Third-line and rescue therapy for refractory Helicobacter pylori infection: A systematic review

BACKGROUND Due to increasing resistance rates of Helicobacter pylori(H.pylori)to different antibiotics,failures in eradication therapies are becoming more frequent.Even though eradication criteria and treatment algorithms for first-line and second-line therapy against H.pylori infection are well-established,there is no clear recommendation for third-line and rescue therapy in refractory H.pylori infection.AIM To perform a systematic review evaluating the efficacy and safety of rescue therapies against refractory H.pylori infection.METHODS A systematic search of available rescue treatments for refractory H.pylori infection was conducted on the National Library of Medicine’s PubMed search platform based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Randomized or non-randomized clinical trials and observational studies evaluating the effectiveness of H.pylori infection rescue therapies were included.RESULTS Twenty-eight studies were included in the analysis of mean eradication rates as rescue therapy,and 21 of these were selected for analysis of mean eradication rate as third-line treatment.For rifabutin-,sitafloxacin-,levofloxacin-,or metronidazole-based triple-therapy as third-line treatment,mean eradication rates of 81.6%and 84.4%,79.4%and 81.5%,55.7%and 60.6%,and 62.0%and 63.0%were found in intention-to-treat(ITT)and per-protocol(PP)analysis,respectively.For third-line quadruple therapy,mean eradication rates of 69.2%and 72.1%were found for bismuth quadruple therapy(BQT),88.9%and 90.9%for bismuth quadruple therapy,three-in-one,Pylera®(BQT-Pylera),and 61.3%and 64.2%for non-BQT)in ITT and PP analysis,respectively.For rifabutin-,sitafloxacin-,levofloxacin-,or metronidazole-based triple therapy as rescue therapy,mean eradication rates of 75.4%and 78.8%,79.4 and 81.5%,55.7%and 60.6%,and 62.0%and 63.0%were found in ITT and PP analysis,respectively.For quadruple therapy as rescue treatment,mean eradication rates of 76.7%and 79.2%for BQT,84.9%and 87.8%for BQT-Pylera,and 61.3%and 64.2%for non-BQT were found in ITT and PP analysis,respectively.For susceptibility-guided therapy,mean eradication rates as third-line and rescue treatment were 75.0%in ITT and 79.2%in PP analysis.CONCLUSION We recommend sitafloxacin-based triple therapy containing vonoprazan in regions with low macrolide resistance profile.In regions with known resistance to macrolides or unavailability of bismuth,rifabutin-based triple therapy is recommended.

A Systematic Approach for Exploring Underground Environment Using LiDAR-Based System

Agricultural projects in different parts of the world depend on underground water wells.Recently,there have been many unfortunate incidents inwhich children have died in abandoned undergroundwells.Providing topographical information for these wells is a prerequisite to protecting people from the dangers of falling into them,especially since most of these wells become buried over time.Many solutions have been developed recently,most with the aimof exploring these well areas.However,these systems suffer fromseveral limitations,including high complexity,large size,or inefficiency.This paper focuses on the development of a smart exploration unit that is able to investigate underground well areas,build a 3D map,search for persons and animals,and determine the levels of oxygen and other gases.The exploration unit has been implemented and validated through several experiments using various experiment testbeds.The results proved the efficiency of the developed exploration unit,in terms of 3D modeling,searching,communication,and measuring the level of oxygen.The average accuracy of the 3D modeling function is approximately 95.5%.A benchmark has been presented for comparing our results with related works,and the comparison has proven the contributions and novelty of the proposed system’s results.

