Treatment Of Ulcers Research Articles

Bioadhesive and drug-loaded cellulose nanofiber/alginate film for healing oral mucosal wounds

Recurrent oral ulcers are common oral mucosal lesions that severely reduce patients' quality of life. Commercial mucoadhesive films are easily disrupted due to oral movement and complex wet environments, thus reducing drug utilization and even causing toxic side effects. Herein, we report a mucoadhesive film composed of Ca2+-crosslinked carboxymethylated cellulose nanofibers and alginate, in which two drugs of dexamethasone (DXM) and dyclonine hydrochloride (DYC) are loaded for the treatment of oral ulcers. The wet films have a high Young's modulus of 7.1 ± 2.6 MPa and a large strain of 53.6 ± 9.8 % and adhere to tissue strongly, which allows them to resist the deformation caused by frequent oral movement. The films also have nice durability against water and excellent biocompatibility. Moreover, the drug release was controlled at different rates. The fast release of DYC facilitates the quick relief of pain, while the slow release of DXM benefits the long-term treatment of wounds. Finally, the animal experiment demonstrates the films displayed excellent therapeutic efficacy in healing oral ulcers.

Clinical characteristics and treatment of Marjolin's ulcer at a major burn center in northwest China: a retrospective review of 126 cases.

Marjolin's ulcer (MU) is a rare, aggressive skin tumor. There are numerous case reports but large long-term studies are lacking, necessitating further exploration of its treatment. This study aimed to summarize and analyze the characteristics, treatment methods, and prognosis of MU. We retrospectively analyzed the clinical data of 126 patients with MU, treated between January 2013 and January 2023 at the burn center. Demographic data, clinical characteristics, treatment, and prognosis were statistically analyzed. Of the 126 included patients, 104 were followed up for 0.1-10.2 years. The most common cause of the primary injury was flame burn (50.8%). Lesions were commonly observed on the lower limbs (47.6%). The predominant histopathological type was squamous cell carcinoma (92.8%). Among the 126 patients, 35 (27.8%) presented with bone invasion, 37 (29.4%) presented with enlarged lymph nodes, and 9 (7.1%) had lymph node metastasis. Extensive local excision (83.3%) was the most common surgical procedure; the defect was repaired using skin grafting (41.9%), free flaps (37.1%), and local flaps (21.0%). Multivariate analysis revealed that bone invasion and lymph node involvement were risk factors for postoperative recurrence. Survival analysis showed that age, latency period, pathological type, and recurrence were significant risk factors for survival. Extensive local resection is necessary to eradicate tumors, and patient follow-up should be more frequent within 1 year postoperatively. As MU is preventable, it is essential to reach a quick diagnosis and avoid delayed management before the occurrence of deadly metastases.

Silk Fibroin Microneedles Loaded with Lipopolysaccharide-Pretreated Bone Marrow Mesenchymal Stem Cell-Derived Exosomes for Oral Ulcer Treatment.

Oral ulcers, superficial lesions on the surface of the oral mucosa, have a high incidence rate, and their main symptoms include local pain and erosion. Lipopolysaccharide (LPS)-preconditioned bone marrow mesenchymal stem cells and their secreted exosomes (LPS-pre-Exos) have been shown to promote recovery in various inflammatory conditions and wounds. However, studies documenting LPS-pre-Exos as a therapeutic intervention for oral mucosal-like diseases are lacking. In this study, we prepared a silk fibroin microneedle (MN) patch consisting of LPS-pre-Exos and zeolitic imidazolate framework-8 (ZIF-8) that localized at the tip and base, respectively, and used this MN patch for oral ulcer treatment. Upon insertion into the oral mucosa, continuous LPS-pre-Exos release was observed, which promoted macrophage polarization and tissue healing. Additionally, the ZIF-8 framework in the MN patch facilitated the controlled release of Zn2+, which demonstrated potent antimicrobial properties via synergistic effects. The in vitro experimental results showed that the silk fibroin MN patch can continuously release LPS-pre-Exos and Zn2+ for more than 7 days. Thus, the LPS-pre-Exos and ZIF-8-loaded silk fibroin MN patch exhibited good anti-inflammatory and antibacterial properties, promoting oral ulcer healing, and showed good histocompatibility. Hence, it may represent a potentially valuable strategy for facilitating oral ulcer healing.

