Healing Process Of Ulcers Research Articles

Expression of VEGF and CD-31 in traumatic ulcer of diabetic Wistar rats after application of Citrus limon peel essential oil.

Diabetes mellitus (DM) is a metabolic disease that delays the healing process, including the interruption of the processes of angiogenesis and vasculogenesis. The etiology of most angiogenic-related diseases, such as diabetes complications, includes the presence of hypoxia caused by declined vascular endothelium growth factor (VEGF) and CD-31. d-limonene, one of the main constituents of Citrus limon, is considered to have angiogenic, antioxidant, hypoglycemic, and anti-inflammatory activities. However, the exact mechanism of this process remains unclear. This study aimed to determine the potential of C. limon as a medication for diabetic ulceration. A total of 30 Wistar rats (Rattus novergicus) induced with DM and traumatic ulcers on the lower lip mucosa were divided into six groups-three each for control and treatment groups. Control groups were treated with CMC 5% gel, and treatment groups were administered with C. limon peel essential oil gel. The expression of VEGF and CD-31 was observed on days 5, 7, and 9. Immunohistochemical examinations were performed with the monoclonal antibodies anti-VEGF and anti-CD-31. ANOVA was conducted to analyze the differences between the groups (p<0.05). An increase in VEGF and CD-31 expression in the treatment group was observed compared with that of the control group (p<0.05). Citrus limon peel essential oil gel increased VEGF and CD-31 expression during the healing process of traumatic ulcers in diabetes-afflicted Wistar rats.

Can collagen sheet work as a catalyst in the healing process of nonhealing ulcers with platelet-rich plasma membrane? - correspondence.

Final Year MBBS Student, NHL Municipal medical college, Ahmedabad, Gujarat Article type :- Letter to Editor Keywords: Non-healing ulcer, Platelet-rich plasma membrane, Platelet-derived growth factor Running title-PRP and collagen sheet in wound healing Submission type – Correspondence (Letter to editor) Disclosure - The authors declare no conflicts of interest.” Being a letter to editor, the article has no patient data. All the research articles that have been cited by the authors has been already presented in the references list. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Published online ■ ■ *Corresponding author. Address: 14, Jagannath Park, NR. Malav-talav, Jivaraj Park, Ahmedabad- 380051. Contact: +91-9173655551. E-mail address: [email protected] (D. H. Desai). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/

Comorbidities as prognostic factors in the healing of venous ulcers

Background: The problem of venous ulcers and chronic venous insufficiency is quite common in dermatological clinics. Every day, we face challenges regarding treatment and prognosis. As the patients are more often over fifty years of age, with more comorbidities, and at the very beginning of treatment, we already have an idea of how the entire process of epithelization of the ulcers may take place. Materials and Methods: A total of 105 patients with chronic venous insufficiency and venous ulcers were included in the study. Each was followed for more than twelve weeks. Patients with hypertension, diabetes mellitus, and thrombophlebitis were analyzed separately. Results: Patients with an ulcer closure time of twelve weeks and longer had a high blood pressure more often. Diabetics with venous ulcers on the lower extremities more often had delayed ulcer healing. A statistically significant difference was confirmed in the distribution of the patients with and without thrombophlebitis. Conclusion: The existence of comorbidities, such as hypertension, diabetes mellitus, and thrombosis, may affect the healing process of venous ulcers, yet thrombosis proved to be the most important factor. Key words: Venous Ulcers; Diabetes Mellitus; Thrombosis; Hypertension

