Nao Tamai

Exploring the prevalence of skin tears and skin properties related to skin tears in elderly patients at a long-term medical facility in Japan.

The identification of appropriate skin tear prevention guidelines for the elderly requires clinicians to focus on local risk factors such as structural alterations of the epidermis and dermis related to skin tears. The aim of this cross‐sectional study is to explore the prevalence of skin tears and to explore skin properties related to skin tears in elderly Japanese patients at a long‐term medical facility. After doing the prevalence study, 18 participants with skin tears and 18 without were recruited and an evaluation of their skin properties using 20‐MHz ultrasonography, skin blotting and also Corneometer CM‐825, Skin‐pH‐meterPH905, VapoMeter, Moisture Meter‐D and CutometerMPA580 was undertaken. A total of 410 patients were examined, the median age was 87 years and 73·2% were women. The prevalence of skin tears was 3·9%, and 50% of skin tears occurred on the dorsal forearm. The changes in skin properties associated with skin tears included increased low‐echogenic pixels (LEP) by 20‐MHz ultrasonography, decreased type IV collagen and matrix metalloproteinase‐2, and increased tumour necrosis factor‐α by skin blotting. In conclusion, this study suggests that increased dermal LEP, including solar elastosis, may represent a risk factor for skin tears; this indicates that skin tear risk factors might not only represent chronological ageing but also photoageing.

Risk Factors and Risk Scoring Tool for Infection during Tissue Expansion in Tissue Expander and Implant Breast Reconstruction

Tissue expander and implant (TE/I) breast reconstruction has been increasing recently. In TE/I breast reconstruction, infection leads to reconstruction failure and is the most serious complication. The infection rate was reported to be higher during the tissue expander period than the implant period. However, few studies have investigated the risk factors for infection during tissue expansion following TE/I breast reconstruction. The goal of this study was to identify risk factors for infection during tissue expansion in TE/I breast reconstruction and to develop a simple risk scoring tool for infection that can be used for clinical application. In this retrospective cohort study, 981 patients who received TE/I breast reconstruction were surveyed and analyzed at one of the main clinics performing TE/I breast reconstruction in Japan. Numerous potential risk factors were collected from the clinical charts. Multiple logistic regression analyses were used to identify risk factors for infection. To develop a risk scoring tool, we converted the coefficients of the identified predictors estimated in the multiple logistic regression analyses into simplified risk scores. We assessed the tool discrimination by drawing a receiver operating characteristic curve and calculating the area under the curve. Infection was noted in 47 patients (4.79%) during tissue expansion. In multiple logistic regression analyses, diabetes, repeated expander insertions, larger expander size (≥400 cc), postoperative hormone therapy before silicone implant surgery, preoperative chemotherapy, and nipple‐sparing mastectomy were identified as risk factors for infection during expansion. The area under the curve of the risk scoring tool for infection was 0.734 (95% CI: 0.662–0.807). We have revealed risk factors and proposed a risk scoring tool for infection during tissue expansion in TE/I breast reconstruction. This study may contribute to the prevention and prediction of infection.

Health-related quality of life and associated factors in patients with primary lymphedema

AIM Primary lymphedema requires continuous conservative treatment during the patients life, which may affect their health-related quality of life (HRQOL). Physical and psychosocial characteristics related to lymphedema are associated with their HRQOL. This study aimed to assess HRQOL in those patients undergoing conservative treatment and to determine the factors associated with their HRQOL. METHODS This was a cross-sectional, observational study that included 83 patients with primary lymphedema at an outpatient clinic for lymphedema. HRQOL was assessed with the Medical Outcomes Study 36-Item Short Form Survey (SF-36) and EuroQol 5-Dimension (EQ-5D). Lymphedema status/complications and psychosocial status were evaluated by medical records, physical assessment, and self-administrative questionnaires. RESULTS The general health perception score in the SF-36 was lower than the age- and sex-stratified national norms (P = 0.001). In the EQ-5D, the proportions of patients with some/moderate or severe problems were 42.2% for pain/discomfort, 21.7% for usual activities, and 20.5% for anxiety/depression. By multiple regression analyses, a lower physical component summary score in the SF-36 was associated with a higher lymphedema stage (P = 0.021), cellulitis within 30 days (P = 0.003), exercise (P = 0.010), and more substance use coping (P = 0.012). A lower mental component summary score was associated with skin lesions over edematous limbs (P = 0.008), less humor coping (P = 0.005), and more self-blame coping (P = 0.014). CONCLUSION Patients with primary lymphedema have problems in health perception, discomfort, usual activities, and anxiety/depression. Preventing cellulitis and skin lesions and humor coping may be able to improve HRQOL.

Screening for tinea unguium by thermography in older adults with subungual hyperkeratosis

The purpose of the present study was to assess the difference in foot temperature between tinea unguium‐positive older adults with subungual hyperkeratosis and tinea unguium‐negative older adults with subungual hyperkeratosis to develop a temperature‐based screening method for tinea unguium.

