There was little damage to body image and sense of manliness Thi

There was little damage to body image and sense of manliness. This information may play a key role in the choice of penis cancer treatment leading to the maintenance of a good sexual life. These results could also be the first step in the development of targeted interventions on sexuality in this population. “
“Management of recurrent neoplasms remains a clinical challenge. Despite aggressive surgery, chemotherapy, and/or radiotherapy, locally advanced cancers recur in 15–50% of patients (1). Locoregional relapse TSA HDAC after resection of colorectal cancer is associated with poor prognosis, with median survival

of 11–15 months, and often as few as 5% of patients survive 5 years (2). Intraoperative radiotherapy (IORT) has been advocated (3) as a component of an aggressive multidisciplinary management in T4 or recurrent tumors. It seems to provide improvement in tumor local control (LC), while limiting dose to normal adjacent structures and minimizing

toxicity; this has been the rationale for its use. It is given as a single fraction with doses ranging from 10 to 20 Gy, which has been estimated to have the cell-killing equivalence of two to three times the dose using conventional external beam radiotherapy (EBRT) (3). IORT can be delivered by several different techniques: electron beam therapy, orthovoltage radiotherapy, and high-dose-rate (HDR) brachytherapy. Most centers use intraoperative electron radiotherapy (IOERT) where the radiation is delivered by a linear accelerator DZNeP thorough a rigid cone directed to the tumor bed. For HDR brachytherapy technique, a flexible applicator is placed PIK3C2G in direct contact to the area to be treated and source guide tubes are connected to an afterloader system to deliver the radiation via a 192Ir source. At our institution, IORT is delivered with HDR brachytherapy using the

Harrison–Anderson–Mick (HAM) applicator (Mick Radio-Nuclear Instruments, Inc., NY) that allows a very conformal treatment even on curved and deep body surfaces (4). The use of HDR-IORT is also ideal in particular sites, such as the lateral pelvic sidewall or deep in the pelvis, as well as in pediatric patients, where an electron rigid cone could be relatively inaccessible. Usually, a square/rectangular area is treated. This multiple-channel applicator and the use of computerized treatment planning systems allow for dose optimization by varying source positions and dwell times. The dose can be sculpted inside of the target area permitting dose escalation or de-escalation, allowing for planned nonhomogenous dose distributions or dose painting (DP). This DP technique allows the sites highly suspicious for positive microscopic disease or close margins to be treated to higher doses, while minimizing dose to areas of subclinical spread; normal organs could also be more effectively spared from high or unnecessary doses of radiation.

Because the subtests designed to probe the central executive and

Because the subtests designed to probe the central executive and phonological loop depend heavily Avasimibe research buy on language, it is possible that the observed working memory deficits in the participants with SLI might be due to their language problems rather than to working memory deficits per se. Therefore we performed additional analyses in which we covaried out a measure of language abilities. We computed a single composite variable of language by submitting the four measures of language (expressive and receptive lexical and grammatical abilities; see Table 2) to a principal components analysis, and extracted

a single factor. This approach aims to create a composite variable that maximizes the shared variance of all four language measures, and minimizes the variability that is unique to a single measure or is shared only between two or three of them. The four measures accounted for Adriamycin order 67.7% of the variance in the language factor. The factor loadings were as follows: Expressive Vocabulary = .853, Receptive Vocabulary = .832, Expressive Language = .769 and Receptive Grammar = .834. The MANCOVAs with the language factor included as covariate yielded significant multivariate group effects both for the central executive (p < .001) and phonological loop subtests (p < .001), although with a reduction of effect sizes in both cases ( Table 3, Covariates: Language

Factor). The post-hoc univariate tests controlling for language abilities revealed significant differences on all the central executive and Chlormezanone phonological loop subtests except the Word List Matching subtest, mostly with medium (partial η2 ≥ .059) or large effect sizes ( Table 4, under “Covariate: Language Factor”). The next set of analyses tested SLI-TD group differences on the CMS, to examine declarative memory for verbal and visual information. Results from between-subjects MANOVAs revealed a significant multivariate group effect for the subtests probing verbal information (p < .001), with a large effect size, but not for the subtests of visual information (p = .350),

which yielded a small effect size ( Table 3, Covariates: None). The post-hoc univariate tests ( Table 5, under “No covariates”) yielded significant group differences, with medium to large effect sizes, on all measures designed to assess verbal aspects of declarative memory. In contrast, small effect sizes were found on all visual subtests, only one of which showed a significant group difference. Many of the subtests from the CMS require children to temporarily store information, and thus the observed group differences could in part be explained by working memory deficits rather than problems with declarative memory itself. Group differences on the CMS were therefore examined while controlling for working memory.

