The histological diagnosis of autoimmune pancreatitis (AIP) by an endoscopic ultrasound (EUS)-guided approach is still challenging. Methods We investigated the utility of the 21-gauge Menghini-type biopsy needle with the rolling method for the histological diagnosis of AIP, in comparison with conventional 22-gauge needles. Among total 28 patients, rate of definitive histological diagnosis, acquired sample area of tissue, rate of histopathological diagnosis of AIP, and adverse events were retrospectively analyzed. Results Definitive histological diagnoses were successfully accomplished in all 14 patients (100%) treated with a Menghini-type needle, and in 57% of cases (8/14) treated with conventional 22-gauge needles (P?0.001). The median sample area of the tissue, except for blood contamination, was remarkably larger by the Menghini-type needle than by conventional-type needles (6.2 [IQR, 4.5?8.8] versus 0.7 [IQR, 0.2?2.0] mm2, P?0.001), and the area per punctures was approximately 4 times larger (1.4 [IQR: 0.9?2.9] versus 0.3 [IQR: 0.1?0.6] mm2/puncture, P?0.001). Based on the International Consensus Diagnostic Criteria, lymphoplasmacytic infiltration, abundant IgG4-postive cells, storiform fibrosis, and obliterative phlebitis were found in 86%/29%, 64%/0%, 36%/0%, and 7%/0% patients who were treated with the Menghini-type needle and conventional-type needles, respectively. Consequently, histopathological diagnosis with type 1 AIP (lever 1 or 2) was achieved in 9 patients (64%) treated with the Menghini-type needle and in no patient treated with conventional-type needles (P?0.001). Two patients who had mild post-procedural pancreatitis improved with conservative treatment, and no bleeding occurred in patients treated with the Menghini-type needle. Conclusion EUS-guided rolling method with the 21-gauge Menghini-type biopsy needle is useful for the histopathological diagnosis of AIP, due to its abundant acquisition of good-quality tissue from the pancreas. en-copyright= kn-copyright= en-aut-name=TsutsumiKoichiro en-aut-sei=Tsutsumi en-aut-mei=Koichiro kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=1 ORCID= en-aut-name=UekiToru en-aut-sei=Ueki en-aut-mei=Toru kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=2 ORCID= en-aut-name=NomaYasuhiro en-aut-sei=Noma en-aut-mei=Yasuhiro kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=3 ORCID= en-aut-name=OmonishiKunihiro en-aut-sei=Omonishi en-aut-mei=Kunihiro kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=4 ORCID= en-aut-name=OhnoKyotaro en-aut-sei=Ohno en-aut-mei=Kyotaro kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=5 ORCID= en-aut-name=KawaharaSoichiro en-aut-sei=Kawahara en-aut-mei=Soichiro kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=6 ORCID= en-aut-name=OdaTakashi en-aut-sei=Oda en-aut-mei=Takashi kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=7 ORCID= en-aut-name=KatoHironari en-aut-sei=Kato en-aut-mei=Hironari kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=8 ORCID= en-aut-name=OkadaHiroyuki en-aut-sei=Okada en-aut-mei=Hiroyuki kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=9 ORCID= affil-num=1 en-affil=Department of Gastroenterology and Hepatology, Okayama University Hospital kn-affil= affil-num=2 en-affil=Departments of Internal Medicine, Fukuyama City Hospital kn-affil= affil-num=3 en-affil=Department of Internal Medicine, National Hospital Organization Fukuyama Medical Center kn-affil= affil-num=4 en-affil=Departments of Internal Medicine and Pathology, Fukuyama City Hospital kn-affil= affil-num=5 en-affil=Departments of Internal Medicine and Pathology, Fukuyama City Hospital kn-affil= affil-num=6 en-affil=Departments of Internal Medicine, Fukuyama City Hospital kn-affil= affil-num=7 en-affil=Departments of Internal Medicine, Fukuyama City Hospital kn-affil= affil-num=8 en-affil=Department of Gastroenterology and Hepatology, Okayama University Hospital kn-affil= affil-num=9 en-affil=Department of Gastroenterology and Hepatology, Okayama University Hospital kn-affil= en-keyword=EUS-FNB kn-keyword=EUS-FNB en-keyword=ICDC kn-keyword=ICDC en-keyword=Sample area kn-keyword=Sample area en-keyword=Good-quality tissue kn-keyword=Good-quality tissue END start-ver=1.4 cd-journal=joma no-vol=1 cd-vols= no-issue=3 article-no= start-page=80 end-page= dt-received= dt-revised= dt-accepted= dt-pub-year=2020 dt-pub=20201217 dt-online= en-article= kn-article= en-subject= kn-subject= en-title= kn-title=On the Occurrence of Clathrate Hydrates in Extreme Conditions: Dissociation Pressures and Occupancies at Cryogenic Temperatures with Application to Planetary Systems en-subtitle= kn-subtitle= en-abstract= kn-abstract=We investigate the thermodynamic stability of clathrate hydrates at cryogenic temperatures from the 0 K limit to 200 K in a wide range of pressures, covering the thermodynamic conditions of interstellar space and the surface of the hydrosphere in satellites. Our evaluation of the phase behaviors is performed by setting up quantum partition functions with variable pressures on the basis of a rigorous statistical mechanics theory that requires only the intermolecular interactions as input. Noble gases, hydrocarbons, nitrogen, and oxygen are chosen as the guest species, which are key components of the volatiles in such satellites. We explore the hydrate/water two-phase boundary of those clathrate hydrates in water-rich conditions and the hydrate/guest two-phase boundary in guest-rich conditions, either of