Ulcer Length Research Articles

740. RABEPRAZOLE PROTECTS REFLUX ESOPHAGITIS DUE TO BILE IN RAT MODEL

Abstract Aims we studied the effect of proton pump inhibitor(PPI)(Rabeprazole) therapy on esophageal bile reflux in esophagitis after total gastrectomy. (Methodology) Sixteen 8-week old male Wistar rats were underwent total gastrectomy and esophagoduodenostomy to induce esophageal reflux of biliary and pancreatic juice. In 5 rats the sham operation induced a midline laparatomy alone (Sham). One week following surgery, they were treated with saline (Control) (n=8) PPI (Rabeprazole)(n=8)(30mg/kg/day) ip for 2 weeks. 3 weeks after operation, all rats were killed and the esophagus was evaluated histologically. Esophageal injury was evaluated by macroscopic, microscopic findings and expression of COX2 and PGE2. We performed the measurement of bile acid in the esophageal lumen and common bile duct. Results At 3 weeks after surgery, duodenal reflux induced esophageal erosions and ulcer formation. The macroscopic ulcer score and microscopic ulcer length were significantly reduced by PPI. The enhanced expression of COX2 and PGE2 in the control group was also markedly inhibited in the PPI group. Really, there is no difference between control group and PPI group in bile acid concentration from the common bile duct. PPI does not inhibit the secretion of bile acid from the common bile duct. But, the bile acid activity in the esophageal lumen was significantly increased in the control group, and this increase was significantly inhibited in the PPI group. Conclusion These results indicate that bile acid, which is inhibited by Rabeprazole, plays an important role in the mucosal damage induced by duodenal reflux.

Midterm survival after aortic repair versus conservative treatment in patients with penetrating aortic ulcer.

Background: The clinical outcomes and survival of patients with penetrating aortic ulcers (PAU) were evaluated in a tertiary care hospital, comparing those who underwent aortic repair to those treated conservatively. Patients and methods: A retrospective single-centre analysis included all patients that underwent a computed tomography angiography (CT-A) scan with the diagnosis of a PAU between January 2009 and May 2019. "PAU" was identified in 1,493 of 112,506 CT-A scan reports in 576 patients. Clinical and angiomorphological data were collected. The primary outcome was overall survival (OS), with secondary outcomes focusing on identifying risk factors for poor OS. Survival probabilities were analysed by the Kaplan-Meier method using the log-rank test. A Cox hazard model using survival as dependent variable with stepwise backward eliminations based on the likelihood ratios was employed. Results: 315 PAUs were identified in 278 patients. The prevalence in the cohort was 0.8%. The mean age of the patients was 74.4 years, and they were predominantly male (n = 208, 74.8%). The mean ulcer depth was 11.8 mm (range 2-50 mm). Out of the patients, 232 were asymptomatic (83.5%). Among 178 PAUs (56.5%), high-risk factors, such as ulcer depth >10 mm, aortic diameter >40 mm, and ulcer length >20 mm, were observed. Aortic repair was associated with a better mean OS compared to conservatively managed patients (72.6 versus 32.2 months, p = 0.001). The Cox hazard model showed that ulcer depth >1 mm was associated with poor OS (HR 0.67, p = 0.048), while aortic repair was related to a better OS (HR 4.365, p<0.013). Conclusions: Aortic repair is associated with better OS, but this finding should be interpreted with caution because of differences in age and comorbidities between the groups. Further evaluation is warranted through prospective studies with randomized groups. Further assessment for angiomorphological parameters is recommended to identify patients at increased risk for poor OS.

