It is recommended that patients with acute upper gastrointestinal bleeding undergo endoscopy within 24 hours after gastroenterologic consultation. The role of endoscopy performed within time frames ...shorter than 24 hours has not been adequately defined.
To evaluate whether urgent endoscopy improves outcomes in patients predicted to be at high risk for further bleeding or death, we randomly assigned patients with overt signs of acute upper gastrointestinal bleeding and a Glasgow-Blatchford score of 12 or higher (scores range from 0 to 23, with higher scores indicating a higher risk of further bleeding or death) to undergo endoscopy within 6 hours (urgent-endoscopy group) or between 6 and 24 hours (early-endoscopy group) after gastroenterologic consultation. The primary end point was death from any cause within 30 days after randomization.
A total of 516 patients were enrolled. The 30-day mortality was 8.9% (23 of 258 patients) in the urgent-endoscopy group and 6.6% (17 of 258) in the early-endoscopy group (difference, 2.3 percentage points; 95% confidence interval CI, -2.3 to 6.9). Further bleeding within 30 days occurred in 28 patients (10.9%) in the urgent-endoscopy group and in 20 (7.8%) in the early-endoscopy group (difference, 3.1 percentage points; 95% CI, -1.9 to 8.1). Ulcers with active bleeding or visible vessels were found on initial endoscopy in 105 of the 158 patients (66.4%) with peptic ulcers in the urgent-endoscopy group and in 76 of 159 (47.8%) in the early-endoscopy group. Endoscopic hemostatic treatment was administered at initial endoscopy for 155 patients (60.1%) in the urgent-endoscopy group and for 125 (48.4%) in the early-endoscopy group.
In patients with acute upper gastrointestinal bleeding who were at high risk for further bleeding or death, endoscopy performed within 6 hours after gastroenterologic consultation was not associated with lower 30-day mortality than endoscopy performed between 6 and 24 hours after consultation. (Funded by the Health and Medical Fund of the Food and Health Bureau, Government of Hong Kong Special Administrative Region; ClinicalTrials.gov number, NCT01675856.).
Abstract
Hyper Suprime-Cam (HSC) is a wide-field imaging camera on the prime focus of the 8.2-m Subaru telescope on the summit of Mauna Kea in Hawaii. A team of scientists from Japan, Taiwan, and ...Princeton University is using HSC to carry out a 300-night multi-band imaging survey of the high-latitude sky. The survey includes three layers: the Wide layer will cover 1400 deg2 in five broad bands (grizy), with a 5 σ point-source depth of r ≈ 26. The Deep layer covers a total of 26 deg2 in four fields, going roughly a magnitude fainter, while the UltraDeep layer goes almost a magnitude fainter still in two pointings of HSC (a total of 3.5 deg2). Here we describe the instrument, the science goals of the survey, and the survey strategy and data processing. This paper serves as an introduction to a special issue of the Publications of the Astronomical Society of Japan, which includes a large number of technical and scientific papers describing results from the early phases of this survey.
ABSTRACT
We present the lens mass model of the quadruply-imaged gravitationally lensed quasar WFI2033 − 4723, and perform a blind cosmographical analysis based on this system. Our analysis combines ...(1) time-delay measurements from 14 yr of data obtained by the COSmological MOnitoring of GRAvItational Lenses (COSMOGRAIL) collaboration, (2) high-resolution Hubble Space Telescope imaging, (3) a measurement of the velocity dispersion of the lens galaxy based on ESO-MUSE data, and (4) multi-band, wide-field imaging and spectroscopy characterizing the lens environment. We account for all known sources of systematics, including the influence of nearby perturbers and complex line-of-sight structure, as well as the parametrization of the light and mass profiles of the lensing galaxy. After unblinding, we determine the effective time-delay distance to be $4784_{-248}^{+399}~\mathrm{Mpc}$, an average precision of $6.6{{\ \rm per\ cent}}$. This translates to a Hubble constant $H_{0} = 71.6_{-4.9}^{+3.8}~\mathrm{km~s^{-1}~Mpc^{-1}}$, assuming a flat ΛCDM cosmology with a uniform prior on Ωm in the range 0.05, 0.5. This work is part of the H0 Lenses in COSMOGRAIL’s Wellspring (H0LiCOW) collaboration, and the full time-delay cosmography results from a total of six strongly lensed systems are presented in a companion paper (H0LiCOW XIII).
We investigate the local and line-of-sight (LOS) overdensities of strong gravitational lens galaxies using wide-area multiband imaging from the Hyper Suprime-Cam Subaru Strategic Program. We present ...41 new definite or probable lens candidates discovered in Data Release 2 of the survey. Using a combined sample of 87 galaxy-scale lenses out to a lens redshift of zL ∼ 0.8, we compare galaxy number counts in LOSs toward known and newly discovered lenses in the survey to those of a control sample consisting of random LOSs. We also compare the local overdensity of lens galaxies to a sample of "twin" galaxies that have similar redshift and velocity dispersion to test whether lenses lie in different environments from similar nonlens galaxies. We find that lens fields contain higher number counts of galaxies compared to the control fields, but this effect arises from the local environment of the lens. Once galaxies in the lens plane are removed, the lens LOSs are consistent with the control sample. The local environments of the lenses are overdense compared to the control sample, and are slightly overdense compared to those of the twin sample, although the significance is marginal. There is no significant evidence of the evolution of the local overdensity of lens environments with redshift.
