Scarring Stage Research Articles

THE HEALING PROCESS OF GASTRIC ARTIFICIAL ULCERS AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION

Background: Due to the remarkable progress of endoscopic resection techniques, endoscopic submucosal dissection (ESD) has been widely performed for larger mucosal tumors that would result in large artificial ulcers. The healing process of peptic ulcers has been previously studied in detail; however, no precise investigation for artificial ulcers after ESD has been reported. To confirm the validity of the treatment from the aspect of wound healing, we aimed to clarify the healing process of large gastric artificial ulcers after ESD. Methods: Seventy patients with gastric mucosal tumors treated by ESD were enrolled. The size, location and time of scar formation of the ulcers were reviewed using endoscopic pictures taken from the same view and angle. Follow-up endoscopy was performed at 1, 4, 8 and 12 weeks after ESD. For postoperative medication, all patients received normal doses of proton pump inhibitors and sucralfate for 8 weeks. Results: The average size of the resected specimen was 34.7 mm (20–90 mm). Irrespective of ulcer size and location, all of the cases healed up to scarring stages within 8 weeks. Conclusions: Gastric artificial ulcers after ESD healed within 8 weeks regardless of size and location using normal doses of medication as peptic ulcers. The fact that even giant ulcers after ESD heal within 8 weeks could be helpful information for candidates for ESD and for postoperative management of patients after ESD.

Transesophageal echocardiography is suitable for evaluating the stage of takayasu arteritis with aortic aneurysm

Takayasu arteritis (TA) is occasionally complicated with aneurysm formation. Imaging modalities, such as CT and MRI, can detect aortic wall inflammatory lesions but not the stage of inflammation. Here we evaluated the usefulness of transesophageal echo (TEE) for detection of TA inflammatory lesions and their stages. Aortae were obtained from 9 autopsies of patients with TA. Specimens were evaluated while in degassing water. The distance between the specimen and TEE transducer (5.0-MHz, electric sector scanning) was constant for all specimens. The echo gain was set at 52, which visualized delineation of the normal left ventricle in degassing water. The areas observed by ultrasonography were then examined histopathologically. Eight atherosclerotic aneurysms with/without mural thrombi and 7 normal aortae were included as control samples and processed in a similar fashion. TA showed two patterns: 2 showed intima-media thickening (IMT) and dense echogenic layers outside of IMT, corresponding to the acute stage of TA, and 7 showed a single thickened echogenic homogeneous layer, corresponding to the scar stage of TA. Atherosclerotic aneurysms included 6 samples with mural thrombi and their image were echogenic and showed heterogeneous thin layers, while 2 samples had no mural thrombi and the images showed thickened inner echogenic layer combined with localized sonolucent area. Normal control aortae showed IMT. TEE is a suitable imaging modality for determining the pathology of aneurysm and stage of inflammation in Takayasu arteritis.

A clinicopathological study of inflammatory abdominal aortic aneurysms: Relationship between clinical presentations and histological findings

Many authors have reported on so-called inflammatory abdominal aortic aneurysm (IAAA) clinically or histologically. However, there have been few reports associating both presentations. The purpose of this paper was to report the relationship between clinical data and histological findings of IAAA. We examined 10 cases of nonruptured IAAA. IAAA varied from the “scarring stage” to the “active stage” according to the clinical rank of inflammation based on C-reactive protein and/or erythrocyte sedimentation rate. Abdominal or back pain, and weight loss were common clinical symptoms in both stages, although they were observed more frequently in the active stage. Mantle sign was characteristic of the active stage. Patients with higher clinical ranks of inflammation were likely to have thicker adventitia although this difference was not significant. A significant correlation was observed between the clinical ranks of inflammation and histological scores of inflammatory cell infiltration in the aneurysmal adventitia. In most cases, white blood cell counts were within the normal range. Inflammatory cell infiltration was characteristic of the active stage and fibrous thickening of the adventitia was the most common character in both stages. Our data suggest that histologically diagnosed IAAA should correspond to the active stage of grossly diagnosed IAAA, and IAAA in the scarring stage will be histologically diagnosed as a noninflammatory atherosclerotic aneurysm.

