Ulcer Risk Research Articles

Metabolomics in Pathogenic Pathways and Targeted Therapies for Diabetic Neuropathy: A Comprehensive Review

Introduction and objective: This literature review aims to provide an overview of the progress in metabolomic assessment in animal and cell models and in humans with diabetic neuropathy (DN). Methods: Metabolomics has emerged as an important approach for investigating, identifying, and describing biomarkers related to DN. None has yet been validated for use in clinical practice. Results: DN induced significant alterations in energy metabolism and carbohydrates, lipids, amino acids, peptides, and proteins. Several treatments for DN, evaluated using metabolomics, were proved to have promising results. Conclusions: The ideal metabolite or set of metabolites that could be used as biomarkers should identify patients with diabetes prone to develop DN or those prone to progress to severe forms of sensory loss, associated with risk of ulcerations and amputation. Another potential use of a metabolite might be as an indicator of treatment response in clinical trials using agents with potential disease-modifying properties.

Long-term Recurrence Risk of Diabetic Foot Ulcers After Healing: A 5-Year Retrospective Cohort Study on the Influence of Hemodialysis and Amputation Levels.

This retrospective study aimed to evaluate diabetic foot ulcer (DFU) recurrence rates and associated risk factors, focusing on hemodialysis and specific amputation levels. Patients with diabetes treated for DFU between 2003 and 2019 at a wound-care center in Japan were studied. The primary outcome was DFU recurrence, and the factors evaluated included age, sex, hemodialysis treatment, revascularization type, and amputation level. Among 236 participants (mean age: 65 years; male: 73%; 33% on hemodialysis), DFU recurrence rates were 40.3% and 77.1% at 1 and 5 years, respectively. Hemodialysis was significantly associated with an increased DFU recurrence risk (hazard ratio: 1.92; 95% confidence interval: 1.40-2.64, P < .001). Revascularization did not significantly impact DFU recurrence rates after ulcer healing. Contralateral DFU recurrence was the most frequent, occurring in 45% of cases. Higher DFU recurrence rates were observed at adjacent toes on the same side in patients who underwent great toe amputation and at the treated site in patients who underwent transmetatarsal, Lisfranc, or Chopart amputations. These findings indicate that DFU recurrence poses a higher risk in patients undergoing hemodialysis. Tailored postoperative management focusing on both contralateral and ipsilateral recurrences is essential to minimize recurrence and improve long-term outcomes.

Feasibility for Utilization of Assessment for Lack of Protective Sensation as Part of a Foot Screening for Persons with Intellectual Disabilities.

Persons with intellectual disability have a significantly higher prevalence of diabetes than the general population. Special Olympics Fit Feet, a major screening process for evaluating foot health in persons with intellectual disability, has not included an assessment for the risk of diabetic foot ulcers thus far. A probable reason for this may be that clinicians in the past have felt that persons with intellectual disability were not capable of understanding how to complete the Semmes-Weinstein test for lack of protective sensation. A study was designed to assess whether the Special Olympics athletes could complete the Semmes-Weinstein test for lack of protective sensation. 31 Special Olympics athletes with intellectual disability participating in a Fit Feet foot screening underwent a Semmes-Weinstein test for lack of protective sensation (LOPS). An assessment was completed using predetermined criteria to establish whether the subject understood what was required and could satisfactorily complete the test. Likewise, it was also determined if the Special Olympics athletes believed they understood the test. Study findings determined that approximately 67% of the athletes in the study were able to successfully complete the test and 90% of the Special Olympics athletes reported they completely understood the test. These results do not apply to the intellectual disability population at large. A significant percentage of the test population appeared able to successfully undergo the Semmes-Weinstein test for lack of protective sensation (LOPS). Therefore, it is recommended that any foot screening process for Special Olympics athletes should include an assessment for loss of protective sensation including use of monofilament testing.

