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Purpose: To identify pressure areas using an impression technique and to evaluate whether adjustment of dentures prior to installation can decrease ulcer frequency, reduce the number of adjustments, and improve satisfaction with treatment. Materials and Methods: A total of 50 complete denture users were selected and randomly divided into two groups. Pressure areas were identified in 25 subjects using the impression technique with fluid silicone, and the denture base in these areas was adjusted before installation. A total of 25 patients received new complete dentures without adjustments before installation. The number of ulcers observed was registered at 1, 7, 15, and 30 days after installation. Patient satisfaction was registered before installation and 1 month after installation. The number of necessary postinstallation adjustments was considered. Comparisons between the groups with respect to the number of ulcers and adjustments and patient satisfaction were performed using the Mann-Whitney test. Results: Identification of pressure areas reduced the number of ulcers after installation of the new prostheses. These results were observed in the 1- (P = .004) and 7-day (P = .002) adjustments for the maxilla and in all the adjustments for the mandible. The technique improved patient satisfaction (P = .031) and reduced the number of postinstallation adjustments (P ≤ .001). Conclusions: A reduction in the incidence of ulcers and number of adjustments and improvement in patient satisfaction could be observed with the use of the impression technique. [ABSTRACT FROM AUTHOR]

Purpose: To examine the clinical efficacy of a chlorhexidine gargle combined with recombinant bovine basic fibroblast growth factor (rb-bFGF) gel in the treatment of recurrent oral ulcers and its effects on inflammatory factors, immune function, and recurrence rate. Materials and Methods: Ninety-six patients with recurrent oral ulcers were randomly assigned to two groups: experimental (treatment with chlorhexidine gargle plus rb-bFGF gel) and control (treatment with chlorhexidine gargle alone) (n = 48 cases). The therapeutic efficacy, clinical improvement of symptoms, and recurrence rate within 3 months were compared between the two groups. Serum inflammatory factor and immune factor levels of patients in the two groups were measured before and after treatment. Results: A statistically significantly higher total effective rate was found in patients of the experimental group (95.83%) versus the control group (81.25%) (p < 0.05). The time to onset of pain relief was shortened, the duration of pain relief was prolonged, and VAS scores for pain level were lower in the experimental than the control group (p < 0.05). Among patients in the experimental group, the number of oral ulcers and ulcer area decreased, and faster onset of pain relief and time until normal eating improved in comparison to the control group (p < 0.05). Reduced levels of IL-2, IL-6, IL-8, and TNF-α were observed in the experimental vs the control group (p < 0.05). Elevated levels of CD3+, CD4+, and NKT and reduced levels of CD8+ were found in the experimental group compared to the control group (p < 0.05). The ulcer recurrence rate of patients in the experimental group (8.33%) was notably lower in comparison to the control group (29.17%). Conclusion: Chlorhexidine gargle plus rb-bFGF gel can improve the clinical outcome of patients with recurrent oral ulcers. It can reduce the levels of inflammatory factors, improve immune function, and reduce the recurrence rate. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a disease characterized by immunological granuloma formation in various organs. Cutaneous manifestations occur in about 25% of patients with rare cases showing ulcerative sarcoidosis, that can be debilitating if not treated promptly. This article presents a patient with isolated ulcerative sarcoidosis and reviews existing literature. A 44-year-old woman presented with a non-healing ulcer on her right gluteal area. A skin biopsy confirmed sarcoidosis with non-necrotizing granulomas. Systemic involvement of sarcoidosis was ruled out. Treatment involved topical corticosteroids and intralesional corticosteroid injections, resulting in complete healing. This case emphasizes the importance of considering ulcerative sarcoidosis in non-healing wounds and the efficacy of corticosteroid treatment.

BACKGROUND: There is only limited information on the clinical presentation, medical management, and outcomes of hospitalized sheep diagnosed with bluetongue virus (BTV) disease. OBJECTIVES: To describe the signalment, history, clinical signs, clinicopathological findings, medical management, and clinical outcomes of sheep diagnosed with BTV disease. ANIMALS: Thirty-five hospitalized sheep with BTV disease. METHODS: Retrospective case series. Medical records from 1989 to 2021 were evaluated. History, signalment, clinical signs, laboratory test results, treatments, and outcomes were recorded. RESULTS: BTV disease was diagnosed from July to December, with a peak proportion (43%; 15/35) of diagnoses recorded in October. Pyrexia and anorexia, respiratory disease, vasculitis, coronitis and lameness, and ulcerative mucosal lesions were present in 71%, 71%, 66%, 49%, and 22% of sheep, respectively. BTV serotypes 10, 11, 13, and 17 were identified, with serotype 17 (75%) being the most frequent. Management of cases included administration of antimicrobials (89%), anti-inflammatories (77%), IV fluids (60%), vitamins (20%), proton-pump inhibitors (14%), diuretics (9%), and antioxidants (9%). Six ewes were pregnant on presentation, but none aborted. Six (17%) sheep died or were euthanized because of clinical deterioration, whereas 83% were discharged. CONCLUSIONS AND CLINICAL IMPORTANCE: The proportion of sheep that survived BTV disease after treatment was relatively high. Serotyping of BTV is recommended because of the mismatch between frequently identified serotypes and the serotype present in the vaccine.

Lower extremity ulcers contribute a significant burden to patient care. Targeted investigation and management are pertinent to improving patient outcomes. We evaluated the aetiology, risk factors, investigations and management of lower extremity ulcers in general medicine patients. There was evidence of under‐ordering of appropriate investigations, and over‐treatment for infection. We proposed a quality improvement initiative to optimise lower extremity ulcer care. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Aims Materials & Methods Results Discussion Conclusion Foot sole plantar pressure generates transient but habitual cutaneous ischemia, which is even more exacerbated in atypical gait patterns. Thus, adequate post‐occlusive reactive hyperaemia (PORH) is necessary to maintain skin health. Plantar pressure regional variance during daily tasks potentially generates region‐specific PORH, crucial for ischemic defence.The current work investigated regional PORH across the human foot sole resulting from stance‐like loading.A loading device equipped with an in‐line laser speckle contrast imager measured blood flux before, during, and after whole‐foot loading for 2 and 10 min durations at 15% and 50% body weight. Flux was compared between six regions: the heel, lateral arch, medial arch, and fifth, third, and first metatarsals (MT).Baseline flux was significantly greater in the 1MT and 3MT than all other regions. Loading occluded the heel, 5MT and 3MT more than all other regions. Regional PORH peak, time to peak, area under the curve, and recovery rate were ranked between regions.The 3MT, followed by 5MT, overall had the strongest PORH response, suggesting a heightened protection against ischemia compared to other regions.This work highlights regional variations within a healthy foot, providing a framework for future ulcer risk assessments and interventions to preserve foot health. [ABSTRACT FROM AUTHOR]

Background: To analyze the diagnostic efficiency of the four absolute endoscopic submucosal dissection (ESD) indications for lymph node metastasis (LNM) of Chinese patients with early gastric cancer (EGC). Methods: We retrospectively analyzed EGC patients who underwent radical D2 gastrectomy from January 2019 to December 2022. We evaluated the rate of LNM, false-negative rate, and negative predictive value of the four ESD indications. Results: Of enrolled 2722 EGC patients, 388 (14.3%) patients presented LNM. Tumor size > 2 cm, ulceration, submucosal invasion, undifferentiated type, and lymphovascular invasion were independent risk factors of LNM in patients with EGC. 1062 (39%) cases of EGC conformed to the four EDS indications; however, 4% of them had LNM. 451 cases were fully in accord with the fourth ESD indication (undifferentiated intramucosal carcinoma without ulceration and a maximum lesion diameter of ≤ 2 cm), and 35 of them had LNM, with a false-negative rate (FNR) of 9.02% and a negative predictive value (NPV) of 92.24%. There was significant difference among the four indications in terms of the rate of LNM (1.0% vs 1.5% vs 1.3% vs 7.8%, P < 0.001), FNR (1.03% vs 0.52% vs 0.26% vs 9.02%, P < 0.001), and NPV (98.99% vs 98.53% vs 98.75% vs 92.24%, P < 0.001). Conclusion: Overall, the fourth ESD indication was associated with a high rate of LNM compared to the other three indications. Thus, it might not be safe to classify it as an absolute indication in Chinese patients with EGC. [ABSTRACT FROM AUTHOR]

