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.

Evidence supporting the relationship between maternal asthma and risk for autism spectrum disorders

During pregnancy,maternal immune activation(MIA),due to infection,chronic inflammatory disorders,or toxic exposures,can result in lasting health impacts on the developing fetus.MIA has been associated with an increased risk of neurodevelopmental disorders,such as autism spectrum disorder(ASD)in the offspring.ASD is characterized by increased repetitive and stereotyped behaviors and decreased sociability.As of 2020,1 in 36 children are diagnosed with ASD by the age of 8 years,with ASD rates continuing to increase in prevalence in USA(Tamayo et al.,2023).Post-mortem brain studies,biomarker and transcriptomic studies,and epidemiology studies have provided compelling evidence of immune dysregulation in the circulation and brain of individuals diagnosed with ASD.Currently,the etiology of ASD is largely unknown,however,genetic components and environmental factors can contribute to increased susceptibility.Maternal allergic asthma(MAA),a form of MIA,has been identified as a potential risk factor for developing neurodevelopmental disorders(Patel et al.,2020).Asthma is a chronic inflammatory condition driven by a T-helper type(TH)2 immune response.

Implications of Pediatric Chest Wall Surgery on the Risk of Developing of Scoliosis

Scoliosis, a three-dimensional deformity of the spine, is commonly encountered in orthopedic and multidisciplinary settings, with idiopathic scoliosis being the most diagnosed form. Complications arising from thoracic chest wall surgeries, including thoracotomy and sternotomy, often include scoliosis among other complications. However, reported prevalence rates of scoliosis following chest wall surgery vary widely. This study aims to compare the prevalence of scoliosis in children who have undergone chest wall surgery to the prevalence of idiopathic scoliosis in the general population, as well as to observe gender ratios and curve direction in post-surgery scoliosis cases. A systematic review was conducted using PubMed and Scopus databases to identify relevant studies. Inclusion criteria comprised studies reporting scoliosis prevalence post chest wall surgery with follow-up times post-surgery. The search yielded 30 articles, all retrospective institutional cohort studies published between 1975 and 2024. Despite heterogeneity in study characteristics, the analysis revealed a 19% prevalence of acquired scoliosis among 5722 children who underwent chest wall surgery, higher than the reported 1% - 4% prevalence in the idiopathic population. Only three studies showed prevalence rates similar to the idiopathic population, possibly due to short follow-up periods. Further research with longer follow-up into skeletal maturity is warranted to better understand the implications of pediatric chest wall surgery on scoliosis development.

Surgeon preferences in the treatment of thumb carpometacarpal osteoarthritis

BACKGROUND Primary thumb carpometacarpal(CMC)osteoarthritis is one of the most common conditions encountered by hand surgeons.Of the vast number of operations that have been proposed,none have demonstrated results significantly superior to trapeziectomy alone.AIM The purpose of our study was to determine why surgeons opt for their technique in treating CMC arthritis.METHODS A cross-sectional survey of active members of the American Society for Surgery of the Hand was conducted to evaluate the reasons behind their preferred technique in the treatment of isolated thumb CMC arthritis.Surgeons were contacted by email once and provided with a link to a de-identified survey consisting of 5 treatment questions and 5 demographic questions.RESULTS Of 950 responses were received.40.5%of surgeons preferred trapeziectomy+ligament reconstruction tendon interposition(LRTI),followed by trapeziectomy+suspensionplasty(28.2%),suture button suspension(5.9%),trapeziectomy alone(4.6%),prosthetic arthroplasty(3.2%),arthrodesis(1.1%),and other(6.6%).Proponents of trapeziectomy+LRTI cited familiarity(73.2%),exposure during fellowship(48.8%)and less proximal migration(60%)to be the main reasons affecting their decision.Surgeons who preferred trapeziectomy+suspensionplasty most reported simplicity(74.9%),fewer complications(45.3%),less proximal migration(43.8%),and avoidance of autogenous tissue harvest(42.7%).Advocates of suture button suspension cited avoidance of autogenous tissue harvest(80.4%),shorter immobilization(76.8%),and quicker recovery(73.2%)with their technique.Advocates of trapeziectomy alone cited simplicity(97.7%),fewer complications(86.4%),and avoidance of autogenous tissue harvest(59.1%).In their comments,45%of surgeons choosing trapeziectomy alone cited evidence as an additional rationale.Advocates of prosthetic arthroplasty cited improved pinch strength(83.3%)and improved range of motion(63.3%),while those preferring arthrodesis cited better pinch strength(90%)and frequently in their comments,durability.Of the surgeons who preferred a technique other than LRTI,41.8%reported they had tried LRTI in the past,citing complexity of the procedure,flexor carpi radialis harvest,and longer operative time as reasons for moving on.CONCLUSION Our study provides an update on current treatment trends and offers new insight into the reasons behind surgeons'decision making in the management of thumb carpometacarpal osteoarthritis.Despite strong Level 1 evidence supporting the use of trapeziectomy alone,our findings demonstrate that most surgeons continue to supplement trapeziectomy with other techniques such as LRTI or suspensionplasty.Several factors including familiarity,personal experience(Level 4 evidence),and comfort may be more influential than Level 1 evidence in determining the techniques in a surgeon's armamentarium.Further prospective studies are needed to determine the optimal technique for surgical management of Eaton stages II-IV CMC arthritis and how these studies will affect surgeons’choice.

