Úlceras cutâneas constituem um problema de saúde pública no mundo atual. A eficiência do seu tratamento é observada pela redução das áreas total, de fibrina (amarelo) e de granulação (vermelho) da úlcera, calculados manualmente e/ou por imagens, processos demorados e posteriores à consulta médica. O trabalho propõe uma nova técnica não-invasiva e automatizada de acompanhamento das úlceras por redes neurais artificiais (RNAs). Foram utilizadas imagens digitais do banco de imagens do ADUN (Ambulatório da Dermatologia de Úlceras Neurovasculares) do Hospital das Clínicas da FMRP-USP (Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo), escolhidas aleatoriamente, sendo 50 imagens para treinamento da RNA e 250 para o teste da RNA. Para validação da RNA foram criados os grupos: 1 (n=15 imagens poligonais com áreas e cores definidas previamente); 2 (n=15 imagens poligonais com áreas e cores definidas previamente, submetidas a variações de iluminação, brilho, contraste, saturação); 3 (n=15 imagens poligonais constituídas de texturas de fibrina e de granulação); 4 (n=15 imagens de úlceras cutâneas reais preenchidas totalmente em cor preta sua superfície). Para avaliar a sua aplicação clínica foram utilizadas 50 imagens padronizadas submetidas aos cálculos das áreas pela RNA. Os resultados da RNA foram comparados aos do programa Image J (segmentação manual) e/ou às medidas-padrão. Estatisticamente os programas foram considerados similares quando p > 0,05 pelo Teste t Student. Quando p < 0,05 e r positivo, considerou-se o coeficiente de correlação de Pearson. A base de imagens de úlceras cutâneas foi eficiente para a aquisição das imagens, para a criação e execução dos algoritmos de extração de cores, de treinamento e de teste da RNA. A rede neural artificial desenvolvida apresentou desempenho similar ao Image J e às medidas-padrão adotadas para a segmentação das figuras do grupo 1, sendo p > 0,05 para as áreas total, de fibrina e de granulação. Na avaliação de interferência de ruídos (grupo 2), foi verificado que tais fatores não interferiram na segmentação da área dos polígonos (p > 0,05), pela RNA e pelo Image J. Entretanto, apesar de interferirem na segmentação de cores de granulação, sendo p < 0,05, o coeficiente de correlação RNA/Image J foi de 0,90 com p < 0,0001. No grupo 3, os cálculos das áreas foram semelhantes pela RNA e pelo Image J (p > 0,05). Quando comparadas às áreas calculadas pelos programas às medidas-padrão, o coeficiente de correlação foi significante (p < 0,0001) para todas as áreas. A segmentação das áreas das úlceras do grupo 4 pela RNA foi validada quando comparada à segmentação manual pelo Image J (p> 0,05). A aplicação clínica da RNA sobre o banco de imagens foi semelhante ao Image J para a segmentação das áreas (p > 0,05). Enfim, a rede neural artificial desenvolvida no Matlab 7.0 mostrou desempenho eficaz e validado na segmentação das úlceras de perna quanto à automatização do cálculo das áreas total, de fibrina e de granulação, semelhante à oferecida manualmente pelo programa Image J. Além disso, mostrou-se de grande aplicação clínica devido a facilidade de sua utilização através da interface web criada, sua praticidade, não interferência do usuário (automatização), propriedades essas que a consolida como uma metodologia adequada para o acompanhamento dinâmico-terapêutico da evolução das úlceras cutâneas. / Cutaneous ulcers are a public health problem worldwide. The efficiency of their treatment is observed through the reduction on the total affected areas, slough (yellow) and granulation (red) of the ulcer, manually calculated and/or through images, which are delayed processes usually performed after medical consultation. This work proposes a new non-invasive and automated technique to follow-up ulcers through artificial neural networks (ANN). Digital images from the ADUN (Neurovascular Ulcers Dermatology Ambulatory) image bank - FMRP General Hospital (Ribeirão Preto Medical School - University of São Paulo) were used and randomly selected as follows: 50 images for ANN training and 250 for the ANN test. For the ANN validation, the following groups were created: 1 (n=15 polygonal images with areas and colors previously defined); 2 (n=15 polygonal images with areas and colors previously defined submitted to illumination, brightness, contrast and saturation variation); 3 (n=15 polygonal images composed of slough and granulation textures); 4 (n=15 images of actual cutaneous ulcers with their surface fully filled in black). To evaluate its clinical application, 50 standard images were used and submitted to calculation of areas using ANN. The ANN results were compared to those obtained with the Image J software (manual segmentation) and/or to standard measures. The programs were statistically considered similar when p > 0.05 through the t Student test. When p < 0.05 and r is positive, the Pearson correlation coefficient was considered. The cutaneous ulcer image bank was efficient for the acquisition of images, for the creation and execution of color extraction algorithms, ANN training and tests. The artificial neural network developed presented performance similar to that obtained with the Image J software and to standard measures adopted for the segmentation of figures from group 1, with p > 0.05 for total areas, slough and granulation. In the noise interference assessment (group 2), it was verified that such factors did not interfere in the polygons area segmentation (p > 0.05) through both ANN and Image J. However, although interfering in the color and granulation segmentation, with p < 0.05, the ANN/Image J correlation coefficient was of 0.90, with p < 0.0001. In group 3, the calculations of areas were similar through both ANN and Image J (p > 0.05). When compared to standard measures, the correlation coefficient was significant (p < 0.0001) for all areas. The segmentation of ulcer areas of group 4 through ANN was validated when compared to manual segmentation through Image J (p> 0.05). The clinical application of ANN on the image bank was similar to Image J for the segmentation of areas (p > 0.05). Finally, the Artificial Neural Network developed in Matlab 7.0 environment showed good performance and was validated in the segmentation of leg ulcers in relation to the automation of the calculation of total areas, slough and granulation, which was similar to that obtained with the Image J software. Moreover, it presented a large clinical application due to the easiness of its application through the web interface created and the non interference of the user (automation), properties that consolidate this technique as a suitable methodology for the dynamic-therapeutic follow-up of the evolution of cutaneous ulcers.

