bluuebunny/crossref_metadata_2025 huggingface dataset:
Post-lithiation: a way to control the ionic conductivity of solid-state thin film electrolyte
Authors: Chen Jixi , Palliotto Alessandro , Yun Shinhee , Christensen Dennis Valbjørn , Esposito Vincenzo , Pryds Nini
Published: November 2023

Adding lithium to Li-containing thin film materials after the deposition of the films, thus little attention needs to the paid to the stoichiometry of Li in the films.
An extracellular matrix-mimicking magnetic microrobot for targeted elimination of circulating cancer cells
Authors: Huang Jing , Liu Yuan , Wu Jiandong , Dong Fuping , Liu Chu , Luo Jiawei , Liu Xiangchao , Wang Ning , Wang Lei , Xu Haifeng
Published: November 2023

A magnetic microrobot has been developed using natural materials derived from the extracellular matrix (ECM) to mimic the ligand–receptor interaction between cancer cells and the ECM, offering targeted elimination of circulating tumor cells.
Mechanosynthesis of a bifunctional FeNi–N–C oxygen electrocatalyst via facile mixed-phase templating and preheating-pyrolysis
Authors: Kosimov Akmal , Yusibova Gulnara , Wojsiat Ivan Tito , Aruväli Jaan , Käärik Maike , Leis Jaan , Paaver Peeter , Vlassov Sergei , Kikas Arvo , Kisand Vambola , Piirsoo Helle-Mai , Kukli Kaupo , Heinmaa Ivo , Kaljuvee Tiit , Kongi Nadezda
Published: November 2023

This study presents a cost-effective and sustainable approach to create a bifunctional FeNi–N–C electrocatalyst using template-assisted mechanosynthesis.
Ultrahigh phase-transition electric field and giant energy density in NaNbO3–Bi(Zn0.5Sn0.5)O3 lead-free antiferroelectric ceramics
Authors: Xu Yuanjie , Xie Aiwen , Jiang Xuewen , Wang Jun , Shi Ruijian , Li Tianyu , Xie Xinchun , Zuo Ruzhong
Published: November 2023

Synergistic effect of reduced off-centering displacements of B-site cations, enhanced antiferrodistortive and decreased AFE domain size leads to significantly enhanced EAF of ≥45 kV mm−1 and Wrec of ∼5.5 J cm−3 in NaNbO3-based lead-free ceramics.
Wird KI neue Medikamente gegen Herzkrankheiten hervorbringen?
Authors: Glaser Manuel , Ritterhof Julia , Most Patrick , Wade Rebecca C.
Published: November 2023

Angesichts der umwälzenden Auswirkungen, die künstliche Intelligenz (KI) auf Wissenschaft,
Medizin und darüber hinaus hat, betrachten wir hier das Potenzial von KI für die Entdeckung
neuer Medikamente gegen Herzkrankheiten. Wir definieren KI im weitesten Sinne als den Einsatz
von maschinellem Lernen, einschließlich Statistik und Deep Learning, um Muster in Datensätzen
zu erkennen, die für Vorhersagen genutzt werden können. Jüngste Durchbrüche in der Fähigkeit,
sehr große Datenmengen zu berücksichtigen, haben einen Boom in der KI-gestützten
Arzneimittelentdeckung sowohl in der Wissenschaft als auch in der Industrie ausgelöst. Viele
neue Unternehmen verfügen bereits über Arzneimittel-Pipelines, die bis in die klinische
Erprobung reichen, aber noch keine Medikamente gegen Herzkrankheiten enthalten. Wir
beschreiben hier den Einsatz von KI für die Entdeckung von niedermolekularen Medikamenten und
Biologika, einschließlich therapeutischer Peptide, sowie für die Vorhersage von Wirkungen wie
Kardiotoxizität. Der konzertierte Einsatz von KI zusammen mit physikbasierten Simulationen und
experimentellen Rückkopplungsschleifen wird notwendig sein, um das Potenzial der KI für die
Arzneimittelentdeckung und die Entwicklung von Präzisionsarzneimitteln für Herzkrankheiten
voll auszuschöpfen.
Rhythmusdiagnostik mittels Wearables – Einsatz und Nutzen im klinischen Alltag
Authors: Hillmann Henrike A. K. , Veltmann Christian , Duncker David
Published: November 2023

Wearables zur Rhythmusdetektion sind tragbare Devices, die dazu dienen, den Herzrhythmus
des Trägers zu überwachen und Abnormalitäten zu erkennen. Die verschiedenen Technologien,
einschließlich Elektrokardiogramm, Photoplethysmografie und Phonokardiogramm, können zur
Diagnose und Überwachung von Herzrhythmusstörungen eingesetzt werden. Die Empfehlungen
wissenschaftlicher Fachgesellschaften betonen die Bedeutung einer korrekten Datenaufzeichnung
und -interpretation sowie einer sorgfältigen klinischen Bewertung. Wearables zur
Rhythmusdetektion haben Vor- und Nachteile, und die Kostenerstattung kann je nach Land
unterschiedlich sein. In Zukunft werden Wearables zur Rhythmusdetektion voraussichtlich eine
wichtigere Rolle bei der Diagnose und Überwachung von Herzrhythmusstörungen spielen.
Students’ online learning adaptability and their continuous usage intention across different disciplines
Authors: Li Zheng , Lou Xiaodong , Chen Minwei , Li Siyu , Lv Cixian , Song Shuting , Li Linlin
Published: November 2023

