Healing Rates In Patients Research Articles

Application of health empowerment theory in postoperative rehabilitation management of elderly patients with femoral fracture

Objective To investigate the clinical value of health empowerment theory applied to postoperative rehabilitation management of elderly patients with femoral fracture. Methods A total of 94 cases of elderly patients with femoral fractures hospitalized in the Second Hospital of Jilin University from March 2015 to February 2017 were selected as the research objects. Using random number table method, the patients were randomly divided into the observation group and the control group, with 47 cases in each group. Patients in the control group received routine nursing, and patients in the observation group received nursing with health empowerment theory. Perceived empowerment level, the total incidence of postoperative complications, grade A healing rate of incisions and the situation of hip joint function of patients were evaluated and compared between the two groups. Results There were interaction among different times and groups of the perceived empowerment between two groups, and the differences were statistically significant (P 0.05). The grade A healing rate of patients in the observation group was significantly higher than that in the control group (P<0.05). The Harris score of patients that six months after surgery in two groups all elevated, and there was significant difference compared with the score before surgery (P<0.05), and the Harris score of patients in the observation group was higher than that of the control group (P<0.05). The good rate of hip joint function of patients in observation group that 6 months after surgery was significantly higher than that of control group (P<0.05). Conclusions The application of health empowerment theory in elderly patients with femoral fractures is favorable for postoperative rehabilitation, and it can reduce the patients' postoperative pain and improve their hip joint function. Key words: Aged; Femoral fractures; Health empowerment theory; Rehabilitation management

The Effect of Individualised Glycemic Intervention on Wound Healing Rate in Diabetic Foot Ulcer (The EIGIFU Study).

ObjectiveTo evaluate the association of glycated haemoglobin (HbA1c) reduction and wound healing in patients with diabetic foot ulcer (DFU).MethodologyA 12-week prospective, non-controlled, interventional study in suboptimal-controlled T2DM patients with DFU was conducted. Antidiabetic medications were adjusted with the aim of at least 1% in relation to patient’s individualised HbA1c target. The wound area was determined by using specific wound tracing. The daily wound area healing rate in cm2 per day was calculated as the difference between wound area at first visit and the subsequent visit divided by the number of days between the two visits.Results19 patients were included in the study. There was a significant HbA1c reduction from 10.33 %+1.83% to 6.89%+1.4% (p<0.001) with no severe hypoglycaemia. The median daily wound area healing rate was 0.234 (0.025,0.453) cm2/day. There was a strong positive correlation between these two variables (r=0.752, p=0.01). After dividing the patients into four quartiles based on final HbA1c and comparing the first quartile vs fourth quartile, there was a significant difference in daily wound area healing rates (0.597 vs 0.044 cm2/day, p=0.012).ConclusionThere was a positive correlation between HbA1c reduction and wound healing rate in patients with DFU. Although this is an association study, the study postulated the benefits of achieving lower HbA1c on wound healing rate in DFU which require evidence from future randomised controlled studies.

P642 Adaptive dosing during infliximab induction therapy can improve mucosal healing rates in patients with ulcerative colitis

P642 Adaptive dosing during infliximab induction therapy can improve mucosal healing rates in patients with ulcerative colitis

