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%.

Organic Matter Accumulation in the Upper Permian Dalong Formation from the Lower Yangtze Region,South China

The Late Permian was marked by a series of important geological events and widespread organic-rich black shale depositions,acting as important unconventional hydrocarbon source rocks.However,the mechanism of organic matter(OM)enrichment throughout this period is still controversial.Based on geochemical data,the marine redox conditions,paleogeographic and hydrographic environment,primary productivity,volcanism,and terrigenous input during the Late Permian in the Lower Yangtze region have been studied from the Putaoling section,Chaohu,to provide new insights into OM accumulation.Five Phases are distinguished based on the TOC and environmental variations.In Phase I,anoxic conditions driven by water restriction enhanced OM preservation.In Phase II,euxinic and cycling hydrological environments were the two most substantial controlling factors for the massive OM deposition.During Phase III,intensified terrestrial input potentially diluted the OM in sediment and the presence of oxygen in bottom water weakened the preservation condition.Phase IV was characterized by a relatively higher abundance of mercury(Hg)and TOC(peak at 16.98 wt%),indicating that enhanced volcanism potentially stimulated higher productivity and a euxinic environment.In Phase V,extremely lean OM was preserved as a result of terrestrial dilutions and decreasing primary productivity.Phases I,II and IV are characterized as the most prominent OM-rich zones due to the effective interactions of the controlling factors,namely paleogeographic,hydrographic environment,volcanism,and redox conditions.

Enrichment model and major controlling factors of below-source tight oil in Lower Cretaceous Fuyu reservoirs in northern Songliao Basin,NE China

Based on the geochemical,seismic,logging and drilling data,the Fuyu reservoirs of the Lower Cretaceous Quantou Formation in northern Songliao Basin are systematically studied in terms of the geological characteristics,the tight oil enrichment model and its major controlling factors.First,the Quantou Formation is overlaid by high-quality source rocks of the Upper Cretaceous Qingshankou Formation,with the development of nose structure around sag and the broad and continuous distribution of sand bodies.The reservoirs are tight on the whole.Second,the configuration of multiple elements,such as high-quality source rocks,reservoir rocks,fault,overpressure and structure,controls the tight oil enrichment in the Fuyu reservoirs.The source-reservoir combination controls the tight oil distribution pattern.The pressure difference between source and reservoir drives the charging of tight oil.The fault-sandbody transport system determines the migration and accumulation of oil and gas.The positive structure is the favorable place for tight oil enrichment,and the fault-horst zone is the key part of syncline area for tight oil exploration.Third,based on the source-reservoir relationship,transport mode,accumulation dynamics and other elements,three tight oil enrichment models are recognized in the Fuyu reservoirs:(1)vertical or lateral migration of hydrocarbon from source rocks to adjacent reservoir rocks,that is,driven by overpressure,hydrocarbon generated is migrated vertically or laterally to and accumulates in the adjacent reservoir rocks;(2)transport of hydrocarbon through faults between separated source and reservoirs,that is,driven by overpressure,hydrocarbon migrates downward through faults to the sandbodies that are separated from the source rocks;and(3)migration of hydrocarbon through faults and sandbodies between separated source and reservoirs,that is,driven by overpressure,hydrocarbon migrates downwards through faults to the reservoir rocks that are separated from the source rocks,and then migrates laterally through sandbodies.Fourth,the differences in oil source conditions,charging drive,fault distribution,sandbody and reservoir physical properties cause the differential enrichment of tight oil in the Fuyu reservoirs.Comprehensive analysis suggests that the Fuyu reservoir in the Qijia-Gulong Sag has good conditions for tight oil enrichment and has been less explored,and it is an important new zone for tight oil exploration in the future.

