bluuebunny/crossref_metadata_2025 huggingface dataset:
Preparation of Ag@PDA@SiO2 electrospinning nanofibrous membranes for direct bacteria SERS detection and antimicrobial activities
Authors: Wan Menghui , Zhao Haodong , Wang Zhihua , Zhao Yanbao , Sun Lei
Published: September 2020

In this paper, a convenient method to fabricate flexible and free-standing surface-enhanced Raman scatting (SERS) substrates for direct bacteria detection without aptamer bonding is presented. SiO2 nanofibers were prepared via electrospinning and calcination by using tetraethyl orthosilicate as the precursor. Subsequently, it was coated with polydopamine (PDA) by self-polymerization. Finally, Ag@PDA@SiO2 nanofibrous membranes were obtained through in situ growth of Ag nanoparticles in Tollens’ reagents. The as-prepared Ag@PDA@SiO2 composite nanofibrous membranes were characterized by techniques of scanning electron microscopy, transmission electron microscopy, X-ray powder diffraction, energy-dispersive x-ray spectroscopy and thermo gravimetric analysis. The flexibility of the as-prepared nanofibrous membranes were verified simply through manual folding. Small molecule probes of 4-mercaptophenol (4-MPh) and 4-mercaptobenzoic acid (4-MBA) were chosen to investigate the SERS sensitivity of the as-prepared Ag@PDA@SiO2 as free-standing substrates. Furthermore, Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), as typical strains of Gram-negative and Gram-positive bacteria, were performed to directly SERS detection by dropping bacteria suspension onto the fibrous membranes without any previous treatment, such as aptamer combination. In addition, the antimicrobial properties of the as-prepared Ag@PDA@SiO2 electrospinning nanofibrous membranes were tested by inhibition zone and turbidity methods. The results show that Ag nanoparticles with an average diameter of 50 nm are uniformly deposited on the surface of electrospinning nanofibers, and the as-prepared Ag@PDA@SiO2 nanofibrous membranes are flexible. As SERS substrates, it shows a rather high detection limitation of 10−11 mol l−1 for 4-MPh and 4-MBA. More importantly, this substrate can be applied for bacteria label-free SERS detection, i.e., complicated procedures are avoided. Meanwihile, the as-prepared Ag@PDA@SiO2 nanofibrous membranes exhibit excellent antibacterial properties. Thus, it has application prospects in trace bacteria detection and water purification.
Effect of rubber ash on mechanical properties of Al6061 based hybrid FGMMC
Authors: B Madhu , Ranganath G , Konga Ajaykumar
Published: September 2020

The usage of rubber ash as a reinforcement material for aluminium composite has never been used, this work pertains to one such experimentation. In this work rubber ash and boron carbide in varying proportions to reinforce Aluminium based Hybrid functional grade metal matrix composite (FGMMC). The fabrication is done using the centrifugal casting method. The rubbish ash and B4C content are varied and the samples are tested to get the ratio with the optimal mechanical properties. The tensile strength of the Aluminium based Matrix Composites (AMC) seems to increase with an increase in % weight of rubber ash. Further analysis of the composite reveals that the B4C and rubber ash particles were evenly distributed in the AMC. This can be confirmed using SEM imaging. This work studies the usage of boron Carbide and rubber ash to reinforce the FGMMC by comparing its properties to conventional AMC’s. The mechanical properties along with the cost factor are weighed to arrive at a convincing solution.
Population dynamics model and analysis for bacteria transformation and conjugation
Authors: Dong J J , Russo J D , Sampson K
Published: September 2020

We present a two-species population model in a well-mixed environment where the dynamics involves, in addition to birth and death, changes due to environmental factors and inter-species interactions. The novel dynamical components are motivated by two common mechanisms for developing antibiotic resistance in bacteria: plasmid transformation, where external genetic material in the form of a plasmid is transferred inside a host cell; and conjugation by which one cell transfers genetic material to another by direct cell-to-cell contact. Through analytical and numerical methods, we identify the effects of transformation and conjugation individually. With transformation only, the two-species system will evolve towards one species’ extinction, or a stable co-existence in the long-time limit. With conjugation only, we discover interesting oscillations for the system. Further, we quantify the combined effects of transformation and conjugation, and chart the regimes of stable co-existence, a result with ecological implications.
A coupled Cahn–Hilliard model for the proliferative-to-invasive transition of hypoxic glioma cells
Authors: Li Lu , Miranville Alain , Guillevin Rémy
Published: September 2020

