Performance of American Society for Gastrointestinal Endoscopy guidelines for dyspepsia in Saudi population: Prospective observational study

AIM: To evaluate adherence of primary care physicians(PCPs) to international guidelines when referring patients for upper-gastrointestinal endoscopy(UGE), evaluate the importance of alarm symptoms and the performance of the American Society for Gastrointestinal Endoscopy(ASGE) guidelines in a Saudi population.METHODS: A prospective, observational cross-sectional study on dyspeptic patients undergoing UGE who were referred by PCPs over a 4 mo period. Refer-rals were classified as appropriate or inappropriate according to adherence to ASGE guidelines.RESULTS: Total of 221 dyspeptic patients was enrolled; 161 patients met our inclusion criteria. Mean age was 40.3 years(SD ± 18.1). Females comprised 70.1%. Alarm symptoms included low hemoglobin level(39%), weight loss(18%), vomiting(16%), loss of appetite(16%), difficulty swallowing(3%), and gastrointestinal bleeding(3%). Abnormal endoscopy findings included gastritis(52%), duodenitis(10%), hiatus hernia(7.8%), features suggestive of celiac disease(6.5%), ulcers(3.9%), malignancy(2.6%) and gastroesophageal reflux disease(GERD: 17%). Among patients who underwent UGE, 63% met ASGE guidelines, and 50% had abnormal endoscopic findings. Endoscopy was not indicated in remaining 37% of patients. Among the latter group, endoscopy was normal in 54% of patients. There was no difference in proportion of abnormal endoscopic findings between two groups(P = 0.639).CONCLUSION: Dyspeptic patients had a low prevalence of important endoscopic lesions, and none of the alarm symptoms could significantly predict abnormalendoscopic findings.

Evaluating the accuracy of American Society for Gastrointestinal Endoscopy guidelines in patients with acute gallstone pancreatitis with choledocholithiasis

BACKGROUND Acute gallstone pancreatitis(AGP) is the most common cause of acute pancreatitis(AP) in the United States. Patients with AGP may also present with choledocholithiasis. In 2010, the American Society for Gastrointestinal Endoscopy(ASGE) suggested a management algorithm based on probability for choledocholithiasis, recommending additional imaging for patients at intermediate risk and endoscopic retrograde cholangiopancreatography(ERCP) for patients at high risk of choledocholithiasis. In 2019, the ASGE guidelines were updated using more specific criteria to categorize individuals at high risk for choledocholithiasis. Neither ASGE guideline has been studied in AGP to determine the probability of having choledocholithiasis.AIM To determine compliance with ASGE guidelines, assess outcomes, and compare 2019 vs 2010 ASGE criteria for suspected choledocholithiasis in AGP.METHODS We conducted a retrospective cohort study of 882 patients admitted with AP to a single tertiary care center from 2008-2018. AP was diagnosed using revised Atlanta criteria and AGP was defined as the presence of gallstones on imaging or with cholestatic pattern of liver injury in the absence of another cause. Patients with chronic pancreatitis and pancreatic malignancy were excluded as were those who went directly to cholecystectomy prior to assessment for choledocholithiasis. Patients were assigned low, intermediate or high risk based on ASGE guidelines. Our primary outcomes of interest were the proportion of patients in the intermediate risk group undergoing magnetic resonance cholangiopancreatography(MRCP) first and the proportion of patients in the high risk group undergoing ERCP directly without preceding imaging. Secondary outcomes of interest included outcome differences based on if guidelines were not adhered to. We then evaluated the diagnostic accuracy of 2019 in comparison to the 2010 ASGE criteria for patients with suspected choledocholithiasis. We performed the t test or Wilcoxon rank sum test, as appropriate, to analyze if there were outcome differences based on if guidelines were not adhered to. Kappa coefficients were calculated to measure the degree of agreement between pairs of variables.RESULTS In this cohort, we identified 235 patients with AGP of which 79 patients were excluded as they went directly to surgery for cholecystectomy without prior MRCP or ERCP. Of the remaining 156 patients, 79 patients were categorized as intermediate risk and 77 patients were high risk for choledocholithiasis according to the 2010 ASGE guidelines. Among 79 intermediate risk patients, 54(68%) underwent MRCP first whereas 25 patients(32%) went directly to ERCP. For the 54 patients with intermediate risk who had MRCP first, 36 patients had no choledocholithiasis while 18 patients had evidence of choledocholithiasis prompting ERCP. Of these patients, ERCP confirmed stone disease in 11 patients. Of the 25 intermediate risk patients who directly underwent ERCP, 18 patients had stone disease. One patient with a normal ERCP developed post ERCP pancreatitis. Patients undergoing MRCP in this group had a significantly longer length of stay(5.0 vs 4.0 d, P = 0.02). In the high risk group, 64 patients(83%) had ERCP without preceding imaging, of which, 53 patients had findings consistent with choledocholithiasis, of which 13 patients(17%) underwent MRCP before ERCP, all of which showed evidence of stone disease. Furthermore, all of these patients ultimately had an ERCP, of which 8 patients had evidence of stones and 5 had normal examination.RESULTS Our cohort also demonstrated that 58% of all 156 patients with AGP had confirmed choledocholithiasis(79% of the high risk group and 37% of the intermediate group when risk was assigned based on the 2010 ASGE guidelines). When the updated 2019 ASGE guidelines were applied instead of the original 2010 guidelines, there was moderate agreement between the 2010 and 2019 guidelines(kappa = 0.46, 95%CI: 0.34-0.58). Forty-two of 77 patients were still deemed to be high risk and 35 patients were downgraded to intermediate risk. Thirty-five patients who were originally assigned high risk were reclassified as intermediate risk. For these 35 patients, 26 patients had ERCP findings consistent with choledocholithiasis and 9 patients had a normal examination. Based on the 2019 criteria, 9/35 patients who were downgraded to intermediate risk had an unnecessary ERCP with normal findings(without a preceding MRCP).CONCLUSION Two-thirds in intermediate risk and 83% in high risk group followed ASGE guidelines for choledocholithiasis. One intermediate-group patient with normal ERCP had post-ERCP AP, highlighting the risk of unnecessary procedures.

