Ulcer Area Research Articles

Unidirectional drug release from 3D printed personalized buccal patches using FDM technology

Oromucosal delivery of active ingredients of drugs provides a superior administration route for the treatment of oral diseases, due to avoidance of the first pass effect. In the present work, in view of the characteristics of large differences between oral ulcer symptoms and different lesion sizes, dexamethasone acetate unidirectional drug release buccal patches has been prepared based on Fused Deposition Modelling (FDM). Unidirectional drug release was achieved by covering the top and side with ethyl cellulose. Polyvinyl alcohol as a drug carrier, xylitol as a plasticizer. First, the protection effect of different thicknesses of the protective layer is investigated to determine the thickness of the protective layer. Co-extrusion printing method was adapted, utilizing blank filament to regulate preparations with different areas' drug loading. The results show that co-extrusion had no significant impact on the overall patches' drug release and adhesion properties. The physicochemical properties of the patches were also characterized. Evaluation of irritation is showed that these patches do not cause irritation to the oral mucosa of rats. Pharmacodynamic evaluation results showed that the preparation could promote the reduction of ulcer area. The results showed that FDM printing is a convenient and practical approach in manufacturing buccal patches.

Local Application of Timolol 0.5% Solution in Treating Chronic Non-Healing Ulcers – A Prospective Study

Chronic non-healing ulcers are a variety of ulcers that occur mainly over the lower limb and are resistant to conventional therapy. There are modern treatments like various types of dressings and topical preparations available in the market. However, they are costly and may not be freely available to the general population. Topical usage of β2-AR antagonists like timolol may promote wound healing by enabling keratinocyte migration into the wound to initiate the re-epithelisation. The objective of this study is to assess the effectiveness of topical timolol 0.5% in accelerating the wound healing process by observing the signs of healing. It is a prospective observational study conducted in Government General Hospital, Rangaya Medical Medical College, Kakinada, after getting Institutional Ethical Committee approval from March 2021 to March 2023. One hundred patients with Chronic non-healing foot ulcers were taken for this study. Mean age was 47.64.60% of the study population was in the 20-55 years age group. Reduction in mean ulcer area was on day 15 and day 30 with topical application of timolol.

Learning curve of tibial cortex transverse transport: a cumulative sum analysis

ObjectiveThis study aimed to describe the learning curve of surgeons performing tibial cortex transverse transport (TTT) and explore its safety and effectiveness during the initial stages of surgeon’s learning.MethodsThe clinical data of patients with diabetic foot ulcers classified as Wagner grade ≥ 2, who underwent TTT at our hospital from January 2020 to July 2021, were included in this retrospective analysis. The same physician performed all procedures. Patients were numbered according to the chronological order of their surgery dates. The cumulative sum and piecewise linear regression were used to evaluate the surgeon's learning curve, identify the cut-off point, and divide the patients into learning and mastery groups. A minimum follow-up period of 3 months was ensured for all patients. Baseline data, perioperative parameters, complications, and efficacy evaluation indicators were recorded and compared between the two groups.ResultsSixty patients were included in this study based on the inclusion and exclusion criteria. After completing 20 TTT surgeries, the surgeon reached the cut-off point of the learning curve. Compared to the learning group, the mastery group demonstrated a significant reduction in the average duration of the surgical procedure (34.88 min vs. 54.20 min, P < 0.05) along with a notable decrease in intraoperative fluoroscopy (9.75 times vs. 16.9 times, P < 0.05) frequency, while no significant difference was found regarding intraoperative blood loss (P = 0.318). Of the patients, seven (11.7%) experienced complications, with three (15%) and four cases (10%) occurring during the learning phase and the mastery phase, respectively. The postoperative ulcer area was significantly reduced, and the overall healing rate was 94.8%. Significant improvements were observed in postoperative VAS, ABI, and WIFI classification (P < 0.05). There were no significant differences in the occurrence of complications or efficacy indicators between the learning and mastery groups (P > 0.05).ConclusionSurgeons can master TTT after completing approximately 20 procedures. TTT is easy, secure, and highly efficient for treating foot ulcers. Furthermore, TTT’s application by surgeons can achieve almost consistent clinical outcomes in the initial implementation stages, comparable to the mastery phase.

