浦井 珠恵

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.

AIM: This clinical practice guideline aims to provide and recommend methods of assessing aspiration and pharyngeal residue during eating and swallowing and methods of selecting and implementing nursing care for adults to prevent the development of aspiration pneumonia through early and appropriate management of oropharyngeal dysphagia. METHODS: In April 2018, the Japan Academy of Nursing Science established the Supervisory Committee in Nursing Care Development/Standardization Committee to develop clinical practice guidelines for aspiration and pharyngeal residual assessment during eating and swallowing for nursing care. This clinical practice guideline was developed according to the Minds Manual for Guideline Development 2017, with the aim of providing a specific pathway for nurses to determine the policy for selecting management for oropharyngeal dysphagia based on research evidence and multifaceted factors including the balance of benefits and harms and patients' values. RESULTS: Based on the 10 clinical questions related to assessment by physical assessment, the Repetitive Saliva Swallowing Test, Modified Water Swallowing Test, Food Test, cervical auscultation, observation using an ultrasound diagnostic device, and an endoscope, 10 recommendations have been developed. Eight recommendations have been evaluated as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) 2C, and the other two have been evaluated as no GRADE. CONCLUSION: The first reliable clinical practice guideline has been produced from an academic nursing organization that focuses on assessment for nursing care and incorporates the latest findings.

Preventing recurrent pressure ulcers is an important challenge in healthcare. One of the reasons for the high rate of recurrent pressure ulcers is the lack of assessment methods for their early detection. Therefore, this study aimed to determine the thermographic characteristics of the healed area and to consider the predictive validity of thermographic images for recurrent pressure ulcers within a 2-week period. This observational study was conducted at a long-term care facility in Japan between July 2017 and February 2019 among patients whose pressure ulcers had healed. Thermographic images of the healed area were recorded once a week until recurrence or until the end of the study. We enrolled 30 participants, among whom 8 developed recurrent pressure ulcers. The generalised estimation equation revealed that the thermographic finding of increased temperature at the healed area compared to that of the surrounding skin was significantly associated with recurrent pressure ulcers (odds ratio: 101.13, 95% confidence interval: 3.60-2840.77, p = .007); the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio for recurrent pressure ulcers within 2 weeks were 0.80, 0.94, 0.62, 0.97, 12.9 and 0.2, respectively. Our thermographic findings revealed that the temperature of the healed area was higher than that of the surrounding skin; this could be a useful predictor of pressure ulcer recurrence within 2 weeks, even in the absence of macroscopic changes.

Top Cited Article 2021-2022 in Japan Journal of Nursing Science

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.

[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.

BACKGROUND: Preventing recurrent pressure injuries (RPIs) is one of the important challenges faced in healthcare, but the risk factors of RPIs have not been fully revealed. This study aims to explore factors associated with RPIs, by focusing on skin physiology and its microbiome as local factors crucial for the health of healed tissue after pressure injury healing. METHODS: This prospective observational study was conducted in a long-term care facility in Japan with patients whose PIs had healed within 1 month. Skin physiology was evaluated by stratum corneum (SC) hydration, pH, and transepidermal water loss. Skin bacteria was collected by tape stripping, followed by 16S ribosomal RNA-based metagenomics analysis. These parameters were evaluated every two weeks over a period of six weeks. RESULTS: A total of 30 patients were included in this study, and 8 patients (26.7%) had an RPI within 6 weeks. In this study, significantly lower SC hydration and a higher rate of Staphylococcus species on the healed site were found in the RPI group. DISCUSSION: A high rate of RPIs (about one in four) points out the necessity of a further care strategy on the healed PIs. Lower skin hydration and/or the increase in Staphylococcus bacteria may have a potential to be used as a biomarker for the prediction of RPIs, or may be an intervention point for the prevention of RPIs by, for example, skin cleansing with moisturizing care.

OBJECTIVE: The sacral skin of bedridden older patients often develops a dysbiotic condition. To clarify whether the condition changes or is sustained over time, we analyzed the skin microbiome and the skin physiological functions of the sacral skin in patients who completed our 2017 study. METHODS: In 2019, we collected the microbiome on the sacral region and measured sacral skin hydration, pH, and transepidermal water loss from 7 healthy young adults, 10 ambulatory older adults, and 8 bedridden older patients, all of whom had been recruited for the 2017 study. For microbiome analysis, 16S ribosomal RNA-based metagenomic analysis was used. RESULTS: No significant differences in the microbial compositions or any alpha diversity metrics were found in the bedridden older patients between the 2017 and 2019 studies; the higher gut-related bacteria were still observed on the sacral skin of the bedridden older patients even after 2 years. Only skin pH showed a significant decrease, approaching normal skin condition, in the bedridden older patients over 2 years. CONCLUSION: This study indicated that gut-related bacteria stably resided in the sacral skin in bedridden patients, even if the patient had tried to restore skin physiological functions using daily skin care. We propose the importance of skin care that focuses more on bacterial decontamination for the sacral region of bedridden older patients, in order to decrease the chances of skin/wound infection and inflammation.

