Randomized prospective comparative study of platelet-rich plasma versus conventional compression in treatment of post-phlebitic venous ulcer.

OBJECTIVES: to assess the safety and efficacy of platelet-rich plasma (PRP) as adjunctive to compression therapy for post-phlebitic venous ulcers. METHODS: This is a single-center randomized controlled trial on patients with persistent chronic post-phlebitic lower limb venous ulcers from March 2019 to March 2020. Patients were randomly allocated to one of two equal cohort groups. Patients group in which patients underwent combined PRP with compression therapy versus control group in which patients underwent placebo+ compression therapy alone. The primary endpoint of the study was the improvement in ulcer topographic measurement. Secondary endpoints included ulcer healing parameters, possible healing factors, reduction in pain score (VAS), and the achievement of complete healing. RESULTS: Forty patients were available equally for randomization and analysis in both groups. The median number of PRP applications for every patient in the patient group was 6 (ranging from 3 to 6). There was a significant decline in the median length, width, and depth of ulcers in the patients group versus control group. Consequently, there was a significant decline of the median ulcer area, in the patient group versus control group (4 (3-9) cm2 vs. 10 (6-14) cm2, p = .036). Also, the median volume of the ulcers showed a significant decline in the patient group versus control group (1 (.7-3) cm3 vs 3 (2-6) cm3, p = .008). Complete healing was achieved in 45% of patient group. There was a significant decline in pain scores at 3- and 6 months from the therapy starting point in both groups (patient group: pre-VAS = 6.5 vs. post(3 months)-VAS = 1 vs. post(6 months)-VAS = 0.5) and (control group: pre-VAS = 6.4 vs. post(3 months)-VAS = 4.5 vs. post(6 months)-VAS = 2.2), (p < .0001 for each). On the other hand, the decline in pain scores between both groups was statistically significant in favor of the patient group, (post (3 months); PRP-VAS = 1 vs. control-VAS = 4.5, and post(6 months); PRP-VAS = 0.5 vs. control-VAS = 2.2), (p < .0001). CONCLUSION: Platelet-rich plasma as an adjunct to compression therapy for chronic post-phlebitic venous ulcers is safe and effective as regards the ulcer healing and improvement of pain score. PRP may be useful adjunct in treatment of post-phlebitic venous ulcer. However, larger trials are warranted.

Treatment of cutaneous basal cell carcinoma with combined laser extirpation and methyl aminolevulinic acid: five-year success rates.

INTRODUCTION: Basal cell carcinoma is the most common cancer. Excisional surgery is associated with a high clearance rate, at the expense of significant functional and aesthetic morbidity, especially within the T-zone or for extensive lesions. We report five-year follow-up outcomes for carbon dioxide laser extirpation of cutaneous basal cell carcinoma, assisted by immediate methyl aminolevulinate photodynamic therapy and cost-benefit considerations. MATERIALS AND METHODS: Retrospective cohort database analysis of adult patients with biopsy-proven primary cutaneous basal cell carcinoma, completing five years of follow-up. Direct per-lesion cost was compared with conventional wide local excision. Patients with morphoeic basal cell carcinoma were excluded. RESULTS: Treated lesions were up to 1% total body surface area and up to 3.8mm (1.38 ± 0.695cm, mean ± standard deviation) in biopsy-proven depth. At the five-year follow-up mark, 93.6% of treated areas remained free of recurrence. Nodular basal cell carcinoma was the most common subtype (41.5%). A mean tumour depth greater than 2 ± 0.872mm was significantly associated with recurrence (Mann-Whitney, p = 0.0487). For a service delivered through the NHS at 2015 prices, we report a 43% saving, equating to a saving of £235 per basal cell carcinoma or a national annualised saving of £70 million by 2025 for the NHS. CONCLUSION: Our results suggest that CO2-assisted photodynamic therapy is non-inferior to excision but may offer better functional and cosmetic preservation at a fraction of the direct like for like cost of operative surgery. Investigation of this method by randomised controlled methodology is warranted.

Growth performance, carcass criteria, and serum biochemical parameters of broiler chickens supplemented with either synbiotic or prebiotic under hot climatic conditions.