As úlceras Venosas (UV) produzem modificações radicais na vida dos indivíduos em decorrência de sua etiopatogenia. Estas são as formas mais comuns de úlceras de perna e causam um impacto significante na qualidade de vida dos pacientes, pois reduzem a produtividade no trabalho, além dos custos associados a tratamentos de longa duração, em virtude da cronicidade, tempo de cicatrização e freqüentes recidivas das lesões. Este trabalho teve como objetivos identificar as características sócio-demográficas da clientela, incluindo a caracterização da UV, calcular o custo total direto(CTD) dos materiais e de pessoal de enfermagem utilizados na realização do procedimento com bota de unna em pacientes portadores de UV, por um método baseado nas médias(CTDM) e um método baseado nas observações(CTDO) e correlacionar o CTDO, Circunferência do joelho e tornozelo, área e tempo de procedimento entre si e com as demais variáveis quantitativas do estudo. Como referencial teórico para aferição dos custos utilizou-se o sistema de custeio por absorção por procedimento ou produto. A pesquisa é do tipo exploratória, descritiva, comparativa, correlacional, com abordagem quantitativa. Foi realizada na unidade de ambulatório da clínica cirúrgica do Hospital Universitário da Universidade de São Paulo (HU-USP). A amostra foi constituída de 65 procedimentos com bota de unna realizados em nove pacientes portadores de UV. Para coleta de dados, foi utilizado um instrumento contendo dados demográficos e clínicos da clientela, caracterização da lesão e relativos ao tempo e consumo de material. Os resultados mostraram que os pacientes com UV 5 (55,55%) apresentavam idade igual e abaixo de 64 anos, com faixa etária predominante entre 49 a 56 anos (33,33%) e de 65 a 72 anos (33,33%). Foi verificado o predomínio do sexo feminino com 7 (77,78%) pacientes. Com relação à doença associada houve predomínio de HAS (33,33%) seguida de DM (22,22%), um mesmo paciente apresentou mais de uma patologia associada e que 5(55,55%) pacientes não apresentavam doenças associadas. O tempo de existência da úlcera mostrou um predomínio de menos de 2 anos (44,44%) e de mais de 5 anos (44,44%). As úlceras estavam localizadas preferencialmente na região maleolar 7 (77,77%) pacientes. Houve um predomínio de circunferência de joelho de 32 a 35,9 cm, circunferência de tornozelo entre 24,5 a 25,5 cm e de áreas de lesão de 2,0 e 61,0 cm2. O custo total direto médio (CTDM), relacionado ao procedimento com bota de unna foi de R$ 139,48 e a média do custo total direto observado(CTDO) foi R$ 96,47 (DP = 16,22) com variação de R$ 76,84 a 184,65. A média do custo da mão de obra do procedimento foi R$ 15,39 (DP = 3,28) com variação de R$ 8,00 a 22,50. Em relação às correlações foi evidenciado que custos elevados estão associados a procedimentos com maiores áreas de lesão, maiores Cj, com maior consumo de gaze n, rayon, zobec, fita adesiva, soro, faixa elástica, gaze, zobec e faixa crepe domiciliar, que maiores Ct tendem a estar associadas ao menor consumo de rayon e maior consumo de luva proc, que grandes áreas de lesão tendem a estar associadas a maior consumo de gaze e, rayon, zobec, luva proc e zobec domiciliar e tendem a estar associadas ao menor consumo de tempo e de faixa elástica, que maior tempo de procedimento a estar associado a maior consumo de gaze e soro e a menor consumo de luva de procedimentos. Acreditamos que os enfermeiros precisam ter conhecimento e meios para tomar decisões, baseados em evidências científicas, a respeito do tratamento mais apropriado para o paciente e que essa escolha deve estar baseada no custo-efetividade, lembrando que no cotidiano das atividades gerenciais, esses dados são imprescindíveis. Desta forma , podem respaldar seus argumentos em relação à necessidade de gastos frente aos diversos tipos de produtos, bem como suas decisões sobre alocação de recursos para as diferentes atividades junto à administração / The veined ulcers (UV) bring forth radical modifications in the life of the individuals resulting from their condition. The most common forms of ulcers are of the leg and it causes significant impact in the quality of life of the patients, reducing the work productivity, beside the costs associated with the long treatments, due to the chronic condition, time of healing and the frequent reappearance of the lesions. This work has the objective to identify the typical traits social-demographic of the clientele, including the characterization of the UV, calculate the total direct cost (CTD) of the materials and the nursing staff used to realize the procedure with the boot of unna in patients bearing the UV, by a method based in the medium (CTDM) and a method based in the observations (CTDO) establishing a relationship with the CTDO. Circumference of the knee and ankle, area and time of the procedure, alone and with the other variable quantity of study. As a theoretical reference to check the costs, we utilize the system of the cost by absorption of the procedure or product. The search is of the exploratory type, descriptive, establishing a relationship, comparative with a quantitative approach. It was realized in the ambulatory unit of the surgery clinic of the University Hospital of the University of Sao Paulo (HU-USP). The sample was formed of 65 procedures with the boot of unna, realized in nine patients affected with UV. To collect the data it was utilized an instrument containing demographic data and physicians of the clientele, characterized of the lesion and related to the time and use of the material. The results showed that the patients with UV 5 (55,55%) presented age equal and below of 64 years old, with etaria band predominantly between 49 and 56 years (33,33%) and between 65 and 72 years old (33,33%) It was verified the predominance of the feminine sex with 7 (77,78%) patients. In regards to the disease associated there was a predominance of HAS (33,33%) following of DM (22,22%), one patient presented more than one associated pathology and that 5 (55,55%) patients did not appear with associated deceases. The time that the ulcer demonstrated a predominance of less than 2 years (44,44%) and above 5 years old (44,44%) The ulcers were mainly localized in the malleolus region 7 (77,77%) patients. There was a predominance of the knee circumference of 32 to 35.9 cm, circumference of the ankle between 24, 5 to 25,5 cm and of the areas of lesion of 2,0 and 61,0 cm2. The total direct medium cost (CTDM), related to the procedure with the boot of unna was of R$ 139,48 and the medium total cost directly observed (CTDO) was of R$ 96,47 (DP = 16,22) with variation of R$ 76,84 to 184,65. The medium cost of the labor of the procedure was RS 15,39 (DP=3,28) with a variation of R$ 8,00 to 22,50. In regards to the correlations it was evident that the high costs were associated with procedures with major areas of lesion, major Cj, with more use of gauze, rayon, zobec, adhesive tape, serum, elastic band, gauze, zobec and crape band to domiciliate, and the major Ct have the tendency of being associated to the least usage of rayon and more use of glove proc, that large areas of lesion have the tendency to be associated to a bigger consume of gauze e, rayon, zobec, glove proc and zobec and have the tendency to be associates to the least consume of time and the elastic band, that large time of procedure to be associated with a major consume of gauze and serum and the lesser consume of glove of procedures. We believe that the nurses need to have knowledge and means to make decisions, based in scientific evidences, related to the best appropriated treatment to the patient and that this choice must be based in a cost effective, remembering of the daily general vital activities. Therefore, they can polish theirarguments in relation to the necessity of future expenses with the various types of products, as well as their decisions about allocating the source for the different activities along with the administration

