Eosinophilic esophagitis (EoE) is a clinicopathologic condition of increasing recognition and prevalence. In 2007, a consensus recommendation provided clinical and histopathologic guidance for the diagnosis and treatment of EoE; however, only a minority of physicians use the 2007 guidelines, which require fulfillment of both histologic and clinical features. Since 2007, the number of EoE publications has doubled, providing new disease insight. Accordingly, a panel of 33 physicians with expertise in pediatric and adult allergy/immunology, gastroenterology, and pathology conducted a systematic review of the EoE literature (since September 2006) using electronic databases. Based on the literature review and expertise of the panel, information and recommendations were provided in each of the following areas of EoE: diagnostics, genetics, allergy testing, therapeutics, and disease complications. Because accumulating animal and human data have provided evidence that EoE appears to be an antigen-driven immunologic process that involves multiple pathogenic pathways, a new conceptual definition is proposed highlighting that EoE represents a chronic, immune/antigen-mediated disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. The diagnostic guidelines continue to define EoE as an isolated chronic disorder of the esophagus diagnosed by the need of both clinical and pathologic features. Patients commonly have high rates of concurrent allergic diatheses, especially food sensitization, compared with the general population. Proved therapeutic options include chronic dietary elimination, topical corticosteroids, and esophageal dilation. Important additions since 2007 include genetic underpinnings that implicate EoE susceptibility caused by polymorphisms in the thymic stromal lymphopoietin protein gene and the description of a new potential disease phenotype, proton pump inhibitor-responsive esophageal eosinophila. Further advances and controversies regarding diagnostic methods, surrogate disease markers, allergy testing, and treatment approaches are discussed.

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Eosinophilic esophagitis: Updated consensus recommendations for children and adults


 The spectral ratio between horizontal and vertical components (H/V ratio) of microtremors measured at the ground surface has been used to estimate fundamental periods and amplification factors of a site, although this technique lacks theoretical background. The aim of this article is to formulate the H/V technique in terms of the characteristics of Rayleigh and Love waves, and to contribute to improve the technique. The improvement includes use of not only peaks but also troughs in the H/V ratio for reliable estimation of the period and use of a newly proposed smoothing function for better estimation of the amplification factor. The formulation leads to a simple formula for the amplification factor expressed with the H/V ratio. With microtremor data measured at 546 junior high schools in 23 wards of Tokyo, the improved technique is applied to mapping site periods and amplification factors in the area.

Ground Motion Characteristics Estimated from Spectral Ratio between Horizontal and Verticcl Components of Mietremors.

https://jcp.bmj.com/content/jclinpath/35/1/123.2.full.pdf

Ackerman's Surgical Pathology

Epidemiology of Eosinophilic Esophagitis Over Three Decades in Olmsted County, Minnesota

Faults are unlocked by earthquakes. Analysis of seismic data from the 2015 Nepal earthquake shows that only part of the Main Himalayan Thrust fault was unzipped by the quake, leaving much of the fault locked and ready to slip in a future event.

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Lower edge of locked Main Himalayan Thrust unzipped by the 2015 Gorkha earthquake

[1] We present crustal thickness and Poisson's ratio determinations from receiver function analyzes at 32 sites on the Archaean and Proterozoic terrains of South India. The crustal thickness in the late Archaean (2.5 Ga) Eastern Dharwar Craton varies from 34–39 km. Similar crustal thickness is observed beneath the Deccan Volcanic Province and the Cuddapah basin. The most unexpected result is the anomalous present-day crustal thickness of 42–51 km beneath the mid-Archaean (3.4–3.0 Ga) segment of the Western Dharwar Craton. Since the amphibolite-grade metamorphic mineral assemblages (5–7 Kbar paleopressures) in this part of Western Dharwar Craton equilibrated at the depths of 15–20 km, our observations suggest the existence of an exceptionally thick (57–70 km) crust 3.0 Ga ago. Beneath the exhumed granulite terrain in southernmost India, the crustal thickness varies between 42–60 km. The Poisson's ratio ranges between 0.24–0.28 beneath the Precambrian terrains, indicating the presence of intermediate rock type in the lower crust. These observations of thickened crust suggest significant crustal shortening in South India during the Archaean.

https://agupubs.onlinelibrary.wiley.com/doi/pdf/10.1029/2002GL016770

The nature of the crust in southern India: Implications for Precambrian crustal evolution

Introduction Allergic eosinophilic esophagitis (AEE) is thought to be an allergic reaction that is characterized by inflammation caused by predominant accumulation of eosinophils in esophageal mucosa (> or =15 eosinophils per high power field). Aims To examine the seasonal distribution of newly diagnosed AEE children. Methods Retrospective analysis of all patients diagnosed with AEE at our institution over a nearly 6-year period (December 1998 to October 2004). Results Two hundred thirty-four children (mean age 7.3 y, median age 7.0 y, age range 0.2 to 19.5 y) were diagnosed with AEE during the study period. Significantly fewer patients were diagnosed with AEE in Winter as compared with Spring, Summer, and Fall. Although all the patients had severe eosinophilic esophagitis, the intensity of esophageal eosinophilia was less in Winter than in Summer or Fall, but not Spring, seasons. Conclusions A seasonal variation was noted with Winter, a season of low outdoor allergens, having the fewest number of newly diagnosed AEE patients.