Maternal meddling in neonatal sharks: implications for interpreting stable isotopes in young animals

Stable isotopes of neonatal vertebrates reflect those of their mother's diet and foraging location. Evaluating feeding strategies and habitat use of neonates is consequently complicated by the maternal isotopic signal and its subsequent elimination with growth. Thus, methods that measure the loss of the maternal signal, i.e. when the isotopic signal of a neonate reflects its own diet, are needed. Values of δ(13)C and δ(15)N were measured in liver and muscle tissues of <1 year old bull (Carcharhinus leucas) and Atlantic sharpnose (Rhizoprionodon terraenovae) sharks and related to age using, total length, date sampled and umbilical scar stage (USS). We observed a decline in δ(13)C and δ(15)N values with age that was different among species, similar among isotopes, and greater in liver than in muscle; highlighting that retention of the maternal signal is dependent on species-specific life history and tissue characteristics. USS was most effective for assessing the loss of the maternal isotopic signal in the faster growing Atlantic sharpnose shark, but was less effective for the slower growing bull shark. Total length and date sampled were overall less effective and may be more informative for slower growing species when coupled with USS, as variable size at birth and misclassification of animals >1 year old, which remain in nursery habitats, increase the variability of the isotopic values. Consideration of the maternal signal and measuring its loss are thus necessary when analyzing the stable isotopes of young animals, as there is potential to misinterpret feeding strategies, over-estimate trophic position and incorrectly assign carbon source.

Effects of Endolithic Boring on the Muscle Scar and Growth of PinkHaliotis corrugata(Gray 1828)

ABSTRACT In Baja California, Mexico, pink abalone (Haliotis corrugala) banks have been found to be heavily infested by endolithic (boring) organisms, which damage the shell, reduce individual growth, and, in many cases, prevent the abalone from reaching the minimum legal size of capture (140 mm). Thus, the accumulation of endolithic borings has a negative impact on the fishery. Infested shells have a different appearance from healthy shells, decreasing their ornamental value. As the size of the muscle scar of pink abalone increases with age, we assume that endolithic infestation affects individual growth and produces adults of a smaller size than normal. The correlation among the degree of muscle scar development, shell length, and percent coverage by endolithic borings was determined. We identified five stages of muscle scar development and found a significant correlation between scar stages and percentage of endolithic boring coverage and shell length. This correlation may be an indication of the profou...

Enhanced possibilities to make statements on the ossification status of the medial clavicular epiphysis using an amplified staging scheme in evaluating thin-slice CT scans

Thin-slice computed tomography provides the imaging modality of choice in analysing the ossification process of the medial clavicular epiphysis for the purpose of forensic age diagnostics in the living in the course of criminal proceedings. The classification of the ossification stages by Schmeling et al. compass the emergence of an epiphyseal ossification centre (stage 2), the partial fusion of the epiphysis with the metaphysis (stage 3), the complete fusion of these osseous elements including a visible epiphyseal scar (stage 4), and the complete fusion without a visible epiphyseal scar (stage 5). In the present study, each of the ossification stages 2 and 3 was divided into an early, intermediate and late phase. The authors evaluated the thin-slice CT scans of 185 patients aged between 13 and 26 years. In all these cases, a stage 2 or 3 had been determined in a previous study. The late stage 3, which is characterized by a fusion between metaphysis and epiphysis completing more than two thirds of the former epiphyseal gap, first appeared at age 19 in both sexes. If a late stage 3 is found, it is therefore possible to substantiate that an individual has already reached the legally important age threshold of 18 years.

