須釜 淳子

近年、在宅介護の負担軽減や患者の睡眠を妨げずに褥瘡好発部位の有効な除圧ができることから、スモールチェンジ(以下、SC)という体位変換方法が注目されている。これまで、SCを寝たきり高齢者に実施した場合の体圧変化は明らかにされていない。本研究の目的は、寝たきり高齢者においてSCシステム搭載型エアマットレス(以下、SCマット)を用いてSCを実施した際の体圧と接触面積の変化から、寝たきり高齢者におけるSCマット使用の安全性および適用可能性を検討することである。使用したSCマットは、右上半身と左下半身、左上半身と右下半身の2種の組合せでSCされる設計であった。SC実施前後に体圧分布、各対象者における最高体圧部位の局所体圧値を測定した結果、対象者4名中2名において最高体圧部位の体圧値が減少し、SCにより接触面積増加がみられたことから有効なSCが実施されていたことが示唆された。SCにより接触面積の増加がみられなかった対象者の特徴から、円背・上下肢に拘縮のある者はSC用セルの動作が身体に適切に伝わらず、除圧効果が得られない可能性が考えられた。(著者抄録)

近年、在宅介護の負担軽減や患者の睡眠を妨げずに褥瘡好発部位の有効な除圧ができることから、スモールチェンジ(以下、SC)という体位変換方法が注目されている。これまで、SCを寝たきり高齢者に実施した場合の体圧変化は明らかにされていない。本研究の目的は、寝たきり高齢者においてSCシステム搭載型エアマットレス(以下、SCマット)を用いてSCを実施した際の体圧と接触面積の変化から、寝たきり高齢者におけるSCマット使用の安全性および適用可能性を検討することである。使用したSCマットは、右上半身と左下半身、左上半身と右下半身の2種の組合せでSCされる設計であった。SC実施前後に体圧分布、各対象者における最高体圧部位の局所体圧値を測定した結果、対象者4名中2名において最高体圧部位の体圧値が減少し、SCにより接触面積増加がみられたことから有効なSCが実施されていたことが示唆された。SCにより接触面積の増加がみられなかった対象者の特徴から、円背・上下肢に拘縮のある者はSC用セルの動作が身体に適切に伝わらず、除圧効果が得られない可能性が考えられた。(著者抄録)

© 2018 Ibuki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. We previously reported elevated oxidative stress-related mechanical vulnerabilities of the skin as sparse distributions of hyperechoic areas. Although this helped establish a personalized skin care system to prevent skin disorders related to mechanical stress, obesity-related skin vulnerability involves individual differences. Here, we hypothesized that individual differences are caused by polymorphisms of GT repetitive sequences in the heme oxygenase1 (HMOX1) promoter region, which encodes an antioxidant enzyme. This cross-sectional study enrolled healthy male volunteers in a walking classroom aimed at weight control. Subjects with a body mass index <25 kg/m2 were classified as non-obese and those with body mass index 25 kg/m2 were classified as obese. Subject skin was categorized into sparse dermis or normal groups according to the distribution of hyperechoic areas by high-resolution skin ultrasonography (20 MHz). Genomic DNA and mRNA extracted from three body hairs with attached follicle cells were used to analyze GT repetitive sequences of the HMOX1 promoter, HMOX1 mRNA expression levels, and oxidative stress levels (8-hydroxy-2’-deoxyguanosine). Classifications of GT repetitive sequence of HMOX1 promoter were Short (<27 times) and Long (27 times). Higher numbers of subjects with sparse dermis were in the obese group compared with the non-obese group. In obese subjects, the number of subjects that had the Long allele of the HMOX1 promoter with sparse dermis was significantly higher compared with the normal group, whereas no association was observed between the polymorphism and ultrasonographic features in non-obese subjects. Thus, HMOX1 polymorphisms detected a risk of low collagen density in Japanese obese male subjects.