Integrating new approaches to care in a vascular wound clinic

IntroductionAn evidence-based approach is essential in the treatment of wounds to optimise healing, reduce costs and improve patient outcomes. AimThis case study aimed to demonstrate our model of care, which assesses and manages patients with venous disease and complex wounds. In this case, venous leg ulcer (VLU) was treated with TLC-NOSF dressing and therapeutic compression. The wound was serially assessed using a smart App that gave the patient a graphic representation of their progress. DesignDescriptive Observational Case Study. Clinical careAn evidence-based approach for managing a chronic, severe VLU. The patient was initially seen at the Outpatient Vascular Wound Clinic twice weekly, then every two weeks for conservative sharp wound debridement, skin care, dressing change, and compression therapy using a compression (Ready) wrap. Wound progress was monitored by the digital application ‘Tissue Analytics’, a “purposedesigned digital wound management platform that records, tracks, and analyses wounds”. ResultsWeek 1: On initial review, ulcer length was 3.15cm, width was 3.1 cm, and total surface area was 6.31 cm2. The wound base was mildly sloughy (<25%), with areas of good granulation tissue on view.Week 12: Length was 1.32 cm, width 1.50 cm, and total surface area of 1.45 cm2, a 77% reduction in wound size.Week 24: The length was 0.48 cm, the width was 0.64 cm, and the total surface area was 0.18 cm2. This represented a 97% reduction in wound size.Week 36: Length was 0.01 cm, the width 0.06 cm, with a total surface area of 0.00 cm2. This represented a 99.99% reduction in wound size. ConclusionThe patient’s treatment for a complex venous leg ulcer included the application of TLC-NOSF dressing in combination with individualised therapeutic compression therapy. We found TLC-NOSF was very effective in combination with the best standard of VLU care (i.e. therapeutic graduated compression therapy). The clinician and patient were impressed with the healing rate at 12 weeks, as the wound dimensions were the lowest since the wound started six years ago. This dramatically improved patient concordance and engagement in care. Despite incomplete healing at 36 weeks, the wound-healing journey over the 36 weeks indicated wound closure was close. In addition, using a wound assessment App, the patient could immediately see the benefits of the new treatment, facilitating patient compliance with the treatment.

A simple index to predict healing in venous leg ulcers: a secondary analysis from four randomised controlled trials.

To investigate whether the use of a simple baseline measurement predicts venous leg ulcer healing at 12 and 24 weeks. This was a secondary analysis of a cohort of four randomised controlled trials (RCTs) of treatments adjuvant to compression. Self-reported ulcer duration, and measured ulcer length and width, to calculate estimated ulcer area, were used to obtain a Margolis index score. The score created three prognostic strata for likelihood to heal within 24 weeks, and the number of participants healed and time-to-healing were compared. There were a total of 802 participants across the four RCTs-408 (50.9%) in two 12-week trials and 394 (49.1%) in two 24-week trials. The mean age of participants was 63.7±17.6 years, and 372 were female (46.4%). The Margolis index score at baseline was 0 for 320 participants (predicted normal healing); 1 for 334 participants; and 2 for 148 participants (both 1 and 2 predicted slow-to-heal). Overall, 248 (77.5%) of those participants who scored 0 at baseline healed within 24 weeks, compared with 182 (54.5%) of participants who scored 1, and 30 (20.3%) participants who scored 2. The median time-to-healing was 40 (24-62) days, 57 (35-100) days and 86.5 (56-151) days, respectively. The area under the receiver operating characteristic curve was 0.69 and 0.77, respectively, for the 12 and 24 week trials. A simple baseline index identifies participants with normal or slow-to-heal wounds and could be used to demonstrate prognostic balance between treatment groups in trials. This approach could also be used in clinical practice to assist with managing expectations and for early identification of patients who may best benefit from adjuvant treatments.

Effectiveness of Secretome from Human Umbilical Cord Mesenchymal Stem Cells in Gel (10% SM-hUCMSC Gel) for Chronic Wounds (Diabetic and Trophic Ulcer) - Phase 2 Clinical Trial.

Chronic wounds carry financial burdens and increase morbidity and mortality, especially in diabetic ulcers and Hansen's Morbus. More than 50% of chronic ulcers are difficult to heal with regular treatment and require new types of therapy such as the use of secretome of human umbilical cord mesenchymal stem cells (SM-hUCMSC). This experimental study was carried out to see the effectiveness of using SM-hUCMSC in diabetic ulcers and Hansen's Morbus in four medical facilities (multicentre). The level of active secretion has been measured by default in 10% SM-hUCMSC gel, used as a treatment intervention. The primary outcome is wound healing in terms of the length, width, and extent of the wound. The secondary is the side effects of treatment 2 weeks after administration. Follow-up visits will be scheduled at 1 and 2 weeks post-treatment. Forty-one chronic ulcers successfully followed the study until the end. In patients with chronic ulcers, the mean ulcer length, width, and area were 1.60 (0,50-13,0), 1.3 (0,5-6,0), and 2.21 (0,25-78) cm square, respectively, before interventions and 1 (0-12), 0,8 (0-6,0), and 1 (0-72) square cm after interventions at the second follow-up. The change between the beginning and end of the intervention was significant (p-value <0.05). The use of 10% SM-hUCMSC gel topically has been proven effective in accelerating the process of wound healing, especially chronic ulcers with side effects that are not present in this study.