With the increase in the older populations, the number of bedridden older patients is becoming a matter of concern. Skin microbiome and skin physiological functions are known to change according to lifestyle and community; however, such changes in case of movement- and cleaning-restricted bedridden older patients have not yet been revealed. To address this issue, we analyzed skin microbiome and skin physiological functions, including pH, hydration, sebum level, and transepidermal water loss (TEWL), of bedridden older patients, compared with those of ambulatory older and young individuals. For this analysis, we enrolled 19 healthy young and 18 ambulatory older individuals from the community and 31 bedridden older patients from a single, long-term care hospital in Japan. The area of interest was set to the sacral (lower back) skin, where pressure injuries (PIs) and subsequent infection frequently occurs in bedridden older patients. We observed a higher number of gut-related bacteria, fewer commensals, higher skin pH, and lower TEWL on the sacral skin of bedridden older patients than on that of young or ambulatory older individuals. In addition, we observed that 4 of the 31 bedridden older patients developed PIs during the research period; a higher abundance of pathogenic skin bacteria were also observed inside the PI wounds. These findings imply distinct skin microbiome and skin physiological functions in bedridden older patients in comparison with healthy individuals and may suggest the need for more stringent cleaning of the skin of bedridden older patients in light of the closeness of skin and wound microbiome.

OBJECTIVE: Prevention of recurrent pressure ulcers (PU) is one of the most important challenges in wound care, furthermore, the risk factors for recurrent PUs are still not fully understood. This study aimed to explore the risk factors for recurrent PU development within two weeks, including biophysical skin properties, pro-inflammatory cytokine (tumour necrosis factor [TNF]-α) levels and bacterial species, in older patients. METHOD: This prospective study was conducted in a long-term care facility with patients whose PU had healed within two months. Biophysical skin properties were evaluated by stratum corneum hydration, pH, sebum content and transepidermal water loss. TNF-α level was measured using skin blotting. Skin bacteria were collected using tape stripping and determined by species-specific gene amplification. These parameters, along with Braden scale and interface pressure, were evaluated every two weeks for a total period of eight weeks. A penalised generalised estimating equation analysis was used to determine the risk factors for recurrent PUs. RESULTS: In total, 20 patients were included in this study, with 57 observations. Of these, recurrent PU was seen in eight observations. Elevation of pH (p=0.049; odds ratio [OR] per 1 unit=3.91, 95% confidence interval [CI]:1.01-15.15), presence of Acinetobacter spp. (p=0.039; OR versus culture-negative=6.28, 95%CI:1.10-35.86) and higher interface pressure (p=0.008; OR per 1 mmHg=1.06, 95%CI:1.01-1.10) on the healed PU were significantly related to the development of recurrent PU. CONCLUSION: Higher pH, existence of Acinetobacter spp. and higher interface pressure on the site of the healed PU were associated with the development of recurrent PUs in older patients undergoing conservative treatments.

BACKGROUND: Previously, we showed that lymphatic vessels (LVs) formed detours after lymphatic obstruction, contributing to preventing lymphedema. In this study, we developed detours using lymphatic ligation in mice and we identified the detours histologically. METHODS AND RESULTS: Under anesthesia, both hindlimbs in mice were subcutaneously injected with Evans blue dye to detect LVs. We tied the right collecting LV on the abdomen that passes through the inguinal lymph node (LN) at two points. The right and left sides comprised the operation and sham operation sides, respectively. Lymphography was performed to investigate the lymph flow after lymphatic ligation until day 30, using a near-infrared fluorescence imaging system. Anti-podoplanin antibody and 5-ethynyl-2'-deoxyuridine (EdU) were used to detect LVs and lymphangiogenesis. Within 30 days, detours had developed in 62.5% of the mice. Detours observed between two ligation sites were enlarged and irregular in shape. Podoplanin+ LVs, which were located in the subcutaneous tissue of the upper panniculus carnosus muscle, connected to collecting LVs at the upper portion from the cranial ligation site and at the lower portion from the caudal ligation site. EdU+ cells were not observed in these detours. The sham operation side showed normal lymph flow and did not show enlarged pre-collecting LVs until day 30. CONCLUSIONS: Detours after lymphatic ligation were formed not by lymphangiogenesis but through an enlargement of pre-collecting LVs that functioned as collecting LVs after lymphatic ligation. Further studies are required to explore the developmental mechanism of the lymphatic detour for treatment and effective care of lymphedema in humans.

