***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective The efficacy of topical phenytoin in the treatment of  diabetic foot ulcers  was evaluated in a controlled inpatient study . Research Design and Methods Fifty patients were treated with topical phenytoin , and 50 patients matched for age , sex , and ulcer areas , depth , chronicity , and infection were dressed with dry sterile occlusive dressing . Results Both groups improved , but the ulcers treated with topical phenytoin  healed more rapidly . Mean time to complete healing was 21 days with phenytoin and 45 days with control . The differences seen were statistically significant ( P < 0.05 ) via the chi 2 test . Conclusions Phenytoin appears to be useful as a topical agent in promoting the healing of diabetic foot ulcers Honey dressing has been used to promote wound healing for years but scanty scientific studies did not provide enough evidence s to justify it benefits in the treatment of diabetic foot ulcers . We conducted a prospect i ve study to compare the effect of honey dressing  for  Wagner 's grade -II diabetic foot ulcers  with controlled dressing group ( povidone iodine followed by normal saline ) . Surgical debridement and appropriate antibiotics were prescribed in all patients . There were 30 patients age between 31 to 65-years-old ( mean of 52.1 years ) . The mean healing time in the st and ard dressing group was 15.4 days ( range 9 - 36 days ) compared to 14.4 days ( range 7 - 26 days ) in the honey group ( p < 0.005 ) . In conclusion , ulcer healing was not significantly different in both study groups . Honey dressing is a safe alternative dressing for Wagner grade -II diabetic foot ulcers Basic fibroblast growth factor ( bFGF ) has been shown to promote wound healing . The present trial evaluated the clinical efficacy of bFGF for diabetic ulcer , a type of refractory skin ulcer , and the dose-response relationship . This was design ed as a r and omized , double-blind , dose-ranging , placebo-controlled trial . A total of 150 patients with non-ischaemic diabetic ulcers measuring 900 mm2 or less were r and omized into a placebo group ( n = 51 ) , a 0.001 % bFGF group ( n = 49 ) and a 0.01 % bFGF group ( n = 50 ) , and 148 of these patients received treatment for 8 weeks or less . The efficacy evaluation was carried out on 139 patients who met the protocol in this trial . The primary outcome was the percentage of patients showing 75 % or greater reductions in the area of ulcer . The area of ulcer decreased by 75 % or more in 57.5 % ( 27/47 ) , 72.3 % ( 34/47 ) , and 82.2 % ( 37/45 ) in the placebo , 0.001 % bFGF and 0.01 % bFGF groups , respectively , and differences were significant between the 0.01 % bFGF and placebo groups ( p = 0.025 ) . The cure rate was 46.8 % ( 22/47 ) , 57.4 % ( 27/47 ) , and 66.7 % ( 30/45 ) in the placebo , 0.001 % bFGF and 0.01 % bFGF groups , respectively . The findings obtained in this trial showed wound healing accelerating effects of bFGF on diabetic ulcers : In recent years , skin grafting has evolved from the initial autograft and allograft preparations to biosynthetic and tissue-engineered living skin replacements . This review details the pioneering work of numerous investigators that led to the following precursors of tissue-engineered skin replacement : cultured autologous keratinocyte grafts , cultured allogeneic keratinocyte grafts , autologous/allogeneic composites , acellular collagen matrices , and cellular matrices . It also discusses the rationale for the development of the newer products and describes the technical advances leading to the development of Apligraf , a tissue-engineered human skin product Abstract Aims /hypothesis . To re-evaluate the use of Granulocyte-Colony Stimulating Factor ( G-CSF ) in the treatment of infected diabetic foot ulcers . Methods . Thirty-seven diabetic subjects were r and omised to Granulocyte-Colony Stimulating Factor ( G-CSF ) ( n=20 ) or placebo ( n=17 ) . The primary endpoint was resolution of cellulitis , which was evaluated clinical ly and with an infection summary score . Patients were hospitalised for 10 days and received subcutaneously either 5 µg/kg G-CSF or placebo daily . Ulcers were treated with a st