Galvanic Skin Response—Extinction Biofeedback Training for Psychogenic Abdominal Pain: A Validation Protocol

Abdominal and pelvic pain of psychogenic origin is a widespread, disabling, difficult to identify, and often inadequately treated medical condition. This condition is often associated with poor quality of life due to high pain interference with daily activities. Cognitive behavioral psychological therapy and neuromodulation with biofeedback are validated therapies for the treatment of this condition. Aim of the present research work is the validation of a therapeutic protocol that involves the use of both techniques in combination. 20 patients diagnosed with psychogenic abdominal pain, of both sexes, aged between 18 and 60 years who had not benefited from pharmacological therapies were enrolled. 10 patients were randomly assigned to the control group (psychological treatment only), another 10 patients were assigned to the study group (neuromodulation with biofeedback-Galvanic skin response-extinction in combination with psychological therapy). For both groups, the pain score, interference of pain with daily living activities, pain relief, and the share of anxiety associated with the pain condition were evaluated (pre- and post-treatment). The patients who underwent the combined treatment achieved statistically significant better scores than patients in the control group, respectively −4.9 ± 0.9 vs −1.0 ± 0.4 for Pain;−5.1 ± 1.1 vs −0.9 ± 0.3 for Interference with life;−7.2 ± 3.7 vs −2.2 ± 2.1 for HAMA;4.6 ± 1.2 vs 1.1 ± 0.6 for Relief.

Isolation and Identification of the Pathogen Causing Skin Ulcer Disease in Cynoglossus semilaevis Günther and Its Sensitivity to Chinese Herbal Medicine

In this study, the pathogen causing skin ulcer disease in Cynoglossus semilaevis Gunther was isolated for morphological observation, physiological and bio- chemical identification. According to the result, the isolated pathogen was identified as Vibrio harveyi. The results of recurrent infection of C. semilaevis Gonther showed that the pathogen was strongly pathogenic to C. semilaevis Gunther. In or- der to explore the pathogenesis, outer membrane protein （OMP） gene of C. semi- laevis Gunther was detected by PCR. The results showed that all the three repre- sentative strains harbored OMP gene. According to the results of sensitivity test of the pathogen to Chinese herbal medicine, Galla Chinensis, Fructus Mume, Fructus Hippophae and Lignum Sappan exerted strong antibacterial effects against V. harveyr, Pericarpium Granati exhibited slight antibacterial effect against V. harveyi; Pericarpium Citri Reticulatae, Rhizoma Acori GramineL Herba Houttuyniae, Herba Portulacae, Herba Andrographis, Eucalyptus globulus Labill. and Herba Menthae Heplocalycis had little effect on V. harveyi. Galla Chinensis, Fructus Mume, Fructus Hippophae and Lignum Sappan were prepared into three prescriptions, among which prescription 1 （Galla Chinensis ＋ Fructus Mume） exhibited the strongest antibacterial effect.

Mucocele of the appendix: An unusual cause of lower abdominal pain in a patient with ulcerative colitis-. A case report and review of literature

The authors report the case of a 60-year-old male patient. In November 2001 he developed intestinal symptoms of bloody diarrhea and abdominal pain. Colononoscopy and biopsy established the diagnosis of ulcerative colitis (proctosigmoiditis). The disease activity was moderate at the beginning. No significant laboratory alterations were found (including CEA, CA19-9), and mesalazine was started orally. He was in remission until November 2003, when he was admitted to our Outpatient Clinic for upper and right lower abdominal pain and bloody diarrhea. Colonoscopy found proctosigmoiditis with a moderate activity, gastroscopy revealed chronic gastritis, laboratory data was normal. Treatment was amended with mesalazine clysma and methylprednisolone (16 mg) orally. Symptoms ameliorated; however, right lower abdominal pain persisted. US and CT examinat'on demonstrated a pericecal cystic mass (11 cm×3.5 cm). At first pericecal abscess was suspected, as the previous US examination (6 mo earlier) had revealed normal findings. Fine needie aspiration was performed. Cytology confirmed the diagnosis of mucocele. The patientunderwent partial cecum resection and extirpation of the mucocele. He recovered well and the final histology revealed a cystadenoma of the appendix. Follow up was started. The pati雗t is now free of symptoms. Although primary adenocarcinoma of the appendix is uncommon, the authors emphasize that preoperative diagnosis of an underlying malignancy in a mucocele is important for pati雗t management; however, it is difficult on imaging studies.

