Is it necessary to stop glucagon-like peptide-1 receptor agonists prior to endoscopic procedure? A retrospective study

BACKGROUND Glucagon-like peptide-1 receptor agonists(GLP-1 RA)are effective in diabetes and obesity,reducing hyperglycemia by increasing insulin release and delaying gastric emptying.However,they can cause gastroparesis,raising concerns about aspiration during procedures.Recent guidelines advise discontinuing GLP-1 RA before surgery to reduce the risk of pulmonary aspiration.AIM To evaluate the effect of GLP-1 RAs on gastric residual contents during endosco-pic procedures.METHODS A retrospective chart review at BronxCare Health System,New York,from January 2019 to October 2023,assessed gastric residue and aspiration in GLP-1 RA patients undergoing endoscopic procedures.Two groups were compared based on dietary status before the procedure.Data included demographics,symptoms of gastroparesis,opiate use,hemoglobin A1c,GLP-1 agonist indication,endo-scopic details,and aspiration occurrence.IBM SPSS was used for analysis,cal-culating means,standard deviations,and applying Pearson’s chi-square and t-tests for associations,with P<0.05 as being significant.RESULTS During the study,306 patients were included,with 41.2%on a clear liquid/low residue diet and 58.8%on a regular diet before endoscopy.Most patients(63.1%)were male,with a mean age of 60±12 years.The majority(85.6%)were on GLP-1 RAs for diabetes,and 10.1%reported digestive symptoms before endoscopy.Among those on a clear liquid diet,1.5%had residual food at endoscopy compared to 10%on a regular diet,which was statistically significant(P=0.03).Out of 31 patients with digestive symptoms,13%had residual food,all from the regular diet group(P=0.130).No complications were reported during or after the procedures.CONCLUSION The study reflects a significant rise in GLP-1 RA use for diabetes and obesity.A 24-hour liquid diet seems safe for endoscopic procedures without aspiration.Patients with upper gastrointestinal symptoms might have a higher residual food risk,though not statistically significant.Further research is needed to assess risks based on diabetes duration,gastroparesis,and GLP-1 RA dosing,aiming to minimize interruptions in therapy during procedures.

Chronic hepatitis-C infection in COVID-19 patients is associated with in-hospital mortality

BACKGROUND There is little evidence about the association of pre-existing hepatitis C infection(HCV)with outcomes in patients with coronavirus disease 2019(COVID-19).AIM To assess the prevalence of history of HCV among patients with COVID-19 and to study the relationship of in-hospital mortality in relation with other predictors of poor outcomes in the presence or absence of COVID-19 induced acute liver injury.METHODS In a retrospective single-center study design,1193 patients with COVID-19 infection were studied.Patients were then classified into those with and without a history of HCV,50(4.1%)and 1157(95.9%)respectively.RESULTS Multivariate cox-regression models showed that age,HCV,D-Dimer,and ferritin were the only predictors of in-hospital mortality.Acute liver injury and fibrosis score(Fib-4 score)were not different between both groups.Multivariate coxregression model for liver profile revealed that aspartate aminotransferase/alanine aminotransferase ratio,Fib-4 score,and HCV were predictors of inhospital mortality.After propensity score matching HCV was the only predictor of mortality in the multivariate cox-regression model.A model including HCV was found to add predictive value to clinical and laboratory parameters.CONCLUSION In patients with COVID-19,history of HCV infection leads to an accentuated severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)virulence,irrespective of baseline comorbidities,admission laboratory variables,or COVID-19-induced liver injury,which may be related to extrahepatic effects of HCV leading to enhanced ACE-2/TMPRSS mechanisms of SARS-CoV-2 viral entry,baseline cytokine-mediated pro-inflammation,and endothelial dysfunction.

3D Model Construction and Ecological Environment Investigation on a Regional Scale Using UAV Remote Sensing

The acquisition of digital regional-scale information and ecological environmental data has high requirements for structural texture,spatial res-olution,and multiple parameter categories,which is challenging to achieve using satellite remote sensing.Considering the convenient,facilitative,and flexible characteristics of UAV(unmanned air vehicle)remote sensing tech-nology,this study selects a campus as a typical research area and uses the Pegasus D2000 equipped with a D-MSPC2000 multi-spectral camera and a CAM3000 aerial camera to acquire oblique images and multi-spectral data.Using professional software,including Context Capture,ENVI,and ArcGIS,a 3D(three-dimensional)campus model,a digital orthophoto map,and multi-spectral remote sensing map drawing are realized,and the geometric accuracy of typical feature selection is evaluated.Based on a quantitative remote sensing model,the campus ecological environment assessment is performed from the perspectives of vegetation and water body.The results presented in this study could be of great significance to the scientific management and sustainable development of regional natural resources.

