Link between pharyngeal acid reflux episodes and the effectiveness of proton pump inhibitor therapy

BACKGROUND Diagnosing laryngopharyngeal reflux(LPR)is challenging due to overlapping symptoms.While proton pump inhibitors(PPIs)are commonly prescribed,reliable predictors of their responsiveness are unclear.Reflux monitoring techno-server reliability.We hypothesized that PAR episodes alone might also predict PPI responsiveness.AIM To investigate whether PAR episodes alone predict a positive response to PPI therapy.METHODS Patients suspected of having LPR were prospectively recruited from otolaryngologic clinics in three Taiwan residents tertiary centers.They underwent a 24-hour esophagopharyngeal pH test using either 3-pH-sensor or hypopha-ryngeal MII-pH catheters while off medication,followed by a 12-week esomeprazole course(40 mg twice daily).Participants were categorized into four groups based on pH results:PAR alone,EAR alone,both pH(+),and both pH(-).The primary outcome was a≥50%reduction in primary laryngeal symptoms,with observers blinded to group assignments.RESULTS A total of 522 patients(mean age 52.3±12.8 years,54%male)were recruited.Of these,190(mean age 51.5±12.4 years,61%male)completed the treatment,and 89(47%)responded to PPI therapy.Response rates were highest in the PAR alone group(73%,n=11),followed by EAR alone(59%,n=68),both pH(+)(56%,n=18),and both pH(-)(33%,n=93).Multivariate analysis adjusting for age,sex,body mass index,and endoscopic esophagitis showed that participants with PAR alone,EAR alone,and both pH(+)were 7.4-fold(P=0.008),4.2-fold(P=0.0002),and 3.4-fold(P=0.03)more likely to respond to PPI therapy,respectively,compared to the both pH(-)group.Secondary analyses using the definition of≥1 PAR episode were less robust.CONCLUSION In the absence of proven hypopharyngeal predictors,this post-hoc analysis found that baseline≥2 PAR episodes alone are linked to PPI responsiveness,suggesting the importance of hypopharyngeal reflux monitoring.

Chronology of the Tungsten Deposits in Southern Jiangxi Province, and Episodes and Zonation of the Regional W-Sn Mineralization-Evidence from High-precision Zircon U-Pb, Molybdenite Re-Os and Muscovite Ar-Ar Ages

Previous studies have obtained some petrogenetic and metallogenic chronological data with SHRIMP （sensitive high-resolution ion microprobe） zircon U-Pb, zircon LA-ICPMS （laser-ablation-inductively coupled plasma mass spectroscopy） U-Pb, molybdenite Re-Os isochron and muscovite Ar-Ar methods in southern Jiangxi Province and its adjacent areas. Based on these, the purpose of this paper is to study the petrogenetic and metallogenic ages and their time gap for different genetic types of W-Sn deposits, and thus to research their numerous episodes, zonal arrangement and their geodynamic background. The result shows that the large-scale W-Sn mineralization in southern Jiangxi Province occurred in the middle to late Jurassic （170-150 Ma）, the skarn W-Sn-polymetallic deposits formed much earlier （170-161 Ma）, and all of the wolframite-quartz vein type, greisen type, altered granite type and fractured zone type tungsten deposits formed in the late Jurassic （160-150 Ma）. In one ore field or ore district, greisen type tungsten deposits formed earlier than quartz vein type ones hosted in the endoor exo-contact zone; and quartz vein type hosted in the endocontact zone formed earlier than that of exocontact zone. There is no significant time difference between tungstentin mineralization and its intimately associated parent granite emplacement （1-6 Ma）. They all formed in the same rock-forming and ore-forming system and under the same geodynamic setting. Regionally, rock-forming and ore-forming processes of the W-Sn deposits in the Nanling region （include southern Jiangxi Province, southern Hunan Province, northern Guangdong Province and eastern Guangxi Zhuang Autonomous Region） exhibit numerous episodes. The mineralization in the Nanling region mainly occurred at （240-210） Ma, （170-150） Ma and （130-90） Ma. The tungsten-tin deposits in this region are centered by the largest scale in southern Jiangxi Province and southern Hunan Province, and become small in the east, west, south and north directions. This displays a zonal arrangement and temporal and spatial distribution regularity. Integrated with the latest research results, it is concluded that the W-Sn mineralization in southern Jiangxi Province and its adjacent areas corresponds to the second large-scale mineralization in South China. The Indosinian W-Sn mineralization formed under the extensional tectonic regime between collisional compressional stages, while the Yanshanian large-scale petrogenetic and metallogenic processes occurred in the Jurassic intraplate extensional geodynamic setting of lithosphere extension.

