Ulcer Region Research Articles

Diagnosis of Pressure Ulcer Stage Using On-Device AI

Pressure ulcers are serious healthcare concerns, especially for the elderly with reduced mobility. Severe pressure ulcers are accompanied by pain, degrading patients’ quality of life. Thus, speedy and accurate detection and classification of pressure ulcers are vital for timely treatment. The conventional visual examination method requires professional expertise for diagnosing pressure ulcer severity but it is difficult for the lay carer in domiciliary settings. In this study, we present a mobile healthcare platform incorporated with a light-weight deep learning model to exactly detect pressure ulcer regions and classify pressure ulcers into six severities such as stage 1–4, deep tissue pressure injury, and unstageable. YOLOv8 models were trained and tested using 2800 annotated pressure ulcer images. Among the five tested YOLOv8 models, the YOLOv8m model exhibited promising detection performance with overall classification accuracy of 84.6% and a mAP@50 value of 90.8%. The mobile application (app) was also developed applying the trained YOLOv8m model. The mobile app returned the diagnostic result within a short time (≒3 s). Accordingly, the proposed on-device AI app can contribute to early diagnosis and systematic management of pressure ulcers.

Insights into the Structure of Sucralfate by Advanced Solid- and Liquid-State NMR.

Sucralfate, which is a sucrose octasulfate aluminum complex, is an active pharmaceutical ingredient (API) falling in the category of cytoprotective agents which are very effective for gastric and duodenal ulcers. On interaction with stomach acid, it ionizes into aluminum and sucrose octasulfate ions to form a protective layer over the ulcerated region inhibiting further attack from acid. The mechanism of action of sucralfate in the context of its structure is not well understood. Considering that at least two forms of this API are available in the market, there are no reports on the various forms of sucralfate and differences in their pharmacological action. We characterized the two forms of sucralfate using multinuclear, multidimensional solid-state NMR, and the results show significant structural differences between them arising from variation in the aluminum environment and the level of hydration. The impact of structural differences on pharmacological action was examined by studying acid-induced Al release by 27Al liquid-state NMR. The sucralfate, European pharmaceutical standard, Form I, undergoes faster disruption in acid compared to Form II. The difference is explained on the basis of structural differences in the two forms which gives significant insights into the action of sucralfate in relation to its structure.

P160 Integrative transcriptional analysis to identify predictive biomarkers for IBD severity and subtyping

Abstract Background Conventional diagnostic strategies for Inflammatory Bowel Diseases (IBD) heavily rely on invasive biopsy procedures and subjective questionnaires, thereby introducing intrinsic limitations in the context of precision medicine. By understanding the molecular mechanisms behind IBD disease biology, we aim to identify certain signalling pathways relevant for epithelial tissue regeneration under chronic inflammation conditions. Methods To address these limitations, we compared gene expression in a large cohort of IBD patients, utilizing the IBD Plexus database (Crohn’s & Colitis Foundation, US) as well as other publicly available datasets. We further validated our results derived from the transcriptional programs by using patient derived advanced 3D-organoid models (Hospital of Nottingham, UK). These models, derived from ulcerated and normal tissue regions of IBD patients, serve as a sophisticated platform for robust validation, bridging the gap between molecular insights and clinical applications. Results Our primary objective was to discern putative biomarkers that are capable of effectively stratifying IBD subtypes. We further identified the genes that were upregulated exclusively in each subtypes and the gene signature that is elevated in inflamed samples compared to non-inflamed samples. We found that either the chemokine and interleukin (IL-17) signalling pathways which have known roles in recruitment of immune cells thereby perpetuating chronic inflammation and several key chemokines influence the integrity of the epithelial barrier function and regeneration. We are also analysing non-invasive biomarkers by using samples such as blood, plasma and stool and employ machine learning methods to correlate with established clinical indicators such as sCDAI, PRO2, PRO3, and MAYO categories. Conclusion Hence, in identifying specific targets we can introduce novel therapeutic strategies to mitigate inflammation and restore integrity of the gut epithelial barrier. With this research we aim to improve the current IBD diagnostics landscape as well propels it towards precision medicine by offering precise subtyping and predictive markers for disease severity, ultimately contributing to more personalised and effective therapeutics interventions.

The effect of calcaneus and metatarsal head offloading insoles on healthy subjects' gait kinematics, kinetics, asymmetry, and the implications for plantar pressure management: A pilot study.