1. Two separate experiments were conducted to evaluate the efficacy of either prebiotic or synbiotic on growth performance, carcass yield, organ weights, and serum metabolic profile of broilers under hot climatic conditions. 2. In experiment 1, 150 1-d-old Ross 308 male broiler chickens were fed dietary synbiotic (Biomin® IMBO, 0, 1 or 1.5 g kg-1 of the starter diets and 0, 0.5 or 0.75 g kg-1 of the grower diets) for 6 weeks. In experiment 2, 150 1-d-old Ross 308 male broiler chickens were fed dietary prebiotic (Mannan oligosaccharide 0, 0.5 or 1 g kg-1 of the starter diets and 0, 0.25 or 0.5 g kg-1 of the grower diets) for 6 weeks. Each treatment had 10 replicates containing 5 broiler chickens each. 3. Supplementation of synbiotic at 1 or 1.5 g kg-1 feed to broiler diets during 1-21 d and 0.5 or 0.75 g kg-1 feed, respectively, during 22-42 d improved (P < 0.01) body weight gain, feed conversion ratio (FCR), and decreased (P < 0.01) abdominal fat, serum total cholesterol, and low-density lipoprotein (LDL) cholesterol levels in experiment 1. 4. Similarly, supplementation of the prebiotic at 0.5 or 1 g kg-1 in broiler diets during 1-21 d and 0.25 or 0.50 g kg-1 feed, respectively, during 22-42 d improved (P < 0.01) body weight gain, FCR, and decreased (P < 0.01) abdominal fat, serum cholesterol, and LDL-cholesterol levels in experiment 2.

A case of pachydermodactyly in a seventeen year old associated with repetitive minor trauma.

A boy presented initially to a Rheumatology clinic with a three year history of asymptomatic swelling of the third to fourth proximal interphalangeal (PIP) joints bilaterally. A presumptive diagnosis of seronegative arthritis was made. Sulfasalazine was commenced without improvement and resulted in mood disturbance. Blood tests including ESR, lupus anticoagulant, rheumatoid factor and CCP antibodies were unremarkable. Hand radiographs were normal. MRI showed oedema within soft tissues around PIP joints. His care was transferred to the Rheumatology unit in our hospital and the rheumatological diagnosis was revised; sulfasalazine was stopped and skin biopsy organised. Onward referral to Dermatology was made. Examination revealed symmetrical swelling and thickening of soft tissues on PIP joints with no evidence of joint synovitis. He denied habitual behaviour but was noted to rub his fingers subconsciously. With this as a cause of repetitive minor trauma, a clinical diagnosis of pachydermodactyly was made. Skin biopsy was supportive showing a dermis with coarse collagen. Pachydermodactyly is rare. This case highlights the importance of prompt recognition to avoid invasive and excessive diagnostic procedures as well as unnecessary immunosuppression.

Probiotic form effects on growth performance, digestive function, and immune related biomarkers in broilers.

The aim of this work was to assess the effect of dietary viable or heat inactivated probiotic forms (PF) combined or not with avilamycin (AV) used as a growth promoter, on broiler growth performance, nutrient digestibility, digestive enzyme activities, and expression of immune response related genes.Depending on the type of PF (i.e., no addition, viable, inactivated) and AV addition (no/yes), 450 one-day-old Cobb male broilers were allocated in the following 6 treatments according to a 3 × 2 factorial arrangement with 5 replicates of 15 broilers each for 6 wk: CoN: diet without any addition; CoN+A: combination of CoN with AV; ViP: viable PF - no AV; ViP+A: combination of ViP with AV; InP: inactivated PF - no AV; InP+A: combination of InP with AV.There were no interactions (P > 0.05) for overall performance parameters. In contrast, PF or AV addition improved BW gain (PPF= 0.015; PAV < 0.001), FCR (PPF < 0.001; PAV < 0.001) and production efficiency factor (PPF= 0.001; PAV= 0.001).Significant (PPF×AV ≤ 0.05) interaction effects regarding ileal digestibility (IAD) of DM and total tract apparent digestibility (TTAD) of DM and ether extracts (EE) were noted. In addition, PF affected IAD and TTAD of CP (PPF < 0.001, PPF= 0.004, respectively). Inactivated PF increased (PPR= 0.024) lipase activity in jejunal digesta.At spleen level InP and ViP+A down-regulated TGF-ß4 (PPF × AV = 0.035) compared to CoN and ViP, whereas ViP+A up-regulated iNOS (PPF × AV = 0.022). An anti-inflammatory effect of live and inactive PF and/or AV addition at cecal tonsils was shown by iNOS down-regulation (PPF × AV= 0.015) compared to CoN. Furthermore, AV down-regulated IFN-γ (PAV= 0.002).In conclusion, viable probiotic, as well as inactivated probiotic alone or in combination with avilamycin, improved nutrient digestibility. All dietary additives affected growth performance positively and induced an anti-inflammatory response at cecal level.

Analyses of axisymmetric waves in layered piezoelectric rods and their composites.

An exact treatment of the propagation of axisymmetric waves in coaxial anisotropic assembly of piezoelectric rod systems is presented. The rod system consists of an arbitrary number of coaxial layers, each possessing transversely isotropic symmetry properties. The treatment, which is based on the transfer matrix technique, is capable of deriving the dispersion relations for a variety of situations. These include the case of a single rod system that is either embedded in an infinitely extended solid or fluid host or kept free. The procedure is also adapted to derive approximate solutions for the cases of a periodic fiber distribution in a matrix material, which model unidirectional fiber-reinforced composites. The results are numerically illustrated for a widely used piezoelectric-polymer composite. It is seen that piezoelectric coupling can significantly change the morphology of the dispersive behavior of the composite.