Delayed Impacts of the El Nio Episodes in the Central Pacific on the Summertime Climate Anomalies of Eastern China in 2003 and 2007

In the summers of 2003 and 2007, eastern China suffered similar climate disasters with severe flooding in the Huaihe River valley and heat waves in the southern Yangtze River delta and South China. Using SST data and outgoing longwave radiation （OLR） data from NOAA along with reanalysis data from NCEP/NCAR, the 2002/03 and 2006/07 E1 Nifio episodes in the central Pacific and their delayed impacts on the following early summertime climate anomalies of eastern China were analyzed. The possible physical progresses behaved as follows： Both of the moderate E1 Ninio episodes matured in the central equatorial Pacific during the early winter. The zonal wind anomalies near the sea surface of the west-central equatorial Pacific excited equatorial Kelvin waves propagating eastward and affected the evolution of the E1 Nifio episodes. From spring to early summer, the concurring anomalous easterly winds in the central equatorial Pacific and the end of upwelling Kelvin waves propagating eastward in the western equatorial Pacific, favored the equatorial warm water both of the SST and the subsurface temperature in the western Pacific. These conditions favored the warm state of the western equatorial Pacific in the early summer for both cases of 2003 and 2007. Due to the active convection in the western equatorial Pacific in the early summer and the weak warm SST anomalies in the tropical western Pacific from spring to early summer, the convective activities in the western Pacific warm pool showed the pattern in which the anomalous strong convection only appeared over the southern regions of the tropical western Pacific warm pool, which effects the meridional shift of the western Pacific subtropical high in the summer. The physical progress of the delayed impacts of the E1 Nino episodes in the central equatorial Pacific and their decaying evolution on the climate anomalies in eastern China were interpreted through the key role of special pattern for the heat convection in the tropical western Pacific warm pool and the response of the western North Pacific anomalous anticyclone.

Episodes of Cenozoic Gold Mineralization on the Eastern Margin of the Qinghai-Tibet Plateau:40Ar/39Ar Dating and Implication for Geodynamic Events

