須釜 淳子

BACKGROUND: Aspiration pneumonia (AP), which is a major cause of death in the elderly, does present with typical symptoms in the early stages of onset, thus it is difficult to detect and treat at an early stage. In this study, we identified biomarkers that are useful for the detection of AP and focused on salivary proteins, which may be collected non-invasively. Because expectorating saliva is often difficult for elderly people, we collected salivary proteins from the buccal mucosa. METHODS: We collected samples from the buccal mucosa of six patients with AP and six control patients (no AP) in an acute-care hospital. Following protein precipitation using trichloroacetic acid and washing with acetone, the samples were analyzed by liquid chromatography and tandem mass spectrometry (LC-MS/MS). We also determined the levels of cytokines and chemokines in non-precipitated samples from buccal mucosa. RESULTS: Comparative quantitative analysis of LC-MS/MS spectra revealed 55 highly (P values < 0.10) abundant proteins with high FDR confidence (q values < 0.01) and high coverage (> 50%) in the AP group compared with the control group. Among the 55 proteins, the protein abundances of four proteins (protein S100-A7A, eukaryotic translation initiation factor 1, Serpin B4, and peptidoglycan recognition protein 1) in the AP group showed a negative correlation with the time post-onset; these proteins are promising AP biomarker candidates. In addition, the abundance of C-reactive protein (CRP) in oral samples was highly correlated with serum CRP levels, suggesting that oral CRP levels may be used as a surrogate to predict serum CRP in AP patients. A multiplex cytokine/chemokine assay revealed that MCP-1 tended to be low, indicating unresponsiveness of MCP-1 and its downstream immune pathways in AP. CONCLUSION: Our findings suggest that oral salivary proteins, which are obtained non-invasively, can be utilized for the detection of AP.

目的:高齢者において,側頭部陥没の外観的評価から骨格筋量の損失の程度を評価できるか,その信頼性・妥当性を検証した.方法:対象者は65歳以上の高齢者73名であった.信頼性評価は,評価者2名が独立して側頭部陥没を外観から評価し,カッパ係数から評価者間信頼性を検証した.妥当性評価は,弁別妥当性として側頭部陥没の程度(なし,軽度,重度)による四肢の骨格筋量の差異を,既知集団妥当性として側頭部陥没の程度による側頭筋厚の差異を比較することで検証した.結果:評価者2名の側頭部陥没の外観的評価の一致は,カッパ係数0.594であった.側頭部陥没のない者とくらべ,軽度および重度の者で上腕筋囲長および下腿周囲長が有意に低かった.側頭部陥没が軽度またはない者とくらべ,重度の者で側頭筋厚が有意に薄かった.結論:側頭部陥没の外観評価について,中等度の評価者間信頼性,弁別妥当性と既知集団妥当性が確認された.(著者抄録)

皮膚・排泄ケア認定看護師(WOCN)の資格をもちWOC領域の専門外来に従事している11名にアンケートとインタビューを行い、以下の項目について調査した結果を報告した。1)実施している特定行為の内容。2)従事している専門外来の概要。3)同行訪問の状況。4)専門外来における診療報酬の算定。5)専門外来におけるアウトカム評価。6)主治医との連携。7)病棟との連携。8)訪問看護師との連携。9)在宅医療との連携。10)高齢者施設との連携。11)施設管理職との関係性。12)所属する施設の組織体制。13)所属施設での環境調整。14)施設の医師との関係性。15)施設の職員との関係性。16)複数のWOCN間の連携。17)WOCNの業務の調整。18)物品の調達。19)専門外来におけるWOCNの存在意義。20)専門外来におけるWOCNの役割。