Paeonol accelerates skin wound healing by regulating macrophage polarization and inflammation in diabetic rats.

Diabetic ulcer is usually seen in people with uncontrolled blood sugar. Reportedly, many factors such as impaired glucose metabolism, and macrovascular and microvascular diseases caused angiogenesis disorders and delayed the healing of diabetic ulcers, thus affecting the body's metabolism, nutrition, and immune function. This study aimed to explore the effect of paeonol on skin wound healing in diabetic rats and the related mechanism. A rat model of diabetic ulcer was established. High glucose-treated mouse skin fibroblasts were co-cultured with M1 or M2-polarized macrophages treated with or without paeonol. H&E and Masson staining were used to reveal inflammatory cell infiltration and collagen deposition, respectively. Immunohistochemistry visualized the expression of Ki67, CD31, and vascular endothelial growth factor (VEGF). Western blot was used to detect interleukin (IL)-1β, tumor necrosis factor (TNF)-α, IL-4, IL-10, CD31, VEGFA, and collagen I/III. The expression of iNOS and arginase 1 was revealed by immunofluorescence staining. Paeonol treatment augmented collagen deposition and the expression of Ki67, CD31, VEGF, and macrophage M2 polarization markers (IL-4 and IL-10) and reduced wound area, inflammatory cell infiltration, and macrophage M1 polarization markers (IL-1β and TNF-α) in the ulcerated area. In vitro, paeonol treatment promoted M2-polarization and repressed M1-polarization in macrophages, thereby improving the repair of cell damage induced by high glucose. Paeonol accelerates the healing of diabetic ulcers by promoting M2 macrophage polarization and inhibiting M1 macrophage polarization.

Tormentic acid, a triterpenoid isolated from the fruits of Chaenomeles speciose, protected indomethacin-induced gastric mucosal lesion via modulating miR-139 and the CXCR4/CXCL12/PLC/PKC/Rho a/MLC pathway

Context Tormentic acid (TA), an effective triterpenoid isolated from Chaenomeles speciosa (Sweet) Nakai (Rosaceae) fruits, exerts an effective treatment for gastric damage. Objective To investigate the gastroprotective effect of TA on indomethacin (IND) damaged GES-1 cells and rats, and explore potential mechanisms. Materials and methods TA concentrations of 1.563–25 µM were used. Cell proliferation, apoptosis and migration were performed using MTT, colony formation, wound healing, migration, Hoechst staining assays. SD rats were divided into control, IND, TA (1, 2 and 4 mg/kg) + IND groups, once a day for 21 continuous days. Twenty-four hours after the last administration, all groups except the control group were given IND (100 mg/kg) by gavage. Gastric juice parameters, gastric ulcer, gastric blood flow (GBF), blood biochemical parameters and cytokine analysis and gastric mucosal histopathology were detected for 2 h and 6 h after IND oral administration. The mRNA and protein expression of miR-139 and the CXCR4/CXCL12/PLC/PKC/Rho A/MLC pathway were analyzed in the IND-damaged GES-1 cells and gastric tissue of rats. Results TA might ameliorate the gastric mucosal injury by accelerating the IND-damaged GES-1 cell proliferation and migration, ameliorating GBF, ulcer area and pathologic changes, the redox system and cytokine levels, the gastric juice parameters, elevating the gastric pH in IND damaged rats; suppressed miR-139 mRNA expression, elevated CXCR4 and CXCL12 mRNA and protein expression, p-PLC, p-PKC, Rho A, MLCK and p-MLC protein expression. Discussion and conclusions TA may have potential use as a clinical drug candidate for gastric mucosal lesion treatment.

P22 Life-threatening bleeding is a serious potential complication of ulcerated congenital haemangiomas: three case reports