Online learning, as a pivotal element in modern education, is introducing fresh demands and challenges to the established teaching norms across various subjects. The adaptability of students to online learning and their sustained willingness to engage with it constitute two pivotal factors influencing the effective operation of online education systems. The dynamic relationship between these aspects may manifest unique traits within different academic disciplines, yet comprehensive research in this area remains notably scarce. In light of this, this study constructs an Adaptive Structural Learning and Technology Acceptance Model (ASL-TAM) with satisfaction towards online teaching as the mediating variable to investigate the impact and mechanism of online learning adaptivity on continuous usage intention for students from different disciplines. A total of 11,832 undergraduate students from 334 universities in 12 disciplinary categories in mainland China were selected, and structural equation modeling was used for analysis. The results showed that the ASL-TAM model could be fitted for all 12 disciplines. The perceived ease of use, perceived usefulness, and system environment adaptability dimensions of online learning adaptivity significantly and positively affect satisfaction towards online teaching and continuous usage intention. Satisfaction towards online teaching partially mediates the relationship between online learning adaptivity and continuous usage intention. There were significant differences in the results of the single-factor analysis of the observed variables for the 12 disciplines, and the path coefficients in the ASL-TAM model fitted for each discipline were also significantly different. Compared to the six disciplines under the science, technology, engineering, and mathematics (STEM) category, six disciplines under the humanities category exhibited more significant internal differences in the results of the single-factor analysis of perceived usefulness and the path coefficients for satisfaction towards online teaching. This research seeks to bridge existing research gaps and provide novel guidance and recommendations for the personalized design and distinctive implementation of online learning platforms and courses across various academic disciplines.
Machine-guided discovery of a real-world rogue wave model
Authors: Häfner Dion , Gemmrich Johannes , Jochum Markus
Published: November 2023

Big data and large-scale machine learning have had a profound impact on science and engineering, particularly in fields focused on forecasting and prediction. Yet, it is still not clear how we can use the superior pattern-matching abilities of machine learning models for scientific discovery. This is because the goals of machine learning and science are generally not aligned. In addition to being accurate, scientific theories must also be causally consistent with the underlying physical process and allow for human analysis, reasoning, and manipulation to advance the field. In this paper, we present a case study on discovering a symbolic model for oceanic rogue waves from data using causal analysis, deep learning, parsimony-guided model selection, and symbolic regression. We train an artificial neural network on causal features from an extensive dataset of observations from wave buoys, while selecting for predictive performance and causal invariance. We apply symbolic regression to distill this black-box model into a mathematical equation that retains the neural network’s predictive capabilities, while allowing for interpretation in the context of existing wave theory. The resulting model reproduces known behavior, generates well-calibrated probabilities, and achieves better predictive scores on unseen data than current theory. This showcases how machine learning can facilitate inductive scientific discovery and paves the way for more accurate rogue wave forecasting.
Seasonality predicts variation in life history phenotypes in the livebearing fish Priapichthys annectens
Authors: Johnson Erik S , Tobler Michael , Johnson Jerald B
Published: November 2023

Livebearing fishes (Poeciliidae) have been used as models to test several aspects of life history theory. Previous work in these fishes showed that traits such as age and size at maturity, reproductive allocation, and number and size of offspring can each be shaped by natural selection. Life history traits can also be influenced by the environment, and in some cases, such phenotypic plasticity can also be adaptive. Resource availability in the environment can affect life history trait expression with increased resources expected to result in increased investment in reproduction. Here, we test this hypothesis in the Costa Rican livebearing fish Priapichthys annectens by quantifying life history traits and comparing trait values between populations collected during the dry season versus the wet season, periods when resource availability varies. We found that life history traits related to reproductive investment, but not the timing of reproductive events, differed between seasons. During the wet season, female body condition increased, and females invested less in reproduction, having fewer but larger offspring. Irrespective of the season, larger females gave birth to larger offspring. Finally, we found that this species utilizes a lecithotrophic strategy of provisioning eggs with nutrients being deposited in the ova prior to fertilization, and that females only carry one developing brood at a time (no superfetation). This is the first study documenting the life history of P. annectens, and it adds to a growing body of work suggesting that seasonal environmental differences can induce changes in the expression of some—but not all—life history traits.
A O03 Host phenotypic adversity independently predicts progression to resection in neoadjuvantly-treated pancreatic cancer
Authors: Bryce Adam , Dreyer Stephan , Dolan Ross , Froeling Fieke , Chang David
Published: November 2023

Background

Neoadjuvant treatment (NAT) offers a modest survival benefit to the otherwise dismal outcomes of pancreatic ductal adenocarcinoma (PDAC), however methods for assessing treatment response and disease trajectory during NAT are limited. Cachexia and sarcopenia are hallmark features of PDAC and defining host phenotypic adversity is crucial in understanding the tumour-host relationship and its influence on clinical outcomes. We sought to determine the relationship between body composition, systemic inflammation, and outcomes in NAT PDAC to lay foundations for improving assessment of treatment response.

Methods

This is a retrospective, observational study with an intention-to-treat design, analysing resected (n = 109) and non-resected (n = 117) NAT PDAC (total n = 226) from the tertiary West of Scotland Pancreatic Unit, Glasgow Royal Infirmary. Patients were included if they had resectable or borderline resectable disease and received NAT. Patients were excluded if they had locally advanced or metastatic disease. Body composition was determined by single-slice L3 cross-sectional measurements.