Allogeneic platelet-rich plasma (al-PRP) is gaining attention in clinical practice for treating chronic refractory wounds, though research results remain controversial. To assess the clinical efficacy of al-PRP for chronic refractory wounds. Databases including PubMed, Cochrane Library, Embase, CNKI, SinoMed, VIP, and WFPD were searched for randomized controlled trials comparing al-PRP with conventional treatments up to October 2023. Two researchers independently screened studies, extracted data, and assessed quality. Statistical analysis was conducted using RevMan 5.4, and potential publication bias was assessed and corrected using funnel plots and Egger's test. Twelve studies with 717 cases were included. Meta-analysis showed al-PRP significantly improved outcomes compared to non-al-PRP treatments: increased healing rate (RR 2.72, 95% CI 1.77–4.19, p < 0.00001), shortened healing time (SMD − 1.03, 95% CI -1.31 to -0.75, p < 0.00001), improved efficacy rate (RR 1.19, 95% CI 1.10–1.28, p < 0.00001), increased wound shrinkage (MD 35.65%, 95% CI 21.65–49.64, p < 0.00001), and reduced hospital stays (MD -2.62, 95% CI -4.35 to -0.90, p = 0.003). Al-PRP is a feasible, effective, and safe biological therapy for chronic refractory wounds. Trial registration: PROSPERO Identifier CRD42022374920. [ABSTRACT FROM AUTHOR]

The early expectations about growth factors' (GFs') discovery as an undisputed therapeutic solution for chronic wounds progressively eclipsed when they failed to accelerate acute wound closure and restore the healing trajectory of stagnant ulcers. Critical knowledge about chronic wound biology and GF pharmacology was a conundrum at that time. Diabetes undermines keratinocytes' and fibroblasts' physiology, impairing skin healing abilities. Diabetic ulcers, as other chronic wounds, are characterized by hyperinflammation, unbalanced proteolytic activity, catabolism, and free radical cytotoxicity. This hostile scenario for the chemical stability, integrity, and functionality of GFs led to the conclusion that topical administration may jeopardize GFs' clinical effectiveness. Epidermal growth factor (EGF) has a proximal position in tissues homeostasis by activating survival and mitogenic pathways from embryonic life to adulthood. Seminal experiments disclosed unprecedented pharmacological bounties of parenterally administered EGF. Accordingly, the experience accumulated for more than 20 years of EGF intralesional infiltration of diabetic wound bottoms and edges has translated into sustained healing responses, such as low recurrences and amputation rates. This delivery route, in addition to being safe and tolerated, has shown to restore a variety of circulating biochemical markers ordinarily disturbed in diabetic conditions. EGF infiltration triggers a cascade of local fibroblast reactions, supporting its molecular integrity, prolonged mean residence time, and ultimately eliciting its receptor trafficking and nuclear translocation. The intralesional delivery route seems to warrant that EGF reaches wound fibroblasts' epigenetic core, mitigating the consequences of metabolic memory imprinting. [ABSTRACT FROM AUTHOR]

Given progressive population ageing and the increase in the number of patients with comorbidities, the management of chronic and/or hard-to-heal wounds (HHWs) nowadays represents a common problem in many clinical settings. In these cases, standard strategies may not be sufficient. Autologous grafting represent the gold standard for permanent wound closure, but is almost never realized when the skin loss is extensive/the patient is young. The grafting of homologous skin/dermal tissue procured from cadaver donors (i.e., allografting) represents the best alternative, especially when the dermal component is lost. This request supports the activities of skin bank establishments (including donor screening, skin procurement, processing, storage, and distribution) that are regulated by specific guidelines and need to continuously meet quality standard requirements. The aim of this work is to both give specific insights of all the procedures implied in allograft preparation as well as an overview of their practical application in the treatment of different HHWs. The particular characteristics of each skin/dermal allograft released by Siena Skin Bank (cryopreserved/glycerol-preserved skin/de-epidermized dermis, acellular lyophilized de-epidermized dermis/reticular dermis) are also discussed. The exemplificative series of HHWs managed in the Dermatology Department of Siena were classified according their etiology into post-traumatic, vascular (arterial/venous/mixed/lymphatic), inflammatory, surgical, and heat/chemical burns. Globally, the clinical advantages obtained include: acceleration of healing process, pain sparing, resistance to bacterial contamination, dermal regeneration (instead of scarring), and better aesthetic–functional outcome. [ABSTRACT FROM AUTHOR]

Introduction: Although Vonoprazan, a potassium-competitive acid blocker, is superior to proton pump inhibitors (PPIs) in treating Helicobacter pylori and erosive esophagitis, its efficacy for treating gastric and/or duodenal ulcers remains controversial. This meta-analysis summarizes the efficacy and safety of Vonoprazan vs. PPI for treating and preventing gastric and/or duodenal ulcers. Methods: Only randomized controlled trials randomizing gastric and/or duodenal ulcer patients, regardless of etiology, into Vonoprazan or any PPI and indexed in Embase, Medline, and CENTRAL until March 2, 2024 were searched. Primary outcomes were ulcer healing rates at Weeks 2, 4, 6, and 8 and recurrence rates at Week 24. Other outcomes included shrinkage rates, any adverse events (AEs), serious AEs (SAEs), and risks of delayed bleeding and perforation. The overall risk ratio (RR) and mean difference were pooled using the random-effects model. The risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB2) Tool. Results: Fifteen studies comprising 43 reports were included in the analysis. Healing rates of gastric and/or duodenal ulcers were similar in both Vonoprazan and PPI groups at all weeks (Week 2 RR 1.02 [95% CI 0.89–1.16]; Week 4 0.99 [95% CI 0.95–1.04]; Week 6 1.00 [95% CI 0.96–1.03]; Week 8 0.99 [95% CI 0.95–1.03]). The recurrence prevention of peptic ulcers was not different in Vonoprazan 10 mg (RR 0.48; 95% CI 0.18–1.27) or 20 mg (0.60; 95% CI 0.28–1.30) to PPI. Shrinkage rates, any AEs, SAEs, and risks of delayed bleeding and perforation were similar in both groups. Conclusion: Vonoprazan is not significantly better than PPI in treating and preventing gastric and/or duodenal ulcers. [ABSTRACT FROM AUTHOR]

Background: Radiologic ulcers are increasingly recognized as an imaging finding of bowel wall active inflammation in Crohn disease (CD). Objective: To determine the frequency of ulcers at MR enterography (MRE) in children with newly diagnosed ileal CD, assess agreement between radiologists, and evaluate if their presence correlates with other imaging and clinical features of intestinal active inflammation. Materials and methods: This retrospective study included 108 consecutive pediatric patients (ages 6–18 years) with newly diagnosed ileal CD that underwent clinical MRE prior to treatment initiation between January 2021 and December 2022. MRE examinations were independently reviewed by three pediatric radiologists who indicated the presence vs. absence of ulcers, ulcer severity (categorical depth), and ulcer extent (categorical number of ulcers). Maximum bowel wall thickness and length of disease were measured and averaged across readers. Patient demographics and clinical inflammatory markers were documented from electronic health records. Inter-radiologist agreement was assessed using Fleiss' kappa (k) statistics. Student's t-test was used to compare continuous variables. Results: Mean patient age was 13.9 years (67 [62%] boys). Radiologic ulcers were recorded in 64/108 (59.3%) cases by reader 1, 70/108 (64.8%) cases by reader 2, and 49/108 (45.4%) cases by reader 3 (k = 0.36). Based on majority consensus, radiologic ulcers were present in 60/108 (55.6%) participants. Inter-radiologist agreement for ulcer severity was k = 0.23, while ulcer extent was k = 0.66. There were significant differences in C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, albumin, maximum bowel wall thickness, and length of disease between patients without and with radiologic ulcers (P < 0.05). The sensitivity and specificity of MRE for detecting endoscopic ulcers were 66.7% (95% CI, 52.1–79.2%) and 69.2% (95% CI, 48.2–85.7%), respectively. Conclusion: Radiologic ulcers are visible in children with newly diagnosed ileal CD, although inter-radiologist agreement is only fair. The presence of ulcers is associated with clinical laboratory inflammatory markers as well as other MRE findings of disease activity and is an additional imaging finding that can be used to evaluate intestinal inflammation. [ABSTRACT FROM AUTHOR]

