創傷環境を整える看護ケアのための褥瘡部貼付型ずれセンサーの開発

金沢大学医薬保健研究域医学系背面可視ギャチベットに背部の皮膚を露出した状態で臥床後、骨突出部と皮膚表面の状態を観察し、ギャッチアップ時の背部の皮膚に生じる変化を記述した。ギャッチアップによる皮膚への影響が顕著に現れる70度ギャツチアップ(以下GU)時と垂直力のみが影響する仰臥位時で比較した。倫理的配慮として、対象の安全性と安楽性を確保し、自らの意思で臥床中断を可能とした。測定者が苦痛と判断した時も中止した。2つの体位における測定は連続して行わず、前回の測定の影響が除かれたと判断した24時間以上後に測定した。対象は健康成人1名。各体位90分間の測定が可能であった。特徴的に観察された事象は、臥床圧迫時は骨突出部の圧迫を示す蒼白化した皮膚変化、臥床圧迫解除後は反応性充血であった。蒼白化した周囲の皮膚は背部床板に密着し、密着しなかった皮膚は充血と発汗が観察された。仰臥位とGUの違いは、蒼白化した皮膚変化が現れた時間とその範囲、反応性充血の範囲と消失までの時間であった。蒼白化した皮膚変化が現れた時間は、測定開始後から仰臥位4分15秒、GU10分30秒であった。圧迫解除直前の蒼白化した皮膚の面積は仰臥位708mm^2、GU1082mm^2であった。仰臥位の反応性充血は骨突出部を中心に楕円型であり、圧迫解除直後の面積は2905mm^2、39分後に消失した。GUでは反応性充血は不整であり、圧迫解除直後の面積は3380mm^2、2時間20分後に消失した。臥床時骨突出部体圧(垂直力)を比較すると、仰臥位89.8mmHg、GU42.3mmHgと仰臥位の方が大きく、蒼白化した皮膚変化が仰臥位時に速く現れたことに影響していると考えた。しかし、反応性充血の範囲と消失時間の結果が示す組織の損傷範囲はGUの方が大きいと言える。反応性充血は虚血となった血管床に血液が再還流する現象であり、この現象が広範囲・長時間持続することは、真皮層への損傷がより大きいことを示している。ギャッチアップ体位では、垂直力は小さくとも水平方向のせん断力等(ずれ)が広範囲に生じることで、真皮層組織へ影響を及ぼすことが示唆された。研究課題/領域番号:12771487, 研究期間(年度):2000-2001出典：「創傷環境を整える看護ケアのための褥瘡部貼付型ずれセンサーの開発」研究成果報告書　課題番号 12771487（KAKEN：科学研究費助成事業データベース（国立情報学研究所））（https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-12771487/)を加工して作

寝たきり高齢者における下肢褥瘡の発生要因に関するコホート研究

取得学位 : 博士（保健学）, 学位授与番号 : 医博甲第1811号 , 学位授与年月日 : 平成18年9月28日, 学位授与大学 : 金沢大学, 審査結果の報告日 : 平成18年8月28日, 主査 : 稲垣 美智子, 副査 :城戸 照彦, 須釜 淳

Relationship between lymphangiogenesis and exudates during the wound-healing process of mouse skin full-thickness wound

金沢大学医薬保健研究域保健学系We considered the relationship among exudate, wound area, angiogenesis, lymphangiogenesis, and reepithelialization during wound healing. Full-thickness wounds were made on the dorsum of mice. The weight of exudate absorbed into the dressing as well as the wound area was determined daily. Sections of the wounds were stained with anti-LYVE-1 and CD31 antibodies. Indian ink was injected into the wound for observing the movement of the exudate on days 3, 5, and 7 after wounding. New epithelium completely covered the wound on day 11. The quantity of exudate peaked on day 1, and then rapidly decreased until it was undetectable on day 11. Most of the Indian ink injected into the wound was retained within the wound and did not flow into the surrounding tissue. New blood vessels showed a uniform distribution in the granulation tissue on day 5. New lymphatics appeared in the granulation tissue approximately 2 days later than the blood vessels and they were distributed toward the center of the granulation tissue on day 11. Thus, reduction of exudate from the wound appears to be related to blood vessels, not lymphatics. However, increasing lymphatics may play a role in the late phase of the wound-healing process. © 2009 by the Wound Healing Society

