Ulcer Area Research Articles

Endoscopic severity and classification of lesions with pan-enteric capsule endoscopy and ileocolonoscopy in ileocolonic Crohn's disease.

Background and study aims Recent evidence supports the use of pan-enteric capsule endoscopy (CE) for the diagnosis and follow-up of Crohn's disease (CD). The aim of this study was to examine the agreement between CE and ileocolonoscopy (IC) for determining the severity and classification of lesions in ileocolonic CD. Patients and methods In a prospective blinded multicenter study, patients with suspected CD were examined with CE and IC within 2 weeks. Ninety-nine participants with a full IC and CE were included in the analysis. The ileocolonic disease severity was assessed with the Simple Endoscopic Score for Crohn's Disease (SES-CD). Results CD was diagnosed in 30 patients with IC and CE. The mean SES-CD was 9.8 (CI 7.9-11.8) and 10.6 (CI 8.2-13.1), respectively ( P = 0.69). There was a substantial agreement (ICC 0.83, CI 0.68-0.92) and a strong correlation between SES-CD assessed with IC and CE (r s = 0.78, P < 0.001). 55 bowel segments had ulcerations with both modalities (terminal ileum 24, right colon 12, transverse colon eight, left colon eight and rectum three). Mean sub-scores for ulcer size, area of ulcerated surface and area of affected surface did not differ between modalities. The inter-modality agreement (κ) was 0.46, 0.34 and 0.43, respectively ( P < 0.001). Conclusions There is a strong correlation between IC and CE for the severity of ileocolonic CD. The agreement for SES-CD sub-scores is fair to moderate. CE could be an alternative to IC for the assessment of endoscopic severity in selected patients with suspected CD.

Preliminary Application of Contrast-Enhanced Ultrasound in the Treatment of Diabetic Ulcers

To investigate the role of contrast-enhanced ultrasound (CEUS) in the treatment of diabetic ulcers. The clinical data of 27 diabetic patients, who underwent CEUS examination of their ulcers in our hospital between April 2021 and July 2022 were collected. Among them, 26 patients suffered from diabetic foot ulcers, 5 of whom underwent amputation during hospitalization, and one patient suffered from hip ulcer. The 27 patients' mean age was (64.08±12.57) years. Fasting blood glucose levels of the patients were 3.36-34.61 mmol/L, with a mean of (10.62±8.77) mmol/L. Their glycosylated hemoglobin levels were 5.80%-10.70%, with an average of 7.96%±1.50%. Philips EPIQ7 ultrasound system with L9-3 linear probe of 3-9 MHz was used. First, the patients' ulcers were examined with conventional ultrasound to observe for abnormal echo. Then, 2.4 mL SonoVue (Bracco, Italy), a contrast agent, was injected intravenously through the elbow to look for effusion/pus, sinus tract, or dead space in the lesion area, and images were acquired. Among the 27 patients, except for 5 with amputation stumps, 22 patients had wound areas ranging from 0.16 cm 2 to 215 cm 2, all being accompanied by sinus tract formation. Ten patients underwent ultrasound examination during their treatment. The positive rate of the results of conventional ultrasound was 50% (5/10) for identifying effusion/pus and pseudoaneurysm in the deep area of ulcers, while the positive rate of CEUS results was 100% (10/10). In addition to the lesions found by conventional ultrasound, CEUS also found large sinus tracts or dead spaces in the deep surface of ulcers in 5 additional patients. Of the 27 patients, 17 underwent ultrasound examination of the healing status of sinus tracts and dead spaces in the deep areas of ulcers before discharge. No sinus tracts in the deep areas of the ulcers were found by conventional ultrasound. However, relatively small dead spaces or sinus tracts in the deep areas of the ulcers were found in 10 patients by CEUS. Conventional ultrasound and CEUS found that 1 patient had a small amount of fluid in the amputation stump. In the remaining 6 patients, no deep sinus tracts in the ulcers were found by either conventional ultrasound or CUES, and the ulcers healed completely. By examining microvascular perfusion in diabetic wounds with CEUS, we can observe the extent of sinus tracts during treatment and whether the sinus tracts have healed or whether there are still dead spaces before patient discharge, which provides support for clinical decision-making concerning the treatment of diabetic ulcers.

