Background
Fundoplication and medical management are current mainstays for management of Barrett’s esophagus (BE), however our understanding of differences in outcomes between these two treatments is ...limited. The aim of this study was to perform a systematic review and meta-analysis to evaluate the efficacy of these interventions on BE disease regression and progression.
Methods and procedures
A comprehensive search in MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library databases was performed on February 22, 2021. Inclusion criteria were studies with both medical and surgical management comparators, BE diagnosis prior to treatment, patients aged ≥ 18 years, and studies with greater than five patients. Primary outcomes of interest included evaluating changes in histopathologic BE regression and disease progression between interventions. Meta-analysis was performed using a Mantel–Haenszel random-effects model (RevMan 5.4.1).
Results
A total of 7231 studies were retrieved after initial search with nine studies (1 randomized trial, 7 prospective cohorts, 1 retrospective cohort) meeting final inclusion criteria. Of included studies, 890 (65%) patients received medical management while 470 (35%) received surgical management. Medical management included proton pump inhibitors (
n
= 807, 91%; 6 studies), H2-receptor blockers (
n
= 40, 4% patients; 3 studies), and combination therapy (
n
= 43, 5%; 1 study). Nissen fundoplication was the most commonly performed type of fundoplication (
n
= 265, 93%). Median length of follow-up ranged from 1.5–7 years. Meta-analysis revealed that fundoplication was associated with improved histopathologic regression of metaplasia/low-grade dysplasia (OR 4.38; 95% CI 2.28–8.42;
p
< 0.00001) and disease progression to dysplasia/adenocarcinoma (OR 0.34; 95% CI 0.12–0.96;
p
= 0.04) compared to medical therapy.
Conclusion
Fundoplication is superior to medical therapy with regards to improved odds of histopathologic BE disease regression and disease progression. Additional randomized trials which directly compare medical management and surgical intervention are required to delineate the optimal delivery and timing of these interventions.
Preventing intimate partner violence or dating violence (DV) among adolescents is a public health priority due to its magnitude and damaging short and long-term consequences for adolescent and adult ...health. In our study protocol, we complement prior experiences in DV prevention by promoting protective factors (or assets) against gender violence such as communication skills, empathy and problem-solving capability through "Cinema Voice", a participatory educational intervention based on adolescents' strengths to tackle DV.
A longitudinal quasi-experimental educational intervention addressed to boys and girls ages 13-17 years, enrolled in secondary education schools in Alicante (Spain), Rome (Italy), Cardiff (UK), Iasi (Romania), Poznan (Poland) and Matosinhos (Portugal). Both process and results evaluations will be carried out with 100-120 intervention and 120-150 control group students per city at three time periods: before, after and 6 months after the implementation of the following interventions: 1) Training seminar with teachers to promote knowledge and skills on the core issues of intervention; 2) Workshops with intervention groups, where participants produce their own digital content presenting their perspective on DV; and 3) Short film exhibitions with participants, their families, authorities and other stakeholders with the objective of share the results and engage the community. Outcome measures are self-perceived social support, machismo, sexism, tolerance towards gender violence, social problem-solving and assertiveness as well as involvement in bullying/cyberbullying. Other socio-demographic, attitudes and violence-related co-variables were also included.
This study may provide relevant information about the effectiveness of educational interventions that combine a positive youth development framework with educational awareness about the importance of achieving gender equality and preventing and combating gender violence. To our knowledge, this is the first study that involves six European countries in an educational intervention to promote violence protective assets among enrolled adolescents in secondary schools. This study may provide the needed tools to replicate the experience in other contexts and other countries.
Clinicaltrials.gov: NCT03411564 . Unique Protocol ID: 776905. Date registered: 18-01-2018.
