bluuebunny/crossref_metadata_2025 huggingface dataset:
La-doped Hf0.5Zr0.5O2 thin films for high-efficiency electrostatic supercapacitors
Authors: Kozodaev Maxim G. , Chernikova Anna G. , Khakimov Roman R. , Park Min Hyuk , Markeev Andrey M. , Hwang Cheol Seong
Published: September 2018

The influence of La content on the ferroelectric properties of HfO2-ZrO2 thin films was examined for integrated electrostatic supercapacitor applications. A transition from ferroelectric to antiferroelectric-like behavior, accompanied by a significant increase of energy storage density value and efficiency, was observed with the increasing La concentration in La-doped HfO2-ZrO2-based capacitor structures, where the processing temperature remained below 400 °C. The combination of high energy storage density value (≈50 J/cm3) with high efficiency (70%) was obtained for the film with the highest La content (2.0 mol. %). The 2.0 mol. % La-doped HfO2-ZrO2-based capacitor structures were field cycled up to 109 times and were found to provide >40 J/cm3 energy storage density along with up to 80% efficiency. Moreover, the high thermal stability of such capacitors was confirmed. The founded property combination makes the La-doped HfO2-ZrO2 thin films suitable for integrated energy storage and pulse-power devices.
MonteCoffee: A programmable kinetic Monte Carlo framework
Authors: Jørgensen Mikkel , Grönbeck Henrik
Published: September 2018

Kinetic Monte Carlo (kMC) is an essential tool in heterogeneous catalysis enabling the understanding of dominant reaction mechanisms and kinetic bottlenecks. Here we present MonteCoffee, which is a general-purpose object-oriented and programmable kMC application written in python. We outline the implementation and provide examples on how to perform simulations of reactions on surfaces and nanoparticles and how to simulate sorption isotherms in zeolites. By permitting flexible and fast code development, MonteCoffee is a valuable alternative to previous kMC implementations.
Frequency domain analysis of pyroelectric response in silicon-doped hafnium oxide (HfO2) thin films
Authors: Mart C. , Czernohorsky M. , Zybell S. , Kämpfe T. , Weinreich W.
Published: September 2018

The pyroelectric response of polycrystalline, Si-doped HfO2 layers with a thickness of 20 nm is investigated in a frequency range of 2 Hz to 20 kHz. Local Joule heating of the pyroelectric material by a deposited nickel strip is used to achieve fast thermal cycles. Over the whole frequency range, a distinct pyroelectric response is registered. A pyroelectric coefficient of −72 μC/m2K is obtained at a frequency of 10 Hz, which is in good agreement with earlier low-frequency measurements. The pyroelectric current is evaluated with respect to electric field cycling, where a successive increase is observed during wake-up. By comparing measurement results in the low- and high-frequency limit, primary and secondary pyroelectric coefficients of −53 μC/m2K and −19 μC/m2K are estimated, respectively. Si-doped HfO2 is a promising material for future energy harvesting and IR sensor applications due to environmental friendliness and CMOS compatible manufacturing.
Room temperature luminescence of passivated InGaN quantum dots formed by quantum-sized-controlled photoelectrochemical etching
Authors: Wei Xiongliang , Al Muyeed Syed Ahmed , Peart Matthew R. , Sun Wei , Tansu Nelson , Wierer Jonathan J.
Published: September 2018

Room temperature luminescence of epitaxial InGaN quantum dots (QDs) formed by quantum sized-controlled photoelectrochemical (QSC-PEC) etching and passivation layer regrowth is demonstrated. QSC-PEC etching is performed on a 7.5 nm thick In0.20Ga0.80N layer emitting at ∼514–521 nm and with a laser diode emitting at 445 nm. Parameters such as etch bias (0.9 V and 1.5 V), laser average power (20 mW/cm2 and 100 mW/cm2), and laser operating conditions (pulsed and continuous wave) are explored. QSC-PEC etching of In0.20Ga0.80N requires a minimum bias (>0.9 V) and pulsed laser conditions in order to form QDs. After etching, the QDs do not exhibit photoluminescence due to defect recombination. Regrowth of passivation layers consisting of a 2 nm thick Al0.45Ga0.55N layer and a 11 nm thick GaN layer reduce the defect recombination, and room temperature photoluminescence is observed at room temperature at ∼435–445 nm with narrow full-width at half-maximum of ∼35 nm.
Using magnetic hyperbolic metamaterials as high frequency tunable filters
Authors: Macêdo Rair , Livesey Karen L. , Camley Robert E.
Published: September 2018

Metamaterials have enabled a series of major advances in optical devices in the past decade. Here, we suggest a type of hyperbolic metamaterial based on spin canting in magnetic multi-layers. We show that these structures have unique features in microwave waveguides that act as tunable filters. In the resulting band pass filter, we demonstrate an exceptional frequency tunability of 30 GHz with external fields smaller than 500 Oe. Unlike single metallic ferromagnetic films, we also demonstrate a high-frequency band-stop filter at very low fields.
Ultrafast laser generated strain in granular and continuous FePt thin films
Authors: von Reppert A. , Willig L. , Pudell J.-E. , Rössle M. , Leitenberger W. , Herzog M. , Ganss F. , Hellwig O. , Bargheer M.
Published: September 2018

