Main recommendations
ESGE recommends that the evaluation of superficial gastrointestinal (GI) lesions should be made by an experienced endoscopist, using high definition white-light and ...chromoendoscopy (virtual or dye-based).
ESGE does not recommend routine performance of endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)-CT prior to endoscopic resection.
ESGE recommends endoscopic submucosal dissection (ESD) as the treatment of choice for most superficial esophageal squamous cell and superficial gastric lesions.
For Barrett’s esophagus (BE)-associated lesions, ESGE suggests the use of ESD for lesions suspicious of submucosal invasion (Paris type 0-Is, 0-IIc), for malignant lesions > 20 mm, and for lesions in scarred/fibrotic areas.
ESGE does not recommend routine use of ESD for duodenal or small-bowel lesions.
ESGE suggests that ESD should be considered for en bloc resection of colorectal (but particularly rectal) lesions with suspicion of limited submucosal invasion (demarcated depressed area with irregular surface pattern or a large protruding or bulky component, particularly if the lesions are larger than 20 mm) or for lesions that otherwise cannot be completely removed by snare-based techniques.
ESGE recommends that an en bloc R0 resection of a superficial GI lesion with histology no more advanced than intramucosal cancer (no more than m2 in esophageal squamous cell carcinoma), well to moderately differentiated, with no lymphovascular invasion or ulceration, should be considered a very low risk (curative) resection, and no further staging procedure or treatment is generally recommended.
ESGE recommends that the following should be considered to be a low risk (curative) resection and no further treatment is generally recommended: an en bloc R0 resection of a superficial GI lesion with superficial submucosal invasion (sm1), that is well to moderately differentiated, with no lymphovascular invasion, of size ≤ 20 mm for an esophageal squamous cell carcinoma or ≤ 30 mm for a stomach lesion or of any size for a BE-related or colorectal lesion, and with no lymphovascular invasion, and no budding grade 2 or 3 for colorectal lesions.
ESGE recommends that, after an endoscopically complete resection, if there is a positive horizontal margin or if resection is piecemeal, but there is no submucosal invasion and no other high risk criteria are met, this should be considered a local-risk resection and endoscopic surveillance or re-treatment is recommended rather than surgery or other additional treatment.
ESGE recommends that when there is a diagnosis of lymphovascular invasion, or deeper infiltration than sm1, or positive vertical margins, or undifferentiated tumor, or, for colorectal lesions, budding grade 2 or 3, this should be considered a high risk (noncurative) resection, and complete staging and strong consideration for additional treatments should be considered on an individual basis in a multidisciplinary discussion.
ESGE recommends scheduled endoscopic surveillance with high definition white-light and chromoendoscopy (virtual or dye-based) with biopsies of only the suspicious areas after a curative ESD.
ABSTRACT
After 15 yr, in late 2018, the magnetar XTE J1810−197 underwent a second recorded X-ray outburst event and reactivated as a radio pulsar. We initiated an X-ray monitoring campaign to follow ...the timing and spectral evolution of the magnetar as its flux decays using Swift, XMM–Newton, NuSTAR, and NICER observations. During the year-long campaign, the magnetar reproduced similar behaviour to that found for the first outburst, with a factor of 2 change in its spin-down rate from ∼7.2 × 10−12 to ∼1.5 × 10−11 s s−1 after two months. Unique to this outburst, we confirm the peculiar energy-dependent phase shift of the pulse profile. Following the initial outburst, the spectrum of XTE J1810−197 is well modelled by multiple blackbody components corresponding to a pair of non-concentric, hot thermal caps surrounded by a cooler one, superposed to the colder star surface. We model the energy-dependent pulse profile to constrain the viewing and surface emission geometry and find that the overall geometry of XTE J1810−197 has likely evolved relative to that found for the 2003 event.
We review our understanding of Saturn's rings after nearly 6 years of observations by the Cassini spacecraft. Saturn's rings are composed mostly of water ice but also contain an undetermined reddish ...contaminant. The rings exhibit a range of structure across many spatial scales; some of this involves the interplay of the fluid nature and the self-gravity of innumerable orbiting centimeter- to meter-sized particles, and the effects of several peripheral and embedded moonlets, but much remains unexplained. A few aspects of ring structure change on time scales as short as days. It remains unclear whether the vigorous evolutionary processes to which the rings are subject imply a much younger age than that of the solar system. Processes on view at Saturn have parallels in circumstellar disks.
Background
Melasma can be refractory to treatment, and relapses are frequent. Thiamidol is a new potent tyrosinase inhibitor that has been found effective as a cosmeceutical for the depigmenting of ...melasma.
Objective
This study compared the efficacy and tolerability of topical 0.2% Thiamidol vs. 4% hydroquinone for facial melasma.
