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%.

Reservoir characteristics and formation model of Upper Carboniferous bauxite series in eastern Ordos Basin,NW China

Through core observation,thin section identification,X-ray diffraction analysis,scanning electron microscopy,and low-temperature nitrogen adsorption and isothermal adsorption experiments,the lithology and pore characteristics of the Upper Carboniferous bauxite series in eastern Ordos Basin were analyzed to reveal the formation and evolution process of the bauxite reservoirs.A petrological nomenclature and classification scheme for bauxitic rocks based on three units(aluminum hydroxides,iron minerals and clay minerals)is proposed.It is found that bauxitic mudstone is in the form of dense massive and clastic structures,while the(clayey)bauxite is of dense massive,pisolite,oolite,porous soil and clastic structures.Both bauxitic mudstone and bauxite reservoirs develop dissolution pores,intercrystalline pores,and microfractures as the dominant gas storage space,with the porosity less than 10% and mesopores in dominance.The bauxite series in the North China Craton can be divided into five sections,i.e.,ferrilite(Shanxi-style iron ore,section A),bauxitic mudstone(section B),bauxite(section C),bauxite mudstone(debris-containing,section D)and dark mudstone-coal section(section E).The burrow/funnel filling,lenticular,layered/massive bauxite deposits occur separately in the karst platforms,gentle slopes and low-lying areas.The karst platforms and gentle slopes are conducive to surface water leaching,with strong karstification,well-developed pores,large reservoir thickness and good physical properties,but poor strata continuity.The low-lying areas have poor physical properties but relatively continuous and stable reservoirs.The gas enrichment in bauxites is jointly controlled by source rock,reservoir rock and fractures.This recognition provides geological basis for the exploration and development of natural gas in the Upper Carboniferous in the study area and similar bauxite systems.

Discovery of tuff in Wujiaping Formation of Upper Permian in the northern Sichuan Basin:Implications for the termination of Emeishan Large Igneous Province

1.Objective The Emeishan basalts is located in southwest China and northern Vietnam,covering an area of 2.5×10^(5) km^(2)(Zhong YT et al.,2014),which is the first widely recognized large igneous province(LIP)in China(Zhang ZS,2009).The Emeishan LIP has attracted a numbers of scholars for the reason that the LIP may play a significant role in the evolution of environment and climate.Yang JH et al.,(2018)pointed out that the weathering of the Emeishan basalts consumed carbon dioxide and caused a decrease in the climate of the early Wuchiapingian.However,the duration and termination of the Emeishan basalts eruption remain in doubt.This paper reports a new discovery of tuffaceous in the middle part of the Upper Permian Wujiaping Formation from the northern margin of the Sichuan Basin,applying of LA-ICP-MS to obtain zircon U-Pb ages of tuffaceous and to constrain the lasted eruption timing of Emeishan LIP.

Analysing the Potential Impact of Climate Change on the Hydrological Regime of the Upper Benue River Basin (North Cameroon)

In this study, we analyse the climate variability in the Upper Benue basin and assess its potential impact on the hydrology regime under two different greenhouse gas emission scenarios. The hydrological regime of the basin is more vulnerable to climate variability, especially precipitation and temperature. Observed hydroclimatic data (1950-2015) was analysed using a statistical approach. The potential impact of future climate change on the hydrological regime is quantified using the GR2M model and two climate models: HadGEM2-ES and MIROC5 from CMIP5 under RCP 4.5 and RCP 8.5 greenhouse gas emission scenarios. The main result shows that precipitation varies significantly according to the geographical location and time in the Upper Benue basin. The trend analysis of climatic parameters shows a decrease in annual average precipitation across the study area at a rate of -0.568 mm/year which represents about 37 mm/year over the time 1950-2015 compared to the 1961-1990 reference period. An increase of 0.7°C in mean temperature and 14% of PET are also observed according to the same reference period. The two climate models predict a warming of the basin of about 2°C for both RCP 4.5 and 8.5 scenarios and an increase in precipitation between 1% and 10% between 2015 and 2100. Similarly, the average annual flow is projected to increase by about +2% to +10% in the future for both RCP 4.5 and 8.5 scenarios between 2015 and 2100. Therefore, it is primordial to develop adaptation and mitigation measures to manage efficiently the availability of water resources.