The Benefits and Barriers Related to Regular Participation in Physical Activity by African-American Women: Implications for Intervention Development

A common strategy for improving health behaviors is to emphasize the benefits and reduce the barriers to behavior change. This study investigated potential differences in perceived benefits and barriers related to participation in physical activity (PA) between women in pre-maintenance versus the maintenance phase of PA behavior to determine if perceived benefits were greater and perceived barriers lower in women with more extensive and successful PA participation experience. Data were collected from a community-based sample (N = 113) of middle-aged African-American women. The sample was stratified into two groups according to how long they had been regularly engaging in PA (6 months or longer versus less than 6 months). Chi-square analyses were conducted to investigate possible differences between the two groups of women in regard to perceived benefits and barriers associated with PA. Descriptive data showed that nearly all of the benefits and barriers to PA were perceived as being important for a majority of the participants and chi-square and t-test results indicated few significant between-group differences (p < .05) in regard to these perceptions. Additional analyses indicated there was no significant between-group difference (p < .05) for Body Mass Index. The results suggest the benefits and barriers related to PA behavior are already valued and understood by many African-American women. Further, the results do not support the commonly held belief that effective health behavior improvement programming should emphasize the benefits and reduce the barriers related to the behavior. Practitioners should consider focusing on other evidenced based factors proven to promote PA behavior such as counseling regarding social support (e.g., buddy system) and increasing self-efficacy (e.g., goal setting) to initiate and sustain a physically active lifestyle.

American Epilepsy Society(AES) 2019 Annual Meeting

Time:December 6-10,2019Venue:Baltimore Convention Center,Baltimore MD,USA Website:https://meeting.aesnet.org/American Epilepsy Society(AES)2019 Annual Meeting will take place in Baltimore Convention Center,Baltimore MD,USA on December 6-10,2019.From best practices to breakthrough research,the AES 2019 Annual Meeting offers the most extensive education on everything epilepsy and an unparalleled opportunity to network with the brightest minds in the field.

American Epilepsy Society 2019 Annual Meeting

Time:December 6-10,2019Venue:Baltimore Convention Center,Baltimore MD,USA Website:https://meeting.aesnet.org/American Epilepsy Society(AES)2019 Annual Meeting will take place in Baltimore Convention Center,Baltimore MD,USA on December 6-10,2019.From best practices to breakthrough research,the AES 2019 Annual Meeting offers the most extensive education on everything epilepsy and an unparalleled opportunity to network with the brightest minds in the field.

