Search

Background: endoscopic retrograde cholangiopancreatography (ERCP) is a first-line procedure for biliary drainage in patients with acute cholangitis, and there are no studies focused on very urgent ERCP within several hours of hospital arrival. This study aimed to elucidate the use of very urgent ERCP for non-severe acute cholangitis. Methods: this retrospective observational study included patients with non-severe acute cholangitis who underwent ERCP between April 2011 and June 2020 in our institution. Patients were stratified into three groups based on time to ERCP after hospital arrival: very urgent ( 24 hours). The primary outcome was length of hospital stay (LOS). Results: the study cohort included 291 patients, 168 males (57.7 %), with a median age of 76 (interquartile range, 70-83) years. In all, 47, 196 and 48 patients underwent very urgent, urgent and elective ERCP, respectively. Median LOS in the very urgent, urgent, and elective groups was 12, 14, and 15 days, respectively (Kaplan-Meier method). A shorter LOS was associated with earlier ERCP (log-rank trend test, p = 0.04). The rates of readmission within 30 days of discharge and of adverse events were not significantly different among the three groups. By multivariate analysis, very urgent ERCP was associated with a significantly earlier discharge than urgent and elective ERCP (HR, 0.71, p = 0.04 and HR, 0.47, p < 0.01, respectively). In addition, age >= 75 years, pancreatitis, albumin

Objective To elucidate the long-term outcomes of permanent endoscopic biliary stenting (EBS) and risk factors for recurrent biliary obstruction (RBO) in high-risk or elderly patients with common bile duct (CBD) stones. Methods The electronic database of Hakodate Municipal Hospital was searched to identify elderly or high-risk patients with CBD stones who had undergone permanent EBS using a plastic stent without stone removal and were followed up between April 2011 and May 2019, with no further intervention until symptoms occurred. Results We analyzed a total of 47 patients, of whom 19 (40.4%) were men, with a median age of 86 years (interquartile range 80-90 years). RBO and death without biliary disease occurred in 14 (29.8%) and 19 (40.4%) patients, respectively. The cumulative RBO rates at 20, 40, and 60 months were 22.1%, 31.8%, and 35.5%, respectively. The median time to RBO was 13.0 and 38.0 months in the group with CBD stone >= 15 mm and 11-14 mm in diameter, respectively. The cumulative RBO incidence rate in the group with CBD stone

Additional file 1: Supplemental Figure 1. Distribution of time interval between symptom onset and the time patients asked for emergency medical services. n = 1173 (time interval

A carrier doping by a hydrogen substitution in LaFeAsO1−xHx is known to cause two superconducting (SC) domes with the magnetic order at both end sides of the doping. In contrast, SmFeAsO1−xHx has a similar phase diagram but shows single SC dome. Here, we investigated the electronic and crystal structures for iron oxynitride LnFeAsO1−xHx (Ln = La, Sm) with the range of x = 0-0.5 by using x-ray absorption spectroscopy, x-ray emission spectroscopy, and x-ray diffraction. For both compounds, we observed that the pre-edge peaks of x-ray absorption spectra near the Fe-K edge were reduced in intensity on doping. The character arises from the weaker As–Fe hybridization with the longer As–Fe distance in the higher doped region. We can reproduce the spectra near the Fe-K edge according to the Anderson impurity model with realistic valence structures using the local-density approximation (LDA) plus dynamical mean-field theory (DMFT). For Ln = Sm, the integrated-absolute difference (IAD) analysis from x-ray Fe-Kβ emission spectra increases significantly. This is attributed to the enhancement of magnetic moment of Fe 3d electrons stemming from the localized picture in the higher doped region. A theoretical simulation implementing the self-consistent vertex-correction method reveals that the single dome superconducting phase for Ln = Sm arises from a better nesting condition in comparison with Ln = La.

We examine electronic and crystal structures of iron-based superconductors LnFeAsO1−xHx (Ln = La, Sm) under pressure by means of x-ray absorption spectroscopy (XAS), x-ray emission spectroscopy (XES), and x-ray diffraction. In LaFeAsO the pre-edge peak on high-resolution XAS at the Fe-K absorption edge gains in intensity on the application of pressure up to 5.7 GPa and it saturates in the higher pressure region. We found integrated-absolute difference values on XES for Ln = La, corresponding to a spin state, decline on the application of pressure, and then it is minimized when the Tc approaches the maximum at around 5 GPa. In contrast, such the optimum value was not detected for Ln = Sm. We reveal that the superconductivity is closely related to the lower spin state for Ln = La unlike Sm case. We observed that As height from the Fe basal plane and As-Fe-As angle on the FeAs4 tetrahedron for Ln = La deviate from the optimum values of the regular tetrahedron in superconducting (SC) phase, which has been widely accepted structural guide to SC thus far. In contrast, the structural parameters were held near the optimum values up to ∼15 GPa for Ln = Sm.

