The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020)

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.other authors: Satoru Hashimoto,Daisuke Hasegawa,Junji Hatakeyama,Naoki Hara,Naoki Higashibeppu,Nana Furushima,Hirotaka Furusono,Yujiro Matsuishi,Tasuku Matsuyama,Yusuke Minematsu,Ryoichi Miyashita,Yuji Miyatake,Megumi Moriyasu,Toru Yamada,Hiroyuki Yamada,Ryo Yamamoto,Takeshi Yoshida,Yuhei Yoshida,Jumpei Yoshimura,Ryuichi Yotsumoto,Hiroshi Yonekura,Takeshi Wada,Eizo Watanabe,Makoto Aoki,Hideki Asai,Takakuni Abe,Yutaka Igarashi,Naoya Iguchi,Masami Ishikawa,Go Ishimaru,Shutaro Isokawa,Ryuta Itakura,Hisashi Imahase,Haruki Imura,Takashi Irinoda,Kenji Uehara,Noritaka Ushio,Takeshi Umegaki,Yuko Egawa,Yuki Enomoto,Kohei Ota,Yoshifumi Ohchi,Takanori Ohno,Hiroyuki Ohbe,Kazuyuki Oka,Nobunaga Okada,Yohei Okada,Hiromu Okano,Jun Okamoto,Hiroshi Okuda,Takayuki Ogura,Yu Onodera,Yuhta Oyama,Motoshi Kainuma,Eisuke Kako,Masahiro Kashiura,Hiromi Kato,Akihiro Kanaya,Tadashi Kaneko,Keita Kanehata,Ken-ichi Kano,Hiroyuki Kawano,Kazuya Kikutani,Hitoshi Kikuchi,Takahiro Kido,Sho Kimura,Hiroyuki Koami,Daisuke Kobashi,Iwao Saiki,Masahito Sakai,Ayaka Sakamoto,Tetsuya Sato,Yasuhiro Shiga,Manabu Shimoto,Shinya Shimoyama,Tomohisa Shoko,Yoh Sugawara,Atsunori Sugita,Satoshi Suzuki,Yuji Suzuki,Tomohiro Suhara,Kenji Sonota,Shuhei Takauji,Kohei Takashima,Sho Takahashi,Yoko Takahashi,Jun Takeshita,Yuuki Tanaka,Akihito Tampo,Taichiro Tsunoyama,Kenichi Tetsuhara,Kentaro Tokunaga,Yoshihiro Tomioka,Kentaro Tomita,Naoki Tominaga,Mitsunobu Toyosaki,Yukitoshi Toyoda,Hiromichi Naito,Isao Nagata,Tadashi Nagato,Yoshimi Nakamura,Yuki Nakamori,Isao Nahara,Hiromu Naraba,Chihiro Narita,Norihiro Nishioka,Tomoya Nishimura,Kei Nishiyama,Tomohisa Nomura,Taiki Haga,Yoshihiro Hagiwara,Katsuhiko Hashimoto,Takeshi Hatachi,Toshiaki Hamasaki,Takuya Hayashi,Minoru Hayashi,Atsuki Hayamizu,Go Haraguchi,Yohei Hirano,Ryo Fujii,Motoki Fujita,Naoyuki Fujimura,Hiraku Funakoshi,Masahito Horiguchi,Jun Maki,Naohisa Masunaga,Yosuke Matsumura,Takuya Mayumi,Keisuke Minami,Yuya Miyazaki,Kazuyuki Miyamoto,Teppei Murata,Machi Yanai,Takao Yano,Kohei Yamada,Naoki Yamada,Tomonori Yamamoto,Shodai Yoshihiro,Hiroshi Tanaka,Osamu NishidaGuideline

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020)