背景 ドセタキセルは、乳がんの抗がん剤治療におけるキードラッグであり、副作用の1つとして浮腫が知られている。乳がん患者の浮腫治療は上肢のリンパ節郭清後に発生するリンパ浮腫に焦点があたっており、ドセタキセルによる浮腫とそのケアに関しては言及されてこなかった。乳がん患者に対するドセタキセル療法による浮腫ケアの確立を目指し、本研究の目的はドセタキセルを投与した乳がん患者の浮腫の臨床的特徴に関するエビデンスを要約することとした。方法 本研究はスコーピングレビューデザインを用いた。検索対象は英語で発行された論文タイトルに限定した。すべての年齢およびすべてのステージの乳がん患者を対象とした論文を選定対象とした。2006年1月から2021年7月の間に発表された論文を対象とし、データベースは、PubMed、CINAHLおよびCochrane Centralを用いた。結果 合計283件の論文がヒットし、最終的に8件の論文がレビュー対象に選定された。浮腫の出現部位はおもに上肢と下肢であった。ドセタキセルの投与終了後3週間で浮腫が出現し、化学療法後6ヵ月で手術の反対側の腕と、下肢の浮腫がドセタキセル投与前のレベルに戻っていた。結論 乳がん患者の上肢の浮腫の要因は、リンパ節郭清とドセタキセルが混在している。したがって、ドセタキセルによる浮腫のマネージメントを確立するためには、リンパ節郭清の影響を受けない下肢浮腫の特徴を明らかにする必要がある。(著者抄録)

皮膚・排泄ケア認定看護師(WOCN)の資格をもちWOC領域の専門外来に従事している11名にアンケートとインタビューを行い、以下の項目について調査した結果を報告した。1)実施している特定行為の内容。2)従事している専門外来の概要。3)同行訪問の状況。4)専門外来における診療報酬の算定。5)専門外来におけるアウトカム評価。6)主治医との連携。7)病棟との連携。8)訪問看護師との連携。9)在宅医療との連携。10)高齢者施設との連携。11)施設管理職との関係性。12)所属する施設の組織体制。13)所属施設での環境調整。14)施設の医師との関係性。15)施設の職員との関係性。16)複数のWOCN間の連携。17)WOCNの業務の調整。18)物品の調達。19)専門外来におけるWOCNの存在意義。20)専門外来におけるWOCNの役割。

高齢者のおもな死因の1つである誤嚥性肺炎は,感染初期は肺炎症状が乏しいため,早期発見がむずかしい疾患である.われわれは,誤嚥性肺炎の発症兆候を口腔内の試料から客観的に検知する手法の開発を目指している.その第一段階として,本研究では頬粘膜から唾液タンパク質を採取するための条件(採取に用いる物品の種類,擦過方法ならびに回数,保湿剤使用の影響)を検討した.その結果,口腔ケア用スポンジブラシを用いて頬粘膜部の奥から前方向へ10回擦過する方法が最適であると考えられた.保湿剤は,サンプル採取後の使用が好ましいことが示された.つぎに,本手法の有用性を検証するため,サンプルをLC-MS/MSに供した.その結果,データベース上に登録されている唾液タンパク質の半数以上が検出され,唾液中に多く存在するα-amylaseやIgAなどが含まれたことから,本手法により唾液タンパク質を解析することが可能であることが確認できた.(著者抄録)

【目的】信頼でき、継続性があり、正確な創傷の記述は創傷評価において重要な要素である。この創傷アセスメントは創傷ケアの専門家に創傷管理の適切な情報を与え、臨床上の意思決定を支援する。糖尿病足潰瘍の創縁のレッドリングの形態的特徴と発生要因について、いまだ明らかにされていない。本研究の目的は、糖尿病足潰瘍の創縁のレッドリングの特徴を記述し、その発生要因を探索することである。<br> 【方法】本調査は、過去にわれわれが行ったインドネシアの創傷クリニックで局所管理を受けた糖尿病足潰瘍の治癒過程に関する2つの前向き調査で収集したデータを用いて行った。35名の患者の足潰瘍の創状態に関する質的記述的研究を行った。また、レッドリング所見の有無で患者ならびに創傷の特徴を比較した。<br> 【結果】35名中10名の足潰瘍に鮮紅色の線状の形状を認めた。すべてのレッドリングは線状であった。この線は、創底のスラフに沿って出現していた。また、この所見を有する創の深さ、浸軟、炎症／感染、創底組織のタイプのDMIST得点が、所見がない潰瘍とくらべて有意に高かった。<br> 【結論】鮮紅色の線状は局所の感染と関連があると示唆された。創傷管理において、創縁の鮮紅色の線上所見にも注視して創評価を行う必要がある。