Abstract Congenital haemangiomas (CH) are rare vascular tumours that can be complicated by high-output heart failure (HOHF), transient thrombocytopaenia and ulceration. We present three patients who had life-threatening bleeding from the ulcerated CH, which was fatal for one of the patients. The first patient was born with a large CH of his left thigh, causing thrombocytopaenia and HOHF, requiring ventilation. He was discharged home after 3 weeks, but subsequently developed an ulceration and had a profuse bleeding following a dressing change at home. He required admission to PICU and ventilation support. The second patient was born with a large segmental CH of his right scalp with two ulcerated areas, without HOHF or thrombocytopaenia. He developed a massive bleeding from the ulcerated area at 6 weeks of age, was admitted to PICU with cardiac arrest, but died a few hours later due to multiorgan failure. The third patient was born at 29 weeks’ gestation with a large CH of her right thigh which was ulcerated. She had a profuse arterial bleeding after the dressing was removed in the hospital, requiring emergency surgery and admission to PICU. Although it is a rare complication, neonates/infants with ulcerated CH are at risk for severe, life-threatening arterial bleeding. If an ulceration is present, it needs to be protected with a suitable dressing, until it heals completely. Parents need to be educated on appropriate dressing changing technique, have the support of local tissue viability nurses and learn basic CPR techniques should arterial bleeding occur and necessitate CPR.

The Gastro-Protective Effect of Ulmus Rubra, Piper Nigrum, and Brassica Oleracea in Ethanol-Induced Model of Gastric Ulcer

Background: Gastric ulcer is a state that results from an imbalance between the erosive effect of acid and pepsin and the mucosal defense mechanism of the stomach; it is correlated with the lesions induced by ethanol. Methods: Forty-eight healthy albino rats weighing (150-200gm) were involved in the present study. The animals withholding food for 24hrs were allocated to six groups. Each group was given orally one of the following agents: distilled water for the control group, esomeprazole, aqueous extract of Ulmus rubra or Piper nigrum, or Brassica oleracea, then after one hour ethanol was given to all groups except group 1, which act as the control. Animals were sacrificed one hour later; the main parameters used in the present study were ulcer numbers and areas, preventive index, and changes in the trace elements (Zn and Cu) and serum electrolytes (Na+ and K+). Results: Ethanol was found to be highly ulcerogenic at high concentrations. The preventive index of these agents was 90%, 47.7%, and 91.8% for Ulmus rubra, Piper nigrum, and Brassica oleracea, respectively, in comparison with esomeprazole 94.7%. These agents also produced significant changes in trace elements levels of Zn and Cu but with no significant changes in electrolytes Na+ and K+. Conclusion: Both Ulmus rubra and Brassica oleracea extracts proved to have a potent gastroprotective effect against the ethanol-induced model of gastric ulcer and the possibility to be used in the management of peptic ulcer after assessment by clinical trials.

Evaluation of the healing potential of Nile tilapia skin collagen in traumatic oral ulcers in male rats

ObjectiveTo evaluate the healing potential of Nile tilapia skin collagen using a rat model with experimentally induced traumatic oral ulcers. DesignMale Wistar rats were segregated into three experimental groups (n = 8/group/euthanasia day). Ulcers were induced using a dermatological punch on the left buccal mucosa. The rats were then euthanized on days 1, 5, 10, 15, and 20 (ntotal=120 rats). Each group received topical treatment, 2x/day, with 1 % Nile tilapia skin collagen orabase (experimental group), only orabase (negative control), or Oncilom-A® orabase (positive control). Ulcer area, closure percentage, and body mass variation were measured. Slides were prepared for histological analysis, which included Picrosirius red staining (collagen analysis), and immunohistochemistry (platelet endothelial cell adhesion molecule, alpha-smooth muscle actin, and transforming growth factor-beta). ResultsOn day 15, the experimental and positive control groups displayed smaller ulcer areas, a higher percentage of closure, complete re-epithelialization, superior histological repair scores, and a reduced count of polymorphonuclear cells in comparison to the negative control group (p < 0.05). Additionally, the experimental group exhibited an increased number of blood vessels, total collagen (types I and III) and expression of platelet endothelial cell adhesion molecule, alpha-smooth muscle actin, and transforming growth factor-beta relative to the negative and positive control groups (p < 0.05). By day 20, the experimental group showed a more significant weight gain compared to the other groups (p < 0.0001). ConclusionsNile tilapia skin collagen orabase optimizes the healing of traumatic ulcers by stimulating re-epithelialization, angiogenesis, and collagenesis. Transforming growth factor-beta plays a significant role in this process.

Short term-efficacy and tolerability of Rheocarna, a novel direct hemoperfusion adsorptive column, for chronic limb-threatening ischemia in dialysis patients: A single-center case series.