253. RABEPRAZOLE IS EFFECTIVE FOR BILE REFLUX ESOPHAGITIS AFTER TOTAL GASTRECTOMY IN A RAT MODEL

Abstract To evaluate the effect of PPI (Rabeprazole) on esophageal bile reflux in esophagitis after total gastrectomy. Twenty -one 8 week old male Wistar rats were studied. They were performed esophagoduodenostomy of total gastrectomy to induce esophageal reflux of biliary and pancreatic juice. Five rats were performed the sham operation (Sham) (n = 8). On the postoperative day 7, they were treated with saline (Control) (n = 8) or PPI (Rabeprazole 30 mg/kg per day, ip) (n = 8) for 2 weeks. On the postoperative 21 days, all rats were sacrificed and each esophagus was evaluated histologically. Esophageal injury was evaluated by macroscopic and microscopic findings as well as the expression of COX2. We measured bile acid in the esophageal lumen and common bile duct. The macroscopic ulcer score and microscopic ulcer length of the control group were significantly higher compared to those of the rabeprazole treated group. The expression of COX2 was significantly increased according to the immunostaing in the control group compared to rabeprazole treated group. Although there was no difference between the control and PPI groups in the total bile acids in the common bile duct, the bile acid in the esophageal lumen was significantly decreased in the rabeprazole treated group due to augmentation of the duodenal motor complex. With this model, rabeprazole is good effect for reflux esophagitis after total gastrectomy from bile reflux. Bile acid is an important factor in the mucosal lesion induced by duodenal reflux. PPI does not inhibit the secretion of bile acid from the common bile duct. Therefore, we speculate PPI accelerates duodenal phase III migrating motor complex, accelerating duodenal passage of duodenal contents (bile acids), which should reduce duodenoesophageal reflux.

Therapeutic Potential of a Self-Assembling Peptide Hydrogel to Treat Colonic Injuries Associated with Inflammatory Bowel Disease.

Background and AimsThe Self-assembling Peptide Hydrogel [SAPH, PuraMatrix], a fully synthetic peptide solution designed to replace collagen, has recently been used to promote mucosal regeneration in iatrogenic ulcers following endoscopic submucosal dissection. Herein, we evaluated its utility in ulcer repair using a rat model of topical trinitrobenzene sulphonic acid [TNBS]-induced colonic injuries.MethodsColonic injuries were generated in 7-week-old rats by injecting an ethanol solution [35%, 0.2 mL] containing 0.15 M TNBS into the colonic lumen. At 2 and 4 days post-injury, the rats were subjected to endoscopy, and SAPH [or vehicle] was topically applied to the ulcerative lesion. Time-of-flight secondary ion mass spectrometry [TOF-SIMS] was used to detect SAPH. Colonic expression of cytokines and wound healing-related factors were assessed using real-time polymerase chain reaction or immunohistochemistry.ResultsSAPH treatment significantly reduced ulcer length [p = 0.0014] and area [p = 0.045], while decreasing colonic weight [p = 0.0375] and histological score [p = 0.0005] 7 days after injury. SAPH treatment also decreased colonic expression of interleukin [IL]-1α [p = 0.0233] and IL-6[p = 0.0343] and increased that of claudin-1 [p = 0.0486] and villin [p = 0.0183], and β-catenin staining [p = 0.0237]. TOF-SIMS revealed lesional retention of SAPH on day 7 post-injury. Furthermore, SAPH significantly promoted healing in in vivo mechanical intestinal wound models.ConclusionsSAPH application effectively suppressed colonic injury, downregulated inflammatory cytokine expression, and upregulated wound healing-related factor expression in the rat model; thus, it may represent a promising therapeutic strategy for IBD-related colonic ulcers.

Analysis of predicted full recovery time for venous leg ulcers treated with intermittent pneumatic compression.

