bluuebunny/crossref_metadata_2025 huggingface dataset:
An expression for the angle of repose of dry cohesive granular materials on Earth and in planetary environments
Authors: Elekes Filip , Parteli Eric J. R.
Published: September 2021

Significance

The angle between the sloping side of a heap of particles and the horizontal, called angle of repose, is often used to characterize the flowability of granular materials on Earth and planetary environments, such as sand, dust aerosols, and powders. In planetary research, this angle provides an excellent proxy for particle size. The smaller the particle is, the larger the effect of attractive forces between atoms and molecules on the surface of the particles relative to particle weight, the less flowable the material, and the steeper, thus, the angle of repose. We present a model that accurately predicts the angle of repose as a function of particle size, both on Earth and under extraterrestrial gravity.
Geometry of gene regulatory dynamics
Authors: Rand David A. , Raju Archishman , Sáez Meritxell , Corson Francis , Siggia Eric D.
Published: September 2021

Significance

Genetic screens have enumerated the genes that control the process of self-organization that converts a featureless fertilized egg into an embryo. Even the elementary steps may involve 10 genes, so models that attempt to represent each gene contain a plethora of unmeasured parameters. Mathematics has largely categorized the types of solutions that can arise from the equations governing gene networks. These representations are well suited to modern time-lapse imaging, where a limited number of genetic markers are followed in time. Models with minimal parameters that focus on the nonlinear regime from inception to pattern maturation simplify data fitting and provide an intuitive and transparent representation for the dynamics of development.
Aire regulates chromatin looping by evicting CTCF from domain boundaries and favoring accumulation of cohesin on superenhancers
Authors: Bansal Kushagra , Michelson Daniel A. , Ramirez Ricardo N. , Viny Aaron D. , Levine Ross L. , Benoist Christophe , Mathis Diane
Published: September 2021

Significance

Aire controls immunological tolerance by driving promiscuous expression of a large swath of the genome in medullary thymic epithelial cells (mTECs). Its molecular mechanism remains enigmatic. To address the hypothesis that Aire impacts chromatin organization through widespread promotion of superenhancer–promoter loops, we performed genome-wide, high-resolution chromosome-conformation capture (Hi-C) experiments on ex vivo mTECs from thymi of mice expressing Aire or not. Integration of the resulting data with inventories of the genome-wide locations of Aire, subunits of the mediator and cohesin complexes, and the chromatin-domain enforcer, CCCTC-binding factor (CTCF), indeed argued for a looping model, which was further supported by biochemical and in vivo loss-of-function analyses.
TIMP1 expression underlies sex disparity in liver metastasis and survival in pancreatic cancer
Authors: Hermann Chris D. , Schoeps Benjamin , Eckfeld Celina , Munkhbaatar Enkhtsetseg , Kniep Lukas , Prokopchuk Olga , Wirges Nils , Steiger Katja , Häußler Daniel , Knolle Percy , Poulton Emily , Khokha Rama , Grünwald Barbara T. , Demir Ihsan Ekin , Krüger Achim
Published: September 2021

Sex disparity in cancer is so far inadequately considered, and components of its basis are rather unknown. We reveal that male versus female pancreatic cancer (PC) patients and mice show shortened survival, more frequent liver metastasis, and elevated hepatic metastasis-promoting gene expression. Tissue inhibitor of metalloproteinases 1 (TIMP1) was the secreted factor with the strongest male-biased expression in patient-derived pancreatic tumors. Male-specific up-regulation of systemic TIMP1 was demonstrated in PC mouse models and patients. Using TIMP1-competent and TIMP1-deficient PC mouse models, we established a causal role of TIMP1 in determining shortened survival and increased liver metastasis in males. Observing TIMP1 expression as a risk parameter in males led to identification of a subpopulation exhibiting increased TIMP1 levels (T1HI males) in both primary tumors and blood. T1HI males showed increased risk for liver metastasis development not only in PC but also in colorectal cancer and melanoma. This study reveals a lifestyle-independent sex disparity in liver metastasis and may open new avenues toward precision medicine.
A diffuse argon plume generated downstream of an atmospheric pressure plasma jet equipped with a positively biased electrode
Authors: Zhao Na , Wu Kaiyue , He Xingran , Chen Junyu , Tan Xin , Wu Jiacun , Ran Junxia , Jia Pengying , Li Xuechen
Published: September 2021

Compared with the diffuse mode of helium plasma jets, a filamentary mode is normally produced in the plasma plume with less expensive inert gas, such as argon, which is undesirable because intense discharge in the filamentary mode may cause damage to fragile samples. Many efforts have been attempted to realize the diffuse mode of an argon plasma jet. In this paper, the diffuse mode is realized in an atmospheric pressure argon plasma jet with increasing biased voltage (V
b) applied to a downstream plate electrode. Results show that the diffuse mode transits from the filamentary mode with the increase of V
b. Waveforms of voltage, current and integrated light emission reveal that the filament originates from a positive discharge with a needle anode, while the diffuse mode results from negative discharges with a needle cathode, which consist of a Trichel-pulse phase and a slower-varying phase. By fast photography, the positive discharge is attributed to a streamer regime, whereas the negative discharges belong to a Townsend-discharge regime. From optical emission spectroscopy, electron density, electron excitation temperature, vibrational temperature, and rotational temperature are studied as functions of V
b.
Detection of single 13C spins coupled to NV center via dynamical decoupling design
Authors: Fan Pengcheng , Yuan Heng , Xu Lixia , Zhang Jixing , Bian Guodong , Li Mingxin , Wang Zhuo
Published: September 2021