Results

Patients with an adverse phenotype defined by change in body composition were less likely to progress to resection (40.9% vs 68.8%, p < 0.001). Logistic regression confirms the independence of this effect (OR 3.79, 95% CI 1.99-7.22, p < 0.001). There was a trend towards systemic inflammation in the non-resected group (CRP rise 51.4% vs 29.9%, p = 0.008). Patients treated with Folfirinox who required dose reduction received higher doses of irinotecan, 5-fluorouracil (bolus) and 5-fluorouracil (infusion) per unit muscle mass (7.3 vs 6.9mg/cm2⋅m-2, p = 0.010; 16.2 vs 14.7mg/cm2⋅m-2, p = 0.002; 96.5 vs 91.1mg/cm2⋅m-2, p = 0.026).

Conclusions

Host phenotypic adversity during NAT presents a potentially valuable addition to a limited arsenal of tools to aid decision making in resectable and borderline resectable PDAC. Early assessment of body composition trend during chemotherapy may present an opportunity to switch the host phenotype from adverse to favourable in some patients, or highlight the futility of continuing aggressive treatment in others. Chemotherapeutic prescribing by body surface area overlooks crucial differences in lean body mass and may be exposing patients to avoidable and burdensome toxicities.
BS O07 Short-Term and Long-Term Changes in Natriuretic Peptide Levels After Bariatric Surgery: A Meta-Analysis
Authors: Wong Zhen Yu , Murugan Veylamuthen , Parmar Chetan , Ramnarain Dharmanand , Dekker Lukas R , Hasenberg Till , Pouwels Sjaak
Published: November 2023

Background

Bariatric surgery (BS) has demonstrated cardiovascular benefits in patients and was previously proven to be associated with an increased natriuretic peptide level without cardiac dysfunction. However, new studies have emerged, which require us to re-examine the relationship and extent of the correlation between BS, weight loss, and cardiac natriuretic peptide levels.

Methods

A PRISMA-compliant systematic search was conducted across Medline, Cochrane, and Embase, until 15th February 2023. Primary outcomes include short- and long-term changes in B-type natriuretic peptide (BNP) and N-terminal pro BNP (NT-proBNP) post-BS. Secondary outcomes included changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), atrial natriuretic peptide (ANP), N-Terminal atrial natriuretic peptide (NT-ANP), ejection fraction (EF) and left ventricular mass (LVM). Outcomes were pooled using the DerSimonian and Laird random effects model.

Results

Twenty-two studies with 1219 patients (33.2% Male, 45.5% gastric bypass surgery). Mean difference of short- and long-term NT-proBNP levels after BS were 52.88 pg/mL (95% CI, 21.30-84.46) and 50.42 pg/mL (95% CI, 28.18-72.67) respectively with a similar rise observed in BNP levels. Short-term NT-ANP levels significantly increased, but not in long-term ANP and short-term NT-ANP levels. There were no significant post-BS changes in EF but SBP, DBP and LVM significantly reduced. Subgroup analysis in NT-proBNP levels demonstrated a significant rise among patients with >30% BMI loss and a significant reduction in patients with <30% BMI loss.

Conclusions

BS is associated with increased natriuretic peptide levels in the absence of deteriorating cardiac function. Further studies should investigate its correlation with clinical symptoms, cardiac structural changes and the longitudinal risk of heart failure, enabling informed decision-making and tailored management strategies to optimize patient care and improve postoperative cardiac outcomes in the context of BS.
BS O08 The burden of bariatric health tourism on publicly funded health services in the UK
Authors: Alabdellat Osama , Alwani Omneya , Nima Bara Abu , Alkhaffaf Bilal
Published: November 2023

Background

Bariatric surgery is a safe and effective treatment for obesity and it's associated co-morbidities. Limited access to surgery in the NHS and a combination of cheaper costs and aggressive advertising by international clinics has led to a surge in people seeking surgery abroad. There is a perception that an indeterminate volume of bariatric health tourism has resulted in increased rate of serious complications in UK. This study aimed to objectively quantify this perceived burden by describing the presentation, management and outcomes of bariatric emergencies in cases undertaken abroad and comparing them to emergency cases originating in the UK.

Methods

This was a retrospective review of all consecutive non-elective attendances and admissions between January 2018 and April 2023. The setting was a regional bariatric and metabolic surgery centre with a dedicated bariatric on-call service serving Greater Manchester and the North-West of England. Patient demographics, data on index procedures, diagnostic and therapeutic interventions as well as length of hospital and ITU stay was collected. Changes in trends in patients undergoing their index procedure abroad (bariatric health tourist BHT group) were explored and compared to those undergoing surgery in the UK (UK group).

Results

373 non-elective episodes were included; 28% related to index procedures abroad. The proportion of admissions related to BHT was 35.5% (17/48), 21% (10/48), 16.5% (9/54), 17% (6/35) and 36.5% (47/128) in years 1 to 5 respectively.

BHT patients presented were most likely to present with sleeve complications (33% vs UK 20%) whilst UK patients were most likely to present with band-related problems (46% vs BHT 20%). BHT patients underwent 124 fluoroscopies, 115 CT-scans and 60% required surgical interventions. BHT patients accounted for 37% of total bed days (1610/4311) and had longer median ITU stays (8 v 3 days).

Conclusions

The total number of emergency episodes related to bariatric surgery undertaken abroad increased eight-fold in the last 12 months compared to the preceding year, and was higher than the total number of episodes in the preceding 4 years. This reflects the ongoing challenges with patient access to publicly funded and affordable bariatric surgery in the UK. Complications arising in this patient group result in longer stays and greater resource burden compared to those patients who have undergone surgery in the UK. This trend has enormous resource implications for service design and an urgent response is needed.
HPB O02 Autologous blood transfusion reduces the requirement for peri-operative allogenic blood transfusion in patients undergoing major hepatopancreatobiliary surgery
Authors: Lakha Adil Siraj , Chadha Radhika , Von-Kier Stephen , Barbosa Antonio , Maher Keith , Pirkl Martin , Stoneham Mark , Silva Michael A , Soonawalla Zahir , Udupa Venkatesha , Reddy Srikanth , Gordon-Weeks Alex
Published: November 2023

Background

Major hepatopancreatobiliary surgery is associated with a risk of major blood loss. We aimed to assess whether autologous transfusion of blood salvaged intra-operatively reduces the requirement for post-operative allogenic transfusion in this patient cohort.

