Ring-Over-Ring Deslipping From Imine-Bridged Heterorotaxanes.

Ring-over-ring slippage and ring-through-ring penetration are important processes in the construction of ring-in-ring multiple interlocked architectures. We have successfully observed "ring-over-ring deslipping" on the rotaxane axle by exploiting the dynamic covalent nature of imine bonds in imine-bridged heterorotaxanes R1 and R2 with two macrocycles of different ring sizes on the axle. When the imine bridges of R1 were cleaved, a hydrolyzed hetero[4]rotaxane [4]R1' was formed as an intermediate under dynamic equilibrium, and the larger 38-membered macrocycle M was deslipped over the 24-membered ring (24C8 or DB24C8) to dissociate into a [3]rotaxane [3]R3 and a macrocycle M. The time dependent NMR measurement and the determined thermodynamic parameters revealed that the rate-limiting step of the deslipping process was attributed to steric hindrance between two rings and reduced mobility of M due to proximity to the crown ether, which was bound to the anilinium on the axle molecule.

Simple and Easily Interpretable Flap Monitoring Method Using a Commercial Pulse Oximeter and a Widely Used Bedside Patient Monitor.

Background  Various methods for monitoring after free flap surgery have been reported in the literature. Among them, pulse oximetry shows a sensitive reaction to vascular issues, and it is easy to interpret visually. However, previous reports used special equipment that was less commonly used and difficult to generalize. In this study, we used a commercial pulse oximeter and a widely used bedside patient monitor to monitor transplanted free tissue and lower extremities of healthy subjects with impaired circulation. Methods  A reflectance pulse oximeter sensor was attached on the flap after free tissue transplantation. The sensor was connected to a bedside patient monitor, and the flap oxygen saturation (SpO2) levels and arterial waveforms were continuously monitored. Additionally, blood circulation disorder was induced in the lower limbs of healthy volunteers using pressure cuff inflation on the thigh, and the waveform and SpO2 levels on the pulse oximeter attached to the lower leg were monitored. Results  Twenty-two patients were included in this study. No postoperative vascular issues were observed in any case. Pulse oximeters showed normal rhythmic wavelengths, and the flap SpO2 level ranged approximately >90%. The pulse oximeter waveform rapidly disappeared during arterial occlusion in the thigh pressure cuff inflation test, and the waveform flattened and the SpO2 level decreased slightly during venous congestion. Conclusion  Flap monitoring using a commercially available pulse oximeter and a bedside patient monitor is a versatile, easy-to-interpret, and useful method. Changes in waveform and SpO2 levels appear during arterial and venous circulation disorders, and these changes can be differentiated.

Development of a Tool for Hospital Nurses' Fatigue Self-Management That Can Be Used for Organizational Management.

The purpose of this research is to develop a tool for fatigue self-management for hospital nurses. It is based on a nursing fatigue management education program that we have developed by utilizing the airline industry's Fatigue Risk Management System (FRMS). More specifically, this research aims to develop a tool to check fatigue and sleep conditions, deepen the knowledge about fatigue management, devise a measure to avoid the risk of fatigue, and continuously conduct evaluation.

Asymptomatic bilateral delayed ureteral obstruction following dextranomer/hyaluronic acid copolymer (Deflux) injection for vesicoureteral reflux.: A case report.

We here present a case of a 4-year-old girl who exhibited an asymptomatic bilateral de novo hydroureteronephrosis seven months after undergoing endoscopic treatment for bilateral vesicoureteral reflux. The child underwent an open bilateral reimplantation. Intraoperatively, a 14 mm nodule on the right and a 16 mm on the left located periureteral orifice were observed. When a small incision was made on nodules, a yellowish-white mucinous fluid flowed out.

Virilization of a female infant genitalia caused by a maternal androgen-producing adrenocortical tumor: A case report.

A 4-month-old girl presented us with genital ambiguity. The patient had a persistent urogenital sinus, posterior labial fusion with clitoromegaly. MRI reveals ovary-like mass in left inguinal region and right abdominal cavity. Uterus and vagina was also identified. Her mother was diagnosed with a right androgen-producing adrenocortical tumor 14 months after the birth of a virilized infant.

Free Tube Graft Urethroplasty for Repair of Hypospadias.

INTRODUCTION: We aimed to assess the outcome of free tube graft urethroplasty for single-stage repair of hypospadias with chordee in children. MATERIALS AND METHODS: We retrospectively evaluated a series of 56 patients (16 months to 9 years old, median 24 months) who underwent free graft urethroplasty for repair of hypospadias with chordee between May 2005 and November 2017. The median follow-up was 7 years (range 1-11). RESULTS: After releasing the chordee, the hypospadiac orifice was retracted to become penile in 32 patients (57%), penoscrotal in 18 patients (32%), and scrotal in 6 patients (11%). Single-stage repair was achieved without complications in 42 patients (75%). Of the remaining 14 patients with postoperative complications requiring surgical intervention, 2 had meatal stenosis, 9 had urethrocutaneous fistula, 1 had urethral diverticulum without meatal stenosis, and 1 had meatal regression. One patient who complained the urine stream went upwards in an arc underwent cutback meatoplasty to correct the stream. In all patients, a neomeatus with a vertically oriented slit-like appearance was eventually achieved at the tip of the glans. CONCLUSION: A free graft is an appropriate choice for repairing hypospadias with chordee. Our procedure achieved favorable functional and cosmetic outcomes with a low postoperative morbidity rate.