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| 1.
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Haryanto ; Mukai, Kanae ; Nakajima, Yukari ; Okuwa, Mayumi ; Cau, Kim Jiu ; Sugama, Junko ; Nakatani, Toshio ; 向井, 加奈恵 ; 中島, 由加里 ; 大桑, 麻由美 ; 須釜, 淳子 ; 中谷, 壽男
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金沢大学医薬保健研究域保健学系<br />The purpose of this study is to evaluate and clarify the effect of Indonesian honey, two types of J
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apanese honey and hydrocolloid dressing on wound healing process. Four 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, Japanese honey (Buckwheat and Acacia honey) or hydrocolloid dressing as a control for treatment application. Macroscopic findings were observed from day 0 to 14 after wounding. Microscopic evaluation was assessed using qualitative analysis. The ratios of wound areas for honey groups on day 3 and 7 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. Microscopic finding that Indonesian honey was different with Japanese honey especially Buckwheat honey.
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Mukai, Kanae ; Komatsu, Emi ; Nakajima, Yukari ; Urai, Tamae ; Nasruddin ; Sugama, Junko ; Nakatani, Toshio ; 向井, 加奈恵 ; 中島, 由加里 ; 須釜, 淳子 ; 中谷, 壽男
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金沢大学医薬保健研究域保健学系<br />Cutaneous wound healing is delayed by protein malnutrition (PM). On the other hand, estrogen promot
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es cutaneous wound healing by its anti-inflammatory and cell proliferation effects. Therefore, we hypothesized that estrogen administration in protein-malnourished ovariectomized (OVX) female mice might improve the inflammatory response and promote cutaneous wound healing as well as normal nutrition. To test this hypothesis, we used full-thickness excisional wounds in Control SHAM, PM SHAM, PM OVX and PM OVX+17β-estradiol mice. The Control diet included 200 g/kg protein and the PM diet included 30 g/kg protein. The ratio of wound area in the Control SHAM group was significantly smaller than those in the three PM groups. In addition, microscopic findings also showed that the ratio of collagen fibers, the ratio of myofibroblasts and the number of new blood vessels in the Control SHAM group were significantly greater than those in the three PM groups. However, the number of Ym1-positive cells as an anti-inflammatory M2-like macrophage marker in the PM OVX+17β-estradiol group was significantly higher than those in the other three groups. These results indicate that the appearance of anti-inflammatory M2-like macrophages was promoted by estrogen administration; however, it could not promote cutaneous wound healing upon a low-protein diet. Therefore, it may be confirmed that nutrition is more important for promoting cutaneous wound healing than estrogen administration.
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Mukai, Kanae ; Komatsu, Emi ; Nakajima, Yukari ; Urai, Tamae ; Nasruddin ; Sugama, Junko ; Nakatani, Toshio ; 向井, 加奈恵 ; 中島, 由加里 ; 浦井, 珠恵 ; 須釜, 淳子 ; 中谷, 壽男
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金沢大学医薬保健研究域保健学系<br />Topical estrogen application to wounds is effective in promoting cutaneous wound healing. However,
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whether it promotes cutaneous wound healing in delayed cutaneous wound healing associated with advanced age remains to be elucidated. This study aimed to evaluate the effect of topical estrogen application to wounds in cutaneous wound healing in 80-week-old female mice. C57BL/6J female mice aged 82–85 and 12 weeks old were submitted to two full-thickness wounds. Mice were divided into four groups: aged group, topical estrogen wound treatment aged group (aged-E), vehicle wound treatment aged group (aged-vehicle), and young group. Wound healing was observed until day 14. In the aged group, wound area ratio (wound area / initial wound area) was significantly higher on days 3–14, ratio of re-epithelialization was significantly lower on day 3 and tended to be lower on day 14, and neutrophil number was significantly higher on day 7 compared with the young group. In contrast, in the aged-E group, wound area ratio was significantly smaller on days 1–14, re-epithelialization ratio was significantly higher on days 3–14, and neutrophil and macrophage number was significantly lower on days 3 and 7 compared with the aged group. These results demonstrate that topical estrogen application to wounds in 80-week-old female mice promoted cutaneous wound healing by reducing wound area and inflammatory response and promoting re-epithelialization.
