Malignant Pseudoachalasia: An Unexpected Etiology Fernandez, Carlos; Cerra-Franco, Javier A.; Class-Vazquez, Walisbeth ...
The American journal of gastroenterology,
10/2018, Letnik:
113, Številka:
Supplement
Journal Article
Recenzirano
Malignant pseudoachalasia is a rare disease that presents with similar radiographic and manometrie features as primary achalasia; however their clinical presentation may vary. Most of the malignant ...tumors associated with secondary achalasia are adenocarcinomas of the esophagogastric (EG) junction, which account for more than 70% of cases. Rarely, processes other than esophagogastric junction cancers may lead to secondary pseudoachalasia. This is the case of an 83-year-old man with medical history of previous ischemic cerebrovascular accident and hypertension, who was evaluated due to progressive dysphagia to solid food of four months in evolution. Prior to our evaluation, the patient had an episode of food impaction after a solid meal in which he was also not able to tolerate water. Symptomatology progressed to nausea and vomiting of undigested food contents. Initial laboratories only remarkable for normochromic, normocytic anemia. Chest CT scan revealed dilation of esophagus with retained debris. Esophagogastroduodenoscopy revealed food impaction at mid esophagus, removed with overtube assistance using a basket and Roth net. Upon stomach inspection, an ulcerated mass was observed at the distal body of the stomach. Multiple biopsies were obtained which later confirmed moderately differentiated gastric adenocarcinoma. Endoscopic ultrasound showed a hypoechoic lesion with infiltration of submucosa and muscularis propria layer of the gastric wall without lymphadenopathies, for a tumor staging of T2N0M0 No metastasis on PET/CT. Barium swallow revealed a proximal dilation with distal narrowing consistent with achalasia. Manometry was remarkable for aperistalsis and increased lower esophageal sphincter resting pressure. Negative paraneoplastic workup. Diagnosis of pseudoachalasia secondary to infiltrative gastric adenocarcinoma causing myenteric plexus dysfunction at muscularis propria on distal body was made. This is a very rare etiology as most common cause is compression of the esophagus by an extraluminal mass at fundus or cardia. Due to poor functional status patient wasn't a surgical candidate and was started on chemotherapy with 5FU and cisplatin. However, differentiation of primary from secondary achalasia has critical implications for patient management because of vastly different approaches for the work-up and treatment of these conditions. Also, it is important to not only consider EG junction tumors alone when considering secondary achalasia.
The airborne laser scanning LIDAR (LIght Detection And Ranging) provides high-resolution Digital Terrain Models (DTM) that have been applied recently to the characterization, quantification and ...monitoring of coastal environments. This study assesses the contribution of LIDAR altimetry and intensity data, topographically-derived features (slope and aspect), and multi-spectral imagery (three visible and a near-infrared band), to map coastal habitats in the Bidasoa estuary and its adjacent coastal area (Basque Country, northern Spain). The performance of high-resolution data sources was individually and jointly tested, with the maximum likelihood algorithm classifier in a rocky shore and a wetland zone; thus, including some of the most extended Cantabrian Sea littoral habitats, within the Bay of Biscay. The results show that reliability of coastal habitat classification was more enhanced with LIDAR-based DTM, compared with the other data sources: slope, aspect, intensity or near-infrared band. The addition of the DTM, to the three visible bands, produced gains of between 10% and 27% in the agreement measures, between the mapped and validation data (i.e. mean producer's and user's accuracy) for the two test sites. Raw LIDAR intensity images are only of limited value here, since they appeared heterogeneous and speckled. However, the enhanced Lee smoothing filter, applied to the LIDAR intensity, improved the overall accuracy measurements of the habitat classification, especially in the wetland zone; here, there were gains up to 7.9% in mean producer's and 11.6% in mean user's accuracy. This suggests that LIDAR can be useful for habitat mapping, when few data sources are available. The synergy between the LIDAR data, with multi-spectral bands, produced high accurate classifications (mean producer's accuracy: 92% for the 16 rocky habitats and 88% for the 11 wetland habitats). Fusion of the data enabled discrimination of intertidal communities, such as
Corallina elongata, barnacles (
Chthamalus spp.), and stands of
Spartina alterniflora and
Phragmites australis, which presented misclassification when conventional visible bands were used alone. All of these results were corroborated by the kappa coefficient of agreement. The high classification accuracy found here, selecting data sources, highlights the value of integrating LIDAR data with multi-spectral imagery for habitat mapping in the intertidal complex fringe.
