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.

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.

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.

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.

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.

Enhancing the Goos-Hänchen shift based on quasi-bound states in the continuum through material asymmetric dielectric compound gratings

Quasi-bound state in the continuum(QBIC)resonance is gradually attracting attention and being applied in Goos-Hänchen(GH)shift enhancement due to its high quality(Q)factor and superior optical confinement.Currently,symmetry-protected QBIC resonance is often achieved by breaking the geometric symmetry,but few cases are achieved by breaking the material symmetry.This paper proposes a dielectric compound grating to achieve a high Q factor and high-reflection symmetry-protectede QBIC resonance based on material asymmetry.Theoretical calculations show that the symmetry-protected QBIC resonance achieved by material asymmetry can significantly increase the GH shift up to-980 times the resonance wavelength,and the maximum GH shift is located at the reflection peak with unity reflectance.This paper provides a theoretical basis for designing and fabricating high-performance GH shift tunable metasurfaces/dielectric gratings in the future.

A High Order Accurate Bound-Preserving Compact Finite Difference Scheme for Two-Dimensional Incompressible Flow

For solving two-dimensional incompressible flow in the vorticity form by the fourth-order compact finite difference scheme and explicit strong stability preserving temporal discretizations,we show that the simple bound-preserving limiter in Li et al.(SIAM J Numer Anal 56:3308–3345,2018)can enforce the strict bounds of the vorticity,if the velocity field satisfies a discrete divergence free constraint.For reducing oscillations,a modified TVB limiter adapted from Cockburn and Shu(SIAM J Numer Anal 31:607–627,1994)is constructed without affecting the bound-preserving property.This bound-preserving finite difference method can be used for any passive convection equation with a divergence free velocity field.

Upper gastrointestinal bleeding in Bangladeshi children:Analysis of 100 cases

BACKGROUND Upper gastrointestinal bleeding(UGIB)is defined as bleeding that occurs proximal to the ligament of Treitz and can sometimes lead to potentially serious and life-threatening clinical situations in children.Globally,the cause of UGIB differs significantly depending on the geographic location,patient population and presence of comorbid conditions.AIM To observe endoscopic findings of UGIB in children at a tertiary care center of Bangladesh.METHODS This retrospective study was carried out in the department of Pediatric Gastroenterology and Nutrition of Bangabandhu Shiekh Mujib Medical University,a tertiary care hospital of Bangladesh,between January 2017 and January 2019.Data collected from hospital records of 100 children who were 16 years of age or younger,came with hematemesis,melena or both hematemesis and melena.All patients underwent upper gastrointestinal endoscopy(Olympus CV 1000 upper gastrointestinal video endoscope)after initial stabilization.Necessary investigations to diagnose portal hypertension and chronic liver disease with underlying causes for management purposes were also done.RESULTS A total of 100 patients were studied.UGIB was common in the age group 5-10 years(42%),followed by above 10 years(37%).Hematemesis was the most common presenting symptom(75%)followed by both hematemesis and melena(25%).UGIB from ruptured esophageal varices was the most common cause(65%)on UGI endoscopy followed by gastric erosion(5%)and prolapsed gastropathy(2%).We observed that 23%of children were normal after endoscopic examination.CONCLUSION Ruptured esophageal varices were the most common cause of UGIB in children in Bangladesh.Other causes included gastric erosions and prolapsed gastropathy syndrome.

Large isolated fibrous tumors in the upper esophagus: A case report

BACKGROUND Solitary fibrous tumors(SFT)are rare spindle cell tumors that are usually benign.A total of 10 cases of SFTs in the upper esophagus have ever been reported.Here,we report the anesthetic management of a patient with a large isolated fibrous tumor of the upper esophagus compressing the tracheal membrane.We also provide a literature review of the current research.CASE SUMMARY We report the case of a 49 year old male with“cough aggravation and wheezing after exercise”,who underwent esophagectomy for a large isolated fibrous tumor compressing the tracheal membrane in the upper esophagus.We advise the use of a single-lumen tube with a blocker in patients with difficult airways to reduce the incidence of airway injury and fibrinoscopy at all stages of the perioperative period to guide airway management.This case study is the first report of the anesthetic management of a large,isolated fibrous tumor compressing the tracheal membrane in the upper esophagus.CONCLUSION This rare case emphasizes the importance of perioperative management of anesthesia in patients with large isolated fibrous tumors of the upper esophagus that compress the tracheal membrane.The use of blocker reduce the incidence of airway injury and fibrinoscopy at the perioperative period to guide airway mana-gement.