Healing Diabetic Ulcers with Pure Honey dressing: Literature Review

Poor peripheral circulation in patients with diabetes mellitus causes wounds to be difficult to heal. Therefore, patients with diabetes mellitus with diabetic ulcers require wound care to reduce the risk of amputation. One alternative material that can be used for wound care is the topical application of pure honey. The purpose of the study was to determine the effect of honey dressing on the healing process of diabetic ulcers through a literature review. The databases used include PubMed, ScienceDirect, Google Scholar, and Garuda. Keywords using (((honey) OR honey dressing) AND wound healing) AND diabetic ulcer) OR diabetic foot ulcer. The library sources used are from 2010-2020. The search results obtained 9,507 articles. Furthermore, articles were selected based on inclusion and exclusion criteria, obtained 11 articles. The assessment of articles uses a checklist on the JBI (Joanna Briggs Institute) assessment list. Eleven articles that met the assessment criteria were then analyzed one by one. The results showed that eleven articles showed the effect of giving honey dressing on the healing process of diabetic ulcers. A total of 3 articles showed wound healing based on changes in score, 2 articles based on changes in grade, 5 articles based on changes in wound characteristics, and 2 articles based on healing time. Of the eleven journals analyzed, honey dressing on diabetic ulcers were most effectively used in wound Grade I and II (Wagner Classification) ulcer patients who received drug therapy with a GDS &lt;200 mg/dL and received daily wound care for 1 month. Healthcare professionals may consider using honey dressings for the treatment of diabetic ulcers. In addition to a more affordable price, honey has good benefits for wound healing. Further research is needed on the type of honey that is more effective as an ingredient in wound care.

Adipose Mesenchymal Stem Cell Metabolites Oral Gel Enhance Pro-Angiogenic Factors Expression, Angiogenesis, and Clinical Outcome of Oral Ulcer Rat Model.

Enhancing wound healing capacity is one of the main principles in oral ulcer management. Efficient oral ulcer management will accelerate clinical symptom amelioration and prevent complications. Adipose mesenchymal stem cell metabolites (AdMSCM), a novel biological product, contains a plethora of bioactive mediators that can induce a series of processes in wound healing. This study will analyze the clinical outcome, angiogenesis, and expression of FGF-2 and VEGFA in the oral ulcer rat model after AdMSCM oral gel application. Twenty healthy male Wistar rats (Rattus novergicus) were used to create oral ulcer animal models. AdMSCM oral gel treatment was performed three times daily for 3 and 7 days. Clinical outcome was assessed by measuring the major diameter of the ulcer; the angiogenesis was evaluated through histological assessment; the expression of VEGFA and FGF-2 was assessed using the immunohistochemistry method. This study uses parametric comparative analysis using one-way analysis of variance (ANOVA) and post-hoc Tukey's HSD test RESULTS: The application of AdMSCM oral gel in an oral ulcer rat model significantly enhanced the clinical outcome (p < 0.05). In addition, similar results were shown in the histologic assessment of angiogenesis and supported by the significant increase of VEGFA and FGF-2 expression. AdMSCM oral gel accelerates oral ulcer healing processes, proven by the enhancement of angiogenesis, pro-angiogenic factors expression, and clinical outcomes.

Evaluation of Antifungal Potential and Gastroprotective Effect of Ethanol Seed Extract of Spathodea Campanulata of Indomethacin Induced Gastric Ulcer, A Possible Application for Veterinary Animal

The present study evaluates the effects of the plant seed extract of Spathodea Campanulata administration on microbial (Aspergillus niger, Aspergillus flavin, Candida tropicalis and Fusarium oxysporium.) and ulcer inhibition on common Veterinary Albino rats.Spathodea campanulata is an African plant which is used in tropical and subtropical areas for ornamental purposes as well as for the treatment of a range of diseases such as wounds, skin rashes, and haemorrhoids. Materials and Methods: Indomethacin for gastric-ulcer induction, Omeprazole and Tetracycline as standard drug, Disc diffusion method for antifungal and Histopathology for ulcer index. Results: The effects of ethanol seeds extract were studied for antifungal and antiulcer. Where a significant activity observed in various concentration on different fungi indicating a positive agent for the selected pathogens. Also, with 40 albino rats over a period of 7 days, the rats were divided into five groups, those in group one served as the control, group two as the negative control (Indomethacin), group three as the positive control (Omeprazole) and group four and five are dosed ranged groups from 200-400mg/kg extract. Tissue injury and its infiltration were examined and scored; the length and breadth of the lesion were measured for ulcer index. Inflammatory and fibrosis alteration were present in ulcer treated rats, at days 7 colonic wall thickening and fibrotic remodelling were evident as well as blood vessels remodelling. The percentage rate of healing was 10.03% at 200 ppm and 25.51% at 500ppm. The present findings provide an integrated view of ulcer healing processes occurring in the ulcer induced colonic compartment of rats induced by indomethacin. Conclusion: These ulcerogenic alterations may represent a suitable basis for understanding the effects of Spathodea campanulata ethanol seeds extract to ulcer treatment as well as an antifungal.