With population aging and lifestyle changes, the number of patients with chronic limb-threatening ischemia (CLTI) is increasing, and refractory or recurrent lesions are more common, especially in chronic dialysis patients. In March 2021, a new type of adsorptive cellulose bead column immobilized with dextran sulfate and L-tryptophan for direct hemoperfusion (DHP) was approved by Japan's medical insurance system as a treatment for CLTI. We retrospectively analyzed 17 cases of CLTI in dialysis patients treated with DHP using the novel column (Rheocarna) (DHP-R) at our hospital from May 2021 to October 2022. The short-term of efficacy of DHP-R was judged qualitatively by the foot care team every 2 weeks based on the assessment of skin color, warmth, ulcer epithelialization or shrinkage of the ulcer area, and foot pain. The final judgment of efficacy was made after the final DHP-R session. The median age of patients was 66 years, the median dialysis duration was 10 years, 15 cases (88%) were male, and 15 cases (88%) had diabetes. The median total number of sessions was eight. In comparing the groups in which DHP-R was effective and ineffective, there was no significant difference in any factors including patient background data (i.e., age, diabetes, low-density lipoprotein cholesterol, hemoglobin, dialysis duration, etc.), type of anticoagulants, and presence of episodes of blood pressure drop or circuit clotting during session. Three cases with symptomatic hypotension during the session and two cases with circuit clotting that did not improve with increased heparin dose all resolved immediately after changing the anticoagulant from heparin to nafamostat mesylate (NM). Identification of patients' characteristics in which DHP-R is favorable and some reliable index that allow a rapid decision to continue DHP-R are needed. In addition, validating whether the use of NM as anticoagulant affects the efficacy of DHP-R for CTLI treatment remains a challenge to resolve.

Effect of co-administered dalteparin sodium and alteplase on clinical and biochemical parameters in postpartum patients with lower extremity deep venous thrombosis

Purpose: To investigate the clinical efficacy of co-administration of dalteparin sodium and alteplase in the treatment of postpartum lower extremity deep venous thrombosis.Methods: A total of 88 patients with postpartum lower extremity deep venous thrombosis admitted to Jiangxi Provincial People's Hospital of The First Affiliated Hospital of Nanchang Medical College, Nanchang, China from January 2020 to December 2022 were enrolled in this study and divided into study group (treated with dalteparin sodium and alteplase) and control group (treated with alteplase only), with 44 patients in each group. Clinical parameters (limb circumference, pigmentation and ulcer area), hemorheological parameters [D-Dimer (D_D), fibrinogen (FIB), centipoise (CP), red cell assembling index (RCAI)], inflammatory factors (hs-CRP, IL-6, THF-a, NMP-9) and cell adhesion factors {platelet endothelial cell adhesion molecule-1 (PECAM-1) and vascular cell adhesion molecule 1 (VCAM-1)} were determined and recorded.Results: Post-treatment, all the clinical and biochemical parameters in the study group were significantly improved compared with pre-treatment levels and the respective levels in the control group (p &lt; 0.05). The overall response rate (ORR) in the study group was 95.45 %, which was higher than the 79.55 % for the control group (p &lt; 0.05).Conclusion: Concomitant administration of dalteparin sodium and alteplase is more efficacious than treatment of with alteplase alone in the management of postpartum lower extremity deep venous thrombosis. However, further clinical trials on this combination therapy is required for the validation of findings obtained in this work.

Bovine lactoferrin inhibits resistant Helicobacter pylori in vitro and protects gastric mucosal injury in vivo

Helicobacter pylori (H. pylori) is associated with gastric mucosal injury, gastric ulcer and other gastrointestinal diseases. Resistance of H. pylori to antibiotics has become an obstacle to clinical eradication therapy. Bovine lactoferrin (bLF) has a broad spectrum of antibacterial effects, high safety and no side effects, which may be conductive to improving the dilemma of antibiotic resistance. We aimed to explore the bactericidal effect of bLF on resistant H. pylori and the protective effect on gastric mucosal injury. In vitro experiments demonstrated that bLF has obvious antibacterial effect on resistant H. pylori and synergistic antibacterial effect when combined with clarithromycin. The MIC and MBC of bLF against resistant H. pylori ranged from 1.25 to 5 mg mL−1. In vivo experiments showed that bLF could improve the degree of gastric mucosa injury, decrease the area of gastric ulcer. Results indicate that bLF has a wide clinical application prospect in medical field.

