***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 To estimate the prevalence of wounds managed by the UK 's National Health Service ( NHS ) in 2012/2013 and the annual levels of healthcare re source use attributable to their management and corresponding costs . Methods This was a retrospective cohort analysis of the records of patients in The Health Improvement Network ( THIN ) Data base . Records of 1000 adult patients who had a wound in 2012/2013 ( cases ) were r and omly selected and matched with 1000 patients with no history of a wound ( controls ) .  Patients ’ characteristics , wound-related health outcomes and all healthcare re source use were quantified and the total NHS cost of patient management was estimated at 2013/2014 prices . Results Patients ’ mean age was 69.0 years and 45 % were male . 76 % of patients presented with a new wound in the study year and 61 % of wounds healed during the study year . Nutritional deficiency ( OR 0.53 ; p<0.001 ) and diabetes ( OR 0.65 ; p<0.001 ) were independent risk factors for non-healing . There were an estimated 2.2 million wounds managed by the NHS in 2012/2013 . Annual levels of re source use attributable to managing these wounds and associated comorbidities included 18.6 million practice nurse visits , 10.9 million community nurse visits , 7.7 million GP visits and 3.4 million hospital outpatient visits . The annual NHS cost of managing these wounds and associated comorbidities was £ 5.3 billion . This was reduced to between £ 5.1 and £ 4.5 billion after adjusting for comorbidities . Conclusions Real world evidence highlights wound management is predominantly a nurse-led discipline . Approximately 30 % of wounds lacked a differential diagnosis , indicative of practical difficulties experienced by non-specialist clinicians . Wounds impose a substantial health economic burden on the UK 's NHS , comparable to that of managing obesity ( £ 5.0 billion ) . Clinical and economic benefits could accrue from improved systems of care and an increased awareness of the impact that wounds impose on patients and the NHS Leg ulcers are a chronic manifestation of sickle-cell disease ( SCD ) and are often painful , disabling , and difficult to treat . RGD peptide matrix treatment is a novel therapy design ed to provide a topical synthetic extracellular matrix that can act as a temporary substitute for the damaged natural matrix at the ulcer site . In this r and omized , placebo-controlled , double-blind , prospect i ve , multicenter investigation , SCD patients with full-thickness leg ulcers were treated with st and ard therapy plus RGD peptide matrix or saline placebo once weekly for up to 10 weeks . Healing in patients with chronic ulcers ( 2 months or greater in duration ) was significantly accelerated ( P = .0085 ) in RGD peptide matrix recipients compared with the placebo group . In these chronic ulcer cases , the average percent ulcer closure ( decrease in ulcer surface area ) in the RGD peptide matrix group ( 54.4 % + /- 8.9 % ) exceeded that in the placebo group ( 19.0 % + /- 24.3 % ) nearly threefold by study endpoint . Furthermore , RGD peptide matrix was equally effective in promoting healing of long persistent ulcers and ulcers of shorter duration . In contrast , st and ard therapy plus placebo was significantly less effective ( P = .001 ) in promoting healing for ulcers of progressively greater duration . The results of this study provide preliminary evidence that RGD peptide matrix treatment may significantly accelerate healing of chronic sickle-cell leg ulcers OBJECTIVE Comparison of desloughing efficacy after four weeks and healing outcomes after 12 weeks in sloughy venous leg ulcers treated with Manuka honey ( Woundcare 18 + ) vs. st and ard hydrogel therapy ( IntraSite Gel ) . BACKGROUND Expert opinion suggests that Manuka honey is effective as a desloughing agent but clinical evidence in the form of a r and omised controlled trial is not available . There is a paucity of research which uses Manuka honey in venous ulcers . DESIGN Prospect i ve , multicentre , open label r and omised controlled trial . METHOD R and omisation was via remote telephone . One hundred and eight patients with venous leg ulcers having > or=50 % wound area covered in slough , not taking antibiotics or immunosuppressant therapy were recruited from vascular centres , acute and community care hospitals and leg ulcer clinics . The efficacy of WoundCare 18 + to deslough the wounds after four weeks