Type Of Ulcer Research Articles

Prevalence of cutaneous leishmaniasis infection and clinico-epidemiological patterns among military personnel in Mullaitivu and Kilinochchi districts of the Northern Province, early war-torn areas in Sri Lanka

BackgroundThe 30-year-old armed conflict in Sri Lanka resulted in a general breakdown of civil administration in the Northern and Eastern provinces, leading to mobilisation of many armed forces personnel to assist with reconstruction and resettlement. This occupational group has been identified as a priority risk group for leishmaniasis.MethodsIndividuals enlisted at all military establishments in Mullaitivu and Kilinochchi districts, Northern Province of Sri Lanka were included. Five thousand individuals were screened for skin lesions between September 2018 and August 2019. Persons with lesions suspected as cutaneous leishmaniasis (CL) were further investigated. Information on sociodemographic/other potential risk factors was obtained through an interviewer-administered structured questionnaire. The diagnosis was confirmed by microscopic visualization of parasitic stages from different samples obtained (skin scraping, lesion aspirate and tissue impression smears), histopathology and polymerase chain reaction DNA amplification.ResultsAmong 5000 individuals screened, 74 individuals were suspected of having CL. Of these, 67.6% (n = 50) patients were confirmed for CL by microscopy. Around two third of both males (67.6%; n = 48) and females (66.6%; n = 2) were positive for Leishmania. The soldiers belonging to 26–35-year age group reported the highest susceptibility (83.3%; OR: 4.83, 95% CI: 3.49–6.20%). Of the sociodemographic factors, age, wearing short-sleeved upper body clothing as the uniform and non-use of insect repellents were identified as significant risk factors. Most of the CL patients had a single lesion (86.0%; n = 43) of an ulcerative type (34.0%; n = 17), mostly on their upper limb (67.9%; n = 34). Lesions were mostly 5–10 mm diameter (59.9%; n = 30) in size with poorly defined margins (72.0%; n = 36). Amongst the diagnostic techniques, microscopic examination of slit skin smear and tissue impression smear were able to discriminate the majority of patients (92.1%; n = 46) for CL.ConclusionsIn order to highlight the true burden of leishmaniasis in the military personnel, cases of leishmaniasis from military institutes should be recognized as a different entity per say and be included in the national figures so as to depict the real magnitude of the disease burden amongst this high-risk group.

Integrated approach in the control and management of skin neglected tropical diseases in three health districts of C\xf4te d\u2019Ivoire

BackgroundNeglected tropical diseases (NTDs) comprise 20 communicable diseases that are prevalent in rural poor and remote communities with less access to the health system. For effective and efficient control, the WHO recommends that affected countries implement integrated control interventions that take into account the different co-endemic NTDs in the same community. However, implementing these integrated interventions involving several diseases with different etiologies, requiring different control approaches and driven by different vertical programs, remains a challenge. We report here the results and lessons learned from a pilot test of this integrated approach based on integrated screening of skin diseases in three co-endemic health districts of Côte d’Ivoire, a West African country endemic for Buruli ulcer, leprosy and yaw.MethodThis cross-sectional study took place from April 2016 to March 2017 in 3 districts of Côte d’Ivoire co-endemic for BU, leprosy and yaws. The study was carried out in 6 stages: identification of potentially co-endemic communities; stakeholder training; social mobilization; mobile medical consultations; case detection and management; and a review meeting.ResultsWe included in the study all patients with skin signs and symptoms at the screening stage who voluntarily accepted screening.In total, 2310 persons screened had skin lesions at the screening stage. Among them, 07 cases were diagnosed with Buruli ulcer. There were 30 leprosy cases and 15 yaws detected. Other types of ulcerations and skin conditions have been identified and represent the majority of cases detected. We learned from this pilot experience that integration can be successfully implemented in co-endemic communities in Côte d’Ivoire. Health workers are motivated and available to implement integrated interventions instead of interventions focused on a single disease. However, it is essential to provide capacity building, a minimum of drugs and consumables for the care of the patients identified, as well as follow-up of identified patients, including those with other skin conditions.ConclusionsThe results of this study show that the integration of activities can be successfully implemented in co-endemic communities under the condition of staff capacity building and minimal care of identified patients.

Prevalence of acute and chronic wounds - with emphasis on pressure ulcers - in integrated continuing care units in Alentejo, Portugal.

