Changes in long-term care insurance revenue among service providers during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has impacted peoples' health-related behaviors, especially those of older adults, who have restricted their activities in order to avoid contact with others. Moreover, the pandemic has caused concerns in long-term care insurance (LTCI) providers regarding management and financial issues. This study aimed to examine the changes in revenues among LTCI service providers in Japan during the pandemic and analyze its impact on different types of services. METHODS: In this study, we used anonymized data from "Kaipoke," a management support platform for older adult care operators provided by SMS Co., Ltd. Kaipoke provides management support services to more than 27,400 care service offices nationwide and has been introduced in many home-care support offices. The data used in this study were extracted from care plans created by care managers on the Kaipoke platform. To examine the impact of the pandemic, an interrupted time-series analysis was conducted in which the date of the beginning of the pandemic was set as the prior independent variable. RESULTS: The participating providers were care management providers (n = 5,767), home-visit care providers (n = 3,506), home-visit nursing providers (n = 971), and adult day care providers (n = 4,650). The results revealed that LTCI revenues decreased significantly for care management providers, home-visit nursing providers, and adult day care providers after the COVID-19 pandemic began. The largest decrease was an average base of USD - 1668.8 in adult day care. CONCLUSION: The decrease in revenue among adult day care providers was particularly concerning in terms of the sustainability of their business. This decrease in revenue may have made it difficult to retain personnel, and staff may have needed to be laid off as a result. Although this study has limitations, it may provide useful suggestions for countermeasures in such scenarios, in addition to support conducted measures.

Continuous-Flow Enantioselective Hydroacylations under Heterogeneous Chiral Rhodium Catalysts.

Transition metal-catalyzed enantioselective C-H bond functionalizations have become efficient methods for the synthesis of complex optically active molecules. Heterogeneous catalysts for this chemistry remain largely unexplored despite the advantages they offer in terms of ease of separation and reuse of catalysts. Herein, we report the development of heterogeneous chiral Rh catalysts for continuous-flow enantioselective hydroacylations. Heterogeneous catalysts could be prepared simply by mixing supports and Rh complexes. The prepared catalysts exhibited excellent activity and enantioselectivity affording optically active ketones in quantitative yields with 99 % ee's. Under the optimized reaction conditions, a turnover number >300 was achieved without the leaching of Rh species. The catalysts exhibited a wide substrate scope and in sequential-flow reactions with other heterogeneous catalysts, the syntheses of biologically active molecules and functional materials were demonstrated.

Photoinduced Efficient Catalytic α-Alkylation Reactions of Active Methylene and Methine Compounds with Nonactivated Alkenes.

In catalytic α-alkylation reactions of carbonyl compounds, although SN2-type substitution reactions of enolates with alkyl halides are a conventional methodology, addition reactions with alkenes are more desirable because of their atom-economical character; however, reactions with nonactivated alkenes are challenging. Here, we developed highly efficient catalytic α-alkylation reactions of active methylene and methine compounds with nonactivated alkenes such as 1-decene using an organophotocatalyst and lithium thiophenoxide as a Lewis acid/Brønsted base/hydrogen atom transfer (HAT) multifunctional catalyst under blue-light irradiation. The reaction was also performed with a higher degree of efficiency under a continuous-flow system to obtain the products in multigram scales. The present reaction system enables highly efficient and practical α-alkylation reactions of active methylene and methine compounds to be achieved.

Heterogeneous Single-Atom Zinc on Nitrogen-Doped Carbon Catalyzed Electrochemical Allylation of Imines.

Organometallic reagents are effective for carbon-carbon bond formation; however, consumption of stoichiometric amounts of metals is problematic. We developed electrochemical allylation reactions of imines catalyzed by nitrogen-doped carbon-supported single-atom zinc, which were fixed on a cathode to afford a range of homoallylic amines efficiently. The system could suppress generation of metallic waste, and the catalyst electrode showed advantages over bulk zinc in terms of activity and robustness. An electrochemical flow reaction was also successfully performed to produce the homoallylic amine continuously with minimum amounts of waste.

Aluminium-catalysed synthesis of aryl enol ethers from phenols and dimethyl ketals.

We report an environmentally friendly, aluminium-catalysed, halide- and transition metal-free method for the synthesis of aryl enol ethers from phenols and dimethyl ketals that involves ketal exchange driven by the removal of methanol. The obtained aryl enol ethers were transformed into the corresponding diaryl ethers by Pd/C-catalysed dehydrogenation or DDQ oxidation.