A non-thermal atmospheric pressure plasma jet (APPJ) may stimulate cells and tissues or result in cell death depending on the intensity of plasma at the target; therefore, we herein investigated the effects of non-thermal plasma under non-contact conditions on the healing of full-thickness wounds in diabetic mice (DM+ group) and normal mice (DM- group). A hydrogen peroxide colorimetric method and high performance liquid chromatography showed that APPJ produced low amounts of reactive oxygen and nitrogen species. Ten-week-old male C57BL/6j mice with normal blood glucose levels (DM- group) and 10-week-old male C57BLKS/J Iar-+Leprdb/+Leprdb mice (DM+ group) received two full-thickness cutaneous wounds (4 mm in diameter) on both sides of the dorsum. Wounds were treated with or without the plasma jet or argon gas for 1 minute and were then covered with a hydrocolloid dressing (Hydrocolloid), according to which mice were divided into the following groups: DM+Plasma, DM+Argon, DM+Hydrocolloid, DM-Plasma, DM-Argon, and DM-Hydrocolloid. Exudate weights, wound areas, and wound area ratios were recorded every day. Hematoxylin and eosin staining was performed to assess re-epithelialization and α-SMA immunohistological staining to evaluate the formation of new blood vessels. Non-thermal plasma under non-contact conditions reduced the production of exudate. Exudate weights were smaller in the DM+Plasma group than in the DM+Hydrocolloid and DM+Argon groups. The wound area ratio was smaller for plasma-treated wounds, and was also smaller in the DM+Plasma group than in the DM+Hydrocolloid and DM+Argon groups on days 1–21 (p&lt;0.01). Wound areas were smaller in the DM-Plasma group than in the DM-Argon group until day 14 and differences were significant on days 1–5 (p&lt;0.01). The percentage of re-epithelialization was significantly higher in the DM+Plasma group than in the DM+Argon and DM+Hydrocolloid groups (p&lt;0.01). The number of new blood vessels that had formed by day 7 was significantly higher in the DM+Plasma group than in the DM+Hydrocolloid and DM+Argon groups (p&lt;0.05). These results indicate that treatment with the current non-thermal plasma APPJ device under non-contact conditions accelerated wound healing in diabetic mice.

INTRODUCTION: Compression therapy is important in oedema control in lymphoedema. However, some patients have difficulties starting compression therapy because standard self-care education does not enable them to fully understand lymphoedema and recognise it as their problem. To overcome this, real-time image-sharing education, using a combination of indocyanine green lymphography (ICG) and ultrasonography, may be used to educate patients. In this case study, real-time image-sharing education promoted decision-making and behaviour change in a patient with lower extremity lymphoedema so she would wear elastic stockings. CASE: A 51-year-old woman with a BMI of 31.7 kg/m2 and secondary lower extremity lymphoedema following cervical cancer surgery did not adhere to self-care instructions regarding wearing elastic stockings for 5 years. The oedema worsened, her limb circumference increased and she had two episodes of cellulitis within a year. Because the patient had a negative attitude towards elastic stockings, real-time image-sharing education was used to promote recognition of illness using ICG and an understanding of the condition of lymphoedema using ultrasonography. After the images were shared and explained, the patient discussed her recognition and understanding of lymphoedema, then decided to use compression stockings. She continued to wear them for 4 months, and her limb circumference decreased. CONCLUSION: Real-time image-sharing education using ICG and ultrasonography as self-care support for a lymphoedema patient who would not start compression therapy could result in behavioural changes and the patient starting and continuing to wear elastic stockings.

AIM: This study aimed to evaluate the use of multilayered silicone foam dressings for preventing pressure injury recurrence by reducing friction, pressure, and shear force at skin sites where previous pressure injuries closed. METHODS: A bench-to-clinical bedside investigation was conducted. In the bench, three multilayered silicone foam dressings were assessed. The simulated skin-shearing test consisted of a weight, a polyurethane-based skin model containing a three-axis tactile sensor, dressings, a table covered with bedsheets, and a mechanical tester. The mechanical tester simultaneously measured the interface friction force and internal shear force and pressure continuously during skin model movements. No-dressing was used as a negative control. In clinical bedside assessments, a multilayered silicone foam dressing with lower friction and shear force was applied to two bedridden patients. Photographs and ultrasound images were used to assess the recurrence of pressure injury. RESULTS: The dressings significantly reduced friction, pressure, and shear force compared with these parameters in the negative control. No significant differences in the shear forces between the dressings were observed. One clinical case did not develop a new pressure injury reaching the dermis. However, the second case developed a new pressure injury within one month after the first pressure injury closed. CONCLUSION: Our bench-to-clinical bedside study revealed that multilayered silicone foam dressings can potentially prevent pressure injury recurrence.