and its impact on healing after 12 weeks when compared with IntraSite Gel control was determined . Treatment was applied weekly for four weeks and follow-up was made at week 12 . RESULTS At week 4 , mean % reduction in slough was 67 % WoundCare 18 + vs. 52.9 % IntraSite Gel ( p = 0.054 ) . Mean wound area covered in slough reduced to 29 % and 43 % , respectively ( p = 0.065 ) . Median reduction in wound size was 34 % vs. 13 % ( p = 0.001 ) . At 12 weeks , 44 % vs. 33 % healed ( p = 0.037 ) . Wounds having > 50 % reduction in slough had greater probability of healing at week 12 ( 95 % confidence interval 1.12 , 9.7 ; risk ratio 3.3 ; p = 0.029 ) . Infection developed in 6 of the WoundCare 18 + group vs. 12 in the IntraSite Gel group . CONCLUSION The WoundCare 18 + group had increased incidence of healing , effective desloughing and a lower incidence of infection than the control . Manuka honey has therapeutic value and further research is required to examine its use in other wound aetiologies . RELEVANCE TO CLINICAL PRACTICE This study confirms that Manuka honey may be considered by clinicians for use in sloughy venous ulcers . Additionally , effective desloughing significantly improves healing outcomes Summary .— The results of a double‐blind trial of zinc sulphate in patients with chronic venous leg ulceration are reported . No significantly increased rate of healing was observed in the zinc‐treated group In order to assess the reported efficacy of natural honey in the healing of chronic ulcers  , the efficacy of locally applied natural honey was compared to that of Eusol solution in an open trial involving 20 patients with sickle cell anaemia ( SS ) who were in steady clinical states and had chronic leg ulceration . All patients were admitted to hospital for the 4 week duration of the trial for bed rest , daily aseptic dressings , and weekly measurement of the size of the ulcer . Fifteen patients with a total of 19 leg ulcers were evaluable at the end of the trial . Eleven ulcers were dressed with honey while 8 were dressed with Eusol . No significant differences were found in rates of healing of the ulcers in either treatment groups . This trial does not support the suggestion that natural honey is superior to Eusol in the healing of chronic sickle cell leg ulceration A double-blind , placebo-controlled study was carried out in 12 patients suffering from chronic venous insufficiency and persistent leg ulcers to assess the efficacy of pentoxifylline treatment as an adjunct to compression b and aging in the conservative management of venous leg ulcers . Six patients were allocated at r and om to receive twice-daily infusions of 200 mg pentoxifylline intravenously and 400 mg pentoxifylline orally 3-times daily for 7 days then 400 mg oral doses 3-times daily for a further 60 days . The control group received matching placebo in an identical regimen . Treatment outcome was assessed by changes between the start and end of the study in venous ulcer surface area , and continuous wave Doppler ultrasound was used to monitor ankle/arm systolic pressure ratio , venous pressure at the ankle , valvular competence and possible venous reflux at intervals throughout the study period . The results showed that in the patients treated with pentoxifylline  complete ulcer healing took place in 4 out of 6 and there was a significant reduction in mean ulcer surface area . In the control group , complete ulcer healing was recorded in 1 out of 6 patient only and the ulcer area was only moderately reduced in the others . There was no statistically significant differences between the two groups in the variables monitored by Doppler ultrasound but the difference between treatment outcome was significant . Treatment was well-tolerated Abstract Objective : To determine whether pentoxifylline 400 mg ( Trental 400 ) taken orally three times daily , in addition to ambulatory compression b and ages and dressings , improves the healing rate of pure venous ulcers . Design : R and omised , double blind placebo controlled trial , parallel group study of factorial design , permitting the simultaneous evaluation of alternative pharmaceutical , b and aging , and dressings material s. Setting : Leg ulcer clinics of a teaching and a district general hospital in southern Scotl and . Participants : 200 patients with confirmed venous ulcers and in whom other major causal factors were excluded . Interventions : Pentoxifylline 400 mg three times daily or placebo . Main