須釜 淳子

研究目的はリンパ浮腫におけるデータセットを構築し、内容妥当性および操作性を評価することである。リンパ浮腫に精通した研究者でワーキンググループを構成し、リンパ浮腫ケアの評価を行うHealth Service EvaluationDataset(HSED)を構築した。HSEDは、基本属性、ヘルスサービス/客観的評価、主観的評価の3画面で構成し、英語版と日本語版を作成し、評価を行った。対象者は、リンパ浮腫の専門家(日本語版6名、英語版6名)とし、患者5名のデータ入力と、調査票の記載を依頼した。調査票は、内容妥当性を問う質問、操作性を問う質問とした。内容妥当性は内容妥当性指数を算出した。操作性は、対象者の50%以上が容易であると回答し、さらに患者1名あたりの入力時間の中央値が基本属性4分、ヘルスサービス/客観的評価7分、主観的評価9分の基準内を容易とした。内容妥当性指数は、全画面で0.8以上であった。操作性は、容易60.0-100.0%であった。入力時間の中央値は日本語版のヘルスサービス/客観的評価で日本語版7.5分であったが、それ以外は基準内であった。内容妥当性は全画面で高かった。入力の操作容易性は、全画面で基準をクリアした。しかし入力時間は1画面で基準を超えた。入力に時間のかかった対象者は、データの編集や削除の方法が不明であったとしており、オペレーションガイドの追加が必要である。(著者抄録)

褥瘡保有者の退院前から退院後に、皮膚・排泄ケア認定看護師(以下WOCNとする)が退院後療養先の医療・福祉職と連携し、褥瘡ケア支援を行うことによって、褥瘡の改善および治癒が促進されるかを明らかにした。対象はDESIGN-Rでd2以上の褥瘡を保有し、自宅、介護保険施設、療養型病院に退院する者であった。介入群19名には、WOCNが退院前に退院後療養先の医療・福祉職と合同カンファレンスを実施、退院後は相談・指導、病院専門職との調整による支援を退院後90日まで行った。対照群11名には従来通りのケアが行われた。対象者の概要、交絡因子、退院時褥瘡概要には差がなかった。介入群の褥瘡治癒までの期間は、対照群より短かった(p<0.038)。介入群では退院後60日までDESIGN-R総点は減少(p<0.001)、創面積は退院後45日まで減少した(p<0.001)。WOCNの支援は特に深い褥瘡で有効であった。(著者抄録)

We investigated cold plasma effects on acute wounds of mice. The mice were classified into experimental and control groups. In the former, wounds were treated using cold plasma once daily for 1 min, and then covered with hydrocolloid dressing; wounds in the control were left to heal under hydrocolloid dressing. Daily evaluation was conducted for 15 days. General and specific staining was applied to evaluate re-epithelialization, neutrophil, macrophage, myofibroblast and transforming growth factor beta. It was found that cold plasma accelerated wound healing by 1 day. Plasma may promote the late phase of inflammation, accelerate re-epithelialization and increase wound contraction. © 2014 Elsevier GmbH. All rights reserved.

OBJECTIVE: The skin performs important structural and physiological functions, and skin assessment represents an important step in identifying skin problems. Although noninvasive techniques for assessing skin status exist, no such techniques for monitoring its physiological status are available. This study aimed to develop a novel skin-assessment technique known as skin blotting, based on the leakage of secreted proteins from inside the skin following overhydration in mice. The applicability of this technique was further investigated in a clinical setting. DESIGN: Skin blotting involves 2 steps: collecting proteins by attaching a damp nitrocellulose membrane to the surface of the skin, and immunostaining the collected proteins. The authors implanted fluorescein-conjugated dextran (F-DEX)-containing agarose gels into mice and detected the tissue distribution of F-DEX under different blotting conditions. They also analyzed the correlations between inflammatory cytokine secretion and leakage following ultraviolet irradiation in mice and in relation to body mass index in humans. MAIN RESULTS: The F-DEX in mice was distributed in the deeper and shallower layers of skin and leaked through the transfollicular and transepidermal routes, respectively. Ultraviolet irradiation induced tumor necrosis factor secretion in the epidermis in mice, which was detected by skin blotting, whereas follicular tumor necrosis factor was associated with body mass index in obese human subjects. These results support the applicability of skin blotting for skin assessment. CONCLUSIONS: Skin blotting represents a noninvasive technique for assessing skin physiology and has potential as a predictive and diagnostic tool for skin disorders.

