The Role of Vitamin D on the Wound Healing Process: A Case Series.

Introduction: Vitamin D is an essential steroid hormone that consists of two forms, namely vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol), which can be obtained from exposure to sunlight, synthesis of vitamin D in the skin, food and dietary supplements. Prevalence of vitamin D deficiency in several countries including Indonesia is still high, while the role of vitamin D is very important including accelerating the wound healing process, increasing the immune system, anti-inflammatory, and anti-bacterial. Purpose: This case report aims to find out the role of vitamin D in the wound-healing process in the oral mucosa. Case Reports: Two men went to the Oral Disease Clinic with complaints of canker sores on the oral mucosa for more than a month accompanied by pain. Intra-oral condition in the first patient showed multiple ulcers with yellowish white base surrounded by erythematous areas, well-defined, irregular with a size of 1.5 × 1 cm and 1 × 0.5 cm on the right and left buccal mucosa, while intra-oral in the second patient, a single ulcer with a base was found yellowish colour surrounded by erythematous area, oval measuring 3x1 cm, clearly demarcated with induration. Results: Laboratory examination of vitamin D in both patients showed decreased levels of vitamin D with values of 28.7 and 9.8 ng/mL. Conclusion: Vitamin D supplementation has shown effectiveness in wound-healing processes in the oral mucosa.

Factors influencing diabetes-related foot ulcer healing in Australian adults: A prospective cohort study.

OBJECTIVE: Diabetes-related foot ulceration (DFU) is a common limb-threatening condition, which is complex and subsequently challenging to manage. The aim of this study was to determine the contribution of a range of clinical and social factors to the healing of diabetes-related foot ulceration in an Australian population. RESEARCH DESIGN AND METHODS: This was a prospective cohort study of individuals with diabetes-related foot ulceration (DFU). Age, sex, medical history, medications, dietary supplementation (e.g. vitamin C intake) and smoking history were elicited at baseline. The index of relative socio-economic disadvantage (IRSD) was calculated. The Australian Eating Survey and International Physical Activity Questionnaire-short were administered. Wound history, size, grade, time to healing and infection were captured and monitored over 6 months. Logistic regression was performed to determine the relationship between healing and diet quality, toe systolic pressure, wound size at, IRSD, infection and previous amputation. RESULTS: A total of 117 participants were included. The majority were male n = 96 (82%), socio-economically disadvantaged (mean IRSD 965, SD 60), and obese (BMI 36 kg/m2 , SD 11) with a long history of diabetes (20 years, SD 11). Wounds were predominantly neuropathic (n = 85, 73%) and classified 1A (n = 63, 54%) on the University of Texas wound classification system with few infections (n = 23, 16%). Dietary supplementation was associated with 4.36 increased odds of healing (95% 1.28-14.84, p = 0.02), and greater levels of socio-economic advantage were also associated with increased odds of healing (OR 1.01, 95% CI 1.01-1.02, p = 0.03). CONCLUSIONS: In this cohort study of predominantly neuropathic, non-infected DFU, individuals who had greater levels of socio-economic advantage had significantly greater odds of DFU healing. Diet quality was poor in most participants, with individuals taking supplementation significantly more likely to heal.

Effect Of The Flavonoid 6-Aminoflavone In Aspirin Induced Gastric Ulcer In Sprague-Dawely Rats: A Histomorphological Study.

Background: The analgesic drugs are the main cause of gastric ulcer. The objective of this study was to determine the gastroprotective ability of flavonoid, 6-aminoflavone in a rat pyloric ligation model of aspirin associated gastro-ulcerogenesis. Methods: A laboratory based experimental study was conducted in the animal house and research laboratory at Khyber Medical College, Peshawar from July to November 2019. A total of 42 adult male Spargue-Dawely rats were divided into seven groups. Flavonoid, 6-aminoflavone was administered orally in doses of 10, 25 and 100 mg/kg with misoprostol, as standard at 50 µg/kg orally for 4 days. On the last day aspirin was given orally at 200 mg/kg and the pyloric ligation surgery was performed. After 4 hours all animals were killed by cervical dislocation. The gastric tissues were collected for histomorphological study. The obtained data were expressed as mean±SEM. Analysis was carried out by using ANOVA. p value ˂0.05 was considered significant. Results: The animals treated with the different doses of 6-aminoflavone showed a marked protective effect in the histological observations. The 10 mg/kg dose had a mild protective effect as occasional ulcerative changes were observed. However, doses of 25 and 100 mg/kg significantly caused the reduction in the ulcer score. These effects produced were equipotent to the gastroprotective effectiveness inherent in the misoprostol. . Conclusion: These findings conclude that 6-aminoflavone as like other flavonoids has a significant gastroprotective propensity with significant effect produced at doses of 25 and 100 mg/kg and can be used as a part of therapy management for the treatment of gastrointestinal disease particularly ulcerative condition.