Chronic constipation is a common gastrointestinal disorder in older adults, and it is very important to manage chronic constipation. However, evaluating these subjective symptoms is extremely difficult in cases where patients are unable to express their symptoms because of a cognitive or physical impairment. Hence, it is necessary to observe the patient's colonic faecal retention using objective methods. Ultrasonography observation for colonic faecal retention is useful for diagnosing constipation and evaluating the effectiveness of treatment. Since there was no standard protocol for interpreting rectal ultrasonography findings, we developed an observation protocol through an expert consensus. We convened a group of experts in the diagnosis and evaluation of chronic constipation and ultrasonography to discuss and review the current literature on this matter. Together, they composed a succinct, evidence-based observation protocol for rectal faecal retention using ultrasonography. We created an observation protocol to enhance the quality and accuracy of diagnosis of chronic constipation, especially rectal constipation. This consensus statement is intended to serve as a guide for physicians, laboratory technicians and nurses who do not specialise in ultrasound or the diagnosis of chronic constipation.

本研究では3種類のドレッシング材を用いた頭側挙上での踵部の圧力およびせん断応力の軽減効果を比較した.合計26名の健常ボランティアが本研究に参加した.3軸触覚センサーを踵に直接貼り付けたあと,フィルムドレッシング,低摩擦外層ハイドロコロイドドレッシング(LFHドレッシング),および多層シリコーンフォームドレッシング(MSFドレッシング)で覆った.頭側挙上の角度0度,30度,45度,および60度において,センサーによる圧力とせん断応力を計測した.LFHおよびMSFドレッシングは頭側挙上の各角度において,圧力とせん断応力は同等であったが,フィルムドレッシングでは高かった(p<0.05).圧力に対する垂直せん断応力の相対値は,フィルムドレッシングは1.7であるのに対し,LFHおよびMSFドレッシングでは1.0であった.LFHおよびMSFドレッシングはフィルムドレッシングと比較して頭側挙上時の圧力およびせん断応力を軽減し,踵部褥瘡の予防に利用可能と考えられた.(著者抄録)

Background: Cellulitis is frequently encountered in patients with lymphedema despite existing prevention protocols. To resolve this issue, social aspects surrounding patients, such as communication with patients and professionals, are necessary to consider new approaches. This study aimed to clarify the association between the history of cellulitis in patients with lymphedema and access to specialists after adjustment for relevant confounding factors. Methods and Results: This study was a secondary analysis of the Lymphoedema IMpact and PRevalence-INTernational (LIMPRINT) study using a national Japanese database of adult lymphedema compiled between 2014 and 2015 (n = 113). Descriptive data were collected for patient characteristics. Multivariate logistic regression analysis was conducted to explore possible risk factors for patients having experienced cellulitis. The duration of edema ranged from <6 months (16.2%) to 10 years or longer (25.2%), with varying severity. History of cellulitis was observed in 31.9% of patients. The prevalent treatment techniques within the context of complex decongestive therapy included skin care advice (52.2%), compression garments (55.8%), exercise advice (41.6%), multilayer bandages (38.1%), cellulitis advice (49.6%), and massage (61.1%). Overall, 57.1% of patients had access to lymphedema specialists. Longer duration of lymphedema (adjusted odds ratio [AOR] = 4.10, p = 0.005) and access to lymphedema specialists (AOR = 0.28, p = 0.009) were significantly associated with a history of cellulitis. Conclusions: A history of cellulitis in patients with lymphedema is associated with limited access to specialists. To support self-care in this patient population, reasonable consideration systems, including telehealth, should be developed to facilitate communication between specialists and patients and decrease the occurrence of cellulitis in lymphedema.