and ard wound protocol and the patients were instructed to stay in bed . All subjects received antibiotics ( clindamycin and ciprofloxacin ) intravenously until the inflammation had subsided . Results . Patients who received G-CSF did not have an earlier resolution of clinical ly defined cellulitis ( p=0.57 ) . The infection summary score declined , but comparably , in both groups ( G-CSF : 29.5±18.4 to 6.7±6.3 p<0.001 , placebo : 24.2±16.9 to 8.9±7.2 p<0.001 ) . The ulcer volume , which was not greater among placebo patients , was reduced by 59 % in G-CSF and by 35 % in placebo patients . Conclusion /interpretation . We conclude that antibiotic and non weight-bearing therapy ( bed rest ) accelerated the resolution of cellulitis in infected foot ulcers . Additional treatment with G-CSF had no further beneficial effect This study tests the hypothesis that addition of a protease-modulating matrix enhances the efficacy of autologous growth factors in diabetic ulcers .  Fifty-one patients with chronic diabetic foot ulcers were managed as out patients at the Democritus University Hospital of Alex and roupolis and followed up for 8 weeks . All target ulcers were > or = 2.5 cm in any one dimension and had been previously treated only with moist gauze .  Patients were r and omly allocated in three groups of 17 patients each : Group A was treated only with the oxidized regenerated cellulose/collagen bio material ( Promogran , Johnson & Johnson , New Brunswick , NJ ) , Group B was treated only with autologous growth factors delivered by Gravitational Platelet Separation System ( GPS , Biomet ) , and Group C was managed by a combination of both . All ulcers were digitally photographed at initiation of the study and then at change of dressings once weekly . Computerized planimetry ( Texas Health Science Center ImageTool , Version 3.0 ) was used to assess ulcer dimensions that were analyzed for homogeneity and significance using the Statistical Package for Social Sciences , Version 13.0 . Post hoc analysis revealed that there was significantly greater reduction of all three dimensions of the ulcers in Group C compared to Groups A and B ( all P<.001 ) . Although reduction of ulcer dimensions was greater in Group A than in Group B , these differences did not reach statistical significance . It is concluded that protease-modulating dressings act synergistically with autologous growth factors and enhance their efficacy in diabetic foot ulcers CONTEXT Foot ulcer is the principal cause of hospitalization for patients with diabetes .  Polydeoxyribonucleotide ( PDRN ) , an adenosine A2A receptor agonist , improves wound healing in diabetic mice . OBJECTIVE The aim of this study was to evaluate the effect of PDRN on chronic ulcer healing in patients with diabetes . DESIGN AND SETTING This r and omized , double-blind , placebo-controlled trial , involved two medical centers in Italy . INTERVENTION Patients with diabetes showing hard-to-heal ulcers ( Wagner grade 1 or 2 ) were r and omly assigned to receive placebo ( n = 106 ) or PDRN ( n = 110 ) . The treatments ( PDRN and placebo ) were performed for 8 weeks by intramuscular and perilesional route [ corrected ] . MAIN OUTCOME MEASURES The primary outcome was complete ulcer healing . Secondary outcomes were the days needed to complete wound closure and the reepithelialization of wound surface ( as percentage of the original area ) . RESULTS After 8 weeks , 91 placebo and 101 PDRN subjects completed the study .  Complete healing was achieved in 18.9 % [ 95 % confidence interval ( CI ) 11.4 - 26.3 ] of placebo and in 37.3 % ( 95 % CI 28.2 - 46.3 ) of PDRN-treated patients ( P = .0027 ) . After 8 weeks , PDRN increased the closure of foot ulcers in diabetic subjects ( hazard ratio 2.20 ; 95 % CI 1.29 - 3.75 ; P = .004 ) . The median time to complete wound healing was 49 days for placebo ( range 28 - 56 d ) and 30 days for PDRN-treated subjects ( range 14 - 56 d ; P = .0027 ) . The median epithelialized area of the ulcers ( expressed as percentage ) was 49.3 % in the placebo and 82.2 % in the PDRN group ( P < .001 ) . CONCLUSIONS PDRN facilitates the healing of Wagner 1 or 2 diabetic foot ulcers OBJECTIVES To determine the comparative