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Asano, Kimi ; Nakajima, Yukari ; Mukai, Kanae ; Urai, Tamae ; Okuwa, Mayumi ; Sugama, Junko ; Konya, Chizuko ; Nakatani, Toshio ; 浅野, きみ ; 中島, 由加里 ; 向井, 加奈恵 ; 浦井, 珠恵 ; 大桑, 麻由美 ; 須釜, 淳子 ; 紺家, 千津子 ; 中谷, 壽男
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金沢大学医薬保健研究域保健学系<br />Background Previously, we showed that lymphatic vessels (LVs) formed detours after lymphatic obstru
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ction, 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. © 2020 Asano 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.
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木森, 佳子 ; 須釜, 淳子 ; 中谷, 壽男 ; 福田, 汐里 ; 宮地, 利明 ; 紺家, 千津子 ; 大桑, 麻由美 ; 真田, 弘美 ; Kimori, Keiko ; Sugama, Junko ; Nakatani, Toshio ; Fukuda, Shiori ; Miyati, Toshiaki ; Konya, Chizuko ; Okuwa, Mayumi ; Sanada, Hiromi
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金沢大学医薬保健研究域保健学系<br />末梢静脈内カテーテル留置法では，対象静脈が目視困難な場合，確実な穿刺，合併症の発生に影響を及ぼす．本研究の目的は目視困難静脈の穿刺技術向上に向け，目視の可否による血管径 ・ 深さ，動脈との位置関係を
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超音波診断装置で，皮膚色を色差計で計測し違いを明らかにすることである．研究デザインは実態調査型研究である．対象者は健常若年女性 20名，計測静脈は 58本，計測動脈は 18本であった．その結果，目視の可否に有意差があったのは深さのみで，血管径，動脈との位置関係，皮膚色は同等であることが明らかになった．静脈の深さの平均 (SD) は，目視可能静脈が2.7 (0.7) mm，目視困難静脈が4.6 (1.8) mmであった (p=.0001)．目視の可否の分離値は 3.0mm (AUC=0.919，95％CI 0.84－0.99)で，深さ3mm以上の留置カテーテル用末梢静脈は目視困難になることが明らかとなった．したがって，目視困難な静脈は深さ3mm以上の穿刺技術が，動脈穿刺の防止は，目視の可否に関わらない穿刺技術の必要性が示唆された．<br />During catheter placement, peripheral intravenous access is affected by the visibility of the vein, such that the risk of peripheral nerve injuries and arterial punctures, increases as the visibility decreases. This study examined the relation between vein visibility and (a) vein width, (b) vein depth, (c) position of the artery relative to the vein, and (d) skin color. This was an observational study with prospective data collection. A total of 20 healthy young women (58 veins and 18 arteries) were examined. As a result, vein visibility demonstrated significant differences in relation to vein depth, but not in relation to the other three factors. The mean depth (SD) was 2.7 (0.7) mm for visible veins and 4.6 (1.8) mm for invisible veins (p=0.0001). The cut off point was 3.0 mm (AUC=0.919 95％ CI-0.84 to 0.99), indicating that peripheral veins for catheter placement are more likely to be invisible when the depth is 3.0 mm or more. These findings highlight the need for two kinds of venipuncture skills : those for invisible veins with a depth of 3.0 mm or more, and those that will prevent arterial puncture regardless of vein visibility.