Holistic multi-class classification & grading of diabetic foot ulcerations from plantar thermal images using deep learning.

Purpose: Diabetic foot is a common complication associated with diabetes mellitus (DM) leading to ulcerations in the feet. Due to diabetic neuropathy, most patients have reduced sensitivity to pain. As a result, minor injuries go unnoticed and progress into ulcers. The timely detection of potential ulceration points and intervention is crucial in preventing amputation. Changes in plantar temperature are one of the early signs of ulceration. Previous studies have focused on either binary classification or grading of DM severity, but neglect the holistic consideration of the problem. Moreover, multi-class studies exhibit severe performance variations between different classes. Methods: We propose a new convolutional neural network for discrimination between non-DM and five DM severity grades from plantar thermal images and compare its performance against pre-trained networks such as AlexNet and related works. We address the lack of data and imbalanced class distribution, prevalent in prior work, achieving well-balanced classification performance. Results: Our proposed model achieved the best performance with a mean accuracy of 0.9827, mean sensitivity of 0.9684 and mean specificity of 0.9892 in combined diabetic foot detection and grading. Conclusion: To the best of our knowledge, this study sets a new state-of-the-art in plantar foot thermogram detection and grading, while being the first to implement a holistic multi-class classification and grading solution. Reliable automatic thermogram grading is a first step towards the development of smart health devices for DM patients.

Perceptions of Diet Quality, Advice, and Dietary Interventions in Individuals with Diabetes-Related Foot Ulceration; A Qualitative Research Study.

BACKGROUND: Dietary intake is a recognised contributor to healing in diabetes-related foot ulceration (DFU). However, it is currently unknown how individuals with DFU perceive their diet, and what is deemed an acceptable dietary intervention. Therefore, the aims of this study were to explore perceptions of diet quality, previous dietary advice, and dietary interventions in individuals with DFU, and secondly to determine acceptable dietary interventions in individuals with DFU to assist with wound healing. METHODS: A qualitative study using reflexive thematic analysis was undertaken. Individuals with active or recent history of DFU were recruited from a high-risk foot service. Semi-structured interviews were undertaken. RESULTS: Nineteen participants were included with three themes identified: A complex relationship with food, perceptions of food, diet and dietitians, and self-management. Dietary misconceptions were common. Self-perceived diet quality varied, with most unaware of how diet could impact wound healing. Many expressed barriers relating to food agency (purchasing, preparing, and accessing food). Participants expressed a strong preference for personalised, face-to-face dietary advice and nutritional supplementation. CONCLUSIONS: There is a need for personalised dietary re-education and assistance with food agency in this cohort to overcome commonly held misconceptions of diet and improve dietary intake to facilitate wound healing.

The influence of low- intensity laser irradiation versus hyperbaric oxygen therapy on transcutaneous oxygen tension in chronic diabetic foot ulcers: a controlled randomized trial.

