Videofluoroscopy-guided balloon dilatation for treatment of severe pharyngeal dysphagia

Balloon dilatation is a widely accepted technique in the management of esophageal and other types of gastrointestinal strictures, but it is rarely used for the treatment of pharyngeal dysphagia. Therefore, the aim of our prospective study was to evaluate the use of videofluoroscopy-guided balloon dilatation (VGBD) for the treatment of severe pharyngeal dysphagia. The study included 32 stroke patients who had been diagnosed with oral and/or pharyngeal dysphagia. All patients underwent dilatation of the esophageal inlet using a balloon catheter under videofluoroscopic guidance during one or more sessions. Following esophageal dilatation, manual feeding was provided twice weekly. VGBD was effective in 10 out of 32 patients; however, the remaining 22 patients were unable to attempt oral food consumption because aspiration was not completely resolved on videofluoroscopy. According to this case series, VGBD may provide treatment for patients with severe pharyngeal dysphagia, who have not consumed food orally for a long period of tim

Development and evaluation of automated ultrasonographic detection of bladder diameter for estimation of bladder urine volume

Bladder urine volume has been estimated using an ellipsoid method based on triaxial measurements of the bladder extrapolated from two-dimensional ultrasound images. This study aimed to automate this process and to determine the accuracy of the automated estimation method for normal and small amounts of urine. A training set of 81 pairs of transverse and longitudinal ultrasound images were collected from healthy volunteers on a tablet-type ultrasound device, and an automatic detection tool was developed using them. The tool was evaluated using paired transverse/longitudinal ultrasound images from 27 other healthy volunteers. After imaging, the participants voided and their urine volume was measured. For determining accuracy, regression coefficients were calculated between estimated bladder volume and urine volume. Further, sensitivity and specificity for 50 and 100 ml bladder volume thresholds were evaluated. Data from 50 procedures were included. The regression coefficient was very similar between the automatic estimation (β = 0.99, R2 = 0.96) and manual estimation (β = 1.05, R2 = 0.97) methods. The sensitivity and specificity of the automatic estimation method were 88.5% and 100.0%, respectively, for 100 ml and were 94.1% and 100.0%, respectively, for 50 ml. The newly-developed automated tool accurately and reliably estimated bladder volume at two different volume thresholds of approximately 50 ml and 100 ml

Preventive Effects of Salacia reticulata on Obesity and Metabolic Disorders in TSOD Mice

The extracts of Salacia reticulata (Salacia extract), a plant that has been used for the treatment of early diabetes, rheumatism and gonorrhea in Ayurveda, have been shown to have an anti-obesity effect and suppress hyperglycemia. In this study, the effects of Salacia extract on various symptoms of metabolic disorder were investigated and compared using these TSOD mice and non-obese TSNO mice. Body weight, food intake, plasma biochemistry, visceral and subcutaneous fat (X-ray and CT), glucose tolerance, blood pressure and pain tolerance were measured, and histopathological examination of the liver was carried out. A significant dose-dependent decline in the gain in body weight, accumulation of visceral and subcutaneous fat and an improvement of abnormal glucose tolerance, hypertension and peripheral neuropathy were noticed in TSOD mice. In addition, hepatocellular swelling, fatty degeneration of hepatocytes, inflammatory cell infiltration and single-cell necrosis were observed on histopathological examination of the liver in TSOD mice. Salacia extract markedly improved these symptoms upon treatment. Based on the above results, it is concluded that Salacia extract has remarkable potential to prevent obesity and associated metabolic disorders including the development of metabolic syndrome