184 Can Adjunct Use of Topical Provodine® Improve Healing Rates in Patients With Skin Abscesses?

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an important cause of skin abscesses in patients seen in emergency departments. Provodine® is a topical povidone-iodine broad-spectrum antiseptic. The potential benefit of Provodine® for patients with a drained abscess is unclear. Our objectives were to determine if the addition of Provodine® would be superior to standard treatment in patients who had an abscess that was treated with incision and drainage (I&D). The primary outcome was clinical cure 7-10 days after I&D. The secondary outcomes were rate of development of new skin lesions and spread in household contacts (HC) within 30 days. This is a randomized controlled pilot study of a convenience sample of 100 adult patients presenting with an abscess requiring I&D. Patients were excluded if they were unable to provide informed consent, were homeless or incarcerated, had active IV drug use or iodine allergy, had an abscess on the face or breast, or required admission or surgical drainage. Patients were randomized to Provodine® or standard care. All patients had I&D and packing of the abscess and wound cultures sent. Patients randomized to Provodine® had the agent applied with a Q-tip to the abscess cavity and surrounding skin after I&D. Patients were instructed to leave packing in place and change the dressing daily until the first wound check. Subjects returned at 48-72 hours. All patients were instructed on daily dressing changes with gauze. Patients randomized to Provodine® were instructed to wash hands with Provodine® and apply the agent to the cavity and skin daily. Patients randomized to standard care were instructed to wash hands daily with soap and water. All patients were advised to continue daily wound care until the second wound check or until cavity had closed. Subjects returned at 7-10 days. They were also contacted by telephone for data collection at 30 days. Compliance with intervention and side effects were recorded. Additional interventions for patients not clinically improving or worsening were considered treatment failures. Data was collected including clinical cure, new lesion development, and spread to HC at each visit and at 30 days. The mean age of patients was 41.73 years (range, 19 to 74). Thirty-seven percent of cultures were positive for MRSA. Clinical cure at 7-10 days occurred in 42 of 46 patients (91.3%) in the standard group versus 45 of 51 patients (88.2%) in the Provodine® group (difference, 3.1 percentage points; 95% confidence interval [CI], 0.19 to 2.71; p=0.744). Spread to HC within 30 days occurred in 4 of 39 patients (10.26%) in the standard group versus 2 of 39 patients (5.13%) in the Provodine® group (difference, 5.13 percentage points; 95% confidence interval [CI], 0.36 to 12.28; p=0.675). Development of a new lesion within 30 days occurred in 8 of 41 patients (19.51%) in the standard group versus 8 of 39 patients (20.51%) in the Provodine® group (difference, 1.0 percentage points; 95% confidence interval [CI], 0.31 to 2.81; p=1). The addition of Provodine® to standard treatment did not improve clinical cure, rate of new lesion development, or spread to HC in patients with cutaneous abscesses requiring incision and drainage.

Effect of sulfadiazine silver lipid water gel dressing on PICC placement related skin complications

Objective To observe the clinical effect of sulfadiazine silver lipid water gel dressing on PICC placement related skin complications. Methods A total of 106 patients with skin defect combined with local infective wound after PICC placement were recruited. And then, the sulfadiazine silver lipid water gel dressing was used to cover the point of puncture and surrounding skin after changing a medical prescription with the conventional method. Besides, it depended on effusion situation whether they were packaged with the sterile transparent dressing or the sterile gauze. The pain score, the situation of adhesion between dressing and the surface of a wound, the healing rates of patients were observed when changing a medical prescription. Results The pain score was all lower than 3 during changing a medical prescription. There was no adhesion between dressing and the surface of a wound after changing a medical prescription. The healing rate was 82.08% at the seventh day and 98.11% at the fourteenth day. Conclusions The sulfadiazine silver lipid water gel dressing has good effects on skin defect combined with local infective wound after PICC placement. It can relieve the pain when and after changing a medical prescription, avoid the situation of adhesion between dressing and the surface of a wound, effectively control infection and promote wound healing. Key words: Peripherally inserted central catheter; Wound healing; Skin complications; Sulfadiazine silver lipid water gel dressing

Sa1951 - Mucosal Healing Rates in Patients with Upper Gastrointestinal Tract Crohn's Disease

Sa1951 - Mucosal Healing Rates in Patients with Upper Gastrointestinal Tract Crohn's Disease

Early Venous Reflux Ablation (EVRA) Ulcer Trial: Baseline Characteristics and Event Rates