Fecal calprotectin in estimation of activity of peptic ulcers

Objective To explore the clinical value of fecal calprotectin （FCP） in peptic ulcer （PU） as an non-invasive indicator of disease activity compared with gastroscope. Methods The study was conducted in 62 patients with PU confirmed by endoscopy （PU group） and 30 subjects with normal findings under endoscopy （ control group）. Fecal sample （ weight 5-10 g） was collected within 3 days after endoscopy and FCP was measured by emzyme-linked immunosorbent assay （ELISA）. The case history and clinical data were collected as well. Results The level of FCP in PU group was significantly higher than that in control group （ 154. 72μg/g vs. 25. 18 μg/g, P 〈0. 001 ）. In patients with PU at active stage （n =32） , the level of FCP was significantly higher than that at scar stage （n =30, 318.34 μg/g vs. 54. 10 μg/g, P 〈0. 01 ）, and that in control group （25. 18 μg/g, P 〈0. 01 ） , while there was no significant difference in FCP between the latter two groups （ P 〉 0. 05 ）. The level of FCP had no significant correlation with the location, size or number of the ulcer. Among patients in PU group, the level of FCP in patients presented with haematemesis or melena （ n = 20） was significantly higher than that in patients presented with other symptoms （ n = 42, 1257.41 μg/g vs. 92. 77 μg/g, P 〈 0. 01 ）. Conclusion The level of FCP is closely correlated with the activity of PU, which is significantly higher at active stage than that at scar stage, as well as in PU patients with bleeding than those without. Measurement of FCP is a convenient and noninvasive method with well compliance of patients, which might be used as an indicator of disease activity in PU. Key words: Peptic ulcer ; Fecal calprotectin ; Gastroscopy

Endoscopic classification of healing process in tracheobronchial tuberculosis

Out of 404 patients with pulmonary and/or tracheobronchial tuberculosis treated during the last 10 years at Kurume University Hospital and St. Mary Hospital, in 41 patients, who had been histopathologically or bacteriologically diagnosed as having active tracheobronchial tuberculosis, tracheobronchial lesions were examined by use of bronchofiberscope. Most patients were treated by a combination of three antituberculous agents (INH, RFP and SM or EB). In 31 patients out of the 41 patients, broncho-fiberscopic examinations were performed twice or more. We observed the ulcerous lesions of bronchial tuberculosis at various stages of healing, and could classify the ulcerous lesions into the following three stages. Active Stage: stage A; ulcer formation without regenerating epithelium, Healing Stage: stage H; ulcer formation with regenerating epithelium, Scarring Stage: stage S; and no ulcer formation. Only the lesions of stage A were observed before treatment. In many patients during the first and second month of treatment, the lesions were stage A or H. It was found that healing of the lesions of tracheobronchial tuberculosis progressed through the stages A, H, and S, in this order. The smear positive rates in sputum were 88.5% in stage A, 12.9% in stage H and 5.0% in stage S. The culture positive rates in sputum were 88.5% in stage A, 20.0% in stage H, and 0% in stage S. We conclude that at least 3 months were generally required for the healing of tracheobronchial tuberculosis with ulcerous lesion. However, it seems that the period of time for healing of ulcerous lesions is shorter in patients who are treated by aerosol therapy with SM.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical trial: rebamipide promotes gastric ulcer healing by proton pump inhibitor after endoscopic submucosal dissection—a randomized controlled study

Endoscopic submucosal dissection (ESD) is useful for treating gastric tumors. Several trials have shown the efficacy of 4 or 8 weeks of proton pump inhibitor (PPI) administration for post-ESD ulcers. However, if the size of the post-ESD ulcer is larger than predicted, PPI administration alone might not be sufficient for the ulcer to heal within 4 weeks. We examined the efficacy of a combination therapy of PPI and rebamipide, a mucosal-protective antiulcer drug, on the acceleration of post-ESD ulcer healing. Patients were randomly assigned to either the PPI and rebamipide therapy or the PPI alone. Sixty-two consecutive patients with gastric tumors gave informed consent for enrolling in the study. In all cases, the estimated size of the post-ESD ulcer was larger than 20 mm. Oral administration of the drug was started on the 2nd day post-ESD and continued to the 28th day. All patients received the assigned pharmaceuticals and adhered well to the treatment regimen for 28 days. The endpoint ulcers reached S1 (scar stage) in 11/31 (36%) patients in the PPI-only group and in 21/31 (68%) in the combination group (P = 0.010). The combination of PPI plus rebamipide was more effective than the PPI alone for treating ulcers larger than 20 mm within 4 weeks after ESD.