Efficacy and safety of total glucosides of paeony in the treatment of recurrent aphthous ulcers: a single-center, double-blind, randomized, placebo-controlled clinical trial.

Introduction: There has been a lack of treatments available to lower the frequency of recurrent aphthous ulcers (RAUs) until now. Total glucosides of paeony (TGP) is a botanical drug extracted from the dried roots of Paeonia lactiflora Pall. [Ranunculaceae; Paeoniae Radix Alba]. This study aims to evaluate the efficacy and safety of TGP in the treatment of RAU. Methods: This study was registered with the Chinese Clinical Trial Registry (ChiCTR1900025623). Patients were randomly assigned to the TGP or placebo group and treated with 1.8g/day for 24weeks. Participants were observed for a total of 36weeks and were asked to record ulcer severity, medication, and adverse reactions in the form of diaries or apps every day. The primary outcome was the monthly ulcer-free interval. Results: A total of 79 individuals were enrolled, with 40 assigned to the TGP group and 39 to the placebo group. The dropout rate was 18.18%. In the TGP group, the monthly ulcer-free interval was significantly longer than baseline (median, 9.6days) since weeks 13-24 (median, 18.5days) (p < 0.05), and after discontinuation, it was further prolonged (median, 24.7days) than in weeks 13-24 (p < 0.05). In addition, the monthly ulcer-free interval was longer in the TGP group than in the placebo group (median, 15.9days) at weeks 25-36 (p < 0.001). There were better improvements in the monthly number of ulcers and monthly area of ulcers, and visual analog scoring in the TGP group at weeks 25-36 (p < 0.001). Conclusion: TGP had a good long-term therapeutic effect on RAU with frequent occurrence. Systematic Review Registration: www.chictr.org.cn, identifier ChiCTR1900025623.

Betalain-Enriched Beetroots Exhibit Antiulcer and Anti-inflammatory Potentials

Introduction. Recently, plant natural food colorants have received a growing interest due to their therapeutic and preventive activities against various diseases. This study is aimed at evaluating the phytochemical composition by high-performance liquid chromatography with diode array detection (HPLC-DAD) and at evaluating the antiulcer effect of red beetroot betalains (BRB). Materials and Methods. Ethanol was used for gastric mucosa damage, ulcer, and inflammation induction in rat. Results. HPLC-DAD data revealed the existence of numerous compounds, including betanidin 5-glucoside (43.22%), isobetanidin 5-glucoside (18.47%), 2,17-bidecarboxy-neobetanin (7.07%), 2-O-glucosyl-betanin (4.03%), 17-decarboxy-betanidin (3.61%), neobetanin (3.24%), and eight other compounds whose yields were too low. In vitro as in gastric tissues in rats, BRB potentially inhibited key enzymes—relation to gastric ulceration and damage as pepsin, lipoxygenase, and hyaluronidase activities. In ethanol-induced gastric ulcer and inflammation, BRB administration at doses 200, 400, and 800 mg/kg significantly ( p ≤ 0.05 ) decreases the ulcer areas (UA) and index (UI); increases the curative index (CI) by 78.1, 78.4, and 78%, respectively; and ameliorates the pathological damage induced by ethanol. In addition, BRB administration to rat gastric ulcer rats prevented significantly ( p ≤ 0.05 ) the decrease of gastric mucus (GM) content (by 116%) and reduced the stress oxidant, evidenced by a significant ( p ≤ 0.05 ) decrease of gastric mucosa thiobarbituric acid reactive species (TBARS) (by 28%) and mucus juice pepsin by 56%. Conclusion. Taken together, BRB exerted potential therapeutic efficacy for gastric ulceration.

Cutis marmorata telangiectatica congenita: Incidence of extracutaneous manifestations and a proposed clinical definition.