2023 Brazilian Society of Rheumatology guidelines for the treatment of systemic sclerosis

BackgroundSystemic sclerosis (SSc) is a rare chronic autoimmune disease with heterogeneous manifestations. In the last decade, several clinical trials have been conducted to evaluate new treatment options for SSc. The purpose of this work is to update the recommendations of the Brazilian Society of Rheumatology in light of the new evidence available for the pharmacological management of SSc.MethodsA systematic review including randomized clinical trials (RCTs) for predefined questions that were elaborated according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) strategy was conducted. The rating of the available evidence was performed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. To become a recommendation, at least 75% agreement of the voting panel was needed.ResultsSix recommendations were elaborated regarding the pharmacological treatment of Raynaud’s phenomenon, the treatment (healing) and prevention of digital ulcers, skin involvement, interstitial lung disease (ILD) and gastrointestinal involvement in SSc patients based on results available from RCTs. New drugs, such as rituximab, were included as therapeutic options for skin involvement, and rituximab, tocilizumab and nintedanib were included as therapeutic options for ILD. Recommendations for the pharmacological treatment of scleroderma renal crisis and musculoskeletal involvement were elaborated based on the expert opinion of the voting panel, as no placebo-controlled RCTs were found.ConclusionThese guidelines updated and incorporated new treatment options for the management of SSc based on evidence from the literature and expert opinion regarding SSc, providing support for decision-making in clinical practice.

Integrating bioinformatics and multiple machine learning to identify mitophagy-related targets for the diagnosis and treatment of diabetic foot ulcers: evidence from transcriptome analysis and drug docking.

Diabetic foot ulcers are the most common and serious complication of diabetes mellitus, the high morbidity, mortality, and disability of which greatly diminish the quality of life of patients and impose a heavy socioeconomic burden. Thus, it is urgent to identify potential biomarkers and targeted drugs for diabetic foot ulcers. In this study, we downloaded datasets related to diabetic foot ulcers from gene expression omnibus. Dysregulation of mitophagy-related genes was identified by differential analysis and weighted gene co-expression network analysis. Multiple machine algorithms were utilized to identify hub mitophagy-related genes, and a novel artificial neural network model for assisting in the diagnosis of diabetic foot ulcers was constructed based on their transcriptome expression patterns. Finally, potential drugs that can target hub mitophagy-related genes were identified using the Enrichr platform and molecular docking methods. In this study, we identified 702 differentially expressed genes related to diabetic foot ulcers, and enrichment analysis showed that these genes were associated with mitochondria and energy metabolism. Subsequently, we identified hexokinase-2, small ribosomal subunit protein us3, and l-lactate dehydrogenase A chain as hub mitophagy-related genes of diabetic foot ulcers using multiple machine learning algorithms and validated their diagnostic performance in a validation cohort independent of the present study (The areas under roc curve of hexokinase-2, small ribosomal subunit protein us3, and l-lactate dehydrogenase A chain are 0.671, 0.870, and 0.739, respectively). Next, we constructed a novel artificial neural network model for the molecular diagnosis of diabetic foot ulcers, and the diagnostic performance of the training cohort and validation cohort was good, with areas under roc curve of 0.924 and 0.840, respectively. Finally, we identified retinoic acid and estradiol as promising anti-diabetic foot ulcers by targeting hexokinase-2 (-6.6 and -7.2kcal/mol), small ribosomal subunit protein us3 (-7.5 and -8.3kcal/mol), and l-lactate dehydrogenase A chain (-7.6 and -8.5kcal/mol). The present study identified hexokinase-2, small ribosomal subunit protein us3 and l-lactate dehydrogenase A chain, and emphasized their critical roles in the diagnosis and treatment of diabetic foot ulcers through multiple dimensions, providing promising diagnostic biomarkers and targeted drugs for diabetic foot ulcers.