The IntegraⓇ Dermal Regeneration Template (DRT) is a bioengineered dermal substitute that is becoming increasingly popular in the field of reconstruction. Its unique properties allow for immediate wound closure while providing a scaffold for tissue regeneration. Currently, it is commonly used to treat burns, ulcers, and complex wounds. In the setting of traumatic periocular tissue loss, only two prior reports have been published on its use for primary reconstruction. We present our institution's experience with a series of four young patients who received primary reconstruction with IntegraⓇ DRT as a full-thickness skin substitute for their large traumatic periorbital skin defects. [ABSTRACT FROM AUTHOR]

Background: While Sodium-glucose cotransporter 2 (SGLT2) inhibitors are effective in managing diabetes and reducing cardiovascular risk, concerns about their association with lower limb complications, including, osteomyelitis, ulcers, and peripheral artery disease (PAD), persist. This study employs Mendelian Randomization (MR) to assess the causal relationship between SGLT2 inhibitors and these lower limb safety outcomes. Methods: A two-sample drug-target MR approach was used, complemented by a one-sample MR and genetic association analysis. Six SNPs were selected as instrumental variables to proxy the effect of SGLT2 inhibition. Primary outcomes were major limb safety outcomes, including osteomyelitis, lower limb ulcers, PAD, and cellulitis. The primary analytical method was the generalized inverse variance-weighted (IVW) approach, along with several sensitivity analyses. Results: The MR analysis indicated no significant causal association between genetically proxied SGLT2 inhibition and most of the studied lower limb safety outcomes. However, a significant association with PAD was observed, necessitating careful interpretation due to discrepancies between IVW and MR-Egger results. Sensitivity analyses supported these findings, showing little evidence of heterogeneity or directional pleiotropy. Conclusion: This study suggests that SGLT2 inhibitors may not be significantly associated with an increased risk of most lower limb safety outcomes, including osteomyelitis, lower limb ulcers, and cellulitis, in patients with type 2 diabetes. However, the complex relationship with PAD highlights the need for further research. These findings contribute to the understanding of the safety profile of SGLT2 inhibitors, supporting their continued use in diabetes management while underlining the importance of continuous safety monitoring. [ABSTRACT FROM AUTHOR]

The objective of the study was to compare outcomes in patients with complete surgical resection versus partial resection of diabetic foot osteomyelitis (OM). A post hoc analysis of 171 patients with OM was performed using data from two randomized clinical trials. OM was confirmed with bone culture or histopathology. Surgical culture specimens were obtained from resected bone and sent for histopathology and microbiology. Residual osteomyelitis (RO) was defined as a positive resected margin on culture or histopathology. No residual osteomyelitis (NRO) was defined as no growth from bone culture and no histopathological inflammation in the biopsy of the resection margin. Data from the 12‐month follow‐up were used to determine clinical outcomes. During the index hospitalization, NRO patients had significantly shorter duration of antibiotic therapy (NRO 21.0, 13.0–38.0 vs. RO 37.0, 20.8–50.0, p <0.01) and more amputations than patients with RO (NRO 89.9% vs. RO 60.9%, p <0.01). During the 12‐month follow‐up, patients with NRO also had significantly shorter duration of antibiotic therapy (NRO 42, 21.0–66.5 vs. RO 50.5, 35.0–75.0, p = 0.02). During the 12‐month follow‐up, there was no difference in ulceration at the same site (NRO 3.7%, RO 4.3% p = 0.85), hospitalization (NRO 32.6%, RO 34.8%, p = 0.76), total re‐infections (NRO 25.3%, RO 29.3%, p = 0.56), re‐infection with osteomyelitis (NRO 13.3% vs. 13.5%, p = 0.36), amputation (NRO 8.8%, RO 5.4%, p = 0.86) and time to wound healing in days (NRO 94, 41.0–365 vs. RO 106, 42.8–365, p = 0.77). Successful treatment of osteomyelitis was achieved by 86.7% and 86.5% of patients. During the index hospitalization, patients with no residual osteomyelitis had more amputations and were treated with antibiotics for a shorter duration. During the 12‐month follow‐up, patients with no residual osteomyelitis had shorter durations of antibiotics. There were no differences in re‐infection, amputation, re‐ulceration or hospitalization. Level of evidence: 1 [ABSTRACT FROM AUTHOR]

Background: Recurrent aphthous stomatitis (RAS) is considered as the most common oral mucosal lesion affecting up to 25% of people worldwide. Thalidomide has been reported for the treatment of RAS, but the evidence has not been systematically evaluated. We first systematically reviewed the efficacy and safety of thalidomide for the treatment of RAS. Methods: We searched The Cochrane Library, PubMed, Scopus, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Database (CBM), Wanfang Data, and VIP information from inception to December 2023. Randomized controlled trials (RCTs) comparing thalidomide with control for RAS were included in the analysis. The primary outcome were complete response and overall response, and the secondary outcome were recurrence interval (RI), ulcer number and size, healing time, visual analogue scale (VAS), immunological data, and adverse events. Meta-analysis was conducted using the Review Manager 5.4 software. Results: Twenty-one trials involving 1668 patients were included in this review. The results of our meta-analysis showed that thalidomide significantly improved the complete response rate and overall response rate, prolonged the recurrence interval, accelerated the healing process, reduced the number and size of ulcers, and lowered TNF-α levels in the treatment of RAS. However, thalidomide significantly increases adverse events. Results: Thalidomide has a significant benefit in the treatment of RAS. However, considering the potential side effects of thalidomide, it may be an optimal treatment option for major RAS patients or cases that do not respond to topical agents. Trial registration: PROSPERO registration number: CRD42024495038. [ABSTRACT FROM AUTHOR]

Introduction: Many patients consult general practitioners instead of dentists for their oral and dental problems every year. This study aims to find the reasons why patients consult general practitioners when they have dental problems. Methods: The sample consisted of patients visiting dentists and general practitioners in Kerman, Iran. A thematic interview guide, semi-structured questions, and a mind map that allowed for structured and open-ended questions were prepared and used for the interviews. All interviews were recorded and transcribed verbatim by a final-year student. Data collection, transcription, and analysis were conducted simultaneously to allow for new topics to be raised and theoretical saturation to be reached. When researchers determined that sufficient information was available for analysis and understanding of patient opinions and beliefs, the interview process was stopped. As all audio conversations were recorded with the participant's permission, no note-taking was done during the interviews, which allowed for greater focus on the participants' conversation. The obtained data was analyzed using the content analysis. Results: A total of 52 patients were included in this study. The codes related to patients participating in this research, along with the number of respondent groups related to each code were as follows: patient's perceptions of general practitioner(GP) and dental practitioner's scope of work [21], flawed dental system (34), dental anxiety [28], financial considerations [25], and more accessibility to GPs (31). Dental abscesses and dental pain were reported as the most common reasons for consulting GPs. Conclusion: Most participants agreed that dental problems are more effectively treated by dentists. Reasons for visiting a general practitioner included lack of a specific dentist, dissatisfaction with dental treatments, lack of a dentist nearby, absence of emergency dental care, and familiarity with a physician. The most common reasons for visits were toothache and dental abscesses. Patients also sought treatment for TMJ pain, referred nerve pain, wisdom tooth pain, numbness and tingling in the jaw, gum inflammation, oral lesions, and ulcers. Furthermore, other factors such as opening hours, appointment systems and waiting time can also affect patient's consult behaviors regarding dental problems. [ABSTRACT FROM AUTHOR]

