The postanesthesia care unit (PACU), which is run and coordinated by anesthesiologists, delivers general medical supervision as well as close and constant care to patients who have just undergone a ...surgical procedure under anesthesia. Although PACU management has been considered a standard procedure in many developed countries since the 1940s, Japanese hospitals have tended to cease their management, and only 16.1% of hospitals in Japan currently have PACUs. In today’s efficiency-required atmosphere in Japan, we need to consider a better postoperative management method, including facilities similar to the PACU, to prevent serious adverse events and improve the postoperative outcomes and quality of life. Nevertheless, the way postoperative patients are treated and cared for, and the location in which they receive such attention, will likely need to be modified to fit the Japanese style due to Japan’s unique medical systems and traditions. Here, we describe the past, present and future of the PACU and postanesthesia care in Japan compared with other countries.
The discreteness of cell fates is an inherent and fundamental feature of multicellular organisms. Here we show that cross-antagonistic mechanisms of actions of MyoD and PPARγ, which are the master ...regulators of muscle and adipose differentiation, respectively, confer robustness to the integrity of cell differentiation. Simultaneous expression of MyoD and PPARγ in mesenchymal stem/stromal cells led to the generation of a mixture of multinucleated myotubes and lipid-filled adipocytes. Interestingly, hybrid cells (i.e., lipid-filled myotubes) were not generated, suggesting that these differentiation programs are mutually exclusive. Mechanistically, although exogenously expressed MyoD was rapidly degraded in adipocytes through ubiquitin-proteasome pathways, exogenously expressed PPARγ was not downregulated in myotubes. In PPARγ-expressing myotubes, PPARγ-dependent histone hyperacetylation was inhibited in a subset of adipogenic gene loci, including that of C/EBPα, an essential effector of PPARγ. Thus, the cross-repressive interactions between MyoD- and PPARγ-induced differentiation programs ensure discrete cell-fate decisions.
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•The simultaneous expression of MyoD and PPARγ in MSCs does not generate hybrid cells•MyoD protein is degraded in adipocytes through the ubiquitin proteasome system•In myotubes expressing PPARγ, PPARγ itself is not downregulated•PPARγ-dependent histone hyperacetylation is inhibited in adipogenic gene loci
Sunadome et al. uncover cross-antagonistic mechanisms underlying the actions of MyoD and PPARγ, the master regulators of muscle and adipose differentiation, respectively. Whereas MyoD protein is degraded through the ubiquitin proteasome system in MyoD-expressing adipocytes, PPARγ-dependent histone hyperacetylation is inhibited in adipogenic gene loci in PPARγ-expressing myotubes.
Strong intermolecular electronic coupling and well-ordered molecular arrangements enable efficient transport of both charge carriers and excitons in semiconducting π-conjugated molecular solids. ...Thus, molecular heteroepitaxy to form crystallized donor–acceptor molecular interfaces potentially leads to a novel strategy for creating efficient organic optoelectronic devices via the concomitance of these two requirements. In the present study, the crystallographic and electronic structures of a heteroepitaxial molecular interface, perfluoropentacene (PFP, C22F14) grown on pentacene single crystals (Pn-SCs, C22H14), were determined by means of grazing-incidence X-ray diffraction (GIXD) and angle-resolved ultraviolet photoelectron spectroscopy (ARUPS), respectively. GIXD revealed that PFP uniquely aligned its primary axis along the 11̅0 axis of crystalline pentacene to form well-crystallized overlayers. Valence band dispersion (at least 0.49 eV wide) was successfully resolved by ARUPS. This indicated a significant transfer integral between the frontier molecular orbitals of the nearest-neighbor PFP molecules.
