Ulcer Area Research Articles

Gastroprotective effect of rhodanine and 2,4-thiazolidinediones scaffolds in rat stomachs by contribution of anti-apoptotic (BCL-2) and tumor suppressor (P53) proteins

In recent times, the methods used to evaluate gastric ulcer healing worldwide have been based on visual examinations and estimating ulcer dimensions in experimental animals. In this study, the protective effect of rhodanine and 2,4-thiazolidinediones scaffolds compared to esomeprazole was investigated in an ethanol model of stomach ulcers in rats. Pretreatment with experimental treatments or esomeprazole prevented the development of ethanol-induced gastric ulcers. The severity of the lesions and injuries was significantly lower than that of vehicle (10% Tween 80) treated rats. Significant and excellent results were obtained with the compound 6 group, with inhibition percentage and ulcer area values of 97.8% and 12.8 ± 1.1 mm2, respectively. Synthesized compounds 2, 7 and 8 exhibited inhibition percentages and ulcer areas of 94.3% and 31.2 ± 1.1 mm2, 91. 3% and 48.1 ± 0. 8 mm2, 89. 5% and 57. 6 ± 1. 2 mm2, and 89. 1% and 60.3 ± 0. 8 mm2, respectively. These biological outcomes are consistent with the docking studies in which Compounds 7 and 8 showed remarkable binding site affinities toward human H+/K+-ATPase α protein (ID: P20648), rat H+/K+-ATPase α protein (ID: P09626), and Na+/K+-ATPase crystal structure (PDB ID:2ZXE) with binding site energies of − 10.7, − 9.0, and − 10.4 (kcal/mol) and − 8.7, − 8.5, and − 8.0 (kcal/mol), respectively. These results indicate that these test samples were as effective as esomeprazole. Likewise, immunohistochemical staining of antiapoptotic (BCL2) and tumor suppressor (P53) proteins showed strong positive marks in the10% Tween 80- treated group, opposing the mild staining results for the esomeprazole-treated group. Similarly, the staining intensity of the group treated with Compounds 2–8 was variable for both proteins.

Efficacy and Safety of Platelet-Rich Plasma for Pressure Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Pressure ulcers are common chronic wounds in clinical practice, severely affecting patients' quality of life and causing substantial economic burdens. Platelet-rich plasma (PRP) has been explored for its potential in treating pressure ulcers. Herein, a study was carried out to evaluate the efficacy and safety of PRP in comparison to conventional treatments for pressure ulcers. A comprehensive search was conducted in databases including PubMed, Embase, Web of Science, and Cochrane Library, covering studies published from the inception to May 20, 2023, with only randomized controlled trials (RCTs) assessing the effect of PRP on the healing of pressure ulcers included. The outcomes of interest included healing rates, ulcer area, ulcer volume, Pressure Ulcer Scale for Healing (PUSH) score, healing time, and complications. Finally, 9 RCTs, involving 511 patients with 523 pressure ulcers, met the inclusion criteria. Our meta-analysis revealed a significant improvement in the healing rate, as evidenced by a weighted odds ratio (OR) of 3.40 (95% CI = 1.87 to 6.21, I2 = 32%, P < 0.0001). Additionally, the standard mean difference (SMD) for healed ulcer area favored the PRP group, reflecting an improvement of 1.38 cm2 (P = 0.02). Furthermore, the reduction in PUSH scores within the PRP group outperformed that observed in the control group, demonstrating a SMD of 1.69 (P = 0.01). Nevertheless, complications and the SMD for ulcer volume reduction revealed no statistically significant differences between the groups. From these findings, PRP stands out as a promising and safe therapeutic approach for pressure ulcers. For a deeper understanding of PRP's role in pressure ulcer healing, it is crucial to conduct more well-structured, high-quality RCTs in upcoming studies.

Treatment of severe pressure ulcers with protein-enriched filtered platelet-rich plasma (PEFPRP): a possible management.

