A Case of Right Hepatic Artery Syndrome Diagnosed by Using SpyGlassDSTM System

We report the case of a 68-year-old woman who had abdominal pain and slightly elevated biliary enzymes. Magnetic resonance cholangiopancreatography detected biliary duct stenosis, while contrast-enhanced magnetic resonance imaging showed that the right hepatic artery transversed the extrahepatic bile duct at the level of bifurcation of the bile duct. We performed endoscopic retrograde cholangiopancreatography and peroral cholangioscopy with the SpyGlass DS? system. Then, mild extrinsic pulsatile compression of the bile duct was observed at stricture level with an intact bile duct epithelium. Therefore, she was diagnosed with right hepatic artery syndrome and underwent cholecystectomy. Six months later, her biliary enzyme level decreased, and the recurrence of pain gradually decreased

Hypergeometric solutions to the q-Painlev\'e equation of type A4(1)A_4^{(1)}

We consider the q-Painlev\'e equation of type $A_4^{(1)}$ (a version of q-Painlev\'e V equation) and construct a family of solutions expressible in terms of certain basic hypergeometric series. We also present the determinant formula for the solutions.Comment: 16 pages, IOP styl

新たな鼻過敏症の初期病変モデルマウスの作製

アレルギー性鼻炎は臨床における検討だけでなく，in vitro やin vivo においても様々な方法で病態解析が行われている．マウスを用いた様々なアレルギー性鼻炎解析モデルの中で代表的なものとして，抗原として卵白アルブミンを用いて感作後に鼻腔局所に抗原を投与するモデルがある．これは抗原とAlum adjuvant を腹腔内投与することによって感作を成立させてアレルギー性炎症を誘導する．このモデルは病態解析だけでなく，薬剤の治療効果判定としても用いられ，新たな治療薬の検討や臨床応用につながっている．アレルギー性鼻炎は抗原特異的IgE 抗体を介した獲得型アレルギーが重要であり，早期相の誘導にはIgE とマスト細胞を介して局所に放出されるヒスタミンなどの炎症性物質が症状を起こすきっかけとなる．今回我々は，抗原特異的IgE を静脈注射して受動感作を成立させ，抗原抗体反応を介したマスト細胞からの脱顆粒で誘導されるアレルギー性炎症を中心に解析する実験モデルを考案したので，文献的考察を踏まえて報告する．Allergic rhinitis is not only clinically assessed, but also pathologically analyzed both in vitro and in vivo in various ways. There are a variety of mouse models for the analysis of allergic rhinitis. In one of the most well-known models, mice are sensitized by intraperitoneal injection of ovalbumin and alum adjuvant to induce allergic inflammation, and then an antigen is administered locally in the nasal cavity. This model is used for evaluating the therapeutic effects of drugs as well as for pathological analysis, leading to new treatments and clinical applications. Acquired allergy mediated by antigen-specific IgE antibodies plays an important role in allergic rhinitis. Inflammatory substances such as histamine, which are released locally from IgE-activated mast cells, induce the early phase of allergy and trigger symptoms. We developed an experimental model that allows us to analyze nasal hypersensitivity, focusing on allergic inflammation induced by degranulation of mast cells by an antigen-antibody reaction. In this model, mice are passively sensitized by intravenous injection of antigen-specific IgE, so we can approach the early phase in allergic rhinitis specially. We report this new mouse model with a literature review

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Hypergeometric solutions to the q-Painlevé equation of {type A^(1)}_4

Kyushu University 21st Century COE Program Development of Dynamic Mathematics with High Functionality九州大学21世紀COEプログラム「機能数理学の構築と展開」We consider the q-Painlevé equation of type {type A^(1)}_4 (a version of q-Painlevé V equation) and construct a family of solutions expressible in terms of certain basic hypergeometric series. We also present the determinant formula for the solutions

Hypergeometric solutions to the q-Painlevé equation of type {({A}_{1}+{A}_{1}^{prime })}^{left(1\right)}

Kyushu University 21st Century COE Program Development of Dynamic Mathematics with High Functionality九州大学21世紀COEプログラム「機能数理学の構築と展開」A class of classical solutions to the q-Painlevé equation of type {({A}_{1}+{A}_{1}^{prime })}^{left(1\right)} (a q-difference analog of the Painlevé II equation) is constructed in a determinantal form with basic hypergeometric function elements. The continuous limit of this q-Painlevé equation to the Painlevé II equation and its hypergeometric solutions are discussed. The continuous limit of these hypergeometric solutions to the Airy function is obtained through a uniform asymptotic expansion of their integral representation

Peroral Cholangioscopy-Guided Forceps Biopsy and Endoscopic Scraper for the Diagnosis of Indeterminate Extrahepatic Biliary Stricture

Background: Peroral cholangioscopy (POCS) has become a widely-used technique in diagnosing indeterminate biliary strictures, enabling optical viewing of the biliary system and targeted biopsies under direct vision. The diagnostic utility of the new endoscopic scraper, Trefle&reg;, for extrahepatic cholangiocarcinoma (ECC) has also been reported. However, the diagnostic utility of POCS-guided and Trefle&reg;-assisted tissue acquisition for ECC has never been compared empirically. We evaluated the efficacy and safety of Trefle&reg;-assisted tissue acquisition for diagnosing ECC compared with POCS-guided tissue sampling. Methods: Patients who underwent Trefle&reg;-assisted tissue acquisition or POCS-guided forceps biopsy to differentiate ECC from benign biliary disease between April 2014 and March 2018 were enrolled retrospectively. We evaluated the diagnostic performance of Trefle&reg;-assisted tissue acquisition and POCS-guided forceps biopsy based on pathological evaluation. We also compared adverse events associated with Trefle&reg;-assisted tissue acquisition with those of POCS-guided forceps biopsy. Results: We enrolled 34 patients with biliary disease and performed Trefle&reg;-assisted tissue acquisition and POCS-guided forceps biopsy in 14 and 20 patients, respectively. Sensitivity, specificity, and accuracy of Trefle&reg;-assisted tissue acquisition were 87.5%, 83.3%, and 85.7%, respectively, and for POCS-guided forceps biopsy, these were 90.0% each. Statistical values of Trefle&reg;-assisted tissue acquisition and POCS-guided tissue acquisition were not significantly different. There were no significant differences in the occurrence of adverse events between the Trefle&reg;-assisted tissue acquisition and the POCS-guided forceps biopsy (35.7% vs. 25.0%, p = 0.770). Compared with patients who underwent POCS procedure, endoscopic sphincterotomy was performed for fewer patients who underwent Trefle&reg;-assisted tissue acquisition (p &lt; 0.001). Conclusions: The diagnostic ability of Trefle&reg;-assisted tissue acquisition for ECC is similar to that of POCS-guided tissue acquisition. Trefle&reg;-assisted tissue acquisition might also help to preserve the sphincter of Oddi and its digestive function