Nurses encounter difficulties evaluating constipation in elderly people with physical and cognitive impairment. Transabdominal ultrasonography (US) has been used to evaluate fecal impaction or fecal quality. However, it is unclear whether colorectal US can evaluate constipation symptoms in older people. Using colorectal US, we continuously observed the elderly and clarified the relationship between patterns of fecal distribution changes and constipation symptoms in older people with physical and cognitive impairment at long-term care facilities. This study included patients aged ≥65 years with oral intake. US was performed once a day until the next defecation, and fecal hardness was assessed. US images were extracted and categorized. Then, patterns of fecal distribution changes in the colorectum were classified. Multiple logistic regression analysis was performed to examine related factors associated with a constipation pattern. Among 101 patients, US images of 95 patients were analyzed. In 74.4% of the patients, US showed continuation of reflection with acoustic shadow in the rectum, which was significantly associated with defecation on the bed. Of the patients with a continuous crescent-shaped reflection pattern (R3), 92.9% had hard stool. R3 was found to be significantly associated with a Mini-Mental State Examination score of ≤10. In most of the patients, US detected a continuation of reflection with acoustic shadow in rectal patterns, indicating fecal retention in the rectum. Point-of-care US can be used by nurses to visualize rectal fecal retention as constipation patterns in the older people with physical and cognitive impairment at long-term care facilities.

Since lymphedema rarely develops in the mouse hindlimb, the underlying mechanisms remain unclear. We herein investigated the resolution of chronic hindlimb lymphedema in mice using a Near-Infrared Fluorescence (NIRF) imaging system. Nineteen 7-28-week-old BALB/c male and female mice were injected with two dyes for lymphography and dissection. Lymphadenectomy was performed on six male mice to completely obstruct lymph flow in the hindlimb. Edematous changes in both hindlimbs were compared until 60 days after surgery. The NIRF imaging system detected three lymphatic collecting systems in the mouse hindlimb: superficial lateral, superficial medial, and deep medial. It also showed connections between the superficial and deep lymphatic systems in the inguinal region. Lymphadenectomy of the iliac, inguinal, and popliteal lymph nodes caused edematous changes. However, lymph flow in these operated areas restarted within 60 days and the severity of lymphedema appeared to be low. NIRF imaging showed that the deep medial system and a connection between the superficial and deep lymphatic systems in the inguinal region drain lymph from the hindlimb. This is the one reasons why lymphedema does not develop in the mouse hindlimb. The stable obstruction of lymph flow in these three systems is desired to develop chronic lymphedema.

本研究の目的は、初めて採血をする看護学生に対して超音波画像診断装置(以下、エコー)を用いて血管アセスメント採血教育を行い、従来までの血管アセスメント採血教育と比較し、その教育効果を明らかにすることである。参加者は、看護大学4年生117名であり、人に対する採血前にエコーによる血管アセスメントを行うエコー群と従来群の2群に分け実施した。効果の評価項目は、採血成功率、人への侵襲的行為に対する態度・情動(質問紙及び自由記載による感想)とした。採血成功率は、両群の成功が96%であった。人への侵襲的行為に対する態度・情動質問紙では、「安堵感」「血管の深さをうまく判断できる感覚」「血管に針をうまく刺入できる感覚」の3項目において従来群よりエコー群の得点が高かった。自由記載による人に対する採血の感想では、両群に人に対して侵襲を与える緊張感の記載があったが、エコー群ではエコーを用いることで、安心・安全の記載があった。(著者抄録)

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.