Oriented cellulose hydrogel: Directed tissue regeneration for reducing corneal leukoplakia and managing fungal corneal ulcers

Fungal corneal ulcer is one of the leading causes of corneal blindness in developing countries. Corneal scars such as leukoplakia are formed due to inflammation, oxidative stress and non-directed repair, which seriously affect the patients' subsequent visual and life quality. In this study, drawing inspiration from the oriented structure of collagen fibers within the corneal stroma, we first proposed the directional arrangement of CuTA-CMHT hydrogel system at micro and macro scales based on the 3D printing extrusion method combined with secondary patterning. It played an antifungal role and induced oriented repair in therapy of fungal corneal ulcer. The results showed that it effectively inhibited Candida albicans, Aspergillus Niger, Fusarium sapropelum, which mainly affects TNF, NF-kappa B, and HIF-1 signaling pathways, achieving effective antifungal functions. More importantly, the fibroblasts interacted with extracellular matrix (ECM) of corneal stroma through formation of focal adhesions, promoted the proliferation and directional migration of cells in vitro, induced the directional alignment of collagen fibers and corneal stromal orthogonally oriented repair in vivo. This process is mainly associated with MYLK, MYL9, and ITGA3 molecules. Furthermore, the downregulation the growth factors TGF-β and PDGF-β inhibits myofibroblast development and reduces scar-type ECM production, thereby reducing corneal leukoplakia. It also activates the PI3K-AKT signaling pathway, promoting corneal healing. In conclusion, the oriented CuTA-CMHT hydrogel system mimics the orthogonal arrangement of collagen fibers, inhibits inflammation, eliminates reactive oxygen species, and reduces corneal leukoplakia, which is of great significance in the treatment of fungal corneal ulcer and is expected to write a new chapter in corneal tissue engineering.

Antibacterial composite protein microneedle loaded with hypoxia-treated exosomes for oral ulcer healing

Oral ulcer treatment is challenging: various dressings have been developed, but they have poor efficacy. The efficacy of oral ulcer treatment depends on the local drug concentration; low drug concentrations result in slow wound healing. Therefore, the sustained release of active therapeutic ingredients from wound dressings with few administrations is promising. Hypoxic exosomes (Exos) can promote cell proliferation and angiogenesis. Further, silver nanoparticles (AgNPs) confer broad-spectrum antimicrobial effects. We prepared a light-cured composite microneedle (MN) patch based on bovine serum albumin methacryloyl (BSAMA) and methacrylic gelatin (GelMA) (the combination is denoted BG). Control, BG, BG@Exos, and BG@Exos&AgNPs were used to explore the therapeutic effects of hypoxic Exos and AgNPs on oral ulcers. In vitro experiments showed that BG@Exos&AgNPs MN patches effectively promoted cell migration, proliferation, and angiogenesis and significantly inhibited bacterial growth and expression of IL-2 and TNF-ɑ. We found that BG@Exos&AgNPs promoted the healing of oral ulcers in rats, demonstrated by rapid wound epithelial healing, downregulation of inflammatory factor expression, and increased macrophage polarization. Therefore, the designed BG@Exos&AgNPs MN patch is a valuable approach for treating oral ulcers.

Implementation and evaluation of a system for assessment of the quality of long-term management of patients at a geriatric hospital

BackgroundThe increasing aging population presents a significant challenge, accompanied by a shortage of professional caregivers, adding to the therapeutic burden. Clinical decision support systems, utilizing computerized clinical guidelines, can improve healthcare quality, reduce expenses, save time, and boost caregiver efficiency. Objectives1) Develop and evaluate an automated quality assessment (QA) system for retrospective longitudinal care quality analysis, focusing on clinical staff adherence to evidence-based guidelines (GLs). 2) Assess the system’s technical feasibility and functional capability for senior nurse use in geriatric pressure-ulcer management. MethodsA computational QA system using our Quality Assessment Temporal Patterns (QATP) methodology was designed and implemented. Our methodology transforms the GL’s procedural-knowledge into declarative-knowledge temporal-abstraction patterns representing the expected execution trace in the patient’s data for correct therapy application. Fuzzy temporal logic allows for partial compliance, reflecting individual and grouped action performance considering their values and temporal aspects. The system was tested using a pressure ulcer treatment GL and data from 100 geriatric patients’ Electronic Medical Records (EMR). After technical evaluation for accuracy and feasibility, an extensive functional evaluation was conducted by an experienced nurse, comparing QA scores with and without system support, and versus automated system scores. Time efficiency was also measured. ResultsQA scores from the geriatric nurse, with and without system’s support, did not significantly differ from those provided by the automated system (p < 0.05), demonstrating the effectiveness and reliability of both manual and automated methods. The system-supported manual QA process reduced scoring time by approximately two-thirds, from an average of 17.3 min per patient manually to about 5.9 min with the system’s assistance, highlighting the system’s efficiency potential in clinical practice. ConclusionThe QA system based on QATP, produces scores consistent with an experienced nurse’s assessment for complex care over extended periods. It enables quick and accurate quality care evaluation for multiple patients after brief training. Such automated QA systems may empower nursing staff, enabling them to manage more patients, accurately and consistently, while reducing costs due to saved time and effort, and enhanced compliance with evidence-based guidelines.