Background: Biological dressings with non-transfusion blood components are among the treatments available for pressure ulcers (PUs). Biological dressings contain active concentrated pro-regenerative molecules that can modify and switch off local inflammatory pathways. This re-establishes the physiological homing, which results in healing. In our study, we used a biological component obtained by ultrafiltration of plasma-platelet concentrate: protein-enriched filtered platelet-rich plasma (PEFPRP) with a higher platelet and higher plasma protein concentration. We tested whether treatment with PEFPRP could improve healing in advanced-stage pressure ulcers with a large surface area. All the patients in this study had a surgical indication but were not able to undergo surgery for various reasons. Materials and methods: Ten patients with severe neurological disability and advanced-stage sacral pressure ulcers were treated with allogenic PEFPRP. The mean lesion surface area at T0 was 13.4cm2 (±9.8 SD). PEFPRP was derived from allogenic plasma-platelet apheresis that had been pre-ultrafiltered with a ProSmart™ filter (Medica, Italy) to obtain a concentration after filtration of the plasma protein (12-16g/dL) and platelet (1-1.2 x 106 microL). Results and Conclusion: All cases showed a reduction in the surface area of the pressure ulcer and in the Pressure Ulcer Scale for Healing (PUSH) score. The mean reduction values at week 6 were as follows: -52% for surface area and -21% for PUSH. Rapid wound healing is fundamental to avoid infections and improve patients' quality of life. This blood component builds new tissue by creating a new extracellular matrix. This, in turn, promotes rapid restoration of the three-dimensional structure of the tissue necessary for healing deeper wounds. PEFPRP shrinks the PU and improves its morphological features (reducing undermining and boosting granulation tissue). PEFPRP also promotes tissue restoration, obtaining an optimal scar. It is a safe and feasible treatment, and these preliminary results support the use of PEFPRP in the treatment of pressure ulcers. PEFPRP dressings could be integrated in the standard treatment of advanced-stage PU.

Biocellulose-based hydrogel dressing as a strategy for the management of chronic arterial wounds.

To evaluate using a biocellulose-based hydrogel as an adjuvant in the healing process of arterial ulcers. A prospective single group quasi-experimental study was carried out with chronic lower limb arterial ulcer patients. These patients received biocellulose-based hydrogel dressings and outpatient guidance on dressing and periodic reassessments. The primary outcomes were the ulcer-healing rate and product safety, which were assessed by ulcer area measured in photographic records of pre-treatment and posttreatment after 7, 30, and 60 days. Secondary outcomes were related to clinical assessment by the quality-of-life scores (SF-36 and EQ-5D) and pain, evaluated by the visual analogue scale (VAS). Seventeen participants were included, and one of them was excluded. Six patients (37%) had complete wound healing, and all patients had a significant reduction in the ulcer area during follow-up (233.6mm2 versus 2.7mm2) and reduction on the score PUSH 3.0 (p < 0.0001). The analysis of the SF-36 and EQ-5D questionnaires showed a statistically significant improvement in almost all parameters analyzed and with a reduction of pain assessed by the VAS. The biocellulose-based hydrogel was safe and showed a good perspective to promoting the necessary conditions to facilitate partial or complete healing of chronic arterial ulcers within a 60-day follow-up. Quality of life and pain were positively affected by the treatment.

Aspectos clínicos, ultrassonográficos e patológicos da tromboflebite iatrogênica em uma égua - relato de caso

ABSTRACT A 7-year-old quarter horse mare showed swelling of the tongue, head and neck region, dyspnea, and red urine after eight days of administration of intravenous medications by the animal's handler. The horse was referred to the University Veterinary Hospital of the Federal University of Pará and, at the clinical examination, showed apathy, edema in the head, neck, and tongue region, which was slightly cyanotic and with loss of epithelium in the dorsal region. The maxillary, linguofacial and external jugular veins were bilaterally engorged, firm to palpation and with cord-shaped appearance, with extension of the head to the entrance to the thoracic cavity. Ultrasound examination showed a thrombi with a hyperechoic and heterogeneous appearance that completely obstructed the vessel. The horse died five days after entering the Hospital and at necropsy it was observed: maxillary, linguofacial and external jugular veins bilaterally filled with firm, dark red to blackish thrombi; ulcerated areas in the final third of the esophagus and the stomach; lighter areas on the surface of the kidneys and dark areas at the corticomedullary junction. Based on clinical, ultrasonographic and necropsy findings, iatrogenic thrombophlebitis was diagnosed, associated with repeated injections of drugs administered intravenously.

Amelioration of acetic acid-induced ulcerative colitis in rats by cetirizine and loratadine via regulation of the PI3K/Akt/Nrf2 signalling pathway and pro-inflammatory cytokine release.

Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that causes inflammation and ulcers in the rectum and the innermost layer of the large intestine. Our study aimed to elucidate the ameliorative effect of cetirizine (CTZ) and loratadine (LOR) against acetic acid-induced ulcerative colitis in rats via assessment of the PI3K/p-Akt/Nrf2 signaling pathway and proinflammatory cytokine release. Thirty-two rats were allocated into four groups (n=8). Group (I) was considered normal control. Acetic acid (AA) was injected intrarectally in groups (2-4). Group (2) was kept untreated. Group (3) was administered CTZ (20 mg/kg/day) for 7 days. Group (4) was administered LOR (10 mg/kg/day) for 7 days. AA showed severe macroscopic colonic lesions associated with increased ulcer number, area, and severity with significantly elevated PI3K, p-Akt, Nrf2, TNF-α, and IL-6 in colorectal tissue as compared to the normal control group. All the aforementioned indicators were greatly improved by CTZ and LOR therapy. This is the first study to elucidate the ameliorative effect of CTZ and LOR against AA-induced UC in rats. CTZ and LOR treatment mitigates UC via amelioration of the PI3K/p-Akt/Nrf2 pathway and proinflammatory cytokine release.

Gastroprotective activity of the galactomannan extracted from cassia grandis seeds: an in vivo study

Peptic ulcer is a common disease with a high clinical incidence and frequent recurrences. The well-characterized galactomannan-type polysaccharide, extracted from Cassia grandis seeds, can accelerate the stages of wound healing and improve the remodeling of the extracellular matrix of injured tissues; this way, the gastroprotective potential of the galactomannan was proposed to be evaluated in the treatment of rat peptic ulcers induced by ethanol. Galactomannan was extracted by ethanol precipitation and prepared at 0.1, 1.0, and 10 mg/kg concentrations. Male Wistar rats were randomly divided into groups (n = 5) and orally treated with saline (negative control, NC), galactomannan at 0.1 mg/Kg (G0.1), galactomannan at 1.0 mg/Kg (G1), galactomannan at 10 mg/Kg (G10), and lansoprazole 30 mg/Kg (positive control, CP). Ethanol (1 mL/100g of body mass) was administered 1 h after the treatments and, after another hour, the animals were euthanized. The stomachs were removed, fixed between Petri dishes, and photographed to calculate the percentage of the injured regions by computerized software. Histological analysis and the quantification of lipid peroxidation and reduced glutathione (GSH) were also performed. G1 and G10 reduced the injured area (P &lt; 0.001) by 40 and 36%, respectively, concerning NC. It was observed the preservation of the gastric mucosa in all of the animals treated with galactomannan, in addition to reduced (P &lt; 0.001) lipid peroxidation and GSH levels higher (P &lt; 0.05) than NC. The galactomannan extracted from C. grandis seeds showed gastroprotective activity at 1.0 and 10 mg/kg by reducing the area of ulceration and oxidative stress.

Effect of Visible and Infrared Photobiomodulation on Diabetic Foot Ulcers.

Introduction: Diabetes is a highly prevalent disease worldwide. Despite routine treatments, there is no effective treatment approach for patients with diabetic foot ulcers (DFUs). A new approach to reduce complications and control DFU is low-level laser therapy (LLLT). In the present study, we evaluated the therapeutic effects of LLLT on the symptoms of DFU patients. Methods: Sixty diabetic patients with DFU were included in this randomized clinical trial and were randomly allocated into two groups of laser (n=30) and control (n=30) with signed written consent. The LLLT group underwent visible and infra-red laser therapy and conventional medical treatment, while the control group received only conventional medical treatment. The total laser irradiation sessions of the patients were 20 sessions, (three sessions a week) and each session lasted for 30 minutes over the entire surface of the wound. The power density per session for each laser was calculated to be 35.65 mW/cm2 with an energy density of 64.17 J/cm2. Results: The mean area of ulcers in the LLLT group reduced significantly (P<0.001) from 441.7±365.5 mm2 before LLLT to 163.9±213.9 mm2 from the baseline up to the last session of LLLT, indicating a 62.99% reduction in mean ulcer area. In the control group, the mean ulcer area did not change significantly. Wagner's classification of the patients in the LLLT group reduced to lower grades significantly (P<0.01), while the classification moved towards higher grades in the control group (P<0.08). Conclusion: In this study, we showed the effectiveness of LLLT in the reduction of the surface and depth of DFUs. The results documented that patients experienced significant improvements in the healing of their foot ulcers after laser therapy. It is recommended that the LLLT be considered as a non-invasive method for the treatment of DFU patients.