The aim of the study was to describe the prevalence and general characteristics of acute and chronic wounds in 2018 in Alentejo (Portugal) continuing care units. In order to look at associations, wound characteristics studied were location, type, place of acquisition, number, and duration, and patient characteristics were sex, age, and presence of risk factors. During the first 2 weeks of February 2018, a total of 770 patients were assessed at continuing care units of Alentejo. Of these, 135 exhibited wounds, a prevalence of 17.5%. Almost two out of three patients (63%) had arterial hypertension, slightly more than one in three (37%) had a stroke and/or immobility and 30% had diabetes. Of the total wounds identified, 18% were acute wounds and 82% were chronic wounds. Of the 24 acute wounds, traumatic wounds (76%), and surgical wounds (22%) were the most prevalent. The four types of pressure ulcers represented 80% of the chronic wounds. The median duration of the pressure ulcers was 5.5 months and 25% had duration over 10 months.

Clinical study of sterile collagen (Biofil) particles in the management of chronic non healing ulcers and their comparison with saline dressings

Background: Chronic non healing ulcers are a challenge to the patient and health care professional. They require special care and intensive treatment often for prolonged periods. These ulcers do not generally heal with conventional types of treatment within a reasonable time period and need special types of treatment like collagen particles, vacuum dressing, chemical debridement etc. The aim of the study was to compare the effect of sterile collagen particles with saline dressings in treatment of chronic non healing ulcers.Methods: 30 test subjects were dressed using sterile collagen particles and 30 controls using saline gauze on day 2 and every 3rd day. The condition of the ulcer was followed up using the Bates-Jensen wound assessment score (BJWA score).Results: BJWA score was significantly lesser at 4th week in test group. The p value was 0.00021. Test group mean score was 17.23 and for control group it was 21.467. BJWA score was significantly lesser even at 8th week in Test group. The p value was 0.00026. Test group mean score was 12.47 and control group it was 17.43. This signifies that healing rate is better in test group compared to control group.Conclusions: Comparing the components in BJWA score we can conclude from our study that; collagen dressings are superior to saline dressing in all type of ulcers and irrespective of gender and age of a person. The best response was seen in non diabetic ulcer without Saphenofemoral incompetence who are non smokers.

Rifampicin and clarithromycin (extended release) versus rifampicin and streptomycin for limited Buruli ulcer lesions: a randomised, open-label, non-inferiority phase 3 trial

SummaryBackgroundBuruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans infection that damages the skin and subcutis. It is most prevalent in western and central Africa and Australia. Standard antimicrobial treatment with oral rifampicin 10 mg/kg plus intramuscular streptomycin 15 mg/kg once daily for 8 weeks (RS8) is highly effective, but streptomycin injections are painful and potentially harmful. We aimed to compare the efficacy and tolerability of fully oral rifampicin 10 mg/kg plus clarithromycin 15 mg/kg extended release once daily for 8 weeks (RC8) with that of RS8 for treatment of early Buruli ulcer lesions.MethodsWe did an open-label, non-inferiority, randomised (1:1 with blocks of six), multicentre, phase 3 clinical trial comparing fully oral RC8 with RS8 in patients with early, limited Buruli ulcer lesions. There were four trial sites in hospitals in Ghana (Agogo, Tepa, Nkawie, Dunkwa) and one in Benin (Pobè). Participants were included if they were aged 5 years or older and had typical Buruli ulcer with no more than one lesion (caterories I and II) no larger than 10 cm in diameter. The trial was open label, and neither the investigators who took measurements of the lesions nor the attending doctors were masked to treatment assignment. The primary clinical endpoint was lesion healing (ie, full epithelialisation or stable scar) without recurrence at 52 weeks after start of antimicrobial therapy. The primary endpoint and safety were assessed in the intention-to-treat population. A sample size of 332 participants was calculated to detect inferiority of RC8 by a margin of 12%. This study was registered with ClinicalTrials.gov, NCT01659437.FindingsBetween Jan 1, 2013, and Dec 31, 2017, participants were recruited to the trial. We stopped recruitment after 310 participants. Median age of participants was 14 years (IQR 10–29) and 153 (52%) were female. 297 patients had PCR-confirmed Buruli ulcer; 151 (51%) were assigned to RS8 treatment, and 146 (49%) received oral RC8 treatment. In the RS8 group, lesions healed in 144 (95%, 95% CI 91 to 98) of 151 patients, whereas lesions healed in 140 (96%, 91 to 99) of 146 patients in the RC8 group. The difference in proportion, −0·5% (–5·2 to 4·2), was not significantly greater than zero (p=0·59), showing that RC8 treatment is non-inferior to RS8 treatment for lesion healing at 52 weeks. Treatment-related adverse events were recorded in 20 (13%) patients receiving RS8 and in nine (7%) patients receiving RC8. Most adverse events were grade 1–2, but one (1%) patient receiving RS8 developed serious ototoxicity and ended treatment after 6 weeks. No patients needed surgical resection. Four patients (two in each study group) had skin grafts.InterpretationFully oral RC8 regimen was non-inferior to RS8 for treatment of early, limited Buruli ulcer and was associated with fewer adverse events. Therefore, we propose that fully oral RC8 should be the preferred therapy for early, limited lesions of Buruli ulcer.FundingWHO with additional support from MAP International, American Leprosy Missions, Fondation Raoul Follereau France, Buruli ulcer Groningen Foundation, Sanofi-Pasteur, and BuruliVac.