Summary
Globodera presently contains 13 valid and three as yet undescribed species. Three species, G. rostochiensis, G. pallida and G. ellingtonae, the potato cyst nematodes (PCN), cause significant ...economic losses on potatoes around the world. In our study we provide comprehensive phylogenetic analyses of 455 ITS rRNA, 219 COI and 164 cytb gene sequences of 11 valid and two undescribed species of Globodera using Bayesian inference, maximum likelihood and statistical parsimony. New 205 COI, 116 cytb and 21 ITS rRNA gene sequences were obtained from 148 populations of these species collected from 23 countries. The phylogenetic analysis revealed that Globodera displayed two main clades in the trees: i) Globodera from South and North America parasitising plants from Solanaceae; and ii) Globodera from Africa, Europe, Asia and New Zealand parasitising plants from Asteraceae and other families. Based on the results of phylogeographical analysis and age estimation of clades with a molecular clock approach, it is hypothesised that Globodera species originated and diversified from several centres of speciation located in mountain regions and then dispersed across the world from these regions during the Pleistocene. High genetic diversity of Bolivian populations of G. rostochiensis was observed for both mtDNA genes. Analysis of phylogenetic relationships of G. pallida and G. rostochiensis populations revealed incongruence in topology between networks inferred from mtDNA genes, which might be an indication of possible recombination and selective introgression events through gene flow between previously isolated populations. This puts some limitations on the use of the mtDNA marker as universal DNA barcoding identifier for PCN. Globodera bravoae syn. n. is proposed as a junior synonym of G. mexicana.
En este artículo se presenta un análisis sobre la naturaleza y evolución de las tesis doctorales que abordan los estudios traducción e interpretación (ETI) en España. Con una metodología mixta, ...esencialmente cuantitativa pero también cualitativa en el apartado interpretativo, se lleva a cabo un repaso crítico de la producción doctoral sobre los ETI en España, contextualizándola en los ETI globales. Los principales indicadores estudiados son el diacrónico, la productividad por universidades, la extensión, las lenguas vehiculares, el tipo de acceso a las tesis, la distribución temática y el impacto causado por las tesis. La principal fuente de datos es BITRA (Bibliografía de Interpretación y Traducción), una base de datos de ETI holística que a fecha de agosto de 2019 recogía más de 77.000 entradas. Entre los resultados cabe destacar una intensa productividad de tesis doctorales españolas en ETI, que se sitúan a la cabeza de la disciplina en el mundo, una distribución abierta de la lengua vehicular y su publicación casi sistemática en acceso abierto en la actualidad.
In this work, we analyze the cross-entropy function, widely used in classifiers both as a performance measure and as an optimization objective. We contextualize cross-entropy in the light of Bayesian ...decision theory, the formal probabilistic framework for making decisions, and we thoroughly analyze its motivation, meaning and interpretation from an information-theoretical point of view. In this sense, this article presents several contributions: First, we explicitly analyze the contribution to cross-entropy of (i) prior knowledge; and (ii) the value of the features in the form of a likelihood ratio. Second, we introduce a decomposition of cross-entropy into two components: discrimination and calibration. This decomposition enables the measurement of different performance aspects of a classifier in a more precise way; and justifies previously reported strategies to obtain reliable probabilities by means of the calibration of the output of a discriminating classifier. Third, we give different information-theoretical interpretations of cross-entropy, which can be useful in different application scenarios, and which are related to the concept of reference probabilities. Fourth, we present an analysis tool, the Empirical Cross-Entropy (ECE) plot, a compact representation of cross-entropy and its aforementioned decomposition. We show the power of ECE plots, as compared to other classical performance representations, in two diverse experimental examples: a speaker verification system, and a forensic case where some glass findings are present.