Evaluation of autologous platelet rich fibrin in chronic non-healing leg ulcers

Context: Chronic non healing leg ulcers cause psychological, social, and financial burden to the patient. Platelet rich fibrin (PRF), a biological membrane with plethora of growth factors acts as a cheaper and simpler option for the management of non-healing leg ulcers. Aims: To evaluate the effectiveness of PRF in the treatment of chronic nonhealing leg ulcers of varying etiologies. Material and Methods: It was a prospective study conducted in 30 patients in a tertiary care center. PRF dressing was done weekly for the chronic non healings ulcers of various etiologies for 6 weeks. Response to therapy was assessed by calculation of wound area and volume and digital photographs before each treatment session. Statistical analysis was done using Chi-square test, paired t-test and ANOVA test to get P values. Results: In our study, the mean age of subjects was 55.9 ± 14.08. 21 (70%) subjects were male and 9 (30%) were female. Majority of the ulcers were trophic ulcers due to hansen’s disease (n = 11, 36.7%), followed by diabetic ulcers (n = 9, 30%), venous ulcers (n = 6, 20%) and traumatic ulcers (n = 4, 13.3%). Percentage decrease of mean ulcer area and volume were 92.3% and 97.6%, respectively. There was significant decrease in the mean area and volume (P &lt; 0.0001) of the ulcer from 2nd week onwards till the end of 6th week. Conclusions: PRF can be used as an adjuvant along with standard treatment in the management of chronic non healing ulcers to reduce the duration of healing.

Antibiotic bone cement combined with vacuum sealing drainage effectively repairs sacrococcygeal pressure ulcer.

To investigate the effectiveness of antibiotic bone cement combined with the vacuum sealing drainage (VSD) technique for repairing sacrococcygeal pressure ulcer wounds. A retrospective analysis was conducted on data from 136 patients treated at Yantai Affiliated Hospital of Binzhou Medical College between May 2020 and June 2022. The cases were devided into a control group and a study group according to their treatment regimen. Indicators of postoperative recovery including blood routine recovery time, hospital stay, antibiotic application time, and healing time were compared between the two groups. Before the procedure and 6, 12, 24, and 48 hours following the operation, the pain levels of patients in both groups were examined using a visual analogue scale (VAS). On the 3rd, 7th, 14th, 21st, and 28th days of treatment, the pressure ulcer scale for healing (PUSH) was used to measure the pressure ulcer area between the two groups. On the 7th, 14th, 21st, and 28th days following treatment, the capillary density values were compared between the two groups, along with the levels of interleukin-1β (IL-1β), interleukin-12 (IL-12), and c-reactive protein (CRP). The proportions of immunoglobulin M (IgM) and immunoglobulin G (IgG) levels, CD3+, CD4+, and CD8+ T cell subsets, as well as CD4+/CD8+ ratio, were compared between the two groups. The blood routine recovery time, hospital stays, antibiotic usage duration, and healing time were all significantly shorter in the study group compared to those in the control group (all P<0.05). At 6 h, 12 h, 24 h, and 48 h following surgery, the VAS score in study group was significantly lower than that of the control group (P<0.05). The study group also showed a greater reduction in pressure ulcer area, with lower PUSH scores observed on days 14, 21, and 28 (P<0.05). Post-treatment levels of IL-1β, IL-12, and CRP decreased in both groups, with significantly lower levels in the study group (P<0.05). Following therapy, both groups demonstrated significantly increased levels of CD3+, CD4+, CD4+/CD8+, IgM and IgG and reduced level of CD8+. These improvements were more pronounced in the study group (all P<0.05). The combination of antibiotic bone cement and VSD is effective in enhancing recovery, reducing pain and inflammation, and improving immune response in the treatment of sacrococcygeal pressure ulcers.