Bed sheets generate high surface tension across the support surface and increase pressure to the body through a process known as the hammock effect. Using an anatomical model and a loading device characterized by extreme bony prominences, the present study compared pressure distributions on support surfaces across different bed making methods and bed sheet materials to determine the factors that influence pressure distribution. The model was placed on a pressure mapping system (CONFORMat (R); NITTA Corp., Osaka, Japan), and interface pressure was measured. Bed sheet elasticity and friction between the support surface and the bed sheets were also measured. For maximum interface pressure, the relative values of the following methods were higher than those of the control method, which did not use any bed sheets: cotton sheets with hospital corners (1.28, p = 0.02), polyester with no corners (1.29, p = 0.01), cotton with no corners (1.31, p = 0.003), and fitted polyester sheets (1.35, p = 0.002). Stepwise multiple regression analysis indicated that maximum interface pressure was negatively correlated with bed sheet elasticity (R-2 = 0.74). A statistically significant negative correlation was observed between maximum interface pressure and immersion depth, which was measured using the loading device (r = -0.40 and p = 0.04). We found that several combinations of bed making methods and bed sheet materials induced maximum interface pressures greater than those observed for the control method. Bed sheet materials influenced maximum interface pressure, and bed sheet elasticity was particularly important in reducing maximum interface pressure. (C) 2014 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Objective: Granulation tissue colour may be an indicator for nutritional assessment in pressure ulcer (PU) care. This study evaluated the relationship between nutritional status, anaemia and diabetes, and granulation tissue colour of PUs by colour analysis of digital photographs in the clinical setting. Method: The cross-sectional study included 42 older patients with 51 full-thickness PUs from 10 institutions. Patient demographics, wound status, nutritional status and dietary intakes were obtained from medical charts. From a wound image, the granulation red index was processed by computer software and the proportion of pixels exceeding the threshold intensity of 80 for the granulation tissue surface (% GRI80) was calculated. Results: Haemoglobin levels were positively associated with % GRI80 levels (p=0.007) in the crude model, but not in the adjusted model (p=0.260). The interaction term between diabetes and protein intake was significantly associated with % GRI80 levels in the adjusted models (p=0.010). At protein intakes of 0.95 g/kg or higher, diabetic wounds exhibited lower % GRI80 levels than non-diabetic wounds (p=0.002). At protein intakes of less than 0.95 g/kg, % GRI80 levels did not differ between diabetic and non-diabetic patients (p=0.247). Protein intakes of 0.95 g/kg or higher were associated with higher % GRI80 levels in non-diabetic patients (p=0.015), but not in diabetic patients (p=0.127). Conclusion: Granulation tissue colour, evaluated by the objective and quantitative analysis of digital photography, is related to haemoglobin level, diabetes and dietary intakes in clinical settings.

SynopsisObjective The objective of this study was to clarify the effects of different body washing methods on skin texture. Methods Subjects were nine healthy women in their 20s. Skin on the inside of the forearms was washed every day for 4 weeks with protective washing (right forearm) and with non-protective washing (left forearm). We performed comparison of the right forearm and the left forearm. For the evaluation of skin texture, the interval of the sulcus cutis, and the mean and variance of the thickness of the sulcus cutis on digitized images were measured. Moreover, the numbers of equilateral triangles consisting of sulcus cutis were counted to evaluate skin texture. Results From the first week, the interval of sulcus cutis was significantly narrower with protective washing than with non-protective washing. The numbers of equilateral triangles increased significantly more with protective washing than with non-protective washing in weeks 1, 2 and 4. Although this study found no significant difference in mean of the thickness of the sulcus cutis, the interval of sulcus cutis and the number of triangles differed significantly with protective washing. The narrower intervals between sulcus cutis mean finer-textured skin and sulcus cutis are formed by triangles or quadrilaterals, and the more uniform these shapes are, the finer and more regular the texture Therefore, skin texture may have become finer as a result of protective washing. Conclusion These findings suggest that protective washing produces an even skin texture. They also suggest that number of equilateral triangles, as used in this study, may be useful as an index of skin texture.