Risk Factors of Esophageal Squamous Cell Cancer Specific for Different Macroscopic Types

Objective: To further explore risk factors of esophageal squamous cell cancer specific for different macroscopic types.Methods: A total of 423 patients and 423 age (±3 years) and gender matched controls were recruited. Multinomial logistic regression and multivariable logistic regression analysis were used to evaluate the risk factors of ESCC specific for different macroscopic types.Results: In this study, we found that drinking hot tea (OR = 1.98, 95% CI:1.14–3.43) and higher intake of hard food (OR = 1.64, 95% CI:1.05–2.58) positively associated with ulcerative type of ESCC, but not with medullary type or other types. Although alcohol drinking and lower intake of fresh vegetable appeared to be more harmful to the ulcerative-type ESCC, the discrepant risks were not significantly different in ulcerative type and medullary type. Moreover, tobacco smoking, intake of hot food, spicy food, fresh fruit, scallion and garlic were related to ESCC risk, whereas no significant difference in magnitude of their associations with respect to macroscopic type was observed. Furthermore, significant multiplicative interaction between tobacco smoking and alcohol drinking was found in ulcerative-type and medullary-type ESCC.Conclusion: Drinking hot tea and higher intake of hard food were associated with increased risk of ulcerative type of ESCC. However, the mechanism for this difference needs to be further studied.

Robert S. Kirsner Gary Delhougne Richard J. Searle

The purpose of this economic evaluation was to determine the cost-effectiveness of single-use negative pressure wound therapy (sNPWT) compared with traditional NPWT (tNPWT) for the treatment of VLUs and DFUs in the United States. A Markov decision-analytic model was used to compare the incremental cost and ulcer weeks avoided for a time horizon of 12 and 26 weeks using lower extremity ulcer closure rates from a published randomized controlled trial (N = 161) that compared sNPWT with tNPWT. Treatment costs were extracted from a retrospective cost-minimization study of sNPWT and tNPWT from the payer perspective using US national 2016 Medicare claims data inflated to 2018 costs and multiplied by 7 to estimate the weekly costs of treatment for sNPWT and tNPWT. Two (2) arms of the model, tNPWT and sNPWT, were calculated separately for a combination of both VLU and DFU ulcer types. In this model, a hypothetical cohort of patients began in the open ulcer health state, and at the end of each weekly cycle a proportion of the cohort moved into the closed ulcer health state according to a constant transition probability. The costs over the defined timescale were summed to give a total cost of treatment for each arm of the model, and then the difference between the arms was calculated. Effectiveness was calculated by noting the incidence of healing at 12 and 26 weeks and the total number of open ulcer weeks; the incremental effectiveness was calculated as sNPWT effectiveness minus tNPWT effectiveness. Data were extracted to Excel spreadsheets and subjected to one-way sensitivity, scenario (where patients with unhealed ulcers were changed to standard care at 4 or 12 weeks), probabilistic, and threshold analyses. sNPWT was found to provide an expected cost saving of $7756 per patient and an expected reduction of 1.67 open ulcer weeks per patient over 12 weeks and a cost reduction of $15 749 and 5.31 open ulcer weeks over 26 weeks. Probabilistic analysis at 26 weeks showed 99.8% of the simulations resulted in sNPWT dominating tNPWT. Scenario analyses showed that sNPWT remained dominant over tNPWT (cost reductions over 26 weeks of $2536 and $7976 per patient, respectively). Using sNPWT for VLUs and DFUs is likely to be more cost-effective than tNPWT from the US payer perspective and may provide an opportunity for policymakers to reduce the economic burden of lower extremity ulcers.

