Asymmetric synthesis of (-)-dehydro-exo-brevicomin with a photoisomerisation-intramolecular acetalisation sequence.

We herein report a novel, short asymmetric synthesis of (-)-dehydro-exo-brevicomin (DHB, 1), a sex pheromone isolated from house mice, in 44% overall yield, the highest yield reported so far, over eight steps from trans-3-hexen-1-ol (7). We successfully prepared the target molecule (-)-1 from spontaneous intramolecular acetalisation after the photoisomerisation of trans-enone 6, which generated the corresponding cis-enone 5in situ, the possible biosynthetic precursor of DHB.

Clinical characteristics and outcomes of critically ill patients with COVID-19 in Kobe, Japan: a single-center, retrospective, observational study.

PURPOSE: Coronavirus disease 2019 (COVID-19) has placed a great burden on critical care services worldwide. Data regarding critically ill COVID-19 patients and their demand of critical care services outside of initial COVID-19 epicenters are lacking. This study described clinical characteristics and outcomes of critically ill COVID-19 patients and the capacity of a COVID-19-dedicated intensive care unit (ICU) in Kobe, Japan. METHODS: This retrospective observational study included critically ill COVID-19 patients admitted to a 14-bed COVID-19-dedicated ICU in Kobe between March 3, 2020 and June 21, 2020. Clinical and daily ICU occupancy data were obtained from electrical medical records. The last follow-up day was June 28, 2020. RESULTS: Of 32 patients included, the median hospital follow-up period was 27 (interquartile range 19-50) days. The median age was 68 (57-76) years; 23 (72%) were men and 25 (78%) had at least one comorbidity. Nineteen (59%) patients received invasive mechanical ventilation for a median duration of 14 (8-27) days. Until all patients were discharged from the ICU on June 5, 2020, the median daily ICU occupancy was 50% (36-71%). As of June 28, 2020, six (19%) died during hospitalization. Of 26 (81%) survivors, 23 (72%) were discharged from the hospital and three (9%) remained in the hospital. CONCLUSION: During the first months of the outbreak in Kobe, most critically ill patients were men aged ≥ 60 years with at least one comorbidity and on mechanical ventilation; the ICU capacity was not strained, and the case-fatality rate was 19%.

Ventricular septal rupture with right hypochondrial pain mimicking acute cholecystitis.

A 67-year-old man was admitted for anterior acute ST elevation myocardial infarction (STEMI) management. He developed a severe acute right subcostal pain with normal cardiac tests. On day 5 of hospitalization, cholecystectomy was performed for suspected acute cholecystitis, but the pain intensified with hemodynamical instability. Transthoracic echocardiography revealed ventricular septal rupture (VSR). After emergency operation was performed, the pain diminished with improved hemodynamics. Right subcostal pain associated with heart disease can be referred from STEMI or liver congestion with right heart failure. VSR and right heart failure may be considered as a cause of right subcostal pain of uncertain etiology. .

Incidence of Adverse Events Associated With the In-Hospital Transport of Critically Ill Patients.

IMPORTANCE: Despite various reports on the incidence of adverse events related to the in-hospital transport of critically ill patients, there is little verification of the correlation between the occurrence of adverse events and the use of checklists. The risk factors for the occurrence of adverse events during transport based on the use of checklists have not been well studied. Understanding them can contribute to making patient transport safer. OBJECTIVES: We aimed to investigate the frequency of adverse events and risk factors related to the in-hospital transport of critically ill patients in a hospital that uses a checklist for transporting patients. DESIGN SETTING AND PARTICIPANTS: This single-center, prospective, observational study was conducted between February 1, 2020, and July 31, 2020, at Kobe City Medical Center General Hospital, Japan. Patients greater than or equal to 18 years old who were admitted to the ICU and were transported for examination or procedures were included. MAIN OUTCOMES AND MEASURES: The transport member recorded patient information and any adverse events that occurred and filled out an information collection form. We then applied multivariate analysis to identify risk factors. RESULTS: A total of 117 transports for 117 patients were evaluated in this study. Twenty-two adverse events occurred in 20 transports (17.1%). There were nine transports (7.7%) in which the patients required treatment, all of which were related to patient instability. Multivariate logistic regression analysis showed that the use of sedative drugs was related to adverse events (odds ratio, 2.9; 95% CI, 1.0-8.5; p = 0.04). We were not able to show a relationship of either the severity of the illness or body mass index with the occurrence of adverse events. CONCLUSIONS AND RELEVANCE: This study revealed that the frequency of adverse events related to the in-hospital transportation of critically ill patients based on the use of a checklist was 17.1% and that the use of sedatives was associated with adverse events.

