A Controversy That Has Been Tough to Swallow: Is the Treatment of Achalasia Now Digested?

Esophageal achalasia is a rare neurodegenerative disease of the esophagus and the lower esophageal sphincter that presents within a spectrum of disease severity related to progressive pathological changes, most commonly resulting in dysphagia. The pathophysiology of achalasia is still incompletely understood, but recent evidence suggests that degeneration of the postganglionic inhibitory nerves of the myenteric plexus could be due to an infectious or autoimmune mechanism, and nitric oxide is the neurotransmitter affected. Current treatment of achalasia is directed at palliation of symptoms. Therapies include pharmacological therapy, endoscopic injection of botulinum toxin, endoscopic dilation, and surgery. Until the late 1980s, endoscopic dilation was the first line of therapy. The advent of safe and effective minimally invasive surgical techniques in the early 1990s paved the way for the introduction of laparoscopic myotomy. This review will discuss the most up-to-date information regarding the pathophysiology, diagnosis, and treatment of achalasia, including a historical perspective. The laparoscopic Heller myotomy with partial fundoplication performed at an experienced center is currently the first line of therapy because it offers a low complication rate, the most durable symptom relief, and the lowest incidence of postoperative gastroesophageal reflux

A(c)(+) Production and Baryon-to-Meson Ratios in pp and p-Pb Collisions at root S-NN=5.02 TeV at the LHC

The prompt production of the charm baryon \u39bc+ and the \u39bc+/D0 production ratios were measured at midrapidity with the ALICE detector in pp and p-Pb collisions at sNN=5.02 TeV. These new measurements show a clear decrease of the \u39bc+/D0 ratio with increasing transverse momentum (pT) in both collision systems in the range 2<12 GeV/c, exhibiting similarities with the light-flavor baryon-to-meson ratios p/\u3c0 and \u39b/KS0. At low pT, predictions that include additional color-reconnection mechanisms beyond the leading-color approximation, assume the existence of additional higher-mass charm-baryon states, or include hadronization via coalescence can describe the data, while predictions driven by charm-quark fragmentation processes measured in e+e- and e-p collisions significantly underestimate the data. The results presented in this Letter provide significant evidence that the established assumption of universality (colliding-system independence) of parton-to-hadron fragmentation is not sufficient to describe charm-baryon production in hadronic collisions at LHC energies

A(c)(+) Production and Baryon-to-Meson Ratios in pp and p-Pb Collisions at root S-NN=5.02 TeV at the LHC

The prompt production of the charm baryon Λ_{c}^{+} and the Λ_{c}^{+}/D^{0} production ratios were measured at midrapidity with the ALICE detector in pp and p-Pb collisions at sqrt[s_{NN}]=5.02  TeV. These new measurements show a clear decrease of the Λ_{c}^{+}/D^{0} ratio with increasing transverse momentum (p_{T}) in both collision systems in the range 2<p_{T}<12  GeV/c, exhibiting similarities with the light-flavor baryon-to-meson ratios p/π and Λ/K_{S}^{0}. At low p_{T}, predictions that include additional color-reconnection mechanisms beyond the leading-color approximation, assume the existence of additional higher-mass charm-baryon states, or include hadronization via coalescence can describe the data, while predictions driven by charm-quark fragmentation processes measured in e^{+}e^{-} and e^{-}p collisions significantly underestimate the data. The results presented in this Letter provide significant evidence that the established assumption of universality (colliding-system independence) of parton-to-hadron fragmentation is not sufficient to describe charm-baryon production in hadronic collisions at LHC energies

Suppression in Pb-Pb Collisions at the LHC.

The production of the ψ(2S) charmonium state was measured with ALICE in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV, in the dimuon decay channel. A significant signal was observed for the first time at LHC energies down to zero transverse momentum, at forward rapidity (2.5<y<4). The measurement of the ratio of the inclusive production cross sections of the ψ(2S) and J/ψ resonances is reported as a function of the centrality of the collisions and of transverse momentum, in the region p_{T}<12  GeV/c. The results are compared with the corresponding measurements in pp collisions, by forming the double ratio [σ^{ψ(2S)}/σ^{J/ψ}]_{Pb-Pb}/[σ^{ψ(2S)}/σ^{J/ψ}]_{pp}. It is found that in Pb-Pb collisions the ψ(2S) is suppressed by a factor of ∼2 with respect to the J/ψ. The ψ(2S) nuclear modification factor R_{AA} was also obtained as a function of both centrality and p_{T}. The results show that the ψ(2S) resonance yield is strongly suppressed in Pb-Pb collisions, by a factor of up to ∼3 with respect to pp. Comparisons of cross section ratios with previous Super Proton Synchrotron findings by the NA50 experiment and of R_{AA} with higher-p_{T} results at LHC energy are also reported. These results and the corresponding comparisons with calculations of transport and statistical models address questions on the presence and properties of charmonium states in the quark-gluon plasma formed in nuclear collisions at the LHC

Tailoring of defect luminescence in CVD grown monolayer MoS2 film

Optical properties of strictly monolayer MoS2 films, which are grown on c-sapphire substrates using microcavity based CVD route, have been investigated by temperature dependent absorption and temperature as well as excitation intensity dependent photoluminescence (PL) spectroscopy. Our study reveals a high intensity broad luminescence band appearing at similar to 1.7 eV along with the usual free exciton/trion peak (similar to 1.86 eV). The investigation furthermore attributes this broad transition to excitons bound to two types of defects, whose binding energies are found to be similar to 11 and similar to 118 meV. Integrated intensity of this feature decreases with the increase in the impinging sulfur flux during growth and by post-growth annealing in sulfur atmosphere suggesting that these defects must be related to sulfur deficiency. Interestingly, exciton-phonon coupling for these defect bound excitons is found to be much stronger than that is associated with free excitons/trions. (C) 2018 Elsevier B.V. All rights reserved

Descriptive Epidemiology of a Gastroenteritis Out Break in Sunsari District, Nepal

Gastroenteritis (GE) outbreak and cholera epidemics continue to be the major public health problems in Nepal. Every year during and immediately after the rainy season, outbreak of GE occurs. In the post monsoon period of 1998 also, outbreak of GE occurred in a wide area covering several districts in terai region. In this paper, several epidemiological aspects of the current outbreak are being reported. This study was carried out in sunsari district. The cases of GE brought to district hospital were interviewed by a trained health worker to collect information about the episode and possible source of infection. Stool samples were collected from the patients and tested for organisms. On the spot visits were made to collect more information. Water samples were also collected and tested in Microbiology laboratory, B. P. Koirala Institute of Health Sciences (BPKIHS). There were 947 cases of GE. Among them 55.2% were females and 44.8% males patients. The age ranged from 7 months to 86 years with mean age of 22.8 years. There were 8 deaths. Maximum number of cases occurred in the first fornight of October 1998. Due to prior administration of antibiotics, no growth was seen in 27 samples. However, 4 samples showed growth of Shigella. Vibrio cholera was isolated from 2 cases. Eight out of thirteen water samples were found to be unsatisfactory for drinking. The contamination of drinking water source and unhygienic habits were the main causes for such outbreaks. Therefore, it is pertinent that GE outbreaks may be prevented by simply promoting sanitation and hygienic practices related to handling of drinking water and defecation