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.

Flat-footed Females and Missing Males:A New Genus and Species of Pleciofungivoridae(Diptera:Bibionomorpha)Represents the First Record of the Family from Mid-Cretaceous Kachin Amber

A new genus and species,Cretopleciofungivora simpsoni gen.et sp.nov.,from the extinct family Pleciofungivoridae(Diptera:Bibionomorpha),is discovered in mid-Cretaceous Kachin amber.Previously,this family was known only from imprints in sedimentary rocks of the Jurassic and the Lower Cretaceous.Discovery of a representative of Pleciofungivoridae in Kachin amber confirms the presence of the family in the Upper Cretaceous.The new species has a unique structure of fore tarsus,with lobed and extended tarsal segments Ⅱ to Ⅳ,a feature hitherto known only in a few species of extant Sciaroidea.Although not particularly rare,the new species is currently known only from female specimens.Possible reasons for this phenomenon,very unusual in Sciaroidea,are briefly discussed,including parthenogenesis as a potentially plausible hypothesis.

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.

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.

Standardization of meibomian gland dysfunction in an Egyptian population sample using a non-contact meibography technique

AIM:To develop normative data for meibomian gland dysfunction(MGD)parameters,using non-contact meibography technique of Sirius Costruzione Strumenti Oftalmici(CSO)machine,in an Egyptian population sample.METHODS:Observational,cross-sectional,analytic study,in which 104 Egyptian volunteers were included.Both upper lids were examined,using“Sirius CSO”machine.Each eyelid was given a degree of meibomian gland loss(MGL),which was calculated by the software of the machine.RESULTS:Mean percentage MGL in right upper lid was of 30.9%±12.6%,and that of left upper lid was 32.6%±11.8%.Thirty-four volunteers(32.7%)had first-degree MGL in their right upper lid,and 67.3%had second-degree loss.One volunteer(1%)had zero-degree MGL in left upper lid,28(26.9%)had first-degree loss,and 75(72.1%)had second-degree loss.Degree of MGL in right upper eyelid was not related to age,but degree of MGL in left upper eyelid increased with age.There was statistically significant difference between both genders for degree of MGL in right eye(P=0.036)and in left eye(P=0.027).CONCLUSION:Noncontact meibography is a useful non-invasive tool for diagnosing MGL.MGL is diagnosed in 100%of apparently normal individuals;26.9%-32.7%of which have first-degree MGL,and 67.3%-72.1%have second-degree MGL.

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.

Experimental study on temperature fluctuations on plate surface induced by coaxial-jet flow

In nuclear reactors,temperature fluctuations of fluids may cause fatigue damage to adjacent structures;this is referred to as thermal striping.Research on thermal striping in the upper plenum has mainly focused on fluid fields.Few experimental studies have been reported on solid structures in a fluid field with a coaxial jet.This study entailed an experimental study of the temperature fluctuations in the fluid and on a plate surface caused by a coaxial jet.The temperature fluctuations of the fluid and plate surfaces located at different heights were analyzed.The cause of the temperature fluctuation was analyzed using a transient temperature distribution.The results show that the mixing of the hot and cold fluids gradually becomes uniform in the positive axial direction.The average surface temperatures tended to be consistent.When the jet reaches the plate surface,the swing of the jet center,contraction and expansion of the cold jet,and changes in the jet shape result in temperature fluctuations.The intensity of the temperature fluctuation was affected by the position.More attention should be paid when the plate is located at a lower height,and between the hot and cold-fluid nozzles.