地域住民は労働者と比較し、保健指導や健康教育を受ける機会が少なく、自ら健康情報を選択し健康行動をとる必要がある。また、人が適正体重(Healthy Weight)に向けた健康行動をとるには、Health Literacy(以下HL)とHealth Locus of Control(以下HLC)が作用していることが推測される。そこで本研究は、地域住民を対象にHL、HLC、健康行動とHealthy Weightとの関連を明らかにすることを目的とした。T町の健康診査またはがん検診受診者に無記名自記式質問紙調査を実施し、803名から有効回答を得た。HLの各能力とHLCの各因子と健康行動の各分類との関連、健康行動の各分類と肥満度との関連を検討した結果、HL3(情報伝達能力)とIHLC(自分自身HLC)(r=.222)、HL5(行動決定能力)とIHLC(r=.287)に弱い正の相関がみられた。また先行研究より、HLとHLCそれぞれが健康行動と関連していることが示されているが、本研究結果では同様の結果がみられなかった。以上より、地域住民のHLとHLCと健康行動と関係があり、さらに健康行動がHealthy Weightと関係がある場合、地域住民に対してHL、HLCに焦点をあてた新たなアプローチ法を見出す一助となりうる研究となった。(著者抄録)

片側性続発性リンパ浮腫患者15例を対象に、徒手的リンパドレナージ(MLD)前後の皮膚硬さを測定し、乳癌関連リンパ浮腫(BRCL)評価における皮膚・皮下組織に対する超音波検査の有用性を評価した。皮膚の硬さは10cmの視覚的アナログスケール(VAS)により評価した。超音波検査は、皮膚に対して20MHz、皮下組織に対して10MHzで施行した。MLD後に皮膚が柔らかくなった患者(10例、年齢52〜66歳)と硬さが不変の患者(5例、年齢30〜64歳)の両群で超音波検査所見とその他の特性を比較した。VAS低下患者ではMLD後に低輝度所見割合とpixel uniformityが低下したが、VAS低下患者ではそのような所見はみられなかった。皮膚が柔らかくなった患者では、MLD後に皮膚および皮下組織内の間質液が減少していると考えられた。

Objective: To identify the physiological and appearance characteristics of skin maceration caused by urine and/or faeces and determine their suitability as risk indicators for incontinence-associated dermatitis. Method: This cross-sectional, comparative study involved sixty-nine elderly women with urinary and/ or faecal incontinence who provided informed consent to participate. Exclusion criteria included serious medical problems, acute illness and the presence of damaged skin on the buttocks. The physiological and appearance characteristics of macerated skin on the buttocks of the patients were examined. Stratum corneum and dermis hydration levels, transepidermal water loss and skin pH were used to assess skin condition. Skin morphology (sulcus cutis) was confirmed using images at x15 magnification. The erythema index and white index were used to evaluate colour in the macerated skin areas. Results: Forty-four patients exhibited skin maceration. Stratum corneum and dermis hydration levels were significantly greater in the maceration group than in the non-maceration group, as were transepidermal water loss, skin pH and differences in sulcus cutis interval between the buttock of interest and the subumbilical region. Furthermore, differences in the erythema and white indices between these two regions were significantly higher and lower, respectively, in the maceration group than in the non-maceration group. Conclusion: To our knowledge, this is the first report to note that there are interesting changes not only in the epidermal layer but also in the dermis layer in patients with skin maceration. This finding confirmed that skin maceration caused by incontinence is a severe condition. Moreover, the erythema index was the best index for identifying skin maceration caused by incontinence, indicating that it can be used for precise and easy identification of the condition in clinical practice. Declaration of interest: Funding for this study was obtained from the Japan Society for the Promotion of Science (JSPS) KAKENHI (Grant-in-Aid for Young Scientists) under grant agreement number 21890217. The authors have no conflicts of interest to declare. © 2014 MA Health care ltd.

