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.

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.

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.

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.

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.

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.

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.

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.

Optimization of the Pre-Hospital Rescue System for Out-of-Hospital Cardiac Arrest in China

Out-of-hospital cardiac arrest(OHCA)presents a significant public health challenge in China.A sharp contrast in survival rate after OHCA exists between China and more developed countries.Due to the short life-saving time window,emergency medical services(EMS)and bystanders peripheral to EMS are key contributors to survival after OHCA.Here we discuss limitations and challenges for current EMS in rescuing OHCA by reviewing requirements for EMS in China.We call for an updated public health-based prehospital rescue system that includes establishing a cardiac arrest registry,promoting a“Three Early’s”campaign[early dialing of emergency hotline 120,early cardiopulmonary resuscitation(CPR),and early defibrillation],and operating a mechanism comprised of professional public health institutions(EMS,CDC,specialized disease prevention and control institutions,and health education institutions)as well as many governmental departments,such as healthcare,industry and information technology,and education,and non-governmental organizations,such as the Red Cross Society.Following the optimization of the prehospital rescue system and the participation of the whole population in self-rescue and mutual rescue,we believe that a dramatic improvement in OHCA survival will come about in China.

A novel explosion-proof walking system: Twin dual-motor drive tracked units for coal mine rescue robots

A new explosion-proof walking system was designed for the coal mine rescue robot(CMRR) by optimizing the mechanical structure and control algorithm. The mechanical structure innovation lies mainly in the dual-motor drive tracked unit used, which showed high dynamic performance compared with the conventional tracked unit. The control algorithm, developed based on decision trees and neural networking, facilitates autonomous switching between "Velocity-driven Mode" and "Torquedriven Mode". To verify the feasibility and effectiveness of the control strategy, we built a self-designed test platform and used it to debug the control program; we then made a robot prototype and conducted further experiments on single-step, ramp, and rubble terrains. The results show that the proposed walking system has excellent dynamic performance and the control strategy is very efficient, suggesting that a robot with this type of explosion-proof walking system can be successfully applied in Chinese coal mines.

Safety and effectiveness of vonoprazan-based rescue therapy for Helicobacter pylori infection

BACKGROUND Vonoprazan(VPZ)-based regimens are an effective first-line therapy for Helicobacter pylori(H.pylori)infection.However,their value as a rescue therapy needs to be explored.AIM To assess a VPZ-based regimen as H.pylori rescue therapy.METHODS This prospective,single-center,clinical trial was conducted between January and August 2022.Patients with a history of H.pylori treatment failure were administered 20 mg VPZ twice daily,750 mg amoxicillin 3 times daily,and 250 mg Saccharomyces boulardii(S.boulardii)twice daily for 14 d(14-d VAS regimen).VPZ and S.boulardii were taken before meals,while amoxicillin was taken after meals.Within 3 d after the end of eradication therapy,all patients were asked to fill in a questionnaire to assess any adverse events they may have experienced.At least 4-6 wk after the end of eradication therapy,eradication success was assessed using a 13C-urea breath test,and factors associated with eradication success were explored.RESULTS Herein,103 patients were assessed,and 68 patients were finally included.All included patients had 1-3 previous eradication failures.The overall eradication rates calculated using intention-to-treat and per-protocol analyses were 92.6%(63/68)and 92.3%(60/65),respectively.The eradication rate did not differ with the number of treatment failures(P=0.433).The rates of clarithromycin,metronidazole,and levofloxacin resistance were 91.3%(21/23),100.0%(23/23),and 60.9%(14/23),respectively.There were no cases of resistance to tetracycline,amoxicillin,or furazolidone.In 60.9%(14/23)patients,the H.pylori isolate was resistant to all 3 antibiotics(clarithromycin,metronidazole,and levofloxacin);however,eradication was achieved in 92.9%(13/14)patients.All patients showed metronidazole resistance,and had an eradication rate of 91.3%(21/23).The eradication rate was higher among patients without anxiety(96.8%)than among patients with anxiety(60.0%,P=0.025).No severe adverse events occurred;most adverse events were mild and disappeared without intervention.Good compliance was seen in 95.6%(65/68)patients.Serological examination showed no significant changes in liver and kidney function.CONCLUSION VAS is a safe and effective rescue therapy,with an acceptable eradication rate(>90%),regardless of the number of prior treatment failures.Anxiety may be associated with eradication failure.