Our aim in this paper is to prove the existence of solutions for a model for the proliferative-to-invasive transition of hypoxic glioma cells. The equations consist of the coupling of a reaction-diffusion equation for the tumor density and of a Cahn–Hilliard type equation for the oxygen concentration. The main difficulty is to prove the existence of a biologically relevant solution. This is achieved by considering a modified equation and taking a logarithmic nonlinear term in the Cahn–Hilliard equation.
Strichartz estimates and Strauss conjecture on non-trapping asymptotically hyperbolic manifolds
Authors: Sire Yannick , Sogge Christopher , Wang Chengbo , Zhang Junyong
Published: September 2020

We prove global-in-time Strichartz estimates for the shifted wave equations on non-trapping asymptotically hyperbolic manifolds. The key tools are the spectral measure estimates from [Ann. Inst. Fourier, Grenoble 68 (2018), pp. 1011–1075] and arguments borrowed from [Analysis PDE 9 (2016), pp. 151–192], [Adv. Math. 271 (2015), pp. 91–111]. As an application, we prove the small data global existence for any power

p
∈
(
1
,
1
+

4

n
−
1

)

p\in (1, 1+\frac {4}{n-1})

for the shifted wave equation in this setting, involving nonlinearities of the form

±

|

u

|

p

\pm |u|^p

or

±

|

u

|

p
−
1

u

\pm |u|^{p-1}u

, which answers partially an open question raised in [Discrete Contin. Dyn. Syst. 39 (2019), pp. 7081–7099].
Innate Immune Mechanisms of Arterial Hypertension and Autoimmune Disease
Authors: Jung Rebecca , Wild Johannes , Ringen Julia , Karbach Susanne , Wenzel Philip
Published: September 2020

The immune system is indispensable in the development of vascular dysfunction and hypertension. The interplay between immune cells and the vasculature, kidneys, heart, and blood pressure regulating nuclei in the central nervous system results in a complex and closely interwoven relationship of the immune system with arterial hypertension. A better understanding of this interplay is necessary for optimized and individualized antihypertensive therapy. Our review article focuses on innate cells in hypertension and to what extent they impact on development and preservation of elevated blood pressure. Moreover, we address the association of hypertension with chronic autoimmune diseases. The latter are ideally suited to learn about immune-mediated mechanisms in cardiovascular disease leading to high blood pressure.
Rice withSUB1QTL possesses greater initial leaf gas film thickness leading to delayed perception of submergence stress
Authors: Chakraborty Koushik , Guru Akankhya , Jena Priyanka , Ray Soham , Guhey Arti , Chattopadhyay Krishnendu , Sarkar Ramani K
Published: September 2020

Background and Aims

Submergence tolerance in rice is primarily attributed to the action of the SUB1 gene, but other associated traits such as leaf gas film (LGF) thickness, leaf hydrophobicity, porosity and leaf density have been known to aid submergence tolerance in rice. However, association of these traits with SUB1 quantitative trait locus (QTL) has not been demonstrated. In this study, we aim to investigate (1) whether the presence of the SUB1 QTL in the genetic background has any influence on the thickness of the LGF and (ii) whether its removal has any impact on stress perception and submergence tolerance in Sub1 and non-Sub1 rice.

Methods

We examined 12 genotypes (including both Sub1 and non-Sub1 types) for different leaf traits such as initial LGF thickness, leaf hydrophobicity, tissue porosity and leaf density in order to work out the relatioship of these traits to the SUB1 QTL in rice. Furthermore, we investigated the changes in the gene expression profile and different metabolic processes in selected genotypes in the presence and absence of their LGF to study its impact on stress perception and adaptation.

Key Results

The initial thickness of the LGF and hydrophobicity seemed to have a highly positive correlation with the presence of the SUB1 QTL in the genetic background of rice; however, other leaf traits such as porosity and density seemed to be independent of it. Artificial removal of the LGF resulted in partial loss of tolerance, showing increased ethylene production and early induction of anoxia-related genes (SUB1A-1, ACS5, Ramy3D and ADH1) which manifested symptoms such as increased stem elongation, faster chlorophyll and starch breakdown, and partial loss of quiescence in SUB1-containing rice genotypes. Stripping of the LGF resulted in early and enhanced induction of SUB1A-1, indicating a quicker perception of stress.