15 (Table 2) (Gundersen et al , 1999) The estimation of DG micro

15 (Table 2) (Gundersen et al., 1999). The estimation of DG microglia mean body cell volume, microglia mean body cell number, and DG volume, was assisted by Stereologer™ software (Stereology Resource Center, Chester, MD). The software was installed on a Dell Optiplex tower computer and connected to a Nikon Eclipse E600 microscope

(Nikon, Melville, NY) fitted with an X–Y–Z motorized stage controller (Prior Scientific, Rockland, MA), linear encoder microcator (z-axis gauge) (Heidenhain, Schaumburg, IL), high resolution color video camera (IMI Tech, Inc., Encinitas, CA) buy Trichostatin A and .50 C-mount (Nikon, Melville, NY). DG volume was estimated at 4× (Nikon Plan 4× 0.10); click here DG microglia mean cell volume and mean cell number were estimated at 60× (Nikon Plan APO 1.40 Oil). The camera image was processed with a high resolution video card and displayed on a 21 in. high resolution Dell monitor. One experimenter (C.S.) collected all of the stereological data without knowledge of the blood Pb level of each subject;

the experimenter was not blind to treatment group. An unbiased estimate of the number of microglia in the DG was obtained using the optical fractionator method (West et al., 1991) as reported previously for quantification of total number of microglia in mouse models of aging and neuropathology (Mouton et al., 2002). For each section the software randomly sampled virtual 3-D counting frames (disector) at 60× magnification with a 2 μm guard area. Using thin-focal

plane optical scanning, microglia were counted when they fell within the central depth of the counting frame and/or touched the inclusion lines. The total number of microglia was estimated with the following Anidulafungin (LY303366) formula: Nobj = ΣQ− × 1/SSF × 1/ASF × 1/TSF; where ΣQ− = sum of the objects sampled; SSF = sampling interval; ASF = total area sampled/total area on all sampled sections; and TSF = the height of the sample/total section thickness. For each frame, mean cell volume was quantified on microglia counted with the disector probe. The dentate gyrus reference volume (V(ref)) was determined at 4× magnification using the Cavalieri-point counting approach ( Gundersen and Jensen, 1987): V(ref) = ([k × t] × ∑P × [a(p)/M2]); where: k = sampling interval; t = post-processing section average thickness; and thus [k × t] = distance between planes; ∑P = sum of points counted; [a(p)/M2] = test grid area per point (μm2) divided by the magnification factor squared. Examples of microglia images are provided in Fig. 4. SAS Version 9.2 statistical software was used for all analyses. All data were entered and checked for accuracy and distribution properties prior to analysis. No extreme outliers were identified, and all data were included for analysis.

Ethylene glycol is a CPA commonly used in vitrification solutions

Ethylene glycol is a CPA commonly used in vitrification solutions for bovine embryos [35] and [7] and Aqp3 channel may participate in the diffusion rate of this CPA during vitrification. Considering that dehydration and rehydration are important events during cryopreservation, this study aimed to evaluate the effect of culture media and stage of development in the osmotic ability of in vitro-fertilized bovine embryos. In addition, the relative expression of Aqp3 and Na/K ATPase isoform alpha 1 (ATPase1) gene was also evaluated in blastocysts with

different ability to undergo rehydration and after vitrification. Selleckchem Caspase inhibitor All chemicals were from Sigma Chemical (St. Louis, MO, USA) unless stated otherwise. Three experiments were carried out in order to evaluate: (1) the effect of culture media and stage of development in the capacity of in vitro-fertilized bovine embryos to undergo shrinkage and swelling; (2) the expression of Aqp3 and ATPase1 genes in embryos with different ability to undergo rehydration and; (3) the expression of Aqp3 and ATPase1 genes in embryos after vitrification/warming. Two trials were performed. In the first one, in vitro fertilized presumptive zygotes were co-culture with their own cumulus cells in SOFaac [14] or modified CR2aa (modified from Rosenkrans Jr. and First buy 17-AAG [27] – sodium chloride 108.0 mM,

