Laparoscopic Nissen fundoplication is currently considered the surgical treatment of choice for gastroesophageal reflux disease (GERD) and its long-term effectiveness is above 90%. Adequate patient ...selection and the experience of the surgeon are among the predictive factors of good clinical response. However, there can be new, persistent, and recurrent symptoms after the antireflux procedure in up to 30% of the cases. There are numerous causes, but in general, they are due to one or more anatomic abnormalities and esophageal and gastric function alterations. When there are persistent symptoms after the surgical procedure, the surgery should be described as "failed". In the case of a patient that initially manifests symptom control, but the symptoms then reappear, the term "dysfunction" could be used. When symptoms worsen, or when symptoms or clinical situations appear that did not exist before the surgery, this should be considered a "complication". Postoperative dysphagia and dyspeptic symptoms are very frequent and require an integrated approach to determine the best possible treatment. This review details the pathophysiologic aspects, diagnostic approach, and treatment of the symptoms and complications after fundoplication for the management of GERD.
Cosmic rays, along with stellar radiation and magnetic fields, are known to make up a significant fraction of the energy density of galaxies such as the Milky Way. When cosmic rays interact in the ...interstellar medium, they produce gamma-ray emission which provides an important indication of how the cosmic rays propagate. Gamma-rays from the Andromeda galaxy (M31), located 785 kpc away, provide a unique opportunity to study cosmic-ray acceleration and diffusion in a galaxy with a structure and evolution very similar to the Milky Way. Using 33 months of data from the High Altitude Water Cherenkov Observatory, we search for teraelectronvolt gamma-rays from the galactic plane of M31. We also investigate past and present evidence of galactic activity in M31 by searching for Fermi bubble-like structures above and below the galactic nucleus. No significant gamma-ray emission is observed, so we use the null result to compute upper limits on the energy density of cosmic rays >10 TeV in M31.
To present our experience with helical computed tomographic (CT) arteriography as the initial diagnostic examination in patients suspected to have focal arterial injuries of the proximal extremities.
...During 19 months, 142 arterial segments in the proximal portions of the extremities of 139 patients with trauma were evaluated with helical CT arteriography. CT arteriograms were interpreted on site by the radiologist in charge of emergency procedures and retrospectively with consensus interpretation between two radiologists. CT study quality and the presence of arterial injuries were noted. CT arteriographic findings were compared with those of surgery, conventional arteriography, and/or clinical follow-up.
Five (3.6%) patients had nondiagnostic studies and underwent conventional arteriography. In the remaining 137 arterial segments in 134 patients, helical CT arteriography demonstrated arterial injuries in 61 segments and normal arteries in 76 segments. These segments were treated initially with surgery (55 segments) or endovascular intervention (four segments) or were observed (78 segments); 77 of the 78 observed segments remained stable at 3-18 months (mean follow-up, 5.2 months). There were no differences between the on-site and consensus interpretations (kappa = 1.0). The sensitivity of CT arteriography was 95.1%, and the specificity was 98.7%.
Helical CT arteriography can be performed as the initial diagnostic method in most patients suspected to have focal arterial injuries of the proximal portions of the extremities.
Because of the high energies and long distances to the sources, astrophysical observations provide a unique opportunity to test possible signatures of Lorentz invariance violation (LIV). Superluminal ...LIV enables the decay of photons at high energy. The high altitude water Cherenkov (HAWC) observatory is among the most sensitive gamma-ray instruments currently operating above 10 TeV. HAWC finds evidence of 100 TeV photon emission from at least four astrophysical sources. These observations exclude, for the strongest of the limits set, the LIV energy scale to 2.2 × 1031 eV , over 1800 times the Planck energy and an improvement of 1 to 2 orders of magnitude over previous limits.