Methods
Fifty women with facial melasma participated in a randomized, evaluator‐blinded, controlled study from September through November 2020. Patients were randomly assigned to apply a double layer of 0.2% Thiamidol twice a day or 4% hydroquinone cream at bedtime, for 90 days. Both groups received tinted sunscreen (sun protection factor 60, PPD 20). The primary outcome was the change from the baseline Modified Melasma Area Seve:rity Index (mMASI) score. Secondary outcomes were improvements in the patients’ quality of life Melasma Quality of Life Index (MELASQoL), colourimetry, and Global Aesthetic Improvement Scale (GAIS) evaluation.
Results
One participant, from the hydroquinone group, did not complete the study (unrelated to adverse effects). The mean (SD) age of the participants was 43 (6) years, and 86% were phototypes III–IV. Both groups exhibited a reduction in mMASI, MELASQoL, and colour contrast scores (P < 0.01). The mean 95% confidence interval (CI 95%) reductions of the mMASI scores were 43% (35–50%) for Thiamidol and 33% (23–42%) for hydroquinone. There was no difference between the groups in the reductions in mMASI, MELASQoL, colourimetric contrast and GAIS scores (P ≥ 0.09). The GAIS analysis resulted in an improvement of 84% (CI: 95% 67–97%) for participants in the Thiamidol group and 74% (CI: 95% 61–93%) for those in the hydroquinone group. There were only mild adverse effects in the Thiamidol group, but allergic contact dermatitis was evidenced in two (8%) participants.
Conclusion
The melasma improvement achieved using 0.2% Thiamidol did not differ from that of 4% hydroquinone cream. Thiamidol can be considered a suitable option for melasma patients with poor tolerability or treatment failure with hydroquinone.
We report on the long-term X-ray monitoring of the outburst decay of the low magnetic field magnetar SGR 0418 + 5729 using all the available X-ray data obtained with RXTE, Swift, Chandra, and ...XMM-Newton observations from the discovery of the source in 2009 June up to 2012 August. The timing analysis allowed us to obtain the first measurement of the period derivative of SGR 0418 + 5729: P = 4(1) x 10sup -15 s ssup -1, significant at a ~3.5sigma confidence level. By modeling the magneto-thermal secular evolution of SGR 0418 + 5729, we infer a realistic age of ~550 kyr, and a dipolar magnetic field at birth of ~10sup14 G. We estimate the outburst rate of low magnetic field magnetars to be about one per year per galaxy, and we briefly discuss the consequences of such a result in several other astrophysical contexts.
Background
Melasma can be recalcitrant to treatment, and relapses are common. Pycnogenol has been reported to be effective in treating melasma.
Objective
To compare the efficacy, safety and ...tolerability of 75 mg pycnogenol taken orally twice a day vs. a placebo, in association with the triple combination and broad‐spectrum sunscreen for the treatment of facial melasma.
Methods
A randomized, double‐blind, parallel, placebo‐controlled study was conducted on 44 women with facial melasma in a single centre from May 2019 through November 2019. Patients with melasma were randomly assigned to orally take 75 mg pycnogenol (PYC) or a placebo (PLAC) twice a day for 60 days. Both groups also received tinted sunscreen Sun Protection Factor (SPF) 50; Persistent Pigment Darkening (PPD) 17 for daytime use and a topical triple combination at bedtime. The primary outcome was a change from the baseline Modified Melasma Area Severity Index (mMASI) score. Secondary outcomes were improvements in the patients' quality of life (MELASQoL), colorimetric indices and Global Aesthetic Improvement Scale (GAIS).
Results
All participants completed the trial. The mean (SD) age of the participants was 39 (7) years, and 91% were phototypes III–IV. Both groups exhibited a reduction in mMASI scores, MELASQoL scores and colour contrast (P < 0.01). The mean (CI 95%) reductions of the mMASI scores were 49% (36–61%) for PYC and 34% (16–47%) for PLAC. The reductions in mMASI scores and colorimetric contrast were superior for the PYC group (P < 0.05). The analysis of GAIS resulted in an improvement of 86% (CI 95%: 68–96%) for the participants in the PYC group and 55% (CI 95%: 32–73%) for those in the PLAC group. There were no adverse effects related to oral treatment.
Conclusion
Pycnogenol is well‐tolerated and increases the effectiveness of broad‐spectrum sunscreen and the triple combination in the treatment of facial melasma in women.
We present timing observations of 4-ms pulsars discovered in the Parkes 20-cm multibeam pulsar survey of the Galactic plane. PSRs J1552−4937 and J1843−1448 are isolated objects with spin periods of ...6.28 and 5.47 ms, respectively. PSR J1727−2946 is in a 40-d binary orbit and has a spin period of 27 ms. The 4.43-ms pulsar J1813−2621 is in a circular 8.16-d binary orbit around a low-mass companion star with a minimum companion mass of 0.2 M⊙. Combining these results with detections from five other Parkes multibeam surveys, gives a well-defined sample of 56 pulsars with spin periods below 20 ms. We develop a likelihood analysis to constrain the functional form which best describes the underlying distribution of spin periods for millisecond pulsars. The best results were obtained with a lognormal distribution. A gamma distribution is less favoured, but still compatible with the observations. Uniform, power-law and Gaussian distributions are found to be inconsistent with the data. Galactic millisecond pulsars being found by current surveys appear to be in agreement with a lognormal distribution which allows for the existence of pulsars with periods below 1.5 ms.