Lower Extremity Arterial Disease in Patients with Type 2 Diabetes: Prevalence and Associated Factors at the Libreville University Hospital Center

Introduction: Lower extremity arterial disease in diabetic patients has distinct characteristics. Objectives: To study the hospital frequency of lower extremity arterial disease and identify associated factors in diabetic patients at the Libreville University Hospital Center (CHUL). Materials and Methods: This was a cross-sectional study conducted from July 1, 2023, to January 31, 2024, in the endocrinology department of the CHUL. All patients with type 2 diabetes over the age of 18 admitted to this department, regardless of the reason for hospitalization, who provided informed consent, were included. Socio-demographic data and cardiovascular risk factors were recorded. Personal and family cardiovascular history and functional symptoms were investigated. The physical examination included measuring blood pressure, heart rate, and the ankle-brachial index in all patients. Results: A total of 219 patients were included, of whom 75 had lower extremity arterial disease, representing a prevalence of 34.24%. It was compensated in 28 cases (37.33%) and decompensated in 39 patients (52%). In eight cases (10.67%), there was critical chronic ischemia. Cardiovascular risk factors associated with diabetes were physical inactivity (89.5%), hypertension (55.25%), overweight (49.77%), obesity (22.84%), and smoking (10.04%). In multivariate analysis, only hypertension (OR = 2.09;95% CI: 1.05 - 4.17;p = 0.035) and LDL cholesterol (OR = 2.75;95% CI: 1.10 - 6.85;p = 0.03) were significantly associated with lower extremity arterial disease in diabetics at the University Hospital of Libreville. Conclusion: Lower extremity arterial disease is common in diabetic patients at the University Hospital of Libreville. It is often asymptomatic, thus requiring systematic screening.[-rId11-]

Epidemiological, Clinical and Paraclinical Profile of Osteoarthritis of the Lower Limbs in Obese Patients at the Cocody University Teaching Hospital

Objective: To describe the epidemiological, clinical and paraclinical characteristics of osteoarthritis of the lower limbs in obese patients at the Cocody University Teaching Hospital. Methodology: This was an analytical cross-sectional study carried out in the rheumatology department of the Cocody UTH in Abidjan (Ivory Coast) from March 1 to April 30 2023. Patients who came for rheumatology consultation presenting with mechanical arthralgia of the lower limbs, who were obese, had radiographic images were included. All patients without radiographic images were excluded. Obesity was defined as a body mass index (BMI) greater than or equal to 30 kg/m. The Chi2 test was used to compare proportions and determine the existence of associations between osteoarthristis and obesity, obesity severity and radiographic stage of osteoarthritis as well as the functional impact. A p-value below a predefined threshold (p = 0,05) indicates a significant relationship between the variables. Result: Out of 185 patients received for osteoarthritis of the lower limbs during the study period, 136 were obese (74%). There were 115 women (84.6%) with an average age of 56.03 with a standard deviation of 12.72 years (extremes: 22 and 84 years). The main socio-professional category was the informal sector (30%). The majority of patients had a low socio-economic level (80.2%) and lived in urban areas (92.6%). The most common past medical history was hypertension (33.08%) followed by peptic ulcer disease (16.91%). Patients had a body mass index class 1 (81.6%), class 2 (15.40%) and class 3 (2.90%). The average duration of symptom progression until diagnosis was 11 months. Genu varum was the main static disorder (56.10%) and the knee joint was the dominant topography (90.4%) with a bilateral localization (80%). The average Lequesne index was greater than 8 (59.5%). The Kellgren and Lawrence radiographic stages were stage 1 (9.20%), stage 2 (46.90%), stage 3 (29.20%) and stage 4 (6.90%). The Obesity severity was significantly associated with osteoarthritis of the knee (p = 0.042). There was no statistically significant association between obesity severity and radiographic stage of osteoarthritis (p = 0.163) or functional impact (p = 0.180). Conclusion: Osteoarthritis of the lower limbs affected obese women and was dominated by stage 2 osteoarthritis of the knee (Kellgren and Lawrence). There is an association between the severity of obesity and osteoarthritis of the knee.