IntroductionVenous leg ulcers are difficult-to-heal wounds. Reduction of venous hypertension and eradication of oedema is of key importance in the treatment of clinical symptoms of venous hypertension and venous leg ulcers. This can be done by using compression therapy in which external pressure is applied to the skin surface, giving a positive effect on the venous, lymphatic and arterial systems of macro- and microcirculation.AimAnalysis of full recovery predicted time for venous ulcers.Material and methodsThe purpose of our study was to rate the intermittent pneumatic compression (IPC) therapy in venous leg ulcers treatment. In the study group, the IPC therapy (pressure of 60 mm Hg at the ankle) was used – one treatment daily for 4 weeks. The changes of the total area, circumference, maximum length and maximum width of ulcers were measured. Then, based on the collected values, we calculated healing progress (Gilman index), healing rate, predicted healing time and non-linear approximation of the treatment time needed to decrease the ulcer surface area by 50% and then we compared them the treatment times.ResultsAnalysis of the results shows that a percentage change in the surface area in the treatment group was 52%. There was a statistically significant difference between the ulcer surface area before and after treatment (p < 0.05). There was no statistically significant difference between the healing rate in individual weeks of treatment (p > 0.05). The percentage reduction in circumferences of the lower limb showed a statistically significant advantage in the study group comparison baseline (p < 0.05).ConclusionsTreatment of venous leg ulcers with the IPC therapy is effective.

Gastroprotective Effects of Betanin Against Ethanol-induced Gastric Ulcer in Rats

BackgroundBetanin is the principal pigment and active phytochemical constituent of beetroot. The protective roles of betanin are documented in the heart, kidney, liver, and lung, but its potential gastroprotective effect is not assessed thus far. A number of studies demonstrated that betanin could inhibit lipid peroxidation.ObjectivesThe current study aimed at investigating the gastroprotective effect of betanin in gastric ulcer induced by ethanol.MethodsIn the present study, a group of animals were treated with betanin (50, 100, and 200 mg/kg, orally) and the other group received ranitidine as a reference antiulcer agent. One hour later, the gastric mucosal ulceration was induced by oral administration of absolute ethanol and the rats were sacrificed one hour. The gastric ulcers were assessed by macroscopic and histopathological examinations. Also, gastric malondialdehyde (MDA) level and nitric oxide (NO) content were measured.ResultsOral administration of betanin 100 and 200 mg/kg of body weight prior to receiving ethanol significantly attenuated the number and length of gastric ulcers as compared to the ethanol group. Moreover, pretreatment with betanin could significantly decrease stomach MDA level and maintain stomach NO content similar to that of the control group. Histopathological examinations indicated that ethanol-induced gastric ulcer was attenuated by betanin and no significant difference was observed between the betanin (200 mg/kg) and ranitidine groups.ConclusionsThe findings indicated that betanin has gastroprotective effects on gastric ulcers, which could be related to attenuated lipid peroxidation and reestablished gastric NO content.

Gastroprotective Effect of Zingerone on Ethanol-Induced Gastric Ulcers in Rats.

Background and objectives: Zingerone is an ingredient of ginger (Zingiber officinale) with different pharmacological activities. Several studies have investigated the effect of zingerone on various gastrointestinal diseases, including irritable bowel syndrome and diarrhea. This study is aimed to evaluate the effect of zingerone on ethanol-induced gastric ulcers in rats. Materials and Methods: Gastric ulcers were induced by ethanol (96%, 5 mL/kg, po) in male wistar rats and zingerone (50, 100, and 200 mg/kg) was administrated orally. Normal saline and ranitidine were used as negative and positive control, respectively. In this study, the number and length of ulcers, and malondialdehyde (MDA) and nitric oxide (NO) levels in stomach tissues were determined. Results: The findings showed that the mean number and length of gastric ulcers were significantly lower in zingerone-received groups than ethanol group (P < 0.05). The level of malondialdehyde was decreased in the stomach of zingerone groups (P < 0.05) compared to the ethanol group. In addition, zingerone treatment prevented the decrease of nitric oxide level by ethanol in the stomach tissue. Conclusions: The present study showed that zingerone has a protective effect on the ethanol-induced gastric ulcer, which may be due to its free radical scavenging activity.

The effects of magnesium and vitamin E co-supplementation on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial.