We report on the first star discovered to host a planet detected by radial velocity (RV) observations obtained within the CARMENES survey for exoplanets around M dwarfs. HD 147379 (
V
= 8.9 mag,
M
...= 0.58 ± 0.08
M
⊙
), a bright M0.0 V star at a distance of 10.7 pc, is found to undergo periodic RV variations with a semi-amplitude of
K
= 5.1 ± 0.4 m s
−1
and a period of
P
= 86.54 ± 0.06 d. The RV signal is found in our CARMENES data, which were taken between 2016 and 2017, and is supported by HIRES/Keck observations that were obtained since 2000. The RV variations are interpreted as resulting from a planet of minimum mass
m
P
sin
i
= 25 ± 2
M
⊕
, 1.5 times the mass of Neptune, with an orbital semi-major axis
a
= 0.32 au and low eccentricity (
e
< 0.13). HD 147379 b is orbiting inside the temperate zone around the star, where water could exist in liquid form. The RV time-series and various spectroscopic indicators show additional hints of variations at an approximate period of 21.1 d (and its first harmonic), which we attribute to the rotation period of the star.
The close location of the HAWC observatory to the largest volcano in Mexico allows to perform a search for neutrino-induced horizontal muon and tau charged leptons. The section of the volcano located ...at the horizon reaches values of slant depth larger than 8 km of rock, making it an excellent shield for the cosmic ray horizontal background. We report the search method and background suppression technique developed for the detection of Earth-skimming neutrinos with HAWC, as well as a model that describes the remaining background produced by scattered muons. We show that by increasing the detection energy threshold we could use HAWC to search for neutrino-induced charged leptons.
Mariculture of Florida pompano Trachinotus carolinus in Central America has increased over the last few decades and it is now a highly valued food fish. High feed costs and infectious diseases are ...significant impediments to the expansion of mariculture. Members of the genus Megalocytivirus (MCV), subfamily Alphairidovirinae, within the family Iridoviridae, are emerging pathogens that negatively impact Asian mariculture. A significant mortality event in Florida pompano fingerlings cultured in Central America occurred in October 2014. Affected fish presented with abdominal distension, darkening of the skin, and periocular hemorrhages. Microscopic lesions included cytomegalic 'inclusion body-bearing cells' characterized by basophilic granular cytoplasmic inclusions in multiple organs. Transmission electron microscopy revealed arrays of hexagonal virions (155-180 nm in diameter) with electron-dense cores within the cytoplasm of cytomegalic cells. Pathological findings were suggestive of an MCV infection, and the diagnosis was later confirmed by partial PCR amplification and sequencing of the viral gene encoding the myristylated membrane protein. The viral sequence revealed that the fingerlings were infected with an MCV genotype, red seabream iridovirus (RSIV), previously reported only from epizootics in Asian mariculture. This case underscores the threat RSIV poses to global mariculture, including the production of Florida pompano in Central America.
The High-Altitude Water Cherenkov (HAWC) observatory is a second-generation continuously operated, wide field-of-view, TeV gamma-ray observatory. The HAWC observatory and its analysis techniques ...build on experience of the Milagro experiment in using ground-based water Cherenkov detectors for gamma-ray astronomy. HAWC is located on the Sierra Negra volcano in México at an elevation of 4100 meters above sea level. The completed HAWC observatory principal detector (HAWC) consists of 300 closely spaced water Cherenkov detectors, each equipped with four photomultiplier tubes to provide timing and charge information to reconstruct the extensive air shower energy and arrival direction. The HAWC observatory has been optimized to observe transient and steady emission from sources of gamma rays within an energy range from several hundred GeV to several hundred TeV. However, most of the air showers detected are initiated by cosmic rays, allowing studies of cosmic rays also to be performed. This paper describes the characteristics of the HAWC main array and its hardware.
In this work Sm3+ (0–2.0 at%) and Bi3+ (0–2.0 at%) doped Y2O3 luminescent powders were prepared by a sol–gel method from yttrium acetylacetonate, samarium and bismuth nitrates as metal sources. The ...as prepared powders (chemical composition is close to stoichiometric Y2O3) present the cubic structure from 700°C, and at 900°C are characterized by the presence of rounded particles with heterogeneous size of 42.9nm. Luminescent effect of ions of Sm3+ and Bi3+ into Y2O3 host as was studied on heat treated powders from 800 to 1100°C. The combination of the red luminescence from the Sm3+ ions and the bluish from Bi3+, makes the synthesized phosphors candidates to be used in fabrication of phosphor-converted light-emitting diodes (LEDs).
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