We employ ultrafast X-ray diffraction to compare the lattice dynamics of laser-excited continuous and granular FePt films on MgO (100) substrates. Contrary to recent results on free-standing granular films, we observe in both cases a pronounced and long-lasting out-of-plane expansion. We attribute this discrepancy to the in-plane expansion, which is suppressed by symmetry in continuous films. Granular films on substrates are less constrained and already show a reduced out-of-plane contraction. Via the Poisson effect, out-of-plane contractions drive in-plane expansion and vice versa. Consistently, the granular film exhibits a short-lived out-of-plane contraction driven by ultrafast demagnetization which is followed by a reduced and delayed expansion. From the acoustic reflections of the observed strain waves at the film-substrate interface, we extract a 13% reduction of the elastic constants in thin 10 nm FePt films compared to bulk-like samples.
ACSS2 promotes systemic fat storage and utilization through selective regulation of genes involved in lipid metabolism
Authors: Huang Zhiguang , Zhang Menglu , Plec Abigail A. , Estill Sandi Jo , Cai Ling , Repa Joyce J. , McKnight Steven L. , Tu Benjamin P.
Published: September 2018

Acetyl-CoA synthetase 2 (ACSS2) is a conserved nucleocytosolic enzyme that converts acetate to acetyl-CoA. Adult mice lacking ACSS2 appear phenotypically normal but exhibit reduced tumor burdens in mouse models of liver cancer. The normal physiological functions of this alternate pathway of acetyl-CoA synthesis remain unclear, however. Here, we reveal that mice lacking ACSS2 exhibit a significant reduction in body weight and hepatic steatosis in a diet-induced obesity model. ACSS2 deficiency reduces dietary lipid absorption by the intestine and also perturbs repartitioning and utilization of triglycerides from adipose tissue to the liver due to lowered expression of lipid transporters and fatty acid oxidation genes. In this manner, ACSS2 promotes the systemic storage or metabolism of fat according to the fed or fasted state through the selective regulation of genes involved in lipid metabolism. Thus, targeting ACSS2 may offer a therapeutic benefit for the treatment of fatty liver disease.
PreB cells are moving on
Authors: Dixit Dhaval , Schwab Susan R.
Published: September 2018

In this issue of JEM, Fistonich et al. (https://doi.org/10.1084/jem.20180778) address how the bone marrow microenvironment supports diverse lineages through multiple developmental stages. Differential motility between pro- and preB cells results in differential IL-7 exposure, and, intriguingly, stromal cells respond to abnormal B cells by reducing Il7.
Pumping blood with self-reliance and cooperation
Authors: Iruela-Arispe M. Luisa
Published: September 2018

In this issue of JEM, Singhal et al. (https://doi.org/10.1084/jem.20180008) explore the cellular mechanisms involved in endothelial cell regeneration in the liver. Using a combination of myeloablative and nonmyeloablative approaches, the authors found that repair of the endothelium is mediated by endothelial cells themselves, but when injured, endothelial cells enlist myeloid counterparts that aid in vascular repair.
The Encyclopedia of Proteome Dynamics: the KinoViewer
Authors: Brenes Alejandro , Lamond Angus I
Published: September 2018

The Encyclopedia of Proteome Dynamics (EPD) ‘KinoViewer’ is an interactive data visualization tool designed for analysis and exploration of both protein and transcript data, showing expression of kinase genes in either human or mouse cells and tissues. The KinoViewer provides a comprehensive, updated graphical display of all human/mouse kinases and an open access analysis tool for the community with a user-friendly graphical interface.

Availability and implementation

The KinoViewer is based on a manually drawn SVG, which is utilized with D3.js to create a dynamic visualization. It can be accessed at: https://peptracker.com/epd/analytics/. The KinoViewer is currently only accessible through the EPD, it is open access and can be used either to view internal datasets, or used to upload and visualize external user datasets.

Supplementary information

Supplementary data are available at Bioinformatics online.
FA03.03: RISK FACTORS FOR MALLORY-WEISS TEAR DURING ENDOSCOPIC SUBMUCOSAL DISSECTION OF SUPERFICIAL ESOPHAGEAL NEOPLASMS
Authors: Chen Wei , Wu Junchao , Gan Tao , Yang Jinlin
Published: September 2018

Background

Adverse events such as perforation and bleeding during endoscopic submucosal dissection (ESD) of superficial esophageal neoplasms have been well acquainted. However, Mallory Weiss Tear (MWT) during esophageal ESD is still under obscurity. Therefore, this study was carried out to elucidate the incidence and risk factors for MWT during esophageal ESD.

Methods

Patients received ESD for superficial esophageal neoplasms from June, 2014 to July 2017 in our institution were retrospectively analyzed. Clinicopathological characteristics of the patients were collected. Patients were allocated into MWT group or non-MWT group based on the presence of MWT occurred during ESD. The incidence of MWT was determined and the risk factors for MWT were identified.

Results

A total of 337 patients with 373 lesions treated by ESD were analyzed. 20 patients developed MWT during ESD (5.4%). Multivariate analysis identified female gender (OR = 5.36, 95%CI: 1.47–19.50, P = 0.011) and procedure time (OR = 1.01, 95%CI: 1.00–1.02, P = 0.048) were independent risk factors for MWT during ESD. The characteristics of the esophageal lesions had no influence on the development of MWT. The vast majority of patients with MWT did not receive endoscopic treatment for the laceration and seven of the MWT patients received endoscopic hemostasis using APC, hemoclips, or hemoclips combined with endoloop. All the patients recovered satisfactorily without surgery for the laceration. We believe the placement of gastrointestinal decompression tube and the use of PPI and hemostatic drugs after ESD contributed to the hemostasis and mucosal healing.

Conclusion

The incidence of MWT during esophageal ESD was much higher than expected. Although most cases had a benign course, fetal conditions such as massive hemorrhage may also occur. We recommend an inspection of the stomach after ESD procedure in order to take timely management in case of bleeding MWT or even perforation outside the procedure region.