Phenytoin versus Normal Saline Dressings in the Healing of Chronic Diabetic Foot Ulcers: A Longitudinal Study

Introduction: Chronic wounds, especially the non healing type, are among the foremost common conditions encountered by a surgeon. Currently, steady research is being pursued on the creation of fancy and indulgent topical growth factors for wound healing. One such agent is phenytoin which has a stimulatory effect on connective tissue. Several studies were conducted worldwide to study the effect of phenytoin on chronic ulcers. However, such studies are lacking in our geographical area. Aim: To compare the efficacy of topical phenytoin dressings with conventional saline dressings in the healing of chronic Diabetic Foot Ulcers (DFUs), in terms of the surface area of ulcer, granulation tissue formation as a percentage of the surface area of ulcer, duration of hospital stay, and side effects. Materials and Methods: This was a longitudinal study that included 100 patients with chronic DFUs admitted to a tertiary care hospital, in North Andhra Pradesh for a period of 1 year. The study population was divided into two groups based on the patient’s willingness for undergoing topical phenytoin therapy. Patients willing to undergo the topical phenytoin dressing therapy formed the study group (n=50) and those who were not willing were subjected to traditional saline dressings, which formed the control group (n=50). The variables of the surface area of the ulcer, granulation tissue formation as a percentage of the surface area of the ulcer, duration of hospital stay, and side effects of topical phenytoin dressings were compared using Paired, and Unpaired Student’s t-test, and the p-value of &lt;0.05 was considered significant. Results: The mean age in the study group was 53.94 years and in the control group was 55.92 years. The male:female ratio in the study group was 5:1 and in the control group was 3:1. The mean ulcer surface area in the control group was 37.6 cm2 and in the study group was 40.4 cm2 (p-value=0.012). The mean area of granulation tissue formation in the control group was 36.07 cm2±5.7, and in the study group was 39.63 cm2±2.6 of the total ulcer surface area (p-value=0.001). The granulation tissue formation in the control group was 95.93% of the total ulcer surface area, and in the study group was 98.09% of the total ulcer surface area (p-value=0.001). The mean hospital stay in the control group was 31.3±4.2 days and in the study group was 27.8±2.4 days (p-value=0.001). Conclusion: Phenytoin is better alternative dressing agent with lesser side effects for diabetic foot ulcer care.

Dermoscopic Findings of Clonal Seborrheic Keratosis and Pigmented Basal Cell Carcinoma in the Skin of Color Patients - A Comparison.

Dermoscopic Findings of Clonal Seborrheic Keratosis and Pigmented Basal Cell Carcinoma in the Skin of Color Patients - A Comparison.

Dynamic characterization of vascular response and treatment in oral traumatic ulcer in mice via photoacoustic imaging.

Dynamic surveillance of vasculature is essential for evaluating the healing of oral ulcer. Existing techniques used in vascular imaging face limitations, such as inadequate spatial resolution, restricted diagnostic depth, and the necessity of exogenous contrast agents. Therefore, this study aimed to use robust photoacoustic imaging (PAI) for the dynamic monitoring of vascular response during healing and the associated treatment process of oral ulcer. Kunming mice (male, 8 weeks old, 31-41 g) were treated with 50% acetic acid for 90 s on the tongue mucosa for induction of oral traumatic ulcer. Mice were randomly divided into three groups (n=12): the control, compound chamomile and lidocaine hydrochloride gel (CCLH), and phycocyanin (PC) groups. PAI was then conducted on days 0, 2, 3, 5, and 7 to obtain vessel parameters of the ulcer area, including vessel intensity, density, mean diameter, maximum diameter, and curvature. Immunohistochemical and hematoxylin and eosin (HE) staining were performed on days 3 and 7 to assess microvessel density and inflammation score. The ulcer healing rate and body weight changes were evaluated for clinical observation. Beginning on the second day after ulcer induction, there was a progressive increase over time in blood intensity and vessel parameters, including vascular density and diameter. On day 7, the CCLH and PC groups demonstrated significantly higher measures than did the control group in terms of blood intensity (P<0.05 and P<0.01), vascular density (both P values <0.05), mean diameter (both P values <0.01), and maximum diameter (P<0.01 and P<0.05). Vessel curvature in the two treatment groups exhibited no significant differences compared to that in the control group (both P values >0.05). The effects of vascular morphological changes were further supported by the histological and clinical outcomes. On day 7, compared to that of the control group, the level of microvessel density was significantly higher in both the CCLH (P<0.01) and PC (P<0.05) groups. The histopathological score in PC group was significantly lower than that of the control group on day 7 (P<0.05). Additionally, compared to that of the control group, the healing rates of the CCLH (P<0.01) and PC groups (P<0.05) were superior on day 7. On day 3, the control group showed more weight loss than did the CCLH (P<0.05) and PC (P<0.01) groups. These findings indicate that PAI is a valuable strategy for the dynamic and quantitative analysis of vascular alterations in oral traumatic ulcers and support its prospective application in improving clinical treatment.