Outcomes of endoscopic submucosal dissection in cirrhotic patients: First American cohort

BACKGROUND Among patients with cirrhosis and pre-malignant or early malignant mucosal lesions,surgical intervention carries a much higher bleeding risk.When such lesions are discovered,endoscopic submucosal dissection(ESD)may offer curative therapy with lower risks than surgery and improved outcomes compared to traditional endoscopic resection.AIM To evaluate the outcomes of ESD in patients with cirrhosis.METHODS Patients with cirrhosis undergoing ESD between July 2015 and August 2022 were retrospectively matched in 1:2 fashion to controls based on lesion location,size,and anticoagulation use.Procedural outcomes were compared between groups.RESULTS A total of 64 Lesions from 59 patients were included(16 cirrhosis,43 control).There were no differences in patient or lesion characteristics between groups.En bloc and curative resection was achieved in 84.21%,78.94%of the cirrhosis group and 88.89%,68.89%of controls,respectively,with no significant differences.Cirrhotic patients had significantly higher rates of intra-procedural coagulation grasper use for control of bleeding(47.37%vs 20%;P=0.02).There were otherwise no significant differences in adverse event rates.In the 29 patients with follow up,we found higher rates of recurrence in the cirrhosis group compared to controls(40%vs 5.26%;P=0.019),however this effect did not persist on multivariable analysis controlling for known confounders.CONCLUSION ESD may be safe and effective in patients with cirrhosis.Most procedure related outcomes were not significantly different between groups.Intra-procedural bleeding requiring use of the coagulation grasper use was expectedly higher in the cirrhosis group given the known effects of liver disease on hemostasis.

Flipped classroom approach to global outreach:cross-cultural teaching of horizontal strabismus to Chinese ophthalmology residents

AIM:To evaluate the flipped classroom model for teaching horizontal strabismus didactics in an ophthalmology residency program in China as part of a visiting professorship from the United States.METHODS:Residents from an ophthalmology residency program in China were invited to participate in flipped classroom sessions taught by an experienced American ophthalmology faculty in 2018.Residents were instructed to watch a pre-class video lecture prior to the in-class-casebased activity.Content tests(5 Ophthalmic Knowledge Assessment Program style questions)and surveys were administered before and after the classroom sessions(100%response rate).These results were compared to that of an American cohort who were taught the same content.RESULTS:The Chinese cohort of 12 residents preferred the flipped classroom to the traditional classroom at higher rates than the American cohort of 40 residents(92%vs 55%,P=0.04)and felt that all ophthalmology topics would be appropriate for the flipped classroom teaching style(P-values between 0.008 and<0.001).In both Chinese and American cohorts,we found that the exotropia curriculum saw a small but significant improvement in performance following the flipped classroom session(P=0.025 for Chinese residents;P=0.001 for US residents),whereas scores in both groups for the esotropia course did not significantly improve.CONCLUSION:This is the first study to evaluate the flipped classroom model implemented by a visiting ophthalmology professor in a global outreach setting.The flipped classroom sessions are viewed favorably by the Chinese residents relative to the US cohort with a modest impact on knowledge.Decreased in-person interpreter requirement and increased student engagement make this model valuable in cross-cultural visiting professorship settings.Finally,the flipped classroom may lend itself well to a virtual format to prevent the transmission of COVID-19,although such a format requires further study.

