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Chino DYT, Scabora LC, Cazzolato MT, Jorge AES, Traina-Jr C, Traina AJM. Segmenting skin ulcers and measuring the wound area using deep convolutional networks. Comput Methods Programs Biomed 2020; 191:105376. [PMID: 32066047 DOI: 10.1016/j.cmpb.2020.105376] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/17/2020] [Accepted: 01/29/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Bedridden patients presenting chronic skin ulcers often need to be examined at home. Healthcare professionals follow the evolution of the patients' condition by regularly taking pictures of the wounds, as different aspects of the wound can indicate the healing stages of the ulcer, including depth, location, and size. The manual measurement of the wounds' size is often inaccurate, time-consuming, and can also cause discomfort to the patient. In this work, we propose the Automatic Skin Ulcer Region Assessment ASURA framework to accurately segment the wound and automatically measure its size. METHODS ASURA uses an encoder/decoder deep neural network to perform the segmentation, which detects the measurement ruler/tape present in the image and estimates its pixel density. RESULTS Experimental results show that ASURA outperforms the state-of-the-art methods by up to 16% regarding the Dice score, being able to correctly segment the wound with a Dice score higher than 90%. ASURA automatically estimates the pixel density of the images with a relative error of 5%. When using a semi-automatic approach, ASURA was able to estimate the area of the wound in square centimeters with a relative error of 14%. CONCLUSIONS The results show that ASURA is well-suited for the problem of segmenting and automatically measuring skin ulcers.
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Affiliation(s)
- Daniel Y T Chino
- Institute of Mathematical and Computer Sciences, University of Sao Paulo, Brazil.
| | - Lucas C Scabora
- Institute of Mathematical and Computer Sciences, University of Sao Paulo, Brazil.
| | - Mirela T Cazzolato
- Institute of Mathematical and Computer Sciences, University of Sao Paulo, Brazil.
| | - Ana E S Jorge
- Department of Physical Therapy, Federal University of Sao Carlos, Brazil.
| | - Caetano Traina-Jr
- Institute of Mathematical and Computer Sciences, University of Sao Paulo, Brazil.
| | - Agma J M Traina
- Institute of Mathematical and Computer Sciences, University of Sao Paulo, Brazil.
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2
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Nagaraja V, Matucci-Cerinic M, Furst DE, Kuwana M, Allanore Y, Denton CP, Raghu G, Mclaughlin V, Rao PS, Seibold JR, Pauling JD, Whitfield ML, Khanna D. Current and Future Outlook on Disease Modification and Defining Low Disease Activity in Systemic Sclerosis. Arthritis Rheumatol 2020; 72:1049-1058. [PMID: 32134199 DOI: 10.1002/art.41246] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 02/27/2020] [Indexed: 01/15/2023]
Abstract
Systemic sclerosis (SSc) is an autoimmune rheumatic disease with heterogeneous clinical manifestations and a variable course in which the severity of the pathology dictates the disease prognosis and course. Among autoimmune rheumatic diseases, SSc has the highest mortality rate among all rheumatic diseases, though there are exciting new therapeutic targets that appear to halt the progression of SSc manifestations such as skin or lung fibrosis. In selected patients, high-intensity regimens with autologous stem cell transplantation can favorably modify the course. In what was once thought to be an untreatable disease, targeted therapies have now changed the outlook of SSc to a treatable disorder. Herein, we discuss the targeted therapies modifying the outlook on selected organ involvement and creating opportunities for future treatment. We also present a framework for defining low disease activity in SSc.
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Affiliation(s)
| | | | - Daniel E Furst
- University of California in Los Angeles, University of Washington, Seattle, and University of Florence, Florence, Italy
| | | | - Yannick Allanore
- Paris Descartes University, INSERM U1016, Université Sorbonne Paris Cité, and Cochin Hospital, Paris, France
| | | | | | | | | | - James R Seibold
- Scleroderma Research Consultants, LLC, Aiken, South Carolina
| | - John D Pauling
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, UK
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3
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Suvirya S, Pathania S, Malhotra KP, Jain A, Verma P, Kumari P. A case of diffuse lepromatous leprosy with Lucio phenomenon. QJM 2020; 113:138-139. [PMID: 31198950 DOI: 10.1093/qjmed/hcz146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Suvirya
- Department of Dermatology, King George Medical University, Lucknow 226003, Uttar Pradesh, India
| | - S Pathania
- Department of Dermatology, King George Medical University, Lucknow 226003, Uttar Pradesh, India
| | - K P Malhotra
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand, Gomti Nagar, Lucknow 226010, Uttar Pradesh, India
| | - A Jain
- Department of Dermatology, King George Medical University, Lucknow 226003, Uttar Pradesh, India
| | - P Verma
- Department of Dermatology, King George Medical University, Lucknow 226003, Uttar Pradesh, India
| | - P Kumari
- Department of Dermatology, King George Medical University, Lucknow 226003, Uttar Pradesh, India
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4
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Huang ET, Savaser DJ, Heyboer Iii M. ARTERIAL INSUFFICIENCIES: Hyperbaric Oxygen Therapy for Selected Problem Wounds. Undersea Hyperb Med 2020; 47:491-530. [PMID: 32931678 DOI: 10.22462/03.07.2020.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The use of hyperbaric oxygen (HBO2) for the treatment of selected problem wounds has focused almost entirely on the diabetic foot ulcer (DFU) in recent years. The prevalence of DFUs in today's patient population and the reimbursement available for the treatment of DFUs have given it priority status in discussions about problem wounds, but there are sound fundamental reasons why additional oxygen may have benefits in the treatment of non-DFU wounds.
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Affiliation(s)
- Enoch T Huang
- Hyperbaric Medicine / Wound Healing, Legacy Emanuel Medical Center, Portland, Oregon U.S
| | - Davut J Savaser
- Hyperbaric Medicine / Wound Healing, Legacy Emanuel Medical Center, Portland, Oregon U.S
| | - Marvin Heyboer Iii
- Department of Emergency Medicine, Division of Hyperbaric Medicine and Wound Care, SUNY Upstate Medical University, Syracuse, New York U.S
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Jenkins DA, Mohamed S, Taylor JK, Peek N, van der Veer SN. Potential prognostic factors for delayed healing of common, non-traumatic skin ulcers: A scoping review. Int Wound J 2019; 16:800-812. [PMID: 30821117 PMCID: PMC6563199 DOI: 10.1111/iwj.13100] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/04/2019] [Indexed: 01/08/2023] Open
Abstract
Healing of non-traumatic skin ulcers is often suboptimal. Prognostic tools that identify people at high risk of delayed healing within the context of routine ulcer assessments may improve this, but robust evidence on which factors to include is lacking. Therefore, we scoped the literature to identify which potentially prognostic factors may warrant future systematic reviews and meta-analyses. We conducted electronic searches in MEDLINE and Embase to identify studies in English published between 1997 and 2017 that tested the association between healing of the three most common non-traumatic skin ulcers encountered by health care professionals (venous leg, diabetic foot, and pressure ulcers) and patient characteristics, ulcer characteristics, and results from clinical investigations. We included 42 studies that investigated factors which may be associated with the healing of venous leg ulcers (n = 17), diabetic foot ulcers (n = 15), and pressure ulcers (n = 10). Across ulcer types, ulcer characteristics were most commonly reported as potential prognostic factors for healing (n = 37), including the size of the ulcer area (n = 29) and ulcer duration at first assessment (n = 16). A total of 35 studies investigated the prognostic value of patient characteristics (n = 35), including age (n = 31), gender (n = 30), diabetes (n = 22), smoking status (n = 15), and history of deep vein thrombosis (DVT) (n = 13). Of these studies, 23 reported results from clinical investigations as potential prognostic factors, with the majority regarding vessel quality. Age, gender, diabetes, smoking status, history of DVT, ulcer area, and ulcer duration at time of first assessment warrant a systematic review and meta-analysis to quantify their prognostic value for delayed ulcer healing.
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Affiliation(s)
- David A. Jenkins
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
- Health e‐Research Centre, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Manchester Academic Health Science CentreThe University of ManchesterManchesterUK
| | - Sundus Mohamed
- Health e‐Research Centre, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Manchester Academic Health Science CentreThe University of ManchesterManchesterUK
| | - Joanne K. Taylor
- Health e‐Research Centre, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Manchester Academic Health Science CentreThe University of ManchesterManchesterUK
- Manchester University NHS Foundation TrustManchesterUK
| | - Niels Peek
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
- Health e‐Research Centre, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Manchester Academic Health Science CentreThe University of ManchesterManchesterUK
- NIHR Manchester Biomedical Research Centre, Faculty of Biology Medicine and HealthThe University of ManchesterManchesterUK
| | - Sabine N. van der Veer
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
- Health e‐Research Centre, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Manchester Academic Health Science CentreThe University of ManchesterManchesterUK
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Abstract
Timely wound healing supports positive outcomes for both the patient and the clinician. The cause of a non-healing wound needs both identifying and addressing. A dry wound bed will result in a lengthy healing process, impacting both the patient and the clinician, physically and financially. It is imperative to correctly identify the cause of a non-healing wound and address the causative factors using evidence-based best practice. A non-healing wound may be attributed to various factors, such as inappropriate dressing, lack of hydration, medication or underlying medical disease. Identification of the cause will support the most appropriate management choice. In order to explain the issues of a dry wound, it is imperative that the clinician first has an understanding of the concept of moist wound healing.