Context. During the period between 15 September 2014 and 4 February 2015, the Rosetta spacecraft accomplished the circular orbit phase around the nucleus of comet 67P/Churyumov-Gerasimenko (67P). The ...Grain Impact Analyzer and Dust Accumulator (GIADA) onboard Rosetta monitored the 67P coma dust environment for the entire period. Aims. We aim to describe the dust spatial distribution in the coma of comet 67P by means of in situ measurements. We determine dynamical and physical properties of cometary dust particles to support the study of the production process and dust environment modification. Methods. We analyzed GIADA data with respect to the observation geometry and heliocentric distance to describe the coma dust spatial distribution of 67P, to monitor its activity, and to retrieve information on active areas present on its nucleus. We combined GIADA detection information with calibration activity to distinguish different types of particles that populate the coma of 67P: compact particles and fluffy porous aggregates. By means of particle dynamical parameters measured by GIADA, we studied the dust acceleration region. Results. GIADA was able to distinguish different types of particles populating the coma of 67P: compact particles and fluffy porous aggregates. Most of the compact particle detections occurred at latitudes and longitudes where the spacecraft was in view of the comet’s neck region of the nucleus, the so-called Hapi region. This resulted in an oscillation of the compact particle abundance with respect to the spacecraft position and a global increase as the comet moved from 3.36 to 2.43 AU heliocentric distance. The speed of these particles, having masses from 10-10 to 10-7 kg, ranged from 0.3 to 12.2 m s-1. The variation of particle mass and speed distribution with respect to the distance from the nucleus gave indications of the dust acceleration region. The influence of solar radiation pressure on micron and submicron particles was studied. The integrated dust mass flux collected from the Sun direction, that is, particles reflected by solar radiation pressure, was three times higher than the flux coming directly from the comet nucleus. The awakening 67P comet shows a strong dust flux anisotropy, confirming what was suggested by on-ground dust coma observations performed in 2008.
Abstract
The young (50–400 Myr) A3V star
β
Leo is a primary target to study the formation history and evolution of extrasolar planetary systems as one of the few stars with known hot (∼1600 K), warm ...(∼600 K), and cold (∼120 K) dust belt components. In this paper, we present deep mid-infrared measurements of the warm dust brightness obtained with the Large Binocular Telescope Interferometer (LBTI) as part of its exozodiacal dust survey (HOSTS). The measured excess is 0.47% ± 0.050% within the central 1.5 au, rising to 0.81% ± 0.026% within 4.5 au, outside the habitable zone of
β
Leo. This dust level is 50 ± 10 times greater than in the solar system’s zodiacal cloud. Poynting–Robertson drag on the cold dust detected by Spitzer, and Herschel underpredicts the dust present in the habitable zone of
β
Leo, suggesting an additional delivery mechanism (e.g., comets) or an additional belt at ∼5.5 au. A model of these dust components is provided that implies the absence of planets more than a few Saturn masses between ∼5 au and the outer belt at ∼40 au. We also observationally constrain giant planets with the LBTI imaging channel at 3.8
μ
m wavelength. Assuming an age of 50 Myr, any planet in the system between approximately 5–50 au must be less than a few Jupiter masses, consistent with our dust model. Taken together, these observations showcase the deep contrasts and detection capabilities attainable by the LBTI for both warm exozodiacal dust and giant exoplanets in or near the habitable zone of nearby stars.
Abstract Olive oil (OO) is the most representative food of the traditional Mediterranean Diet (MedDiet). Increasing evidence suggests that monounsaturated fatty acids (MUFA) as a nutrient, OO as a ...food, and the MedDiet as a food pattern are associated with a decreased risk of cardiovascular disease, obesity, metabolic syndrome, type 2 diabetes and hypertension. A MedDiet rich in OO and OO per se has been shown to improve cardiovascular risk factors, such as lipid profiles, blood pressure, postprandial hyperlipidemia, endothelial dysfunction, oxidative stress, and antithrombotic profiles. Some of these beneficial effects can be attributed to the OO minor components. Therefore, the definition of the MedDiet should include OO. Phenolic compounds in OO have shown antioxidant and anti-inflammatory properties, prevent lipoperoxidation, induce favorable changes of lipid profile, improve endothelial function, and disclose antithrombotic properties. Observational studies from Mediterranean cohorts have suggested that dietary MUFA may be protective against age-related cognitive decline and Alzheimer's disease. Recent studies consistently support the concept that the OO-rich MedDiet is compatible with healthier aging and increased longevity. In countries where the population adheres to the MedDiet, such as Spain, Greece and Italy, and OO is the principal source of fat, rates of cancer incidence are lower than in northern European countries. Experimental and human cellular studies have provided new evidence on the potential protective effect of OO on cancer. Furthermore, results of case-control and cohort studies suggest that MUFA intake including OO is associated with a reduction in cancer risk (mainly breast, colorectal and prostate cancers).
PDF
