The burden of upper motor neuron involvement is correlated with the bilateral limb involvement interval in patients with amyotrophic lateral sclerosis:a retrospective observational study

Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives and may lead them to be confined to bed.However,the effect of upper and lower motor neuron impairment and other risk factors on bilateral limb involvement is unclear.To address this issue,we retrospectively collected data from 586 amyotrophic lateral sclerosis patients with limb onset diagnosed at Peking University Third Hospital between January 2020 and May 2022.A univariate analysis revealed no significant differences in the time intervals of spread in different directions between individuals with upper motor neuron-dominant amyotrophic lateral sclerosis and those with classic amyotrophic lateral sclerosis.We used causal directed acyclic graphs for risk factor determination and Cox proportional hazards models to investigate the association between the duration of bilateral limb involvement and clinical baseline characteristics in amyotrophic lateral sclerosis patients.Multiple factor analyses revealed that higher upper motor neuron scores(hazard ratio[HR]=1.05,95%confidence interval[CI]=1.01–1.09,P=0.018),onset in the left limb(HR=0.72,95%CI=0.58–0.89,P=0.002),and a horizontal pattern of progression(HR=0.46,95%CI=0.37–0.58,P<0.001)were risk factors for a shorter interval until bilateral limb involvement.The results demonstrated that a greater degree of upper motor neuron involvement might cause contralateral limb involvement to progress more quickly in limb-onset amyotrophic lateral sclerosis patients.These findings may improve the management of amyotrophic lateral sclerosis patients with limb onset and the prediction of patient prognosis.

Characteristics and accumulation mechanism of tight sandstone gas reservoirs in the Upper Paleozoic, northern Ordos Basin, China

The Ordos Basin is a significant petroliferous basin in the central part of China.The Carboniferous and Permian deposits of transitional and continental facies are the main gas-bearing layers in the north part of the basin.The Carboniferous and Permian natural gas reservoirs in the northern Ordos Basin are mainly tight sandstone reservoirs with low porosity and low permeability,developing lots of ＂sweet spots＂ with comparatively high porosity and permeability.The tight sandstones in the study area are gas-bearing,and the sweet spots are rich in gas.Sweet spots and tight sandstones are connected rather than being separated by an interface seal.Sweet spot sand bodies are vertically and horizontally overlapped,forming a large gas reservoir group.In fact,a reservoir formed by a single sweet spot sand body is an open gas accumulation.In the gentle dipping geological setting and with the source rocks directly beneath the tight reservoirs over a large area,the balance between gas charging into tight reservoirs from source rocks and gas loss from tight reservoirs through caprock is the key of gas accumulation in tight sandstones.Both the non-Darcy flow charging driven by source-reservoir excess pressure difference and the diffusion flow charging driven by source-reservoir gas concentration difference play an important role in gas accumulation.The results of mathematical modeling indicate that the gas accumulation cannot be formed by just one of the above mechanisms.The diffusion of gas from source rocks to reservoirs is a significant mechanism of tight sandstone gas accumulation.

Formation Mechanism of the High-quality Upper Paleozoic Natural Gas Reservoirs in the Ordos Basin

The upper Paleozoic natural gas reservoirs in the Ordos basin are generally characterized by a large gas-bearing area and low reserve abundance. On such a geological background, there still exist gas-enriched zones, with relatively high outputs, high reserve abundance and stably distributed gas layers. The gas-enriched layers with relatively high permeability （the lower limit permeability is 0.5×10^-3μm^2） are key factors for the enrichment and high output of natural gas. Based on core observation, analytic results of inclusions, and a great deal of drilling data, we proposed the following four mechanisms for the formation of high-quality reservoirs： （1） in the source area the parent rocks are mainly metamorphic rocks and granites, which are favorable to keeping primary porosity; （2） under the condition of low A/S （accommodation/sediment supply） ratios, sandstone complex formed due to multistage fluvial stacking and filling are coarse in grain size with a high degree of sorting, low content of mud and good physical properties; （3） early-stage recharge of hydrocarbons restricted compaction and cementation, and thus are favorable to preservation of primary pores; （4） microfractures caused by the activity of basement faults during the Yanshan Movement stage can not only improve the permeability of tight sandstones, but also afford vertical pathways for hydrocarbon gas migration.