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de Wert LA, Geerts M, van der Brug S, Adriaansen L, Poeze M, Schaper N, Bouvy ND. The Effect of Shear Force on Skin Viability in Patients with Type 2 Diabetes. J Diabetes Res 2019; 2019:1973704. [PMID: 31781661 PMCID: PMC6875394 DOI: 10.1155/2019/1973704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/02/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Shear is a major risk factor in the development of diabetic foot ulcers, but its effect on the skin of patients with type 2 diabetes mellitus (DM) remains to be elucidated. The aim was to determine skin responses to shear in DM patients with and without diabetic polyneuropathy (DNP). METHODS The forearm skin was loaded with 14.5 N shear (+2.4 kPa pressure) and with 3.5 kPa pressure for 30 minutes in 10 type 2 DM patients without DNP, 10 type 2 DM patients with DNP, and 10 healthy participants. A Sebutape collected IL-1α (measure of tissue damage). A laser Doppler flowmeter measured cutaneous blood cell flux (CBF) as a measure of the reactive hyperaemic skin response. FINDINGS Reactive hyperaemia and IL-1α release was significantly increased after shear loading in all three groups and was higher compared to the responses to pressure loading. The reactive hyperaemic response after shear loading was impaired in patients with type 2 DM compared to healthy participants but did not differ between patients with and without DNP. The reactive hyperaemic response was negatively correlated with the blood glucose level but did not correlate with the DNP severity score. INTERPRETATION Shear is important in the development of tissue damage, but the reparative responses to shear are impaired in patients with type 2 DM. DNP was not associated with altered skin responses, suggesting that the loss of protective sensation to sense shear to skin remains a key factor in the development of diabetic foot ulcers in patients with DNP.
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Affiliation(s)
- Luuk A. de Wert
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Margot Geerts
- Department of Neurology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Sander van der Brug
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Laura Adriaansen
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Martijn Poeze
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Nicolaas Schaper
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Nicole D. Bouvy
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
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Affiliation(s)
- Ruth Ellen Jones
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Deshka S Foster
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Michael T Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
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9
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Gigante A, Margiotta D, Navarini L, Liberatori M, Barbano B, Tubani L, Afeltra A, Rosato E. Parasympathetic activity increases with digital microvascular damage and vascular endothelial growth factor in systemic sclerosis. Clin Exp Rheumatol 2018; 36 Suppl 113:24-27. [PMID: 29787366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/27/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The imbalance between angiogenic and angiostatic factors with derangement of the microvasculature are hallmarks of systemic sclerosis (SSc). Raynaud's phenomenon in SSc probably is due to the impaired neuroendothelial control mechanisms between vasoconstriction and vasodilatation. The aim of this study is to evaluate autonomic nervous system function using heart rate variability (HRV) analysis and to correlate with vascular endothelial growth factor (VEGF). METHODS Twenty-seven SSc patients were enrolled. HRV was measured and markers of global sympathetic and parasympathetic system, respectively standard deviation of normal-to-normal RR intervals (SDNN) and square root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD) were evaluated. Serum VEGF levels and nailfold videocapillaroscopy (NVC) were performed. RESULTS A linear positive correlation was observed between RMSSD and VEGF (p<0.01, r=0.55), and RMSSD and disease duration (p< 0.01, r=0.54). The RMSSD median value was significantly increased (p< 0.05) with NVC damage progression. The RMSSD median value was significantly (p<0.05) higher in SSc patients with digital ulcers (DUs) than in SSc patients without DUs [44 (39.4-60.2) vs 24.6 (23-37.1)]. CONCLUSIONS In our study parasympathetic modulation increases in relation to VEGF. When microcirculation is modified with capillaroscopic pattern progression and DUs, autonomic system seems to stimulate vasodilatation trough parasympathetic system. We can conclude that parasympathetic activity increases with digital microvascular damage and promotes VEGF release.
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Affiliation(s)
- Antonietta Gigante
- Department of Clinical Medicine, Scleroderma Unit, Sapienza University of Rome, Italy.
| | - Domenico Margiotta
- Department of Immuno-Rheumatology Unit, Campus Bio-Medico, University of Rome, Italy
| | - Luca Navarini
- Department of Immuno-Rheumatology Unit, Campus Bio-Medico, University of Rome, Italy
| | - Marta Liberatori
- Department of Clinical Medicine, Scleroderma Unit, Sapienza University of Rome, Italy
| | - Biagio Barbano
- Department of Clinical Medicine, Scleroderma Unit, Sapienza University of Rome, Italy
| | - Luigi Tubani
- Department of Clinical Medicine, Scleroderma Unit, Sapienza University of Rome, Italy
| | - Antonella Afeltra
- Department of Immuno-Rheumatology Unit, Campus Bio-Medico, University of Rome, Italy
| | - Edoardo Rosato
- Department of Clinical Medicine, Scleroderma Unit, Sapienza University of Rome, Italy
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10
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Frech TM, Machin DR, Murtaugh MA, Stoddard GJ, Bloom SI, Phibbs JV, Donato AJ. Implications of endothelial shear stress on systemic sclerosis vasculopathy and treatment. Clin Exp Rheumatol 2018; 36 Suppl 113:175-182. [PMID: 30277867 PMCID: PMC6542469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/30/2018] [Indexed: 02/16/2023]
Abstract
There are no Federal Drug Administration approved drugs for the treatment of systemic sclerosis vascular digital ulcers (DU) in the United States, which are thought to be an end-stage result of prolonged ischaemia due to severe, prolonged Raynaud's phenomenon. Most therapeutics for vasodilation used in SSc work different pathways to target the smooth muscle to induce vessel relaxation. Longitudinal studies of vascular function allow insight into the effects of medications used for Raynaud's phenomenon in the SSc patient population. In this review, we discuss vascular tone, the function of the endothelium in SSc, and provide the rationale for longitudinal studies of vascular function and therapeutics that target the endothelial shear stress in addition to vasodilation for treatment and prevention of DU. This review provides the rationale for vasodilatory medication use for treatment of SSc-related DU and justifies access to non-FDA approved medications for this indication.
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Affiliation(s)
- Tracy M Frech
- University of Utah, Department of Internal Medicine; University of Utah Hospitals and Clinics; and VAMC Salt Lake City, GRECC, Salt Lake City, UT, USA.
| | - Daniel R Machin
- University of Utah, Department of Internal Medicine, Salt Lake City, UT, USA
| | - Maureen A Murtaugh
- University of Utah, Department of Internal Medicine, Salt Lake City, UT, USA
| | - Gregory J Stoddard
- University of Utah, Department of Internal Medicine, Salt Lake City, UT, USA
| | - Samuel I Bloom
- University of Utah, Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Jessica V Phibbs
- University of Utah Hospitals and Clinics, Salt Lake City, UT, USA
| | - Anthony J Donato
- University of Utah, Department of Internal Medicine; University of Utah, Department of Exercise and Sport Science; University of Utah, Dept. of Nutrition and Integrative Physiology, University of Utah; and VAMC Salt Lake City, GRECC, Salt Lake City, USA
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11
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Kwakkenbos L, Sanchez TA, Turner KA, Mouthon L, Carrier ME, Hudson M, van den Ende CHM, Schouffoer AA, Welling JJKC, Sauvé M, Thombs BD. The association of sociodemographic and disease variables with hand function: a Scleroderma Patient-centered Intervention Network cohort study. Clin Exp Rheumatol 2018; 36 Suppl 113:88-94. [PMID: 30277865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Impaired hand function in systemic sclerosis (SSc) is a primary cause of disability and contributes diminished health-related quality of life. The objective of the present study was to evaluate sociodemographic, lifestyle, and disease-related factors independently associated with hand function in SSc. METHODS Patients enrolled in the Scleroderma Patient-centered Intervention Network Cohort who completed baseline study questionnaires between March 2014 and September 2017 were included. Hand function was measured using the Cochin Hand Function Scale (CHFS). Multiple linear regression analysis was used to identify independent correlates of impaired hand function. RESULTS Among 1193 participants (88% female), the mean CHFS score was 13.3 (SD=16.1). Female sex (standardised regression coefficient, beta (β)=.05), current smoking (β=.07), higher BMI (β=.06), diffuse SSc (β=0.14), more severe Raynaud's scores (β=.23), more severe finger ulcer scores (β=.23), moderate (β=0.19) or severe small joint contractures (β=.20), rheumatoid arthritis (β=0.07), and idiopathic inflammatory myositis (β=0.06) were significantly associated with higher CHFS scores (more impaired hand function). Consumption of 1-7 alcoholic drinks per week (β=-0.07) was associated with lower CHFS scores (less impaired hand function) compared to no drinking. CONCLUSIONS Multiple factors are associated with hand function in SSc. The presence of moderate or severe small joint contractures, the presence of digital ulcers, and severity of Raynaud's phenomenon had the largest associations. Effective interventions are needed to improve the management of hand function in patients with SSc.
