Endoscopic full-thickness plication along with argon plasma coagulation for treatment of proton pump inhibitor dependent gastroesophageal reflux disease

BACKGROUND Most endoscopic anti-reflux interventions for gastroesophageal reflux disease(GERD)management are technically challenging to practice with inadequate data to support it utility.Therefore,this study was carried to evaluate the effectiveness and safety newer endoscopic full-thickness fundoplication(EFTP)device along with Argon Plasma Coagulation to treat individuals with GERD.AIM To evaluate the effectiveness and safety newer EFTP device along with Argon Plasma Coagulation to treat individuals with GERD.METHODS This study was a single-center comparative analysis conducted on patients treated at a Noble Institute of Gastroenterology,Ahmedabad,hospital between 2020 and 2022.The research aimed to retrospectively analyze patient data on GERD symptoms and proton pump inhibitor(PPI)dependence who underwent EFTP using the GERD-X system along with argon plasma coagulation(APC).The primary endpoint was the mean change in the total gastroesophageal reflux disease health-related quality of life(GERD-HRQL)score compared to the baseline measurement at the 3-month follow-up.Secondary endpoints encompassed enhancements in the overall GERD-HRQL score,improvements in GERD symptom scores at the 3 and changes in PPI usage at the 3 and 12-month time points.RESULTS In this study,patients most were in Hill Class II,and over half had ineffective esophageal motility.Following the EFTP procedure,there were significant improvements in heartburn and regurgitation scores,as well as GERDHRQL scores(P<0.001).PPI use significantly decreased,with 82.6%not needing PPIs or prokinetics at end of 1 year.No significant adverse events related to the procedures were observed in either group.CONCLUSION The EFTP along with APC procedure shows promise in addressing GERD symptoms and improving patients'quality of life,particularly for suitable candidates.Moreover,the application of a lone clip with APC yielded superior outcomes and exhibited greater cost-effectiveness.

Effects of postoperative use of proton pump inhibitors on gastrointestinal bleeding after endoscopic variceal treatment during hospitalization

BACKGROUND Endoscopic variceal treatment(EVT)is recommended as the mainstay choice for the management of high-risk gastroesophageal varices and acute variceal bleeding in liver cirrhosis.Proton pump inhibitors(PPIs)are widely used for various gastric acid-related diseases.However,the effects of PPIs on the development of post-EVT complications,especially gastrointestinal bleeding(GIB),remain controversial.AIM To evaluate the effects of postoperative use of PPIs on post-EVT complications in patients with liver cirrhosis during hospitalization.METHODS Patients with a diagnosis of liver cirrhosis who were admitted to the Department of Gastroenterology of the General Hospital of Northern Theater Command,treated by an attending physician between January 2016 and June 2020 and underwent EVT during their hospitalization were included.Logistic regression analyses were performed to explore the effects of postoperative use of PPIs on the development of post-EVT complications during hospitalization.Odds ratios(ORs)with 95%confidence intervals(CIs)were calculated.RESULTS A total of 143 patients were included.The incidence of post-EVT GIB and other post-EVT complications was 4.90%and 46.85%,respectively.In the overall analyses,postoperative use of PPIs did not significantly reduce the risk of post-EVT GIB(OR=0.525,95%CI=0.113-2.438,P=0.411)or other post-EVT complications(OR=0.804,95%CI=0.413-1.565,P=0.522).In the subgroup analyses according to the enrollment period,type and route of PPIs after the index EVT,use of PPIs before the index EVT,use of vasoactive drugs after the index EVT,indication of EVT(prophylactic and therapeutic),and presence of portal venous system thrombosis,ascites,and hepatocellular carcinoma,the effects of postoperative use of PPIs on the risk of post-EVT GIB or other post-EVT complications remain not statistically significant.CONCLUSION Routine use of PPIs after EVT should not be recommended in patients with liver cirrhosis for the prevention of post-EVT complications during hospitalization.