Methods

In this single centre study, information from a prospective database of 501 patients undergoing major HPB resection (2015–2022) was analysed. Patients who received cell salvage (n=264) were compared with those who did not (n=237). Non-autologous (allogenic) transfusion was assessed from the time of surgery to 5 days post-surgery, and blood loss tolerance was calculated using the Lemmens-Bernstein-Brodosky formula. Multivariate analysis was used to identify factors associated with allogenic blood transfusion avoidance.

Results

32% of lost blood volume was replaced through autologous transfusion in patients receiving cell salvage. Although the cell salvage group experienced significantly higher intra-operative blood loss compared with the non-cell salvage group (1360ml vs 971ml, p=0.0005), they received significantly less allogenic red blood cell units (1.5 vs 0.92 units/patient, p=0.03). Correction of blood loss tolerance in patients who underwent cell salvage was independently associated with avoidance of allogenic transfusion (OR 0.05 (0.006-0.38) p=0.005). In a subgroup analysis, cell salvage use was associated with a significant reduction in 30-day mortality in patients undergoing major hepatectomy (6% vs 1%, P=0.04).  

Conclusions

Cell salvage use was associated with a reduction in allogenic blood transfusion and a reduction in 30-day mortality in patients undergoing major hepatectomy. Prospective trials are warranted to understand whether the use of cell salvage should be routinely utilised for major hepatectomy.
HPB O08 Championing benign biliary patients in Emergency General Surgery: A 3 year quality improvement project
Authors: Johnson Roisin , Forsyth Katrina , El-Boghdady Michael , Wheatstone Sarah , Tomasi Ivan , Atkinson Simon , Ebied Husam , Kinight William
Published: November 2023

Background

A biliary quality improvement project (QuIP) was established in 2019 following 3 audit cycles highlighting delays to laparoscopic cholecystectomy (Lap-C) in patients with gallstone pancreatitis. Limited theatre space and other urgent care priorities hindered efforts to meet other biliary key performance indicator targets between 2015 and 2019. The last phase of the QuIP has introduced a dedicated consultant lead biliary service, a live biliary patient tracking system, increased in-patient Lap-C, implementation of ambulatory pathways and a patient centred integrated care approach.

Methods

Prospectively collected data from a live biliary tracking system was compared with retrospective audit data from 2015-2019. Key performance indicators were; average time to Lap-C, rate of Lap-C with-in 2 weeks following pancreatitis, inpatient Lap-C rate and out-patient appointments saved.

Results

523 patients were managed through inpatient and ambulatory biliary pathways from November 2021-June 2023. 2 week Lap-C post pancreatitis improved from 27% to 79% (43% as inpatients) with average time to Lap-C improving from 68 days to 13 days. 191 outpatient appointments were saved by counselling and pre-assessing patients for Lap-C as inpatients, saving £22920 in outpatient costs. In-patient Lap-C rate improved from 2% to 19% for fit and consenting patients.

Conclusions

A higher quality of care can be achieved for biliary patients through; effective patient prioritisation, increasing inpatient Lap-C, the establishment of ambulatory pathways and a robust outpatient tracking system.
OGBN O01 Durability of Radiofrequency Ablation for Long-segment and Ultralong-segment Barrett’s Esophagus over 10 years
Authors: Nguyen Chu Luan , Zhou Michael , Tovmassian David , Seyfi Doruk , Gooley Suzanna , Falk Gregory
Published: November 2023

Background

Long-term durability data for radiofrequency ablation(RFA) to prevent esophageal adenocarcinoma in long-segment(LSBE) and ultralong-segment Barrett’s esophagus(ULSBE) is lacking. This study aimed to determine 10-year cancer progression, eradication, and complication rates in LSBE and ULSBE patients treated with RFA.

Methods

Single surgeon prospective database of patients with LSBE (≥3 to <8cm) and ULSBE (≥8cm) who underwent RFA (2001-2021) were retrospectively analyzed. Ten-year cancer progression calculated with Kaplan-Meier analysis. Eradication rates, including complete remission of dysplasia (CR-D) and intestinal metaplasia (CR-IM), and rates of recurrence and complications, compared between LSBE and ULSBE groups.

Results

Ten years after starting treatment, the cancer rate was 14.3% in 56 patients. CR-D and CR-IM rates were 87.5% and 67.9%, respectively. Eradication rates for dysplasia in LSBE and ULSBE patients(90.6%versus83.3%) and IM(71.9%versus62.5%) were not significantly different. ULSBE patients required higher mean number of ablation sessions for IM eradication(4.7versus3.7,p=0.032), while complication rates including strictures(4.2%versus6.2%), perforation(0versus0) and bleeding(4.2%versus3.1%), were similar between ULSBE and LSBE patients, respectively. On multivariate analysis, shorter Barrett’s segment and baseline low grade dysplasia were associated with increased likelihood for eradication of IM and dysplasia.