Disclosure

All authors have declared no conflicts of interest.
FA03.05: NEOADJUVANT CHEMOTHERAPY OR CHEMORADIOTHERAPY FOR ADENOCARCINOMA OF THE ESOPHAGUS
Authors: Visser Els , Edholm David , Smithers Mark , Thomson Iain , Burmeister Bryan , Walpole Euan , Gotley David , Joubert Warren , Atkinson Victoria , Mai Tao , Thomas Janine , Barbour Andrew
Published: September 2018

Background

Multimodality treatment of patients with esophageal adenocarcinoma (EAC) improve survival, but the optimal treatment strategy remains undetermined. The aim of this study was to compare outcomes in patients undergoing neoadjuvant chemotherapy (nCT) and neoadjuvant chemoradiotherapy (nCRT) for EAC.

Methods

Patients who underwent nCT or nCRT followed by surgery for EAC were identified from a prospective database (2000–2017) and included in this study. After propensity score matching, we compared the impact of the treatments on postoperative complications, in-hospital mortality, pathological outcomes and survival rates.

Results

Of the 396 eligible patients, 262 patients were analysed following propensity score matching. This resulted in 131 patients in the nCT group versus 131 patients in the nCRT group. There were no significant differences between the nCT and nCRT groups for overall complications (59% vs 57%, P = 0.802) or in-hospital mortality (2% vs 0%, P = 0.156). Patients who had nCRT had more R0 resections (93% vs. 83%, P = 0.013), and a higher pathological complete response rate (15% vs. 5%, P < 0.001). The pattern of recurrence was similar (P = 0.753) and there were no differences in 5-year disease-free survival rates (nCT vs nCRT; 39% vs 39%, P = 0.879) or 5-year overall survival rates (nCT vs nCRT; 44% vs 33%, P = 0.645).

Conclusion

In this study no differences between nCT and nCRT were seen in postoperative complications and in-hospital mortality in patients treated for EAC. Inspite of improved complete resection and pathological response there was no difference in the overall survival between the treatment modalities.

Disclosure

All authors have declared no conflicts of interest.
FA04.03: MIE VERSUS RAMIE: PROMISING RESULTS OF A SINGLE-CENTER AND SINGLE-SURGEON ANALYSIS
Authors: Grimminger Peter , Tagkalos Evangelos , Hadzijusufovic Edin , Babic Benjamin , Lang Hauke
Published: September 2018

Background

Robot assisted surgery for esophageal cancer is rapidly increasing, especially high-volume centers with access to a robot. The fully robotic minimally invasive esophagectomy using 4 robotic arms in the abdomen and thorax (RAMIE4) is performed as standard procedure in our department. In this analysis we compare the results of our first 50 RAMIE4 procedures with our last 50 fully minimally-invasive esophagectomies (MIE), which was our standard prior the robotic era.

Methods

Between April 2016 and March 2018, the data from 100 consecutive patients with esophageal carcinoma undergoing modified Ivor-Lewis esophagectomy, performed by the same surgeon using the identical intrathoracic anastomotic reconstruction technique (circular stapler). 50 patients were treated with MIE and the other 50 with RAMIE4. Demographic data, extracted lymph nodes and R-status were compared. Complications occurred were compered according to the Dindo-Clavien classification.

Results

Demographic data did not show significant differences between the groups. The overall 30- and 90- mortality rates were 1% (1/100) and 3% (3/100) respectively (P = 0.305 and P = 0.499 respectively). In the RAMIE group the median lymph node harvest was significantly higher (27 vs. 23; P = 0.045), the median hospital stay was less in the RAMIE group, however not significantly (11.5d vs 13d; P = 0.112), the median ICU stay was significantly lower in the RAMIE group compared to MIE (1d vs 2.5d; P = 0.002). The complications according to the Dindo-Calvien classification were not significantly different between the two groups (P = 0.091).

Conclusion

In this study we were able to demonstrate the superiority of robotic assisted lymph node dissection for esophageal cancer surgery in a highly comparable setting. In addition the perioperative parameters, especially ICU stay seem to be in favor of RAMIE. The future potential of standardized RAMIE and RAMIE4 seems to be high.

Disclosure

All authors have declared no conflicts of interest.
FA04.06: RESECTION OF HEPATIC AND PULMONARY METASTASIS FROM ESOPHAGEAL AND GASTRIC CANCER: A NATIONWIDE STUDY
Authors: Van Der Veen A , Seesing Mfj , Brenkman Hjf , Stockmann Hba , Nieuwenhuijzen Gap , Rosman Camiel , Van Den Wildenberg Frits , Van Berge Henegouwen Mark I , Van Duijvendijk P , Wijnhoven Bpl , Stoot Jh , Lacle M , Ruurda Jelle , Hillegersberg Richard
Published: September 2018

Background

Best supportive care or palliative chemotherapy is the standard of care for gastroesophageal cancer patients with hepatic or pulmonary metastases, leading to a median survival of 4–11 months. Occasionally, patients with oligometastatic disease may be eligible for curative treatment. The aim of the current study was to evaluate the outcomes of all patients in the Netherlands who underwent a resection of hepatic or pulmonary metastases with curative intent for metastatic gastroesophageal cancer.

Methods

The Dutch National Registry for Histo- and Cytopathology was used to identify all patients who underwent a resection of hepatic or pulmonary metastasis from gastroesophageal cancer. Patients who were treated with curative intent and had available patient records were included. Data on treatment and outcomes were retrieved from the patient's record. Kaplan-Meier survival analysis was performed.

Results

The primary tumor of 34 patients with gastroesophageal cancer was resected in 21 different hospitals between 1991–2016. Additionally, resection of hepatic metastasis was performed in 19 patients and of pulmonary metastasis in 15 patients. Only 4 patients received neoadjuvant therapy before metastasectomy. The majority of patients had solitary, metachronous metastases. After metastasectomy, grade 3 (Clavien-Dindo) complications occurred in 7 patients and mortality in 1 patient. After resection of hepatic metastases, the median overall survival (OS) was 28 months and the 1-, 3- and 5- year OS were 84%, 41% and 31% respectively. After pulmonary metastases resection, the median OS was not reached and the 1-, 3- and 5- year OS were 67%, 53% and 53% respectively.

