Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis

BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)constitutes a prevalent emergency within Gastroenterology,encompassing 80%-90%of all gastrointestinal hemorrhage incidents.This condition is distinguished by its abrupt onset,swift progression,and notably elevated mortality rate.AIM To gather clinical data from patients with ANVUGIB at our hospital in order to elucidate the clinical characteristics specific to our institution and analyze the therapeutic effectiveness of endoscopic hemostasis.METHODS We retrospectively retrieved the records of 532 patients diagnosed with ANVUGIB by endoscopy at our hospital between March 2021 and March 2023,utilizing our medical record system.Data pertaining to general patient information,etiological factors,disease outcomes,and other relevant variables were meticulously collected and analyzed.RESULTS Among the 532 patients diagnosed with ANVUGIB,the male-to-female ratio was 2.91:1,with a higher prevalence among males.Notably,43.6%of patients presented with black stool as their primary complaint,while 27.4%had hematemesis as their initial symptom.Upon admission,17%of patients exhibited both hematemesis and black stool,while most ANVUGIB patients primarily complained of overt gastrointestinal bleeding.Urgent routine blood examinations at admission revealed that 75.8%of patients had anemia,with 63.4%experiencing moderate to severe anemia,and 1.5%having extremely severe anemia(hemoglobin<30 g/L).With regard to etiology,53.2%of patients experienced bleeding without a definitive trigger,24.2%had a history of using gastric mucosa-irritating medications,24.2%developed bleeding after alcohol consumption,2.8%attributed it to improper diet,1.7%to emotional excitement,and 2.3%to fatigue preceding the bleeding episode.Drug-induced ANVUGIB was more prevalent in the elderly than middle-aged and young individuals,while bleeding due to alcohol consumption showed the opposite trend.Additionally,diet-related bleeding was more common among the young age group compared to the middle-aged group.Gastrointestinal endoscopy identified peptic ulcers as the most frequent cause of ANVUGIB(73.3%),followed by gastrointestinal malignancies(10.9%),acute gastric mucous lesions(9.8%),and androgenic upper gastrointestinal bleeding(1.5%)among inpatients with ANVUGIB.Of the 532 patients with gastrointestinal bleeding,68 underwent endoscopic hemostasis,resulting in an endoscopic treatment rate of 12.8%,with a high immediate hemostasis success rate of 94.1%.

TiB、TiC和Y_(2)O_(3)增强钛基复合材料的蠕变行为和组织演变

采用感应熔炼法制备(TiB+TiC)和(TiB+TiC+Y_(2)O_(3))增强钛基复合材料。蠕变试验在650℃和120~160 MPa下进行,通过XRD、SEM和TEM对铸态试样和蠕变试样的显微组织演变进行详细表征。结果表明,两种复合材料的铸态组织均为网篮组织。在相同的蠕变条件下,添加Y_(2)O_(3)的复合材料具有更低的稳态蠕变速率。蠕变后,在α/β界面、溶解的β相和增强体周围有硅化物析出,这些硅化物对位错有很强的钉扎作用。因为存在贯穿TiB晶须的层错结构,所以TiB周围的硅化物尺寸明显大于TiC和Y_(2)O_(3)周围的硅化物尺寸。蠕变变形主要受溶质阻力控制,位错运动还受到α/β界面、增强相和硅化物的影响。

硼化物原位自生增强TiAl基复合材料的组织演化、热变形行为及加工工艺设计

硼元素添加造成的相转变和硼化物析出等因素会对原位TiAl基复合材料显微组织演化及热变形行为产生影响。利用等温压缩实验、扫描电子显微技术以及透射电子显微技术等研究材料的动态再结晶和动态回复机制,并计算出其表现变形激活能为691.506 k J/mol。在1100~1200℃温度区间,再结晶γ和α晶粒的形核长大分别主导α2→α相转变温度上、下的热变形行为。α相的动态回复主导材料在1250℃低应变速率下的热变形行为;同时,硼元素会提高α相含量,降低γ→α和α2→α相转变温度,进而促进加载过程中回复α相晶粒的形核长大。根据新建的本构模型,对TiAl基复合材料的变形机制和加工工艺进行详细阐述.

