Preoperative stoma site marking reduces postoperative stoma-related complications in emergency surgery: A single center retrospective cohort study.

BACKGROUND AND OBJECTIVE: Stoma site marking is an important factor in reducing stoma-related complications, thereby influencing the long-term quality of life in the elective setting. The impact of preoperative stoma site marking in emergency stoma creation is largely unknown. We aimed to determine whether preoperative stoma site marking in emergency stoma creation reduces stoma-related complications. METHODS: Patients who underwent emergency stoma creation at our hospital between 2009 and 2022 were examined by reviewing our prospective database and retrospective chart review. Subjects were classified into the "marking (+)" or "marking (-)" group according to stoma site marking (194 and 151 patients, respectively). The changes in the frequency of stoma marking over time and the effects of stoma marking on stoma-related complications were analyzed. RESULTS: The overall frequency of grade 2 or higher stoma-related complications was lower in the marking (+) group than in the marking (-) group (24% versus 36%, p = 0.010). Stoma site marking was associated with fewer soma site bleeding (2% versus 10%, p < 0.001), and the frequency of peristomal dermatitis was also lower (10%) in the marking (+) group (versus 18%, p = 0.042). Moreover, the lack of stoma site marking was an independent risk factor for overall stoma-related complications (adjusted odds ratio: 1.69, p = 0.034). CONCLUSIONS: Preoperative stoma site marking was associated with stoma-related complications in emergency surgery. The clinical significance of our attempt is worth validating with prospective studies.

Impact of COVID-19 Outbreak on Stoma Surgery and Stoma Clinic Service: A Retrospective Study at a Single Japanese Referral Hospital.

Aim: The impact of the COVID-19 pandemic on medical practice has been frequently reported from Western countries, but there have been few studies in other areas, especially regarding stoma surgery and stoma care. Methods: We investigated the numbers of all operations and stoma-related surgeries at our hospital in 2019 and 2020. The cumulative numbers of consultations at our ostomy clinic and patient population stratified by the period of having a stoma were compared between these calendar years. The frequency of ostomy clinic visit by individual patients within the first year after stoma creation and stoma-related complications per consultation were also analyzed. Results: The number of elective surgeries decreased by approximately 10% from 2019 to 2020, but the numbers of stoma creation and closure procedures did not differ. The total numbers of consultations at our ostomy clinic were also similar between these years. However, the percentage of patients with a stoma for less than a year who visited our ostomy clinic increased from 49.7% in 2019 to 53.5% in 2020, whereas the visitation rate for other patients decreased. Moreover, patients with a stoma for less than a year visited the ostomy clinic more frequently in 2020 (0.42/month) than in 2019 (0.30/month, p=0.032). There were fewer grade 2 or more severe peristomal complications in 2020 (11% vs 17% in 2019, p < 0.001) at our ostomy clinic. Conclusion: The COVID-19 outbreak led to a shift in the patient population at ostomy clinics of new stoma patients, which may have resulted in fewer peristomal complications.

Revealing the thermal oxidation stability and its mechanism of rice bran oil.

Although the stability of rice bran oil (RBO) has been showed on several studies, the factors which make it capable on maintaining its stability under thermal oxidation has not been sure yet. We hypothesized that its fatty acid composition [high composition of oleic acid (OA), lower composition of linoleic acid (LA) and α-linolenic acid (LnA)] and/or its antioxidant agents [γ-oryzanol (OZ)] and vitamin E [tocopherol (Toc), tocotrienol (T3)] might be the biggest factor. To prove the hypothesis, we thermally oxidized RBO under 40 °C for 17 days to mimic the harsh daily storage condition, and compared it with soybean oil (SO) and rapeseed oil (RPO) then monitoring their primary oxidation products [triacylglycerol hydroperoxide (TGOOH)] from easily oxidized fatty acid contained in triacylglycerol (TG) and the amount loss of antioxidant agents. As a result, RBO showed the lowest TGOOH/TG ratio, followed by RPO and SO. The superior stability RPO compared SO might occur due to because of the influence of the fatty acid profile (higher OA and lower LA). For RBO's case, besides its fatty acid profile, the existence of OZ and the synergistic effect of OZ and vitamin E might have a greater contribution in maintaining its stability under thermal oxidation.

Rapid detection of biofilm by wound blotting following sharp debridement of chronic pressure ulcers predicts wound healing: A preliminary study.

For optimal wound bed preparation, wound debridement is essential to eliminate bacterial biofilms. However, it is challenging for clinicians to determine whether the biofilm is completely removed. A newly developed biofilm detection method based on wound blotting technology may be useful. Thus, we aimed to investigate the effect of biofilm elimination on wound area decrease in pressure ulcers, as confirmed using the wound blotting method. In this retrospective observational study, we enrolled patients with pressure ulcers who underwent sharp debridement with pre- and post-debridement wound blotting. Biofilm was detected on the nitrocellulose membrane using ruthenium red or alcian blue staining. Patients were included if the test was positive for biofilm before wound debridement. Percent decrease in wound area after 1 week was calculated as an outcome measure. We classified the wounds into a biofilm-eliminated group and a biofilm-remaining group based on the post-debridement wound blotting result. Sixteen wound blotting samples from nine pressure ulcers were collected. The percent decrease in wound area was significantly higher in the biofilm-eliminated group (median: 14.4%, interquartile range: 4.6%-20.1%) than in the biofilm-remaining group (median: -14.5%, interquartile range: -25.3%-9.6%; P = .040). The presence of remaining biofilms was an independent predictor for reduced percent decrease in wound area (coefficient = -22.84, P = .040). Biofilm-based wound care guided by wound blotting is a promising measure to help clinicians eliminate bacterial bioburden more effectively for wound area reduction.