Application of Stichopus hermanni Nanoparticle Gel in the Healing of Traumatic Ulcers.

The aim of this research was to investigate the use of Stichopus herrmanni nanoparticle gel on the ulcer healing process by observing blood vessels, fibroblasts, and Collagen type-I (COL-1) expression on the 4 and 7th days after trauma. Gold sea cucumber (Stichopus herrmanni) powder was processed by freeze-drying method, then by high-energy milling to form nanoparticle size, and then with CMC 2% to make hydrogel. Traumatic ulcers were formed by induction using a burner. Five groups of male Wistar rats, each consisting of six tails, were divided into a negative control group that was given a placebo, the positive control group was given 0.2% hyaluronic acid, and the treatment group was given gold sea cucumbers with concentrations of 0.135, 0.27, and 0.54% (SH1-SH2-SH3). Fibroblast and blood vessels were examined with hematoxylin-eosin on day 3 and 7, while COL-1 expression was examined with immunohistochemistry on day 7. The rats' mucosa was taken on the 3rd and 7th days after the traumatic ulcer was formed. The data were analyzed using a one-way analysis of variance followed by a post-hoc test with a p less than 0.05. Nanoparticles gel freeze-drying of Stichopus herrmanni increased blood vessels on day 3. Angiogenesis continued to occur, which resulted in increased fibroblast and COL-1 expression on day 7. The application of Stichopus herrmanni nanoparticle gel at 0.27% effectively increased the number of blood vessels, fibroblasts, and COL-1 expression in healing traumatic ulcers.

PENGARUH DUKUNGAN KELUARGA TERHADAP KEPATUHAN PASIEN MENJALANI PERAWATAN LUKA ULKUS DIABETIK

Diabetic ulcers are open sores on the skin layer to the dermis, which usually occur on the soles of the feet. Wounds that arise in DM patients due to complications of microangiopathy and macroangiopathy. Peripheral neuropathy will cause loss of sensation in the distal area of ​​the foot. The length of time a person suffers from DM will cause microangiopathic complications so diabetic neuropathy will cause ulcers on the feet. This study aims to determine the relationship between family support in the healing process of diabetic ulcers with patient compliance in undergoing treatment at the Asri Wound Care Center clinic in Medan using a descriptive correlation research design with a cross-sectional design. The sample in this study was 36 respondents using an accidental sampling technique. The results of the Spearman rank test (rho) with a p-value = 0.004 with a coefficient value of 0.467 then p-value &lt;a (0.000 &lt;0.05), meaning that there is a relationship between family support in the healing process of diabetic ulcers with patient compliance in undergoing treatment at the Asri Wound clinic. Care Center Medan. For education, it is expected that educational institutions can increase the knowledge of students at the institution regarding the importance of family support in the process of healing diabetic ulcers with patient compliance in undergoing treatment.

Effect of Antioxidant Activity of Red Dragon Fruit (Hylocereus polyrhizus) Peel on Fibroblast Proliferation in the Healing Process of Oral Ulcers in Wistar Rats

The purpose of this study is to understand effect of antioxidant activity of red dragon fruit (Hylocereus polyrhizus) peel on fibroblast proliferation in the healing process of oral ulcers in wistar rats. This type of research is a quasi-laboratory experiment with a randomized post test only control group design. This research will be carried out from May to June 2022, including the preparation of red dragon fruit (Hylocereus polyrhizus) peel extract, antioxidant activity tests, making wounds until the time for wound healing, as well as histopathological examination. The population of are wistar rats bred at Eldwin Laboratory is 300 individuals. Based on the calculation, the total sample in this study is 10 multiplied by 3 so there are 30 samples. The data obtained is not normally distributed then the statistical test is continued with kruskal-willis test to determine differences in the effectiveness of red dragon fruit (Hylocereus polyrhizus) peel extract in all groups. The results show that there is an effect of antioxidant activity of red dragon fruit (Hylocereus polyrhizus) peel extract on fibroblast proliferation in the healing process of oral ulcers in wistar rats. Keywords: Antioxidant Activity, Red Dragon Fruit, Peel, Fibroblast Proliferation