The global number of people with diabetes is estimated to reach 643 million by 2030 of whom 19-34% will present with diabetic foot ulceration. Insoles which offload high-risk ulcerative regions on the foot, by removing insole material, are the main contemporary conservative treatment to maintain mobility and reduce the likelihood of ulceration. However, their effect on the rest of the foot and relationship with key gait propulsive and balance kinematics and kinetics has not been well researched. The aim of this study is to investigate the effect of offloading insoles on gait kinematics, kinetics, and plantar pressure throughout the gait cycle. 10 healthy subjects were recruited for this experiment to walk in 6 different insole conditions. Subjects walked at three speeds on a treadmill for 10 minutes while both plantar pressure and gait kinematics, kinetics were measured using an in-shoe pressure measurement insole and motion capture system/force plates. Average peak plantar pressure, pressure time integrals, gait kinematics and centre of force were analysed. The average peak plantar pressure and pressure time integrals changed by -30% (-68% to 3%) and -36% (-75% to -1%) at the region of interest when applying offloading insoles, whereas the heel strike and toe-off velocity changed by 15% (-6% to 32%) and 12% (-2% to 19%) whilst walking at three speeds. The study found that offloading insoles reduced plantar pressure in the region of interest with loading transferred to surrounding regions increasing the risk of higher pressure time integrals in these locations. Heel strike and toe-off velocities were increased under certain configurations of offloading insoles which may explain the higher plantar pressures and supporting the potential of integrating kinematic gait variables within a more optimal therapeutic approach. However, there was inter-individual variability in responses for all variables measured supporting individualised prescription.

DUTC Net: A novel deep ulcer tissue classification network with stage prediction and treatment plan recommendation

Background and objectivesThe Chronic injuries caused by the venous valve called as Varicose ulcers. The pressure in the veins is increased as the valves of the veins allows blood to flow in backward direction. Detecting and segmenting varicose ulcer wound region is a separate step prior to the classification operation. In this work the novel customized Deep Ulcer Tissue Classification Network is proposed and it is named as “DUTC Net”. The goal of the proposed DUTC Net is i) to classify the tissue type by generating tissue map using segmented ulcer wound image ii) to identify the stages of ulcer and iii) Percentage of affected tissues in the wound. MethodsThe dataset contains various stages of varicose ulcer wound images. The first step is to preprocess the ulcer wound image to remove light artifacts and noise. After preprocessing segmentation is done to isolate the region of the varicose ulcer using active contour algorithm. The segmented area can be fed into proposed DUTC Net to get the respective tissue map of the ulcer wound images. The tissue map images are assigned as input to DUTC Net at the phase II. In this phase II, DUTC Net learns the features from the tissue map of the phase I and classifies the stages and percentage of affected tissues in the varicose ulcer wound image. ResultsWhile experimental analysis, the proposed method DUTC Net results sensitivity 97.9%, specificity 98% and accuracy 97.2% for the average of tissue classification and sensitivity 97.1%, specificity 98% and accuracy 97.5% for the average of stage classification. ConclusionThe proposed work is mainly used to classify the varicose ulcer stages, tissues types and affected area using DUTC Net to investigate the patients status and treatment methods.

Effectiveness of natural biomaterials in the protection and healing of experimentally induced gastric mucosa Ulcer in rats

BackgroundA gastric ulcer is a painful lesion of the gastric mucosa that can be debilitating or even fatal. The effectiveness of several plant extracts in the therapy of this illness has been demonstrated in traditional pharmacopoeias. Aim: this study was aimed to see if propolis, ginseng in normal or nano form, and amygdalin might help in preventing the ulcerative effects of absolute ethanol.MethodsGastroprotective properties of pretreatments before ethanol gavage in rats were compared to omeprazole. The ulcer and stomach parameters (ulcerated regions) were measured (mm2), ulcer inhibition percentage, the stomachs were assessed macroscopically with gastric biopsy histological examinations.ResultsAmygdalin, normal and nano ginseng, nano propolis followed by propolis all showed great efficacy in protecting the cyto-architecture and function of the gastric mucosa. The number of ulcerated sites was greatly reduced, and the percentage of stomach protection was increased. Histopathological examination had confirmed great protective effects of the nanoformulations followed by amygdalin. The protection and healing rate was completed to about 100% in all tested materials while ulcer areas were still partially unhealed in normal propolis and omeprazole. Quantitative assay of the m-RNA levels Enothelin 1(ET-1), leukotriene4 (LT-4), and caspase 3(Cas-3) genes and Histamine were done and revealed significant up-regulations in ethanol group and the maximum protective effect was reported with ginseng nano, moreover the histamine content was significantly decreased with nano- formulated extracts.ConclusionAmygdalin and the nanoformulated ginseng and propolis had exhibited a marked protective effect against the ulcerative toxic effects of ethanol.