Correction: Low Prevalence of Helicobacter pylori-Positive Peptic Ulcers in Private Outpatient Endoscopy Centers in the United States.

Objectives During the past decades, the prevalence of gastric and duodenal ulcers, as well as Helicobacter pylori infection, has markedly declined. We hypothesized that the decline in H. pylori prevalence has decreased the fraction of H. pylori-positive gastric and duodenal ulcers. The present study was designed to test this hypothesis in a large US population undergoing esophagogastro-duodenoscopy in community-based endoscopy centers. Methods The Inform Diagnostics database is a national electronic repository of histopathologic records of patients distributed throughout the United States. A cross-sectional study among 1,289,641 individual esophagogastro-duodenoscopy patients analyzed the prevalence of peptic ulcers stratified by age, sex, ethnicity, H. pylori status, year of diagnosis, and ulcer type. The joint influence of multiple predictor variables on the occurrence of gastric and duodenal ulcers was analyzed using multivariate logistic regression analysis. Results Between 2009 and 2018, the general prevalence of H. pylori infection fell significantly from 11% to 9%. This decline was accompanied by a similar decline in the fraction of H. pylori-positive gastric ulcers from 17% to 14% and H. pylori-positive duodenal ulcers from 25% to 21%. Nowadays, only 17% of all patients with ulcer harbor H. pylori. The fraction of H. pylori-positive ulcers was significantly greater in duodenal than in gastric ulcers and in male than in female patients with ulcer. The prevalence of H. pylori was 2.6-fold higher among Hispanics and 3.2-fold higher among East Asians compared with the general population. The H. pylori prevalence fell from 24% to 22% among Hispanics and from 21% to 15% among East Asians. In East Asians and Hispanics, the fraction of H. pylori-positive gastric ulcers was 37% and 35%, respectively. Discussion H. pylori infection continues to fall in the general population. Nowadays, even among patients with ulcer only a small minority harbors H. pylori infection.

Chemical Composition, Antioxidant and Anti-Inflammatory Properties of Salvia Officinalis Extract from Algeria

Background: Due to its flavoring and seasoning properties, Salvia officinalis has been widely used in the preparation of many foods. In folk medicine in Asia and Latin America, it has been used for the treatment of various types of disorders, including seizures, ulcers, rheumatism, inflammation, dizziness, and high blood sugar. Objective: The purpose of this study is to determine the chemical composition by HPLC/UV, antioxidant activity and lipid peroxidation; thus the, the anti-inflammatory effect of the ethanolic extract of Salvia officinalis (EES) on certain homeostatic parameters, inflammatory biomarkers and antioxidant status in Wistar rats subjected to inflammation induced by carrageenan. Method: Male rats (n = 24) were exposed to inflammation of the peritoneal by carrageenan (200 μL: 2%) and treated for 5 days with ethanolic extract of Salvia officinalis (EES) in order to repair the damage caused by inflammation on homeostasis, TNF-α and PGE2. Results: The results of scavenging of DPPH and lipoperoxidation of the extract, showed an IC50 of 29.69 ± 1.32 and 46.17 ± 1.51 μg/mL, respectively. The identification of EEC by HPLC shows the presence of polyphenolic acids (salvianolic acid, rosmarinic acid, caffeic acid, ferulic acid) and many flavonoids (Cirsimaritin, Catechin, Acacetin, kaempferol, pinocembrine, quercetin). Salvia extract contains 221.08 ± 2.36 mg EAG/g and 80.54 ± 1.3 mg EQ/g dry extract. Compared to the control group, carrageenan induced a substantial decrease (P<0.05) in antioxidant enzymes and a highly significant increase (P<0.05) in homeostatic parameters (blood sugar, CRP and fibrinogen), biomarkers of inflammation (TNF-α and PGE2) and malondialdehyde levels. Conclusion: The administration of Salvia extract corrects this perturbation where there is an improvement in antioxidant enzymes and a decrease in biomarkers of inflammation. Salvia officinalis has been able to repair carrageenin-induced perturbations homeostasis and inflammation markers in Wistar rats.