Diabetic Peripheral Neuropathy: Navigating Controversies and Pioneering Advances

This review examines Diabetic Peripheral Neuropathy (DPN), a significant complication of diabetes affecting nearly half of diabetic patients. DPN is crucial to understand due to its high prevalence and profound impact on patients’ quality of life, causing pain, sensory loss, motor dysfunction, and heightened risks of foot ulcers and amputations. As a leading cause of disability, grasping DPN’s pathophysiology, early diagnosis, and treatment options are essential for alleviating its burden. Key facets of DPN include its complex pathophysiology stemming from chronic hyperglycemia, oxidative stress, inflammation, and vascular problems that damage nerves. The review highlights the rising rates of diabetes and DPN in regions like Saudi Arabia, noting that factors such as poor glycemic control, prolonged diabetes duration, and comorbidities like hypertension significantly contribute to DPN progression. Diagnostic challenges are also addressed; traditional nerve conduction studies are gold standards yet limited in detecting early-stage neuropathy, especially small-fiber damage. Emerging methods, like skin biopsy and corneal confocal microscopy, show promise for earlier detection. Treatment mainly focuses on glycemic control and pain management without reversing nerve damage. Innovative therapies targeting DPN mechanisms include antioxidant treatments, anti-inflammatory agents, and phytomedicine, which utilizes bioactive compounds for their neuroprotective effects. The review concludes by stressing the need for ongoing research into DPN's molecular mechanisms and the development of personalized medicine approaches, which could significantly enhance patient outcomes.Keywords: Diabetic Peripheral Neuropathy; DPN induced disability; DPN Pathophysiology; DPN treatment; DPN controversies

Burden of diabetic peripheral neuropathy in a rural demography of India is revealed by biothesiometry: a reliable screening tool

Background: Diabetes mellitus (DM) is the most prevalent non-communicable disease in the world estimated to be 4.4% in 2030 globally. Among its complications, diabetic peripheral neuropathy (DPN) is the common disorder manifested as ‘glove and stocking sensation’ in the lower extremities. Aim to study the prevalence and to grade DPN in patients attending OPD. Methods: Patients coming to the general surgery and plastic surgery outpatient department were selected. A total of 331 patients will be asked history by a simple questionnaire and symptoms are graded by modified neuropathy symptom score (MNSS) and clinical examination are done and graded by diabetic neuropathy examination (DNE) and vibration perception threshold (VPT) is measured by biothesiometry. Results: Among the DPN patients, 57.40% are asymptomatic and 12.08% are having severe symptoms by MNDS score and about 27.49% having increased risk for pronation for foot ulcer by DNE score and about 43.2% having risk for foot ulcer by biothesiometry average from the most common site for loss of sensation involving over 1st, 3rd, 5th metatarsal head to the least involved site as midfoot. Conclusions: This study reveals the impact of DPN in a rural area, so by implementing this type of screening method reduces the development of foot ulcers by about 60% in asymptomatic patients and leg amputations by 85% in patients with severe stage of DPN with proper foot care.

Assessment of nurses’ knowledge and practice of pressure injuries prevention for critically ill patients in Rwanda: a cross-sectional study

BackgroundPressure injuries are costly and can lead to mortality and psychosocial consequences if not managed effectively. Proper management of pressure injuries is crucial for quality nursing care. However, there is limited research on nurses’ knowledge and practices in preventing and managing pressure injuries among critically ill patients in Rwanda. In addition, barriers affecting nurses’ practices in this area also need further investigation in order to inform the interventions to improve nursing care of patients with pressure injuries in Rwandan hospitals.MethodologyA cross-sectional study involving 129 health nurses was conducted to determine their knowledge and practice levels regarding the prevention of pressure injuries in critically ill patients, and barriers impeding practice in this area. The research modified the Pieper-Zulkowski Pressure Ulcer Knowledge Test to evaluate the knowledge of nurses concerning the prevention of pressure injuries. A 33-item instrument drawn from pressure ulcer risk assessment and prevention toolkits established by the Agency for Healthcare Research and Quality was used to assess nurses’ practices. Additionally, barriers influencing nurses’ knowledge and practices related to the prevention of pressure injuries were evaluated through questions derived from a comparable study conducted in Ethiopia. Descriptive statistics were computed for each variable. Mean scores were computed to categorize nurses’ level of knowledge and practice. Logistic regression analysis was employed to examine the influence of sociodemographic factors and training on the nurses’ knowledge and practice, with a statistical significance set at a p-value less than 0.05.ResultsThe study found that 40.0% of nurses had inadequate knowledge towards pressure injury prevention, and 60.0% reported that they inadequately practiced pressure injury prevention among critically ill patients. Nurses who have not been trained in pressure injury prevention have a 52.4% reduction in the odd of having adequate practice compared to those who have been trained (OR 0.476; 95% CI 0.211–0.996). Heavy workload, inadequate staff, shortage of equipments, presence of other priorities than pressure injury prevention, inadequate training coverage of pressure injury prevention were the most prevalent barriers reported.ConclusionThe evaluation of nurses’ knowledge and practices on pressure injury prevention in critically ill patients at the study setting found that while nurses have satisfactory knowledge, their practical application is lacking due to factors like high workloads and insufficient staffing. The study recommends caution in interpreting the results due to a limited sample size, suggesting further research to guide improvements in nursing practices.