ABSTRACT
We report the largest sample of candidate strong gravitational lenses belonging to the Survey of Gravitationally lensed Objects in HSC Imaging for group-to-cluster scale (SuGOHI-c) systems. ...These candidates are compiled from the S18A data release of the Hyper Suprime-Cam Subaru Strategic Program (HSC–SSP) Survey. We visually inspect ∼39 500 galaxy clusters, selected from several catalogues, overlapping with the Wide, Deep, and UltraDeep fields, spanning the cluster redshift range of 0.05 < zcl < 1.38. We discover 641 candidate lens systems, of which 536 are new. From the full sample, 47 are almost certainly bona fide lenses, 181 of them are highly probable lenses, and 413 are possible lens systems. Additionally, we present 131 lens candidates at galaxy scale serendipitously discovered during the inspection. We obtained spectroscopic follow-up of 10 candidates using the X-shooter. With this follow-up, we confirm eight systems as strong gravitational lenses. Of the remaining two, one of the sources is too faint to detect any emission, and the other has a tentative redshift close to the lens redshift, but additional arcs in this system are yet to be observed spectroscopically. Since the HSC–SSP is an ongoing survey, we expect to find ∼600 definite or probable lenses using this procedure and even more if combined with other lens finding methods.
Abstract
The Hyper Suprime-Cam Subaru Strategic Program (HSC-SSP) is an excellent survey for the search for strong lenses, thanks to its area, image quality, and depth. We use three different methods ...to look for lenses among 43000 luminous red galaxies from the Baryon Oscillation Spectroscopic Survey (BOSS) sample with photometry from the S16A internal data release of the HSC-SSP. The first method is a newly developed algorithm, named YattaLens, which looks for arc-like features around massive galaxies and then estimates the likelihood of an object being a lens by performing a lens model fit. The second method, Chitah, is a modeling-based algorithm originally developed to look for lensed quasars. The third method makes use of spectroscopic data to look for emission lines from objects at a different redshift from that of the main galaxy. We find 15 definite lenses, 36 highly probable lenses, and 282 possible lenses. Among the three methods, YattaLens, which was developed specifically for this study, performs best in terms of both completeness and purity. Nevertheless, five highly probable lenses were missed by YattaLens but found by the other two methods, indicating that the three methods are highly complementary. Based on these numbers, we expect to find ∼300 definite or probable lenses by the end of the HSC-SSP.
This update of the 2010 International Consensus Recommendations on the Management of Patients With Nonvariceal Upper Gastrointestinal Bleeding (UGIB) refines previous important statements and ...presents new clinically relevant recommendations.
An international multidisciplinary group of experts developed the recommendations. Data sources included evidence summarized in previous recommendations, as well as systematic reviews and trials identified from a series of literature searches of several electronic bibliographic databases from inception to April 2018. Using an iterative process, group members formulated key questions. Two methodologists prepared evidence profiles and assessed quality (certainty) of evidence relevant to the key questions according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Group members reviewed the evidence profiles and, using a consensus process, voted on recommendations and determined the strength of recommendations as strong or conditional.
Preendoscopic management: The group suggests using a Glasgow Blatchford score of 1 or less to identify patients at very low risk for rebleeding, who may not require hospitalization. In patients without cardiovascular disease, the suggested hemoglobin threshold for blood transfusion is less than 80 g/L, with a higher threshold for those with cardiovascular disease. Endoscopic management: The group suggests that patients with acute UGIB undergo endoscopy within 24 hours of presentation. Thermocoagulation and sclerosant injection are recommended, and clips are suggested, for endoscopic therapy in patients with high-risk stigmata. Use of TC-325 (hemostatic powder) was suggested as temporizing therapy, but not as sole treatment, in patients with actively bleeding ulcers. Pharmacologic management: The group recommends that patients with bleeding ulcers with high-risk stigmata who have had successful endoscopic therapy receive high-dose proton-pump inhibitor (PPI) therapy (intravenous loading dose followed by continuous infusion) for 3 days. For these high-risk patients, continued oral PPI therapy is suggested twice daily through 14 days, then once daily for a total duration that depends on the nature of the bleeding lesion. Secondary prophylaxis: The group suggests PPI therapy for patients with previous ulcer bleeding who require antiplatelet or anticoagulant therapy for cardiovascular prophylaxis.
Recent studies have identified a Lys 27-to-methionine (K27M) mutation at one allele of H3F3A, one of the two genes encoding histone H3 variant H3.3, in 60% of high-grade pediatric glioma cases. The ...median survival of this group of patients after diagnosis is ∼1 yr. Here we show that the levels of H3K27 di- and trimethylation (H3K27me2 and H3K27me3) are reduced globally in H3.3K27M patient samples due to the expression of the H3.3K27M mutant allele. Remarkably, we also observed that H3K27me3 and Ezh2 (the catalytic subunit of H3K27 methyltransferase) at chromatin are dramatically increased locally at hundreds of gene loci in H3.3K27M patient cells. Moreover, the gain of H3K27me3 and Ezh2 at gene promoters alters the expression of genes that are associated with various cancer pathways. These results indicate that H3.3K27M mutation reprograms epigenetic landscape and gene expression, which may drive tumorigenesis.
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