Structural Evolution and Hydrocarbon Potential of the Upper Paleozoic Northern Ordos Basin, North China

The hydrocarbon potential of the Hangjinqi area in the northern Ordos Basin is not well known, compared to the other areas of the basin, despite its substantial petroleum system.Restoration of a depth-converted seismic profile across the Hangjinqi Fault Zone（HFZ） in the eastern Hangjinqi area shows one compression that created anticlinal structures in the Late Triassic, and two extensions in ~Middle Jurassic and Late Early Cretaceous, which were interrupted by inversions in the Late Jurassic–Early Early Cretaceous and Late Cretaceous, respectively.Hydrocarbon generation at the well locations in the Central Ordos Basin（COB） began in the Late Triassic.Basin modeling of Well Zhao-4 suggests that hydrocarbon generation from the Late Carboniferous–Early Permian coal measures of the northern Shanbei Slope peaked in the Early Cretaceous, predating the inversion in the Late Cretaceous.Most source rocks in the Shanbei Slope passed the main gas-migration phase except for the Hangjinqi area source rocks（Well Jin-48）.Hydrocarbons generated from the COB are likely to have migrated northward toward the anticlinal structures and traps along the HFZ because the basin-fill strata are dipping south.Faulting that continued during the extensional phase（Late Early Cretaceous） of the Hangjinqi area probably acted as conduits for the migration of hydrocarbons.Thus, the anticlinal structures and associated traps to the north of the HFZ might have trapped hydrocarbons that were charged from the Late Carboniferous–Early Permian coal measures in the COB since the Middle Jurassic.

Complex Exploration Techniques for the Low-permeability Lithologic Gas Pool in the Upper Paleozoic of Ordos Basin

The Ordos basin is a stable craton whose late Paleozoic undergoes two sedimentary stages: from the middle- late Carboniferous offshore plain to the Permian continental river and lake delta. Sandstones in delta plain channels, delta-front river mouth bars and tidal channels are well developed. The sandstones are distributed on or between the genetic source rocks, forming good gas source conditions with widespread subtle lithologic gas pools of low porosity, low permeability, low pressure and low abundance. In recent years, a series of experiments has been done, aimed at overcoming difficulties in the exploration of lithologic gas pools. A set of exploration techniques, focusing on geological appraisal, seismic exploration, accurate logging evaluation and interpretation, well testing fracturing, has been developed to guide the exploration into the upper Paleozoic in the basin, leading to the discoveries of four large gas fields: Sulige, Yulin, Wushenqi and Mizhi.

Upper Paleozoic coal measures and unconventional natural gas systems of the Ordos Basin,China

Upper Paleozoic coal measures in the Ordos Basin consist of dark mudstone and coal beds and are important source rocks for gas generation. Gas accumulations include coal-bed methane （CBM）, tight gas and conventional gas in different structural areas. CBM accumulations are mainly distributed in the marginal area of the Ordos Basin, and are estimated at 3.5 × 1012 m3. Tight gas accumulations exist in the middle part of the Yishan Slope area, previously regarded as the basin-centered gas system and now considered as stratigraphic lithologic gas reservoirs. This paper reviews the characteristics of tight gas accumulations： poor physical properties （porosity 〈 8%, permeability 〈 0.85 × 10 3 μm2）, abnormal pressure and the absence of well-defined gas water contacts. CBM is a self-generation and self- reservoir, while gas derived from coal measures migrates only for a short distance to accumulate in a tight reservoir and is termed near-generation and near-reservoir. Both CBM and tight gas systems require source rocks with a strong gas generation ability that extends together over wide area. However, the producing area of the two systems may be significantly different.