Influence of the timing of switching a protein-free to a protein-containing diet on the wound healing process in a rat all-layer skin defect

金沢大学医薬保健研究域保健学系We prepared full thickness skin defects in rats fed on a protein-free diet as a hypoproteinaemia model, then switched the animals to a diet containing a normal protein level 1, 6 or 12 days after wounding (inflammatory, granulation and rearrangement phases of the wound healing process) to examine whether improvement in the low-protein state promotes subsequent wound healing. The interval until wound healing in rats fed on a normal protein diet was significantly shorter, whereas that in rats continuously fed on a protein-free diet was significantly longer than those of other groups. Early correction tended to accelerate wound healing. Although wound contraction in groups receiving a protein-corrected or protein-free diet remained similar until 15 days after wounding, thereafter the duration of the rearrangement phase was significantly longer in the protein-free group than in the other groups. The collagen level per unit of granulation tissue area during wound healing was significantly lower in the protein-free group than in the other groups. These findings indicate that protein correction at any time after wounding accelerates wound healing, although early correction is more effective, and reduces the duration of the rearrangement phase more than those of the inflammatory and granulation phases because of the deposit of collagen

Lymph Drainage during Wound Healing in a Hindlimb Lymphedema Mouse Model

Background: Although lymphedematous skin exhibits delayed wound healing, little is known about lymph drainage during wound healing. We investigated the wound healing process in the presence of lymphatic dysfunction. Methods and Results: The right inguinal lymph nodes (iLNs) and the surrounding tissue were excised in each mouse (the operation side), and a sham operation was performed in the left hindlimb (the control side). The next day, full-thickness wounds were made on both hindlimbs. The right hindlimb exhibited acute edema until day 3; however, it started to improve after day 4, and the wound area and epithelialization ratio were similar on both sides. Indocyanine green (ICG) was injected into both hindlimbs to observe lymph flow. On the operation side, ICG leaked out of the surgical site or remained at the injection site until day 2. Some lymph flow toward the existing lymph vessels was seen on day 3, and on day 10, lymph flow toward the axial LNs was detected on the operation side in all mice. On the operation side, the number of dermal lymph vessels was significantly increased on days 3 and 15. The dermal lymph vessel area of the peripheral wound was significantly smaller on the operation side. Conclusions: In a hindlimb lymphedema mouse model, lymph transiently accumulated in subcutaneous tissue, and then was gradually absorbed by the existing lymph vessels. The increase in the number of lymph vessels contributes to lymph drainage during wound healing. Acute lymphedema because of transient lymphatic dysfunction has little effect on wound healing. © Copyright 2017, Mary Ann Liebert, Inc. 2017.Embargo Period 12 month

The Relationship between Cutaneous Wounds Made on Obese Mice or Those with Decreased Body Weight and Serum Leptin Level

Purpose: Not all obese people have hyperglycemia. We wondered about the healing progress in obese people without hyperglycemia. The purpose of this study is to observe the cutaneous wound healing process. Methods: Three-week-old male mice were fed high-fat diets (containing 60% fat) in the diet group, and commercial diets in the control group, ad libitum for 15 weeks. Circle-full-thickness cutaneous wounds were made on the dorsal skin of mice. From day 0 to day 15 after wounding, we analyzed wound healing process. We measured the blood concentration of leptin, and observed the distribution of leptin-positive cells in each wound. Results: Mean body weight, the areas of subcutaneous fat and visceral fat, and the weight of epididymal fat in the diet group were significantly greater than those in the control group at 15 weeks after feeding. The diet group did not feed on the diet after wounding; their body weight decreased remarkably to the level of the control group. The ratio of wound area, re-epithelialization, and collagen fibers did not differ between the diet and control groups on each day. The blood concentration of leptin in the diet group was significantly greater than that in the control group before wounding and until day 6 after wounding (day 0, 10 hour and day 1: p < 0.01, day 6: p < 0.05). Conclusion: The results show that the wound healing process is similar between obese and non-obese mice, and that the decrease in the leptin level in the obese mouse to that in the non-obese mouse may depend on the decrease of body weight of obese mouse