KCNE3 is a single-pass integral membrane protein that regulates numerous voltage-gated potassium channel functions such as KCNQ1. Previous solution NMR studies suggested a moderate degree of curved ...α-helical structure in the transmembrane domain (TMD) of KCNE3 in lyso-myristoylphosphatidylcholine (LMPC) micelles and isotropic bicelles with the residues T71, S74 and G78 situated along the concave face of the curved helix. During the interaction of KCNE3 and KCNQ1, KCNE3 pushes its transmembrane domain against KCNQ1 to lock the voltage sensor in its depolarized conformation. A cryo-EM study of KCNE3 complexed with KCNQ1 in nanodiscs suggested a deviation of the KCNE3 structure from its independent structure in isotropic bicelles. Despite the biological significance of KCNE3 TMD, the conformational properties of KCNE3 are poorly understood. Here, all atom molecular dynamics (MD) simulations were utilized to investigate the conformational dynamics of the transmembrane domain of KCNE3 in a lipid bilayer containing a mixture of POPC and POPG lipids (3:1). Further, the effect of the interaction impairing mutations (V72A, I76A and F68A) on the conformational properties of the KCNE3 TMD in lipid bilayers was investigated. Our MD simulation results suggest that the KCNE3 TMD adopts a nearly linear α helical structural conformation in POPC-POPG lipid bilayers. Additionally, the results showed no significant change in the nearly linear α-helical conformation of KCNE3 TMD in the presence of interaction impairing mutations within the sampled time frame. The KCNE3 TMD is more stable with lower flexibility in comparison to the N-terminal and C-terminal of KCNE3 in lipid bilayers. The overall conformational flexibility of KCNE3 also varies in the presence of the interaction-impairing mutations. The MD simulation data further suggest that the membrane bilayer width is similar for wild-type KCNE3 and KCNE3 containing mutations. The Z-distance measurement data revealed that the TMD residue site A69 is close to the lipid bilayer center, and residue sites S57 and S82 are close to the surfaces of the lipid bilayer membrane for wild-type KCNE3 and KCNE3 containing interaction-impairing mutations. These results agree with earlier KCNE3 biophysical studies. The results of these MD simulations will provide complementary data to the experimental outcomes of KCNE3 to help understand its conformational dynamic properties in a more native lipid bilayer environment.
The tannery industry during its process generates various polluting substances such as organic matter from the skin and chemical inputs, producing wastewater with a high concentration of turbidity. ...The objective of this research is to evaluate the most appropriate operational parameters of the coupled process of electrocoagulation and advanced oxidation to achieve the removal of turbidity in wastewater from a tannery in the riparian zone (tannery). This process uses a direct current source between perforated aluminum electrodes of circular geometry submerged in the effluent, which causes the dissolution of the aluminum plates. For our study, an electrocoagulation unit coupled to an ozone generator has been built at the laboratory level, where the influence of five factors (voltage, inlet flow to the reactor, initial turbidity, pH, and ozone flow) has been studied with three levels with regarding turbidity, using the Taguchi experimental methodology. The optimal conditions for the removal of turbidity were obtained at 10 volts, 7.5 pH, 360 L/h of wastewater recirculation flow rate; 2400 mg/h of ozone flow rate; and 1130 NTU of initial turbidity of the sample in 60 min of treatment reaching a removal of 99.75% of the turbidity. Under optimal conditions, the removal of chemical oxygen demand (COD) and biochemical oxygen demand (BOD) was determined, reaching a removal percentage of 33.2% of COD and 39.36% of BOD was achieved. Likewise, the degree of biodegradability of the organic load obtained increased from 0.467 to 0.553.
It has been widely described that chronic intake of fructose causes metabolic alterations which can be associated with brain function impairment. In this study, we evaluated the effects of fructose ...intake on the sleep⁻wake cycle, locomotion, and neurochemical parameters in Wistar rats. The experimental group was fed with 10% fructose in drinking water for five weeks. After treatment, metabolic indicators were quantified in blood. Electroencephalographic recordings were used to evaluate the sleep architecture and the spectral power of frequency bands. Likewise, the locomotor activity and the concentrations of orexin A and monoamines were estimated. Our results show that fructose diet significantly increased the blood levels of glucose, cholesterol, and triglycerides. Fructose modified the sleep⁻wake cycle of rats, increasing the waking duration and conversely decreasing the non-rapid eye movement sleep. Furthermore, these effects were accompanied by increases of the spectral power at different frequency bands. Chronic consumption of fructose caused a slight increase in the locomotor activity as well as an increase of orexin A and dopamine levels in the hypothalamus and brainstem. Specifically, immunoreactivity for orexin A was increased in the ventral tegmental area after the intake of fructose. Our study suggests that fructose induces metabolic changes and stimulates the activity of orexinergic and dopaminergic neurons, which may be responsible for alterations of the sleep⁻wake cycle.