Thermal Evolution of Organic Matter and Secondary Hydrocarbon Generation from Upper Paleozoic Coal Deposits in Northern China

The metamorphism and hydrocarbon generation from the Upper Paleozoic coal-bearing strata in Northern China have been widely studied by Chinese geologists since the 1990s. Based on a large amount of data of Ro values,combined with geological background,we have systematically analyzed the thermal evolutionary characteristics of or-ganic matter and the stages of hydrocarbon generation from the Permo-Carboniferous coal deposits and discussed the condition of secondary hydrocarbon generation. The distribution range of secondary hydrocarbon generation in North-ern China is thus determined. It is shown that the coal ranks of the Upper Paleozoic coal deposits are higher in the southern and western belts than those in the northern and eastern belts. Really significant secondary hydrocarbon gen-eration is mainly related to the thermal evolution of organic matter during the Himalayan Period. Profitable areas for secondary hydrocarbon generation should be buried at 3000-4000 m up to the present. Maturity of the Permo-Carbon-iferous source rocks is not very high. It is suggested that the Bohai Bay depression is favourable for secondary hydro-carbon generation and has good oil and gas prospects.

Upper Paleozoic total petroleum system and geological model of natural gas enrichment in Ordos Basin, NW China

Based on the analysis of Upper Paleozoic source rocks, source-reservoir-caprock assemblage, and gas accumulation characteristics in the Ordos Basin, the gas accumulation geological model of total petroleum system is determined. Then, taking the Carboniferous Benxi Formation and the Permian Taiyuan Formation and Shanxi Formation as examples, the main controlling factors of gas accumulation and enrichment are discussed, and the gas enrichment models of total petroleum system are established. The results show that the source rocks, faults and tight reservoirs and their mutual coupling relations control the distribution and enrichment of gas. Specifically, the distribution and hydrocarbon generation capacity of source rocks control the enrichment degree and distribution range of retained shale gas and tight gas in the source. The coupling between the hydrocarbon generation capacity of source rocks and the physical properties of tight reservoirs controls the distribution and sweet spot development of near-source tight gas in the basin center. The far-source tight gas in the basin margin is mainly controlled by the distribution of faults, and the distribution of inner-source, near-source and far-source gas is adjusted and reformed by faults. Generally, the Upper Paleozoic gas in the Ordos Basin is recognized in four enrichment models: inner-source coalbed gas and shale gas, inner-source tight sandstone gas, near-source tight gas, and far-source fault-transported gas. In the Ordos Basin, inner-source tight gas and near-source tight gas are the current focuses of exploration, and inner-source coalbed gas and shale gas and far-source gas will be important potential targets in the future.

Discovery of Upper Paleozoic marine shale gas in the western part of the Lianyuan Depression (Well XXY-1), central Hunan, China

1.Objectives Lower Paleozoic shale gas in southern China has been comprehensively explored over the past few decades(Zhai GY et al.,2018;Bao SJ et al.,2018).Many gas fields targeting Wufeng-Longmaxi Formations in the Sichuan Basin,including Changning,Weiyuan,and Fuling gas fields,have been discovered and commercialized(Zhai GY et al.,2018;Meng FY et al.,2020).Moreover,breakthroughs have been made in shale gas from the Silurian,Cambrian,and Sinian in the Yichang area,revealing a tremendous potential for shale gas exploration in the Lower Paleozoic of southern China.Although there is much organic-rich mud shale of Upper Paleozoic erathem in southern China,especially in central Hunan,their contributions to shale gas resources are unknown.

The First Report of Thermochemical Sulfate Reduction Reaction in the Upper Paleozoic Carbonate Rocks of Southeastern Ordos Basin

Thermochemical sulfate reduction （TSR） is the reaction between anhydrite and petroleum fluids at elevated temperatures to produce H2S and CO2. TSR has been studied in many sedimentary basins such as China＇s Sichuan and Tarim basins because it has a profound impact on the commercial viability of petroleum resources, with HzS typically being undesirable.

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%.

