Wound,pressure ulcer and burn guidelines – 6: Guidelines for the management of burns,second edition

“Wound, pressure ulcer and burn guidelines – 6: Guidelines for the management of burns, second edition” is revised from the first edition which was published in the Japanese Journal of Dermatology in 2016. The guidelines were drafted by the Wound, Pressure Ulcer and Burn Guidelines Drafting Committee delegated by the Japanese Dermatological Association, and intend to facilitate physicians’ clinical decisions in preventing, diagnosing and treating burn injury. All sections are updated by collecting documents published since the publication of the first edition. Especially, the recommendation levels of dressing materials newly covered by the Japanese national health insurance are mentioned. In addition, the clinical questions (CQ) regarding the initial treatment of electrical (CQ15) and chemical burns (CQ16), and also the use of escharotomy (CQ22), are newly created.     

In Vivo Evidence of Organic Cation Transporter-Mediated Tracheal Accumulation of the Anticholinergic Agent Ipratropium in Mice

Ipratropium bromide (IPR) is an anticholinergic used to treat chronic obstructive pulmonary disease (COPD), and is a substrate of organic cation transporters. The present study aimed to assess the contribution of organic cation transporters to tracheobronchial absorption of IPR in vivo by directly injecting [³H]IPR into the tracheal lumen of mice and measuring its accumulation in tracheal tissue. RT-PCR and immunohistochemical analysis showed that Octnl, Octn2, and Oct2 were localized at epithelial cells in the respiratory tract. Electron-microscopic immunohistochemistry indicated that Octnl and Octn2 were localized at the apical portions of ciliated epithelial cells of trachea. In vitro uptake studies in HEK293 cells expressing these transporters demonstrated that IPR is a preferred substrate of Octn2. Inhibition of mouse tracheal accumulation of [³H]IPR by carnitine was concentration-dependent, reaching a maximum of 42% at 1 mM, whereas inhibition by 0.1 mM MPP + amounted to 62%. Tracheal accumulation of [³H]IPR was unchanged when mice were simultaneously injected with Octnl substrate ergothioneine and organic anion transporter substrate estrone sulfate. These results suggest that Octn2 is involved in membrane permeation of IPR in the respiratory tract in vivo. Targeting organic cation transporters may be an effective strategy for delivery of cationic anti-COPD drugs to patients.     

Effect of β-Agonists on Production of Cytokines by Activated T Cells Obtained from Asthmatic Patients and Normal Subjects

Intracellular levels of cAMP were found to regulate T cell activity. We examined whether β₂-agonists altered cytokine production and cyclic adenosine monophosphate (cAMP) accumulation in concanavalin A (ConA)-activated peripheral T cells from asthmatic patients. Procaterol and isoproterenol weakly decreased the ConA-elicited interleukin (IL)-4 and IL-5 secretion; however, the inhibitory effect of procaterol on the ConA-induced IL-2 secretion was inferior to that of isoproterenol in normal controls and was little in asthmatics. The intracellular accumulation of cAMP by procaterol was not altered compared with that by isoproterenol. Results suggest that there is a qualitative difference between procaterol- and isoproterenol-induced cAMP accumulation in T cells.     

Efficacy of three-dimensional computed tomography for evaluating airway tract involvement in patients with relapsing polychondritis

The airway tract involvement is known to be one of the most important prognostic factors in patients with relapsing polychondritis (RP). Sequential evaluations of airway tract involvements are necessary, however, the insertion of flexible bronchoscope into the affected airway tract may exacerbate their airway tract stenosis. Three-dimensional computed tomography (3D-CT) showed stenosis of the trachea and bilateral main bronchi in 2 patients with RP. 3D-CT is an effective non-invasive method for evaluating airway tract involvement in RP.     

Successful treatment for a benign esophagorespiratory fistula with perioperative nutritional management and multistep esophageal bypass operation: a case report

A 49-year-old man was referred to our hospital for treatment of an esophagorespiratory fistula following 5-year airway stenting for stenosis of tracheal anastomosis. In consideration of the prior polysurgery and the patient’s poor general status and malnutrition, we selected multistep esophageal bypass combined with feeding enterostomy for nutritional support. Respiratory symptoms and pneumonia were rapidly improved by esophageal transection and decompression via a catheter esophagostomy. Nutritional status was also improved by enteral nutrition via a catheter gastrostomy. Four months after the esophageal transection, we conducted an esophageal bypass using an ileocolonic conduit because the right gastroepiploic artery had been used for omental reinforcement of tracheal anastomosis. The patient had no postoperative complications and was discharged 53 days after the bypass surgery. Multistep esophageal bypass including feeding enterostomy for perioperative nutritional management is a safe and useful alternative to direct closure for a critically ill patient with an esophagorespiratory fistula who is at high risk for operative mortality.     

Dynamic instability during stair descent in isolated PCL-deficient knees: what affects abnormal posterior translation of the tibia in PCL-deficient knees?

Posterior cruciate ligament (PCL)-deficient patients usually display few functional disabilities during activities of daily living (ADL), even in the presence of significant objective knee laxity. This suggests that the magnitude of posterior instability occurring in ADL (dynamic instability) does not parallel the knee laxity detected in clinical examinations. The present study analyzed kinematics of the knee joint during stair descent in 14 isolated PCL-deficient patients and ten healthy volunteers using fluoroscopy. Factors influencing dynamic instability were investigated. In addition, magnitude of posterior tibial translation occurring during stair descent was measured and compared with static knee laxity measured on posterior stress radiography. Increased posterior tibial translation was observed in early swing phase (52.5 ± 5.6%) in PCL-deficient knees compared with normal knees (48.2 ± 8.6%). Almost the same magnitude of posterior instability was observed at early swing phase during stair descent using fluoroscopy and on posterior stress radiography. These results indicate that in PCL-deficient patients, posterior instability does not occur when weight is loaded onto the knee, but occurs when weight-bearing is released during stair descent.     

Perioperative complications of anterior decompression with fusion versus laminoplasty for the treatment of cervical ossification of the posterior longitudinal ligament: propensity score matching analysis using a nation-wide inpatient database

BACKGROUND CONTEXT

Surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL) has a high risk of various complications. Anterior decompression with fusion (ADF) and laminoplasty (LAMP) are the most representative surgical procedures. However, few studies have compared the two procedures in terms of perioperative surgical complications.