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.other authors: Yasuhiro Norisue, Satoru Hashimoto, Daisuke Hasegawa, Junji Hatakeyama, Naoki Hara, Naoki Higashibeppu, Nana Furushima, Hirotaka Furusono, Yujiro Matsuishi, Tasuku Matsuyama, Yusuke Minematsu, Ryoichi Miyashita, Yuji Miyatake, Megumi Moriyasu, Toru Yamada, Hiroyuki Yamada, Ryo Yamamoto, Takeshi Yoshida, Yuhei Yoshida, Jumpei Yoshimura, Ryuichi Yotsumoto, Hiroshi Yonekura, Takeshi Wada, Eizo Watanabe, Makoto Aoki, Hideki Asai, Takakuni Abe, Yutaka Igarashi, Naoya Iguchi, Masami Ishikawa, Go Ishimaru, Shutaro Isokawa, Ryuta Itakura, Hisashi Imahase, Haruki Imura, Takashi Irinoda, Kenji Uehara, Noritaka Ushio, Takeshi Umegaki, Yuko Egawa, Yuki Enomoto, Kohei Ota, Yoshifumi Ohchi, Takanori Ohno, Hiroyuki Ohbe, Kazuyuki Oka, Nobunaga Okada, Yohei Okada, Hiromu Okano, Jun Okamoto, Hiroshi Okuda, Takayuki Ogura, Yu Onodera, Yuhta Oyama, Motoshi Kainuma, Eisuke Kako, Masahiro Kashiura, Hiromi Kato, Akihiro Kanaya, Tadashi Kaneko, Keita Kanehata, Ken-ichi Kano, Hiroyuki Kawano, Kazuya Kikutani, Hitoshi Kikuchi, Takahiro Kido, Sho Kimura, Hiroyuki Koami, Daisuke Kobashi, Iwao Saiki, Masahito Sakai, Ayaka Sakamoto, Tetsuya Sato, Yasuhiro Shiga, Manabu Shimoto, Shinya Shimoyama, Tomohisa Shoko, Yoh Sugawara, Atsunori Sugita, Satoshi Suzuki, Yuji Suzuki, Tomohiro Suhara, Kenji Sonota, Shuhei Takauji, Kohei Takashima, Sho Takahashi, Yoko Takahashi, Jun Takeshita, Yuuki Tanaka, Akihito Tampo, Taichiro Tsunoyama, Kenichi Tetsuhara, Kentaro Tokunaga, Yoshihiro Tomioka, Kentaro Tomita, Naoki Tominaga, Mitsunobu Toyosaki, Yukitoshi Toyoda, Hiromichi Naito, Isao Nagata, Tadashi Nagato, Yoshimi Nakamura, Yuki Nakamori, Isao Nahara, Hiromu Naraba, Chihiro Narita, Norihiro Nishioka, Tomoya Nishimura, Kei Nishiyama, Tomohisa Nomura, Taiki Haga, Yoshihiro Hagiwara, Katsuhiko Hashimoto, Takeshi Hatachi, Toshiaki Hamasaki, Takuya Hayashi, Minoru Hayashi, Atsuki Hayamizu, Go Haraguchi, Yohei Hirano, Ryo Fujii, Motoki Fujita, Naoyuki Fujimura, Hiraku Funakoshi, Masahito Horiguchi, Jun Maki, Naohisa Masunaga, Yosuke Matsumura, Takuya Mayumi, Keisuke Minami, Yuya Miyazaki, Kazuyuki Miyamoto, Teppei Murata, Machi Yanai, Takao Yano, Kohei Yamada, Naoki Yamada, Tomonori Yamamoto, Shodai Yoshihiro, Hiroshi Tanaka & Osamu Nishid

Formation of GaN porous structures with improved structural controllability by photoassisted electrochemical etching

We aimed to develop a photoassisted electrochemical etching process for the formation of GaN porous structures. Pore linearity and depth controllability were strongly affected by the anode voltage. In addition, the use of light with an energy below the band gap played an important role in controlling the pore diameter. Spectro-electrochemical measurements revealed that the high electric field induced at the GaN/electrolyte interface caused a redshift of the photoabsorption edge. This specific phenomenon can be explained by a theoretical calculation based on the Franz-Keldysh effect. On the basis of the results of our experimental and theoretical analyze, we propose a formation model for GaN porous structures. We also note that the application of the Franz-Keldysh effect is useful in controlling the structural properties of GaN porous structures

Formation of GaN-Porous Structures Using Photo-Assisted Electrochemical Process in Back-Side Illumination Mode