The timing of offering superficial venous intervention to patients in terms of leg ulcer healing is controversial. Standard care in the United Kingdom derived from the 2007 Effect of Surgery and Compression on Healing and Recurrence (ESCHAR) trial involves compression bandaging to heal the ulcer followed by surgery to treat the underlying reflux to reduce the recurrence risk. The American Venous Forum has made the Grade 2, Level C recommendation in favor of early intervention in active ulceration based on the results of some cohort studies despite the randomized controlled trial evidence that there is no benefit. A trial has been designed to clarify this issue. This is a multicenter, prospective, randomized controlled trial funded by the National Institute for Health Research Health Technology Assessment Programme (project No. 11/129/197). The sample size of 450 patients was based on the primary outcome of time to ulcer healing. According to previous published literature, the 24-week healing rate in patients randomized to compression alone was approximately 60%. To calculate a sample size for this study, we estimated a benefit associated with early treatment of around 15%. Incorporating dropouts, 208 subjects per group are required (254 events in total) to identify a difference of 60% vs 75% in 24-week healing rates with 90% power. Patients are randomized to either early endovenous treatment of superficial venous reflux in addition to standard care or standard care alone. All patients are seen in an outpatient clinic at 6 weeks and examined clinically (with a duplex ultrasound scan taken in the early group), in addition to monthly telephone follow-ups to document resource use for the health economic analysis and to monitor patient safety. Weekly ulcer healing verification visits are performed on notification of healing. Quality of life is measured at baseline, 6 weeks, 6 months, and 12 months. The trial closed to recruitment on September 30, 2016. There were 5866 patients (51% men, 49% women; mean age, 72 years) who were screened, with 450 patients randomized (8% inclusion rate; 56% men, 44%women; mean age, 68 years); 27% of patients screened were ineligible with respect to ulcer duration and 6% declined to take part. The median baseline ulcer duration was 3.1 months, and the median size was 3.0 cm2 (interquartile range, 1.5-6.8) with a venous incompetence pattern of 56% great saphenous vein incompetence alone, 13% small saphenous vein incompetence alone, and 25% both great saphenous vein and small saphenous vein incompetence combined; 27% had evidence of deep venous incompetence. In the early arm, the interventional treatment strategy employed was 53% by foam alone, 26% with endothermal ablation alone, and 20% by a combination of therapies. To date, a total of 356 (81%) ulcers have healed within 12 months. This study will be the first large randomized multicenter trial to report on the clinical outcomes, quality of life, and cost-effectiveness of treating patients with venous ulcers by early superficial venous intervention.

LL-37 but Not 25-Hydroxy-Vitamin D Serum Level Correlates with Healing of Venous Leg Ulcers

Human cathelicidin, LL-37, is small antimicrobial peptide, which reveals also some immunomodulatory and proangiogenic properties and, therefore, may promote wound healing. The expression of LL-37 is controlled by various factors, including vitamin D. Thus, any disturbances in vitamin D level may influence LL-37 production and, possibly, affect wound healing. Since deficiency of vitamin D was identified as a common problem in the population, this proof of concept study aimed to verify the relationship between serum levels of LL-37, vitamin D, and healing rate of venous leg ulcers. The study involved small group (n = 19) of patients with venous leg ulcers. Apart from non-venous ulcer aethiology, compression intolerance, active vein thrombosis, and wound infection, the exclusion criteria concerned also kidney insufficiency. The results of the analysis of wound healing rates were correlated with patients’ serum levels of 25(OH) vitamin D and LL-37. In addition, serum levels of pro-inflammatory cytokines (IL-6, IL-8, and TNF) were analyzed. We have found strong association between serum concentrations of LL-37 and the healing rates in patients with leg ulcers. Despite the fact that 25(OH) vitamin D levels in all patients were below the normal range, they did not show any correlation with healing rates. Furthermore, no association was observed between serum levels of 25(OH) vitamin D and LL-37. No significant correlation between tested pro-inflammatory cytokines and healing rate, LL-37, or 25(OH) vitamin D levels was also observed. Regardless of small study group, our results suggest that the assessment of serum concentration of LL-37, but not 25-hydroxy vitamin D, may help in predicting the wound healing efficacy. Moreover, this assessment may be useful in pre-selection of patients, which could benefit from local treatment with exogenous LL-37.