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Affiliation(s)
- Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, the Netherlands; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal; Department of Psychiatry, McGill University, Montreal, Canada
| | - Tatiana A Sanchez
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Kimberly A Turner
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Luc Mouthon
- Université Paris Descartes, Assistance Publique-Hopitaux de Paris; Service de Medicine Interne, Centre de Reference Maladies Systémiques Autoimmunes Rares, vascularites nécrosantes et sclérodermie systémique, Hopital Cochin, Paris, France
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Marie Hudson
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal; Department of Medicine, McGill University, Montreal, Canada
| | | | - Anne A Schouffoer
- Leiden University Medical Center, Leiden; Haga Teaching Hospital, The Hague, the Netherlands
| | - Joep J K C Welling
- NVLE Dutch patient organisation for systemic autoimmune diseases, Utrecht, the Netherlands; and Federation of European Scleroderma Associations, Brussels, Belgium
| | - Maureen Sauvé
- Scleroderma Society of Ontario, Hamilton; and Scleroderma Society of Canada, Ottawa, Canada
| | - Brett D Thombs
- Lady Davis Inst. Med. Res., Jewish General Hosp., Montreal; Dept.of Psychiatry, Dept.of Medicine, Dept.of Epidemiology, Biostatistics and Occupational Health, Dept.of Educational & Counselling Psychology, Dept.of Psychology , McGill Univ., Montreal, Canada
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12
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Raposio E, Bortolini S, Maistrello L, Grasso DA. Larval Therapy for Chronic Cutaneous Ulcers: Historical Review and Future Perspectives. Wounds 2017; 29:367-373. [PMID: 29324424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cutaneous ulcers tend to become chronic and have a profound impact on quality of life. These wounds may become infected and lead to greater morbidity and even mortality. In the past, larvae (ie, maggots) of certain common flies (Lucilia sericata and Lucilia cuprina) were considered useful in ulcer management because they only remove necrotic tissue while promoting healthy tissue in the wound bed, thus helping wounds heal faster. Recently, maggots from several other fly species (Calliphora vicina, Calliphora vomitoria, Phormia regina, Chrysomya albiceps, Sarcophaga carnaria, and Hermetia illucens) have been shown in vitro to possess characteristics (ie, debridement efficacy and putative antimicrobial potentialities) that make them suitable candidates for possible use in clinical practice. This review presents a historical analysis of larval debridement and speculates future directions based on the literature presented.
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Affiliation(s)
- Edoardo Raposio
- Department of Medicine and Surgery, Plastic Surgery Chair, University of Parma, Parma, Italy; Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Sara Bortolini
- Department of Life Sciences, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Lara Maistrello
- Department of Life Sciences, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Donato A Grasso
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma
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13
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Motegi SI, Uehara A, Yamada K, Sekiguchi A, Fujiwara C, Toki S, Date Y, Nakamura T, Ishikawa O. Efficacy of Botulinum Toxin B Injection for Raynaud's Phenomenon and Digital Ulcers in Patients with Systemic Sclerosis. Acta Derm Venereol 2017; 97:843-850. [PMID: 28358168 DOI: 10.2340/00015555-2665] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The efficacy and safety of botulinum toxin B (BTX-B) for treatment of Raynaud's phenomenon and digital ulcers in patients with systemic sclerosis was assessed. A total of 45 patients with systemic sclerosis who had Raynaud's phenomenon were blinded and divided randomly into 4 groups: a no-treatment control group, and 3 treatment groups, using 250, 1,000 or 2,000 international units (U) of BTX-B injections in the hand with more severe symptoms. Four weeks after injection, pain/numbness visual analogue scale scores and Raynaud's score in the groups treated with 1,000 and 2,000 U BTX-B were significantly lower than in the control group and the group treated with 250 U BTX-B. These beneficial effects were sustained until 16 weeks after the single injection. At 4 weeks after injection skin temperature recovery in the group treated with 2,000 U BTX-B was significantly improved. The numbers of digital ulcers in the groups treated with 1,000 and 2,000 U BTX-B were significantly lower than in the control group. In conclusion, 1,000 and 2,000 U BTX-B injections significantly suppressed the activity of Raynaud's phenomenon and digital ulcers in patients with SSc without serious adverse events.
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Affiliation(s)
- Sei-Ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
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14
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Abstract
CD271 is common stem cell marker for the epidermis and dermis. We assessed a kinetic movement of epidermal and dermal CD271+ cells in the wound healing process to elucidate the possible involvement with chronic skin ulcers. Epidermal CD271+ cells were proliferated and migrated from 3 days after wounding. Purified epidermal CD271+ cells expressed higher TGFβ2 and VEGFα transcripts than CD271- cells. Delayed wound healing was observed in the aged mice compared with young mice. During the wound healing process, the peak of dermal CD271+ cell accumulation was delayed in aged mice compared with young mice. The expression levels of collagen-1, -3, -5, F4-80, EGF, FGF2, TGFβ1, and IL-1α were significantly increased in young mice compared with aged mice. Furthermore, purified dermal CD271+ cells expressed higher FGF2, EGF, PDGFB, and TGFβ1 gene transcripts than CD271- cells. These results suggested that epidermal and dermal CD271+ cells were closely associated with wound healing process by producing various growth factors. Epidermal and dermal CD271+ cells in chronic skin ulcer patients were significantly reduced compared with healthy controls. Thus, both epidermal and dermal stem cells can play an important role in wound healing process.
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Affiliation(s)
- Yohei Iwata
- Department of Dermatology, Fujita Health University School of Medicine
| | - Hirohiko Akamatsu
- Department of applied Cell and Regenerative Medicine, Fujita Health University School of Medical
| | - Yuichi Hasebe
- Research Laboratories, Nippon Menard Cosmetic Co., Ltd
- MENARD Collaborative Research Chair, Nagoya University Graduate School of Medicine
| | - Seiji Hasegawa
- Department of Dermatology, Fujita Health University School of Medicine
- Research Laboratories, Nippon Menard Cosmetic Co., Ltd
- MENARD Collaborative Research Chair, Nagoya University Graduate School of Medicine
| | - Kazumitsu Sugiura
- Department of Dermatology, Fujita Health University School of Medicine
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15
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Liao A, Lin MC, Ritz LC, Swisher SL, Ni D, Mann K, Khan Y, Roy S, Harrison MR, Arias AC, Subramanian V, Young D, Maharbiz MM. Impedance sensing device for monitoring ulcer healing in human patients. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:5130-3. [PMID: 26737446 DOI: 10.1109/embc.2015.7319546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic skin wounds affect millions of people each year and take billions of dollars to treat. Ulcers are a type of chronic skin wound that can be especially painful for patients and are tricky to treat because current monitoring solutions are subjective. We have developed an impedance sensing tool to objectively monitor the progression of healing in ulcers, and have begun a clinical trial to evaluate the safety and feasibility of our device to map damaged regions of skin. Impedance data has been collected on five patients with ulcers, and impedance was found to correlate with tissue health. A damage threshold was applied to effectively identify certain regions of skin as "damaged tissue".
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16
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Jacks SK, Zirwas MJ. Abnormal wound healing related to high-dose systemic corticosteroid therapy in a patient with Ehlers-Danlos syndrome benign hypermobility Type. Cutis 2016; 98:E20-E23. [PMID: 27874893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The adverse impact of chronic corticosteroid therapy on wound healing has been well characterized, as has abnormal wound healing known to occur in the classic type of Ehlers-Danlos syndrome (EDS). In contrast, abnormal wound healing is absent in cases of EDS benign hypermobility type (EDS-BHT). We present the case of a patient with EDS-BHT with no history of abnormal wound healing who developed large nonhealing ulcers to sites of minor trauma after initiating therapy with high-dose systemic corticosteroids for dermatomyositis. This case provides a dramatic illustration of the effects of chronic systemic corticosteroids on skin fragility and wound healing in a patient with an underlying genetic defect of the connective tissue.
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17
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Ahrens HC, Siegert E, Tomsitz D, Mattat K, March C, Worm M, Riemekasten G. Digital ulcers score: a scoring system to assess digital ulcers in patients suffering from systemic sclerosis. Clin Exp Rheumatol 2016; 34 Suppl 100:142-147. [PMID: 27749240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/15/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To develop a standardized scoring system to assess the severity of DUs in SSc patients and correlate it with functional outcomes. METHODS In this cross-sectional, longitudinal study in SSc patients with DUs (n=65) we developed a digital ulcers score (DUS) for the assessment of DUs. DUS and the ABILHAND score were measured at each visit and differences were analysed using Tamhane's T2 test. Spearman's Rho test was applied for correlational analysis of DUS and functional outcomes. We calculated a linear regression model using clustered standard errors for correlation analysis between DUS and ABILHAND over time. RESULTS 117 assessments of DUS were performed in 65 SSc patients. Mean DUS was 11.6±1.9 (range: 0-68). Subgroup analyses showed a higher DUS in patients suffering from diffuse cutaneous SSc when compared to patients with limited cutaneous SSc (12.8±3.0 vs. 9.7±2.2 p=0.18). There was no correlation between the DUS and manual ability using the ABILHAND score (overall: n=106 r=-0.138, p=0.22). We observed a small but significant linear correlation between the DUS and the ABILHAND score for a single patient over time (n=14, R2=0.31, r=0.06, p=0.02). CONCLUSIONS The DUS is a feasible scoring instrument to assess severity of DUs in SSc patients. In accordance with the literature the severity of DUs correlates with clinical parameters but also severity of the disease. Further study is needed to establish the DUS as a standardized tool for the assessment of DUs.