Randomized, parallel, double-blind comparison of the ulcer-healing effects of ilaprazole and omeprazole in the treatment of gastric and duodenal ulcers

Ilaprazole (IY-81149) is a new proton-pump inhibitor (PPI) not previously studied in human patients with ulcer disease. This study evaluated and compared it with a reference PPI, omeprazole, in the treatment of gastric and duodenal ulcers. This was a double-blind, parallel, randomized study. Patients aged 18 years and above with at least one endoscopically confirmed active non-malignant gastric/duodenal ulcer were treated with 20 mg/day omeprazole or 5 mg/day or 10 mg/day ilaprazole for four weeks. Healing of ulcer was determined by its resolution from active to scarring stage. Symptoms relief was evaluated using a graded score. Safety and tolerability were evaluated on basis of clinical assessments. Between-group differences were tested using ANOVA or ANCOVA, as appropriate. Statistical significance was assumed at a two-tailed p value of </=0.05. Two hundred and twelve gastric ulcer patients (median age 53.3 years) and 306 duodenal ulcer patients (median age 49.7 years) were recruited; 71.8 and 85% of gastric and duodenal ulcer patients, respectively, completed the study. Ulcers were successfully healed in 64.29, 67.14, and 63.89% of gastric ulcer patients and 78.85, 83.65, and 78.57% of duodenal ulcer patients after treatment with 20 mg omeprazole, 5 mg ilaprazole, and 10 mg ilaprazole, respectively. Most patients (>90%) became asymptomatic after treatment. At the dosages administered, both drugs exhibited similar efficacy and a similar safety profile. Ilaprazole is as tolerable, safe, and efficacious as omeprazole in the treatment of gastroduodenal ulcers, at a much lower dose (5 vs. 20 mg omeprazole).

Technical feasibility of endoscopic submucosal dissection for early gastric cancer in patients taking anti-coagulants or anti-platelet agents

Endoscopic submucosal dissection is a novel technique that is expected to be a curative treatment for early gastric cancers. Anti-coagulants and anti-platelet agents are widely used, especially in elderly patients, to prevent thromboembolic disease. However, the feasibility of endoscopic submucosal dissection for such patients has not been investigated. To determine the feasibility of endoscopic submucosal dissection for patients using anti-coagulant and anti-platelet agents via retrospective investigation of clinical outcomes. Of 408 patients with 444 early gastric cancers consecutively treated by endoscopic submucosal dissection from January 2000 to December 2007 in our hospital, 47 patients with 56 early gastric cancers were receiving anti-coagulants or anti-platelet agents. All patients were classified into groups for high and low risk of thromboembolism. In 44 low-risk patients, these agents were stopped for 1 week before and after treatment. Only three high-risk patients underwent intravenous heparin replacement during the cessation period. Comparison with other patients showed no significant differences in complete en-bloc resection (96.4%) or perforation (1.8%). Postoperative bleeding requiring endoscopic treatment occurred for six early gastric cancers (10.7%) in the anti-coagulant and anti-platelet group; this frequency was slightly higher than that observed for other patients (5.2%). The healing of endoscopic submucosal dissection ulcers was not delayed by anti-coagulant and anti-platelet treatment (91% in the scarring stage) when checked at the 8th week after endoscopic submucosal dissection. The clinical outcomes of endoscopic submucosal dissection for early gastric cancers in patients receiving anti-coagulants or anti-platelet agents indicated that endoscopic submucosal dissection for low-risk patients could be a reliable technique with equivalent efficacy and risk in comparison with that for other early gastric cancer patients.