Antibacterial Activity of Extracts from Zostera marina Against Pathogens of Apostichopus japonicus Skin Ulceration Disease

The purpose of this study was to investigate the antibacterial activity of extracts from Zostera marina against the pathogens of Apostichopus japonicus skin ulceration disease.When 95% ethanol (v/v) solvent was used to extract Zostera marina at 50℃,aqueous extract (ZA) showed obvious bacteriostatic effects on the tested bacterial strains (inhibition halo diameters between 8.23 mm and 13.62 mm),whereas the ethyl acetate extract (ZE) was almost inactive.The minimal inhibitory concentration (MIC) of ZA against four pathogens were homogeneous at 12.8 g L-1.ZA components were analyzed by thin layer chromatography (TLC) assay and six fractions were obtained.In another study,the six fractions showed inhibitory effects against the tested bacteria while their functions seemed to counteract the ZA activity.

Effect of viscoelasticity on skin pain sensation

Pain sensation may appear under long-lasting mechanical stimulation. Although people have the experience that pain sensation generally decreases with time while the stimulation remains, the underlying mechanism remains elusive. We experimentally studied the thermal and strain rate- dependent viscoelastic behavior of skin in uniaxial stretch and numerically investigated the effects of temperature and strain rate on pain sensation. The results indicate that the viscosity of skin tissue decreases with increasing temperature and reducing strain rate, which subsequently decreases the discharge frequency of skin nociceptor and thus relieves the pain sensation. The results would contribute to the understanding of pain relief mechanism and optimizing for mechanical treatment.

XB130 inhibits healing of diabetic skin ulcers through the PI3K/Akt signalling pathway

BACKGROUND Diabetic skin ulcers,a significant global healthcare burden,are mainly caused by the inhibition of cell proliferation and impaired angiogenesis.XB130 is an adaptor protein that regulates cell proliferation and migration.However,the role of XB130 in the development of diabetic skin ulcers remains unclear.AIM To investigate whether XB130 can regulate the inhibition of proliferation and vascular damage induced by high glucose.Additionally,we aim to determine whether XB130 is involved in the healing process of diabetic skin ulcers,along with its molecular mechanisms.METHODS We conducted RNA-sequencing analysis to identify the key genes involved in diabetic skin ulcers.We investigated the effects of XB130 on wound healing using histological analyses.In addition,we used reverse transcription-quantitative polymerase chain reaction,Western blot,terminal deoxynucleotidyl transferasemediated dUTP nick end labeling staining,immunofluorescence,wound healing,and tubule formation experiments to investigate their effects on cellular processes in human umbilical vein endothelial cells(HUVECs)stimulated with high glucose.Finally,we performed functional analysis to elucidate the molecular mechanisms underlying diabetic skin ulcers.RESULTS RNA-sequencing analysis showed that the expression of XB130 was up-regulated in the tissues of diabetic skin ulcers.Knockdown of XB130 promoted the healing of skin wounds in mice,leading to an accelerated wound healing process and shortened wound healing time.At the cellular level,knockdown of XB130 alleviated high glucose-induced inhibition of cell proliferation and angiogenic impairment in HUVECs.Inhibition of the PI3K/Akt pathway removed the proliferative effects and endothelial protection mediated by XB130.CONCLUSION The findings of this study indicated that the expression of XB130 is up-regulated in high glucose-stimulated diabetic skin ulcers and HUVECs.Knockdown of XB130 promotes cell proliferation and angiogenesis via the PI3K/Akt signalling pathway,which accelerates the healing of diabetic skin ulcers.