Different Thicknesses of Acellular Porcine Corneal Stroma on Prognosis of Fungal Corneal Ulcers Treated by Lamellar Keratoplasty: A Five-Year Retrospective Study.

To compare the prognosis and efficacy of acellular porcine corneal stroma (APCS) with different thicknesses for the treatment of fungal corneal ulcers by lamellar keratoplasty (LKP). A total of 52 patients who underwent LKP with APCS for the treatment of fungal corneal ulcers were included in this retrospective study. Patients were divided into 2 groups according to the different thicknesses of APCS (0.30 ± 0.05 mm, L2 group, n = 20; 0.40 ± 0.05 mm, L3 group, n = 32). Observation indicators included best corrected visual acuity, graft transparency, corneal neovascularization, ocular irritation symptoms, corneal epithelial healing time, graft survival, central corneal thickness at 1 year after surgery, and postoperative complications. Compared with the L3 group, the L2 group had better postoperative best corrected visual acuity and graft transparency (P < 0.001), less corneal neovascularization (P < 0.001), and lower incidence of complications (P < 0.05). There were significant differences in ocular irritation symptoms between the 2 groups (P < 0.05) at 3 and 6 months postoperatively, which might be related to the higher recurrence rate and graft rejection rate in the L3 group. The comparison of postoperative epithelial healing time also showed significant differences in 2 groups (P < 0.01). The 1-year survival rate was up to 63.5% in both groups, with no significant difference (P < 0.05). However, the risk of transplantation was less in the L2 group. Both APCS thicknesses could provide adequate central corneal thickness at 1 year after surgery (P > 0.05). APCS was safe and effective in the treatment of fungal corneal ulcers by LKP. Thinner grafts should be preferred for LKP for fungal corneal ulcers to reduce the risk of grafting.

Enhanced curcumin solubility in epichlorohydrin engineered β-Cyclodextrin copolymer for gastric maladies

The present work relates to a β-cyclodextrin based drug delivery system with epichlorohydrin as cross-linking agent, with higher binding efficiency of the drug curcumin and enhanced solubility of the curcumin in complex form when simulated in gastric fluid and increased sustained release of curcumin from complex for 2 h to act in gastric region. Although cross-linking with epichlorohydrin (EPC) is a process studied long time ago, however its use as a gastric solubility enhancer for curcumin has been studied for the first time. The synthesized polymer was well characterized by FT-IR, SEM, XRD, TGA and particle size analysis. The polymer enhanced the water solubility of curcumin by ∼ 800–850 times and the gastric solubility was increased by ∼ 1400–1500 times and acted as a sustained release system as verified by the pepsin inhibition studies which makes it a potential drug carrier for gastric specific drug targeting that can be a promising treatment for gastritis and gastric ulcers.

Hydroxypropyl Cellulose-Based Orally Dissolving Film Loaded with Insoluble Dexamethasone for Treatment of Oral Ulcers.