Conclusions

RFA was durable in maintaining dysplasia and IM eradication in both LSBE and ULSBE over 10 years, and with low complication rates. IM eradication was more difficult to achieve in ULSBE. Late development of cancer occurred in 14.3%.
OGBN O03 Quality of life of patients with gastroesophageal reflux disease: findings from a systematic literature review
Authors: Goldsmith Paul , Das Shuchesmita , Hoffsten Johanna
Published: November 2023

Background

Gastroesophageal reflux disease (GERD), affecting over a billion people worldwide, is associated with significant impairment and productivity loss. Understanding the quality of life among GERD patients may provide important clinical relevance to treatment management and highlight the patient perspective. The aim of this study was to conduct a systematic review of GERD and quality of life, including any potential effects on treatment management.

Methods

MEDLINE, Embase, and the Cochrane Library were searched for randomized controlled trials, case-control, and cohort studies published in English from 2013 to 2023. Eligible studies included adult GERD patients with quality of life data from a disease-specific or generic instrument. Data analysis contained a narrative synthesis of pre- and post-procedural total scores.

Results

Eight trials and 34 observational studies were included. The disease-specific instruments GERD Health-Related Quality of Life (GERD-HRQL) (n = 35) and Gastrointestinal Quality of Life Index (GIQLI) (n = 4) had baseline mean scores ranging from 13.3 to 37.1 and 72.0 to 96.3, which changed to 1.3 to 31.6 and 94.8 to 119.8 post-treatment, respectively. Besides the Reflux Symptom Index (RSI) (n = 3), EQ-5D, Psychological General Well-Being (PGWB), SF-36, and GastroEsophageal Reflux Symptom Score (GERSS) were only used by single studies to evaluate the quality of life among GERD patients. In general, these results indicated an improvement post-treatment.

Conclusions

As a general finding, patients with GERD have poor quality of life and active treatment seems to influence and improve GERD patients’ quality of life, considering the pre-post results of GERD-HRQL and GIQLI scores. As expected, generic quality of life instruments are seldom used.
OGBN O04 Modern surgery and endoscopic procedures for gastro-oesophageal reflux in lung transplant recipients: a systematic review and meta-analysis
Authors: Ali Iihan , Namgoong Christoper , Das Bibek , Robb Henry , Fehervari Matyas
Published: November 2023

Background

Gastro-Oesophageal Reflux Disease (GORD) is a major cause of morbidity and rejection following lung transplantation. Interventional treatment of GORD is a widely accepted management strategy for GORD in the context of lung transplant surgery. We conducted a systematic review of all modern interventions to treat GORD following lung transplantation to identify the optimum management strategy for these patients.

Methods

We conducted a literature search of MEDLINE, Embase and the Cochrane library, using a tailored search strategy, from inception until 18/10/2022. Articles reporting outcomes of Anti-Reflux Surgery (ARS) following lung transplantation were included. Two independent reviewers performed screening, full text review and data extraction using the COVIDENCE platform. The study protocol was registered on PROSPERO (CRD42022379748).

Results

The screen identified 236 studies, with 21 deemed suitable for inclusion. These studies included a total of 1063 patients. The procedures described included fundoplication (n = 19), (Nissen, Toupet, Dor), Stretta (n=1) and LINX (n=1) procedures. Follow up ranged from 50 days to 6.9 years. 6 studies reported FEV1 outcomes which all demonstrated stable or improved lung function following ARS. From identified literature, 9 papers reported survival outcomes with 4 studies demonstrating improved survival following ARS.

Conclusions

ARS appears to be an effective management strategy for GORD in the context of lung transplantation. However, modern alternatives, such as Stretta and LINX require further clinical evaluation to assess their impact on lung function and survival.
OGBN O05 Short term outcomes after mesh hiatal hernioplasty versus suture cruroplasty in hiatus hernia repair at a busy District General Hospital
Authors: Patel Maitreyi , Suresh Reena , Woods-orugboh James , Shetty Jeevith , Amalesh Thangadorai , Mukherjee Samrat , Mukherjee Dipankar
Published: November 2023

Background

Laparoscopic cruroplasty for giant hiatus hernias utilizing non-absorbable sutures, has been demonstrated to be safe with good symptomatic relief. However, recurrence rates as high as 42% have been reported. Hiatoplasty using synthetic mesh was introduced to reduce recurrence. However, there are concerns due to complications, most notably oesophageal erosion. Due to the lack of high-quality comparative data between different types of mesh for hiatus hernia repairs, there is little evidence to guide use of mesh. We aimed to assess outcomes comparing suture cruroplasty (SC) with mesh hiatus hernioplasty (MHH) after HH repair in our unit at a busy DGH.

Methods

We retrospectively collected data of consecutive patients undergoing hiatus hernia repair between January 2016 and December 2021. Data was obtained from electronic patient records form hospital system. Primary outcomes assessed were recurrence and re-operation rates at follow up. Secondary outcomes assessed were peri-operative morbidity. We used PTFE coated composite (dual gore) mesh for MHH. Data were analysed using the two-tailed t-test for continuous data and χ2 or Fishers exact tests for categorical data. Level of statistical significance was set at p value of <0.05.

Results

145 patients (SC= 98, MHH= 47) underwent hiatus hernia repair. Indications were paraesophageal (Type II-IV) HH in 58.62%, and large Type I HH in 41.38%. Conversion rate was 0.67%. There was no significant difference in post –operative morbidity. An outcome without postoperative complications was achieved in 77.24% of cases overall. After a mean follow-up of 17 months, hernia recurrence (10.2% versus 14.89%, p=0.42) and re-operation rates (5.1% versus 8.51%, p=0.47) were not significantly different. There were no mesh erosions. Overall, 132patients (91.03%) had relief from symptoms, 115 (79.31%) were able to stop GORD medications.