The Effectiveness of Ozone Therapy on Diabetic Ulcer Repair: A Systematic Review and Meta-analysis: Study of Changes in Wound Size

Introduction: Diabetic foot ulcer (DFU) is a typical dermatological complication often found in patients with diabetes mellitus (DM). Chronic hyperglycemia state causes microvascular impairment that leads to loss of peripheral sensory, motor, and autonomous functions. The current diabetic ulcer therapy has not yet provided a satisfactory reduction of the ulcer area; thus, several adjuvant therapies were tried, such as using ozone therapy, either systematically or topically. Ozone increases the cell membrane permeability to glucose, increases oxygen metabolism, improves oxidative preconditioning, stimulates endogenous antioxidant systems, and has anti-inflammatory and antibacterial effects. Methods: This study was an analytic observational study, with systematic review and meta-analysis. Data searching were conducted online at Pubmed-MEDLINE, Scopus, EBSCOhost, ProQuest, Cochrane library, ClinicalTrials.gov, and Google Scholar, as well as hand-searching from libraries in Indonesia. Five most relevant articles included in the qualitative (systematic review) (n = 449) and three of those five articles included in the quantitative analysis (meta-analysis) (n = 211). Reduction of ulcer area was assessed. Results: The meta-analysis of effectiveness of ozone intervention group compared to the control group showed a homogeneity in data (Q=95.547, df=2; p=0.000, Tau2=5.276). Meta-analysis showed the value of Q statistic was z value = -9.478; (p=0.000). This shows that the overall administration of ozone can significantly improve the diabetic ulcer repair. The overall standardized mean difference showed an increase in the reduction of ulcer area following ozone therapy was -1.740 (95% CI [-2.100 to -1.380], p=0.00). These results indicate that the ulcer healing of the intervention group was significantly better than the control group. Conclusion: Systematic review and meta-analysis results show that the application of ozone therapy significantly improves DFU repair.

Photobiomodulation Therapy Improves Inflammatory Responses by Modifying Stereological Parameters, microRNA-21 and FGF2 Expression.

Introduction: Photobiomodulation treatment (PBMT) is a relatively invasive method for treating wounds. An appropriate type of PBMT can produce desired and directed cellular and molecular processes. The aim of this study was to investigate the impacts of PBMT on stereological factors, bacterial count, and the expression of microRNA-21 and FGF2 in an infected, ischemic, and delayed wound healing model in rats with type one diabetes mellitus. Methods: A delayed, ischemic, and infected wound was produced on the back skin of all 24 DM1 rats. Then, they were put into 4 groups at random (n=6 per group): 1=Control group day4 (CGday4); 2=Control group day 8 (CGday8); 3=PBMT group day4 (PGday4), in which the rats were exposed to PBMT and killed on day 4; 4=PBMT group day8 (PGday8), in which the rats received PBMT and they were killed on day 8. The size of the wound, the number of microbial colonies, stereological parameters, and the expression of microRNA-21 and FGF2 were all assessed in this study throughout the inflammation (day 4) and proliferation (day 8) stages of wound healing. Results: On days 4 and 8, we discovered that the PGday4 and PGday8 groups significantly improved stereological parameters in comparison with the same CG groups. In terms of ulcer area size and microbiological counts, the PGday4 and PGday8 groups performed much better than the same CG groups. Simultaneously, the biomechanical findings in the PGday4 and PGday8 groups were much more extensive than those in the same CG groups. On days 4 and 8, the expression of FGF2 and microRNA-21 was more in all PG groups than in the CG groups (P<0.01). Conclusion: PBMT significantly speeds up the repair of ischemic and MARS-infected wounds in DM1 rats by lowering microbial counts and modifying stereological parameters, microRNA-21, and FGF2 expression.