Nomogram to predict gas-related complications during transoral endoscopic resection of upper gastrointestinal submucosal lesions:Clinical significance

Transoral endoscopic resections in treating upper gastrointestinal submucosal lesions have the advantages of maintaining the integrity of the gastrointestinal lumen,avoiding perforation and reducing gastrointestinal fistulae.They are becoming more widely used in clinical practice,but,they may also present a variety of complications.Gas-related complications are one of the most common,which can be left untreated if the symptoms are mild,but in severe cases,they can lead to rapid changes in the respiratory and circulatory systems in a short period,which can be life-threatening.Therefore,it is important to predict the occurrence of gas-related complications early and take preventive measures actively.Based on the authors'results in the prepublication of the article“Nomogram to predict gas-related complications during transoral endoscopic resection of upper gastrointestinal submucosal lesions,”and in conjunction with our evaluation and additions to the relevant content,radiographs may help screen patients at high risk for gas-related complications.Controlling blood glucose levels,shortening the duration of surgery,and choosing the most appropriate surgical resection may positively impact the prognosis of patients at high risk for gas-related complications during transoral endoscopic resection of upper gastrointestinal submucosal lesions.

Insights into upper blepharoplasty: Conservative volume-preserving techniques

This editorial commentary critically examines the systematic review by Miotti et al,which discusses the evolving trends in upper lid blepharoplasty towards a conservative,volume-preserving approach.The review emphasizes the shift from traditional tissue resection to techniques that maintain anatomical integrity,paralleling broader trends in panfacial rejuvenation.Miotti et al delve into the nuances of fat pad management,advocating for conservation over reduction to sustain natural contours and improve long-term aesthetic outcomes.This perspective is supported by comparative studies and empirical data,such as those from Massry and Alghoul et al,highlighting the benefits of conservative approaches in terms of patient satisfaction and aesthetic longevity.The review also stresses the importance of surgeon discretion in adapting procedures to diverse patient demographics,particularly in addressing distinct features such as the Asian upper eyelid.However,it identifies a significant gap in long-term comparative research,underscoring the need for future studies to substantiate the safety and efficacy of these minimalist techniques.Overall,Miotti et al.'s work contributes profoundly to the discourse on personalized,conservative cosmetic surgery,urging ongoing research to refine and validate surgical best practices in upper eyelid blepharoplasty.

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.

MH-STRALP:A scoring system for prognostication in patients with upper gastrointestinal bleeding

BACKGROUND Upper gastrointestinal bleeding(UGIB)is a common medical emergency and early assessment of its outcomes is vital for treatment decisions.AIM To develop a new scoring system to predict its prognosis.METHODS In this retrospective study,692 patients with UGIB were enrolled from two cen-ters and divided into a training(n=591)and a validation cohort(n=101).The clinical data were collected to develop new prognostic prediction models.The en-dpoint was compound outcome defined as(1)demand for emergency surgery or vascular intervention,(2)being transferred to the intensive care unit,or(3)death during hos-pitalization.The models’predictive ability was compared with previously esta-blished scores by receiver operating characteristic(ROC)curves.RESULTS Totally 22.2%(131/591)patients in the training cohort and 22.8%(23/101)in the validation cohort presented poor outcomes.Based on the stepwise-forward Lo-gistic regression analysis,eight predictors were integrated to determine a new post-endoscopic prognostic scoring system(MH-STRALP);a nomogram was de-termined to present the model.Compared with the previous scores(GBS,Rock-all,ABC,AIMS65,and PNED score),MH-STRALP showed the best prognostic prediction ability with area under the ROC curves(AUROCs)of 0.899 and 0.826 in the training and validation cohorts,respectively.According to the calibration cur-ve,decision curve analysis,and internal cross-validation,the nomogram showed good calibration ability and net clinical benefit in both cohorts.After removing the endoscopic indicators,the pre-endoscopic model(pre-MH-STRALP score)was conducted.Similarly,the pre-MHSTRALP score showed better predictive value(AUROCs of 0.868 and 0.767 in the training and validation cohorts,respectively)than the other pre-endoscopic scores.CONCLUSION The MH-STRALP score and pre-MH-STRALP score are simple,convenient,and accurate tools for prognosis prediction of UGIB,and may be applied for early decision on its management strategies.

Pleomorphic adenoma(mixed tumor)of the upper lip:A case report

BACKGROUND Salivary gland tumors are relatively rare.Most minor salivary gland tumors are malignant with benign tumors accounting for 18%of the tumors.Pleomorphic adenoma(PA)is the most common salivary gland tumor.Lip PA is uncommon with 9.8%occurring in the upper lip.We are adding on the knowledge of the rare upper lip PA(benign mixed tumor).CASE SUMMARY We report an upper lip PA(benign mixed tumor)in a 28-year-old man.His complaint was a painless swelling on the upper lip.A painless,non-tender,well-circumscribed,slightly mobile,sessile,nodular,and rubbery(in consistency)tumor measuring 5.0 cm x 2.0 cm was noted on the left side of his upper lip.The overlying skin was not fixed and of normal color.There was no ulceration,and palpation did not elicit pain or bleeding.There was no history of trauma.Blunt dissection was used to completely excise the nodular,whitish,and encapsulated tumor.Microscopy showed a well-circumscribed and partly encapsulated biphasic lesion,with large lobules of myxo-chondroid stroma and intervening cellular nodules of basaloid cells,well-formed tubules containing eosinic secretion,and nests of myoepithelial cells.A diagnosis of PA(benign mixed tumor)was confirmed.CONCLUSION Blunt dissection is indicated to preserve the cosmesis and function of the upper lip.