The adjusted Carr–Purcell–Meiboom–Gill (CPMG) sequence is mathematically simulated to obtain the 13C nuclear spin signals coupled to a negatively-charged nitrogen-vacancy (NV−) center in diamond. The pulse interval ratio and scanning frequency of the sequence were precisely adjusted to achieve the high-resolution 13C nuclear spin detection. The frequency resolution of the sequence was 5.8 times improved than that of the original CPMG sequence, and the full width at half maximum of the coherence dips were less than 1.7 kHz. The adjusted method can be extended to other dynamical decoupling sequence, and offers a promising approach to improve identification of the nuclear spins in coupled electron-nuclear spin systems.
Electron energy deposition in molecular hydrogen gas: a Monte Carlo simulation using convergent close-coupling cross sections
Authors: Horton Reese K , Scarlett Liam H , Zammit Mark C , Bray Igor , Fursa Dmitry V
Published: September 2021

A Monte Carlo simulation of electron energy deposition in a gas of molecular hydrogen has been conducted with the aim of producing an ab initio estimate of energy deposition parameters such as the mean energy per ion pair. A set of cross sections obtained using the molecular convergent close-coupling method were used as input. At high incident electron energies the mean energy per ion pair was calculated to be 36.3 eV, agreeing with the recommended value of 36.5 ± 0.3 eV. This represents the first fully ab initio calculation of the mean energy per ion pair using a self consistent data set.
Retrofitting urban land through integrative, subsoils-based planning of green stormwater infrastructure: a research framework
Authors: McGuire Mary Pat , Grimley David A , Phillips Andrew C , Stillwell Ashlynn S , William Reshmina , Shen Jinyu , Schneemann Margaret
Published: September 2021

We present a research framework that integrates native subsoil performance and surface retrofitting into coordinated green stormwater infrastructure (GSI) planning. This framework provides communities a strategy to move beyond opportunistic GSI, which can be limited to capturing marginal amounts of stormwater, toward more impactful, coordinated GSI planning that restores the lost hydrologic functioning of the pre-development landscape. We create this framework by establishing critical performance-based relationships among four variables: (1) saturated hydraulic conductivity of native subsoils (∼upper 2 m below urban compaction and fill); (2) GSI design depth for both rain gardens and permeable pavement (in increments of 6″ from 12–30″ for planted and paved GSI); (3) loading ratio, defined as the ratio of GSI retrofit area to upstream impervious surface runoff area (from 1:2 to 1:5 for planted GSI; and 1:1 and direct infiltration for paved GSI); and (4) design storms (rainfall quantity up to 5-inches over 2 h and 24 h durations). We model the four variables using GSI models (built in the US Environmental Protection Agency’s Storm Water Management Model) and reliability analysis, a risk-assessment method adapted to characterize the reliability of GSI in response to varying stormwater runoff loading. The outcome of the modeling is a set of fragility curves and design prototypes, adjustable to catchment and sub-catchment scales, to assist municipalities in early funding and investment decisions to retrofit urbanized land through GSI. We also share two piloted applications in which we use the research framework within the Chicago-Calumet region in Illinois, USA, to conduct site-specific subsoil sampling and determinations of saturated hydraulic conductivity and to develop urban-scale GSI retrofit scenarios. Our framework is transferable to other urban regions, and particularly useful where a lack of integrating native subsoil performance into GSI design hinders decision-making, coordinated GSI planning at scale, and achieving high runoff reduction targets.
Cytosolic phosphofructokinases are important for sugar homeostasis in leaves of Arabidopsis thaliana
Authors: Perby Laura Kathrine , Richter Simon , Weber Konrad , Hieber Alina Johanna , Hess Natalia , Crocoll Christoph , Mogensen Helle Kildal , Pribil Mathias , Burow Meike , Nielsen Tom Hamborg , Mustroph Angelika
Published: September 2021

Background and Aims

ATP-dependent phosphofructokinases (PFKs) catalyse phosphorylation of the carbon-1 position of fructose-6-phosphate, to form fructose-1,6-bisphosphate. In the cytosol, this is considered a key step in channelling carbon into glycolysis. Arabidopsis thaliana has seven genes encoding PFK isoforms, two chloroplastic and five cytosolic. This study focuses on the four major cytosolic isoforms of PFK in vegetative tissues of A. thaliana.

Methods

We isolated homozygous knockout individual mutants (pfk1, pfk3, pfk6 and pfk7) and two double mutants (pfk1/7 and pfk3/6), and characterized their growth and metabolic phenotypes.

Key Results

In contrast to single mutants and the double mutant pfk3/6 for the hypoxia-responsive isoforms, the double mutant pfk1/7 had reduced PFK activity and showed a clear visual and metabolic phenotype with reduced shoot growth, early flowering and elevated hexose levels. This mutant also has an altered ratio of short/long aliphatic glucosinolates and an altered root–shoot distribution. Surprisingly, this mutant does not show any major changes in short-term carbon flux and in levels of hexose-phosphates.

Conclusions

We conclude that the two isoforms PFK1 and PFK7 are important for sugar homeostasis in leaf metabolism and apparently in source–sink relationships in A. thaliana, while PFK3 and PFK6 only play a minor role under normal growth conditions.
Botulinum Toxin A in the Management of a Gummy Smile: A Clinical Controlled Preliminary Study
Authors: Costa Aline Bitencourt , Romansina Dinete , Ramalho Juliana , Pereira Priscilla , Tedesco Tamara Kerber , Morimoto Susana , Gonçalves Flávia , Ramalho Karen Müller
Published: September 2021

Background

Botulinum toxin type A (BTX-A) is recent technique for the treatment of gummy smile.