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Affiliation(s)
- Hannah Clara Ahrens
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Germany
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Germany
| | - Dirk Tomsitz
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Germany
| | - Kathrin Mattat
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Germany
| | - Christine March
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Germany
| | - Margitta Worm
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Germany.
| | - Gabriela Riemekasten
- 4Department of Rheumatology, University Hospital of Schleswig-Holstein, Lübeck, Germany
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18
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Murray AK, Moore TL, Wragg E, Ennis H, Vail A, Dinsdale G, Muir L, Griffiths CEM, Herrick AL. Pilot study assessing pathophysiology and healing of digital ulcers in patients with systemic sclerosis using laser Doppler imaging and thermography. Clin Exp Rheumatol 2016; 34 Suppl 100:100-105. [PMID: 27749241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/04/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Systemic sclerosis (SSc)-related digital ulcers (DU) cause significant pain and disability and are often a primary endpoint in clinical trials. However, their pathophysiology has been little studied. The objectives of this prospective study were to determine whether laser Doppler imaging (LDI) and thermography can identify ischaemic components in both fingertip and extensor surface DU and assess ulcer healing. METHODS Patients prospectively reported new DU over a year. Patients' DU underwent imaging until the ulcer had healed. Ischaemia was defined as lower blood flow or skin temperature (and inflammation as higher) within the ulcer, compared to a non-affected site. RESULTS 53 ulcers (19 fingertip, 18 extensor, 16 'other' sites) in 17 patients were imaged (53 with LDI, 52 with thermography). For LDI data 32 (60%) ulcers were ischaemic; median perfusion ulcer/unaffected area; 0.79 (range 0.11-2.9). For thermography data 35 (66%) were ischaemic; 0.98 (0.89 to 1.1). Inflammation in the surrounding area was identified for all ulcers by LDI but not thermography. In the 36 ulcers with repeat imaging, LDI showed trends (with healing) towards increased ulcer perfusion (p=0.23) and decreased hyperaemia in adjacent areas (p=0.59). Skin temperature at the ulcer site showed no significant change (p=0.13) but adjacent area showed decreased temperature (p=0.04 signifying decreased blood flow). CONCLUSIONS LDI and thermography are sufficiently sensitive to measure ischaemia in both fingertip and extensor ulcers. LDI was better suited to monitoring change in perfusion with healing (due to higher imaging resolution, or vascular changes occurring in more superficial skin layers).
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Affiliation(s)
- Andrea K Murray
- Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK; and Photon Science Institute, University of Manchester, UK.
| | - Tonia L Moore
- Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Elizabeth Wragg
- Rheumatology Directorate, Salford Royal NHS Foundation Trust, Salford, UK
| | - Holly Ennis
- Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Andy Vail
- School of Community Based Medicine, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Graham Dinsdale
- Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Lindsay Muir
- Department of Hand Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Christopher E M Griffiths
- Dermatology Centre, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Ariane L Herrick
- Inst.of Inflammation and Repair, University of Manchester, Salford Royal NHS Foundation Trust, Salford; and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, UK
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19
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Zheng L, Urban C, Musiek A. Nonpainful ulcerations on the nose and forehead. Cutis 2016; 98:E3-E4. [PMID: 27529718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Lida Zheng
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Christopher Urban
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Amy Musiek
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri, USA
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21
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Weitzel T, Soto A, Sánchez M, Larrondo J. Chronic skin ulcers in a patient returning from Mexico. Lancet Infect Dis 2016; 16:264. [PMID: 26867465 DOI: 10.1016/s1473-3099(15)00370-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 09/15/2015] [Accepted: 10/01/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Thomas Weitzel
- Laboratorio Clínico, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
| | - Andrés Soto
- Servicio de Medicina Interna, Hospital del Salvador, Santiago, Chile; Servicio de Infectología, Hospital Militar, Santiago, Chile
| | - Macarena Sánchez
- Servicio de Medicina Interna, Hospital del Salvador, Santiago, Chile
| | - Jorge Larrondo
- Servicio de Dermatología, Hospital del Salvador, Santiago, Chile
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22
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Nguyen VT, Nassar D, Batteux F, Raymond K, Tharaux PL, Aractingi S. Delayed Healing of Sickle Cell Ulcers Is due to Impaired Angiogenesis and CXCL12 Secretion in Skin Wounds. J Invest Dermatol 2015; 136:497-506. [PMID: 26967481 DOI: 10.1016/j.jid.2015.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/14/2015] [Accepted: 10/12/2015] [Indexed: 01/31/2023]
Abstract
Leg ulcers are a major complication of sickle cell disease that occur in 2.5-40% of patients. Leg ulcers are responsible for frequent complications because they are often long-lasting and are highly resistant to therapy. Although their occurrence is associated with hyperhemolysis, the mechanisms underlying sickle cell ulcers remain poorly understood. In this study, we show that skin wound healing is severely altered in old SAD sickle cell mice but is normal in young animals, consistent with reports in humans. Alterations of wound healing were associated with impaired blood and lymphatic angiogenesis in the wound beds and poor endothelial progenitor cell mobilization from the bone marrow. CXCL12 secretion by keratinocytes and inflammatory cells was low in the wounds of SAD mice. Local therapy with endothelial progenitor cells or recombinant CXCL12 injections restored wound angiogenesis and rescued the healing defect together with mobilization of circulating endothelial progenitor cells. To our knowledge, this is a previously unreported study of the cellular and molecular mechanisms of sickle cell ulcers in a murine model that provides promising therapeutic perspectives for clinical trials.
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Affiliation(s)
- Van Tuan Nguyen
- Progenitors and Endothelial Cells During and After Pregnancy Laboratory, INSERM UMR_S 938, Centre de Recherche, St. Antoine, Paris, France; UPMC-Université Paris 6, Paris, France
| | - Dany Nassar
- Progenitors and Endothelial Cells During and After Pregnancy Laboratory, INSERM UMR_S 938, Centre de Recherche, St. Antoine, Paris, France; UPMC-Université Paris 6, Paris, France; Department of Dermatology, American University of Beirut Medical Centre, Beirut, Lebanon; Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Fréderic Batteux
- Faculty of Medicine, Université Paris Descartes-Paris 5, Paris, France
| | - Karine Raymond
- Progenitors and Endothelial Cells During and After Pregnancy Laboratory, INSERM UMR_S 938, Centre de Recherche, St. Antoine, Paris, France
| | | | - Sélim Aractingi
- Progenitors and Endothelial Cells During and After Pregnancy Laboratory, INSERM UMR_S 938, Centre de Recherche, St. Antoine, Paris, France; Faculty of Medicine, Université Paris Descartes-Paris 5, Paris, France; Department of Dermatology, Hôpital Cochin-Tarnier, Paris, France.
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23
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Silva I, Teixeira A, Oliveira J, Almeida I, Almeida R, Vasconcelos C. Predictive value of vascular disease biomarkers for digital ulcers in systemic sclerosis patients. Clin Exp Rheumatol 2015; 33:S127-S130. [PMID: 26242908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 06/23/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To investigate the role of endothelial dysfunction and angiogenesis vascular biomarkers as risk factors and their predictive value for digital ulcers in systemic sclerosis patients. METHODS Endothelin-1 (ET-1), asymmetric dimethylarginine (ADMA), vascular endothelial growth factor (VEGF), endostatin and endoglin were measured in an observational prospective cohort of 77 SSc patients. The primary outcome was the occurrence of one or more new ischaemic digital ulcers during a planned 3-year follow-up. RESULTS After the 3-year follow-up, 40 patients developed new digital ulcers. Logistic regression confirmed VEGF (HR 1.128, 95% CI 1.010-1.260, p=0.033) and ADMA (HR 0.995, 95% CI 0.991-0.998, p=0.006) as independent predictors of new digital ulcers. Patients with serum levels of ET-1>11.9 pmol/ml (p<0.001) and VEGF<422.47 pg/ml (p=0.028) had significantly more DU in the 3-year follow-up. Although not significant, a trend towards increased serum levels of endoglin>4.215 ng/ml (p=0.053) was associated to a new DU episode. No predictive serum value was found for ADMA (p=0.075) and endostatin (p=0.130). CONCLUSIONS Endothelial dysfunction and angiogenic vascular biomarkers have an important role in the underlying and in the progression of microvascular disease in systemic sclerosis. Increased serum levels of ET-1, ADMA and VEGF are strong predictors of severe microangiopathy complications, namely ischaemic digital ulcers.
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Affiliation(s)
- Ivone Silva
- Angiology and Vascular Surgery Service and Clinical Immunology Unit, Centro Hospitalar do Porto, Portugal.
| | - Andreia Teixeira
- Health Information and Decision Sciences Department, Universidade do Porto; CINTESIS, Center for Research in Health Technologies and Information Systems, Porto, Portugal
| | - José Oliveira
- Clinical Pathology Department, Clinical Chemistry, Centro Hospitalar do Porto, Portugal
| | - Isabel Almeida
- Clinical Immunology Unit, Centro Hospitalar do Porto, Portugal
| | - Rui Almeida
- Angiology and Vascular Surgery Service, Centro Hospitalar do Porto, Portugal
| | - Carlos Vasconcelos
- Clinical Immunology Unit, Centro Hospitalar do Porto; Instituto de Ciências Biomédicas Abel Salazar, University of Porto; Multidisciplinar Unit of biomedical investigation, Porto, Portugal
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24
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Brand M, Hollaender R, Rosenberg D, Scott M, Hunsche E, Tyndall A, Denaro V, Carreira P, Varju C, Gabrielli B, Zingarelli S, Caramaschi P, Simic-Pasalic K, Müller-Ladner U, Vasile M, Mihai C, Rosato E, Vacca A, Zenone T, Mohamed WA, Ancuta C, Zampogna G, Rednic S, Jabaar N, Belloli L, Pozzi MR, Foti R, Walker UA. An observational cohort study of patients with newly diagnosed digital ulcer disease secondary to systemic sclerosis registered in the EUSTAR database. Clin Exp Rheumatol 2015; 33:S47-S54. [PMID: 26243652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 04/30/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This study describes clinical characteristics, prognostic factors, and quality of life in patients with newly diagnosed (incident) digital ulcers (DU). METHODS Observational cohort study of 189 consecutive SSc patients with incident DU diagnosis identified from the EUSTAR database (22 centres in 10 countries). Data were collected from medical charts and during one prospective visit between 01/2004 and 09/2010. RESULTS Median age at DU diagnosis was 51 years, majority of patients were female (88%), and limited cutaneous SSc was the most common subtype (61%). At incident DU diagnosis, 41% of patients had one DU and 59% had ≥2 DU; at the prospective visit 52% had DU. Pulmonary arterial hypertension (PAH) and multiple DU at diagnosis were associated with presence of any DU at the prospective visit (odds ratios: 4.34 and 1.32). During the observation period (median follow-up was 2 years) 127 patients had ≥1 hospitalisation. The event rate of new DU per person-year was 0.66, of DU-associated complications was 0.10, and of surgical or diagnostic procedures was 0.12. At the prospective visit, patients with ≥1 DU reported impairment in daily activities by 57%, those with 0 DU by 37%. The mean difference between patients with or without DU in the SF-36 physical component was 2.2, and in the mental component 1.4. DU patients were not routinely prescribed endothelin receptor antagonists or prostanoids. CONCLUSIONS This real world cohort demonstrates that DU require hospital admission, and impair daily activity. PAH and multiple DU at diagnosis were associated with future occurrence of DU.
