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Acute upper gastrointestinal bleeding (UGIB) in acute coronary syndrome (ACS) patients are not uncommon, particularly under dual antiplatelet therapy (DAPT). The efficiency and safety of early endoscopy (EE) for UGIB in these patients needs to be elucidated. This multicenter randomized controlled trial randomized recent ACS patients presenting acute UGIB to non-EE and EE groups. All eligible patients received intravenous proton pump inhibitor therapy. Those in EE group underwent therapeutic endoscopy within 24 h after bleeding. The data regarding efficacy and safety of EE were analyzed. It was early terminated because the UGIB rate was lower than expected and interim analysis was done. In total, 43 patients were randomized to non-EE (21 patients) and EE (22 patients) groups. The failure rate of control hemorrhage (intention-to-treat [ITT] 4.55% vs. 23.81%, p

Posterior lumbar interbody fusion (PLIF) with a spacer and posterior instrument (PI) via minimally invasive surgery (MIS) restores intervertebral height in degenerated disks. To align with MIS, the spacer has to be shaped with a slim geometry. However, the thin spacer increases the subsidence and migration after PLIF. This study aimed to propose a new lumbar fusion approach using bone cement to achieve a larger supporting area than that achieved by the currently used poly aryl-ether-ether-ketone (PEEK) spacer and assess the feasibility of this approach using a sawbone model. Furthermore, the mechanical responses, including the range of motion (ROM) and bone stress with the bone cement spacer were compared to those noted with the PEEK spacer by finite element (FE) simulation. An FE lumbar L3-L4 model with PEEK and bone cement spacers and PI was developed. Four fixing conditions were considered: intact lumbar L3-L4 segment, lumbar L3-L4 segment with PI, PEEK spacer plus PI, and bone cement spacer plus PI. Four kinds of 10-NM moments (flexion, extension, lateral bending, and rotation) and two different bone qualities (normal and osteoporotic) were considered. The bone cement spacer yielded smaller ROMs in extension and rotation than the PEEK spacer, while the ROMs of the bone cement spacer in flexion and lateral bending were slightly greater than with the PEEK spacer. Compared with the PEEK spacer, peak contact pressure on the superior surface of L4 with the bone cement spacer in rotation decreased by 74% (from 8.68 to 2.25 MPa) and 69.1% (from 9.1 to 2.82 MPa), respectively, in the normal and osteoporotic bone. Use of bone cement as a spacer with PI is a potential approach to decrease the bone stress in lumbar fusion and warrants further research.

Prolonged static sitting in wheelchairs increases the risk of pressure ulcers. This exploratory study proposed three dynamic sitting techniques in order to reduce the risk of developing pressure ulcer during wheelchair sitting, namely lumbar prominent dynamic sitting, femur upward dynamic sitting, and lumbar prominent with femur upward dynamic sitting. The purpose of this study was to analyze the biomechanical effects of these three techniques on interface pressure. 15 able-bodied people were recruited as subjects to compare the aforementioned sitting techniques in a random order. All parameters, including dynamic contact area, dynamic average pressure, and dynamic peak pressure on backrest and seat were measured and compared. In result, when compared with lumbar prominent dynamic sitting, femur upward dynamic sitting and lumbar prominent with femur upward dynamic sitting appeared to yield significantly lower dynamic average and peak pressure on the back part of seat, and significantly higher dynamic average and peak pressure on the front part of seat. This study can serve as a reference point for clinical physicians or wheelchair users to identify a suitable dynamic sitting technique.

Prolonged static sitting in a wheelchair is associated with an increased risk of lower back pain. The wheelchair seating system is a key factor of this risk because it affects spinal loading in the sitting position. In this study, 7 dynamic sitting strategies (DSSs) are examined: lumbar prominent dynamic sitting (LPDS), back reclined dynamic sitting (BRDS), femur upward dynamic sitting (FUDS), lumbar prominent with back reclined dynamic sitting (LBDS), lumbar prominent with femur upward dynamic sitting (LFDS), back reclined with femur upward dynamic sitting (BFDS), and lumbar prominent with back reclined with femur upward dynamic sitting (LBFDS). The objective of this study was to analyze the biomechanical effects of these sitting strategies on lumbar-pelvic angles. Twenty able-bodied participants were recruited for the study. All participants performed LPDS, BRDS, FUDS, LBDS, LFDS, BFDS, and LBFDS in a random order. All lumbar-pelvic angle parameters, including the static lumbar angle, static pelvic angle, lumbar range of motion, and pelvic range of motion were measured and compared. Results show that LBDS and LBFDS enabled the most beneficial lumbar movements, although the difference between the 2 strategies was nonsignificant. BRDS and BFDS enabled the most beneficial pelvic movements, although the difference between the 2 strategies was nonsignificant. Among all the upright DSSs, LPDS and LFDS enabled the most beneficial lumbar and pelvic movements, although no significant difference was observed between these 2 strategies. We identified the effects and differences among 7 DSSs on lumbar-pelvic angles. Wheelchair users can choose the most suitable DSS that meets their needs. These findings may serve as a reference for practicing physicians or wheelchair users to choose an appropriate dynamic wheelchair seating system. ISRCTN12389808 , 18th November 2016, retrospectively registered.