potassium chloride 3.0 mM, sodium bicarbonate 26.0 mM, hemicalcium lactate 5.0 mM, sodium pyruvate 0.36 mM, glycine 10.0 mM, alanine 1.0 mM, glutamine 1.0 mM, minimal essential

medium amino acids [MEM] 10 μL/mL, basal medium Eagle [BME] amino acids 20 μL/mL and BSA 3 mg/mL), both supplemented with 10% fetal calf serum (FCS). Data of cleavage was collected at 72 h post insemination and blastocyst production at day 7 and 8 post-insemination. Six replicates were performed. The second trial evaluated the ability of blastocysts and expanded blastocysts, co-cultured in CR2aa or SOFaa as in the first trial, to undergo shrinkage and swelling. Embryos at day 7 post-insemination were exposed to a buffered hypertonic Rebamipide medium with 900 mOsm (TALP-HEPES supplemented with NaCl) for 5 min and then transferred to an isotonic medium where they remained for 10 min. Afterwards the embryos were cultured in CR2aa medium under 5% CO2 and 39 °C for 120 min. Pictures of embryos from each culture media were taken at 0, 5, 10 and 120 min (T0, T5, T10 and T120, respectively), for further area measurement and dehydration and rehydration calculations. Ability in dehydrate and rehydrate of embryos co-cultured in CR2aa or SOFaac and of embryos at different stages of development (blastocyst and expanded blastocyst) were compared. Six replicates were performed. In this experiment embryos cultured in CR2aa plus 10% (FCS) for 7 days post-insemination were exposed to a hypertonic medium in the same conditions of experiment 1.

, 2006) In a review by Nel et al (2006) a question, “Do nanomat

, 2006). In a review by Nel et al. (2006) a question, “Do nanomaterials properties necessitate a new toxicological science?” was raised. It was argued that the main characteristic of nanomaterials is their size in the transitional zone between individual

atoms or molecules and the corresponding bulk materials. This can modify the physicochemical properties of the material as well as create the opportunity for increased uptake and interaction with biological tissues (Chithrani et al., 2006 and Sonavane et al., 2008). This combination of effects can generate adverse biological responses in living cells GDC-0199 order otherwise not seen with the same material in larger (bulk) form (Nel et al., 2006). The increase in surface area determines the potential number of reactive groups on the particle surface. Table 1 summarizes the observed biological effects vis-à-vis physicochemical properties and the types of nanomaterials. Shape of the nanoparticles has been shown to have a pronounced effect on the biological activity. It is reported that silver nanoparticles undergo shape-dependent interaction with E. coli ( Pal et al., 2007); Chithrani et al. (2006) reported better uptake of spherical gold nanoparticles than gold nanorods in HeLa cells. In case of anatase TiO2 nanomaterial, it was shown that alteration to a fiber structure of greater Forskolin price than 15 μm created a highly toxic particle that initiated an inflammatory response by alveolar macrophages

and that length may be an important determinant of nanomaterial biocompatibility ( Hamilton et al., 2009). Another study by Journeay et al. (2008) demonstrated that water-soluble rosette nanotube structures display low pulmonary toxicity due to their biologically inspired design and self-assembled architecture. In a review on widely used metal oxide and carbon nanomaterials,

Landsiedel et al. (2010) emphasized that physico-chemical characterization www.selleck.co.jp/products/AG-014699.html of nanomaterials and their interaction with biological media are essential for reliable studies. In a study with 1.5 nm sized gold nanoparticles it was observed that surface charge was a major determinant of their action on cellular processes; the charged NPs inducing cell death through apoptosis and neutral NPs leading to necrosis in HaCaT cells ( Schaeublin et al., 2011). Considering the physicochemical properties of various nanomaterials and their interactions with the biological environment, Maynard et al. (2011) state that the challenges presented by simple nanoscale materials such as TiO2, ZnO, Ag, carbon nanotubes, and CeO2 are now beginning to be appreciated. But these simple materials are merely the vanguard of a new era of complex materials, where novel and dynamic functionality is engineered into multifaceted substances. Further, according to Maynard et al. (2011), if we are to meet the challenge of ensuring the safe use of this new generation of substances, it is time to move beyond “nano” toxicology and toward a new toxicology of sophisticated materials.

