The wound/burn guidelines - 3: Guidelines for the diagnosis and treatment for diabetic ulcer/gangrene.

We aimed to prepare guidelines for the management of diabetic ulcer/gangrene with emphasis on the diagnosis and treatment of skin symptoms. They serve as a tool to improve the quality of the diagnosis and treatment in each patient and, further, to improve the level of the care for diabetic ulcer in Japan by systematically presenting evidence-based recommendations for clinical judgments by incorporating various viewpoints.

The wound/burn guidelines - 6: Guidelines for the management of burns.

Burns are a common type of skin injury encountered at all levels of medical facilities from private clinics to core hospitals. Minor burns heal by topical treatment alone, but moderate to severe burns require systemic management, and skin grafting is often necessary also for topical treatment. Inappropriate initial treatment or delay of initial treatment may exert adverse effects on the subsequent treatment and course. Therefore, accurate evaluation of the severity and initiation of appropriate treatment are necessary. The Guidelines for the Management of Burn Injuries were issued in March 2009 from the Japanese Society for Burn Injuries as guidelines concerning burns, but they were focused on the treatment for extensive and severe burns in the acute period. Therefore, we prepared guidelines intended to support the appropriate diagnosis and initial treatment for patients with burns that are commonly encountered including minor as well as moderate and severe cases. Because of this intention of the present guidelines, there is no recommendation of individual surgical procedures.

Increased levels of urinary nitrite and nitrotyrosine in Yusho victims 40 years after accidental poisoning with polychlorinated biphenyls in Nagasaki, Japan.

Forty years have passed since the accidental poisoning with polychlorinated biphenyls (PCB) in Japan in 1968, named Yusho. High concentrations of PCB are still detected in the serum of the Yusho victims. PCB produces superoxide (O(2) (-)) in the metabolic process and we reported high concentrations of serum nitrite, a stable metabolite reflecting nitric oxide (NO), in the Yusho victims. NO reacts with O(2) (-) and immediately produces peroxynitrite (ONOO(-)). ONOO(-) causes nitration of tyrosine residues and produces nitrotyrosine (NT). Therefore, we measured urinary concentrations of nitrite and NT in the victims and age-matched controls. The mean urinary concentrations of nitrite and NT were significantly higher than in the controls. There was a positive correlation between urinary nitrite and NT in the Yusho victims. Furthermore, there was a positive correlation between the ratio of urinary NT to nitrite and serum PCB concentrations in the Yusho victims. It was considered that the emergence of some ailments could be presumed to have been caused by high levels of urinary nitrite and NT in the Yusho victims.

[Estimation of total antioxidant power in the serum of Yusho victims].

Polychlorinated biphenyls (PCB) causes the release of superoxide during the metabolic process. Therefore, Yusho victims are thought to be exposed to oxidative stress caused by PCB, because high concentrations of PCB are still detected in the serum of Yusho victims. Recently, total antioxidant power (TAP) has been proposed as one of excellent markers of defense capacity against oxidative stresses. In order to estimate the antioxidant capacity in Yusho victims, we measured serum TAP in certified Yusho victims and age-matched noncertified subjects. The mean values of serum TAP were 0.479 +/- 0.017 in certified Yusho victims and 0.397 +/- 0.013 microM in non-certified subjects, respectively. There was a significant difference in the serum values of TAP between certified Yusho victims and uncertified subjects. TAP was reported to increase in the case of severe oxidative stress and PCB can give rise to an oxidative stress in Yusho victims. Therefore, it was supposed that TAP could increase in the oxidative stress of Yusho probably by some negative feedback mechanisms. The exact mechanism is still unclear, and further examinations should be conducted in the future.

[Examination of "areas cutanea" in Yusho patients].

In the field of Dermatology, one of the representatives of oxidative stresses is ultraviolet irradiation. Repetitive ultraviolet exposure results in cutaneous photoaging. Otherwise, polychlorinated biphenyls (PCB) give rise to superoxide, which means Yusho patients have been affected by oxidative stress for more than thirty years. In order to examine the influence of oxidative stress by PCB to the skin, we measured the "areas cutanea" in the inner aspect of upper arm in Yusho patients and in age-matched controls. "Areas cutanea" were significantly smaller in Yusho patients than in controls. Although PCB can give an oxidative stress, the influence seemed to be little to the skin. There might be another mechanisms involved in this result except the oxidative stress by PCB. Further examination should be conducted in the future.