Úlceras cutâneas constituem um problema de saúde pública no mundo atual. A eficiência do seu tratamento é observada pela redução das áreas total, de fibrina (amarelo) e de granulação (vermelho) da úlcera, calculados manualmente e/ou por imagens, processos demorados e posteriores à consulta médica. O trabalho propõe uma nova técnica não-invasiva e automatizada de acompanhamento das úlceras por redes neurais artificiais (RNAs). Foram utilizadas imagens digitais do banco de imagens do ADUN (Ambulatório da Dermatologia de Úlceras Neurovasculares) do Hospital das Clínicas da FMRP-USP (Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo), escolhidas aleatoriamente, sendo 50 imagens para treinamento da RNA e 250 para o teste da RNA. Para validação da RNA foram criados os grupos: 1 (n=15 imagens poligonais com áreas e cores definidas previamente); 2 (n=15 imagens poligonais com áreas e cores definidas previamente, submetidas a variações de iluminação, brilho, contraste, saturação); 3 (n=15 imagens poligonais constituídas de texturas de fibrina e de granulação); 4 (n=15 imagens de úlceras cutâneas reais preenchidas totalmente em cor preta sua superfície). Para avaliar a sua aplicação clínica foram utilizadas 50 imagens padronizadas submetidas aos cálculos das áreas pela RNA. Os resultados da RNA foram comparados aos do programa Image J (segmentação manual) e/ou às medidas-padrão. Estatisticamente os programas foram considerados similares quando p > 0,05 pelo Teste t Student. Quando p < 0,05 e r positivo, considerou-se o coeficiente de correlação de Pearson. A base de imagens de úlceras cutâneas foi eficiente para a aquisição das imagens, para a criação e execução dos algoritmos de extração de cores, de treinamento e de teste da RNA. A rede neural artificial desenvolvida apresentou desempenho similar ao Image J e às medidas-padrão adotadas para a segmentação das figuras do grupo 1, sendo p > 0,05 para as áreas total, de fibrina e de granulação. Na avaliação de interferência de ruídos (grupo 2), foi verificado que tais fatores não interferiram na segmentação da área dos polígonos (p > 0,05), pela RNA e pelo Image J. Entretanto, apesar de interferirem na segmentação de cores de granulação, sendo p < 0,05, o coeficiente de correlação RNA/Image J foi de 0,90 com p < 0,0001. No grupo 3, os cálculos das áreas foram semelhantes pela RNA e pelo Image J (p > 0,05). Quando comparadas às áreas calculadas pelos programas às medidas-padrão, o coeficiente de correlação foi significante (p < 0,0001) para todas as áreas. A segmentação das áreas das úlceras do grupo 4 pela RNA foi validada quando comparada à segmentação manual pelo Image J (p> 0,05). A aplicação clínica da RNA sobre o banco de imagens foi semelhante ao Image J para a segmentação das áreas (p > 0,05). Enfim, a rede neural artificial desenvolvida no Matlab 7.0 mostrou desempenho eficaz e validado na segmentação das úlceras de perna quanto à automatização do cálculo das áreas total, de fibrina e de granulação, semelhante à oferecida manualmente pelo programa Image J. Além disso, mostrou-se de grande aplicação clínica devido a facilidade de sua utilização através da interface web criada, sua praticidade, não interferência do usuário (automatização), propriedades essas que a consolida como uma metodologia adequada para o acompanhamento dinâmico-terapêutico da evolução das úlceras cutâneas. / Cutaneous ulcers are a public health problem worldwide. The efficiency of their treatment is observed through the reduction on the total affected areas, slough (yellow) and granulation (red) of the ulcer, manually calculated and/or through images, which are delayed processes usually performed after medical consultation. This work proposes a new non-invasive and automated technique to follow-up ulcers through artificial neural networks (ANN). Digital images from the ADUN (Neurovascular Ulcers Dermatology Ambulatory) image bank - FMRP General Hospital (Ribeirão Preto Medical School - University of São Paulo) were used and randomly selected as follows: 50 images for ANN training and 250 for the ANN test. For the ANN validation, the following groups were created: 1 (n=15 polygonal images with areas and colors previously defined); 2 (n=15 polygonal images with areas and colors previously defined submitted to illumination, brightness, contrast and saturation variation); 3 (n=15 polygonal images composed of slough and granulation textures); 4 (n=15 images of actual cutaneous ulcers with their surface fully filled in black). To evaluate its clinical application, 50 standard images were used and submitted to calculation of areas using ANN. The ANN results were compared to those obtained with the Image J software (manual segmentation) and/or to standard measures. The programs were statistically considered similar when p > 0.05 through the t Student test. When p < 0.05 and r is positive, the Pearson correlation coefficient was considered. The cutaneous ulcer image bank was efficient for the acquisition of images, for the creation and execution of color extraction algorithms, ANN training and tests. The artificial neural network developed presented performance similar to that obtained with the Image J software and to standard measures adopted for the segmentation of figures from group 1, with p > 0.05 for total areas, slough and granulation. In the noise interference assessment (group 2), it was verified that such factors did not interfere in the polygons area segmentation (p > 0.05) through both ANN and Image J. However, although interfering in the color and granulation segmentation, with p < 0.05, the ANN/Image J correlation coefficient was of 0.90, with p < 0.0001. In group 3, the calculations of areas were similar through both ANN and Image J (p > 0.05). When compared to standard measures, the correlation coefficient was significant (p < 0.0001) for all areas. The segmentation of ulcer areas of group 4 through ANN was validated when compared to manual segmentation through Image J (p> 0.05). The clinical application of ANN on the image bank was similar to Image J for the segmentation of areas (p > 0.05). Finally, the Artificial Neural Network developed in Matlab 7.0 environment showed good performance and was validated in the segmentation of leg ulcers in relation to the automation of the calculation of total areas, slough and granulation, which was similar to that obtained with the Image J software. Moreover, it presented a large clinical application due to the easiness of its application through the web interface created and the non interference of the user (automation), properties that consolidate this technique as a suitable methodology for the dynamic-therapeutic follow-up of the evolution of cutaneous ulcers.