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Affiliation(s)
- Monika Brand
- Actelion Pharmaceuticals Ltd., Departments of Epidemiology and Observational Studies, and Global Market Access and Pricing, Allschwil, Switzerland
| | - Rebecca Hollaender
- Basel University Department of Rheumatology, Felix Platter-Spital, Basel, Switzerland
| | - Daniel Rosenberg
- Actelion Pharmaceuticals Ltd., Departments of Epidemiology and Observational Studies, and Global Market Access and Pricing, Allschwil, Switzerland
| | | | - Elke Hunsche
- Actelion Pharmaceuticals Ltd., Departments of Epidemiology and Observational Studies, and Global Market Access and Pricing, Allschwil, Switzerland
| | - Alan Tyndall
- Basel University Department of Rheumatology, Felix Platter-Spital, Basel, Switzerland
| | - Valentina Denaro
- Department of Biomedicine, Section of Rheumatology, University of Florence, Florence, Italy
| | - Patricia Carreira
- Servicio de Reumatologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cecilia Varju
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
| | - Barbara Gabrielli
- Department Clinica Medica, Università Politecnica delle Marche, Ancona, Italy
| | - Stefania Zingarelli
- Rheumatology and Clinical Immunology Service, Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Ulf Müller-Ladner
- Department of Rheumatology, Justus- Liebig-University, Bad Nauheim, Germany
| | - Massimiliano Vasile
- Department of Internal Medicine and Medical Specialities, Sapienza University of Rome, Rome, Italy
| | - Carina Mihai
- Department of Rheumatology, Cantacuzino Hospital, Carol Davila University, Bucharest, Romania
| | - Edoardo Rosato
- Clinical Immunology Unit, Sapienza University of Rome, Rome, Italy
| | - Alessandra Vacca
- AOU Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Thierry Zenone
- Department of Internal Medicine, Centre Hospitalier, Valence, France
| | | | - Codrina Ancuta
- Department of Rheumatology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | | | - Simona Rednic
- University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca, Romania
| | - Nadia Jabaar
- Division of Rheumatology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Laura Belloli
- Rheumatology Unit, Istituto Clinico Humanitas, University of Milan, Rozzano, Italy
| | - Maria R Pozzi
- Clinica Medica, Azienda Ospedaliera San Gerardo, University of Milano, Bicocca, Italy
| | - Rosario Foti
- Rheumatology Unit, Azienda Ospedaliera Universitaria Policlinico V.E., Catania, Italy
| | - Ulrich A Walker
- Basel University Department of Rheumatology, Felix Platter-Spital, Basel, Switzerland.
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25
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Bergersen TK, Hoffmann-Vold AM, Midtvedt Ø, Gran JT, Mørk C, Toska K, Elstad M. Dysfunctional arteriovenous anastomoses in hands of systemic sclerosis patients with digital ulcers. Clin Exp Rheumatol 2014; 32:S-53-9. [PMID: 24847906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 12/18/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Previous studies indicate that the arteriovenous anastomoses (AVAs) and the arterioles with the nutritive flow are involved in the pathophysiologic process disturbing hand blood flow in systemic sclerosis (SSc). However, impact of different part of the microvascular system involved in digital ulcers (DU) is not well known. Here, we aimed to assess the vasomotor activity of the AVAs in the hands of patients with and without DU in SSc. METHODS Simultaneous recordings were made of laser Doppler flux in the finger pulp and thenar eminence, together with ipsilateral radial artery blood velocity and mean arterial blood pressure (MAP) in 22 non-smoking SSc patients and 13 aged-matched healthy controls. RESULTS AVA responses in the finger pulp to spontaneous vasoconstrictor nerve impulses were abolished in 64% of the SSc patients. Correlation and cross-spectra analysis showed positive correlation between blood flow changes and MAP changes, indicating a passive vascular bed in the SSc finger pulp with blood flow variations depending on short-term variability in MAP. Dysfunctional AVAs were identified in all the patients with a history of DU (n=8), while none of the patients with normal AVA function had episodes of DU (n=8) (p= 0.017). CONCLUSIONS We found that in SSc patients with DU there is a dysfunction of the AVAs of the finger pulp. This proof-of-concept study supports the notion that AVA dysfunction may play a critical role in SSc related DU. AVA dysfunction may be a part of autonomic dysfunction in SSc.
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Affiliation(s)
- T K Bergersen
- Department of Dermatology, Oslo University Hospital, Oslo, Norway.
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26
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Kaffenberger BH, Zuo RC, Gru A, Plotner AN, Sweeney SA, Devine SM, Hymes SR, Cowen EW. Graft-versus-host disease-associated angiomatosis: a clinicopathologically distinct entity. J Am Acad Dermatol 2014; 71:745-53. [PMID: 24993601 DOI: 10.1016/j.jaad.2014.05.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/26/2014] [Accepted: 05/12/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic graft-versus-host disease (GVHD) may present with various cutaneous manifestations. Isolated case reports describe eruptive angiomas in this setting. OBJECTIVE We sought to provide a clinical and pathologic description of vascular proliferations in patients with GVHD. METHODS Cases of documented GVHD associated with vascular proliferations were collected from the National Institutes of Health, Ohio State University, and MD Anderson Cancer Center. RESULTS Eleven patients with a diagnosis of GVHD who developed vascular proliferations were identified. All patients manifested sclerotic type chronic GVHD of the skin. Vascular lesions were first documented a median of 44 months after transplantation and occurred primarily on the lower extremities or trunk. Histopathology revealed anastomosing networks of thin-walled vascular proliferations in a vague lobular growth pattern, with overlying epidermal acanthosis, peripheral collarette, ulceration, and disorganized fibroblast-rich and fibrotic stroma. Improvement was noted in 1 patient treated with propranolol and sirolimus and 1 patient with electrocautery. LIMITATIONS Given the retrospective nature of the study, the overall incidence of vascular lesions in patients with GVHD is unknown. Histopathology was present for review on only 3 of 11 patients. CONCLUSION The phenomenon of vascular lesions appears to be relatively specific for sclerotic type chronic GVHD when compared with other fibrosing diseases. We propose the term "graft-versus-host disease-associated angiomatosis" to describe this entity.
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Affiliation(s)
| | - Rena C Zuo
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Alejandro Gru
- Division of Dermatology, Ohio State University Wexner Medical Center, Columbus, Ohio; Division of Dermatopathology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alisha N Plotner
- Division of Dermatology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sarah A Sweeney
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven M Devine
- Division of Blood and Marrow Transplantation, Ohio State University James Cancer Hospital, Columbus, Ohio
| | - Sharon R Hymes
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Edward W Cowen
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Ichimura Y, Asano Y, Akamata K, Aozasa N, Noda S, Taniguchi T, Takahashi T, Toyama T, Sumida H, Kuwano Y, Yanaba K, Tada Y, Sugaya M, Sato S, Kadono T. Serum angiopoietin-like protein 3 levels: possible correlation with progressive skin sclerosis, digital ulcers and pulmonary vascular involvement in patients with systemic sclerosis. Acta Derm Venereol 2014; 94:157-62. [PMID: 23995677 DOI: 10.2340/00015555-1680] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Angiopoietin-like protein 3 (ANGPTL3), which is part of a family of secreted glycoproteins that are structurally similar to angiopoietins, is principally expressed in the liver and is involved in lipid metabolism and angiogenesis. The aim of this study was to determine the clinical significance of serum ANGPTL3 levels, measured with a specific enzyme-linked immunosorbent assay, in patients with systemic sclerosis. Serum ANGPTL3 levels correlated positively with skin score in diffuse cutaneous systemic sclerosis with a disease duration ≤ 6 years. Furthermore, the prevalence of digital ulcers was significantly higher in patients with elevated serum ANGPTL3 levels than in other patients. Moreover, among patients excluding diffuse cutaneous systemic sclerosis with disease duration ≤ 6 years, serum ANGPTL3 levels correlated positively with estimated right ventricular systolic pressure. In conclusion, ANGPTL3 may contribute to the development of progressive skin sclerosis and proliferative obliterative vasculopathy, such as digital ulcers and pulmonary vascular involvement leading to pulmonary arterial hypertension, in systemic sclerosis.