Conclusions

The presence of SUB1 in the genetic background positively influences surface hydrophobicity and the concomitant LGF thickness of rice. Furthermore, LGF helps in terms of providing better ethylene dissipation and reduced in planta accumulation, owing to the slowing down of ethylene-induced leaf senescence under submergence stress.
Verbal Learning Mediates the Relationship Between Executive Functions and a Laboratory Task of Medication Management in HIV Disease
Authors: Sullivan Kelli L , Babicz Michelle A , Woods Steven Paul
Published: September 2020

Objective

Impairments in executive functions and learning are common in HIV disease and increase the risk of nonadherence to antiretroviral therapy. The mixed encoding/retrieval profile of HIV-associated deficits in learning and memory is largely driven by dysregulation of prefrontal systems and related executive dysfunction. This study tested the hypothesis that learning may be one pathway by which executive dysfunction disrupts medication management in people living with HIV (PLWH).

Method

A total of 195 PLWH completed a performance-based laboratory task of medication management capacity and clinical measures of executive functions, verbal learning and memory, and motor skills.

Results

Executive functions were significantly associated with verbal learning and medication management performance. In a model controlling for education, learning significantly mediated the relationship between executive functions and medication management, and this mediation was associated with a small effect size. In particular, executive dysfunction was associated with diminished use of higher-order learning strategies. Alternate models showed that executive functions did not mediate the relationship between learning and medication management nor did motor skills mediate the relationship between executive functions and medication management.

Conclusions

PLWH with executive dysfunction may demonstrate difficulty in learning new information, potentially due to ineffective strategy use, which may in turn put them at a higher risk for problems managing their medications in the laboratory. Future studies may wish to investigate whether compensatory neurocognitive training (e.g., using more effective learning strategies) may improve medication management among PLWH.
MCCS: a novel recognition pattern-based method for fast track discovery of anti-SARS-CoV-2 drugs
Authors: Feng Zhiwei , Chen Maozi , Xue Ying , Liang Tianjian , Chen Hui , Zhou Yuehan , Nolin Thomas D , Smith Randall B , Xie Xiang-Qun
Published: September 2020

Given the scale and rapid spread of the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, or 2019-nCoV), there is an urgent need to identify therapeutics that are effective against COVID-19 before vaccines are available. Since the current rate of SARS-CoV-2 knowledge acquisition via traditional research methods is not sufficient to match the rapid spread of the virus, novel strategies of drug discovery for SARS-CoV-2 infection are required. Structure-based virtual screening for example relies primarily on docking scores and does not take the importance of key residues into consideration, which may lead to a significantly higher incidence rate of false-positive results. Our novel in silico approach, which overcomes these limitations, can be utilized to quickly evaluate FDA-approved drugs for repurposing and combination, as well as designing new chemical agents with therapeutic potential for COVID-19. As a result, anti-HIV or antiviral drugs (lopinavir, tenofovir disoproxil, fosamprenavir and ganciclovir), antiflu drugs (peramivir and zanamivir) and an anti-HCV drug (sofosbuvir) are predicted to bind to 3CLPro in SARS-CoV-2 with therapeutic potential for COVID-19 infection by our new protocol. In addition, we also propose three antidiabetic drugs (acarbose, glyburide and tolazamide) for the potential treatment of COVID-19. Finally, we apply our new virus chemogenomics knowledgebase platform with the integrated machine-learning computing algorithms to identify the potential drug combinations (e.g. remdesivir+chloroquine), which are congruent with ongoing clinical trials. In addition, another 10 compounds from CAS COVID-19 antiviral candidate compounds dataset are also suggested by Molecular Complex Characterizing System with potential treatment for COVID-19. Our work provides a novel strategy for the repurposing and combinations of drugs in the market and for prediction of chemical candidates with anti-COVID-19 potential.
Vascular bundle modifications in nodes and internodes of climbing Marantaceae
Authors: Krähmer Hansjörg , Hesse Linnea , Krüger Friederike , Speck Thomas , Claßen-Bockhoff Regine
Published: September 2020

Nodes are interfaces between stems and leaves. Vascular bundles originate here and elongate into leaves and internodes. In Marantaceae, internodal bundles are highly diverse, including inverted bundles in the climbing genus Haumania. The objective of this paper is to characterize bundle forms, their position across the stem and their connection to leaves and short shoots in Haumania spp. and other unrelated African branch-angle climbers in the family (Hypselodelphys, Trachyphrynium). We question whether bundle inversion is a genus-specific trait in Haumania or related to the climbing growth form. Vascular bundles in internodes are scattered across the stem diameter in a characteristic pattern. Four (to five) bundle types follow each other in a centripetal order from highly sclerenchymatic ‘a’-bundles close to the epidermis to ‘d’-bundles in the centre with a low sclerenchyma proportion. Inverted bundles only appear in internodes of Haumania, making this trait a synapomorphy for the genus. The nodes show stem, leaf and short shoot bundles in a remarkably diverse pattern with partitioned phloem clusters and apparently augmented xylem elements. Our preliminary conclusion is that the inversion of bundles happens when leaf and short shoot traces join the main axis bundle layers.
In Vitro and In Vivo Evaluation of Two Hydroxychloroquine Tablet Formulations: HPLC Assay Development
Authors: Emami Jaber , Kazemi Moloud , Salehi Anahita
Published: September 2020