Highly enantioselective hydroxymethylation of unmodified α-substituted aryl ketones in water.

Catalytic asymmetric direct-type aldol reactions of ketones with aldehydes are a perennial puzzle for organic chemists. Notwithstanding the emergence of a myriad of chiral catalysts to address the inherent reversibility of the aldol products, a general method to access acyclic α-chiral ketones from prochiral aryl ketones has remained an unmet synthetic challenge. The approach outlined herein is fundamentally different to that used in conventional catalysis, which typically commences with an α-proton abstraction by a Brønsted base. The use of a chiral 2,2'-bipyridine scandium complex enabled the hydroxymethylation of propiophenone to be run under base-free conditions, which avails effectual suppression of hydrolytic deactivation of the Lewis acid catalyst. Intriguingly, the use of water as a reaction medium had an overriding effect on the progress of the reaction. The sagacious selection of sodium dodecyl sulfate and lithium dodecyl sulfate as surfactants allowed a variety of propiophenone derivatives to react in a highly enantioselective manner.

The Stat3 inhibitor F0648-0027 is a potential therapeutic against rheumatoid arthritis.

Rheumatoid arthritis (RA) is a disease characterized by chronic joint inflammation, pain and joint destruction, leading to alteration in activities of daily living, yet pathological mechanisms underlying the condition are not fully clarified. To date, various therapeutic agents have been developed as RA therapy including DMARDs and/or biological agents that target inflammatory cytokines or inhibit JAK. Here we asked whether inhibiting signal transducer and activator of transcription 3 (Stat3) activity would antagonize RA. Stat3 forms dimers when activated and undergoes nuclear translocalization; thus we screened approximately 4.9 million small compounds as potential blockers of protein-protein interactions required for Stat3 dimerization using in silico screening. We identified 15 as strong candidates as potential blockers of protein-protein interactions required for Stat3 dimerization using in silico screening from those compounds. Four of the 15 significantly inhibited expression of IL-6 and RANKL, both of which are direct targets of Stat3, induced by IL-6. Among four, one compound, F0648-0027, significantly inhibited arthritis development without apparent adverse effects in vivo in collagen-induced arthritis model mice. F0648-0027 also significantly blocked Stat3 phosphorylation and nuclear localization following IL-6 stimulation of fibroblasts. These data suggest that Stat3 is a target for collagen-induced arthritis in mice, and that F0648-0027 could serve as a therapeutic reagent against comparable conditions in humans.

Nitrogen-Doped Carbon-Incarcerated Zinc Electrodes as Heterogeneous Catalysts for Electrochemical Allylation of Carbonyl Compounds.

Electrochemical allylation reactions of carbonyl compounds using cathodes prepared from nitrogen-doped carbon (NDC)-incarcerated zinc catalysts have been developed. A range of aldehydes and ketones afforded the desired allylic alcohols in high yields with <10 mol % zinc leaching, and the heterogeneous nature of the active species was suggested. Compared with bulk zinc electrodes, NDC-stabilized zinc nanoparticle species were compatible with a broader range of heteroaromatic substrates and enabled the use of an undivided cell.

Development of Metal-Free, Trifluoromethanesulfonic Acid-Immobilized Nitrogen-Doped Carbon Catalysts for Povarov Reactions.

A metal-free, heterogeneous acid catalyst, trifluoromethanesulfonic acid-immobilized nitrogen-doped carbon catalyst, was developed for Povarov reactions. This catalyst exhibited excellent catalytic activity, achieving high turnover frequency (>400 h-1) and good cis-selectivity of the desired 1,2,3,4-tetrahydroquinoline products. The reaction had a broad substrate scope, and the multicomponent Povarov reaction proceeded smoothly with readily accessible aldehydes and anilines. The heterogeneity and reusability of this catalytic system were confirmed. The catalyst was characterized by spectroscopic and microscopic analysis studies.

Effect of Activation Methods of Molecular Sieves on Ketimine Synthesis.

Although the use of molecular sieves for imine synthesis is a common protocol, there have been no comprehensive studies on heat-drying methods. This can be crucial for reproducibility. It was found that molecular sieve 5A dried at 160 °C for 5 h under vacuum efficiently promoted the condensation of various ketones and amines to afford even relatively bulky ketimines. Several control experiments and analyses revealed that only a small amount of Brønsted acid sites was important for the activity, rather than dehydration ability. Other types of molecular sieves could be utilized for the reaction after treatment with water followed by heat drying. A continuous-flow acetalization reaction of alcohols using the activated molecular sieve 5A was also demonstrated.