A fototerapia laser (FTL) tem sido usada clinicamente para auxiliar na cicatrização de inúmeras doenças bucais, especialmente no tratamento de lesões ulceradas. Os mecanismos celulares através dos quais o laser é capaz de promover a bioestimulação não são completamente compreendidos. Dessa forma, o objetivo do presente estudo foi avaliar in vitro o efeito da FTL no comportamento de queratinócitos bucais no processo de cicatrização. Células epiteliais bucais (NOK-SI) foram cultivadas sob duas condições nutricionais: suplementadas com 10% de soro fetal bovino (FBS) e sob déficit nutricional (2% FBS) seguido de irradiação com laser de diodo InGaAlP (660nm, 40mW, 4 e 20J/cm2, 4 e 20s), através da técnica pontual e em contato. Foram realizados ensaio de viabilidade celular (MTT), migração celular (cicatrização) e análise proteica (Western Blotting e Fluorescência). Os resultados obtidos indicaram que a FTL influencia diretamente a migração epitelial evidenciado pelo fechamento acelerado das feridas irradiadas e polarização do citoesqueleto celular (F-actina). Conclui-se que os efeitos clínicos da FTL estão associados, entre outros fatores, ao aumento da migração epitelial. / Laser phototherapy (LPT) has been used clinically to accelerate wound healing in a variety of oral diseases. The cell mechanisms by which LPT can promote biostimulation have not yet been fully elucidated. Epithelial cells play an important role in the reparative process since it proliferation and migration from the wound margin is crucial for restore epithelial continuity. It is unclear whether LPT has an effect on epithelial cell migration. Based on this, the aim of this study was to investigate the effect of LPT in oral wound healing process using oral keratinocytes. Oral keratinocytes were maintained under two nutritional conditions supplemented with 10% of fetal bovine serum (FBS) and in nutritional deficit (2% FBS). Laser irradiation was delivered with InGaAlP laser (660nm, 40mW, 4 e 20J/cm2, 4 e 20s). Irradiations were performed in contact, using the punctual irradiation mode. The following tests were performed cell viability, cell migration and protein analysis. Results obtained suggest that LPT influences epithelial migration and cytoskeleton polarization. Interestingly, LPT effect under epithelial cell migration occurs independently of cell viability. In conclusion, clinical LPT effects are associated with an increase in epithelial cell migration.

Orientador: Juliana Regina Peiró / Banca:Lina Maria Wehrle Gomide / Banca: José Paes de Oliveira Filho / Resumo: As úlceras abomasais atingem bovinos de todas as idades e raças em todos os sistemas de produção, gerando perdas econômicas. A úlcera resulta da isquemia, atraindo leucócitos e macrófagos, estimulando fibroblastos, células endoteliais e epiteliais. A proteína do grupo de alta mobilidade 1 (HMGB1) liga-se a diferentes receptores de superfície celular, incluindo Toll-like-2 (TLR-2) e -4 (TLR-4), produzindo citocinas. A presença da HMGB1 causa aumento dos níveis do fator de crescimento endotelial vascular (VEGF), um regulador fundamental da angiogênese. Assim, investigou-se a participação da HMGB1, TLR-2, TLR-4 e VEGF em úlceras abomasais em bovinos de corte. Um total de 150 abomasos de bovinos de corte foi examinado em um abatedouro; 17 amostras da região cárdica foram colhidas. Os tecidos extraídos foram classificados em grupo normal (sem ulceração de mucosa); ulceração de grau 1 (erosões não perfuradas com lesões mínimas da mucosa) e ulceração de grau 2 (erosões não perfuradas combinadas com sangramento moderado da mucosa) e confirmado pela histopatologia. A expressão dos genes nas amostras normais ou ulceradas no abomaso foi avaliada pela RT qPCR. Os dados foram submetidos à ANOVA seguido por teste de Bonferroni ao nível de p<0,05. Não houve diferença de expressão de HMGB1, de TLR-4 e de VEGF entre os dois tipos de úlceras em relação aos abomasos normais. Úlceras de grau 2 tiveram expressão de TLR-2 superior a úlceras de grau 1. O aumento da expressão de TLR-2 pode estar ass... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Abomasal ulcers affect cattle of all ages and breeds in all production systems, leading to economic losses. The ulcer resulting from tissue ischemia, attracting leukocytes and macrophages, stimulates fibroblasts, endothelial and epithelial cells. The protein of high mobility group 1 (HMGB1) binds to different cell surface receptors, including Toll - like - 2 (TLR - 2) and 4 (TLR - 4) resulting in cytokine production. The presence of HMGB1 causes increased levels of vascula r endothelial growth factor (VEGF), a key regulator of angiogenesis. Thus, it was investigated whether HMGB1, TLR - 2, TLR - 4 and VEGF play a role in abomasal ulcers in beef cattle. A total of 150 abomasums from beef cattle were examined in a slaughterhouse; 17 samples were collected from the cardiac region. The extracted tissues were divided into normal group (without ulceration of the mucosa); type 1 ulcers (unperforated erosions with minimal mucosal injury) and type 2 ulcers (unperforated erosions combined with moderate bleeding of the mucosa) and confirmed by histopathology. Gene expression was evaluated by RT qPCR in samples of normal or ulcerated abomasums. Data were analyzed by ANOVA followed by Bonferroni test at p <0.05. No difference in expression of HMGB1, TLR - 4 and VEGF was detected between the two types of ulcers when compared to normal abomasums. TLR - 2 expression was higher in type 2 ulcers than in type 1 ulcers. Increased TLR - 2 expression might be associated with the maintenance of abomasal healin g, promoting the inflammatory response, as evidenced by the presence of mononuclear cell infiltration and neutrophils / Mestre