Honduran nursing care to pressure injuries in patients with invasive mechanical ventilation: A qualitative study.

Although substantial evidence exists regarding the treatment of pressure ulcers, there is a lack of studies demonstrating a comprehensive nursing approach for managing pressure ulcers in the ICU, particularly among patients with invasive mechanical ventilation from developing countries like Honduras. This gap in research is significant as the risk and impact of pressure ulcers on health recovery cannot be disregarded. This study aimed to analyze Honduran nursing care for pressure ulcers in patients with invasive mechanical ventilation admitted to Intensive Care Units. A qualitative study approach was used, with in-depth interviews conducted with 12 critical care nurses from July to September 2022. The interviews were recorded, and data analysis was performed using the participants' narratives following Colaizzi's steps. Three themes were obtained, which provide insight into the phenomenon: "The strengths in Honduran nursing interventions," "Negligence in the Honduran nursing care processes," and "Vulnerabilities in the organizational structures." Nurses' experiences highlighted their timely reports and comprehensive, holistic care. However, they undergo negligence in their caring processes, such as low frequency of repositioning, lack of caring plans, and absence of self-training, leading to interdisciplinary work codependency for decision-making. Allocating resources toward nursing care and their professional growth is an investment in providing humane treatment and ensuring the prevention and management of pressure injuries in critical care patients. This study highlights the importance of comprehensive training and standardized protocols for intensive care nurses to improve pressure injury prevention and management in mechanically ventilated patients, emphasizing the need for regular patient repositioning, effective communication, and adequate resources to enhance patient care quality.

Factors Reducing Pressure Ulcer Risk and the Importance of Care in ALS Patients: A Comprehensive Review

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease characterized by muscle atrophy, weakness, and loss of motor function. ALS patients are often bedridden for extended periods, increasing their risk of pressure ulcers. However, clinical data suggests that the incidence of pressure ulcers in ALS patients is lower compared to other bedridden patients. This review analyzes the factors contributing to reduced pressure ulcer risk in ALS patients, focusing on "pressure redistribution due to muscle atrophy," "stabilized postures caused by joint contractures," and "comprehensive care provided by caregivers." Additionally, this paper discusses a comprehensive approach to pressure ulcer prevention, including nutritional management, skincare, pressure redistribution techniques, and advanced technologies. Challenges in pressure ulcer prevention and the importance of ALS-specific care are also emphasized.

Gastric Ulcer and Canned Materials and Smoking: Case Control Study

This study aimed to explore the potential role of smoking and canned material consumption in the development of gastric ulcer disease. Researchers compared 104 gastric ulcer patients with a control group matched for age, sex, and social status. The analysis examined exposure to these factors during three periods: over a lifetime, within five years, and in the year preceding the onset of symptoms. Results revealed a significant link between smoking, regular canned material consumption, and a higher risk of gastric ulcers across all time frames. Since these exposures occurred prior to symptom onset, the findings suggest a possible causal relationship. If confirmed, these factors could account for up to 80% of gastric ulcer cases. smoking with a corresponding increase in rate of development of gastric ulcer allowing to become more prominent. In the early 20th century physician’s believed they could diagnose ulcers clinically and that the diagnosis required hospitalization for “surgical disease. We show that while smoking and canned materials remained common and virulent in Egypt and the Middle East, environmental changes resulted in changes of the pattern of gastric ulcer producing a change in the manifestations. The consumption of many of canned materials, mainlyFava beans, fava beans, chickpeas and mortadella, increase risk. Many of these canned material contain presentatives cause diseases, which were also inversely related to gastric cancer risk. The intake of smoking was positively associatedwith gastric cancer risk, but primarily in men.

A fusion model of manually extracted visual features and deep learning features for rebleeding risk stratification in peptic ulcers.