When Focal Pancreatitis Bounces From the Head to the Tail Rabell-Bernal, Andres; Estremera-Marcial, Rodolfo; Pagan-Torres, Hendrick ...
The American journal of gastroenterology,
10/2018, Letnik:
113, Številka:
Supplement
Journal Article
Recenzirano
Acute pancreatitis is a serious condition which must be identified rapidly to prevent significant morbidity and mortality. Although gallstones are known to be the culprit in most cases, other ...etiologies should also be considered. We want to illustrate the importance of a thorough past medical and surgical history when treating patients with acute pancreatitis.This is the case of a 63 year-old man with past medical history of an unknown pancreatic surgery 6 years prior to our evaluation. He came to the ER due to complaints of nausea, vomiting, and abdominal pain which radiated to his back. He had no history of alcohol abuse, nor similar episodes in the past. On physical exam (PE), the abdomen was tender to palpation, mostly at the epigastric area. Laboratories showed elevated amylase and lipase levels. An abdominal CT demonstrated cholelithiasis, a prominent common bile duct, and changes compatible with focal pancreatitis at the head. The patient was treated conservatively with bowel rest and IV fluids. He was discharged and scheduled for a laparoscopic cholecystectomy. Prior to the procedure he presented again with abdominal pain and jaundice. Abdominal CT showed dilatation of the common bile duct secondary to distal choledocholithiasis and changes compatible with acute cholecystitis. He had an ERCP with papillotomy and an uneventful subsequent laparoscopic cholecystectomy performed. Nine months later, the patient presented again to the ER due to diffuse abdominal pain. PE was unremarkable. Amylase and lipase levels were elevated. The abdominal CT suggested changes of focal pancreatitis at the distal body and tail, and ductal dilatation traced to the level of a pancreaticojejunostomy. Although this patient had a history of gallstone pancreatitis 11 months prior, a second episode of pancreatitis was caused most likely due to a postsurgical stricture. After multiple efforts to elucidate the pancreatic surgery, we learned that he had a central pancreatectomy with a pancreaticojejunostomy due to a neuroendocrine tumor. This disconnection between the head and the tail of the pancreas lead to distinct focal pancreatitis of the head and tail. This case demonstrates the importance of taking into consideration a patient's surgical history when trying to elucidate the etiology of the presenting disease. Within 1 year, our patient had two episodes of focal acute pancreatitis in opposite ends of the pancreas secondary to two very different etiologies.
Strongyloidiasis is a parasitic infection classified by the World Health Organization as a neglected tropical disease. Although predominantly asymptomatic, it can become a life-threatening disease in ...an immunocompromised host. Epidemiologic studies in the Western Hemisphere are scarce, but even more scarce are descriptions of the natural course of this disease. Our objectives were to identify the different manifestations and outcomes of Strongyloides stercoralis infection in the Hispanic veteran population in Puerto Rico. We also discuss the importance of pursuing a timely diagnosis in high-risk patients migrating from or traveling to endemic areas, regardless of their symptomatic status.
This was a single-center, retrospective record review study involving patients diagnosed with S. stercoralis via serology, stool samples, or organ biopsies, from 2008 through 2014.
A total of 270 patients tested positive; 210 (77.8%) were asymptomatic. The mean age at diagnosis was 75.4 years old. Symptomatic patients had pulmonary (n = 25), gastrointestinal (n = 21), and dermatologic (n = 5) symptoms; 9 had multiple symptoms. Five had hyperinfection, mostly after treatment with systemic steroids or preexisting immunosuppression. The most common laboratory abnormality was eosinophilia. Reasons for testing were eosinophilia, asthma, diarrhea, screening for parasites, and unexplained skin rash.
Our study highlights the importance of being aware of this potentially fatal infection, especially when treating patients traveling from endemic countries. It also highlights the importance of timely screening, diagnosis, and treatment of S. stercoralis infection in order to prevent potentially fatal outcomes, especially when considering immunosuppressive drugs.
PDF
