Clinical evidence on whether acute cholangitis accelerates early stent failure via rapid bacterial adhesion and biofilm formation remains limited. We assessed the influence of pre-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis on time to recurrent biliary obstruction (TRBO) and early post-ERCP infection in patients with distal malignant biliary obstruction (DMBO). We retrospectively reviewed consecutive patients with DMBO who underwent their first ERCP-guided stenting at five Japanese centers (January 2020–August 2024). Patients were classified by pre-ERCP cholangitis status and matched at a 2:1 ratio of noncholangitis to cholangitis using propensity scores (PSM). The primary outcome was TRBO; secondary outcomes were post-ERCP infection, clinical success, and RBO rates. TRBO was analyzed using Kaplan–Meier, log-rank, and multivariable Cox analyses; sensitivity analyses yielded concordant results. Of 588 eligible patients, 508 had no cholangitis. PSM yielded 136 and 68 patients in well-balanced groups. The median TRBO was 140 vs. 114 d (p = 0.939). In the Cox models, nonpancreatic etiology lowered RBO risk (hazard ratio [HR]: 0.59, p = 0.04); plastic stents carried a higher risk than metal (HR: 4.71, p < 0.001), and pre-ERCP cholangitis was not associated with RBO (HR: 1.20, p = 0.46). Infections occurred in 9.6 and 4.4
This post-marketing surveillance study assessed the safety and effectiveness of guanfacine hydrochloride extended-release (GXR) in adults with attention-deficit/hyperactivity disorder (ADHD) in routine clinical practice in Japan. In this prospective, multicenter study, adults (≥ 18 years) were followed for 1 year after initiating GXR treatment or until treatment discontinuation, whichever occurred first (enrollment: June 2020–March 2022). Hypotension and bradycardia, syncope, blood pressure elevation upon discontinuation, and QT prolongation were key safety concerns for evaluation. Missing data were not imputed; therefore, effectiveness outcomes reflect only the observed data. In total, 961 patients were enrolled across 155 sites; case report forms were collected for 949 patients. Of these, 912 and 784 were included in the safety and effectiveness analyses, respectively. The 12-month GXR continuation rate was 45.2
Effect of water and organic solvents on dynamic viscoelasticity of cellulose triacetate fiber (CTA(f)) was studied comparing with that of regenerated cellulose fibers such as rayon, cupra and lyocell. The peak of the mechanical loss tangent (tan (sic): ratio of the storage modulus to loss modulus of viscoelastic materials) was observed during drying process of wet CTA(f) indicating that glass transition temperature of 193 degrees C in dry state decreased to room temperature in wet state. The same phenomenon has been observed for regenerated cellulose fibers; however, the height of the tan (sic) peak (tan (sic)(max).) for CTA(f) was lower than those of regenerated cellulose fibers. Tan (sic)(max) qualitatively indicates the size of the moving unit suggesting smaller size of the moving unit affected by water for CTA(f) than those of regenerated cellulose fibers despite quite low crystallnity of CTA(f). Organic solvents including both polar and nonpolar solvents induced glass transition for CTA(f). n-alkane with relatively large molecular weight, n-nonane and n-decane, also caused glass transition at room temperature for CTA(f) not for regenerated cellulose fibers.
Asplenium simaoense K. W. Xu, Li Bing Zhang, and W. B. Liao was found in Shan State, Myanmar. This discovery contributes to a better understanding of pteridophyte diversity in Myanmar and provides insights into species distributions in neighboring China, Laos, and Thailand, emphasizing the need for further taxonomic and conservation efforts.
PURPOSE:Few reports have investigated the attitudes of medical students and early residents toward medical oncology and their career decisions. This study aimed to assess recognition, interest, and factors influencing the intention to specialize in medical oncology among medical students and junior residents. METHODS:A 20-item questionnaire survey was conducted online from November to December 2024. Participants were recruited from medical universities, university hospitals, and general hospitals across Japan. Responses regarding perceptions of medical oncology and decisive factors for career choice were analyzed. RESULTS:A total of 632 medical students and junior residents completed the survey. Among them, 545 (86%) recognized medical oncology, and 243 (38%) considered it a potential future career. The correlation coefficient between academic year and recognition of medical oncology was 0.976, whereas that between academic year and interest was -0.810. Sensitivity of interest, defined as the proportion of participants considering medical oncology as a career among those interested in it, was highest in third-year students (0.78). Multivariate analysis identified interest in cancer treatment as the strongest predictor of considering medical oncology as a career (contribution rate, 43%; range, 1.62; partial correlation coefficient, 0.28). CONCLUSION:Recognition of medical oncology increased with academic year, whereas interest declined. Interest in cancer treatment was the strongest predictor of intention to specialize in medical oncology.
