Wound, pressure ulcer and burn guidelines - 1: Guidelines for wounds in general, second edition

The Japanese Dermatological Association prepared the clinical guidelines for the "Wound, pressure ulcer and burn guidelines", second edition, focusing on treatments. Among them, "Guidelines for wounds in general" is intended to provide the knowledge necessary to heal wounds, without focusing on particular disorders. It informs the basic principles of wound treatment, before explanations are provided in individual chapters of the guidelines. We updated all sections by collecting references published since the publication of the first edition. In particular, we included new wound dressings and topical medications. Additionally, we added "Question 6: How should wound-related pain be considered, and what should be done to control it?" as a new section addressing wound pain, which was not included in the first edition.

Wound, pressure ulcer and burn guidelines - 4: Guidelines for the management of connective tissue disease/vasculitis-associated skin ulcers

The Japanese Dermatological Association prepared guidelines focused on the treatment of skin ulcers associated with connective tissue disease/vasculitis practical in clinical settings of dermatological care. Skin ulcers associated with connective tissue diseases or vasculitis occur on the background of a wide variety of diseases including, typically, systemic sclerosis but also systemic lupus erythematosus (SLE), dermatomyositis, rheumatoid arthritis (RA), various vasculitides and antiphospholipid antibody syndrome (APS). Therefore, in preparing the present guidelines, we considered diagnostic/therapeutic approaches appropriate for each of these disorders to be necessary and developed algorithms and clinical questions for systemic sclerosis, SLE, dermatomyositis, RA, vasculitis and APS.

Overexpression of p16(INK4a) in Mastocytosis (Urticarial Pigmentosa)

The expression of p16(INK4a) has been reported to induce cell-cycle arrest and cellular senescence. The p16(INK4a) expression has never been examined in human mast cells and mastocytosis. We immunohistologically examined the expression of p16(INK4a) and tryptase in 5 normal human skin and 4 mastocytosis. In normal mast cells, only 5.9 ± 3.4 (mean ± standard deviation) % of tryptase-positive mast cells coexpressed p16(INK4a). However, significantly higher percentage (86.0 ± 14.1%) of tryptase-positive tumor cells was immunoreactive to p16(INK4a) in all of 4 mastocytosis. The p16(INK4a) overexpression may induce the senescence of neoplastic mast cells to undergo spontaneous regression of mastocytosis.

Immunohistological Expression of p16INK4a is Commonly Present Both in Benign and Malignant Sweat Gland Neoplasias

The expression of p16INK4a has been reported to be a significant marker for malignant transformation of epidermal tumors. However, little is known about sweat gland tumors. We examined the immunohistological expression of p16INK4a in benign and malignant sweat gland tumors. The ductal and acrosyringial portion of normal eccrine glands were positively stained with p16INK4a while it was negative in the normal epidermis. Moderate to strong expression of p16INK4a was found in 16 of 17 eccrine poromas, 4 of 5 hidradenomas, 3 of 3 syringocystadenoma papilliferums, 2 of 2 mixed tumors, and 3 of 3 syringomas. The p16INK4a expression was observed focally or diffusely in 4 of 4 porocarcinomas, 4 of 4 apocrine carcinomas and 12 of 17 extramammary Paget's diseases. We conclude that the p16INK4a expression is not a good marker for dictating malignant transformation of sweat gland tumors.

A case of bleeding duodenal ulcer with pemphigus vulgaris during steroid therapy

We report a rare case of bleeding duodenal ulceration in the different form of pemphigus vulgaris (PV). A 52-year-old female was diagnosed with acute pharyngitis and administered methylprednisolone. After several days, melena and many blisters were noted on her body. Endoscopy revealed blood oozing from the second part of a duodeneal ulcer around the major duodenal papilla. After initial endoscopic hemostasis, we observed a large regional, shallow duodenal ulcer. The blisters were suspected to represent the Nikolsky's sign. The histological findings of her skin were characterized by suprabasal acantholysis and mixed inflammatory cell infiltrates, including scattered eosinophils. There were no other significant findings on skin biopsy or by direct immunofluorescence. Enzyme-linked immunosorbent assay showed an elevated titer of anti-desmoglein 3 autoantibodies in her serum, and the patient was finally diagnosed with mucosal-dominant PV. Although we performed multiple biopsies from the esophagus, stomach and duodenum, the samples did not contain significant findings to enable us to distinguish from pemphigus vulgaris. Corticosteroids remain an essential component of PV treatment. When clinicians encounter PV development during steroid therapy, upper gastrointestinal complications should be considered and diagnostic endoscopy conducted.