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Affiliation(s)
- Yohei Ichimura
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan
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Ubbink DT, Santema TB, Stoekenbroek RM. Systemic wound care: a meta-review of cochrane systematic reviews. Surg Technol Int 2014; 24:99-111. [PMID: 24700218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Wound care is a classic example of a surgical realm with a great variation in care. The diversity in wounds and wound treatments, the limited amount of convincing evidence, and the diverging opinions among doctors and nurses involved in wound care contribute to this undesirable variation in care. For chronic wounds, such as arterial or venous ulcers, pressure sores, and diabetic foot ulcers, but also for acute wounds after surgery or trauma, international and national guidelines provide recommendations on diagnostic procedures and treatment options, but rely mostly on expert opinion. We present the available evidence from Cochrane systematic reviews for the systemic treatment (i.e., not prevention) of patients with wounds, as opposed to topical wound treatments. This evidence shows: - Venous ulcers: High-compression therapy is the classic and evidence-based treatment for treating venous ulcers. Oral pentoxifylline promotes ulcer healing with and without compression therapy. Oral zinc is not effective to heal venous ulcers. - Acute wounds: Recombinant human growth hormone accelerates healing of large burn wounds and donor sites, while high-carbohydrate feeding might reduce the risk of pneumonia. Linezolid is more effective than vancomycin for treating skin and soft tissue infections. Hyperbaric oxygen may help heal crush wounds and skin grafts. Therapeutic touch does not heal acute wounds. - Pressure sores: Air-fluidized and some low-tech devices appear effective for treating existing pressure ulcers. Oral zinc, protein, or vitamin C supplements seem ineffective. Also, evidence is lacking on the effectiveness of repositioning regimes as a treatment option. - Diabetic ulcers: Hyperbaric oxygen therapy and pressure-relieving devices may improve healing rates. - Arterial ulcers: Prostanoids and spinal cord stimulation may be effective in healing ischemic ulcers. Thus, fortunately, some high-level evidence exists for various local and systemic interventions in wound care. Caregivers should be aware of, and apply, the strongest evidence available. Only when all stakeholders (patients, physicians, wound care nurses, but also manufacturers and buyers) implement this available evidence will optimum quality of care for patients with wounds be ensured.
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Affiliation(s)
- Dirk T Ubbink
- Department of Surgery Academic Medical Center Amsterdam, The Netherlands
| | - Trientje B Santema
- Department of Surgery Academic Medical Center Amsterdam, The Netherlands
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Situm M, Kolić M. [Chronic wounds: differential diagnosis]. Acta Med Croatica 2013; 67 Suppl 1:11-20. [PMID: 24371971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Wound is a disruption of anatomic and physiologic continuity of the skin. According to the healing process, wounds are classified as acute and chronic wounds. A wound is considered chronic if standard medical procedures do not lead to the expected healing, or if the wound does not heal within six weeks. Chronic wounds are classified as typical and atypical. Typical wounds include ischemic, neurotrophic and hypostatic wounds. Diabetic foot and decubitus ulcers stand out as a specific entity among typical wounds. About 80 percent of chronic wounds localized on lower leg are the result of chronic venous insufficiency, in 5-10 percent the cause is of arterial etiology, whereas the remainder are mostly neuropathic ulcers. About 95 percent of chronic wounds manifest as one of the above-mentioned entities. Other forms of chronic wounds are atypical chronic wounds, which can be caused by autoimmune disorders, infectious diseases, vascular diseases and vasculopathies, metabolic and genetic diseases, neoplasm, external factors, psychiatric disorders, drug related reactions, etc. Numerous systemic diseases can present with atypical wounds. The primary cause of the wound can be either systemic disease itself (Crohn's disease) or aberrant immune response due to systemic disease (pyoderma gangrenosum, paraneoplastic syndrome). Although atypical wounds are a rare cause of chronic wounds, it should always be taken in consideration during diagnostic procedure.
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Affiliation(s)
- Mirna Situm
- Klinicki bolnicki centar Sestre milosrdnice, Klinika za kozne i spolne bolesti, Zagreb, Hrvatska
| | - Maja Kolić
- Klinicki bolnicki centar Sestre milosrdnice, Klinika za kozne i spolne bolesti, Zagreb, Hrvatska
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Klopp RC, Niemer W, Schulz J, Ruhnau KJ. Influence of a specific, biorhythmically defined physical stimulus on deficient vasomotion in small-caliber arterioles in the subcutis in patients with diabetic polyneuropathy. J Complement Integr Med 2013; 10:S21-7, S23-9. [PMID: 24021603 DOI: 10.1515/jcim-2013-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As part of a placebo-controlled study series on a random sample of patients with diabetic polyneuropathy and trophic skin lesions on the edge of the foot, functional characteristics of the local microcirculation and immune system were measured to check the complementary-therapy success of biorhythmically defined vasomotion stimulation. Over a 30-day treatment period, complementary-therapy success was demonstrated for an additional physical vasomotion stimulation to increase the therapeutic success of established treatment concepts.
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Guillevin L, Hunsche E, Denton CP, Krieg T, Schwierin B, Rosenberg D, Matucci-Cerinic M. Functional impairment of systemic scleroderma patients with digital ulcerations: results from the DUO Registry. Clin Exp Rheumatol 2013; 31:71-80. [PMID: 23910613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 06/20/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Digital ulcers (DUs) are frequent manifestations of systemic scleroderma (SSc). This study assessed functional limitations due to DUs among patients enrolled in the Digital Ulcer Outcome (DUO) Registry, an international, multicentre, observational registry of SSc patients with DU disease. METHODS Patients completed at enrolment a DU-specific functional assessment questionnaire with a 1-month recall period, measuring impairment in work and daily activities, and hours of help needed from others. Physician-reported clinical parameters were used to describe the population. For patients who completed at least part of the questionnaire, descriptive analyses were performed for overall results, and stratified by number of DUs at enrolment. RESULTS This study included 2327 patients who completed at least part of the questionnaire. For patients with 0, 1-2, and ≥3 DUs at enrolment, mean overall work impairment during the prior month among employed/self-employed patients was 28%, 42%, and 48%, respectively. Across all included patients, ability to perform daily activities was impaired on average by 35%, 54%, and 63%, respectively. Patients required a mean of 2.0, 8.7, and 8.8 hours of paid help and 17.0, 35.9, and 63.7 hours of unpaid help, respectively, due to DUs in the prior month. Patients with DUs had more complications and medication use than patients with no DUs. CONCLUSIONS With increasing number of DUs, SSc patients reported more impairment in work and daily activities and required more support from others.
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Affiliation(s)
- Loïc Guillevin
- Department of Internal Medicine, Centre de Référence pour les Vascularites Nécrosantes et la Sclérodermie Systémique, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.
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32
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Pellicano R, Guerra L. [Skin ulcer pain]. Minerva Med 2012; 103:525-531. [PMID: 23229371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Chronic or acute pain related to skin ulcers or their management (medication, debridement) is a typical case of mixed pain, both neuropathic and nociceptive. It represents a disabling clinical condition that deteriorates the patient's quality of life. The pharmaceutical therapy must be based on both, intensity and the type of pain. Although NSAIDs, Non Steroidal Anti-Inflammatory Drugs are notoriously effective on nociceptive pain, do not give great results on neuropathic and mixed pain. Also the consumption of NSAIDs is affected by a series of side effects that may involve several organs. In case of neuropathic pain, the benefit deriving from the use of a single active principle is relative. This sets the rational grounds for the use of combined drugs. The paracetamol/tramadol combination represents an innovative solution in the treatment of both the neuropathic and nociceptive components of the pain, since both active principles have a different action mechanism, multiple targets and different pharmacokinetics. It is very interesting, from the clinical point of view, that tramadol is a pure antagonist, not selective, of µ, δ, and κ receptors and carries out and important inhibition action of serotonin and norepinephrine reuptake. This double mechanism, opioid and non-opioid, explains its analgesic efficacy also on neuropathic pain. Besides, since its opioid action is rather weak, it does not induce the severe side effects typical of traditional opioids. The benefit of such combination comes from their complementary pharmacokinetic profile, since the first has a quick action insurgence, while tramadol has a more prolonged effect. Therefore, this combination allows to obtain a quick and long lasting effect with a high tolerability profile also when treating skin ulcer pain.
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Affiliation(s)
- R Pellicano
- Department of Gastroenterology and Hepatology, Molinette Hospital, Turin, Italy.
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Sun LH, Liang YL, Sun YH, Sun YH, Zhang HZ, Li XF, Ma HL, Zhao ZS, Jiang HT. [Effect of mild moxibustion on macrophage number and collagen expression of raw surface tissue in chronic refractory skin ulcer rats]. Zhen Ci Yan Jiu 2012; 37:259-265. [PMID: 23140044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To observe the effect of mild moxibustion on the number of macrophages and contents of collagen I and III in the raw surface tissue in chronic skin ulcer rats so as to study its mechanism underlying promoting scar formation. METHODS Eighty male SD rats were randomly divided into normal (n = 8), model (n = 24), TDP (n = 24) and moxibustion (n = 24) groups. Chronic refractory skin ulcer was established by making an open wound at the back and local intramuscular injection of hydrocortisone sodium succinate. For rats of the TDP and moxibustion groups, TDP irradiation or mild moxibustion was applied to the raw surface, bilateral "Shenshu" (BL 23) and "Zusanli" (ST 36) for 15 min, once daily for 7, 10 and 14 days, respectively. The number of macrophages in the raw surface tissue was counted under light microscope after H. E. staining and col- lagen I and III expressions of the raw surface tissue were detected by immunohistochemistry. RESULTS In comparison with the normal group, the numbers of macrophages in the raw surface tissue were increased significantly in the model group on day 7, 10 and 14 (P < 0.05); while compared with the model group, the numbers of macrophages were increased further obviously in the moxibustion group on day 7 and 10 and in the TDP group on day 10 after the treatment (P < 0.05). Compared with the model group, the numbers of macrophages in both TDP and moxibustion groups were down-regulated obviously (P < 0. 05). In regard to collagen I and III expression of the raw surface tissue, compared with the normal group, the collagen I protein expression level was down-regulated markedly in the model group on the 7th day (P < 0.01); whereas in comparison with the model group, the expression levels of collagen I and III were increased considerably in the TDP and moxibustion groups on day 7 and 14 after the treatment (P < 0.05, P < 0.01). The ratios of collagen I/III expression were remarkably higher in the model group than in the normal group on day 7 and 14 (P < 0.05), and significantly lower in the TDP group on day 7 and 14 and in the moxibustion group on day 14 than in the model group (P < 0.05, P < 0.01). The effects of moxibustion were obviously superior to those of TDP in up-regulating macrophage number on day 10, up-regulating collagen I and III expressions on day 14, and down-regulating macrophage number on day 14 after the treatment (P < 0.05, P < 0.01). No significant differences were found between the TDP and moxibustion groups in up-regulating macrophage number, and collagen I and III protein expressions, and in down-regulating the ratios of collagen I/III expression on day 7 after the treatment (P > 0.05). CONCLUSION Mild moxibustion can regulate the number of macrophages and strengthen the expression of collagen proteins in the raw surface tissue in the chronic skin ulcer rats, which may contribute to its effect in promoting wound healing and reducing scar formation.