Conclusion

In selected patients with gastroesophageal cancer with hepatic or pulmonary metastases, metastasectomy was performed with limited morbidity and mortality and offered a 5-year OS of 31–53%. Further prospective studies are required.

Disclosure

All authors have declared no conflicts of interest.
FA05.06: EXACT METASTATIC RATE OF CERVICAL NODES BY NON-SELECTIVE THREE-FIELD DISSECTION FOR THE THORACIC ESOPHAGEAL CARCINOMA
Authors: Tachimori Yuji , Koyanagi Kazuo , Daiko Hiroyuki
Published: September 2018

Background

Three-field dissection is usually adapted for selected patients with esophageal carcinoma. Exact metastatic rate of cervical lymph nodes for thoracic esophageal carcinoma remains speculation.

Methods

Three-field dissection was performed for 96% of patients who underwent radical esophagectomy for thoracic esophageal carcinoma during 2001–2010. Exact metastatic rate and survival after dissection of metastatic nodes were evaluated for assessment of efficacy of three-field dissection.

Results

During 2001 to 2010, 1075 patients underwent esophagectomy for thoracic esophageal carcinoma. Excluding 115 patients underwent salvage esophagectomy and 39 patients underwent R1–2 resection, 921 patients underwent radical esophagectomy. Three-field dissection was performed in 882 patients (96%) and avoided in 19 patients because of systemic morbidity. The incidence of clinically positive supraclavicular lymph nodes 6.7%. The incidence of pathologically positive supraclavicular lymph nodes 14.1%. According to tumor location, the incidence of pathologically positive supraclavicular lymph nodes was 18.3% for the upper thoracic tumor, 17.2% for the mid thoracic tumor, 8.4% for the lower thoracic tumor. According to cT category, the incidence of pathologically positive supraclavicular lymph nodes was 8.4% for cT1b tumor, 9.9% for cT2 tumor, 17.2% for cT3 tumor. Of 823 patients with clinically negative supraclavicular node, 82 patients (10%) had pathologically positive supraclavicular nodes. Of patients with clinically positive recurrent laryngeal nerve node, 27.1% of patiets had pathologically positive supraclavicular nodes. Over-all 5-year survival of patients with pathologically positive supraclavicular lymph node was 20.8% for the upper thoracic tumor, 31.5% for the mid thoracic tumor, 14.3% for the lower thoracic tumor.

Conclusion

Exact metastatic rate and survival after dissection of metastatic nodes for supraclavicular lymph node were evaluated for assessment of efficacy of three-field dissection for thoracic esophageal carcinoma. Of patients with clinically negative node, 10% of patients had pathologically positive supraclavicular nodes. High incidence of positive supraclavicular nodes in patients with clinically positive recurrent laryngeal nerve node indicated posibility of selection for three-field dissection. Overall 5-year survival of patients with pathologically positive supraclavicular lymph node was better than that of patients with organ metastasis reported previously.

Disclosure

All authors have declared no conflicts of interest.
FA06.01: CLINICAL EFFECT OF NEOADJUVANT CHEMOTHERAPY OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA FOR SUPERFICIAL PHARYNGEAL SQUAMOUS CELL CARCINOMA
Authors: Ishida Hiroki , Kawakubo Hirofumi , Mayanagi Shuhei , Fukuda Kazumasa , Nakamura Rieko , Suda Koichi , Wada Norihito , Kitagawa Yuko
Published: September 2018

Background

Esophageal squamous cell carcinoma (ESCC) is often synchronously accompanied by pharyngeal squamous cell carcinoma (PSCC). However, the treatment strategies for these cancers have not been established. Neoadjuvant chemotherapy is the standard treatment for advanced ESCC and is also effective for PSCC patients. However, few studies have focused on the efficacy of systemic chemotherapy for patients with superficial PSCC.

Methods

We retrospectively examined 22 cases of superficial PSCC that occurred in 14 patients with ESCC who received neoadjuvant therapy between January 2011 and June 2017.

Results

Of the 14 patients, 13 (93%) were male, and the median age was 63.5 years (range: 35–74 years). The clinical stage of ESCC was II for 7, III for 5, and IVB for 2 (AJCC 8th staging system). The PSCC origin included the oropharynx in 9 lesions (40.9%) and the hypopharynx in 13 lesions (59.1%). Macroscopic type was classified as protruding (type1 or 0-I) for 2, superficial elevated (0-IIa) for 5, superficial flat (0-IIb) for 13, and superficial depressed (0-IIc) for 2. The estimated depth of invasion was EP in 12 lesions, SEP in 8 lesions, and MP in 2 lesions. FP regimen was administered to 11 patients in 15 lesions and DCF to 3 patients in 7 lesions. One patient had concurrent chemoradiotherapy. Chemotherapy for PSCC resulted in CR in 10 lesions (45.4%). In CR, 9 of 10 lesions were of superficial flat type. All non-CR lesions also had tumor regression. In the CR patients, 5 lesions(50%) had local recurrence, and the median duration until recurrence was 4 months (range: 4 to 17 months). Endoscopic resection(ER) for PSCC was performed in the 13 lesions after esophagectomy. The median duration after diagnosis was 7 months (range: 3 to 20 months).

Conclusion

Systemic chemotherapy of ESCC has tumor regression potential for superficial flat-type PSCC with clinical tumor invasion in EP or SEP. Although chemotherapy for PSCC results in non-CR, additional ER is quite effective. Because half of the CR lesions had recurrence, strict follow-up and observation of the pharynx are reasonable options for patients with ESCC.