Objectives

The aim of this randomized controlled preliminary clinical trial was to evaluate the effects of BTX-A on excessive gingiva display (EGD) reduction, muscle activity, and patient satisfaction at 2, 8, 12, 16, 21, and 25 weeks.

Methods

Group 1 (G1) received 4 points of BTX-A application (2 U/point) for relaxation of the levator labii superioris alaeque nasi and levator labii superioris muscles; Group 2 (G2) received 2 points of BTX-A (2 U/point) for relaxation of only the levator labii superioris alaeque nasi muscle.

Results

A high dropout of patients from follow-up sessions occurred. Therefore, because of this data limitation, the results were considered a preliminary outcome. At 2 weeks, there was a significant difference between baseline regarding the reduction of EGD in G1 and G2, reduction in muscle activity in G1, and increased satisfaction in G1 and G2. At 2 weeks, there was no difference between the 2 groups. Statistically significant EGD reduction was maintained until 16 weeks in G2 and 25 weeks in G1. After 14 days there was a gradual recovery of muscle activity in both groups until recovery of baseline values by 25 weeks. Patients’ satisfaction with treatment lasted 21 weeks in G1 and 16 weeks in G2.

Conclusions

Increasing the number of BTX-A injection points resulted in a prolonged effect regarding EGD reduction and patient satisfaction but did not increase the intensity of the outcome. However, due to the high dropout of patients, this is a preliminary conclusion and further studies are necessary to confirm these results.

Level of Evidence: 2
Waking up from a taxonomist’s nightmare: emerging structure ofRanunculussectionBatrachium(Ranunculaceae) in central Europe based on molecular data and genome sizes
Authors: Koutecký Petr , Prančl Jan , Košnar Jiří , Koutecká Eva , Hanzlíčková Johana , Lučanová Magdalena , Nejedlá Michaela , Kaplan Zdeněk
Published: September 2021

Ranunculus section Batrachium (water crowfoot) ranks among the most taxonomically challenging aquatic plant groups due to morphological reduction, phenotypic plasticity, polyploidy and reticulate evolution. This study, for the first time in this group, linked morphology, genome size and genetic data (two non-coding regions of plastid DNA and the ITS region of nuclear ribosomal DNA). This extensive data set, including 258 central European populations, enables us to recognize widespread lineages from hybrids and to trace the evolutionary processes underlying the observed diversity. Most of the traditionally recognized species are supported. However, the presence of two morphologically cryptic but genetically well-differentiated lineages was detected within Ranunculus trichophyllus, and three separate lineages of different parentage were confirmed in the Ranunculus penicillatus complex. An allopolyploid origin was revealed in Ranunculus aquatilis, Ranunculus baudotii and in both lineages of R. trichophyllus, for which the parentage has not yet been studied, and allopolyploidy is suspected in all other polyploid taxa except for the triploid cytotype of Ranunculus fluitans, which is most likely autopolyploid. We detected putative F1 hybrids of seven different parentage combinations, including two involving Ranunculus rionii, representing the first known hybrids of this species. An additional 13 hybrid cytotypes (backcrosses or entailing additional polyploidization) were revealed; c. 20% of Ranunculus peltatus accessions seem to be influenced by introgression detectable only using sequence data. The Batrachium group is remarkable due to the coexistence of well-defined lineages with recently evolved biotypes arising due to hybridization and polyploidization.
Total and Unbound Doravirine Concentrations and Viral Suppression in CSF
Authors: Tiraboschi Juan , Scévola Sofia , Penchala Sujan Dilly , Challenger Elisabeth , Else Laura , Prieto Paula , Saumoy Maria , Imaz Arkaitz , Silva-Klug Ana , Niubó Jordi , Soriano Irene , Khoo Saye , Rigo-Bonin Raul , Podzamczer Daniel
Published: September 2021

We determined total and unbound concentrations of doravirine (DOR) in cerebrospinal fluid and blood plasma. Total and unbound DOR concentrations in cerebrospinal fluid exceeded the half-maximal effective concentration against wild-type virus (5.1 ng/mL) in all patients, suggesting that DOR may contribute to inhibit viral replication in this compartment.
10 EFFECT OF SUBSPECIALTIES OF GASTRO-INTESTINAL SURGERIES ON PATIENT’S OUTCOMES
Authors: Ezz Reda
Published: September 2021

Subspecialty policy is increasing all over the world aiming to improve the results of heavy esophageal surgeries.

Our aim is to define the impact of having surgical specialized esophageal unit on the volume of patients and the results.

Methods

We reviewed all esophageal cases managed in our esophageal specialized department (from May 2016 to May 2019 Group A) and we compared the results to previous 3 years (from May 2013 to May 2016 Group B) and to the international results. There was 394 cases in group A compared to 104 cases in group B.

Results

For Gastro esophageal reflux disease (GERD),180 operations were performed in group a (45.7%) compared to 61 cases in group B (68.7%). Forty two (10.7%) modified Heller’s cardiomyotomy (Open and laparoscopic) for achalasia were performed in group A compared to 17 cases (16.3%) in group B. Surgeries for malignant lesions were performed for 122 cases (30.9%) in group A compared to 13 cases (12.5%) in group B. Other Esophageal operations were also done for 50 cases (12.7%) in group A compared to 13 cases (12.5%) in group B. Morbidities and mortalities are reported and compared to the international results.

Conclusion

Our results in group A are comparable to Hospital mortality rates for patients in medium-volume centers (7.5%). Also we approach the International results for morbidities of benign esophageal disease (5.7–12.7%) for fundoplication.