The electronic and crystal structures of (Na1−xCax)Cr2O4 have been studied in detail by combining photoelectron spectroscopy (PES), x-ray absorption spectroscopy (XAS), and x-ray diffraction (XRD). The PES results suggest a gap opening at the Fermi level with decreasing temperature and/or increasing the Ca concentration. The XAS spectra at the O K-absorption edge suggest a slight increase of the O 2p–Cr 3d hybridization at low temperatures in NaCr2O4 and Na0.8Ca0.2Cr2O4, which corresponds to the appearance of the antiferromagnetic order. However, XRD showed no corresponding structural transition. The experimental results were compared with spin-resolved density functional theory (DFT) calculations. In Na1−xCaxCr2O4 the pre-edge intensity of the XAS spectra at the O K-absorption edge is strongly suppressed with increasing x, in accordance with the gap opening by Ca doping. This observation is consistent with the DFT calculation, where the density of states just above and below the Fermi level diminishes as the electron is doped into NaCr2O4.

A Mössbauer spectroscopy study of the iron-based superconductor KxFe2−ySe2, with two superconducting phases of SC1 and a pressure induced SC2 was performed under pressure. This compound consists of two separated phases of major magnetic (non-superconducting) and minor superconducting components. The internal magnetic field of the major magnetic component decreased at the SC2 phase and disappeared around 15 GPa, while that of the minor non-magnetic component maintained its intensity up to 14.9 GPa. Multiple internal magnetic fields were introduced for improved fits to the spectra of the magnetic component at the SC2 phase, suggesting the importance of the electron–electron correlation in the emergence of the SC2 phase.

Background. Prediction and prevention of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) recurrence is an important clinical issue. We investigated whether HBV DNA level and antiviral therapy are associated with HCC recurrence. Methods. This retrospective study involved 103 patients who underwent hepatic resection or radiofrequency ablation for initial HCC. Patients were divided into four groups. Thirty had high serum HBV DNA levels (>4 log10 copies/mL) and had not received antiviral therapy (high virus group; HVG). Thirty-four had low HBV DNA levels (≤4 log10 copies/mL) and had not received antiviral therapy (low virus group; LVG). Twenty received antiviral therapy after HCC developed (therapeutic group A, TG-A). Nineteen received antiviral therapy before HCC developed (therapeutic group B, TG-B). Results. Cumulative HCC recurrence rates at 3 years in the HVG, LVG, TG-B, and TG-A were 71.1%, 42.2%, 42.3%, and 52.0%, respectively. Recurrence rates differed significantly between the HVG and LVG (P = 0.016) and between the HVG and TG-B (P = 0.008). Recurrence rate in the TG-A was marginally lower than in the HVG (P = 0.10). On multivariate analysis, high serum hepatitis B virus DNA levels (hazard ratio: HR, 2.67; 95% CI, 1.31-5.47; P = 0.007) and absence of antiviral therapy (HR, 2.57; 95% CI, 1.34-4.94; P = 0.005) were independent risk factors for hepatocellular carcinoma recurrence. Conclusion. HBV DNA level and antiviral therapy are associated with HCC recurrence. For patients with high HBV DNA levels, antiviral therapy before the development of HCC is important for prevention of recurrence.

We investigate electronic excitations in La$_{2-x}$(Br,Sr)$_x$CuO$_4$ using resonant inelastic X-ray scattering (RIXS) at the oxygen $K$ edge. We observed momentum-dependent spectral weight below 1 eV, which is consistent with theoretical calculation of the dynamical charge structure factor on oxygen orbitals in a three-band Hubbard model. Our results confirm that the momentum-dependent charge excitations exist on the order of the transfer energy ($t$), and the broad spectral line shape indicates damped and incoherent character of the charge excitations at the energy range in the doped Mott insulators.

Rituximab is a drug used for the treatment of B-cell non-Hodgkin's lymphoma, and its range of use has expanded to the treatment of collagen diseases such as idiopathic thrombocytopenic purpura and rheumatoid arthritis. One serious complication of rituximab use is the reactivation of dormant hepatitis B virus, and prevention of this phenomenon has become an urgent issue. This paper provides a general outline of the problem through an analysis of patient cases that we and other groups have experienced to date.