OBJECTIVE: It has been reported that obese people have poorly organized dermal collagen structure because of the degradation of collagen fibers, which is caused by an increase in oxidative stress levels associated with the hypertrophy of subcutaneous adipose cells. However, it is unclear whether an increase in oxidative stress levels caused by the accumulation of subcutaneous adipose tissue and a change in the dermal structure also occur in overweight and obese Japanese people. The objectives of this study are to identify structural changes that occur in the dermis and to measure the levels of oxidative stress in Japanese overweight males. METHODS: The overweight group included 43 Japanese male volunteers aged between 25 and 64 years and with a body mass index (BMI) of ≥25 and <30. The control group included 47 male volunteers aged between 22 and 64 years and with BMI of <25. The 20-MHz Dermascan C ultrasound scanner with software for image analyses was used. Echogenicity of the upper and lower dermis was measured. The mRNA expression level of heme oxygenase- 1 (HMOX1) in hair follicles was quantitatively analyzed by real-time reverse transcription polymerase chain reaction (RT-PCR) and was used as a marker of oxidative stress. Ultrasonographic imaging and collection of hair follicles were performed at the same site on the thigh, abdomen, and upper arm. RESULTS: The HMOX1 mRNA expression level in the abdomen and thigh was significantly lower in the overweight group than in the control group. Moreover, the echogenicity of the upper dermis of the abdomen and the lower dermis of the abdomen and thigh was significantly lower in the overweight group than in the control group. CONCLUSION: We detected an increase in oxidative stress levels and a decrease in the density of dermal collagen at the same site on the thigh, abdomen, and upper arm of Japanese overweight males. These findings suggest the fragility of the dermis of Japanese overweight males, which might have been caused by the accumulation of subcutaneous adipose tissue.

Aim: Primary lymphedema requires continuous conservative treatment during the patient's life, which may affect their health-related quality of life (HRQOL). Physical and psychosocial characteristics related to lymphedema are associated with their HRQOL. This study aimed to assess HRQOL in those patients undergoing conservative treatment and to determine the factors associated with their HRQOL. Methods: This was a cross-sectional, observational study that included 83 patients with primary lymphedema at an outpatient clinic for lymphedema. HRQOL was assessed with the Medical Outcomes Study 36-Item Short Form Survey (SF-36) and EuroQol 5-Dimension (EQ-5D). Lymphedema status/complications and psychosocial status were evaluated by medical records, physical assessment, and self-administrative questionnaires. Results: The general health perception score in the SF-36 was lower than the age- and sex-stratified national norms (P=0.001). In the EQ-5D, the proportions of patients with some/moderate or severe problems were 42.2% for pain/discomfort, 21.7% for usual activities, and 20.5% for anxiety/depression. By multiple regression analyses, a lower physical component summary score in the SF-36 was associated with a higher lymphedema stage (P=0.021), cellulitis within 30days (P=0.003), exercise (P=0.010), and more substance use coping (P=0.012). A lower mental component summary score was associated with skin lesions over edematous limbs (P=0.008), less humor coping (P=0.005), and more self-blame coping (P=0.014). Conclusion: Patients with primary lymphedema have problems in health perception, discomfort, usual activities, and anxiety/depression. Preventing cellulitis and skin lesions and humor coping may be able to improve HRQOL.

The purpose of this study was to elucidate the body core temperature rhythms of bedridden elderly patients with disorders of consciousness (DOC) in a Japanese hospital using a simple, non-invasive, deep-body thermometer. We measured body core temperature on the surface of abdomen in 10 bedridden elderly patients with DOC continuously over 72 h. A non-heated core body temperature thermometer was used. The cycle of the body core temperature rhythm was initially derived by using the least squares method. Then, based on that rhythm, the mean, amplitude, and times of day of the highest and lowest body temperatures during the optimum cycle were determined using the cosinor method. We found a 24-h cycle in seven of the 10 patients. One patient had a 6-h, one a 12-h, and one a 63-h cycle. The mean value of the cosine curve in the respective optimum cycles was 36.48 +/- 0.34 degrees C, and the amplitude was 0.22 +/- 0.09 degrees C. Of the seven subjects with 24-h cycles, the highest body temperature occurred between 12: 58 and 14: 44 h in four. In addition to 24-h cycles of core temperature rhythm, short cycles of 12 and 6-h and a long cycle of 63-h were seen. In order to understand the temperature rhythms of bedridden elderly patients with DOC, it is necessary to monitor their core body temperatures, ideally using a simple, non-invasive device. In the future, it will be important to investigate the relationship of the core temperature rhythm to nursing care and living environment. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