Surface and Deep Structure of the Hanshan-Wuwei Basins in the Lower Yangtze Region:Implications for Mesozoic Tectonic Evolution of the South China Block

Indicating the tectonic features of the Hanshan-Wuwei basin can reconstruct the framework of the basins formed in Mesozoic and further understand the Mesozoic tectonic evolution of the South China Block.Studies on surface structure,regional stress field and deep geophysical characteristics of the Mesozoic Hanshan-Wuwei basin in Lower Yangtze region were carried out.NE-NNE trending folds and faults developed in the northern margin of the basins.The reconstruction of tectonic stress fields indicates four stress stages dominating the basins'evolution including NW-SE compression,N-S compression,NW-SE extension and NWW-SEE compression.2D seismic profiles reveal coexistence of thrust,strike-slip and normal faults in the basin.Combined with regional geological studies,the geodynamic processes for the formation of the Hanshan-Wuwei basin can be divided into five stages:1)During the Late Triassic,EW trending foreland basin was formed by N-S compression;2)From Mid-Jurassic to Late Jurassic,continuous compression strengthened the foreland deformation and formed thrust nappes.In this stage,the integrated foreland basin was compartmentalized or fragmented,and transferred to the broken foreland basin;3)NE-trending sinistral strike-slip movement at the beginning of the Early Cretaceous;4)Regional extension resulted in normal faults and rift basins developing in the Late Cretaceous;5)The NWW-SEE compression at the end of the Late Cretaceous caused NW sinistral strike-slip faults to form,which partly transformed the rift basin.

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.

Kinematics ofmandibular advancement devices(MADs):Why do some MADs move the lower jaw backward duringmouth opening?

Mandibular advancement devices(MADs)are widely used treatments for obstructive sleep apnea.MADs function by advancing the lower jaw to open the upper airway.To increase patient comfort,most patients allow the mouth to be opened.However,not all systems maintain the lower jaw in a forward position during mouth opening,which results in the production of a retrusion that favors the collapse of the upper airway.Furthermore,the kinematic behavior of the mechanism formed by the mandible-device assembly depends on jaw morphology.This means that,during mouth opening,some devices cause lower jaw protrusion in some patients,but cause its retraction in others.In this study,we report the behavior of well-known devices currently on themarket.To do so,we developed a kinematic model of the lower jawdevice assembly.Thismodelwas validated for all devices analyzed using a high-resolution camera system.Our results show that some of the devices analyzed here did not produce the correct behavior during patient mouth opening.

Establishing the relationship between land use land cover,normalized difference vegetation index and land surface temperature:A case of Lower Son River Basin,India

The study explores the intricate interplay between land use land cover(LULC),normalized difference vegetation index(NDVI),and land surface temperature(LST)within the Lower Son River Basin in India from 1991 to 2020.The region’s ecological balance has been increasingly strained due to rapid urbanization and changing land use patterns.Through a combination of Landsat TM&OLI/TIRS satellite imageries and geospatial analysis techniques,this study unveils the intricate connection between land use and land cover changes,vegetation,and land surface temperature variations.The study area is classified into three altitudinal zones(Zone Ⅰ:39–300 m,Zone Ⅱ:301–600 m and Zone Ⅲ:601–1,247 m)to examine the changes in depth.The area has seen significant changes in LULC,vegetation and LST in all the three altitudinal zones.The findings hold significant implications for sustainable land management and environmental conservation strategies in the Lower Son River Basin.As per the result,103,438 ha of vegetation was converted into agriculture land and 82,572 ha of agricultural land was transformed into settlements from 1991 to 2020.This trend shows human pressure on the land resource in the study area.Minor increase in water body is seen which is attributed to commissioning of Bansagar dam.Zone Ⅰ has seen highest settlement growth while Zone Ⅲ experienced severe deforestation of around 15%.Zone Ⅱ and Ⅲ needs attention for holistic sustenance.Analysis of LST shows that it has increased by 0.82℃ from 1991 to 2020 which is a red flag.The study underscores the critical importance of balanced land use practices to preserve ecological integrity and mitigate the adverse effects of urbanization and climate change.