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Affiliation(s)
- Li-Hong Sun
- Department of Acu-moxibustion, College of Chinese Medicine, Hebei Medical University, Shijiazhuang 050091, China.
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White-Chu EF, Reddy M. Wound care in short-term rehabilitation facilities and long-term care: special needs for a special population. Skinmed 2012; 10:75-81. [PMID: 22545321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Chronic wounds can pose a challenging diagnostic and treatment dilemma in the older frail adult population. The benefits of short-term rehabilitation and long-term care settings are the access to interdisciplinary resources. Rehabilitative specialists, dieticians, and skilled nurses are readily available to meet the patients' needs as they transition to home or remain in a long-term care setting for their higher level of care needs. This article follows 3 cases: a skin tear complicated by venous ulceration, a pressure ulcer with fever, and arterial ulcers in a patient who opts for comfort care. The cases illustrate the higher needs of this population and emphasize the attention that must be paid to respect nursing-time intensiveness, incorporate realistic goals of care for wound healing, and ensure excellent communication with the team members, patients, and family.
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Affiliation(s)
- E Foy White-Chu
- Wound Healing Center, Hebrew Senior Life Department of Medicine, Boston, MA 02131, USA.
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35
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Bushmanov AI, Eremin II, Moroz BB, Galstian IA, Nadezhina NM, Slobodina TS, Grinakovskaia OS. [Experience of contemporary treatment of radiation burns in individuals subjected to ionizing radiation]. Med Tr Prom Ekol 2012:20-27. [PMID: 23210179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The article presents new approach to treatment of radiation disorders presenting as indolent ulcers. The approach is based on autologous multipotent mesenchimal stromal cells applied locally and injected around the injuried zone. The ulcers heal due to the fact that the transplanted cells stimulate local regeneration processes, angiogenesis, ceased inflammation and apoptosis. The method is a new medical technology based on vast preclinical studies and could be put into medical practice.
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Sun YH, Sun YH, Sun LH, Liang YL, Zhao ZS, Zhang HZ, Li XF. [Effect of mild-warm moxibustion on microcirculation in the raw surface tissue of chronic refractory wound in skin ulcer rats]. Zhen Ci Yan Jiu 2011; 36:321-326. [PMID: 22073882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To observe the effects of mild-warm moxibustion on dynamic blood flow, microvessel count (MVC)and vascular endothelial growth factor (VEGF) expression in the wound tissue of the chronic skin ulcer in rats, so as to reveal its underlying mechanism in promoting wound recovery. METHODS A total of 104 male SD rats with skin injury were randomly divided into control group (n=8), model group (n=32), TDP (far-infrared heating device) group (n=32) and moxibustion group (n=32). Chronic refractory raw surface wound model was established by muscular injection of Hydrocortisone Sodium Succinate. For rats of the TDP and moxibustion groups, TDP irridiation and mild-warm moxibustion were applied to the raw surface, bilateral "Shenshu" (BL 23) and "Zusanli" (ST 36) for 15 min, once daily for 3, 7 and 14 days respectively. The healing rate and the healing time of raw surface of the wound were observed. The blood flow of the raw surface of the wound tissue was measured by laser Doppler flowmeter and the MVC in granulation tissue of chronic skin ulcer was counted under light microscope. VEGF expression was detected by immunohistochemistry. RESULTS In comparison with the control group, the healing rate of the wound raw surface was significantly lower and the healing time was prolonged in the model group (P < 0.01). Compared with the model group, the healing rates on day 3, 7, 10 and 14 were significantly higher and the healing time was strikingly faster in both TDP and moxibustion groups (P < 0.01, P < 0.05), and the effects of the moxibustion group in increasing the healing rate and shortening the healing time were significantly better than those of TDP group (P < 0.01). In comparison with the model group, the blood flow volume, MVC and VEGF expression levels on day 3 and 7 were upregulated significantly in both TDP and moxibustion groups (P < 0.01, P < 0.05); while the blood flow volume, MVC and VEGF expression level in the moxibustion group and the blood flow volume and VEGF expression level in the TDP group downregulated considerably on day 14 (P < 0.01). No significant difference was found between the TDP and moxibustion groups in the MVC on day 14 after the treatment (P > 0.05). CONCLUSION Mild-warm moxibustion can promote wound healing, which is closely with its effects in increasing blood flow and MVC, and upregulating VEGF expression in the wound granulation tissue of the chronic skin ulcer.
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Affiliation(s)
- Yan-hui Sun
- Departmenent of Acu-moxribustion, College of Chinese Medicine, Hebei Medical University, Shijiazhuang 050091, China.
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Casey G. Wound healing--repair at the expense of function. Nurs N Z 2011; 17:22-27. [PMID: 21894790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Bredemeier M. A higher degree of criticism about the effectiveness of bosentan for digital ulcers in scleroderma patients, as for interstitial disease, is also necessary: comment on the article by Seibold et al. ACTA ACUST UNITED AC 2010; 62:3128-9; author reply 3129-30. [PMID: 20597113 DOI: 10.1002/art.27637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
ADAM-9 belongs to a family of transmembrane, disintegrin-containing metalloproteinases (ADAMs) involved in protein ectodomain shedding and cell-cell and cell-matrix interactions. Although the functions of many ADAM family members are known, the specific biological function of ADAM-9 is still unclear. In this study, we have analyzed ADAM-9 temporal and spatial distribution during wound healing. We showed increased ADAM-9 transcript expression during the first 7 days post-wounding and, by immunolocalization, detected ADAM-9 in all migrating and proliferating keratinocytes from days 3 to 7. In older 14-day-old wounds, ADAM-9 expression was restored. We have investigated the role of this protein in the healing process following excisional wounding. Animals deficient in ADAM-9 showed accelerated wound repair compared with control littermates. No alterations in neutrophil, leukocyte, and macrophage infiltration were observed. However, re-epithelialization was significantly faster in Adam-9 -/- than control wounds. Although no differences in proliferation were observed in vivo and in vitro, increased migration of keratinocytes was responsible for this effect. These results show the previously unreported role of ADAM-9 in wound repair by regulating keratinocyte migration through modulation of collagen XVII shedding.
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Affiliation(s)
- Cornelia Mauch
- Department of Dermatology and Center for Molecular Medicine (CMMC), University of Cologne, Cologne, Germany
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Dönmez O, Durmaz O. Calcinosis cutis universalis with pediatric systemic lupus erythematosus. Pediatr Nephrol 2010; 25:1375-6. [PMID: 20130918 DOI: 10.1007/s00467-010-1441-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 12/22/2009] [Accepted: 12/30/2009] [Indexed: 11/29/2022]
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Prus V. [Digital ulcers in systemic sclerosis]. Reumatizam 2010; 57:115-117. [PMID: 21875016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Digital ulcers occur in up to 50% of patients with limited or diffuse systemic sclerosis. The lesions are extremely painful leading to substantial functional disability, local infection susceptibility and can escalate to gangrene and amputation. Underlying vasculopathy and angiopathy cause obliteration of digital arteries and ischemic tissue changes. Management of digital ulcers includes non-pharmacological and pharmacological modalities. Early diagnosis in preclinical phase would enable preventive treatment prior to irreversible changes.
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Affiliation(s)
- Visnja Prus
- Klinicki odjel za imunologiju i alergologiju, Josipa Huttlera 4, 31000 Osijek
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42
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Schank JE. Kennedy terminal ulcer: the "ah-ha!" moment and diagnosis. Ostomy Wound Manage 2009; 55:40-44. [PMID: 19797802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The Kennedy Terminal Ulcer (KTU) is an unavoidable skin breakdown or skin failure that occurs as part of the dying process. Research is limited but the literature suggests that KTUs are typically pear-shaped, red/yellow/black, similar in appearance to an abrasion, and tend to occur suddenly in the sacral/coccygeal region not long before death. In this case study, one resident of a long-term care facility suddenly developed a full-thickness ulcer. The ulcer did not respond to treatment and the resident died 6 weeks following ulcer development. Another resident, admitted with a full-thickness ulcer, also did not respond to standard measures of care and general skin failure was observed. She died after 5 months. Research about end-of-life phenomena such as skin failure is needed to help clinicians, caregivers, and patients understand what is occurring and facilitate the provision of optimal and appropriate end-of-life care.
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Abstract
HYPOTHESIS Impaired wound healing in diabetics is due to pathologic angiogenesis, which is a result of aberrant sphingosine-1-phosphate signaling. Pharmacologic modulation of sphingosine-1-phosphate-dependent signaling normalizes healing in diabetic wounds.
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Affiliation(s)
- Kellie N Francis-Goforth
- Department of General Surgery, University of California San Francisco-East Bay, Oakland, CA, USA
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Kulikovsky M, Gil T, Mettanes I, Karmeli R, Har-Shai Y. Hyperbaric oxygen therapy for non-healing wounds. Isr Med Assoc J 2009; 11:480-485. [PMID: 19891236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Moshe Kulikovsky
- Wound Care Clinic, Linn Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel.