Having a specialized esophageal unit resulted in increase of the volume of patients and improvement of the results.
113 CONCURRENT SURGICAL TREATMENT STRATEGY FOR SYNCHRONOUS ESOPHAGEAL CANCER AND HEAD AND NECK CANCER IN OUR INSTITUTION
Authors: Shimada Ayako , Tanaka Motomu , Ishii Satoru , Yamamoto Yusuke , Oosaki Masaumi , Nishijima Wataru , Oomura Kenji , Wakabayashi Go
Published: September 2021

Esophageal cancer patients have a high frequency to coincide with head and neck (H&N) cancer. We have corporated together with Otorhinolaryngology, H&N Surgery, and Plastic surgery department doctors for the treatment of synchronous esophageal and H&N cancer patients. The aim of this study is to analyze the treatment results and prognosis of synchronous esophageal and H&N cancer patients.

Methods

From January 2014 to December 2019, 5 patients underwent concurrent surgical resection of synchronous esophageal and H&N cancer in our institution. We retrospectively reviewed the surgical outcomes and prognosis of these patients of synchronous esophageal and H&N cancer (HNEC group) and compared the results with 27 patients who had esophagectomy with 3 regional lymph node dissection during the same period (EC group).

Results

The location of H&N cancers were pharynx/tongue; 4/1, and clinical stage was all Stage IV. The clinical stage of esophageal cancers was Stage 0/I/II/III; 1/1/2/1. All patients underwent video-assisted thoracic esophagectomy. The surgical procedures concurrently performed for the H&N cancer were pharyngolaryngectomy with free jejunum transfer for 3 patients, wide tongue and mandibular segment resection with mandibular reconstruction in 1 patient, and mandibular transection with radial forearm flap reconstruction in 1 patient. There was no significant difference in the frequency of postoperative complication between 2 groups. HNEC group tend to have shorter recurrence free survival compared to EC group (p = 0.051).

Conclusion

H&N surgery with thoracotomy is a highly invasive surgery, however, it can be safely performed with local management. The risk of recurrence is high in H&N cancer patients, therefore it is important to move onto adjuvant therapy without delay. Paraenteral nutrition may be useful in management of these patients.
131 PRACTICES IN PERIOPERATIVE NUTRITION PRECEDING OR FOLLOWING OESOPHAGECTOMY: RESULTS OF A EUROPEAN SURVEY
Authors: Van Veer Hans , Luyer Misha , Depypere Lieven , Nafteux Philippe , Coosemans Willy
Published: September 2021

The route and type of peri-operative feeding after oesophagectomy varies widely across centres, usually based on local experiences and standing orders. The aim of this survey on perioperative nutrition after oesophagectomy (PONOS) was to create a snapshot the way perioperative nutrition preceding or following oesophagectomy is established across reference centres in Europe, and what the reasons are for preferring one method over another.

Methods

A survey consisting of four parts was distributed to the membership of 3 European, mainly surgical oriented scientific societies between October 2019 and January 2020. The first part contained some general questions regarding demographics of the participants and type of performed surgery. In the second section, centres were asked about practices in preoperative nutrition. The third section questioned participants about their practices in postoperative nutrition; in the last part the daily practice was reflected against the current available ESPEN guidelines.

Results

Fifty-one surgeons from 49 centres in 16 countries participated. The majority had a structured nutrition team in their institution. An Enhanced Recovery Pathway was implemented in 2/3 of centres. ESPEN guidelines were followed in 50% of centers. Routine preoperative nutritional assessment was performed in 84%. Preoperative nutritional support consisted mainly of enteral and oral support; immediate postoperatively mostly a combination of oral and enteral or enteral only; at discharge mostly a combination of oral and enteral or only oral nutritional supplementation were used. Timing, definition and means of postoperative oral intake also seemed to differ widely across centres.

Conclusion

The PONOS survey confirmed our assumption that perioperative feeding after oesophagectomy exists in a wide variety across European centres performing oesophageal resections for cancer. Survey based feedback to the surgical community draws attention to this often underexposed part of the surgical pathway of a patient. As such, this might further enhance the exchange of experiences in order to try to harmonise peri-operative feeding regimen.
142 A RANDOMIZED TRIAL: THREE-FILED LYMPHADENECTOMY COMPARED WITH TWO-FIELD LYMPHADENECTOMY FOR MIDDLE AND LOWER THORACIC ESOPHAGEAL CANCER
Authors: Li Bin
Published: September 2021

Esophagectomy combined with radical lymphadenectomy is widely accepted, but the role of three-field lymphadenectomy (3-FLD) remains unclear.

Methods

We performed an open-label, randomized, controlled trial involving patients with resectable cancer of the middle or lower third of the esophagus. Patients were randomly assigned to undergo esophagectomy with either 3-FLD (cervical-thoracic-abdominal lymphadenectomy) or two-field lymphadenectomy (thoracic-abdominal lymphadenectomy, 2-FLD) at a 1:1 ratio. The primary endpoint was overall survival (OS). Analysis were done according to the intent-to-treat principle.

Results

Postoperative complications were similar in the two arms. More lymph nodes were resected in 3-field arm (Median, 37 vs. 24 [2-FLD], P < 0.001), 43 (21.5%) patients had cervical LNM. More pN3 patients were identified in the 3-FLD arm (10.5%, 21/200 vs. 5.0%, 10/200 [2-FLD], P = 0.040). The cumulative probability of disease-free survival (DFS) was comparable between the two arms (HR, 1.021, 95%CI, 0.735–1.417, P = 0.903), as well as the OS (HR, 1.026, 95%CI, 0.694–1.515, P = 0.899). The cumulative 5-year DFS was 52% in the 3-FLD arm, as compared with 53% in the 2-FLD arm; 5-year OS rates were 64% and 62%.