Cutis marmorata telangiectatica congenita (CMTC) is a capillary malformation characterized by congenital, reticulated, well-demarcated dark blue, red-purple, or violaceous macules or plaques, with a coarse fixed livedo pattern. Nearly always, contiguous areas of skin atrophy and/or ulceration are present. CMTC is usually localized but may rarely be generalized. Such generalized cases may be a feature of Adams-Oliver syndrome (AOS). The nosologic confusion surrounding the term CMTC and uncertainty about the risk of associated abnormalities hinders the appropriate workup of patients and prognostic counseling for families. We hypothesized that the risk of associated anomalies in children with localized CMTC is very low. We performed a literature review and retrospective review of patients with CMTC to propose a more precise clinical definition and ascertain the risk of associated anomalies. We included 78 patients determined to have a diagnosis of CMTC based on consensus. The majority of patients had localized CMTC. Most patients with generalized CMTC met the criteria for the diagnosis of AOS. The associations found in patients with localized CMTC were mostly dermatological, with atrophy, ulcerations, or erosions present in 71%. Extracutaneous findings were present in 34.4% of patients and consisted mainly of extremity asymmetry (24.5%) that improved over time. Our study showed a very low frequency of extracutaneous anomalies among patients with localized CTMC, ipsilateral limb discrepancy being the most common. We did not find a strong association with any other visceral anomalies that would justify routine evaluation in patients with localized CMTC.

In vitro anti-inflammatory activity and ameliorative effects on gastric ulcers of Licania rigida benth seed extract.

Licania rigida Benth., a Brazilian endemic plant, has been traditionally used for treating inflammation and stomach pain. This work investigates the anti-inflammatory and gastroprotective activities of the ethanolic extract from L. rigida seeds (EELr) by in vitro and in vivo methods. The phytochemical profile was determined and the in vitro antioxidant activity was investigated by radical scavenging and thiobarbituric acid reactive substances methods. The ovalbumin denaturation method was used with sodium diclofenac as standard for the in vitro anti-inflammatory activity assessment. Acetylsalicylic acid was used to induce gastric ulcers in male mice and then to evaluate the preventive and therapeutic gastroprotective effect of EELr, using omeprazole as the reference drug. The extract exhibited relevant amount of phenolic compounds and flavonoids, in particular, demonstrating in vitro antioxidant capacity. EELr was able to inhibit almost 60% of ovalbumin denaturation at a concentration considered low. It also prevented the decrease of biochemical markers for oxidative stress such as superoxide dismutase (SOD) and reduced glutathione (GSH) in the stomach and SOD and catalase (CAT) in the liver. EELr also significantly decreased the number of lesions as well as reduced the ulcerated area when used as therapy. The observed effect may be due to its phenolic compounds, such as chlorogenic acid, caffeic acid and tannins, as previously reported. EELr is a potential source of compounds with anti-inflammatory activity, protects the liver from oxidative damage and improves healing of aspirin-induced ulcers. This work contributes to the knowledge of L. rigida species.

Gastro-protective Effect of Corn Diet against Indomethacin Induced Ulceration in Experimental Rats

Introduction: One of the most prevalent gastrointestinal ailments is gastric ulcer, which is caused by an imbalance between protective and aggressive factors. Zea mays Corn is a significant cereal crop containing natural phytochemical substances that are sources of nourishment. The methanolic extract of Corn, according to a previous study, lowers stomach acidity and inhibits the percentage of gastric ulceration with no knowledge on the mechanisms involved.&#x0D; Aim: This study investigated the underlying gastroprotective mechanisms of the Corn diet (ZD).&#x0D; Materials and Methods: Sixty male Wistar rats were used, randomly grouped into 6; 1(Normal control), 2(Ulcerated control), 3, 4, 5 (prefed with ZD -55%, 65%, 75%) and 6 (cimetidine- 25mg/kg) for 28 days. Gastric ulcer was induced by oral administration of indomethacin (40mg/kg) and animals were sacrificed after 4 hours. The stomach was excised and cleaned, it was then homogenized and centrifuged for biochemical assays.&#x0D; Results: There is a significant reduction in gastric ulcer area in all treated groups. Significant increase in gastric tissue mucin content and gastric mucosal SOD, NO and PGE2 levels and significant reduction in the MDA was observed in the ZD and cimetidine group. Histological evaluation showed tubular glands closely packed and separated from each other by laminar propia, however there is mild presence of inflammatory cells within the laminar propia in the ZD groups compared to ulcerated control group that showed moderate oedema with infiltration of inflammatory cells with mild vascular congestion in the mucosa. There is significant reduction in the macroscopic gastric mucosal lesions with percentage inhibition of 90%, 92%, 90% and 92% in the ZD (55%, 65% and 75%) and cimetidine group respectively.&#x0D; Conclusion: Results obtained from this study suggests that Zm diet may have anti-ulcerogenic properties by enhancing antioxidant enzymes as well as, nitric oxide and prostaglandin E2 mechanisms.