BACKGROUND AND OBJECTIVE: Evaluation of the stage and severity of the chronic diabetic foot ulcer (CDFU) is vital to increase the healing rate and to select the suitable treatment. We aim to assess the influence of low-intensity laser irradiation (LILI) and hyperbaric oxygenation therapy (HBOT) to accelerate the CDFU healing thru the transcutaneous oxygen tension (TcPO2) measurements. MATERIALS AND METHODS: Seventy-five diabetic patients (type 2) of both genders, their ages ranged from 40-65 years with CDFUs (duration of ulcer < 6 weeks). All patients were randomly assigned into LILI, HBOT, and the control group. Measurement of TcPO2 using transcutaneous oximetry was performed for all patients once in the baseline and consequently in the second, fourth, and sixth- weeks duration. LILI utilized by a 33-diode cluster contact applicator with output power 1440 mW, energy density (fluency) was adjusted for 4 J/Cm2 at 10 kHz, and for 8 min per session, three times per week for a total of consecutive 6 weeks. HBOT was pressurized up to 2.5 ATA and patients delivered 100% oxygen for 60 min per session for 30 sessions. The Control group received conventional wound care only, twice daily, with saline and apply a new bandage after cleaning. RESULTS: MANOVA revealed a statistically insignificant difference in the control group, while statistically significant improvement in both the LILI and HBOT groups. The intergroup comparisons showed an insignificant statistical difference in the pre-test, while highly statistically significant differences for the three post-measures in favor of HBOT and LILI groups. The percentage of improvement of the HBOT group was higher than LILI. Post-hoc test using the least significant difference (LSD) revealed statistically significant differences of HBOT in favor of the LILI group. CONCLUSION: Both LILI and HBOT may be used as adjunctive methods to improve TcPO2 that accelerate healing in CDFUs. HBOT may be favorable in the improvement of TcPO2 than LILI.

Common femoral artery doppler findings pre and post hyperbaric oxygen therapy for leg ulceration / Achados de doppler da artéria femoral comum antes e depois da oxigenoterapia hiperbárica para úlcera de perna / Hallazgos de doppler de la arteria femoral común antes y después de la terapia con oxígeno hiperbárico para la ulceración de la pierna

Hyperbaric Oxygen Therapy (HBOT) assumes that high pressure hyperoxygenation causes faster tissue recovery and wound healing. Lower extremity flow rates are affected by leg ulcers that change vasodilation, microcirculation resistance, and local tissue demands; how blood hyper oxygenation influences these factors is still unclear. Peripheral arterial occlusive disease (PAOD) has been mostly associated with HBOT results in the femoral artery than in other arteries. Common femoral artery (CFA) peak systolic velocities (PSV), measured pre and post HBOT, were analyzed to research HBOT hemodynamics. Sixteen patients with leg ulcers who were 65 ± 11 (SD) (38-87) years-old, had HBOT of 90 minutes at 2.6 ATA. Bilateral CFA Doppler velocity waveforms were recorded immediately pre and post HBOT. Ulcerated vs non-ulcerated peak systolic velocity (PSV) data were compared using paired t-test. CFA PSV were significantly equal in the ulcerated and non-ulcerated extremities before HBOT: 114 ± 35 (SD) cm/s vs 116 ± 41 cm/s (p = 0.87 by paired t-test). CFA PSV in the ulcerated extremity increased to 122 ± 35 cm/s after HBOT but were statistically insignificant (p =.19 by one-tailed paired t-test). On the other hand, CFA PSV decreased to 103 ± 28 cm/s (p =.049 by one-tailed paired t-test) in the non-ulcerated extremity and were significantly lower after HBOT, with 103 ± 28 cm/s vs 122 ± 35 cm/s for the ulcerated limb (p =.02 by paired t-test). Blood velocity responses post HBOT showed differences between ulcerated vs non-ulcerated extremities. The non-ulcerated extremity apparently responded to oxygenation more than the ulcerated extremity. Such observation suggests further research on hemodynamic reactions caused by HBOT.