Management of Idiopathic Vocal Process Granuloma: A Survey of Academic Laryngologists.

Vocal process granulomas (VPGs) are benign laryngeal lesions that may manifest as ulcerated regions of the vocal fold or nodular polypoid lesions. Gold standard treatments for idiopathic VPG are yet to be established at this time. This study evaluated clinical decision-making and outcomes in the treatment of VPG patients based on experiences of academic laryngologists across the United States. A 21-question survey was developed to evaluate each respondent's specific VPG patient population, clinical decision-making in treating VPG, and corresponding treatment outcomes. The survey was distributed to 168 laryngologists at academic institutions across the United States. Data were analyzed through the Qualtrics platform. A total of 106 responses were analyzed, with a completion rate of 63.1%. Etiology of VPG was most commonly attributed to phonotrauma (96.2%) and reflux (71.8%). Primary first-line treatment was most commonly antireflux medications (92%). Other common first line treatments included voice therapy (58.8%) and inhaled steroids (42.5%). With these treatments, the majority of laryngologists report that recurrence is uncommon (68.4%). Dysphonia was cited as the most frequent long-term sequelae at 27.8%. VPG treatment strategies continue to be controversial across the United States with many treatments described in the literature with variable application in the practice of academic laryngologists today. Based on survey results, antireflux medications and voice therapy may be the most widely used and most effective treatment options. Establishment of gold standard therapy for VPG as well as further research into recurrent or persistent VPG despite antireflux and voice therapy should be explored. 5 Laryngoscope, 134:795-802, 2024.

Selective oxidative protection leads to tissue topological changes orchestrated by macrophage during ulcerative colitis

Ulcerative colitis is a chronic inflammatory bowel disorder with cellular heterogeneity. To understand the composition and spatial changes of the ulcerative colitis ecosystem, here we use imaging mass cytometry and single-cell RNA sequencing to depict the single-cell landscape of the human colon ecosystem. We find tissue topological changes featured with macrophage disappearance reaction in the ulcerative colitis region, occurring only for tissue-resident macrophages. Reactive oxygen species levels are higher in the ulcerative colitis region, but reactive oxygen species scavenging enzyme SOD2 is barely detected in resident macrophages, resulting in distinct reactive oxygen species vulnerability for inflammatory macrophages and resident macrophages. Inflammatory macrophages replace resident macrophages and cause a spatial shift of TNF production during ulcerative colitis via a cytokine production network formed with T and B cells. Our study suggests components of a mechanism for the observed macrophage disappearance reaction of resident macrophages, providing mechanistic hints for macrophage disappearance reaction in other inflammation or infection situations.

Hepcidin expression in the trigeminal ganglion and the oral mucosa in an oral ulcerative mucositis rat model.

Severe intraoral pain induces difficulty in eating and speaking, leading to a decline in the quality of life. However, the molecular mechanisms underlying intraoral pain remain unclear. Here, we investigated gene modulation in the trigeminal ganglion and intraoral pain-related behavior in a rat model of acetic acid-induced oral ulcerative mucositis. Oral ulceration was observed on day 2 after acetic acid treatment to the oral mucosa of male Wistar rats, causing spontaneous pain and mechanical allodynia. Deoxyribonucleic acid microarray analysis of trigeminal ganglion tissue indicated that Hamp (a hepcidin gene that regulates cellular iron transport) was the most upregulated gene. In the oral ulcerative mucositis model, the upregulation of Hamp was also induced in the ulcer region but not in the liver, with no increase in hepcidin levels in the plasma and saliva, indicating that hepcidin was produced locally in the ulcer region in the model. Systemic antibiotic pretreatment did not increase the mRNA levels of Hamp in the trigeminal ganglion and ulcer regions. Hepcidin injection into the oral mucosa enhanced neuronal excitability in response to noxious mechanical stimulation of the oral mucosa in trigeminal spinal subnucleus interpolaris/caudalis neurons. These results imply that oral ulcerative mucositis induces oral mucosal pain because of infectious inflammation of the ulcerative area and potentiates Hamp, which represents anti-bacterial and anti-peptidase gene expression in the ulcer region and trigeminal ganglion. The regulation of cellular iron transport by hepcidin is likely involved in oral ulcerative mucositis-induced pain.