Diplomatic Implications of Women＇s Work in American Consumer Society

American foreign policies have observed guiding principles of democracy, yet an overemphasis on political values leads to more conflicts than mutual understandings in today＇s world. Therefore, this paper proposes that exploring diplomatic implications of ＂women＇s work＂ provides new insights into cultural values of the Four Freedomsmmajor pillars supporting modern American liberalism. This paper foregrounds the domestic and diplomatic significance of ＂women＇s work＂ by analyzing women＇s contributions as laborers at home, in the labor force, and in American consumer society. As American women participated in the paid labor force and took up most consumptive activities, women outside America also worked hard to provide food and care for families. This paper argues that a more comprehensive definition of＂women＇s work＂ is not only indispensable for the development of American industry, consumer society, and the expansion of marketplace, but integrates a system of dualisms separating wage labor and housework, or divisions between spheres of men and women. Moreover, investigations into hidden values of women＇s work alleviate worries arising from information revolution and economic globalization. Moreover, placing women＇s work in perspective enables diplomats to see through factors leading to international hostilities, to reduce conflicts arising from information revolution and economic globalization, and to understand America＇s soft power pertinently.

A Glimpse of American Society through the American TV Drama Series "the Desperate Housewives"

The paper presents an analytical study on the American society through a popular American drama series "the Desperate House Wives". Typical American values can be found everywhere on the show as they have been ingrained in the soul of the American people. As a nation with not very long history but great achievements, its people are the one that should be highlighted. Unlike China, the nation of which have formed since thousands of years ago, so has its culture, America's history is an immigration history. People started migrating from other parts of the world since the 17 thcentury and gathered at the land of America to build up their new homes and realize their dreams. They influence each other and fuse with each other. America is one of the countries in the world that plural cultures successfully mix together.The paper focuses on the American people's daily life to explain to the readers the American traits and values prevailing in their society. Except the Foreword which is the general introduction to the paper, this paper is presented in five parts. The first part to the forth part are the emphasis of the paper which respectively analyze the American traits and values. A series of vivid examples are provided with a wide range of study objects, man and woman, kids to elders, in hope of making the paper understandable and persuasive. It is expected that the study can offer a general idea to the people who are interested in the American society and its people.

CAS researcher Receives Distinguished Service Award from American Fisheries Society

CHEN Yushun,an expert on aquaculture and aquatic ecosystems from the Institute of Hydrobiology,Chinese Academy of Sciences,received the Distinguished Service Award on August 23,2017 at the American Fisheries Society(AFS)Annual Meeting in Tampa,Florida.The Distinguished Service Award recognizes outstanding contributions of time and energy for

A Probe into the Spiritual and Intellectual Impetus that has Animated America as a Nation——American Puritanism

Puritanism was entirely English in its origins,yet the movement achieved its greatest influence in America.As a cultural heritage,American Puritanism had become one of the most enduring shaping influences in American thought and American culture.

On Individualism and Self-Reliance of Americans

The American self-concept is the integral assumption of the culture, and the best expression of it is the individualism and self-reliance. In social relations, individualism asserts its influence om many aspects such as morality, ethics, or financial matters. Also individualism reflects a continuous frontier between the individual and the cultural. For being self-reliance, Americans approve self-motivation,which in the sense of long-range goals, as well as for a specific and immediate task.

美国麻醉医师协会分级在局部麻醉经皮肾镜碎石取石术的上尿路结石患者中的应用评价

目的分析美国麻醉医师协会(ASA)分级在行局部麻醉经皮肾镜碎石取石术(PCNL)的上尿路结石患者中的应用价值。方法将80例行局部麻醉PCNL的上尿路结石患者根据ASA分级分为高危组(ASA分级Ⅲ~Ⅳ级)36例和低危组(ASA分级Ⅰ~Ⅱ级)44例,比较2组围术期指标(手术时间、术中出血量、住院时间)、结石清除率、炎性因子[C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、疼痛视觉模拟评分法(VAS)评分及并发症发生率。结果低危组住院时间短于高危组,差异有统计学意义(P<0.05);低危组结石清除率为93.18%,高于高危组的75.00%,差异有统计学意义(P<0.05)。术前,高危组血清CRP、IL-6、TNF-α水平高于低危组,差异有统计学意义(P<0.05);术后1 d,高危组术后血清CRP、IL-6、TNF-α水平高于低危组,差异有统计学意义(P<0.05)。术后1、3、5 d时,高危组和低危组VAS评分均降低,且低危组VAS评分低于高危组,差异有统计学意义(P<0.05)。低危组并发症发生率为4.54%,低于高危组的19.44%,差异有统计学意义(P<0.05)。结论局部麻醉PCNL治疗ASA分级Ⅰ~Ⅱ级的上尿路结石患者的炎症反应、疼痛程度较ASA分级Ⅲ~Ⅳ级患者轻,且并发症发生率低。