Efficacy of Topical Recombinant Human Epidermal Growth Factor for Treatment of Diabetic Foot Ulcer: A Systematic Review and Meta-Analysis.

Diabetic foot ulceration is a major complication of diabetes mellitus. Recombinant human epidermal growth factor (rhEGF) is used topically in the treatment of diabetic foot ulcers. This meta-analysis was designed to evaluate if rhEGF increased the complete healing rate of diabetic foot compared with controls. We searched the MEDLINE, Cochrane Library, EMBASE, and Web of Knowledge databases (up to December 22, 2015). Studies were identified and selected, and data were extracted by 2 independent reviewers. A total of 4 randomized controlled trials including 294 patients were identified. The studies evaluated the rate of healing of diabetic foot that were treated with rhEGF or controls. On account of study heterogeneity, a random-effects model was performed, and the combined odds ratio (OR) indicated a significantly greater complete healing rate in patients treated with rhEGF compared to placebo. The ORs ranged from 1.66 to 14.64, with a combined OR of 4.36 (95% confidence interval = 1.48-12.81, P = .007). These results indicate that rhEGF is efficacious in the treatment of diabetic foot ulcers by increasing the rate of wound healing. These findings support the use of rhEGF in treating diabetic foot.

The clinical effect and cost analysis of patients of oral and maxillofacial space infection treated with improved closed negative pressure drainage

Objective To explore the clinical effect of patients of oral and maxillofacial space infection treated with improved closed negative pressure drainage combined with hyperbaric oxygen, and the possibility of using this method to decrease the hospital expenses. Methods 156 patients with oral and maxillofacial space infection were divided into control group, closed negative pressure drainage group and improved closed negative pressure drainage combined with hyperbaric oxygen group by random number table. 52 patients in each group. The granulation tissue growth time, the healing of wound, clinical effect of the 8thday, hospitalization days, wound healing time, antibiotic cost, average cost in hospital were recorded after treatment. Results The average wound healing time of patients in improved closed negative pressure drainage combined with hyperbaric oxygen group was (6.06±0.23)days, while the granulation tissue growth time was (16.13±2.89) days, both of them were much shorter than the control group[(15.46±4.68)days and (28.60±3.50)days respectively],as well as the closed negative pressure drainage group [(7.43±0.75) days and (22.67±4.34) days respectively], and the differences were statistically significant which the F values equaled to 6.213 and 8.451, P values all less than 0.05. The total healing rate of patients in closed negative pressure drainage group and improved closed negative pressure drainage combined with hyperbaric oxygen group were both 100.00% (52/52), the difference was statistically significant compared with control group (χ2=6.89, P < 0.05). The average hospitalization days of the patients in the closed negative pressure drainage group and improved closed negative pressure drainage combined with hyperbaric oxygen group were (8.20±1.49) days and (7.45±0.42)days, the antibiotic cost were(5 068.34±1 074.68)RMB and (5 001.00±456.00) RMB, the average total cost were(9 457.43±647.23)RMB and (9 249.00±367.00)RMB, all these indexes were much lower that which in control group[(18.40±5.89)days,(21 000.43±2 036.48) RMB and (31 000.66±2 711.36) RMB], and the differences were statistically significant, F values equaled to 15.221, 29.434 and 81.220 each, P values were all less than 0.01. Conclusions Improved closed negative pressure drainage combined with hyperbaric oxygen method could improve the clinical effect of patients with oral and maxillofacial space infection, speed up the granulation tissue, shorten the in-hospital time as well as reduce the medical cost. Key words: Oral and maxillofacial space infection; Improved closed negative pressure drainage; Hyperbaric oxygen treatment; Cure rate; Hospital costs

514 Higher Infliximab Trough Levels Are Associated With a Higher Rate of Perianal Fistula Healing in Patients With Crohn's Disease

514 Higher Infliximab Trough Levels Are Associated With a Higher Rate of Perianal Fistula Healing in Patients With Crohn's Disease

Wound Healing Society 2015 update on guidelines for pressure ulcers.