Purine nucleoside analog

Purine nucleoside analog buy BIRB 796 (PNA) therapy induces a high complete response (CR) rate both during initial therapy and as re-induction therapy, however the greatly expanded life expectancy that has been achieved with PNA therapy has created the need for alternative therapies with novel mechanisms of action for the treatment of patients with chemotherapy-resistant disease or treatment-associated marrow damage [9], [10], [11], [12] and [13]. Many questions remain unanswered and deserve further clinical investigation to truly optimize the outcomes for patients with this disease [7]. The WHO now recognizes classic hairy cell leukemia (HCLc) and the variant of hairy cell leukemia (HCLv) as two

distinct clinical entities, representing a major advancement in the further biologic characterization of these diseases [14] and [15]. Although the variant accounts for only learn more about 10% of cases of hairy cell leukemia, its definition and clinical recognition as a distinct entity are considerably important, as these patients typically have more aggressive disease with worse response to standard therapies [16]. This difference is dramatic: whereas up to 90%

of patients with classical HCL may achieve a CR with PNA therapy alone, fewer than 50% of variant patients do [17]. Recently, Kreitman showed that cladribine combined with rituxan produced a high complete response in HCLv but follow-up will be needed [17]. Correct identification of HCLv is important in light of these differential responses to therapy as well as for potential eligibility in clinical trials of new agents. Patients with the classic form of this disease have a distinct immunophenotypic profile on their malignant leukemic cells: CD20+, CD19+, CD11c+, CD25+, CD103+, Loperamide and CD123+. In contrast, the leukemic

cells from patients with the variant form of hairy cell leukemia are characterized as being CD11c+, CD20+, and CD19+; whereas CD25 and CD123 are typically negative (Table 1) [7], [18] and [19]. Recently additional molecular features that distinguish these different subsets of the disease have been identified [20] and [21]. Patients with classic hairy cell leukemia predominantly have cells that possess the BRAF p.V600E mutation, with both diagnostic and therapeutic implications. Patients with the variant HCL do not have this mutation, but show wild type BRAF. With the introduction of BRAF inhibitors, and with the lower response rate of HCLv to standard therapies, determination of BRAF mutation status is therefore important in distinguishing these entities. While Tiacci initially identified the specific BRAF V600E mutation by genome analysis with Sanger sequencing, recently a mutation-specific antibody (VE1) has been developed that can be used to recognize this mutation on formalin-fixed paraffin embedded tissue sections.

The slides were again placed in phosphate buffered saline (0 01 M

The slides were again placed in phosphate buffered saline (0.01 M PBS [pH 7.4]) and allowed PLX4032 in vivo to cool at room temperature for 30 min. All of the immunomarkers that were evaluated were examined on slides that underwent treatment for antigen retrieval. The endogenous biotin was blocked using 0.02 M PBS/0.3% Triton X100 (pH 7.4) and

5% skim milk for 4 h at room temperature. Incubation with anti-FasL rabbit polyclonal antibody (C-178, 1:500; Santa Cruz Biotechnology), anti-Fas rabbit polyclonal antibody (FL-335, 1:200; Santa Cruz Biotechnology), anti-cleaved caspase-8 mouse monoclonal antibody (AP1013, 1:100; Calbiochem), anti-cleaved caspase-3 rabbit polyclonal antibody (AP1027, 1:500; Calbiochem), anti-IDH1 rabbit polyclonal antibody (AP7454a, 1:50; Abgent), or anti-MGMT mouse monoclonal antibody (SPM287, 1:150; Santa Cruz Biotechnology) diluted in PBS with 1.0% bovine serum albumin (Sigma, USA) lasted for 12 h in a moist chamber at 4 °C. The slides were then washed in PBS and incubated

with secondary biotinylated antibody followed by streptavidin–biotin-peroxidase (anti-mouse or anti-rabbit Kit LSAB, DAKO) for 30 min each. Finally, to visualize the reactions, the slides were incubated with light-sensitive 3,3′-diaminobenzidine tetrahydrochloride (Sigma) in 0.05 M PBS (pH 7.6) and quickly IDO inhibitor counterstained with Harris hematoxylin. Coverslips were applied using Entellan (Sigma). A positive reaction was visualized as a brown deposit in the cell that indicated an area where the antigen–antibody reaction had occurred. Negative and positive controls were run simultaneously. Lymphoid tonsil tissue with follicular germinative centers was used as a positive control for FasL, Fas, cleaved caspase-8, heptaminol and cleaved caspase-3.