AIM: To investigate how nursing faculties' perceived time devoted to research changed during the first wave of the pandemic in Japan (April-June 2020) compared to pre-pandemic. METHODS: This cross-sectional study was conducted online from July 1 to August 10, 2020 and involved 1,023 nursing faculties in Japan. Participants were asked to respond to a questionnaire based on their experiences from April to June 2020. We calculated descriptive statistics for several measures and examined associations between professional/personal demographic factors and declines in overall research time. RESULTS: Of the 1,023 participants, 71.1% were spending less time on overall research activity; 79.6% spent less time attending academic events/conferences, and 77.4% spent less time conducting experiments/surveys. In contrast, 81.2% spent more time teaching, a much greater proportion than the global scientific community in a previous survey. As for work time allocation during the pandemic, teaching was by far the one activity that participants spent the most time on. Logistic regression analysis revealed that declines in overall research time were associated with several professional demographic factors, such as type of university, current academic position, and acquisition status of Japan's major research grant (KAKENHI) (all p < .05). CONCLUSIONS: Nursing faculties in Japan clearly spent less time on research, and more time on teaching during the first wave of the pandemic compared to pre-pandemic. The initial impact of the pandemic on nursing faculties revealed through this study is an eye-opener and a start for addressing the long-term impact on the nursing scientific community.

Advances in patient care for pressure injuries (PIs) have reduced the prevalence of PIs in Japan, although not in recent years. Several single-nucleotide polymorphisms (SNPs) have been identified in genes potentially associated with PIs. However, individual variance among PI risks require targeted investigations that may lead to the identification of PI susceptibilities or preventive care options that directly influence PI development pathways. This cross-sectional study examined the association between PIs and SNPs in genes related to tissue tolerance in patients in a long-term care hospital in Japan. A total of 178 participants (130 control, 20 with superficial PI history, and 28 with deep PI history) were enrolled in this study of eight SNPs in hypoxia inducible factor 1 subunit alpha (HIF1A), vascular endothelial growth factor C (VEGFC), heat shock protein 90 alpha family class A member 1 (HSP90AA1), myostatin (MSTN), and vitamin D receptor (VDR). The primary outcome was a history of superficial and deep PIs in the last 6 months. SNPs were examined by real-time polymerase chain reaction, followed by multivariate logistic regression analyses of the associations between the SNPs and PI history. The results showed a significant association between VEGFC rs1485766 and the history of superficial PIs (odds ratio = 2.95; 95% confidence interval = 1.07-8.11; p = 0.04). Stratified analysis using the Braden Scale (≤14) indicated a significant association between HIF1A rs11549465 and deep PIs (p = 0.04). Our study demonstrated that VEGFC rs1485766 and HIF1A rs11549465 were associated with superficial and deep PI susceptibilities, respectively.

BACKGROUND: This study seeks to establish the skin barrier dysfunction model at the heel via tape-stripping (TS) by evaluating the skin moisturizing effects. MATERIALS AND METHODS: Nineteen young, female participated in the study. A sequence of TS was performed at the heel and trans-epidermal water loss (TEWL), stratum corneum (SC) hydration, and surface pH were measured. Following TS, the subjects were divided into three groups: moisturizer, emollient, and overcoat. These agents were applied daily at night, and the skin parameters were measured the next morning for a week. RESULTS: The TEWL value of TS immediately and 5 min after TS were significantly higher than what was obtained before TS, while the SC hydration after TS was significantly lower than what was obtained before TS. However, there were no significant differences in the skin parameters among the three agents on day 7 after application, with the two-way ANOVA showing no interaction among the agents and number of days. CONCLUSION: The skin barrier dysfunction model at the heel was established by TS in healthy, young adults. However, the physiological function of the skin at the heel did not change drastically and showed no differences even after continuous application for 7 days.

Pressure injuries have been identified as one of the main health hazards among bedridden elderly people. Bedridden elderly people often stay in the same position for a long time, because they cannot switch positions; thus, the blood flow in the part of the body that is being compressed between the bed and their own weight is continuously blocked. As a result, redness and ulcers occur due to lacking oxygen and nutrients in the skin tissues, and these sites are often infected with microorganisms and, thus, become suppurative wounds, a condition commonly determined as pressure injuries. If left untreated, the pressure injury will recur with microbial infections, often resulting in cellulitis, osteomyelitis, and sepsis. The skin microbiome, in which many types of bacteria coexist, is formed on the skin surface. However, it remains unclear what characteristic of the skin microbiome among the bedridden elderly constitutes the development and severity of pressure injuries and the development of post-pressure injury infections. Thus, in this review article, we outlined the changes in the skin microbiome among the bedridden elderly people and their potential involvement in the onset and recurrence of pressure injuries.

