BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased morta...BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased mortality and prolonged hospitalization,particularly in ACS patients.Despite advancements in management strategies,the role of gastrointestinal endoscopy(GIE)in this population remains controversial,with concerns about timing,safety,and clinical outcomes.AIM To evaluate the safety and efficacy of GIE in patients with ACS and acute GIB,focusing on outcomes such as mortality,hospital length of stay(LOS),hemorrhage control,rebleeding,and blood transfusion requirements.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a systematic review was conducted using databases including PubMed,Cochrane,and EMBASE,up to December 2024.The protocol was registered with the International Prospective Register of Systematic Reviews(CRD42025630188).Study quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials(RCTs)and the Newcastle-Ottawa Scale for cohort studies.RESULTS Four studies met the inclusion criteria,comprising one RCT and three cohort studies with a total population of 1676130 patients.Most studies indicated that GIE was associated with improved survival in ACS patients with GIB.Three of our studies reported lower mortality rates in patients undergoing GIE compared to those managed without endoscopy,although this varied by study.While GIE demonstrated effectiveness in controlling hemorrhage and reducing rebleeding rates in one study.The rest of the studies did not evaluate these outcomes comprehensively.Hospital LOS outcomes were inconsistent,with two studies suggesting no significant difference,while only one study indicated potential reductions in LOS with GIE.Blood transfusion requirements were reported in one study to be higher in patients undergoing GIE,reflecting its frequent use in severe cases.The safety and effectiveness of GIE varied depending on patient characteristics,timing of the procedure,and type of intervention.CONCLUSION GIE has the potential to improve survival in certain patients with ACS complicated by GIB;however,determining the ideal timing and appropriate candidates necessitates careful individual assessment.While evidence suggests benefits,the limitations of observational studies warrant caution.Collaboration between cardiology and gastroenterology is essential to optimizing outcomes.Future randomized trials should focus on timing,severity,and diverse populations to refine guidelines and improve care for this high-risk group.展开更多
BASF presents a new high viscosity ester base stock technology.Viscosity profiles of these new candidates are comparable to market-known high viscosity PAO types such as PAO 40 and PAO 100.Due to the more polar nature...BASF presents a new high viscosity ester base stock technology.Viscosity profiles of these new candidates are comparable to market-known high viscosity PAO types such as PAO 40 and PAO 100.Due to the more polar nature of the new ester base stocks additional benefits can be achieved in terms of friction reduction,energy efficiency or facilitated additive solubilisation against high viscosity PAOs.The superior performance of the new high viscosity ester base stock technology is demonstrated in direct comparison against high viscosity PAO counterparts in industrial gear applications.The basic advantages found herein in industrial gear applications are also of relevance for other lubricant applications such as automotive driveline oil or engine oil applications.As one exemplary area industrial gear applications play a dominant role in modern wind turbines.The latest generation of lubricants used in these turbine gear boxes are required to provide a greater performance in terms of wear protection,durability,foam resistance,shear stability,and oxidation resistance.Common formulations are based on a PAO base stock thickened with high molecular weight PAO polymers to achieve a viscosity of ISO 320 combined with additives to provide wear protection,foam resistance etc.A recent plant outage coupled with high demand for high molecular weight PAO polymers has led to the market becoming aware of potential availability issues.In response to this important challenge BASF has developed a new formulation strategy-based on the new high viscosity ester technology and upon a widely available low molecular weight PAO base stock employing a new concept in a thickening system that avoids the use of high molecular weight PAO polymers.The novel ester base stock can be manufactured at multiple locations and is based on sustainable raw materials that can be sourced from a wide supplier base.展开更多
文摘BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased mortality and prolonged hospitalization,particularly in ACS patients.Despite advancements in management strategies,the role of gastrointestinal endoscopy(GIE)in this population remains controversial,with concerns about timing,safety,and clinical outcomes.AIM To evaluate the safety and efficacy of GIE in patients with ACS and acute GIB,focusing on outcomes such as mortality,hospital length of stay(LOS),hemorrhage control,rebleeding,and blood transfusion requirements.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a systematic review was conducted using databases including PubMed,Cochrane,and EMBASE,up to December 2024.The protocol was registered with the International Prospective Register of Systematic Reviews(CRD42025630188).Study quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials(RCTs)and the Newcastle-Ottawa Scale for cohort studies.RESULTS Four studies met the inclusion criteria,comprising one RCT and three cohort studies with a total population of 1676130 patients.Most studies indicated that GIE was associated with improved survival in ACS patients with GIB.Three of our studies reported lower mortality rates in patients undergoing GIE compared to those managed without endoscopy,although this varied by study.While GIE demonstrated effectiveness in controlling hemorrhage and reducing rebleeding rates in one study.The rest of the studies did not evaluate these outcomes comprehensively.Hospital LOS outcomes were inconsistent,with two studies suggesting no significant difference,while only one study indicated potential reductions in LOS with GIE.Blood transfusion requirements were reported in one study to be higher in patients undergoing GIE,reflecting its frequent use in severe cases.The safety and effectiveness of GIE varied depending on patient characteristics,timing of the procedure,and type of intervention.CONCLUSION GIE has the potential to improve survival in certain patients with ACS complicated by GIB;however,determining the ideal timing and appropriate candidates necessitates careful individual assessment.While evidence suggests benefits,the limitations of observational studies warrant caution.Collaboration between cardiology and gastroenterology is essential to optimizing outcomes.Future randomized trials should focus on timing,severity,and diverse populations to refine guidelines and improve care for this high-risk group.
文摘BASF presents a new high viscosity ester base stock technology.Viscosity profiles of these new candidates are comparable to market-known high viscosity PAO types such as PAO 40 and PAO 100.Due to the more polar nature of the new ester base stocks additional benefits can be achieved in terms of friction reduction,energy efficiency or facilitated additive solubilisation against high viscosity PAOs.The superior performance of the new high viscosity ester base stock technology is demonstrated in direct comparison against high viscosity PAO counterparts in industrial gear applications.The basic advantages found herein in industrial gear applications are also of relevance for other lubricant applications such as automotive driveline oil or engine oil applications.As one exemplary area industrial gear applications play a dominant role in modern wind turbines.The latest generation of lubricants used in these turbine gear boxes are required to provide a greater performance in terms of wear protection,durability,foam resistance,shear stability,and oxidation resistance.Common formulations are based on a PAO base stock thickened with high molecular weight PAO polymers to achieve a viscosity of ISO 320 combined with additives to provide wear protection,foam resistance etc.A recent plant outage coupled with high demand for high molecular weight PAO polymers has led to the market becoming aware of potential availability issues.In response to this important challenge BASF has developed a new formulation strategy-based on the new high viscosity ester technology and upon a widely available low molecular weight PAO base stock employing a new concept in a thickening system that avoids the use of high molecular weight PAO polymers.The novel ester base stock can be manufactured at multiple locations and is based on sustainable raw materials that can be sourced from a wide supplier base.