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Melamed Y, Bitterman H. Non-healing wounds and hyperbaric oxygen: a growing awareness. Isr Med Assoc J 2009; 11:498-500. [PMID: 19891239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Fiori G, Galluccio F, Braschi F, Amanzi L, Miniati I, Conforti ML, Del Rosso A, Generini S, Candelieri A, Magonio A, Goretti R, Rasero L, Matucci-Cerinic M. Vitamin E gel reduces time of healing of digital ulcers in systemic sclerosis. Clin Exp Rheumatol 2009; 27:51-54. [PMID: 19796562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND In systemic sclerosis (SSc), digital ulcers (DU) are painful, difficult to heal and frequently infected, thus greatly affecting quality of life and increasing SSc-related disability. Vitamin E has been previously used in cutaneous lesions for its antioxidant and anti-inflammatory effects. OBJECTIVES To study the healing effect of D-alpha-tocopheryl acetate (acetic ester of alpha-tocopherol) (VE) gel on DU of SSc patients. METHODS 27 SSc patients with a total of 86 DU were enrolled in an open pilot study. The patients were randomly assigned to two groups: 15 patients were treated until DU healing with the local standard ulcer care protocol with the application of vitamin E gel (experimental group), while 12 patients were treated with standard ulcer care protocol only (control group). In both groups, DU were treated twice a week and pain was scored by a NRS (numeric rating scale). In both groups the cost of medications was analysed. RESULTS VE induced a faster healing of DU in respect to controls (13.22+/-2.72 weeks, versus 20.94+/-3.65; p<0.0001) with a lower number of medications (26.18+/-5.63 vs. 41.88+/-7.31; p<0.0001). Resolution of pain was faster in experimental (17.82+/-4,59 medications) than in controls (26.26+/-19.16 medications) (p=0.0022). In the experimental group, the cost of medications was significantly lower (6,919.15 euros/patient) than in the control group (11,056.32 euros/patient). CONCLUSION The application of VE reduces time of healing and has a faster resolution of pain, with a significant reduction of costs. Topical VE may improve the management of DU in SSc.
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Affiliation(s)
- G Fiori
- Department of Biomedicine, Scleroderma Ulcer Care Unit, Division of Rheumatology, AOUC, University of Florence, Italy
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Abou-Raya A, Abou-Raya S, Helmii M. Statins: potentially useful in therapy of systemic sclerosis-related Raynaud's phenomenon and digital ulcers. J Rheumatol 2008; 35:1801-1808. [PMID: 18709692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is characterized by fibrosis and widespread vascular pathology. Raynaud's phenomenon (RP) and digital ulceration are prominent manifestations of vascular involvement in SSc. Digital ulcers (DU) remain a serious complication, and effective therapy remains elusive. Statins display pleiotropic effects on endothelial function that may potentially retard vascular injury. We evaluated the potential efficacy of statin therapy in endothelial dysfunction and in management of RP and DU. METHODS Eighty-four SSc patients who fulfilled the American College of Rheumatology criteria for classification of SSc with secondary RP despite ongoing vasodilator therapy were randomized into 2 groups; the first group (n = 56) received 40 mg/day atorvastatin for 4 months; the second group (n = 28) received placebo. Seventy-five healthy volunteers served as controls. Assessment of RP and DU was performed monthly. The primary outcome measure was the number of DU. Secondary endpoints included the modified Scleroderma Health Assessment Questionnaire Disability Index (SHAQ-DI), safety, and tolerability. Measurement of functional status in relation to RP included the SHAQ-DI, visual analog scale (VAS) for RP, DU and pain scales, and VAS for physician's global assessment for health. Endothelial damage markers were also assessed. Endothelium-dependent flow-mediated dilatation was measured by high-resolution echo-Doppler ultrasonography. RESULTS The overall number of DU was significantly reduced in the statin group. Among patients in the statin group a mean of 1.6 new ulcers developed per patient compared to 2.5 new ulcers per patient in the placebo group. There was a statistically significant improvement in SHAQ-DI score in patients receiving statin versus those on placebo. VAS for RP, DU severity, and pain scales and the VAS for physician global assessment improved significantly in the statin group compared to the placebo group. Endothelial markers of activation showed statistically significant improvement from baseline values in the statin versus the placebo group. CONCLUSION Our results showed that statins retarded vascular injury and improved patient function. The findings suggest that statins may aid in treating RP and DU in SSc patients. Given the safety and relative low cost of statins and good patient tolerability to this class of drugs, statins may be of clinical benefit in SSc patients.
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Affiliation(s)
- Anna Abou-Raya
- Department of Rheumatology, University of Alexandria, Alexandria, Egypt.
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Kawald A, Burmester GR, Huscher D, Sunderkötter C, Riemekasten G. Low versus high-dose iloprost therapy over 21 days in patients with secondary Raynaud's phenomenon and systemic sclerosis: a randomized, open, single-center study. J Rheumatol 2008; 35:1830-1837. [PMID: 18634152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE We compared the efficacy of different dosages of longterm iloprost treatment on Raynaud's phenomenon (RP), ulcer healing, skin thickening, and progression of internal organ sclerosis in patients with systemic sclerosis (SSc). METHODS Fifty patients with SSc were randomized 1:1 for the maximally tolerated dose up to 2 ng/kg body weight per minute or low-dose (0.5 ng/kg bw per min) intravenous iloprost administration, applied for 6 hours daily over 21 days. Effects on RP, ulcer healing, skin thickness, esophageal function, and lung involvement assessed by forced vital capacity (FVC) and DLCO were measured, as well as side effects. RESULTS Both regimens yielded 70% reduction of digital ulcers, 40% reduction in frequency of RP, and 30% reduction in duration of RP. One year after therapy, the modified Rodnan skin score appeared to be unchanged. FVC and DLCO-SB were stable in 87% and 74% of the patients, respectively. The effect of iloprost on skin thickness and lung function was sustained in a subgroup of patients receiving several courses of iloprost. As assessed by a patient questionnaire, 12% of all patients did not respond to iloprost therapy, but 78% experienced a longlasting effect. Mild side effects were common in both groups, but did not lead to discontinuation of therapy. CONCLUSION Low-dose iloprost was shown to be equally effective as high-dose iloprost in longterm treatment and was very effective in therapy of digital ulcers. Registered in www.ClinicalTrials.gov (registration no. NCT00622687).
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Affiliation(s)
- Annegret Kawald
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
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Abstract
A retrospective study of clinical tularaemia in an emergent area in Sweden is presented. 234 patients seen during the y 2000-2004 were studied, using case files and a questionnaire. There was a predominance of ulceroglandular tularaemia (89%), occurring in late summer and early autumn, reflecting the dominance of mosquito-borne transmission. The incubation period varied from a few hours to 11 d, with a median of 3 d. Cutaneous manifestations of tularaemia, apart from primary lesions, were noted in 43% of the cases. Coughing was common, even in patients with ulceroglandular tularaemia, supporting the view that haematogenous spread to the respiratory system occurs. Regular laboratory tests, such as WBC, ESR and C-reactive protein, were in general only moderately elevated. In the earlier y studied, the Doctor's Delay was substantial as was the misdiagnosis and prescription of inadequate antibiotics. In the later y, however, the delay and misdiagnosis were significantly lower, reflecting the increased recognition of the disease by the physicians in the area. A few relapses occurred, all in patients treated with doxycycline. No lethality was seen, reflecting the benign course of tularaemia type B infection.
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Affiliation(s)
- Henrik Eliasson
- Department of Infectious Diseases, Orebro University Hospital, Sweden.
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Hachulla E, Clerson P, Launay D, Lambert M, Morell-Dubois S, Queyrel V, Hatron PY. Natural history of ischemic digital ulcers in systemic sclerosis: single-center retrospective longitudinal study. J Rheumatol 2007; 34:2423-2430. [PMID: 17985402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To describe the natural history of ischemic digital ulcers (DU) in systemic sclerosis (SSc). METHODS This single-center, retrospective, longitudinal study identified patients by demographic data, SSc history and type, Rodnan score, tobacco use, presence of autoantibodies, ongoing treatment, and DU history. RESULTS One hundred three patients were enrolled, 46 with DU history and 57 without; 2 with DU were excluded. The mean duration of followup from the first non-Raynaud SSc symptoms was 12.3 +/- 6.3 years in patients with DU history and 12.1 +/- 7.0 years in patients without. In 43% of cases, first DU occurred within 1 year following first non-Raynaud SSc symptoms, and within 5 years in 73% of cases. In a multivariate analysis, younger patients at occurrence of first non-Raynaud SSc symptoms (HR = 0.77 per each 5 years older, 95% CI 0.66-0.90) with higher Rodnan scores (HR = 1.21 per 5 points, 95% CI 1.05-1.47) experienced earlier DU occurrences, which were delayed by vasodilator therapy (HR = 0.17, 95% CI 0.09-0.32). Patients with shorter durations between first and second DU episodes, particularly with a second episode within 2 years of the first, experienced a higher yearly incidence of DU episodes (0.85 +/- 0.57 and 0.48 +/- 0.26, respectively, if less or more than 2 yrs; p = 0.04). Throughout the duration of followup, the incidence of finger amputation was 1.2% per patient-year in patients with DU history. CONCLUSION Patients who are young at first sign of SSc, with high Rodnan scores and without vasodilator therapy, are at high risk of developing DU. Development of DU typically occurred within 5 years of the first non-Raynaud clinical symptom of SSc in the majority of patients.
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Affiliation(s)
- Eric Hachulla
- Department of Internal Medicine, National Reference Center for Scleroderma, Claude Huriez Hospital, University of Lille, Lille, France.
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