Comparison of the Effect of Phenylalanine Arginine Beta Naphthylamide (PAβN) and Curcumin on Minimum Inhibitory Concentration of Aminoglycosides on Pseudomonas aeruginosa Clinical Isolates

Background and Objective: Efflux pump inhibitors (EPIs) can block efflux pumps and are helpful in potentiating the activity of aminoglycosides against Pseudomonas aeruginosa. The present study compared the effects of phenylalanine-arginine beta naphthylamide (PAβN) and curcumin on aminoglycoside minimum inhibitory concentration (MIC) on Pseudomonas aeruginosa clinical isolates. Materials and Methods: For this descriptive-analytical study, 100 clinical isolates of Pseudomonas aeruginosa were collected and identified by differential diagnostic tests. The MICs of amikacin, gentamicin, and tobramycin were evaluated before and after adding EPIs using a micro-broth dilution test. Results: The bacteria were isolated from different types of samples, including urine (26 isolates), sputum (37 isolates), ulcers (20 isolates), catheters (eight isolates), blood (five isolates), feces (two isolates), and eyes (two isolates). Overall, 60 of the isolates were obtained from males (mean age = 47.85), and 40 from females (mean age = 44.76). In the MIC test, 11 (25.5), 15 (34.8), and 18 (41.8) isolates were resistant to amikacin, gentamicin, and tobramycin, respectively. Significant reductions in the MICs of amikacin, gentamicin, and tobramycin were observed after adding curcumin in 54-100 of aminoglycoside-resistant isolates, while fewer changes in the MICs of aminoglycosides were seen against these clinical isolates after adding PAβN (36-55). Conclusion: Curcumin and PAβN can potentiate the effect of aminoglycosides on clinical isolates of Pseudomonas aeruginosa and change their susceptibility pattern due to efflux pump inhibition. However, our outcomes detected that curcumin was more effective than the PAβN against the aminoglycoside-resistant isolates of P. aeruginosa.

Mucinous Adenocarcinoma as a High-risk Factor in Stage II Colorectal Cancer: A Propensity Score-matched Study from Japan.

The purpose of this study was to investigate the clinical, pathological, and prognostic differences between adenocarcinoma (ADC) and mucinous adenocarcinoma (MUC) in colorectal cancer (CRC). This was a retrospective study of a Japanese high-volume cancer Center over a 10-year period. From April 2007 to December 2016, a total of 3,296 patients with primary CRC were included in the study. The clinical characteristics of MUC and ADC were compared. Then, propensity score matching was performed according to a 1:2 ratio. Multivariate analysis was used for independent risk factors related to prognosis. The overall survival (OS) and disease-free survival (DFS) of 126 cases of MUC and 256 cases of ADC were studied, as well as the survival rate of each stage. MUC accounts for 3.82% of the total CRC. Compared to ADC, MUC is more common in female patients (47.62% vs. 38.77%; p=0.045), with higher carcinoembryonic antigen levels (56.35% vs. 34.95%; p<0.001), more ulcerative and infiltrative types (82.54% vs. 72.93%; p=0.016), higher incidence of perineural infiltration (51.59% vs. 41.04%; p=0.018), deeper infiltration (T3-T4: 90.48% vs. 65.84%; p<0.001), and more advanced cancer (stage III-IV: 59.52% vs. 44.79%; p=0.001). MUC is also more likely to recur (24.6% vs. 14.32%; p=0.001). Regarding the long-term survival rate, the OS (p<0.001) and DFS (p=0.05) is consequently worse. After propensity score matching, multivariate analysis showed that MUC was a common independent risk factor for DFS [odds ratio (OR)=4.277; 95% confidence interval (CI), 0.327-0.97; p=0.039], and also for OS (OR= 6.836; 95% CI, 0.274-0.831; p=0.009). In MUC, OS and DFS were still relatively worse (OS: p=0.017; DFS: p=0.038). However, only significant statistical differences were shown in stage II (OS: p=0.003; DFS: p=0.007). No significant differences were noted in the stages I, III, or IV. MUC is a high-risk factor for stage II CRC. Adjuvant chemotherapy should be routinely recommended for patients with MUC stage II, and special attention should be paid during their follow-up.