Selective accumulation of ionic nanocrystal H2 storage system as an in situ H2/boric acid nanogenerator fights against ethanol-induced gastric ulcers

Ethanol is a potential causative factor of gastric ulcers, which are associated with gastric injury and the overproduction of reactive oxygen species. Molecular hydrogen (H2) is reportedly a benign antioxidant and boric acid is an effective medication in repairing deep wounds. In this work, a nanoparticle system that consists of potassium borohydride ionic nanocrystals (KBH4 NCs) with a high H2 storage capacity is developed for the treatment and prevention of ethanol-induced gastric ulcers in mice. H2-rich water (HRW) is used as a control. Since the evolution of gaseous H2 from the HRW is abrupt, most of the evolved H2 gas is lost to the surrounding environment before and during oral administration. By contrast, KBH4 NCs can be trapped at the defect sites of ulcerated regions, reacting with the gastric fluid to generate sustainably gaseous H2 and boric acid, mitigating oxidative stress and excessive inflammation in tissues and repairing the gastric injury. Additionally, the protection that is afforded by gastric mucosa against ethanol-induced damage is stronger in mice that have been pretreated with KBH4 NCs than in those that have been pretreated with HRW, indicating the protective effect of KBH4 NCs. Overall, the data suggest that the as-developed KBH4 NCs are a promising oral formulation for the effective management of gastric ulcers.

A223 UNMASKED OR INDUCED COLITIS: COULD IT BE SECUKINUMAB?

Abstract Background Spondyloarthropathies (SpA), such as Ankylosing Spondylitis (AS) are inflammatory disorders which have coheritability with inflammatory bowel disease (IBD). Secukinumab is a monoclonal antibody inhibitor of IL-17A used to treat SpA, but has also been reported to cause de novo and exacerbations of known IBD. Rare reports of Secukinumab induced microscopic colitis have also been documented. Purpose To present and discuss the diagnostic challenges in a case of undifferentiated colitis in a patient with AS treated with Secukinumab. Method Case report and literature review. Result(s) Case Report: A 62-year-old male with a history of AS was admitted to hospital with acute on chronic diarrhea. The patient’s AS was unresponsive to Infliximab, Methotrexate, and Adalimumab, although the latter improved his diarrhea at the time. A Colonoscopy completed 14 years earlier for chronic diarrhea was endoscopically normal with biopsies of the left colon notable for mild patchy inflammation and fibrosis. A subsequent Colonoscopy with random biopsies 8 years later showed normal mucosa while he was treated with Adalimumab. He was started on Secukinumab 4 months prior to hospitalization noting progressive watery diarrhea and weight loss of 15kg. Investigations were notable for microcytic anemia (Hemoglobin 120 g/L, MCV 78 fL), elevated CRP (33 mg/L), and a creatinine of 508 µmol/L. Negative tTg antibodies and normal IgA levels ruled out celiac disease. Stool studies were unremarkable. Colonoscopy showed several linear ulcerations in the descending colon and rectum with a normal terminal ileum, transverse, and ascending colon. Biopsies from the endoscopically normal mucosa showed thickened subepithelial collagen band suggestive of microscopic colitis while the ulcerated regions showed cryptic rupture with associated granuloma representing possible Crohn’s colitis versus drug-induced injury. Stains were negative for CMV. Secukinumab was stopped and he was started on Budesonide with significant improvement in symptoms. Literature Review Almost half of all patients with SpA have microscopic intestinal inflammation and of these, 7% eventually develop IBD. Shorter symptom duration, higher SpA activity and male sex are known risk factors for underlying intestinal involvement. However, the exact role of microscopic intestinal inflammation in SpA has yet to be determined. Secukinumab is an inhibitor of IL-17A with significant efficacy in the treatment of SpA but has been associated with exacerbations of Crohn’s disease and de novo cases of IBD. Thus, the role of IL-17 in IBD remains uncertain and may suggest a protective effect rather than an inflammatory one seen in SpA. The long half-life of Secukinumab (24-31 days) presents challenges when considering treatment with other biologics, such as anti-TNFs, which may cause excessive immunosuppression. Image Conclusion(s) New onset colitis is a described but rare entity in patients treated with Secukinumab presenting several diagnostic and treatment challenges. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Automated Detection of Corneal Ulcer Using Combination Image Processing and Deep Learning.