Background In vitro and in vivo studies have indicated that the sea cucumber has biological and pharmacological activities, including antiinflammatory, antimicrobial, antibacterial, antibiofilm, and wound healing activities. However, there have been no studies to evaluate the effects of sea cucumber on wound healing in clinical settings.ObjectiveThis study was performed to evaluate wound healing of diabetic foot ulcers （DFUs） using sea cucumber and to evaluate the effects of sea cucumber on biofilm, tumor necrosis factor alpha （TNF-α）, matrix metalloproteinase （MMP-2）, and matrix metalloproteinase （MMP-9）.Subjects and MethodsThis study had a prospective cohort design. The study population consisted of 42 DFU patients with new ulcers; 21 each were treated using sea cucumber and honey. This study was conducted at two sites: Kitamura Wound Care Clinic and the Outpatient Wound Care Clinic at Soedarso General Hospital, Pontianak, West Kalimantan, Indonesia, from March 2016 to February 2017. The participants were followed up for 12 weeks.ResultsThere were significant differences in the TNF-αlevel between weeks 0 vs. 8, 0 vs. 10, and 0 vs. 12 in the sea cucumber group （p = 0.005, p = 0.006, and p = 0.010, respectively; Steel post hoc test）. There was no significant difference in the change in pattern of biofilm-like staining from positive to negative between the groups （p = 0.55, Fisherʼs exact test）. There was no significant difference in wound healing between the sea cucumber and honey groups （p = 0.66; Kaplan-Meier analysis, log rank test）.ConclusionThese results indicated that sea cucumber could be used as an alternative wound dressing for DFUs in a clinical setting.【背景】海鼠の抗炎症作用、抗菌作用、創傷治癒効果については生物学的、薬理学的にあるいは実験動物にて報告されている。しかし臨床においての創傷治癒効果については報告されていない。【目的】本研究の目的は海鼠の糖尿病足潰瘍（DFU）における創傷治癒効果をバイオフィルム、腫瘍壊死因子（TNF-α）、マトリックス分解酵素（MMP）-2、9 を指標として評価することである。【対象・方法】研究デザインは前向き観察研究である。42 名の糖尿病患者に新規に発生した DFU に、海鼠あるいは蜂蜜が創部に使用された（各群 21 名）。調査場所は、インドネシア西カリマンタン・ポンティアナックにある創傷専門クリニックまたは創傷外来であった。調査期間は 2016 年 3 月から 2017 年 2 月であった。創傷は 12 週間観察された。【結果】海鼠使用群では、調査開始時と比べ 8 週、10 週、12 週の TNF- αが有意に低下した（p=.005, 006, 010）。両群のバイオフィルム陽性→陰性変化割合に有意差はなかった（ｐ =.55、Fisher exact test）。さらに群間の創傷治癒に有意差はなかった（p=.66, Kaplan-Meier 解析、log rank test）。【結論】海鼠は DFU の創傷局所療法として使用可能であると示唆された。

<p>在宅では看護師が排便を直接観察できない場合があり，特に認知機能が低下した高齢者では客観的指標による便秘症状の評価が難しいため，症状に応じた排便ケアが提供できていない可能性がある．そこで我々は超音波検査（エコー）により直腸の便の有無が確認できることをこれまで明らかにしてきたが，エコーにより便性状と量を区別できるかは明らかになっていない．今回，便性状の異なる3症例において直腸エコーによる便性状と便量の評価が可能かを検討したので報告する．長期療養型施設に入院する高齢者3名を対象にし，排便後より次回排便後まで，直腸のエコー画像を経時的に収集した．直腸のエコー所見および直腸に高エコー域が確認された場合は，その長径（連続した高エコー域の始点と終点を結ぶ直線の長さ）を計測した．エコー所見と便性状は研究者が直接観察し，ブリストル便性状スコア（以下BS）によって評価した．症例1：94歳男性で，便性状はBSタイプ4の普通便であった．直腸エコーでは，排便後より次回排便後に至るまで，直腸内腔に後方音響陰影を伴わないCrescent shapeの高エコー域が観察された．高エコー域の長径は観察期間中に徐々に上昇し，排便後に低下した．症例2：92歳女性で，便性状はBSタイプ1の硬便であった．直腸エコーでは，排便後より次回排便後に至るまで，直腸内腔に後方音響陰影を伴うCrescent shapeの強い高エコー域が観察された．高エコー域の長径は観察期間中に徐々に上昇し，排便後に低下した．症例3：67歳男性で，BSタイプ7の水様便であった．直腸エコーでは，Crescent shapeの高エコー域を認めず，後方音響陰影を伴わない全周性の低エコー域が観察された．硬便の有無は後方音響陰影を伴うCrescent shapeの強い高エコー域の有無で評価できる可能性があり，Crescent shapeの高エコー域の長径により便量を評価できる可能性がある．今後エコーを用いて評価した便性状・便量に基づく排便ケア選択が可能となると考えられる．</p>