Oral ulcers present as recurrent and spontaneous lesions, often causing intolerable burning pain that significantly disrupts patients' daily lives and compromises their quality of life. In addressing this clinical challenge, oral dissolving films (ODFs) have emerged as promising pharmaceutical formulations for oral ulcer management due to their rapid onset of action, ease of administration, and portability. In this study, ODFs containing the insoluble drug dexamethasone (Dex) were formulated for the treatment of oral ulcers in rabbits using a solvent casting method with ethanol as the solvent. To optimize the composition of the ODFs, a Box-Behnken Design (BBD) experiment was employed to investigate the effects of varying concentrations of hydroxypropyl cellulose (HPC), low-substituted hydroxypropyl cellulose (L-HPC), and plasticizer (glycerol) on key parameters, such as disintegration time, tensile strength, and peel-off efficiency of the films. Subsequently, the film properties of the Dex-loaded ODFs (ODF@Dex) were thoroughly assessed, revealing favorable attributes, including homogeneity, mechanical strength, and solubility. Notably, the use of ethanol as the solvent in the ODF preparation facilitated the homogeneous distribution of insoluble drugs within the film matrix, thereby enhancing their solubility and dissolution rate. Leveraging the potent pharmacological activity of Dex, ODF@Dex was further evaluated for its efficacy in promoting ulcer healing and mitigating the expression of inflammatory factors both in vitro and in vivo. The findings demonstrated that the ODF@Dex exerted significant antiulcer effects by modulating the PI3K/Akt signaling pathway, thus contributing to ulcer resolution. In conclusion, our study underscores the potential of HPC-based ODFs formulated with ethanol as a solvent as a promising platform for delivering insoluble drugs, offering a viable strategy for the clinical management of oral ulcers.

Surgical Offloading versus Medical Conservative Methods in Management of Diabetic Foot Plantar Ulcers (Interventional study)

Abstract Background As a result, peripheral neuropathy is frequently caused by diabetes (DM). Diabetic plantar foot pressure ulcers develop from the lack of protective pain sensibility as a result of recurrent shear and tear pressures. Relieving pressure on the foot's sole is necessary for the ulcers to heal. The purpose of the study is to compare the effectiveness of surgical and nonsurgical unloading procedures in the healing of plantar ulcers. Subjects and Methods 50 diabetic foot ulcer patients who visited Ain Shams University, the national institute of DM, and the endocrinology outpatient clinic participated in this interventional trial (NIDE). We employed mechanical and surgical unloading methods in this trial, and patients were monitored for 6 months to see how long it took for their injuries to recover. Results At the conclusion of the follow-up period, 88% of the surgical group's pressure ulcers were fully healed, compared to 86.7% of the non-surgical patients (6 months). Infection, recurrence, and non-healing were complications we encountered throughout the follow-up period. Regarding the treatment of plantar diabetic foot ulcers, offloading is crucial (DFUs). Compared to using only non-surgical methods, surgical offloading may hasten the recovery time. A well- trained team is necessary to prevent the issues with improperly fitting footwear and to teach the patient how to use them on a regular basis with the non-surgical offloading technique.

Omeprazole-Loaded Copper Nanoparticles for Mitochondrial Damage Mediated Synergistic Anticancer Activity against Melanoma Cells.

Metallic nanoparticles are promising candidates for anticancer therapies. Among the different metallic systems studied, copper is an affordable and biologically available metal with a high redox potential. Copper-based nanoparticles are widely used in anticancer studies owing to their ability to react with intracellular glutathione (GSH) to induce a Fenton-like reaction. However, considering the high metastatic potential and versatility of the tumor microenvironment, modalities with a single therapeutic agent may not be effective. Hence, to enhance the efficiency of chemotherapeutic drugs, repurposing them or conjugating them with other modalities is essential. Omeprazole is an FDA-approved proton pump inhibitor used in clinics for the treatment of ulcers. Omeprazole has also been studied for its ability to sensitize cancer cells to chemotherapy and induce apoptosis. Herein, we report a nanosystem comprising of copper nanoparticles encapsulating omeprazole (CuOzL) against B16 melanoma cells. The developed nanoformulation exerted significant synergistic anticancer activity when compared with either copper nanoparticles or omeprazole alone by inducing cell death through excessive ROS generation and subsequent mitochondrial damage.