A lot of new gold deposits have been found on the eastern margin of the Qinghai-Tibet Plateau during the past two decades. Among them, three main types of gold deposits have been recognized, including quartz-vein-type, shear- zone-type and porphyry-type. The former two types of gold deposits are mainly hosted within metamorphic rocks, while the latter is related to Cenozoic magmatism. Although all of these gold deposits are believed to have been formed during the uplift process of the Qinghai-Tibet Plateau in the Cenozoic era (Wang et al., 2002b), precise isotopic age constraints have still been lacking until quite recently. This paper presents new 40Ar/39Ar data of some gold deposits on the eastern margin of the Qinghai-Tibet Plateau, which indicate that gold mineralization in the region occurred in response to the episodic stages of the orogenies. Recently obtained 40Ar/39Ar data on quartz and feldspars from several gold deposits, such as the Sandiao deposit, the Baijintaizi deposit, the Pusagang deposits, provide new constraints on gold mineralization on the eastern margin of the Qinghai-Tibet Plateau. Geochronological studies of gold deposits along the Daduhe River indicate that there are three stages of gold mineralization. The early two stages occurred as early as 65.1 Ma in the Shuibaiyang deposit and 58.95 Ma in the Ruoji deposit, while the latter stage occurred as late as 25.35 Ma in Baijintaizi and 24.70 Ma in Sandiao. Isotopic dating of three plagioclases from the Beiya deposit, Zhifanggou deposit and Luobodi deposit and a K-feldspar from the Jinchangqing deposit in Yunnan Province indicates that these deposits were formed at two stages. The Zhifanggou and Jinchangqing deposits have early stage records as old as 58.82 Ma in Zhifanggou and 55.49 Ma in Jinchangqing, but all of the above four deposits in Yunnan have late stage records of 23.18 Ma in Jinchangqing, 24.54 Ma in Zhifanggou, 24.60 Ma in Luobodi and 24.56 Ma in Hongnitang. The above results suggest that the gold deposits on the eastern margin of the Qinghai-Tibet Plateau were formed concentratedly at two main episodes, i.e. the end of the Paleocene (about 58 Ma) and the boundary between the Paleogene and the Neogene (about 25 Ma). The later episode appears to be looks like more important and was coupled with the Sichuan movement, which was extensively activated at that period. The beginning of the Cenozoic Era (about 65 Ma) might be another episode of gold mineralization, but only one deposit (Shuibaiyang) in this study has been proved to have been be formed at this stage and might be earlier than the initial collision between the Indian Plate and the Eurasia Plate. In view of geology, the above three episodes of gold mineralization are associated with three events of tectonic- magmatism and/or fluid events. Even though the gold deposits (for example, the Shuibaiyang deposit, Ruoji deposit and Pusagang deposit) were formed at different episodes, all of them are genetically related to tectonic movements in large- scale shear zones. It looks like theat tectonic events (including large-scale strike-slip) between Paleogene and Neogene had a wide influence upon gold mineralization, with new deposits formed and old deposits enriched or superimposed to be a higher grade by new stage of mineralization. The above data suggest that gold deposits were not only concentrated in some areas, but also formed mainly at different boundaries of geological times, indicating that there existed some peak stages of gold mineralization (metallogenic episodes), and that the gold deposits were formed mainly by episodic mineralization.

THE FREQUENCY CHARACTERISTICS OF WARM AND COLD EPISODES IN THE NIO REGIONS

On the basis of NOAA/CPC data of sea surface temperature anomaly in the Nifio regions during Jan. 1950 - Dec. 2003, the wavelet power spectrum of SST were studied with significance and confidence testing at different scales in this paper. It shows that the SST are provided with multi-time scales structure nested one another, and vary on scales of 2 - 7 years, 8 - 20 years and 〉30 years. The most significant variation of the warm and cold episodes is in the 4-year band of period. The power, frequency structure and confidence of the same episode are different in different Nino regions. The intensity of oscillations is increasing at low frequency bands and decreasing at high frequency bands from east to west in the Nino regions, especially after 1970.

EVALUATION OF MITOCHONDRIAL ENCEPHALOMYOPATHY WITH LACTIC ACIDOSIS AND STROKE-LIKE EPISODES WITH MAGNETIC RESONANCE IMAGING AND PROTON MAGNETIC RESONANCE SPECTROSCOPY

Objective To study the characteristics of spectra on proton magnetic resonance spectroscopy （^1H-MRS） and its value in patients with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes （MELAS）. Methods Seven clinically diagnosed patients with MELAS underwent magnetic resonance imaging （MRI） and ^1H-MRS examinations. The ^1H-MRS techniques, characteristics of the spectra, and its correlation with the laboratory tests were analyzed. Reaults Cerebral abnormalities were revealed in all 7 patients on conventional MR images, and most abnormal signals were observed in bilateral occipital, parietal, and temporal lobes. We found 4 cases with basal ganglia involvement, 2 cases with mild frontal lobe lesions, and 1 case with involvement of lateral cerebral peduncles and thalami. Additionally, 1 patient was involved with left insular lobe. Spectra from prominent lesions in brain parenchyma showed lactate doublet peak in 6 patients, 3 of whom were also noted lactate peak in ventricular cerehrospinal fluid （CSF）. Conclusion ^1H-MRS may provide more direct information about the metabolism changes, which aids to affirm the diagnosis, and may replace the conventional invasive method of quantifying lactate in CSF.