Use of Homologous Platelet Gel to Manage Refractory Diabetic Lower Extremity Ulcers: Additional Experience at a Tertiary Hospital

Background. DLEUs are a major cause of morbidity. Appropriate treatment is essential, and newer methods to achieve ulcer healing have been described, including application of PG. Objective. This study evaluated the effectiveness and safety of homologous PG in patients with chronic noninfected DLEU refractory to standard treatment as well as possible correlations between patient comorbidities and response to treatment. Materials and Methods. Data from patients with chronic refractory DLEU managed with homologous PG between January 2014 and October 2022 were evaluated (comorbidities, wound characteristics, number and time of treatment, outcome). Outcome was classified as complete response (complete ulcer healing with reepithelialization), partial response (≥50% reduction in area and/or improvement of pain), or absence of response. The chi-square test was used to compare groups, with alpha level set at less than .05. Results. A total of 81 patients (63 male, 18 female; median age, 65 years; median HbA1c, 7.6%; median ulcer area, 2.9 cm2) were proposed for PG application. A total of 62 patients had 3 or more comorbidities. Outcome was evaluated in 69 patients, with response observed in 49% (complete, 32%; partial, 17%). Worse outcomes occurred in patients with polyneuropathy (chi-square statistic: 4.183; P = .041). Conclusion. Homologous PG is a safe and possibly effective therapeutic alternative for DLEU that is unresponsive to standard therapies.

The Effect of Platelet Rich Plasma (PRP) Injection to the Wound Compared to PRP Jel Local Application Compared to Classic Dressing on Diabetic Foot Healing Ulcer

Background: The goal of our work-study was to detect the net result and potency of of PRP local jnj. Dressings compared to PRP in jel to the wound for DFU healing compared to a control therapy of traditional classic dressing (PRP) also to decrease the recurrence (DFUs). Diabetic foot is a more famous and face any surgeon in his clinic or hospital. It has a new promise therapy of diabetic foot ulceration (DFU), with cellular and tissue regeneration, because of several methods in wound care management. All hope to attain good healing and hope to decrease recurrent rate. Patients and Methods: Forty-five patients with DFU were matched and grouped for (PRP) local injection dressings (n = 15), PRP jel to wound edges (n = 15), or classic dressing (n = 15) from August 2019 to March 2021. There were additional complications and ulcer recurrences were detected Ulcer or raw area healing and reduction were the primary objectives at 1; 3, 6, and 12 months. The study comprised 36 (80.0%) males and 9 (20.0%) females between the ages of 30 and 65 who had DFU for 1 to 10 years. Results: Local PRP injections improved healing 12/15 (80%) greater than local PRP jel dressings 10/15 (66.7%) and classic dressings 7/15(46.7%). However, PRP wound injection increase the healing of diabetic ulcers raw area more than PRP local jel or traditional classic dressing the healing period following local PRP injection was much shorter. At all follow-up visits, the in all the groups had similar rates of recurrence and complications. All of them had similar recurrence and variant safety. Conclusions: PRP injection is a more potent technique for treating DFU than local PRP jel administration and classic wound dressings, with slight the same recurrence. Less Amputation rates, infection rates, and discharges are all reduced with PRP injection than PRP jel than classic treatment.

The Use of Selamectin in Treating Notoedric Mange in Cats: A Case Report

Notoedric mange in cats is less commonly diagnosed compared to sarcoptic mange. In the present study, a 9-month-old tomcat with severe itching, alopecia, crusts, and ulcerative necrotic areas on the head and neck underwent a clinical examination. The laboratory tests (superficial scrapes of the skin) confirmed the presence of Notoedres mites. The topical administration of 2 doses of 45 mg selamectin, 14 days apart, resulted in the complete healing of the animal.

Freshwater Clam Extract Attenuates Indomethacin-Induced Gastric Damage In Vitro and In Vivo.