Background: Given the limited treatment options available for oral lichen planus (OLP), a study was undertaken to obtain preliminary information on the therapeutic efficacy of tinidazole mouth rinse in patients with OLP. Methods: A prospective, open-label pilot study was conducted to assess the efficacy of thrice-daily tinidazole mouth rinse for one week in OLP patients (n = 27). Reticulation/erythema/ulceration (REU) scores and visual analog scale (VAS) scores were used to measure lesions at baseline and after one week of treatment. Mucosal samples were collected, and the abundance of Fusobacterium nucleatum was quantified using RT-PCR. Statistical analysis using t-test, Wilcoxon signed rank test and Pearson correlation test. Results: After treatment, VAS scores significantly decreased in both reticular (P = 0.03) and erosive OLP patients (P = 0.003). However, REU scores significantly decreased only in erosive OLP patients (P = 0.002). The relative abundance of Fusobacterium nucleatum on the damaged mucosa surface significantly decreased in all OLP patients (P = 0.01). In erosive OLP patients, the triamcinolone group showed a significantly greater improvement in VAS scores compared to the tinidazole group (P = 0.01). However, there was no statistically significant correlation between the relative abundance of Fusobacterium nucleatum and REU scores in OLP patients (r = 0.0754, P = 0.61). Conclusion: Tinidazole mouth rinse showed potential in reducing disease severity in OLP patients and was well-tolerated, suggesting its viability as a local therapeutic option. However, randomized controlled studies are warranted to confirm these preliminary findings. [ABSTRACT FROM AUTHOR]

Deep learning techniques can accurately detect and grade abnormal findings on images from Wireless Capsule Endoscopy (WCE). However, the prediction accuracy of handcrafted or deep learning in red Lesion, polyp and ulcer diseases is still under investigation. Knowing the utility of an automatic method for abnormalities detection from WCE images and how helpful it might be for the physicians, we proposed a new methodology in approaching this field. In this paper, patches with fixed size are extracted from WCE images, then, encoded using linear projection and position embedding and passed through an embedding model in a forward pass. Moreover, triplet loss is employed to adjust the embeddings. Afterwards, the trained embedding model is exploited for classification. Two strategies are followed in the design of the embedding model namely; training from scratch and fine tuning. The presented scheme, attains satisfactory results in different datasets compared to existing approaches. The detection accuracy has reached 99.9% in some used datasets. [ABSTRACT FROM AUTHOR]

In children - polyetiological diseases of the gastrointestinal tract and 12-finger ulcer, in children they are rare, in origin pylori Hilobacteri plays an important role. In children, diseases of the gastrointestinal tract by 9% and 12 fingers - by 91%, and in 600 children - by 1. Manifested by various clinical signs, which in some cases are characterized by bleeding, increasing lateral tissues, pyloric ring stenosis and require long-term treatment. To date, the incidence is more, in school-aged children - 60%, in children 5-7 years old - 40%, which is associated with pylori Hilobacteri infection. [ABSTRACT FROM AUTHOR]

Background: Gastric cancer is the fifth most commonly diagnosed cancer and the third most prevalent cause of cancerrelated mortality globally. Although there has been a decline in the overall occurrence of gastric cancer over recent years, the incidence of signet-ring cell carcinoma (SRCC) has shown a consistent rise, representing up to 30% of gastric adenocarcinoma cases. Case Presentation: We present an unusual case of a 22-year-old woman with gastric outlet syndrome secondary to a primary gastric SRCC. A gastro-duodenal endoscopy showed a markedly edematous substenotic pyloro-bulbar region without any ulcers. Biopsy demonstrated gastric mucosa with tumor cells originating from an adenocarcinoma of the diffuse type (SRCC). An abdominal Computed Tomography (CT) scan detected an intestinal malrotation, making an endoscopic gastro-enterostomy not feasible. Despite fluorodeoxyglucose (FDG)-positron emission tomography (PET-CT) showed no distant metastasis, during staging laparoscopy metastatic implants were detected on the peritoneum, diaphragm, and small bowel mesentery. There was no amplification of the HER2 gene and no PD-L1 expression in the tumor cells, making this patient not eligible for immunotherapy. A jejunostomy was placed for enteral nutrition and chemotherapy (FOLFOX) was initiated. Conclusion: Although diffuse-type gastric carcinoma in young adults (<30 years) is extremely rare, clinicians should be aware of its growing incidence and the importance of early diagnosis. This case advocates for considering gastric carcinoma in the differential diagnosis of gastric outlet syndrome, even in a patient population where this rarely occurs, as early stage diagnosis is crucial to afford these patients improved opportunities for curative treatment. [ABSTRACT FROM AUTHOR]

Worldwide perforated peptic ulcer disease is the leading cause of mortality after abdominal emergency surgery Rapid clinical assessment, proper diagnostics, and timely decision-making are vital in handling patients with suspected or identified perforated peptic ulcer CT has high diagnostic sensitivity, whereas perforation is only evident on three-quarters of plain abdominal X-rays Delay in surgical intervention increases mortality risk Simple closure of the perforated ulcer is still the preferred method of surgery Laparoscopic surgery is the preferred approach in experienced hands [ABSTRACT FROM AUTHOR]

Background: Pressure offloading is a critical component of plantar foot ulcer management, including diabetes‐related foot ulcers (DFU). Conventional offloading options such as total contact casting and removable knee‐high walkers may be unsuitable or unsuccessful in patients with morbid obesity, intermittent lower limb oedema, high exudative wounds or poor mobility. A mouldable fibreglass backslab device (BSD) may be a practical alternative to be considered in these situations. Methods: Data were retrospectively collected on 28 patients (29 foot ulcers) with non‐healing ulcers who received a BSD to offload their foot ulcer as an extension to standard offloading care. Baseline data included: patient demographics, type of offloading prior to BSD application, date of ulcer onset, days ulcer present prior to BSD application and ulcer size at BSD initiation. Measures of success included ulcer size reduction 12 weeks post‐BSD application, time to complete ulcer healing in BSD, time to 50% reduction in ulcer size post‐BSD application and total number of days ulcer present. Results: The median (IQR) ulcer area and ulcer duration at baseline for 19 patients (20 ulcers) who used the BSD was 1.65 (0.4–3.8) cm2 and 531 (101–635) days. At 12 weeks, the median (IQR) ulcer area was 0.3 (0–0.55) cm2 with a median (IQR) reduction of 97 (80–100) %. Nine (45%) ulcers achieved complete wound healing (100% reduction in wound size) at 12 weeks post‐BSD application, and the remaining 11 (55%) ulcers achieved at least 50% reduction in wound size. The median (IQR) time to complete wound healing and 50% reduction in wound size was 71 (35–134) days and 24 (15–44) days, respectively. Nine patients ceased use of the BSD and reverted to conventional offloading before their wounds had healed. Of these, four patients achieved a 50% reduction in wound size at the 12‐week mark with conventional offloading. Conclusion: Our preliminary data suggests that a mouldable fibreglass BSD may be a practical offloading option in the management of DFUs, especially when conventional offloading methods are unsuccessful, unsuitable or unacceptable to patients. Higher level evidence is required to demonstrate suitability or efficacy of the BSD compared to current evidence‐based recommended offloading methods. [ABSTRACT FROM AUTHOR]

A reverse sural flap is a surgical procedure to repair soft tissue defects, usually in the ankle region. This procedure involves moving a tissue flap from the calf to cover a defect in the ankle. The flap is turned 180° so that the tissue around the wound is supplied with blood by the vessels at the base of the flap, typically preserving the sural nerve and artery. This method is particularly valuable when thick and robust tissue is required to cover defects resulting from traumatic injuries, chronic wounds, or post-skin tumor removal when the local tissue is insufficient for direct closure. In this case, a patient who had undergone surgery for a chronic ulcerative lesion on the Achilles tendon three years prior to presentation at the authors' hospital was treated using a half-width reverse sural flap. Modifications to the sural flap design may be crucial considering the surgical history, blood supply, and defect size around the lower leg. In particular, previous surgeries for lower leg fractures or ligament damage may limit blood supply and require flap design modifications. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the prevalence and types of oral adverse events following immunization (AEFIs) in people who received at least one dose of any type of vaccine. Materials and Methods: We conducted a bibliographic search about oral AEFIs in MEDLINE, Embase, PubMed, and Ovid from database inception to November 07, 2022. Risk of bias was assessed using the MURAD or the Quality In Prognosis Studies tools. Random‐effects proportional meta‐analysis was applied. Results: A total of 119 studies involving 343 people were eligible. These reported AEFIs occurred following administration of the coronavirus disease 2019 vaccine, anti‐influenza vaccine, hepatitis B vaccine, and anti‐smallpox vaccine. The most common to be affected in vaccinated people were buccal mucosa (63.1%; 95% confidence interval (CI) 33.4–88.2) and lips (55.7%; 95% CI, 41.1–69.8). The most prevalent oral AEFIs were ulceration (55.2%; 95% CI 24.4–84.0), swelling (65.2%; 95% CI 34.9–89.8), and burning sensation (18.3%; 95% CI 7.9–31.8). Conclusions: The mechanisms underlying oral AEFIs should be further investigated to promptly recognize oral manifestations and provide optimal management for people undergoing vaccination. [ABSTRACT FROM AUTHOR]