Effects of proton pump inhibitors on inflammatory bowel disease:An updated review

Inflammatory bowel disease(IBD)is believed to be caused by various factors,including abnormalities in disease susceptibility genes,environmental factors,immune factors,and intestinal bacteria.Proton pump inhibitors(PPIs)are the primary drugs used to treat acid-related diseases.They are also commonly prescribed to patients with IBD.Recent studies have suggested a potential association between the use of certain medications,such as PPIs,and the occurrence and progression of IBD.In this review,we summarize the potential impact of PPIs on IBD and analyze the underlying mechanisms.Our findings may provide insights for conducting further investigations into the effects of PPIs on IBD and serve as an important reminder for physicians to exercise caution when prescribing PPIs to patients with IBD.

Ultra-Robust and High-Performance Rotational Triboelectric Nanogenerator by Bearing Charge Pumping

As an emerging technology to convert environmental high-entropy energy into electrical energy,triboelectric nanogenerator(TENG)has great demands for further enhancing the service lifetime and output performance in practical applications.Here,an ultra-robust and high-performance rotational triboelectric nanogenerator(R-TENG)by bearing charge pumping is proposed.The R-TENG composes of a pumping TENG(P-TENG),an output TENG(O-TENG),a voltage-multiplying circuit(VMC),and a buffer capacitor.The P-TENG is designed with freestanding mode based on a rolling ball bearing,which can also act as the rotating mechanical energy harvester.The output low charge from the P-TENG is accumulated and pumped to the non-contact O-TENG,which can simultaneously realize ultralow mechanical wear and high output performance.The matched instantaneous power of R-TENG is increased by 32 times under 300 r/min.Furthermore,the transferring charge of R-TENG can remain 95%during 15 days(6.4×10^(6)cycles)continuous operation.This work presents a realizable method to further enhance the durability of TENG,which would facilitate the practical applications of high-performance TENG in harvesting distributed ambient micro mechanical energy.

An NMOS output-capacitorless low-dropout regulator with dynamic-strength event-driven charge pump

In this paper,an NMOS output-capacitorless low-dropout regulator(OCL-LDO)featuring dual-loop regulation has been proposed,achieving fast transient response with low power consumption.An event-driven charge pump(CP)loop with the dynamic strength control(DSC),is proposed in this paper,which overcomes trade-offs inherent in conventional structures.The presented design addresses and resolves the large signal stability issue,which has been previously overlooked in the event-driven charge pump structure.This breakthrough allows for the full exploitation of the charge-pump structure's poten-tial,particularly in enhancing transient recovery.Moreover,a dynamic error amplifier is utilized to attain precise regulation of the steady-state output voltage,leading to favorable static characteristics.A prototype chip has been fabricated in 65 nm CMOS technology.The measurement results show that the proposed OCL-LDO achieves a 410 nA low quiescent current(IQ)and can recover within 30 ns under 200 mA/10 ns loading change.

Treat to target in Crohn’s disease:A practical guide for clinicians

A treat-to-target(T2T)approach applies the principles of early intervention and tight disease control to optimise long-term outcomes in Crohn's disease.The Selecting Therapeutic Targets in Inflammatory Bowel Disease(STRIDE)-II guidelines specify short,intermediate,and long-term treatment goals,documenting specific treatment targets to be achieved at each of these timepoints.Scheduled appraisal of Crohn’s disease activity against pre-defined treatment targets at these timepoints remains central to determining whether current therapy should be continued or modified.Consensus treatment targets in Crohn’s disease comprise combination clinical and patient-reported outcome remission,in conjunction with biomarker normalisation and endoscopic healing.Although the STRIDE-II guidelines endorse the pursuit of endoscopic healing,clinicians must consider that this may not always be appropriate,acceptable,or achievable in all patients.This underscores the need to engage patients at the outset in an effort to personalise care and individualise treatment targets.The use of non-invasive biomarkers such as faecal calprotectin in conjunction with cross-sectional imaging techniques,particularly intestinal ultrasound,holds great promise;as do emerging treatment targets such as transmural healing.Two randomised clinical trials,namely,CALM and STARDUST,have evaluated the efficacy of a T2T approach in achieving endoscopic endpoints in patients with Crohn’s disease.Findings from these studies reflect that patient subgroups and Crohn’s disease characteristics likely to benefit most from a T2T approach,remain to be clarified.Moreover,outside of clinical trials,data pertaining to the real-world effectiveness of a T2T approach remains scare,highlighting the need for pragmatic real-world studies.Despite the obvious promise of a T2T approach,a lack of guidance to support its integration into real-world clinical practice has the potential to limit its uptake.This highlights the need to describe strategies,processes,and models of care capable of supporting the integration and execution of a T2T approach in real-world clinical practice.Hence,this review seeks to examine the current and emerging literature to provide clinicians with practical guidance on how to incorporate the principles of T2T into routine clinical practice for the management of Crohn’s disease.