A oxigenoterapia hiperbárica (HbOT) assume que a oxigenação de alta pressão resulta em mais celeridade na recuperação do tecido e na cicatrização de feridas. As taxas de fluxo nas extremidades inferiores são afetadas por úlceras nas pernas que alteram a vasodilatação, a resistência da microcirculação e as demandas locais de tecido; esses fatores podem ser influenciados pela hiperoxigenação sanguínea de maneiras ainda não claramente compreendidas. A doença arterial oclusiva periférica femoral (DAOP) tem sido associada a melhores resultados de HBOT quando comparada a outras artérias. As velocidades sistólicas de pico (PSV) da artéria femoral comum (CFA) medidas antes e depois da HBOT foram analisadas como parte de um projeto de pesquisa da hemodinâmica da HBOT. Dezesseis pacientes com úlceras de perna, com idade 65 ± 11 (DP), 38-87 anos, realizaram HBOT com duração de 90 minutos a 2,6 ATA. As formas de onda de velocidade do Doppler CFA bilateral foram registradas imediatamente antes e depois da HBOT. Os dados de PSV ulcerado vs. não ulcerado foram comparados usando o teste t pareado. Pre HBOT CFA PSV não foi significativamente diferente nas extremidades ulceradas e não ulceradas: 114 ± 35 (DP) cm/s vs 116 ± 41 cm/s (p = 0,87 pelo teste t pareado). O PSV pós HbOT CFA na extremidade ulcerada aumentou para 122 ± 35 cm/s, mas não atingiu significância estatística (p = 0,19 pelo teste t pareado unicaudal). Em contraste, CFA PSV na extremidade não ulcerada diminuiu para 103 ± 28 cm/s (p = 0,049 pelo teste t pareado unicaudal). O pós-HbOT CFA PSV foi significativamente menor no membro não ulcerado, 103 ± 28 cm/s vs 122 ± 35 cm/s para o membro ulcerado (p = 0,02 pelo teste t pareado). As respostas da velocidade do sangue após HbOT mostraram diferenças entre as extremidades ulceradas e não ulceradas. Aparentemente, a extremidade não ulcerada respondeu mais significativamente à oxigenação do que a extremidade ulcerada. Tal observação sugere pesquisas adicionais sobre as reações hemodinâmicas decorrentes da HbOT.

La terapia de oxígeno hiperbárico (HbOT) asume que la hiperoxigenación a alta presión da como resultado una recuperación más rápida de los tejidos y una cicatrización de heridas. Las tasas de flujo de las extremidades inferiores se ven afectadas por úlceras en las piernas que alteran la vasodilatación, la resistencia de la microcirculación y las demandas de los tejidos locales; estos factores pueden verse influenciados por la hiperoxigenación de la sangre, de formas que aún no se han entendido con claridad. La enfermedad oclusiva arterial periférica femoral (PAOD) se ha relacionado con los mejores resultados de HbOT que otras arterias. Las velocidades sistólicas máximas (PSV) de la arteria femoral común (CFA) medidas antes y después de la HbOT se analizaron como parte de un proyecto para investigar la hemodinámica de la HbOT. Dieciséis pacientes con úlceras en pierna, 65 ± 11 (DE) (38-87) años, 12 hombres, 11 diabéticos, tenían HbOT de 90 minutos a 2,6 ATA. Se registraron formas de onda de velocidad de CFA Doppler bilaterales inmediatamente antes y después de la HbOT. Se compararon los datos de la velocidad sistólica máxima (PSV) ulcerada frente a la no ulcerada mediante la prueba t pareada. Pre HbOT CFA PSV no fue significativamente diferente en las extremidades ulceradas y no ulceradas: 114 ± 35 (DE) cm/s vs 116 ± 41 cm/s (p = 0,87 por prueba t pareada). Post HbOT CFA PSV en la extremidad ulcerada aumentó a 122 ± 35 cm/s pero no alcanzó significación estadística (p =.19 por prueba t unilateral pareada). En contraste, CFA PSV en la extremidad no ulcerada disminuyó a 103 ± 28 cm/s (p =.049 por prueba t unilateral pareada). El PSV después de la HbOT CFA fue significativamente menor en la extremidad no ulcerada, 103 ± 28 cm/s frente a 122 ± 35 cm/s para la extremidad ulcerada (p = 0,02 según la prueba t pareada). Las respuestas de velocidad sanguínea post HbOT mostraron diferencias entre las extremidades ulceradas y no ulceradas. Aparentemente, la extremidad no ulcerada respondió más significativamente a la oxigenación que la extremidad ulcerada. Tal observación sugiere una mayor investigación sobre las reacciones hemodinámicas debidas a la HbOT.

Assessment of Prevalence of Recurrent Aphthous Stomatitis in the North Indian Population: A Cross-Sectional Study.