This prospective study describes the occurrence, morphology and localisation of type 1 abomasal ulcers (AU1) in various diseases of buffaloes and cattle. The carcasses were examined to confirm the cause of death. The abomasa were examined for AU1 and their characteristics. The AU1 were categorised into four subtypes, 1a, 1b, 1c and 1d, as per standard procedure. Traumatic reticuloperitonitis/pericarditis, reticular diaphragmatic hernia, intestinal obstruction, peritonitis, bronchopneumonia and theileriosis were the common causes for AU1. The overall prevalence of AU1 was 62.9%, which did not differ significantly with species and age. The prevalence of acute ulcers (1a and 1b) was significantly higher than that of chronic ulcers (1c and 1d). Most AU1 were located in the caudal third of abomasal body on parietal surface along the greater curvature. Most of the 1a ulcers were located in the pylorus, while 1b, 1c and 1d were located in the abomasal body. The overall prevalence of AU1 was lower (P<0.05) in the fundus than in other anatomical regions of the abomasum. Type 1b ulcers were more numerous than other subtypes. It was concluded that AU1 may be an important cause of slow recovery/poor prognosis under clinical situations and hence, the therapy protocol for such cases should include treatment for probable gastrointestinal bleeding. [ABSTRACT FROM AUTHOR]

Emilia sonchifolia is used in traditional medicine for the treatment of wounds, diabetes, inflammation and ulcer. This study aims to investigate the analgesic, anti-inflammatory and antiulcer effects of the aqueous leaf extract of Emilia sonchifolia (ALEES). In the acute toxicity test, ALEES was administered up to 5 g/kg body weight via oral route. In the ulcer experiments, Group II-VI rats were pretreated with 1000 mg/kg ethanol or ibuprofen before Group III rats received 20 mg/kg omeprazole and Group IV-VI rats received various doses of ALEES. In the anti-inflammatory and analgesic studies, group II rats received 100 mg/kg acetylsalicylic acid (ASA). For the ulcer, anti-inflammatory and analgesic studies, rats were administered ALEES at doses of 200, 400 and 600 mg/kg body weight while group I served as a normal control. In ethanol-induced ulcer, rats administered 600 mg/kg ALEES showed a higher percentage (%) ulcer inhibition compared to standard drug (omeprazole) treated group (p<0.05). The % ulcer inhibition in the ibuprofen-induced ulcer test did not exhibit any significant changes (p>0.05) between the group treated with 600 mg/kg ALEES and the omeprazole group. In addition, there was no significant anti-inflammatory activity between ALEES at a dose of 600 mg/kg (52.78%) and ASA at a dose of 100 mg/kg (66.61%), however, ASA had a stronger analgesic effect compared to all ALEES-treated groups (p<0.05). The results of this study suggest that ALEES is safe and has the potential to be used as an anti-ulcer and anti-inflammatory agent. [ABSTRACT FROM AUTHOR]

Abstract Allogeneic platelet-rich plasma (al-PRP) is gaining attention in clinical practice for treating chronic refractory wounds, though research results remain controversial. To assess the clinical efficacy of al-PRP for chronic refractory wounds. Databases including PubMed, Cochrane Library, Embase, CNKI, SinoMed, VIP, and WFPD were searched for randomized controlled trials comparing al-PRP with conventional treatments up to October 2023. Two researchers independently screened studies, extracted data, and assessed quality. Statistical analysis was conducted using RevMan 5.4, and potential publication bias was assessed and corrected using funnel plots and Egger’s test. Twelve studies with 717 cases were included. Meta-analysis showed al-PRP significantly improved outcomes compared to non-al-PRP treatments: increased healing rate (RR 2.72, 95% CI 1.77–4.19, p

Introduction: Wound healing is severely compromised in patients with diabetes owing to factors such poor blood circulation, delayed immune response, elevated blood sugar levels, and neuropathy. Although the development of new wound healing products and prevention of serious complications such as infections in wounds have received substantial interest, wound healing remains a challenge in regenerative medicine. Burn wounds, especially third-degree burns, are difficult to treat because they are associated with immune and inflammatory reactions and distributive shock. Wound care and treatment that protects the burn site from infection and allows wound healing can be achieved with bioengineered wound dressings. However, few studies have reported effective dressings for third-degree burn wounds, making it important to develop new dressing materials. Methods: In this study, we developed an artificial amniotic membrane (AM) using epithelial and mesenchymal cells derived from human amnion as a novel dressing material. The artificial AM was applied to the wound of a diabetic third-degree burn model and its wound healing ability was evaluated. Results: This artificial amnion produced multiple growth factors associated with angiogenesis, fibroblast proliferation, and anti-inflammation. In addition, angiogenesis and granulation tissue formation were promoted in the artificial AM-treated mouse group compared with the control group. Furthermore, the inflammatory phase was prolonged in the control group. Conclusions: Our preliminary results indicate that the artificial AM might be useful as a new dressing for refractory ulcers and third-degree burns. This artificial AM-based material represents great potential for downstream clinical research and treatment of diabetes patients with third-degree burns.

Introduction: Reactive angioendotheliomatosis (RAE) is a rare, benign, angioproliferative disorder with poorly understood aetiopathogenesis. It is characterised by vascular occlusion that occurs in patients with coexistent systemic or autoimmune disease. Case Presentation: A 60-year-old female presented with an 8-week history of a painful, non-healing, and non-traumatic ulcer on the left thigh. Her past medical history included smoking, peripheral vascular disease (PVD) and previously treated rectal squamous cell carcinoma. The diagnosis of pyoderma gangrenosum with superimposed cellulitis was considered and treatment with oral antibiotics was initiated. Following failure to improve, a biopsy was undertaken leading to the diagnosis of RAE. The patient was referred for urgent consideration of surgical correction of PVD, but was deemed unsuitable for surgical treatment due to a poor performance status. The patient was treated with conservative measures, but her condition rapidly deteriorated and she passed away a few weeks later. Conclusion: RAE is notorious for mimicking a wide spectrum of diseases. It is an important differential diagnosis to consider in patients with non-healing ulceration and underlying systemic or autoimmune disorders. Our case raises awareness of this rare condition and the mortality that it carries if left untreated. In an attempt to reverse disease progression and mortality, we urge clinicians to attempt surgical correction of PVD even when faced with multiple comorbidities and poor performance status.