Proteome-wide Profiling Reveals Molecular Mechanism Underlying the Therapeutic Effect of Mongolian Medicine Sulongga-4 on Pyloric Ligation-induced Gastroduodenal Ulcer in Rats

Background: Gastroduodenal ulcer is one of the common global gastrointestinal diseases. Sulongga-4 is a traditional Mongolian medicine used for the treatment of gastroduodenal ulcer. However, the molecular mechanism underlying the therapeutic effect of Sulongga-4 on gastroduodenal ulcer in the proteome has not been clarified. Objective: The purpose of this study was to explore the molecular mechanism behind the therapeutic efficacy of traditional Mongolian medicine Sulongga-4 on pyloric ligation-induced gastroduodenal ulcer in rats. Methods: Gastroduodenal ulcer was induced by pyloric ligation in rats. The pathological changes of gastric and duodenal tissues were observed first, and then the serum levels of AST and ALT were measured. The significantly different proteins were verified by western blot and qRT-PCR. Results: The proteomics results showed that the Mongolian medicine Sulongga-4 might act on pyloric ligation-induced gastroduodenal ulcer through differentially expressing several proteins, including RPL35, RPL37, and LOC102548628 in gastric tissue, as well as Serpin b1a, Serpin b6a, and Vtn in duodenal tissue by regulating ribosome, alcoholism and amoebiasis, and complement and coagulation cascade pathways. In addition, the changes in serum AST and ALT levels in rats showed gastroduodenal ulcer to be associated with liver injury. Conclusion: Sulongga-4 has shown a robust therapeutic effect against gastric duodenal ulcer. This therapeutic effect may be mainly associated with pathways of ribosome, alcoholism in gastric tissue, and amoebiasis, as well as complement and coagulation cascades in duodenal tissue.

Comparison of the effect of combination therapies in the treatment of large varicose ulcers: A real-world cohort study.

The primary treatment for varicose ulcers is to address the underlying cause of venous hypertension, additionally, split-thickness skin transplantation (ST) is an effective option for large ulcers. The aim of this study was to compare the efficacy of venous surgery with or without split-thickness ST in the management of varicose ulcers (diameter ≥6 cm). Patients with varicose ulcers between 2013 and 2023 were included in the real-world retrospective cohort study. The endovenous microwave ablation/endovenous laser ablation-high ligation-foam sclerotherapy-compression therapy + ST group (EMA/EVLA-CT-HL-FS + ST) consisted of 32 patients, while the EMA/EVLA-CT-HL-FS group consisted of 48 patients. A difference in ulcer healing time was found between the two groups (the hazard ratio [HR] was 4.4, 95% CI [2.3-8.2], P < 0.0001). However, the healing rate did not differ between the two groups at 6 and 12 months postoperatively. ST has been shown to expedite ulcer healing and ameliorate the symptoms of VVs in the early stages of treatment, while its intermediate to long-term efficacy for ulcer healing and overall patient quality of life may be limited.

Single-center clinical experience of cyanoacrylate embolization method for incompetent perforating veins in treating CEAP-6 patients