The relative in vitro and in vivo evaluation of two hydroxychloroquine (HCQ) products was conducted. In vitro studies involved assay, content uniformity and dissolution test, and a two-way crossover fashion were used for in vivo studies. Blood samples were collected at appropriate intervals and HCQ levels were measured using a validated reversed-phase high-performance liquid chromatography (HPLC) method. The drug and the internal standard, chloroquine (CQ), were extracted from blood with diethyl ether, separated and dried under nitrogen gas. Residues were reconstituted in the mobile phase and analyzed at 340 nm on a μ-bondapack C18 (250 × 4.6 mm) HPLC column with acetonitrile:methanol:KH2PO4 (10:10:80) mixture containing 0.01% triethylamine. The standard curve was linear within 50–1,500 ng/mL HCQ (R2 = 0.9996), relative errors were 1.6 to 5%, and the CV% ranged from 7 to 15.4. The resolution factor and RSD were 1.62 and 0.35% and in vitro data of both products met the USP requirements. The 90% confidence intervals for the ratios of the AUC0–96, Cmax and Tmax and their corresponding logarithmically transformed values of generic product over those of Plaquenil® were within the acceptable limit of 0.80–1.20 and 0.80–1.25, respectively. Therefore, the generic HCQ was bioequivalent to the innovator formulation.
Cefiderocol as Rescue Therapy for Acinetobacter baumannii and Other Carbapenem-resistant Gram-negative Infections in Intensive Care Unit Patients
Authors: Falcone Marco , Tiseo Giusy , Nicastro Manuela , Leonildi Alessandro , Vecchione Alessandra , Casella Costanza , Forfori Francesco , Malacarne Paolo , Guarracino Fabio , Barnini Simona , Menichetti Francesco
Published: September 2020

Ten critically ill patients with either bacteremia or ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii, Stenotrophomonas maltophilia, or New Delhi metallo-β-lactamase–producing Klebsiella pneumoniae received cefiderocol. All strains had minimum inhibitory concentration ≤2 μg/mL. Thirty-day clinical success and survival rates were 70% and 90%, respectively. Two patients had a microbiological failure. Future prospective studies are warranted.
Categorizing human phishing difficulty: a Phish Scale
Authors: Steves Michelle , Greene Kristen , Theofanos Mary
Published: September 2020

As organizations continue to invest in phishing awareness training programs, many chief information security officers (CISOs) are concerned when their training exercise click rates are high or variable, as they must justify training budgets to organization officials who question the efficacy of awareness training when click rates are not declining. We argue that click rates should be expected to vary based on the difficulty of the phishing email for a target audience. Past research has shown that when the premise of a phishing email aligns with a user’s work context, it is much more challenging for users to detect a phish. Given this, we propose a Phish Scale, so CISOs and phishing training implementers can easily rate the difficulty of their phishing exercises and help explain associated click rates. We base our scale on past research in phishing cues and user context, and apply the scale to previously published and new data from enterprise-based phishing exercises. The Phish Scale performed well with the current phishing dataset, but future work is needed to validate it with a larger variety of phishing emails. The Phish Scale shows great promise as a tool to help frame data sharing on phishing exercise click rates across sectors.
46 ESOPHAGECTOMY FOR ESOPHAGEAL CANCER TO THE PATIENT ACCOMPANIED WITH PROTEIN C DEFICIENCY
Authors: Ujiie N , Taniyama Y , Sato C , Takaya K , Okamoto H , Fukutomi T , Hatoyama K , Kamei T
Published: September 2020

Protein C deficiency is a rare genetic disease that predisposes to thrombotic disease, which is characterized by tendency to form thrombus due to hypercoagulation. The incidence of protein C deficiency with clinical symptoms has been reported to be estimated at 1 in 20,000. Only a few cases of surgery for gastrointestinal cancer with protein C deficiency have been reported, however, there have been no reports regarding the perioperative management in detail for those patients.

Methods

We present. We assess perioperative management for the case of esophagectomy for an esophageal cancer accompanied with protein C deficiency.