Objective evaluation for venous leg ulcer-related nociceptive pain using thermography

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Chronic Wound Care Management and Research 2014:1 23–30 Chronic Wound Care Management and Research Dovepress

Association Between Components of Exudates and Periwound Moisture-Associated Dermatitis in Breast Cancer Patients With Malignant Fungating Wounds

Excessive wound exudates are troublesome symptoms of malignant fungating wounds. In particular, such exudates may cause periwound moisture-associated dermatitis (MAD). In this study, we focused on factors that contribute to skin irritation by exudates in breast cancer patients with malignant fungating wounds. Our aim was to identify the relationship between MAD surrounding malignant fungating wounds and levels of various candidate irritating factors in their exudates. We recruited 20 breast cancer patients with exudates from malignant fungating wounds and collected three types of exudate samples: pooled exudate, swab, and fresh exudate samples. We measured the pH, concentrations of polyamines (putrescine [PUT], cadaverine [CAD], spermidine, and spermine), and matrix metalloproteinases (MMP2 and MMP9) in the exudates and cultured them for bacteria. Differences between participants with and without MAD were assessed using Fisher’s exact test or the Mann–Whitney U test. Of the 20 participants, 14 had MAD. There were no significant differences in median pH and MMP activity between patients with and without MAD. The level of PUT was significantly higher in the MAD than in the non-MAD group (p = .008), and CAD was detected only in the MAD group (p = .016). Prospective studies are needed to clarify correlations and causal relationships between polyamines and erythema and identify therapeutic targets for preventing the development of MAD.

Can Wound Exudate from Venous Leg Ulcers Measure Wound Pain Status?: A Pilot Study.

We investigated the associations between the self-evaluated pain status and two pain biomarker candidates, nerve growth factor and S100A8/A9, in exudate from venous leg ulcer to finally develop an objective pain evaluation method. Patients with venous leg ulcer participated in this cross-sectional observational study conducted between April and October 2014 at two medical facilities. During routine wound care, each participant self-evaluated their pain status at each examination using the 10-point numerical rating scale (present pain intensity) and the short-form McGill Pain Questionnaire 2 (continuous pain, intermittent pain, neuropathic pain, affective descriptors, and total score). Venous leg ulcer exudate sample was collected after wound cleansing. The nerve growth factor and S100A8/A9 concentrations in the venous leg ulcer exudate were measured by enzyme-linked immunosorbent assay and standardized according to the wound area. The association between each pain status and the two standardized protein concentrations was evaluated using Spearman’s correlation coefficient. In 30 sample collected from 13 participants, the standardized nerve growth factor concentration was negatively correlated with continuous pain (ρ = -0.47, P = 0.01), intermittent pain (ρ = -0.48, P = 0.01), neuropathic pain (ρ = -0.51, P = 0.01), and total score (ρ = -0.46, P = 0.01). The standardized S100A8/A9 concentration was positively correlated with present pain intensity (ρ = 0.46, P = 0.03) and continuous pain (ρ = 0.48, P = 0.03). Thus, these two proteins may be useful for objective evaluation of wound pain in venous leg ulcer patients.

Fecal Distribution Changes Using Colorectal Ultrasonography in Older People with Physical and Cognitive Impairment Living in Long-Term Care Facilities: A Longitudinal Observational Study

Nurses encounter difficulties evaluating constipation in elderly people with physical and cognitive impairment. Transabdominal ultrasonography (US) has been used to evaluate fecal impaction or fecal quality. However, it is unclear whether colorectal US can evaluate constipation symptoms in older people. Using colorectal US, we continuously observed the elderly and clarified the relationship between patterns of fecal distribution changes and constipation symptoms in older people with physical and cognitive impairment at long-term care facilities. This study included patients aged ≥65 years with oral intake. US was performed once a day until the next defecation, and fecal hardness was assessed. US images were extracted and categorized. Then, patterns of fecal distribution changes in the colorectum were classified. Multiple logistic regression analysis was performed to examine related factors associated with a constipation pattern. Among 101 patients, US images of 95 patients were analyzed. In 74.4% of the patients, US showed continuation of reflection with acoustic shadow in the rectum, which was significantly associated with defecation on the bed. Of the patients with a continuous crescent-shaped reflection pattern (R3), 92.9% had hard stool. R3 was found to be significantly associated with a Mini-Mental State Examination score of ≤10. In most of the patients, US detected a continuation of reflection with acoustic shadow in rectal patterns, indicating fecal retention in the rectum. Point-of-care US can be used by nurses to visualize rectal fecal retention as constipation patterns in the older people with physical and cognitive impairment at long-term care facilities.