Proton pump inhibitors and gastroprotection in patients treated with antithrombotic drugs: A cardiologic point of view

Aspirin,other antiplatelet agents,and anticoagulant drugs are used across a wide spectrum of cardiovascular and cerebrovascular diseases.A concomitant proton pump inhibitor(PPI)treatment is often prescribed in these patients,as gastrointestinal complications are relatively frequent.On the other hand,a potential increased risk of cardiovascular events has been suggested in patients treated with PPIs;in particular,it has been discussed whether these drugs may reduce the cardiovascular protection of clopidogrel,due to pharmacodynamic and pharmacokinetic interactions through hepatic metabolism.Previously,the concomitant use of clopidogrel and omeprazole or esomeprazole has been discouraged.In contrast,it remains less known whether PPI use may affect the clinical efficacy of ticagrelor and prasugrel,new P2Y12 receptor antagonists.Current guidelines recommend PPI use in combination with antiplatelet treatment in patients with risk factors for gastrointestinal bleeding,including advanced age,concurrent use of anticoagulants,steroids,or non-steroidal anti-inflammatory drugs,and Helicobacter pylori(H.pylori)infection.In patients taking oral anticoagulant with risk factors for gastrointestinal bleeding,PPIs could be recommended,even if their usefulness deserves further data.H.pylori infection should always be investigated and treated in patients with a history of peptic ulcer disease(with or without complication)treated with antithrombotic drugs.The present review summarizes the current knowledge regarding the widespread combined use of platelet inhibitors,anticoagulants,and PPIs,discussing consequent clinical implications.

Progress in the Study of Vonoprazan Fumarate vs. Proton Pump Inhibitors in the Treatment of Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a common gastrointestinal disease, and proton pump inhibitors (PPIs) have been recommended as the first-line treatment for GERD. In recent years, studies on vonoprazan fumarate in the treatment of GERD have attracted widespread attention. In this paper, we review the research progress of vonoprazan fumarate and proton pump inhibitors in the treatment of GERD in recent years, and compare and analyze the efficacy, safety, tolerability, and advantages and disadvantages of long-term application of both. By reviewing the relevant literature, we found that vonoprazan fumarate has similar performance with proton pump inhibitors in terms of efficacy and safety, but has potential advantages in terms of tolerability and long-term application. Therefore, we believe that vonoprazan fumarate may become a new option for GERD treatment, helping clinicians to develop more appropriate treatment plans for patients and providing new ideas and directions for research in related fields.

Preface:Development and utilization of pumped storage in closed/abandoned mines

China has embarked on an extensive and sustained endeavor to harness its coal resources for a substantial period.However,the depletion of coal reserves in mining regions has necessitated the closure or abandonment of numerous mines,resulting in a marked increase in the number of such facilities.Parallel to this,China is vigorously advancing the development of a novel energy power system,aimed at transitioning the power sector from a high-carbon,fossil fuel-dependent paradigm to a low-carbon,clean energy footing.

An LED-Side-Pumped Intracavity Frequency-Doubled Nd,Ce:YAG Laser Producing a 2W Q-Switched Red Beam

We report a high-average-power acousto-optic(AO)Q-switched intracavity frequency-doubled red laser based on a high-efficiency light-emitting-diode(LED)pumped two-rod Nd,Ce:YAG laser module.Under quasi-continuous wave operation conditions,a maximum output power of 1319.08 nm wavelength was achieved at 11.26 W at a repetition rate of 100 Hz.