Contemporary pharmacological studies have reported that freshwater clam (Corbicula fluminea) can provide a broad spectrum of bioactivities, including antioxidant, anticancer, antihypertensive, hepatoprotective, and hypocholesterolemic effects. The aim of this study was to evaluate the gastroprotective effects of water extract of freshwater clam (WEC) on indomethacin (IND)-induced gastric mucosal cell damage in vitro and gastric ulcer in vivo. The cell viability of rat gastric mucosa RGM-1 cells was markedly decreased by 0.8 mM of IND treatment, and pre-treated with various concentration of WEC significantly restored IND-induced cell damage in a dose-dependent manner. WEC also significantly attenuated the elevated reactive oxygen species (ROS) levels, inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) expression, and nuclear factor-κB (NF-κB) p65 nuclear translocation induced by IND. In the in vivo study, IND caused severe gastric ulcer in Wistar rats, while WEC pretreatment effectively reduced the ulcer area and edema in the submucosa. We found that WEC significantly restored glutathione (GSH) content in gastric mucosa in a dose-dependent manner (p < 0.05). The reduction of prostaglandin E2 (PGE2) caused by IND was also improved with higher doses of WEC administration. Moreover, the overexpression of COX-2, iNOS, and tumor necrosis factor-α (TNF-α) proteins in gastric mucosa was downregulated by administration of WEC. Consequently, WEC can be used as a potential nutritional supplement to improve NSAIDs-caused gastric mucosal lesions.

Oral Immune-Related Adverse Events Associated with PD-1 Inhibitor Treatment: A Case Series

Introduction: Immune Checkpoint Inhibitor (ICI) drugs have led to a revolution in the treatment of different forms of cancer, shifting the target of action from cancer cells to the patient’s immune system, enhancing their responses against the tumor itself. On the other hand, this mechanism can lead to responses against oneself, with the appearance of immune-related adverse events. The aim of the present study was to examine the immune-related adverse events (irAEs) affecting the mucous membranes of the oral cavity and the possible correlation between these and skin toxicities, which are reported in the literature as the most common adverse events. Materials and methods: Thirteen patients treated with anti-Programmed Death (PD-1) drugs (pembrolizumab, nivolumab, and cemiplimab) were selected. The data collected include the general history of the patient and the type of anticancer treatment. The sample was then analyzed by recording the alterations found on the mucous membranes of the oral cavity and on the skin. Finally, the average time that elapsed between the start of immunotherapy and the onset of lesions was analyzed. Results: Patients often had multiple lesions at the same time. Hyperkeratosis was found in three patients, candidiasis (pseudomembranous and median rhomboid glossitis) in two patients, epithelial atrophy in four patients, and ulcerative areas in two patients. One patient reported xerostomia with dysphagia. The anatomical areas most involved were the dorsal tongue and palate. Skin irAEs included skin rash erythema (n = 7) with diffuse redness, the presence of small bubbles with a crusty outcome, and dryness of the skin in the affected areas. Discussion: In the literature, there are few studies that analyze how irAEs affect the mucous membranes of the oral cavity in patients treated with ICI drugs. The most frequently described lesions are lichenoid reactions and xerostomia. Moreover, the development of mucositis, generally of low grade, has been reported. The present study has confirmed the data from the literature and, in addition, reports two cases of candidiasis, an adverse event that has never been shown in the literature. Conclusions: irAEs have the potential to affect any organ. The only way to avoid the occurrence of serious events that is currently available is early interception, which is only possible through the knowledge of these manifestations. It is therefore considered necessary to deepen our knowledge of oral irAEs and their correlation with dermatological toxicities, allowing for a multidisciplinary classification of the patient and a timely diagnosis of any adverse event and avoiding progression to more advanced stages, which could lead to the temporary or permanent suspension of anticancer drugs.

Adjacent Fu's subcutaneous needling as an adjunctive healing strategy for diabetic foot ulcers: Two case reports.

Diabetic foot ulcers (DFUs) present with different grades of ischemia and infection and are associated with high mortality and disability rates with little effective treatment. We used Fu Subcutaneous Needling (FSN) to treat 2 cases with DFUs and achieved satisfactory results. Two cases of DFUs showed poor recovery after conventional wound care treatment, and case 2 was confronted with the risk of amputation. Two patients with history of diabetes were diagnosed with DFUs, presenting with lower leg and foot ulcers. Case 1 received 6 sessions of FSN treatment in 8 days, and case 2 received 10 sessions of FSN treatment in 14 days. Case 1 completely healed from a 1 × 0.5-cm blister and a 0.5 × 0.5-cm ulcer of the right lower leg 14 days after the first FSN treatment. The ulcer area of the left foot in case 2 decreased from 6 × 7 cm to 4 × 3.5 × 0.2 cm. Three months of follow-up revealed full wound closure. FSN is effective for healing with DFUs, and it may be used as an adjunctive healing strategy for DFUs patients when conventional treatments such as infection, glycemic control, and local ulcer care are not available.

Management of Vaginal Hyperplasia in Bitches by Bühner Suture.