Ion transport and morphological changes of mitochondria in brown adipocytes of warm- and cold-acclimatized obese Zucker rats

Brown adipose tissue plays the dominant role in response to cold acclimatization through its capacity to produce heat. To demonstrate the cellular function for thermogenesis induced by cold acclimation in the brown adipose tissue of obese Zucker rats, we examined the changes for the area as well as the Na, K, Cl, and Ca concentrations in the mitochondria of brown adipocytes after the warm (25 degrees C, WG) and the cold acclimations (10 degrees C, CG). Moreover, the respiratory quotients (RQs) of these rats were measured. After the acclimations, the RQ in the CG was decreased and the oxygen consumption increased. A morphometric analysis of electron micrographs of brown adipocytes from the two groups of rats showed a marked increase in the area of the mitochondria in the CG. An electron probe X-ray microanalysis showed an increase in the Ca concentration and decreases in the Na and K concentrations in the matrix of the mitochondria of the cells in the CG. These results suggest that the reduction in the RQ of obese Zucker rats acclimated to cold is the consequence of the metabolism of a large quantity of lipid in the brown adipocytes. Our data also indicate that the observed change in the mitochondrial area and the increase for Ca in the mitochondria were associated with the cold-induced thermogenesis in brown adipocytes of obese Zucker rats.

Subcutaneous panniculitis by Epstein-Barr virus-infected natural killer (NK) cell proliferation terminating in aggressive subcutaneous NK cell lymphoma

We describe here a case involving a patient presenting initially with subcutaneous panniculitis, which developed after 12 years into aggressive subcutaneous natural killer (NK) cell lymphoma with peripheral blood involvement and hemophagocytosis. The surface marker of lymphoid cells in peripheral blood was CD2+3-7+8-16+56+. Skin biopsies were taken in May 1986 and June 1998. The initial biopsy revealed a diffuse proliferation of atypical lymphoid cells in the subcutaneous tissue with panniculitis, while the second biopsy revealed the presence of large lymphoid cells in the subcutaneous tissue with necrotic changes, consistent with a diagnosis of malignant lymphoma (diffuse pleomorphic type). The lymphoid cells from these two specimens were positive for CD56 and such cytotoxic molecules as T-cell intracellular antigen-1 (TIA-1), granzyme B, and, interestingly, also positive for Epstein-Barr (EB) virus by in situ hybridization. This suggests that chronic EB virus infections play an important role in the early stages of tumorigenesis and in the progression of NK cell lymphoproliferative disorders.

Role of xanthine oxidase in delayed lipid peroxidation in rat liver induced by acute exhausting exercise

The aim of this study was to examine whether xanthine oxidase (XOD)-derived hepatic oxidative damage occurs in the main not during but following strenuous exercise. The degree of damage to hepatic tissue catalyzed by XOD was investigated immediately and 3 h after a single bout of exhausting exercise, in allopurinol and saline injected female Wistar rats. Allopurinol treatment resulted in increased hypoxanthine and decreased uric acid contents in the liver compared with the saline treated group, immediately and 3 h after the exercise. Analysis immediately after the exercise showed no changes in hepatic hypoxanthine, uric acid, and thiobarbituric acid-reactive substance (TBARS) contents in the saline treated group, when compared with the resting controls. However, significant increases in uric acid contents in the saline treated livers were observed 3 h after the exercise, relative to the controls. Hepatic TBARS content in the saline treated group were markedly greater than those in both the control and allopurinol treated groups after 3 h of recovery following the exercise. It was concluded that a single bout of exhausting exercise may impose XOD-derived hepatic oxidative damage, primarily during the recovery phase after acute severe exercise.

Adaptive changes in the thermogenesis of rats by cold acclimation and deacclimation

Male Wistar rats, aged 6 weeks, were maintained at 25 degreesC for 9 to 11 weeks (W group), at 10 degreesC for 9 to 11 weeks (C group), and at 25 degreesC for 2 weeks after exposure to 10 degreesC for 9 weeks (D group). Thermogenesis at 10 degreesC was significantly greater than at 25 degreesC. Thermogenesis per body mass in the C group was greater than in the W and D groups. The RQ value at 10 degreesC was greater than at 25 degreesC in the W group, whereas the opposite was observed in the C and D groups. It is suggested that a large part of enhanced thermogenesis, caused by cold acclimation for 9 weeks, is lost because of a decreased secretion of calorigenic hormones, in spite of a slight decrease in BAT mass, during deacclimation for 2 weeks.