AIM AND OBJECTIVE: The present study was undertaken for assessing the prevalence of recurrent aphthous stomatitis (RAS) in the North Indian population. MATERIALS AND METHODS: Assessment of a total of 4255 patients was done over a period of 2 years, who came for a routine dental checkup. Recording of the complete demographic and clinical details of all the patients was done. The prevalence of RAS was assessed. Profile of patients with RAS was assessed separately. A pro forma was made and the type of treatment protocol followed by patients with RAS was also recorded. All the results were recorded in a Microsoft Excel sheet and were analyzed using SPSS software. RESULTS: Analysis of a total of 4255 patients was done. RAS was found to be present in 800 patients. The overall prevalence of RAS was found to be 18.93%. Significant results were obtained when analyzing age, gender, and occupation as risk factors for RAS. Labial/buccal mucosa involvement occurred in 51.875% of the cases. In 44% of the cases, the size of the RAS was between 1 cm and 3 cm. Home remedy was followed in 17.875% of the cases. CONCLUSION: A significant proportion of patients in the North Indian population is affected by RAS. In comparison to males, females are more commonly affected.

[Textual research on Xilei Powder].

Xilei Powder is a commonly used prescription for the treatment of oral ulcers, and is originally used to treat scarlet fever. Scarlet fever is a warm-toxin disease from the perspective of the theory of warm disease. It is a warm infectious disease caused by epidemic. Xilei Powder was recorded in the Chinese Pharmacopoeia from 1953 edition to 2010 edition. As China joined Convention on International Trade in Endangered Species of Wild Fauna and Flora(CITES), Xilei Powder was removed from the Chinese Pharmacopoeia of 2015 edition due to the limitation of the use of animal drugs, such as ivory and rhinoceros horn. Xilei Powder has been widely used to treat such diseases as otolaryngology, fever, gynecological diseases, digestive diseases, and tumors. Does Xilei Powder have a unique place in clinical application? Can stable and effective alternative drugs be derived from original prescription? Due to the lack of theoretical studies on Xilei Powder, by consulting ancient books, monographs and papers, we comprehensively summarized and studied historical evolution and prescription connotation of Xilei Powder, and analyzed its drug origin and clinical application, in the hope to promote the theoretical study and clinical application.

Anti-inflammatory Activity of Etlingera elatior (Jack) R.M. Smith Flower on Gastric Ulceration-induced Wistar Rats.

BACKGROUND AND OBJECTIVE: Etlingera elatior (Jack) R.M. Smith rhizome, which has been traditionally used to reduce stomach discomfort, was reported to possess anti-inflammatory activity, however, there is a lack of such a study on the flower. MATERIALS AND METHODS: To investigate the anti-inflammatory activity of the E. elatior flower extract on gastric ulceration-induced Wistar rats. The Wistar rats were divided into 6 groups. Group 1 was the normal control, group 2 was the negative control (Arabic gum suspension 2%), group 3 was the positive control (quercetin), group 4-6 were treated with E. elatior flower extract dose of 500, 1000 and 2000 mg kg-1 of b.wt., respectively. The rats were conditioned to gastric ulceration. The stomach weight, microscopic and macroscopic evaluation of gastric mucosal damage was examined. Subsequently, the nuclear factor-kappaB-p65 (NF-kappaB-p65) expression in the fundus was Western-blotted by employing ß-actin and GAPDH as the loading controls. RESULTS: Etlingera elatior flower extract dose of 1000 mg kg-1 b.wt., reduces the ulceration index and the infiltration of inflammatory cells. Western blot analysis showed inhibition of NF-kappaB-p65 expression by E. elatior flower extract dose of 1000 mg kg-1 of b.wt. CONCLUSION: Etlingera elatior flower might possess anti-inflammatory activity by downregulating the expression of NF-kappaB-p65 in the fundus of gastric ulceration-induced Wistar rats.

Ulceration occurring after ALA-PDT combined with plum-blossom needle percussion for the treatment of pretibial Bowen's disease: A case report.