This study was carried out to determine the effects of magnesium and vitamin E co-supplementation on wound healing and metabolic status in patients with diabetic foot ulcer (DFU). The current randomized, double-blind, placebo-controlled trial was conducted among 57 patients with grade 3 DFU. Participants were randomly divided into two groups to take either 250 mg magnesium oxide plus 400 IU vitamin E (n = 29) or placebo per day (n = 28) for 12 weeks. Compared with the placebo, taking magnesium plus vitamin E supplements reduced ulcer length (β [difference in the mean of outcomes measures between treatment groups] -0.56 cm; 95% CI, -0.92, -0.20; p = 0.003), width (β -0.35 cm; 95% CI, -0.64, -0.05; p = 0.02) and depth (β -0.18 cm; 95% CI, -0.33, -0.02; p = 0.02). In addition, co-supplementation led to a significant reduction in fasting plasma glucose (β -13.41 mg/dL; 95% CI, -20.96, -5.86; p = 0.001), insulin (β -1.45 μIU/ml; 95% CI, -2.37, -0.52; p = 0.003), insulin resistance (β -0.60; 95% CI, -0.99, -0.20; p = 0.003) and HbA1c (β -0.32%; 95% CI, -0.48, -0.16; p < 0.003), and a significant elevation in insulin sensitivity (β 0.007; 95% CI, 0.003, 0.01; p < 0.001) compared with the placebo. Additionally, compared with the placebo, taking magnesium plus vitamin E supplements decreased triglycerides (β -10.08 mg/dL; 95% CI, -19.70, -0.46; p = 0.04), LDL-cholesterol (β -5.88 mg/dL; 95% CI, -11.42, -0.34; p = 0.03), high sensitivity C-reactive protein (hs-CRP) (β -3.42 mg/L; 95% CI, -4.44, -2.41; p < 0.001) and malondialdehyde (MDA) (β -0.30 μmol/L; 95% CI, -0.45, -0.15; p < 0.001), and increased HDL-cholesterol (β 2.62 mg/dL; 95% CI, 0.60, 4.63; p = 0.01) and total antioxidant capacity (TAC) levels (β 53.61 mmol/L; 95% CI, 4.65, 102.57; p = 0.03). Overall, magnesium and vitamin E co-supplementation for 12 weeks to patients with DFU had beneficial effects on ulcer size, glycemic control, triglycerides, LDL- and HDL-cholesterol, hs-CRP, TAC, and MDA levels.

Vascular endothelial growth factor receptor 1 tyrosine kinase signaling facilitates healing of DSS-induced colitis by accumulation of Tregs in ulcer area

BackgroundUlcerative Colitis (UC) is an inflammatory bowel disease that affects the colon. The development of UC is regulated by immune cells. Previously, we showed that vascular endothelial growth factor receptor 1 (VEGFR1) tyrosine kinase (TK) signaling induces healing of mucosal damage by recruiting VEGFR1+ cells appear to be lineage monocyte cells. Recent studies show that development of UC correlates with the number of regulatory T cells (Tregs). Here, we investigated whether VEGFR1-TK signaling induces healing of UC via accumulation of Tregs or not. MethodAcute colitis was induced in C57/Bl6N (wild-type [WT]) and VEGFR1 T K knockout (VEGFR1 T K−/−) mice by administration of 2.0% dextran sulfate sodium (DSS). ResultsTotal colon length in VEGFR1 T K−/− mice was shorter than that in WT mice. The ulcer length and the disease activity index (DAI) score were significantly higher in VEGFR1 T K−/− mice than in WT mice, whereas CD31 mRNA and protein levels were significantly lower. Accumulation of forkhead box P3+ (Foxp3+) VEGFR1+ Tregs was lower in VEGFR1 T K−/− mice, as was expression of interleukin (IL)-10 and transforming growth factor (TGF)-β. The survival rate of WT mice treated with an anti-folate receptor 4 (FR4) antibody was 40%, while that of WT mice treated with control IgG was 90%. Moreover, WT mice treated with a neutralizing antibody against C-X-C chemokine receptor type 4 (CXCR4) showed significantly shorter colon length than WT with control antibody. In VEGFR1 T K−/−, infiltration of Foxp3+ Tregs expressing VEGFR1 and CXCR4 into ulcerated areas was lower than that in WT mice. ConclusionVEGFR1-TK signaling plays a critical role in UC healing and angiogenesis via accumulation of VEGFR1+CXCR4+Foxp3+ Tregs in ulcerated tissue. (264 words)

Randomized, controlled clinical pilot study of venous leg ulcers treated with using two types of shockwave therapy.