Comparative Analysis of Continuous versus Intermittent Proton Pump Inhibitor Therapy in Patients with Upper Gastrointestinal Bleeding Due to Ulcers

Upper gastrointestinal bleeding (UGIB) presents as a prevalent clinical challenge, with annual incidence rates ranging from 80 to 150 cases per 100,000 individuals. Guidelines for managing patients with UGIB due to bleeding ulcers recommend a continuous infusion of proton pump inhibitors (PPI). However, studies comparing intermittent dosing of PPI therapy show that this regimen achieves similar clinical benefits. If the clinical efficacy remains equivalent, intermittent dosing will be more cost-effective for patients and the health care system. Our research study aims to analyze the comparative effectiveness of intermittent versus continuous PPI therapy after endoscopic treatment in patients with UGIB, focusing on such endpoints as rebleeding risk at 3-and 7-day mortality rates. Methods: Resources searched included MEDLINE, EMBASE, PUBMED, and the Cochrane Central Register of Controlled Trials databases from January 2010 through December 2023 with the inclusion of meta-analysis, systematic review, review, or ACG guideline recommendations. Results of the analysis show how recommendations regarding high vs. low PPI regimen changed over time: from no difference in regimen in 2010 to recommending continuous regimen in 2012 to declaring insufficient evidence between choosing one regimen over another in 2013 to determine that both regimens were comparable to each other in 2014-2018 and finally to recommending both regimens in 2021. To conclude, our review shows that in patients with bleeding ulcers and high-risk endoscopic findings, intermittent PPI therapy is non-inferior to continuous PPI infusion for three days, seven days bleeding risk or mortality rates;however, it remains challenging to determine the most optimal intermittent regimen due to heterogeneity of RCTs included in meta-analyses, and further trials will need to be performed.

Advancements in hemostatic strategies for managing upper gastrointestinal bleeding: A comprehensive review

Upper gastrointestinal(GI)hemorrhage presents a substantial clinical challenge.Initial management typically involves resuscitation and endoscopy within 24 h,although the benefit of very early endoscopy(<12 h)for high-risk patients is debated.Treatment goals include stopping acute bleeding,preventing rebleeding,and using a multimodal approach encompassing endoscopic,pharmacological,angiographic,and surgical methods.Pharmacological agents such as vasopressin,prostaglandins,and proton pump inhibitors are effective,but the increase in antithrombotic use has increased GI bleeding morbidity.Endoscopic hemostasis,particularly for nonvariceal bleeding,employs techniques such as electrocoagu-lation and heater probes,with concerns over tissue injury from monopolar electrocoagulation.Novel methods such as Hemospray and Endoclot show promise in creating mechanical tamponades but have limitations.Currently,the first-line therapy includes thermal probes and hemoclips,with over-the-scope clips emerging for larger ulcer bleeding.The gold probe,combining bipolar electrocoagulation and injection,offers targeted coagulation but has faced device-related issues.Future advancements involve combining techniques and improving endoscopic imaging,with studies exploring combined approaches showing promise.Ongoing research is crucial for developing standardized and effective hemorrhage management strategies.

Chiral bound states in a staggered array of coupled resonators

We study the chiral bound states in a coupled-resonator array with staggered hopping strengths,which interacts with a two-level small atom through a single coupling point or two adjacent ones.In addition to the two typical bound states found above and below the energy bands,this system presents an extraordinary chiral bound state located within the energy gap.We use the chirality to quantify the breaking of the mirror symmetry.We find that the chirality value undergoes continuous changes by tuning the coupling strengths.The preferred direction of the chirality is controlled not only by the competition between the intracell and the intercell hoppings in the coupled-resonator array,but also by the coherence between the two coupling points.In the case with one coupling point,the chirality values varies monotonously with difference between the intracell hopping and the intercell hoppings.While in the case with two coupling points,due to the coherence between the two coupling points the perfect chiral states can be obtained.