クリティカルコロナイゼーション状態の褥瘡の局所管理に関する前向き調査

AimsCritical colonization has attracted attention as a cause of delayed healing of pressure ulcers. However, there is no clear strategy for local wound management in such cases. Here, we prospectively investigated exudate, infection, and pressure ulcer status in a critical colonization state to determine the optimal strategy for local wound management of such pressure ulcers.MethodsThis prospective cohort study was conducted in three facilities: a university hospital, a general hospital, and a long-term care hospital. Subjects were patients with pressure ulcers at a depth deeper than the dermis with a diagnosis of critical colonization by a dermatologist or wound ostomy continence nurse. Patients were divided into three groups according to local wound management: Group A, hydrating ointment with infection control or low exudate-absorption dressing material; Group B, high exudate-absorption dressing material; and Group C, hydrating ointment with exudate-absorption and infection control. Exudate, the moisture of the surrounding wound skin, stratum corneum hydration, area of biofilm, bacterial count, and wound severity assessed by DESIGN-R, were measured at baseline and at 1 week. The relative changes in these variables at 1 week were calculated for the analysis. ResultsOverall, 16 patients were classified into Group A (n = 7), Group B (n = 5), and Group C (n = 4). The patients in all three groups ranged in age from 78 to 86 years old and ≥ 50% were male. At baseline, the median proportion of wound area covered by the biofilm was similar between the three groups (0.50, 0.59, and 0.30, respectively). The median total DESIGN-R score in Group A was lower than those in the other groups (12, 24, and 21.5, respectively). With regard to the changes after 1 week, the proportion of wound area covered by the biofilm in Group C was larger than those in the other groups (-0.18, -0.27, and -0.87, respectively). However, the change in total DESIGN-R score in Group C was smaller than those in the other groups (-0.12, -0.11, and -0.01, respectively).ConclusionChanges in infection and pressure ulcer status in cases of critical colonization were described according to local wound management. However, due to the small number of patients, it was not possible to determine the most appropriate local wound management for pressure ulcers in a critical colonization state.【目的】クリティカルコロナイゼーションは、褥瘡の治癒遅延の原因として、最近注目を受けている。しかし、クリティカルコロナイゼーション状態への局所管理に関する対策は明らかでない。この研究において、私たちは、クリティカルコロナイゼーション状態の褥瘡の局所管理の最適な方法を検討するために、滲出液、感染と褥瘡状態を前向きに調査した。【方法】本研究は、前向きコホート研究であり、大学病院、総合病院、長期ケア病院の 3施設で実施した。対象者は、皮膚科医師または皮膚・排泄ケア認定看護師によって真皮より深い褥瘡で、かつクリティカルコロナイゼーション状態であると判断された褥瘡を有する入院患者である。患者は、局所管理方法によって 3 つの群に分けられた：A 群（補水と感染制御作用がある外用薬または滲出液吸収作用の低いドレッシング材）;B 群（滲出液吸収作用が高いドレッシング材）;C 群（滲出液吸収作用と感染制御作用がある外用薬）。滲出液、褥瘡周囲皮膚と健常皮膚の角質水分量、バイオフィルム面積、褥瘡表面の細菌数と DESIGN-R による褥瘡状態得点を、ベースラインと 1 週間後に測定した。これらの変数の 1 週間後の変化量の相対値により分析した。【結果】全 16 例の患者は、A 群（n = 7 ）、B 群（n = 5 ）、C 群（n = 4 ）に分類された。3 群の年齢の中央値は 78 〜 86 歳であった。また患者の 50% 以上は男性だった。ベースライン時に、バイオフィフムの面積が創面の面積に占める割合の中央値は同程度であった(0.50 vs. 0.59 vs. 0.30)。さらに、A 群のDESIGN-R 総点の中央値は、他の群より低かった（12 vs. 24 vs. 21.5）。一方、 1 週間後の変化量の相対値は、バイオフィフムの面積が創面の面積に占める割合は C 群が他の群より大きかった（-0.18 vs. -0.27 vs. -0.87）。DESIGN-R の合計点は C 群が他の群より低かった（-0.12 vs. -0.11 vs. -0.01）。【結論】本研究では、褥瘡の局所管理方法別に、バイオフィルムの面積、バイオフィルムの面積が創面の面積に占める割合、褥瘡表面の細菌数、DESIGN-R による創傷治癒過程を記述した。しかし、症例数が少なく、クリティカルコロナイゼーションの褥瘡の管理方法を明らかにすることはできなかった。

The prevalence and functional impact of chronic edema and lymphedema in Japan: LIMPRINT study

Background: This was a part of LIMPRINT (Lymphoedema IMpact and PRevalence – INTernational), an international study aimed at capturing the size and impact of lymphedema and chronic edema in different countries and health services across the world. The purpose of this study was to clarify the prevalence and the impact of chronic edema in Japan. Methods and Results: This was a two-phase facility-based study to determine the prevalence and functional impact of chronic edema in the adult population in Japan between 2014 and 2015. The prevalence study involved a university hospital, an acute community hospital, and a long-term medical facility. The impact study involved 6 facilities, including two outpatient clinics in acute care hospitals (one led by a physician and the other led by a nurse), inpatient wards in two acute care hospitals, and two nursing home/long-term care facilities. Various questionnaires and clinical assessments were used to gather patient demographic data and assess the functional impact of chronic edema. The results showed that: chronic edema was much more prevalent in the long-term care facility than in acute care hospitals; cellulitis episodes occurred in approximately 50% of cases in the gynecologist-led outpatient clinic, even though >80.0% of patients received standard management for edema; edema was found in the trunk region, including the buttock, abdomen, and chest-breast areas, in addition to the upper and lower limbs; and subjective satisfaction with edema control was low, even though the quality of life scores were good. Conclusions: The prevalence of chronic edema varied according to the facility type, ranging from 5.0% to 66.1%. The edema was located in all body parts, including the trunk region. Subjective satisfaction with control of edema was poor, while general quality of life was good. This large health care issue needs more attention