皮膚汚れ除去に最も効果的な拭き取りによる洗浄剤除去方法を明らかにすることを目的とし、健康成人女性の前腕部を対象に準実験研究を実施した。洗浄剤により皮膚表面の汚れを浮かせたあと、3種類の異なる拭き取り方法により皮膚汚れおよび皮膚洗浄剤を除去した(WIPE A:末梢から中枢方向、WIPE B:中枢から末梢方向、WIPE C:中枢から外側へ円を描く)。皮膚汚れとして油性口紅を使用し、汚れ塗布部位とその周囲合計5ヶ所において、拭き取り前後の皮膚色の差を算出することで、皮膚汚れ除去効果の指標とした。拭き取り方法間で統計学的有意差を認めた場合にその回数を数え、評価部位5ヶ所の統計学的有意差の合計数(Total score)が最も高いものを最も皮膚汚れ除去効果の高い方法とした。結果としてWIPE CはWIPE AおよびWIPE Bにくらべて高い5ヶ所のTotal scoreを示した。本研究における3種類のなかでは、中枢から外側へ円を描く拭き取り方法が最も皮膚汚れ除去効果が高いことが明らかになった。(著者抄録)

背景:高周波超音波診断装置(エコー)は皮膚の非侵襲的イメージングに用いられているが、実組織との関係を検討した知見は少ない。本研究の目的は、エコー画像と実際の皮膚組織に着目し、手術の際に除去される帝王切開痕を用いて比較することである。方法:本研究では、書面によるインフォームドコンセントを得られた12名の妊婦を対象とした。出産前に瘢痕部と周囲皮膚をエコーで撮影した。反復帝王切開時、産科医によって瘢痕組織が採取され、コラーゲン・エラスチン染色に供された。染色画像を用いてコラーゲン量とエラスチン量の定量を行った。結果:瘢痕部は密な構造であったが、低エコーであった。エコー輝度とエラスチン陽性面積に有意な相関が認められたが、コラーゲン陽性面積とは有意な相関は認められなかった。結論:エコー輝度はコラーゲンの量や密度よりはむしろ、エラスチンの量とより相関することが明らかとなった。(著者抄録)

本研究は枕のあて方の違いならびに同一の枕のあて方による臥床開始時と臥床開始30分後の上肢・胸部の筋の硬さと自覚症状の違いを比較し、エアマットレス臥床時に最適な枕のあて方を明らかにすることを目的とした。20歳代の健康成人10名を対象とし、準実験研究を行った。操作変数は枕のあて方3種類(肩口まで、耳孔まで、枕なし)とし、観察変数は大胸筋・上腕二頭筋・上腕三頭筋・総指伸筋における筋の硬さおよび自覚症状とした。筋の硬さとしてエラストグラフィを用いてStrain ratioを算出した。自覚症状として頭部から腰部の疲労感、苦痛の程度等を5段階で評価した。対象者はエアマットレス上で仰臥位となり、臥床開始時と30分後にデータを収集した。臥床開始時の上腕二頭筋の硬さは、肩口まで、耳孔までが枕なしと比較して有意に低値であり、総指伸筋の硬さは、耳孔までが肩口まで、枕なしと比較して有意に低値であった。臥床開始時の苦痛の程度は肩口までが耳孔までと比較して有意に低値であり、首の痛み・痺れ・疲労感は臥床開始時、30分後ともに耳孔までが肩口まで、枕なしと比較して有意に高値であった。臥床開始30分後には、全ての枕のあて方で開始時よりも自覚症状の点数が増加していた。以上より、肩口までがエアマットレス臥床時の枕のあて方として望ましいことが明らかとなった。また、看護師は臥床時間が30分間であっても苦痛が増強することを念頭に置き、ケアを行う必要がある。(著者抄録)