Úlceras indolentes são úlceras corneais superficiais, espontâneas, que apresentam curso prolongado e que tendem a recidivar. Comumente observadas em cães de meia idade, da raça Boxer, provoca dor de início agudo e necessita de tratamento específico, já que este, quando não realizado de forma correta, pode prolongar o curso da lesão por semanas a meses. A doença é explicada por diversas alterações da superfície ocular. Com o objetivo de avaliar a eficácia dos tratamentos ambulatoriais preconizados no Serviço de Oftalmologia do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo (HOVET-FMVZ-USP), e as principais considerações observadas no levantamento dos prontuários, realizou-se estudo retrospectivo dos casos atendidos entre os anos de 1997 e 2008. Segundo os resultados, observou-se que a maioria dos cães da raça Boxer apresentaram úlcera indolente, distrofia corneal e catarata; que as úlceras indolentes foram mais frequentemente observadas em fêmeas de meia idade e que a maioria dos proprietários demoraram mais de 15 dias para levar seus animais ao HOVET-FMVZ-USP; que as alterações oculares mais frequentemente referidas pelos proprietários foram o blefarospasmo, olho vermelho e a secreção; que as principais características das lesões observadas após o exame oftalmológico foram que a maioria das úlceras eram transparentes, apresentando epitélio não aderido ou com algum grau de vascularização; unilaterais, mais frequentemente observadas no olho direito; de aparecimento espontâneo e localizadas no centro da córnea. Quanto ao tratamento, observou-se que os inibidores das proteinases foram as medicações mais frequentemente prescritas e que sua administração não interferiu no tempo de cicatrização corneal ou na formação de granuloma. Vitamina C, apesar de ter prolongado de maneira significante o tempo de cicatrização corneal, reduziu a inflamação, consideração observada pela diminuição da presença de granuloma. Debridamento/cauterização corneal, além de não interferir na formação de granuloma, acelerou, significativamente, o processo de cicatrização. A antibioticoterapia e a administração de Atropina 1 % não interferiu no tempo de cicatrização, mas se relacionaram diretamente, de forma estatisticamente significante, à presença de granuloma. O uso de anti-inflamatórios tópicos e sistêmicos também não interferiu no tempo de cicatrização, mas diminuíram, de maneira significante, a presença de granuloma nos cães em que foram administrados. Observou-se também que a não administração de atropina 1 %, antibióticos e anti-inflamatórios não interferiu no tempo de cicatrização, nem na formação de granuloma; que o tempo de alteração ocular, antes da primeira consulta e as características das lesões não interferiram, de maneira relevante, no tempo de cicatrização corneal. Portanto, conhecer os diversos tipos de tratamento se mostra fundamental para o sucesso da resolução da doença, já que este deve ser específico, realizado de forma cautelosa e por tempo indeterminado, cuidando para que a lesão não progrida e promovendo o retorno da transparência corneal. / Indolent ulcers are superficial corneal ulcers that occurs spontaneously, presents prolonged course and tend to relapse. Commonly observed in middle-aged Boxer dogs, causes pain of acute onset and requires appropriate treatment. The disease is explained by several changes on the corneal surface. Aiming to assess the effectiveness of clinical treatments, recommended by the Ophthalmology Service of the Veterinary Hospital, of the Veterinary College, of the University of São Paulo (HOVET-FMVZ-USP) and to evaluate major considerations registered on its medical records, a retrospective study was conducted (1997 2008). Results demonstrated that, during studied period: most Boxer dogs presented indolent ulcers, corneal dystrophy and cataracts; indolent ulcers were frequently observed in middle-aged female Boxers and most owners took more than 15 days to bring their animals to the hospital; blepharospasm, red eye and ocular discharge were the most owner´s referred ocular alterations at the primary consultation; main features of examined lesions were transparent ulcers presenting non adherent epithelium and/or some degree of vascularization; unilateral, often observed at the right eye, of spontaneous onset and located at the center of the cornea. Regarding treatment, proteinase inhibitors were the most often prescribed medications; its administration did not affect corneal healing or granuloma formation. Vitamin C prolonged, significantly, the corneal healing time, although, its administration reduced its inflammation, observed by the decrement on the granuloma frequency. Corneal debridement / cauterization, did not interfere on granuloma formation and was capable to accelerate, significantly, the healing process. Antibiotics and 1 % atropine did not affect the healing time, but were statistically related to the presence of granuloma. Topical and systemic antiinflammatories did not interfere at the healing time, but decreased, significantly, the presence of granuloma. Not to administer atropine 1%, antibiotics and antiinflammatories, did not interfere at the corneal healing time nor the formation of granuloma. Duration period of ocular alterations before the first consultation and characteristics of the lesions did not interfere at the corneal healing time. Therefore, to know the various types of treatments seems to be fundamental to the resolution of the indolent ulcer, as treatment must be specific, performed cautiously and for indefinitely period, preventing the progression of the lesion, and promoting the return of corneal transparency.