<p>マウス円形皮膚全層欠損創において、円形を保つために創周囲に板状皮膚保護材を貼付した副子が有効であるかを非肥満と肥満マウス（体重が非肥満マウスの1.4倍）を用いて検討した。マウスの背部に直径4mmの円形皮膚全層欠損創を作製し、副子貼付群と非副子貼付群に無作為分類した。副子貼付群に用いた副子は中央に直径1.5cmの円形の穴を開けた板状皮膚保護材（縦2cm、横2.5cm）とした。副子の穴の中央に創が位置するようにマウスの背部皮膚に貼付後、創にはハイドロコロイド被覆材を貼付し、ハイドロコロイド被覆材と副子を固定するために極低刺激テープで体幹を覆った。非副子貼付群の創にはハイドロコロイド被覆材を貼付し、極低刺激テープで体幹を覆った。非肥満マウスと肥満マウスでそれぞれ副子貼付群と非副子貼付群の創傷治癒過程を比較した。</p><p>非肥満マウスの創の形状は、副子貼付群と非副子貼付群でほぼ円形を保っており、明確な差は認められなかった。一方で、肥満マウスの創の形状は、非副子貼付群では左右方向に長く頭尾方向が短い楕円形を呈したが、副子貼付群ではほぼ円形を保っていた。</p><p>すなわち、肥満マウスにおいて円形皮膚全層欠損創の創部にかかる張力を防止し、創形状を保持するためには、板状皮膚保護材を副子として使用することが有用と考えられる。</p>

目的と方法：布メジャーで距離を計測する方法（布メジャー法）と比べて器具を使用する方法（器具法）が、ご遺体を用いた三角筋筋肉内注射部位の想定に有効であることを我々は報告した。しかしながら、生体における両方法の比較は未実施であり、さらに両方法を熟知している者と未経験者間の判断部位に違いがあるかどうかは不明である。そこで今回は両方法を熟知している研究者１名と両方法未経験の看護学生24名に、被験者１名での両方法の三角筋筋肉内注射部位決定を依頼し、両者間の結果を比較した。結果：看護学生の位置は、布メジャー法で肩峰外側端のa点は0.2±1.0cm、前後腋窩線b点は1.9±1.2cm、腋窩神経が位置する下1/3ab点は1.4±0.8cm､器具法ではa点は0.7±1.0cm､b点は0.3±0.8cm､下1/3ab点は0.9±0.7cmそれぞれ研究者の位置よりも中枢側に位置していた｡下1/3ab点とb点で有意に器具法の方が布メジャー法よりも研究者の測定値と看護学生の測定値の距離の差が小さかった（順にp<0.05､p<0.01）。看護学生が測定に要した時間は、布メジャー法で117.4±31.9秒､器具法で115.6±29.5秒であり、有意な差を認めなかった。考察・結論：三角筋筋肉内注射部位を決定する上で重要な部位決定に関して、肩峰外側端は両方法とも看護学生の位置が研究者の位置と比べて1.0cm未満の差となり比較的近かった。一方前後腋窩線は、器具法の方が布メジャー法よりも研究者の測定値と看護学生の測定値の距離の差が有意に小さかった。これは未経験者でも器具を用いた方が熟練者と同じような測定ができる可能性を示唆している。つまり、器具を用いた方が測定に慣れていない看護学生でも熟練した研究者と同じような三角筋筋肉内注射部位決定ができる可能性が考えられる。

本研究は静脈穿刺時の橈骨神経浅枝損傷を防ぐために、手首付近での橈骨神経浅枝と橈側皮静脈の交叉の位置と頻度を明らかにすることを目的とした。本学において解剖実習に供されたご遺体28体28右肢の前腕、手首、手背を用いた。外側上顆から橈骨茎状突起までの距離は22.3±1.7cm であった。橈骨茎状突起より近位6.7±0.8cm の地点で橈骨神経浅枝が腕橈骨筋の深部より皮下に出現し、この神経より内側に位置する橈側皮静脈と伴行、下行した。この橈骨神経浅枝の出現部位は、外側上顆から橈骨茎状突起までの距離の遠位30.0±3.3％に位置していた。また、皮下に出現した橈骨神経浅枝と橈側皮静脈の交叉の頻度は、橈骨茎状突起より近位で62.6％、遠位で17.1％、橈骨茎状突起の位置で14.3％であった。また、橈骨神経浅枝は常に橈側皮静脈より深層に位置していた。橈骨神経浅枝と橈側皮静脈の太さの比は0.88±0.31であった。以上の結果より、外側上顆から橈骨茎状突起までの距離の遠位約1/3の位置で静脈穿刺を実施する際には、橈骨神経浅枝と橈側皮静脈の位置関係を考慮して行う必要があることが示唆された。