Theoretical investigation of excited dipole bound states of alkali-containing diatomic anions

Information about electronic excited states of molecular anions plays an important role in investigating electron attachment and detachment processes.Here we present a high-level theoretical study of the electronic structures of 12 alkali-metal-containing diatomic anions MX-(MX = LiH,LiF,LiCl,NaF,NaCl,NaBr,RbCl,KCl,KBr,RbI,KI and CsI).The equation-of-motion electron-attachment coupled-cluster singles and doubles(EOM-EA-CCSD) method is used to calculate the electron binding energies(EBEs) of 10 electronic excited states of each of the 12 molecule anions.With addition of different s-/p-/d-type diffusion functions in the basis set,we have identified possible excited dipole bound states(DBSs) of each anion.With the investigation of EBEs on the 12 MXs with dipole moment(DM) up to 12.1 D,we evaluate the dependence of the number of anionic excited DBSs on molecular DM.The results indicate that there are at least two or three DBSs of anions with a molecular DM larger than 7 D and a molecule with DM > 10 D can sustain a π-DBS of the anion.Our study has some implications for the excited DBS electronic states of alkali-metal-containing diatomic molecules.

Comparison of the Minimum Bounding Rectangle and Minimum Circumscribed Ellipse of Rain Cells from TRMM

Based on the TRMM dataset, this paper compares the applicability of the improved MCE(minimum circumscribed ellipse), MBR(minimum bounding rectangle), and DIA(direct indexing area) methods for rain cell fitting. These three methods can reflect the geometric characteristics of clouds and apply geometric parameters to estimate the real dimensions of rain cells. The MCE method shows a major advantage in identifying the circumference of rain cells. The circumference of rain cells identified by MCE in most samples is smaller than that identified by DIA and MBR, and more similar to the observed rain cells. The area of rain cells identified by MBR is relatively robust. For rain cells composed of many pixels(N> 20), the overall performance is better than that of MCE, but the contribution of MBR to the best identification results,which have the shortest circumference and the smallest area, is less than that of MCE. The DIA method is best suited to small rain cells with a circumference of less than 100 km and an area of less than 120 km^(2), but the overall performance is mediocre. The MCE method tends to achieve the highest success at any angle, whereas there are fewer “best identification”results from DIA or MBR and more of the worst ones in the along-track direction and cross-track direction. Through this comprehensive comparison, we conclude that MCE can obtain the best fitting results with the shortest circumference and the smallest area on behalf of the high filling effect for all sizes of rain cells.

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.

Plasma Metabonomics of Human Adenovirus-infected Patients with Pneumonia and Upper Respiratory Tract Infection

Objective Human adenovirus(HAdV)infection is common and can develop to serious conditions with high mortality,yet the mechanism of HAdV infection remains unclear.In the present study,the serum metabolite profiles of HAdV-7-infected patients with pneumonia or upper respiratory tract infection(URTI)were explored.Methods In total,35 patients were enrolled in the study following an outbreak of HAdV-7 in the army,of whom 14 had pneumonia and 21 had URTI.Blood samples were collected at the acute stage and at the recovery stage and were analyzed by untargeted metabolomics.Results Over 90% of the differential metabolites identified between the pneumonia patients and URTI patients were lipids and lipid-like molecules,including glycerophospholipids,fatty acyls,and sphingolipids.The metabolic pathways that were significantly enriched were primarily the lipid metabolism pathways,including sphingolipid metabolism,glycerophospholipid metabolism,and linoleic acid metabolism.The sphingolipid metabolism was identified as a significantly differential pathway between the pneumonia patients and URTI patients and between the acute and recovery stages for the pneumonia patients,but not between the acute and recovery stages for the URTI patients.Ceramide and lactosylceramide,involved in sphingolipid metabolism,were significantly higher in the pneumonia patients than in the URTI patients with good discrimination abilities[area under curve(AUC)0.742 and 0.716,respectively;combination AUC 0.801].Conclusion Our results suggested that HAdV modulated lipid metabolism for both the patients with URTI and pneumonia,especially the sphingolipid metabolism involving ceramide and lactosylceramide,which might thus be a potential intervention target in the treatment of HAdV infection.

