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Global climate change poses significant societal and political challenges. The rapid increase in the near-surface air temperatures and the drastic retreat of the Arctic sea ice during summer are not well represented by climate models. The data sets introduced here intend to help improving the current understanding of the ongoing Arctic climate changes. In particular, this study considers observations from 24 helicopter flights (June-September 2020) and 5 flights with the helicopter-towed probe HELiPOD (May-July 2020) during MOSAiC. Distributions of various surface types (white ice/snow, bright melt ponds, dark melt ponds, open water, and bare ice) were determined using fisheye camera images. They were related to collocated broadband irradiance measurements to analyse the temporal and spatial changes of the surface albedo. Multiple linear regression was applied to assign the measured areal albedo to the corresponding surface-types. The resulting surface-type fractions, the albedo data and respective upward and downward broadband solar irradiances of several flights throughout the melting and refreezing season are provided.
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INTRODUCTION: Gastroparesis is a life-altering diagnosis caused by the stomach's inability to function in the absence of a mechanical obstruction. The primary causes are idiopathic, diabetic, and postoperative. Our first-line treatment for medical refractory gastroparesis is the endoscopic per-oral pyloromyotomy (POP) procedure. Predicting clinical response cost effectively remains elusive. METHODS: All patients who underwent a POP procedure at our institution by a single surgical endoscopist from January 1, 2019 to June 30, 2020 were retrospectively reviewed. All endoscopic data were prospectively collected. The patients were followed by a survey including the Gastroparesis Cardinal Symptom Index (GCSI) and other relevant postoperative measures. The primary endpoint was clinical response defined as ≥ 1.0 decrease in the GCSI from preoperative to the time of survey. Secondary outcome was normalization of the gastric emptying study (GES). RESULTS: Our patient population is 85% female and has an average age of 44.8 years. The diagnosis of gastroparesis is 71% iatrogenic, 19% postoperative, and 10% diabetic. On endoscopy, 30% had bile in the stomach and 65% had any degree of pylorospasm. The primary outcome measure of clinical response was 39% at an average of 697 ± 151 days post-POP, but 66% of patients attested to an improvement in their symptoms. Of 68 postoperative gastric emptying studies 50% normalized at an average of 145 ± 98 days. Following univariate and multivariate analyses of preoperative data and endoscopic findings, there were no significant predictors of clinical response. A preoperative GCSI ≥ 2.6 trends toward significance (OR 6.87, p = 0.058). CONCLUSION: Endoscopic findings at the time of POP do not correlate with clinical response. The GCSI model currently used to measure clinical response may not accurately capture the full clinical picture. The long-term durability of endoscopic myotomy to treat medical refractory gastroparesis needs to be studied further to improve patient selection.
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Diabetes Mellitus , Gastroparesia , Piloromiotomia , Humanos , Feminino , Adulto , Masculino , Piloromiotomia/métodos , Gastroparesia/cirurgia , Esvaziamento Gástrico/fisiologia , Estudos Retrospectivos , Resultado do Tratamento , Piloro/cirurgiaRESUMO
We report a case of a 64-year-old Jehovah's Witness male, who was post-operative day five of laparoscopic cholecystectomy. He presented with anemia, severe ischemic gastritis, and pneumatosis seen on CT with intravenous contrast. A subsequent upper endoscopy revealed patchy gastric ulceration with bleeding but no overt evidence of perforation. Biopsies were taken, and immunohistological staining identified Sarcina ventriculi. The patient was treated non-operatively with fluconazole and piperacillin-tazobactam for the infection and with sucralfate tablets and pantoprazole injections for ulcer treatment. After five days, a repeat CT scan revealed a resolved pneumatosis. S. ventriculi is a rare bacterium that is increasingly being reported as a cause of emphysematous gastritis with potentially fatal perforation. Surgical intervention should be reserved for unstable patients with perforations and significant, overt bleeding. In this case, non-operative treatment with antibiotics and proton pump inhibitor (PPI) medications were preferred in the setting of anemia in a Jehovah's Witness patient without perforation. The patient showed clinical and radiologic improvement. Further understanding of the role of surgical intervention versus non-operative management is needed for this rare and potentially life-threatening organism.