A corneal ulcers are one of the most common eye diseases. They come from various infections, such as bacteria, viruses, or parasites. They may lead to ocular morbidity and visual disability. Therefore, early detection can reduce the probability of reaching the visually impaired. One of the most common techniques exploited for corneal ulcer screening is slit-lamp images. This paper proposes two highly accurate automated systems to localize the corneal ulcer region. The designed approaches are image processing techniques with Hough transform and deep learning approaches. The two methods are validated and tested on the publicly available SUSTech-SYSU database. The accuracy is evaluated and compared between both systems. Both systems achieve an accuracy of more than 90%. However, the deep learning approach is more accurate than the traditional image processing techniques. It reaches 98.9% accuracy and Dice similarity 99.3%. However, the first method does not require parameters to optimize an explicit training model. The two approaches can perform well in the medical field. Moreover, the first model has more leverage than the deep learning model because the last one needs a large training dataset to build reliable software in clinics. Both proposed methods help physicians in corneal ulcer level assessment and improve treatment efficiency.

Effect of cisplatin on oral ulcer-induced nociception in rats

ObjectiveThe aim of this study is to investigate effects of cisplatin preadministration on oral ulcerative mucositis-induced nociception by using an experimental model of rats. DesignAfter two rounds of cisplatin administration, oral ulcers developed with topical acetic acid treatment in rats. Spontaneous mouth rubbing behavior was observed as spontaneous nociceptive behavior in a plastic cage. Head-withdrawal behavior was observed as mechanical allodynia by using von Frey test in the oral mucosa of conscious rats. Bacterial invasion and inflammatory cell infiltration into oral ulcerative region and systemic leukocyte phagocytic activity were assessed. ResultsFollowing cisplatin preadministration, oral ulcerative mucositis-induced spontaneous nociceptive behavior was not observed in the model. The preadministration enhanced leukocyte phagocytic activity, leading to reduce bacterial invasion and inflammatory cell infiltration in the oral ulcerative region. In contrast, oral ulcerative mucositis-induced mechanical allodynia was induced. The exaggerated mechanical allodynia in the oral ulcerative region was largely inhibited by topical treatment with the antioxidative drug, ɑ-lipoic acid, or the blocker of N-formyl peptide receptor 1, N-t-butoxycarbonyl-methionyl-leucyl-phenylalanine. ConclusionsThese results suggest that cisplatin preadministration suppresses spontaneous nociception in oral ulcerative region, due to antiinflammatory effects by enhancement of leukocyte phagocytic activity, but exaggerates mechanical allodynia due to oxidative stress with N-formyl peptide receptor 1 activation. The suppression of spontaneous nociception is one of the advantages of cisplatin treatment for head and neck cancer patients although the exaggerated allodynia is a serious symptom.

S2007 Chronic Lymphocytic Leukemia Presenting as Colonic Ulcers

Introduction: Chronic Lymphocytic Leukemia (CLL) accounts for 25% of leukemias. One can present with hepatomegaly, splenomegaly, and lymphadenopathy. CLL infiltration in the gastrointestinal (GI) mucosa is rare. Colonic CLL can develop late in the disease course with mild to no GI symptoms. Awareness of CLL and its various extra-nodal presentations allow for prompt diagnosis and treatment. Case Description/Methods: An 80-year-old female with untreated CLL presented with 2 months of rectal bleeding. She denied weight loss, anorexia, night sweats, blood thinners, and NSAID use. She had WBC 34.3, platelets 139, and a normal Hgb of 13.2. Colonoscopy showed ulcerations at the ileocecal valve and transverse colon, a 30 mm ascending colon polyp, and multiple 10-20 mm transverse and descending colon polyps. Pathology showed only chronic inflammation of the ulcerated regions, and a sessile serrated adenoma at the ascending colon. The remaining polyps were not removed due to concern for cancer and potential colectomy. A CT chest, abdomen, and pelvis was unremarkable. Tumor markers showed CEA 8 and normal Ca19-9 and Ca-125. Due to an unclear diagnosis, a second colonoscopy was performed with repeat biopsies and removal of all polyps in the descending and sigmoid colon. Pathology results were negative for inflammatory bowel disease and infection. The polyps were tubular adenomas and hyperplastic. However, immunohistochemical analysis was positive for CD5/CD43 and CD23, indicative of CLL in the ulcerated mucosa. Treatment options were discussed with surgery and oncology. The patient was offered right colon resection or endoscopic removal of the remaining polyps prior to chemotherapy (Figure). Discussion: Colorectal lymphomas are rare and account for 1% of all GI malignancies with CLL usually found proximal to the hepatic flexure. In this case, the presence of ulcerations and large polyps were concerning for colorectal cancer. However, the initial work-up was negative. After a repeat colonoscopy, testing for specific CLL markers was requested. In a review of literature, chemotherapy alone for colonic CLL had a perforation risk of 15%. While it is unclear if surgical treatment is beneficial, it is a potential option. Due to the high risk of perforation on chemotherapy, recommendations included right hemicolectomy or endoscopic removal of the remaining polyps prior to starting treatment. This demonstrates the importance of knowing the varying presentations of colonic CLL as its treatment may require multidisciplinary discussion.Figure 1.: Colonic ulcers located at the transverse colon (top left) and IC valve (top right). H&E stain of the colonic mucosa (bottom) that showed positive markers for CLL on IHC analysis.