Convergence of human and veterinary medicine:leveraging canine naturally occurring neurological disorders to develop regenerative treatments

In recent years,large animal models of naturally occurring diseases have become increasingly studied,with the rationale that their disease attributes may better recapitulate the pathological features of corresponding human diseases as compared to induced disease models(Hoffman and Dow,2016).Of the available naturally occurring disease models,the canine is increasingly recognized as a valuable pre-clinical animal model in translational medicine for numerous human diseases,including cancer.

Paravertebral block for analgesia following excision of osteochondroma of the scapula:A case report

Scapular surgery has mainly been studied in the setting of fractures;regional anesthesia can be utilized as part of a multimodal analgesia regimen for postoperative pain relief.Previous studies are limited to scapular fracture pain.The available literature supports the use of various types of nerve blocks and even combinations of different blocks,of which the paravertebral nerve block is one such block that has been effective.We present a case of a patient undergoing excision of a scapular osteochondroma who received a single-shot paravertebral nerve block after surgery with an effective analgesia.

Multi-targeted anti-inflammatory drugs for the treatment of neurological disorders

Inflammation and kinase pathophysiology in neurological disorders:Inflammation is one of the common features of various acute and degenerative neurological disorders,such as stroke,traumatic brain injury(TBI),Alzheimer’s disease(AD),Parkinson’s disease(PD),and others.The inflammatory responses are manifested as the synthesis of inflammation mediators,recruitment of leukocytes,and other secondary injuries.Compelling evidence shows that a large number of inflammation mediators(e.g.,thrombin,reactive oxygen species,cytokines,chemokines,and other molecules)are implicated in the pathophysiological processes in neurological disorders(Liu and Ander,2012)(Figure 1).These increased inflammation mediators stimulate their downstream transmembrane receptors(e.g.,protease-activated receptors,cytokine receptors,and others),and further activate the intracellular downstream effector kinases,such as Src family kinase,Rho-associated protein kinase,Jun N-terminal kinase,extracellular signal-regulated kinase,cyclin-dependent kinase(CDK),and others(Liu and Ander,2012)(Figure 1).Aside from overlapping in different neurological disorders,numerous inflammatory molecules and multiple kinase-involved signaling pathways can be linked to a single neurological disorder such as AD(Heneka et al.,2015).Because of their pivot roles in the process of inflammation,kinases have been regarded as anti-inflammatory targets to improve outcomes of neurological disorders.

叙事暴露疗法在叙利亚创伤后应激障碍难民中应用的可行性和效果研究

目的创伤后应激障碍(osttraumatic stress disorder,PISD)、焦虑和抑郁是难民中常见的心理健康障碍,需要及时给予心理健康支持,以防止短期和长期的不良后果。本研究旨在评估叙事暴露疗法在减少居住在约旦的叙利亚难民的创伤后应激障碍、抑郁和焦虑症状方面的可行性和初步疗效。方法采用随机对照试验。共有40例年龄为18~64岁、被诊断患有PISD的叙利亚难民被随机分配到干预组(n=20)或对照组(n=20)。干预组应用叙事暴露疗法,每周1次,平均为10次;对照组接受育儿培训,并在本研究结束后接受相同的干预。干预前后应用哈佛创伤问卷(Harvard Trauma Questionnaire)阿拉伯语版评估PTSD症状,应用霍普金斯症状清单-25(Hopkins Symptoms Checklist-25)阿拉伯语版评估抑郁和焦虑症状。采用独立样本t检验评估两组间得分差异。结果与对照组相比,干预后干预组的PTSD(t=-10.00,P<0.001).焦虑(t=-9.46,P<0.001)和抑郁(=-6.00,P<0.001)评分明显降低。PTSD、抑郁和焦虑的效应量值(Cohen's d)分别为0.73、0.79和0.97。所有研究参与者全程参与研究,未发生不良事件。结论本研究结果为未来在更大范围实施叙事暴露疗法提供了有力的支持。叙事暴露疗法对于难民和其他患有PTSD焦虑和抑郁的患者来说可能是一种可行且賄用的方法。

Astrocyte evolution and human specificity

The cerebral cortex is one of the most complex structures of the mammalian central nervous system and accounts for the extraordinary cognitive abilities in primates and humans.Since the 19th century,neur ons have been believed to be the main players in the building of the brain,yet astrocytes also play a crucial role as fundamental building blocks of the cerebral cortex complexity.