Cap-assisted endoscopic sclerotherapy for hemorrhoids: Methods, feasibility and efficacy

AIM: To evaluate the methodology, feasibility, safety and efficacy of a novel method called cap-assisted endoscopic sclerotherapy(CAES) for internal hemorrhoids.METHODS: A pilot study on CAES for grade Ⅰ to Ⅲ internal hemorrhoids was performed. Colon and terminal ileum examination by colonoscopy was performed for all patients before starting CAES. Polypectomy and excision of anal papilla fibroma were performed if polyps or anal papilla fibroma were found and assessed to be suitable for resection under endoscopy. CAES was performed based on the requirement of the cap, endoscope, disposable endoscopic long injection needle, enough insufflated air and sclerosing agent.RESULTS: A total of 30 patients with grade Ⅰ to Ⅲ internal hemorrhoids was included. The follow-up was more than four weeks. No bleeding was observed after CAES. One(3.33%) patient claimed mild tenesmus within four days after CAES in that an endoscopist performed this procedure for the first time. One hundred percent of patients were satisfied with this novel procedure, especially for those patients who underwent CAES in conjunction with polypectomy or excision of anal papilla fibroma.CONCLUSION: CAES as a novel endoscopic sclerotherapy should be a convenient, safe and effective flexible endoscopic therapy for internal hemorrhoids.

Adipose-derived stromal cells resemble bone marrow stromal cells in hepatocyte differentiation potential in vitro and in vivo

AIM To investigate whether mesenchymal stem cells(MSCs) from adipose-derived stromal cells(ADSCs) and bone marrow stromal cells(BMSCs) have similar hepatic differentiation potential.METHODS Mouse ADSCs and BMSCs were isolated and cultured. Their morphological and phenotypic characteristics, as well as their multiple differentiation capacity were compared. A new culture system was established to induce ADSCs and BMSCs into functional hepatocytes. Reverse transcription polymerase chain reaction, Western blot, and immunofluorescence analyses were performed to identify the induced hepatocytelike cells. CM-Dil-labeled ADSCs and BMSCs were then transplanted into a mouse model of CCl4-induced acute liver failure. fluorescence microscopy was used to track the transplanted MSCs. Liver function was tested by an automatic biochemistry analyzer, and liver tissue histology was observed by hematoxylin and eosin(HE) staining.RESULTS ADSCs and BMSCs shared a similar morphology and multiple differentiation capacity, as well as a similar phenotype(with expression of CD29 and CD90 and no expression of CD11 b or CD45). Morphologically, ADSCs and BMSCs became round and epithelioid following hepatic induction. These two cell types differentiated into hepatocyte-like cells with similar expression of albumin, cytokeratin 18, cytokeratin 19, alpha fetoprotein, and cytochrome P450. fluorescence microscopy revealed that both ADSCs and BMSCs were observed in the mouse liver at different time points. Compared to the control group, both the function of the injured livers and HE staining showed significant improvement in the ADSC-and BMSC-transplanted mice. There was no significant difference between the two MSC groups.CONCLUSION ADSCs share a similar hepatic differentiation capacity and therapeutic effect with BMSCs in an acute liver failure model. ADSCs may represent an ideal seed cell type for cell transplantation or a bio-artificial liver support system.

Characterization of hot deformation and microstructure evolution of a new metastableβtitanium alloy

The hot deformation characteristics of as-forged Ti−3.5Al−5Mo−6V−3Cr−2Sn−0.5Fe−0.1B−0.1C alloy within a temperature range from 750 to 910℃and a strain rate range from 0.001 to 1 s^(-1) were investigated by hot compression tests.The stress−strain curves show that the flow stress decreases with the increase of temperature and the decrease of strain rate.The microstructure is sensitive to deformation parameters.The dynamic recrystallization(DRX)grains appear while the temperature reaches 790℃at a constant strain rate of 0.001 s^(-1) and strain rate is not higher than 0.1 s^(-1) at a constant temperature of 910℃.The work-hardening rateθis calculated and it is found that DRX prefers to happen at high temperature and low strain rate.The constitutive equation and processing map were obtained.The average activation energy of the alloy is 242.78 kJ/mol and there are few unstable regions on the processing map,which indicates excellent hot workability.At the strain rate of 0.1 s^(-1),the stress−strain curves show an abnormal shape where there are two stress peaks simultaneously.This can be attributed to the alternation of hardening effect,which results from the continuous dynamic recrystallization(CDRX)and the rotation of DRX grains,and dynamic softening mechanism.