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.

Clinical Assessment of Diabetic Foot Ulcers Using GWO-CNN based Hyperspectral Image Processing Approach

ABSTRACT Diabetes Mellitus has turned out to be a complicated disease and as of 2016 one out of eleven humans suffer from this disease leading to Diabetic Foot Ulcers (DFU). When not treated, DFUs lead to amputation and in this work, a novel image processing method is proposed for the efficient assessment and classification of DFU images. Initially, pre-processing is done by cascaded fuzzy filter followed by nonlinear partial differential equation (NPDE) based segmentation that segments the foot ulcer regions. Consequently, the local binary pattern (LBP) is employed to extract the useful features. Then the proposed hybrid Grey Wolf Optimization-Convolutional Neural Network (GWO-CNN) model uses these features to identify the DFU regions. The performance evaluation is done by the estimation of the performance metrics and the results are compared with existing algorithms indicating the efficacy of the proposed technique. The obtained results reveal that the proposed work generates an accuracy of 98.5% with a reduced error percentage of 1.4%.

Hemangiosarcoma de perro: Reporte de un caso

Hemangiosarcoma (HSA) presents itself as an extremely invasive and metastatic neoplasm, affecting any vascularized organ because it is derived from growth changes of cells with endothelial lineage. They can also occur in the liver, lungs, heart and kidneys. The definitive diagnosis is obtained by histopathological examinations of primary tumor samples or metastases. A seven-year-old male canine, castrated, pit bull breed, weighing 24.8 kg of body mass, was attended at the Veterinary Clinic - Pet Shop. The main complaint reported by the guardian was hemorrhage in the pelvic region for five days, weight loss, loss of appetite and was anemic. On physical examination, putrid odor was seen, the presence of a firm mass in the adhered and ulcerated pelvic region, suspected of a malignant tumor. The animal was referred to hospitalization, where treatment was initiated as enrofloxacin (1.2 ml, EV, IDB), dipyrone (1.2 ml, EV, IDB), maxicam 2% (0.12ml, EV, SID), oral support, hemoitam (3ml, VO, BID) and glyccolturbo (3ml, VO, BID). After 7 days of hospitalization, the presence of a neoplasm located in the subcutaneous tissue to the penis was confirmed by a cytopathological examination. Surgery was performed to remove the mass in which he completed the diagnosis as high-grade cutaneous hemangiosarcoma. The aim of this study is to report a case of canine hemangiosarcoma. El objetivo de este estudio es reportar un caso de hemangiosarcoma canino.

Benefit of Foot Thermogram Analysis in the Treatment of Diabetic Foot Ulcer: A Systematic Review

