Ayano NAKAI

Persistent and blanchable redness (PBR) is not currently included in category I pressure injury (PI), which is defined as non-blanchable redness (NBR). However, PBR progresses to PI in a clinical setting. Therefore, it should be clinically managed as category I PI, and a method to distinctly identify PBR is needed. This study aimed to examine whether PI-related biomarkers can distinguish PRB from transient redness (TR) and NBR using skin blotting. TR, PBR, and NBR models were established by the different conditions of dorsal skin compression. Redness observation and skin blotting were performed, and the skin tissue samples were subjected to histological and molecular biological analyses. The vascular endothelial growth factor (Vegf) b, heat shock protein (Hsp) 90aa1, tumour necrosis factor, interleukin (Il) 1b, and Il6 messenger ribonucleic acid levels were significantly different between the three models. The VEGF-A, VEGF-B, IL-1β, and IL-6 protein levels were different between the three models. Although the results of skin blot examinations were inconsistent with those of the expression analysis of tissue, HSP90α and IL-1β are suggested to be potential markers to distinguish PBR from TR and NBR.

背景:小児湿疹に対し,紫外線光線療法を長期間行うことは有害である.本研究の目的は紫外線を含まない可視光線療法の小児湿疹への効果を検討することである.方法:シングルケース実験デザイン研究.3週間の非照射期間のあと,30分間の光線療法を週3回,5週間行った.評価項目は,Patient-Oriented Eczema Measure(POEM),経表皮水分蒸散量(TEWL),皮膚表面水分量,pH,TSLP,IL-4,IL-13とした.結果:症例は中等度の湿疹を有する3歳男児で,10ヵ月間の治療を経ても悪化していた.照射・非照射期間を比較しPOEMは臨床的に有意に低下していた.炎症部のTEWLも低下傾向を示した.結論:紫外線を含まない可視光線療法により,かゆみが改善したことで,掻き動作やそれに伴う出血が軽減した.このことから,本療法が小児湿疹の改善に一定の効果をもたらす可能性が示唆された.今後は客観的指標による皮膚バリア機能の改善効果を検証する必要がある.(著者抄録)

Pressure injuries (PIs) are localised skin injuries that result from pressure with or without shear force. Shear force is more destructive than pressure in clinical settings. Therefore, determining the critical external forces is important for selecting the appropriate care to prevent PIs. To quantitatively distinguish pressure and shear loading with high specificity, we focused on microRNAs (miRs). This study aimed to identify the miRs that are distinguishable between pressure with and without shear loading in rat skin. Microarray analysis identified six candidate miRs from the comparisons among the pressure, shear, and unloaded groups. We analysed the expression levels of the candidate miRs in the process of PI development using real-time reverse transcriptase polymerase chain reaction. In the pressure and shear groups, miR-92b expressions at 6 hours after loading were 2.3 ± 1.3 and 2.9 ± 1.0, respectively, which were significantly higher than those in the control group (P = .014 and .004, respectively). miR-877 expression at 6 hours after loading was significantly increased only in the shear group (2.8 ± 0.9) compared with the control group (P = .016). These results indicate that miR-92b and miR-877 are promising biomarkers to determine for which external force healthcare professionals should intervene.

[Aim] Because painful skin tears frequently occur in older patients, the prevention of skin tears is fundamental to improve their quality of life. However, a risk assessment tool for skin tears has not been established yet in Japan. Therefore, we aimed to propose a risk scoring tool for skin tears in Japanese older adult. [Methods] We conducted a prospective cohort study with 6-month follow-up in two long-term care hospitals in Japan. A total of 257 inpatients were recruited. Patient and skin characteristics were collected at baseline, and the occurrence of forearm skin tears were examined during follow-up. To develop a risk scoring tool, we identified risk factors, and converted their coefficients estimated in the multiple logistic regression analysis into simplified scores. The predictive accuracy of the total score was evaluated. [Results] Of 244 participants, 29 developed forearm skin tears during the follow-up period, a cumulative incidence of 13.5%. Senile purpura, pseudoscar, contracture, and dry skin were identified as risk factors for skin tears. Their weighted scores were 6, 4, 5, and 6, respectively. The area under the receiver operating characteristic curve of the total score was 0.806. At a cut-off score of 12, the sensitivity was 0.86, and the specificity was 0.67. [Conclusion] Our forearm skin tear risk scoring tool showed high accuracy, whereas specificity was low. This tool can contribute to prevent forearm skin tears in Japanese older adults.