Evaluating the Impact of the Universal Test and Treat Strategy on the Survival of Patients in the Northwest Region of Cameroon

Introduction: The main outcome of efficiently implemented universal test and treat (UTT) program is improved survival. UTT implementation has been ongoing in Cameroon since 2016 but evaluation data are scarce. This study aims to assess the survival of antiretroviral therapy (ART) patients initiated under UTT in Northwest region of Cameroon. Methods: This retrospective cohort study included HIV-positive patients initiated in 2016 at 27 purposefully selected sites and followed until 2021. Data was anonymously abstracted from ART registers and patients’ charts. Kaplan-Meier survival estimates and Cox model were used to compare the survival of patients initiated under UTT with those initiated otherwise, using stata version 14.0. Results: In total, 2490 HIV-positive patients (median age 42.7 years, 94.7% adults, and 69.0% female) participated in the study. Of 1389 patients with viral load (VL) test results, 55% were initiated on ART late. The VL suppression rate of patients initiated late and those initiated early were similar. During follow-up, 1020 (40.9%) participants censored. The survival curves of patients initiated early on ART and those initiated late were similar during the first 2.5 years of follow-up but significantly (p Conclusions: This study confirms the expected impact of UTT. Programs only need to close existing implementation gaps along the critical pathways (diagnosis and treatment) of UTT, focusing more on males.

Wear dependent virtual flow rate sensor for progressing cavity pumps with deformable stator

This contribution presents a novel wear dependent virtual flow rate sensor for single stage single lobe progressing cavity pumps. We study the wear-induced material loss of the pump components and the impact of this material loss on the volumetric efficiency. The results are combined with an established backflow model to implement a backflow calculation procedure that is adaptive to wear. We use a laboratory test setup with a highly abrasive fluid and operate a pump from new to worn condition to validate our approach. The obtained measurement data show that the presented virtual sensor is capable of calculating the flow rate of a pump being subject to wear during its regular operation.

Dual-wavelength pumped latticed Fermi-Pasta-Ulam recurrences in nonlinear Schrödinger equation

We show that the nonlinear stage of the dual-wavelength pumped modulation instability(MI)in nonlinear Schrödinger equation(NLSE)can be effectively analyzed by mode truncation methods.The resulting complicated heteroclinic structure of instability unveils all possible dynamic trajectories of nonlinear waves.Significantly,the latticed-Fermi-Pasta-Ulam recurrences on the modulated-wave background in NLSE are also investigated and their dynamic trajectories run along the Hamiltonian contours of the heteroclinic structure.It is demonstrated that there has much richer dynamic behavior,in contrast to the nonlinear waves reported before.This novel nonlinear wave promises to inject new vitality into the study of MI.

Dynamic response characteristics of muddy sandstone in pumped storage mine under action of high-stress dynamic disturbance

During the construction and operation of the abandoned mine pumped storage power station,the underground space surrounding rock body faces the complex stress environment under the action of mining disturbance,frequent pumping,water storage and other dynamic disturbances.The stability of the abandoned mine surrounding rock body is the basis for guaranteeing the safety and effectiveness of water storage in the underground space of the abandoned mine.By considering the two main factors of different stress levels and disturbance amplitudes,the mechanical properties,damage characteristics and acoustic emission characteristics of the abandoned mine perimeter rock body under dynamic disturbance were investigated using a creep-disturbed dynamic impact loading system.The experimental results show that:1)The stress level is considered to be the major contributing factor of the failure of muddy sandstone,followed by the amplitude of the disturbances;2)The time required for the destruction of muddy sandstone decreases with the increase of amplitude.When the stress level is 80%,the sandstone specimens have a decreasing number of cycles as the disturbance amplitude increases.The disturbance amplitude is sequentially increased from 4 MPa to 5,6,7,and 8 MPa,the number of cycles required for specimen destruction decreases significantly by 96.71%,99.13%,99.60%,and 99.93%,respectively;3)Disturbance amplitude and stress level have a significant effect on muddy sandstone damage and damage occurs only after a certain threshold is reached.With the increase of stress level and disturbance amplitude,the macroscopic damage of muddy sandstone is mainly conical,with obvious flake spalling and poor damage integrity;4)According to the time-dependent changes in AE energy and ringing counts,the acoustic emission activity during the failure process could be divided into three phases,namely,weakening period,smooth period,and surge period,corresponding to the compaction phase,elastic rise phase and post-peak damage phase.The research results are of reference significance for the damage evolution analysis of muddy sandstone under dynamic disturbance and the safety and stability of abandoned mine perimeter rock body.