Serine and arginine rich splicing factor 1:a potential target for neuroprotection and other diseases

Alternative splicing is the process of producing variably spliced mRNAs by choosing distinct combinations of splice sites within a messenger RNA precursor.This splicing enables mRNA from a single gene to synthesize different proteins,which have different cellular properties and functions and yet arise from the same single gene.A family of splicing factors,Serine-arginine rich proteins,are needed to initiate the assembly and activation of the spliceosome.Serine and arginine rich splicing factor 1,part of the arginine/serine-rich splicing factor protein family,can either activate or inhibit the splicing of mRNAs,depending on the phosphorylation status of the protein and its interaction partners.Considering that serine and arginine rich splicing factor 1 is either an activator or an inhibitor,this protein has been studied widely to identify its various roles in different diseases.Research has found that serine and arginine rich splicing factor 1 is a key target for neuroprotection,showing its promising potential use in therapeutics for neurodegenerative disorders.Furthermore,serine and arginine rich splicing factor 1 might be used to regulate cancer development and autoimmune diseases.In this review,we highlight how serine and arginine rich splicing factor 1 has been studied concerning neuroprotection.In addition,we draw attention to how serine and arginine rich splicing factor 1 is being studied in cancer and immunological disorders,as well as how serine and arginine rich splicing factor 1 acts outside the central or peripheral nervous system.

Utility of D-dimer in total joint arthroplasty

As the number of patients receiving total joint replacements continues to rise,considerable attention has been directed towards the early detection and prevention of postoperative complications.While D-dimer has long been studied as a diagnostic tool in venous thromboembolism(VTE),this assay has recently received considerable attention in the diagnosis of periprosthetic joint infection(PJI).D-dimer values are substantially elevated in the acute postoperative period after total joint arthroplasty,with levels often exceeding the standard institutional cutoff for VTE(500µg/L).The utility of D-dimer in detecting VTE after total joint replacement is currently limited,and more research to assess its value in the setting of contemporary prophylaxis protocols is warranted.Recent literature supports D-dimer as a good to excellent biomarker for the diagnosis of chronic PJI,especially when using serum sample technique.Providers should exercise caution when interpreting D-dimer levels in patients with inflammatory and hypercoagulability disorders,as the diagnostic value is decreased.The updated 2018 Musculoskeletal Infection Society criteria,which includes D-dimer levels>860µg/L as a minor criterion,may be the most accurate for diagnosing chronic PJI to date.Larger prospective trials with transparent lab testing protocols are needed to establish best assay practices and optimal cutoff values for D-dimer in the diagnosis of PJI.This review summarizes the most current literature on the value of D-dimer in total joint arthroplasty and elucidates areas for future progress.

Role of endoscopic ultrasound for pre-intervention evaluation in early esophageal cancer

BACKGROUND Endoscopic ultrasound(EUS)stands as an accurate imaging modality for esophageal cancer staging,however utilization of EUS in early-stage cancer management remains controversial.Identification of non-applicability of endoscopic interventions with deep muscular invasion with EUS in pre-intervention evaluation of early-stage esophageal cancer is compared to endoscopic and histologic indicators.AIM To display the role of EUS in pre-intervention early esophageal cancer staging and how the index endoscopic features of invasive esophageal malignancy compare for prediction of depth of invasion and cancer management.METHODS This was a retrospective study of patients who underwent pre-resection EUS after a diagnosis of esophageal cancer at a tertiary medical center from 2012 to 2022.Patient clinical data,initial esophagogastroduodenoscopy/biopsy,EUS,and final resection pathology reports were abstracted,and statistical analysis was conducted to assess the role of EUS in management decisions.RESULTS Forty nine patients were identified for this study.EUS T stage was concordant with histological T stage in 75.5%of patients.In determining submucosal involvement(T1a vs T1b),EUS had a specificity of 85.0%,sensitivity of 53.9%,and accuracy of 72.7%.Endoscopic features of tumor size>2 cm and the presence of esophageal ulceration were significantly associated with deep invasion of cancer on histology.EUS affected management from endoscopic mucosal resection/submucosal dissection to esophagectomy in 23.5%of patients without esophageal ulceration and 6.9%of patients with tumor size<2 cm.In patients without both endoscopic findings,EUS identified deeper cancer and changed management in 4.8%(1/20)of cases.CONCLUSION EUS was reasonably specific in ruling out submucosal invasion but had relatively poor sensitivity.Data validated endoscopic indicators suggested superficial cancers in the group with a tumor size<2 cm and the lack of esophageal ulceration.In patients with these findings,EUS rarely identified a deep cancer that warranted a change in management.