Efficacy of compound Bai Yu San in treating diabetic skin ulcer

Objective:To assess the efficacy of compound Bai Yu San(CBYS)as a new treatment option,in healing diabetic skin ulcer.Materials and Methods:A total of 64 diabetic patients with skin ulcer were enrolled and randomly assigned to experimental group(n=33)and control group(n=31).In the control group,normal saline(NS)was used to cleanse the wound.After debridement,the wound was dressed with modern materials.In the experimental group,the NS‑cleansed wound was dressed with CBYS.The infection rate,healing rate,treatment cost,and patient satisfaction between the two groups were compared.Results:On the 35th day after treatment,the infection rate and healing rate showed no between‑group difference(P>0.05);the experimental group showed lower treatment cost and higher satisfaction than the control group(P<0.05).Conclusion:As a new treatment option for diabetes‑induced skin ulcer,CBYS can effectively control the infection,promote the healing,reduce treatment cost,and increase patient satisfaction.Dressing with CBYS can be clinically replicated in the treatment of diabetic skin ulcer.

Unilateral peripheral neuropathic pain: The role of neurodiagnostic skin biopsy

According to the current definition of neuropathic pain("pain arising as a direct consequence of a lesion or disease affecting the somatosensory system"), the demonstration of a lesion or disease involving the somatosensory system is mandatory for the diagnosis of definite neuropathic pain. Although several methods are currently available for this aim, none is suitable for every type of disease(or lesion). Neurodiagnostic skin biopsy(NSB) is a relatively new technique for the diagnosis of peripheral nerve lesions. It is an objective method, completely independent from the patient's complaining, based on immunohistochemical staining techniques that allow measurement of the density of the epidermal nerve fibers, currently considered the free nerve endings of small diameter(A-delta and C) afferent fibers. NSB has the important property of being used to investigate the skin, allowing obtaining a diagnosis of small fiber axonal neuropathy of peripheral nerves supplying every body part covered by skin. This feature appears to be very important, particularly in cases of unilateral nerve lesions, because it allows going beyond the possibilities of neurophysiological tests which are available only for a limited number of peripheral nerves. All these characteristics make NSB a precious instrument for the diagnosis of peripheral unilateral neuropathic pain.

Effectiveness of Virtual Reality for Pediatric Pain and Anxiety Management during Skin Prick Testing

This study investigated the effectiveness of virtual reality (VR) distraction, compared to comic book distraction and no distraction, in reducing pain and anxiety during a medical procedure in a pediatric population: the skin prick test. Although this test has many advantages and is considered to be minimally invasive, it causes anxiety and painful discomfort in children. Ninety-two children aged 7 to 17 years consulting for an allergic test received VR distraction, comic book distraction, or no distraction. Outcome measures included pain score, level of anxiety, and VR measures. The results showed that there were no significant differences between the three groups regarding sex, age, and preprocedural anxiety level. In the distraction groups (VR and comic book), children reported significantly lower pain and procedural anxiety scores than children with no distraction;VR distraction had a more significant effect than comic book distraction. A decrease in anxiety before and during the skin prick test is significantly more significant in VR distraction. This study suggested the effectiveness and feasibility of VR to reduce pain and anxiety during the pediatric skin prick test.

Clustered Pain Procedures in Skin-to-Skin Contact (SSC) Position for Full Term Newborns

As a part of their routine care, full term newborns face many painful procedures immediately after birth and during the first couple days of life. Skin-to-Skin Contact (SSC) has been recommended as a non-pharmacological pain management intervention in newborns. However, the use of SSC in labor and delivery rooms as well as in postnatal units and nurseries is limited due to the discomfort that the nurses and phlebotomists themselves experience during positioning the newborns and themselves to complete these routine procedures. The objective of this paper is to describe a step-by-step procedure that was developed and used in a randomized clinical trial to manage newborns pain during clustered pain procedures. The procedure worked well and no complaints of discomfort were reported by the nurses during the study.

A Royal Jelly Mixture with Berberine for Dressing Change on a Refractory Skin Ulcer:A Case Report

It has been reported that a 92-year-old female had got a bruise superficial wound on her right leg one and a half years ago,developing into refractory skin ulcer due to improper management before.A prepared cream,mixed royal jelly with berberine for dressing change,was made on the scene through the crush of berberine tablets,working with fresh royal jelly.Topical dressing change with the cream was done every 3 days,and two months later,such the ulcer became clean and was covered fully with fresh granulation tissue.This kind of cream consists of the ingredients of TCM purely,free of antibiotic,and being quite effective clinically,also helpful for proper use of antibiotic.