サルコペニア(加齢性筋肉減少症)予防に向けた保健指導の検討に資することを目的に、健康診査を受診した地域の女性516名(平均年齢50.8±13.7歳)を対象に、筋肉量と骨量の評価、および健康行動との関連を検討した。その結果、50歳以上の女性で、筋肉量32.4kg未満の場合は、筋肉量維持の意識づけ、骨量維持を含めた栄養と運動指導の必要性が示唆された。

The purpose of this study was to evaluate the differences in heel blood flow during loading and off-loading in bedridden adults older than 65 years. The patients were divided into three groups based on ankle-brachial pressure index (ABI) and transcutaneous oxygen tension (tcPO(2)): (1) patients with an ABI 0.8 (Group A); (2) patients with an ABI < 0.8 and heel tcPO(2) 10 mmHg (Group B); and (3) patients with an ABI < 0.8 and heel tcPO(2) < 10 mmHg (Group C). Heel blood flow was monitored using tcPO(2) sensors. Data were collected with the heel (1) suspended above the bed surface (preload), (2) on the bed surface for 30 min (loading), and (3) again suspended above the bed surface for 60 min (off-loading). Heel blood flow during off-loading was assessed using three parameters: oxygen recovery index (ORI), total tcPO(2) for the first 10 min, and change in tcPO(2) after 60 min of off-loading. ORI in Group C (n = 8) was significantly shorter than in Groups A (n = 22) and B (n = 15). Total tcPO(2) for the first 10 min of off-loading in Group C was significantly less than that in Groups A and B. Change in tcPO(2) after 60 min of off-loading in Group C was less than in Group A. Based on these findings, additional preventive care against heel blood flow decrease in older adults with an ABI < 0.8 and heel tcPO(2) < 10 mmHg might be necessary after loading.

目的:男性の尿失禁に起因する皮膚障害の予防にはパッドを用いた従来のケアでは不十分である。そこで本研究は新たに開発したパウチを用いた男性用尿失禁ケア用具(パウチ付き紙おむつ)を使用してモデルおよび健常人実験を行い、おむつ内・外への尿漏れ防止効果ならびに皮膚生理機能へ与える影響を評価した。方法:モデル人形と健常男性を対象にパウチ付き紙おむつの使用またはパッドを陰茎に巻くケアを行い、各ケアがおむつ内・外への尿漏れや皮膚生理機能、温湿度、使用者の主観的評価に与える影響を群間で比較した。本研究は東京大学大学院医学系研究科倫理委員会の承認を得て行った。結果:モデル実験ではパウチ付き紙おむつ使用群ですべての実験条件で有意におむつ内・外への尿漏れ割合が減少した。健常人実験(N=15)では、パウチ付き紙おむつ使用群でおむつ内への尿漏れ割合が有意に減少した。また皮膚生理機能は、角質水分量がパッドによるケアで鼠径部、仙骨部、臀部で排尿前より排尿後に有意に上昇し、皮膚pHはパッドによるケアで仙骨部および臀部で排尿前より排尿後に有意に上昇していた。使用者の主観的評価は排尿後の履き心地、かゆみとにおいにおいてパウチ付き紙おむつ使用群のほうが有意に良好であった。結論:パウチ付き紙おむつの使用はパッドによるケアよりもおむつ内への尿漏れの発生や皮膚生理機能の変化を抑えることができた。さらに使用者の主観的な評価も高いことから、新たな尿失禁ケア方法として用いることが期待できる。(著者抄録)