Hsa_circRNA_102610 upregulation in Crohn’s disease promotes transforming growth factor-β1-induced epithelial-mesenchymal transition via sponging of hsa-miR-130a-3p

BACKGROUND The incidence of inflammatory bowel disease,a chronic intestinal inflammatory disorder that includes Crohn’s disease(CD)and ulcerative colitis,is rising.Circular RNAs are considered valuable diagnostic biomarkers for CD.Current evidence supports the views that epithelial-mesenchymal transition(EMT)plays an important role in CD pathogenesis,and that hsa-miR-130a-3p can inhibit transforming growth factor-β1(TGF-β1)-induced EMT.Our previous study revealed that hsa_circRNA_102610 was upregulated in CD patients.Moreover,we predicted an interaction between hsa_circRNA_102610 and hsa-miR-130a-3p.Thus,we hypothesized that hsa_circRNA_102610 may play roles in the proliferation and EMT of intestinal epithelial cells by sponging hsa-miR-130a-3p to participate in the pathogenesis of CD.AIM To explore the mechanism of hsa_circRNA_102610 in the pathogenesis of CD.METHODS The relative expression levels of hsa_circRNA_102610 and hsa-miR-130a-3p in patients were detected by quantitative reverse transcription-polymerase chain reaction.The proliferation of human intestinal epithelial cells(HIECs)and normal-derived colon mucosa cell line 460(NCM460)cells was detected by cell counting kit-8,5-ethynyl-2’-deoxyuridine staining and cell cycle assays following overexpression or downregulation of hsa_circRNA_102610.Cell proliferation assays were performed as described above in a rescue experiment with hsa-miR-130a-3p mimics.The interaction of hsa_circRNA_102610 and hsa-miR-130a-3p was verified by fluorescence in situ hybridization and dual luciferase reporter assays.The relative expression levels of CyclinD1,mothers against decapentaplegic homolog 4(SMAD4),E-cadherin,N-cadherin and Vimentin were detected by western blotting following hsa_circRNA_102610 overexpression,TGF-β1-induced EMT or hsa-miR-130a-3p mimic transfection(in rescue experiments).RESULTS Upregulation of hsa_circRNA_102610 was determined to be positively correlated with elevated fecal calprotectin levels in CD(r=0.359,P=0.007)by Pearson correlation analysis.Hsa_circRNA_102610 promoted the proliferation of HIECs and NCM460 cells,while hsa-miR-130a-3p reversed the cell proliferationpromoting effects of hsa_circRNA_102610.Fluorescence in situ hybridization and dual luciferase reporter assays showed that hsa_circRNA_102610 directly bound hsa-miR-130a-3p in NCM460 and 293T cells.An inverse correlation between downregulation of hsa-miR-130a-3p and upregulation of hsa_circRNA_102610 in CD patients was observed(r=-0.290,P=0.024)by Pearson correlation analysis.Moreover,overexpression of hsa_circRNA_102610 promoted SMAD4 and CyclinD1 protein expression validated by western-blotting.Furthermore,overexpression of hsa_circRNA_102610 promoted TGF-β1 induced EMT in HIECs and NCM460 cells via targeting of hsa-miR-130a-3p,with increased expression of Vimentin and N-cadherin and decreased expression of E-cadherin.CONCLUSION Hsa_circRNA_102610 upregulation in CD patients could promote the proliferation and EMT of intestinal epithelial cells via sponging of hsa-miR-130a-3p.

