bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modelling the relative cost-effectiveness of amelogenin in non-healing venous leg ulcers
Authors: Guest J.F. , Nagy E. , Sladkevicius E. , Vowden P. , Price P. 
Published: May 2014

Objective: To assess the cost-effectiveness of using amelogenin plus compression bandaging versus compression bandaging alone in treating non-healing venous leg ulcers (VLUs) of over six months' duration, from the perspective of the national health service in England. Method: A 12-month Markov model was constructed that depicted the management of a chronic, non-healing VLU of over six months' duration. The model considers the decision by a clinician to treat a recalcitrant VLU with amelogenin plus compression bandaging or compression bandaging alone, and was used to estimate the relative cost-effectiveness of amelogenin plus compression bandaging at 2006–2007 prices. Results: According to the model, 60% of all wounds treated with amelogenin plus compression bandaging are expected to heal within 12 months of the start of treatment compared with 41% of wounds treated with compression bandaging alone (p<0.01). Additionally, 23% of all amelogenin-treated wounds are expected to improve compared with 18% of wounds in the compression bandaging alone group. This difference in effectiveness between the two groups is expected to lead to a 7% improvement in health gain among amelogenin-treated patients when compared with those treated with compression bandaging alone (0.800 versus 0.746 QALYs; p<0.01) at 12 months after the start of treatment. Use of amelogenin is expected to lead a 10% reduction in NHS cost over 12 months from £4,261 (95% CI: £3,409; £5,114) to £3,816 (95% CI: £3,227; £4,405), due in part to a reduction in the requirement for nurse visits. Hence, amelogenin plus compression bandaging was found to be a dominant treatment. Moreover, use of amelogenin is expected to free-up NHS resources for alternative use within the system. Conclusion: Within the model's limitations, amelogenin plus compression bandaging is expected to afford the NHS a cost-effective dressing compared with compression bandaging alone in the management of chronic non-healing VLUs of more than six months' duration. Declaration of interest: This study was sponsored by Mölnlycke Heath Care. The authors have no other conflicts of interest that are directly relevant to the content of this manuscript.
Prolonged healing of venous leg ulcers: the role of venous reflux, ulcer characteristics and mobility
Authors: Hjerppe A. , Saarinen J.P. , Venermo M.A. , Huhtala H.S. , Vaalasti A. 
Published: May 2014

Objective To assess whether a difference in venous reflux pattern, ulcer size or duration, regular medications or the daily use of walking aids can predict the healing of a chronic venous leg ulcer (VLU). Method In this prospective, randomised, single-centre study, 110 consecutive patients with chronic leg ulcers were assessed. Ninety-nine patients met the inclusion criteria and a controlled, conservative 3-month treatment period was initiated, in which 90 patients were managed with standardised local treatment combined with compression therapy. In this group, 62 VLUs healed within 12 weeks and 28 were still open after 12 weeks. The study group consisted of 22 patients with non-healed ulcers and a control group (n=28), which was selected randomly from the healers. In both groups, venous reflux profiles were assessed using colour-flow duplex imaging. Results The study and control groups did not differ in smoking habits, age, gender or daily oral medications. On average, the healing wounds were 5cm2 before starting controlled treatment (range 1–80cm2) and had been open for 7 months (range 2–48 months); the non-healing wounds were on average 11.2cm2 (range 1–31cm2) and had been open for 26 months (range 8–106 months). Venous disease severity scores were similar for both groups (12.6 vs. 13.4). Five patients (18%) with healed ulcers regularly used walking aids, the use of which was more frequent (36%) among non-healers (p<0.001). Venous reflux profiles differed significantly between the groups, with isolated superficial reflux noted in 64% of healers, compared with 36% of non-healers. In addition, isolated deep reflux was found in 14% of the healers, compared with 41% of non-healers (p=0.0002). The rate of popliteal reflux was significantly higher in non-healers (59% versus 21%; p=0.0004). Conclusion Long duration of a chronic venous ulcer may predict a poor outcome. The presence of deep venous reflux, especially in the popliteal vein, is typically found in those legs with non-healed ulcers. Conflict of interest None.
Effect of simulated leg length discrepancy on plantar pressure distribution in diabetic patients with neuropathic foot ulceration
Authors: El-nahas M.R. , Gawish H.M. , Tarshoby M.M. , State O.I. , Aboelyazid A. 
Published: May 2014