MAXIMAL FUNCTION CHARACTERIZATIONS OF HARDY SPACES ASSOCIATED WITH BOTH NON-NEGATIVE SELF-ADJOINT OPERATORS SATISFYING GAUSSIAN ESTIMATES AND BALL QUASI-BANACH FUNCTION SPACES

Assume that L is a non-negative self-adjoint operator on L^(2)(ℝ^(n))with its heat kernels satisfying the so-called Gaussian upper bound estimate and that X is a ball quasi-Banach function space onℝ^(n) satisfying some mild assumptions.Let HX,L(ℝ^(n))be the Hardy space associated with both X and L,which is defined by the Lusin area function related to the semigroup generated by L.In this article,the authors establish various maximal function characterizations of the Hardy space HX,L(ℝ^(n))and then apply these characterizations to obtain the solvability of the related Cauchy problem.These results have a wide range of generality and,in particular,the specific spaces X to which these results can be applied include the weighted space,the variable space,the mixed-norm space,the Orlicz space,the Orlicz-slice space,and the Morrey space.Moreover,the obtained maximal function characterizations of the mixed-norm Hardy space,the Orlicz-slice Hardy space,and the Morrey-Hardy space associated with L are completely new.

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.

Construction and Research Progress of the Chinese Meridian Project in 2022–2023

The Chinese Meridian Project(CMP)is a major national science and technology infrastructure constructed in two steps.The first phase of the CMP has been operating for more than a solar cycle.From 2022 to 2023,utilizing the monitoring data collected by the CMP,scientists made major breakthroughs in fields of ionosphere,middle and upper atmosphere,and coupling between layers.The construction of the second phase of the CMP is nearly finished,and the project is expected to operate as a whole in 2025 after national acceptance of the second phase.The whole project was built in an architecture of so-called“One Chain,Three Networks and Four Focuses”.It is promising to make a three-dimensional observation of the whole solar-terrestrial space.The science community is looking forward to the great contribution of the CMP to space weather and space physics research.

Carbon allocation in Picea jezoensis:Adaptation strategies of a non-treeline species at its upper elevation limit

Understanding the physiological adaptations of non-treeline trees to environmental stress is important to understand future shifts in species composition and distribution of current treeline ecotone.The aim of the present study was to elucidate the mechanisms of the formation of the upper elevation limit of non-treeline tree species,Picea jezoensis,and the carbon allocation strategies of the species on Changbai Mountain.We employed the^(13)C in situ pulse labeling technique to trace the distribution of photosynthetically assimilated carbon in Picea jezoensis at different elevational positions(tree species at its upper elevation limit(TSAUE,1,700 m a.s.l.)under treeline ecotone;tree species at a lower elevation position(TSALE,1,400 m a.s.l.).We analyzed^(13)C and the non-structural carbohydrate(NSC)concentrations in various tissues following labeling.Our findings revealed a significant shift in carbon allocation in TSAUE compared to TSALE.There was a pronounced increase inδ^(13)C allocation to belowground components(roots,soil,soil respiration)in TSAUE compared to TSALE.Furthermore,the C flow rate within the plant-soil-atmosphere system was faster,and the C residence time in the plant was shorter in TSAUE.The trends indicate enhanced C sink activity in belowground tissues in TSAUE,with newly assimilated C being preferentially directed there,suggesting a more conservative C allocation strategy by P.jezoensis at higher elevations under harsher environments.Such a strategy,prioritizing C storage in roots,likely aids in withstanding winter cold stress at the expense of aboveground growth during the growing season,leading to reduced growth of TSAUE compared to TSALE.The results of the present study shed light on the adaptive mechanisms governing the upper elevation limits of non-treeline trees,and enhances our understanding of how non-treeline species might respond to ongoing climate change.

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

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

Variations of shear-wave splitting parameters in the source region of the 2023 Türkiye doublet earthquakes