Digital ulcers: should debridement be a standard of care in systemic sclerosis?

Digital ulcers are a serious, recurrent complication in patients with systemic sclerosis. They are often slow to heal and exquisitely painful. Local wound care, such as debridement of the wound bed, is an essential component in the management of digital ulcers in systemic sclerosis. However, digital ulcer debridement is not a standard of care, and there is substantial international variation in the use of this approach. In this Viewpoint, we discuss the assessment of the wound bed and different methods of debridement using the model of tissue management, infection and inflammation, moisture control, and wound edge or epidermal advancement, known as TIME. We highlight the challenges in standard practice and the need for research into local wound care for this type of ulceration, before suggesting a potential roadmap to develop a standardised approach to support ulcer debridement in systemic sclerosis. Debridement might be the missing component in optimising the management of digital ulcers and we propose that the approach should be rigorously investigated as a standard of care in this common complication of systemic sclerosis.

Gastric and duodenal ulcers, periodontal disease, and risk of bladder cancer in the Health Professionals Follow-up Study.

Studies suggest that peptic ulcer and periodontal disease are positively associated with bladder cancer risk. These two factors are likely to share common biologic mechanisms such as inflammation and dysbiosis. We examined the joint association of peptic ulcer (gastric/duodenal) and periodontal disease on bladder cancer risk. We conducted a prospective analysis among 45,185 men (563 invasive bladder cancer cases) in the Health Professionals Follow-Up Study (follow-up 1986-2016). History of ulcer and periodontal disease was self-reported at baseline and updated during the follow-up. Cox proportional hazards models estimated hazard ratio (HR) and 95% confidence interval (CI) for the joint associations of ulcers (gastric, duodenal) and periodontal disease, adjusting for age and other potential confounders. We tested for interaction using the Wald test for product terms. Compared with men having no history of ulcer and periodontal disease, men with a history of peptic ulcer only (HR 1.22, 95% CI 0.90-1.66) and men with a history of periodontal disease only (HR 1.19, 95% CI 0.98-1.46) were associated with higher risk of invasive bladder cancer. The highest bladder cancer risk was observed in men with a history of both peptic ulcer and periodontal disease (HR 1.52, 95% CI 1.05-2.20). Similar results were found when we stratified by ulcer types. The interactions between ulcer and periodontal disease were not statistically significant for all ulcer types (p-interaction ≥ 0.59). We did not find sufficient evidence for interaction between gastric/duodenal ulcers and periodontal disease on bladder cancer risk.

Phenotypic characterization and genome-wide association studies of digital cushion thickness in Holstein cows

The bovine digital cushion is a compression pad between the distal phalanx and sole and has been associated with claw horn disruption lesions. Digital cushion thickness (DCT) is estimated to be moderately heritable. Therefore, the objectives of our study were to examine influences of management and environment on DCT and to identify genetic markers and candidate genes associated with DCT. In a cohort of 502 Holsteins from 5 farms in New York State, DCT and body condition score (BCS) were collected twice, at <137 d prepartum and from 86 to 127 d in milk, corresponding to periods when the digital cushion is thickest and thinnest, respectively, as determined by previous research. Cows underwent sonographic examination of the digital cushion evaluated at the typical sole ulcer site for the right front and hind foot. Linear mixed models were conducted on DCT with the fixed effects of time point, digit, wither height, sacral height, BCS group, and multiple farm system variables separately and included random effects to control for the random subset of cows per farm, repeated measures, and multiple measurements from each cow. The phenotypic results indicated that DCT varied by sample time point, sacral height, parity, digit, BCS group, and wither height. For the genotypic study, 447 DNA samples were genotyped on the Illumina BovineHD 777K BeadChip (Illumina Inc., San Diego, CA). Quality assessment of markers and samples provided a final data set of 431 samples and 579,449 markers. Genome-wide association studies were conducted for DCT testing inheritance models and genetic variation of digit, foot, time point, and average thickness. One marker passed the Bonferroni correction threshold and 26 passed false discovery rate from 4 genome-wide association studies with covariates of sequencing batch plate, parity group, BCS, wither height, and sacral height. Ten candidate genes were identified, with 2 genes on Bos taurus autosomes 24 and 29 involved in biological functions related to the digital cushion: MC4R and DLG2 were related to fat deposition and bone growth, respectively. The genetic markers discovered in this study have the opportunity to be used in breeding programs using genomic selection to select against claw horn disruption lesions and lameness due to associations between the markers and DCT. Further studies on the biologically plausible candidate genes may identify causative genetic variants and how they relate to DCT through gene regulation, expression, structure, or copy number variation.