抗がん剤の血管外漏出後の重症皮膚障害の発生要因の抽出を目的とした。2014年4〜9月に抗がん剤の点滴静脈内注射を受けた256件のうち漏出した25名を対象とした。滴下中にサーモグラフィーによる皮膚温度の測定と肉眼的観察を行った。重症群を再来時に硬結もしくは水疱があると定義し、重症群(12件)と軽症群(13名)に分け両群の要因を比較した。金沢医科大学倫理委員会の承認を得た。重症皮膚障害が発生した対象の特徴は、サーモグラフィーで血管外漏出を示唆する低温領域出現後の壊死性薬剤もしくは炎症性薬剤の投与時間が長い(重症群28分、軽症群6分、P=0.017)、投与時の腫脹なし(重症群92%、軽症群46%、P=0.03)、年齢が低い(重症群59.4歳、軽症群71.2歳、P=0.037)、であった。抗がん剤の血管外漏出後の重症皮膚障害の発生要因として、肉眼で腫脹が認識されないことによる長時間の漏出が示唆された。(著者抄録)

Complex factors influence adolescents' attitudes. Secondary sexual development and emotional changes are markers of puberty and affect attitudes toward reproductive health (RH). This is especially evident in the society and culture of Indonesia. This study examined the presence of immaturity at puberty and factors associated with negative attitudes toward RH among Indonesian adolescents. We conducted a cross-sectional study with 1040 students (aged 11-16 years) selected using multistage random cluster sampling. Data were collected using a self-administered questionnaire that included the illustrative questionnaire for interview surveys with young people and the pubertal development scale (PDS), modified in accordance with the Indonesian context. Data analysis used descriptive and comparative statistics and logistic regression analyses. Immature pubertal development was higher in boys [22.7%, 95% confidence interval (CI): 14.7%-30.7%] than girls (18.4%, 95% CI: 11%-25.7%). However, negative attitudes were higher in girls (40.6%, 95% CI: 34.3%-46.8%) than boys (37.1%, 95% CI: 29.9%-44.7%). Factors associated with negative attitudes toward RH in both boys and girls were age, RH communication with parents, and pubertal development. Smoking was an additional factor in boys, whereas living in an urban area was an additional factor in girls. High knowledge about RH was associated with less negative attitudes toward RH in both boys and girls. Immaturity and factors that influence negative attitudes toward RH should be explored during puberty. Improving knowledge about RH may help to prevent negative attitudes toward RH, especially for girls in urban areas and boys with smoking habits.

Background/purpose: Presently, skin-cleaning agents that claim to be removed by water or wiping alone are commercially available and have been used for the purpose of bed baths. However, there is a lack of knowledge on how water washing and wiping differently affect skin physiological functions or ceramide content. The aim of this study was to compare the effects of water washing and wiping on skin physiological functions and ceramide content. Methods: Three kinds of the cleaning agents with different removal techniques (ie, water washing and wiping) were used in this study. Skin physiological functions (ie, transepidermal water loss, skin hydration, and skin pH) and skin ceramide content were measured before and after seven consecutive days of the application of each cleaning agent. Results: No significant differences in skin physiological functions or ceramide content were observed between water washing and wiping. Conclusion: Cleaning agents that claim to be removed by water washing or wiping do not affect skin physiological functions or ceramide content by either removal method.

金沢大学医薬保健研究域附属健康増進科学センターでは、インターバル速歩を取り入れたウォーキング教室を介した、地域の高齢者への健康増進行動支援活動を行っている。この活動の振り返りと今後の支援について検討するため、質問紙調査を実施した。行動療法のABCモデルを参考に、参加者の教室における目標と、参加者の特性、行動、成果が関連するという調査枠組みを作成し、データの記述と分析を行った。対象者は、教室における目標別に6つのグループに分類することができた。目標の内容に関わらず、教室へ参加し健康状態の維持ができていることが明らかとなった。しかし、目標の設定と目標に対する自己評価が適切に行えていない対象者がいることが示唆された。そのため、目標設定と目標に対する自己評価が適切にできるような援助が必要である。(著者抄録)

The aim of this study was to identify skin properties that may be used to predict the development of a skin tear (ST) among elderly patients. A prospective cohort study was conducted among elderly patients aged 65 and older (N = 149) at a long-term medical facility in Japan over an 8-month period. Skin properties at baseline were measured on the forearm using a 20-MHz ultrasound scanner, which measured the thickness of the dermis layer and low-echogenic pixels, and skin blotting method, which evaluated the levels of collagen type IV, matrix metalloproteinase-2 and tumour necrosis factor-alpha. Adjusted hazard ratios (HRs) for the main confounders were obtained using the Cox proportional hazard model. A total of 52 STs were recorded among the 21 patients, resulting in an incidence rate of 1·13/1000 person-days. The predictor of STs was dermis thickness (HR = 0·52; 95% confidence interval = 0·33-0·81; P-value = 0·004). The cut-off point for dermis thickness was 0·80 mm (area under the curve = 0·77; 95% confidence interval = 0·66-0·88; P-value = 0·006). Our results suggest that measuring the dermis thickness at baseline is an easy and accurate way to identify a high-risk patient.