Gastroprotective effect of the flavonoid fustin isolated from Cotinus coggygria heartwood in a rat model of indomethacin-induced gastric ulceration

Abstract Gastric ulcer is a common health issue. Cotinus coggygria heartwood extracts rich in the flavonoids fustin and sulfuretin have shown protective effects in a rat model of indomethacin-induced gastric ulceration. Fustin itself has been protective in a rat model of ethanol-induced gastric ulcer. In the present study we aimed to reveal the effect of the flavonoid fustin isolated from Cotinus coggygria heartwood in a rat model of indomethacin-induced gastric ulceration. Fustin was isolated from Cotinus coggygria heartwood and purified. The experiment was performed on 30 male Wistar rats allocated to three groups – Control, Indo and F10. F10 group was pretreated with fustin (10 mg/kg b.w. for 7 days). Rats were sacrificed and macroscopic, histopathological and immunohistochemical investigations of the stomachs were performed. Indomethacin caused severe mucosal damage, proven by the macroscopic, microscopic and immunohistochemical gastric mucosa investigation. Fustin pretreatment slightly reduced the macroscopic indices for gastric damage (ulcer number, area, score and index), and significantly alleviated the severity of the microscopic indices (mucosal erosions, necrosis, hemorrhages and inflammation). In fustin-pretreated rats, the expression of NF-κB was reduced in comparison with indomethacin-treated animals. In conclusion, fustin exerted a gastroprotective action in an indomethacin-induced gastric ulceration model, probably due to its anti-inflammatory activity.

Use of fibrin glue in the treatment of decubital ulcers in patients after brain damage, as a stage of conservative treatment

BACKGROUND: Patients with brain damage require specific treatment for decubitus ulcers. Given the seriousness of their condition and decompensation of concomitant pathology, surgical treatment is not always possible. Conservative therapy can take a long time, which is aggravated by the unsolvable problem of patient immobilization, microcirculatory tissue disorders, and inevitable chronicity of the purulentinflammatory process. Most authors and practitioners are inclined toward a combined approach in the treatment of decubitus ulcers. AIM: To evaluate the results of using fibrin glue in the treatment of bedsores in patients with severe brain damage. MATERIALS AND METHODS: The article presents the experience of using fibrin glue in the conservative treatment of bedsores. The study included patients in a chronic critical state because of severe brain damage, with a decubitus ulcers area of 80 cm2 (stage III according to the Agency For Health Care Policy and Research classification). In the main group, treatment included the use of fibrin glue in accordance with the Russian Federation Patent No. 2777483 dated 08/04/2022. In the control group, treatment included standard dressings with levomekol ointment. Both groups received treatment for 21 days. Changes in the wound process were assessed using the BatesJensen scale and cytological examination at control points. RESULTS: The study analyzed 58 patients, who were divided into two groups: group 1 (main) included 32 patients (15 men, 17 women), and group 2 (control) included 26 patients (12 women, 14 men). In the main group, after 1 week of applying dressings with fibrin glue, positive changes were noted, such as active marginal epithelialization, disappearance of undermining and swelling of wound edges, appearance of juicy bright granulations, and absence of exudates. After 22.5 weeks, epithelialization exceeded 50% of the total area of the decubitus ulcers (56.2% of cases), and exudation was completely absent. In a cytological study, the percentage of cells responsible for tissue proliferation increased and inflammation decreased in the main group. No significant effect was noted in the control group. In 7.7% of cases, 50% epithelialization was noted on days 2835; in three patients, re-infection of the decubitus ulcers occurred, and ischemia developed, which significantly lengthened the total duration of inpatient treatment and rehabilitation by 1.01.5 months. CONCLUSION: The use of fibrin glue promotes decubitus ulcers epithelization, thereby reducing their size, up to complete healing.