Mechanical Behavioral of Orthopedic Footbed Vertical Curlicue Auxetic Structure

Diabetic foot ulcer is a common worldwide disease resulting in major or minor amputations. Different researchers have suggested that foot ulcers are curable if treated properly. Offloading the ulcer area is the first step in healing foot ulcers. Advanced orthopedic footwear is required to effectively distribute plantar pressure without stressing the ulcer. Based on the literature survey, auxetic structure can be the potential design variable for orthopedic footwear. The maximum compressive strength of specimen 1 is about 0.5 MPa. In this project, two material specimens with auxetic structures are tested. Tensile, compressive, and 3P bending tests are carried out. A comparison is made between materials by plotting stress-strain curves. Specimen 1 performed well under testing conditions and is better for auxetic structure footwear. FEA analysis is carried out to verify the result. The maximum compressive strength of specimen 2 is around 0.1 MPa. The average tensile strength of both specimens is approximately 3.135 MPA. Overall, the results of this study highlight the potential of auxetic structures in orthopedic footwear for diabetic foot ulcer treatment. Specimen 1, with its superior performance in the tests conducted, shows promise for further development and implementation in this field.

Antiulcer activity of the stem bark aqueous extract of Croton oligandrum (Euphorbiaceae) against Ethanol/HCl-induced gastric mucosal injury in rats

Gastric ulcer is an alteration of the lining of the stomach with destruction of mucus-producing cells. Many factors are contributing to the development of peptic ulcer such as phygiological stress, high production of acid, non-steroidal anti-inflammatory drugs (NSAIDs) and alcohol consumption. Croton oligandrum is traditionally used to treat many diseases including gastric ulcers. This study aims to investigate the cytoprotective activity of Croton oligandrum. To assess the gastroprotective potential of Croton oligandrum ulcer models were established using ethanol and indomethacin. Sucralfate was used as reference anti-ulcer drugs. Rats were treated with Croton oligandrum before induction of gastric ulceration by ethanol/HCl or HCl-ethanol-Indomethacin. The area and ulcer index appearance of ulcers were quantified, and mucus was measured. Pretreatment with Croton oligandrum showed a remarkable decrease in ulcer area when compared with control groups. Croton oligandrum (50, 100 mg/kg and 200 mg/kg of body weight) exhibited gastroprotective activity and prevented both gastric lesions induced in rats.

INVESTIGATING THE THERAPEUTIC POTENTIAL OF BENIDIPINE IN INDO-METHACIN-INDUCED PEPTIC ULCERS: AN EXPERIMENTAL STUDY IN RATS

Objective: Peptic ulcer disease is a prevalent gastrointestinal disorder associated with escalating global mortality rates and a heightened risk of gastric cancer. This study investigates the therapeutic potential of Benidipine, an L-type calcium channel blocker known for its antioxidant properties, in an indomethacin-induced peptic ulcer model in rats. Methods: Thirty-six male albino Wistar rats were divided into six groups and subjected to various drug treatments, including Indomethacin, Famotidine, and Benidipine. Stomach tissue samples were collected for analysis. Results: Macroscopic examination revealed that indomethacin significantly increased ulcer areas in the stomach tissue, while Benidipine and Famotidine treatments effectively reduced these ulcer areas. Biochemical analysis indicated that Indomethacin-induced oxidative stress, as evidenced by elevated levels of malondialdehyde, a marker of lipid peroxidation, and decreased levels of total glutathione and superoxide dismutase, are crucial antioxidants. However, Benidipine treatment mitigated these changes, restoring antioxidant levels and reducing malondialdehyde levels. Conclusion: This study demonstrates that indomethacin induces gastric damage and oxidative stress, leading to ulcer formation, while Benidipine, with its antioxidant properties, effectively counteracts these effects and exhibits comparable efficacy to Famotidine in ulcer reduction. These findings suggest that Benidipine may hold promise as a therapeutic agent for mitigating peptic ulcers induced by nonsteroidal anti-inflammatory drugs like Indomethacin, warranting further exploration in clinical settings.

Oral ulceration (Part 2).

Ulceration is probably the oral mucosal condition seen most frequently by general dental practitioners. It is almost always painful and therefore sufferers are prompt to seek advice. An important exception to this generalisation is the occurrence of oral squamous cell carcinoma, which is often painless in its early stages. Definitive diagnosis, which requires mucosal biopsy, is mandatory for any persistent area of oral ulceration.

Comparison of healing effectiveness of different debridement approaches for diabetic foot ulcers: a network meta-analysis of randomized controlled trials.