Objective: To study the effect of a minor degree of artificially induced leg length discrepancy (LLD) on plantar pressure distribution in diabetic patients with neuropathic foot ulceration. Method: In-shoe plantar pressure distributions were measured on the ulcerated foot during walking using F-scan (Tekscan Inc.). to simulate minor LLD, the contralateral leg length was changed by asking patients to walk under three different conditions: wearing shoe of the same sole thickness (NLLD), walking with a bare foot (20mm long leg) and wearing a 40mm-high platform-sole shoe (20mm short leg). these three different walking conditions were compared in a randomised, single-blinded crossover design. Results: The study included 28 diabetic patients with neuropathic foot ulcers (53.7 ± 6.8 years; 16 males, 12 female). notably, the peak pressure and pressure time integral (PTI) were the most affected parameters. PTI significantly increased beneath total foot, mid-foot, 2nd, 3rd, 4th and 5th metatarsal heads (MTHs), and 3rd toe, when the 20mm short leg was simulated (79.4 ± 21.1; 61.5 ± 32.3; 59.9 ± 36.5; 69 ± 42.1; 70.6 ± 42.3; 63.9 ± 33.7; 40.7 ± 33.2kPa·s, respectively), compared with NLLD (73.7 ± 19.9; 55.5 ± 24; 51.8 ± 30.1; 58.4 ± 37.6; 60.3 ± 39.5; 57.2 ± 32.3; 36.9 ± 33.3kPa·s, respectively). Conclusion: The short leg of diabetic patients with neuropathic foot ulcers will be subjected to greater pressure load, primarily beneath the total foot, mid-foot and 2nd, 3rd, 4th and 5th metatarsal heads. As such, care should be taken to avoid minor LLD, as it could inadvertently develop on using offloading devices. Declaration of interest: The authors have nothing to declare.
Effects of amelogenins on angiogenesis-associated processes of endothelial cells
Authors: Almqvist S. , Kleinman H.K. , Werthén M. , Thomsen P. , Ågren M.S. 
Published: May 2014

Objective: To study the effects of an amelogenin mixture on integrin-dependent adhesion, DNA synthesis and apoptosis of cultured human dermal microvascular endothelial cells and angiogenesis in an organotypic assay. Method: Immobilised antibodies against specific integrins (α1, α2, α3, α4, α5, αv, β1, β2, β3, β4, β6, αvβ3, αvβ5 and α5β1) were used to capture treated human dermal microvascular endothelial cells, which were detected colourimetrically. DNA synthesis of the cells was monitored by 5-bromo-2'-deoxyuridine incorporation and apoptosis by a TdT-mediated dUTP nick-end labelling technique. Tubule formation from aortic arches of 13-d-old chick embryos were followed over 48h. Results: The amelogenin mixture increased microvessel outgrowth by 76% (p<0.01, n=12) from the aortic explants. Also, amelogenins increased the adhesion (p<0.01, n=5) by multiple angiogenesis-associated integrin subunits and αvβ3, αvβ5 and α5β1 heterodimers on human dermal microvascular endothelial cells at a non-mitogenic concentration (100μg/ml). Conversely, amelogenins at 1,000μg/ml decreased microvessel formation possibly due to attenuation of corresponding integrins despite increasing (p<0.001, n=8) DNA synthesis. No significant apoptosis was detected in human dermal microvascular endothelial cells cultured on Matrigel with and without amelogenins. Conclusion: Increased surface expression of integrins on endothelial cells may contribute to the proangiogenic property of amelogenins. Conflict of interest: Drs. Almqvist and Werthén are employees of Mölnlycke Health Care AB. The studies were supported by the Swedish Research Council (grant K2009-52X-09495-22-3), Hjalmar Svensson Foundation, Mölnlycke Health Care AB, the VINNOVA VinnVäxt Program Biomedical Development in Western Sweden, Region Västra Götaland and the Danish Medical Research Council (22-02-0287).
Clinical efficacy of a new variant of a foam-based NWPT system
Authors: Bondokji S. , Rangaswamy M. , Reuter C. , Farajalla Y. , Mole T. , Cockwill J. , Smith J. 
Published: May 2014