Performance Evaluation of Three-Dimensional UWB Real-Time Locating Auto-Positioning System for Fire Rescue

Fire rescue challenges and solutions have evolved from straightfor-ward plane rescue to encompass 3D space due to the rise of high-rise city buildings.Hence,this study facilitates a system with quick and simplified on-site launching and generates real-time location data,enabling fire rescuers to arrive at the intended spot faster and correctly for effective and precise rescue.Auto-positioning with step-by-step instructions is proposed when launching the locating system,while no extra measuring instrument like Total Station(TS)is needed.Real-time location tracking is provided via a 3D space real-time locating system(RTLS)constructed using Ultra-wide Bandwidth technology(UWB),which requires electromagnetic waves to pass through concrete walls.A hybrid weighted least squares with a time difference of arrival(WLS/TDOA)positioning method is proposed to address real path-tracking issues in 3D space and to meet RTLS requirements for quick computing in real-world applications.The 3D WLS/TDOA algorithm is theoretically constructed with the Cramer-Rao lower bound(CRLB).The computing complexity is reduced to the lower bound for embedded hardware to directly compute the time differential of the arriving signals using the time-to-digital converter(TDC).The results of the experiments show that the errors are controlled when the positioning algorithm is applied in various complicated situations to fulfill the requirements of engineering applications.The statistical analysis of the data reveals that the proposed UWB RTLS auto-positioning system can track target tags with an accuracy of 0.20 m.

Intelligent fire information system based on 3D GIS

Background This work aims to build a comprehensive and effective fire emergency management system based on the Internet of Things(IoT)and achieve an actual intelligent fire rescue.A smart fire protection information system was designed based on the IoT.A detailed analysis was conducted on the problem of rescue vehicle scheduling and the evacuation of trapped persons in the process of fire rescue.Methods The intelligent fire visualization platform based on the three-dimensional(3D)Geographic Information Science(GIS)covers project overview,equipment status,equipment classification,equipment alarm information,alarm classification,alarm statistics,equipment account information,and other modules.The live video accessed through the visual interface can clearly identify the stage of the fire,which facilitates the arrangement of rescue equipment and personnel.The vehicle scheduling model in the system primarily used two objective functions to solve the Pareto Non-Dominated Solution Set Optimization:emergency rescue time and the number of vehicles.In addition,an evacuation path optimization method based on the Improved Ant Colony(IAC)algorithm was designed to realize the dynamic optimization of building fire evacuation paths.Results The experimental results indicate that all the values of detection signals were significantly larger in the smoldering fire scene at t=17s than the initial value.In addition,the probability of smoldering fire and the probability of open fire were relatively large according to the probability function of the corresponding fire situation,demonstrating that this model could detect fire.Conclusions The IAC algorithm reported here avoided the passages near the fire and spreading areas as much as possible and took the safety of the trapped persons as the premise when planning the evacuation route.Therefore,the IoT-based fire information system has important value for ensuring fire safety and carrying out emergency rescue and is worthy of popularization and application.

Real-time Rescue Target Detection Based on UAV Imagery for Flood Emergency Response

Timely acquisition of rescue target information is critical for emergency response after a flood disaster.Unmanned Aerial Vehicles(UAVs)equipped with remote sensing capabilities offer distinct advantages,including high-resolution imagery and exceptional mobility,making them well suited for monitoring flood extent and identifying rescue targets during floods.However,there are some challenges in interpreting rescue information in real time from flood images captured by UAVs,such as the complexity of the scenarios of UAV images,the lack of flood rescue target detection datasets and the limited real-time processing capabilities of the airborne on-board platform.Thus,we propose a real-time rescue target detection method for UAVs that is capable of efficiently delineating flood extent and identifying rescue targets(i.e.,pedestrians and vehicles trapped by floods).The proposed method achieves real-time rescue information extraction for UAV platforms by lightweight processing and fusion of flood extent extraction model and target detection model.The flood inundation range is extracted by the proposed method in real time and detects targets such as people and vehicles to be rescued based on this layer.Our experimental results demonstrate that the Intersection over Union(IoU)for flood water extraction reaches an impressive 80%,and the IoU for real-time flood water extraction stands at a commendable 76.4%.The information on flood stricken targets extracted by this method in real time can be used for flood emergency rescue.