Disclosure

All authors have declared no conflicts of interest.
FA06.03: THE EFFECT OF LYMPH NODE HARVEST UPON MORTALITY FROM OESOPHAGECTOMY FOR OESOPHAGEAL ADENOCARCINOMA: NATIONAL POPULATION-BASED COHORT STUDY
Authors: Markar Sheraz , Varagunam Mira , Mackenzie Hugh , Brand Christian , Cromwell David , Maynard Nick , Hanna George
Published: September 2018

Background

In an era of increased utilisation of multimodality treatment for oesophageal adenocarcinoma the role of radical lymphadenectomy remains controversial. The objectives of this population-based cohort study were to evaluate the influence of lymph node harvest upon short- and long-term mortality following oesophagectomy for oesophageal adenocarcinoma, with subset analysis of patients receiving neoadjuvant therapy.

Methods

The UK National Oesophago-Gastric Cancer Audit (NOGCA) was used to identify suitable patients operated on between 1st April 2012 and 31st March 2016. Logistic regression of confounders was used to generate predicted mortality probabilities for utilisation in Risk-Adjusted Cumulative Sum (RA-CUSUM) analysis to identify the lymph node harvest change-points associated with changes in one-, two- and three-year mortality.

Results

Within the three-year study period, 3883 patients were included of these 2192 patients (56%) received neoadjuvant chemotherapy. For all patients there were non-significant change-points in 1-, 2-, and 3-year mortality at 19, 27 and 19 lymph nodes respectively. For patients receiving neoadjuvant therapy change-point analysis did show statistically significant reductions in 2-year mortality (44.9% before to 39.2% after 19 lymph nodes; P = 0.017) and 3-year mortality (55.0% before to 47.4% after 20 lymph nodes; P = 0.035). 30-day and 90-day mortality and anastomotic leak were not significantly by lymph node harvest of greater than 19 lymph nodes.

Conclusion

The results of this national population-based cohort study suggest that at least 20 lymph nodes should be harvested during oesophagectomy given the prognostic importance in oesophageal adenocarcinoma, and the benefits to improve pathological staging of the patient and appropriately allocate adjuvant therapy.

Disclosure

All authors have declared no conflicts of interest.
FA06.05: DETECTING RESIDUAL ESOPHAGEAL CANCER AFTER NEOADJUVANT CHEMORADIATION BY ENDOSCOPIC BIOPSIES, EUS AND FDG-PET: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Eyck B , Noordman B , Onstenk B , Nieboer Daan , Spaander M C W , Valkema R , Lagarde Sjoerd M , Wijnhoven Bas P L , Van Lanschot J J B
Published: September 2018

Background

After curatively intended neoadjuvant chemoradiotherapy (nCRT) according to CROSS plus surgery for esophageal cancer, 29% of patients have a pathologic complete response. Active surveillance after nCRT, in which patients undergo frequent clinical examinations and where esophagectomy is only offered to those with a locoregional regrowth without distant metastases, has been proposed as novel treatment option. This study provides a systematic review and meta-analysis of the literature regarding the accuracy of endoscopic biopsies, endoscopic ultrasound (EUS) and 18F-FDG PET(-CT) for detecting residual disease after nCRT for esophageal cancer.

Methods

A systematic literature search in Embase, Medline, Cochrane and Web of Science was performed. Two reviewers independently collected studies on the diagnostic accuracy of endoscopic biopsies, EUS and 18F-FDG PET(-CT) for detecting residual disease after nCRT at the primary tumor site or in regional lymph nodes for potentially curable esophageal adenocarcinoma (AC) or squamous cell carcinoma (SCC). Histopathological examination of the resection specimen was the reference standard. Study quality was appraised with the QUADAS-2 tool. Sensitivity and specificity values were calculated and pooled using meta-analyses. Subgroup analyses were performed to investigate possible sources of heterogeneity.

Results

60 studies were included for qualitative analysis and 40 for quantitative analysis. For detecting residual disease at the primary tumor site, 11 studies evaluated endoscopic biopsies, 11 described EUS qualitatively, 14 evaluated PET qualitatively, 12 evaluated PET quantitatively, 6 of them using SUVmax and 6 of them using DSUVmax. Summary sensitivity values were 0.36 (95%CI 0.27–0.45), 0.97 (95%CI 0.94–0.98), 0.74 (95%CI 0.66–0.81), 0.68 (95%CI 0.61–0.74) and 0.68 (95%CI 0.54–0.79), respectively. Summary specificity values were 0.93 (95%CI 0.85–0.97), 0.09 (95%CI 0.04–0.19), 0.52 (95%CI 0.40–0.63), 0.70 (95%CI 0.61–0.78), 0.70 (95%CI 0.60–0.78) and respectively. For detecting residual malignant lymph nodes, 11 studies evaluated EUS with a summary sensitivity of 0.68 (95%CI 0.54–0.80) and a summary specificity of 0.58 (95%CI 0.45–0.70). Subgroup analyses demonstrated that sensitivity of endoscopic biopsy, PET DSUVmax and EUS for nodal was higher in SCC than in AC.

Conclusion

Current literature suggests insufficient accuracy of endoscopic biopsies, EUS and 18F-FDG PET(-CT) as individual modalities for detecting residual disease after nCRT for potentially curable esophageal cancer.