ObjectiveThe most severe form of chronic venous insufficiency includes venous leg ulcers in the CEAP-6 stage. The aim of this study is to evaluate the relationship between incompetent perforator veins occluding with cyanoacrylate and closure of perforator veins and healing of venous leg ulcers in patients at the CEAP-6 stage. MethodsA total of 187 patients who underwent cyanoacrylate application to incompetent perforator veins due to venous leg ulcers from 2018 to 2021 were retrospectively reviewed. Twelve months after the procedure, patients were evaluated for perforator vein closure, ulcer diameter, and Venous Clinical Severity Scale. Receiver operating characteristic analysis was used to estimate the probability of postoperative nonocclusion of the perforating vein based on the preoperative ulcers’ diameters and the perforating veins’ mean diameters. Univariate and multivariate binary logistic regression analyses were conducted to identify the risk factors associated with incomplete closure of the perforating vein. ResultsAt the 12 months, 87.1% of patients experienced incompetent perforator veins closure, leading to complete healing of venous leg ulcers. Preoperative ulcer diameter significantly decreased from 7.20 ± 3.48 cm2 to 0.28 ± 0.77 cm2 after the procedure (P < .001). On average, 3.5 ± 1.01 perforating veins were treated, with a diameter of 4.09 ± 0.41 mm. No postoperative paresthesia or deep vein thrombosis occurred. Preoperative Venous Clinical Severity Scale scores decreased significantly from 17.85 ± 3.06 to 8.03 ± 3.53 postoperatively (P < .001). Patients with nonoccluded perforating veins had larger preoperative ulcer diameters (13.77 ± 1.78 cm2) than those with occluded perforating veins (6.24 ± 2.47 cm2; P < .001). The mean perforating vein diameter was also larger in nonoccluded perforating veins patients (4.45 ± 0.41 mm) than in occluded perforating veins patients (4.04 ± 0.38 mm; P < .001). The sensitivity, specificity, and accuracy of the preoperative ulcer diameter cutoff point of 11.25 cm2 for the possibility of postoperative nonocclusion of perforating veins were 100% each. In contrast, those for the preoperative mean perforating vein diameter cutoff point of 4.15 mm were determined as 66.7%, 79.1%, and 77.5%, respectively. The presence of diabetes mellitus increased the likelihood of incompetent perforator veins, remaining open by 3.4 times (95% confidence interval: 1.11-10.44; P = .032), whereas a 1 mm larger mean perforating vein diameter increased this likelihood by 9.36 times (95% confidence interval: 3.47-25.29; P < .001). ConclusionsThis study demonstrates that occlusion of incompetent perforator veins with cyanoacrylate is effective, safe, and associated with low complication rates in CEAP-6 patients. The findings support that cyanoacrylate occlusion of perforator veins may be a valuable option in the treatment of venous leg ulcers.

Formulation and Evaluation Herbal Gel from Psidium Guajava and Jasminium Officinali for Mouth Ulcer Treatment

Abstract: India has long employed traditional or herbal medicine to diagnose, treat, and prevent illness. The study's objective was to create and assess a herbal gel that contained extract from jasmine officinale and Psidium guajava for the treatment of mouth ulcers. Herbal gel made using powdered extracts of Psidium guajava and Jasminum officinale at varying concentrations. Psidium guajava has high antifungal and antibacterial action and is used to treat a number of illnesses, including diabetes mellitus, diarrhea, rheumatism, wounds in the throat, and coughs. Tannins, flavonoids, triterpene, quercetin, pentacycline, triterpenoids, gujanoic acid, saponins, carotenoids, lectin, ellugic acid, sitosterol, and oleanolic acid are found in Psidium guajava leaves, whereas the properties of Jasmine Officinale include analgesic, antioxidant, anti-inflammatory, stomachic, astringent, stimulating, and sedative effects. Alkaloids, tannins, terpenoids, glycosides, steroids, essential oil, and saponin are among its constituents.Guava and jasmine leaf extracts, Carbopol 934, propylene glycol, propyl paraben, methyl paraben, triethanolamine, and distilled water were used to make the herbal gel formulation. To keep the pH between 7 and7.5, triethanolamine was added. The evaluation's viscosity, homogeneity, PH, and spreadability parameters. The gel strength and extruadability were ascertained.The results indicate that all assessment parameters found to be acceptable with the normal range were discovered in the optimized herbal gel formulation containing extracts from guava and jasmine leaves. For the treatment of oral ulcers, the herbal formulation proved to be more stable, safe, and successful than the synthetic formulation.

Design and Characterisation of Curcumin-Loaded Nanostructured Lipid Carriers for Safe and Efficient Topical Drug Delivery in The Treatment of Pressure Ulcer