Metabolomics analysis for skin ulceration syndrome of Apostichopus japonicus based on UPLC/Q-TOF MS

Skin ulceration syndrome(SUS)is the main diseases aff ected the development of sea cucumber(Apostichopus japonicus)culture industries.To better observe the changes in the sea cucumber A.japonicus with SUS and understand the pathogenesis of the disease,activities of superoxide dismutase(SOD),catalase(CAT),and level of malondialdehyde(MDA)in coelomic fluid were detected using the Assay Kit and metabolites in the body wall were assessed using ultra-performance liquid chromatography and quadrupole-time of flight mass spectrometry.The results indicated that level of MDA was increased during SUS compared with healthy individuals(P<0.01),but activities of SOD and CAT were reduced(P<0.05).In metabolomics analysis,metabolites,such as adenosine,choline,betaine aldehyde,palmitic acid,and taurine,were found to be upregulated and 2-oxoadipic acid,anthranilic acid(vitamin L1),thioetheramide-PC,cholesterol-3-sulfate,and pentadecanoic acid were downregulated(VIP>1 and P<0.1).Pathway enrichment analysis indicated most enrichment of KEGG pathways were mainly related to energy metabolism,immunity,and osmoregulation such as ABC transporters,glycine,serine and threonine metabolism,tryptophan metabolism and neuroactive ligand-receptor interaction.Our study reflected the difference in enzyme activity and metabolites between A.japonicus with SUS and those without,which will provide reference data for investigating SUS.

Cutaneous leishmaniasis presenting with painless ulcer on the right forearm:A case report

BACKGROUND Leishmaniasis includes a range of chronic infections in humans and animals and can be caused by more than 20 species of Leishmania protozoa.The manifestations of leishmaniasis are diverse and dependent on the immune response capacity of the host and the type of Leishmania.In East Asia,leishmaniasis is relatively rare and prone to misdiagnosis and underdiagnosis.CASE SUMMARY We report a case of a 36-year-old male with cutaneous leishmaniasis.The patient had been misdiagnosed with a bacterial skin infection and was given a dressing change and oral levofloxacin,which proved ineffective.Histopathological examination revealed amastigote(Leishman-Donovan body)in the histocytes,and nucleic acid sequencing proved that the pathogen was Leishmania major.The patient was treated successfully by regional injection of sodium gluconate(600 mg)three times.The ulcer healed and did not recur at 1.5-year follow-up.CONCLUSION Skin ulcers caused by leishmaniasis are easily misdiagnosed in non-epidemic countries,yet it should not be overlooked.

Anti-nuclear matrix protein 2+ juvenile dermatomyositis with severe skin ulcer and infection: A case report and literature review

BACKGROUND Juvenile dermatomyositis(JDM)is an idiopathic inflammatory myopathy that occurs in childhood.It is characterized by muscle weakness and a characteristic rash.Previous literature reports have rarely described JDM with severe skin ulcers and infections.CASE SUMMARY Herein,we describe a case of a 2-year-old female patient who suffered from JDM,whose myositis-specific autoantibodies were positive for anti-nuclear matrix protein 2 antibody,with progressively worsening skin ulcers and severe infections.The patient was treated with glucocorticoids and various immunosuppressants.Nevertheless,further progression of the disease and the combination of primary disease and severe infection in the later period were fatal.CONCLUSION In children,anti-nuclear matrix protein 2+JDM combined with skin ulcers often indicates severe disease.In such cases,personalized treatment for the primary disease and infection prevention and control are essential.

Differential expression of telomerase reverse transcriptase in chronic human skin ulcer induced by radiation and mechanism of cancer transformation and poor healing