Assessing subclinical inflammation by peroxidase detection in patients with pressure ulcers.

OBJECTIVE: This study aimed to examine the superiority of peroxidase detection of macroscopic observations using rat wounds, and to test the external validity of the peroxidase analysis in pressure ulcers (PU) in humans. METHOD: In the animal study, rat wounds were analysed. A cross-sectional study analysed, by wound blotting, exudate samples from full-thickness PUs. Peroxidase activity was divided into two groups (ring and non-ring signals). Scores in the 'inflammation/infection' and 'necrotic tissue' components of DESIGN, a classification tool of PUs, were compared between the groups. RESULTS: In the animal study, 20 rat wounds were assessed and in the clinical study, 62 samples were collected from 26 full-thickness PUs of 21 patients aged ≥ 65 years. In the animal study, five of six wounds with clinical inflammation signs showed ring signal (defined as a signal on the wound edge and no signal on the wound bed). While the tissue sections of three wounds with a ring signal showed inflammatory features, they showed no clinical signs of 'inflammation/infection'. In the clinical study, which analysed 630 ring and 32 non-ring signals, 13 samples in the ring signal group and five in the non-ring signal group had 'inflammation/infection; scores of ≥1 (p=0.016). Despite having no clinical signs, 17 samples showed the ring signal. CONCLUSION: This study revealed the external validity of the wound blotting analysis of peroxidase and demonstrated its use to detect subclinical inflammation.

Effectiveness of biofilm-based wound care system on wound healing in chronic wounds.

A biofilm plays a crucial role in delaying wound healing. Sharp debridement, a possible effective method for eliminating biofilms, can only be applied to the wound with visible necrotic tissue; thus, no option has been available for eliminating biofilms that are not accompanied by necrotic tissue. Wound blotting was recently developed to visualize biofilm noninvasively and quickly, and ultrasonic debridement is available for biofilm removal. Therefore, the purpose of this study was to investigate the efficacy of "biofilm-based wound care system (BWCS)," a combination of wound blotting as a point-of-care testing and ultrasonic debridement, for promoting wound healing. Firstly, the cross-sectional study was conducted to examine the proportion of biofilm removal by ultrasonic debridement in pressure ulcers [Study 1]. Subsequently, the retrospective cohort study was conducted to examine the effectiveness of BWCS for healing of chronic wounds [Study 2]. The proportions of wound healing between wounds treated with BWCS and those with standard care in the home-visiting clinic were compared by Kaplan-Meier curve, and the Cox proportional hazard modeling was used to assess the effect of BWCS on wound healing. In Study 1, the median of biofilm removal proportion was 38.9% (interquartile range, 12.9-68.0%) for pressure ulcers treated with standard care and 65.2% (41.1-78.8%) for those treated with ultrasonic debridement (p = 0.009). In Study 2, the proportion of wound healing within 90 days was significantly higher in wounds treated with BWCS than in those treated with standard care (p = 0.001). The adjusted hazard ratio of BWCS for wound healing was 4.5 (95% confidence interval, 1.3-15.0; p = 0.015). In conclusion, we demonstrated that our novel approach, BWCS, can be a promising therapeutic strategy for visualizing biofilms that are not accompanied by necrotic tissue and promoting healing in chronic wounds.

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.

Autoxidation of Fish Oil Blended with Rice Bran Oil.

Effects of rice bran oil on the oxidative and flavor stability of fish oil were investigated by the gas liquid chromatography-head space method. When fish oil blending with different ratio of rice bran oils was oxidized at room temperature in the dark, volatile compounds produced during autoxidation was measured by gas liquid chromatography. The amounts of volatile compounds were decreased with increased the ratio of blended rice bran oil as well as peroxide value. The level of propanal and acrolein which gave unpleasant flavor was also decreased with increased the ratio of blended rice bran oil. Especially, the level of propanal and acrolein and peroxide value were remarkably decreased when blending more than 75% of rice bran oil. Blending of rice bran oil improved the oxidative and flavor stabilities of fish oil.

Surveillance of Radioactive Cesium in Meats of Wild Animals Caught in Chiba Prefecture.

From fiscal year 2012 to 2014, we surveyed the concentration of radioactive cesium in 39 wild animal meats obtained from 20 wild boars and 19 deer caught in Chiba prefecture, using a germanium semiconductor detector. Four wild boar meats in the fiscal years 2012 and 2013 exceeded the radioactive cesium limit in general foods (100 Bq/kg), whereas none of the deer meats exceeded the limit. The left side of the wild boar that showed a radioactive cesium concentration above 100 Bq/kg was divided into 14 parts. We compared the radioactive cesium concentration in the ham used for the screening test with those in other parts. The concentration was highest in ham, among the edible parts.