Placenta and normal colon, which had immunohistochemistry performed separately from the TMAs, were used as positive controls for IDH1 and MGMT, respectively. Negative controls consisted of slides that underwent the same procedure, except the incubation with primary antibody was eliminated. The staining patterns were analyzed according to their distribution and intensity, and the pathologists were blinded to the clinicopathological data of the GBM patients. A numerical scoring system consisting of 2 categories was used to assess FasL, Fas, cleaved caspase-8 and cleaved caspase-3 expression. Category A documented the number of immunoreactive cells (only ones with their respective nuclei inside were counted) as follows: 0 or negative (no immunoreactive cells or <10% immunoreactive cells), 1 (≥10% and <50% immunoreactive cells), or 2 (≥50% immunoreactive cells). Category B documented the intensity of the immunostaining as follows: 0 or 1 (no immunostaining or weak staining, respectively) or 2 (moderate or strong). The values for categories A and B were summed to provide an “immunoreactivity score”, which could range from 0 to 4.

1) The incubations

proceeded for 1 h, at 37 °C Four rea

1). The incubations

proceeded for 1 h, at 37 °C. Four readings of each concentration were recorded at intervals of 60 s at 37 °C and 450 nm with constant stirring at 600 rpm in a UV/visible HP 8453 spectrophotometer. The absorbance used to calculate the AZD2281 clinical trial enzyme activity was the average per min of these 4 readings. The concentrations of protein samples were evaluated using the Bradford method (1976) before the enzyme evaluations because all of the enzyme activities were reported in terms of μmol/min/g of protein. Calpain activity in the chicken brain and neuroblastoma cells was analyzed as described elsewhere (Emerick et al., 2010), but before the assay, tissue homogenate was incubated with mipafox (0.01 mM) or (+)-methamidophos (10 mM) or (−)-methamidophos (100 mM) for one hour, at 37 °C. CaCl2 in a concentration of 4 mM was added in the follow proportion: 1 g of tissue or 1 ml of cells (1 × 107/ml)/0.01 ml of OP in ethanol/1 ml of CaCl2. The concentrations of OPs used were based on the NTE inhibition with concentration for each compound selleck screening library causing at least 80% NTE inhibition. Inhibitor concentrations capable of inhibiting 50% of enzyme activity (IC50) were determined using the equation of the line graph of the log of % activity versus the concentration of inhibitor (semilog plots). The semilog plots

are not shown to avoid repetitions of results. The regression coefficients of these lines were calculated using the method of least squares. Differences in biochemical see more analyses were examined for statistical significance by one way ANOVA (Analysis Of Variance) followed by Tukey’s test for multiple comparisons. These tests were performed in Microsoft Office Excel 2007 for Windows. The definition of significance was p < 0.05 for all statistical analyses. All biochemical data are presented as the averages of three samples done in triplicate (n = 3). All biochemical data are expressed as means ± the standard deviation (SD). Control values for NTE and AChE activities

in hens and humans are presented in Table 1. All of the coefficients of variation remained below 20%. AChE activity was not evaluated in the hens’ erythrocytes because a previous study showed that this activity could not be detected (Wilson and Henderson, 1992). The potencies of the isomers of methamidophos against NTE and LNTE differed. The inhibition curves of NTE in hens and humans are depicted in Fig. 2A, C, E and G and IC50 values are reported in Table 2. These data indicate that the (+)-methamidophos form was a more potent inhibitor of NTE than the (−)-methamidophos form. The (−)-methamidophos isomer exhibited an IC50 value approximately 5.6 times greater than did the (+)-methamidophos isomer for the LNTE activity of hen and approximately 4 times that observed for the inhibition of human LNTE activity. The percentage activity versus inhibitor concentrations exhibited high inverse regression coefficients for all NTE activities ( Table 2).