which occurs on the surface or subsurface of icy satellites. The obtained phase diagrams indicate that clathrate hydrates can be in equilibrium with either water or the guest species over a wide range far distant from the three-phase coexistence condition and that the stable pressure zone of each clathrate hydrate expands significantly on intense cooling. The implication of our findings for the stable form of water in Titan is that water on the surface exists only as clathrate hydrate with the atmosphere down to a shallow region of the crust, but clathrate hydrate in the remaining part of the crust can coexist with water ice. This is in sharp contrast to the surfaces of Europa and Ganymede, where the thin oxygen air coexists exclusively with pure ice. en-copyright= kn-copyright= en-aut-name=TanakaHideki en-aut-sei=Tanaka en-aut-mei=Hideki kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=1 ORCID= en-aut-name=YagasakiTakuma en-aut-sei=Yagasaki en-aut-mei=Takuma kn-aut-name=‘ô kn-aut-sei= kn-aut-mei=‘ô aut-affil-num=2 ORCID= en-aut-name=MatsumotoMasakazu en-aut-sei=Matsumoto en-aut-mei=Masakazu kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=3 ORCID= affil-num=1 en-affil=Research Institute for Interdisciplinary Science, Okayama University kn-affil= affil-num=2 en-affil=Research Institute for Interdisciplinary Science, Okayama University kn-affil= affil-num=3 en-affil=Research Institute for Interdisciplinary Science, Okayama University kn-affil= END start-ver=1.4 cd-journal=joma no-vol= cd-vols= no-issue= article-no= start-page= end-page= dt-received= dt-revised= dt-accepted= dt-pub-year=2020 dt-pub=20200615 dt-online= en-article= kn-article= en-subject= kn-subject= en-title= kn-title=A novel difficulty grading system for laparoscopic living donor nephrectomy en-subtitle= kn-subtitle= en-abstract= kn-abstract=Background Several difficulty grading systems have been developed as a useful tool for selecting patients and training surgeons in laparoscopic procedures. However, there is little information on predicting the difficulty of laparoscopic donor nephrectomy (LDN). The aim of this study was to develop a grading system to predict the difficulty of LDN. Methods Data of 1741 living donors, who underwent pure or hand-assisted LDN between 1994 and 2018 were analyzed. Multivariable analyses were performed to identify factors associated with prolonged operative time, defined as a difficulty index with 0 to 8. The difficulty of LDN was classified into three levels based on the difficulty index. Results Multivariable analyses identified that male (odds ratio [OR] 1.69, 95% CI 1.37?2.09, P?0.001), BMI?>?28 (OR 1.36, 95% CI 1.08?1.72, P?=?0.009), pure LDN (OR 1.99, 95% CI 1.53?2.60, P?0.001), multiple renal arteries (OR 2.38, 95% CI 1.83?3.10, P?0.001) and multiple renal veins (OR 2.18, 95% CI 1.52?3.16, P?0.001) were independent risk factors influencing prolonged operative time. The difficulty index based on these factors was calculated and categorized into three levels: low (0?2), intermediate (3?5), and high (6?8) difficulty. Operative time was significantly longer in the high difficulty group (225 min) than in the low (169 min, P?0.001) and intermediate difficulty group (194 min, P?0.001). The conversion rate was higher in the high difficulty group (4.4%) than in the low (2.1%, P?=?0.04) and the intermediate difficulty group (3.0%, P?=?0.27). No significant difference in major complications was found between the groups. Conclusion We developed a novel grading system with simple preoperative donor factors to predict the difficulty of LDN. This grading system may help surgeons in patient selection to advance their experiences and/or teach fellows from simple to difficult LDN. en-copyright= kn-copyright= en-aut-name=TakagiKosei en-aut-sei=Takagi en-aut-mei=Kosei kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=1 ORCID= en-aut-name=KimenaiHendrikus J. A. N. en-aut-sei=Kimenai en-aut-mei=Hendrikus J. A. N. kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=2 ORCID= en-aut-name=TerkivatanTurkan en-aut-sei=Terkivatan en-aut-mei=Turkan kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=3 ORCID= en-aut-name=TranKhe T. C. en-aut-sei=Tran en-aut-mei=Khe T. C. kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=4 ORCID= en-aut-name=IjzermansJan N. M. en-aut-sei=Ijzermans en-aut-mei=Jan N. M. kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=5 ORCID= en-aut-name=MinneeRobert C. en-aut-sei=Minnee en-aut-mei=Robert C. kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=6 ORCID= affil-num=1 en-affil=Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine kn-affil= affil-num=2 en-affil=Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam kn-affil= affil-num=3 en-affil=Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam kn-affil= affil-num=4 en-affil=Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam kn-affil= affil-num=5 en-affil=Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam kn-affil= affil-num=6 en-affil=Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam kn-affil= en-keyword=Kidney transplantation kn-keyword=Kidney transplantation en-keyword=Living donors kn-keyword=Living donors en-keyword=Nephrectomy kn-keyword=Nephrectomy en-keyword=Laparoscopy kn-keyword=Laparoscopy en-keyword=Hand-assisted laparoscopy kn-keyword=Hand-assisted laparoscopy en-keyword=Learning curve kn-keyword=Learning curve en-keyword=Education kn-keyword=Education en-keyword=Teaching kn-keyword=Teaching END