In this study,the shear-wave splitting parameters of local seismic events from the source regions of the 2023 Türkiye MW7.7 and MW7.6 doublet earthquakes(event 1 and event 2,respectively)were measured from June 1,2022,to April 25,2023,and their spatiotemporal characteristics were analyzed.The results revealed clear spatial and temporal differences.Spatially,the dominant fast-wave polarization direction at each station shows a strong correlation with the direction of the maximum horizontal principal compressive stress,as characterized by focal mechanism solutions of seismic events(MW≥3.5)near the station.The dominant fast-wave polarization direction and the regional stress field also showed a strong correlation with the intermovement of the Arabian Plate,African Plate,and Anatolian Block.Along the Nurdagi-Pazarcik fault zone,the seismic fault of event 1,stations closer to the middle of the fault where the mainshock occurred exhibited notably greater delay times than stations located towards the ends of the fault and far from the mainshock.In addition,the stations located to the east of the Nurdagi-Pazarcik fault and to the north of the Sürgüfault also exhibited large delay times.The spatial distribution of shear-wave splitting parameters obtained from each station indicates that the upper-crust anisotropy in the source area is mainly controlled by the regional stress field,which is closely related to the state of the block motion.During the seismogenic process of the MW7.7 earthquake,more stress accumulated in the middle of the Nurdagi-Pazarcik fault than at either end of the fault.Under the influence of the MW7.7 and MW7.6 events,the stress that accumulated during the seismogenic process of the earthquake doublet may have migrated towards some areas outside the aftershock intensive area after the earthquakes,and the crustal stress and its adjustment range near the outer stations increased significantly.With the exception of two stations with few effective events,all stations showed a consistent change in shear-wave splitting parameters over time.In particular,each station showed a decreasing trend in delay times after the doublet earthquakes,reflecting the obvious intensification of crustal stress adjustment in the seismogenic zone after the doublet earthquakes.With the occurrence of the earthquake doublet and a large number of aftershocks,the stress accumulated during the seismogenic process of the doublet earthquakes is gradually released,and then the adjustment range of crustal stress is also gradually reduced.

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.

The burden of upper motor neuron involvement is correlated with the bilateral limb involvement interval in patients with amyotrophic lateral sclerosis:a retrospective observational study

Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives and may lead them to be confined to bed.However,the effect of upper and lower motor neuron impairment and other risk factors on bilateral limb involvement is unclear.To address this issue,we retrospectively collected data from 586 amyotrophic lateral sclerosis patients with limb onset diagnosed at Peking University Third Hospital between January 2020 and May 2022.A univariate analysis revealed no significant differences in the time intervals of spread in different directions between individuals with upper motor neuron-dominant amyotrophic lateral sclerosis and those with classic amyotrophic lateral sclerosis.We used causal directed acyclic graphs for risk factor determination and Cox proportional hazards models to investigate the association between the duration of bilateral limb involvement and clinical baseline characteristics in amyotrophic lateral sclerosis patients.Multiple factor analyses revealed that higher upper motor neuron scores(hazard ratio[HR]=1.05,95%confidence interval[CI]=1.01–1.09,P=0.018),onset in the left limb(HR=0.72,95%CI=0.58–0.89,P=0.002),and a horizontal pattern of progression(HR=0.46,95%CI=0.37–0.58,P<0.001)were risk factors for a shorter interval until bilateral limb involvement.The results demonstrated that a greater degree of upper motor neuron involvement might cause contralateral limb involvement to progress more quickly in limb-onset amyotrophic lateral sclerosis patients.These findings may improve the management of amyotrophic lateral sclerosis patients with limb onset and the prediction of patient prognosis.

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.

Comparative Assessment of Impacts of Future Climate Change on Runoff in Upper Daqinghe Basin,China

Assessing runoff changes is of great importance especially its responses to the projected future climate change on local scale basins because such analyses are generally done on global and regional scales which may lead to generalized conclusions rather than specific ones.Climate change affected the runoff variation in the past in the upper Daqinghe Basin,however,the climate was mainly considered uncertain and still needs further studies,especially its future impacts on runoff for better water resources management and planning.Integrated with a set of climate simulations,a daily conceptual hydrological model(MIKE11-NAM)was applied to assess the impact of climate change on runoff conditions in the Daomaguan,Fuping and Zijingguan basins in the upper Daqinghe Basin.Historical hydrological data(2008–2017)were used to evaluate the applicability of the MIKE11-NAM model.After bias correction,future projected climate change and its impacts on runoff(2025–2054)were analysed and compared to the baseline period(1985–2014)under three shared social economic pathways(SSP1-2.6,SSP2-4.5,and SSP5-8.5)scenarios from Coupled Model Intercomparison Project Phase 6(CMIP6)simulations.The MIKE-11 NAM model was applicable in all three Basins,with both R^(2)and Nash-Sutcliffe Efficiency coefficients greater than 0.6 at daily scale for both calibration(2009–2011)and validation(2012–2017)periods,respectively.Although uncertainties remain,temperature and precipitation are projected to increase compared to the baseline where higher increases in precipitation and temperature are projected to occur under SSP2-4.5 and SSP5-8.5 scenarios,respectively in all the basins.Precipitation changes will range between 12%–19%whereas temperature change will be 2.0℃–2.5℃ under the SSP2-4.5 and SSP5-8.5 scenarios,respectively.In addition,higher warming is projected to occur in colder months than in warmer months.Overall,the runoff of these three basins is projected to respond to projected climate changes differently because runoff is projected to only increase in the Fuping basin under SSP2-4.5 whereas decreases in both Daomaguan and Zijingguan Basins under all scenarios.This study’s findings could be important when setting mitigation strategies for climate change and water resources management.