Background. Venous leg ulcers are difficult to heal wounds. The basis of their physiotherapeutic treatment is compression therapy. However, for many years, the search for additional or other methods to supplement the treatment of venous ulcers, which would shorten the duration of treatment, is underway. One of such methods is the shockwave therapy.Methods. The purpose of our study was to compare radial shockwave therapy (R-ESWT) with focused shockwave therapy (F-ESWT) in venous leg ulcers treatment.Patients were randomly assigned to tree groups. In the first group the radial shockwave therapy (0.17mJ/mm2, 100 impulses/cm2, 5 Hz), in the second group the focused shockwave therapy (0.173mJ/mm2, 100 impulses/cm2, 5 Hz) was used and in third group standard care was used. Patients in shockwave therapy groups were given 6 treatments at five-day intervals. Total area, circumference, Gilman index, maximum length and maximum width of ulcers were measured. The patients from the third group wet gauze dressing with saline and gently compressing elastic bandages were used (standard wound care SWC).Results. Analysis of the results shows that a complete cure of ulcers was achieved in 35% of patients who were treated with radial shockwave, 26% of patients with focused shockwave used. There is statistically significant difference between the standard care and radial shockwave therapy as well as between the standard care and focused shockwave therapy. There is no statistically significant difference between the use of radial and focused shockwave in the treatment of venous leg ulcers (p> 0.05).Conclusion. There is no statistically significant difference between the use of radial and focused shockwave in the treatment of venous leg ulcers. Treatment of venous leg ulcers with shockwaves is more effective than the standard wound care.

The beneficial effects of probiotic administration on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial.

This study was conducted to evaluate the effects of probiotic supplementation on wound healing and metabolic status in subjects with diabetic foot ulcer (DFU). This randomized, double-blind, placebo-controlled trial was conducted among 60 subjects (aged 40-85years old) with grade 3 diabetic foot ulcer. Individuals were randomly divided into 2 groups (30 subjects each group) to receive either probiotic or placebo daily for 12weeks. After the 12-week intervention, compared with the placebo, probiotic supplementation led to significant reductions in ulcer length (-1.3±0.9 vs. -0.8±0.7cm, P=.01), width (-1.1±0.7 vs. -0.7±0.7cm, P=.02), and depth (-0.5±0.3 vs. -0.3±0.3cm, P=.02). Furthermore, significant reductions in fasting plasma glucose (-29.6±30.3 vs. -5.8±39.8mg/dL, P=.01), serum insulin concentrations (-4.3±7.9 vs. +0.4±8.5μIU/mL, P=.03), and haemoglobin A1c (-0.6±0.5 vs. -0.2±0.4%, P=.003) and a significant rise in the quantitative insulin sensitivity check index (+0.01±0.01 vs. -0.01±0.02, P=.003) were seen following supplementation of probiotic compared with the placebo. Additionally, compared with the placebo, probiotic supplementation resulted in significant decreases in serum total cholesterol (-4.8±16.1 vs. +7.0±27.1mg/dL, P=.04), high-sensitivity C-reactive protein (-9.0±14.7 vs. -1.7±8.6mg/L, P=.02), plasma malondialdehyde (-0.8±0.8 vs. -0.2±0.8μmol/L, P=.001), and significant increases in plasma nitric oxide (+6.2±8.2 vs. +0.8±8.0μmol/L, P=.01) and total antioxidant capacity concentrations (+179.3±97.2 vs. -85.1±203.4mmol/L, P<.001). Overall, probiotic supplementation for 12weeks among subjects with diabetic foot ulcer had beneficial effects on ulcer size, glycaemic control, total cholesterol, high-sensitivity C-reactive protein, plasma nitric oxide, total antioxidant capacity, and malondialdehyde levels.

Clinical and metabolic response to flaxseed oil omega-3 fatty acids supplementation in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial

BackgroundData on the effects of flaxseed oil omega-3 fatty acids supplementation on wound healing and metabolic status in subjects with diabetic foot ulcer (DFU) are scarce. ObjectiveThis study was conducted to evaluate the effects of flaxseed oil omega-3 fatty acids supplementation on wound healing and metabolic status in subjects with DFU. MethodsThe current randomized, double-blind, placebo-controlled trial was conducted among 60 subjects (aged 40–85years old) with grade 3 DFU. Subjects were randomly allocated into two groups (30 subjects each group) to receive either 1000mg omega-3 fatty acids from flaxseed oil supplements or placebo twice a day for 12weeks. ResultsAfter the 12-week intervention, compared with the placebo, omega-3 fatty acids supplementation resulted in significant decreases in ulcer length (−2.0±2.3 vs. −1.0±1.1cm, P=0.03), width (−1.8±1.7 vs. −1.0±1.0cm, P=0.02) and depth (−0.8±0.6 vs. −0.5±0.5cm, P=0.01). Additionally, significant reductions in serum insulin concentrations (−4.4±5.5 vs. +1.4±8.3 μIU/mL, P=0.002), homeostasis model of assessment-estimated insulin resistance (−2.1±3.0 vs. +1.0±5.0, P=0.005) and HbA1c (−0.9±1.5 vs. −0.1±0.4%, P=0.01), and a significant rise in the quantitative insulin sensitivity check index (+0.01±0.01 vs. −0.005±0.02, P=0.002) were seen following supplementation with omega-3 fatty acids compared with the placebo. In addition, omega-3 fatty acids supplementation significantly decreased serum high sensitivity C-reactive protein (hs-CRP) (−25.5±31.5 vs. −8.2±18.9μg/mL, P=0.01), and significantly increased plasma total antioxidant capacity (TAC) (+83.5±111.7 vs. −73.4±195.5mmol/L, P<0.001) and glutathione (GSH) concentrations (+60.7±140.2 vs. −15.5±129.7μmol/L, P=0.03) compared with the placebo. ConclusionsOverall, omega-3 fatty acids supplementation for 12weeks among subjects with DFU had beneficial effects on parameters of ulcer size, markers of insulin metabolism, serum hs-CRP, plasma TAC and GSH levels. In addition, flaxseed oil omega-3 fatty acids may have played an indirect role in wound healing due to its effects on improved metabolic profiles.