Identification of landing sites for rescue helicopters in mountains with use of Geographic Information Systems

Helicopters are often used in mountain rescue both for rescuers moving in the area of accidents and for evacuating victims, but in steep or forested terrain finding a landing place can be problematic. The main aim of this research is to use Digital Elevation Model(DEM) and cartographic database analysis to select locations that can be used as landing site for the rescue helicopters. Methods were based on GIS analysis;both raster and vector data were used for identifying touchdown points for rescue helicopters. Based on DEM data, locations with a low slope gradient were identified;topographic vector data were used for identifying unforested sites. Then buffer zones for buildings and power lines were excluded, and it was checked whether the areas had any topographic features that prevented helicopter landings. The findings were verified on an orthophotomap. In result, GIS analyses have selected 1232 polygons that fulfilled initial criteria. Their verification on orthophotomap has shown that only 55% of them could be potentially used as landing site. Landing sites can be found mainly on side ridges of mountain ranges and in valley beds, when those on ridges are most important in this research. The greatest difficulties and methodological challenges are posed by: identification of sites having a shape which prevents landing, the obsolescence of data due to environment dynamics, the presence of features that are not shown on maps but prevent helicopter landings. A map of landing sites is a very useful tool to conduct rescue operations, but each use of a given landing site requires both in-field and numerical verification. The analysis demonstrated that GIS toolsare useful in pre-planning of rescue missions, and also showed that such data must be kept up-to-date and in-field verification is needed continuously, the more so as it plays an important role in ensuring the safety of rescuers and victims.

Metagenomic Analysis of Environmental Samples from Wildlife Rescue Station at Poyang Lake, China

Objective To improve the understanding of the virome and bacterial microbiome in the wildlife rescue station of Poyang Lake,China.Methods Ten smear samples were collected in March 2019.Metagenomic sequencing was performed to delineate bacterial and viral diversity.Taxonomic analysis was performed using the Kraken2 and Bracken methods.A maximum-likelihood tree was constructed based on the RNA-dependent RNA polymerase(RdRp)region of picornavirus.Results We identified 363 bacterial and 6 viral families.A significant difference in microbial and viral abundance was found between samples S01–S09 and S10.In S01–S09,members of Flavobacteriia and Gammaproteobacteria were the most prevalent,while in S10,the most prevalent bacteria class was Actinomycetia.Among S01–S09,members of Myoviridae and Herelleviridae were the most prevalent,while the dominant virus family of S10 was Picornaviridae.The full genome of the pigeon mesivirus-like virus(NC-BM-233)was recovered from S10 and contained an open reading frame of 8,124 nt.It showed the best hit to the pigeon mesivirus 2 polyprotein,with 84.10%amino acid identity.Phylogenetic analysis showed that RdRp clustered into Megrivirus B.Conclusion This study provides an initial assessment of the bacteria and viruses in the cage-smeared samples,broadens our knowledge of viral and bacterial diversity,and is a way to discover potential pathogens in wild birds .

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.

System Rescue快速备份数据

通过使用System Rescue CD，可以完成创建分区、备份硬盘数据等系统管理任务。手头保留一张System Rescue CD，用于急救出现故障的系统再好不过了．

Search and Rescue Optimization with Machine Learning Enabled Cybersecurity Model

Presently,smart cities play a vital role to enhance the quality of living among human beings in several ways such as online shopping,e-learning,ehealthcare,etc.Despite the benefits of advanced technologies,issues are also existed from the transformation of the physical word into digital word,particularly in online social networks(OSN).Cyberbullying(CB)is a major problem in OSN which needs to be addressed by the use of automated natural language processing(NLP)and machine learning(ML)approaches.This article devises a novel search and rescue optimization with machine learning enabled cybersecurity model for online social networks,named SRO-MLCOSN model.The presented SRO-MLCOSN model focuses on the identification of CB that occurred in social networking sites.The SRO-MLCOSN model initially employs Glove technique for word embedding process.Besides,a multiclass-weighted kernel extreme learning machine(M-WKELM)model is utilized for effectual identification and categorization of CB.Finally,Search and Rescue Optimization(SRO)algorithm is exploited to fine tune the parameters involved in the M-WKELM model.The experimental validation of the SRO-MLCOSN model on the benchmark dataset reported significant outcomes over the other approaches with precision,recall,and F1-score of 96.24%,98.71%,and 97.46%respectively.

美国FDA发布关于Datascope/Maquet/Getinge公司召回Cardiosave Hybrid和Rescue主动脉内球囊泵(IABPs)的警示信息

发布日期:2023年8月10日召回级别:I级,使用这些器械可能造成严重伤害或者死亡召回产品:产品名称:Cardiosave Hybrid主动脉内球囊泵(IABP)和Cardiosave Rescue主动脉内球囊泵(IABP)产品型号:Cardiosave Hybrid,Cardiosave Rescue分销日期:2012年3月6日至2023年5月19日在美国召回设备:4586台召回发起日期:2023年6月5日产品用途:Cardiosave Hybrid主动脉内球囊泵(IABP)和Cardiosave Rescue IABP是一个机电系统,用于主动脉内球囊的充放气。系统通过反搏为左心室提供临时支持,一旦球囊被定位在主动脉中,泵被设置为与心电图或者动脉压力波形同步工作,以使球囊在心动周期中的正确时间膨胀和收缩。

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.

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.