Objective: To evaluate the clinical efficacy of a new variant of a foam-based negative wound pressure wound therapy (NPWT) system. Method: A newly available polyurethane foam-based NPWT system (RENASYS-F, Smith & Nephew) was used to treat 18 patients in a prospective, multi-centre study. The patients had a variety of wound types including pressure ulcers, diabetic foot ulcers, traumatic and surgical wounds. Results: The mean patient age was 48.3 years (range 25–72). Mean treatment duration was 14.6 days (range 5–29). At the end of therapy, 83% (15) wounds had progressed sufficiently, leading to a change in treatment from NPWT. Median reductions in wound area, depth and volume of 31.3%, 45.5% and 74.2% respectively were observed over the course of therapy. This equated to a weekly reduction in area, depth and volume of 12.9%, 20.0% and 32.1% respectively. Exudate level (p=0.013) and wound malodour (p=0.03) were significantly reduced between the onset and the end of NPWT. The percentage cover of ‘beefy’ red granulation tissue in the wound bed was significantly increased (p<0.001) and non-viable tissue significantly reduced (p=0.008) between the onset and the end of NPWT. Conclusion: These data demonstrate that an alternative foam-based NPWT system (RENASYS-F) is able to address the common treatment goals associated with application of NPWT including reduction in wound dimensions, reduction in exudate levels and an improvement in wound bed quality. Conflict of interest: Funding for this study was provided by Smith & Nephew. Authors TM, JC and JS are all employees of Smith & Nephew.
Necrosis in breast cancer patients with skin metastases receiving bevacizumab-based therapy
Authors: Cottu P.H. , Fourchotte V. , Vincent-Salomon A. , Kriegel I. , Fromantin I. 
Published: May 2014

Objective: Bevacizumab has entered daily practice in advanced breast cancer patients, in whom skin metastases occurrence is a common event. Wound healing impairment has been described with bevacizumab, and this study looks at possible deleterious side effects of bevacizumab in patients with skin metastases. Method: We retrospectively reviewed a series of 12 patients with advanced breast cancer presenting extensive skin metastases, and who received bevacizumab based therapy. Results: Nine patients who initially presented with erosive skin lesions developed extensive and durable skin necrosis, as well as delayed healing of surgical flaps, despite early discontinuation of bevacizumab therapy and intensive skin care in a specialised unit. Skin necrosis was usually associated with extensive tumoural involvement of the skin. Conclusion: Bevacizumab may be harmful in selected breast cancer patients with metastatic cutaneous involvement. Conflict of interest: None.
Optimum microcurrent stimulation intensity for galvanotaxis in human fibroblasts
Authors: Sugimoto M. , Maeshige N. , Honda H. , Yoshikawa Y. , Uemura M. , Yamamoto M. , Terashi H. 
Published: May 2014