Zinc isotopic behavior of mafic rocks during continental deep subduction

Zinc isotopes may act as a new tool of tracking recycling of crustal materials that causes compositional heterogeneity of the mantle.This application relies on an investigation of Zn isotopic behaviors during slab subduction.In this study,we report Zn isotopic compositions for a suite of metabasalts(greenschists,amphibolites,and coesitebearing eclogites)from the Dabie Orogen(China),which were formed via the subduction of mafic rocks into different depths and up to>200 km.Three out of eight greenschists are characterized by lighterδ^(66)ZnJMC-Lyon(0.10‰-0.16‰)than those of global basalts(0.28‰±0.05‰),which may be caused by crustal assimilation of the protoliths by sedimentary rocks due to their extremely high ^(87)Sr/^(86)Sr(up to 0.7130)and lowεNd values(down to−12.3).The remaining greenschists have relatively low ^(87)Sr/^(86)Sr and theirδ66Zn values(0.21‰-0.38‰)overlap the ranges of amphibolites(0.18‰-0.32‰)and coesite-bearing eclogites(0.18‰-0.36‰).There is no correlation betweenδ^(66)Zn and sensitive indicators of dehydration(Rb/TiO_(2),Ba/Yb,and H_(2)O+),suggesting that no detectable Zn isotope fractionation has occurred during the deep subduction of mafic rocks even into>200 km,which is attributed to the limited loss of Zn during prograde metamorphism and dehydration.Thus,Zn isotopic compositions of the deeply subducted mafic rocks are inherited from their protoliths.Considering that these metamorphosed rocks have higherδ66Zn than that of the mantle value by up to 0.2‰,the recycled/subducted mafic crust can incorporate isotopically heavy Zn into the mantle.The subducted slabs may partially melt and generate a metasomatized mantle,resulting in changes of Zn isotopic composition of the hybridized mantle as have been observed in some mantle xenoliths and basaltic lavas.

Interactions between Ti Al alloy and AZC/AMT binder systems in investment casting

In this work, two kinds of binders, Ammonium Zirconium Carbonate(AZC) and Ammonium Metatungstate(AMT) hydrate, and three kinds of powders(ZrO 2, Al2O3 and Y2O3) were mixed to fabricate six kinds of face coating systems. The thermal behaviors of the AZC and AMT dried binders were investigated by TG-DTA, and the phase transformation of the two binders was determined by XRD. Monoclinic ZrO 2 phase was formed from AZC at 620 °C and WO3 at 700 °C, and the phase transformation was completed at lower than 1000 °C in both binders, and therefore, the sintering temperature for the molds was selected at 950 °C. The interaction between the ceramic molds with different face coatings and the Ti-48Al-2Cr-2Nb alloy during investment casting was studied. Results showed no α-case reaction in the TiA l-mold reaction, and the AMT + Y2O3 face coating appeared to be the best choice for investment casting of TiA l alloys under the experimental conditions.

An Approach to Analyze Physical Memory Image File of Mac OS X

Memory analysis is one of the key techniques in computer live forensics. Especially,the analysis of a Mac OS X operating system's memory image file plays an important role in identifying the running status of an apple computer. However,how to analyze the image file without using extra"mach-kernel"file is one of the unsolved difficulties. In this paper,we firstly compare several approaches for physical memory acquisition and analyze the effects of each approach on physical memory. Then,we discuss the traditional methods for the physical memory file analysis of Mac OS X. A novel physical memory image file analysis approach without using extra"mach-kernel"file is proposed base on the discussion. We verify the performance of the new approach on Mac OS X 10. 8. 2. The experimental results show that the proposed approach is simpler and more practical than previous ones.

Microstructure characterization and tensile properties of a Ni-containing TiAl-based alloy with heat treatment

The effects of Ni addition on solidification micro structure and tensile properties of Ti-48Al-2Cr-2Nb alloy were investigated using differential scanning calorimetry（DSC）,X-ray diffraction（XRD）,scanning electron microscopy（SEM） equipped with energy-dispersive spectroscope（EDS） and transmission electron microscopy（TEM）.Results show that with 3 at%Ni addition,the as-cast micro structure is mainly composed of fine lamellar colonies（~50 μm）,γ grains and Ni-ridied τ_3 phase.After heat treatment at 1380℃,the Ni-containing alloy is characterized by fine fully lamellar micro structure（~90 μm）.The heat-treated Ni-containing specimen exhibits superior room temperature tensile properties than other specimens.The tensile properties are discussed in light of the microstructure evolution and role of Ni-riched τ_3 phase.