Results

A 63-year-old male with protein C deficiency underwent thoracoscopic esophagectomy and digestive reconstruction using gastric tube for thoracic esophageal cancer whose clinical stage was T1bN0M0. On postoperative day 3, his gastric tube was removed due to gastric tube necrosis. Digestive reconstruction using free jejunal graft has been attempted after 140 days from first surgery, however, thrombus formation in the jejunal artery and vein caused the reconstruction to failure. Ten days after this surgery, digestive reconstruction using colon was performed with anticoagulation control by administrating intraoperative heparin. The patient went fine without thrombus formation afterward.

Conclusion

During digestive reconstruction in patients with conditions predisposing to thrombus formation as typified by protein C deficiency, the perioperative management should be done with careful attention to prevent thrombus formation. In particular, because there is likely to develop necrosis of reconstructed organ due to thrombus formation, the appropriate anticoagulation control such as intraoperative heparin administration is recommended in patients with protein C deficiency.
55 OPTIMAL LYMPH NODE DISSECTION RANGE FOR ESOPHAGOGASTRIC JUNCTION CANCER
Authors: Okamoto H , Taniyama Y , Sato C , Takaya K , Fukutomi T , Kumagai T , Hatoyama K , Kamei T
Published: September 2020

There is no consensus on the mediastinal lymph node dissection range for esophagogastric junction cancer (EGJC).

Methods

We enrolled 113 patients with EGJC (defined by Nishi’s classification) who underwent R0 resection between January 2001 and December 2016, focusing on comparisons between squamous cell carcinoma (SCC) and adenocarcinoma (AC).

Results

The characteristics of patients with SCC (n = 53) and AC (n = 55) were as follows: age: 65.4 ± 1.4 and 64.1 ± 1.5 years; male/female: 46/12 and 48/7; preoperative treatment (none/NAC/NACRT): 29/19/10 and 53/2/0; surgical method (subtotal esophagectomy/lower esophagectomy and gastrectomy): 39/19 and 34/21; pStage (I/II/III): 15/14/29 and 13/10/32, respectively. Esophageal invasion (EI) exceeding 20 mm was associated with an increased incidence of metastasis to the upper and middle mediastinal LN in patients with SCC and AC. However, for patients with SCC, the upper/middle mediastinal LN dissection effect index was 6.9/6.9 compared with 0/0 for AC patients.

Conclusion

In patients with EI exceeding 20 mm, esophagectomy with lymphadenectomy up to the upper mediastinum should be performed owing to the high incidence of upper and middle mediastinal LNM. However, the dissection effect is very poor in patients with AC; therefore, multidisciplinary treatment should be considered for these patients.
417 GASTRIC CONDUIT FISTULA AFTER ESOPHAGECTOMY: WHY IT HAPPENS AND HOW TO MANAGE
Authors: Bianchi E , Tustumi F , de Miranda Neto A , Duarte A , Seguro F , Szachnowicz S , da Rocha J , Sallum R , Cecconello I
Published: September 2020

Gastric tube fistula is a rare event, but very feared, as it invariably progresses with associated mediastinitis and can be fatal. We present a case in which this fistula occurred together with all diagnostic investigation of etiology and treatment, in addition to a brief review of this complication.

Methods

A 45-year-old patient underwent minimaly invasive esophagectomy due to end-stage achalasia. After 6 days, she presented acute multivisceral migration to the chest and needed to reintervation by open surgery and hiatoplasty. The patient evolved with outflow of bile through the chest drain. Conservative treatment was attempted. However, after 4 days, she underwent thoracotomy and suture of the orifice, and a nasal tube was maintained to drain the gastric tube. There was no suture dehiscence and in control a seriogram evidenced pyloric stenosis. After 2 months, she was submitted to GPOEM with improvement of gastric emptying and normal return to feeding.

Results

The risk factors for gastric tube fistula are the same as those for cervical or intrathoracic anastomosis fistula after esophagectomy. Some authors attribute the vascularization of the stomach and malnutrition. However, as shown in this case, impairment of gastric emptying is an important factor to increased pressure and consequent fistula.

The patient experienced acute migration through the hiatus, which obstructed the tube for a few hours. And after the defect was corrected, he maintained an increased pressure due to pyloric achalasia, which was initially treated by depressurizing the tube by nasogastric tube and then GPOEM.