Tectonic evolution of structures in Southern Sindh Monocline,Indus Basin,Pakistan formed in multi-extensional tectonic episodes of Indian Plate

There are a number of structures and structural styles found in extensional tectonic settings of the world,and it is a big challenge to study the evolution of these structures. Evolution of structures formed in extensional tectonic settings have been studied by researchers on different extensional basins of the world. Southern Sindh Monocline lies on the western corner of Indian Plate and the tectonic history of Indian plate has also experienced different extensional episodes, and its journey rifted from Gondwanaland to its final welding to Asia. The aim of this study is to figure out the evolution of structures in the subsurface of Southern Sindh Monocline, Pakistan using the seismic data interpretation and flattening of horizons approach. Structures within the subsurface of Southern Sindh Monocline have been characterized by different tectonic episodes of Indian plate while rifting from Gondwanaland, rifting from other plates at different geological times and to its collision with the Asia. Basic structures within study area are classified into nine types while the structural styles have been classified into six types as horst and grabens, dominos, crotch, synthetic and antithetic, negative and flashlight structural style. The structures within the study area revealed evidence for three major structural episodes which can be characterized as Episode 1: Structures associated with rifting of Indian plate from Gondwanaland during Late Jurassic to Early Cretaceous, Episode 2: Modification and reactivation of previous structures while Madagascar rifted from Indian Plate during the Middle Cretaceous and during Episode 3: Inversion and reactivation of structures occurred when Indian Plate collided with Asia during Early Eocene.

Meckel's diverticulum masked by a long period of intermittent recurrent subocclusive episodes

Meckel's diverticulum(MD) is the most frequent congenital abnormality of the small bowel and it is often diff icult to diagnose.It is usually asymptomatic but approximately 4% are symptomatic with complications such as bleeding,intestinal obstruction,and inflammation.The authors report a case of a 7-year-old boy with a one-year history of recurrent periumbilical colicky pain with associated alimentary vomiting,symptoms erroneously related to a cyclic vomiting syndrome but not to MD.The clinical features and the differential diagnostic methods employed for diagnosis of MD are discussed.

Mucosal necrosis of the small intestine in myopathy,encephalopathy,lactic acidosis,and stroke-like episodes syndrome

This report presents a case of massive mucosal necrosis of the small intestine in a patient with mitochondrial myopathy,encephalopathy,lactic acidosis,and stroke-like episodes(MELAS),which particularly affects the brain,nervous system and muscles.A 45-year-old Japanese female,with an established diagnosis of MELAS,presented with vomiting.Computed tomography showed portomesenteric venous gas and pneumatosis intestinalis.She underwent a resection of the small intestine.A microscopic study showed necrosis of the mucosa and vacuolar degeneration of smooth muscle cells in the arterial wall.Immunohistochemistry showed anti-mitochondrial antibody to be highly expressed in the crypts adjacent the necrotic mucosa.The microscopic and immunohistochemical findings suggested the presence of a large number of abnormal mitochondria in MELAS to be closely linked to mucosal necrosis of the small intestine.

Modeling Arctic Ocean heat transport and warming episodes in the 20th century caused by the intruding Atlantic Water

This study investigates the Arctic Ocean warming episodes in the 20th century using both a high-resolution coupled global climate model and historical observations. The model, with no flux adjustment, reproduces well the Atlantic Water core temperature （AWCT） in the Arctic Ocean and shows that four largest decadalscale warming episodes occurred in the 1930s, 70s, 80s, and 90s, in agreement with the hydrographic observational data. The difference is that there was no pre-warming prior to the 1930s episode, while there were two pre-warming episodes in the 1970s and 80s prior to the 1990s, leading the 1990s into the largest and prolonged warming in the 20th century. Over the last century, the simulated heat transport via Fram Strait and the Barents Sea was estimated to be, on average, 31.32 TW and 14.82 TW, respectively, while the Bering Strait also provides 15.94 TW heat into the west- ern Arctic Ocean. Heat transport into the Arctic Ocean by the Atlantic Water via Fram Strait and the Barents Sea correlates significantly with AWCT （ C = 0.75 ） at 0- lag. The modeled North Atlantic Oscillation （NAO） index has a significant correlation with the heat transport （ C = 0.37 ）. The observed AWCT has a significant correlation with both the modeled AWCT （ C =0.49） and the heat transport （ C =0.41 ）. However, the modeled NAO index does not significantly correlate with either the observed AWCT （ C = 0.03 ） or modeled AWCT （ C = 0.16 ） at a zero-lag, indicating that the Arctic climate system is far more complex than expected.

