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Background: Duodenal ulcers are classified into bulbar and post-bulbar ulcers. The aim of this study is to compare the long-term outcomes of patients with post-bulbar ulcer bleeding and those with bulbar ulcer bleeding. Methods: A total of 272 patients with hemorrhagic duodenal ulcers requiring hospitalization were included. Their medical records were retrospectively reviewed. Results: All patients were categorized as bulbar or post-bulbar bleeding ulcer groups. The post-bulbar ulcer group had more patients of advanced age, concurrent malignancy, diabetes mellitus, hypertension, cirrhosis, and chronic kidney disease undergoing hemodialysis. We performed long-term follow-up for an average of 2.6 years. The mortality rate during the follow-up period in the post-bulbar ulcer group was significantly higher than that in the bulbar ulcer group (p < 0.001). The PNED score was a better predictor of 30-day mortality compared to the complete Rockall score and the Glasgow-Blatchford Score. Predictors of mortality were evaluated using a Cox proportional hazards regression model. In multivariate analysis, post-bulbar ulcer, concurrent malignancy, cirrhosis, antiplatelet/anticoagulant use, and transfusion were significant predictors of mortality. Conclusions: Patients with post-bulbar ulcers have a poorer prognosis than those with bulbar ulcers. After the diagnosis of hemorrhagic post-bulbar duodenal ulcer, close follow-up is necessary. [ABSTRACT FROM AUTHOR]

Low-pressure endoscopy using the gel immersion method has the potential to facilitate EVL of ruptured esophageal varices with fibrosis. Gel immersion endoscopy: a novel method to secure the visual field during endoscopy in bleeding patients (with videos). [Extracted from the article]

Unoccupied electronic states near the Fermi level of poly(dimethylsilane) were probed using Si 1sX-ray absorption spectroscopy (XAS) and SiKL2,3L2,3resonant Auger spectroscopy (RAS). The measured resonance peaks of XAS spectra near SiK-edge have been assigned in comparison with the discrete variational (DV)-Xα molecular orbital calculations. The rapid delocalization of Si 1score-excited electron through the empty conduction band was observed along the polymer chain with the energy-dependent RAS measurement, and the electron delocalization time was estimated based on the core-hole clock method. [ABSTRACT FROM AUTHOR]

The electronic properties of polycrystalline 6,13-Bis(triisopropylsilylethynyl)pentacene (TIPS-pentacene) was probed by inner-shell spectroscopies such as near-edge X-ray absorption fine structure (NEXAFS) spectroscopy and electron emission spectroscopy at the SiK-edge. Although the lowest unoccupied molecular orbital (LUMO) near the Fermi level is mainly on the acene unit, a small LUMO peak was observed in Si 1s NEXAFS spectra. Angle-dependent NEXAFS spectra indicate that a well-ordered structure is produced in the polycrystalline TIPS-pentacene. It was demonstrated that randomly oriented small single-crystal grains can be aligned by rubbing the powder sample. [ABSTRACT FROM AUTHOR]

Oxide–nitride–oxide (ONO) layer structures are widely used for charge storage in flash memory devices. The ONO layer interfaces should be as flat as possible, so measurement of the nanoscale roughness of those interfaces is needed. In this study, quantification of an ONO film from a commercially available flash memory device was carried out with a pillar-shaped specimen using scanning transmission electron microscopy (STEM) and computed tomography. The ONO area contained only low Z- and low STEM-contrast materials, which makes high-quality reconstruction difficult. The optimum three-dimensional reconstruction was achieved with an STEM annular dark-field detector inner collection angle of 32 mrad, a sample tilt range from −78° to +78° and 25 iterations for the simultaneous iterative reconstruction technique. [ABSTRACT FROM PUBLISHER]

Abstract: We have investigated photon-stimulated ion desorption from deuterated benzene (C6D6) adsorbed on Si(100) and Si(111) surfaces following C 1s core excitation. Using time-of-flight mass spectrometry combined with angle-dependent technique, we measured the dependences of mass-spectra of desorption ions on photon energies and on incident angle (θ) of synchrotron beam. We have found the ion yields for adsorbate-derived fragments of CD+ and CD2 + are enhanced in very small angles of incident X-rays. Moreover, molecular orientation effect appeared in excitation energy dependences of D+ ions from the Si(100) and Si(111) surfaces; that is, ion yield spectra measured at θ =10° are different from that at θ =65°. Furthermore, it was found that desorption ion yields increase greatly with decreasing incident angles. The angular dependences are consistently similar for all ion species, excitation energies, and indexes of substrates. Possible desorption processes are described on the basis of the observations. [Copyright &y& Elsevier]