Duas questões fundamentais no estudo da evolução pré-biótica (origem da vida) referem-se à estabilidade dos primeiros organismos ou replicadores e à possibilidade do surgimento de organismos complexos através de mutações de organismos mais simples. Esses problemas têm sido tratados quase que exclusivamente no contexto determinístico da cinética química de meios perfeitamente homogêneos, que é equivalente à formulação de campo médio da física estatística. Nesta tese, abordamos essas questões utilizando modelos de replicadores na rede que evoluem no tempo de forma síncrona (autômato celular), dando ênfase ao caso limite em que os replicadores são mantidos fixos nos sítios da rede (processo de contato). Encontramos dois regimes estacionários bem definidos: o regime absorvente ou vácuo e o regime ativo caracterizados, respectivamente, pela ausência e presença de replicadores na rede. Esses regimes são separados por transições de fase cuja natureza depende do mecanismo de reprodução dos replicadores. Essas transições são investigadas de maneira sistemática utilizando-se a técnica de espalhamento de Grassberger e de La Torre em que a evolução temporal de uma pequena colônia de replicadores colocada no centro de uma rede infinita vazia \\\'e acompanhada. Em particular, através do cálculo de expoentes críticos dinâmicos mostramos que, as transições contínuas observadas, pertencem à classe de universalidade da percolação direcionada. Complementamos esse estudo investigando a probabilidade de que uma pequena colônia de replicadores invada uma população de replicadores residentes de outra espécie. Ao contrário dos resultados de campo médio, mostramos que no caso de processos de contato, replicadores mais complexos (por exemplo, assexuados) podem invadir uma população estabelecida de replicadores mais simples (por exemplo, assexuados). Em concordância com os resultados de campo médio, encontramos que nunca ocorre coexistência entre replicadores distintos no equilíbrio. Finalmente, utilizando a técnica de espalhamento mencionada, investigamos de forma sistemática um modelo para formação de úlceras devido à infecção do vírus da herpes (HSV-I) no tecido epitelial da córnea. O modelo considerado tenta explicar as diferentes formas de úlceras-dendríticas e amebóides-resultantes desta infecção como um resultado natural do espalhamento do vírus num tecido epitelial formado por células com diferentes graus de susceptibilidade à infecção. Em particular, mostramos que a transição de fase separando os regimes caracterizados pelas diferentes morfologias pertence à classe de universalidade da percolação ordinária. / Two fundamental questions in the study of prebiotic evolution (origin of life) are concerned to the requisites for the persistence of small colonies of self-replicating molecules (replicators) and to the possibility that complex organisms evolve from simpler organisms as a result of mutations. These issues have been studied mainly in the chemical kinetics formulation of well-mixed medium, which is similar to the mean-field limit of statistical physics. In this work, we address these issues using a cellular automaton formulation, in which the replicators are kept fix in the lattice sites (contact process). In the stationary regime, we find that the system can be characterized by the presence (active phase) and the absence (empty phase) of replicators in the lattice. The detailed study of the phase transitions separating those two phases is carried out using the spreading analysis of Grassberger and de La Torre, in which one concentrates on the spreading behavior of a few active cells in the center of an otherwise empty infinite lattice. The nature of the phase transition, whether continuous or discontinuous, depends on the mechanisms of replication. In particular, in the case that the phase transition is continuous, we find that it is in the universality class of the directed percolation. Complementing this study, we irivestigate the possibility that a small colony of replicators invade a settled population of replicators of another species. Contrary to the results of the mean-field limit, we show that in the contact process limit, complex replicators (such as sexual reproducing ones) have a nonvanishing probability to invade a settled population of simpler replicators (such as asexual reproducing ones). In agreement with the mean-field results, we find that two different species of replicators can never coexist in an equilibrium situation. Finally, using the spreading analysis mentioned before we study the critical properties of a cellular automaton model proposed to describe the spreading of infection of the Herpes Simplex Virus (HSV-I) in the corneal tissue. The model takes into account different cell susceptibilities to the viral infection, as suggested by experimental findings, in order to explain the different shapes of the ulcers - dentritic and amoeboid - that result from the infection. We show that the phase transition separating the regimes where one of the shapes dominates is in the universality class of the ordinary percolation.

Chan Chak Ming. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 178-202). / Abstracts in English and Chinese. / Abstract --- p.i / Abstract in Chinese 摘耍 --- p.iii / Acknowledgements --- p.v / Table of contents --- p.vi / List of tables --- p.xii / List of figures --- p.xiii / Abbreviations --- p.xvi / Chapter Chapter 1: --- Introduction --- p.1 / Chapter 1.1 --- Definition of diabetes mellitus --- p.1 / Chapter 1.2 --- Classification of diabetes mellitus --- p.4 / Chapter 1.2.1 --- Type 1 diabetes --- p.4 / Chapter 1.2.2 --- Type 2 diabetes --- p.5 / Chapter 1.2.3 --- Other forms of diabetes --- p.9 / Chapter 1.3 --- Complications of diabetes mellitus --- p.11 / Chapter 1.4 --- Current treatment of diabetes mellitus --- p.12 / Chapter 1.4.1 --- Type 1 diabetes --- p.12 / Chapter 1.4.2 --- Type 2 diabetes --- p.13 / Chapter 1.4.2.1 --- Diet and exercise --- p.13 / Chapter 1.4.2.2 --- Medication --- p.13 / Chapter 1.5 --- The use of herbal medicines in diabetes treatment --- p.18 / Chapter 1.6 --- "Hypothesis, objectives and design of the project" --- p.22 / Chapter Chapter 2: --- Preparation and authentication of traditional Chinese medicines --- p.23 / Chapter 2.1 --- Introduction --- p.23 / Chapter 2.1.1 --- Background information of the formulae --- p.23 / Chapter 2.1.2 --- Component herbs of formula1 --- p.26 / Chapter 2.2 --- Objectives --- p.29 / Chapter 2.3 --- Materials --- p.30 / Chapter 2.3.1 --- Raw herbal materials and formula 1 extract --- p.30 / Chapter 2.3.2 --- Thin layer chromatography --- p.35 / Chapter 2.3.3 --- High performance liquid chromatography determination of the sugar content of the herbal extracts --- p.38 / Chapter 2.4 --- Methods --- p.41 / Chapter 2.4.1 --- Thin layer chromatography of the component herbs --- p.41 / Chapter 2.4.2 --- Raw herbal materials water extraction --- p.46 / Chapter 2.4.3 --- High performance liquid chromatography determination of the sugar content of the herbal extracts --- p.46 / Chapter 2.5 --- Results --- p.49 / Chapter 2.5.1 --- Thin layer chromatography of the component herbs --- p.49 / Chapter 2.5.2 --- Raw herbal materials water extraction --- p.56 / Chapter 2.5.3 --- High performance liquid chromatography determination of the sugar content of the herbal extracts --- p.57 / Chapter 2.6 --- Discussion --- p.62 / Chapter Chapter 3: --- The anti-diabetic effects of formula 1 and its component herbs in vitro --- p.67 / Chapter 3.1 --- Introduction --- p.67 / Chapter 3.1.1 --- Glycaemic control in type 2 diabetes --- p.67 / Chapter 3.1.2 --- Type 2 diabetes and peripheral tissues --- p.70 / Chapter 3.1.3 --- Type 2 diabetes and liver --- p.73 / Chapter 3.1.4 --- Type 2 diabetes and intestinal glucose absorption --- p.76 / Chapter 3.2 --- Objectives --- p.79 / Chapter 3.3 --- Materials --- p.80 / Chapter 3.3.1 --- Cell lines --- p.80 / Chapter 3.3.2 --- "Cell culture media, buffers, reagents and culture wares" --- p.81 / Chapter 3.3.3 --- "Chemicals, media and reagents for 3T3-L1 differentiation" --- p.83 / Chapter 3.3.4 --- Chemicals and reagents for 3T3-L1 and Hs68 2-deoxy-D- glucose (2-DG) uptake assay --- p.84 / Chapter 3.3.5 --- Chemicals and buffers for H4IIE glucose production assay and phosphoenolpyruvate carboxykinase (PEPCK) assay --- p.85 / Chapter 3.3.6 --- "Animal, buffers and reagents for preparation and glucose uptake assay of brush border membrane vesicles (BBMV)" --- p.87 / Chapter 3.3.7 --- Reagents for bicinchoninic acid (BCA) protein assay --- p.88 / Chapter 3.4 --- Methods --- p.89 / Chapter 3.4.1 --- Cell culture --- p.89 / Chapter 3.4.2 --- Studies on glucose uptake in 3T3-L1 adipocytes and Hs68 fibroblasts --- p.90 / Chapter 3.4.2.1 --- Differentiation of 3T3-L1 cells --- p.90 / Chapter 3.4.2.2 --- Oil red O staining of the 3T3-L1 cells --- p.90 / Chapter 3.4.2.3 --- 2-DG uptake assay of 3T3-L1 adipocytes and Hs68 fibroblasts --- p.91 / Chapter 3.4.3 --- Studies on gluconeogenesis in H4IIE hepatoma cells --- p.93 / Chapter 3.4.3.1 --- Glucose production assay --- p.93 / Chapter 3.4.3.2 --- PEPCK assay --- p.94 / Chapter 3.4.4 --- Studies on BBMV glucose uptake --- p.95 / Chapter 3.4.4.1 --- Preparation of BBMV --- p.95 / Chapter 3.4.4.2 --- Preparation of the chloroform extract of the herbal water extract --- p.96 / Chapter 3.4.4.3 --- Glucose uptake assay of BBMV --- p.97 / Chapter 3.4.5 --- BCA (Bicinchoninic acid) protein assay --- p.99 / Chapter 3.4.6 --- Statistical analysis --- p.100 / Chapter 3.5 --- Results --- p.101 / Chapter 3.5.1 --- Glucose uptake assay in 3T3-L1 adipocytes and Hs68 fibroblasts --- p.101 / Chapter 3.5.2 --- Glucose production and PEPCK assay in H4IIE hepatoma cells --- p.108 / Chapter 3.5.3 --- Glucose uptake assay in BBMV --- p.113 / Chapter 3.6 --- Discussion --- p.119 / Chapter 3.6.1 --- Glucose uptake in 3T3-L1 adipocytes and Hs68 fibroblasts --- p.119 / Chapter 3.6.2 --- Glucose production and PEPCK activity in H4IIE hepatoma cells --- p.123 / Chapter 3.6.3 --- Glucose absorption in BBMV --- p.125 / Chapter 3.6.4 --- Conclusion --- p.128 / Chapter Chapter 4: --- The anti-diabetic effects of formula 1 and Rhizoma Smilacis Chinensis in vivo --- p.131 / Chapter 4.1 --- Introduction --- p.131 / Chapter 4.1.1 --- Diabetic animal models --- p.131 / Chapter 4.1.2 --- Neonatal streptozotocin-induced diabetic rat model --- p.133 / Chapter 4.2 --- Objective --- p.136 / Chapter 4.3 --- Materials --- p.137 / Chapter 4.3.1 --- Animals --- p.137 / Chapter 4.3.2 --- Chemicals and reagent kit --- p.137 / Chapter 4.4 --- Methods --- p.139 / Chapter 4.4.1 --- Induction of diabetes in rats --- p.139 / Chapter 4.4.2 --- Oral glucose tolerance test --- p.139 / Chapter 4.4.3 --- Basal glycaemia test --- p.141 / Chapter 4.4.4 --- Plasma glucose level determination --- p.142 / Chapter 4.4.5 --- Statistical analysis --- p.142 / Chapter 4.5 --- Results --- p.143 / Chapter 4.5.1 --- Oral glucose tolerance test --- p.143 / Chapter 4.5.2 --- Basal glycaemia test --- p.147 / Chapter 4.6 --- Discussion --- p.151 / Chapter Chapter 5: --- The effects of the TCM treatment on glucose homeostasis in diabetic foot ulcer patients --- p.155 / Chapter 5.1 --- Introduction --- p.155 / Chapter 5.2 --- Objective --- p.156 / Chapter 5.3 --- Materials --- p.157 / Chapter 5.3.1 --- Study subjects --- p.157 / Chapter 5.3.2 --- Blood sample --- p.158 / Chapter 5.3.3 --- Chemicals and reagents for erythrocyte glucose uptake assay --- p.158 / Chapter 5.4 --- Methods --- p.160 / Chapter 5.4.1 --- Preparation of blood sample --- p.160 / Chapter 5.4.2 --- Zero-trans influx of 3-OMG uptake in erythrocytes --- p.160 / Chapter 5.4.3 --- Statistical analysis --- p.161 / Chapter 5.5 --- Results --- p.162 / Chapter 5.6 --- Discussion --- p.166 / Chapter Chapter 6: --- General discussion and conclusion --- p.168 / Chapter 6.1 --- Overview of the project and analysis of research findings --- p.168 / Chapter 6.2 --- Limitations of the study --- p.173 / Chapter 6.3 --- Future directions --- p.174 / Chapter 6.4 --- Conclusion --- p.177 / Chapter Chapter 7: --- References --- p.177 / Appendices --- p.203 / Appendix I The determination of the sugar contents in the herbal water extracts by high performance liquid chromatography --- p.203 / Appendix II Basal glycaemia test of formula 1 (822mg/kg) on nO-STZ rats --- p.206

A total of 180 patients participated in the study, with 30 withdrawn due to various reasons. At 12 weeks, 76% patients treated with SSB, 78% patients treated with 4LB, and 31% patients treated with usual care alone had completed ulcer healing. The hazard ratios for healing for 4LB and SSB relative to the control group were 3.14 (95% CI = 1.74-5.67) and 2.72 (95% CI = 1.53-4.86), respectively. The key findings indicated the significant effects of compression bandaging resulted in a higher proportion of complete ulcer healing; reduction in ulcer size, pain severity, and pain interference; and improvement in quality of life and lifestyle activity. Across the 12-week study period, the present study also highlighted the significant improvement of the psychosocial composite outcome among the three study groups. Furthermore, the reduction in pain severity and pain interference accounted for the major contribution to the total effect of the psychosocial composite outcome. Therefore, effective pain control and minimizing the effect of pain on daily life is essential in promoting ulcer healing. It is evident that the application of compression bandaging with either 4LB or SSB is feasible and more effective than the current usual care with no compression. This study add new knowledge to the psychosocial benefit of compression bandaging for venous ulcer patients living in the community; and support