Gene mutation of Mycobacterium leprae was studied on bacilli-positive multibacillary leprosy patients since 2000 in Japan. Subjects: LL 31 cases, BL 7 cases. Results: gene mutation of folP was found in 19/36 cases (52.8%), that of rpoB in 13/33 cases (39.4%), that of gyrA in 6/31 cases (16.8%). Five cases showed both mutations of folP and rpoB, and one case showed those of folP and gyrA. Mutations of folP, rpoB and gyrA all were found in 4/36 cases (10.3%). High incidence of resistance to DDS or rifampicin was observed, and incidence of resistance to ofloxacin was considerably high. These results reveal existence of multidrug-resistant bacilli in Japanese leprosy patients. Treatment of these cases was arranged according to the result of gene mutation analysis and satisfactory effects were obtained in 34/38 cases. One case did not response to newer treatment. Three cases refused use of improved treatment and their disease activities are not controlled. This study proved that gene mutation analysis is a rapid and accurate method to know the drug resistance against DDS, rifampicin and new quinolones, and important in chemotherapy of leprosy.

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The long search of an animal model for leprosy were carried out as many researchers since the Mycobacterium leprae discovery by Dr. Hansen in 1874. The remarkable results were left after the development of the foot-pad method by Dr. Shepard in 1960. The introduction of the T-R mouse and athymic (nude) mouse for leprosy research, alsospontaneity examples of Hansen's disease was reported to armadillo, chimpanzee and mangabay monkey, and it was confirmed that Hansen's disease was the zoonosis. Although, We have established a congenic hypertensive nude rat, SHR/NCrj-rnu (SHR.F344-Foxn1^rnu), carrying nude (rnu) and hypertension genes. SHR/NCrj-rnu rats obtained showed high susceptibility to M. leprae and showed a characteristic disease with a progressive pattern of leproma formation. Also this hypertensive nude rat strain produce high level of IL-10. Therefore, congenic hypertensive nude rat may be useful for an animal model to leprosy.

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Previous studies on sociology and cultural anthropology insist that it is impossible to provide sufficient autonomy to clients who enroll for group care at care facilities. The purpose of this study is to analyze the nature of nursing assistant care at the national Hansen's disease sanatorium in Japan. Semi-structured interviews were conducted with 39 nursing assistants and 6 head nurses who cared for physically and socially challenged residents at this sanatorium. The investigation revealed that as a result of facing huge conflicts in the caring process, the nursing assistants had learned to appreciate the inherent life and history of residents. Thus, the nursing assistants and residents were bound together by mutual trust with a view to maximize the “autonomy of the life field.” Conflict had not stunted the self-affirmation of nursing assistants; moreover, mutual trust had reorganized the “relevant system pertaining to care” for nursing assistants, which consisted of “the unification of care” and “the equality of care.” It is suggested that group care at this sanatorium promotes the “autonomy of the life field” by valuing conflicts between nursing assistants and residents.

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The causes of skin ulcers in collagen vascular diseases are complicated, and involve peripheral vascular complications, vasculitis, and thrombosis. It is necessary to determine the treatment, such as oral medication, infusion, ointment and surgery after careful consideration of its causes. This review shows skin manifestations of various collagen vascular diseases and the causes of skin ulcers in these diseases.

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Neuropathic pain has been known to be refractory to traditional analgesics, such as opioids and nonsteroidal anti-inflammatoy drugs. Some mechanisms of the development of neuropathic pain have been proposed; 1) sprouting of A β fibers to the superficial layer of the dorsal horn, 2) ectopic discharge in the dorsal root ganglion and/or in neuroma at the nerve stump, 3) spinal sensitization. Ectopic discharge has been reported to be inhibited by Na+ channel blocker, such as lidocaine, and anticonvulsant. Lidocaine and anticonvulsant are used in the management of neuropathic pain. Activation of NMDA receptor is usually involved in the development of spinal sensitization and NMDA receptor antagonist, such as ketamine, is used in the management of neuropathic pain. Recently, α2δ subunit blocker, new class of anticonvulsant, is introduced to the management of neuropathic pain. α2δ subunit is the subunit of Ca²⁺ channel and modulate the influx of Ca²⁺. This Ca²⁺ influx induces release of neurotransmitter in the neuron. α2δ subunit blockers, such as gabapentin and pregabalin, may reduce the release of neurotransmitter and elicit analgesic effect in the treatment of neuropathic pain.

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Mycobacterium tuberculosis (MTB) is an intracellular pathogen that has evolved strategies to enable growth in macrophages. The bacterium is able to inhibit fusion of phagosomes with lysosomes through secretion of some bacterial components and modulation of host intracellular signaling pathways. Furthermore, it has been shown that phagositosed MTB is killed within macrophages after treatment with IFN-γ in vitro. However, virulent MTB is capable of surviving in macrophages in vivo and persists in host even after acquired immunity has developed. These data suggest that MTB has developed a sophisticated immune evasion mechanism. In this issue, the strategies of MTB for intracellular survival and immune evasion, which have been unraveled so far, are shown and the mechanisms are discussed.

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The change of shift report is of great importance in nursing in order to ensure the continuity of care, transfer information among nurses, and to ensure the transfer of responsibility from one shift to the next. In workplaces where nursing staff work together with personal support workers, it is important for staff to have common access to patient information in order to be able to use the information practically and carry out their individual responsibilities and roles. Until now, nursing staff and personal support workers collaborated and combined information for the verbal change of shift report, but the role of the personal support worker was in practice, more passive.Beginning 3 years ago, nurses began planning training sessions to educate personal support workers to increase their practical abilities. Through the training, personal support workers learned how to leave accurate patient records and nursing staff and personal support worker staff began to use a joint flow sheet to keep a record of patient information. This written record became the means of communication, making the verbal change of shift report redundant. As a result of trying to discontinue the verbal change of shift reports, personal support workers began to collect information more independently, and began to practice care more intentionally. In addition, the understanding of the role of the personal support worker deepened, the ability to care for patients improved, and it also led to better cooperation between nursing staff and personal support workers.

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At this sanatorium, the number of foot bottom ulcer patients/was 13. and the tenure of the foot bottom ulcer was average 11 years.
According to the treatment that was not unified, we thought about the cause of the prolongation.
Therefore, we made evaluation and care method sheet (“foot care sheet”) of the ulcer for the unification.
We used the foot pressure measurement system (F-scan) to 4 patients for the pressure dispersion of the ulcer.
We devised the protection law of the ulcer, and an ulcer did not require pressure more than 5kilos/cm². We recorded the size of the ulcer, weight of the liquid from ulcer, a photograph to care sheet once a week.
I performed ulcer protection law and management with the foot care sheet to 4 patients for average 4 months
As a result, the ulcers of 3 patients out of 4 patients became small.

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The pathophysiology of chronic wounds differ from that of acute wounds, and the etiology has various, for example decubitus, diabetes, insufficient venous circulation, radiation, et al. Now, for diabetic foot ulcers with/without PAD, internist (diabetologist, interventionalist), radiologist, vascular surgeon, orthopedic surgeon, dermatologist, plastic surgeon tackle this difficult problem respectively. But it is far from total medical care as a team medicine. In this mini-review, I want to introduce our project for diabetic foot ulcers and gangrene with/without PAD, presenting our cases. I shall be happy if I can be of any help to any neurogenic foot problems in Hansen's disease.

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