AIM: The purpose of this study is to describe the influences of lower limb edema on the daily lives of elderly individuals in elderly day care to describe the necessity of care for lower limb edema. METHODS: Semi-structured interviews based on a quality of life questionnaire for limb lymphedema were conducted. Two types of text mining analysis methods were used: a frequent word analysis and a content analysis. The edema severity was graded on a scale of 0 to 3, and the sum of the numerical values of the grades for each person was defined as the pitting score. RESULTS: The seven participants had a mean age of 83.4 ± 4.6 years (mean ± SD). The pitting scores ranged from 1 to 25 in the participants. The words "think" (389 times), "walk" (136 times), and "put on" (135 times) were extracted frequently. The content analysis focused on the words "walk" and "put on." The participants complained of difficulty walking, pain, and numbness when walking, weakness of their lower limbs, difficulty putting on shoes, restrictions on shoe types, and difficulty finding shoes. CONCLUSIONS: These results demonstrate that elderly individuals experienced troubles during their daily lives caused by lower limb edema, which highlights the necessity of symptom management. Active interventions for edema by nurses are necessary to improve quality of life in elderly individuals.

AIMS: Critical colonization in pressure ulcers delays healing and has been studied. However, local wound management includes no clear strategy for preventing the development of biofilms. Therefore, this multicenter, prospective, observational study was conducted to examine the effect of local management on the biofilm area of pressure ulcers with critical colonization. METHODS: Participants were 34 patients with a pressure ulcer deeper than the dermis and in a state of critical colonization. The primary outcome was the change over a week in the proportion of the biofilm area in relation to that of the pressure ulcer area. We investigated the relationship between primary outcome and local wound management. The wound-blotting method was used for determining the biofilm area. To calculate the change in the biofilm area, baseline proportion was subtracted from proportion 1 week later. RESULTS: Six types of topical treatment were used in three facilities. The proportion of the biofilm area at 1 week follow-up was significantly smaller with iodine ointment than that without iodine ointment (p = .02). The standardized partial regression coefficient of iodine ointment adjusted by the type of medical facility was -0.26 (p = .003). CONCLUSION: This study revealed that the use of iodine ointment reduced the proportion of the biofilm area in the pressure ulcer surface. To manage pressure ulcers in a state of critical colonization, these results suggest that local management include the use of iodine ointment.

AIM: To estimate diagnostic accuracy of ultrasonography for detecting aspiration and pharyngeal residue in patients with dysphagia. METHODS: A systematic search was conducted in MEDLINE (via PubMed), CINAHL, EMBASE, Ichushi-Web, and Cochrane Library databases to identify articles that showed diagnostic accuracy of ultrasonography for detecting aspiration and residue published in English and Japanese until August 2019. Cross-sectional studies, case-control studies, and cohort studies were included. The diagnostic accuracy results were extracted and the pooled estimated sensitivity and specificity were calculated. The risk of bias of the studies was assessed using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies 2. The certainty of the evidence was assessed using the Grades of Recommendation Assessment, Development, and Evaluation methodology. RESULTS: Five studies were included in this review. The pooled estimated sensitivity and specificity for detecting aspiration were 0.82 (95% CI: 0.72-0.89) and 0.87 (95% CI: 0.81-0.92), respectively. One study was included that evaluated ultrasound assessments of pharyngeal residue. The sensitivity and specificity were 0.62 (95% CI: 0.32-0.86) and 0.67 (95% CI: 0.22-0.96), respectively. The certainty of the evidence was low and very low for the diagnostic accuracy of aspiration and pharyngeal residue, respectively. CONCLUSION: Ultrasound is a non-invasive method with good sensitivity and specificity in detecting aspiration as well as reference standards. While risk of bias and small number of studies limited the strength of this systematic review, our results suggested that ultrasound examination was useful as a bedside screening tool for detecting aspiration.