Is there a seasonal variation in the incidence or intensity of allergic eosinophilic esophagitis in newly diagnosed children

We report an optimum 1D velocity model of the Kumaon–Garhwal Himalaya, based on analysis of ∼5000 seismograms generated at 50 digital broadband seismic stations in the region during April 2005 and June 2008. These include data from 385 local earthquakes with azimuth gaps of <180°, each of which had a minimum of seven P ‐ and five S ‐phase readings. This velocity model was then used to map the locations of 1150 earthquakes (1< M <5) that occurred in the region. A majority (∼75%) of these earthquakes occurred in the upper 20 km of the crust, largely above the Main Himalayan Thrust, and forms an ∼10‐km‐wide band along the surface trace of the Munsiari Thrust. However, we also find another parallel band of earthquakes, about 70 km to its southwest through the Tehri dam in the Lesser Himalaya, and a significant number (∼15%) both in the Tethys Himalaya and within the flexed crust of the underthrusting Indian plate, beneath the Ganga basin. Furthermore, unlike the reported absence of seismicity in the lower crust of the Nepal Himalaya, and its reappearance in the shallow mantle, the Kumaon–Garhwal Himalayan crust is found to be seismically active throughout, with no event reliably recorded in the shallow mantle of this region during the epoch of our seismic recording.

Online Material: Figures show constrains and distribution of data used in joint inversion; and table shows P ‐ and S ‐wave corrections obtained from travel‐time inversion.

One‐Dimensional Reference Velocity Model and Precise Locations of Earthquake Hypocenters in the Kumaon–Garhwal Himalaya

SUMMARY The Archean Dharwar craton in south India is known for long time to be different from most other cratons. Specifically, at station Hyderabad (HYB) the Ps converted phases from the 410and 660-km mantle discontinuities arrive up to 2 s later than in other cratons of comparable age, which implies lower upper mantle velocities. To resolve the unique lithosphere‐asthenosphere system of the Dharwar craton, we inverted jointly P and S receiver functions and teleseismic P and S traveltime residuals at 10 seismograph stations. This method operates in the same depth range as long-period surface waves but differs by much higher lateral and radial resolution. We observe striking differences in crustal structures between the eastern and western Dharwar craton (EDC and WDC, respectively): crustal thickness is of around 31 km, with predominantly felsic velocities, in the EDC and of around 55 km, with predominantly mafic velocities, in the WDC. In the mantle we observe significant variations in the P velocity with depth, practically without accompanying variations in the S velocity. In the mantle S velocity there are azimuthdependent indications of the Hales discontinuity at a depth of ∼100 km. The most conspicuous feature of our models is the lack of the high velocity mantle keel with the S velocity of ∼4.7 km s −1 , typical of other Archean cratons. The S velocity in our models is close to 4.5 km s −1 from the Moho to a depth of ∼250 km. There are indications of a similar upper mantle structure in the northeast of the Indian craton and of a partial recovery of the normal shield structure in the northwest. A division between the high S-velocity western Tibet and low S-velocity eastern Tibet may be related to a similar division between the northeastern and northwestern Indian craton.

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Lithosphere of the Dharwar craton by joint inversion of P and S receiver functions

We report an anomalous present day crustal thickness of 43-52 km beneath the 3.4-3.0 Ga mid-Archean segment of the western Dharwar craton (WDC) undisturbed by Proterozoic events. In contrast, adjoining late-Archean (2.7-2.5 Ga) eastern Dharwar craton (EDC) has a 33-40 km crustal thickness similar to the Archean global average. Considering that mineral assemblages in the central part of the WDC crust (amphibolite grade metamorphics) equilibrated at a depth of 15-20 km, we argue that the western Dharwar crust 3.0 Ga ago must have been at least 60-80 km thick. Both segments of Dharwar craton crust exhibit Poisson's ratio of 0.24-0.28 suggesting felsic to intermediate average crustal composition. The thickest crust beneath WDC has also underlying high-velocity thicker lithosphere compared to EDC, inferred from faster arrivals of teleseismic P and S wave. The contact between WDC and EDC is marked as gradational thinning of crust (42-36 km) from Chitradurga thrust to the western part of Closepet granite. In WDC, the crustal thickness increases in step fashion towards the oldest crustal block. These details suggest terrain accretion in Dharwar craton during 3.4 to 2.5 Ga through subduction related process.

Sandeep Gupta

Papers

The nature of the crust in southern India: Implications for Precambrian crustal evolution

Is there a seasonal variation in the incidence or intensity of allergic eosinophilic esophagitis in newly diagnosed children

One‐Dimensional Reference Velocity Model and Precise Locations of Earthquake Hypocenters in the Kumaon–Garhwal Himalaya

Lithosphere of the Dharwar craton by joint inversion of P and S receiver functions

First evidence for anomalous thick crust beneath mid-Archean western Dharwar craton