Conclusion

Gastric tube fistula can be avoided when we can establish a good gastric tube emptying condition.
418 SYSTEMATIC REVIEW OF LEARNING CURVES IN MINIMALLY INVASIVE PARAESOPHAGEAL HERNIA REPAIR: IS THERE ENOUGH EVIDENCE FOR MENTORSHIP IN SURGICAL RESIDENCY?
Authors: Prasad P , Navidi M , Hayes N , Wahed S , Immanuel A , Phillips A
Published: September 2020

Laparoscopic repair remains the approach of choice for the surgical management of symptomatic paraesophageal hernia (PEH), although robotic techniques are becoming increasingly popular. The learning curve for minimally invasive PEH repair can be variable and little is known of its potential impact upon surgical residents’ training. The aim of this review is to appraise current literature on learning curves in PEH repair and its impact on training and mentorship of surgical residents.

Methods

Literature searches were performed in three databases: MEDLINE (1980-2020), EMBASE and the Cochrane Library. Search results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data quality was assessed in accordance with the Newcastle-Ottawa Scale for cohort studies.

Results

A total of 6 studies were identified; 4 laparoscopic and 2 robotic assisted with 2678 patients assessed in total. One study used a cumulative sum (CUSUM) analysis to define learning with the remainder of studies using between 3 and 11 parameters. 2 studies evaluated trainees’ performance in performing laparoscopic PEH repair when mentored by surgeons who had achieved competence on the learning curve. Both studies reported equivalent clinical outcomes for laparoscopic PEH repair performed by trainees versus consultants, although one study suggested 5-year outcomes were inferior in the trainee group despite mentorship.

Conclusion

Despite being commonly performed, little is known about the learning curves for minimally invasive PEH repair. Furthermore, whether prior laparoscopic experience confers any advantage to performing robotic PEH repair is not known at present. Further data to help evaluate the learning curve for those performing PEH is required in order to enhance training and permit quicker attainment of competency.
423 OUTCOME OF LAPAROSCOPIC SURGERY FOR THE MANAGEMENT OF CORROSIVE STRICTURE OF THE OESOPHAGUS
Authors: Javed A , Agarwal A , Kumar N
Published: September 2020

The surgical treatment for a corrosive stricture of the oesophagus, after failed endoscopic dilatation, often involves oesophageal replacement using a gastric or a colonic conduit. This is traditionally done via the conventional open approach. The objective of this study was to ascertain short and long term outcomes of Laparoscopic gastric (LGP) and colon pull up (LCP) for the treatment of corrosive stricture of the oesophagus

Methods

Retrospective study of patients of corrosive oesophageal stricture, who, following a failed endoscopic dilatation, underwent a laparoscopic gastric or colon pullup between Jan 2011 and November 2019. All patients were evaluated with an upper endoscopy/contrast study to determine upper level and extent of stricture. Stomach was the preferred conduit, colon was used when either stomach was involved in the scarring process or in high pharyngeal strictures. Early and late postoperative outcomes were ascertained.

Results

During the study period, 254 patients with corrosive stricture oesophagus were managed surgically. Of these 50 underwent LGP and 10 underwent a LCP and these formed the study group. Mean age was 22.4 (2–42) years. The mean operative time (174.6 ± 43 and 322 ± 63 min) and blood loss (58.6 ± 23.9 and 108 ± 30.8 mL) for LGP and LCP respectively. Four patients developed mild respiratory infection. Eight patients developed cervical anastomotic leak. One patient had a colojejunal leak and another leak from the gastric tube staple line which was managed with drainage and antibiotics. At a mean followup of 51 months all patients were euphagic.

Conclusion

Laparoscopic surgery for corrosive strictures of oesophagus is safe and provides good short and long term outcomes.
430 BALLOON TAMPONADE UTILIZATION FOR SEVERE ESOPHAGITIS CAUSING HEMORRHAGIC SHOCK
Authors: Thaker S , Pajot G , Mikolajczyk A , Lipowska A
Published: September 2020

Esophagitis as a cause of upper gastrointestinal bleeding (UGIB) is a difficult entity to treat and is associated with significant morbidity. Epidemiologic studies note a 7-18% incidence of significant hemorrhage due to esophagitis. Current existing treatment options for UGIB complicated by hemorrhagic shock secondary to severe esophagitis are limited when there is a lack of response to proton pump inhibitor (PPI) medical therapy.

Methods

We present a case series of two patients who developed hemorrhagic shock from esophagitis, underwent endoscopic evaluation revealing limited treatment options, and ultimately required balloon tamponade resulting in successful resolution of bleeding and improvement in hemodynamics. A 55-year-old male with history of alcoholism complicated chronic pancreatitis and esophagitis presented with seizures. On admission he experienced hemorrhagic nasogastric tube output, anemia unresponsive to transfusions and hemodynamic instability. A 44-year-old patient with decompensated alcoholic cirrhosis was initially admitted for renal failure, and during the hospitalization developed melena and hemorrhagic shock requiring transfusions and vasopressors. The patients were promptly started on PPI infusion.