AIM:To study the expression of the catalytic subunit of telomerase, telomerase reverse transcriptase(TRT) and explore the possible relationship between the TR T and cancer transformation or poor healing in radiation-induced chronic human skin ulcer.METHODS:Rabbit antibody to human TRT and SP immunohistochemical metho d were used to detect TRT expression in 24 cases of formalin-fixed,paraffin-em beded chronic human skin ulcer tissues induced by radiation, 5 cases of normal s kin,2 of burnt skin,and 8 of carcinoma.RESULTS: The TRT was detected positive in 14 of 24 (58.3%) chronic radiation ulcers, of which the strongly positive was 10 of 24 (41.7%) and the weakly positive 4 of 24 (16.7%);in 0 of 5 normal and 0 of 2 burnt skins;and in 8 of 8 (100%) carcinomas.The expression of TRT was ob served almost always strongly positive in the cytoplasm and nucleus of squamous epithelial cells of epidermis but negatively in the endoepithelial cells of capi llaries and small blood vessels,or weakly in the cytoplasm of smooth myocytes of media and fibroblasts,of dermis. Chronic inflammtory cells,such as plasma cells and lymphocytes also showed weakly positive for TRT.CONCLUSION:The strong TRT e xpression in the epidermis could be involved in the cancer transformation from c hronic radiation ulcer to squamous carcinoma, whereas the negative or weak TRT e xpression in the capillaries, small blood vessels and fibroblasts of dermis migh t be responsible for the poor healing of chronic ulcers induced by radiation, ca used by sclerosis of small blood vessels and lack of granulation tissue consisti ng of capillaries and fibroblasts.

Research on combination of PRP,PRF and adipose-derived stem cells for wound healing of chronic skin ulcer

Objective To investigate the effects of combination of PRP,PRF and adipose-derived stem cells(ADSC)for wound healing of chronic skin ulcer,and provide evidences for clinical application.Methods Twenty-four SD rats aged 6-8 weeks were used in this study.5 grams of groin adipose tissue were derived from each rat.After collagenase digestion,mesenchyma stem cells derived from adipose tissue(ADSCs)were determined by immunocytochemical method and flow cytometry.After continuous culturing,the 3th passage of ADSCs in good condition was prepared for transplantation.Ten milliliters of whole blood were extracted from one rat for making PRP and PRF backup.Full thickness skin defect model with six wounds with an area of 1.5cm*1.5cm on each side of the spine on the back was established in rats after anesthesia.Then the rats were randomly divided into six groups.Skin wounds were injected with PRF combining ADSC in group A,PRF in group B,ADSC in group C,ADSC combining PRP in group D,PRP in group E,and same amount of normal saline(NS)in group F.Histological analysis was performed to evaluate the velocity and the quality of the wound healing 7 days,14 days,21days and 28 days after treatment,and comparing the regeneration of epidermis,corium,fibroblast,blood vessel and skin appendages respectively.Results The woulds in each group healed well,without symptoms of infection.Skin wounds were almost healed in 21 days,and no significant difference in healing velocity was found among these groups.There were no apparent inflammatory cells in 7 days.The wounds were filled with granulation formed by proliferation of connective tissue with visible new blood capillary and repair cells like fibroblast.Epidermis grew out and became thick,and gradually grew to the wounds,with active proliferation of re-epithelization.Re-epithelization was completed in 14 days,with granulation tissue covered by epidermis and fibrosis showing a significant increase in collagenous fiber,and visible skin appendages like new hair follicle,glandula sebacea,sweat gland and corneum.Appendages like hair follicle,glandula sebacea,sweat gland and corneum increased in 21 days,and granulation tissue gradually formed scar tissue and entered remodeling phase.There was no significant changes from 21 days to 28 days,and the tissues were entering a long remodeling phase.Healing status:Group D,A and C could be observed with more complete epidermis,new blood vessel and new hair follicle.Among them,Group D was most significant,while group A,C,E,B successively and group F had the slowest epidermal migration and the least new hair follicle.The velocity and the quality of these groups were as follows:D>A>C>E>B>F,indicating that ADSC combining PRP can improve quality in wound healing of skin ulcer effectively.Conclusions After the general and pathological observation on the effects,the velocity and the quality for the skin ulcer healing of SD rats on the back were as follows:ADSC+PRP>ADSC+PRF>ADSC>PRP>PRF>NS,indicating that PRP or PRF combining ADSC can improve quality in wound healing of skin ulcer effectively.