骨突出部位にかかる外力を管理するために体圧分散寝具が使用されるが、シーツの張りによってハンモック現象が生じ褥瘡発生の原因ともなりうる。そこで本研究目的は、ベッドメーキング方法の違いによる、エアマットレスの圧再分配機能への影響を明らかにすることとした。静止型エアマットレスに綿100%平織りのシーツを敷いた。その上に、骨突出モデルを設置し垂直荷重を加え、沈み込み距離と接触面積、最大接触圧を測定した。シーツは、シーツの角を三角に折り込む「コーナー法」、コーナー処理をしない「処理なし法」、シーツの角をマットレスの裏面に折り込んで結ぶ「結ぶ法」、エアマットレスのカバーのみの「シーツなし」に分類し比較検討した。結果、「シーツなし」に対して、「処理なし法」は接触面積、最大接触圧値に有意差はみられなかった。「コーナー法」は、接触面積が0.61倍に縮小、最大接触圧値が1.87倍に上昇しており、マットレスの圧再分配機能が阻害されていた。また、「結ぶ法」も同様に圧再分配機能が阻害されていた。以上より、シーツのコーナー処理がエアマットレスの圧再分配機能に影響を及ぼしていることが示唆された。(著者抄録)

本研究の目的は、座位能力が低下している高齢者において、圧切り替えクッションが従来のウレタンクッションに比べ圧やズレ度において有効であるかを明らかにすることである。研究デザインは、非ランダム化比較試験である。方法は座位能力が低下している高齢者を対象に、圧切り替えクッションとウレタンクッションを用いて、車椅子座位5分後、60分後の体圧測定及びJSCC版にそって座位60分後に前方向のズレ度を測定した。結果は、右坐骨結節部において60分後の体圧値と体圧変化量は、有意に圧切り替えクッションが低く、圧分散能が高いことが示された。このクッションは、底付き自動感知・回避機能および自動内圧調整機能を有しており、最適な体圧分散状態が保たれたと言える。ズレ度は両クッション間の差はみられなかった。以上より、座位に問題がある高齢者において、圧切り替えクッションは褥瘡予防に有効である可能性があることが示唆された。(著者抄録)

目的:褥瘡発生予防のために体圧分散マットレスを使用することは褥瘡予防・管理ガイドラインで推奨されている。一方で、終末期がん患者の褥瘡発生頻度は高く、これには寝心地の不快感から適切な体圧分散マットレスを拒否し、不適切な体圧分散マットレスを選択後、褥瘡を発生する場面があり、看護師は褥瘡予防と患者の意向の間でジレンマを抱いていた。ジレンマを解決するには患者の寝心地の意向を加味した体圧分散マットレスを選択することが必要であると考える。しかし、患者がどのような寝心地を抱き、体圧分散マットレスを選択、変更しているのか、体圧分散マットレス選択のプロセスは明らかにされていない。本研究の目的は、終末期がん患者の体圧分散マットレスに対する寝心地とその選択のプロセスについて記述することである。方法:対象は施設の3病棟に入院する終末期がん患者で、床上安静でperformance scale 3-4点の褥瘡ハイリスク状態の患者を対象に、褥瘡発生あるいは退院までの体圧分散マットレス選択プロセスとその理由を前向きに調査し、質的帰納的に分析した。結果:対象は14名であり、女性10名、男性4名、年齢28-71歳であった。体圧分散マットレス選択のプロセスパターンは6個抽出された。対象は看護師が提案するエアマットレスを拒否しており、これには過去のエアマットレス初期使用時の寝心地の体験が影響していた。結論:終末期がん患者が体圧分散マットレスの寝心地を安楽と考える要件は《動作・姿勢は安定》し、《苦痛を誘発しない》ことであった。以上より、終末期がん患者にエアマットレスを使用する際には、初期使用時から可動性・活動性にあわせた内圧を調整するプロセスを踏むことが必要である示唆された。(著者抄録)