On the beginning of the Japanese Upper Paleolithic:A review of recent archaeological and anthropological evidence

The beginning of the Japanese Upper Paleolithic has mainly been examined using two major models:the Middle Paleolithic evolutionary model within the archipelago and the continental Upper Paleolithic diffusion/migration model.However,recent archeological data from Japan and nearby countries are challenging such simple models.This paper critically reviews previous chronology of the Japanese Paleolithic,including possible Lower and Middle Paleolithic(LP/MP),and attempts to show an alternative model of the beginning of the Japanese Upper Paleolithic.This paper suggests several possible specimens of LP/MP and recommends further geoarchaeological investigation to understand the reliability and cultural relationship between possible LP/MP specimens and the Early Upper Paleolithic(EUP).The start of the Japanese EUP is presently characterized by a flake industry with trapezoids and denticulates around 39-37 kaBP cal on Paleo-Honshu Island,which has partial resemblance with contemporary assemblages in China and the Korean Peninsula,although trapezoids are endemic only to the Japanese EUP and may have derived from the ancestral lithic tradition.Blade technology appeared earliest on Central Paleo-Honshu Island,about 1000 years later than the earliest flake technology.Although blade technology may have originated from the elongated flake technology of the previous period,the sudden simultaneous emergence implies that it diffused from the Korean Peninsula.This paper proposes that blade technology from the Korean Peninsula arrived on the northeastern Paleo-Honshu Island,including the Japan Sea coastal region of western Honshu,rather than the southwest,where flake technology long prospered,due to differences in ecological settings and adaptation strategies between the two regions.

Evaluation of Agricultural Contamination Level by Heavy Metals and Pesticides in Sediments of Rivers and Water Bodies for Shrimp Fishing in the Lower Ouémé: Case of the Aguigadji, Ahlan and Sele Stations in Benin

This study assessed sediment contamination by heavy metals and pesticide active ingredients linked to chemical inputs used in agricultural activities in the lower Ouémé. Pesticide residues from the organochlorine, pyrethroid and organophosphorus families were investigated by gas chromatography, and heavy metals (Cd, Pb, As, Ni, Zn, Fe, Mg, Cr and Hg) by atomic absorption spectrophotometry. The metallic pollution indices, the contamination factor (CF) and the ecological risk index were calculated. The results revealed 8 active ingredients in the rainy season and 9 in the dry season. Glyphosate was the active ingredient with the highest concentration at all stations, 9.65 ± 0.84 mg/kg recorded in the dry season at the Aguigadji station. All glyphosate values were above the EQS. DDT, Atrazine and Endosulfan also showed high concentrations in the dry and rainy seasons. Emamectin, Abamectin and Lambda Cyhalothrin also showed high concentrations in the dry season at Aguigadji, Ahlan and Sele. Only glyphosate was recorded at the control station (Toho), but in very low concentrations. Lead showed the highest concentrations at all the stations, 265.96 ± 21.02 mg/Kg in the rainy season and 255.38 ± 79.09 mg/Kg in the dry season, all detected at the Aguigadji station and above the EQS. Zn, Ni, Fe, Cu and Cr were all representative in both the dry and rainy seasons at the contaminated stations. Manganese showed high concentrations in the rainy season. Pb showed very high contamination (FC ≥ 6) at the Aguigadji and Ahlan stations and significant contamination (3 ≤ FC 6) at the Sele station in both the rainy and dry seasons. Ni, Hg and Cd, showed either moderate or significant contamination at the contaminated stations. The risk values showed a considerable ecological Ri (190 ≤ Ri < 380) in the rainy season and a moderate ecological Ri (95 ≤ Ri < 190) in the dry season at these contaminated stations.

The Upper Jurassic sediments,Marib-Shabwa Basin,Yemen:Lithofacies aspects and sequence stratigraphic analysis

The present study is devoted to understanding the evolution of the Upper Jurassic Sab'atayn Formation in the Marib-Shabwa Basin,Yemen,through a sequence stratigraphic analysis based on integrating datasets of sedimentology,seismic sections,and well logs.The Sab'atayn Formation(Tithonian age)is represented by a series of clastic and evaporites that were deposited under fluvio-deltaic to prodeltaic settings.It is divided into four members including Yah(at the base),upwards to Seen,Alif,and Safir at the top.Two third-order depositional sequences were determined for the Tithonian succession which were separated by three sequence boundaries.These sequences were classified into their systems tracts signifying several sedimentation patterns of progradational,aggradational,and retrogradational parasequence sets.The first depositional sequence corresponds to the early-middle Tithonian Yah and Seen units that can be classified into lowstand,transgressive,and highstand systems tracts.The second sequence comprises the late Tithonian Alif unit that can be subdivided into transgressive and highstand systems tracts.The sandy deposits of the Alif Member(highstand deposits)represent the most productive hydrocarbon reservoir in the basin.The Upper Jurassic sediments in the study area were resulted from a combination of eustatic and tectonic effects.