We investigated the structural features of gallium-nitride-porous structures formed using the photo-assisted electrochemical process in the back-side illumination (BSI) mode. The pore diameter and depth were strongly affected by the direction of illumination, where higher controllability was achieved compared with front-side illumination. The spectroscopic measurements revealed that illumination with photon energy below the bulk bandgap plays an important role in pore formation. We propose a formation model by considering the Franz-Keldysh effect that can consistently explain the obtained experimental data in which anodic etching occurs only at the pore tips under the high electric field induced in the depletion region

Correlation between Structural and Photoelectrochemical Properties of GaN Porous Nanostructures Formed by Photo-Assisted Electrochemical Etching

We investigated the correlation between structural and photoelectrochemical properties of GaN porous nanostructures formed by photo-assisted electrochemical etching. The porous nanostructures were formed during light irradiation of the top-surface of homo-epitaxial layers grown on freestanding GaN substrates. The pore depth, wall thickness, and surface morphology of porous nanostructures were strongly influenced by the way holes generated by the light irradiation were supplied. Such structural features influenced the optical properties of GaN porous nanostructures. The photoluminescence peaks measured on GaN porous nanostructures were shifted to higher energies because of the quantum confinement in the thin GaN walls between pores. Formation of porous nanostructure decreased the photoreflectance of the GaN surface, and the smallest reflectance was obtained from the porous sample having large pores on its surface after the ultrathin layer with small pores had been removed by surface-etching. The photoelectrochemical response measured on GaN porous nanostructures in a NaCl electrolyte were drastically enhanced by the unique features of those structures, such as low photoreflectance and large surface area. The largest photocurrents were obtained from the sample from which H3PO4 treatment had removed the ultrathin layer without thinning the pore walls

Investigation on optical absorption properties of electrochemically formed porous InP using photoelectric conversion devices

We investigated the optical absorption properties of InP porous structures formed by the electrochemical process using photoelectric conversion (PC) devices formed on p-n junction substrates. The photocurrent measurements revealed that the current from PC devices changed in response to the incident light power and the thickness of the top layer on the p-n interface. Since the photocarriers contributing to the observed photocurrents are excited by the photons reaching the p-n interface through the top layer, the photocurrents give us information on the optical absorption properties of the top layer. The photocurrents observed on a porous device with a porous structure in the top layer were lower than that of a non-porous device, indicating that the absorption properties of InP were enhanced after the formation of porous structures. This phenomenon can be explained in terms of absorption coefficient, α, increased by the light scattering and the sub-bandgap absorption in the porous layer. (C) 2013 Elsevier B.V. All rights reserved

Large photocurrents in GaN porous structures with a redshift of the photoabsorption edge

Photoresponse and photoabsorption properties of GaN porous structures were investigated by measuring photocurrent and spectroscopic photoabsorption under monochromatic light with various wavelengths. The measured photocurrents on the porous GaN electrodes were larger than those on the planar electrodes due to the unique features of the former electrode, such as large surface area and low photoreflectance properties. Moreover, the photocurrents were observed even under illumination with wavelength of 380 nm, corresponding to photon energy of 3.26 eV, which is 130 meV lower than the bandgap energy of bulk GaN. A potential simulation revealed that a high-electric field was induced at the pore tips due to modification of the potential in the porous structures. The observed redshift of the photoabsorption edge can be qualitatively explained by the Franz-Keldysh effect

シンコウセイ カクジョウセイ マヒ ノ セイシン ショウジョウ コウドウ ショウガイ

進行性核上性麻痺（PSP）は核上性眼球運動障害、姿勢不安定性、無動、その他のパーキンソニズムを特徴とする神経変性疾患である。PSPは前頭-皮質下回路の損傷の結果、二次的に起こる前頭葉機能障害によりしばしば多彩な認知症症状を呈する。一方、前頭側頭型認知症（FTD）でも前頭葉機能障害による特徴的な症候がみられ、PSPとFTDは臨床症候のみならず、病理学的背景にもオーバーラップがみられる。しかし、両疾患の精神症状・行動障害を直接比較した研究や、FTDに特徴的とされる常同行動や反社会的行動をPSPで調べた研究はない。本研究では、PSPの精神症状・行動障害を系統的かつ包括的に調査し、FTDと比較することを目的とした