Vaginal hyperplasia in bitch is an exaggerated response of the vaginal mucosa to estrogens during the proestral-estral phase of the cycle that can protrude through the vulvar lips. The present study refers to the management of vaginal hyperplasia in bitches by Bühner vulvar suture. Fourteen private-owners animals were refereed for spontaneous vaginal hyperplasia and complete protrusion of the mucosa, without ischemic or necrotic areas, which occurred during the proestral-estral phase. Under general anesthesia, prolapsed mass was cleaned with 50% glucose solution to reduce oedema and gently repositioned; the Bühner suture was applied using a Gerlach needle and a sterile vaginal suture tape, maintaining a minimal opening to allow urination in order to avoid possible recurrence in the same estrus. None of the bitches showed recurrence during the current cycle, proving the effectiveness of the Bühner suture. To prevent the possible recurrence of vaginal hyperplasia at the subsequent estrus, all the bitches underwent an ovariectomy 2 months later, when the Bühner suture was removed. In conclusion, the Bühner suture proved to be useful for the conservative treatment of vaginal hyperplasia in medium- or large-sized bitches. However, this approach should be considered only for cases in which the prolapsed mass does not show trauma, ulceration, ischemic or necrotic areas.

Fungal keratitis treated with a combination of traditional Chinese medicine and Western medicine: A case report

Currently, the primary treatments for fungal keratitis (FK) are drugs and surgery. However, drug treatment has low efficacy and many side effects, and surgical treatment is costly. Therefore, it is critical to develop a new method of FK treatment. This report describes a 56-year-old male patient with FK who was treated with a combination of traditional Chinese medicine (TCM) and Western medicine with noticeable results and few side effects. The main symptoms were blurred vision in the right eye and pain. On the corneal surface, a large area of ulcer with a turbid margin was visible, along with an oral ulcer. Additionally, the patient was afraid of corneal transplantation due to financial constraints. The case was diagnosed as FK. In vivo confocal microscopy is the first choice for the diagnosis of this condition. Corneal ulcer was infiltrated with numerous inflammatory cells and dendritic fungal hyphae, as determined by in vivo confocal microscopy. Early in his illness, the patient was treated with only Western medicine, which resulted in poor outcomes and severe adverse reactions. Corneal transplantation was recommended by the first hospital. The patient was later transferred to our hospital for treatment with TCM decoction. After 21 days of treatment, the corneal ulcer of the patient became shallower, his vision improved, and his discomfort disappeared. Due to financial concerns, the patient and his family requested early discharge, so no follow-up disease information was obtained. However, when analyzing the disease development process in the hospital, the combination of TCM and Western medicine had obvious effects and a high level of safety. This case report shows that TCM is safe and effective in the treatment of FK and is worthy of promotion. However, in practice, we found that TCM is better for patients with early FK, so early diagnosis of FK is crucial.

Melanin from Sepia pharaonis ink alleviates mucosal damage and reduces inflammation to prevent alcohol-induced gastric ulcers

Melanin (MSI) is the primary component of Sepia pharaonis ink. Studies have demonstrated melanin's anti-inflammatory and antioxidant activities in colitis. In the present study, the protective effect of ink melanin against ethanol-induced gastric mucosal damage in mice was investigated. After oral administration of MSI for 12 days, the mice were treated with anhydrous ethanol (0.2 mL) to establish the gastric ulcer model. Histopathological analysis showed that MSI reduced the ulcer area and bleeding symptoms of gastric tissue. MSI exhibited significant antioxidant properties by upregulating superoxide dismutase (SOD), glutathione (GSH), and catalase (CAT) activities and decreasing malondialdehyde (MDA) content. The expression levels of epidermal growth factor (EGF), epidermal growth factor receptor (EGFR), and prostaglandin E−2 (PGE2) significantly decreased during gastric mucosal injury, while MSI significantly reversed the effects. Furthermore, MSI reduced the expression of inflammatory factors tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β) and the protein expression of toll-like receptor 4 (TLR4), p38 mitogen-activated protein kinase (p38 MAPK) and extracellular signal-regulated protein kinases 1/2 (ERK1/2). In addition, MSI repressed gastric cell apoptosis by decreasing the expression of Caspase-3. In conclusion, MSI alleviated ethanol-induced gastric ulcer injury by modulating oxidation stress and inflammatory cytokines and maintaining the mucosal barrier, which can be used as therapeutic functional food or nutritional supplement to prevent gastric ulcers. Meanwhile, the mechanism of MSI targeted gastric TLR4/MAPKs pathway deserves further verification.