Substitutions of stem-loop subdomains in internal ribosome entry site of Senecavirus A:Impacts on rescue of sequence-modifying viruses

Senecavirus A(SVA)has a positive-sense,single-stranded RNA genome.Its 5´untranslated region harbors an internal ribosome entry site(IRES),comprising 10 larger or smaller stem-loop structures(including a pseudoknot)that have been demonstrated to be well conserved.However,it is still unclear whether each stem-loop subdomain,such as a single stem or loop,is also highly conserved.To clarify this issue in the present study,a set of 29 SVA cDNA clones were constructed by site-directed mutagenesis(SDM)on the IRES.The SDM-modified scenarios included:(1)stem-formed complementary sequences exchanging with each other;(2)loop transversion;(3)loop transition;and(4)point mutations.All cDNA clones were separately transfected into cells for rescuing viable viruses,whereas only four SVAs of interest could be recovered,and were genetically stable during 20 passages.One progeny grew significantly slower than the other three did.The dual-luciferase reporter assay showed that none of the SDM-modified IRESes significantly inhibited the IRES activity.Our previous study indicated that a single motif from any of the ten stem structures,if completely mutated,would cause the failure of virus recovery.Interestingly,our present study revealed three stem structures,whose individual complementary sequences could exchange with each other to rescue sequence-modifying SVAs.Moreover,one apical loop was demonstrated to have the ability to tolerate its own full-length transition,also having no impact on the recovery of sequence-modifying SVA.The present study suggested that not every stem-loop structure was strictly conserved in its conformation,while the full-length IRES itself was well conserved.This provides a new research direction on interaction between the IRES and many factors.

Design of AI-Enhanced and Hardware-Supported Multimodal E-Skin for Environmental Object Recognition and Wireless Toxic Gas Alarm

Post-earthquake rescue missions are full of challenges due to the unstable structure of ruins and successive aftershocks.Most of the current rescue robots lack the ability to interact with environments,leading to low rescue efficiency.The multimodal electronic skin(e-skin)proposed not only reproduces the pressure,temperature,and humidity sensing capabilities of natural skin but also develops sensing functions beyond it—perceiving object proximity and NO2 gas.Its multilayer stacked structure based on Ecoflex and organohydrogel endows the e-skin with mechanical properties similar to natural skin.Rescue robots integrated with multimodal e-skin and artificial intelligence(AI)algorithms show strong environmental perception capabilities and can accurately distinguish objects and identify human limbs through grasping,laying the foundation for automated post-earthquake rescue.Besides,the combination of e-skin and NO2 wireless alarm circuits allows robots to sense toxic gases in the environment in real time,thereby adopting appropriate measures to protect trapped people from the toxic environment.Multimodal e-skin powered by AI algorithms and hardware circuits exhibits powerful environmental perception and information processing capabilities,which,as an interface for interaction with the physical world,dramatically expands intelligent robots’application scenarios.

Vonoprazan-amoxicillin dual regimen with Saccharomyces boulardii as a rescue therapy for Helicobacter pylori:Current perspectives and implications

Yu et al’s study in the World Journal of Gastroenterology(2023)introduced a novel regimen of Vonoprazan-amoxicillin dual therapy combined with Saccharomyces boulardii(S.boulardii)for the rescue therapy against Helicobacter pylori(H.pylori),a pathogen responsible for peptic ulcers and gastric cancer.Vonoprazan is a potassium-competitive acid blocker renowned for its rapid and long-lasting acid suppression,which is minimally affected by mealtime.Compared to proton pump inhibitors,which bind irreversibly to cysteine residues in the H+/K+-ATPase pump,Vonoprazan competes with the K+ions,prevents the ions from binding to the pump and blocks acid secretion.Concerns with increasing antibiotic resistance,effects on the gut microbiota,patient compliance,and side effects have led to the advent of a dual regimen for H.pylori.Previous studies suggested that S.boulardii plays a role in stabilizing the gut barrier which improves H.pylori eradication rate.With an acceptable safety profile,the dual-adjunct regimen was effective regardless of prior treatment failure and antibiotic resistance profile,thereby strengthening the applicability in clinical settings.Nonetheless,S.boulardii comes in various formulations and dosages,warranting further exploration into the optimal dosage for supplementation in rescue therapy.Additionally,larger,randomized,double-blinded controlled trials are warranted to confirm these promising results.

Device-assisted enteroscopy: Are we ready to dismiss the spiral?