Biomechanical features of drop vertical jump are different among various sporting activities.

BACKGROUND: Risk for non-contact anterior cruciate ligament (ACL) injury can be assessed based on drop vertical jump (DVJ). However, biomechanics of DVJ may differ with various sporting activities. The purpose of the present study was to clarify whether biomechanical features of DVJ are different among various sporting activities in female athletes. METHODS: A total of 42 female athletes, including 25 basketball, 8 soccer and 9 volleyball players, participated in the current investigation. DVJ was done for each female athlete using a three-dimensional motion analysis system which consisted of six cameras, two force plates and 46 retro-reflective markers. Kinematic and kinetic data were recorded for both limbs in each athlete. Simultaneously, frontal and sagittal plane views of the DVJ were recorded using two different high-resolution video cameras to evaluate Landing Error Scoring System (LESS) score. Three-dimensional biomechanical parameters at the knee joint and LESS were compared among three different sporting activities using ANOVA or Kruskal-Wallis test after confirming normality assumption. Thereafter post hoc Tukey or Steel-Dwass was utilized for multiple comparison. RESULTS: Soccer players had better LESS score, and peak knee flexion angle was significantly larger in soccer players compared to the other sports. In addition, knee abduction angle at initial contact (IC), peak knee abduction angle, knee internal rotation angle, and knee abduction moment within 40 ms from IC were significantly smaller in soccer players, compared to basketball players. In terms of volleyball players, knee abduction angle at IC and knee internal rotation angle at IC were significantly larger than soccer players, whereas no significant biomechanical differences were found between basketball and volleyball players. CONCLUSIONS: From the present study, female basketball and volleyball players have worse LESS score, smaller peak knee flexion angle, greater knee abduction angle at IC and greater knee internal rotation angle at IC, compared to female soccer players. Thus, female basketball and volleyball players may have an increased risk of non-contact ACL injury during the jump-landing task, compared to soccer players. Biomechanics of DVJ depends on characteristics of the athlete's primary sport.

Chlamydial Infection-Dependent Synthesis of Sphingomyelin as a Novel Anti-Chlamydial Target of Ceramide Mimetic Compounds.

The obligate intracellular bacterium Chlamydia trachomatis is the major causative agent of bacterial sexually transmitted diseases worldwide. In infected cells, the ceramide transport protein (CERT) is recruited to inclusions, where C. trachomatis replicates using host-synthesized ceramide. The ceramide is converted to sphingomyelin (SM) by a chlamydial infection-dependent SM synthesis (cidSM-synthesis) pathway, which occurs even in the absence of the SM synthases (SMS)-1 and -2 of host cells. The ceramide mimetic compound (1R,3S)-HPA-12 and the nonmimetic compound E16A, both of which are potent inhibitors of CERT, repressed the proliferation of C. trachomatis in HeLa cells. Unexpectedly, (1R,3R)-HPA-12, a ceramide mimetic compound that lacks CERT inhibitory activity, also exhibited potent anti-chlamydial activity. Using endogenous SMS-knockout mutant HeLa cells, we revealed that (1R,3R)-HPA-12 mildly inhibited cidSM-synthesis. In addition, LC-MS analysis revealed that (1R,3R)-HPA-12 is converted to a phosphocholine-conjugated metabolite in an infection-dependent manner. Imaging analysis with a fluorescent analog of ceramide suggested that cidSM-synthesis occurs in the bacterial bodies and/or inclusions. Collectively, these results suggested that (1R,3R)-HPA-12 exerts its anti-chlamydia activity not only as an inhibitor of cidSM-synthesis, but also via putative toxic effects of its phosphocholine adduct, which is most likely produced by the cidSM-synthesis route.

[Two Cases of Emphysematous Pyelonephritis Successfully Treated by Transurethral Catheterization].