Conclusion

Three-field lymphadenectomy offered more accurate nodal staging without increasing the surgical complications. Comparing with radical 2-FLD, there was no improvement in OS or DFS after 3-FLD for patients with middle and lower thoracic esophageal cancer.

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173 CATERPILLAR SIGN: NOVEL ENDOSCOPIC FINDING IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS
Authors: Ayaki Maki , Manabe Noriaki , Haruma Ken , Nakamura Jun , Fujita Minoru , Suehiro Mitsuhiko , Kawamoto Hirofumi , Kamada Tomoari , Yamatsuji Tomoki , Naomoto Yoshio
Published: September 2021

Pathological identification of esophageal eosinophilia (EE) is considered to be most important and critical step for diagnosis of eosinophilic esophagitis (EoE). Although several endoscopic findings related with EoE have been reported, it is still difficult to exclude other causes of EE, such as gastroesophageal reflux disease. Here, we noted a novel endoscopic finding related with EoE termed ‘Caterpillar sign’. The aim of this study was to evaluate its clinical significance for the diagnosis of EoE.

Methods

One hundred and seventy-four patients who were endoscopically suspected with EoE at our hospital and affiliated institutions were enrolled. EoE was defined clinically by symptoms of esophageal dysfunction and histologically by the presence of EE [≧15 eosinophils/high power field (HPF)]. Endoscopic findings at baseline were retrospectively reviewed. ‘Caterpillar sign’ was defined as a stair-like, fragile, slight mucosal protruded lesion sandwiched between longitudinal furrows, such as the Caterpillar traces remaining on the ground (Figure). Furthermore, the clinicopathological features of patients having ‘Caterpillar sign’ were evaluated.

Results

One hundred and seventy-four patients (92 males, 82 females with mean age of 49.7) suspected with EoE were evaluated, of whom 60 (34.5%) was finally diagnosed as EoE. ‘Caterpillar sign’ was found in 48 patients (80.0%). Sensitivity and Specificity of ‘Caterpillar sign’ for the diagnosis of EoE was 0.80 (95% confidence interval [CI] 0.72–0.85) and 0.94 (95% CI 0.90–0.97), respectively. Furthermore, the presence of ‘Caterpillar sign’ was associated with degree of eosinophil infiltration (Caterpillar sign positive: 42.9 ± 49.3/HPF vs. Caterpillar sign negative: 6.7 ± 24.4/HPF, p < 0.0001).

Conclusion

This novel finding termed ‘Caterpillar sign’ was clinically useful for the definitive diagnosis of EoE and associated with degree of eosinophil infiltration.
185 THE EFFECT OF PSYCHOLOGICAL PREPARATION ON THE LEVEL OF ANXIETY BEFORE UPPER GASTROINTESTINAL ENDOSCOPY
Authors: Javaherforoushzadeh Ali , Behrouzian Forouzan , Sadrizadeh Neda , Nematpour Sorour , Seyedian Seyed Saeed , Nassiryan Maryam
Published: September 2021

Anxiety is one of the problems in patients undergoing invasive procedures. One way to control anxiety is through psychological preparation. This study was aimed to evaluate the effect of psychological preparation on anxiety level in patients undergoing upper gastrointestinal endoscopy.

Methods

The present study consisted of 98 patients which were referred to Ahvaz Golestan Hospital for upper gastrointestinal endoscopy. They were randomly (table of random numbers) divided into a control group and an experimental group. All of the participants filled out Spielberg State–Trait Anxiety Inventory (STAI). The experimental group was psychologically prepared for endoscopy (given information about endoscopy and behavioural intervention), and then both groups were asked to complete STAI again an hour before endoscopy. The collected data were analysed through Mann–Whitney, Kruskal-Wallis, and Chi-square tests using SPSS 17.0.

Results

Before the intervention was carried out, there was no significant difference between the two groups in terms of the rate of state and trait anxiety (p > 0.05). After the intervention, the rate of state and trait anxiety decreased significantly (p < 0.05) in experimental group.

Conclusion

In patients subjected to endoscopy, psychological preparation was effective in reducing their anxiety and thus this can be considered as an efficient method in decreasing anxiety.
190 THE USEFULNESS OF A BILATERAL TRANS-CERVICAL PNEUMOMEDIASTINAL APPROACH FOR MEDIASTINOSCOPIC RADICAL ESOPHAGECTOMY
Authors: Tokairin Yutaka , Nakajima Yasuaki , Kawada Kenro , Hoshino Akihiro , Okada Takuya , Matsui Toshihiro , Yamaguchi Kazuya , Nagai Kagami , Kinugasa Yusuke
Published: September 2021

Several authors have reported on the left trans-cervical and transhiatal approaches under pneumomediastinum and right cervical open surgery for mediastinoscopic esophagectomy. However, with these approaches, sufficient dissection of the right upper mediastinal paraesophageal lymph nodes, right recurrent nerve lymph nodes and the subaortic arch to the left tracheobronchial lymph nodes is thought to be difficult. We herein report the usefulness of the ‘bilateral’ trans-cervical pneumomediastinal approach.

Methods

Ten patients with thoracic esophageal cancer were treated using this approach. Under pneumomediastinum via a right neck incision, the right cervical and upper mediastinal paraesophageal lymph nodes were dissected. The left recurrent nerve lymph nodes were dissected using a left trans-cervical pneumomediastinal approach. The subaortic arch to the left tracheobronchial lymph nodes was dissected with a combined right and left trans-cervical crossover approach. After this approach, thoracoscopic observation was then performed in the left decubitus position, and if the lymph nodes were not sufficiently dissected, the remnant lymph nodes were retrieved thoracoscopically.