Ultrasonography (US) is useful for visual detection of edematous tissues to assess subcutaneous echogenicity. However, visualization of subcutaneous echogenicity is interpreted differently among operators because the evaluation is subjective and individual operators have unique knowledge. This study objectively assessed leg edema using US with a gel pad including fat for normalization of echogenicity in subcutaneous tissue. Five younger adults and four elderly people with leg edema were recruited. We compared assessments of US and limb circumference before and after the intervention of vibration to decrease edema in younger adults, and edema prior to going to sleep and reduced edema in the early morning in elderly people. These assessments were performed twice in elderly people by three operators and reliability, interrater differences, and bias were assessed. For US assessment, echogenicity in subcutaneous tissue was normalized to that of the gel pad by dividing the mean echogenicity of subcutaneous tissue by the mean echogenicity of the gel pad. In younger adults, the normalized subcutaneous echogenicity before the intervention was significantly higher than that after the intervention. In elderly people, echogenicity indicating edema was significantly higher than that after edema reduction. Edema was detected with accuracy rates of 76.9% in younger adults and 75.0% in elderly people. Meanwhile, limb circumference could be used to detect edema in 50.0% of healthy adults and 87.8% of elderly people. The intra-reliability was excellent (intraclass correlation coefficient &gt; 0.9, p &lt; 0.01), and the inter-reliability was good (intraclass correlation coefficient &gt; 0.7, p &lt; 0.01) for normalized subcutaneous echogenicity. Bland-Altman plots revealed that inter-rater differences and systematic bias were small. Normalized subcutaneous echogenicity with the pad can sensitively and objectively assess leg edema with high reliability. Therefore, this method has the potential to become a new gold standard for objective assessment of leg edema in clinical practice.

The aim of this study was to clarify the relationship between maceration and wound healing. A prospective longitudinal design was used in this study. The wound condition determined the type of dressings used and the dressing change frequency. A total of 62 participants with diabetic foot ulcers (70 wounds) were divided into two groups: non-macerated (n = 52) and macerated wounds (n = 18). Each group was evaluated weekly using the Bates-JensenWound Assessment Tool, with follow-ups until week 4. The Mann-Whitney U test showed that the changes in the wound area in week 1 were faster in the non-macerated group than the macerated group (P = 0.02). The Pearson correlation analysis showed a moderate correlation between maceration and wound healing from enrolment until week 4 (P = 0.002). After week 4, the Kaplan-Meier analysis showed that the non-macerated wounds healed significantly faster than the macerated wounds (log-rank test = 19.378, P = 0.000). The Cox regression analysis confirmed thatmaceration was a significant and independent predictor of wound healing in this study (adjusted hazard ratio, 0.324; 95% CI, 0.131-0.799; P = 0.014). The results of this study demonstrated that there is a relationship between maceration and wound healing. Changes in the wound area can help predict the healing of wounds with maceration in clinical settings.

Background: Although lymphedematous skin exhibits delayed wound healing, little is known about lymph drainage during wound healing. We investigated the wound healing process in the presence of lymphatic dysfunction. Methods and Results: The right inguinal lymph nodes (iLNs) and the surrounding tissue were excised in each mouse (the operation side), and a sham operation was performed in the left hindlimb (the control side). The next day, full-thickness wounds were made on both hindlimbs. The right hindlimb exhibited acute edema until day 3; however, it started to improve after day 4, and the wound area and epithelialization ratio were similar on both sides. Indocyanine green (ICG) was injected into both hindlimbs to observe lymph flow. On the operation side, ICG leaked out of the surgical site or remained at the injection site until day 2. Some lymph flow toward the existing lymph vessels was seen on day 3, and on day 10, lymph flow toward the axial LNs was detected on the operation side in all mice. On the operation side, the number of dermal lymph vessels was significantly increased on days 3 and 15. The dermal lymph vessel area of the peripheral wound was significantly smaller on the operation side. Conclusions: In a hindlimb lymphedema mouse model, lymph transiently accumulated in subcutaneous tissue, and then was gradually absorbed by the existing lymph vessels. The increase in the number of lymph vessels contributes to lymph drainage during wound healing. Acute lymphedema because of transient lymphatic dysfunction has little effect on wound healing.

