⏩Diffuse esophageal spasm (DES)
It is a rare esophageal motility disorder characterized by, simultaneous, uncoordinated or rapidly propagated contractions that are of normal amplitude and accompanied by dysphagia.⠀
⠀
⏩ It is defined manometrically as simultaneous contractions in the smooth muscle of the esophagus alternating with normal peristalsis in over 20% of wet swallows with amplitude contractions of greater than 30 mmHg. ⠀
⠀
⏩after the introduction of high-resolution esophageal pressure topography, the defining criteria for DES has been changed and is the presence of at least two premature contractions with the distal latency of under 4.5 seconds in a context of normal esophagogastric junction relaxation.⠀
⠀
⏩There is a disruption of coordination in peristalsis which is probably due to an imbalance between the inhibitory and excitatory postganglionic pathways. Muscular hypertrophy or hyperplasia is present in the distal part of the esophagus comprising almost two-thirds of the esophagus in DES. ⠀
⏩Other theories include⠀
✅nitric oxide-mediated impairment of inhibitory ganglion neuronal function, ⠀
✅gastric reflux ⠀
✅a primary nerve or motor disorder as likely mechanisms of the peristaltic abnormalities seen in DES.⠀
⠀
⏩The typical clinical features ⠀
⠀
1. Dysphagia that can occur with both solids and liquids.⠀
⠀
2. Globus hystericus in which the patient presents with a sensation of an object getting trapped on the back of the throat.⠀
⠀
3. Chest pain which is noncardiac in nature, retrosternal in presentation, and with the possibility of radiating to the back. ⠀
⠀
4. Occasional regurgitation of the undigested food.⠀
⠀
⏩Current treatment agents include nitrates (both short and long-acting), calcium-channel blockers, visceral analgesics (tricyclic agents or SSRI), and esophageal dilation.
⏩First-line therapy is with calcium channel blockers and nitrates.
⏩Endoscopic botulinum toxin injection and pneumatic dilation are second-line therapies.
⏩Selected cases may receive treatment with extended myotomy of the esophageal body or peroral endoscopic myotomy.
#医学生Medic[超话]##medicaltalks##影像检查#
It is a rare esophageal motility disorder characterized by, simultaneous, uncoordinated or rapidly propagated contractions that are of normal amplitude and accompanied by dysphagia.⠀
⠀
⏩ It is defined manometrically as simultaneous contractions in the smooth muscle of the esophagus alternating with normal peristalsis in over 20% of wet swallows with amplitude contractions of greater than 30 mmHg. ⠀
⠀
⏩after the introduction of high-resolution esophageal pressure topography, the defining criteria for DES has been changed and is the presence of at least two premature contractions with the distal latency of under 4.5 seconds in a context of normal esophagogastric junction relaxation.⠀
⠀
⏩There is a disruption of coordination in peristalsis which is probably due to an imbalance between the inhibitory and excitatory postganglionic pathways. Muscular hypertrophy or hyperplasia is present in the distal part of the esophagus comprising almost two-thirds of the esophagus in DES. ⠀
⏩Other theories include⠀
✅nitric oxide-mediated impairment of inhibitory ganglion neuronal function, ⠀
✅gastric reflux ⠀
✅a primary nerve or motor disorder as likely mechanisms of the peristaltic abnormalities seen in DES.⠀
⠀
⏩The typical clinical features ⠀
⠀
1. Dysphagia that can occur with both solids and liquids.⠀
⠀
2. Globus hystericus in which the patient presents with a sensation of an object getting trapped on the back of the throat.⠀
⠀
3. Chest pain which is noncardiac in nature, retrosternal in presentation, and with the possibility of radiating to the back. ⠀
⠀
4. Occasional regurgitation of the undigested food.⠀
⠀
⏩Current treatment agents include nitrates (both short and long-acting), calcium-channel blockers, visceral analgesics (tricyclic agents or SSRI), and esophageal dilation.
⏩First-line therapy is with calcium channel blockers and nitrates.
⏩Endoscopic botulinum toxin injection and pneumatic dilation are second-line therapies.
⏩Selected cases may receive treatment with extended myotomy of the esophageal body or peroral endoscopic myotomy.
#医学生Medic[超话]##medicaltalks##影像检查#
1生豆处理工艺/Process
a.水洗（Wet/washed/fully washed process ）：常见于中南美洲和非洲，最主要是在巴西和埃塞俄比亚。水洗咖啡口感纯净，味道鲜活，酸度更高，带有新鲜水果味；
b.日晒（Dry/natural process ）：口感更佳醇厚，酸度和纯净度略低，水果味更浓；
c.半水洗/蜜处理（Semi washed/honey/pulped natural process ）：巧克力味、坚果味更浓，带有类似蜂蜜的口味。
2. 烘焙程度／Roast Character
a.轻度烘焙（Light Roast ）：对咖啡口味的影响最低，最能体现咖啡产地特色，酸度较高，苦味较淡，甜度很好；
b.中度烘焙（Medium roast） ：甜度更加成熟，酸度较轻度烘焙更低，口感圆润不强烈；
c.深度烘焙（Dark roast ）：苦味较重，甜度较低，酸度很低，大部分产地特色被烘焙味道掩盖。
3. 杯测得分／Cupping Score：杯测得分用来评定咖啡品质和价值。低于80分级评为“商业级”或“商品级”，高于80分评定为“精品级”。
a.水洗（Wet/washed/fully washed process ）：常见于中南美洲和非洲，最主要是在巴西和埃塞俄比亚。水洗咖啡口感纯净，味道鲜活，酸度更高，带有新鲜水果味；
b.日晒（Dry/natural process ）：口感更佳醇厚，酸度和纯净度略低，水果味更浓；
c.半水洗/蜜处理（Semi washed/honey/pulped natural process ）：巧克力味、坚果味更浓，带有类似蜂蜜的口味。
2. 烘焙程度／Roast Character
a.轻度烘焙（Light Roast ）：对咖啡口味的影响最低，最能体现咖啡产地特色，酸度较高，苦味较淡，甜度很好；
b.中度烘焙（Medium roast） ：甜度更加成熟，酸度较轻度烘焙更低，口感圆润不强烈；
c.深度烘焙（Dark roast ）：苦味较重，甜度较低，酸度很低，大部分产地特色被烘焙味道掩盖。
3. 杯测得分／Cupping Score：杯测得分用来评定咖啡品质和价值。低于80分级评为“商业级”或“商品级”，高于80分评定为“精品级”。
右下快铁皮的wet n wild 的杏桃美味，颜色自然百搭，不挑肤色。唯一问题就是比较飞粉，但是性价比高[doge]综合使用感还是可以滴！
所以这次又买了wnw新的颜色试试，上面那盘是nars的脸部综合盘。颜值高，但是显色度好，而且很好上色，所以新手容易手重[允悲]感觉更适合技术熟练的盆友[憧憬]
#好物分享##美妆生活##美妆#
所以这次又买了wnw新的颜色试试，上面那盘是nars的脸部综合盘。颜值高，但是显色度好，而且很好上色，所以新手容易手重[允悲]感觉更适合技术熟练的盆友[憧憬]
#好物分享##美妆生活##美妆#
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