Longitudinal cognitive dysfunction in patients with obstructive sleep apnea syndrome after transient ischemic attack

To the Editor:Obstructive sleep apnea syndrome(OSAS)is characterized by repetitive episodes of upper airway obstruction(partial or complete)during sleep,which leads to recurrent arterial hypoxemia and sleep fragmentation.Untreated OSAS in middle-aged patients cause impair-ments in attention,vigilance,some aspects of memory,and executive function.[1]Transient ischemic attack(TIA)is characterized by a transient episode of neurological dysfunction caused by focal brain ischemia.By definition,TIA should not bring persistent deficits but it does increase the risk of long-term cognitive impairment.

Central visual function and inner retinal structure in primary open-angle glaucoma

To investigate associations between central visual function and inner retinal structure in primary open-angle glaucoma(POAG). This study enrolled 78 POAG patients and 58 healthy controls. POAG was classified into early glaucoma and moderate to advanced glaucoma. The following tests were performed on all participants: isolated-check visual evoked potential(ic VEP) testing, 24-2 standard automated perimetry(SAP), and Cirrus optical coherence tomography(OCT) examinations. Signal-to-noise ratio(SNR) measures obtained from ic VEP responses to isolated checks presented at four depths of modulation(DOMs;8%, 14%, 22%, and 32%) were explored. Mean macular sensitivity(mMS) was assessed by calculating the mean sensitivities of central 12 SAP points. Ganglion cell layer+ inner plexiform layer thickness(GCL+IPLT) and peripapillary retinal nerve fiber layer thickness(pRNFLT) were measured by OCT scanning. For each group of subjects, linear relationships among the following measures were analyzed: SNR, mMS, GCL+IPLT, and pRNFLT. SNR, mMS, GCL+IPLT, and pRNFLT were all more significantly decreased in glaucoma than in controls(P<0.001). A significant positive association was found between SNR at 14% DOM and GCL+IPLT at the inferior sector in early glaucoma(r=0.465, P=0.004). In moderate to advanced glaucoma, significant correlations were found between SNR at 32% DOM and mean GCL+IPLT(r=0.364, P=0.023), superior GCL+IPLT(r=0.358, P=0.025), and mean p RNFLT(r=0.396, P=0.025). In addition, in moderate to advanced glaucoma, there were significant correlations between mMS and all relevant measures of retinal thickness(r=0.330–0.663, P< 0.010). In early glaucoma, significant correlations were found between mean mMS and minimum GCL+IPLT(r=0.373, P=0.023), and between inferior mMS and superior GCL+IPLT(r=0.470, P=0.003). Linear models provided a good explanation for the relationship between SNR and inner retinal thickness(IRT), whereas nonlinear models better explained the relationship between mMS and IRT. In early glaucoma, both SNR and mMS were related moderately and significantly to IRT, whereas in moderate to advanced glaucoma, mMS was more strongly correlated with IRT than SNR.

Microstructure evolution of Ti–46Al–6Nb–(Si,B) alloys during heat treatment with W addition

The cast ingots of Ti-46Al-6Nb-0.25Si-0.2B and Ti-46Al-6Nb-0.5W-0.25Si-0.2B（at%） were made by induction skull melting（ISM） technique.A series of heat treatments（HTs） were conducted to research the microstructure evolution of both alloys.Microstructure and tensile property were examined by scanning electron microscope（SEM）,X-ray diffraction（XRD）,transmission electron microscope（TEM）,and tensile testing machine.The results show that microsegregation（liquid segregation and solid segregation） is exacerbated by the addition of0.5 at%W;the addition of Nb,W in TiAl alloy makes the phase transition difficultly take place;then,the microstructures and tensile properties of both alloys are improved after certain HT processes;finally,the thicknesses of the γ/α_2 lamellae after a certain HT process are significantly affected by the number of residual γ phases before the furnace-cooling moment.

Effect of tumor size on dermoscopic features of pigmented basal cell carcinoma

Basal cell carcinoma(BCC)is the most common malignant tumor of the skin and the incidence increases yearly worldwide.Most BCC is an indolent kind of tumor,it can grow into a large lesion and lost its classic performance.In addition,giant BCC has attracted the attention of researchers in recent years.111 Thus,BCC with a large tumor size also catches our attention.Dermoscopy is a useful adjuvant tool for the diagnosis and management of BCCs.[2].There are few literatures on BCC tumor size and BCC dermoscopic features.We observed and analyzed 98 cases of BCCs and found that dermoscopic features of BCCs>1 cm in diameter were different from that of smaller BCCs.