Magnesium Supplementation and the Effects on Wound Healing and Metabolic Status in Patients with Diabetic Foot Ulcer: a Randomized, Double-Blind, Placebo-Controlled Trial.

http://www.irct.ir : IRCT201612225623N96.

The effects of zinc supplementation on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial.

This study was performed to determine the effects of zinc supplementation on wound healing and metabolic status in patients with diabetic foot ulcer. The current randomized, double-blind, placebo-controlled trial was conducted among 60 patients (aged 40-85 years old) with grade 3 diabetic foot ulcer. Participants were randomly divided into two groups (30 participants in each group) to take either 220 mg zinc sulfate supplements containing 50 mg elemental zinc or placebo daily for 12 weeks. After the 12-week intervention, compared with the placebo, zinc supplementation was associated with significant reductions in ulcer length (-1.5 ± 0.7 vs. -0.9 ± 1.2 cm, p = 0.02) and width (-1.4 ± 0.8 vs. -0.8 ± 1.0 cm, p = 0.02). In addition, changes in fasting plasma glucose (-40.5 ± 71.0 vs. -3.9 ± 48.5 mg/dl, p = 0.02), serum insulin concentration (-8.0 ± 15.4 vs. +1.1 ± 10.3 µIU/ml, p = 0.009), homeostasis model of assessment-estimated insulin resistance (-3.9 ± 7.1 vs. +0.8 ± 5.9, p = 0.007), the quantitative insulin sensitivity check index (+0.01 ± 0.03 vs. -0.002 ± 0.02, p = 0.04) and HbA1c (-0.5 ± 0.8 vs. -0.1 ± 0.5%, p = 0.01) in the supplemented group were significantly different from the changes in these indicators in the placebo group. Additionally, significant increases in serum HDL-cholesterol (+4.1 ± 4.3 vs. +1.1 ± 5.1 mg/dl, p = 0.01), plasma total antioxidant capacity (+91.7 ± 213.9 vs. -111.9 ± 188.7 mmol/L, p < 0.01) and total glutathione (+68.1 ± 140.8 vs. -35.0 ± 136.1 µmol/L, p = 0.006), and significant decreases in high sensitivity C-reactive protein (-20.4 ± 24.6 vs. -6.8 ± 21.3 µg/ml, p = 0.02) and plasma malondialdehyde concentrations (-0.6 ± 0.9 vs. -0.2 ± 0.7 µmol/L, p = 0.03) were seen following supplementation with zinc compared with the placebo. Zinc supplementation for 12 weeks among diabetic foot ulcer patients had beneficial effects on parameters of ulcer size and metabolic profiles.

Gastroprotective effects of 1-Hydroxy-2-phenylbenzimidazole in ethanol-induced gastric ulcers in rats

Abstract Introduction: Benzimidazole compounds are known for their reduction of gastric secretion by inhibition of H+/K+-ATPase enzyme. Aim: The gastroprotective activity of the synthesized 1-hydroxy-2-phenylbenzimidazole (HPB) is examined on gastric lesions induced in rats by the oral ingestion of ethanol. Methods: Gastroprotective activity was evaluated by estimation of the numbers and cumulative lengths of glandular gastric ulcers induce by ethanol. The effect of pretreatment with HPB given alone and in combination with ranitidine on the number and length of gastric ulcers; and as well as on gastric volume and total gastric acidity were investigated. Results: Pre-treatment of rats with HPB at the doses of 25 and 50 mg/kg IP, significantly decreased the number and the length of ethanol induced gastric ulcers compared to control group. The highest curative ratio 53.89% and the most reduction of gastric acidity were obtained with the highest dose of HPB (50 mg/kg) in combination with ranitidine. Histopathological findings confirmed the protective effect of the HPB. Conclusion: The synthesized benzimidazole derivative (HPB) provided a gastroprotective effects on ethanol-induced gastric lesions in rats. This protective activity may be partly due to its ability to attenuate acid secretion.