Evaluation of clinical, histology, TNF-α, and collagen expressions on oral ulcer in rats after treatment with areca nut and chrysanthemum oral gel

Background: Areca nut (Areca catechu Linn.) is the seed of the fruit of the oriental palm that is commonly used among Southeast Asian communities. Chrysanthemum (Dendrathema grandiflora) is a flowering plant originating from East Asia and dominantly grows in China. Both of these plants have strong antioxidant activities. To investigate the mechanism of their wound healing activities, we prepared areca nut and chrysanthemum polyethylene oral gel and performed several in vivo assays using Sprague–Dawley rats. Methods: Sprague–Dawley rats were divided into six groups: Negative control group (rats with base gel treatment), positive control group (rats treated with triamcinolone acetonide), F1 (treatment with 20% areca nut:80% chrysanthemum), F2 (treatment with 50% areca nut:50% chrysanthemum), F3 (treatment with 80% areca nut:20% chrysanthemum), and normal group (without ulcer and treatment). Traumatic ulcers were performed on the buccal mucosa of all experimental animals that received topical oral gel and triamcinolone acetonide twice a day for seven days. The clinical and histological characteristics were analyzed and scored. Results: During the six days, the ulcerated area receded linearly over time and was completely cicatrized in F2, F3, and the positive control group (Dependent t-test, p&lt;0.05). There were significant increases in body weight in F2 and positive control groups. There were no significant differences between groups in histology examination (Kruskal Wallis test, p&lt;0.05). The moderate score of TNF-α levels was seen in F2 and positive control groups (ANOVA/Tukey test, p&lt;0.05). In the collagenases assay, a high concentration of areca nut (F3) induced the abundance of collagen during the ulcer healing process. Conclusions: The combination of areca nut and chrysanthemum extract in the oral gel can optimize the healing of traumatic oral ulcers in Sprague-Dawley rats through the increase of TNF-α and collagen deposition.

Protective Effects of Piperine on Ethanol-Induced Gastric Mucosa Injury by Oxidative Stress Inhibition.

Piper nigrum Linnaeus is often used as a treatment for chills, stomach diseases, and other ailments. Piperine has many biological functions; however, its mechanism for preventing gastric mucosal damage is still unclear. The objective of this study was to investigate the preventive effects of piperine on ethanol-induced gastric mucosal injury by using GES-1 cells and rats. SOD, CAT, GSH-Px and MDA were effectively regulated in GES-1 cells pre-treated with piperine. Piperine significantly increased SOD, CAT and GSH-Px activities, but decreased the ulcer area, MDA, ROS and MPO levels in the gastric tissues of rats. RT-PCR analysis showed that piperine downregulated the mRNA expression levels of keap1, JNK, ERK and p38, and upregulated the mRNA transcription levels of Nrf2 and HO-1. Western blotting results indicated that piperine could activate the protein expression levels of Nrf2 and HO-1 and inhibit the protein expression levels of keap1, p-JNK, p-ERK and p-p38. In conclusion, piperine suppressed ethanol-induced gastric ulcers in vitro and in vivo via oxidation inhibition and improving gastric-protecting activity by regulating the Nrf2/HO-1 and MAPK signalling pathways.

Использование аутологичной кондиционированной плазмы (ACP) в лечении перфоративной язвы роговицы (клинический случай)