Disclosure

All authors have declared no conflicts of interest.
FA08.01: MORTALITY AND REFRAINMENT FROM ESOPHAGECTOMY IN ESOPHAGEAL CANCER PATIENTS THAT STARTED NEOADJUVANT CHEMORADIOTHERAPY: A POPULATION-BASED COHORT STUDY
Authors: Borggreve Alicia , Van Rossum Peter , Mook Stella , Haj Mohammad Nadia , Hillegersberg Richard , Ruurda Jelle
Published: September 2018

Background

Esophagectomy functions as the cornerstone of the curative treatment for locally advanced esophageal cancer. The addition of neoadjuvant chemoradiotherapy (nCRT) to surgery improves survival, but can be accompanied by substantial toxicity on the other hand. This cohort study describes the consequences of nCRT for esophageal cancer in terms of mortality (during or after the course of nCRT) in real-world clinical practice, as well as the proportion of patients that do not proceed to planned esophagectomy after finishing nCRT.

Methods

All patients that started nCRT (carboplatin/paclitaxel with 41.4 Gy) for primary, locally advanced, esophageal cancer in 2015 were included from the nationwide population-based cancer registry. Outcome measurements were mortality during or within 90 days after neoadjuvant therapy (and before planned esophagectomy), as well as refrainment from planned esophagectomy after starting nCRT and the reasons for cancelled esophagectomy.

Results

Some 740 patients that started nCRT for esophageal cancer were included (Table 1). A total of 13 (1.8%) patients died during or within 90 days after nCRT (before planned esophagectomy). A total of 79 (10.7%) patients that started nCRT did not proceed to esophagectomy. The most frequently reported reasons for not proceeding to esophagectomy were tumor progression (4.6%, n = 34), performance status (2.7%, n = 20), and patients’ request (1.8%, n = 13).

Conclusion

In this population-based study, 1 in 10 (10.7%) patients that started nCRT for locally advanced esophageal cancer did not undergo esophagectomy. Further research should aim to investigate whether this patient group can be selected prior to treatment, and if interventions and counseling will result in a larger proportion of patients who will undergo surgery.

Disclosure

All authors have declared no conflicts of interest.
FA08.02: ENHANCED RECOVERY AFTER ESOPHAGECTOMY AND RECONSTRUCTION FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Chou Shah-Hwa , Liu Yu-Wei
Published: September 2018

Background

Enhanced recovery after surgery (ERAS) was originally designed and used in colorectal surgery. Recently there were some related reports of its implementation on esophageal cancer surgery, mainly adenocarcinoma. This study is to determine if ERAS can be effectively and safely applied to esophageal squamous cell carcinoma in Asian population.

Methods

In early 2012, our perioperative management protocol was reinvented and has been implemented thereafter. So two groups of patients were set up and compared. Group A is the patients operated on before 2012, managed by the old protocol. Group B is the patients managed under the new protocol. Their demographics, complications, hospital stay and charges were reviewed and analysed.

Results

Group A 65 patients. Group B 61 patients. The ventilator days, ICU stay and postoperative stay were statistically shorter in group B. There was no hospital mortality in either groups. No increase of complications was noted in group B. The hospital charges in group B were lower although statistically insignificant.

Conclusion

The new protocol of perioperative care is safe and effectively enhanced the postoperative recovery after esophagectomy and reconstruction for esophageal squamous cell carcinoma.

Table 1. Clinical protocol for group A and B

POD, post-operative day; ICU, intensive care unit; TPN, total parenteral nutrition; J-P drain, Jackson-Pratt drain; N/S, normal saline; CVC, central venous catheter; NG, nasogastric tube; OR, operating room; NPO, nil per os; IV, intravenous; PCA, patient control analgesia.

Disclosure

All authors have declared no conflicts of interest.
PS01.002: INTERSPHINCTERIC ESOPHAGEAL LENGTH IN ADULTS
Authors: Kovacs Balazs , Masuda Takahiro , Bremner Ross , Mittal Sumeet
Published: September 2018

Background

High Resolution Manometry (HRM) has replaced standard water perfused manometery as the gold standard for esophageal testing. While normal and abnormal parameters continue to be refined for HRM there is no literature related to manometric esophageal length in adult population using HRM. Aim of this study is to define normal range for esophageal length and variation with patient height.

Methods

An IRB approved, prospectively maintained esophageal testing registry was queried to identify patients who underwent HRM between 11/01/2016 and 11/01/2017. Patients with history of previous esophageal surgery, hiatal hernia or major disorders of peristalsis were excluded. Inter-sphincteric esophageal length (cm) was measured from the lower border of UES to the upper border of LES during inhalation. Esophageal Length Index (ELI) was calculated by dividing the esophageal length by patient height.

Results

A total of1139 patients underwent HRM in the study period of which 235 patients met inclusion criteria and form the cohort for this study. Mean age was 57.3; BMI was 27.3. Median height was 166.6 cm, inter-sphincteric length was 22.4 cm. Mean ELI was 0.135 (+ 0.012), with 5th and 95th percentile range of 0.113 and 0.154 respectively (Figure 1).

Conclusion

Esophageal length and ELI varies in the normal population. An ELI of < 0.113 draws attention to possible short esophagus. It would be interesting to correlate these parameters with intra-abdominal esophageal length in patients undergoing hiatus hernia repair.

Disclosure

All authors have declared no conflicts of interest.
PS01.003: EVALUATION OF BOTH STANDARD AND NOVEL HRM METRICS OF THE UPPER ESOPHAGEAL SPHINCTER (UES) IN ACHALASIA AND REFLUX DISEASE. APPLICATION OF THE CONTRACTILE INTEGRAL IN THE UES
Authors: Triantafyllou Tania , Theodoropoulos Charalampos , Zografos Georgios , Theodorou Dimitrios
Published: September 2018

Background

The literature is still lacking thorough manometric analysis of the function of the Upper Esophageal Sphincter (UES) among patients with motility disorders. Assessment of the High Resolution Manometry (HRM) features of the UES may be the key in further understanding the manometric profile of achalasia and even predicting treatment outcome. Furthermore, the Contractile Integral (CI) may be a more representative measure of contractility of the UES too.