The embolization of thrombi formed within the atria can occur in any form of atrial fibrillation (AF), i.e., paroxysmal, persistent, or permanent. Although ischemic stroke is the most frequent ...embolic event associated with AF, embolization to other sites in the pulmonary and systemic circulations may occasionally occur. To avert the risk of embolization, long-term oral anticoagulation therapy is recommended for all AF patients if the CHA2DS2-VASC score is at least 1 for men and at least 2 for women. Since anticoagulant therapy is associated with an increased risk of bleeding, the choice of oral anticoagulant agent should be made by careful consideration of the benefit-to-risk ratio. The use of a newer class of direct oral anticoagulants (DOACs) as an alternative to the anti-vitamin K (AVK) anticoagulants (warfarin, acenocumarol, etc.) can help mitigate the need for periodic monitoring of International Normalized Ratio (INR) and adverse bleeding events that are commonly associated with the use of AVK anticoagulants. Though the use of DOACs (dabigatran, rivaroxaban, edoxaban, apixaban, etc.) is gaining ground due to their relative safety profile and the low overall cost, quite a few clinicians remain skeptical about their use.
Our objective was to evaluate the risk of thromboembolism, stroke, neuropsychiatric illness, depression, and dementia, in patients with non-valvular atrial fibrillation who have been treated with either acenocumarol or apixaban, as well as to see the inflammatory status (ESR) and levels of fibrinogen. Our team at Municipal Emergency University Hospital, Timisoara, Romania, conducted a retrospective study using the medical records of AF patients who were treated with either apixaban or acenocumarol between 2016-2019. We divided the patients into two groups and compared the groups for the aforementioned outcomes.
AF patients who were prescribed apixaban had a lower rate of stroke and psychiatric illness compared to those on acenocumarol. No significant correlation was found in terms of risk of developing depression or dementia between the groups.
Non-valvular AF patients on apixaban had lower rates of thromboembolic events than the patients on acenocumarol. This article will serve as a reminder of the positive health and financial outcomes of apixaban use, especially to those healthcare systems that are still oblivious to the decrease in economic burden and gain in quality-adjusted life years (QALY) by the long-term use of NOACS/ DOACS instead of the AVK anticoagulants.
The Petrosani basin is a large and important coal mining zone in the South Carpathians area of Romania. In recent times, most mines have been closed, but an extensive and dense network of galleries ...still exists. Most of the abandoned ones were not filled in with mine tailings. There is strong concern and evidence that the old galleries are collapsing and/or filling up with water, leading to significant surface deformation and potential hazards, especially for the local communities. We present an analysis of GPS data from nineteen (19) campaign sites spanning the period 2007–2012. Our results are quite consistent and show significant horizontal and vertical surface motions. The horizontal velocities range from 0 to 260 mm/year (mainly in WSW direction), while the vertical velocities range from +39 (uplift) to −263 (subsidence) mm/year. The largest motions appear to be associated with the central (oldest) sector of the mining area. The pattern of vertical motions suggests that the peripheral area is affected by slight uplift in response to the subsidence of the central sector.
Abstract
Objectives
Current gold standard investigations to determine the pathology of ineffective esophageal motility (IEM) are invasive and resource-intensive. Marshmallow barium swallow ...esophagogram (MBSE) is emerging as a more feasible modality; however, our understanding of its role in the clinical setting is limited. Our aim was to appraise the current literature and describe the effectiveness and limitations of MBSE as a potential diagnostic tool when investigating the pathological cause of IEM.
Methods
A search in PubMed was conducted on May 23, 2021. Search terms included “marshmallow” AND “barium.” We included all studies which examined MBSE in the context of esophageal disease. The primary outcome of interest was to characterize the use of MBSE in current literature.
Results
A total of 12 studies were retrieved after initial search with 9 studies meeting final inclusion criteria. A total of 375 patients were included, with 296 patients (79%) having a relevant diagnosis or symptom prompting investigation with MBSE. The most common diagnoses included referral to a gastroenterology clinic for a barium swallow (44%), post-Angelchik insertion (23%), and dysphagia (13%). Esophageal disease was identified in both the MBSE and other screening tests in 63% participants, whereas in 27% participants abnormalities were only seen using the MBSE.
Conclusion
There is currently limited high-quality evidence on the use of MBSE to diagnose IEM. Further large-scale studies comparing its use in patients with different pathologic causes of IEM and of older age are required to further delineate the optimal delivery of this emerging diagnostic modality.