We propose a multi-feature fusion model based on manually extracted features and deep learning features from endoscopic images for grading rebleeding risk of peptic ulcers. Based on the endoscopic appearance of peptic ulcers, color features were extracted to distinguish active bleeding (Forrest I) from non-bleeding ulcers (Forrest II and III). The edge and texture features were used to describe the morphology and appearance of the ulcers in different grades. By integrating deep features extracted from a deep learning network with manually extracted visual features, a multi-feature representation of endoscopic images was created to predict the risk of rebleeding of peptic ulcers. In a dataset consisting of 3573 images from 708 patients with Forrest classification, the proposed multi-feature fusion model achieved an accuracy of 74.94% in the 6-level rebleeding risk classification task, outperforming the experienced physicians who had a classification accuracy of 59.9% (P<0.05). The F1 scores of the model for identifying Forrest Ib, IIa, and III ulcers were 90.16%, 75.44%, and 77.13%, respectively, demonstrating particularly good performance of the model for Forrest Ib ulcers. Compared with the first model for peptic ulcer rebleeding classification, the proposed model had improved F1 scores by 5.8%. In the simplified 3-level risk (high-risk, low-risk, and non-endoscopic treatment) classification task, the model achieved F1 scores of 93.74%, 81.30%, and 73.59%, respectively. The proposed multi-feature fusion model integrating deep features from CNNs with manually extracted visual features effectively improves the accuracy of rebleeding risk classification for peptic ulcers, thus providing an efficient diagnostic tool for clinical assessment of rebleeding risks of peptic ulcers.

Leg Ulcer and Venous Symptoms Related to Lower Extremity Arteriovenous Access for Hemodialysis: A Retrospective Review with Emphasis on Wound Complications.

Lower extremity arteriovenous (AV) access serves as a crucial alternative for hemodialysis when upper extremity options are no longer viable. While there are numerous reports on functional patency, limited information exists regarding complications related to venous insufficiency and postoperative quality of life. This study aims to assess the actual incidence of such complications and provide evidence-based insights for clinical decision-making. We retrospectively analyzed 121 end-stage renal disease patients who underwent lower extremity AV access at Maharaj Nakorn Chiang Mai Hospital from 2006 to 2023. Among them, 105 patients (86.8%) had lower extremity AV grafts, while 16 patients (13.2%) had lower extremity AVF. Primary and secondary patency rate were 69.4% and 81.8% at one year, respectively. The mortality probability was 50.4% with a mean follow-up of 58 months. Mortality predictors included age (P = .001), aspirin use (P = .022) and statin use (P = .005). Primary failure occurred in 8 patients (6.6%) and vascular graft infection is the primary cause. There were no occurrences of venous leg ulcers developed, suggesting that the risk of this complication may be lower than previously thought in the short to medium term. However, 13.3% of patients experienced leg swelling and 21.7% had hyperpigmentation. The mean revised venous clinical severity score was 1.22 and the average EQ-5D-5L quality of life score was 0.99. Our findings suggest that the risk of venous leg ulcers in patients with lower extremity AV access may be lower than previously thought, at least in the short to medium term. This should encourage surgeons to consider this technique when upper extremity options are exhausted, while maintaining vigilance for early signs of venous insufficiency. Continued research into the detrimental effects of the hyper-dynamic blood flow rate on AV access and preventive strategies will enhance the benefit of lower extremity AV access in the future.

The Design Body Support Pillow Prevent and Reduce Pressure Ulcers

Patients with a long duration of bed rest have a potential risk of impaired skin integrity due to prolonged pressure that can lead to the appearance of decubitus. One alternative to prevent decubitus is by giving mobilization over the bed that is tilt right and left every 2 hours with an angle of 30° with a foam pillow as a buffer in bed. This study aims to design a right and left tilt body support pillow as an effort to prevent and reduce the risk of decubitus ulcers in bed rest patients. The method used in this study is Research and Development (R&amp;D) with ADDIE method which consists of five stages which include analysis, design, development, implementation and evaluation. This study was conducted at Mitra Medika Clinic in Blitar Regency with 6 participants and 3 media experts. The results of this study show that the value of product feasibility from expert validators is 98% and from participants is 99%. The results showed the product has met the criteria very feasible based on the assessment of the participants. It is expected that this product can help nurses in maintaining the right and left tilt position as an effort to prevent and reduce the risk of decubitus ulcers in bed rest patients. Keywords: Pressure Ulcer, Body Support Pillow, Design

A bioactive multifunctional dressing with simultaneous visible monitoring of pH values and H2O2 concentrations for promoting diabetic wound healing.