BACKGROUND: Energy inadequacy has a great impact on health outcomes in older adult patients; however, it is difficult to evaluate energy adequacy in these patients, especially in home-care settings. We recently reported that temporal muscle thickness can be an indicator of nutritional status. The present study aims to examine whether a change in temporal muscle thickness is directly correlated with energy adequacy and, if so, to determine the cutoff value of a change in temporal muscle thickness to detect energy inadequacy. METHODS: A prospective cohort study was conducted from September 2015 to June 2016 in two hospitals in Japan, and included bedridden older adult patients aged ≥65 years. Temporal muscle thickness was measured using ultrasonography. Energy intake was estimated by photographic diet records. Total energy expenditure (TEE) was estimated by multiplying basal energy expenditure calculated using the Harris- Benedict equation by activity and stress factors. Energy adequacy was then calculated by dividing TEE by energy intake. Pearson's correlation coefficient was used to examine the relationship between percentage change in temporal muscle thickness and energy adequacy. Multiple logistic regression analysis was conducted to determine the direct relationship between percentage change in temporal muscle thickness and moderate energy inadequacy (energy adequacy< 75%). Receiver operating characteristic (ROC) analysis was performed to determine the cutoff point for percentage change in temporal muscle thickness to detect moderate energy inadequacy. RESULTS: Forty-eight patients were analyzed (mean age 84.4 ± 7.8 years; 54.2% were women). The percentage change in muscle thickness was significantly correlated with energy adequacy (r = 0.733, p < 0.001). ROC analysis identified a percentage change in temporal muscle thickness of - 3.6% as the optimal cutoff point for detecting moderate energy inadequacy. Percentage change in muscle thickness was independently correlated with energy inadequacy after adjusting for age, sex, and masticatory status (AOR 0.281, 95% CI 0.125-0.635). CONCLUSIONS: Changes in temporal muscle thickness are directly correlated with energy adequacy and can indicate moderate energy inadequacy in bedridden older adults. These results suggest the assessment of changes in temporal muscle thickness could be useful for guiding nutritional care in older adult patients in home-care settings.

We herein used MAZ51 to inhibit lymphangiogenesis and aimed to clarify the effect of inhibition of lymphangiogenesis on wound healing. BALB/c male mice were divided into two groups: the control group which was injected the dimethyl sulfoxide (DMSO), the experiment group was injected MAZ51 in the DMSO. All wounds were observed for 15 days and the wound areas were measured. Tissue samples were harvested on day 3, 7, 9, 11, 13 and 15, and subjected to immunostaining of blood vessels and lymphatic vessels. There are no significant differences between two groups in the wound area, the number of blood vessels and lymphatic vessels. The number of blood vessels peaked on day 7 in both groups as with previous studies, while the number of lymphatic vessels peaked on 13 or 15 in both groups. This result revealed delayed lymphangiogenesis in comparison with previous studies. The wound healing process in the control and experiment groups were similar, but both groups seemed delayed lymphangiogenesis comparing with previous studies. Injections of MAZ51 or/and DMSO did not affect angiogenesis, while they may affect lymphangiogenesis.

BACKGROUND: Medical film dressings have been used to obtain skin microbiota for skin microbiome studies, although their adhesive force may be so strong that the skin could be injured when applied to those who have fragile skin, such as older people. Several products with less adhesive force are available, although their applicability for skin microbiome studies remains unknown. This study aimed to test whether the dressings with less adhesive force could be used for amplicon-based skin microbiome studies. A set of three different film dressings, with acrylic, urethane, or silicone adhesive, was applied to the back skin of nine healthy young participants. The copy number of the 16S ribosomal RNA (rRNA) gene, microbial compositions, and alpha and beta diversity indices were analyzed by amplicon analysis of the 16S rRNA gene using next-generation sequencing and were compared among the three film dressings. RESULTS: The dressing with acrylic adhesive yielded the highest copy number of 16S rRNA genes, followed by that with urethane adhesive. The silicone-adhesive dressing yielded a significantly lower copy number of the 16S rRNA gene. The microbial composition of skin microbiota was similar among the three film dressings, although significant differences in the relative abundance of Pseudomonas species and alpha diversity indices were found in the silicone-adhesive dressing. The Bray-Curtis dissimilarity was significantly higher between the acrylic- and silicone-adhesive dressings than between the acrylic- and urethane-adhesive dressings. No adverse effects related to tape stripping were observed for any of the film dressings. CONCLUSION: We recommend dressings with acrylic or urethane adhesive for amplicon-based skin microbiome studies. An acrylic adhesive has an advantage in the yield of skin microbiota, and a urethane adhesive should be chosen when applied to fragile skin. The adhesive force of the dressing with silicone adhesive was too weak to be used for collecting skin microbiota.