Health Risk Impacts of Exposure to Airborne Metals and Benzo(a)Pyrene during Episodes of High PM10 Concentrations in Poland

Objective To check whether health risk impacts of exposure to airborne metals and Benzo（a） Pyrene during episodes of high PM10 concentrations lead to an increased number of lung cancer cases in Poland. Methods In this work, we gathered data from 2002 to 2014 concerning the ambient concentrations of PM10 and PM10-bound carcinogenic Benzo（a）pyrene [B（a）P] and As, Cd, Pb, and Ni. With the use of the criterion of the exceedance in the daily PM10 mass concentration on at least 50% of all the analyzed stations, the PM10 maxima’s were selected. Lung cancer occurrences in periods with and without the episodes were further compared. Results During a 12-year period, 348 large-scale smog episodes occurred in Poland. A total of 307 of these episodes occurred in the winter season, which is characterized by increased emissions from residential heating. The occurrence of episodes significantly （P 〈 0.05） increased the concentrations of PM10-bound carcinogenic As, Cd, Pb, Ni, and B（a）P. During these events, a significant increase in the overall health risk from those PM10-related compounds was also observed. The highest probability of lung cancer occurrences was found in cities, and the smallest probability was found in the remaining areas outside the cities and agglomerations. Conclusion The link between PM pollution and cancer risk in Poland is a serious public health threat that needs further investigation.

Nature of Three Episodes of Magmatism(2181 Ma, 2115 Ma and 1891 Ma) in the Liaohe Rift of North China: Implications for Tectonic Evolution

To define a tectonic environment switching from rifting to subduction and their respective duration time are usually largely debated.Such case occurs for the Liaohe rift:whether it went through a long subduction from 2100to 1850 Ma or there were two different events in different

REDEFINING ENSO EPISODES BASED ON CHANGED CLIMATE REFERENCES

Through studying changes in ENSO indices relative to change of climate reference from 1961~1990 to 1971~2000, the study generated new standards to define ENSO episodes and their intensities. Then according to the new climate references and new index standards, ENSO episodes and their intensities for the period 1951 -2003 have been classified. Finally, an analysis has been performed comparing the new characteristics with the old ones for ENSO period, peak values and intensities.

X-linked Charcot-Marie-Tooth disease after SARS-CoV-2 vaccination mimicked stroke-like episodes: A case report

BACKGROUND Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) vaccinations have been administered worldwide, with occasional reports of associated neurological complications. Specifically, the impact of vaccinations on individuals with Xlinked Charcot-Marie-Tooth disease type 1(CMTX1) is unclear. Patients with CMTX1 can have stroke-like episodes with posterior reversible encephalopathy syndrome on magnetic resonance imaging(MRI), although this is rare.CASE SUMMARY A 39-year-old man was admitted with episodic aphasia and dysphagia for 2 d. He received SARS-CoV-2 vaccination 39 d before admission. Physical examination showed pes cavus and reduced tendon reflexes. Brain MRI showed bilateral, symmetrical, restricted diffusion with T2 hyperintensities in the cerebral hemispheres. Nerve conduction studies revealed peripheral nerve damage. He was diagnosed with Charcot-Marie-Tooth disease, and a hemizygous mutation in the GJB1 gene on the X chromosome, known to be pathogenic for CMTX1, was identified. Initially, we suspected transient ischemic attack or demyelinating leukoencephalopathy. We initiated treatment with antithrombotic therapy and immunotherapy. At 1.5 mo after discharge, brain MRI showed complete resolution of lesions, with no recurrence.CONCLUSION SARS-CoV-2 vaccination could be a predisposing factor for CMTX1 and trigger a sudden presentation.