Methods

Achalasia patients (study group) and a control group of individuals underwent HRM. Resting pressure, residual pressure, UES length and the Landmark UES-CI corrected for respiration were analyzed and compared between the two groups. The UES-CI metric was calculated according to the method applied for the Distal Contractile Integral (DCI).

Results

24 achalasia patients and 24 subjects consisting the control group with mean age 55.2 and 56.1, respectively, were enrolled. Although the mean UES length was found significantly lower in our study group (3.2 vs. 4.3, P = 0), mean residual pressure was found significantly higher among the same group as compared to controls (12.5 vs. 3, P = 0.01). Interestingly, we found a trend towards lower values of the corrected UES-CI in achalasia compared to the control group (132 vs. 207.8, P = 0.08). The resting pressure did not differ between the two groups.

Conclusion

Increased residual pressure values of the UES in achalasia compared to control group is a reasonable finding that indicates that UES may also be affected by the neuronal damage in this disorder or that the pressurization phenomenon (mainly in achalasia type II) disrupts the function of the UES during swallowing. However, results on the UES-CI in resting phase cannot confirm the hypothesis of higher risk of aspiration among achalasia patients whose esophageal lumen is known to present with incomplete clearance and stasis.

Disclosure

All authors have declared no conflicts of interest.
PS01.009: COMPREHENSIVE CLASSIFICATION FOR ANTIREFLUX FUNCTION OF THE ESOPHAGOGASTRIC JUNCTION BASED ON HIGH-RESOLUTION MANOMETRY
Authors: Masuda Takahiro , Kovacs Balazs , Bremner Ross , Mittal Sumeet
Published: September 2018

Background

The anatomical configuration of the esophagogastric junction (EGJ) and the thoracoabdominal pressure gradient (TAPG) affect gastric content backflow into the esophagus. A comprehensive antireflux function assessment is needed to identify underlying derangements in patients with gastroesophageal reflux (GER). Herein we propose an objective scoring system for grading EGJ function.

Methods

We analyzed patients who underwent 24-hour pH study and high-resolution manometry in 2017 at our institution. We assessed three factors: EGJ morphology, lower esophageal sphincter pressure integral, and TAPG. Each factor was scored on a scale of 0–2, and a cumulative score was calculated (Table 1). Patients were divided into 3 groups based on cumulative score: 0, competent EGJ function (Grade I); 1–3, moderate incompetency (Grade II); 4–6, poor competency (Grade III).

Results

In total, 140 patients were studied. The mean age was 58.6 years, 75 patients (53.6%) were men, and the mean body mass index was 28.6 kg/m2. Fifty-one patients (36.4%) had an abnormal DeMeester score (ie, > 14.72). A significant, progressive increase was seen in number of reflux episodes (I-25.7, II-36.4, III-50.5, rs = 0.207, P = 0.015), total acid exposure time (I-1.0%, II-2.1%, III-5.0%, rs = 0.312, P < 0.001) and prevalence of abnormal pH score (I-13.0%, II-32.0%, III-57.1%, rs = 0.314, P < 0.001) from Grade I to III.

Conclusion

The proposed grading of the EGJ based on a cumulative score of individual parameters has a good correlation with GER.

Disclosure

All authors have declared no conflicts of interest.
PS01.013: CLINICAL SIGNIFICANCE OF ESOPHAGOGASTRODUODENOSCOPY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS
Authors: Manabe Noriaki , Haruma Ken , Nakato Rui , Nakamura Jun , Murao Takahisa , Fujita Minoru , Suehiro Mitsuhiko , Kamada Tomoari , Shiotani Akiko , Kawamoto Hirofumi , Yamatsuji Tomoki , Naomoto Yoshio
Published: September 2018

Background

Although dysphagia is an indication for esophagogastroduodenoscopy (EGD) its causes include organic and non-organic disorders. There has been no study to investigate the clinical significance of EGD in patients with esophageal motility disorders (EMD). The first aim was to elucidate the detection ratio for EMD with EGD. The second aim was to clarify useful EGD parameters associated with them.

Methods

Participants included 372 patients who underwent EGD before high resolution manometry for dysphagia. EGD findings were investigated according to the following five parameters: resistance when passing through the esophagogastric junction (EGJ), residue in the esophageal lumen, esophageal dilation, spastic and non-occlusive contraction. The EGD finding was positive when at least one EGD finding was detected. HRM diagnoses were made based on the Chicago classification (v3.0).

Results

Of 372 participants, pseudoachalasia were diagnosed in 6 patients (1.61%), EMD in 250, and normal in 116. The detection ratio for each EMD by EGD is shown in Table 1. There were significant differences in the detection ratio among the three groups (81.1% in major, 50.0% in minor EMD and 15.5% in normal, P < 0.05). On multivariate analysis, resistance when passing through the EGJ (adjusted odds ratio (aOR): 3.99; 95% CI [1.26–12.66]), and non-occlusive contraction (aOR: 10.3; 95% CI [5.26–20.19]) were significantly associated with EMD.

Conclusion

The ratio of abnormal EGD findings was different in each EMD. Major EMD can be screened with EGD. Among several endoscopic parameters related with EMD, the non-occlusive contraction is most useful endoscopic parameter.

Disclosure

All authors have declared no conflicts of interest.
PS01.018: PERSISTENT DYSPHAGIA AFTER FUNDOPLICATION WITH MESH PLASTY –MISSED OR MISTAKEN –A CASE REPORT
Authors: Chandramohan Servarayan , Varadharajan Visvarath , Chinnathambi Madeshwaran , Manickavasagam Kanagavel , Jebaraj Abishai , Chandramohan Apsara
Published: September 2018

Background

Scleroderma esophagus is a rare entity. Only few case reports of esophagectomy were done and reported for this condition. We are presenting this rare case of failed fundoplication and mesh repair with a diagnosis of GERD and hiatus hernia, which was found later on due to Scleroderma with Esophageal involvement.