The choice of the debridement method is very important for the healing of diabetic foot ulcers (DFUs), but the relative effectiveness of different debridement methods in the healing of DFUs remains unclear. This study conducted a network meta-analysis of the relative healing effectiveness of different debridement methods in patients with DFUs. We performed a literature search in PubMed, Embase, and Cochrane Library from database inception up to 30 June 2023 for screening randomized controlled trials on the healing effectiveness of debridement in DFUs. Outcome measures included ulcer healing rate and ulcer area reduction rate. The Cochrane Risk Bias Tool, version 2.0, was used to assess the risk of bias in the included trials. R software was used for performing statistical analysis and GraphPad Prism was used for image plotting. A total of 19 randomized controlled trials were included, and 900 patients with DFUs were assessed in this analysis. The proteolytic fraction from the latex of Vasconcellea cundinamarcensis (P1G10) in enzymatic debridement showed the best ulcer healing rate (SURCA = 0.919) when compared with the standard of care (SOC) group, with a mean difference (MD) and 95% confidence interval (CI) of 1.40 (0.57, 2.36). Kiwifruit extract demonstrated the best effect on the ulcer area reduction rate (SURCA = 0.931), when compared with that in the SOC group, with an MD and 95% CI of 0.47 (0.27, 0.66). Enzymatic debridement was superior to other debridement methods in terms of ulcer healing rate and ulcer area reduction rate in patients with DFUs. However, as the quality of the included trials is low, enzymatic debridement can be used as a candidate debridement method in addition to sharp-based debridement in clinical practice. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023441715.

Advanced platelet-rich fibrin promotes healing of induced corneal ulcer in donkeys (Equus asinus)

Ulcerative keratitis is a common disease in horses which may cause blindness. To prevent secondary bacterial and fungal infections and promote quick re-growth of the epithelial layer, different treatment approaches have been employed. This study aimed to examine the effects of advanced platelet-rich fibrin (A-PRF) gel on the healing process of experimentally induced corneal ulcers in donkeys. Nine healthy adult donkeys were used for the study. The donkeys were divided into two groups: the control group, where no medication was applied to the corneal ulcer, and the A-PRF gel group, where A-PRF gel was applied once a day on specific days after ulcer induction. The healing process was evaluated through various examinations and analyses. The results demonstrated that the A-PRF gel group showed significant improvement in the corneal ulcer area, with epithelial and stromal regeneration. At day 35, about 60% of the A-PRF group showed negative fluorescein uptake. Additionally, fewer complications were observed during the healing process compared to the control group. In conclusion, A-PRF gel is an important and safe therapeutic option for controlling ocular surface infection and promoting corneal healing. We recommend using A-PRF gel as an alternative approach, avoiding eyelid suturing, and minimizing corneal irritation.

A New Treatment for Recalcitrant Neurotrophic Keratopathy of Ocular Graft-Versus-Host Disease with Virus Infection.

Neurotrophic keratopathy (NK) is a rare degenerative ocular disease that can be difficult to treat. There were no effective resolutive treatments for severe NK caused by ocular graft-versus-host disease (oGVHD) along with virus infection. To address this question, we designed a prospective cohort study to evaluate the efficacy and safety of topical recombinant human nerve growth factor (rhNGF) in patients with recalcitrant NK of oGVHD and viral infection. This prospective cohort study enrolled patients with recalcitrant NK diagnosed with oGVHD and treated with rhNGF. Clinical evaluations included the range of epithelial defects, best corrected visual acuity, intraocular pressure, slit-lamp examination, and corneal fluorescein staining. Examinations of the central corneal thickness, corneal sensitivity, and nerve fiber regeneration were performed at each visit at 4, 8, 12, 20weeks and 6months, respectively, after initiating rhNGF treatment. All enrolled patients were diagnosed with NK at stage2 (7 eyes, 63.6%) or stage3 (4 eyes, 36.4%) and responded to rhNGF treatment. Five of 11 (45.5%) and 9 of 11 eyes (81.8%) achieved complete corneal epithelial healing after 4 and 8weeks, respectively. All 11 eyes (100%) achieved complete corneal healing after 12weeks. There was also a significant reduction in the corneal ulcer area during each visit (P < 0.001), as well as in the corneal fluorescein staining score (P < 0.010). There was a significant improvement in corneal sensation when compared to the baseline (P < 0.050). Topical treatment with rhNGF effectively promoted the complete corneal healing of persistent epithelial defects and corneal ulcers in patients with recalcitrant NK in oGVHD and viral infection.