Chronic Gastric Ulcer Healing Actions of the Aqueous Extracts of Staple Plant Foods of the North-West, Adamawa, and West Regions of Cameroon.

This study is aimed at establishing phenolic compound profile and assessing the possible antiulcer activities of aqueous extracts of some staple plant foods from the West and North-West regions of Cameroon against chronic gastric ulcer models in rats. Phenolic constituents of extracts were evaluated using HPLC-DAD. Aqueous extracts of Corchorus olitorius, Solanum nigrum, Vigna unguiculata, Triumfetta pentandra, "nkui" spices, and "yellow soup" spices were tested at two doses (200 and 400 mg/kg). After treatments, animals were sacrificed, healing percentage and antioxidant status (catalase, superoxide dismutase, and glutathione peroxidase) were evaluated, and histological examination of gastric mucosa was realized. HPLC-DAD revealed that p-hydroxybenzoic and protocatechuic acids were the phenolic compound present in all extracts. Oral administration of extracts (200 and 400 mg/kg) significantly reduced ulcer surface value and significantly increased mucus production compared to the control groups (p < 0.05). Histological study supported the observed healing activity of different extracts characterized by a reduced inflammatory response. Moreover, administration of aqueous extracts increased the activity of antioxidant enzymes. This study revealed that aqueous extracts of Solanum nigrum, Corchorus olitorius, Vigna unguiculata, Triumfetta pentandra, "yellow soup" spices, and "nkui" spices possess healing antiulcer effects against models of gastric ulcers. The antiulcer mechanisms involved may include increase of gastric mucus production and improvement of the antioxidant activity of gastric tissue. These activities may be due to the phenolic compounds identified in the extracts, especially p-hydroxybenzoic and protocatechuic acids present in all extracts and with known antioxidant, cytoprotective, and healing properties. However, all the diets may promote the healing process of chronic ulcers caused by excessive alcohol consumption/stress.

Bioinformatics analysis of differentially expressed genes in diabetic foot ulcer and preliminary experimental verification.

Molecular changes are closely related to the pathogenesis and healing process of diabetic foot ulcers (DFUs), and are crucial for the early prediction and intervention of DFU. Bioinformatics analysis was performed in this study to identify the key differentially expressed genes (DEGs) in DFU, analyze their functions and function modes, and conduct preliminary experimental verification to determine the potential pivotal genes in the pathogenesis of DFU. Two datasets, GSE68183 and GSE80178, were obtained from the Gene Expression Omnibus (GEO). DEGs were obtained using GEO2R. Six co-expressed DEGs (co-DEGs) were obtained by R language analysis. The co-DEGs were constructed by using STRING and Cytoscape 3.7.2 to construct a protein-protein interaction (PPI) network, and two hub genes, NHLRC3 and BNIP3, were identified. The BNIP3 gene was selected for further analysis. Co-DEGs were used for Gene Ontology (GO) function analysis using the WebGestalt database, and BNIP3-related biological processes focused on mitochondrial protein decomposition. GO function analysis of the BNIP3 gene and its interacting genes was carried out using the cluster profile package and org.hs.eg. db package of the R language and its biological process was enriched in the cell response to external stimuli and autophagy. BNIP3 and its interacting genes were retrieved from the Kyoto Encyclopedia of Genes and Genomes (KEGG) database and KEGG pathway enrichment analysis was performed using the WebGestalt database. The results showed that BNIP3 was significantly correlated with mitochondrial autophagy and the FoxO signaling pathway. The miRDB and TargetScan databases were used to identify the relevant microRNAs (miRNAs) regulating the BNIP3 gene, and it was found that miRNA-182 may be involved in the targeted regulation of BNIP3. Western blot analysis was performed to determine the abnormal expression of BNIP3. Our study found that the BNIP3 gene may be a new biomarker and intervention target for DFU.