Using a newly developed rotatable-time-of-flight mass spectrometer (TOF-MS) and polarized synchrotron radiation, we have investigated orientation effect on fragmentation and desorption pathways occurring at the top-most layers of molecular solids. Polarization-angle dependencies electron- and ion-NEXAFS of a condensed layer of partially deuterated formamide (HCOND2) are reported. A marked orientation effect was observed for enhanced H+-yields following C 1s→σ&ast;C–H core-resonance. This effect was attributed to the existence of direct photodissociation as well as to the change of charge-neutralization probability. The product yields of some fragments, however, showed no polarization dependence especially when dissociation sites were far from core-excited atoms. This is the case for N–D breaking and D+-desorption following C 1s→σ&ast;N–D resonance. It suggests that higher Rydberg states with plural symmetries are mixed. [Copyright &y& Elsevier]

Background: The number of adult patients with childhood-onset chronic diseases is increasing. However, the process of transitioning these patients from child- to adult-centered medical services faces many difficulties. Despite the key role that doctors in the pediatric field are considered to play in transition, few fact-finding surveys about transition have been conducted among these doctors. Objective: The aim of this study was to demonstrate the current status and challenges in the transition of patients with childhood-onset chronic diseases by a fact-finding survey of pediatricians and pediatric surgeons at a university hospital. Methods: A cross-sectional survey was performed using an anonymous self-administered questionnaire. Seventy-six doctors of pediatrics and pediatric surgery (excluding junior residents) in a university hospital were asked to answer an anonymous self-report questionnaire. A multidisciplinary research team selected items related to the transitional process. Results: Sixty (79%) doctors participated, of whom 52 (87%) showed awareness of transition. No doctor answered that "Transition is conducted smoothly." Doctors with shorter pediatric department experience had lower awareness and poorer experience with transition. In contrast to pediatric surgeons, pediatricians explained "job-seeking activities" and "contraceptive methods" to the patient, and reported a higher patient age at which to initiate explanation of transition to the patient and his/her family. Among factors inhibiting transition, 39 (65%) respondents selected "The patient's family members do not desire transition" and 34 (57%) selected "Although a relevant adult healthcare department is available, it will not accept the patient." The medical providers most frequently considered to have responsibility for playing a central role in the transition process were "pediatrician/pediatric surgeon," "medical social worker," and "regional medical liaison office." Discussion: To promote transition, pediatric and adult healthcare departments should share concerns about and cooperate in the establishment of more effective methods of transition, and provide multidisciplinary collaboration to support patients and their families. [ABSTRACT FROM AUTHOR]

Objectives: Early gastric cancers (EGCs) of the elevated type or with submucosal invasion are easily found by routine endoscopy. However, most early cancers are challenging to detect because of subtle morphological or color differences from surrounding atrophic mucosa and intestinal metaplasia. Linked color imaging (LCI) enhances mucosal color difference, making it easier to detect EGCs. The aim of this study is to clarify the advantages and possible disadvantages of LCI for screening for obscure EGC. Methods: A total of 665 malignant gastric lesions resected using endoscopic submucosal dissection between January 2015 and April 2018 were retrospectively reviewed. Obviously detectable lesions were not included in the main analysis when determining the target lesion. White light imaging (WLI)/LCI images of 508 endoscopically obscure malignant lesions were included in the final analysis and evaluated by three non‐expert and three expert endoscopists using visibility scores for detection and extent. Results: The detection visibility scores using LCI were significantly higher than those using WLI regardless of lesion characteristics including location, size, histological type, depth of invasion, and Helicobacter pylori status. The detection score improved in 46.4% cases and deteriorated in 4.9% when the modality changed from WLI to LCI. A mixed‐effects multivariate logistic regression analysis showed that use of LCI (odds ratio [OR] 2.57), elevated type (OR 1.92), invasion to submucosa (OR 2.18) were significantly associated with improved visibility of EGC. Conclusions: Linked color imaging significantly improves visibility of EGC regardless of differences in lesion morphology, histology, location, depth of invasion, and H. pylori status compared to conventional WLI. [ABSTRACT FROM AUTHOR]

This paper presents precise sensitization test data of 15 chemicals with a wide spectrum of sensitization potencies, and proposes a new protocol and criteria for quantitative evaluation of sensitization potencies of chemicals. The tests were performed according to the design of Magnusson and Kligman, changing the application concentrations for induction as well as for challenge phases. 3-dimensional relationships between mean response (or sensitization rate), induction and challenge concentrations were found in all chemicals tested. The following 2 values are proposed as a quantitative measure of sensitization potency: (a) the minimum induction concentration that induces a positive response; (b) the challenge concentration that induces a mean response approximately equal to 1.0 among the animals applied with the highest concentration for induction. Both values coincided with each other within the range of 1 order of magnitude in every compound except 2. The values varied by 5 orders or more of magnitude among the compounds, showing a wide variation of sensitization potencies among chemicals. A good correlation was found for every chemical between the value of sensitization potency thus obtained and the residual levels in causative products in human cases of allergic contact dermatitis. A new experimental protocol for obtaining values (a) and (b) is proposed. [ABSTRACT FROM AUTHOR]