Conclusions

Suture cruroplasty and mesh hernioplasty produce comparable results with respect to recurrence and re-operation rates. Recurrence rates after repair are low, and are asymptomatic in most cases. A long-term follow up will enable to identify any significant future impact of method or modality of repair on patient outcome.
OGBN O07 Factors in recurrence following 862 giant paraesophageal hernia repairs
Authors: Nguyen Chu Luan , Zhou Michael , Tovmassian David , Seyfi Doruk , Isaacs Anna , Gooley Suzanna , Falk Gregory
Published: November 2023

Background

Repair of giant paraesophageal hernia (PEH) is associated with a considerable hernia recurrence rate by objective measures. This study evaluated trends in outcomes of laparoscopic non-mesh repair of giant PEH over 30 years, and factors associated with anatomical recurrence.

Methods

Data was extracted from a single-surgeon prospective database of laparoscopic repair of giant PEH from 1991-2021. Upper endoscopy was performed within 12 months postoperatively and selectively thereafter. Any supra-diaphragmatic stomach was defined as anatomical recurrence. Cases were chronologically divided into tertiles with trends in casemix, operative factors and outcomes evaluated. Patient and hernia characteristics, and technical operative factors, including “composite repair” (360-degree fundoplication with esophagopexy and cardiopexy to right crus), were evaluated with univariate and multivariate analysis.

Results

862 repairs met selection criteria. Mean age 69.3years, majority(65.8%) female and hernia type III(87.4%) with median hernia size 66%. There was an increasing proportion of “composite repair” after the first decade(Group1, 2.7%;Group2, 81.9%;Group3, 100%;p<0.001).There were less anatomical hernia recurrence(Group1, 36.6%;Group2, 22.9%;Group3, 22.7%;p<0.001) over time. The overall anatomical recurrence rate was 27.3% with median followup 33months(IQR 16, 68). There were 10(1.2%) Clavien-Dindo grade ≥III complications including two perioperative deaths(0.2%). Multivariate analysis identified age<70years, presence of Barrett’s, absence of “composite repair”, and hiatus closure under tension as independent factors associated with recurrence(HR1.27,95%CI0.88-1.82,p=0.01;HR1.58,95%CI1.12-2.23,p=0.009;HR1.72,95%CI1.2-2.44,p=0.002;HR2.05,95%CI1.33-3.17,p=0.001,respectively).

Conclusions

Hernia recurrence rates decreased with increasing case volume. This coincided with the increasing adoption of “composite repair”, supporting the possible improvement in recurrence rates with this approach. Repair was associated with substantial anatomical recurrence associated with patient and technique factors. Patient factors included age <70 years, Barrett’s esophagus, and hiatus tension. “Composite repair” was associated with lower recurrence rate.
OGC O02 CLDN18.2 expression in resectable gastroesophageal cancers: associated clinical and molecular signatures and impact of neoadjuvant chemotherapy on intra-tumour heterogeneity
Authors: Cammarota Antonella , Devonshire Ginny , Miremadi Ahmad , Zhuang Lizhe , Zamani Shawn , Smith Rebecca , Masqué-Soler Neus , Ustaoglu Ahsen , Rimassa Lorenza , Fitzgerald Rebecca , Smyth Elizabeth
Published: November 2023

Background

Claudin 18.2 (CLDN18.2), a key component of tight junctions, is overexpressed in up to 40% of oesophagogastric adenocarcinoma (OGA) and is a clinically validated biomarker in the unresectable setting. However, data is required in the resectable stages, including chemotherapy effects, relationship with genomic and immune factors, and measures of heterogeneity.

Methods

CLDN18.2 (ab222512, Abcam) and PD-L1 (E1L3N, Cell Signaling) were assessed by immunohistochemistry on adjacent FFPE slides in 57 patients with resectable OGA. Positivity was defined as 2+/3+ staining in ≥40% of tumour cells for CLDN18.2 and combined positive score (CPS)≥1 for PD-L1. Twenty-four patients (43%) had additional tumour samples to assess CLDN18.2 intra-tumour heterogeneity. Tumour mutational burden (TMB) and copy number aberrations (CNAs) were estimated from WGS and tumour microenvironment (TME) composition from transcriptomic data. Mann Whitney/t-test was used to compare clinical and molecular characteristics, and log-rank test to compare survival curves. Statistical significance was set at p=0.05.

Results

Fifty-seven patients with resected OGA (79% after neoadjuvant chemotherapy (nCT)) were evaluated. CLDN18.2 was expressed in 18% and CLDN18.2 expression was not associated with clinicopathological features or survival. CLDN18.2 copy numbers (n=57, p=0.24) and RNA levels (n=20, p=0.48) were not associated with staining intensity. Compared to CLDN18.2-ve, CLDN18.2+ve cases did not differ in PD-L1 expression, TMB, CNAs, or TME composition (all p>0.05). However, exposure to chemotherapy was significantly associated with lack of CLDN18.2 (OR=0.2, 95% CI 0.04-0.79, p=0.03) and, among CLDN18.2+ve cases, CLDN18.2 status concordance between tumour samples was 100% in treatment-naïve but only 29% in cases exposed to chemotherapy.  