© MA Healthcare Ltd. Objective: Evaluating bacterial load in pressure ulcers (PUs) is key to combat infection; therefore, using technologies to measure bacterial count can be particularly useful. A rapid bacteria counting system was recently developed and introduced to the wound care field. However, its reliability was not established. This cross-sectional study aimed to evaluate the inter-rater and intra-rater reliability of bacterial count using this rapid counting system. Method: We took bacterial swabs from patients with category I or greater PUs to assess inter- and intra-rater reliability. An assessor swabbed the longest axis of the PU once and bacterial counts were measured using a rapid bacteria counting system. To confirm the inter-rater and intra-rater reliability, intraclass correlation coefficients (ICCs) were calculated. Results: We took 63 and 57 pairs of bacterial counts from 13 patients with 16 category I or greater PUs to assess inter- and intra-rater reliability, respectively. Overall ICCs [95% confidence intervals (CI)] for the bacterial counts were 0.83 [0.73-0.90, p&lt;0.001, inter-rater reliability, n=63], and 0.89 [0.82-0.94, p&lt; 0.001, intra-rater reliability, n=57]. Conclusion: A high level of reliability for counting bacterial numbers in PU sites was confirmed. The results should encourage clinicians and researchers to use this type of device for the real-time assessment of wound bacterial bioburden at the patient&#039;s bedside. Declaration of interest: This study was partly supported by a grant-inaid for Scientific Research A from the Japan Society for the Promotion of Science. The authors have no conflict of interest to declare.

低栄養状態では、側頭部皮下の筋肉や脂肪の厚みが減少し、側頭部が陥没するが、その客観的評価法は未確立である。そこで、側頭部の皮膚硬度計による測定が皮下の組織厚の代替指標として側頭部の形状を反映し、栄養状態の指標になりうると考えた。健常成人13名において、皮膚硬度計で側頭部の皮膚硬度を、超音波検査法で側頭部の総組織厚、筋厚、脂肪厚を計測し、身体計測による栄養評価を実施した。側頭部の皮膚硬度は、側頭部の総組織厚(r=0.782、p=0.002)、脂肪厚(r=0.717、p=0.006)と有意に相関し、さらに栄養状態の指標であるBody Mass Index(r=0.665、p=0.013)、上腕周囲長(r=0.682、p=0.010)、下腿周囲長(r=0.618、p=0.024)と有意に相関した。側頭部の皮膚硬度は皮下の総組織厚(特に脂肪厚)および栄養状態を反映し、新たな栄養指標になりうると示唆された。(著者抄録)

Bacteria have been found to form multicellular aggregates which have collectively been termed "biofilms." It is hypothesized that biofilm formation is a means to protect bacterial cells including protection form the immune response of humans. This protective mechanism is believed to explain persistent chronic wound infections. At times, the biofilms are abundant enough to see, and remove by simple wiping. However, recent evidence has shown that the removal of these visible portions are not sufficient, and that biofilms can continue to form even with daily wiping. In this work, we tested an approach to detect the biofilms which are present after clinically wiping or sharp wound debridement. Our method is based on a variation of impression cytology in which a nitrocellulose membrane was used to collect surface biofilm components, which were then differentially stained. In this prospective study, members of an interdisciplinary pressure ulcer team at a university hospital tested our method's ability to predict the generation of wound slough in the week that followed each blotting. A total of 70 blots collected from 23 pressure ulcers produced 27 wounds negative for staining and 43 positive. In the negative blots 55.6% were found to have decreased wound slough, while 81.4% with positive staining had either increase or unchanged wound slough generation. These results lead to an odds ratio of positive blotting cases of 9.37 (95% confidence intervals: 2.47-35.5, p = 0.001) for slough formation; suggesting that the changes in wound slough formation can be predicted clinically using a non-invasive wound blotting method.

