Evaluation of the Effects of Honey on Acute-Phase Deep Burn Wounds

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

Inter-rater reliability of the AFTD-pitting test among elderly patients in a long-term medical facility

BACKGROUND and AIM: The pitting test has been reported in various methods as a standard for evaluating chronic oedema, but a unified method has not been determined. This makes it difficult to accurately specify the prevalence of oedema. The present study aimed to evaluate inter-rater reliability of the AFTD-pitting test, which included 4 factors: Anatomical locations of oedema; Force required to pit; the amount of Time; and the Definition of oedema. The present study is the first stage of an international epidemiological study of chronic oedema.METHODS: This cross-sectional observational study was performed at a long-term care hospital in Ishikawa Prefecture, Japan. The inter-rater reliability of the pitting test for evaluating oedema using the AFTD-pitting test was tested for 34 locations on the body, with 10 seconds of pitting with a similar force to that of the reference rater and assessed using the modified Fukazawa method. One reference rater and four raters evaluated oedema in five patients. Then, the agreement rate and Cohen-s kappa coefficient were calculated.RESULTS: All protocols were completed by four raters for five bedridden patients. Agreement among the four raters was high, at >0.85, and the kappa coefficient showed almost perfect, moderate, and fair agreement for one (0.81), four (0.51-0.60) rater, respectively.CONCLUSION: The inter-rater reliability of four nurses who applied the AFTD-pitting test was high, and the kappa coefficient showed at least fair agreement. Therefore, the AFTD-pitting test is a useful method to assess whole-body chronic oedema

A Comparison of Techniques for Collecting Skin Microbiome Samples: Swabbing Versus Tape-Stripping

The swabbing and tape-stripping methods have traditionally been used for collecting skin microbiome samples for skin bacterial analysis, although no reports have compared the outcome of these methods for collecting skin bacteria. Our purpose was to show the differences in microbial composition between samples collected using the swabbing and tape-stripping methods, by both the next generation sequencing and culture studies. The skin microbiome was collected by both methods, and the samples were processed for a sequence-based microbiome analysis and culture study. The next-generation sequencing results showed that skin bacteria collected using the tape-stripping method were comparable to those collected using the swabbing method. In the culture study, the tape-stripping method collected a greater number and wider variety of viable skin bacteria than the swabbing method. These results suggest that the tape-stripping method is comparable to the swabbing method for collecting viable skin bacteria, without losing fidelity to the composition of skin microbiome

Examining the positioning of pillows on an air mattress-Evaluation of muscle stiffness in the upper limbs and thorax and subjectivesymptoms-

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。This study was performed to examine stiffness of the muscles of the upper limbs and thorax and subjective symptoms immediately and 30 minutes after positioning of pillows on an air mattress.　Ten healthy subjects participated in the study. We examined the effects of three pillow positions （around the shoulders, by one ear, and no pillow） on subjective evaluation of pectoralis major, biceps brachii, triceps brachii, and musculus extensor digitorum stiffness. Muscle stiffness was measured as strain ratio determined by elastography with a diagnostic ultrasound imaging system. The subjective symptoms evaluated were the degrees of fatigue, pain, hypesthesia and a feeling of shear of the pillow, and others. The subjects lay in the supine position on an air mattress, and data were collected after 0 and 30 minutes. 　At the initial time point, the stiffness of the biceps brachii was significantly lower when pillows were placed around the shoulders or at one ear than when there was no pillow. The stiffness in the musculus extensor digitorum at 0 minutes was significantly lower when pillows were placed at one ear than when placed around the shoulders or when no pillow was used. However, the degrees of neck fatigue, pain, and hypesthesia at 0 and 30 minutes was higher when the pillow was placed at the ear compared with other positions; the degree of distress at 0 minutes was also significantly higher when the pillow was placed at the ear than when placed around the shoulders. The degree of subjective symptoms was higher in all positions after 30 minutes compared to the initial time point. 　Based on these results, it is recommended to place pillows around the shoulders when lying on an air mattress. Nurses should consider the fatigue of patients lying on an air mattress for at least 30 minutes

Evaluation of the Effects of Honey on Acute-Phase Deep Burn Wounds

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

Assessment of the interstitial fluid in the subcutaneous tissue of healthy adults using ultrasonography

Objective: Lymphoedema involves swelling, especially in the subcutaneous tissues. For lymphoedema management to be successful, it is necessary to remove the interstitial fluid. Subcutaneous echogenicity may be associated with interstitial fluid, but echogenicity is not an indicator for the evaluation of management because we do not directly compare echogenicity with the interstitial fluid. We aimed to identify an outcome indicator for the evaluation of interstitial fluid using ultrasonography. We assessed the correlation between echogenicity and transverse relaxation rate (R 2 ) on magnetic resonance imaging. Methods: This was an observational study. Healthy adults with leg swelling after activity for >8 h were recruited. The legs of 13 women were evaluated using ultrasonography, magnetic resonance imaging and measurements of the limb circumference before and after an intervention to reduce the swelling. Results: Echogenicity in the oedema group was greater than that of the controls. Echogenicity decreased with reductions in oedema. The range of the strongest correlations with the changes in R 2 occurred at echogenicity values of 48–144 (Pearson’s correlation coefficient: r  = −0.63 and p  < 0.01). Thus, it was possible to evaluate the interstitial fluid using echogenicity. Conclusion: The outcome indicators for the evaluation of interstitial fluid using ultrasonography were echogenicities in the range of 48–144, and these values were valid for assessing the interstitial fluid in the subcutaneous tissue

Objective assessment of leg edema using ultrasonography with a gel pad.

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 > 0.9, p 0.7, p < 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