Motorized spiral enteroscopy(MSE)is the latest advance in device-assisted enteroscopy.Adverse events related to MSE were discussed in a recent large systematic review and meta-analysis and were directly compared with those of balloon enteroscopy in a case-matched study and a randomized controlled trial.Following the real-life application of MSE,an unexpected safety issue emerged regarding esophageal injury and the technique has been withdrawn from the global market,despite encouraging results in terms of diagnostic and therapeutic yield.We conducted an Italian multicenter real-life prospective study,which was prematurely terminated after the withdrawal of MSE from the market.The primary goals were the evaluation of MSE performance(both diagnostic and therapeutic)and its safety in routine endoscopic practice,particularly in the early phase of introduction in the endoscopic unit.A subanalysis,which involved patients who underwent MSE after unsuccessful balloon enteroscopy,demonstrated,for the first time,the promising performance of MSE as a rescue procedure.Given its remarkable performance in clinical practice and its potential role as a backup technique following a previously failed enteroscopy,it may be more appropriate to refine and enhance MSE in the future rather than completely abandoning it.

An Improved Iterated Greedy Algorithm for Solving Rescue Robot Path Planning Problem with Limited Survival Time

Effective path planning is crucial for mobile robots to quickly reach rescue destination and complete rescue tasks in a post-disaster scenario.In this study,we investigated the post-disaster rescue path planning problem and modeled this problem as a variant of the travel salesman problem(TSP)with life-strength constraints.To address this problem,we proposed an improved iterated greedy(IIG)algorithm.First,a push-forward insertion heuristic(PFIH)strategy was employed to generate a high-quality initial solution.Second,a greedy-based insertion strategy was designed and used in the destruction-construction stage to increase the algorithm’s exploration ability.Furthermore,three problem-specific swap operators were developed to improve the algorithm’s exploitation ability.Additionally,an improved simulated annealing(SA)strategy was used as an acceptance criterion to effectively prevent the algorithm from falling into local optima.To verify the effectiveness of the proposed algorithm,the Solomon dataset was extended to generate 27 instances for simulation.Finally,the proposed IIG was compared with five state-of-the-art algorithms.The parameter analysiswas conducted using the design of experiments(DOE)Taguchi method,and the effectiveness analysis of each component has been verified one by one.Simulation results indicate that IIGoutperforms the compared algorithms in terms of the number of rescue survivors and convergence speed,proving the effectiveness of the proposed algorithm.

Failure to Rescue as a Quality Metric in Congenital Heart Surgeries in a High-Complexity Service Provider Institution Located in a Middle-Income Country

Background:Failure to rescue has been an effective quality metric in congenital heart surgery.Conversely,mor-bidity and mortality depend greatly on non-modifiable individual factors and have a weak correlation with better-quality performance.We aim to measure the complications,mortality,and risk factors in pediatric patients undergoing congenital heart surgery in a high-complexity institution located in a middle-income country and compare it with other institutions that have conducted a similar study.Methods:A retrospective observational study was conducted in a high-complexity service provider institution,in Cali,Colombia.All pediatric patients undergoing any congenital heart surgery between 2019 and 2022 were included.The main outcomes evaluated in the study were complication,mortality,and failure to rescue rate.Univariate and multivariate logistic regression analysis was performed with mortality as the outcome variable.Results:We evaluated 308 congenital heart sur-geries.Regarding the outcomes,201(65%)complications occurred,23(7.5%)patients died,and the FTR of the entire cohort was 11.4%.The presence of a postoperative complication(OR 14.88,CI 3.06–268.37,p=0.009),age(OR 0.79,CI 0.57–0.96,p=0.068),and urgent/emergent surgery(OR 8.14,CI 2.97–28.66,p<0.001)were the most significant variables in predicting mortality.Conclusions:Failure to rescue is an effective and comparable quality measure in healthcare institutions and is the major contributor to postoperative mortality in congenital heart surgeries.Despite our higher mortality and complication rate,we obtained a comparable failure to rescue rate to high-income countries’health institutions.

Rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center:Value of tailored peri-pancreatectomy protocols

BACKGROUND Pancreaticoduodenectomy(PD)is a technically complex operation,with a re-latively high risk for complications.The ability to rescue patients from post-PD complications is as a recognized quality measure.Tailored protocols were instituted at our low volume facility in the year 2013.AIM To document the rate of rescue from post-PD complications with tailored protocols in place as a measure of quality.METHODS A retrospective audit was performed to collect data from patients who experienced major post-PD complications at a low volume pancreatic surgery unit in Trinidad and Tobago between January 1,2013 and June 30,2023.Stan-dardized definitions from the International Study Group of Pancreatic Surgery were used to define post-PD complications,and the modified Clavien-Dindo classification was used to classify post-PD complications.RESULTS Over the study period,113 patients at a mean age of 57.5 years(standard deviation[SD]±9.23;range:30-90;median:56)underwent PDs at this facility.Major complications were recorded in 33(29.2%)patients at a mean age of 53.8 years(SD:±7.9).Twenty-nine(87.9%)patients who experienced major morbidity were salvaged after aggre-ssive treatment of their complication.Four(3.5%)died from bleeding pseudoaneurysm(1),septic shock secondary to a bile leak(1),anastomotic leak(1),and myocardial infarction(1).There was a significantly greater salvage rate in patients with American Society of Anesthesiologists scores≤2(93.3%vs 25%;P=0.0024).CONCLUSION This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring PD.Despite low volumes at our facility,we demonstrated that 87.9%of patients were rescued from major complications.We attributed this to several factors including development of rescue protocols,the competence of the pancreatic surgery teams and continuous,and adaptive learning by the entire institution,cul-minating in the development of tailored peri-pancreatectomy protocols.

Benchmarking YOLOv5 models for improved human detection in search and rescue missions

Drone or unmanned aerial vehicle(UAV)technology has undergone significant changes.The technology allows UAV to carry out a wide range of tasks with an increasing level of sophistication,since drones can cover a large area with cameras.Meanwhile,the increasing number of computer vision applications utilizing deep learning provides a unique insight into such applications.The primary target in UAV-based detection applications is humans,yet aerial recordings are not included in the massive datasets used to train object detectors,which makes it necessary to gather the model data from such platforms.You only look once(YOLO)version 4,RetinaNet,faster region-based convolutional neural network(R-CNN),and cascade R-CNN are several well-known detectors that have been studied in the past using a variety of datasets to replicate rescue scenes.Here,we used the search and rescue(SAR)dataset to train the you only look once version 5(YOLOv5)algorithm to validate its speed,accuracy,and low false detection rate.In comparison to YOLOv4 and R-CNN,the highest mean average accuracy of 96.9%is obtained by YOLOv5.For comparison,experimental findings utilizing the SAR and the human rescue imaging database on land(HERIDAL)datasets are presented.The results show that the YOLOv5-based approach is the most successful human detection model for SAR missions.

The Association between Fear of COVID-19,Obsession with COVID-19,and Post Traumatic Stress Disorder in Korean Emergency Rescue Firefighters:A Cross-Sectional Study

During the rapid spread of COVID-19,first responders are at risk of being exposed to COVID-19 due to their role in providing first aid and responding to an unspecified number of people.This uncertainty can have adverse mental health effects,such as increased anxiety and fear.This study aimed to investigate the degree of association between fear of COVID-19,obsession with COVID-19,and post-traumatic stress disorder(PTSD)in emergency rescue firefighters.The participants were 150 emergency rescue firefighters working in Region S,Korea.They filled out self-report questionnaires:The data obtained through the Fear of COVID-19 Scale,Obsession with COVID-19 Scale,and Impact of Event Scale-Revised Korean version were subjected to nonparametric statistical analysis using SPSS WIN 25.0.The study found a significant correlation between emergency rescue firefighters’fear of COVID-19,obsession with COVID-19,and PTSD.Fear and obsession with COVID-19 were higher among first responder firefighters who were directly involved in COVID-19-related tasks.Furthermore,a one-point increase in obsession was associated with a 2.837-point increase in PTSD.Based on the results,we found that there is a need for effective control of obsessions and fears among first responder firefighters during COVID-19,and we suggest that there is a need for mental health care for first responder firefighters during the pandemic through the development and support of programs to prevent and mitigate obsessions.