Incontinence-associated dermatitis (IAD) is caused from the repeated exposure to urine/faeces and reduces quality of life. However, the underlying mechanisms are poorly understood. This study explored the effects of urine on the growth and motility of common uropathogens. Pseudomonas aeruginosa, Proteus mirabilis, Escherichia coli and Klebsiella pneumoniae were grown for 24 hrs at 37℃ in Luria-Bertani (LB) medium supplemented with various concentrations of synthetic urine. Bacterial growth was monitored over time by measuring absorbance at 600nm. Swimming, swarming, and twitching motilities were determined in cultures of LB with (1: 1 ratio) and without synthetic urine. Results demonstrated that bacterial growth was inhibited during early phase (0-6 hrs), and enhanced after 8 hrs. For P. mirabilis and K. pneumoniae, the increase in growth was in a dose-dependent manner. Swimming motility of P. mirabilis was inhibited. This study suggested the different effect of fresh and infectious urine on the bacterial growth, which is important to understand the mechanisms of IAD development due to urine incontinence.

Objective: Skin tears cause pain and distress for patients, and it is important to educate nurses regarding skin tear prevention. This study aimed to investigate the effectiveness of a nursing education regarding skin tear prevention in a Japanese long-term care hospital. <br> Methods: A pre-post study was conducted at a 736-bed long-term care facility in Tokyo, Japan (December 2018 to August 2019). Nurses attended a skin tear prevention seminar, which provided information regarding the definition of skin tears, risk factors, a skin tear classification system, treatment, preventive care, and various related products (arm protectors, dressings, and skin friendly silicone adhesive tapes). The primary outcome for evaluating the effectiveness of the education program was the incidences of skin tears during the 1-month period before the seminar and during the 6-month period after the seminar. <br> Results: Forty-two nurses were recruited and attended the educational seminar, and 97 older adults consented to evaluations of their forearm skin. The care products introduced in the hospital after the educational seminar were skin moisturizers, silicon medical tapes, silicone foam dressings, and arm protectors. The incidence of skin tears was 2.1% during the 1-month period before the seminar. During the 6-month period after the seminary, the monthly incidences of skin tears were 4.2% during the first month after the seminar, 1.1% during the next 4 months, and 0.0% during the sixth month. <br> Conclusion: Education regarding skin tear prevention may help nurses better identify and prevent skin tears.

The prevention of progression of Category I pressure ulcers (PUs) to Category II or higher is important, as Category II or higher PUs are open wounds and have a higher infection risk. Prognosis prediction of Category I PUs is necessary to provide successful intensive care for PUs with impaired healing. We focused on skin blotting using plasminogen activator inhibitor 1 (PAI1), interleukin-1α (IL-1α), vascular endothelial growth factor C (VEGF-C), and heat shock protein 90α (HSP90α). This pilot study was conducted at long-term-care and general hospitals to examine the applicability of DESIGN-R and thermography; the feasibility of skin blotting technique; the biomarker candidates, PAI1, IL-1α, VEGF-C, and HSP90α; and sample size for prognosis prediction for Category I PUs. Patients aged >65 years underwent skin blotting, scoring for DESIGN-R, and took thermography images of their Category I PU site. Albumin signals were not detected in one out of three participants. PAI1, IL-1α, VEGF-C, and HSP90α were detected in 19 participants, among whom 11 participants could be followed up after one week. There was no difference in DESIGN-R score and skin surface temperature between normal and impaired healing groups, and the sample size was calculated as 16. In conclusion, the feasibility of skin blotting was confirmed. PAI1, IL-1α, VEGF-C, and HSP90α could be biomarker candidates for prognosis prediction for Category I PU and the combination of VEGF-C and HSP90α could be associated with the prognosis of Category I PU. We need to investigate 842 patients in a future study.