Results

The average total number of dissected lymph nodes among the right cervical and upper mediastinal paraesophageal lymph nodes identified with a right cervical open/right trans-cervical mediastinoscopic/right thoracoscopic approach was 3.2/4.0/0.6, respectively. The average total number of dissected lymph nodes among the subaortic arch to the left tracheobronchial lymph nodes with a right trans-cervical mediastinoscopic/right thoracoscopic approach was 1.5/0.6, respectively. These findings indicate that, without the right trans-cervical pneumomediastinal approach, roughly four of the right cervical and upper mediastinal paraesophageal lymph nodes and one or two of the subaortic arch to the left tracheobronchial lymph nodes could not have been retrieved.

Conclusion

A bilateral trans-cervical pneumomediastinal approach is useful for achieving sufficient upper mediastinal lymph node dissection and esophagectomy.
201 POSTOPERATIVE OUTCOMES OF MINIMALLY INVASIVE ESOPHAGEAL SURGERY FOR ESOPHAGEAL CANCER IN A SINGLE CENTER
Authors: Yi Eunjue , Lee Jun Hee , Jung Younggi , Lee Kwanghyong , Lee Sungho
Published: September 2021

The aim if this study is to evaluate the safety and feasibility of minimally invasive esophageal surgery for esophageal cancer in a small volume center.

Methods

The medical records of patients who had undergone minimally invasive esophageal surgery (VATS Ivor Lewis operation with laparoscopic gastric mobilization) for their esophageal cancer between June 2017 and September 2019 in our institute were reviewed retrospectively. Perioperative outcomes including postoperative morbidities and mortalities were evaluated.

Results

A total of 31 patients were included in this study. The mean operation time for laparoscopic gastric mobilization were 111.3 minutes and those for VATS Ivor Lewis operation were 235.5 minutes. Seven patients underwent Neoadjuvant therapy. Half of the cases were stage I, however, operation could be performed in more advanced cases. There was no conversion to open procedure.

Overall complication rates were 49.1%, and complication more than Grade III in Clavien-Dindo classification were 16.1%. Overall postoperative morality was 6.4%. Two patients died at 42 and 47 postoperative days due to acute respiratory failure, and one patient.

Conclusion

Minimally invasive esophageal surgery for esophageal cancer could be feasibly performed even in advanced cases. Postoperative pneumonia should be carefully managed to prevent postoperative mortality.
213 CLINICAL SIGNIFICANCE OF ROBOTIC ESOPHAGECTOMY FOR THORACIC ESOPHAGEAL CANCER
Authors: Takeuchi Hiroya , Kikuchi Hirotoshi , Hiramatsu Yoshihiro , Matsumoto Tomohiro , Soneda Wataru , Kamiya Kinji
Published: September 2021

Nowadays many patients with esophageal cancer are treated with thoracoscopic esophagectomy (TE) with precise mediastinal lymphadenectomy as a minimally invasive esophagectomy (MIE) in Japan. These advanced endoscopic surgeries are believed to contribute to early postoperative recovery. More recently robotic esophagectomy (RE) appeared attractively. To date, however, there has been a very limited number of comparison studies to verify the benefits of RE for esophageal cancer, especially in Japan where squamous cell carcinoma is predominant.

Methods

We retrospectively compared the short-term outcomes between TE (n = 43) and RE (n = 19) which were performed in our institution between 2018 and 2020 to verify the clinical significance of RE. Preoperative background factors of the patients compared were almost identical between the two groups.

Results

The operative time was longer in the RE group than in the OE group, whereas blood loss was equivalent between the two groups. There was no significant differences in the number of dissected mediastinal lymph nodes between the TE and RE groups (33+/−15 vs 29+/−11).

The incidence of postoperative recurrent laryngeal nerve palsy was markedly less in the RE group than the TE group (5.2% vs. 18.6%). Moreover, the incidence of postoperative pneumonia also tended to be less in the RE group than in the TE group (5.2% vs. 11.6%). There were no operative mortality in the two groups.

Conclusion

Our results suggest that RE is comparable with conventional TE in terms of short-term outcome after surgery, and beneficial to technically reduce the recurrent laryngeal nerve palsy as a promising MIE.
235 5-YEAR FOLLOW-UP OF A PROSPECTIVE CLINICAL TRIAL OF AN ENDOSCOPIC FULL-THICKNESS PLICATION DEVICE (GERDX™) FOR THE TREATMENT OF GERD
Authors: Tschoner Andreas , Punkenhofer Paul , Spaun Georg , Koch Oliver , Fuegger Reinhold
Published: September 2021

The gold-standard in the operative treatment of gastroesophageal reflux disease (GERD) is the laparoscopic fundoplication. Alternatively, endoscopic devices to rebuild the gastroesophageal valve were invented. The aim of our study is to assess the improvement of GERD symptoms and quality of life in patients five years after the endoscopic full-thickness plication with the GERDx™ device.

Methods

Between 2013 and 2016 a prospective trial was implemented with forty patients and an endoscopic plication due to reflux symptoms with a pathologic workup for GERD. Limitation for the use of GERDx™ was a 2 cm hiatal hernia. Follow-up workup was done with high resolution manometry (HRM), 24 h-pH-impedance-catheter gastroscopy and questionaires for quality of life (GIQLI) and reflux-symptoms (SCL).

Results

Median follow-up time was 57 months (36–74 months). There was a significant improvement of the DeMeester score, GIQLI and SCL between pre- and postoperative values in short-term as well as long-term follow-up. At least 55% of patients were assessed as failure of the plication device due to redo operations with laparoscopic fundoplication in 25% and/or necessary PPI use for GERD symptoms (40%). There is no pre- and postoperative significant difference in quality of life or reflux scores between successful and failed endoplications, but patients with laparoscopic redo operations showed significant higher DeMeester scores before and after endoscopic treatment.

