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Abstract The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

Background: Hand tremors during surgery requiring precise techniques increase procedure durations and adversely affect outcomes. Most of the currently available devices used to reduce tremors during surgery are large, heavy, and expensive. This study aimed to develop and evaluate an easily movable hand support device to improve surgical outcomes.Methods: We designed and developed a new device comprising a hand support bar and foot switch. The utility of the device was experimentally evaluated by 11 neurosurgeons with a mean experience of 6.7 (range: 0-13) years. A patient model simulating puncture techniques of suture needles in superficial and deep cerebral vessels during brain surgery was created, and the accuracy of targeting puncture sites and the time required for puncture were measured.Results: The use of the newly developed hand support device resulted in a significant improvement in the accuracy of targeting puncture site in both, superficial (p < 0.0001) and deep (p = 0.0041) surgery conditions and reduced the time required to puncture both, superficial (p=0.0006) and deep (p=0.0527) targets compared to non-use of the hand support device.Conclusion: The newly developed hand support device has the potential to improve microsurgery outcomes by stabilizing hand tremors and reducing procedure duration.

Objective: To describe the detailed clinical course of patients with coronavirus disease 2019 (COVID-19) who received invasive mechanical ventilation. Methods: We conducted a case series of patients with COVID-19 who received invasive mechanical ventilation in Osaka, Japan, between January 29 and May 28, 2020. We describe the patient characteristics and clinical course from onset. Additionally, we fitted logistic regression models to investigate the associations between patient characteristics and the 30-day mortality rate. Results: A total of 125 patients who received invasive mechanical ventilation (median age [interquartile range], 68 [57–73] years; male, 77.6%) were enrolled. Overall, the 30-day mortality was 24.0%, and the median (interquartile range) length of ICU stay and length of invasive mechanical ventilation use were 16 (12–29) days and 13 (9–26) days, respectively. From clinical onset, 121 patients (96.8%) were intubated within 14 days. In multivariable logistic regression analysis, age of 65 years or older (odds ratio, 3.56; 95% confidence interval, 1.21–10.49; P = 0.02) and male sex (odds ratio, 3.75; 95% confidence interval, 1.00–11.24, P = 0.04) were significantly associated with a higher 30-day mortality rate. Conclusions: In this case series of patients with COVID-19 who received invasive mechanical ventilation in Japan, the 30-day mortality rate was 24.0%, and age 65 years or older and male sex were associated with higher 30-day mortality rate.

The combinatory use of high-intensity focused ultrasound (HIFU) and epirubicin (EPI)-conjugated polymeric micellar nanoparticles (NC-6300) is thought to be a less invasive and more efficient method of cancer therapy. To investigate the mechanism underlying the combination effect, we examined the effect of trigger-pulsed HIFU (TP-HIFU) and NC-6300 from the perspective of reactive oxygen species (ROS) generation, which is considered the primary function of sonodynamic therapy (SDT), and changes in drug characteristics. TP-HIFU is an effective sequence for generating hydroxyl radicals to kill cancer cells. EPI was susceptible to degradation by TP-HIFU through the production of hydroxyl radicals. In contrast, EPI degradation of NC-6300 was suppressed by the hydrophilic shell of the micelles. NC-6300 also exhibited a sonosensitizer function, which promoted the generation of superoxide anions by TP-HIFU irradiation. The amount of ROS produced by TP-HIFU reached a level that caused structural changes to the cellular membrane. In conclusion, drug-conjugated micellar nanoparticles are more desirable for SDT because of accelerated ROS production and drug protection from ROS. Furthermore, a combination of NC-6300 and TP-HIFU is useful for minimally invasive cancer therapy with cooperative effects of HIFU-derived features, antitumor activity of EPI, and increased ROS generation to cause damage to cancer cells.

Sonodynamic therapy (SDT) is a minimally invasive anticancer therapy involving a chemical sonosensitizer and high-intensity focused ultrasound (HIFU). SDT enables the reduction of drug dose and HIFU irradiation power compared to those of conventional monotherapies. In our previous study, mouse models of colon and pancreatic cancer were used to confirm the effectiveness of SDT vs. drug-only or HIFU-only therapy. To validate its usefulness, we performed a clinical trial of SDT using an anticancer micelle (NC-6300) and our HIFU system in four pet dogs with spontaneous tumors, including chondrosarcoma, osteosarcoma, hepatocellular cancer, and prostate cancer. The fact that no adverse events were observed, suggests the usefulness of SDT.

We have been developing the Orthopaedic physical examination assisting system using magnetic position tracker to quantitate knee laxity diagnosis. In this study, to investigate the influence of anatomical landmark sampling error for bone coordinate registration, reproducibility verification simulation was done. Firstly, the motion data of imitation bones was acquired using the system and set as a reference data. To get the error motion data, virtual error vectors were added on the reference sampling points and new motion data was recomputed. Evaluation was executed by comparison with the reference data and recomputed data. The evaluation results lead improvement methods of measurement reproducibility as follows. 1. It is important to point the landmarks proximal to the knee carefully because the contribution of the motion error is higher than the distal landmarks. 2. To reduce the registration error, thigh and shank receivers should be set close to the knee as possible. 3. If the allowance area of the sampling error is in 2.0 mm diameter circle, Diagnosis error using IKDC Knee examination form is approximately 20 %.

In this study, to improve accuracy and reproducibility of knee laxity diagnosis, Orthopaedic physical examination assisting system was developed. The system enables the surgeon to monitor the force vector added by himself and the posture of the knee in real-time. The advantage of the developed system is to quantify the normal orthopaedic physical examination, without any modification, which is accustomed to general orthopaedic surgeons. The force vector added to the shank by a surgeon is measured with 3 axis force sensor and 6DOF magnetic tracker FASTRAK, and 6DOF knee joint motion of the patient is measured with two FASTRAK receivers which are attached on its thigh and shank. In this system, to describe the 6DOF knee motion, Femoral and tibial coordinate systems are defined with bony landmark which is easily palpated and are registered to the thigh or shank receiver coordinate system by homogeneous transformation matrix which is acquired by the special stylus. To evaluate the effectiveness of the system, the posterior drawer test with the system was done by 5 young healthy people. The evaluation parameters were knee posture, load magnitude and load position during the experiment. The result showed examination accuracy was significantly improved in all evaluation parameters.

Large-scale communication-infrastructure failures have a tremendous impact on daily life and economic activities, requiring more resilient networks. We at NTT laboratories aim to achieve robust networks that minimize service impact by improving network adaptability to system failures and shorten recovery time by improving network resilience. This article describes our research and development efforts in operation-related technologies to achieve robust networks. [ABSTRACT FROM AUTHOR]