Advancements in hemostatic strategies for managing upper gastrointestinal bleeding: A comprehensive review

Upper gastrointestinal(GI)hemorrhage presents a substantial clinical challenge.Initial management typically involves resuscitation and endoscopy within 24 h,although the benefit of very early endoscopy(<12 h)for high-risk patients is debated.Treatment goals include stopping acute bleeding,preventing rebleeding,and using a multimodal approach encompassing endoscopic,pharmacological,angiographic,and surgical methods.Pharmacological agents such as vasopressin,prostaglandins,and proton pump inhibitors are effective,but the increase in antithrombotic use has increased GI bleeding morbidity.Endoscopic hemostasis,particularly for nonvariceal bleeding,employs techniques such as electrocoagu-lation and heater probes,with concerns over tissue injury from monopolar electrocoagulation.Novel methods such as Hemospray and Endoclot show promise in creating mechanical tamponades but have limitations.Currently,the first-line therapy includes thermal probes and hemoclips,with over-the-scope clips emerging for larger ulcer bleeding.The gold probe,combining bipolar electrocoagulation and injection,offers targeted coagulation but has faced device-related issues.Future advancements involve combining techniques and improving endoscopic imaging,with studies exploring combined approaches showing promise.Ongoing research is crucial for developing standardized and effective hemorrhage management strategies.

Importance of risk assessment,endoscopic hemostasis,and recent advancements in the management of acute non-variceal upper gastrointestinal bleeding

Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)is a common medical emergency in clinical practice.While the incidence has significantly reduced,the mortality rates have not undergone a similar reduction in the last few decades,thus presenting a significant challenge.This editorial outlines the key causes and risk factors of ANVUGIB and explores the current standards and recent updates in risk assessment scoring systems for predicting mortality and endoscopic treatments for achieving hemostasis.Since ANUVGIB predominantly affects the elderly population,the impact of comorbidities may be responsible for the poor outcomes.A thorough drug history is important due to the increasing use of antiplatelet agents and anticoagulants in the elderly.Early risk stratification plays a crucial role in deciding the line of management and predicting mortality.Emerging scoring systems such as the ABC(age,blood tests,co-morbidities)score show promise in predicting mortality and guiding clinical decisions.While conventional endoscopic therapies remain cornerstone approaches,novel techniques like hemostatic powders and over-the-scope clips offer promising alternatives,particularly in cases refractory to traditional modalities.By integrating validated scoring systems and leveraging novel therapeutic modalities,clinicians can enhance patient care and mitigate the substantial morbidity and mortality associated with ANVUGIB.

Efficacy and safety of over-the-scope-clips in the therapy of acute nonvariceal upper gastrointestinal bleeding:Meta-analysis

BACKGROUND Acute nonvariceal upper gastrointestinal bleeding(ANVUGIB)is a frequent lifethreatening acute condition in gastroenterology associated with high morbidity and mortality.Over-the-scope-clip(OTSC)is a new endoscopic hemostasis technique,which is being used in ANVUGIB and is more effective.AIM To summarize and analyze the effects of the OTSC in prevention of recurrent bleeding,clinical success rate,procedure time,hospital stay,and adverse events in the treatment of ANVUGIB,to evaluate whether OTSC can replace standard endoscopic therapy as a new generation of treatment for ANVUGIB.METHODS The literature related to OTSC and standard therapy for ANVUGIB published before January 2023 was searched in PubMed,Web of Science,EMBASE,Cochrane,Google,and CNKI databases.Changes in recurrent bleeding(7 or 30 days),clinical results(clinical success rate,conversion rate to surgery,mortality),therapy time(procedure time,hospital stay),and adverse events in the OTSC intervention group were summarized and analyzed,and the MD or OR of 95%CI is calculated by Review Manager 5.3.RESULTS This meta-analysis involved 11 studies with 1266 patients.Total risk of bias was moderate-to-high.For patients in the OTSC group,7-and 30-days recurrent bleeding rates,as well as procedure time,hospital stay,and intensive care unit stay,were greatly inhibited.OTSC could significantly improve the clinical success rate of ANVUGIB.OTSC therapy did not cause serious adverse and was effective in reducing patient mortality.CONCLUSION OTSC may provide more rapid and sustained hemostasis,and thus,promote recovery and reduce mortality in patients with ANVUGIB.In addition,the safety of OTSC is assured.