Monitoring and evaluation of the water quality of the Lower Neches River, Texas, USA

Increasing bacteria levels in the Lower Neches River caused by Hurricane Harvey has been of a serious concern.This study is to analyze the historical water sampling measurements and real-time water quality data collected with wireless sensors to monitor and evaluate water quality under different hydrological and hydraulic conditions.The statistical and Pearson correlation analysis on historical water samples determines that alkalinity,chloride,hardness,conductivity,and pH are highly correlated,and they decrease with increasing flow rate due to dilution.The flow rate has positive correlations with Escherichia coli,total suspended solids,and turbidity,which demonstrates that runoff is one of the causes of the elevated bacteria and sediment loadings in the river.The correlation between E.coli and turbidity indicates that turbidity greater than 45 nephelometric turbidity units in the Neches River can serve as a proxy for E.coli to indicate the bacterial outbreak.A series of statistical tools and an innovative two-layer data smoothing filter are developed to detect outliers,fill missing values,and filter spikes of the sensor measurements.The correlation analysis on the sensor data illustrates that the elevated sediment/bacteria/algae in the river is either caused by the first flush rain and heavy rain events in December to March or practices of land use and land cover.Therefore,utilizing sensor measurements along with rainfall and discharge data is recommended to monitor and evaluate water quality,then in turn to provide early alerts on water resources management decisions.

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.

Virtual Reality-Based Mirror Therapy for Upper Extremity Function among Stroke Patients:A Meta-analysis and Systematic Review

[Objectives]To investigate the evidence-based effect of virtual reality-based mirror therapy system(VR-MT)on upper extremity function among stroke patients.[Methods]A systematic electronic searching of the Medline,PubMed,Web of Science and CNKI was initially performed up to June 10,2024.The risk of bias of the included studies was evaluated using RevMan 5.4 software based on the Cochrane Handbook for Systematic Reviews.The random-effects model or fixed-effects models was employed to estimate the standardized mean difference(SMD).The subgroup analyses were conducted exploring theVR-MT type(immersive or non-immersive)and comparing with MT or control group.[Results]In total 8 studies with a total of 273 stroke patients were included in this review.The pooled analysis of these trials showed a statistically significant enhancement inFMA-UE scores(6 studies,SMD=0.72,[95%CI 0.37 to 1.06];P<0.0001,I^(2)=31%)and Box and Block Test(BBT)(3 studies,SMD=0.49,[95%C/0.05 to 0.93];P=0.03,I^(2)=0%),rather than Manual Function Test(MFT)scores(3 studies,SMD=0.38,[95%CI-0.09 to 0.84];P=0.11,I^(2)=0%)following the application of reality-based mirror therapy.Additionally,the subgroup analysis results indicated that immersive VR-MT can significantly improve FMA-UE(5studies,SMD=0.73,[95%CI 0.24 to 1.23];P=0.004,I^(2)=43%).In contrast,the overall effect of non-immersive VR-MT was non-significant(2 studies,SMD=0.33,[95%CI-0.69 to 1.34];P=0.53,I^(2)=72%).[Conclusions]In this systematic review and meta-analysis,our findings indicate that immersiveVR-MT has the potential to improve upper extremity function among stroke patients.

Main controlling factor and mechanism of gas-in-place content of the Lower Cambrian shale from different sedimentary facies in the western Hubei area, South China