目的:乳癌術後患者のリンパ浮腫に対し、リンパ浮腫の標準的治療として複合的理学療法が行われており、その一環として簡易的リンパドレナージ(SLD)がある。しかし、SLDは患者自身で行う手技であり、機能障害のために背中や肩へのマッサージが困難であること、毎回一定の技術での実施が困難であることが問題である。我々は、加振器を用いたマッサージ効果に着目し、乳癌術後のリンパ浮腫患者に対し、SLDに振動を追加した場合、SLD単独よりも効果があるかを検証した。方法:対照期はSLD単独実施、介入期はSLDに振動器を追加して実施し、対象者は対照期または介入期のいずれかを先に実施するグループに分けた。SLDは1日2回実施し、振動器はSLD直後に使用した。アウトカムは、対照期と介入期の容積過剰率で評価した。結果:20名がリクルートされ、除外8名とデータ欠損2名を除き、全過程を終了したのは10名であった。SLDに振動を追加した介入期では、10名全員が容積過剰率減少を示した。結論:乳癌術後のリンパ浮腫患者の管理において、SLDへの加振は、補助的療法として有効であることが期待できる。(著者抄録)

Aging is accelerated, at least in part, by pathological condition such as metabolic syndrome (MetS), and various molecular pathways such as oxidative stress are common mediators of aging and MetS. We previously developed the aging-like skin model by single ultraviolet (UV) irradiation on the MetS model mice. Recent studies revealed that mineralocorticoid receptor (MR) signaling plays a pivotal role for various tissue inflammation and damages in MetS. Although previous studies reported that MR is expressed in the skin and that overexpression of MR in the skin resulted in the skin atrophy, the physiological or pathological functions of MR in the skin are not fully elucidated. Here, we show the involvement of MR signaling in the aging-like skin changes in our own model. Elevations of oxidative stress and inflammation markers were observed in the MetS mice, and the UV-evoked aging-like skin damages were attenuated by topical antioxidant. MR expression was higher in the MetS mouse skin, and notably, expression of its effecter gene Sgk1 was significantly upregulated in the aging-like skin in the UV-irradiated MetS mice. Furthermore, topical application of MR antagonist spironolactone suppressed Sgk1 expression, oxidative stress, inflammation, and the aging-like changes in the skin. The 2-week UV onto the non-MetS mice, the more usual photoaging model, resulted in the skin damages mostly equivalent to the MetS mice with single UV, but they were not associated with upregulation of MR signaling. Our studies suggested an unexpected role of MR signaling in the skin aging in MetS status.

Objective: To assess a new rapid bacterial counting device for evaluating wound cleansing effectiveness based on dielectrophoretic impedance measurement. Method: Three patients with pressure ulcers with undermining were recruited, and pressure ulcer severity assessed using the DESIGN-R tool. The number of bacteria was measured using this new apparatus both before and after wound cleansing, performed by wound, ostomy, and continence nurses using a pH-balanced cleanser for periwound skin and with normal saline for the wound bed and undermining area. Results: The results showed that wound cleansing effectively reduced bacterial counts on the periwound skin, wound bed and undermined site, with a median number of bacteria of 3.6×106CFU/ml before cleansing, which decreased to 1.1×106CFU/ml after cleansing. Conclusion: This pilot study result suggests the usefulness of this new device for assessing the effectiveness of wound cleansing on reduction of bacterial number. Standardisation of wound cleansing technique may be achieved by hands-on education using this apparatus at bedside. Declaration of interest: This study was partly supported by a Grant-in-Aid for Scientific Research A from the Japan Society for the Promotion of Science. The authors have no conflicts of interest to declare.

This study aimed to clarify the effects of honey on acute-phase deep burn wounds. Two deep burn wounds were created on mice which were divided into four groups: no treatment, silver sulfadiazine, manuka honey, and Japanese acacia honey. Wound sizes were calculated as expanded wound areas and sampled 30 minutes and 1-4 days after wounding for histological observation. The wound sections were subjected to hematoxylin and eosin and immunohistological staining to detect necrotic cells, apoptotic cells, neutrophils, and macrophages. The no treatment group formed a scar. The redness around the wound edges in the silver sulfadiazine group was the most intense. All groups exhibited increased wound areas after wounding. The proportions of necrotic cells and the numbers of neutrophils in the manuka and acacia honey groups were lower than those in the no treatment and silver sulfadiazine groups until day 3; however, there were no significant differences between all groups on day 4. These results show that honey treatment on deep burn wounds cannot prevent wound progression. Moreover, comparing our observations with those of Jackson, there are some differences between humans and animals in this regard, and the zone of hyperemia and its surrounding area fall into necrosis, which contributes to burn wound progression.