Reservoir characteristics and formation model of Upper Carboniferous bauxite series in eastern Ordos Basin,NW China

Through core observation,thin section identification,X-ray diffraction analysis,scanning electron microscopy,and low-temperature nitrogen adsorption and isothermal adsorption experiments,the lithology and pore characteristics of the Upper Carboniferous bauxite series in eastern Ordos Basin were analyzed to reveal the formation and evolution process of the bauxite reservoirs.A petrological nomenclature and classification scheme for bauxitic rocks based on three units(aluminum hydroxides,iron minerals and clay minerals)is proposed.It is found that bauxitic mudstone is in the form of dense massive and clastic structures,while the(clayey)bauxite is of dense massive,pisolite,oolite,porous soil and clastic structures.Both bauxitic mudstone and bauxite reservoirs develop dissolution pores,intercrystalline pores,and microfractures as the dominant gas storage space,with the porosity less than 10% and mesopores in dominance.The bauxite series in the North China Craton can be divided into five sections,i.e.,ferrilite(Shanxi-style iron ore,section A),bauxitic mudstone(section B),bauxite(section C),bauxite mudstone(debris-containing,section D)and dark mudstone-coal section(section E).The burrow/funnel filling,lenticular,layered/massive bauxite deposits occur separately in the karst platforms,gentle slopes and low-lying areas.The karst platforms and gentle slopes are conducive to surface water leaching,with strong karstification,well-developed pores,large reservoir thickness and good physical properties,but poor strata continuity.The low-lying areas have poor physical properties but relatively continuous and stable reservoirs.The gas enrichment in bauxites is jointly controlled by source rock,reservoir rock and fractures.This recognition provides geological basis for the exploration and development of natural gas in the Upper Carboniferous in the study area and similar bauxite systems.

Influencing factors of gas content evaluation for shale gas:a case study of Lower Paleozoic Wuling fold belt in Upper Yangtze Basin

Factors of shale gas accumulation can be divided into the external and internal factors,according to accumulation mechanism and characteristics of shale gas. The internal factors mainly refer to parameters of organic geochemistry,mineral components and physical parameters. Six factors were presented in this study,i. e.organic matter,maturity,quartz,carbonate,clay mineral and pore. The external factors mainly refer to geologic environment of shale gas reservoir,including four factors: temperature,pressure,depth and thickness.Based on the experiment results of 26 samples of drilling cores from Wuling fold belt in Lower Paleozoic Silurian of the Upper Yangtze Basin,combined with the integrated analysis of geology,logging and test,the correlation of the gas content of shale gas to the above-mentioned ten factors was concluded. Six important evaluation indicators were preliminarily established in the gas-bearing core area of marine shale in the Upper Yangtze Basin.

Discovery and Significance of the Triassic–Late Paleozoic Double-layered Basement in the Songliao Basin:Based on the Complete Coring Data from ICDP Borehole SK2

The Songliao Basin(SLB)covers an area of approximately 260,000 km2in northeastern Asia and preserves a continuous and complete Cretaceous terrestrial record(Wang et al.,2021).The region is the most important petroliferous sedimentary basin in China because of its continual annual oil and gas equivalent production of tens of millions of tons(ca.220–440 million barrels per year)since 1959.The SLB was previously thought to have developed on Hercynian basement and accumulated continuous sedimentary deposits during the Late Jurassic and Cretaceous(Wan et al.,2013;Wang et al.,2016).