incorporating compression bandaging in the routine venous ulcer care. Further studies are therefore suggested to focus on the assessment of the cost-effectiveness of and the satisfaction and experience of both patients and nurses with compression bandaging using different high compression bandage systems. / The study was a randomized controlled trial. Those patients who participated in the experimental groups received compression bandaging with either the 4LB or SSB along with a local usual care. In contrast, the control group participants received usual care. A 12-week study intervention was given individually to the study participants. The research outcome of this study was the proportion of complete ulcer healing, ulcer size, pain severity, pain interference, disease-specific and generic health-related quality of life measures, and lifestyle activity. The instruments used include VeV MD stereophotogrammetry, Brief pain Inventory, The SF-12 Health Survey, Charing Cross Venous Ulcer Questionnaire, and the Frenchay Activity Index. Data analysis involved the use of descriptive statistics and inferential statistics such as survival analysis, one way analysis of variance (ANOVA), multivariate analysis variance (MANOVA), doubly multivariate analysis of variance (Doubly MANOVA), and Roy-Bargman stepdown analysis were used. / Venous ulcer is the most serious clinical consequence of chronic venous insufficiency. It is a chronic health problem that afflicts older people as well as health care professions. Its chronicity, together with its high recurrent rate, creates not only a big challenge to nurses' workload and health cost, but it also has a direct impact on patients' physiological and psychosocial well-being. Compression bandaging has been identified as the mainstream form of treatment for venous ulcer in previous literature, although this is not very well known by the nurses in Hong Kong. Previous studies have confirmed that the proportion of complete ulcer healing is improved with high compression as compared to no compression. However, a definite conclusion on the effectiveness of different high compression systems, such as the four-layer compression system (4LB) and short-stretch compression system (SSB), was not found. Most importantly the treatment impacts on proportion of complete ulcer healing, ulcer size, pain severity and pain interference, health-related quality of life, and lifestyle activities are essential influences on patients' participation in venous ulcer care and treatment choice. These limited data leave a gap in today's knowledge on venous ulcer management in relation to both patients and health care providers. Therefore, the aim of this study is to examine the effect of two compression bandage systems, the 4LB and SSB, in promoting ulcer healing in terms of the proportion of complete ulcer healing and ulcer size, as well as the psychosocial well-being including pain, heath-related quality of life, and lifestyle activity for older people in the community. / Wong, Kit Yee Irene. / "December 2007." / Adviser: Diana T. F. Lee. / Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4672. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 248-268). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

Bakgrund: Diabetes mellitus är en kronisk folksjukdom som drabbar miljoner människor över hela världen. Denna långvariga sjukdom kan leda till komplikationer som svårläkta fotsår som medför lidande för patienten, begränsar vardagen och sänker livskvaliten, vilket i svåra fall kan leda till amputation. Dessa svårläkta fotsår kostar samhället massor vilket är ett bekymmer. Syfte: Syftet med denna litteraturstudie var att beskriva sjuksköterskans arbete i förebyggandet av fotsår hos personer med diabetes mellitus samt att beskriva de ingående artiklarnas undersökningsgrupp. Metod: En beskrivande litteraturstudie som baserats på tio vetenskapliga artiklar, åtta med kvantitativ ansats, en med kvalitativ ansats samt en med mixad ansats. Artiklarna söktes i sökmotorn PubMed samt databasen Cinahl. Resultat: Det finns några punkter som spelar stor roll i förebyggandet av diabetes fotsår. Detta är att sjuksköterskor ska identifiera risker hos personer med diabetes. Detta görs med hjälp av olika instrument för att upptäcka neutrovaskulärpati. Det andra sättet i förebyggandet är att öka kunskap hos personer med diabetes och vägleda dem till egenvård. Detta möjliggörs genom att ge fotvårdsutbildning till patienter för att sköta sina fötter och på så sätt förhindra uppkomsten av fotsår och fotkomplikationer. Det sista resultatet som kom fram i den här litteraturstudien är att ett samarbete mellan olika vårdprofessioner krävs i det förebyggande arbetet. Framför allt är ett bra samarbete mellan sjuksköterskor och undersköterskor som är angeläget.   Slutsats: Olika faktorer kan påverka positivt på förebyggandet av fotsår hos personer med diabetes. Dessa faktorer är att identifiera risker, upptäcka neurovaskulärpati i tid, öka kunskap hos dessa personer och vägleda dem till egenvård samt skapa en bra kommunikation mellan olika vårdprofessioner. / Background: Diabetes mellitus is a chronic disease that affects millions of people worldwide. This long-lasting disease may have bad complications like chronic foot ulcers that causes suffering for the patient, limits the everyday life and lowers quality of life and severe cases can lead to amputations. The slow-healing foot ulcers costs society a lot, which is a concern. Purpose: The purpose of this study was to describe the nurse's work in the prevention of foot ulcers in people with diabetes mellitus and to describe the depth of the articles study group. Method: A descriptive literature study based on ten scientific articles, eight of the quantitative approach, a qualitative approach and a mixed approach. Articles were searched in the databases CINAHL and PubMed. Results: There are some points that play a major role in the prevention of diabetic foot ulcers. This is nurses to identify risks in people with diabetes. This is done using a variety of instruments to detect neutrovaskulärpati. The other way of prevention is to increase the knowledge of the person with diabetes and to guide the self-care. This made real by providing foot care training patients to manage their feet and so prevent the formation of ulcers and foot complications. The final results came in this literature is that cooperation between different health care professions needed in preventive work. Above all, a good collaboration between nurses and assistant nurses are set location. Conclusion: Various factors can affect positively on the prevention of foot ulcers in people with diabetes. These factors are to identify risks and detect neurovaskulärpati in time, increase the knowledge of these people and guide them to self-care and good communication between various health care professions.