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381 Is There A Role for Tranexamic Acid in Upper GI Bleeding? A Systematic Review and Meta-Analysis

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Abstract

Introduction Upper Gastrointestinal bleeding is associated with increased morbidity and mortality. It has been suggested that tranexamic acid (TXA) may be useful in arresting bleeding. Aim To synthesise available evidence of the effect of TXA on upper GI bleeding. Method A systematic review was conducted. PubMed, EMBASE and Cochrane central register of controlled trials were searched for relevant studies. A random effects meta-analysis was performed to determine the risk ratio of primary and secondary outcomes. Results 8 studies were included in the review. Total number of patients included was 12994 including 4550 females (35%). The effect of TXA on mortality: risk ratio was 0.95 which favoured TXA however the 95% CI ranged from 0.80 to 1.13 and was not statistically significant. The re-bleeding rate risk ratio was 0.64, which favoured the TXA group and with a 95% CI ranging from 0.47 to 0.86 this was statistically significant. The risk of adverse thromboembolic events: risk ratio was 0.93 favoured the TXA group however the 95% CI extended from 0.62 to 1.39 and so was not statistically significant. Conclusions We cannot recommend the routine use of TXA in the setting of acute upper GI bleeding outside its use in randomised controlled clinical trials.

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This chapter examines the main determinants of hinterland evolution through a literature review. It explores the possibilities and challenges for interregional comparisons, and suggests a tentative common framework. The chapter mainly deals with European issues, though complementing them by integrating studies done on other regions. The literature review covers mainly the last two decades, during which containerisation have reached maturity in most world regions. The chapter is organised as follows. The first section introduces some historical elements to understand the specificity of European hinterlands, mostly shaped during the 16th–18th centuries. The second section presents the current situation of European ports compared with the rest of the world. The third section reviews current determinants of hinterland expansion and shrinkage in various regional contexts. Finally, the conclusion discusses the need for pushing further the elaboration of a common framework notwithstanding challenges for interregional comparison.
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The Rail Baltica initiative represents one of the highest ranked infrastructural projects on the European transport agenda aiming for the construction of a European gauge railway link from Tallinn via Riga and Kaunas to Warsaw in order to connect the Baltic States to the European railway system. Since 2017 the project has been provided with European finances to promote the first investments and to start the construction activities. The coordination work in the Baltic States is coordinated by RB Rail AS which is located in Riga. Until now the Rail Baltica initiative has been mainly considered as a transport infrastructural project trying to link the Baltics closer to Central Europe without changing the railway platforms at the Polish border.
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The relevance of issues about development of the customs and logistics framework of international transport corridors is caused by constantly increasing value of global supply chains. The international differentiation of labor creates conditions for increase in volumes of the export–import cargo transportation that, in its turn, leads fight for attraction of international transportation flows. The purpose of the contribution consists in determination of development prospects of the International North-South Transport Corridor and designation of the most important improvement tendencies of its customs and logistic infrastructure. The key regularities of development of the commodity turnover between the members countries of the North-South corridor are revealed in the work, the factors exerting the greatest impact on the volumes of cargo transportation are defined, and the development prospects of the foreign trade cooperation are designated. In the course of the research, the main issues impeding full use of the transit potential of the transport corridor are emphasized, the improvement tendencies of its transport, customs and logistics infrastructure are determined. The relevance of the studied issue is caused by keen interest of the member countries of the International North-South Transport Corridor to its further development and increase in volumes of mutual trade. Development of the transport corridor is especially important for Russia. It allows enhancing our own export potential and increasing budget revenues due to attraction of the considerable transit freight traffic, passing between the countries of Europe and Southeast Asia.
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The Iranian Empire emerged in the third century in the interstices of the Silk Road that increasingly linked the markets of the Mediterranean and the Near East with South, Central, and East Asia. The ensuing four centuries of Iranian rule corresponded with the heyday of trans-Eurasian trade, as the demand of moneyed imperial elites across the continent for one another's high-value commodities stimulated the development of long-distance networks. Despite its position at the nexus of trans-continental and trans-oceanic commerce, accounts of Iran in late antiquity relegate trade to a marginal role in its political economy. The present article seeks to foreground the contribution of trans-continental mercantile networks to the formation of Iran and to argue that its development depended as much on the political economies of its western and eastern neighbours as on internal Near Eastern factors.
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The International Maritime Organization (IMO) and the European Parliament (EP) decided in 2005 and 2012 to establish Sulphur Emission Control Areas (SECA) in Northern Europe where operating ships from 2015 must use fuel with a low sulphur content not exceeding 0.1% (IMO, 2011). Some of the first reactions were seen with vessels operating in the Baltic Sea who had switched to low sulphur content fuel or LNG. Meanwhile, the SECA regulations had spurred intensive discussions that the regulation somewhat seems to have created some economic disadvantages to maritime stakeholders who must comply with strict regulations which competitors in other parts of the world are not subjected to. This paper presents the first results on measures taken by stakeholders towards sulphur emission reduction and stakeholders impressions of the financial impact of SECA regulations on their businesses and BSR. Results show that the BSR is at the forefront of clean shipping campaign and that the maritime stakeholders attribute significant SECA impacts to innovation and the reputation of BSR. This contribution will improve the prospect of using the BSR as a test bed for future integrated knowledge for cleaner and more cost-effective shipping globally.