The effects of vitamin D supplementation on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial

ObjectiveThis study was conducted to evaluate the effects of vitamin D supplementation on wound healing and metabolic status in patients with diabetic foot ulcer (DFU). MethodsThis randomized, double-blind, placebo-controlled trial was performed among 60 patients with grade 3 DFU according to "Wagner–Meggitt’s" criteria. Participants were randomly divided into two groups (each 30 participants) and received either 50,000IU vitamin D supplements every 2weeks for 12weeks (group A) or placebo (group B). Fasting blood samples were taken at study baseline and after 12-week intervention to determine related markers. ResultsAfter 12weeks of intervention, compared with the placebo, vitamin D supplementation resulted in a significant reduction in ulcer length (−2.1±1.1 vs. −1.1±1.1cm, P=0.001), width (−2.0±1.2 vs. −1.1±1.0cm, P=0.02) and depth (−1.0±0.5 vs. −0.5±0.5cm, P<0.001), and erythema rate (100% vs. 80%, P=0.01). In addition, in supplemented patients changes in serum insulin concentration (−3.4±9.2 vs. +2.8±9.3 μIU/mL, P=0.01), homeostasis model of assessment-estimated insulin resistance (−1.5±4.1 vs. +1.7±5.1, P=0.01), the quantitative insulin sensitivity check index (+0.006±0.02 vs. −0.006±0.02, P=0.03) and HbA1c (−0.6±0.6 vs. −0.1±0.5%, P=0.004) were significantly different from those of patients in the placebo group. Additionally, following supplementation with vitamin D, significant reductions in serum total- (−15.8±18.9 vs. +5.3±31.8mg/dL, P=0.003), LDL- (−17.2±19.8 vs. +2.2±28.6mg/dL, P=0.003), total-/HDL-cholesterol ratio (−1.1±0.8 vs. −0.2±1.1, P=0.001), high sensitivity C-reactive protein (hs-CRP) (−0.4±2.5 vs. +1.9±4.2μg/mL, P=0.01), erythrocyte sedimentation rate (ESR) (−34.7±32.4 vs. −18.0±26.6mm/h, P=0.03) and plasma malondialdehyde (MDA) concentrations (−0.7±0.9 vs. −0.2±0.5μmol/L, P=0.008) were seen compared with the placebo. ConclusionsOverall, vitamin D supplementation for 12weeks among patients with DFU had beneficial effects on glucose homeostasis, total-, LDL-, total-/HDL-cholesterol, ESR, hs-CRP and MDA levels. In addition, vitamin D may have played an indirect role in wound healing due to its effect on improved glycemic control.

Cost analysis of negative-pressure wound therapy with instillation for wound bed preparation preceding split-thickness skin grafts for massive (>100 cm2) chronic venous leg ulcers

Massive (≥100 cm(2)) venous leg ulcers (VLUs) demonstrate very low closure rates with standard compression therapy and are costly to manage. Negative-pressure wound therapy (NPWT), followed by a split-thickness skin graft (STSG), can be a cost-effective alternative to this standard care. We performed a cost analysis of these two treatments. A retrospective review was performed of 10 ulcers treated with surgical debridement, 7 days of inpatient NPWT with topical antiseptic instillation (NPWTi), and STSG, with 4 additional days of inpatient NPWT bolster over the graft. Independent medical cost estimators were used to compare the cost of this treatment protocol with standard outpatient compression therapy. The average length of time ulcers were present before patients entered the study was 38 months (range, 3-120 months). Eight of 10 patients had complete VLU closure by 6 months after NPWTi with STSG. The 6-month costs of the proposed treatment protocol and standard twice-weekly compression therapy were estimated to be $27,000 and $28,000, respectively. NPWTi with STSG treatment is more effective for closure of massive VLUs at 6 months than that reported for standard compression therapy. Further, the cost of the proposed treatment protocol is comparable with standard compression therapy.