Visible-light-induced decarboxylative and deboronative reactions using two-molecule organic photoredox catalysts, namely, phenanthrene (Phen) and biphenyl (BP), as electron donors and ...9-cyano-10-methoxycarbonylanthracene 1a as an electron acceptor were achieved. The high solubility of 1a significantly improved the reaction efficiency and product yield. In addition, the facile tuning of the oxidation potential of the electron-donor molecule via the replacement of Phen with BP enabled the application of the two-molecule photoredox system to a wide range of substrates.
Visible‐light‐induced decarboxylative and deboronative radical addition of aliphatic carboxylic acids and arylboronic acid pinacol esters to electron‐deficient alkenes using two‐molecule organic ...photoredox catalysts, such as dibenzog,pchrysene as an electron donor and 1,4‐dicyanobenzene as an electron acceptor, proceeded efficiently to furnish radical adducts via the generation of alkyl and aryl radicals. The base and substrate play important roles in this photochemical system, and the sequential photoinduced decarboxylation of glutamic acid having two different carboxy groups was successful.
Visible‐light‐induced decarboxylative and deboronative radical addition of aliphatic carboxylic acids and arylboronic acid pinacol esters to electron‐deficient alkenes using two‐molecule organic photoredox catalysts, such as dibenzog,pchrysene and 1,4‐dicyanobenzene, proceeded efficiently to furnish radical adducts via the generation of alkyl and aryl radicals.
A Photoinduced dearomative nucleophilic addition to N-Boc indoles mediated by two-molecule organic photoredox catalysts such as phenanthrene and 1,4-dicyanobenzene with UV irradiation furnished ...2-substituted indolines in moderate to quantitative yields. Hydroxide, alkoxide, and cyanide ions can be used as a nucleophile to provide 2-hydroxy, 2-alkoxy, and 2-cyanoindolines, respectively. Both electron-rich and -deficient indoles, including tryptophan derivatives, can be employed in the photoreaction to provide various indolines. This method provides transition-metal-free access to 2-subsituted indolines from indoles using organic photoredox catalysts under mild conditions.
Visible‐light‐induced decarboxylative and deboronative radical addition of aliphatic carboxylic acids and arylboronic acid pinacol esters to electron‐deficient alkenes using two‐molecule organic ...photoredox catalysts, such as dibenzog,pchrysene as an electron donor and 1,4‐dicyanobenzene as an electron acceptor, proceeded efficiently to furnish radical adducts via the generation of alkyl and aryl radicals. The base and substrate play important roles in this photochemical system, and the sequential photoinduced decarboxylation of glutamic acid having two different carboxy groups was successful.
Using the out-of-hospital cardiac arrest (OHCA) registry in Japan, we evaluated the effectiveness of physicians’ presence in pre-hospital settings after adjusting in-hospital treatments.
This was a ...multicenter cohort study. We registered all consecutive OHCA patients in Japan who, from 1 June 2014 through 31 December 2017, were transported to institutions participating in the Japanese Association for Acute Medicine OHCA registry. We included OHCA patients aged at least 18 years, with medical etiology, and who received resuscitation from emergency medical services (EMS) personnel and medical professionals in hospitals. The primary outcome was one-month favorable neurological survival. We estimated the propensity score by fitting a logistic regression model that was adjusted for several variables before the arrival of EMS personnel and/or pre-hospital physician. A multivariable logistic regression analysis in propensity score-matched patients was used to adjust confounders, including extracorporeal membrane oxygenation, percutaneous coronary intervention, intra-aortic balloon pumping, and targeted temperature management.
We analyzed 19,247 patients. Among them, 5.4% (N = 1040) had a neurologically favorable outcome. The adjusted odds ratio (AOR) of the physicians’ presence compared with their absence for primary outcome was 1.84 (95% confidence interval (CI): 1.43–2.37). Among first documented non-shockable cardiac rhythm, the AOR was 1.51 (95% CI: 1.04–2.22). Among first documented shockable cardiac rhythm, the AOR of the physicians’ presence for primary outcome was 1.15 (95% CI: 0.83–1.59).
The improved one-month favorable neurological survival was significantly associated with the physicians’ presence in pre-hospital settings, compared with the physicians’ absence.
Aim
To describe the registry design of the Japanese Association for Acute Medicine – out‐of‐hospital cardiac arrest (JAAM‐OHCA) Registry as well as its profile on hospital information, patient and ...emergency medical service characteristics, and in‐hospital procedures and outcomes among patients with OHCA who were transported to the participating institutions.
Methods
The special committee aiming to improve the survival after OHCA by providing evidence‐based therapeutic strategies and emergency medical systems from the JAAM has launched a multicenter, prospective registry that enrolled OHCA patients who were transported to critical care medical centers or hospitals with an emergency care department. The primary outcome was a favorable neurological status 1 month after OHCA.
Results
Between June 2014 and December 2015, a total of 12,024 eligible patients with OHCA were registered in 73 participating institutions. The mean age of the patients was 69.2 years, and 61.0% of them were male. The first documented shockable rhythm on arrival of emergency medical services was 9.0%. After hospital arrival, 9.4% underwent defibrillation, 68.9% tracheal intubation, 3.7% extracorporeal cardiopulmonary resuscitation, 3.0% intra‐aortic balloon pumping, 6.4% coronary angiography, 3.0% percutaneous coronary intervention, 6.4% targeted temperature management, and 81.1% adrenaline administration. The proportion of cerebral performance category 1 or 2 at 1 month after OHCA was 3.9% among adult patients and 5.5% among pediatric patients.