Conclusion

There is a higher failure rate to the endoscopic full-thickness plication than to the laparoscopic fundoplication. A small group of well selected patients is eligible for the endoscopic GERDx™ device. In case of therapeutic failure a classic laparoscopic redo fundoplication is possible under more challenging operative conditions.
238 SERUM ALBUMIN EARLY DECREASE IS AN INDEPENDENT PREDICTOR OF MAJOR COMPLICATIONS AFTER ONCOLOGICAL ESOPHAGECTOMY; RESULTS FROM A LARGE EUROPEAN SERIES
Authors: Labgaa Ismail , Mantziari Styliani , Winiker-Seeberger Michael , Pasquier Jerôme , Messier Marguerite , Elliot Jessie A , Kamiya Satoshi , Kalff Marianne C , Hübner Martin , Allemann Pierre , Henegouwen Mark Van Berge , Nilsen Magnus , Reynolds John , Piessen Guillaume , Demartines Nicolas , Schäfer Markus
Published: September 2021

The predictive value of postoperative albuminemia decrease (ΔAlb) has been increasingly evidenced in different types of major surgery but data on esophagectomy remain scarce. This study aimed to assess the predictive value of ΔAlb for adverse short-term outcomes after oncological esophagectomy.

Methods

Retrospective analysis of an international multicentric cohort of patients undergoing oncological esophagectomy between 2006–2017. Patients with missing pre- and postoperative albumin values were excluded from the analysis. Primary endpoint was postoperative morbidity according to Clavien classification. Secondary endpoints were Comprehensive Complication Index (CCI) and length of hospital stay (LoS).

Results

A total of 1046 patients were analyzed. Major complications were reported in 363 (34.7%) patients. Albuminemia showed a rapid postoperative decrease on postoperative day 1 (POD1) (ΔAlb POD1) with a median value of 11 g/L. ROC curve analysis determined a cut-off of 11 g/L for the prediction of overall complications. Patients with ΔAlb POD1 ≥ 11 g/L showed increased overall complications (p = 0.004), major complications (p = 0.009) and CCI (p = 0.006) while LoS was comparable (p = 0.099). On multivariable analysis, ΔAlb POD1 ≥ 11 g/L was an independent predictor of overall (OR: 1.55; 95% CI 1.09–2.21; p = 0.015) and major complications (OR: 1.43; 95% CI 1.09–1.89; p = 0.009).

Conclusion

Oncological esophagectomy induced a rapid decrease of albuminemia. ΔAlb POD1 ≥ 11 g/L was independently associated with the occurrence of overall and major postoperative complications. ΔAlb appears as a promising biomarker to detect patients at risk of adverse outcomes after oncological esophagectomy.
244 MICROBIOME ANALYSIS OF UPPER DIGESTIVE TRACT BIOPSY SAMPLES FROM INDIVIDUALS ALONG THE METAPLASIA-DYSPLASIA-ADENOCARCINOMA SEQUENCE.
Authors: Elliott Jessie , Elliott Jessie , Hand Collette , Shanahan Fergus , Murphy Thomas , O'Toole Paul
Published: September 2021

The human microbiota, the collection of microbes that inhabit the human body, is increasingly being appreciated as playing a role in human health. A seminal example of this relationship is Helicobacter pylori and gastric cancer oncogenesis. The drop in H.pylori infections and non-cardia gastric cancer incidences has coincided with the rise in oesophageal adenocarcinoma (OAC) incidences. We sought to explore the relationship between the upper digestive tract microbiome and OAC oncogenesis.

Methods

Pinch biopsies were taken from individual’s oesophagus and stomach who were along the metaplasia-dysplasia-adenocarcinoma sequence (GERD, Barrett's oesophagus, dysplasia, OAC, metastatic OAC) as well as healthy controls. We carried out 16 s rRNA gene DNA sequencing protocols on these samples. DNA extraction and library preparation was performed with consideration to the low mass nature of oesophageal biopsies. Raw reads were processed and amplicon sequence variants (ASVs) were generated using the DADA2. We dissected ecological differences between sample site and clinical classification using a variety of approaches including examining differentially abundant taxa and inferred metabolic pathways, alpha diversity and beta-diversity.

Results

The upper digestive tract was found to be dominated by the genera Streptococcus, Prevotella, and Haemophilus. There was no statistically significant shift in beta diversity with respect to biopsy location. Alpha diversity was reduced in gastric biopsies compare to oesophageal biopsies. A slight yet significant shift was seen in beta diversity (Bray–Curtis Dissimilarity) with respect to clinical classification in biopsies derived from the gastroesophageal junction (GEJ) and stomach.

Various taxa were found to be differentially abundant between biopsy site and with regard to clinical classification.

Conclusion

OAC primarily occurs at the GEJ. Community structure was shifted in samples derived from the GEJ and the stomach. Fusobacterium nucleatum was overrepresented in oesophageal biopsies from individuals with diseased oesophagus compared to individuals with a histologically normal oesophagus. This bacterium has been implicated in oncogenesis of various cancers most notably colorectal cancer. Serval ASVs assigned to the genus Prevotella were depleted in stomachs of individuals with metastatic OAC compared to all other groups.
254 LYMPH NODE DISSECTION IN T1 AND T2 ESOPHAGEAL SQUAMOUS CELL CARCINOMA: MINIMALLY INVASIVE ESOPHAGECTOMY VERSUS OPEN SURGERY
Authors: Teng Xiao , Cao Jinlin , Xu Jinming , He Cheng , Zhang Chong , Ye Peng , Hu Jian
Published: September 2021

Minimally invasive esophagectomy is increasingly performed for esophageal squamous carcinoma, with advantages of improved perioperative outcomes in comparison with open esophagectomy. Lymph node dissection is one of most important prognostic factors, in esophageal squamous cell carcinoma. It is still unknown whether MIE can meet the criteria of lymph node dissection in the mediastinum, especially in T1 and T2 esophageal cancer. Here, we compared the lymph node dissection between MIE and open surgery.