Recurrent Inflammation of Incontinentia Pigmenti in a 30-year-old Woman

Incontinentia pigmenti (IP) is an X-linked dominant disorder with a complex multisystemic and developmental phenotype. Classically, the skin lesions occur perinatally in four successive stages: inflammatory vesicular (stage 1), verrucous (stage 2), hyperpigmented (stage 3), and scarring (stage 4), along the lines of Blaschko, reflecting the somatic mosaicism of X-chromosome inactivation in female patients. In general, the lesions of stage 1 IP begin perinatally and clear completely within the age of 4 months. We report a rare case of late recurrence of first stage lesions of IP in adulthood. This 30-year-old woman with a history of IP presented with multiple erythematous papules on pigmented patches distributing along the lines of Blaschko. Histological findings exhibited dyskeratosis in the epidermis along with perivascular and interstitial infiltrations composed of lymphocytes and eosinophils, consisting with the diagnosis of IP. In addition, we also review the recurrent cases with IP previously reported in the literature.

The course of gastric type epithelium in duodenal ulcer and duodenitis; role on the eradication of Helicobacter pylori

The course of gastric type epithelium during the healing process and beyond the scarring stage of duodenal ulcer was studied in patients with and without Helicobacter pylori (H. pylori) eradication. Materials were consist of 110 patients with active H. pylori ulcers, 27 patients with H. pylori positive ulcer scars and 6 patients with active H. pylori positive duodenitis. The results obtained were as follows. 1) In the non-eradication group, the degree of gastric type epithelium increased as the ulcers healed, but gastric type epithelium remained immature compared with the eradication group. 2) In the non-eradication group, the degree of gastric type epithelium decreased subsequently with or without recurrence of the duodenal ulcer. Under H. pylori positive condition, the degree of gastric type epithelium appeared to be reduced because of invasion by H. pylori. When this condition continued, ulcers probably recurred because of diminished defences against acid in damaged areas of gastric type epithelium. 3) In the successful eradication group, gastric type epithelium became well developed and mature state (grade 4), and remained in this condition for long period because it was not invaded by H. pylori. The appearance of mature state of gastric type epithelium appears to play a role in the prevention of ulcer recurrences by maintaining an adequate defence mechanisms against acid. 4) In the unsuccessful eradication group, the degree of gastric type epithelium remained lower mature state than that of successful eradication group. 5) In cases of H. pylori positive ulcer scar, the degree of gastric type epithelium reached also well developed and mature state when H. pylori was successfully eradicated, and maintained in this condition for a prolonged period. Ulcer recurrence was not observed. 6) In case of H. pylori positive duodenitis, the degree of gastric type epithelium reached mature state after successful eradication, and endoscopic findings of inflammation was improved.

Prevalence of trachoma in the adult Chinese population. The Beijing Eye Study

To determine the prevalence of trachoma in the adult Chinese population. The Beijing Eye Study as a population-based, cross-sectional cohort study included 4439 subjects out of 5324 subjects invited to participate with an age of 40+ years. Trachomatous abnormalities were assessed by slit lamp examination. Examination data were available for 4411 (99.4%) subjects. Trachomatous abnormalities were present in 850 eyes (mean+/-SE: 9.64+/-3.14%) or 422 subjects (9.57+/-0.44%), differentiated into follicular trachomatous inflammation (stage 1) (0.92+/-0.11%), intensive trachomatous inflammation (stage 2) (1.01+/-0.11%), trachomatous scarring (stage 3) (7.61+/-0.29%), and trachomatous trichiasis (stage 4) (0.47+/-0.08%). Trachomatous scarring was significantly associated with higher age (P<0.001), low level of education (P<0.001), rural versusurban region (P=0.04), and low visual acuity (P<0.001). Active trachoma is present in about 2 out of 100 Chinese adults, and trachomatous scarring is present in about in about 8 out of 100 Chinese adults in Northern China with age, socioeconomic background, and rural region as main risk factors.