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藤居, 久美子 ; 須釜, 淳子 ; 中谷, 壽男 ; 真田, 弘美 ; 大桑, 麻由美 ; Fujii, Kumiko ; Sugama, Junko ; Nakatani, Toshio ; Sanada, Hiromi ; Okuwa, Mayumi
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金沢大学医薬保健研究域保健学系<br />本研究の目的は, 1方向のずれが褥瘡治癒過程にどのような影響を及ぼすのかを明らかにすることである. 方法は, ラット褥瘡モデルを用いて, 圧迫と1方向(尾側方向)のずれを1kgの重りを用いて負荷した
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群(実験群)と圧迫のみを負荷した群(対照群)との治癒過程を肉眼的・組織学的に比較した. 肉眼的所見では実験群には局所の壊死がみられ, 対照群より治癒が遅延した. 組織学的所見では実験群で7, 14日目ともに尾側の筋層の変性が顕著であった. また, 頭側の真皮にうっ血, 出血がみられた. 対照群では, 7日目, 14日目ともに表皮の欠損はなかったが, 中央部の損傷は頭側, 尾側より強かった. 以上より, 1方向のずれと圧迫を負荷した褥瘡では尾側の皮下組織から筋層にかけての変性とそのために引き起こされる頭側の真皮のうっ血によって, 圧迫のみを負荷した褥瘡と比較して, 壊死が形成され, 治癒が遅延することが示唆された.<br />This study aimed to clarify the effects of shear stress towards the caudal side in pressure-induced ischemic wound healing in a rat model. We compared wound healing that produced pressure combined with shear using a 1kg weight (experimental group) with wound healing that produced pressure only (control group). Macroscopic findings showed that the experimental group developed local necrosis and healing was delayed by 1 week compared with the control group. Histological findings showed that necrosis had developed to the muscle layer on the tail side and that hemostasis and bleeding occurred to the dermal layer on the head side in the experimental group over 7 and 14 days. In the control group, the wound was covered by epidermis and muscular degeneration, and necrosis in the middle was more severe than on the head and tail side. These results suggested that wounds produced by pressure and shear formed necrosis and so suffered delayed healing compared with the control group. The reason for these results might be the development of necrosis to the muscle layer on the tail side and hemostasis to the dermal layer on the head side.<br />日本褥瘡学会の許可を得て登録_2021.9.22
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熊谷, あゆ美 ; 須釜, 淳子 ; 大桑, 麻由美 ; 奥田, 鉄人 ; 垣内, 紀子 ; 神野, 亜紀子 ; 中谷, 壽男 ; Kumagai, Ayumi ; Sugama, Junko ; Okuwa, Mayumi ; Okuda, Tetsuhito ; Kakiuchi, Noriko ; Kanno, Akiko ; Nakatani, Toshio
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金沢大学医薬保健研究域保健学系<br />手術室では腹臥位手術の褥瘡発生率が高い. その原因として, 患者は四点支持器の上に腹臥位固定されるため, 四点支持器と身体との接触面積が小さく骨突出部にかかる圧力が高いのではないか, また時間経過と
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ともに身体がずれて底づきすることにより, 骨突出部にかかる圧力が高くなるのではないかと考えた. この2つの仮説を検証する目的で, 腹臥位手術を受ける患者を対象に腹臥位固定中の四点支持器と右腸骨部皮膚との接触面の圧力を連続測定し, 褥瘡の有無別に比較した. その結果18名中14名に反応性充血, 4名にStage Iの褥瘡が発生した. Stage I発生者の最大体圧値は反応性充血発生者とくらべて有意に高値であった(P=.035). また, 両者で腹臥位固定開始時と終了時の平均体圧値, 最大体圧値には差がなかった. 腹臥位手術における褥瘡予防を図るための指標として腹臥位固定開始時の最大体圧値を用いることにより, 除圧ケアの介入が可能であることが示唆された.<br />The incidence of pressure ulcers is high in prone position surgery. We hypothesized that the cause for this high incidence is as follows: (1) High pressure is placed on the bony areas of the body when the patient's body is fixed on the Hall frame and the contact area between the body and the operating table is small. (2) The pressure increases for bottoming out to shear force with time on the bony areas of the body. In order to verify the above hypotheses, we examined adult patients who underwent prone position surgery. Specifically, we measured the real-time pressure placed on the contact area between the patients' right ilium and the Hall frame and examined the presence of pressure ulcers. The results of the experiment showed that 14 out of 18 patients developed blanching erythema and 4 developed Stage I pressure ulcers. The development of Stage I pressure ulcers was found to be related to maximum interface pressure. Our study suggests that using the maximum interface pressure at the beginning of the prone position setting as an index for pressure reduction care may be effective in pressure ulcer prevention in prone position surgery.<br />日本褥瘡学会の許可を得て登録_2021.9.21