Patients with Clostridium difficile infection and prior appendectomy may be prone to worse outcomes

BACKGROUND Clostridium difficile infection(CDI)occurs due to a dysbiosis in the colon.The appendix is considered a‘safe house’for gut microbiota and may help repopulate gut flora of patients with CDI.AIM To study the impact of prior appendectomy on the severity and outcomes of CDI.METHODS We retrospectively reviewed data of 1580 patients with CDI,admitted to our hospital between 2008 to 2018.Patients were grouped based on the presence or absence of the appendix.The primary aim was to(1)assess all-cause mortality and(2)the severity of CDI.Severity was defined as per the Infectious Diseases Society of America criteria.Logistic regression,and propensity score analysis using inverse probability of treatment weights(IPTW)was performed.RESULTS Of the 1580 patients,12.5%had a history of appendectomy.There was no statistical difference in mortality between patients with a prior appendectomy or without(13.7%vs 14%,P=0.877).However,a history of appendectomy affected the severity of CDI[odds ratio(OR)=1.32,95%confidence interval:1.01-1.75].On IPTW,this association remained significant(OR=1.59,P<0.05).On multivariable toxic megacolon(OR=5.37,P<0.05)and colectomy(OR=2.77,P<0.05).CONCLUSION Prior appendectomy may affect the severity of CDI,development of toxic megacolon and the eventual need for colectomy.Since treatment of CDI is governed by its severity,stronger antibiotic regimens or earlier use of fecal microbiota transplant may be a viable option for patients with prior appendectomy.

Kissing-loop nano-kirigami structures with asymmetric transmission and anomalous reflection

Nano-kirigami technology enables the flexible transformation of two-dimensional(2D)micro/nanoscale structures into three-dimensional(3D)structures with either open-loop or close-loop topological morphologies,and has aroused significant interest in the fields of nanophotonics and optoelectronics.Here,we propose an innovative kissing-loop nano-kirigami strategy,wherein 2D open-loop structures can transform into 3D kissing-loop structures while retaining advantages such as large deformation heights and multiple optical modulations.Benefited from the unidirectional deformation of the structures,the kissing-loop nano-kirigami exhibits significant asymmetric transmission under x-polarized light incidence.Importantly,the Pancharatnam-Berry geometric phase is experimentally realized in nano-kirigami structures for the first time,resulting in broadband anomalous reflection in the near-infrared wavelength region.The kissing-loop nano-kirigami strategy can expand the existing platform of micro/nanoscale fabrication and provide an effective method for developing optical sensing,spatial light modulations,and optoelectronic devices.

Effects of biodiversity,stand factors and functional identity on biomass and productivity during the restoration of subtropical forests in Central China

Biodiversity is found to have a significant promotion effect on ecosystem functions in manipulation experiments on grassland communities.However,its relative role compared with stand factors or functional identity is still controversial in natural forests.Here,we examined their relative effects on biomass and productivity during forest restoration.We investigated stand biomass and productivity for 24 plots(600 m2)across restoration stages in the subtropical forests of Mt.Shennongjia,Central China.We measured five key functional traits and calculated functional diversity(functional richness,evenness and dispersion)and community-weighted mean of traits.We used general linear models,variation partitioning methods to test the relative importance of stand factors(density,stand age,maximum height,etc.),functional identity,species and functional diversity on biomass and productivity.Our results illustrated that stand biomass and productivity increased significantly as forest restoration,and that community species richness increased,while functional dispersion decreased significantly.Variation partitioning analyses showed that diversity had no significant pure effects on biomass and productivity.However,diversity may affect biomass and productivity through the joint effect with stand factors and functional identity.Overall,we found that stand factors had the strongest effect on biomass and productivity,while functional identity significantly affects productivity but not biomass,suggesting that modulating stand structure and species identity are effective ways to enhance forest carbon storage and sequestrations potential in forest management.