The Lower Cambrian shale gas in the western Hubei area,South China has a great resource prospect,but the gas-in-place(GIP)content in different sedimentary facies varies widely,and the relevant mechanism has been not well understood.In the present study,two sets of the Lower Cambrian shale samples from the Wells YD4 and YD5 in the western Hubei area,representing the deep-water shelf facies and shallowwater platform facies,respectively,were investigated on the differences of pore types,pore structure and methane adsorption capacity between them,and the main controlling factor and mechanism of their methane adsorption capacities and GIP contents were discussed.The results show that the organic matter(OM)pores in the YD4 shale samples are dominant,while the inorganic mineral(IM)pores in the YD5 shale samples are primary,with underdeveloped OM pores.The pore specific surface area(SSA)and pore volume(PV)of the YD4 shale samples are mainly from micropores and mesopores,respectively,while those of the YD5 shale samples are mainly from micropores and macropores,respectively.The methane adsorption capacity of the YD4 shale samples is significantly higher than that of the YD5 shale samples,with a maximum absolute adsorption capacity of 3.13 cm^(3)/g and 1.31 cm^(3)/g in average,respectively.Compared with the shallow-water platform shale,the deep-water shelf shale has a higher TOC content,a better kerogen type and more developed OM pores,which is the main mechanism for its higher adsorption capacity.The GIP content models based on two samples with a similar TOC content selected respectively from the Wells YD4 and YD5 further indicate that the GIP content of the deep-water shelf shale is mainly 34 m^(3)/t within a depth range of 1000—4000 m,with shale gas exploration and development potential,while the shallow-water platform shale has normally a GIP content of<1 m^(3)/t,with little shale gas potential.Considering the geological and geochemical conditions of shale gas formation and preservation,the deep-water shelf facies is the most favorable target for the Lower Cambrian shale gas exploration and development in the western Hubei area,South China.

Advances in the management of arteriosclerosis of the lower extremity:Integrating Western and Chinese medicine approaches

This editorial provides a commentary on the recent article.The paper reviews current literature and explores innovative treatment strategies for lower extremity arteriosclerosis obliterans(LEASO)through an integrative approach.It highlights the effectiveness of combination therapies that merge traditional Chinese medicine(TCM)with Western medical practices,suggesting that such integrative methods may improve patient compliance and outcomes through personalized care.This paper stresses the importance of rigorous clinical trials to evaluate the efficacy and safety of TCM interventions within LEASO treatment protocols,advocating for evidence-based validation of these combined therapies.Our recommendations emphasize accurate diagnosis,appropriate pharmacological in-terventions,the use of advanced surgical and endovascular techniques,and the inclusion of TCM to address underlying dysfunctions.Additionally,continuous monitoring,patient education,and lifestyle modifications are essential to slow disease progression and achieve optimal patient outcomes.The paper concludes by calling for further research to develop standardized treatment protocols that effectively integrate both Western and Chinese medical approaches in managing LEASO.

A new technique for correction of iatrogenic upper eyelid retraction by using a composite flap of the orbicularis muscle and fascia on the anterior surface of the tarsal plate

Background:Upper eyelid retraction is a challenging complication of cosmetic upper eyelid blepharoplasty.To avoid extra trauma,we developed a new technique for correcting iatrogenic upper eyelid retraction by postmigrating a compound flap of the orbicularis muscle and fascia(OFC)on the anterior surface of the tarsal plate.This method extends the aponeurosis of the levator palpebrae superioris muscle(LPS),which can achieve a good correction for post-blepharoplasty retraction.Methods:We collected data from 15 patients with mild to moderate iatrogenic upper eyelid retraction who were treated at our hospital between February 2017 and December 2019.The OFC was used to replace the missing part of the LPS,and post-migration of the LPS and fixation of the OFC to the tarsal margin were conducted.Postoperative outcome measurements included postoperative binocular symmetry,double eyelid smoothness,eyelid fullness,margin reflex distance(MRD1),degree of eyelid closure,and exposure keratitis.The patients were followed-up at seven days,one month,and six months postoperatively.Results:One patient with moderate eyelid retraction showed undercorrection 6 months postoperatively,with the upper eyelid margin located at the upper edge of the pupil.The remaining patients had the upper eyelid margin stabilized at 1.0–2.0 mm below the upper corneal margin.Other observational indicators were satisfactory,including binocular symmetry,double eyelid fluency,and eyelid fullness.During the follow-up,no exposure keratitis was identified.The MRD1 indexes after the operation were significantly different(P<0.001)from those before the procedure.Conclusions:Extension and post-migration of the LPS using the orbicularis muscle and OFC structure can effectively correct mild iatrogenic eyelid retraction after ptosis with less damage and good postoperative eyelid morphology and closure function.