effectiveness and cost-effectiveness of three dressing products , N-A , Inadine and Aquacel , for patients with diabetic foot ulcers , as well as the feasibility and consequences of less frequent dressing changes by health-care professionals . DESIGN A multicentre , prospect i ve , observer-blinded , parallel group , r and omised controlled trial , with three arms . SETTING Established expert multidisciplinary clinics for the management of diabetic foot ulcers across the UK . PARTICIPANTS Patients over age 18 with type 1 or type 2 diabetes with a chronic ( present for at least 6 weeks ) full-thickness foot ulcer ( on or below the malleoli ) not penetrating to tendon , periosteum or bone , and with a cross-sectional area between 25 and 2500 mm(2 ) . INTERVENTIONS Participants were r and omised 1:1:1 to treatment with one of N-A ( a non-adherent , knitted , viscose filament gauze ) , Inadine ( an iodine-impregnated dressing ) , both traditional dressings , or Aquacel , a newer product . MAIN OUTCOME MEASURES The primary outcome measure was the number of ulcers healed in each group at week 24 . Secondary measures included time to healing , new ulcerations , major and minor amputations , and episodes of secondary infection . RESULTS A total of 317 patients were r and omised . After 88 withdrawals , 229 remained evaluable . A greater proportion of smaller ( 25 - 100 mm(2 ) ulcers healed within the specified time ( 48.3 % versus 37.3 % ; p = 0.048 ) . There was , however , no difference between the three dressings in terms of percentage healed by 24 weeks , or in the mean time to healing , whether analysed on the basis of intention to treat ( Inadine 44.4 % , N-A 38.7 % , Aquacel 44.7 % ; not significant ) or per protocol ( Inadine 55.2 % , N-A 59.4 % , Aquacel 63.0 % ; not significant ) . There was no difference in the quality of healing , as reflected in the incidence of recurrence within 12 weeks . Likewise , there was no difference in the incidence of adverse events , although a greater proportion of those r and omised to the non-adherent dressings were withdrawn from the study ( 34.9 % versus 29.1 % Aquacel and 19.4 % Inadine ; p = 0.038 ) . The only statistically significant difference found in the health economic analysis was the cost associated with the provision of dressings ( mean cost per patient : N-A 14.85 pounds , Inadine 17.48 pounds , Aquacel 43.60 pounds ) . The higher cost of Aquacel was not offset by the fewer dressings required . There was no difference in measures of either generic or condition-specific measures of quality of life . However , there was a significant difference in the change in pain associated with dressing changes between the first and second visits , with least pain reported by those receiving non-adherent dressings ( p = 0.012 ) . There was no difference in the costs of professional time , and this may relate to the number of dressing changes undertaken by non-professionals . Fifty-one per cent of all participants had at least one dressing change undertaken by themselves or a non-professional carer , although this ranged from 22 % to 82 % between the different centres . CONCLUSIONS As there was no difference in effectiveness , there is no reason why the least costly of the three dressings could not be used more widely across the UK National Health Service , thus generating potentially substantial savings . The option of involving patients and non-professional carers in changing dressings needs to be assessed more formally and could be associated with further significant reductions in health-care costs . TRIAL REGISTRATION Current Controlled Trials IS RCT N78366977 BACKGROUND Diabetic foot ulcers are associated with significant morbidity . Conventional treatment modalities are often of limited success in promoting complete wound closure . The aim of the present study was to examine the efficacy of noninvasive ozone-oxygen therapy in the treatment of  
    Output:
    
The present report is an up date of the earlier IWGDF systematic review s , and the conclusion is similar : that with the possible exception of negative pressure wound therapy in post-operative wounds , there is little published evidence to justify the use of newer therapies .