Diagnosis and treatment of pseudoachalasia: how to catch the mimic

Published: 25 June 2020Pseudoachalasia, or secondary achalasia, is an uncommon esophageal dysmotility syndrome with symptoms and manometric findings indistinguishable from primary achalasia, but due to any mechanism other than idiopathic degeneration of the inhibitory neurons of the esophageal submucosal myenteric plexus. Whilst pseudoachalasia is rare, affecting some 1.4–5.4% of all achalasia patients, it is essential this diagnosis is always considered and excluded, as the treatment and outcomes for these patients will be very different from those with true achalasia. Pseudoachalasia can be difficult to differentiate from primary or “idiopathic achalasia”. Several particular clinical features have been described as more common in patients with pseudoachalasia than in achalasia, but because of the low prevalence of this condition, the positive predictive value remains low. The majority of patients with pseudoachalasia have an underlying malignancy, predominantly gastro-esophageal adenocarcinoma, which is usually advanced. Management revolves around treating the underlying cause where possible, as this may lead to reversal of the esophageal dysmotility. In patients presenting with symptoms and manometry findings consistent with achalasia, the diagnosis initially should be one of an achalasia-like syndrome. Idiopathic achalasia can then only be confirmed after other potential causes have been considered and excluded. We describe a case of pseudoachalasia encountered in our clinical practice, followed by a review of current practice regarding diagnosis and management of pseudoachalasia.Dylan R. Barnett, George L. Balalis, Jennifer C. Myers, Peter G. Devit

Teleportation of a Zero-and One-photon Running Wave State by Projection Synthesis

We show how to teleport a running wave superposition of zero- and one-photon field state through the projection synthesis technique. The fidelity of the scheme is computed taking into account the noise introduced by dissipation and the efficiency of the detectors. These error sources have been introduced through a single general relationship between input and output operators.Comment: 11 pages, 1 figur

Estudio del efecto de los ácidos grasos poliinsaturados de la dieta: Mecanismos moleculares involucrados en la inflamación intestinal

The use of “omics” techniques in combination with model systems and molecular tools allows to understand how foods and food components act on metabolic pathways to regulate transcriptional processes. Polyunsaturated fatty acids have distinctive nutritional and metabolic effects because they give rise to lipid mediated products and affect the expression of various genes involved in intestinal inflammation. The present review focuses on the molecular effects of dietary polyunsaturated fatty acids on intestinal inflammation.El uso de técnicas «omic» en combinación con sistemas modelo y herramientas moleculares nos permiten entender como los alimentos y sus componentes actúan en las rutas metabólicas que regulan los procesos transcripcionales. Los ácidos grasos poliinsaturados tienen efectos nutricionales y metabólicos diferenciadores porque producen una elevación de los productos regulados por lípidos y afectan a la expresión de varios genes involucrados en la inflamación intestinal. La presente revisión se enfoca en los efectos moleculares de los ácidos grasos poliinsaturados de la dieta en la inflamación intestinal

Un "simposio di sapienza e affetto"

Muscle hypertrophy occurs following increased protein synthesis, which requires activation of the ribosomal complex. Additionally, increased translational capacity via elevated ribosomal RNA (rRNA) synthesis has also been implicated in resistance training-induced skeletal muscle hypertrophy. The time course of ribosome biogenesis following resistance exercise (RE) and the impact exerted by differing recovery strategies remains unknown. In the present study, the activation of transcriptional regulators, the expression levels of pre-rRNA, and mature rRNA components were measured through 48 h after a single-bout RE. In addition, the effects of either low-intensity cycling (active recovery, ACT) or a cold-water immersion (CWI) recovery strategy were compared. Nine male subjects performed two bouts of high-load RE randomized to be followed by 10 min of either ACT or CWI. Muscle biopsies were collected before RE and at 2, 24, and 48 h after RE. RE increased the phosphorylation of the p38-MNK1-eIF4E axis, an effect only evident with ACT recovery. Downstream, cyclin D1 protein, total eIF4E, upstream binding factor 1 (UBF1), and c-Myc proteins were all increased only after RE with ACT. This corresponded with elevated abundance of the pre-rRNAs (45S, ITS-28S, ITS-5.8S, and ETS-18S) from 24 h after RE with ACT. In conclusion, coordinated upstream signaling and activation of transcriptional factors stimulated pre-rRNA expression after RE. CWI, as a recovery strategy, markedly blunted these events, suggesting that suppressed ribosome biogenesis may be one factor contributing to the impaired hypertrophic response observed when CWI is used regularly after exercise

Quantum spiral bandwidth of entangled two-photon states

We put forward the concept of quantum spiral bandwidth of the spatial mode function of the two-photon entangled state in spontaneous parametric downconversion. We obtain the bandwidth using the eigenstates of the orbital angular momentum of the biphoton states, and reveal its dependence with the length of the down converting crystal and waist of the pump beam. The connection between the quantum spiral bandwidth and the entropy of entanglement of the quantum state is discussed.Comment: 10 pages, 3 figure

Extrusion limits of magnesium alloys

Magnesium alloys are generally found to be slower to extrude than aluminum alloys; however, limited quantitative comparisons of the actual operating windows have been published. In this work, the extrusion limits are determined for a series of commercial magnesium alloys (M1, ZM21, AZ31, AZ61, and ZK60). These are compared with the limits established for aluminum alloy AA6063. The maximum extrusion speed of alloy M1 is shown to be similar to AA6063. Alloys ZM21, AZ31, ZK60, and AZ61 exhibit maximum extrusion speeds 44, 18, 4, and 3 pct, respectively, of the maximum measured for AA6063. For AZ31, the maximum extrusion speed is increased by 22 pct after homogenization and by 64 pct for repeat extrusions. The variation in the extrusion limits with changing alloy content is rationalized in terms of differences in the hot working flow stress and solidus temperature.<br /

