The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016)

Background and purposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 and published in the Journal of JSICM, [2017; Volume 24 (supplement 2)] https://doi.org/10.3918/jsicm.24S0001 and Journal of Japanese Association for Acute Medicine [2017; Volume 28, (supplement 1)] http://onlinelibrary.wiley.com/doi/10.1002/jja2.2017.28.issue-S1/issuetoc.This abridged English edition of the J-SSCG 2016 was produced with permission from the Japanese Association of Acute Medicine and the Japanese Society for Intensive Care Medicine.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ) and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two-thirds (> 66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J-SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation, and its supporting evidence were also added to each recommendation statement. We conducted meta-analyses for 29 CQs. Thirty-seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for five CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese-specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non-specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals

Control of endoreduplication of trichome by RPT2a, a subunit of the 19S proteasome in Arabidopsis

The ubiquitin/26S proteasome pathway plays a central role in the degradation of short-lived regulatory proteins to control many cellular events. The Arabidopsis knockout mutant rpt2a, which contains a defect in the AtRPT2a subunit of the 26S proteasome regulatory particle, showed enlarged leaves caused by increased cell size that correlated with increased ploidy caused by extended endoreduplication. To clarify the role of RPT2a in endoreduplication control, trichome development was genetically examined in further detail. RHL1 and GL3 encode proteins that have a role in the positive regulation of endocycle progression in trichomes. The rhl1 mutants are stalled at 8C and have trichomes with only a single branch. The rpt2a mutation did not alter the rhl1 mutant phenotype, and trichomes of double rpt2a rhl1 mutants resembled that of single rhl1 mutants. On the other hand, the rpt2a mutation suppressed the gl3 phenotype (stalled at 16C, two trichome branches), and trichomes of the double rpt2a gl3 mutant resembled that of the WT plants. Together, these data suggest that RPT2a functions to negatively regulate endocycle progression following completion of the third endoreduplication step mediated by RHL1 (8C to 16C)

In Situ Observation of a Self-Assembled Monolayer Formation of Octadecyltrimethoxysilane on a Silicon Oxide Surface Using a High-Speed Atomic Force Microscope

The formation mechanism of a self-assembled monolayer (SAM) of octadecyltrimethoxysilane on a silicon oxide surface in reaction is studied in situ by using a high-speed atomic force microscope that has a time resolution of 2 s per frame. The SAM formation of a silane coupling reagent on silicon is known to comprise three development stages of nucleation, growth, and coalescence. In the present study, the first nucleation stage is found to have dynamical processes: a molecular cluster attached to the substrate works as a reaction base, on which additional reactive molecules are in a bind/unbind equilibrium. In this time period, the cluster needs a long time to develop in diameter. Once a domain of ca. 30 nm in diameter is formed, the reaction rate is changed, which is dominated by the rim length of the domain. This implies that the weakly adsorbing limit approximation on the substrate surface can be employed. Another important point is that the molecular domains generate a SAM like an occupied sheet of tiles, and each tile is connected to the substrate by a few feet. In fact, a molecular tile can easily be removed by applying soft air plasma leaving the rest of the tiles of highly packed molecules, which is confirmed by infrared p-polarized external reflection spectroscopy