Introduction: Foot thermograms depict vascular distribution among foot regions with a spectrum of thermal values. Infrared thermography (IRT) is used to explore challenges in diagnosing complications that involve temperature differences. Problem Statement: It is crucial to identify underlying diabetic ulcers in the foot plantar regions, which are typically missed in photographic images. Early detection of ulcer onset can reduce healing time and treatment costs; thus, IRT plays a vital role in identifying early-stage ulcers by detecting vascular changes. This systematic review aimed to identify studies of thermography in foot ulcer diagnosis, including analysis techniques, extracted features, and scores among patients. Method: A literature search was conducted in PubMed and Scopus databases to identify relevant articles published within the last 10 years. The main criteria for the search results were articles in English with abstracts, and full articles that examine the relationship between diabetes mellitus (DM), foot ulcer and thermography among DM patients. Results: The search identified 2,215 articles, with only 8 studies meeting the inclusion criteria. Foot thermograms were used to identify foot ulcer regions associated with temperature differences. The studies included parameters such as ankle brachial index (ABI), toe brachial index (TBI), age, sex, duration of diabetes, and type of diabetes for statistical analyses to verify the validity of temperature difference data in asymmetrical analysis. Conclusion: Further interventional studies should be conducted to investigate foot IRT in patients with DM, as a variation in temperature differences may challenge the validity of foot thermograms in foot ulcer grading.

Evaluation of cephalexin-loaded PHBV nanofibers for MRSA-infected diabetic foot ulcers treatment

The delayed and compromised diabetic foot ulcers (DFUs) healing due to methicillin resistance staphylococcus aureus (MRSA) is an emerging threat to human health and life. Developing new strategies to clear bacteria from ulcerative regions can be helpful to treat DFUs. The current study was designed to fabricate poly (3-hydroxy butyric acid-co-3-hydroxy valeric acid, (PHBV)), nanofibers (PHBV NFs) loaded with cephalexin (CPL) by electrospining technique to improve the bioavailability of CPL at the wound site to inhibit the bacterial growth and trigger the ulcer healing process. Morphological analysis shown that the electrospun nanofibers exhibited smooth surface morphology with an average diameter ranges from 205 ± 25 to 450 ± 55 nm, depending on the cephalexin concentration. The prepared nanofibers showed an enhanced drug loading capacity (LC) and entrapment efficiency (EE) of about 12.1 ± 1.6% and 75.3 ± 2%, respectively. The successful drug loading was also confirmed by FTIR analysis. Moreover, the CPL-loaded PHBV NFs exhibited high water uptake and biodegradation rate compared to blank PHBV NFs. The drug-loaded NFs initially showed a burst drug release followed by a sustained drug release profile with a constant rate up to 48 h. In-vitro studies show that CPL-loaded PHBV NFs exhibited an enhanced antibacterial activity against MRSA strains and have no visible toxic effect against keratinocytes, L929 and HEK293T cell lines. Further, CPL-loaded PHBV NFs showed the enhanced in-vivo bacterial clearance from DFUs using NcZ10 diabetic mice model compared to free CPL. Collectively, our results demonstrated that CPL-loaded PHBV NFs can be applied as a favorable dressing material to treat MRSA-infected chronic DFUs.

Evaluation of Healing Effect of Stromal Vascular Fraction and Platelet Rich Plasma Application on Ulcerative Ear Wound in Diabetic Rabbit

A debilitating complication of diabetes mellitus is diabetic ulcers, which leads to increased overall morbidity in patients. The high growth factor content in Platelet Rich Plasma (PRP) makes it a widely used intervention for the treatment of diabetic foot ulcers. The topical application of Stromal Vascular Fraction (SVF) could possibly enhance wound healing. This study aims at evaluating the efficacy of combining SVF and PRP on wound healing in diabetic rabbit model. Diabetes was induced in New Zealand white rabbits by intravenous injection of 125 mg/Kg Alloxan. After two weeks of alloxan, three 6 mm diameter, full thickness excision wounds were made, on inner side of the right ear pinna. The animals after induction were allocated into 4 groups with [8 Diabetic (treated with SVF+PRP), 4 Diabetic (treated with 10% Povidone Iodine (PI)), 1 non-diabetic (treated with SVF+PRP), 1 non diabetic (treated with 10% PI)]. The effect of combined therapy was evaluated by assessing wound margin closure rate, histo-pathological evaluation, and inflammatory cell infiltration, epithelization of ulcerative region, neo-vascularization, and fibrosis. We observed that the rate of wound closure is enhanced in wounds treated with SVF+PRP as compared to the PI solution. Wound closure and healthy healing were demonstrated by histo-pathological analysis. The analysis clearly indicates that the healing process of PI treated animals is slower than that of SVF + PRP treated animals. In conclusion, based on wound healing assessment and histo-pathological examination, the diabetic rabbits treated with SVF + PRP exhibited early development of granulation tissue and early signs of wound closure as compared to diabetic animals with normal PI dressing