Results

Both patients underwent esophagogastroduodenoscopy revealing severe bleeding esophagitis extending from the gastroesophageal junction to the proximal esophagus and no varices. Active bleeding was not amenable to endoscopic therapy and both patients underwent balloon tamponade placement. The first patient required inflation of both the esophageal and gastric balloons for control of hemorrhage for 6 hours whereas the second patient required just gastric balloon inflation for 12 hours. Bleeding, transfusion requirement, and hemodynamics improved in both patients. Second look endoscopy demonstrated resolution of bleeding and hemostatic spray was applied to the esophagus prophylactically. Neither patient had recurrence of bleeding during the hospitalization.

Conclusion

UGIB secondary to esophagitis is difficult to control due to the highly vascularized nature of the esophagus. Endoscopic therapies are limited in extensive mucosal injury and risks of complications such as perforation are high. Other therapeutic options such as angiography are restricted due to vascular collateralization and surgical interventions have high morbidity and mortality. Balloon tamponade provides a viable treatment option for severe UGIB secondary to esophagitis that is not responsive to medical therapy.
456 PARAVERTEBRAL AND RECTUS SHEATH CATHETERS AS AN ALTERNATIVE TO THORACIC EPIDURAL FOR ANALGESIA POST-ESOPHAGECTOMY
Authors: Ng Cheong Chung J , Mohammed A , Navidi M , Wahed S , Immanuel A , Hayes N , Phillips A
Published: September 2020

Thoracic epidural (TE) analgesia has been the gold standard for pain management post-esophagectomy and is still being widely used. While it offers excellent analgesia, it can negatively impact on recovery due to hypotension.

An alternative is multimodal analgesia using intrathecal-diamorphine, paravertebral and rectus sheaths local anaesthetic infusion-catheters (LAC) and intravenous opioids (PCA).

The aim of this study was to compare the effectiveness of TE analgesia and multimodal LAC analgesia and the associated incidence of hypotension.

Methods

Data were collected over a three-year period for patients who underwent trans-thoracic (Ivor Lewis) esophagectomy from a single high volume unit. Multimodal analgesia was integrated into the patient pathway in early 2016 and adopted by all team members. All patients were treated post operatively with a standardised enhanced recovery pathway.

Pain scores using a visual analogue scale (VAS) at rest and movement, episodes of hypotension (systolic BP < 90 mmHg) and vasopressor requirements for post-operative days 0 to 4 (POD 0–4) were recorded for both groups.

Results

Overall 239 patients were included in this study, 104 patients received TE analgesia and 135 patients received multimodal analgesia. There was no statistically significant difference in the mean VAS pain scores between both cohorts on all post-operative days. (p = 0.06–0.89).

In comparison to TE analgesia, the multimodal patient group had significantly fewer episodes of hypotension (multimodal: 21% vs TE: 38%, p = 0.01) and significantly less vasopressor infusion requirements to maintain their blood pressure (multimodal: 30% vs TE: 55%, p = 0.01).

Conclusion

Multimodal analgesia using intrathecal diamorphine with combined paravertebral and rectus sheath catheters is not inferior to TE in providing pain control post esophagectomy. In addition there are significantly fewer episodes of hypotension and significantly less need for vasopressor use. This may confer a postoperative advantage permitting better patient mobilisation and recovery in the immediate post operative period.
470 OUTCOMES OF COMPOSITE REPAIR OF GIANT HIATAL HERNIA IN A LARGE SINGLE CENTRE COHORT.
Authors: Lee F , Khoma O , Mendu M , Falk G
Published: September 2020

Giant hiatus hernia (GHH) is usually symptomatic and can have significant impact on a patient’s quality of life. There is ongoing debate about optimal technique of giant hiatus hernia repair. This paper aims to look at the outcomes of laparoscopic composite repair of giant hiatus hernia from a large single centre cohort.

Methods

A retrospective analysis of prospectively maintained database was performed. Patients undergoing composite repair for GHH defined as >30% stomach above diaphragm were included. Primary outcome was hernia recurrence. Secondary outcomes were perioperative morbidity and mortality, correlation of symptoms and hernia recurrence post operatively, need for revision surgery, resolution of symptoms post operatively and patient self-reported quality of life (GIQOL, Visik score).

Results

Inclusion criteria were met by 221 patients. Post-operative endoscopic and/or barium swallow follow up was performed in 198 patients with 23.74% recurrence rate. There was no correlation with recurrence of hernia and persistent post-operative symptoms.