Effects of decreased plasma glutamine concentrations on peripheral lymphocyte proliferation in rats

The relationship between exercise-induced lowering of plasma glutamine concentrations and proliferation of peripheral lymphocytes was investigated in male Wistar rats. The T-lymphocyte proliferative responses to the mitogen, concanavalin A, were determined by incorporation of radiolabelled thymidine into the DNA in vitro. The rats ran 2 h x day(-1), 6 days x week(-1) for 4 weeks. Analysis immediately after the final period of exercise showed T-lymphocyte proliferation to be significantly depressed, together with a marked decrease in plasma glutamine concentrations. There were also significant increases in serum corticosterone concentrations immediately after exercise. However, following 24-h recovery, this exercise-induced immunosuppression was not statistically significant when compared with the age-matched control group. In the second experiment, in order to clarify the importance of glutamine for immunological function in vivo, methionine sulfoximine, an effective inhibitor of glutamine synthetase was injected intraperitoneally (12.5 mg x kg body mass[-1]). Plasma glutamine concentrations were decreased 4 h after the injection, compared with the placebo control group, and this resulted in a significant decrease in the rate of T-lymphocyte proliferation. This treatment had no effects on serum corticosterone concentrations. These results would suggest that the chronic exercise-induced reduction in proliferation of peripheral T-lymphocytes is a transient reversible phenomenon, which returns to normal levels within 24 h of the final training period. It is also conceivable that this exercise-induced immunosuppression is associated with a decrease in circulating glutamine concentrations.

Case report: Gianotti-Crosti syndrome associated with human herpesvirus-6 infection

We report a case of Gianotti-Crosti syndrome associated with human herpesvirus-6 (HHV-6) infection. An eight-month-old girl developed monomorphous papules on her cheeks, buttocks, and extremities after the subsidence of exanthema subitum. Viral antibody analysis confirmed primary HHV-6 infection. HHV-6 may be added to the list of causative agents of Gianotti-Crosti syndrome.

Thermoregulatory responses of prepubertal boys and young men in changing temperature linearly from 28 to 15 degrees C

To examine thermoregulatory responses of prepubertal children to cold stress, 11 boys (aged 8 years) and 11 young men (aged 19-23 years), wearing only trunks, participated in this study. They sat in air at 28 degrees C for 30 min (equilibrium period) and then in conditions where air temperature (Ta) was decreased linearly from 28 to 15 degrees C (at a constant rate of 0.22 degrees C.min-1) for 60 min, at a fixed relative humidity of 65%. In the equilibrium period there was no significant difference between the groups for rectal temperature [Tre, mean 37.30 (SEM 0.10) and mean 37.43 (SEM 0.14) degree C in the boys and the men, respectively] or for the respective skin temperatures (except for the forehead), but metabolic heat production (M) was significantly greater for the boys [mean 57.1 (SEM 1.2) and mean 52.0 (SEM 0.9) W.m-2, P < 0.005]. With declining Ta, the skin temperatures decreased in both groups (P < 0.001), but the decrease was significantly greater for the boys (P < 0.05), especially on the limbs as represented by the thigh and forearm. No significant correlations were observed between the limb skin temperatures compared to surface area-to-mass ratio or limb skinfold thicknesses in either group. The rate of increase in M as Ta decreased was significantly lower for the boys (P < 0.01) largely because of a higher M before the cold exposure. Thus, the mean M during the cold exposure did not differ between the groups [mean 63.6 (SEM 1.1) and mean 61.6 (SEM 1.1) W.m-2 in boys and men, respectively]. When the Ta was lowered, Tre in the boys started falling (P < 0.001), whereas the Tre in the young men did not change for 60 min. The Tre during the 60-min exposure was significantly lower (P < 0.001) for the boys [mean 37.01 (SEM 0.13) and mean 37.48 (SEM 0.18) degree C at the end of the exposure]. It was concluded that when Ta was lowered, the prepubertal boys appeared to vasoconstrict more in their limbs and to be somewhat more hypothermic, compared to the young men.