Neoproteroic Magmatism Related to Lithospheric Delamination: Implications from Three Episodes of Mafic Dykes and Associated Granitoids in the Pengguan Complex, Western Sichuan Province, Yangtze Block

The research on dyke swarms is very important,for it can not only shed light on within-plate geological processes of some regions but also contribute to our understanding on evolution of a specific orogenic belt.The Yangtze Block,

An efficient algorithm to generate candidates in discovering frequent episodes

One of the important steps in mining event sequences is to find frequent episodes. Once the frequent episodes are discovered, rules about temporal relationships can he derived. In this paper, an cfficient algorithm for discovering frequent episodes is presented based on the level-wise search algorithm WINEPI. The proposed algorithm gains hetter candidate generation quality by introducing a new Lemma to help to target the combinations of episodes that are interesting in the next level and thins reduces the execution time. Experimental results on artificial and real data show the enhanced efficiency of the algorithm.

AN OPERATIONAL AUTO-MONITORING FOR THE EL NIO EPISODES USING GMS T_(BB)

By making full use of GMS TBB data, diagnosis and analysis of the formation and development of El Ni駉 event in 2002 and 2003 were made. It suggests that the first clue of the El Ni event appeared in December 2001. The event was formed at the end of 2002 after five phases of development, and came into the phase of flourishing in the winter of 2002. From the analysis the dynamics, it is noted that that the position of the ascending branch of Walker cell was moving from the equatorial west Pacific to the equatorial central Pacific in the phase of formation and development of the El Ni駉 event. The process of diagnosis shows that it can provide an important clue for forecasting the genesis and development of the El Ni駉 episodes.

The Personality Beauty Thought in New Accounts of Old Episodes

“New Accounts of Old Episodes”is a classic handed down in China,which reflects the personality image and charm of the scholars in the Wei and Jin dynasties with the original ecological narrative technique.The scholars of the Wei and Jin Dynasties were detached,facing the world with an aesthetic attitude beyond secular utilitarianism,etiquette,and real life,establish a graceful social stage of vulgarity,create a unique personality beauty,providing valuable ideological wealth for the cultivation of poetic spirit,poetic dwelling,aesthetic style,transcend personality,and wisdom.

Subgrouping time-dependent prescribing patterns of first-onset major depressive episodes by psychotropics dissection

BACKGROUND Subgrouping patients with major depressive disorder is a promising solution for the issue of heterogeneity.However,the link between available subtypes and distinct pathological mechanisms is weak and yields disappointing results in clinical application.AIM To develop a novel approach for classification of patients with time-dependent prescription patterns at first onset in real-world settings.METHODS Drug-naive patients experiencing their first major depressive episode(n=105)participated in this study.Psychotropic agents prescribed in the first 24 mo following disease onset were recorded monthly and categorized as antidepressants,augmentation agents,and hypnosedatives.Monthly cumulative doses of agents in each category were converted into relevant equivalents.Four parameters were used to summarize the time-dependent prescription patterns for each psychotropic load:Stability,amount,frequency,and the time trend of monthly prescriptions.A K-means cluster analysis was used to derive subgroups of participants based on these input parameters of psychotropic agents across 24 mo.Clinical validity of the resulting data-driven clusters was compared using relevant severity indicators.RESULTS Four distinct clusters were derived from K-means analysis,which matches experts’consent:"Short-term antidepressants use","long-term antidepressants use","long-term antidepressants and sedatives use",and"long-term antidepressants,sedatives,and augmentation use".At the first 2 years of disease course,the four clusters differed on the number of antidepressants used at adequate dosage and duration,frequency of outpatient service use,and number of psychiatric admissions.After the first 2 years following disease onset,depression severity was differed in the four subgroups.CONCLUSION Our findings suggested a new approach to optimize the subgrouping of patients with major depressive disorder,which may assist future etiological and treatment response studies.