Wound Healing Society 2015 update on guidelines for pressure ulcers.

Prostanoids in patients with peripheral arterial disease: A meta-analysis of placebo-controlled randomized clinical trials

AimsProstanoids are indicated in the treatment of peripheral arterial disease (PAD). Available trials suggest that these compounds could reduce the symptoms of intermittent claudication, even though the quality of studies is poor. The present meta-analysis is aimed at verifying the effects of prostanoids on amputation rate and ulcer healing in patients with lower limb PAD. Materials and methodsThe review protocol was published on http://www.crd.york.ac.uk/prospero (CRD42015020258). A comprehensive search for published and unpublished trials comparing iloprost, alprostadil, prostaglandin-E1, epoprostenol, or taprostene with placebo/no therapy on amputation rate in patients with PAD and ulcer healing rate in patients with concomitant foot ulcers. Mantel–Haenzel odds ratio (MH-OR) was calculated with random effect models for the chosen endpoints. ResultsA total of 18 trials, enrolling 3,077 and 2,763 patients in the prostanoid and comparator groups, respectively were included in the analysis. Only 11 and 10 of those trials reported data on total and major amputations, respectively. Prostanoids were associated with a significantly lower risk of major (MH-OR [95% confidence interval] was 0.77 [0.63; 0.93], p=0.007), but not total, amputations. Healing rate (available only in 7 trials) was not significantly augmented by prostanoid treatment. ConclusionsAvailable data are not sufficient to support an extensive use of prostanoids in patients with critical limb ischemia, as an adjunct to revascularization or as an alternative to major amputation in cases which cannot undergo revascularization.

Efficacy of topical recombinant human platelet-derived growth factor for treatment of diabetic lower-extremity ulcers: Systematic review and meta-analysis

ObjectiveRecombinant human platelet-derived growth factor (rhPDGF) is used topically in the treatment of diabetic lower-extremity ulcers. There have been few meta-analyses of the efficacy of rhPDGF in this treatment context. The aim of this study was to perform an updated systematic review and meta-analysis to assess the clinical efficacy of rhPDGF in the treatment of diabetic lower-extremity ulcers. MethodsWe searched the MEDLINE, Cochrane Library, EMBASE and Web of Knowledge databases up to April 30, 2014. Studies were identified and selected, and data were extracted by two independent reviewers. The primary efficacy outcome was complete healing rate. Adverse events were also assessed. The studies were evaluated for quality and publication bias. ResultsA total of 6 randomized controlled trials including 992 patients were selected from 173 identified studies. The studies compared rhPDGF treatment in the context of standard of care (SOC) to placebo or SOC alone. In the absence of study heterogeneity, a fixed-effects model was performed, and the combined odds ratio (OR) indicated a significantly greater complete healing rate in patients treated with rhPDGF compared to placebo or SOC alone. The ORs ranged from 0.58 to 2.77, with a combined OR of 1.53 (95% CI=1.14 to 2.04, p=0.004). A sensitivity analysis (leave-one-out method) indicated good study reliability, and a funnel plot with Egger test showed no publication bias. ConclusionThese results indicate that rhPDGF is efficacious in the treatment of diabetic lower-extremity ulcers.

Randomized controlled pilot trial of nifedipine as oral therapy vs topical application in the treatment of fissure-in-ano