Emphysematous pyelonephritis (EPN) is a severe necrotic urinary tract infection accompanied by retention of gas in the kidney and areas around it. Formerly, emergency nephrectomy was the primary treatment, but the trend is shifting to treatment with maximum conservation of the kidney. In this report, two cases of EPN successfully treated by transurethral drainage are presented. The first case was in a 63-year-old woman with a history of poorly controlled diabetes. She arrived at the hospital by ambulance with primary symptoms of vomiting and trembling of the hands, and computed tomography (CT) revealed gas in the right renal calix. The second case was in a 61-year-old woman who arrived by ambulance with difficulty of body movement as the primary symptom, and CT revealed a calculus in the right ureter accompanied by right hydronephrosis and retention of gas in the right renal pelvis and right upper ureter. Both patients were diagnosed with EPN and treated by transurethral drainage rather than percutaneous drainage or nephrectomy because of their poor general condition. The treatment was successful. Along with percutaneous drainage, transurethral drainage is considered to be an option of surgical treatment for EPN.

Reaction Rate Acceleration of Cooperative Catalytic Systems: Metal Nanoparticles and Lewis Acids in Arene Hydrogenation.

Employing two distinct catalysts in one reaction medium synergistically is a powerful strategy for activating less reactive substrates. Although the approach has been well-developed in homogeneous conditions, it remains challenging and rare in heterogeneous catalysis, especially under gas-liquid-solid multiphase reaction conditions. Here, we describe the development of cooperative and synergistic catalyst systems of heterogeneous Rh-Pt bimetallic nanoparticle catalysts, Rh-Pt/DMPSi-Al2 O3 , and Sc(OTf)3 in the liquid phase for the hydrogenation of arenes under very mild conditions. Dramatic rate acceleration was achieved with cooperative activation. Remarkably, more challenging substrates that contained strong electron-donating groups and sterically hindered substituents were smoothly hydrogenated. Mechanistic insights into the cooperative activation of an aromatic substrate by heterogeneous metal nanoparticles and a soluble Lewis acid was obtained by kinetic studies and by direct observation of 1 H and 45 Sc NMR spectra.

Continuous-Flow Synthesis of (R)-Tamsulosin Utilizing Sequential Heterogeneous Catalysis.

We describe the continuous-flow synthesis of (R)-tamsulosin, a blockbuster therapeutic drug employed for dysuria associated with urinary stones and benign prostatic hyperplasia, by utilizing sequential heterogeneous catalysis. Two heterogeneous catalysts have been developed for the synthesis, and the key step involves reductive amination of nitriles using dimethylpolysilane-modified Pd on activated carbon/calcium phosphate. Overall, (R)-tamsulosin was obtained in 60 % yield and 64 % ee (99 % ee after recrystallization) in a flow stream through four catalytic transformations without the need for the isolation or purification of any intermediates or byproduct.

Efficient Recycling of Catalyst-Solvent Couples from Lewis Acid-Catalyzed Asymmetric Reactions in Water.

Bioinspired supramolecular architectures were used to compartmentalize highly charged aqua scandium ions into chiral hydrophobic scaffolds for Lewis acid-catalyzed asymmetric reactions. Recycling without significant loss in catalytic performance is a formidable task, especially for Lewis acid-catalyzed reactions. This is because Lewis basic impurities derived from starting materials, products, and water are highly competitive ligands for both substrate binding and metal complexation, thus poisoning the Lewis acids and leading to their leaching. Even when basic aniline is used, the architecture allowed for effective suppression of Sc3+ leaching and for reuse of solvent-catalyst couples in asymmetric ring-opening reactions without deactivation. Application to asymmetric thia-Michael addition and hydroxymethylation was also demonstrated. The successful recycling in highly Lewis basic environments underpins the exceptionally high robustness of the chiral Lewis acid catalyst.

Chiral Metal Salts as Ligands for Catalytic Asymmetric Mannich Reactions with Simple Amides.

Catalytic asymmetric Mannich reactions of imines with weakly acidic simple amides were developed using a chiral potassium hexamethyldisilazide (KHMDS)-bis(oxazoline) potassium salt (K-Box) catalyst system. The desired reactions proceeded to afford the target compounds in high yields with high diastereo- and enantioselectivities. It was suggested that a K enolate interacted with K-Box to form a chiral K enolate that reacted with imines efficiently. In this system, K-Box (potassium salt of Box) worked as a chiral ligand of the active potassium species.

Synoviolin is not a pathogenic factor for auto-inflammatory diseases.