Application of integrated traditional Chinese and Western medicine in the treatment of juvenile localized scleroderma with skin ulcer: a case report

Background:Juvenile Localized Scleroderma(JLS)is a rare pediatric rheumatic disease characterized by inflammation and skin sclerosis.The side effect of consensus-recommended medications and the risk of disability posed challenges to the JLS treatment.We intend to demonstrate the potential of traditional Chinese medicine in treating JLS with skin ulcers and reducing the dose of glucocorticoid.Method:Here we report a case of a 13-year-old male with JLS who took oral methotrexate tablets of 10 mg/week and methylprednisolone of 6 mg/day for over six months without significant effect and suffered from skin ulcers on the dorsal feet one month after drug cessation.Subsequently,the patient was treated with integrated traditional Chinese and Western medicine of low-dose glucocorticosteroid,adjusted Shenqi Huoxue formula and Jinshe Xiaoyan formula,etc.Results:After integrated treatment,the patient’s dorsal feet ulcers healed and the skin sclerosis and hyperpigmentation improved significantly.Conclusions:This case report suggests that integrated traditional Chinese and Western medicine can be used as an effective treatment for JLS.

DIFFERENTIAL EFFECTS OF INTRASEPTAL MICROINJECTION OF CARBACHOL AND SCOPOLAMINE ON VISCERAL AND SKIN PAINS

The cholinergic system plays an active role in analgesia. It is considered that effect of the cholinergic agent in analgesia is central. Intraventricular injections of both acetylcholine and physostigmine have analgesic effect. This means that

Gastrointestinal contrast-enhanced ultrasonography for diagnosis and treatment of peptic ulcer in children

BACKGROUND The detection rate of peptic ulcer in children is improving,with development of diagnostic procedures.Gastroscopy is the gold standard for the diagnosis of peptic ulcer,but it is an invasive procedure.Gastrointestinal contrast-enhanced ultrasonography(CEUS)has the advantages of being painless,noninvasive,nonradioactive,easy to use,and safe.AIM To investigate the clinical value of CEUS for diagnosis and treatment of peptic ulcer in children.METHODS We investigated 43 children with digestive tract symptoms in our hospital from January 2021 to June 2022.All children were examined by routine ultrasound,gastrointestinal CEUS,and gastroscopy.The pathological results of gastroscopy were taken as the gold standard.Routine ultrasonography was performed before gastrointestinal CEUS.Conventional ultrasound showed the thickness of the gastroduodenal wall,gastric peristalsis,and the adjacent organs and tissues around the abdominal cavity.Gastrointestinal CEUS recorded the thickness of the gastroduodenal wall;the size,location and shape of the ulcer;gastric peristalsis;and adjacent organs and tissues around the abdominal cavity.The results of routine ultrasound and gastrointestinal ultrasound were compared with those of gastroscopy to evaluate the diagnostic results and coincidence rate of routine ultrasound and gastrointestinal CEUS.All children received informed consent from their guardians for CEUS.This study was reviewed and approved by the hospital medical ethics committee.RESULTS Among the 43 children,17(15 male,2 female)were diagnosed with peptic ulcer by gastroscopy.There were 26 children with nonpeptic ulcer.There were eight cases of peptic ulcer and 35 of nonpeptic ulcer diagnosed by conventional ultrasound.The diagnostic coincidence rate of peptic ulcer in children diagnosed by conventional ultrasound was 79.1%(34/43),which was significantly different from that of gastroscopy(P=0.033).It indicates that the coincidence rate of gastrointestinal contrast-enhanced ultrasound and gastroscope is low.Fifteen cases of peptic ulcer and 28 of nonpeptic ulcer were diagnosed by CEUS.The diagnostic coincidence rate of peptic ulcer in children was 95.3%(41/43).There was no significant difference between CEUS and gastroscopy(P=0.655).It indicates that the coincidence rate of gastrointestinal contrast-enhanced ultrasound and gastroscope is high.CONCLUSION Gastrointestinal CEUS has a high coincidence rate in the diagnosis of peptic ulcer in children,and can be used as a preliminary examination method.

Abdominal Pain After Cardiac Surgery Caused by Crohn Disease, Intestinal Ischemia, and Colonic Diverticulitis, Respectively: A Report of 3 Cases

Abdominal complications following cardiac surgery are rare events,but can be fatal if not diagnosed and managed in time.Aggressive treatments offer a better chance for survival in patients with risk factors.This case report describes the clinical presentation and details of 3 recently operated patients who suffered acute abdominal pain after cardiac surgery.The underlying causes were Crohn disease-associated ileal perforation,intestinal necrosis,and diverticulitis-associated colonic perforation.The presentation and management of these severe conditions are discussed.