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Matsuzaki K.,Kawasaki Municipal Tama Hospital | Upton D.,University of Worcester
International Wound Journal | Year: 2013

This review and case study report considers the evidence to indicate that the progress of wound healing is negatively affected by the presence of stressors and in circumstances where patients are in painIt considers the relationship between perceptions of pain, stress and delayed wound healing with a specific focus on guidance for clinical practiceIt is appreciated that although the literature has examined these issues in the management of acute wounds, demonstrating that psychological stress can have detrimental effects on the wound-healing process, the evidence to support this link in relation to chronic wounds is limitedThe review considers evidence indicating that punch biopsy wounds heal more slowly in subjects under stress on account of caring for family members with long-term illnesses and also considers briefly the relationship between cortisol secretion in response to stress and the consequent influences on cytokine levels and the wound-healing process. © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc. Source


Togashi I.,Keio University | Sato T.,Kyorin University | Soejima K.,Kawasaki Municipal Tama Hospital | Takatsuki S.,Keio University | And 7 more authors.
International Journal of Cardiology | Year: 2013

Background: Patients with coronary spasm generally have a good prognosis, although it can result in sudden cardiac arrest (SCA) and syncope. We hypothesized that the nature of coronary spasm triggering lethal arrhythmias may be different from that which induces angina-only. Methods: Clinical characteristics were examined in patients who had experienced SCA (n = 18) or syncope (n = 28) triggered by coronary spasm. These characteristics were compared to those of patients who had coronary spastic angina-only (n = 52). Results: SCA and syncope occurred frequently during daytime in 57% and 68%, respectively. Spontaneous ST-segment changes during daytime were recorded more often in patients with SCA (50%) and syncope (39%) than angina-only patients (4%, p < 0.01 for each). Nocturnal angina occurred less frequently in patients with SCA (33%) and syncope (32%) than angina-only patients (83%, p < 0.01 for each). Severe multivessel spasm, daytime ST-segment changes, and younger age were significant predictors of SCA. Daytime ST-segment changes and active smoking were related to syncope. Conclusions: The circadian variance of coronary spasm triggering SCA or syncope may be different from that inducing typical coronary spastic angina. The coronary spasm should be evaluated for patients with aborted SCA or recurrent syncope of unknown cause, even though the patients have not experienced the typical nocturnal angina. © 2011 Elsevier Ireland Ltd. All rights reserved. Source


Hiraki K.,St. Marianna University School of Medicine | Yasuda T.,St. Marianna University School of Medicine | Hotta C.,Kawasaki Municipal Tama Hospital | Izawa K.P.,St. Marianna University School of Medicine | And 5 more authors.
Clinical and Experimental Nephrology | Year: 2013

Background: Patients undergoing dialysis experience decreases in physical function; however, few data exist on physical function in pre-dialysis patients with chronic kidney disease (CKD). The primary objective of this study was to clarify physical function in pre-dialysis patients according to CKD stage. Methods: This was a cross-sectional study of 120 ambulant pre-dialysis CKD stage 2 or higher patients (85 male, 35 female; mean age 66.5 years) who visited St. Marianna University School of Medicine Hospital. Participants were grouped according to CKD stage as follows: stage 2 (n = 17), stage 3 (n = 55), stage 4 (n = 25), and stage 5 (n = 23). Handgrip strength, knee extensor muscle strength, single-leg stance time, and maximum gait speed were used to assess physical function. Clinical laboratory tests were also examined at the same time as physical function measurements. Results: All indices of physical function decreased according to the progression of CKD. Each physical function index was significantly lower in CKD stage 4 or 5 patients than CKD stage 2 or 3 patients. All physical function indices showed a positive correlation with estimated glomerular filtration rate (eGFR), blood hemoglobin level, and serum albumin level, and a negative correlation with urinary protein levels. In multiple regression analysis, age, female sex, body mass index, eGFR and urinary protein were significantly correlated with indices of physical function. Conclusion: Physical function in pre-dialysis CKD patients decreased as the disease progressed according to stage. Early intervention in CKD patients might delay the loss of physical function. © Japanese Society of Nephrology 2012. Source


Hiraki K.,St. Marianna University School of Medicine | Kamijo-Ikemori A.,St. Marianna University School of Medicine | Yasuda T.,St. Marianna University School of Medicine | Hotta C.,Kawasaki Municipal Tama Hospital | And 4 more authors.
Journal of Clinical Laboratory Analysis | Year: 2013

Background: The aim of this study was to determine whether a single moderate-intensity exercise session induces renal injury based on various parameters that reflect kidney dysfunction, including urinary L-type fatty acid-binding protein (L-FABP). Methods: Adult outpatients (n = 31) with chronic kidney disease (CKD) not receiving renal replacement therapy participated in this study. Urine was collected before and after a single 20-min moderate-intensity exercise session. Urinary levels of L-FABP, albumin, N-acetyl-β-d-glucosaminidase (NAG), and α1-microglobrin (α1MG) were measured. In addition, 12 patients with estimated glomerular filtration fraction less than 30 ml/min/1.73 ml2 were selected from all patients and evaluated using the same analysis. Results: Urinary values of L-FABP, albumin, NAG, and α1MG did not increase significantly after exercise compared with before exercise (urinary L-FABP, from 8.3 to 9.4 μg/g of creatinine; urinary albumin, from 293.1 to 333.7 mg/g of creatinine; urinary NAG, from 9.2 to 8.2 U/g of creatinine; urinary α1MG, from 11.4 to 9.8 mg/g of creatinine, not significant). Similar findings were seen in all patients, regardless of degree of renal dysfunction. Conclusions: A single session of moderate-intensity exercise was not associated with an increase in renal parameters used to assess renal damage. © 2013 Wiley Periodicals, Inc. Source


Matsuzaki K.,Kawasaki Municipal Tama Hospital
Japanese Journal of Plastic Surgery | Year: 2012

As a guideline to the treatment of chronic wounds including pressure ulcers, Wound Bed Preparation (WBP) was proposed in 2000. Meanwhile, the Japanese Society of Pressure Ulcers issued the guideline for the prevention and management of pressure ulcers in 2009. Clinical questions, such as "What kind of wound dressing should be used" for the prevention of pressure ulcers, superficial pressure ulcers, and deep pressure ulcers, are provided with statements of recommendation and the degree of recommendation in the guideline. For deep pressure ulcers, statements of recommendation and the degree of recommendation are described by subdividing into 6 items of "removal of necrotic tissues," "control of infection and inflammation, " "exudates control, " "treatment of pocket wounds, " "scale-down of wounds, " and "facilitating granulation. " In this article, we reviewed the role of wound dressing expected in the treatment of pressure ulcers, in accordance with the concepts of the guideline and WBP, also bearing in mind the uniqueness of the mechanism of development for pressure ulcers which is different from other chronic wounds. Source

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