Lead aprons are worn by medical workers to reduce the effects of the radiation doses to which they are exposed during radiography and surgery performed with radioscopic apparatus. Regarding the ...management of such aprons, the Radiation Protection Section of the Japanese Society of Radiological Technology issued the “Guidelines for the Management of Lead Aprons” in 2000, and common management criteria have been set for all institutions. However, we found that the lead aprons used in operating rooms had not been closely inspected before 2014 in our hospital. Thus, we examined the extent of damage of such aprons in our operation room via computed tomography (CT) scout imaging, as well as visual and tactile inspections. Although no abnormality was detected upon visual and tactile inspections, CT images revealed that protective aprons used for 6 years or more had damaged internal radiation shields, thus risking radiation exposure. In response to these results, we fully realized the need to examine the date of the initial use of currently used lead aprons, to routinely perform visual and tactile inspections, and to regularly evaluate the extent of damage to the internal radiation shields via fluoroscopy in cooperation with the radiation management section.
Dorsal scapular nerve (DSN) block is often performed in Japanese pain clinics to treat neck pain and katakori (a unique symptom in Japanese population characterized by myofascial pain syndromes such ...as shoulder girdle pain). However, to the best of our knowledge, there are only a few studies regarding anatomical variations in DSN paths around the middle scalene muscle (MSM) in Japanese population. Thus, we conducted a cadaveric study to examine anatomical variations in DSN paths around the MSM in Japanese population.DSN anatomies of 70 adult Japanese cadavers used for research and gross anatomy practice at the Tokai University School of Medicine between 2015 and 2016 were examined.In all cadavers, DSNs originated from the brachial plexus (BP) and innervated the rhomboid major, rhomboid minor, and levator scapulae muscles via the MSM. Two types of DSN paths were observed: piercing-type (piercing the MSM) and anterior-type (running in front of the MSM). We surveyed all 140 sides in 70 Japanese cadavers; of these, 95 sides had piercing-type and 45 had anterior-type paths. Of the 70 cadavers, 42 had piercing-type and 17 had anterior-type paths on both the sides. In 9 cadavers, the left and right sides had piercing-type and anterior-type paths, respectively. In the other 2 cadavers, the right and left sides had piercing-type and anterior-type paths, respectively.We found 2 distinct anatomical variants for DSN paths around the MSM in this Japanese cohort. Our results suggest that the rate of anterior-type DSN path is higher in Japanese population. Therefore, it is necessary to maintain caution while injecting anesthetic agents during a DSN block and the type of DSN should be considered.
The three-center-four-electron halogen bond (3c4e X-bond) presents a fundamental design concept for catalysis. By integrating halogen(I) (X+: I+ or Br+), the bis-pyridyl ligand NN, and a ...non-nucleophilic counteranion Y, we developed non-metallic complex catalysts, N···X···NYs, that exhibited outstanding activity and facilitated the Mukaiyama-Mannich-type reaction of N-heteroaromatics with parts-per-million-level catalyst loading. The high activity of N···X···NSbF6 was clearly demonstrated. NMR titration experiments, CSI-MS, computations, and UV-vis spectroscopic studies suggest that the robust catalytic activity of N···X···NY can be attributed to the unique ability of the 3c4e X-bond for binding chloride: i) the covalent nature transforms the N···X···N+ complexation to sp2 CH as a hydrogen-bonding donor site, and ii) the noncovalent property allows for the dissociation of N···X···N+ for the formation of Cl···X···Cl−. This study introduces the application of 3c4e X-bonds in catalysis via halogen(I) complexes.
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•Bis-pyridine halogen(I) complexes with 3c4e X-bond act as anion-binding catalysts•Bis-pyridine halogen(I) complexes accelerate nucleophilic pyridine de-aromatization•Bis-pyridine halogen(I) catalysts afford significant yields at ppm-level loading
Chemistry; Organic chemistry
Electron–phonon coupling of the highest occupied molecular orbital (HOMO) state is studied by high-resolution ultraviolet photoelectron spectroscopy (UPS) for pentacene (PEN) and perfluoropentacene ...(PFP) monolayers on graphite. The reorganization energy and related coupling constants associated with the interaction between holes and molecular vibrations are obtained experimentally using a single mode analysis (SMA) of the observed vibronic-satellite intensities of the monolayers. The results are compared with those estimated by multimode analyses of UPS spectra and those derived by means of theoretical approaches, indicating that the purely experimental method with SMA is useful for studying the reorganization energy and the hopping mobility of organic systems. Furthermore, we found that the reorganization energy of PFP is significantly greater than that of PEN, which is ascribed to the extended HOMO distribution of PFP by perfluorination of PEN. The comparison with the results derived from gas-phase UPS measurements is also discussed.