PA02 A teenager with a bleeding neck nodule

Abstract A 14-year-old boy was referred to dermatology with a new bleeding lesion on his right neck that had grown rapidly. There was no preceding history of trauma. Physical examination revealed a discrete eroded pink nodule measuring 10 × 9 mm on his right neck. Dermoscopic examination showed a central area of ulceration, with polymorphous vessels, white lines and multiple shades of pink and milky-white areas. This was excised. Histology confirmed the diagnosis of ulcerated superficial spreading malignant melanoma with a Breslow thickness of 4.8 mm (pT4b). BRAF v600e mutation was present. Initial staging with sentinel lymph node biopsy and whole-body positron emission tomography/­computed tomography were clear, but 6 months after presentation, he developed right-sided cervical lymphadenopathy and a parotid mass that was confirmed to be metastatic disease. Following a right parotidectomy and neck dissection, he was commenced on adjuvant treatment with dabrafenib and trametinib. He remains under close follow-up. Less than 1% of all melanomas are diagnosed in patients younger than 20 years of age. Most paediatric cases occur in adolescence (between 15 and 19 years of age). The majority arise sporadically. Risk factors for melanoma in childhood include giant congenital melanocytic naevi, personal history of malignancy, family history of melanoma, multiple (&amp;gt; 50) melanocytic naevi, history of sunburn or tanning-bed use, immunosuppression or genodermatoses (e.g. xeroderma pigmentosum). Most clinicians are familiar with the ‘ABCDE’ tool (asymmetry, border irregularity, colour variegation, diameter &amp;gt; 6 mm, evolution) used to help with the recognition of melanomas; however, melanoma in children often presents in an atypical fashion. Paediatric melanomas often lack pigment (amelanotic) and are nodular, and so may be misdiagnosed. Because of this, diagnosis may be delayed and patients often present with thicker tumours and lymph node involvement. To facilitate earlier diagnosis, modified ABCD detection criteria have been proposed for paediatric melanoma (amelanosis, bleeding/bump, colour uniformity, de novo development) that can be used in conjunction with the established ABCDE approach. The CUP criteria have also been described (colour that is pink/red/changing, ulceration/upward thickness, pyogenic granuloma-like lesions/pop-up of new lesions). Evolution remains an important point to consider when suspecting melanoma in patients of any age. Management and staging of paediatric melanoma is adopted from the American Joint Committee on Cancer melanoma staging system guidelines for adult melanoma. Currently, there are no specific guidelines for the management of melanoma in children. The mainstay of treatment is surgical resection. Sentinel lymph node biopsy should be considered with ulceration or a Breslow thickness of &amp;gt; 0.75 mm. Patients with stage III and IV melanoma should be considered for adjuvant immunotherapy. All patients with melanoma should be followed-up with regular skin examinations.

Evaluation of Acetic Acid-Induced Chronic Gastric Ulcer Healing by Propionyl-L-Carnitine Administration.

The aim of our study was to investigate the healing effect of propionyl-L-carnitine (PLC) on chronic gastric ulcers and its underlying mechanisms. This study included rats with gastric ulcers induced by applying serosal glacial acetic acid. These rats were then given either saline (vehicle) or PLC at doses of 60 and 120 mg/kg, administered orally 3 days after ulcer induction for 14 consecutive days. Our study found that treatment with PLC resulted in a reduction of the gastric ulcer area, a faster rate of ulcer healing, and stimulated mucosal restoration. Additionally, the treatment with PLC reduced the number of Iba-1+ M1 macrophages while increasing the number of galectin-3+ M2 macrophages, as well as desmin+ microvessels, and α-SMA+ myofibroblasts in the gastric ulcer bed. The mRNA expression of COX-2, eNOS, TGF-β1, VEGFA, and EGF in the ulcerated gastric mucosa was greater in the PLC-treated groups compared with the vehicle-treated rats. In conclusion, these findings suggest that PLC treatment may accelerate gastric ulcer healing by stimulating mucosal reconstruction, macrophage polarization, angiogenesis, and fibroblast proliferation, as well as fibroblast-myofibroblast transition. This process is associated with the upregulation of TGF-β1, VEGFA, and EGF, as well as modulation of the cyclooxygenase/nitric oxide synthase systems.