Background Methods Results Conclusion The course of late‐onset Behçet's disease (LBD) is unknown. This study aimed to determine the characteristics and systemic involvement of LBD.In this retrospective, cross‐sectional, and comparative study, 700 patient files from 4100 patients diagnosed with Behçet's disease (BD) were selected and divided into three groups: LBD, adult BD (ABD), and juvenile BD (JBD). The age limits for LBD and JBD were determined to be 42 and 16, respectively. LBD patients were compared to ABD and JBD patients in terms of demographics, systemic involvement, and disease duration.The LBD rate among BD patients was 4.7% (183/4,100). The time from initial symptom occurrence to the age at which the BD criteria were met was longer in LBD than in ABD or JBD. Except for genital ulcers, the frequencies of involvement in LBD were similar to those in ABD and JBD. The frequency of family history was significantly lower in LBD (12%) than in ABD (15.9%) or JBD (18.2%). The time from the initial symptom to oral aphthae, genital ulcers, and eye involvement was longer in LBD than in ABD or JBD. Furthermore, erythema nodosum was observed after a longer duration in LBD than in ABD.Considering that involvement occurs much later in LBD and there are no differences in the frequencies of involvement except for genital ulcers, LBD patients should be followed up as closely as ABD and JBD patients. [ABSTRACT FROM AUTHOR]

Computer-aided diagnosis has been slow to develop in the field of oral ulcers. One of the major reasons for this is the lack of publicly available datasets. However, oral ulcers have cancerous lesions and their mortality rate is high. The ability to recognize oral ulcers at an early stage in a timely and effective manner is a very critical issue. In recent years, although there exists a small group of researchers working on these, the datasets are private. Therefore to address this challenge, in this paper a multi-tasking oral ulcer dataset (Autooral) containing two major tasks of lesion segmentation and classification is proposed and made publicly available. To the best of our knowledge, we are the first team to make publicly available an oral ulcer dataset with multi-tasking. In addition, we propose a novel modeling framework, HF-UNet, for segmenting oral ulcer lesion regions. Specifically, the proposed high-order focus interaction module (HFblock) performs acquisition of global properties and focus for acquisition of local properties through high-order attention. The proposed lesion localization module (LL-M) employs a novel hybrid sobel filter, which improves the recognition of ulcer edges. Experimental results on the proposed Autooral dataset show that our proposed HF-UNet segmentation of oral ulcers achieves a DSC value of about 0.80 and the inference memory occupies only 2029 MB. The proposed method guarantees a low running load while maintaining a high-performance segmentation capability. The proposed Autooral dataset and code are available from https://github.com/wurenkai/HF-UNet-and-Autooral-dataset. [ABSTRACT FROM AUTHOR]

Background: The probiotic potential of Lacticacid bacteria has been studied in various medical complications, from gastrointestinal diseases to antibiotic resistance infections recently. Moreover, diabetic ulcer (DU) is known as one of the most significant global healthcare concerns, which comprehensively impacts the quality of life for these patients. Given that the conventional treatments of DUs have failed to prevent later complications completely, developing alternative therapies seems to be crucial. Methods: We designed the stable oleogel-based formulation of viable probiotic cells, including Lactobacillus rhamnosus (L. rhamnosus), Lactobacillus casei (L. casei), Lactobacillus fermentum (L. fermentum), and Lactobacillus acidophilus (L. acidophilus) individually to investigate their effect on wound healing process as an in vivo study. The wound repair process was closely monitored regarding morphology, biochemical, and histopathological changes over two weeks and compared it with the effects of topical tetracycline as an antibiotic approach. Furthermore, the antibiofilm activity of probiotic bacteria was assessed against some common pathogens. Results: The findings indicated that all tested lactobacillus groups (excluded L. casei) included in the oleogel-based formulation revealed a high potential for repairing damaged skin due to the considerably more levels of hydroxyproline content of tissue samples along with the higher numerical density of mature fibroblasts cell and volume density of hair follicles, collagen fibrils, and neovascularization in comparison with antibiotic and control groups. L. acidophilus and L. rhamnosus showed the best potential of wound healing among all lactobacillus species, groups treated by tetracycline and control groups. Besides, L. rhamnosus showed a significant biofilm inhibition activity against tested pathogens. Conclusions: This experiment demonstrated that the designed formulations containing probiotics, particularly L. acidophilus and L. rhamnosus, play a central role in manipulating diabetic wound healing. It could be suggested as an encouraging nominee for diabetic wound-healing alternative approaches, though further studies in detailed clinical trials are needed. [ABSTRACT FROM AUTHOR]

Haemophilus ducreyi (HD) is an important cause of cutaneous ulcers in several endemic regions, including the Western Pacific Region, especially among children. An HD sequence typing on swab samples taken from 1,081 ulcers in the Namatanai district of Papua New Guinea, during the pilot study for treatment of yaws, has been performed using the Grant typing system. Of the 363 samples that tested positive for the 16S rDNA of HD, the dsrA sequences of 270 samples were determined. Altogether they revealed 8 HD strain types circulating in Namatanai, including seven strain types of Class I (I.3, I.4, I.5, I.9, I.10, I.11, I.12) and one strain of Class II (II.3); four Class I types (I.9, I.10, I.11, I.12) were novel. The southern region of Namatanai (Matalai Rural) was identified as the region with the lowest genotype diversity and with most infections caused by HD Class II. The middle and northern subdistricts were affected mainly by HD Class I. Analysis of patient characteristics revealed that Class II HD infections were more often represented by longer-lasting ulcers than Class I HD infections. An increase in the prevalence of the I.10 strain was found after azithromycin administration compared to the untreated population at baseline likely reflecting higher infectivity of HD Class I, and more specifically strain type I.10. Author summary: Haemophilus ducreyi (HD) is one of the main causative agents of cutaneous ulcers in children across substantial parts of Africa and the Pacific. A yaws eradication study conducted in the Namatanai district of Papua New Guinea revealed that nearly one-third of all patients were infected with HD. Single locus sequence typing (SLST) of the HD dsrA locus revealed presence of multiple HD strains circulating in the human population of Namatanai region. In contrast to Treponema pallidum subsp. pertenue, the pathogen responsible for yaws, the prevalence of HD strains did not significantly decrease following mass drug administration. In addition, HD strains from patients in Namatanai region revealed a higher genetic diversity compared to the yaws agent present in the same area and the HD strain composition changed following antibiotic treatment. Infections caused by at least some different HD strain types appear to differ in reported ulcer duration and also in resurgence of infection after antibiotic treatment. Therefore, important pathophysiological differences among HD strain types were predicted. [ABSTRACT FROM AUTHOR]

Macrophages play a pivotal role in the healing of diabetic ulcers. The sustained elevation of glucose levels damages the insulin signaling pathway in macrophages, leading to dysfunctional macrophages that struggle to transition from pro-inflammatory (M1) to reparative (M2) states. Therefore, modulating macrophage inflammatory responses via the insulin pathway holds promise for diabetic ulcer treatment. Additionally, the presence of biofilm impedes drug penetration, and the resulting immunosuppressive microenvironment exacerbates the persistent infiltration of pro-inflammatory M1 macrophages. Therefore, we designed an array of dissolvable microneedle (denoted as NPF@MN) loaded with self-assembled nanoparticles that could deliver NPF nanoparticles, acid-sensitive NPF-releasing Protocatechualdehyde (PA) with hypoglycemic and insulin-like effects, regulating macrophage polarization to an anti-inflammatory M2 phenotype. Additionally, this study extensively examined the mechanism by which NPF@MN accelerates the healing of diabetic ulcers through the activation of the insulin signaling pathway. Through RNA-seq and GSEA analysis, we identified a reduction in the expression of pathway-related factors such as IR, IRS-1, IRS-2, and SHC. Our work presents an innovative therapeutic approach targeting the insulin pathway in diabetic ulcers and underscores its translational potential for clinical management. [ABSTRACT FROM AUTHOR]

Simple Summary: Acantholytic squamous cell carcinoma (aSCC) is a rare type of skin cancer that represents about 4.9% of all squamous cell carcinoma cases. Currently, there are no standardized guidelines for diagnosing this cancer. This study aimed to compile and analyze the existing research on the clinical and molecular characteristics of aSCC. We reviewed 52 studies that included 482 patients, most of whom were older males. We found that aSCC commonly appears on the head and neck as nodules with surface changes such as thickening, erosion, or ulceration. Our review also highlights that certain molecular markers, such as cytokeratins, are commonly present, while others, like CD15 and various vascular markers, are often absent. The findings suggest that understanding both the clinical presentation and molecular features of aSCC is crucial for accurate diagnosis. Our systematic review provides data which can help doctors better identify and treat this rare form of cancer, ultimately improving patient outcomes. Introduction: Acantholytic squamous cell carcinoma (aSCC) is a rare clinicopathological subtype of cutaneous squamous cell carcinoma, accounting for approximately 4.9% of all SCC cases. However, there are currently no standardized criteria for the diagnosis of aSCC. This systematic review is the first to summarize the clinical and molecular features of aSCC. Methods: A systematic search of Medline, Embase, Scopus, and PubMed was performed. All articles in English or French were included, with no restriction of publication date. All articles with original data pertaining to clinical or molecular characteristics of aSCC were included. Two reviewers screened articles and resolved conflicts. Results: Our systematic review included 52 studies on the clinical and molecular features of aSCC, including a total of 482 patients (76% male, mean age at diagnosis 68.9 years): 430 cases assessed clinical features, while 149 cases assessed molecular features. The most common location of aSCC was the head and neck (n = 329/430; 76.5%). In terms of morphology, most lesions were described as nodules (n = 93/430, 21.6%), with common surface changes being hyperkeratosis (n = 6), erosion (n = 6), ulceration (n = 5), and crusting (n = 3). With regard to dermoscopy, only six cases were noted in the literature, including findings such as ulceration (n = 3), keratin clots (n = 2), and erosions (n = 2). Thirty-four studies discussed the molecular markers of aSCC, with the most prevalent markers being cytokeratins. CD15 negativity was noted in 23 cases, while common endothelial vascular markers such as CD34 (n = 16), CD31 (n = 15), factor VIII-related antigen (n = 10), and ERG (n = 1) were often not expressed. Finally, expression of intracellular adhesion molecules (i.e., E-cadherin, CD138) was markedly decreased compared to non-acantholytic invasive SCC. Conclusions: This systematic review summarizes the clinical characteristics and molecular features of aSCC. As clinical differentiation can be difficult, clinicopathological correlation with molecular markers may help ensure proper diagnosis. [ABSTRACT FROM AUTHOR]