Coulomb-assisted nonlocal electron transport between two pairs of Majorana bound states in a superconducting island

We investigate the nonlocal transport modulated by Coulomb interactions in devices comprising two interacting Majorana wires,where both nanowires are in proximity to a mesoscopic superconducting(SC)island.Each Majorana bound state(MBS)is coupled to one lead via a quantum dot with resonant levels.In this device,the nonlocal correlations can be induced in the absence of Majorana energy splitting.We find that the negative differential conductance and giant current noise cross correlation could be induced,due to the interplay between nonlocality of MBSs and dynamical Coulomb blockade effect.This feature may provide a signature for the existence of the MBSs.

Selenga River human dispersal path in Initial Upper Paleolithic

Here,we consider earlier Upper Paleolithic sites in the Selenga River Basin,the main fluvial input of Lake Baikal that flows through northern Mongolia and the southwestern Transbaikal region of Russia.Lithic industries from these sites can be attributed to the laminar Initial Upper Paleolithic(IUP)technocomplex,widespread in southern Siberia and Central Asia.IUP industries appear in the Selenga Basin about 45 kaBP cal.Aspects of regional typological variability and the transport of exotic raw materials over long distances indicate that these populations participated in developed exchange networks and employed high mobility targeting the acquisition of necessary raw materials.Two site types are present:quarry-workshops in northern Mongolia and generalized activity settlements in the southwestern Transbaikal.Although faunal data are limited,we interpret available information as indicating a specialization on hunting,focusing on migrating steppe game species.The distribution of sites in the mid-altitudes and landscapes of the Selenga-Orkhon geographical region and the geomorphological homogeneity of this territory also supported interregional human moves during the IUP.

MINIMIZERS OF L^(2)-SUBCRITICAL VARIATIONAL PROBLEMS WITH SPATIALLY DECAYING NONLINEARITIES IN BOUNDED DOMAINS

This paper is concerned with the minimizers of L^(2)-subcritical constraint variar tional problems with spatially decaying nonlinearities in a bounded domain Ω of R~N(N≥1).We prove that the problem admits minimizers for any M> 0.Moreover,the limiting behavior of minimizers as M→∞ is also analyzed rigorously.

Holevo bound independent of weight matrices for estimating two parameters of a qubit

Holevo bound plays an important role in quantum metrology as it sets the ultimate limit for multi-parameter estimations,which can be asymptotically achieved.Except for some trivial cases,the Holevo bound is implicitly defined and formulated with the help of weight matrices.Here we report the first instance of an intrinsic Holevo bound,namely,without any reference to weight matrices,in a nontrivial case.Specifically,we prove that the Holevo bound for estimating two parameters of a qubit is equivalent to the joint constraint imposed by two quantum Cramér–Rao bounds corresponding to symmetric and right logarithmic derivatives.This weightless form of Holevo bound enables us to determine the precise range of independent entries of the mean-square error matrix,i.e.,two variances and one covariance that quantify the precisions of the estimation,as illustrated by different estimation models.Our result sheds some new light on the relations between the Holevo bound and quantum Cramer–Rao bounds.Possible generalizations are discussed.