Methods

58 year old female admitted with dysphagia following laproscopic fundoplication with mesh repair of crura with a diagnosis of GERD and hiatus hernia.She presented with persistent vomiting and loss of weight.On evaluation, her Upper GI scopy revealed dilated esophagus with sluggish peristalisis. Since the patient had tightness of skin over the distal extremities, face and fish mouth appearance with thinning of nail, Skin biopsy was taken. The skin biopsy was reported to be scleroderma.The esophageal manometry demonstrated failed esophageal peristalisis with high normal LES pressure due to tight fundal wrap.The patient was treated with mesh remova, Transhiatal esophagectomy with gastric pull-up and cervical Anastomosis.Post operatively the patient was treated with hydrocholoroquine and predinisolone.

Results

The patient is free of dysphagia and is on regular follow up.

Conclusion

In case of failure, detailed evaluation including High resolution manometry (MII HRM) has to be done before doing laparoscopic fundoplication for GERD has to rule out uncommon and rare disorders of esophagus. Detailed clinical examination in GERD patients has to be done to rule out systemic disease like scleroderma.In case of failed fundoplication for GERD, patients have to investigated for the failure.So patients with incapacitating esophageal neuromotor disease, a more radical approach in the form of esophagectomy may be safer and more reliable than attempting another procedure and risk another failure.

Disclosure

All authors have declared no conflicts of interest.
PS01.021: SHORT POEM GUIDED BY ENDOFLIP RESULTS IN LESS REFLUX RATE IN PATIENTS SUFFERING FROM ACHALASIA
Authors: Barbieri Lavinia , Ilczysyn Andrei , Jafari Jafar , Botha Abraham , Smyth Edel
Published: September 2018

Background

Peroral Endoscopic Myotomy (POEM) has gained ground for achalasia tratment. Although laparoscopic Heller's-Dor (LHD) is a proven intervention, the cut of the inner muscular layer during POEM offers a goal-directed procedure. However, concerns regarding post-procedure reflux had been raised. As during POEM long myotomy is generally adviced, we decreased the length to reduce reflux after treatment.

Methods

19 patients with type 1 or 2 achalasia underwent POEM guided intraoperatively by Endoflip® (Crospon Ltd., Galway, Ireland) to target the myotomy where the major point of tightness was. We aimed for an increase of compliance and distensibility of three times of the lower esophageal sphincter (LOS) via a short myotomy. We compared these patients with a historic control LHD group of 15 patients in terms of Eckardt's score, GERD-HRQL questionnaire, high-resolution manometry to check pressure of the LOS 24h pH-impedence to measure acid exposure with minimum follow-up of 9 months.

Results

Length of myotomy was 7 cm (6–10) for POEM and 9 cm for LHD. Median Eckard's score after POEM was 0.5 versus 2 for LHD group. Median Eckardt's score and GERD-HRQL were 0.5 vs 2 and 13 vs 15, respectively after POEM or LHD. 24h pH-monitoring revealed pathologic reflux in one patient after POEM and in 3 after LHD, with median acid % time of 0,1 vs 1,2. Data are summarized in table.

Conclusion

POEM is effective in achieving symptom relief in patient with achalasia. Although randomized data are not available, reflux rate after POEM with short myotomy guided by Endoflip is comparable with LHD and lower than the data of literature.

Disclosure

All authors have declared no conflicts of interest.
PS01.031: REVISITING THE ESOPHAGOGASTRIC JUNCTION ANATOMY: WHERE IS THE INFRACARDIAC BURSA?
Authors: Nakamura Tatsuro , Shinohara Hisashi , Okada Tomoaki , Hisamori Shigeo , Tsunoda Shigeru , Obama Kazutaka , Kurahashi Yasunori , Takai Akihiro , Takakuwa Tetsuya , Yamada Shigehito , Sakai Yoshiharu
Published: September 2018

Background

The infracardiac bursa (ICB), the closed space encountered in the esophagogastric junction (EGJ) surgery, is rarely described in anatomical atlases. The purpose of the study is to link surgery to embryology and propose the new anatomical chart including the ICB.

Methods

Histological serial sections of Carnegie stages (CS) 13–23 embryos and magnetic resonance (MR) images of the fetus with 43.5 mm crown-rump length from the Kyoto Collection of Human Embryos were examined for embryological changes in the ICB. Seventy-four surgery videos of laparoscopic and thoracoscopic esophagectomy were reviewed to investigate the appearance of the ICB and frequency of the recognition in surgery.

Results

The right pneumato-enteric recess appeared in CS13 embryos and the ICB was separated from the recess by the development of the diaphragm between CS17 and CS18 embryos and established as a closed space up until CS23. The three-dimensional reconstruction of fetus MR images showed the ICB was located adjacent nearly one third around the esophagus above the right crus. The ICB was clinically encountered in 12 of 14 (86%) transhiatal surgeries and 23 of 60 (38%) thoracic surgeries. Via the transhiatal approach, the caudal edge of the ICB appeared as a thick whitish membrane after the dissection of the phrenico-esophageal ligament and a closed space enveloped with a serosa was opened by the incision of the membrane. Via the right thoracic approach, the ICB appeared on the right crus after the dissection of the pulmonary ligament.

Conclusion

We described a new chart around EGJ including the ICB based on embryology. This anatomical chart can contribute to promote accuracy and safety of operating procedures around the EGJ.

Disclosure

All authors have declared no conflicts of interest.