The aim of this experiment was to investigate the effect of 17-estradiol on cutaneous wound healing in 12-week ovariectomized (OVX) female mice. Eight-week-old female mice were divided into three groups: administration of 17-estradiol after OVX (OVX + 17-estradiol), OVX, and sham (SHAM). Four weeks after surgery, the mice received two full-thickness cutaneous wounds. 17-Estradiol at 0.01 g/day was administered on the backs of mice in the OVX + 17-estradiol group every day. Plasma 17-estradiol level in the OVX + 17-estradiol group was thus significantly higher than in the SHAM and OVX groups, but there was no significant difference between SHAM and OVX groups. The ratio of wound area was not significantly different among the three groups. However, the period required to reach a ratio of wound area of 0.15 in the OVX + 17-estradiol group was significantly shorter than in the SHAM and OVX groups. These results indicate that cutaneous wound healing in young OVX mice was promoted by the administration of 17-estradiol compared with that in SHAM and OVX mice without such administration, but there was no difference between the latter two groups that did not differ in 17-estradiol level.

Estrogen replacement promotes cutaneous wound healing in 8–10-week young ovariectomized female mice. However, research using aged ovariectomized female mice has not been reported, to the best of our knowledge. Therefore, we investigated the effect of 17β-estradiol on cutaneous wound healing using 24-week middle-aged ovariectomized female mice. Twenty-week-old female mice were divided into three groups: medication with 17β-estradiol after ovariectomy (OVX + 17β-estradiol), ovariectomy (OVX), and sham(SHAM). After 4 weeks, the mice received two full-thickness wounds. Then, theOVX + 17β-estradiol group was administered 17β-estradiol at 0.01 g/day until healing. The ratio of wound area in the OVX + 17β-estradiol group was significantly decreased compared with that in the OVX group. The numbers of neutrophils and macrophages in the OVX + 17β-estradiol group were significantly smaller than those in the OVX group. In addition, the ratio of myofibroblasts in the OVX + 17β-estradiol group was significantly higher than that in the OVX group. These data suggested that exogenous continuous 17β-estradiol administration promotes cutaneous wound healing in 24-week OVX female mice by reducing wound area, shortening inflammatory response, and promoting wound contraction. However, it is unclear whether the effect of exogenous estrogen on wound healing outweighs the delay of wound healing due to advanced age.

The purpose to investigate the effectiveness of Indonesian honey in wound healing in comparison with Tegaderm hydrocolloid dressing and Manuka honey. Three groups of male mice were treated to produce two circular full-thickness skin wounds on the dorsum. They were then randomly allocated to receive daily Indonesian honey, Manuka honey or hydrocolloid as a control for treatment application. Macroscopic findings were observed from day 0 to 14 after wounding. Microscopic findings on days 3, 7, 11 and 14 after wounding were obtained. The ratios of wound areas for honey groups on day 3 were smaller than those of the control group. Wound areas of honey groups gradually decreased to almost the same wound area as the control group on day 14, while the wound area of the control group peaked on day 5 and rapidly decreased until day 14. On day 3, myofibroblasts and new blood capillaries in wound tissue of honey groups were observed, but not in the control group. After day 7, microscopic findings were almost the same among all groups. These results indicate that Indonesian honey is almost as effective for wound healing as Manuka honey and Tegaderm hydrocolloid dressing.

金沢大学医薬保健研究域保健学系我々は、三角筋筋肉内注射部位に関する解剖体を用いて、腋窩神経損傷を避けるために、同神経の位置を体表面から相対的に決定する方法を明らかにした。その方法を用いて、14 名の被験者において腋窩神経が走行すると推定した部位で後上腕回旋動脈の血流音を超音波血流検知器を用いて聴取し、さらに同じ部位でデジタル超音波診断装置画像を撮影し後上腕回旋動脈が確認されるかを検討した。その結果、先行研究における腋窩神経走行部位の相対的な決定方法が生体にも応用可能であること、また、超音波血流検知器を用いて後上腕回旋動脈の血流音を確認することによって腋窩神経走行部位をより確実に決定できることが示唆された。In our previous studies, we determined the course of the axillary nerve in cadavers and projected these finings on the skin covering the deltoid muscle. Since the posterior humeral circumflex artery runs anatomically along the nerve, in the present study, we examined whether this information could be useful to facilitate detection of the axillary nerve living bodies by detecting the blood flow of the artery using a handhold ultrasound blood flowmeter and ultrasound diagnostic equipment. As a result, the sound of blood flow and the image of the artery were demonstrated adjacent to the course of the axillary nerve, although it was difficult to directly visualize the axillary nerve by this method. This indicates that the method of determining the course of the axillary nerve in a cadaver can be adapted to the living body as well. To ascertain the course of the axillary nerve, it is useful to identify the course of the posterior humeral circumflex artery using an ultrasound blood flowmeter and ultrasound diagnostic equipment.