Assessment of Meteorological Threats to the Coordinated Search and Rescue of Unmanned/Manned Aircraft

The architecture and working principle of coordinated search and rescue system of unmanned/manned aircraft,which is composed of manned/unmanned aircraft and manned aircraft,were first introduced,and they can cooperate with each other to complete a search and rescue task.Secondly,a threat assessment method based on meteorological data was proposed,and potential meteorological threats,such as storms and rainfall,can be predicted by collecting and analyzing meteorological data.Finally,an experiment was carried out to evaluate the performance of the proposed method in different scenarios.The experimental results show that the coordinated search and rescue system of unmanned/manned aircraft can be used to effectively assess meteorological threats and provide accurate search and rescue guidance.

英雄小狗,挽救生命

狗聪明、有洞察力、精力充沛,甚至是现实生活中的英雄。主题语境:人与动物篇幅:346词建议用时:7分钟1 Dogs are incredible. They can be intelligent, insightful, energetic, and real-life heroes! Today, we are commending a dog named Axel, a hero to his whole family. 2 Rescued by the Tanner family in Spring, Axel is about one year old. On August 26, 2023, Axel awakened his owners, Daines and Amanda Tanner, at 5:00 am. Thinking the dog just wanted out, Daines sleepily opened the door. But Axel had stopped in front of the door leading to their 17-year-old son's room and wouldn't budge.

改变人生的礼物

Thanks to the charitable organization Rescue 2000,an elderly woman who had been living in terrible conditions for 32 years finally has a brand new home.82yearold Ibu Latris former residence provided her with the bare minimal shelter from the elements.However,with the help of generous donors,Rescue 2000 was able to build her a beautiful house where shell be way more comfortable.Cris Araya,the founder of the nonprofit,recently shared footage of Ibus upgraded home.

Structural Design Study of Air-Dropped Unmanned Maritime Mobile Search and Rescue Platforms

In order to improve the efficiency and safety of search and rescue(SAR)at sea,this paper proposes a kind of emergency rapid rescue unmanned craft(air-dropped unmanned maritime motorized search and rescue platform)that can be delivered by a large transport aircraft.This paper studies the structural design scheme of the platform,and the main scale of the platform,the choice of power system and the impact resistance performance are considered in the design process to ensure its rapid response and effective rescue capability under complex sea conditions.Simulation results show that the platform can withstand the impact of air injection into the water and the shipboard equipment can operate normally under the impact load,thus verifying the feasibility and safety of the design.This study serves to improve the maritime search and rescue system and enhance the oceanic emergency response capability.

Fractional order PID control for steer-by-wire system of emergency rescue vehicle based on genetic algorithm

Aiming at dealing with the difficulty for traditional emergency rescue vehicle(ECV)to enter into limited rescue scenes,the electro-hydraulic steer-by-wire(SBW)system is introduced to achieve the multi-mode steering of the ECV.The overall structure and mathematical model of the SBW system are described at length.The fractional order proportional-integral-derivative(FOPID)controller based on fractional calculus theory is designed to control the steering cylinder’s movement in SBW system.The anti-windup problem is considered in the FOPID controller design to reduce the bad influence of saturation.Five parameters of the FOPID controller are optimized using the genetic algorithm by maximizing the fitness function which involves integral of time by absolute value error(ITAE),peak overshoot,as well as settling time.The time-domain simulations are implemented to identify the performance of the raised FOPID controller.The simulation results indicate the presented FOPID controller possesses more effective control properties than classical proportional-integral-derivative(PID)controller on the part of transient response,tracking capability and robustness.

Constructing of wireless emergency communication system for underground coal mine based on WMN technology

Based on the Wireless Mesh Network (WMN), a wireless emergency communicationsystem for underground coal mine which was designed to be capable of videosurveillance, voice communication, and environment monitoring at the same time wasproposed.The network architecture of the system was proposed, and its service model,extensible technology, medium access control, routing algorithm, channel allocation andsystem management technologies were analyzed according to the actual rescue requirementsof underground coal mine and the characteristics of underground spatial structureand radio transmissions.The relevant theories and key technologies were extracted,which would provide theoretical support for the system development.