Discovery of tuff in Wujiaping Formation of Upper Permian in the northern Sichuan Basin:Implications for the termination of Emeishan Large Igneous Province

1.Objective The Emeishan basalts is located in southwest China and northern Vietnam,covering an area of 2.5×10^(5) km^(2)(Zhong YT et al.,2014),which is the first widely recognized large igneous province(LIP)in China(Zhang ZS,2009).The Emeishan LIP has attracted a numbers of scholars for the reason that the LIP may play a significant role in the evolution of environment and climate.Yang JH et al.,(2018)pointed out that the weathering of the Emeishan basalts consumed carbon dioxide and caused a decrease in the climate of the early Wuchiapingian.However,the duration and termination of the Emeishan basalts eruption remain in doubt.This paper reports a new discovery of tuffaceous in the middle part of the Upper Permian Wujiaping Formation from the northern margin of the Sichuan Basin,applying of LA-ICP-MS to obtain zircon U-Pb ages of tuffaceous and to constrain the lasted eruption timing of Emeishan LIP.

Analysing the Potential Impact of Climate Change on the Hydrological Regime of the Upper Benue River Basin (North Cameroon)

In this study, we analyse the climate variability in the Upper Benue basin and assess its potential impact on the hydrology regime under two different greenhouse gas emission scenarios. The hydrological regime of the basin is more vulnerable to climate variability, especially precipitation and temperature. Observed hydroclimatic data (1950-2015) was analysed using a statistical approach. The potential impact of future climate change on the hydrological regime is quantified using the GR2M model and two climate models: HadGEM2-ES and MIROC5 from CMIP5 under RCP 4.5 and RCP 8.5 greenhouse gas emission scenarios. The main result shows that precipitation varies significantly according to the geographical location and time in the Upper Benue basin. The trend analysis of climatic parameters shows a decrease in annual average precipitation across the study area at a rate of -0.568 mm/year which represents about 37 mm/year over the time 1950-2015 compared to the 1961-1990 reference period. An increase of 0.7°C in mean temperature and 14% of PET are also observed according to the same reference period. The two climate models predict a warming of the basin of about 2°C for both RCP 4.5 and 8.5 scenarios and an increase in precipitation between 1% and 10% between 2015 and 2100. Similarly, the average annual flow is projected to increase by about +2% to +10% in the future for both RCP 4.5 and 8.5 scenarios between 2015 and 2100. Therefore, it is primordial to develop adaptation and mitigation measures to manage efficiently the availability of water resources.

Comparative Analysis of Continuous versus Intermittent Proton Pump Inhibitor Therapy in Patients with Upper Gastrointestinal Bleeding Due to Ulcers

Upper gastrointestinal bleeding (UGIB) presents as a prevalent clinical challenge, with annual incidence rates ranging from 80 to 150 cases per 100,000 individuals. Guidelines for managing patients with UGIB due to bleeding ulcers recommend a continuous infusion of proton pump inhibitors (PPI). However, studies comparing intermittent dosing of PPI therapy show that this regimen achieves similar clinical benefits. If the clinical efficacy remains equivalent, intermittent dosing will be more cost-effective for patients and the health care system. Our research study aims to analyze the comparative effectiveness of intermittent versus continuous PPI therapy after endoscopic treatment in patients with UGIB, focusing on such endpoints as rebleeding risk at 3-and 7-day mortality rates. Methods: Resources searched included MEDLINE, EMBASE, PUBMED, and the Cochrane Central Register of Controlled Trials databases from January 2010 through December 2023 with the inclusion of meta-analysis, systematic review, review, or ACG guideline recommendations. Results of the analysis show how recommendations regarding high vs. low PPI regimen changed over time: from no difference in regimen in 2010 to recommending continuous regimen in 2012 to declaring insufficient evidence between choosing one regimen over another in 2013 to determine that both regimens were comparable to each other in 2014-2018 and finally to recommending both regimens in 2021. To conclude, our review shows that in patients with bleeding ulcers and high-risk endoscopic findings, intermittent PPI therapy is non-inferior to continuous PPI infusion for three days, seven days bleeding risk or mortality rates;however, it remains challenging to determine the most optimal intermittent regimen due to heterogeneity of RCTs included in meta-analyses, and further trials will need to be performed.