Research on pumped storage and complementary energy development models for abandoned mines in China

Within the framework of achieving carbon neutrality,various industries are confronted with fresh challenges.The ongoing process of downsizing coal industry operations has evolved into a new phase,with the burgeoning proliferation of abandoned mines posing a persistent issue.Addressing the challenges and opportunities presented by these abandoned mines,this paper advocates for a scientific approach centered on the advancement of pumped storage energy alongside gas-oil complementary energy.Leveraging abandoned mine tunnels to establish pumped storage power stations holds significant ecological and economic importance for repurposing these sites.This initiative not only serves as an effective means to restore the ecological balance in mining regions but also provides an environmentally friendly approach to repurposing abandoned mine tunnels,offering a blueprint for economically viable pumped storage power stations.This article delineates five crucial scientific considerations and outlines seven primary models for the utilization of abandoned mine sites,delineating a novel,comprehensive pathway for energy and power development that emphasizes multi-energy complementarity and synergistic optimization within abandoned mines.

Transient Experiments on a Prototype Pump with an Atypical Open Impeller for Different Discharge Valve Openings

In order to obtain the transient characteristics of a low-speed centrifugal pump during the start-up and shutdown stages,dedicated experimental tests were conducted with eight different valve opening conditions.The Pearson correlation coefficient was used to reveal the linear correlation between variables.According to the results,the stable rotational speed decreases with increasing valve opening(rotational speed decreases from approximately 1472 to 1453 r/min),while the stable shaft power exhibits an increasing trend(shaft power increases from approximately 0.242 to 0.390 kW).The stable time and zeroing time of each parameter during start-up and shutdown processes vary,with the flow zeroing time significantly increasing with the relative flow,reaching up to 10.468 s,while the shaft power zeroing time is roughly between 1.219 and 1.375 s.The results demonstrate that with increasing valve opening,the stable and zeroing time of flow significantly increase(|r|greater than 0.95),while the stable and zeroing time of rotational speed,power,and head display a smaller sensitivity on the valve opening(|r|less than 0.6).

In-phase and out-of-phase spin pumping effects in Py/Ru/Pysynthetic antiferromagnetic structures

The spin pumping effect in magnetic heterostructures and multilayers is a highly effective method for the generationand transmission of spin currents. In the increasingly prominent synthetic antiferromagnetic structures, the two ferromagneticlayers demonstrate in-phase and out-of-phase states, corresponding to acoustic and optical precession modes. Withinthis context, our study explores the spin pumping effect in Py/Ru/Py synthetic antiferromagnetic structures across differentmodes. The heightened magnetic damping resulting from the spin pumping effect in the in-phase state initially decreaseswith increasing Py thickness before stabilizing. Conversely, in the out-of-phase state, the amplified damping exceeds thatof the in-phase state, suggesting a greater spin relaxation within this configuration, which demonstrates sensitivity to alterationsin static exchange interactions. These findings contribute to advancing the application of synthetic antiferromagneticstructures in magnonic devices.

Research on Cavitation Characteristics and Influencing Factors of Herringbone Gear Pump

Cavitation is a common issue in pumps,causing a decrease in pump head,a fall in volumetric efficiency,and an intensification of outlet flow pulsation.It is one of the main hazards that affect the regular operation of the pump.Research on pump cavitation mainly focuses on mixed flow pumps,jet pumps,external spur gear pumps,etc.However,there are few cavitation studies on external herringbone gear pumps.In addition,pumps with different working principles significantly differ in the flow and complexity of the internal flow field.Therefore,it is urgent to study the cavitation characteristics of external herringbone gear pumps.Compared with experimentalmethods,visual research and cavitation area identification are achieved through computation fluid dynamic(CFD),and changing the boundary conditions and shape of the gear rotor is easier.The simulation yields a head error of only 0.003%under different grid numbers,and the deviation between experimental and simulation results is less than 5%.The study revealed that cavitation causes flow pulsation at the outlet,and the cavitation serious area is mainly distributed in the meshing gap and meshing area.Cavitation can be inhibited by reducing the speed,increasing the inlet pressure,and changing the helix angle can be achieved.For example,when the inlet pressure is 5 bar,the maximumgas volume fraction in themeshing area is less than 50%.These results provide a reference for optimizing the design and finding the optimal design parameters to reduce or eliminate cavitation.

