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

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。

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。

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。

参与学习活动何以影响老年人的身心健康?——基于CGSS混合截面数据的实证分析

人口老龄化已成为我国人口发展趋势性特征之一,参与学习作为积极应对老龄化的一种重要手段,何以影响老年人的身心健康是一个值得深入探讨的问题。基于2018年和2021年中国综合社会调查(CGSS)的混合截面数据,使用Probit回归模型,实证检验了参与学习活动对老年人身心健康的影响,并采用改变计量模型、倾向得分匹配法(PSM)进行了稳健性检验。研究发现,参与学习对老年人身心健康状况均具有显著的正向提升作用。边际效应分析显示,参与学习能使老年人身体健康和心理健康的概率分别提升6.79%和4.06%。通过进一步的中介效应检验表明,个体的主观幸福感是影响老年人身心健康的重要因素。异质性分析结果显示,老年男性和60~69岁低龄老年人更能从参与学习活动中获得显著的身心健康双重收益。因此,在积极应对人口老龄化的背景下,应鼓励老年人积极参与学习活动,持续扩大老年教育资源供给,注重老年教育服务体系建设的公平性。

腓肠肌内侧头腱膜松解和体外冲击波治疗跖筋膜炎疗效对比研究

目的比较腓肠肌内侧头腱膜松解术与体外冲击波对慢性跖筋膜炎的治疗效果。方法采用前瞻性随机对照研究,选取2021年8月至2023年9月北京京煤集团总医院收治的100例单侧慢性跖筋膜炎患者作为研究对象,采用随机数字表法将其分为腱膜松解组与体外冲击波组,每组50例。腱膜松解组采用腓肠肌内侧头腱膜松解术治疗,体外冲击波组接受体外冲击波治疗。比较2组患者治疗前、后视觉模拟评分(VAS)、踝关节背伸角度(ROM)、美国骨科足踝外科协会踝-后足评分(AOFAS)、足底筋膜厚度以及平衡能力。结果治疗后,腱膜松解组VAS评分明显低于体外冲击波组,差异有统计学意义(P<0.05)。腱膜松解组踝关节背伸ROM大于体外冲击波组,差异有统计学意义(P<0.05)。腱膜松解组AOFAS评分高于体外冲击波组,差异有统计学意义(P<0.05)。腱膜松解组的足底筋膜厚度低于体外冲击波组,差异有统计学意义(P<0.05)。腱膜松解组前侧的星偏移平衡测试法(star excursion balance test,SEBT)检测结果与体外冲击波组比较,差异无统计学意义(P>0.05);其余方向检测结果相较于体外冲击波组均增加(P<0.05)。结论相较于体外冲击波治疗,腓肠肌内侧头腱膜松解术能有效缓解患者疼痛程度、扩大其ROM,改善踝关节功能,降低足底筋膜厚度,提高平衡能力。

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。

为知识辩护:赫希社会本位教育思想研究

知识是学校教育的前提和基础,社会是学生发展的必然所向。面对美国教育质量和社会公平问题,美国教育学家、语言学家赫希展开了从理论到实践的全方位探索,认为从学校教育的角度来看,提升美国教育质量、促进美国社会公平的关键在于正确认识知识之于课程、之于教育、之于社会的重要性和必要性。对于学生来说,阅读能力的提升需要积累一定的词汇和背景知识,技能的培养需要建基于特定的领域知识,成为有文化的公民需要掌握标准语言和共享知识,同化新知识需要先前知识作为基础,缩小与其他学生之间的差距需要学习以核心知识为“同心圆”的课程。作为一名教育上的保守主义者,赫希的知识观和教育观都建立在社会本位的立场之上。赫希强调,教育要从儿童本位转向社会本位的观点并不意味着对儿童关怀和爱护的缺失,反而正是儿童本位思想中存在着的过于浪漫的发展观造成了美国基础教育课程知识的延迟以及对儿童关爱的错位,剥夺了弱势学生学习知识、改变知识状况的机会,这对弱势学生来说才是真正的不公平。因此,学校必须正视“儿童本位”与“社会本位”之间的辩证关系,在基础教育阶段设置以背景知识、领域知识、共享知识、先前知识、核心知识等为内容的高质量课程体系,让教育实践从知识出发走向社会,培养国家真正需要的、有文化的社会公民。

“家校社”体育共育下幼儿体质健康促进的价值意蕴、发展困境与实践策略

从家庭、学校与社会“三位一体”体育协同共育的视域出发,运用文献资料、逻辑分析等方法对幼儿体质健康促进的价值意蕴、发展困境与实践策略进行探究。结果表明:聚焦幼儿体质健康问题,改善幼儿体育教育现状是有效预防与抑制我国青少年体质下滑问题的关键,更是建设健康中国、教育强国与体育强国的重要依托。目前,在我国幼儿体质健康促进的实践中仍存在体育共育与终身体育观念薄弱、文化价值差异与城乡差异桎梏、幼儿体育师资与应用场地匮乏、幼儿体育评价与督促体系缺失等问题。据此,提出树立家校社体育共育意识、平衡不同地域与群体间的教育资源、提升幼儿体育场地资源开放效果、建立幼儿体质健康评价体系等实践策略。

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ASCO肝细胞癌治疗进展

2024年美国临床肿瘤学会(American Society of Clinical Oncology,ASCO)年会于2024年5月31日在美国芝加哥召开。今年大会的主题是“癌症治疗的艺术与科学:从关怀到治愈”。本次大会上报道了多项肝细胞癌(hepatocellular carcinoma,HCC)领域的重磅研究,涵盖晚期系统治疗、局部联合系统治疗和围手术期治疗等。部分研究结果将改变临床实践并推动肝癌领域的发展。本文重点介绍大会HCC相关研究结果,探讨HCC的治疗热点、问题和未来发展方向。

ASA分级预测老年髋部骨折术后医院获得性感染的研究

目的探讨美国麻醉医师协会(American society of anesthesiologists,ASA)分级与老年髋部骨折术后医院获得性感染发生率、住院时间、住ICU时间及住院费用的关系,分析ASA分级对术后医院获得性感染的预测价值。方法回顾性分析2021年10月至2022年4月北京积水潭医院ICU收治的146例老年髋部骨折术后患者资料,根据ASA分级分为ASAⅡ级组和ASAⅢ级组,其中ASAⅡ级组男性32例,女性51例;中位年龄87岁;ASAⅢ级组男28例,女35例;中位年龄86岁。比较两组患者性别、年龄、骨折部位、麻醉方式、手术方式、术后医院获得性感染发生率、住院时间、住ICU时间及住院费用等指标,通过多因素Logistic回归分析,探讨ASA分级与术后医院获得性感染发生的关系,根据受试者工作特征(receiver operating characteristic,ROC)曲线得出ASA分级对老年髋部骨折术后医院获得性感染的预测价值。结果共纳入研究对象146例患者,其中发生术后医院获得性感染者13例,发生率为8.90%。与ASAⅡ级组比较,ASAⅢ级组患者的术后医院获得性感染发生率更高、住ICU时间更长、住院费用更多,两组比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,ASA分级是老年髋部骨折术后医院获得性感染发生的独立危险因素。ROC曲线显示,ASA分级可以预测老年髋部骨折术后医院获得性感染的发生,曲线下面积为0.770(P<0.05)。结论对于老年髋部骨折术后患者,ASAⅢ级者术后医院获得性感染的发生率更高、住ICU时间更长、住院费用更高,ASA分级对术后医院获得性感染的发生有较好的预测价值。