoked remarkable antiulcerogenic activity against ethanol-induced gastric ulceration in rats, which was accentuated by histopathological, immunohistochemical (IHC) and biochemical studies. In conclusion, the prepared ALL-loaded CS/STPP NPs could be presented to the phytomedicine field as an auspicious oral delivery system for gastric ulceration management. [ABSTRACT FROM AUTHOR]

Ischaemic diabetic heel ulcers are difficult to treat and prognosis is often guarded. The aim was to document our outcome of treating heel ulcers following revascularization in a predominantly diabetic Asian cohort presenting with chronic limb threatening ischaemia from Singapore. Retrospective cohort study (n = 66, 66 limbs) over a 5‐year period. Data were collected from hospital electronic health records. Outcomes included time to healing, amputation free survival (AFS), and mortality. Minimum follow‐up period was 6 months. Multivariate regression analysis was performed to look for factors associated with poor outcome. Mean age was 67.4 ± 8.8 years. 62/66 (93.9%) were diabetics. Mean wound size at presentation was 3.6 ± 2.3 cm. Mean Wound, Ischaemia, Foot Infection (WIFI) score was 5 ± 1.6. 12/66 (18%) patients had a patent posterior tibial artery pre‐operatively. Straight line flow was restored in only 31/66 (46.9) patients but 47/66 (71.2%) had successful limb salvage. Median time to wound healing was 90.0 (IQR 60‐180) days. A median of 1 (IQR 0‐2) wound debridement was required. Patients who underwent negative pressure dressing (23/66; 34.8%) required a median of 26 (IQR 13‐33) cycles to achieve healing. Amputation free survival (AFS) was 72% and 68% at 6‐ and 12‐months, respectively. Mortality rate was 16.7% and 19.7% at 6‐ and 12‐months, respectively. Low albumin level and initial Rutherford class were independent predictors of worse 6‐month AFS. Outcomes of heel ulcers post revascularisation may not be as poor as previously described. Persistent attention to wound care with multidisciplinary effort is needed for optimal healing. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Wound Management / Leczenie Ran is the property of Evereth Publishing Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The presence of diabetic keratopathy associated with diabetic corneal neuropathy should be taken into account in the management of corneal inflammation in patients with diabetes mellitus. Purpose: To determine the impact of adjunctive topical autologous serum eye drops on delayed healing of bacterial corneal ulcers in patients with type 1 diabetes mellitus (DM1). Material and Methods: We retrospectively reviewed the results of observing 19 DM1 patients (19 eyes) with bacterial corneal ulcers who exhibited delayed healing of corneal ulceration and whose corneal smears and scrapings taken one week after initiation of treatment were bacteriologically negative. Patients had a routine eye examination (visual acuity, tonometry, and slit-lamp biomicroscopy of anterior and posterior eye segments), bacteriological studies, fluorescein dye test, anterior eye OCT and noncontact corneal esthesiometry. Patients of the control group (9 individuals) continued receiving only background therapy (topical antiseptics, antioxidants, repairing agents, artificial tears, and mydriatics and systemic anti-inflammatory agents), whereas patients of the main group began receiving autologous serum eye drops in addition to background therapy of topical antiseptics, mydriatics and systemic anti-inflammatory agents. Clinical picture data for day 1 (visit 1, before administering the treatment) and days 7 (when corneal samples and scrapings were re-taken), 14 (when bacteriology results became available and main group patients were additionally administered autologous serum), 17, 21 and 24 were analyzed. Results: In DM1 patients with delayed healing of bacterial corneal ulcers, the use of adjunctive autologous serum eye drops after eradication of the offending microorganisms resulted in reductions in precorneal injection and size and depth of the ulcer defect and complete resolution of corneal infiltration and edema of the corneal tissue surrounding the ulcer as early as day 3, and recovery of all patients and a 32.6% improvement in corneal sensitivity on day 10. Conclusion: Using adjunctive topical autologous serum eye drops after eradication of the offending microorganisms was found to be efficacious in the comprehensive treatment of delayed healing of bacterial corneal ulcers in patients with DM1. [ABSTRACT FROM AUTHOR]