Literature Review: Efektifitas Metode Moist Wound Healing pada Ulkus Diabetik

One of the complications of diabetes mellitus is the presence of ulcer wounds which cause 50% to 75% of amputation. This literature review aims to determine the effectiveness of the Moist Wound Healing method in diabetic wounds. The design of this scientific paper is a literature review search using an electronic database, namely google scholar, semantic scholar, and pubmed. The keywords used in the search were: diabetes mellitus AND moist AND diabetic ulcer. Based on a literature review of 4 articles, significant results were obtained in wound healing, namely 2-3 times faster healing. it can be concluded that the moist wound healing method can affect the healing process of diabetic ulcers and has effectiveness for wound healing.

Impact of Blue Light Therapy on Wound Healing in Preclinical and Clinical Subjects: A Systematic Review.

Introduction: While a wound caused by a minor cutaneous incision routinely heals in a short time, wounds from major surgical operations might need numerous days to heal and may leave an obvious cicatrix. The use of blue light therapy (BLT) to destroy infectious microorganisms and disrupt biofilm formation could be an efficient method for healing ulcers. This systematic review focused on the effects of BLT in different preclinical in vivo studies and clinical models of skin wound healing. Furthermore, this study attempted to determine what main light parameters should be tested in preclinical and clinical studies. Methods: The online databases PubMed.gov, Google Scholar, Scopus, Web of Science, and Cochrane were searched using the keywords "blue light" and "wound healing" according to PRISMA guidelines. No publication time limit was enforced. Results: A total of 858 articles were identified, and 17 articles in three distinct categories were included for review. They comprised two articles on humans, fourteen articles on healthy animals, and one article on diabetic animals. Conclusion: Some studies have shown that the application of BLT on preclinical and clinical models of wound healing in vivo is able to significantly accelerate the healing process. Few studies, however, have explored the bactericidal effect of BLT on skin injury repair in burn patients. Further preclinical investigations designed to provide a better understanding of the bactericidal effect of BLT using standardized protocols, different BLT wavelengths, and different stages of the wound healing process of infected wounds and ulcers in healthy and diabetic animals should be carried out before clinical trials can be considered. BLT could eventually be a good option for treating infected chronic wounds, including those in diabetic patients.

EFFECTS OF NANO CHITOSAN MOUTH SPRAY ON THE EPITHELIAL THICKNESS IN THE TRAUMATIC ULCUS HEALING PROCESS (In vivo)

Background: Traumatic ulcer is one of the most common oral mucosal lesions, which are caused by physical trauma. The prevalence of traumatic ulcers in this world is 83.6%. Ulcers cause pain, difficulty in articulation, mastication and swallowing causing discomfort to the patient. The aim of this study is to analyze the effect of nano chitosan mouth spray on epithelial thickness in the healing process of traumatic ulcers. Methods: This research was true experimental type using post test only control group design with the number of samples are 27 rats divided into three groups. The treatment group was given nano chitosan mouth spray, the positive control group was given aloclair plus spray and the negative control group was given aquadest. After 7 days of treatment, the ulcer tissue was observed using a light microscope, then the average thickness of the epithelium was calculated. They were then analyzed using one-way ANOVA and LSD tests. Results: The results showed difference in the average value of each group. The treatment group is higher than the positive control group and the negative control group with an average epithelial thickness (19.42 ± 2.11). Meanwhile, the negative control group is the lowest group among the three groups with an average epithelial thickness (5.72 ± 0.77). The results based on the One Way Anova parametric test, the value of p = 0.000 (p &lt;0.05) Conclusion: The conclusion obtained is that there is an effect of chitosan nano mouth spray on epithelial thickness on the healing process of traumatic ulcers in male Wistar rats after 7 days of treatment

Marine collagen peptides: A novel biomaterial for the healing of oral mucosal ulcers.