Influences of burial process on diagenesis and high-quality reservoir development of deep-ultra-deep clastic rocks:A case study of Lower Cretaceous Qingshuihe Formation in southern margin of Junggar Basin,NW China

Taking the Lower Cretaceous Qingshuihe Formation in the southern margin of Junggar Basin as an example,the influences of the burial process in a foreland basin on the diagenesis and the development of high-quality reservoirs of deep and ultra-deep clastic rocks were investigated using thin section,scanning electron microscope,electron probe,stable isotopic composition and fluid inclusion data.The Qingshuihe Formation went through four burial stages of slow shallow burial,tectonic uplift,progressive deep burial and rapid deep burial successively.The stages of slow shallow burial and tectonic uplift not only can alleviate the mechanical compaction of grains,but also can maintain an open diagenetic system in the reservoirs for a long time,which promotes the dissolution of soluble components by meteoric freshwater and inhibits the precipitation of dissolution products in the reservoirs.The late rapid deep burial process contributed to the development of fluid overpressure,which effectively inhibits the destruction of primary pores by compaction and cementation.The fluid overpressure promotes the development of microfractures in the reservoir,which enhances the dissolution effect of organic acids.Based on the quantitative reconstruction of porosity evolution history,it is found that the long-term slow shallow burial and tectonic uplift processes make the greatest contribution to the development of deep-ultra-deep high-quality clastic rock reservoirs,followed by the late rapid deep burial process,and the progressive deep burial process has little contribution.

Risk factors and clinical significance of posterior slip of the proximal vertebral body after lower lumbar fusion

BACKGROUND Adjacent segment disease(ASD)after fusion surgery is frequently manifests as a cranial segment instability,disc herniation,spinal canal stenosis,spondylolisthesis or retrolisthesis.The risk factors and mechanisms of ASD have been widely discussed but never clearly defined.AIM To investigate the risk factors and clinical significance of retrograde movement of the proximal vertebral body after lower lumbar fusion.METHODS This was a retrospective analysis of the clinical data of patients who underwent transforaminal lumbar interbody fusion surgery between September 2015 and July 2021 and who were followed up for more than 2 years.Ninety-one patients with degenerative lumbar diseases were included(22 males and 69 females),with an average age of 52.3 years(40-73 years).According to whether there was retrograde movement of the adjacent vertebral body on postoperative X-rays,the patients were divided into retrograde and nonretrograde groups.The sagittal parameters of the spine and pelvis were evaluated before surgery,after surgery,and at the final follow-up.At the same time,the Oswestry Disability Index(ODI)and Visual Analogue Scale(VAS)were used to evaluate the patients’quality of life.RESULTS Nineteen patients(20.9%)who experienced retrograde movement of proximal adjacent segments were included in this study.The pelvic incidence(PI)of the patients in the retrograde group were significantly higher than those of the patients in the nonretrograde group before surgery,after surgery and at the final follow-up(P<0.05).There was no significant difference in lumbar lordosis(LL)between the two groups before the operation,but LL in the retrograde group was significantly greater than that in the nonretrograde group postoperatively and at the final follow-up.No significant differences were detected in terms of the|PI–LL|,and there was no significant difference in the preoperative lordosis distribution index(LDI)between the two groups.The LDIs of the retrograde group were 68.1%±11.5%and 67.2%±11.9%,respectively,which were significantly lower than those of the nonretrograde group(75.7%±10.4%and 74.3%±9.4%,respectively)(P<0.05).Moreover,the patients in the retrograde group had a greater incidence of a LDI<50%than those in the nonretrograde group(P<0.05).There were no significant differences in the ODI or VAS scores between the two groups before the operation,but the ODI and VAS scores in the retrograde group were significantly worse than those in the nonretrograde group after the operation and at the last follow-up,(P<0.05).CONCLUSION The incidence of posterior slippage after lower lumbar fusion was approximately 20.9%.The risk factors are related to a higher PI and distribution of lumbar lordosis.When a patient has a high PI and insufficient reconstruction of the lower lumbar spine,adjacent segment compensation via posterior vertebral body slippage is one of the factors that significantly affects surgical outcomes.