Pressure ulcers (PU) are chronic lesions with a high prevalence in at-risk populations. Although curcumin has various therapeutic properties, its use as a dermal therapeutic agent is limited by its poor solubility and permeability. This study aimed to develop nanostructured lipid carriers (NLCs) to facilitate the topical use of curcumin as wound healing agent in treating PU. The optimised curcumin-NLCs were characterised for their physicochemical properties, drug release, and skin permeation, while effectiveness and toxicity were investigated via cell viability, scratch assays, and an in vivo skin irritation test. The optimised curcumin-NLCs comprised 3.5% solid lipids, 1% surfactant, and 2% co-surfactant with an average particle size of 134.68±6.0 nm, polydispersity index of 0.248±0.00, zeta potential of −44.94±5.44, percentage of encapsulation efficiency of 93.42±0.32%, and drug loading of 0.11±0.00%. Curcumin-NLCs showed stable physicochemical properties and extended drug release for up to 48 h, with a cumulative release of 77.72% following a first-order kinetics. The formulation exhibited slower curcumin permeation than the free curcumin. Furthermore, the safe and non-toxic curcumin-NLCs were highly effective at 0.98 μM and showed a high rate of wound closure without skin irritation. Collectively, the NLCs developed for topical delivery of curcumin demonstrated prolonged and sustained release and improved wound healing activity, which indicates that curcumin-NLCs are a viable strategy for treating PU.

Systematic literature review to inform the Portuguese recommendations for the management of Raynaud's phenomenon and digital ulcers in systemic sclerosis and other connective tissue diseases.

To perform a systematic literature review (SLR) aimed at evaluating the efficacy and safety of pharmacological and non-pharmacological treatments for Raynaud's phenomenon (RP) and digital ulcers (DU) in patients with systemic sclerosis (SSc) and other connective tissue diseases (CTD), in order to inform the Portuguese recommendations for managing RP and DU in these patients. A SLR was conducted until May 2022 to identify studies assessing the efficacy and safety of pharmacological and non-pharmacological interventions for RP and DU in SSc and other CTD. Eligible study designs included randomized controlled trials (RCTs), controlled clinical trials, and their extensions for assessing efficacy and safety of interventions. Observational studies with a comparator were included for evaluating the efficacy and safety of non-pharmacological interventions and safety of pharmacological interventions. The risk of bias of each study was assessed using standard tools. Out of 71 publications meeting the inclusion criteria, 59 evaluated pharmacological and 12 non-pharmacological interventions. We found moderate quality evidence supporting the efficacy of calcium channel blockers, phosphodiesterase-5 inhibitors, and intravenous prostacyclin analogues in reducing RP frequency, severity, and duration. Intravenous iloprost had a small to moderate effect size in improving DU healing. Phosphodiesterase-5 inhibitors were effective in reducing total DU count, new DU occurrence, and enhancing DU healing. Bosentan effectively prevented new DU in SSc patients. No new safety concerns were associated with these treatments. The studies on non-pharmacological interventions were, in general, of low quality, and had a small sample size. Warming measures decreased frequency and duration of RP attacks; laser therapy improved RP-related outcomes; local oxygen-ozone therapy improved RP outcomes as an add-on therapy; bone marrow mononuclear cell implantation improved DU-associated pain; periarterial sympathectomy and vascular bypass reduced DU number and finger amputation risk. The available evidence supports the efficacy and safety of pharmacological interventions, namely nifedipine, sildenafil, iloprost, and bosentan in treating RP and DU in patients with SSc and other CTD. Scarce and low-quality evidence does support the use of some non-pharmacological interventions but with only a modest effect size. This SLR underscores the limited availability of high-quality evidence for determining the optimal treatment.

Diagnosis and treatment of venous leg ulcers: S2k Guideline of the German Society of Phlebology and Lymphology (DGPL) e.V.

This S2k guideline on venous leg ulcers was created on the initiative and under the leadership of the German Society of Phlebology and Lymphology (DGPL). The guideline group also consisted of representatives from the German Society for Phlebology and Lymphology, German Dermatological Society, German Society for General Medicine, German Society for Angiology, German Society for Vascular Surgery and Vascular Medicine, German Society for Surgery, German Society for Dermatosurgery, German Society for Wound Healing and Wound Treatment, Professional Association of Phlebologists and Lymphologists and Initiative Chronische Wunden. The aim of this guideline is to combine the different approaches and levels of knowledge of the respective professional groups on the basis of consensus, so that a basic concept for the best possible treatment of patients with venous leg ulcers can be provided. A total of 70 specific recommendations were formulated and agreed upon, divided into the subject areas of diagnostics, therapy, prevention of recurrences, and everyday challenges. The guideline thus reflects the current state of scientific knowledge and is intended to be widely used as the best available document for the treatment of patients with venous leg ulcers in everyday clinical practice.