Symptoms and comorbidities associated with abnormal levels of serum calcium,magnesium,and phosphate in the emergency department:a prospective observational study

Emergency departments(EDs)play a significant role in hospital healthcare systems.[1]According to the US Centers for Disease Control and Prevention,130 million individuals visited the ED in 2018.[2]A previous study has demonstrated that unnecessary laboratory tests did not change the management plan.[3]These actions led to ED overcrowding,causing consequences to patient outcomes.

Multi-temporal NDVI analysis using UAV images of tree crowns in a northern Mexican pine-oak forest

The use of unmanned aerial vehicles(UAV)for forest monitoring has grown significantly in recent years,providing information with high spatial resolution and temporal versatility.UAV with multispectral sensors allow the use of indexes such as the normalized difference vegetation index(NDVI),which determines the vigor,physiological stress and photo synthetic activity of vegetation.This study aimed to analyze the spectral responses and variations of NDVI in tree crowns,as well as their correlation with climatic factors over the course of one year.The study area encompassed a 1.6-ha site in Durango,Mexico,where Pinus cembroides,Pinus engelmannii,and Quercus grisea coexist.Multispectral images were acquired with UAV and information on meteorological variables was obtained from NASA/POWER database.An ANOVA explored possible differences in NDVI among the three species.Pearson correlation was performed to identify the linear relationship between NDVI and meteorological variables.Significant differences in NDVI values were found at the genus level(Pinus and Quercus),possibly related to the physiological features of the species and their phenology.Quercus grisea had the lowest NDVI values throughout the year which may be attributed to its sensitivity to relative humidity and temperatures.Although the use of UAV with a multispectral sensor for NDVI monitoring allowed genera differentiation,in more complex forest analyses hyperspectral and LiDAR sensors should be integrated,as well other vegetation indexes be considered.

美国CSUS混合式教学实践经验的浅析

本文在了解美国混合式教学法的实践及研究现状的基础,提出工程技术类课程开展混合式教学的难点,并重点介绍了美国加州州立大学萨克拉门托分校(CSUS)两门课程开展混合式教学的成功经验。以重庆大学"电工电子学"课程的混合式教学实践为案例,反思教学过程中存在的问题。通过对比发现,合理的课程构建是影响混合式教学效果的重要因素。

贝伐单抗在转移性乳腺癌中的应用

1肿瘤血管的生成理论早在20世纪初就有人注意到了肿瘤组织中有血管结构[1]。肿瘤本身提供了影响血管生长的环境并产生具有扩散性的促血管生成因子[2-3]。美国外科医生Folkman[4]在1971年首次提出了肿瘤生长依赖于新血管生成的理论,他认为在肿瘤早期,微小的细胞群体可在细胞外空间自由扩散,

中国大陆麻醉住院医师毕业后教育的探讨

经过近几年在全国部分省市试点后,2015年教育部和卫计委正式通知在全国范围内改变医学教育的现有模式,新的规范化培养（简称规培）已经逐步开展并日渐规范。各专科住院医师规范化培训的目的是培养具有现代医学素质的专职人员,能够胜任现代医学的临床要求。同时对住院医师进行评估和考核已经日趋重要,同样需要通过规范化的方式进行。现将美国麻醉住院医师培训考核模式与国内麻醉住院医师考核方式进行比较。

中外建筑节能和绿色建筑立法对比研究

从20世纪70年代开始,国际先行地区开始推动建筑节能、绿色建筑等发展,各国逐渐完善形成了既有本国特色又有一定共性的法律法规体系、技术体系和市场化推进体系。我国相关工作主要始于20世纪80年代,在立法、技术和市场方面也都有所发展,不过总的来说仍然存在较大的完善空间。尤其在全面依法治国作为中国特色社会主义本质要求和重要保障的背景下,建议按照习近平总书记及党中央关于依法治国和绿色发展的指示与部署,进一步借鉴国际经验并兼顾我国国情,加快建立推动建筑节能、绿色建筑等建设领域绿色化发展的法律法规体系,推进建筑领域绿色化可持续发展。