Purpose. To evaluate the effectiveness of a combined approach in the treatment of perforated corneal ulcers using autologous conditioned plasma (ACP). Material and methods. In the Republican Clinical Ophthalmological Hospital, 3 patients with a corneal ulcer were treated using ACP. Two patients with corneal ulcer without perforation, one patient with corneal ulcer with perforation. Two patients with a corneal ulcer without perforation, in addition to the standard conservative treatment, received a single application of ACP in the area of the corneal ulcer in several layers, a single subconjunctival injection of ACP. In both cases, the ulcerative process was stopped successfully. A technique for a combined approach to the closure of perforated corneal ulcers has been developed, including primary suturing of the corneal defect in the ulcer area in order to reduce the risk of fluid perfusion; restoration of the anterior chamber with sterile air; multilayer applications of autologous conditioned plasma into the ulcer area and, as it is filled with ACP, the coverage area is expanded to the entire cornea. On average, the coating consists of 5–7 layers with 20–30 sec. polymerization. It is important to remove excess autoplasma with a tupfer and prevent excesses from entering the conjunctival fornix, which minimizes the risk of displacement of the ACP film. Surgery is performed against the background of active antibacterial, antiinflammatory and keratoprotective therapy. Additionally, a soft contact lens was applied at the end of the operation. Results. During surgery, the closure of the perforation of the cornea with an ACP composite was achieved, a stable anterior chamber of the eyeball was noted, and there was no external filtration of the cornea. These results remained stable over the entire follow-up period of 1 month. Conclusions. A positive preliminary clinical result was demonstrated using a combined approach in the treatment of corneal ulcer complicated by perforation using autologous conditioned plasma. Application of ACP to the cornea contributed to the creation of a durable composite to block the perforation. After expanding the number of patients treated by this technique, we assume that this technique can be considered as an alternative for urgent treatment of perforated corneal ulcers without penetrating keratoplasty. Keywords: corneal ulcer with perforation, autologous conditioned plasma, platelet-rich plasma

Morphological and immunohistochemical changes in oxazolone-induced ulcerative colitis under ozone therapy

Introduction. Inflammatory bowel diseases are a serious medical and social problem due to the increase in morbidity and disability among the young, able—bodied population. The aim of the study was to investigate the effect of intraperitoneal and rectal ozone therapy on the morphology and morphometry parameters of the damage zone in oxazole-induced ulcerative colitis in the dynamics of the experiment. Materials and Methods. The study was performed on 97 male Wistar rats. Experimental colitis (EC) was modeled using oxazolone (Sigma-Aldrich; USA). The first stage included skin sensitization by applying 150 ml of a 3% alcohol solution of oxazolone to the interscapular area of the animal, the second stage was a rectal injection of 150 ml of a 3% alcohol solution of oxazolone per rectum to a depth of 7–8 cm. Zoletil-100 (INN: tiletamine hydrochloride) (VirbacSanteAnimale; France) was used for anesthesia at a dose of 20 mg/kg. Morphometry was performed using ImageScope M program (Russia). Colon tissue damage was assessed using tissue damage index (TDI). The content of neutrophils (NF), lymphocytes (LC), eosinophils (EO), histiocytes (HC), plasma cells (PC), fibroblasts (FB) per 1 mm2 was determined in the focus of colorectal damage. Ulcerous defect diameter (in μm) on a PrimoStar microscope (CarlZeiss, Germany), with a Pro150ES morphometric unit (Pixera Corporation, USA). Results. At EC on the second, fourth and sixth days DAI increases, in the lesion of the colon an ulcerous defect is fixed, TDI, the content of NF, LC, EF, PC, HC, FB increase. The intraperitoneal application of ozone was shown to have a positive effect on the tissue morphometry indices of the lesion focus; on the second day and in dynamics on the fourth and sixth day the significant limitation of the ulcerous defect area with the parallel gradual decrease of the tissue damage index (TDI) in comparison with the similar indices in group II was registered. In the rectal variant of ozone application the dynamics of changes in the inflammatory infiltrate composition was also characterized by the significant increase of all parameters on the second, fourth (except for EF), sixth (except for NF, EF) day in comparison with the group of intact animals. The size of the ulcerous defect and tissue damage index after rectal application of ozone on the second day was significantly smaller than in the group with EC and in the intraperitoneal ozone application group, but did not reach the values of the intact group, i.e. there was no complete recovery. Discussion. In experiments on rats it was demonstrated that intraperitoneal injection of ozone at a dose of 150 mg/kg reduces streptozotocin-induced pancreatic damage by increasing the amount of glutathione transferase in the gland tissue, activation of Nrf2-dependent transcriptional pathways, increase in serum insulin and leptin levels. Under clinical conditions the hepatoprotective effect of O3 was shown, as well as an increase in the effectiveness of traditional hepatoprotectors when the latter are combined with O3. Conclusions. Application of ozone therapy in oxazolone-induced ulcerative colitis revealed a positive effect of ozone on the morphological picture of the lesion area and the dynamics of changes in the cellular composition of the inflammatory infiltrate. A more pronounced positive effect of local application of ozone in the form of rectal ozone therapy on morphometry parameters was recorded: normalization on the sixth day of the neutrophil count, more pronounced reduction of the ulcerous defect area, reduction of the tissue damage index.