The purpose of this study was to analyze the therapeutic effects of marine collagen peptides (MCPs) from tilapia skin on oral mucosal ulcers in a rat model. CCK-8 and wound healing assays were performed in vitro to evaluate proliferation and migration of L929 cells after treatment with MCPs. The effects of MCPs on the healing of oral mucosal ulcers in a rat model were macroscopically and microscopically analyzed in vivo. Results showed that MCPs promoted proliferation and migration of L929 cells. Moreover, 75%MCPs enhanced the ulcer healing process, suppressed inflammatory response and up-regulated the expression levels of vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF). MCPs are potentially used as a new therapeutic strategy for oral mucosal ulceration.

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.

Effect of Aloe vera gel on wound healing process for diabetic foot ulcers: A pilot study

Introduction: Patients who experience diabetic foot ulcers (DFU) should have undertaken prompt wound care. Currently, the principles of wound care have shifted to the moist principles of a wide range of treatments, advanced technology, and complementary alternative therapy. This study aimed to investigate the effects of Aloe vera gel therapy as a complementary alternative therapy to promote wound healing of DFU

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 five 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), and F3 (treatment with 80% areca nut:20% chrysanthemum). 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 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.

Diabetic foot ulcer segmentation using logistic regression, DBSCAN clustering and mathematical morphology operators

Digital images are used for evaluation and diagnosis of a diabetic foot ulcer. Selecting the wound region (segmentation) in an image is a preliminary step for subsequent analysis. Most of the time, manual segmentation isn't very reliable because specialists could have different opinions over the ulcer border. This fact encourages researchers to find and test different automatic segmentation techniques. This paper presents a computer-aided ulcer region segmentation algorithm for diabetic foot images. The proposed algorithm has two stages: ulcer region segmentation, and post-processing of segmentation results. For the first stage, a trained machine learning model was selected to classify pixels inside the ulcer's region, after a comparison of five learning models. Exhaustive experiments have been performed with our own annotated dataset from images of Cuban patients. The second stage is needed because of the presence of some misclassified pixels. To solve this, we applied the DBSCAN clustering algorithm, together with dilation, and closing morphological operators. The best-trained model after the post-processing stage was the logistic regressor (Jaccard Index $0.81$, accuracy $0.94$, recall $0.86$, precision $0.91$, and F1 score $0.88$). The trained model was sensitive to irrelevant objects in the scene, but the patient foot. Physicians found these results promising to measure the lesion area and to follow-up the ulcer healing process over treatments, reducing errors.

Local Hyperbaric Oxygen Therapy in the Treatment of Diabetic Foot Ulcers.

Background: Diabetes mellitus is one of the most common metabolic diseases. The most serious complication of diabetes is diabetic foot ulcer, which affects several million people around the world each year. In recent years, increasingly modern methods of physical medicine including hyperbaric oxygen therapy have been used often in the complex therapy of this complication. Methods: This study included 45 patients, 24 male (53.3%) and 21 female (46.6%), whose age was between 49 and 83 years (mean age: 66.7 ± 8.8 years) with diabetes lasting for 1.5–18 years, who underwent local hyperbaric oxygen therapy at the pressure of 2.5 ATA (30 exposures for 30 min each) due to diabetic foot ulcers. The progress in wound healing before and after the end of therapy was evaluated by computerized planimetry, and the pain intensity was assessed with the use of a VAS. Results: The analysis of results showed a statistically significant reduction in the wound surface area after the treatment, from 8.54 ± 3.34 cm to 4.23 ± 3.23 cm² (p = 0.000001). In 5 patients (11.1%), the wounds were healed completely. In 25 patients (55.5%), the topical state of the wound surface was significantly decreased by 50% on average. There was also a significant reduction in the perceived pain on the VAS in all examined patients from 4.64 ± 1.68 points before treatment to 1.51 ± 0.92 points after treatment (p = 0.000001). Conclusions: The application of local HBO therapy in the treatment of diabetic foot ulcers accelerates the ulcer healing process, as judged in objective planimetric assessment, and reduces the intensity of perceived pain ailments.