Orthodontic patients often suffer from mucosal discomfort due to the friction stimulation of orthodontic components on the oral mucosa, and semiconductor laser can treat the oral mucosal discomfort caused by orthodontic treatment, such as redness, swelling, ulcers, etc. This study innovatively created a persistent traumatic environment in the mouth of rats to simulate the intraoral conditions of orthodontic patients, with the aim of using animal models to broaden the understanding of semiconductor laser repair mechanisms of orthodontic traumatic ulcers. 32 male Wistar rats were randomly divided into 6 groups: 1) blank control group; 2) control group; 3) chlorhexidine group; 4) laser group 1; 5) laser group 2; 6) laser group 3. The research contents included ulcer healing degree score, enzyme-linked immunosorbent assay, histological observation of stained sections of ulcer tissue, and analysis of microbial attachment on ulcer surface. The results showed that the continuous traumatic environment significantly prolonged the healing time of ulcer (P<0.05). During the ulcer duration, the proinflammatory factor level was lower, the anti-inflammatory factor level was higher and the healing score was better in the laser group (P<0.05). The antibacterial effect of semiconductor laser is less than 0.12% chlorhexidine solution; Hematoxylin-eosin tissue sections showed lower inflammatory cell infiltration and better epithelial healing in the laser group. This study shows that continuous traumatic environment can delay ulcer healing, and semiconductor laser with appropriate irradiation time is superior to traditional 0.12% chlorhexidine solution in reducing inflammation, relieving pain and promoting ulcer tissue healing. Compared with previous studies, the animal model in this study has made some progress and is closer to the real oral conditions of orthodontic patients. The results further demonstrated the potential of semiconductor laser in the treatment of oral traumatic ulcers during orthodontics. [ABSTRACT FROM AUTHOR]

Background The aim of the study was to document and classify various mucosal lesions observed during upper gastrointestinal endoscopy in patients with confirmed acute pancreatitis. Methods We conducted a prospective study on adult patients (18 years and older) diagnosed with acute pancreatitis. Diagnosis criteria included acute onset of typical abdominal pain consistent with acute pancreatitis, and/or serum amylase and/or lipase levels exceeding two times the upper limit of normal, or characteristic findings on abdominal computed tomography (CT) scan or ultrasonography. Patients who were medically unfit or declined to undergo endoscopy, as well as those with a documented history of peptic ulcer disease confirmed by endoscopy within the past three months, were excluded from the study. Results In the current study, the predominant age group affected by acute pancreatitis was between 30 to 60 years. Alcohol emerged as the leading cause, contributing to 96.6% of cases within the study cohort, with abdominal pain being the most frequently reported symptom. Computed tomography (CT) scan was the universally definitive diagnostic tool for acute pancreatitis, confirming the condition in all cases (100%). Of the 60 patients who underwent upper gastrointestinal endoscopy (OGD), 55 exhibited positive findings. Gastritis was the most prevalent upper gastrointestinal abnormality, accounting for 36 cases (60%) among those with significant findings. Furthermore, the prevalence of H. pylori infection was found to be 25.4% in this study population Conclusion In acute pancreatitis, esophagitis, gastric ulcers, and duodenal ulcers are frequently observed during endoscopic examinations. However, these findings do not show a correlation with the severity of pancreatitis itself [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical efficacy of platelet-rich technology combined with moist dressings in the treatment of chronic infectious ulcers. Methods: This was a retrospective study. The subjects of the study were 48 patients with chronic infectious ulcers in Sichuan Provincial Orthopedics Hospital from January 2019 to June 2022. Enrolled patients were randomly divided into four groups(n=12), and received different treatment methods respectively. Further analysis and comparison were performed on the changes in wound volume, wound healing status, wound bacterial culture results, and the incidence of adverse reactions among the four groups. Results: Three months after debridement, the wound volume of all four groups of patients was significantly reduced compared with that before debridement, with a statistically significant difference in intra-Group-Comparison(P<0.05). The inter-Group-Comparison revealed a statistically significant difference in wound volume in Group-A, Group-B, and Group-C than that in Group-D(P<0.05). After treatment, the wound healing status of patients in groups A, B, and C was significantly better than that of patients in Group-D, with a statistically significant difference(P<0.05). During treatment, patients in all four groups had decreased count of would bacteria, and showed negative results of wound bacterial culture by the three-month follow-up. No serious adverse reactions were observed in the four groups during treatment, and all improved after management, with no statistically significant difference in the incidence of adverse reactions(P>0.05). Conclusion: Platelet-rich technology combined with moist dressings may effectively promote the repair of chronic infectious ulcer wounds, with good clinical safety. [ABSTRACT FROM AUTHOR]

Aims/Introduction: Patients with a healed diabetic foot ulcer (DFU) have a 40% risk of ulcer recurrence within a year. New and effective measures to prevent DFU recurrence are essential. We aimed to highlight emerging trends and future research opportunities in the use of plantar pressure measurement to prevent DFU recurrence. Materials and Methods: Our scoping review protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta‐analysis – Scoping Review protocol. Peer‐reviewed, English‐language papers were included that addressed both plantar pressure measurement and diabetic foot disease, either as primary studies that have advanced the field or as review papers that provide summaries and/or opinion on the field as a whole, as well as specific papers that provide guidelines for future research and advancement in the field. Results: A total of 24 eligible publications were identified in a literature search using PubMed. A further 36 eligible studies were included after searching the references sections of these publications, leaving a total of 60 publications included in this scoping review. Conclusions: Plantar pressure measurement can and will play a major role in the prevention of DFU. There is already a strong, albeit limited, evidence base in place to prove its benefit in reducing DFU recurrence. More research is required in larger populations, using remote monitoring in real‐world settings, and with improved technology. [ABSTRACT FROM AUTHOR]

Objectives: Ixekizumab, an interleukin (IL)-17A inhibitor, exerts its therapeutic effects in psoriasis by inhibiting the interleukin (IL)-17 signaling pathway. Common adverse reactions to ixekizumab include injection site reactions and upper respiratory tract infections (URIs), while occurrences of inflammatory bowel disease (IBD) and multiple mucosal ulcers are infrequent. We present a case of a 51-year-old man who developed multiple mucosal ulcers after ixekizumab treatment. Methods: A 51-year-old man presented to our hospital with a 1-month history of pharyngalgia. The flexible laryngoscope displayed mild hyperemia in the pharyngeal mucosa and tonsils, redness and swelling of the epiglottis, as well as multiple ulcers in the oral cavity, uvula, and epiglottis. These ulcers did not improve with conventional treatment. Results: Upon evaluation, the ulcers were an immune-related adverse event induced by ixekizumab. Consequently, a decision was made to discontinue the drug and initiate a therapeutic regimen including corticosteroids and thalidomide. Eventually, the patient's symptoms abated. Conclusions: Biologics are now becoming increasingly popular in psoriasis. It is vital for clinicians to be aware of this potential adverse event and to identify and intervene early to alleviate patients' suffering. [ABSTRACT FROM AUTHOR]