Wound healing in diabetes is a complex physiological process with risks of ulceration and amputation. Real-time monitoring and treatment of diabetic wounds is an effective prevention of further deterioration. Herein, a multifunctional dressing is developed by encapsulating europium-containing bioactive glass (EuBG) and MoO3-x in a biocompatible sodium alginate (SA) dressing (MoO3-x-EuBG-SA), aiming to simultaneously monitor the wound pH value and hydrogen peroxide (H2O2) concentration, establish an anti-inflammatory microenvironment, and promote wound healing. The pH-responsive fluorescence quenching effect of EuBG contributes to visible monitoring of pH values, and MoO3-x enables high responsiveness and accurate colorimetric indication of H2O2 variability to understand the dynamic wound status. Then, these fluorescent and colorimetric changes can be captured using a smartphone and transformed into signals for wound pH values and H2O2 concentrations, enabling rapid and convenient real-time assessment of wound dynamics. Furthermore, the MoO3-x-EuBG-SA dressing can reduce inflammation and promote the proliferation, differentiation, and migration of fibroblasts and endothelial cells in vitro with the help of the released bioactive Si, Ca, and Mo ions. Notably, the MoO3-x-EuBG-SA dressing exhibits excellent abilities to monitor a wound microenvironment and immune regulation and promote diabetic wound healing in vivo. Overall, the multifunctional dressing has great potential for managing diabetic wounds and promoting wound healing.

Diabetes mellitus and peripheral artery disease.

Atherosclerotic peripheral artery disease (PAD), that is, arteriosclerosis obliterans, is pathologically rooted in atherosclerosis, similar to other cardiovascular diseases. In addition to smoking, hypertension, and dyslipidemia, diabetes mellitus is a major risk factor. People with diabetes mellitus have an elevated risk of developing PAD. PAD in turn increases the risk of diabetic foot ulcers and gangrene in the population. Rest pain, nonhealing ulcers, and gangrene associated with chronic ischemia are known as chronic limb-threatening ischemia (CLTI). This article gives an overview of the link between atherosclerotic PAD, particularly CLTI, and diabetes mellitus. First, the clinical impact of CLTI among patients with diabetes mellitus is presented. Second, its clinical features, including prognosis, comorbidity, occurrence, and seasonality, are mentioned. The clinical management of CLTI is also discussed. Diabetes mellitus has notable clinical impact on CLTI and vice versa. CLTI has different clinical features from those of other atherosclerotic cardiovascular diseases. Its clinical profile also differs between individuals with both diabetes mellitus and CLTI and general people with diabetes mellitus. There is considerable room for improvement in CLTI treatment and management. Clinical measures taken before revascularization, including CLTI risk assessment, prompt diagnosis, and expedited referral to vascular specialists, may enhance CLTI outcomes. Further research is warranted to obtain more evidence.

Impact of wheelchair reclining and leg rest angles on pressure distribution in back, buttocks, and feet: an experimental study in healthy adults

[Purpose] This study aimed to determine the effects of reclining angle and leg rest angle adjustments on pressure distribution in the back, buttocks, and feet in a wheelchair sitting position. [Participants and Methods] Twenty-six healthy young adults participated in this study. Pressures on the back, buttocks, and feet were measured under nine postural conditions with a combination of reclining angles (10°, 30°, and 50°) and leg rest angles (20°, 40°, and 60°). Body pressure distribution was measured for 30 s in each posture using a pressure distribution measuring device, followed by statistical analysis. [Results] Posture adjustments significantly impacted pressure distribution. Pressure was increased on the back and reduced on the buttocks of participants when in the reclining position. The leg rest angle had a minimal effect on foot pressure, but changes in the leg rest angle influenced the balance of pressure between the back and buttocks. [Conclusion] Adjusting wheelchair posture can effectively manage pressure distribution and reduce the risk of pain and pressure ulcers, especially on the back and buttocks. The reclining angle plays a key role in redistributing pressure, making it important for comfort and the prevention of bedsores.

Methods for tissue perfusion assessment after Dellon decompression of tarsal tunnels in diabetic neuropathy: key to effective management-a narrative review.