Conclusions

CLDN18.2+ve and CLDN18.2-ve tumours had similar clinical, genomic and immune features. However, exposure to chemotherapy substantially contributes to CLDN18.2 intra-tumour heterogeneity. Larger cohorts will need to clarify whether the evaluation of multiple tumour samples is required for an accurate assessment of CLDN18.2 expression.
OGC O05 Linear stapled technique for robotic assisted minimally invasive oesophagectomy and gastrectomy: technique, stepwise introduction, reproducibility and outcomes
Authors: Bull Alexander , Paine Heidi , Abbassi Nima , Singh Pritam , Madhavan Anantha , Immanuel Arul , Preston Shaun
Published: November 2023

Background

Robotic-assisted surgery (RAS) for oesophagectomy and gastrectomy is gaining in popularity. Compared to open oesophagectomy and conventional minimally invasive techniques, RAS is associated with decreased rates of complications, increased harvested lymph nodes and shorter length-of-stay. However, high anastomotic leak rates (20-27%) have been seen within randomised trials and case series, with up to 50% early in some published series. We present our technique for a linear anastomosis and the results of its staged introduction.

Methods

Initially developed by a single surgeon at open surgery, it was adapted to thoracoscopic procedures and then reproduced during RAS by several surgeons across two centres. Using a prospectively maintained database we reviewed the first sixty-three cases utilising a modified linear anastomosis technique for oesophageal anastomosis. Outcomes, with particular focus on the anastomosis were reviewed. We also describe in detail the technical steps involved in our technique for a side-to-side linear semi-mechanical stapled anastomosis using a tri-stapler with a 2-layer V-lock closure of the common enterotomy, during robotic surgery (video).

Results

Sixty-one patients had a two-stage oesophagectomy (one for benign disease), one with colonic reconstruction and two total gastrectomy. Median age was 63 (range 47-85). 89% (55/62) were adenocarcinomas, the remainder squamous cell carcinomas. The anastomosis was performed via an open approach initially in 11, thoracoscopically in 4, then robotically in 48 (including the gastrectomies). The first 20 anastomoses were performed by one surgeon, who then proctored four others. Two Type I anastomotic leaks (3.2%) and two Type I conduit necrosis occurred. There was no in hospital mortality. Non-anastomotic complications occurred in 28/63 (44.4%) of patients, most commonly respiratory (15/63, 23.8%).

Conclusions

We report a reproducible technique for semi-mechanical linear stapled anastomosis and its safe introduction into oesophageal and gastric resections including RAS, with anastomotic leak rates below the internationally reported rates, even in the early phase of its introduction in open, thoracoscopic and RAS. This technique, combined with training and mentorship may help more centres safely introduce a RAS oesophago-gastric programme, and improve patient outcomes.
OGC O06 Long term outcomes of immune checkpoint inhibition in oesophageal cancer
Authors: Owen Richard , Fuchs Hannah , James Sabrina , Lord Simon , Underwood Tim , Karydis Ioannis , Petty Russell , Middleton Mark , Lu Xin ,   LUD2015-005 Project Team
Published: November 2023

Background

Phase III studies have shown a survival benefit for the addition of immune checkpoint inhibitors (ICIs) to conventional chemotherapy for patients with gastro-oesophageal cancer. Large scale studies of chemo-immunotherapy prior to and after surgery are under way. We studied the clinical and biological effects of adding the PD-L1 inhibitor durvalumab (D) to peri-operative chemotherapy or chemoradiotherapy in a multi-centre phase II trial and used multiple phenotyping approaches to identify features associated with benefit.

Methods

Patients suitable for surgery were given D for 4 weeks, then one of Oxaliplatin and Capecitabine (CapOx), fluorouracil, leucovorin, oxaliplatin and taxotere (FLOT), or chemoradiotherapy (CXRT, CROSS regimen) were given with D before surgery, and D was continued for up to 12 further infusions postoperatively. Toxicity, response, and survival were recorded until death, for 3 years or until June 2022 when the study ended. Comparisons were made with propensity score matched patients treated over the same period in the one of the participating sites. Tumour phenotyping was with single cell and bulk sequencing approaches.

Results

11 pts received D-CapOx, 9 D-FLOT and 15 D-CXRT. Treatment side effects were as expected. Only 2 out of 35 patients did not have surgery, due to progressive disease on D-CXRT. Two (5.7%) and 6 (17.1%) patients had complete or partial pre-op responses (RECIST) and 3 (8.6%) had progression prior to surgery. Tumour regression at surgery (Mandard 1-3) occurred in 24/33 pts. 2-year survival was 81.8%, 77.8% and 77.8% respectively in the 3 arms. After propensity score matching, there was a survival advantage after addition of ICI (p=0.047). In selected patients we also demonstrate molecular features associated with response.

Conclusions

Adding D to standard neo-adjuvant regimens for gastro-oesophageal cancer is well tolerated. Survival times and response rates exceeded those expected for the regimens used (2-year survivals with FLOT 68% and CROSS 67%) in this non-randomised multi-centre trial. There was a survival advantage from the addition of ICI when compared to a matched cohort of patients treated in one of the study centres over the same period. Specific pre-treatment tumour phenotypes were associated with durable cure.
OGC O07 The prognostic role of positive peritoneal cytology in gastric cancer
Authors: Chidambaram Swathikan , Owen Richard , Maynard Nick , Shamiyah Khalid , Saunders John , Sultan Javed , Bhatti Khalid , Pera Manuel , Dalcero Mariagiulia , Ruurda Jelle , Van Hillegersberg Richard , Triemstra Lianne , van Berge Henegouwen Mark , Gisbertz Suzanne , Keywani Kamran , Piessen Guillaume , Youcef Amina , Grimminger Peter
Published: November 2023

Background

Locally advanced non-metastatic gastric cancer is primarily managed with surgical resection and peri-operative oncological therapies. Positive peritoneal cytology is often considered to be indicative of disseminated malignancy. We have previously shown that conversion from positive (Cy+) to negative (Cy0) cytology with systemic therapy, and absence of macroscopic disease, improves survival. With the advent of novel chemo- and radiotherapy regimes as well as immunotherapy, we recognise a lack of current understanding of the role of peritoneal cytology as a prognostic factor. Our study aims to determine the role of positive peritoneal cytology as a prognostic factor in gastric cancer.