From ocular hypertension to ganglion cell death: a theoretical sequence of events leading to glaucoma

There is substantial evidence that elevated intraocular pressure (IOP) is a critical risk factor for glaucoma.Even with exhaustive investigation, however, there is still little understanding of the pathologic events that translate increased IOP into the process of retinal ganglion cell death. New studies, particularly in rat and mouse models of glaucoma, have helped elucidate some of the important events associated with the initiation of glaucoma. This review summarizes a 5-stage series hypothesizing that elevated IOP causes deleterious changes to glia in the optic nerve head (stage 1), which activate the autonomous self-destruction of ganglion cell axons (stage 2), leading to the loss of neurotrophic support and apoptotic death of ganglion cell somas in the retina (stage 3). In the initial wave of ganglion cell death, dying cells may adversely affect their neighbouring cells in a wave of secondary degeneration involving glutamate exposure (stage 4).As ganglion cell structures disappear through the processes of cell death, glia are again involved, but this time to replace the lost neural tissue with a glial scar (stage 5).

The Relaxin Gene Knockout Mouse: A Model of Progressive Scleroderma

Relaxin is a peptide hormone with anti-fibrotic properties. To investigate the long-term effects of relaxin deficiency on the ageing skin, we compared structural changes in the skin of ageing relaxin-deficient (RLX-/-) and normal (RLX+/+) mice, by biochemical, histological, and magnetic resonance imaging analyses. Skin biopsies from RLX+/+ and RLX-/- mice were obtained at different ages and analyzed for changes in collagen expression and distribution. We demonstrated an age-related progression of dermal fibrosis and thickening in male and female RLX-/- mice, associated with marked increases in types I and III collagen. The increased collagen was observed primarily in the dermis of RLX-/- mice by 1 mo of age, and eventually superseded the hypodermal layer. Additionally, fibroblasts from the dermis of RLX-/- mice were shown to produce increased collagen in vitro. Recombinant human gene-2 (H2) relaxin treatment of RLX-/- mice resulted in the complete reversal of dermal fibrosis, when applied to the early onset of disease, but was ineffective when applied to more established stages of dermal scarring. These combined findings demonstrate that relaxin provides a means to regulate excessive collagen deposition in disease states characterized by dermal fibrosis and with our previously published work demonstrate the relaxin-null mouse as a model of progressive scleroderma.

Physiopathologie des brûlures oculaires

Eye burns are frequent among eye traumas. They induce different effects on the ocular structures, depending on the type of burn: chemical, with an important difference between acids and bases, thermal, or ionizing rays. The physiopathology of eye burns reflects the different stages of progression, with a first stage of destruction, a second stage of cleaning and inflammation, and a last stage of reconstruction and scarring. The final prognosis depends on the initial lesions, not only involving the eye ball, but also the conjunctiva and eyelids. Chemical burns by basic fluids have the worst prognosis because they are able to penetrate the tissues quickly. Burns by acids have a better prognosis and thermal burns are located only at the injured area. Treatment is most effective at the initial stage of destruction and can dramatically change the prognosis. The secondary phase of cleaning includes the entire biochemical cascade of inflammation and the production of proteases. At this stage, treatment can be effective but must be closely monitored because it can inhibit progression to the last stage of scarring. At the scarring stage, neovascularization begins, induced by initial ischemia, the reconstruction of epithelium with a probable role of stem cells, the reconstruction of nerve fibers depending on the nerve growth factor (NGF), and the reconstruction of extracellular matrix in which matrix metalloproteinases (MMPs) are essential. At this stage, therapy can only be surgery of functional after effects and esthetic anomalies.

Relation of Hypoxia-Inducible Factor-1?? to Vascular Endothelial Growth Factor and Vasoactive Factors During Healing of Gastric Ulcers

We studied the relation of hypoxia-inducible factor-1alpha (HIF-1alpha) to vascular endothelial growth factor and vasoactive factors during the healing of gastric ulcers. The gastric ulcers were divided into three stages (active stage, healing stage and scar stage). The expression of HIF-1alpha, endothelin-1, inducible nitric oxide synthase, and vascular endothelial growth factor mRNA was highest during the active stage of ulcer healing, and endothelin-1, vascular endothelial growth factor protein levels and nitric oxide were higher during the healing stage. Thus, levels of HIF-1alpha mRNA tend to increase during the active stage of gastric ulcer healing, suggesting that this factor participates in the induction of endothelin-1, inducible nitric oxide synthase, and vascular endothelial growth factor. Also, the HIF-1alpha mRNA level did not differ significantly among the various stages of ulcer healing, and detectable levels of HIF-1alpha protein were not found during any stage. This suggests that these angiogenic factors and vasoactive substances may be induced by HIF-1alpha. During the active stage on endoscopic examination, considered the initial phase of ulcer healing, the process of ulcer healing has begun, and the tissue at the ulcer margin has already been reoxygenated.