For researchers looking to report relative comparison of various

For researchers looking to report relative comparison of various samples within a single patient cohort and research centre, our approach may be acceptable provided that a single batch of identical standards is

used. Breen et al. (2011) reached similar conclusions. Our study identified imprecision as a potential important limitation of Luminex assays. Repeatability in this study showed high intra-assay %CV values (samples: 15–40%, standards: ≤ 25%) compared with some published data on Luminex kits (Biagini et al., 2004) but were consistent with others (Djoba Siawaya et al., 2008). This imprecision may in part be due to our repeated samples being closer to the LLOQ of each kit, as we were particularly interested in kit sensitivity. Subsequent evaluation of our final ABT-888 mouse method showed improved intra-assay precision for standards (< 15%). In summary, in our hands the MILLIPLEX kit delivered most consistent spiked cytokine recovery (35–50% accuracy), most consistent sensitivity at the lower limit of quantification, the greatest linear dynamic range, the lowest rates of bead aggregation and low bead counts, and the lowest sample volume requirements. We therefore selected MILLIPLEX

kits for future studies, including high-sensitivity bead Fulvestrant mouse kits and use of magnetic plate washing. Interestingly Serelli-Lee et al. (2012) recently used MILLIPLEX assays to analyse mucosal cytokine levels in human gastric biopsies, although used traditional ELISA kits for IL-17 and IFNγ. We found that simple manual methods of disruption and homogenisation were consistently superior to automated methods 3-mercaptopyruvate sulfurtransferase with superior accuracy. This was unexpected but may be the result of sample loss across the relatively large surface area of the 5 mm beads used for

automated processing or from cytokine degradation. However we also observed that homogenisation with a needle and syringe can lead to sample loss in equipment dead space, which can be avoided by aspiration into a pipette tip with similar orifice diameter. We were restrained by sample availability for optimisation (four pairs of biopsies each from four patients) so additional methodological variables could not be empirically evaluated. For example, a sonication-based approach would need detailed optimisation and, like rotor–stator homogenisation, has the disadvantages of sample heating and the need for larger extraction buffer volumes. We also avoided enzymatic, ionic detergent and chemical methods in anticipation of potential protein degradation and impacts on down-stream analysis. This is supported by our finding that commercial protein extraction kits were unsuitable, though others have used non-ionic detergents with success (Luzza et al., 2000 and Newton et al., 2000).

• Primary amputation is indicated in the case of life-threatening

• Primary amputation is indicated in the case of life-threatening infection or extensive necrosis of the foot. PAD is a risk factor for amputation [51] and [80] and needs to be diagnosed early in order to be able to take all of the therapeutic measures necessary to avoid it as soon as possible. In the case of a foot ulcer in a diabetic patient with PAD, it is selleckchem first necessary to evaluate the usefulness of revascularisation and then choose the method of revascularisation on the basis of the following clinical criteria: the healing potential of the ulcer; the local condition of the foot and its residual function after

the healing process; the condition of the vascular tree; and finally the general condition of the patient. Healing potential refers to the real possibility of healing on the basis of foot perfusion. Transcutaneous oximetry and evaluating the pressure of the toe may be helpful because, in addition to stenoses and obstructions, they can determine whether distal blood flow is sufficient to guarantee tissue healing. According Talazoparib nmr to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC

II) document [81], foot lesions generally heal if toe pressure is >50 mm Hg and TcPO2 >50 mm Hg, whereas healing is a remote possibility if both are <30 mm Hg. However, it must be pointed out that TASC II does not specifically refer to diabetics but also includes the non-diabetic population. In a critical review Dichloromethane dehalogenase of TcPO2 levels, Faglia considers values of <34 mm Hg an absolute indication for revascularisation, with an 85% probability of amputation in the case of no revascularisation; values of 34–40 mm Hg represent a less impelling indication for revascularisation,

but there is still a considerable probability of amputation (about 20%). In the case of values of >40 mm Hg, revascularisation can be considered if the tissue loss is significant and there is a need to accelerate healing, or in the presence of osteomyelitis for which conservative treatment is preferred [82]. In any case, once a perfusion deficit has been identified, revascularisation should always be considered. [83]. Another possible situation is one in which the limb is apparently perfused (TcPO2 >40 mm Hg or toe pressure >50 mm Hg) but, despite optimal local treatment, the lesion shows no signs of healing. After having excluded general negative factors such as malnutrition or underlying osteomyelitis, it is necessary to consider the possibility that the non-invasive evaluations have overestimated peripheral perfusion and that there may be undetected ischaemia. In the presence of an ulcer that does not evolve positively within 4–6 weeks, an ischaemic component should always be suspected.