Aim: Nurses are expected to have a role in the transition of care from pediatric to adult medical practices for adolescents and young adults with childhood‐onset chronic diseases. This study compares the experience, knowledge, and perceptions regarding the ideal care among adult unit and pediatric nurses regarding the transition to adult care for those with childhood‐onset chronic diseases. Methods: A cross‐sectional study using self‐report questionnaires was conducted with nurses in a tertiary hospital in Tokyo. Questions were generated based on a literature review and expert discussion. Data from 1,064 participants were analyzed (adult unit nurses: n = 959, 90.1%; pediatric nurses: n = 105, 9.9%). Results: Among 623 adult unit nurses who had care experience for adult patients with a childhood‐onset chronic disease, 458 nurses (73.6%) were unaware of the concept of transitional care. As the obstructive factors for transition, pediatric nurses recognized problems in healthcare providers' attitudes and lack of transitional care coordinators, while the adult unit nurses emphasized the patients' wishes to continue to receive pediatric healthcare. Most adult unit nurses expected pediatric nurses to function as transitional care coordinators. Conclusion: Adult unit and pediatric nurses had different perceptions of the barriers in transitioning children with chronic diseases to adult care. It is important to have educational programs focusing on transitional care for all nurses, both to enable pediatric nurses to improve transition readiness of children with chronic diseases and to offer adult patients with a childhood‐onset chronic disease continuing support through adult unit nurses. [ABSTRACT FROM AUTHOR]

We have developed photoelectron emission microscope (PEEM) system with excitation of linearly polarized synchrotron X-rays at 30° incidence angle arrangement. The morphology, electronic structure, orientation for P3HT:PCBM hybrid films have been investigated using the PEEM instrument. The sulphur 1s near-edge X-ray-absorption fine structure (NEXAFS) spectra at micro-domains were obtained, where sulphur atoms of thiophene ring were detected. The nature and symmetry in the S 1s excitations of P3HT model cluster were elucidated by DFT calculations that we performed to assign resonant peaks in absorption spectra. We demonstrate that the orientation at micro-domains can be deduced from photon-energy dependencies of PEEM images. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The purpose of this study was to clarify the clinical benefits of perioperative administration of high-dose prednisolone (PSL) combined with extended thymectomy on the long-term outcomes of 116 consecutive patients with generalized myasthenia gravis (MG). Methods: A retrospective review was conducted on 116 patients diagnosed with generalized MG who received alternate-day oral administration of high-dose PSL (100mg/alternate days) and had undergone transsternal extended thymectomy. Incidences of postoperative myasthenic crisis, adverse effects of steroid, long-term outcomes, such as complete stable remission (CSR), pharmacologic remission (PR) or improvement (Imp), and disease recurrence after CSR were evaluated. Results: Six patients (5.2%) experienced post-thymectomy myasthenic crisis. Crude cumulative CSR and PR+CSR rates were 44.8 and 62.7%, respectively. Life table analysis showed that 41.8, 52.8 and 63.4% of the patients were in CSR at 3, 5 and 10 years, respectively. Multivariate analysis revealed that age and pretreatment classification according to the Myasthenia Gravis Foundation of America (MGFA) criteria tended to be independent predictors of CSR. There were 6.9% with compressive vertebral fracture, 13.8% with cataract, and 5.2% with steroid-induced diabetes. Life table analysis revealed that recurrence rates after CSR were 36.8 and 46.0% at 3 and 5 years, respectively. Patients with thymoma had a significantly higher rate of recurrence than those without thymoma (p =0.001). Conclusions: Alternate-day administration of high-dose prednisolone reduced the risk of post-thymectomy myasthenic crisis. Presence of thymoma was a risk factor for MG recurrence after CSR. [Copyright &y& Elsevier]

Abstract: Toners are micron scale polymer particles constructed of several kinds of resin, pigment, wax, etc. Transmission electron microscopy (TEM) is used for observation of the dispersion of the component materials in toners, but TEM images cannot identify simultaneously all components. Scanning transmission X-ray microscopy (STXM) not only provides simultaneous observation of spatial distributions of wax, resin and carbon black in toners, but it also provides detailed, quantitative, chemical information about the wax and resin environments through chemical component maps derived from multiple energy image sequences. The capabilities of STXM for toner analysis are illustrated by results of a study of a toner for black/white copy/print applications. [Copyright &y& Elsevier]