We used 5-aminolevulinic acid-photodynamic therapy (ALA-PDT) combined with plum-blossom needle (PBN) on a 3.5 cm × 3.0 cm pretibial region to treat an elderly woman suffering from Bowen's disease (BD). Before the application of ALA, the PBN was inserted 3-4 times vertically starting at 5 cm above the lesion. Then, 20 % 5-ALA cream was applied with an incubation time of 3.5 h. A semiconductor laser at a wavelength of 635 nm was used to illuminate the lesion at 100 J/cm2 using 60 mW/cm2. A total of three sessions of ALA-PDT were performed at 2-3-week intervals, thus removing the lesion of BD. However, a 1.5 cm × 1.0 cm ulceration occurred 2 weeks after the third session when the PBN was used. Therefore, PBN percussion or other methods for promoting ALA penetration should be carefully applied to avoid ulceration, especially on the sites with less subcutaneous tissue.

Congenital erythropoietic porphyria (Gunther disease): a case report.

Congenital erythropoietic porphyria (CEP or Gunther disease) is a very rare subtype of porphyria with a prevalence of <0.9 per 1 000 000. A 13-year-old female patient came to our hospital complaining of a severe cutaneous ulceration and scarring. The symptoms began in her first year of life as urine discoloration and skin blistering in sun-exposed areas. The family had been trapped in a high-risk conflict zone in Syria for many years, which precipitated the aggravation of symptoms. Based on clinical examination and laboratory tests, we diagnosed the patient with CEP and treated her with vitamin D supplementation alongside chronic blood transfusions, strict photoprotection and psychotherapy. After 7 months, there were no longer active ulcers or novel complications. Psychotherapy and patient education were important for her psychological development at this age. This treatment limited the deterioration of the symptoms and made the patient more committed to the periodic examinations.

Anti-inflammatory effects of eriocitrin against the dextran sulfate sodium-induced experimental colitis in murine model.

Inflammatory bowel disease (IBD) is a continual ailment condition which engrosses the entire alimentary canal. The IBD can be primarily distinguished into two forms, ulcerative colitis, and Crohn's disease. The major symptoms of IBD include pustules or abscesses, severe abdominal pain, diarrhea, fistula, and stenosis, which may directly affect the patient's quality of life. A variety of mediators can stimulate the circumstances of IBD, some examples include infections by microbes such as bacteria, perturbation of the immune system and the surrounding environment of the intestines. Severe colitis was stimulated in the experimental animals through administering 4% dextran sulfate sodium (DSS) which is mixed in water ad libitum for 6 days. Eriocitrin (30 mg/kg) was then administered to the experimental animals followed by the induction of severe colitis to evaluate the therapeutic prospective of eriocitrin against the colon inflammation stimulated by DSS. In this study, eriocitrin (30 mg/kg) demonstrated significant (P < .05) attenuation activity against the DSS-stimulated severe colitis in experimental animals. Eriocitrin counteracted all of the clinical deleterious effects induced by DSS, such as body-weight loss, colon shortening, histopathological injury, accretion of infiltrated inflammatory cells at the inflamed region and the secretion of inflammatory cytokines. The results clearly showed that eriocitrin effectively attenuated DSS-induced acute colitis in experimental animals.

Protective effects of Aronia melanocarpa juices either alone or combined with extracts from Rosa canina or Alchemilla vulgaris in a rat model of indomethacin-induced gastric ulcers.

The aim of the study was to investigate the effects of four Aronia melanocarpa-based juices in a rat model of indomethacin-induced gastric ulceration. THE JUICES WERE: AM1 and AM2 (produced from aronia fruits at 20 °C and 60 °C, respectively), AMRC (a mixture of AM2 with Rosa canina extract) and AMAV (aronia juice with Alchemilla vulgaris). Male Wistar rats were used. Each of the juices (10 ml/kg) was administered for 10 days. Indomethacin (30 mg/kg) was injected subcutaneously and after 4 h, the effects were estimated. Indomethacin caused heavy destructions of the gastric mucosa, increased the expression of Bax and decreased the expression of Bcl-2, induced a certain increase in lipid peroxidation and a slight decrease in gastric PGE2 content. The pretreatment with the juices reduced the severity of indomethacin-induced gastric lesions and antagonized the effects of indomethacin on apoptosis and lipid peroxidation. The highest was the protective effect of AMAV, the juice with the highest polyphenolic content. The protective effect of Aronia melanocarpa-based juices against indomethacin-induced gastric lesions could be attributed to their polyphenolic contents. The mechanism involved to the highest extent in the protective effect of the juices was the inhibition of apoptosis.