BackgroundFissure-in-ano is a common condition that leads to pain and affects quality of life. Sphincterotomy remains the gold standard, but it may lead to troublesome incontinence in some patients. To overcome this problem, numerous pharmacologic therapies have been tested with varying outcomes. The investigators compared the effect of the addition of oral and topical nifedipine to conservative measures in the treatment of patients with fissure-in-ano. MethodsNinety patients with fissure-in-ano, randomized into 3 groups of 30 each, were included in the study. Group I received conventional treatment, group II received oral nifedipine and conventional treatment, and group III received topical nifedipine along with conventional treatment. Patients were followed for 8 weeks for pain relief (assessed using a visual analogue scale) and healing to evaluate the effect of treatment. ResultsPain relief was significantly better in the group III at 3 weeks and 2 months compared with group I (P < .05). Groups II and III were comparable in terms of pain relief. Healing rates were significantly better in group II (P = .03) and group III (P = .00) compared with group I, but groups II and III were found to be comparable. Adverse effects were most commonly reported by group II patients, but these were not significantly higher than in other 2 groups. ConclusionsWe recommend the addition of either oral or topical nifedipine to conservative measures to significantly improve pain relief and healing rates in patients with fissure-in-ano.

Obesity Does Not Affect Treatment Outcomes With Proton Pump Inhibitors

Obesity is associated with increased risk of gastroesophageal reflux disease (GERD). To evaluate the effect of obesity on symptom resolution in patients with nonerosive reflux disease (NERD) and healing rates in patients with erosive esophagitis (EE). Two post hoc analyses were performed. Analyses included pooled data from randomized, double-blind, multicenter studies of proton pump inhibitors (PPIs) in GERD patients. Analysis 1 included 704 patients with NERD receiving esomeprazole 20 mg, esomeprazole 40 mg, or placebo. Analysis 2 included 11,027 patients with EE receiving esomeprazole 40 mg, omeprazole 20 mg, or lansoprazole 30 mg. For NERD patients, no significant association between baseline heartburn severity and body mass index (BMI) was observed. In EE patients, overweight (BMI 25 to <35 kg/m) and obese (BMI ≥35 kg/m) patients had significantly higher rates of Los Angeles (LA) grade C or D EE than patients with BMI <25 kg/m (P<0.0001). Percentages of PPI-treated patients who achieved heartburn resolution or EE healing within a given LA grade were similar across BMI categories. Heartburn resolution was significantly associated with treatment (esomeprazole vs. placebo), increasing age, and for men versus women (all P≤0.0284). EE healing was significantly associated with PPI treatment (esomeprazole and lansoprazole vs. omeprazole), increasing age, race, presence of a hiatal hernia, and lower LA grade at baseline (all P≤0.0183). In patients with GERD, high BMI was associated with more severe EE at baseline. However, during PPI treatment, BMI is not a significant independent predictor of heartburn resolution or EE healing.

The effects of increasing body mass index on heartburn severity, frequency and response to treatment with dexlansoprazole or lansoprazole

BackgroundHigher body mass index (BMI) is a recognised risk factor for gastro-oesophageal reflux disease (GERD). Data regarding the impact of BMI on proton pump inhibitor (PPI) therapy are conflicting.AimTo assess the impact of BMI on baseline heartburn symptom severity and frequency and response to PPI therapy in patients with non-erosive GERD (NERD) or erosive oesophagitis (EO).MethodsIn post hoc analyses of phase 3 trial data, 621 NERD and 2692 EO patients were stratified by BMI (<25, 25 to <30 and ≥30 kg/m2). NERD patients received either dexlansoprazole MR 30 mg or placebo daily for 4 weeks. EO patients received either dexlansoprazole MR 60 mg or lansoprazole 30 mg for 8 weeks. Symptom frequency and severity were assessed at baseline and subsequently by daily diary.ResultsIn both the NERD and EO cohorts, baseline heartburn severity increased with increasing BMI. The impact of PPI therapy on the reduction in heartburn symptom frequency and severity in both NERD and EO patients was similar across BMI categories. EO healing rates in patients treated with dexlansoprazole but not lansoprazole were higher in obese patients compared with those with a BMI <30 kg/m2. Differences between the PPIs were small.ConclusionsThe PPIs evaluated in this study reduced the frequency and severity of 24-h heartburn regardless of baseline BMI. In addition, because patients with higher BMI have more severe symptoms at baseline, they may experience greater therapeutic gain with dexlansoprazole (NERD and erosive oesophagitis) and possibly lansoprazole (erosive oesophagitis) treatment.