Cadaveric Skin Grafts May Greatly Increase the Healing Rate of Recalcitrant Ulcers When Used Both Alone and in Combination With Split-Thickness Skin Grafts.

Leg ulcers that do not heal despite appropriate treatment are defined as recalcitrant ulcers. Large surface area, depth, and long duration represent some of most important factors impeding ulcer healing. After sharp debridement, dermal substitutes including skin from cadaver donors may increase the healing rate of recalcitrant ulcers reducing the risk of scar formation and recurrence. Assessing if, after sharp debridement, dermal substitutes including skin from cadaver donors may increase the healing rate of recalcitrant ulcers reducing the risk of scar formation and recurrence. Among patients admitted to our hospital for all types of chronic leg ulcers, we retrospectively reviewed the records of patients affected by recalcitrant ulcers (surface greater than 100 cm, tissue loss involving epidermis, dermis, and subcutaneous tissue, duration longer than 1 year, and showing no healing tendency). After sharp debridement, the ulcers were covered by allografts with strict follow-up after discharge. Multiple allografts were performed when necessary, and a final autograft was applied in case of incomplete healing. The records of 414 patients were analyzed. Forty-three patients were lost at follow-up, and the remaining 371 healed after 765 grafting procedures. In 163 patients, the ulcers healed by means of a final autograft. In all the remaining cases, allograft led to ulcer healing. Allografts represent an effective treatment option in case of recalcitrant, large, deep and long-lasting leg ulcers.

Correlation between healing type of lesion and recurrence in gastric neoplastic lesions after endoscopic submucosal dissection.

To date, there are few reports on the clinical association between healing pattern of lesion and local recurrence after endoscopic resection (ER). We examined the risk factors associated with local recurrence after endoscopic submucosal dissection (ESD) and the correlation between healing type of lesion and recurrence. We retrospectively analyzed medical records of 293 patients who underwent ESD of early gastric cancer or gastric adenoma between April 2010 and January 2012. We analyzed the relationship among factors such as age, location of lesion, size, pathologic diagnosis, presence of Helicobacter pylori (H. pylori), and healing types of ulcers in patients with local recurrence through follow-up endoscopic surveillance (1, 6, and 12 months after ESD). We analyzed 141 patients except for patients who had not undergone surveillance endoscopy, H. pylori test, and ambiguous healing patterns. There were no significant correlations between local recurrences concerning sex, age, tumor size, location, and pathologic diagnosis. When the healing type of the ulcer was divided into hypertrophic polypoid type (9 cases (6.4%)), scar type (122 cases (86.5%)), and nodular type (10 cases (7.1%)), the scar type was found to be most common. A total of eight patients (5.7%) developed local recurrence, of which five were of nodular type and statistically significant (p=0.000). The most common type of ulcer healing was scar type after ESD, but nodular type was associated with local recurrence. When we perform follow-up endoscopy after ESD, we should pay attention to the lesion that has nodular change of mucosal surface.

Numerous lymph node metastases in early gastric cancer without preoperatively enlarged lymph nodes: a case report