Viewing American Heroism from Superman Movies

Viewing the American heroism as an essential part for social development, this paper reveals how Superman movies explain the American heroism and how they impact the audiences. Among five Superman movies, Superman: The Movie is a remarkable terrific film with great story and acting. For the most important part, this movie introduces clearly about the American heroism. Superman movies reflect the idea of American heroism including mission and achievement of hero, goodness of soul, individualism, self-confidence, defender, strength, and courage. With the examples, the paper explores the American heroism in Superman movies and the influences of them on the audiences.

从欧美指南看稳定性冠心病诊断术语的演变

越来越多的证据表明,心绞痛和缺血的非心外膜冠状动脉原因,包括冠状动脉微血管功能障碍、血管痉挛障碍和心肌代谢紊乱,比血流限制性狭窄更常见。为此,2019年欧洲心脏病学会(ESC)指南首次提出慢性冠状动脉综合征的概念,以替代稳定性冠心病的诊断术语。2024年ESC指南进一步明确了慢性冠状动脉综合征的定义。新近,美国心脏协会(AHA)和ESC则建议将稳定性冠心病的诊断术语改名为非急性心肌缺血综合征。这些反映了对稳定性冠心病病理生理学的认识在不断深化,必将带来对稳定性冠心病的进一步精准分类,更好地指导临床实践。

美国汉学刊物与中国文化的海外传播

学术刊物是美国汉学成果发表与传播的重要媒介,其创办进程一定程度上呈现了汉学史发展脉络,推动了汉学的纵深发展。以汉学刊物为窗口,可以透视美国汉学的阶段性特点。根据时间的历史坐标,美国汉学刊物大致可以分为如下阶段:传教士时期,以《中国丛报》与《教务杂志》为代表;本土化与分化时期,以各学会会刊为典型;当代学科细分化时期,以《中国文学》为代表。不同时期的汉学刊物体现了特定的创刊理念与发展思路。分析代表性的汉学刊物,可以为推进整体的美国汉学史研究提供方向和指南。

我国学校体育协同育人“双循环”推进的内在逻辑与路径探索

学校体育应是一项国家顶层设计、教育系统组织、学校全力落实、家庭积极参与、社会全面支持的健康教育事业,蕴含着广泛、深厚、持久的协同育人特征。目前学校体育各项改革存在着“无发展的增长”的“内卷化”隐忧,阻碍协同育人高质量推进。研究认为协同育人是教育各方力量彼此契合、相互配合、互相成就的“双循环”动力系统。家校社三方主体间契合关系不紧密、亲和路径不畅通、相互成就意愿不强烈等问题导致教育各方力量难聚合、难释放、难强劲。以增动力、添活力、挖潜力为目标的联盟化、数据化、议事化推进路径,有助于拓展契合渠道、打开协同空间、筑牢协同根基,可以充分释放协同育人机制的聚合动力。

《漫长的中场休息》中的讽刺主题

美国作家本·方登的小说《漫长的中场休息》主要讲述了19岁的德州男孩比利·林恩和他所在的B班士兵因在伊拉克战场上的英勇表现被邀请参加美国橄榄球超级杯的表演,以及在表演前后所经历的种种事情。小说通过镶嵌在中场休息里的往事回忆,描述了主人公在伊拉克战场的遭遇。小说以讽刺的笔触对伊拉克战争进行深刻反思、对美国“战争英雄”形象进行解构、对美国消费主义文化进行批判性审视和对美国社会中的爱情观念进行社会学剖析,深刻揭示了美国社会的沉疴痼疾。