Troxipide is widely used to treat gastric ulcer (GU) in the clinic. However, a lack of systematic metabolic, pharmacokinetic and pharmacological studies limits its clinical use. This study aimed to firstly explore the metabolic, pharmacokinetic and pharmacological mechanisms of troxipide in rats with GU compared to normal control (NC) rats. First, metabolic study was perormed by a highly selective, high-resolution mass spectrometry method. A total of 45 metabolites, including 9 phase I metabolites and 36 phase II metabolites, were identified based on MS/MS spectra. Subsequently, the pharmacokinetics results suggested that the Cmax, Ka, t1/2, AUC(0−t) and AUC(0−∞) of troxipide were significantly increased in rats with GU compared with NC rats. The Vz, K10 and absolute bioavailability of troxipide were obviously decreased in rats with GU compared with NC rats, and its tissue distribution (in the liver, lung and kidney) was significantly different between the two groups of rats. Additionally, the pharmacodynamic results suggested that the levels of biochemical factors (IL-17, IL-6, TNF-α, IFN-γ, AP-1, MTL, GAS, and PG-II) were significantly increased, the PG-Ӏ level was obviously decreased, and the protein expression levels of HSP-90, C-Cas-3 and C-PARP-1 were markedly increased in rats with GU compared with NC rats. The above results suggested that the therapeutic mechanisms underlying the metabolic, pharmacokinetic and pharmacological properties of troxipide in vivo in rats deserve further attention based on the importance of troxipide in the treatment of GU in this study, and these mechanisms could be targets for future studies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the technical success and short-term outcome of patients with penetrating aortic ulcers (PAUs) and saccular aneurysms (SAs) of the aortic arch treated with the jailed coiling technique. Methods: A retrospective review of 9 patients (mean age 70 years, 9 males) treated for PAUs and SAs of the aortic arch between 2018 and 2019 at our institution. Treatment included thoracic endovascular aneurysm repair (TEVAR) with a short (1cm) proximal landing zone, followed by coiling of aneurysm through a jailed extraluminal catheter. Results: All 9 patients underwent TEVAR followed by jailed coiling of the lumen of the aneurysms. Debranching of supra-aortic vessels was performed in 4 patients in order to create a proximal landing zone of at least 10 mm. Technical success was achieved in all cases. Coils were placed accurately within the aneurysm lumen in all patients. No distal embolization occurred. One patient expired in the perioperative period from a cardiac event. No patient developed spinal cord ischemia or stroke in the perioperative period. Mean follow-up was 10 months (range 3-18). On follow-up imaging, complete thrombosis of the aneurysm lumen was seen in all patients. None experienced enlargement of ulcer dimensions and none required reintervention. Conclusion: PAUs and SAs of the aortic arch with a very short landing zone can be treated successfully by jailed coiling of the aneurysm and TEVAR. The procedure is technically feasible and can be performed with minimal morbidity. Long-term durability of the repair needs to be determined. [ABSTRACT FROM AUTHOR]

Objective: To test the therapeutic effect of integrated traditional Chinese and western medicine on venous ulcer of lower limbs by Meta analysis method, and then to propose the best clinical treatment scheme. Methods: Domestic databases in the past 20 years (January 1999-December 2019) were searched by computer, including China Journal Full-text Database (CNKI), VIP, Wanfang and CBM. Literature was screened according to inclusion and exclusion criteria. Cochrane risk assessment tool was used to evaluate the quality of the included literature. Two-classification method was used to extract data. RevMan 5.3 software was used to make statistical analysis of the data. Results: Eleven articles were finally included, totaling 1,576 patients, 804 cases in the treatment group and 772 cases in the control group. Meta-analysis results show that there is no difference in heterogeneity and bias among the included literatures. The total effective rate (risk ratio [RR]=1.12, 95% confidence interval [CI]=1.09-1.15) of integrated traditional Chinese and western medicine in treating venous ulcer of lower limbs is higher, which is obviously better than that of western medicine alone. Conclusion: Through data analysis, it is concluded that in the study population, the treatment of integrated traditional Chinese and western medicine has a significant effect on venous ulcer of lower limbs. Make up for the deficiency of simple western medicine treatment, improve the cure rate and reduce the recurrence rate. However, there is currently a lack of relevant high-quality literature, so a large sample size, rigorous and standardized experimental design and randomized double-blind clinical study are needed to further test the conclusions. [ABSTRACT FROM AUTHOR]

What is known and objective: The HbA1C marker used in assessing diabetes control quality is not sufficient in diabetes patients with thalassaemia. Case description: A male diabetic patient with thalassaemia was hospitalized due to distal neuropathic pain, right toe trophic ulcer, unacceptable five‐point glycaemic profile and recommended HbA1C value. After simultaneously initiated insulin therapy and management of ulcer by hyperbaric oxygen, the patient showed improved glycaemic control and ulcer healing, which led to the patient's discharge. What is new and conclusion: In thalassaemia and haemoglobinopathies, due to discrepancies in the five‐point glycaemic profile and HbA1C values, it is necessary to measure HbA1C with a different method or to determine HbA1C and fructosamine simultaneously. [ABSTRACT FROM AUTHOR]

After chewing the tablets, the active components of the tablets can be released quickly, and the layered network lattice structure can be generated on the surface of gastric mucosa, which can protect the wounds. At the same time, the active ingredient aluminum can promote ulcer healing. The purpose of this paper is to study the micro mechanism and nursing observation of the treatment of gastric ulcer combined with gastric hemorrhage. This paper introduces the pathogenesis of gastric ulcer and the treatment of gastric ulcer with aluminum and magnesium carbonate, and then summarizes the application of large nursing observation and image processing technology of optical microscope. The experimental results showed that the ulcer area of the control group was large, covered with white moss, the ulcer bottom was dirty, the surrounding mucosa was swollen and swollen; the ulcer surface of the low dose and high dose groups was shallow, the swelling and swelling of the surrounding mucosa was small, the ulcer index was also lower than that of the control group, and the inhibition rate of the low dose group was 15% The inhibition rate of high dose ulcer was 75%. It may be related to the expression of EGF and PGE2. [ABSTRACT FROM AUTHOR]