Early detection of extravasation is important, but conventional methods of detection lack objectivity and reliability. This study evaluated the predictive validity of thermography for identifying extravasation during intravenous antineoplastic therapy. Of 257 patients who received chemotherapy through peripheral veins, extravasation was identified in 26. Thermography was performed every 15 to 30 minutes during the infusions. Sensitivity, specificity, positive predictive value, and negative predictive value using thermography were 84.6%, 94.8%, 64.7%, and 98.2%, respectively. This study showed that thermography offers an accurate prediction of extravasation.

Background: To overcome the shortage of medical care delivery in the rapidly aging Japanese society, the Ministry of Health, Labour and Welfare in 2010 started to train the nurses to be able to conduct the specified medical acts. The Japanese Nursing Association conducted the educational program to train the wound, ostomy, and continence nurses for the specified medical act of wound care. However, the difference between wound, ostomy, and continence nurses who conducted the medical act and those who did not was not clear. The aim of this study was to determine how trained wound, ostomy, and continence nurses spend their time during their entire shift in an acute hospital setting. Methods: In this prospective observational study, we selected those wound, ostomy, and continence nurses who received advanced training in the wound management program (T-WN) in 2011-2012. Wound, ostomy, and continence nurses who did not receive the training (N-WN) were also recruited as controls. We conducted a time and motion study during subject's day shifts for 1 week. We calculated the time spent on tasks based on a task classification code that was created to facilitate a two-group comparison. Results: Six T-WNs and five N-WNs were our analysis subjects. T-WNs spent significantly more time on direct care than did N-WNs (p = 0.00). Moreover, in the sub-categories s of direct care, T-WN spent significantly more time on "treatment" than did N-WN (p = 0.01). T-WN spent significantly more time on treatment with (p = 0.03) or without (p = 0.01) physicians than did N-WN. In the treatment activities, T-WN performed significantly more time on foot care (p = 0.01), wound cleansing (p = 0.01) and conservative sharp wound debridement (p = 0.01) than did N-WN. Frequencies of direct care interventions for the patients was significantly different between T-WN and N-WN (p = 0.04). Conclusions: T-WNs frequently engaged in direct care provided treatment for patients with chronic wounds.

背景:原発性リンパ浮腫患者とがん関連リンパ浮腫患者では疾患の成り立ちやその背景の違いから健康関連QOL(HRQOL)やコーピングスタイルが異なることが予測される。本研究は,原発性下肢リンパ浮腫患者とがん関連下肢リンパ浮腫患者を比較することにより,原発性リンパ浮腫患者のHRQOLとコーピングスタイルを明らかにすることを目的とする。方法:HRQOLを測定するスケールとしてSF-36日本語版,日本語版HAD尺度(HADS)を用い,コーピングスタイルの測定には日本語版Brief-COPEを用いた。基本属性,リンパ浮腫の状態は診療録,フィジカルアセスメントより情報を得た。結果:原発性下肢リンパ浮腫患者78名,がん関連下肢リンパ浮腫患者63名が対象となった。年齢,性別をマッチングさせた国民標準値と比較すると原発性下肢リンパ浮腫患者におけるHRQOLは全般的健康感(GH)のみ低い結果であった。さらに,共分散分析を用い年齢,性別を調整した両群のHRQOLの比較においては,有意差は認められなかった。HADSでは,不安,抑うつともに点数8(不安,抑うつの疑いのあるスコア)以上の患者の割合は低い結果であった。Brief-COPEの項目では,原発性下肢リンパ浮腫患者における積極的コーピングと自己非難の得点が,がん関連下肢リンパ浮腫患者よりも高い結果であった。結論:原発性下肢リンパ浮腫患者とがん関連下肢リンパ浮腫患者のHRQOLの違いは確認されなかったが,コーピングスタイルの違いが明らかとなった。(著者抄録)