Conclusions
The special committee of the JAAM launched the JAAM‐OHCA Registry in June 2014 and continuously gathers data on OHCA patients. This registry can provide valuable information to establish appropriate therapeutic strategies for OHCA patients in the near future.
The special committee of the JAAM has launched a multicenter, prospective registry (the JAAM‐OHCA Registry) that focused on OHCA patients who were transported by EMS personnel to the participating institutions since June 2014. This report described this registry's profile and briefly presented the characteristics of 12,024 OHCA patients between June 2014 and December 2015.
Abstract only
Background:
Little is known about whether pre-hospital administered adrenaline with a physician present could improve the outcome of patients with cardiac arrest.
Hypothesis and Aim:
We ...aimed to test the hypothesis that pre-hospital administered adrenaline provided in the presence of a physician could improve neurological survival of patients with a specific type of first-confirmed cardiac rhythm following cardiac arrest compared with pre-hospital administered adrenaline provided in the absence of a physician.
Methods:
This prospective multi-center cohort study enrolled consecutive patients who were transported to 95 participating hospitals in Japan after out-of-hospital cardiac arrest and later underwent resuscitation at a hospital between June 1 2014 and December 31 2020. We included patients who were administered pre-hospital adrenaline under the presence or absence of a physician, and who were ≥18 years of age with cardiac arrest of a medical etiology. Primary outcome was a favorable neurological outcome (Cerebral Performance Category score of 1 or 2) one month after cardiac arrest. Whether the carotid artery was pulsating and 3-lead electrocardiogram monitor confirmed the first cardiac rhythm. Based on previous findings, those with the first-confirmed cardiac rhythm were subdivided into the non-shockable and shockable groups. Multivariable logistic regression analysis was performed on propensity score-matched patients.
Results:
We analyzed 11,711 patients. Among the 10,113 patients in the non-shockable group, 0.6% (N = 64) had a favorable neurological outcome. The adjusted odds ratio for a favorable neurologic outcome of pre-hospital administered adrenaline under the presence of a physician was 3.94 (95% confidence interval (CI): 1.58-11.4), compared with the absence of a physician. Of 1,598 patients in the shockable group, 10.3% (N = 164) had a favorable neurological outcome with an adjusted odds ratio of 1.30 (95% CI: 0.73-2.35).
Conclusion:
This prospective multi-center cohort study showed that pre-hospital administered adrenaline in the presence of a physician was significantly associated with a higher favorable neurological outcome in non-shockable patients with cardiac arrest.
Abstract only
Purpose:
Using the out-of-hospital cardiac arrest (OHCA) registry in Japan, we evaluated the effectiveness of pre-hospital advanced airway management under physicians’ presence after ...adjusting in-hospital treatments.
Methods:
This was a multicenter cohort study. We registered all consecutive OHCA patients in Japan who, from 1 June 2014 through 31 December 2017, were transported to institutions participating in the Japanese Association for Acute Medicine OHCA Registry. We included OHCA patients performed pre-hospital advanced airway management, who were ≥18 years of age with medical etiology and who received resuscitation from emergency medical services (EMS) personnel and medical professionals in hospitals. The primary outcome was one-month favorable neurological survival.We estimated the propensity score by fitting a logistic regression model that was adjusted for several variables before the arrival of EMS personnel and/ or pre-hospital physician. A multivariable logistic regression analysis in propensity score-matched patients was used to adjust confounders including extracorporeal membrane oxygenation, percutaneous coronary intervention, intra-aortic balloon pumping, and targeted temperature management.
Results:
We analyzed 9,672 patients. Among them, 2.3% (N = 218) had a neurologically favorable outcome. The adjusted odds ratio (AOR) of pre-hospital advanced airway management under physicians’ presence compared with their absence for primary outcome was 0.96 (95% confidence interval (CI): 0.61-1.51). Among first documented non-shockable cardiac rhythm, the AOR was 3.10 (95% CI: 1.05-10.77). Among first documented shockable cardiac rhythm, the AOR was 0.90 (95% CI: 0.53-1.53).
Conclusion:
In Japan, pre-hospital advanced airway management under physicians’ presence was not associated with one-month favorable neurological survival among patients with first documented shockable cardiac rhythm, whereas it was associated with a neurologically favorable outcome among patients with first documented non-shockable cardiac rhythm.
Systemic inflammatory response syndrome (SIRS) reportedly has a low performance for distinguishing infection from non-infection. We explored the distribution of the patients diagnosed by SIRS (SIRS ...patients) or a quick sequential organ failure assessment (qSOFA) (qSOFA patients) and confirmed the performance of the both for predicting ultimate infection after hospital admission. We retrospectively analyzed the data from a multicenter prospective study. When emergency physicians suspected infection, SIRS or the qSOFA were applied. The area under the receiver operating characteristic curves (AUC) was used to assess the performance of the SIRS and qSOFA for predicting established infection. A total of 1,045 patients were eligible for this study. The SIRS patients accounted for 91.6% of qSOFA patients and they showed a higher rate of final infection than that of non-SIRS patients irrespective of the qSOFA diagnosis. The AUCs for predicting infection with SIRS and a qSOFA were 0.647 and 0.582, respectively. The SIRS significantly predicted an ultimate infection (AUC, 0.675; p = 0.018) in patients who met the SIRS and qSOFA simultaneously. In conclusion, the SIRS patients included almost all qSOFA patients. SIRS showed a better performance for predicting infection for qSOFA in those who met both definitions.
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