Objective: In this study, we develop methods to measure galvanotaxis of fibroblasts and determined the optimum conditions of electrical stimulation. Method: an inverted 35mm dish containing cell suspensions (3×10 5 primary human skin fibroblasts, DMEM, and 10% FBS) was placed on the centre of a 100mm dish. The 35mm dish was removed 24 hours later, and culture medium was added to the 100mm dish. Fibroblasts were randomised (double-blind) into three groups, where electrical stimulation was given at varying intensities: 0μa (control), 50μa, and 100μa. Electrical stimulation (frequency = 0.3Hz) was conducted, for a duration of 4 hours, with platinum electrodes in a Co2 incubator. We took pictures immediately before and 20 hours after stimulation. We calculated the migration ratio to the negative pole by dividing the area of attached fibroblasts after stimulation with that before stimulation. Results: The migration ratio to the negative pole was significantly higher in the 100μa group than in the control group (p < 0.05). The ratios were 0.902 ± 0.292 in the control group, 1.128 ± 0.253 in the 50μA group, and 1.245 ± 0.300 in the 100μA group. Conclusion: This study observed the change in cell proliferation during the initial 24-hour period after plating and was thus able to quantitatively evaluate the migration. The results suggest that a low-intensity direct current promotes migration to the negative pole of human dermal fibroblasts, which is charged with positive electricity. Several clinical reports using the methods in this study showed the microcurrent efficacy for pressure ulcer healing. Electrical stimulation based on our in vitro experiment might be important for the development of physical therapy for pressure ulcers. Declaration of interest: The authors have no conflict of interest to declare. There were no external sources of funding for this study.
Amniotic membrane reduces wound size in early stages of the healing process
Authors: Nordback P.H. , Miettinen S. , Kääriäinen M. , Pelto-Huikko M. , Kuokkanen H. , Suuronen R. 
Published: May 2014

Objective: To investigate the effects of dispase de-epithelialised, glycerol cryopreserved amniotic membrane (AM) on full-thickness skin defects, using a rat model. Method: Skin defects of 15mm diameter were surgically created and measured on the scalps of 53 male rats. Animals were divided into two groups and followed for 0, 3, 7, 14 or 21 days. AM group wounds were covered with de-epithelialised AM and sodium chloride-moistened Aquacel (ConvaTec Inc.); control group wounds were covered with sodium chloride-moistened Aquacel alone. After the follow-up, wounds were measured again, serum samples were taken and wound sites were harvested for histological analysis. Systemic interleukin-4 (IL-4) levels were analysed from serum. Results: On day 3, a statistically significant difference (p < 0.01) was observed in mean wound size, with wound size in the AM group smaller than in the control group (60 ± 12% vs 81 ± 13% of the original size); other time points showed no significance difference in wound size between the two groups. We could not detect differences between the groups in histological parameters or serum IL-4 levels. Conclusion: According to this study, AM enhances early stage wound healing in terms of wound size but its effect decreases in later phases. The IL-4 results provide no clear evidence that IL-4 contributes to the effect of AM on wound healing. Declaration of interest: This study was financially supported by the Competitive Research Funding of the Tampere University Hospital (Grant 9H041, 9J047). The authors have no additional conflicts of interest to declare.
An experimental study of prescribed walking in the management of venous leg ulcers
Authors: Meagher H. , Ryan D. , Clarke-Moloney M. , O'Laighin G. , Grace P.A. 
Published: May 2014

Objective: To determine the relationship between the level of patient activity in the form of walking and the rate of venous leg ulcer (VLU) healing. Method: Forty patients with newly diagnosed VLUs were recruited to the study and randomly allocated to either control or exercise groups. All patients were treated with multilayer compression bandaging for 12 weeks, or until their ulcer had fully healed. Daily stepping rate was recorded at initial assessment and following 4 weeks of treatment. Participants in the exercise group were encouraged to increase their daily steps with a target of 10 000 steps per day. The control group were not asked to change their daily steps. Results: In total, 33% of the exercise group achieved an average of 10 000 steps per day. Participants who took more steps at both the baseline and 4-week assessment healed more quickly than those who took fewer steps (p=0.052 and p=0.008 for baseline and week 4, respectively). Sixty-seven per cent of the participants who increased their daily steps had venous ulcers, which were healed by week 8, compared with 35% of those who did not. Conclusion: Participants who took more steps per day showed faster venous ulcer healing times when compared with those who took fewer steps, emphasising the benefit of walking in this patient group. Further studies are necessary to confirm these early findings. Declaration of interest: There were no external sources of funding for this study. The authors have no conflict of interest to declare.
Hemisoleus muscle flap in the reconstruction of exposed bones in the lower limb
Authors: Ahmad I. , Akhtar S. , Rashidi E. , Khurram M. F. 
Published: May 2014