No prospective evaluation of surgical smoke evacuation systems has yet been conducted anywhere in the world. A prospective randomized study was conducted to clarify the usefulness of a surgical smoke ...evacuation system in terms of reducing the quantity of environmental pollutants found in operating room air and reducing the occupational exposure of doctors and nurses involved in surgical procedures to surgical smoke, volatile organic compounds, formaldehyde, etc.
Operating room environment conditions with and without the use of a surgical smoke evacuation system were measured, and the personal exposure levels of doctors and nurses involved in surgical procedures were also surveyed. Use of the evacuation system was determined randomly, and the procedures involved were breast-conserving surgery and mastectomy, which were treated as stratification factors.
The average total volatile organic compound concentration in the operating room was significantly lower when the evacuation system was used compared with when it was not used. The findings were similar for formaldehyde concentration. Multiple regression analysis for healthcare professionals' personal exposure levels showed that the evacuation system was a factor that significantly impacted their formaldehyde and acetaldehyde personal exposure levels, which were greatly reduced by the use of the system.
This study's findings demonstrate the effectiveness of the evacuation systems, which should increase awareness that their benefits take priority over the drawbacks.
The study was conducted after explaining to participants that it was a study of operating room environments in which their participation was voluntary and obtaining their consent. The study was also approved by the Tokai University Hospital clinical research review committee (no. 5R-022) and registered with the UMIN registry (UMIN000029092) on 13, September, 2017- retrospectively registered.
The interfaces formed between pentacene (PEN) and perfluoropentacene (PFP) molecules and Cu(111) were studied using photoelectron spectroscopy, X-ray standing wave (XSW), and scanning tunneling ...microscopy measurements, in conjunction with theoretical modeling. The average carbon bonding distances for PEN and PFP differ strongly, that is, 2.34 Å for PEN versus 2.98 Å for PFP. An adsorption-induced nonplanar conformation of PFP is suggested by XSW (F atoms 0.1 Å above the carbon plane), which causes an intramolecular dipole of ∼0.5 D. These observations explain why the hole injection barriers at both molecule/metal interfaces are comparable (1.10 eV for PEN and 1.35 eV for PFP) whereas the molecular ionization energies differ significantly (5.00 eV for PEN and 5.85 eV for PFP). Our results show that the hypothesis of charge injection barrier tuning at organic/metal interfaces by adjusting the ionization energy of molecules is not always readily applicable.
In this protocol, we describe the application of a halogen(I) complex as a highly active non-metallic complex catalyst. Specifically, we present a detailed guide to synthesize the halogen(I) complex ...catalyst and utilize it as an anion-binding catalyst for the Mukaiyama-Mannich-type reaction of N-heteroaromatics such as pyridines. By utilizing a simple catalyst preparation approach and relatively low catalyst loading, the steps outlined in this protocol contribute to the rapid development of useful substances such as pharmaceuticals and functional materials.
For complete details on the use and execution of this protocol, please refer to Oishi et al. (2022).1
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•Protocol to prepare and synthesize a halogen(I) complex catalyst•Steps to perform Mukaiyama-Mannich-type reaction of N-heteroaromatics such as pyridines•Produces high yields at relatively low (ppm-level) catalyst loading•Applicable to a wide range of silyl ketene acetals
Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.
In this protocol, we describe the application of a halogen(I) complex as a highly active non-metallic complex catalyst. Specifically, we present a detailed guide to synthesize the halogen(I) complex catalyst and utilize it as an anion-binding catalyst for the Mukaiyama-Mannich-type reaction of N-heteroaromatics such as pyridines. By utilizing a simple catalyst preparation approach and relatively low catalyst loading, the steps outlined in this protocol contribute to the rapid development of useful substances such as pharmaceuticals and functional materials.
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