Abstract P5-15-09: National survey of chemotherapy-induced appearance issues in breast cancer patients

Background: Many breast cancer patients suffer hair loss due to chemotherapy, and not only scalp hair loss, but also eyebrow loss, eyelash loss and nail changes induced by chemotherapy are traumatic for patients. These side effects diminish self-esteem and greatly reduce quality of life. However, there has been little research in this field until now. To clarify the actual situation concerning appearance issues in breast cancer patients who received adjuvant chemotherapy, and to consider a support system for these patients, we conducted a questionnaire survey. Methods: Disease-free breast cancer patients who have received adjuvant chemotherapy containing anthracycline and/or taxane within 5 years were recruited from 47 hospitals or clinics in Japan from April to October 2013. The patients participating in this survey completed a 65-question questionnaire concerning appearance issues (48) and their perception of physical and non-physical side effects (17). The drugs administered and treatment period were filled out by their doctors beforehand. The completed questionnaires were mailed directly to the data center by the patients. Results: A total of 1511 patients returned the questionnaire to the data center with a response rate of 82% (1511/1853). Since 33 patients did not meet the entry criteria, the questionnaires returned by 1478 patients were analyzed in this survey. The mean age was 54.7 years (+-10.4, range 17-79). The distribution of the patients by time from the end of chemotherapy to this survey was as follows: Conclusions: Our survey demonstrated the outline of hair loss and appearance issues in breast cancer patients who received chemotherapy. Hair loss is the most distressing and occasionally long-lasting side effect. Lack of information is a serious problem. These facts suggested a need for long-time and careful support of these patients. Citation Format: Takanori Watanabe, Hiroshi Yagata, Mitsue Saito, Hiroko Okada, Tomoko Takayama, Hirohisa Imai, Yuko Yoshida, Nao Tamai, Keiko Nozawa, Tamiko Yajima, Kojiro Shimozuma. National survey of chemotherapy-induced appearance issues in breast cancer patients [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-15-09.

Abstract P5-15-17: National survey of long-term recovery from chemotherapy-induced hair loss in patients with breast cancer

Background: Altered appearance due to chemotherapy is a very distressing adverse event and can remain unrecovered for a long time after chemotherapy. To clarify the current status of appearance change and its support systems, we conducted a national questionnaire survey of patients with breast cancer who had received chemotherapy in Japan. Here, we report on the long-term recovery of scalp hair loss during and after chemotherapy. Patients and methods: A questionnaire was distributed to patients in hospitals throughout Japan between April and October 2013. The questionnaire was regarding the current status of the patients’ appearance issues (scalp hair, eyebrows, eyelashes, nails, skin) related to chemotherapy and its support systems, including chemotherapy regimens received, endocrine therapy received, and duration after chemotherapy. Eligible patients were women with breast cancer without any recurrence who had received adjuvant or neoadjuvant chemotherapy containing anthracycline (A) and/or taxanes (paclitaxel, P; docetaxel, D) and who were within 5 years from the last chemotherapy treatment. The physicians of each hospital asked their patients to fill out the questionnaire and mail it directly to the data center. The scalp hair status was analyzed in a cross-sectional manner according to the duration from chemotherapy. Results: The questionnaires were returned from 1511 patients in 47 hospitals (response rate, 82%; 1511/1853). Thirty-three patients were excluded, mainly because >5 years had passed since chemotherapy. In total, 1478 questionnaires were ultimately analyzed. The median age was 50 (range, 17–79) years. The distribution of patients according to time from the last chemotherapy treatment was as follows: 80% hair loss. Hair growth began during chemotherapy in 13.1% of patients and after chemotherapy in 80.3% (6.6% left the question unanswered). Within 6 months from the start of hair growth, 65% of patients felt a change in hair thickness, while 82% felt it was becoming thin. Of the patients, 70% felt a change in quality, while 48% felt that it had become unruly; 44% felt a color change, while 80% felt that they were growing more gray hair. Of the patients who answered the questions, >80% hair volume recovery was seen in 52.7% of patients within 1 year; in 63.5%, in 1–3 years; and in 61.7%, even after 3 years. After 3 years, volume recovery was seen in 67.8% of patients after an A+P–containing regimen; in 43.4%, after A+D; in 63.5%, after D; and in 88.9%, after A. Patients who had received A+P, D, and A+D had significantly less volume recovery than patients who had received A (P Conclusions: Almost all patients with breast cancer experienced severe hair loss during standard chemotherapy, but a recovery trend was noted after chemotherapy. However, hair remained unrecovered to various degrees in a significant number of patients even 3–5 years after chemotherapy, especially in those who had received taxane-containing regimens. We should consider the support needs of patients who experience chemotherapy-induced hair loss. Citation Format: Hiroshi Yagata, Takanori Watanabe, Hiroko Okada, Mitsue Saito, Tomoko Takayama, Hirohisa Imai, Yuko Yoshida, Nao Tamai, Keiko Nozawa, Tamiko Yajima, Kojiro Shimozuma. National survey of long-term recovery from chemotherapy-induced hair loss in patients with breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-15-17.