Assistive Robotics for Upper Limb Physical Rehabilitation:A Systematic Review and Future Prospects

Physical assistive robotics are oriented to support and improve functional capacities of people.In physical rehabilitation,robots are indeed useful for functional recovery of affected limb.However,there are still open questions related to technological aspects.This work presents a systematic review of upper limb rehabilitation robotics in order to analyze and establish technological challenges and future directions in this area.A bibliometric analysis was performed for the systematic literature review.Literature from the last six years,conducted between August 2020 and May 2021,was reviewed.The methodology for the literature search and a bibliometric analysis of the metadata are presented.After a preliminary search resulted in 820 articles,a total of 66 articles were included.A concurrency network and bibliographic analysis were provided.And an analysis of occurrences,taxonomy,and rehabilitation robotics reported in the literature is presented.This review aims to provide to the scientific community an overview of the state of the art in assistive robotics for upper limb physical rehabilitation.The literature analysis allows access to a gap of unexplored options to define the technological prospects applied to upper limb physical rehabilitation robotics.

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.

Bilateral Congenital Upper Eyelid Eversion (Ectropion): A Rare Presentation Responded Well to Conservative Treatment at Temeke Regional Referral Hospital-Tanzania

Congenital eversion of the upper eyelids is a rare condition, the exact cause of which remains unknown. It is more frequently associated with Down’s syndrome and black babies. If diagnosed early and treated properly, the condition can be managed without surgery. We report a case of non syndromic congenital bilateral severe upper eyelid eversion in otherwise normal 3 days old neonate of African descent (Tanzanian), born by vaginal delivery. The case was conservatively managed by lubricants, antibiotics and eyelid patching. We report this case because from the best of our knowledge it has never been documented here at our hospital and Tanzania before.

Iterative physical optics method based on efficient occlusion judgment with bounding volume hierarchy technology

This paper builds a binary tree for the target based on the bounding volume hierarchy technology,thereby achieving strict acceleration of the shadow judgment process and reducing the computational complexity from the original O(N^(3))to O(N^(2)logN).Numerical results show that the proposed method is more efficient than the traditional method.It is verified in multiple examples that the proposed method can complete the convergence of the current.Moreover,the proposed method avoids the error of judging the lit-shadow relationship based on the normal vector,which is beneficial to current iteration and convergence.Compared with the brute force method,the current method can improve the simulation efficiency by 2 orders of magnitude.The proposed method is more suitable for scattering problems in electrically large cavities and complex scenarios.

Impact of task-oriented training based on acupuncture rehabilitation on upper extremity function and quality of life of patients with early stroke

BACKGROUND Eighty percent of stroke patients develop upper limb dysfunction,especially hand dysfunction,which has a very slow recovery,resulting in economic burden to families and society.AIM To investigate the impact of task-oriented training based on acupuncture therapy on upper extremity function in patients with early stroke.METHODS Patients with early stroke hemiplegia who visited our hospital between January 2021 and October 2022 were divided into a control group and an observation group,each with 50 cases.The control group underwent head acupuncture plus routine upper limb rehabilitation training(acupuncture therapy).In addition to acupuncture and rehabilitation,the observation group underwent upper limb task-oriented training(30 min).Each group underwent treatment 5 d/wk for 4 wk.Upper extremity function was assessed in both groups using the Fugl-Meyer Assessment-Upper Extremity(FMA-UE),Wolf Motor Function Rating Scale(WMFT),modified Barthel Index(MBI),and Canadian Occupational Performance Measure(COPM).Quality of life was evaluated using the Short-Form 36-Item Health Survey(SF-36).Clinical efficacy of the interventions was also evaluated.RESULTS Before intervention,no significant differences were observed in the FMA-UE,MBI,and WMFT scores between the two groups(P>0.05).After intervention,the FMA-UE,WMFT,MBI,COPM-Functional Mobility and Satisfaction,and SF-36 scores increased in both groups(P<0.05),with even higher scores in the observation group(P<0.05).The observation group also obtained a higher total effective rate than the control group(P<0.05).CONCLUSION Task-oriented training based on acupuncture rehabilitation significantly enhanced upper extremity mobility,quality of life,and clinical efficacy in patients with early stroke.