ЯЗВЕННЫЙ КОЛИТ И ВНУТРИПЕЧЕНОЧНЫЙ ХОЛЕСТАЗ

Background. Ulcerative colitis (UC) is an inflammatory bowel disease with unpredicted clinical course and outcomes. Histology is an important part of UC diagnosis and plays an increasing role in management of patients, since more and more histological signs with prognostic value are being identified and confirmed. Objective. To describe a clinical case of death of a UC patient with intrahepatic cholestasis. Material and methods. The article presents autopsy and pathology findings in UC. Results. A patient admitted to the hospital for unspecified acute hepatitis, nonspecific ulcerative colitis and gastrointestinal bleeding died because of ulcerative colitis complicated by sclerosing cholangitis. The course of ulcerative colitis was complicated by bleeding from ulcerated areas; by intrahepatic and extrahepatic cholestasis as well as necrosis of hepatocytes associated with sclerosing cholangitis; by the development of hepatorenal syndrome and sepsis, that resulted in fatal outcome. Conclusions. Multiple severe disturbances occurring in UC pathogenesis result in mutual aggravation syndrome involving interaction of pathophysiological processes with subsequent patient's condition deterioration as well as increased risk of complications and death.

Acellular Dermal Matrix for Treatment of Diabetic Foot Ulcer: An Overview of Systematic Reviews.

Aims: To evaluate the reliability of the methodological quality and outcome measures of systematic reviews (SRs)/metaanalyses (MAs) of the acellular dermal matrix (ADM) for diabetic foot ulcer (DFU). Methods: We searched and retrieved SRs and MAs on the application of ADM for DFU from PubMed, Web of Science, The Cochrane Library, EMBASE, CNKI, CBM, WanFang, and VIP databases. We employed AMSTAR 2 to assess methodological quality, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to grade, and the strength of evidence of included SRs/MAs. We excluded the overlapping randomized controlled trials (RCTs) and conducted a re-MA of the primary RCTs. Results: A total of 7 SRs/MAs were included. Results from the AMSTAR 2 evaluation revealed a low overall quality; the GRADE system showed that the evidence was of moderate to very low quality. Our re-MA showed that ADM was superior to standard of care (SOC), with regards to complete wound healing rate at 12 weeks (RR = 1.74, 95% CI:1.34-2.25, P < .0001), complete wound healing rate at 16 weeks (RR = 1.50, 95% CI: 1.26-1.77, P ＜ .00001); healing time (MD = -2.06, 95% CI: -2.57 to -1.54, P < .00001) and adverse events (RR = 0.62, 95% CI: 0.49-0.80, P = .0002). However, a consensus has not yet been reached between ADM and SOC groups with regard to outcome indicators of the reduction of ulcer area and quality of life; and subgroup analyses showed no statistically significant differences between the xenograft ADM and SOC groups (RR = 1.36, 95% CI: 0.95-1.93, P = .09) at 12 weeks. Conclusion: Current evidence suggests that ADM is more effective than the standard of care in the treatment of DFU, particularly for full-thickness, noninfected, and nonischemic foot ulcers, but with low evidence quality. Therefore, the results of this overview should be interpreted dialectically and prudently, and the role of ADM in DFU needs further exploration.

Pomegranate Juice Attenuates Anti-ulcer in Indomethacin-induced Peptic Ulcer

Introduction: Pomegranate (Punica granatum L.) is a well-known fruit that grows in tropical and subtropical areas of the world. In this study, we wanted to find out how pomegranate juice (POMJ) affected rats with gastric ulcers caused by standard drugs. Indomethacin is the most common drug causes gastric ulcer also, most of the NSAID drugs have harmful side effects, so studies have focused on finding an alternative natural solution. Methods: In this study, 25 male albino rats were used and were split into four groups of five rats each. These groups were called control, pomegranate, indomethacin, and standard. The examination took one week to complete. Indomethacin saline suspension (100 mg/kg rat weight) caused gastric ulcers. Pomegranate peel juice (5-10%) reduced stomach ulcer area and ulcer index, gastric juice volume, and acidity. Pomegranate juice restores stomach mucus content and tissue at the histological level. Results: Rats that were given indomethacin and then given pomegranate juice were significantly less likely to get a gastric ulcer. It also lowered the ulcer index to 0.7093±0.36 showing that 52.25 % prevention. Conclusion: The study's macroscopical and microscopical results showed that pomegranate juice might be able to reduce the ulceration caused by indomethacin in a rat model. Pomegranate as a protective food supplement against gastric ulcers.