Patient-centered outcomes at hospital discharge in mechanically ventilated COVID-19 patients in Kobe, Japan: A single-center retrospective cohort study.

BACKGROUND: Apart from saving the lives of coronavirus disease (COVID-19) patients on mechanical ventilation (MV), recovery from the sequelae of prolonged MV (PMV) is an emerging issue.c METHODS: We conducted a retrospective study among consecutive adult COVID-19 patients admitted to an intensive care unit (ICU) in Kobe, Japan, between March 3, 2020, and January 31, 2021, and received invasive MV. Clinical outcomes included in-hospital mortality and recovery from COVID-19 in survivors regarding organ dysfunction, respiratory symptoms, and functional status at discharge. We compared survivors' outcomes with MV durations of >14 days and ≤14 days. RESULTS: We included 85 patients with a median age of 69 years (interquartile range, 64-75 years); 76 (89%) patients had at least 1 comorbidity, 72 (85%) were non-frail, and 79 (93%) were functionally independent before COVID-19 infection. Eighteen patients (21%) died during hospitalization. At discharge, 59/67 survivors (88%) no longer required respiratory support, 50 (75%) complained of dyspnea, and 40 (60%) were functionally independent. Of the survivors, 23 patients receiving MV for >14 days had a worse recovery from COVID-19 at discharge compared with those on MV for ≤14 days, as observed using the Barthel index (median: 35 [5-65] vs. 100 [85-100]), ICU mobility scale (8 [5-9] vs. 10 [10-10]), and functional oral intake scale (3 [1-7] vs. 7 [7-7]) (P < 0.0001). CONCLUSION: Although four-fifths of the patients survived and >50% of survivors demonstrated clinically important recovery in organ function and functional status during hospitalization, PMV was related to poor recovery from COVID-19 at discharge.

High-speed and on-chip graphene blackbody emitters for optical communications by remote heat transfer.

High-speed light emitters integrated on silicon chips can enable novel architectures for silicon-based optoelectronics, such as on-chip optical interconnects, and silicon photonics. However, conventional light sources based on compound semiconductors face major challenges for their integration with a silicon-based platform because of their difficulty of direct growth on a silicon substrate. Here we report ultra-high-speed (100-ps response time), highly integrated graphene-based on-silicon-chip blackbody emitters in the near-infrared region including telecommunication wavelength. Their emission responses are strongly affected by the graphene contact with the substrate depending on the number of graphene layers. The ultra-high-speed emission can be understood by remote quantum thermal transport via surface polar phonons of the substrates. We demonstrated real-time optical communications, integrated two-dimensional array emitters, capped emitters operable in air, and the direct coupling of optical fibers to the emitters. These emitters can open new routes to on-Si-chip, small footprint, and high-speed emitters for highly integrated optoelectronics and silicon photonics.

The influence of fascicle behavior on the lack of velocity dependence in eccentric joint torque in humans: in vivo observation.

To investigate the relationship between fascicle behavior and joint torque, the fascicle behavior of the triceps surae during isometric and eccentric (30 and 60 deg/s) plantar flexion by maximal voluntary and submaximal electrical activation (MVA and SEA) was measured by realtime ultrasonography. Eccentric torque at 30 and 60 deg/s was significantly higher than isometric torque under SEA, but not under MVA. However, fascicle length did not significantly differ between isometric and eccentric trials under either condition. Therefore, the difference in developed torque by MVA and SEA cannot be explained by fascicle behavior. Under both MVA and SEA conditions, eccentric torque at 30 and 60 deg/s was equivalent. Similarly, fascicle lengthening velocities at 30 and 60deg/s did not show any significant difference. Such fascicle behavior can be attributed to the influence of tendinous tissue and pennation angle, and lead to a lack of increase in eccentric torque with increasing angular velocity.