Diabetic neuropathy significantly elevates the risk of foot ulceration and lower-limb amputation, underscoring the need for precise assessment of tissue perfusion to optimize management. This narrative review explores the intricate relationship between sympathetic nerves and tissue perfusion in diabetic neuropathy, highlighting the important role of autonomic neuropathy in blood flow dynamics and subsequent compromises in tissue perfusion. The consequences extend to the development of diabetic peripheral neuropathy and related foot complications. By analyzing both non-invasive diagnostic methods and surgical interventions, such as tarsal tunnel decompression, the paper seeks to highlight their effectiveness in improving tissue perfusion, preventing ulcers, and reducing the risk of amputations in patients with diabetic peripheral neuropathy. We reviewed current literature on both non-invasive diagnostic tools and surgical techniques for assessing and improving tissue perfusion in diabetic neuropathy. Methods discussed include transcutaneous oxygen pressure (TcPO2), Doppler ultrasound, Tissue-Muscle Perfusion Scintigraphy with 99mTc-MIBI, and the SPY Laser Angiographic System. Emphasizing the critical importance of surgical interventions, such as tarsal tunnel decompression and neurolysis of the posterior tibial nerve, the article underscores their efficacy in enhancing tissue perfusion and preventing ulcers and amputations. Additionally, it addresses the significance of precise blood flow measurement and timely intervention in the management of diabetic neuropathy and foot ulcers. The non-invasive techniques for assessing tissue perfusion and blood flow in diabetic neuropathy such as TcPO2, Doppler ultrasound and Tissue-Muscle Perfusion Scintigraphy with 99mTc-MIBI are explained. Also, this review introduces the SPY Laser Angiographic System, which employs near-infrared fluorescence imaging to assess blood flow and perfusion in tissues. This advanced tool generates real-time microvascular blood flow images and proves instrumental in diagnosing and monitoring diabetic foot ulcers. In conclusion, surgical interventions, both vascular and peripheral nerve are pivotal for optimizing patient care. Early identification of foot ulcers and peripheral arterial disease is imperative, and an understanding of blood flow dynamics, combined with effective surgical techniques, constitutes key elements in managing diabetic neuropathy, healing and preventing ulcers, and limb salvage.

Human Collaborative Control of Lower-Limb Prosthesis Based on Game Theory and Fuzzy Approximation.

For leg prosthesis user, the soft tissue and skin under the stump of are not accustomed to weight bearing, excessive continuous contact pressure can lead to the risk of degenerative tissue ulceration. This article presents a novel human-robot collaborative control scheme that achieves control weight self-adjustment for robotic prostheses to minimize interaction torque. To establish the human-robot interaction relationship, we regard the contact pressure between human residual limb and the prosthetic receiving cavity as the interaction force. We aim at reducing the interaction force under the premise of minimally changing the original motion trajectory of the robotic prosthesis. The control scheme mainly includes trajectory optimization based on a dual-agent game control scheme under a cooperative relationship, and a fuzzy logic system for improving the control accuracy of trajectory tracking of robotic prostheses with unknown dynamic parameters. Experiments were carried out on two amputee participants to verify the proposed human-robot interactive control scheme in a robotic prosthesis. The results show that the interaction torque could be reduced while maintaining minimal trajectory tracking error. The proposed control scheme could potentially facilitate the dexterous manipulation of leg prostheses, thus benefiting amputees.

Stomach and duodenal ulcer as a cause of death in patients with cancer: a cohort study

IntroductionNon-cancer deaths are now becoming a significant threat to the health of cancer patients. Death from stomach and duodenal ulcer is linked to cancer due to the side effects of treatment and its pathogenesis. However, guidelines for identifying cancer patients at the highest risk of death from stomach and duodenal ulcer remain unclear.MethodsData of all patients diagnosed with cancer between 2000 and 2021 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Data regarding the causes of death and clinicopathological features such as sex, age, race, marital status, SEER stage, and treatment procedures were extracted. We calculated standardized mortality ratios (SMRs) using the SEER*Stat software V8.4.3.ResultsOf the 6,891,191 cancer patients, 2,318 died of stomach and duodenal ulcer, a rate higher than that in the general population (SMR = 1.58, 95% CI [1.52–1.65]). Stomach and duodenal ulcer-related deaths decreased over time from 870 deaths between 2000 and 2004 to 294 deaths between 2015 and 2019. Among the 2,318 stomach and duodenal ulcer deaths, the highest numbers were observed in patients with prostate cancer (n = 389, 16.8%), and lung and bronchus cancer (n = 255, 11%). Patients with liver and intrahepatic bile duct cancers (SMR = 10.53, 95% CI [8.3-13.18]), and pancreatic cancer (SMR = 6.84, 95% CI [5.11–8.97]) had a significantly higher rate of death from stomach and duodenal ulcer than the general population.ConclusionOur study revealed a significantly higher risk of stomach and duodenal ulcer mortality among patients with cancer in the United States, underscoring the critical need for integrated care strategies that address both cancer and ulcer-related complications. To reduce ulcer-related mortality, we recommend the implementation of targeted prevention protocols, including routine gastrointestinal screenings for high-risk cancer patients, proactive management of ulcer risk factors, and collaboration between oncology, gastroenterology, and surgical teams.Graphical abstract