Effect of exercise on endotoxin shock with special reference to changes in concentration of cytokines

The effects of exercise on susceptibility to endotoxin shock and the serum levels of interleukin-1 (IL-1) and interleukin-6 (IL-6) were studied in mice primed with Propionibacterium acnes (P. acnes, 1.0 mg). Endotoxin shock was induced by injection of lipopolysaccharide (LPS, 0.2 mg) 7d after the priming injection of P. acnes. The exercise-loaded mice performed voluntary exercise for 120 min on a running-wheel and LPS was injected into the tail vein immediately after the end of exercise. Two of the nine animals in the exercised group survived, whereas all the mice in the control group died. The mean survival time after LPS injection in the exercised group (10.75 +/- 4.51 h) was significantly longer than that in the control group (3.3 +/- 1.34h). The serum concentrations of IL-1 (2,883 +/- 1,542 U/ml) and IL-6 (966 +/- 619 ng/ml) in the exercised group, sampled 2h after LPS challenge, were significantly lower than those in the control group (6,571 +/- 2,766 U/ml and 2,428 +/- 1,228 ng/ml, respectively). It is suggested that the exercise-induced inhibition of endotoxin shock may be caused, at least partly, by the decreased production of IL-1 and IL-6.

Thermoregulatory responses of prepubertal boys to heat and cold in relation to physical training

In an attempt to examine the effect of physical training on thermoregulatory responses in prepubertal boys, three series of experiments were performed, in summer. To all the subjects with swimming pants a heat stress was given through a foot bath of 42 degrees C in a hot climate, and a cold stress through exposure to an atmosphere at 20 degrees C Ta and 60% RH. Physical training increased work performance, whereas no significant effects were observed on rectal and mean skin temperatures. Metabolic rate was measured of children exposed alternately to 30-min heat and 30-min cold for 2 hr, and exposed to 60-min heat and 60-min cold separately, respectively. The mean skin temperature increased and decreased more on exposure to heat and cold, respectively, but the metabolic rate increased less remarkably in the children than in the adults. It was postulated thermoregulation might respond less distinctly to physical training in the children than in the adults, and that the decreased effect of training on the children might originate from an undifferentiated thermoregulatory system.

Physiological reaction of women during exercise and recovery, in a comfortable environment and a hot environment

Physiological reaction and oxygen intake during exercise and recovery were measured in fourteen young female Japanese during the follicular phase of their menstrual cycle at 25 degree C with 50% relative humidity and at 35 degree C with 50% relative humidity. Subjects, clad in bathing suits only, performed a bicycle ergometer exercise at a constant work load of 600 kg . m/min at a cycling rate of 50 rpm for 20 min and recovered while remaining on the bicycle ergometer for 40 min. The mean values of sweat volume and skin temperature were significantly greater at 35 degree C than at 25 degree C. It has been shown that heart rate and rectal temperature during exercise were slightly higher at 35 degree C than at 25 degree C, while those during recovery were significantly higher at 35 degree C than at 25 degree C. Oxygen intake, oxygen debt, and the fall in diastolic blood pressure after exercise were considerably greater at 35 degree C than at 25 degree C. The increase in oxygen intake in a hot environment might result from an increased metabolism due to higher body temperature and increased energy requirement for heat dissipation such as profuse sweating, higher heart rate, and increased ventilatory volume. The increase in oxygen debt in a hot environment might reflect the increased metabolism caused by higher body temperature and the increased production of lactic acid in the working muscle as a result of an insufficient blood supply to the muscle. The increases in sweat volume, oxygen intake during exercise, and oxygen debt in women in a hot environment were considerably smaller than corresponding values for men. The smaller increase in sweat volume in women in a hot environment could reflect a smaller oxygen intake and a more marked dilation of skin vessels in women than in men.

Comparison of physical characteristics, body temperature and basal metabolism between Thai and Japanese in a neutral temperature zone

The aim of this research is to compare the physical status, basal metabolism and some other physiological characteristics between native Thai in Bangkok, Thailand, and native Japanese in Japan, and discuss the results regarding acclimatization to tropical climate. Measurements of the Thai were made in September in Bangkok, while those of native Japanese were done in August at Nishinomiya (Japan). The subjects were adult males (20-22 years old) in both cases. Physically the Thai are generally a little shorter and more slender than Japanese in the mean value. The mean skinfold thickness for Thai was 8.4 mm, which is significantly less than that of Japanese (11.0 mm). The mean oral temperature measured under basal conditions was the same between both subject groups. The Thai showed a slightly lower basal metabolism per unit body surface, and mean skin temperature measured in a similar environmental condition was lower for Thai than for Japanese. The results of anthropometric measurements and physiological characteristics measured were discussed in view of physiology of acclimatization ot tropical climate.