Factors influencing behavioural intention to use a smart shoe insole in regionally based adults with diabetes: a mixed methods study.

BACKGROUND: Smart insole technologies that provide biofeedback on foot health can support foot-care in adults with diabetes. However, the factors that influence patient uptake and acceptance of this technology are unclear. Therefore, the aim of this mixed-methods study was to use an established theoretical framework to determine a model of psychosocial factors that best predicts participant intention to use smart insoles. METHODS: Fifty-three adults with diabetes from regional Australia completed the validated Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Multiple regression analysis was used to determine the psychosocial factors that best predict behavioural intention to adopt a smart insole. Additionally, a focus group was conducted and thematic analysis was performed to explore barriers and enablers to adopting this technology. RESULTS: The multiple regression model that best predicted intention to adopt the smart insole (adjusted R2 = 0.51, p < 0.001) identified that self-efficacy (ß = 0.67, p = 0.001) and attitude (ß = 0.72, p < 0.001) were significant predictors of behavioural intention, while effort expectancy (ß = - 0.52, p = 0.003) and performance expectancy (ß = - 0.40, p = 0.040) were moderating factors. Thematic analysis illustrates the importance of attitude and self-efficacy on participants' behavioural intentions, influenced by participant's belief in the device's clinical efficacy and anticipated effort expectancy. CONCLUSIONS: This mixed-methods study demonstrates that attitude, self-efficacy, performance expectancy and effort expectancy combine to predict intention to adopt smart insole technology. Clinicians should consider these psychosocial factors when they prescribe and implement smart soles with patients at high risk of foot ulceration.

The lived experience of people with diabetes using off-the-shelf prescription footwear in Singapore: a qualitative study using interpretative phenomenological analysis.

BACKGROUND: Diabetic foot ulceration (DFUs) is increasingly prevalent in Singapore. Appropriate management is important since DFU brings with it an associated risk for lower limb amputations, high morbidity rates and costs. Footwear prescription has been a part of clinical guidelines to manage DFUs. However, adherence to prescription footwear is typically poor amongst patients. Reasons for this have been explored in Northern American and Western European studies, but not in Singapore's context. As cultural and climate differences limit transferability of findings from existing studies to individuals in Singapore, this study aims to explore the lived experiences of participants with diabetes using prescription footwear in Singapore. METHODS: This was a qualitative study using interpretative phenomenological analysis (IPA) to understand some people's personal experience of using off the shelf prescription footwear. A total of 8 people with diabetes who received prescription footwear as part of their diabetic foot management were recruited. All participants provided written consent and took part in a semi-structured interview lasting up to an hour. Interviews were digitally recorded, transcribed and analysed using an IPA approach. FINDINGS AND DISCUSSION: The analysis identified the super-ordinate themes of 1) security and 2) acceptance with sub-themes of 1.1) risk and 1.2) protection and 2.1) personal and social acceptance and 2.2) social and cultural acceptance respectively that inter-related to influence how participants' made footwear decisions. This process of evaluation was portrayed to be a fluctuant one, making it difficult to predict yet necessary to understand. A modified seesaw model of adherence is suggested to explain this decision-making process. CONCLUSIONS: The complex manner by which participants grappled with security and acceptance is often overlooked when footwear is prescribed, highlighting a need for a more collaborative clinician-patient partnership for these issues to surface in clinical practice. Furthermore, prescription footwear should be seen more holistically. Empowering patients with choice to select from a range of therapeutic yet normalised footwear could increase the level of security and acceptance they experience with its use.

Understanding venous leg ulcers.