Objectives: To evaluate the efficacy of soleus muscle flap for covering complex defects of the middle and lower leg. The study also outlines functional gain after the reconstructive procedure, the donor site morbidity and the technical details of the operative procedure. Method: This prospective study consists of a total of 40 patients with middle and lower third defects with exposed bone present in the leg. In all cases, a proximally-based hemisoleus flap was used. All patients were between 15–65 years of age. Depending upon the position of the defect and ease of rotation, either the medial or lateral hemisoleus was used to cover the defects. In 7 patients with large defects, both the hemi-gastrocnemius and hemisoleus flap were used. Results: Most of the patients studied (52.5%) had defects in the middle third of their leg. A further 12(30%) patients had defects over the upper part of the lower third of the leg and 7(17.5%) cases involved large defects exposing bones comprising both the middle and lower thirds of the leg. All the flaps survived well except 5 which developed partial skin graft loss, and 1 where complete flap loss was observed. Out of 5 patients who developed partial graft loss, 3 patients achieved complete healing by regular dressings and 2 required regrafting. The patient who developed complete flap loss required below knee amputation. No donor site morbidity was observed, except minimal depression in the posterior leg. Conclusion: Due to a high degree of reliability, versatility, minimal donor site morbidity, less operating time, low cost and good functional gain, this procedure is highly suitable for the treatment of complex middle and lower leg defects. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Pantoea agglomerans as an indicator of a foreign body of plant origin in cases of wound infection
Authors: Vaiman M. , Abuita R. , Lazarovich T. , Lotan G. 
Published: May 2014

Objective: To investigate the role of Pantoea agglomerans as an infectious agent that causes infection in a wound even after the wound was managed at the emergency department. Method: A retrospective cohort study, reviewing the medical records of patients with traumatic wounds that were admitted to the emergency department from 2007–2012 and had signs of wound infection for more than 10 days after the wound was managed. Bacteriological results, clinical picture, and treatment results were obtained. Results: Nine cases were identified. Pantoea agglomerans was detected in all cases. After 1–2 months of ineffective treatment, patients were hospitalised and surgical revisions of the wounds were performed. In all cases, small foreign bodies of plant origin were detected. After surgical revision, wounds were healed in 2–3 days. Conclusion: In cases of prolonged healing of post-traumatic wounds, the presence of foreign bodies of plant origin infected with Pantoea agglomerans should be taken into account. Removal of such foreign bodies leads to rapid healing of the wounds. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Patients' experiences of NPWT in an outpatient setting in Denmark
Authors: Ottosen B. , Pedersen B.D. 
Published: May 2014

Objective: To study patients' experiences of negative pressure wound therapy (NPWT) used for wounds of various aetiologies in the outpatient setting and the influences on daily life. Method: In this qualitative study, a phenomenological-hermeneutic approach was used. Ten patients underwent qualitative interviews regarding their NPWT treatment. The French philosopher, Ricoeur's, theory of interpretation guided the data analysis, which included three levels: naïve reading, structural analysis and critical interpretation and discussion. Results: The patients experienced a high level of dependency on the equipment and a greater confidence as treatment proceeded. There is a link between treatment and tolerance. Duration of treatment influenced the patients' ability to cope with it and the patients gradually developed an acceptance of the technology. The support of relatives was important, particularly after delivery of a baby and wound treatment following caesarean section. Some patients were embarrassed due to the appearance and smell of the exudate. Conclusion: Use of NPWT clearly influences patients' daily life. Patients have a feeling of being dependent on and attached to the equipment, and they experienced embarrassment about odour, anxiety and uneasiness in relation to complications, a need for relatives' support and other social-relation issues. It was important to include relatives as a resource and make use of the opportunity they presented to assist patients during information sessions about treatment. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to report.