BackgroundAccording to the 2018 Japanese gastric cancer treatment guidelines (ver. 5), a reduced extent of lymphadenectomy (D1 or D1+) is indicated for cT1 N0 tumors that do not meet the criteria for endoscopic resection. However, early gastric cancer with multiple lymph node metastases is not unknown, and cases have been reported. We report a case of a patient with early gastric cancer and numerous nodal metastases who underwent laparoscopic proximal gastrectomy based on a preoperative diagnosis of T1 N0.Case presentationA 69-year-old woman underwent emergent endoscopic hemostasis for massive hematemesis of the stomach, and endoscopic examination showed ulceration with a visible vessel. Pathological biopsy examination of the ulcer identified poorly differentiated adenocarcinoma with signet ring cells. The patient was diagnosed with early gastric cancer that was not indicated for endoscopic resection because of the ulceration and histological type. Endoscopic ultrasound showed that the third layer was poorly demarcated at the ulcer scar, indicating invasion to the submucosal layer. Computed tomography did not reveal enlarged lymph nodes or distant metastasis. The preoperative diagnosis was early gastric cancer of the fundus without nodal metastasis, and laparoscopic proximal gastrectomy with D1+ lymphadenectomy was performed. The initial postoperative pathological diagnosis was intramucosal carcinoma without lymphovascular invasion; however, the presence of 26 lymph node metastases was revealed unexpectedly. Additional pathological examination of more resected specimens transected every 2–3 mm revealed that only one lesion contained a small number of cancer cells in the lymphatic duct below the muscularis mucosa.ConclusionsWe report a case of early gastric cancer with 26 nodal metastases in which lymph node involvement was not identified prior to surgery. These findings indicate that the extent of lymphadenectomy and the surgical procedure should be carefully decided even in cT1 N0 early gastric cancer when several risk factors for lymph node metastasis are present.

Low Prevalence of Helicobacter pylori-Positive Peptic Ulcers in Private Outpatient Endoscopy Centers in the United States.

During the past decades, the prevalence of gastric and duodenal ulcers, as well as Helicobacter pylori infection, has markedly declined. We hypothesized that the decline in H. pylori prevalence has decreased the fraction of H. pylori-positive gastric and duodenal ulcers. The present study was designed to test this hypothesis in a large US population undergoing esophagogastro-duodenoscopy in community-based endoscopy centers. The Inform Diagnostics database is a national electronic repository of histopathologic records of patients distributed throughout the United States. A cross-sectional study among 1,289,641 individual esophagogastro-duodenoscopy patients analyzed the prevalence of peptic ulcers stratified by age, sex, ethnicity, H. pylori status, year of diagnosis, and ulcer type. The joint influence of multiple predictor variables on the occurrence of gastric and duodenal ulcers was analyzed using multivariate logistic regression analysis. Between 2009 and 2018, the general prevalence of H. pylori infection fell significantly from 11% to 9%. This decline was accompanied by a similar decline in the fraction of H. pylori-positive gastric ulcers from 17% to 14% and H. pylori-positive duodenal ulcers from 25% to 21%. Nowadays, only 17% of all patients with ulcer harbor H. pylori. The fraction of H. pylori-positive ulcers was significantly greater in duodenal than in gastric ulcers and in male than in female patients with ulcer. The prevalence of H. pylori was 2.6-fold higher among Hispanics and 3.2-fold higher among East Asians compared with the general population. The H. pylori prevalence fell from 24% to 22% among Hispanics and from 21% to 15% among East Asians. In East Asians and Hispanics, the fraction of H. pylori-positive gastric ulcers was 37% and 35%, respectively. H. pylori infection continues to fall in the general population. Nowadays, even among patients with ulcer only a small minority harbors H. pylori infection.

Hyperbaric oxygen therapy in diabetic foot ulceration: Useless or useful? A battle.

The use of hyperbaric oxygen therapy (HBO) in the treatment of certain types of diabetic foot ulcers (DFU) has been the topic of much debate and disagreement over the last several decades. In this review, the evidence for its use is presented and discussed by two experts in DFU management. Whereas some randomized controlled trials suggest that HBO may speed the healing of certain ischaemic or neuroischaemic ulcers after the failure of standard of care, most recent trials have been negative. No RCT is perfect, and the weaknesses of RCTs in this therapeutic area are discussed. It can be concluded that the indications for the use of HBO remain unclear, and that large, rigorously designed and executed RCTs are required to clarify the use of HBO in DFU treatment.

Assessing and managing patients with leg ulceration and oedema

Leg ulcers are some of the most common wounds treated by the NHS. Ulceration is usually classified as being of venous or arterial origin. Arterial ulcers develop because of reduced arterial flow to the leg caused by peripheral arterial disease. Venous leg ulcers, the most common form, develop because of vein incompetence, with valve failure leading to pressure in the veins. Nurses working with patients with oedema find that chronic oedema can cause the affected limb to swell, causing skin to stretch and break and lead to ulceration. This is known as superficial ulceration. This article discusses the causes, assessment and prescribing practices of these different types of leg ulcer.