Methods

This is an international multi-centre retrospective cohort study including high-volume, gastric cancer tertiary referral centres. Adult patients without macroscopic metastatic disease who underwent peritoneal cytology, and subsequently multi-modality treatment including surgical resection between 2011 and 2021 were included. The primary outcome measure is overall survival at 1, 3 and 5 years. Secondary outcome measures include recurrence-free survival at 1, 3 and 5 years; 30-day and 90-day major postoperative morbidity; and subset survival analyses were performed in patients who converted to Cy0 in restaging laparoscopy after neoadjuvant therapy. Statistical analysis was performed using R software.

Results

This is an interim analysis of the data of 280 patients with a mean age of 64.9 (0.72). 231 patients received pre-operative chemotherapy. 51.0% underwent open gastrectomy (41.2% laparoscopic and 4.64% robotic). 55% of patients underwent a total gastrectomy. 25.9% patients had positive cytology on laparoscopy, while 9.71% had indeterminate cytology. There was significant variation in the sites of peritoneal washings (Figure 1). So far, only 1 patient has shown conversion from positive to negative cytology after oncological therapy. At 1 year, the mortality rate was 41.5% (figure 2), while the recurrence rate was 41.4%.  

Conclusions

In this interim report, we demonstrate significant heterogeneity in the way peritoneal cytology is performed, and the peri-operative management of this cohort. The POPEC study closes to patient recruitment at the end of August 2023, and thus at AUGIS we plan to report on the final findings of this study with an anticipated sample size of over 1000 patients.
AHP P04 Utilisation of Jejunostomy (JEJ) placement post Oesophagogastrectomy (OG) surgery and the difference in unintentional weight loss between patients who were placed with a JEJ at the time of surgery compared to those without
Authors: Cross Kayleigh
Published: November 2023

Background

The optimal pathway for reinstating nutrition orally or enterally remains a matter of debate post OG surgery. Historically all patients undergoing OG had routine JEJ placement and there are many studies to support this. However more recently, some trusts are moving away from this notion and opting for selective JEJ placement due to suboptimal tube utilisation rates, psychological impact for patients, enhanced recovery after surgery (ERAS) pathways, wider range of oral nutritional supplements on the market, adaptive hospital menus and snack boxes, Naso-jejunal tubes (NJT) being placed instead of JEJ, JEJ tube complications and more enhanced specialist Dietetic input.

Methods

Data was collected retrospectively from electronic notes for all patients who underwent an OG between April 2020- April 2021 which was during the start of the covid pandemic. The data was reviewed for 2 years following their surgery and compared percentage weight loss of patients with JEJ placed versus patients without at 1-2 months, 3 months, 6 months, 9 months, 1 year and 2 years post surgery. Utilisation rates of JEJ tube were also reviewed alongside establishing if patients did not have JEJ placement at time of OG, required enteral feeding as part of their recovery.

Results

58 OG’s Conducted between 30/4/2020-29/4/21, of which 65.5% had JEJ placed.

Conclusions

Selective JEJ placement during OG surgery requires careful consideration given 23.7% patients didn't use JEJ post discharge and 2years post OG, weight loss was the same in both groups. However, 1year post OG, the non-JEJ group lost nearly double the amount to the JEJ group, highlighting further research is required to inform this debate; especially as the weight loss could be attributed to cancer recurrence which has not been accounted for. Collaborative working between Dietitians, surgeons and nurse specialists is essential if selective JEJ placement is to occur. Data will be repeated during non-covid times to yield more meaningful data.
AHP P05 Attendee perceptions of a support group for patients and carers following Oesophageal or Gastric resection
Authors: Dossou Vida , Murphy Amy
Published: November 2023

Background

The benefits of patient support groups are widely recognised, playing a vital role in cancer survivorship. Patients undergoing Oesophageal or gastric resection for cancer are presented with an array of unique post operative and life altering symptoms. Patients and carers alike can be profoundly affected as they live with their cancer diagnosis and the impact of the substantial surgery. The ‘Little and Often’ support group was established 16 years ago to support patients and carers in this regard, meetings are held monthly at a hospital site venue and combine informal conversation with Health care professional speakers.as requested by attendees.

Methods

A survey was conducted at the ‘Little and Often’ support group amongst attendees, patients and carers alike (n=17). The survey was a combination of open questions and rating scales and was submitted anonymously. Patients and carers were also asked to describe their feelings prior to attending the support group, and to describe how they felt after attending the support group to see if attendance had a bearing. The results were collated and reflected upon to inform the format of future support group meetings.

Results

The results tell us that most patients and carers find the ‘Little and Often’ support group valuable to their cancer journey and survivorship. Many affirmative aspects were identified that had a positive impact on patient experience, and 82% attendees stated there was nothing they did not like about the group. 100% attendees liked having a Health care professional present and accessible at the group. 100% of attendees either strongly agreed or agreed that the group had made an important difference in their life in a safe space that left them with hope for the future.

Conclusions

This survey reinforces the perceived benefits of patients and their carers attending the Little and Often support group. The format of having a health care professional speak alongside informal conversation was welcomed by the attendees. The group facilitates a patients transition from feeling alone and isolated at times to feeling hopeful, supported, and positive about the future. It would be prudent to repeat this survey on a larger cohort of patient across a longer time scale, a validated quality of life assessment tool can be utilised to monitor the impact of the Little and Often group on patients and carers.