The number of commercial ships with electric propulsion is in continuous increase due to their versatility and fuel efficiency. Total harmonic distortion consequences on marine electrical power ...systems will be discussed. This paper aims to highlight the need for harmonic filter implementation on electric propulsion with static converters. For this study, a simulation in Matlab Simulink will reveal the effect of electrical filters on THD and voltage end current waveforms.
In this paper, the authors present new ways of using drones in the marine and offshore environments. The article includes the presentation of the main constructive electrical elements of a marine ...floating buoy, which play the role of charging base for an unmanned aerial drone. Also, are highlighted the main losses of the system’s components, what should have been taken into account when choosing the size of such an independent energy source, as well as the main steps for energy source design.
•Gravity and magnetic crustal model of the earthquake prone Vrancea Zone, Romania.•The crust of the East European Craton (EEC) terminates west of the Vrancea Zone.•The Tornquist-Tesseyre Zone in ...Romania lies beneath the south-eastern Carpathians.•Vrancea Zone intermediate depth earthquakes occur within the EEC lithosphere.
A 2D gravity and magnetic data model has been constructed along a 71km densely observed profile, called DACIA PLAN GRAV MAN's. The profile crosses part of the nappe pile of the south-eastern Carpathians and includes the seismically active Vrancea Zone and was acquired with the objective to illuminate the basement structure and affinity in this area. The modelling approach was to create an initial model from well constrained geological information, integrate it with previous seismic ray tracing and tomographic models and then alter it outside the a priori constraints in order to reach the best fit between observed and calculated potential field anomalies. The results support a realignment of the position of the TTZ (Tornquist-Teisseyre Zone), the profound tectonic boundary within Europe that separates Precambrian cratonic lithosphere of the East European Craton (EEC) from younger accreted lithosphere of Phanerozoic mobile belts to its west. The TTZ is shown to lie further to the south-west than was previously inferred within Romania, where it is largely obscured by the Carpathian nappes. The crust of the EEC beneath the south-eastern Carpathians is inferred to terminate along a major crustal structure lying just west of the Vrancea seismogenic zone. The intermediate depth seismicity of the Vrancea Zone therefore lies within the EEC lithosphere, generally supporting previously proposed models invoking delamination of cratonic lithosphere as the responsible mechanism.
We located continuous seismic tremor with coherent amplitude wave trains in the Chile ridge subduction region (~46.5°S) in two clusters north and south of the Chonos Archipelago, between the Chile ...trench and the North Patagonian fore arc. Tremor persisted from December 2004 to February 2007 (the entire period of the Chile Ridge Subduction Project temporary seismic deployment), and lasted >17 h on six occasions. Tremor in the more active southern cluster reached a maximum duration of 48 h, and we observed no more than 3 continuous days without tremor activity. The cluster locations coincide with the surface projections of subducted transform faults formed at the Chile ridge. We also detected simultaneous, colocated low‐frequency microearthquakes with well‐defined impulsive waves within the tremor signals distributed from the surface to 40 km depth, suggesting tremors and earthquakes are part of the same process. The periodicity of tremor duration is strongly correlated with semidiurnal, diurnal, and long‐period tides, M2, N2, K1, O1, P1, and Mm (12.421 h, 12.000 h, 23.934 h, 25.819 h, 24.066 h, and 27.555 days, respectively). We found a significant correlation between tremor occurrence and Earth tides when tidal stress is calculated for the slip plane of a right‐lateral strike‐slip fault with strike N95°E, which is near parallel to subducted transform faults (N78°E) of the Chile ridge, indicating that the very small stresses resulting from the combination of ocean loading and solid Earth tides (~1 kPa) are sufficient to facilitate or suppress tremor production; tremors occur when shear stresses are maximum and wane or are low when shear stresses are minimum.
Key PointsNon Volcanic Tremors were found in southern ChileThey are located in the forearc regionThey are modulated by soli‐lunar tides
This study presents general theoretical aspects regarding electromagnetic field interferences. The main sources and their influence on GNSS systems of electromagnetic interference involved in the ...naval environment are exposed according to Septentrio GNSS Technology. Referring to new approaches of power supply in the marine industry, are highlighted studies that may attest the influence of wireless energy sources utilized in changing naval drones can influence GNSS systems.
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