THE HEALING PROCESS OF GASTRIC ARTIFICIAL ULCERS AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION

Background: Due to the remarkable progress of endoscopic resection techniques, endoscopic submucosal dissection (ESD) has been widely performed for larger mucosal tumors that would result in large artificial ulcers. The healing process of peptic ulcers has been previously studied in detail; however, no precise investigation for artificial ulcers after ESD has been reported. To confirm the validity of the treatment from the aspect of wound healing, we aimed to clarify the healing process of large gastric artificial ulcers after ESD.Methods: Seventy patients with gastric mucosal tumors treated by ESD were enrolled. The size, location and time of scar formation of the ulcers were reviewed using endoscopic pictures taken from the same view and angle. Follow‐up endoscopy was performed at 1, 4, 8 and 12 weeks after ESD. For postoperative medication, all patients received normal doses of proton pump inhibitors and sucralfate for 8 weeks.Results: The average size of the resected specimen was 34.7 mm (20–90 mm). Irrespective of ulcer size and location, all of the cases healed up to scarring stages within 8 weeks.Conclusions: Gastric artificial ulcers after ESD healed within 8 weeks regardless of size and location using normal doses of medication as peptic ulcers. The fact that even giant ulcers after ESD heal within 8 weeks could be helpful information for candidates for ESD and for postoperative management of patients after ESD.

105 Changes in Nitric Oxide Levels After Deep Dermal injury in the Female, Red Duroc Pig (FRDP)

Introduction: Hypertrophic scar is a devastating sequel to burns and other tangential skin injuries. It follows deep dermal injuries and does not occur after superficial injuries. Nitric oxide (NO) plays many important roles in wound healing from inflammation to scar remodeling. Studies have shown that expression of nitric oxide synthase and nitric oxide production are decreased in human hypertrophic scar. However little is known about NO involvement in the early stages of hypertrophic scarring, because of the lack of an animal model. It was recently reported that the female red Duroc pig (FRDP) makes thick scar, which is similar to human hypertrophic scar. We hypothesized that NO production in wounds on the female, red Duroc pig is similar to that of human hypertrophic scar and that NO involvement in deep wounds is different from that in superficial wounds. Methods: Superficial (0.015” to 0.030”) and deep (0.045” to 0.060”) wounds were created on the backs of four FRDPs. Biopsies were collected at weeks 1.5, 4, 8 and 21 post wounding including samples of uninjured skin. Nitric oxide levels were measured with the Griess reaction assay and normalized with tissue protein level. Results: Superficial wounds healed with an invisible scar whereas the deep wounds healed with scar resembling mild hypertrophic scar. The thickness of the scars from the deep wounds was significantly greater than uninjured skin and healed superficial wounds (p &lt; 0.01). NO levels were increased at 1.5 weeks in deep wounds compared to superficial wounds and uninjured skin (p &lt; 0.05). At 8 weeks, NO levels in deep wounds had returned to the level of uninjured tissue and superficial wounds. By 21 weeks, NO levels had decreased significantly when compared to superficial wounds (p &lt; 0.01). There were no differences in NO levels between uninjured skin and superficial wounds at any time point (p &gt; 0.05). Conclusions: NO production is similar in late, deep wounds on the female, red Duroc pig to that reported in the literature for human hypertrophic scar further validating this animal model. NO production is quite different after deep wounds as compared to superficial wounds in the FRDP. Early elevation in nitric oxide production might account for excessive inflammation in deep wounds that become thick scars in the FRDP. Nitric oxide regulators and effects at early stages of scar formation should be elucidated further and the FRDP appears to be a useful model.