Proton Pump Inhibitors (PPIs): A Review of the Efficacy, Usage, and Current Literature Recommendations

• As Klepser, Collier, and Cochran (2013) noted, PPIs are a class of agents that reduce acid secretion by parietal cells in the stomach by irreversibly blocking H+/K+ adenosine triphosphate. They are commonly prescribed for many gastrointestinal (GI) conditions including gastric and duodenal ulcers, gastroesophageal reflux disease (GERD), upper gastrointestinal bleeding, and Helicobacter pylori infections. They are frequently utilized in the primary care setting. The purpose of this study was to examine the efficacy, usage, and current literature on PPIs. • There were several complications noted with PPI usage. Gomm et al. (2016) found that that use of PPI is associated with an increased risk of dementia and that avoiding PPIs may contribute to the prevention of dementia. Klepser et al. (2013) concluded that PPIs were associated with renal disease after controlling for confounding conditions. They noted patients who had renal disease were twice as likely to have used PPIs in the past. In yet another study, Lazarus et al. (2016) concluded that PPI use is an independent risk factor for CKD and AKI, while H2 antagonist use is not. Shih et al. (2014) concluded PPI use was associated with an increased risk of myocardial infarction for both a 7- and 14- day window period. Finally, van der Hoorn et al. (2015) also determined that PPI use was associated with a substantially increased risk of requiring osteoporosis medication and fractures. • Histamine-2-receptor antagonists (H2RAs) are often prescribed in place of PPIs. Sigterman et al. (2013) concluded that were superior to H2RAs in treating heartburn in patients both treated empirically and in patents with endoscopy-negative reflux disease (ENRD). PPIs were also noted to be more effective in patients requiring long-term treatment. H2RAs, however, were found to be superior to PPIs in speed of relief of symptoms and may be a better option for patients with only occasional symptoms. • Rickenbacher et al. (2014) studied medical vs. surgical management of GERD. Their data showed a statistically significant pooled effect estimate in favor of fundoplication over medical management of GERD, although several patients complained of dysphagia after surgery. Nissen fundoplication has long been the surgical intervention of choice for GERD treatment. It has some drawbacks in that many patients complain of dysphagia and bloating post-surgery. Lal et al. (2017) compared laparoscopic Nissen fundoplication (LNF) to laparoscopic anterior partial fundoplication (LAPF) and found it to be just as effective as LNF for GERD treatment with less dysphagia.https://commons.und.edu/pas-grad-posters/1031/thumbnail.jp

Developing an IF panel to examine Cyclin and CDK interactions in a Pancreatic Adenocarcinoma Patient Derived Xenograph.

https://openworks.mdanderson.org/sumexp22/1084/thumbnail.jp

Studies of the Response of the Prototype CMS Hadron Calorimeter, Including Magnetic Field Effects, to Pion, Electron, and Muon Beams

We report on the response of a prototype CMS hadron calorimeter module to charged particle beams of pions, muons, and electrons with momenta up to 375 GeV/c. The data were taken at the H2 and H4 beamlines at CERN in 1995 and 1996. The prototype sampling calorimeter used copper absorber plates and scintillator tiles with wavelength shifting fibers for readout. The effects of a magnetic field of up to 3 Tesla on the response of the calorimeter to muons, electrons, and pions are presented, and the effects of an upstream lead tungstate crystal electromagnetic calorimeter on the linearity and energy resolution of the combined calorimetric system to hadrons are evaluated. The results are compared with Monte Carlo simulations and are used to optimize the choice of total absorber depth, sampling frequency, and longitudinal readout segmentation.Comment: 89 pages, 41 figures, to be published in NIM, corresponding author: P de Barbaro, [email protected]

High-gradient normal-conducting RF structures for muon cooling channels

We present a status report on the research and development of high-gradient normal-conducting RF structures for the ionization cooling of muons in a neutrino factory or muon collider. High-gradient RF structures are required in regions enclosed in strong focusing solenoidal magnets, precluding the application of superconducting RF technology [1]. We propose using linear accelerating structures, with individual cells electromagnetically isolated, to achieve the required gradients of over 15 MV/m at 201 MHz and 30 MV/m at 805 MHz. Each cell will be powered independently, and cell length and drive phase adjusted to optimize shunt impedance of the assembled structure. This efficient design allows for relatively small field enhancement on the structure walls, and an accelerating field approximately 1.7 times greater than the peak surface field. The electromagnetic boundary of each cell may be provided by a thin Be sheet, or an assembly of thin-walled metal tubes. Use of thin, low-Z materials will allow passage of the muon beams without significant deterioration in beam quality due to scattering. R and D in design and analysis of robust structures that will operate under large electric and magnetic fields and RF current heating are discussed, including the experimental program based in a high-power test laboratory developed for this purpose

Coronary artery surgery: cardiotomy suction or cell salvage?

Coronary artery bypass grafting (CABG) today results in what may be regarded as acceptable levels of blood loss with many institutions avoiding allogeneic red cell transfusion in over 60% of their patients. The majority of cardiac surgeons employ cardiotomy suction to preserve autologous blood during on-pump coronary artery bypass surgery; however the use of cardiotomy suction is associated with a more pronounced systemic inflammatory response and a resulting coagulopathy as well as exacerbating the microembolic load. This leads to a tendency to increased blood loss, transfusion requirement and organ dysfunction. Conversely, the avoidance of cardiotomy suction in coronary artery bypass surgery is not associated with an increased transfusion requirement. There is therefore no indication for the routine use of cardiotomy suction in on-pump coronary artery surgery

Cerebral perfusion in sepsis

This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855