Background
The introduction of high‐resolution manometry and the Chicago classification has made it possible to diagnose achalasia and predict treatment response accurately. The aim of this study was ...to compare the effect of the different treatments available on symptomatic outcomes across all achalasia subtypes.
Methods
The study was conducted according to PRISMA and MOOSE guidelines. A literature search of PubMed and MEDLINE databases was undertaken to identify all relevant articles reporting clinical outcomes of patients with achalasia after botulinum toxin injection, pneumatic dilatation, laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM) based on manometric subtypes. Patients were grouped according to the Chicago classification and the success rate in treating symptoms was measured as the primary endpoint.
Results
Twenty studies (1575 patients) were selected, and data on botulinum toxin, pneumatic dilatation, LHM and POEM were extracted. Success rates for LHM in type I, II and III achalasia were 81, 92 and 71 per cent respectively. Those for POEM were 95, 97 and 93 per cent respectively. POEM was more likely to be successful than LHM for both type I (odds ratio (OR) 2·97, 95 per cent c.i. 1·09 to 8·03; P = 0·032) and type III (OR 3·50, 1·39 to 8·77; P = 0·007) achalasia. The likelihood of success of POEM and LHM for type II achalasia was similar.
Conclusion
Pneumatic dilatation had a lower but still acceptable success rate compared with POEM or LHM in patients with type II achalasia. POEM is an excellent treatment modality for type I and type III achalasia, although it did not show any superiority over LHM for type II achalasia.
Good response rates but longer follow‐up needed
.
The article describes the main achievements of the NUMEN project together with an updated and detailed overview of the related R&D activities and theoretical developments. NUMEN proposes an ...innovative technique to access the nuclear matrix elements entering the expression of the lifetime of the double beta decay by cross section measurements of heavy-ion induced Double Charge Exchange (DCE) reactions. Despite the fact that the two processes, namely neutrinoless double beta decay and DCE reactions, are triggered by the weak and strong interaction respectively, important analogies are suggested. The basic point is the coincidence of the initial and final state many-body wave functions in the two types of processes and the formal similarity of the transition operators. First experimental results obtained at the INFN-LNS laboratory for the
40
Ca(
18
O,
18
Ne)
40
Ar reaction at 270MeV give an encouraging indication on the capability of the proposed technique to access relevant quantitative information. The main experimental tools for this project are the K800 Superconducting Cyclotron and MAGNEX spectrometer. The former is used for the acceleration of the required high resolution and low emittance heavy-ion beams and the latter is the large acceptance magnetic spectrometer for the detection of the ejectiles. The use of the high-order trajectory reconstruction technique, implemented in MAGNEX, allows to reach the experimental resolution and sensitivity required for the accurate measurement of the DCE cross sections at forward angles. However, the tiny values of such cross sections and the resolution requirements demand beam intensities much larger than those manageable with the present facility. The on-going upgrade of the INFN-LNS facilities in this perspective is part of the NUMEN project and will be discussed in the article.
To investigate indications, surgical and functional outcomes of robotic or endoscopic facelift thyroid surgery (FTS) and whether FTS reported comparable outcomes of other surgical approaches.
PubMed, ...Cochrane Library, and Scopus.
A literature search was conducted about indications, clinical and surgical outcomes of patients who underwent FTS using PICOTS and PRISMA Statements. Outcomes reviewed included age; gender; indications; pathology; functional evaluations; surgical outcomes and complications.
Fifteen papers met our inclusion criteria, accounting for 394 patients. Endoscopic or robotic FTS was carried out for benign and malignant thyroid lesions, with or without central neck dissection. Nodule size and thyroid lobe volume did not exceed 6, 10 cm, respectively. FTS reported comparable outcome with transaxillary or oral approaches about operative time, complication rates or drainage features. The mean operative time ranged from 88 to 220 min, depending on the type of surgery (endoscopic vs robotic hemi- or total thyroidectomy). Conversion to open surgery was rare, occurring in 0-6.3% of cases. The most common complications were earlobe hypoesthesia, hematoma, seroma, transient hypocalcemia and transient recurrent nerve palsy. There was an important disparity between studies about the inclusion/exclusion criteria, surgical and functional outcomes.
FTS is a safe and effective approach for thyroid benign and malignant lesions. FTS reports similar complications to conventional thyroidectomy and excellent cosmetic satisfaction.
Blood flow patterns can alter material properties of ascending thoracic aortic aneurysms (ATAA) via vascular wall remodeling. This study examines the relationship between wall shear stress (WSS) ...obtained from image-based computational modelling with tissue-derived mechanical and microstructural properties of the ATAA wall using segmental analysis.
Ten patients undergoing surgery for ATAA were recruited. Exclusions: bicuspid aortopathy, connective tissue disease. All patients had pre-operative 4-dimensional flow magnetic resonance imaging (4D-MRI), allowing for patient-specific computational fluid dynamics (CFD) analysis and anatomically precise WSS mapping of ATAA regions (6-12 segments per patient). ATAA samples were obtained from surgery and subjected to region-specific tensile and peel testing (matched to WSS segments). Computational pathology was used to characterize elastin/collagen abundance and smooth muscle cell (SMC) count.
Elevated values of WSS were predictive of: reduced wall thickness coef -0.0489, 95% CI (-0.0905, -0.00727),
= 0.022 and dissection energy function (longitudinal) -15,0, 95% CI (-33.00, -2.98),
= 0.048. High WSS values also predicted higher ultimate tensile strength coef 0.136, 95% CI (0 0.001, 0.270),
= 0.048. Additionally, elevated WSS also predicted a reduction in elastin levels coef -0.276, 95% (CI -0.531, -0.020),
= 0.035 and lower SMC count (oef -6.19, 95% CI (-11.41, -0.98),
= 0.021. WSS was found to have no effect on collagen abundance or circumferential mechanical properties.