The Health-Related Quality of Life for Cemented Versus Uncemented Hemiarthroplasty in Elderly Patients With Femoral Neck Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Femoral neck fractures in the elderly are a global health issue, with the choice between cemented and uncemented hemiarthroplasty remaining a topic of debate. This systematic review and meta-analysis aims to compare the effects of the two surgical options on health-related quality of life (HRQoL), mortality, and functional outcomes. We searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing cemented with uncemented hemiarthroplasty in patients aged 50 years and older with femoral neck fractures. The primary outcome of interest was HRQoL as measured by the European Quality of Life 5-Dimension Questionnaire (EQ-5D) score. Secondary outcomes included mortality, surgical, general, and local complications. We included 20 RCTs with a total of 3680 patients with femoral neck fractures, of whom 1871 (50.5%) underwent cemented and 1809 (49.5%) uncemented hemiarthroplasty. The follow-up ranged from 1 to 6 years. The early (after 3-4 months) EQ-5D utility score (MD 0.07; 95% CI 0.03-0.12; p = 0.003; I2 = 22%) and the 12-month EQ-5D utility score (MD 0.08; 95% CI 0.00-0.16; p = 0.04; I2 = 67%) suggested an improved HRQoL in the cemented hemiarthroplasty group. The outcomes of 1-year mortality, requirement for additional surgeries, surgery duration, risk of pulmonary embolism, pressure sores or ulcers, intraoperative fractures, and periprosthetic or postoperative fractures demonstrated significant differences between the two groups. The use of cemented hemiarthroplasty in patients with femoral neck fractures presented better results when compared to uncemented hemiarthroplasty in terms of HRQoL during the first year after surgery and greater mortality reduction at 1 year follow-up and reduced the need for further surgery. Therefore, the use of cemented hemiarthroplasty may be preferred for the treatment of femoral neck fractures in elderly patients.

Incidence of Side Effects Associated With Acetaminophen in People Aged 65 Years or More: A Prospective Cohort Study Using Data From the Clinical Practice Research Datalink.

The main objective of this study is to examine the safety of oral acetaminophen at its therapeutic dose in adults aged ≥65 years. This population-based cohort study used the Clinical Practice Research Datalink-Gold data. Participants were aged ≥65 years registered with a UK general practice for at least 12 months between 1998 and 2018. Acetaminophen exposure was defined as at least two acetaminophen prescriptions within six months of the first acetaminophen prescription, the first prescription date being the index date. Acetaminophen nonexposure was defined as the absence of two acetaminophen prescriptions within six months over the study period. We calculated propensity score (PS) for acetaminophen prescription and undertook inverse probability treatment weighting using PS and PS-matched analyses to account for confounding. Missing data were handled using multiple imputation. The adjusted hazard ratio (aHR) and 95% confidence interval (95% CI) were calculated using the Cox proportional hazards regression model. In total, 180,483 acetaminophen exposed and 402,478 unexposed participants were included in this study. Acetaminophen exposure was associated with an increased risk of perforation or ulceration or bleeding (aHR 1.24; 95% CI 1.16-1.34), uncomplicated peptic ulcers (aHR 1.20; 95% CI 1.10-1.31), lower gastrointestinal bleeding (aHR 1.36; 95% CI 1.29-1.46), heart failure (aHR 1.09; 95% CI 1.06-1.13), hypertension (aHR 1.07; 95% CI 1.04-1.11), and chronic kidney disease (aHR 1.19; 95% CI 1.13-1.24). Despite its perceived safety, acetaminophen is associated with several serious complications. Given its minimal analgesic effectiveness, acetaminophen as the first-line oral analgesic option for long-term conditions in older people requires careful reconsideration.