ベトナムにおける下肢浮腫を有する妊娠後期妊婦の生活機能障害と身体活動：横断的相関研究

Purpose: This study was performed to identify risk factors associated with physiological lower extremity oedema in late pregnancy and to evaluate the relationship between disability and physical activity in women with such oedema in late pregnancy.Method: This cross-sectional and correlational study was performed in 300 healthy pregnant women giving birth at gestational week 38 – 42 at Haiphong Hospital of Obstetrics and Gynaecology, Vietnam. Oedema was assessed at three sites, i.e., the foot, medial malleolus and pretibial edge, of both lower extremities. The degree of swelling at each site was graded according to the Fukazawa method, and oedema was given a grade of 0 – 3 at each point on each leg, with the final oedema score taken as the sum of these grades. Women with a score ≥ 2 in at least one leg were defined as positive for oedema.All of the women included in the study completed the 12-item World Health Organisation Disability Assessment Schedule (WHODAS) questionnaire and the Pregnancy Physical Activity Questionnaire (PPAQ).Results: Parity (OR, 2.18; 95%CI, 1.18 – 4.03, p = 0.01), gestational weight gain (OR, 1.19; 95%CI, 1.1 – 1.29, p < 0.01), foetal weight (OR, 1.002; 95%CI, 1.000 – 1.005, p = 0.05) and gestational week (OR, 2.61; 95%CI, 1.04 – 6.59, p = 0.04) were risk factors associated with physiological oedema in late pregnancy. The WHODAS scores were significantly higher in the oedema group than the non-oedema group in the following domains: total score, mobility, participation, getting along and self-care. The PPAQ scores were not significantly different between the groups. The oedema group showed weak negative correlations betweenWHODAS (total score) and PPAQ (exercise, moderate activity) (r = − 0.3, −0.28), WHODAS (mobility) and PPAQ (exercise, moderate activity) (r = − 0.28, −0.32), WHODAS (life activities) and PPAQ (exercise) (r =−0.21) and WHODAS (self-care) and PPAQ (moderate activities) (r = − 0.23). There were also weak positive correlations between severity of oedema and WHODAS (total score, cognition, and participation; r = 0.29, 0.23, 0.27, respectively).Conclusion: Gestational week, gestational weight gain, parity and foetal weight were shown to be risk factors associated with physiological oedema in pregnancy. Women in late pregnancy with physiological lower extremity oedema were more likely to have disability. The results presented here suggested that additional advice, such as dietary salt restriction, leg elevation and left-side sleeping, and specific treatments are required to reduce the incidence of lower extremity oedema during pregnancy

舌癌サバイバーの対処能力とQOL：横断的研究

Aim: This study aimed to clarify the actual conditions of cancer survivor ability, abilityin daily life, quality of life, and speech intelligibility in patients with tongue cancer whounderwent tongue resection.Methods: A questionnaire survey was conducted for this study. Descriptive statistics wereused to elucidate the actual conditions of “cancer survivor ability,” “ability of patients withtongue cancer to lead their lives,” “quality of life (QoL),” and “speech intelligibility.” TheMann–Whitney U test was used to analyze the relationship between the actual conditionsand survivor duration for “cancer survivor ability,” “ability of patients with tongue cancer tolead their lives,” and “quality of life (QoL)”.Results: The number (%) of valid responses was 72 (97.3%). The items that showeddecreased ability in the group who had survived for ≥28 months were “Negotiating: I canask my healthcare provider if I am concerned about the onset or recurrence of an illness (P= 0.044)” and “Standing up for your rights: Do you feel empowered to stand up for yourrights regarding your cancer? (P = 0.044).” There were no significant differences amongthe other items. None of the six skills of Cancer Survivor Competence and Tongue CancerPatient Livelihood Competence were sufficient, and “Information Seeking” was low inboth. The overall QoL score was 62.2 for EORTC QLQ-C30. The lowest score on thefunctioning scale was 83.3 for emotion, and the highest score on the symptom scale was20.0 for fatigue. In terms of speech intelligibility, 44 patients (61.1%) reported that theirspeech had changed from that before surgery.Conclusion: The cancer survivor skills and life skills of patients with tongue cancer areinsufficient and do not improve over time, suggesting a need for long-term support to helpthem acquire these skills

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