Venous leg ulcers are open lesions between the knee and the ankle joint, which occur in the presence of venous insufficiency. There are theories to explain the causes of venous insufficiency, which ultimately leads to venous hypertension and can result in leg ulceration. Although many patients present with evidence of venous hypertension, others do not, except for the manifestation of the ulcer. There are risk factors associated with venous insufficiency and a holistic approach must be taken in order to influence the management approach of venous leg ulceration. This article discusses venous insufficiency as a disease process, and explores the nursing assessment process, when assessing venous leg ulcers related to venous insufficiency.

Clinical impact of ulceration width, lymphovascular invasion, microscopic satellitosis, perineural invasion, and mitotic rate in patients undergoing sentinel lymph node biopsy for cutaneous melanoma: a retrospective observational study at a comprehensive cancer center.

The prognostic significance of the width of the ulceration in primary melanomas remains unclear, and there is a relative paucity of data for lymphovascular invasion (LVI), microscopic satellitosis (MS), perineural invasion (PNI), and mitotic rate when compared with other pathological elements currently required for reporting. To evaluate the prognostic importance of the ulceration width and other important pathologic measurements, a single-institutional retrospective study was conducted using records of cutaneous melanoma patients who underwent sentinel lymph node (SLN) biopsy at The University of Texas, MD Anderson Cancer Center between 2003 and 2008. We identified 1898 eligible patients with median tumor thickness of 1.25 mm and median follow-up of 6.7 years. By multivariable analyses, the strongest risk factor for SLN positivity was high tumor thickness followed by the presence of LVI. The pathologic measures with the strongest influence on recurrence-free survival (RFS) were tumor thickness and positive SLN status. Ulceration width and presence of MS were also significantly associated with RFS while PNI was not. Factors with the strongest influence on melanoma-specific survival (MSS) were positive SLN status and mitotic rate. In conclusion, SLN biopsy should probably be offered if the primary tumor has LVI. MS is an adverse prognostic factor for RFS, but its influence on outcome is modest. Ulceration width predicts RFS but loses its independent prognostic significance for MSS when adjusting for currently used clinicopathological factors. In view of its impact on MSS, mitotic rate should be recorded for cutaneous invasive melanomas across all T categories.

[Acyclovir-resistant perineal HSV infection revealing chronic lymphoid leukaemia]. / Herpès chronique périnéal résistant à l'aciclovir révélateur d'une leucémie lymphoïde chronique.

BACKGROUND: Chronic HSV infection is a cause of chronic perineal ulcerations. We report a case of a chronic and refractory HSV infection revealing chronic lymphoid leukaemia. PATIENTS AND METHODS: An 85-year-old woman with an 8-month history of chronic perineal ulcerations was referred to our dermatology department. She had no previous medical history of herpes infection. Skin biopsies ruled out carcinoma but were consistent with HSV infection. A local swab was positive for HSV2. Treatment with valaciclovir and intravenous acyclovir (ACV) at the recommended doses was ineffective. Laboratory tests revealed type-B chronic lymphoid leukaemia. Molecular biology studies confirmed the presence of ACV-resistant HSV via decreased thymidine kinase activity (stop codon: M183stop). Foscarnet was administered for a period of 3 weeks with almost complete healing of the ulcerations. Treatment was stopped prematurely due to acute renal insufficiency and the remaining lesions were treated using imiquimod cream. Valaciclovir was prescribed to prevent further episodes. The condition recurred a mere 11 months later. DISCUSSION: The prevalence of ACV-resistant HSV is 0.32 % in immunocompetent patients and 3.5 % in immunocompromised patients. Insufficient dosing regimens or prolonged treatment with TK inhibitors result in the local selection of pre-existing mutant HSV viruses. Foscarnet, a DNA polymerase inhibitor, is the treatment of choice in HSV-resistant infections. ACV-resistant HSV is less virulent and replicates less, with reactivations being mainly due to wild-type HSV latent in the neural ganglia. Valaciclovir can be used as a preventive treatment. To our knowledge, this is the first case of ACV-resistant HSV infection revealing chronic lymphoid leukaemia. CONCLUSION: Chronic perineal ulcerations can be the first manifestation of immunodeficiency seen for example with haematological diseases. In the event of clinical resistance of an HSV infection to recommended thymidine kinase inhibitor regimens, the use of foscarnet should be considered.