Auto-inflammatory syndromes are rare diseases characterized by arthritis and joint destruction, symptoms similar to but distinct from rheumatoid arthritis (RA). Therapeutic targets have not been well characterized for auto-inflammatory syndromes, although the E3 ligase Synoviolin was previously shown to be a novel therapeutic target for RA. Here, we show that Synoviolin loss has little impact on a model of auto-inflammatory diseases. We previously established such a model, the hIL-1 cTg mouse, in which IL-1 signaling was constitutively activated, and animals exhibit symptoms recapitulating auto-inflammatory syndromes such as major joint dominant arthritis. Here, we crossed hIL-1 cTg with Synoviolin flox'd mice to yield hIL-1 cTg/Synoviolin cKO mice. Synoviolin gene expression was ablated in adult hIL-1 cTg/Synoviolin cKO mice by injection of pIpC to activate Mx1 promoter-driven Cre recombinase. However, symptoms seen in hIL-1 cTg mice such as arthritis and joint destruction were not alleviated by targeting Synoviolin, ruling out Synoviolin as a therapeutic target for auto-inflammatory disease. Our results indicate that although similar, RA and auto-inflammatory diseases are different diseases, and treatment strategies should differ accordingly.

Chiral Rhodium Nanoparticle-Catalyzed Asymmetric Arylation Reactions.

The development of heterogeneous catalyst systems for enantioselective reactions is an important subject in modern chemistry as they can be easily separated from products and potentially reused; this is particularly favorable in achieving a more sustainable society. Whereas numerous homogeneous chiral small molecule catalysts have been developed to date, there are only limited examples of heterogeneous ones that maintain high activity and have a long lifetime. On the other hand, metal nanoparticle catalysts have attracted much attention in organic chemistry due to their robustness and ease of deposition on solid supports. Given these advantages, metal nanoparticles modified with chiral ligands, defined as "chiral metal nanoparticles", would work efficiently in asymmetric catalysis. Although asymmetric hydrogenation catalyzed by chiral metal nanoparticles was pioneered in the late twentieth century, the application of chiral metal nanoparticle catalysis for asymmetric C-C bond-forming reactions that give a high level of enantioselectivity with wide substrate scope was very limited.This Account summarizes recent investigations that we have carried out in the field of chiral rhodium (Rh) nanoparticle catalysis for asymmetric arylation reactions. We initially utilized composites of polystyrene-based copolymers with cross-linking moieties and carbon black incarcerated Rh nanoparticle catalysts for the asymmetric 1,4-addition of arylboronic acids to enones. We found that chiral diene-modified heterogeneous Rh nanoparticles were effective in these reactions, with excellent enantioselectivities and without causing metal leaching, and that bimetallic Rh/Ag nanoparticle catalysts enhanced activity. The catalyst could be easily recovered and reused more than ten times, thus demonstrating the robustness of metal nanoparticle catalysts.We then developed a secondary amide-substituted chiral diene modifier designed as a bifunctional ligand that possesses a metal biding site and a NH group to activate a substrate through hydrogen bonding. This chiral diene was very effective for the Rh/Ag nanoparticle-catalyzed asymmetric arylation of various electron-deficient olefins, including enones, unsaturated esters, unsaturated amides and nitroolefins, and imines to afford the corresponding products in excellent yields and with outstanding enantioselectivities. The system was also applicable for the synthesis of intermediates of various useful compounds. Furthermore, the compatibility of chiral Rh nanoparticles with other catalysts was confirmed, enabling the development of tandem reaction systems and cooperative catalyst systems.The nature of the active species was investigated. Several characteristic features of the heterogeneous nanoparticle systems that were completely different from those of the corresponding homogeneous metal complex systems were found.

Stereoretentive N-Arylation of Amino Acid Esters with Cyclohexanones Utilizing a Continuous-Flow System.

The N-arylation of chiral amino acid esters with minimal racemization is a challenging transformation because of the sensitivity of the α-stereocenter. A versatile synthetic method was developed to prepare N-arylated amino acid esters using cyclohexanones as aryl sources under continuous-flow conditions. The designed flow system, which consists of a coil reactor and a packed-bed reactor containing a Pd(OH)2 /C catalyst, efficiently afforded the desired N-arylated amino acids without significant racemization, accompanied by only small amounts of easily removable co-products (i. e., H2 O and alkanes). The efficiency and robustness of this method allowed for the continuous synthesis of the desired product in very high yield and enantiopurity with high space-time yield (74.1 g L-1 h-1 ) and turnover frequency (5.9 h-1 ) for at least 3 days.