Evaluation of development potential of pumped hydroelectric storage and geothermal utilization system in abandoned coal mine

Every year in China,a significant number of mines are closed or abandoned.The pumped hydroelectric storage(PHS)and geothermal utilization are vital means to efficiently repurpose resources in abandoned mine.In this work,the development potentials of the PHS and geothermal utilization systems were evaluated.Considering the geological conditions and meteorological data available of Jiahe abandoned mine,a simple evaluation model for PHS and geothermal utilization was established.The average efficiency of the PHS system exceeds 70%and the regulatable energy of a unit volume is over 1.53 kW·h/m^(3).The PHS system achieves optimal performance when the wind/solar power ratio reaches 0.6 and 0.3 in daily and year scale,respectively.In the geothermal utilization system,the outlet temperature and heat production are significantly affected by the injection flow rate.The heat production performance is more stable at lower rate flow,and the proportion of heat production is higher in the initial stage at greater flow rate.As the operating time increases,the proportion of heat production gradually decreases.The cyclic heat storage status has obvious advantages in heat generation and cooling.Furthermore,the energy-saving and emission reduction benefits of PHS and geothermal utilization systems were calculated.

Overlapping approach Proton Pump Inhibitors/Nux vomica-Heel as new intervention for gastro-esophageal reflux management:Delphi consensus study

BACKGROUND Gastro-esophageal reflux disease(GERD)may affect the upper digestive tract;up to 20%of population in Western nations are affected by GERD.Antacids,histamine H2-receptor antagonists,and Proton Pump Inhibitors(PPIs)are considered the referring medications for GERD.Nevertheless,PPIs must be managed carefully because their use,especially chronic,could be linked with some adverse effects.An effective and safe alternative pharmacological tool for GERD is needed.After the identification of potentially new medications to flank PPIs,it is mandatory to revise and improve good clinical practices even through a consensus process.AIM To optimize diagnosis and treatment guidelines for GERD through a consensus based on Delphi method.METHODS The availability of clinical studies describing the action of the multicomponent/multitarget medication Nux vomica-Heel,subject of the consensus,is the basic prerequisite for the consensus itself.A modified Delphi process was used to reach a consensus among a panel of Italian GERD specialists on the overlapping approach PPIs/Nux vomica-Heel as a new intervention model for the management of GERD.The Voting Consensus group was composed of 49 Italian Medical Doctors with different specializations:Gastroenterology,otolaryngology,geriatrics,and general medicine.A scientific committee analyzed the literature,determined areas that required investigation(in agreement with the multiple-choice questionnaire results),and identified two topics of interest:(1)GERD disease;and(2)GERD treatment.Statements for each of these topics were then formulated and validated.The Delphi process involved two rounds of questioning submitted to the panel experts using an online platform.RESULTS According to their routinary GERD practice and current clinical evidence,the panel members provided feedback to each questionnaire statement.The experts evaluated 15 statements and reached consensus on all 15.The statements regarding the GERD disease showed high levels of agreement,with consensus ranging from 70%to 92%.The statements regarding the GERD treatment also showed very high levels of agreement,with consensus ranging from 90%to 100%.This Delphi process was able to reach consensus among physicians in relevant aspects of GERD management,such as the adoption of a new approach to treat patients with GERD based on the overlapping between PPIs and Nux vomica-Heel.The consensus was unanimous among the physicians with different specializations,underlying the uniqueness of the agreement reached to identify in the overlapping approach between PPIs and Nux vomica-Heel a new intervention model for GERD management.The results support that an effective approach to deprescribe PPIs through a progressive decalage timetable(reducing PPIs administration to as-needed use),should be considered.CONCLUSION Nux vomica-Heel appears to be a valid opportunity for GERD treatment to favor the deprescription of PPIs and to maintain low disease activity together with the symptomatology remission.