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越村, 洵子 ; 紺家, 千津子 ; 真田, 弘美 ; 中谷, 壽男 ; 須釜, 淳子 ; 矢島, 博昭 ; 田端, 恵子 ; Koshimura, Junko ; Konya, Chizuko ; Sanada, Hiromi ; Nakatani, Toshio ; Sugama, Junko ; Yajima, Hiroaki ; Tabata, Keiko
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金沢大学医薬保健研究域保健学系<br />本研究の目的は, 褥瘡のポケット形成過程の原因, 要因を明確にすることである. 13部位の褥瘡を発見からプロスペクティブに毎日観察したあと, ポケット形成あり群となし群に分類し, 創の形態と身体状況
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ならびに看護ケアを比較した. その結果, ポケットの形態は, 全周と部分, 筋層と皮下組織に達するものに分類された. ポケット形成前の創の特徴は「顕著な骨突出部と壊死組織との位置の違い」「硬く乾燥し, 限局した黒色壊死組織」「黒色壊死組織周囲に持続する発赤」であった. これらを引き起こす原因は「骨突出部による強い圧迫」「骨突出部上に起こる皮膚のずれ」「感染」であった. ポケットの形態別に原因をみると, 全周, 部分ポケットの違いにはずれの方向が関係し, 筋層, 皮下組織に達するポケットの違いには感染が関係していた. 以上の結果から, ポケット形成モデルを構築した.<br />The purpose of this study was to clearly identify the causes and influencing factors responsible for creating undermining pressure ulcers. We observed 13 pressure ulcers on a daily basis that developed on subjects who participated in this prospective study. The subjects were separated into two groups ：(1)those who developed undermining, and (2)those who did not develop undermining pressure ulcers. We then evaluated the formation changes, the subjects' physical changes and the nursing care provided. Undermining pressure ulcers were further subdivided according to their depth (reaching the fascia or the subcutaneous tissues) and their type (whether the wounds were partial margin or full margin). Distinctive characteristics of the pressure ulcers before undermining occurred were a difference in the position of necrotic tissue and bony prominence, the presence of hard, dry and black escher, and persistent erythema. The causes of undermining can be attributed to high pressure caused by bony prominence, shear occurring over the bony prominent skin, and infection. The type of undermining was determined to be related to the direction of shear, and infection was related to the wound depth. We constructed a model of formation of the undermining based on these results.<br />日本褥瘡学会の許可を得て登録_2021.09.22
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紺家, 千津子 ; 真田, 弘美 ; 須釜, 淳子 ; 大桑, 真由美 ; 中谷, 壽男 ; 永川, 宅和 ; Konya, Chizuko ; Sanada, Hiromi ; Sugama, Junko ; Okuwa, Mayumi ; Nakatani, Toshio ; Nagakata, Takukazu
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金沢大学医薬保健研究域保健学系<br />本研究の目的は, ポケット形成のある褥瘡を形態的に分類し, 治癒過程を明らかにすることである. さらに, その治癒過程の分類と看護ケア要因および身体要因との関係を導き出すことにある. 65歳以上の高
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齢者69名が保有するStage III・IVの褥瘡を調査した. 褥瘡は79部位あり, そのうち45部位(57.0%)にポケット形成を認めた. 褥瘡の治癒過程を帰納的方法により分類すると, 深達度ごとにポケットと表皮化方法によって10に分類できた. 特徴的な形態の変化には, 表皮化ではなく収縮のみによる創閉鎖があった. 収縮は通常の表皮化する創より, 治癒期間が延長していた. さらに, ポケット内に壊死組織はないが創の収縮により逆にポケットが拡大するものがあった. 看護ケア要因と身体要因と関係があったのは, ポケット形成と収縮のみによる創閉鎖であった. ポケット形成は, 骨突出, 尿失禁, 拘縮, 臀部のたるみが関係していた. 収縮のみによる創閉鎖は, 骨突出, 尿失禁, ずれ, 拘縮が関係していた.