J/Psi Suppression in Heavy Ion Collisions at the CERN SPS

We reexamine the production of J/Psi and other charmonium states for a variety of target-projectile choices at the SPS. For this study we use a newly constructed cascade code LUCIFER II, which yields acceptable descriptions of both hard and soft processes, specifically Drell-Yan and hidden charm production, and soft energy loss and meson production, at the SPS. Glauber calculations of other authors are redone, and compared directly to the cascade results. The modeling of the charmonium states differs from that of earlier workers in its unified treatment of the hidden charm meson spectrum, which is introduced from the outset as a set of coupled states. The result is a description of the NA38 and NA50 data in terms of a conventional hadronic picture. The apparently anomalous suppression found in the most massive Pb+Pb system arises from three sources: destruction in the initial nucleon-nucleon cascade, use of coupled channels to exploit the larger breakup in the less bound Chi and Psi' states, and comover interaction in the final low energy phase.Comment: 36 pages (15 figures

Semileptonic decay constants of octet baryons in the chiral quark-soliton model

Based on the recent study of the magnetic moments and axial constants within the framework of the chiral quark-soliton model, we investigate the baryon semileptonic decay constants $(f_1,f_2)$ and $(g_1, g_2)$. Employing the relations between the diagonal transition matrix elements and off-diagonal ones in the vector and axial-vector channels, we obtain the ratios of baryon semileptonic decay constants $f_2/f_1$ and $g_1/f_1$. The $F/D$ ratio is also discussed and found that the value predicted by the present model naturally lies between that of the Skyrme model and that of the nonrelativistic quark model. The singlet axial constant $g^{(0)}_A$ can be expressed in terms of the $F/D$ ratio and $g^{(3)}_A$ in the present model and turns out to be small. The results are compared with available experimental data and found to be in good agreement with them. In addition, the induced pseudotensor coupling constants $g_2/f_1$ are calculated, the SU(3) symmetry breaking being considered. The results indicate that the effect of SU(3) symmetry breaking might play an important role for some decay modes in hyperon semileptonic decay.Comment: 16 pages, RevTeX is used. No figure. Accepted for publication in Phys. Rev.

Associated charged Higgs and W boson production in the MSSM at the CERN Large Hadron Collider

We investigate the viability of observing charged Higgs bosons (H^+/-) produced in association with W bosons at the CERN Large Hadron Collider, using the leptonic decay H^+ -> tau^+ nu_tau and hadronic W-decay, within different scenarios of the Minimal Supersymmetric Standard Model (MSSM) with both real and complex parameters. Performing a parton level study we show how the irreducible Standard Model background from W+2 jets can be controlled by applying appropriate cuts and find that the size of a possible signal depends on the cuts needed to suppress QCD backgrounds and misidentifications. In the standard maximal mixing scenario of the MSSM we find a viable signal for large tan(beta) and intermediate H^+/- masses (~m_t) when using optimistic cuts whereas for more pessimistic ones we only find a viable signal for very large tan(beta) (>~50). We have also investigated a special class of MSSM scenarios with large mass-splittings among the heavy Higgs bosons where the cross-section can be resonantly enhanced by factors up to one hundred, with a strong dependence on the CP-violating phases. Even so we find that the signal after cuts remains small except for small masses (~< m_t) with optimistic cuts. Finally, in all the scenarios we have investigated we have only found small CP-asymmetries.Comment: 28 pages, 12 figures, version to appear in Euro. Phys. J.

Meta-GWAS identifies the heritability of acute radiation-induced toxicities in head and neck cancer

Background and purpose: We aimed to the genetic components and susceptibility variants associated with acute radiation-induced toxicities (RITs) in patients with head and neck cancer (HNC). Materials and methods: We performed the largest meta-GWAS of seven European cohorts (n = 4,042). Patients were scored weekly during radiotherapy for acute RITs including dysphagia, mucositis, and xerostomia. We analyzed the effect of variants on the average burden (measured as area under curve, AUC) per each RIT, and standardized total average acute toxicity (STATacute) score using a multivariate linear regression. We tested suggestive variants (p < 1.0x10-5) in discovery set (three cohorts; n = 2,640) in a replication set (four cohorts; n = 1,402). We meta-analysed all cohorts to calculate RITs specific SNP-based heritability, and effect of polygenic risk scores (PRSs), and genetic correlations among RITS. Results: From 393 suggestive SNPs identified in discovery set; 37 were nominally significant (preplication < 0.05) in replication set, but none reached genome-wide significance (pcombined < 5 × 10-8). In-silico functional analyses identified “3′-5'-exoribonuclease activity” (FDR = 1.6e-10) for dysphagia, “inositol phosphate-mediated signalling” for mucositis (FDR = 2.20e-09), and “drug catabolic process” for STATacute (FDR = 3.57e-12) as the most enriched pathways by the RIT specific suggestive genes. The SNP-based heritability (±standard error) was 29 ± 0.08 % for dysphagia, 9 ± 0.12 % (mucositis) and 27 ± 0.09 % (STATacute). Positive genetic correlation was rg = 0.65 (p = 0.048) between dysphagia and STATacute. PRSs explained limited variation of dysphagia (3 %), mucositis (2.5 %), and STATacute (0.4 %). Conclusion: In HNC patients, acute RITs are modestly heritable, sharing 10 % genetic susceptibility, when PRS explains < 3 % of their variance. We identified numerus suggestive SNPs, which remain to be replicated in larger studies