Efficacy and safety of over-the-scope-clips in the therapy of acute nonvariceal upper gastrointestinal bleeding:Meta-analysis

BACKGROUND Acute nonvariceal upper gastrointestinal bleeding(ANVUGIB)is a frequent lifethreatening acute condition in gastroenterology associated with high morbidity and mortality.Over-the-scope-clip(OTSC)is a new endoscopic hemostasis technique,which is being used in ANVUGIB and is more effective.AIM To summarize and analyze the effects of the OTSC in prevention of recurrent bleeding,clinical success rate,procedure time,hospital stay,and adverse events in the treatment of ANVUGIB,to evaluate whether OTSC can replace standard endoscopic therapy as a new generation of treatment for ANVUGIB.METHODS The literature related to OTSC and standard therapy for ANVUGIB published before January 2023 was searched in PubMed,Web of Science,EMBASE,Cochrane,Google,and CNKI databases.Changes in recurrent bleeding(7 or 30 days),clinical results(clinical success rate,conversion rate to surgery,mortality),therapy time(procedure time,hospital stay),and adverse events in the OTSC intervention group were summarized and analyzed,and the MD or OR of 95%CI is calculated by Review Manager 5.3.RESULTS This meta-analysis involved 11 studies with 1266 patients.Total risk of bias was moderate-to-high.For patients in the OTSC group,7-and 30-days recurrent bleeding rates,as well as procedure time,hospital stay,and intensive care unit stay,were greatly inhibited.OTSC could significantly improve the clinical success rate of ANVUGIB.OTSC therapy did not cause serious adverse and was effective in reducing patient mortality.CONCLUSION OTSC may provide more rapid and sustained hemostasis,and thus,promote recovery and reduce mortality in patients with ANVUGIB.In addition,the safety of OTSC is assured.

Spatiotemporal Characteristics of Typical Ecosystem Services and Their Spatial Responses to Driving Factors in Ecologically Fragile Areas in Upper Yellow River,China

The identification of dominant driving factors for different ecosystem services(ESs)is crucial for ecological conservation and sustainable development.However,the spatial heterogeneity of the dominant driving factors affecting various ESs has not been adequately elucidated,particularly in ecologically fragile regions.This study employed the integrated valuation of ESs and trade-offs(InVEST)model to evaluate four ESs,namely,water yield(WY),soil conservation(SC),habitat quality(HQ),and carbon storage(CS),and then to identify the dominant driving factors of spatiotemporal differentiation of ES and further to characterize the spatial heterogeneity characteristics of the dominant driving factors in the eco-fragile areas of the upper Yellow River,China from 2000 to 2020.The results demonstrated that WY exhibited northeast-high and northwest-low patterns in the upper Yellow River region,while high values of SC and CS were distributed in central forested areas and a high value of HQ was distributed in vast grassland areas.The CS,WY,and SC exhibited decreasing trends over time.The most critical factors affecting WY,SC,HQ,and CS were the actual evapotranspiration,precipitation,slope,and normalized difference vegetation index,respectively.In addition,the effects of different factors on various ESs exhibited spatial heterogeneity.These results could provide spatial decision support for eco-protection and rehabilitation in ecologically fragile areas.