<br />The purpose of this study was to categorize pressure ulcers with various forms of undermining and to examine the healing process of each category. Another attempt to determine whether nursing care and/or physical factors influence the formation of pressure ulcers was also considered. This study was performed with the consent of 69 elderly (65 years old or older) patients with stage III or IV pressure ulcers, who had a total of 79 pressure ulcers. Of the 79 pressure ulcers, 45 (57%) were undermining. Based on the pressure ulcer healing process for stage III or IV pressure ulcers with undermining and epithelialization, 10 healing patterns were inductively categorized. A significant observation was the fact that in undermining with no necrotic tissue, the undermining spread inversely to wound contraction, a phenomenon we categorized as "Us" (Undermining-spread-partial wound margin). Epithelialized wounds closed only by contraction were categorized as Ec (Epithelialization-contraction). Our results showed the wound healing period to be longer for general epithelialization than for "Ec" type wounds. Nursing care and/or physical factors that influenced the form and healing pattern of "Undermining" were externally bony prominence, urinary incontinence, contracture, and flabby skin in the buttock area. Similarly, the influencing factors of "Ec" were an externally bony prominence, urinary incontinence, shear, and contracture.<br />日本褥瘡学会の許可を得て登録_2021.09.22
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紺家, 千津子 ; 真田, 弘美 ; 須釜, 淳子 ; 大桑, 真由美 ; 永川, 宅和 ; 中谷, 壽男 ; 田端, 恵子 ; Konya, Chizuko ; Sanada, Hiromi ; Sugama, Junko ; Ookuwa, Mayumi ; Nagakawa, Takukazu ; Nakatani, Toshio ; Tabata, Keiko
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金沢大学医薬保健研究域保健学系<br />本研究の目的は, 褥瘡部位の低輝度エコー所見と褥瘡の深度との関係を明らかにすることである. 対象は, 38名の49個の褥瘡である. 褥瘡の外診所見と周波数7.5MHzでのエコー所見を1週間ごとに観察
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した. 分析は, 初回の視診と触診による外診所見での深度とエコー所見の低輝度エコーにより判断した深度について, 確定深度との相違を比較した. その結果, (1)49個の褥瘡の初回観察時には, 外診所見では20個が壊死に覆われ, 7個はエコーにて低輝度所見を認めた. (2)壊死組織のないI度およびII度の褥瘡は, 確定深度も同様であった. (3)初回低輝度所見を認めた褥瘡の深度は, III度またはIV度であった. (4)初回観察時に低輝度エコー所見の有無と確定深度の全層損傷の有無との関係は, 感度58.3%, 特異度100.0%, 陽性反応適中度100%, 陰性反応適中度88.1%であった. 以上より, 褥瘡の壊死部に低輝度エコー所見を認めた場合, 全層損傷と判定するアセスメント方法は有効であることが示唆された.<br />The purpose of this study was to examine the predictive validity of ultrasound in the initial assessment for pressure ulcer staging. Forty-nine pressure ulcers of 38 patients were examined. The pressure ulcers were visually assessed using the stages defined by the NPUAP and were examined by ultrasound (7.5 MHz). The initial assessment was determined from the ratio of agreement using visual assessment and ultrasound based on the level of severity. In the first assessment, 20 of the 49 pressure ulcers were assessed to be necrotic by visual observation and 7 of 49 were hypoechoic by ultrasound observation. In the final assessment, all pressure ulcers without necrosis were stage I or stage II types. The hypoechoic pressure ulcers in the first assessment were found to be either stage III or stage IV types. Using these results, the predictive validity of the initial assessment using ultrasound was calculated. The results were as follows : sensitivity 58.3%, specificity 100.0%, positive predictive value 100.0% and negative predictive value 88.1%. This suggests that hypoechoic images detected in initial assessment using ultrasound can be predictive of full-thickness stage III : or IV wounds.<br />日本褥瘡学会の許可を得て登録_2021.09.22
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