Methods

We retrospectively reviewed the clinicopathological data from 147 patients who underwent open surgery and MIE for esophageal squamous cell carcinoma from December 2016 to January 2020. The clinicopathological data including age, gender, number of lymph node resected were analyzed.

Results

68 patients underwent MIE and 79 patients underwent open surgery. The number of harvested lymph node didn’t differ between the open surgery group and MIE group (26 ± 11.9 vs 26 ± 13.4, respectively, p = 0.128). However, the number of resected lymph node in the low para-esophageal region was significantly higher in open surgery group (4.1 ± 3.9 vs 2.8 ± 2.6, respectively, p = 0.019). The number of resected lymph node in the upper mediastinal region was significantly higher in the MIE group in T1 and T2 patients (4.7 ± 3.8 vs 2.7 ± 2.9, respectively, p = 0.014). the difference was also noticed in the para-recurrent laryngeal lymph node regions (3.6 ± 2.9 vs 2.0 ± 2.3, respectively, p = 0.020).

Conclusion

For stages T1 and T2 esophageal squamous cell carcinoma, the lymph node dissection by MIE was comparable to that by open surgery. However, the number of harvested lymph node in the upper mediastinal region was better in the MIE group, which may indicate a better outcome. There was no difference in the postoperative complications, hospital stay and overall survival rate.
280 CONVERSION SURGERY FOR BORDERLINE T4 ESOPHAGEAL CANCER
Authors: Ogata Takashi
Published: September 2021

Due to development of neo-adjuvant chemotherapy or chemoradiotherapy, the possibility of surgical resection for borderlint T4 esophageal cancer that seems difficult to resect is emerging. We retrospectively examine the effects of conversion surgery in patients for esophageal cancer as part of multidisciplinary treatment.

Methods

We undergo 364 cases esophagectomy between Jan 2011 and Dec 2018, and of the 10 cases were diagnosed as borderline resectable esophageal cancer patients at first admission. These 10 cases were undergone conversion surgery after chemotherapy. We retrospectively examined preoperative and postoperative treatment and their prognosis.

Results

The chemotherapy regimens given above 10 cases were DCF (4cases) and FP (6 cases). Borderline target organs: Aorta (4 cases), Left main bronchus(6 cases), LN invasion to pancreas (1 case). R0 surgery was achieved in 8 of 10 cases, and the pathological response was G1a: 5 cases, G1b: 2 cases, G2: 3 cases. The median number of lymph node metastases is 3 (0–19), with recurrence in 6 cases, and the median time to recurrence is 7 months (2–21 months). Treatment was performed in all 6 cases after recurrence. Four patients had radiation therapy, but their prognosis was severe: 2 cases survived and 4 cases died.

Conclusion

Conversion surgery as a multidisciplinary treatment still can not provide a satisfactory prognosis, so additional treatment strategies including radiation and more effective utilization of other modalities are expected.
292 PREOPERATIVE RISK STRATIFICATION IN ESOPHAGEAL SURGERY: COMPARING RISK MODELS WITH THE CLINICAL JUDGEMENT OF THE SURGEON
Authors: Hagens Eliza , Cui Nanke , Eshuis Wietse , Laméris Wytze , Berge Henegouwen Mark , Gisbertz Suzanne
Published: September 2021

Numerous prediction models have been proposed to estimate the risk of complications after esophagectomy. However, these models are not commonly used in practice and surgeons generally trust on their own clinical judgment. The aim of this study is to compare the clinical judgment of the surgeons with the existing risk stratification models with regard to predicting complications after esophageal surgery.

Methods

Patients with resectable esophageal cancer who underwent an esophagectomy between March 2019 and January 2020 were included in this prospective study. Literature was searched to identify prediction models predicting the incidence of postoperative complications after esophagectomy. Clinical judgment of three surgeons was assessed using a standardized form where surgeons could indicate their estimated risk for postoperative complications. The best performing prediction model was compared with the judgment of the surgeons, using the Net Reclassification Improvement (NRI). A higher NRI correlates with better estimation by the surgeon and a negative NRI indicates a better prediction by the prediction model.

Results

Fifty-three patients were included, 36 patients (68%) developed a complication. Two risk classification models were identified in literature: Model 1 (Lagarde et al, Annals of thoracic surgery, 2008) and model 2 (Reeh et al, Medicine, 2016). Model 1 had a better discriminative ability than model 2 (Area Under the Receiver Operator Curve 0.738 versus 0.609). The NRI for the surgeons combined was −2%, meaning that model 1 outperforms the combined judgment of the surgeons. However, there was a large difference in clinical judgment between surgeons. Figure 1 shows the NRI for all three surgeons separately.

Conclusion

Surgeons‘assessment does not outperform prediction models in predicting the incidence of postoperative complications after esophageal surgery. However, there is a poor agreement between surgeons regarding their risk assessment based on their clinical judgment. Some surgeons might individually outperform existing risk stratification models. Surgeon’s assessment can therefore still be important when counseling patients about the risks of esophageal surgery in addition to risk stratification models.