海鼠または蜂蜜局所管理法を受ける糖尿病足潰瘍の創傷治癒に関するインドネシアにおける前向き調査

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

Assessment of histopathology of wounds based on protein distribution detected by wound blotting

Background: Shortening the duration of healing based on an accurate assessment is important in pressure ulcer management. This study focused on the peroxidase and alkaline phosphatase activity detected by wound blotting, a non-invasive method of collecting wound exudate, to establish a non-invasive and point-of-care assessment method for analyzing the histopathology of wounds using an animal model. Methods: Wounds were created on the dorsal skin of rats. Peroxidase and alkaline phosphatase activities in the wound exudate were detected by wound blotting on post-wounding days 1, 4, 7, and 10. Wound tissue was collected on the same sampling days. Peroxidase and alkaline phosphatase activity within the tissue and myeloperoxidase were visualized. Two types of peroxidase activities were detected by wound blotting: ring and non-ring signals. The histopathological features were compared between wounds with ring and non-ring signals. Results: The wounds with ring signals showed a high level of peroxidase activity, and histological analysis demonstrated that the secreted or deviated peroxidase activity originated from myeloperoxidase, indicating a strong inflammation reaction within the tissue. The histopathology of wounds related to the alkaline phosphatase signals was not identified. Conclusion: The results suggested that ring signals indicated a strong inflammatory reaction and that they could be used to assess non-visible inflammation

Predictive Factors for Infusion Site Induration After Outpatient Chemotherapy in Japan: A Secondary Analysis

Summary: Purpose: Even in the absence of extravasation, some patients develop induration at the peripheral intravenous catheterization site prior to the next day's treatment. Infusion site induration commonly affects patients who undergo repeated chemotherapy administrations. Vessel health is crucial for the continuation of chemotherapy. However, there is no effective method to prevent induration. Hence, this study aimed to investigate the factors that could cause induration for preventing its occurrence. Methods: This study was a secondary analysis of a prospective observational study. All participants were undergoing outpatient chemotherapy. Participant characteristics and related catheterization data were collected on the treatment day as baseline, and induration incidence was recorded on the subsequent treatment day. Receiver operating characteristic (ROC) analysis was performed to determine the sensitivity and specificity of cutoff points of the vein and catheter diameter ratios for distinguishing between developed induration and not developed induration. Additionally, cox regression analysis with multiple imputation was used to investigate the factors that predicted induration. Results: Seventy-one patients participated in the study. The cutoff point of the vein/catheter diameter ratio calculated using ROC analysis was ≥3.7. The ratio of larger-diameter veins to catheter diameter of ≥3.7 times was negatively associated with induration in both complete case analysis (HR: 0.11; p = 0.034) and multiple imputation analysis (HR: 0.12; p = .049). Conclusions: Selecting the vein with 3.7 times higher diameter than the catheter diameter for the catheterization site may help prevent induration on the next treatment day

Color doppler ultrasonography to evaluate hypoechoic areas in pressure ulcers: A report of two cases

Ultrasound (US) is frequently used for evaluating inflammation of subcutaneous tissue caused by pressure ulcers (PUs), but color Doppler mode (CDM) helps to better identify inflammatory edema in subcutaneous fat and necrotic tissue in PUs. We report two cases where inflammatory edema in subcutaneous fat and necrotic tissue in PUs are identified using small US equipment with CDM. Case 1 – An 82-year-old male presented with cerebral infarction and a Category III PU in the sacral region. B-mode gray-scale US imaging (B-mode imaging) revealed a thickened layer of subcutaneous fat with fat lobules and homogeneous cobblestone appearance with fluid accumulation within the echo-free space. CDM did not identify any color signal (CS) in hypoechoic areas. Case 2 – A 29-year-old female presented with cytopenia and decreased renal function with a Category IV PU with undermining in the coccyx region. B-mode imaging distinguished the necrotic tissue, indicating a diffuse hypoechoic area with no layers, unclear borders, and uneven gray level (cloud-like image) in the subcutaneous fat. Similar B-mode imaging findings were obtained in inflammatory edema with cobblestone appearance. CDM did not detect a CS in the hypoechoic areas but confirmed peripheral hypervascularity. CDM imaging identified inflammatory edema in the subcutaneous fat and necrotic tissue in PUs. Specifically, CDM may better evaluate early-stage PUs with necrotic tissue by distinguishing necrosis from intense inflammatory edema