AIM: To date no age-comparative study has been reported about effect of exercise on muscle pump action change, while its effect is suggested to differ in ages. This study aims to clarify the changes in muscle pump action with aging by measuring the muscle and vein area, and blood flow in lower legs. METHODS: Subjects were healthy volunteers and consisted of three groups: young age group (N = 20), middle age group (N = 20) and old age group (N = 16). The lower leg flexor muscle area and popliteal vein area were measured by using T1-weighed magnetic resonance imaging at the condition pre- and post-ankle exercise in three positions. Moreover, popliteal blood flow velocity was also measured using phase contrast magnetic resonance imaging. RESULTS: The elderly had the highest number of individuals who had exercise habits (p < .001). In a multiple linear regression analysis, sitting posture, leg muscle volume, and rate of change in the soleus muscle were significantly related to blood flow velocity change. CONCLUSIONS: No difference was found in the changes in muscle pump action with age. The study results suggested that elderly people with exercise habits might be able to maintain the muscle pump action.

AIM: Nurses have difficulty assessing the type of constipation by ordinal assessment methods and may therefore struggle to select an appropriate defecation care. Although previous studies described the safety and effectiveness of defecation care based on ultrasonographic observations in the colorectum, no standardized educational program has been established. This study aimed to determine the feasibility of the constipation point-of-care ultrasound (POCUS) educational program regarding the use of ultrasonography as an assessment tool to determine different types of constipation. METHODS: This descriptive study was conducted for visiting nurses working in Japan. The constipation POCUS educational program that nurses can learn in as short as 7 days comprised four elements: E-learning, a hands-on seminar, self-learning, and objective structured clinical examinations (OSCEs). The nurses were asked to complete a questionnaire regarding the education materials. OSCEs were used to assess the participants' skills in assessing patients based on the use of ultrasound observation in the colorectum. RESULTS: Of the 44 participants who enrolled, 40 were able to complete the program. All the 40 participants (100.0%) who took the OSCEs were able to pass at the first attempt. Moreover, 94.9% of the trainees indicated that this program was able to cover the content necessary to use ultrasonography in home care settings. CONCLUSIONS: The results of this study suggest that the 7-day constipation POCUS educational program provided trainees with a foundational knowledge and skills to observe fecal retention in the colorectum. Thus, further educational program enhancements and clinical skill evaluations are needed to maximize the program's effectiveness in the future.

皮膚・排泄ケア領域で開設されている看護専門外来における、看護専門外来の質評価の対象とされる「構造」と「過程」について明らかにすることを目的に、本会(日本創傷・オストミー・失禁管理学会)会員である皮膚・排泄ケア認定看護師(WOCN)が所属する医療機関を対象に質問紙調査を行い、当該看護専門外来を有する44都道府県の271施設からの回答を分析した。その結果、看護専門外来の構造については、1)看護専門外来の名称はストーマ外来が最も多く、2)WOCN1名で構成された看護専門外来が多く、10分未満の待ち時間で30分〜1時間のケア時間を確保していた。また、過程については、1)看護専門外来におけるケア内容は創傷とオストミーが多く、失禁は少なく、2)ケア内容は患部への直接的なケアのみでなく、家族への支援や意思決定の支援なども実施していることが分かった。

OBJECTIVE: To clarify the surgical indications and the appropriate perioperative management of ischial pressure ulcers (PUs). METHOD: A two-year prospective, nationwide registry study was carried out across 26 medical institutions in Japan. All participating institutions managed ischial PUs according to the standardisation of total management and surgical application for the refractory decubitus (STANDARDS-I) perioperative protocol. Analysis was conducted on a range of clinically or statistically important variables for the achievement of primary or secondary endpoints: complete wound healing and hospital discharge at three months, and complete wound healing at one month after surgery, respectively. RESULTS: A total of 59 patients took part in the study. All patients underwent surgery for ischial PUs during the study period. Patients who had achieved the primary endpoint had a higer preoperative functional independence measurement (FIM score), a higher 'G' score in the DESIGN-R scale and were more likely to have healed by primary intention. Patients who had achieved the secondary endpoint were more likely to have spastic paralysis, preoperative physiotherapy and localised infection of the wound, among other variables. CONCLUSION: This survey suggests that preoperative physiotherapy increases the speed of wound healing, and good granulation of the wound bed preoperatively increases the likelihood of woundless discharge from hospital, whereas the existence of comorbidities negatively influences the likelihood of woundless discharge from hospital. The study also suggests that the existence of spastic paralysis, preoperative infection of the wound, or surgical reduction of the ischial tubercle speeds up the healing of the wound. However, the wound failed to heal significantly more often in patients with increasing white blood cell count after surgery.