Cancer, congestive heart failure, chronic obstructive pulmonary disease, type 2 diabetes and aging induce skeletal muscle atrophy. These diseases and aging promote the formation of reactive oxygen species (ROS), which in turn regulate catabolic pathways involved in muscle atrophy. The first line of antioxidant defense system from ROS is comprised of superoxide dismutase (SOD), which scavenges superoxide (O2•−) to produce the less reactive hydrogen peroxide (H2O2). Mammalian skeletal muscle expresses cytosolic copper/zinc-containing SOD (CuZnSOD or SOD1), manganese SOD (MnSOD or SOD2), and extracellular SOD (EcSOD or SOD3). In this review, we provide an overview of 1) oxidative stress and antioxidants, 2) EcSOD ameliorates skeletal muscle abnormalities, cachexia, and exercise intolerance, 3) muscle-derived EcSOD protects against organ dysfunction, and 4) role of the Keap1-Nrf2 signaling pathway in the regulation of antioxidant defense system.

Even within a hospital, the prognosis after a cardiac arrest is extremely poor if intervention starts only after the event; thus, early recognition and intervention is crucial to reduce inhospital cardiac arrests. This paper aims to assess the results of in-clinic surveys conducted for the implementation of the Rapid Response System (RRS) at our hospital and changes in awareness after awareness initiatives. Excluding the neonatal intensive care unit, all wards were targeted for implementation, with the creation of criteria for requesting the RRS and hospital-wide awareness initiatives. Four items were defined for the request criteria—namely, (1) respiration, (2) circulation, (3) state of consciousness, and (4) others (any concerns)—with a request being warranted if any one of these criteria was met. A pre-awareness survey revealed that respiratory rates were recorded only 6.9% of the time on average, indicating inadequate observation of respiratory rates across all wards. In response to this issue, we announced that respiratory status should be observed at least once a day, which resulted in the recording rate improving to 68.2% after 2 months. Survey results before and after the awareness initiatives among doctors and nurses showed a significant increase in RRS awareness. The percentage of nurses who answered “well aware” or “somewhat aware” increased from 34.8% to 77.6%, and from 63.4% to 88.0% among doctors. However, while the introduction of the RRS was relatively well-received by nurses struggling with on-site responses, some doctors questioned the necessity of the RRS. Upon implementation, it is important to make it known that it is a hospital-wide effort. Simplifying and thoroughly utilizing the request criteria can lead to early recognition of abnormalities. Since it is not easy to gain doctors’ understanding, it is necessary to listen to the needs and requests of each department and patiently continue awareness activities before implementation