家庭、学校、社会三方协同作用对青少年体质健康的影响

该文聚焦于家庭、学校、社会三方协同作用对青少年体质健康的影响,主要以济南市城区内青少年学生及其家长为研究对象,运用文献资料、问卷调查、数理统计等方法,探讨家庭、学校、社会协同作用对青少年体质健康的影响,得出结论:家庭的体育认知态度与青少年参与体育运动的频率呈正相关;家庭的体育认知态度与青少年的体育参与态度表现出较强的相关性。这也说明了家庭体育教育对青少年体质健康的重要作用。同样,社会与学校在青少年的体质健康培养中也表现出了一定的影响作用。目前,强调家庭、学校、社会三方协同作用的背景下,青少年体质健康的培养仍存在一些问题,比如三方并未建立明确的培养机制,责、权不明的情况频频出现;三方没有形成明确的培养目标,而是各自为营,不能很好地发挥出三方协同的优秀效果等。针对以上问题,文章提出了相应建议,以期在三方协同作用下进一步促进青少年体质健康发展。

新时代大学生劳动教育政府、高校、社会协同机制研究

该文在对大学劳动教育现状分析的基础上,提出构建政府高校社会协同劳动教育机制,政府在劳动教育中发挥好引导功能,为劳动教育提供政策和制度支持,做好高校与社会的桥梁和纽带。深化高校劳动教育的主体功能,将立德树人根本任务贯穿到劳动教育中,培养学生正确劳动观念,建设专业工作坊,为劳动教育创造实践场地。社会为高校开展劳动教育提供场地支持,为大学劳动教育的实施和顺利开展提供便利。

2024年美国大选及其对美内政外交的影响

在2024年美国大选中,特朗普赢得了压倒性胜利,聚焦国内经济和非法移民等接地气的热点话题给他带来了丰厚的回报;而民主党人则输在了高高在上、忽略选民切身感受的问题上。特朗普将会带着宏大的改革计划开始其第二任期,从其表态来看,特朗普在国内政治议题上将围绕打击“深层政府”、提升总统权限、推动社会政策明显右转和报复对手等几个方面展开工作。在特朗普就职后的“政治蜜月期”中,美国宪政体制将面临考验,两党斗争会更为激烈,政治暴力倾向将会加剧。在美国经济领域,特朗普第二任期的议程有五大支柱,即削减规章、减税、确保公平贸易协定、开发可靠且丰富的低成本能源和倡导创新,其本质是以“美国优先”为目标,倡导经济民粹主义和经济民族主义政策主张。受美国国内政治、经济约束和国际环境制约,特朗普的经济议程能否顺利实施尚难定论。预计减税、促进公平贸易和管控移民等将是特朗普第二任期重点推进的经济政策,阻力较小的能源和创新等政策可能会优先实施,而削减规章的落实则面临较大不确定性。在社会文化领域,共和党在2024年大选中取得的胜利折射出美国选民基础的显著变化。特朗普在拉美裔和年轻选民群体中支持率上升,这反映了美国少数族裔群体内部的次级分化和社会上性别对立问题的加剧,意味着保守主义的复兴及其对两党选民基本盘带来了冲击。在此背景下,特朗普在第二任内将坚定推行保守的社会政策,回归传统的文化路线。然而,受制于复杂的政治环境,其政策前景存在较大不确定性,虽有机会有效遏止“觉醒文化”的蔓延,但也可能因实施不当而导致共和党在下一个选举周期中遭到选民背弃。在外交领域,特朗普在第二任期内将领导一支对其更加忠诚的外交安全团队,大力推行“美国优先”外交政策,以大国竞争为基调,以重建美国的军事和同盟关系及推广美国价值观为支柱,以维护美国的安全和繁荣及全球领导地位为目标。在地区层面,“美国优先”外交政策旨在调动美国的国家意愿和能力,在印太、欧洲和中东等战略重点地区推行大国竞争,防止这些地区出现有损美国国家利益的变化。在中美关系领域,新一届特朗普政府的对华战略姿态将更为激进,更具不确定性,更难以预期。基于特朗普个人的施政偏好,未来四年美国的对华政策将聚焦经贸问题、台湾地区问题、科技竞争与人文交流。在风险和挑战交织的环境中,中美的合作空间将进一步收窄,两国或将遭遇更多突发事件,世界面临被分割为两个平行体系的风险。尽管如此,特朗普政府的执政风格与政策偏好也可能为中国应对中美关系提供潜在的战略机遇。

面向包容性社会的创新:欧美特殊群体文化志愿服务机制及其启示

文章基于负责任创新视角,调研了欧美国家面向特殊群体的文化志愿服务机制建设实践,总结出保障各类特殊群体的文化志愿需求、依托项目和品牌实现服务的可持续、构建长效系统的招募培训运行机制、以馆际和社会资源为抓手开展服务等四种机制建设路径,以期为完善我国志愿服务机制提供参考。