New techniques for wound debridement

Debridement is a crucial component of wound management. Traditionally, several types of wound debridement techniques have been used in clinical practice such as autolytic, enzymatic, biodebridement, mechanical, conservative sharp and surgical. Various factors determine the method of choice for debridement for a particular wound such as suitability to the patient, the type of wound, its anatomical location and the extent of debridement required. Recently developed products are beginning to challenge traditional techniques that are currently used in wound bed preparation. The purpose of this review was to critically evaluate the current evidence behind the use of these newer techniques in clinical practice. There is some evidence to suggest that low frequency ultrasound therapy may improve healing rates in patients with venous ulcers and diabetic foot ulcers. Hydrosurgery debridement is quick and precise, but the current evidence is limited and further studies are underway. Debridement using a monofilament polyester fibre pad and plasma-mediated bipolar radiofrequency ablation are both very new techniques. The initial evidence is limited, and further studies are warranted to confirm their role in management of chronic wounds.

Influence of Aspirin Therapy in the Ulcer Associated With Chronic Venous Insufficiency

To determine the effect of aspirin on ulcer healing rate in patients with chronic venous insufficiency, and to establish prognostic factors that influence ulcer evolution. Between 2001 and 2005, 78 patients with ulcerated lesions of diameter >2 cm and associated with chronic venous insufficiency were evaluated in our hospital. Of these, 51 patients (22 men, 29 women) with mean age of 60 years (range: 36-86) were included in a prospective randomized trial with a parallel control group. The treatment group received 300 mg of aspirin and the control group received no drug treatment; in both groups, healing was associated with standard compression therapy. During follow-up, held weekly in a blinded fashion, there was ulcer healing as well as cases of recurrence. Results were analyzed by intention-to-treat approach. Cure rate was estimated using Kaplan-Meier survival analysis, and the influence of prognostic factors was analyzed by applying the Cox proportional hazards model. In the presence of gradual compression therapy, healing occurred more rapidly in patients receiving aspirin versus the control subjects (12 weeks in the treated group vs. 22 weeks in the control group), with a 46% reduction in healing time. The main prognostic factor was estimated initial area of injury (P = 0.032). Age, sex, systemic therapy, and infection showed little relevance to evolution. The administration of aspirin daily dose of 300 mg shortens the healing time of ulcerated lesions in the chronic venous insufficiency (CVI). The main prognostic factor for healing of venous ulcerated lesions is the initial surface area of the ulcer.

Mucosal healing with methotrexate in Crohn’s disease: a prospective comparative study with azathioprine and infliximab

Mucosal healing has become a new therapeutic goal in Crohn's disease and can be achieved with azathioprine (AZA) or biologics. Methotrexate (MTX) is an effective drug for both the induction and maintenance of remission in Crohn's disease. However, mucosal healing with MTX has been poorly investigated. To assess the mucosal healing rate in patients with Crohn's disease with clinical response to MTX as compared with AZA or infliximab (IFX). From October 2007 to May 2009, consecutive patients with Crohn's disease were prospectively enrolled into a single-centre study when they met the following criteria: previous identification of mucosal ulcerations with ileo-colonoscopy, clinical remission within at least 3 months with MTX, AZA or IFX monotherapy, usual indication for colonoscopy in Crohn's disease (dysplasia/cancer screening, suspected stenosis) excluding assessment for mucosal healing. Mucosal healing was defined as absence of mucosal ulceration in all segments. Fifty-one patients with Crohn's disease (38 female; median age: 42 years) were included: 18 receiving MTX, 18 AZA and 15 IFX. Mucosal healing was achieved in 2/18 (11%) with MTX, in 9/18 (50%) with AZA (P =0.011 vs. MTX) and in 9/15 (60%) with IFX (P=0.008 vs. MTX). In patients with Crohn's disease in sustained clinical remission, mucosal healing is less frequently achieved with MTX as compared with AZA or IFX.