Human mpox, which has spread worldwide since May 2022, is characterized by symptoms involving the genital area; however, its treatment methods and clinical course are not completely understood. Furthermore, penile swelling in human mpox can be difficult to differentiate from cellulitis and antibiotic use has been reported in such cases. Herein, we report a case of human mpox in Japan with prominent penile swelling and persistent penile ulcers that improved without specific treatment. The patient was a Japanese man in his 20s with a history of having sexual intercourse with men frequently. He visited Tokyo Metropolitan Toshima Hospital because of a fever and rash in the genital area. Physical examination revealed vesicles on the limbs, penile pigmentation, and significant penile swelling and redness. There were no signs of cellulitis and symptomatic treatment was initiated with outpatient follow-up. After 7 days, an improving trend in penile swelling, redness, and pain was observed. However, a partially black skin ulcer with exudate was observed at the left coronal sulcus of the penis. Therefore, the symptomatic treatment was continued. On illness day 28, the penile swelling completely improved; however, the penile ulcer and pain persisted, and the exudate was observed again. By illness day 63, the pain in his anogenital area had disappeared, and the penile skin ulcer had healed. The following observations were noted in this case: (i) human mpox can improve without specific treatment such as tecovirimat administration and (ii) skin lesions in the genital area may change over time. [ABSTRACT FROM AUTHOR]

Background: In general practice, venous ulcers (stasis ulcers) are the most common and recurrent leg ulcers. Ignorance of it can have a severe detrimental effect on one's quality of life, cause gangrene, and even the limb amputation. Venous ulcers are the most dangerous and disabling side effect of chronic venous insufficiency. Leech therapy seems to be effective for the treatment of varicose ulcers due to its salivary secretions which it injects during bloodsucking. The saliva of leeches contains certain biochemical with vaso-dilating, anticoagulant, anesthetic, thrombolytic, antibiotic, analgesic, and anti-inflammatory properties. As a result, Irsal-e-Alaq (Hirudotherapy), one of the Unani regimens, can effectively control it. Objective: The purpose of this case report is to provide insight into the effects of Irsal-e-Alaq (Hirudotherapy) on venous ulcers. Intervention: A 60-year-old male has a complaintof ulceration in his left lower leg near the medial malleolus with swelling, pain, discharge, and darkening of the skin of the left lower limb. Four leeches were applied once every week for 2 months. Efficacy of leech therapy was assessed on every 15th day by pain /leg discomfort on 4 point scale ranging from 0-3, limb girth at calf, ankle & foot, pigmentation color on 4 point scale, pigmentation area, pain in ulcer on 4 point scale from 0-3, ulcer depth, PUSH Score. Hb% was assessed every 15th day to check anemia, colour flow Doppler was done to assess any change in vein anatomy. Result: In this case report, the ulcers were completely healed, and also showed remarkable improvement in other variables. Conclusion: Irsal-e-Alaq has been proven beneficial in treating venous ulcers and enhancing patient’s quality of life. [ABSTRACT FROM AUTHOR]

In an ageing society, the incidence of hard‐to‐heal wounds is rising. Chronic wound healing is a complex process, which requires specialised treatment. Clinical assessment of the wound is essential to establish care approaches but is usually based on visual evaluation and it remains challenging. Therefore, innovative quantitative methods for the assessment of chronic wounds are needed. We conducted a single‐centre observational study designed to assess the feasibility of a bioimpedance measurement method conducted with a multielectrode sensor array to monitor the wound healing process in patients with chronic wounds of venous, mixed venous–arterial and diabetic aetiology. In total, 104 measurements of bioimpedance were conducted in 18 ulcers during the study. Across all 7 patients analysed, the bioimpedance of the ulcers was consistently increasing as the wound surface was decreasing. The variables had significant (p < 0.001) and strong negative correlation (r = −0.86). We validated the feasibility of the bioimpedance measurement method for the monitoring of the wound healing process on the lower legs. It may be a promising quantitative method for monitoring the status of the wounds. However, long‐term measurements are needed to show the usability of the electrode dressing and bioimpedance measurement in the assessment of chronic wounds. [ABSTRACT FROM AUTHOR]

We evaluate the value of oral contrast-enhanced gastric ultrasonography (OCUS) by comparing it with conventional gastroscopy in diagnosing and staging benign peptic ulcer. From July 2018 to December 2020, 44 patients with gastroscopy-confirmed benign peptic ulcers (a total of 45 ulcers were detected), who also received OCUS, were retrospectively reviewed. Each patient's ultrasound images were compared with gastroscopy and pathology findings. The characteristics of ultrasonic images of different stages of ulcer were analysed. A total of 43 ulcers were detected by OCUS in 44 patients with benign peptic ulcers. There were no false positive results among the OCUS exams, but two ulcers were misdiagnosed. OCUS for benign peptic ulcer staging also shows acceptable clinical practice results. OCUS is useful for detecting and staging benign peptic ulcer, and may be considered an alternative method for conventional gastroscopy. OCUS is especially useful in the follow-up of BPU treatment, but futher study is needed to improve the diagnostic accuracy of benign and malignant ulcers. [ABSTRACT FROM AUTHOR]

Introduction: Reactive angioendotheliomatosis (RAE) is a rare, benign, angioproliferative disorder with poorly understood aetiopathogenesis. It is characterised by vascular occlusion that occurs in patients with coexistent systemic or autoimmune disease. Case Presentation: A 60-year-old female presented with an 8-week history of a painful, non-healing, and non-traumatic ulcer on the left thigh. Her past medical history included smoking, peripheral vascular disease (PVD) and previously treated rectal squamous cell carcinoma. The diagnosis of pyoderma gangrenosum with superimposed cellulitis was considered and treatment with oral antibiotics was initiated. Following failure to improve, a biopsy was undertaken leading to the diagnosis of RAE. The patient was referred for urgent consideration of surgical correction of PVD, but was deemed unsuitable for surgical treatment due to a poor performance status. The patient was treated with conservative measures, but her condition rapidly deteriorated and she passed away a few weeks later. Conclusion: RAE is notorious for mimicking a wide spectrum of diseases. It is an important differential diagnosis to consider in patients with non-healing ulceration and underlying systemic or autoimmune disorders. Our case raises awareness of this rare condition and the mortality that it carries if left untreated. In an attempt to reverse disease progression and mortality, we urge clinicians to attempt surgical correction of PVD even when faced with multiple comorbidities and poor performance status. [ABSTRACT FROM AUTHOR]

BACKGROUND: Whether proton-pump inhibitors are beneficial or harmful for stress ulcer prophy- delaxis in critically ill patients undergoing invasive ventilation is unclear. METHODS; In this international, randomized trial, we assigned critically ill adults who were undergoing invasive ventilation to receive intravenous pantoprazole (at a dose of 40 mg daily) or matching placebo. The primary efficacy outcome was clinically important upper gastrointestinal bleeding in the intensive care unit (ICU) at 90 Suppledays, and the primary safety outcome was death from any cause at 90 days. Mul- tiplicity-adjusted key secondary outcomes were ventilator-associated pneumonia, Clostridioides dificile infection, and patient-important bleeding. RESULTS: A total of 4821 patients underwent randomization in 68 ICUs. Clinically important upper gastrointestinal bleeding occurred in 25 of 2385 patients (1.096) receiving pantoprazole and in 84 of 2377 patients (3.5°/0) receiving placebo (hazard ratio, 0.30; 95% confidence interval ICI], 0.19 to 0.47; P<0.001). At 90 days, death was reported in 696 of 2390 patients (29.196) in the pantoprazole group and in 734 of 2379 patients (30.9°/o) in the placebo group (hazard ratio, 0.94; 95% CI, 0.85 to 1.04; P=0.25). Patient-important bleeding was reduced with pantoprazole; all other key secondary outcomes were similar in the two groups. CONCLUSIONS: Among patients undergoing invasive ventilation, pantoprazole resulted in a significantly lower risk of clinically important upper gastrointestinal bleeding than placebo, with no significant effect on mortality. [ABSTRACT FROM AUTHOR]