Our study suggests an association between elevated WSS values and aortic wall degradation in ATAA disease. Further studies might help identify threshold values to predict acute aortic events.
This paper reports on elastic scattering excitation functions for the reaction 9Li+4He measured at backward angles in the centre of mass energy range 5 MeV ≤ E≤c.m.9.5 MeV, with the aim of ...investigating the possible existence of molecular resonances which have been predicted to exist in the case of neutron-rich B-isotopes. Due to the short lifetime of 9Li, the experiment necessitated the use of inverse kinematics on a gaseous 4He target. The Thick Target Inverse Kinematics technique was used which allowed for the measurement of the full excitation function in a single 9Li run. Broad resonances were observed in the excitation region for 13B 15 MeV ≤ Ex≤20 MeV. To understand the nature of such broad structures, various theoretical attempts are reported concerning possible reaction mechanisms for this neutron rich reaction. The most promising approach to interpret the data is within the orbiting reaction scenario.
The low-lying structure of 15C has been investigated via the neutron-removal 16C(d,t) reaction. Along with the known bound neutron sd-shell states, unbound p-shell hole states have been observed. The ...excitation energies and the deduced spectroscopic factors of the cross-shell states are an important measure of the (p)−1(sd)2 neutron configurations in 15C. Our results show a very good agreement with shell-model calculations using the SFO-tls interaction for 15C. However, this same interaction predicted energies that were too low for the corresponding hole states in the N=9 isotone 17O and adjustment of the p-sd and sd-sd monopole terms was required to match the 17O energies. In addition, the excitation energies and spectroscopic factors have been compared to the first calculations of 15C with the ab initio self-consistent Green's function method employing the NNLOsat interaction. The results show the sensitivity to the size of the N=8 shell gap and highlight the need to go beyond the current truncation scheme.
Background
The pathophysiology of hiatal hernias is incompletely understood. This study systematically reviewed the literature of hiatal hernias to provide an evidence-based explanation of the ...pathogenetic theories and to identify any risk factors at the molecular and cellular levels.
Methods
A systematic search of the Medline and Pubmed databases on the pathophysiology of hiatal hernias was performed to identify English-language citations from the database inception to December 2010.
Results
Although few studies have examined the relationship of molecular and cellular changes of the diaphragm to the pathogenesis of hiatal hernias, there appear to be three dominant pathogenic theories: (1) increased intraabdominal pressure forces the gastroesophageal junction (GEJ) into the thorax; (2) esophageal shortening due to fibrosis or excessive vagal nerve stimulation displaces the GEJ into the thorax; and (3) GEJ migrates into the chest secondary to a widening of the diaphragmatic hiatus in response to congenital or acquired molecular and cellular changes, such as the abnormalities of collagen type 3 alpha 1.
Conclusions
The pathogenesis of hiatal hernias at the molecular and cellular levels is poorly described. To date, no single theory has proved to be the definitive explanation for hiatal hernia formation, and its pathogenesis appears to be multifactorial.
Background
Even though the pathogenesis of idiopathic pulmonary fibrosis (IPF) is unknown, there is mounting evidence that abnormal reflux (GERD) and aspiration of gastric contents may play a role in ...the pathogenesis of this disease.
Aims
The aims of this study were to determine in patients with GERD and IPF: (a) the clinical presentation, (b) the esophageal function, and (c) the reflux profile.
Methods
We compared the clinical presentation, the esophageal function (as defined by high-resolution manometry), and the reflux profile (by dual sensor pH monitoring) in 80 patients with GERD (group A) and in 22 patients with GERD and IPF (group B).
Results
Heartburn was present in less than 60 % of patients with GERD and IPF. Lower esophageal sphincter pressure and peristalsis were normal in both groups, while the upper esophageal sphincter (UES) was more frequently hypotensive in IPF patients (
p
= 0.008). In patients with GERD and IPF, the proximal esophageal acid exposure was higher (
p
= 0.047) and the supine acid clearance was slower as compared with patients with GERD only (
p
< 0.001).
Conclusions
The results of this study show that in patients with GERD and IPF: (a) reflux is frequently silent, (b) with the exception of a weaker UES, the esophageal function is preserved, and (c) proximal reflux is more common, and in the supine position, it is coupled with a slower acid clearance. Because these factors predisposing IPF patients to the risk of aspiration, antireflux surgery should be considered early after the diagnosis of IPF and GERD is established.
The isovector and isoscalar components of neutron-proton pairing are investigated in the N=Z unstable nuclei of the fp-shell through the two-nucleon transfer reaction (p,3He) in inverse kinematics. ...The combination of particle and gamma-ray detection with radioactive beams of 56Ni and 52Fe, produced by fragmentation at the GANIL/LISE facility, made it possible to carry out this study for the first time in a closed and an open-shell nucleus in the fp-shell. The transfer cross-sections for ground-state to ground-state (J=0+, T=1) and to the first (J=1+, T=0) state were extracted for both cases together with the transfer cross-section ratios σ(0+,T=1)/σ(1+,T=0). They are compared with second-order distorted-wave born approximation (DWBA) calculations. The enhancement of the ground-state to ground-state pair transfer cross-section close to mid-shell, in 52Fe, points towards a superfluid phase in the isovector channel. For the “deuteron-like” transfer, very low cross-sections to the first (J=1+, T=0) state were observed both for 56Ni(p,3He) and 52Fe(p,3He) and are related to a strong hindrance of this channel due to spin-orbit effect. No evidence for an isoscalar deuteron-like condensate is observed.
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