outcome measure : Complete healing ( full epithelialisation ) of all ulcers on the trial leg . Results : Complete healing occurred in 65 of the 101 ( 64 % ) patients receiving pentoxifylline and 52 of the 99 ( 53 % ) patients receiving placebo . Conclusions : The difference in the healing rates between patients taking pentoxifylline and those taking placebo did not reach statistical significance . Key messages Leg ulcers cost the NHS around £ 400 million per annum 50%-75 % of venous leg ulcers can be succesfully treated with dressings and compression b and ages but take many months to heal A drug that reduced the healing time of venous ulcers would be useful , although no agent has been proved to be effective to date Trials with pentoxifylline , a vasoactive drug used in the treatment of peripheral vascular diseases , as an adjunct to the treatment of venous ulcers have been inconclusive At the 5 % level , pentoxifylline had a non-significant effect on healing rates of pure venous AIM Epidemiological data show that st and ard compression therapy for leg ulceration in chronic venous insufficiency ( CVI ) often fails to effectively improve patients ' condition . This study assesses the contribution of Daflon 500 mg added to conventional therapy in the healing of hypostatic ulcers of CVI patients . METHODS Patients of about 65 years were included , with ulcers > or = 2 and > or = 10 cm diameter on 1 or 2 limbs , Doppler ankle/arm pressure index > 0.9 , and no recent history of skin graft . Controls ( n=68 ) remained on compression alone while the tested group ( n=82 ) also received Daflon 500 mg 2 tablets/day during 6 months . Treatment could be stopped as soon as the reference ulcer appeared fully healed . Primary endpoints were the rate of healed ulcers and the time to complete healing assessed by planimetry/photography and clinical examination . Variations of the ulcer surface , appearance of the skin , and clinical symptoms of CVI were the secondary criteria . RESULTS Only 7 % of Daflon 500 mg patients necessitated the full 6 month therapy . Whatever the lesion size , from W8 significantly more healed ulcers were observed under Daflon 500 mg ( p=0.004 ) , and the ulcer surface was more reduced ( p=0.012 ) . For large ulcers , the rate of healing was approximately 2-fold higher with Daflon 500 mg , and the percentage of ulcers healed before W24 was significantly higher ( p=0.008 ) . Heavy leg sensation was significantly improved by Daflon 500 mg from W4 ( p < 0.05 ) . No treatment-related side effects were reported and the acceptability was considered excellent by 85 % of Daflon 500 mg patients . CONCLUSION Six months of Daflon 500 mg in addition to compression significantly improve some clinical symptoms and accelerate the healing process in patients with ulcerous complications of CVI , with a good acceptability We performed a r and omized , double‐blind study of the efficacy of locally applied zinc oxide on the healing of leg ulcers . Thirty‐seven geriatric patients , nineteen with arterial and eighteen with venous leg ulcers , were treated either with a gauze compress medicated with zinc oxide ( 400 μg ZnO/cm2 ) or with an identical compress without zinc oxide . The treatment was assessed from ulcer size measurements and the presence or abscncc of granulation and ulcer debridement over a period of 8 weeks . The zinc‐treated patients ( 83 % success rate ) responded significantly better ( P < 0·05 ) than the placebo‐treated patients ( 42 % success rate ) . The results suggest that healing of leg ulcers is improved after the addition of zinc oxide to the local regimen Several small studies have indicated that the systemic administration of pentoxifylline may accelerate healing of venous leg ulcers .  The goal of this study was to further evaluate these findings in a larger scale placebo controlled trial and to explore the effect of the dose of pentoxifylline on healing . The study used a prospect i ve , r and omized , double-blind , parallel group placebo controlled design in a multicenter outpatient setting . Patients with one or more venous ulcer were enrolled , with all patients receiving st and ardized compression b and aging for treatment for their ulcers . Patients were 
    Output:
    
These data permit the inferences that nutritional supplementation in the population s studied showed significant benefits in the healing of venous ulcers and tendency ( nonsignificant trends ) in the healing of diabetic and sickle cell ulcers