The most common presenting symptom was shortness of breath, followed by dysphagia, chest pain and heartburn. Dysphagia was most common post-operative symptom.

There was significant improvement in QOL post-operatively.

Conclusion

Laparoscopic composite repair was proven safe and effective in this cohort. Hernia recurrence was not associated with ongoing symptoms and did not have an effect on QOL. A small proportion of patients with recurrence required revision surgery. Overall satisfaction with surgery was high.
561 ENHANCING RADIATION-INDUCED IMMUNOGENICITY IN THE MULTIMODAL TREATMENT OF ESOPHAGEAL CANCER: IS HYPOFRACTIONATION THE ANSWER?
Authors: Donlon N , Davern M , Sheppard A , Elliott J , Ravi N , Donohoe C , Reynolds J , Lysaght J
Published: September 2020

Esophageal adenocarcinoma (EAC) is increasing exponentially year on year in Western civilisation, linked epidemiologically to GERD and obesity. It is characterized by a highly immunosuppressive tumour microenvironment (TME) and evasion of immune surveillance. A novel treatment option is upregulating immune mediated anti-tumour response via Immune Checkpoint Blockers (ICB).

Methods

The effects of immune checkpoint blockers were characterised in terms of proliferation, cytolysis and cancer cell viability. The basal expression of immune checkpoints (TIGIT, PD-1, PD-L1, PD-L2) and Damage Associated Molecular Patterns (Calreticulin, HMGB1) in EAC patients was profiled ex vivo using fresh tumor, blood and lymph-node tissue (n = 10) by flow cytometry. In an in-vitro study, T-lymphocytes were isolated and treated with Nivolumab, Pembrolizumab or Atezolizumab, activated and co-cultured for 48 hours with a panel of four esophageal cancer cell lines; OE33P, OE33R, FLO-1, FLO-1LM treated with 1.8Gy and 3.6Gy of radiation (Fig 1). Cytolysis was measured using a CCK8 assay.(n = 6).

Results

The expression of TIGIT, TIM-3, PD-1 and its ligands (PD-L1, PD-L2) were higher (p < 0.001) in EAC patients compared to age matched healthy controls. Similarly, when mimicking conditions of the TME including nutrient deprivation and hypoxia, this results in a significant (p < 0.001) increase in DAMP and ICB expression on CD3,4 and CD8 T cells in the TME when treated with radiation. T-lymphocytes induced by checkpoint blockers plus ionising radiation directly to the tumor resulted in the best repression of tumour growth with 3.6Gy inducing the highest rate of cytolysis (p < 0.001). ICB and radiation resulted in reduced cancer cell viability and proliferation.

Conclusion

Fractionated radiation can enhance immunologic function. In combination with ICB, this symbiotic relationship enhances the cytotoxic potential of T lymphocytes with conventional dosing, however, with hypofractionation, this signifies true immunogenicity, and as such this provides a basis for advocating for potential combination strategies with ICB in the multimodal treatment of EAC.
79 PREOPERATIVE TOBACCO CESSATION AND MAJOR POSTOPERATIVE MORBIDITY IN PATIENTS UNDERGOING ESOPHAGECTOMY
Authors: Corsini E , Mitchell K , Zhou N , Antonoff M , Mehran R , Rice D , Roth J , Sepesi B , Swisher S , Vaporciyan A , Walsh G , Karam-Hage M , Hofstetter W
Published: September 2020

While preoperative tobacco cessation has been associated with decreased pulmonary complications in lung cancer patients in the postoperative period, this relationship has not been explored among patients undergoing esophagectomy in this era of increasingly prevalent tobacco cessation campaigns and enhanced recovery after surgery.

Methods

We reviewed ever-smokers who underwent esophagectomy at a single institution from January 2004 through June 2019 for esophageal cancer. Occurrence of Clavien-Dindo classification ≥3 major postoperative morbidity (MPM), including anastomotic leak, chylothorax, reoperation, organ dysfunction, respiratory failure, and ICU readmission was calculated. In an effort to evaluate an effect of smoking cessation on outcome, never-smokers were excluded from analyses. Multivariable logistic regression with backwards stepwise elimination was completed to determine the optimal cessation interval associated with reduction in MPM. Robust standard errors were used to account for clustering among surgeons.

Results

725 patients met inclusion criteria, including 666 (92%) with adenocarcinoma and a smaller proportion with squamous cell carcinoma. Most patients were male (650, 90%), and the median age was 63 years (IQR 57–69). Records showed that 505 patients (60%) had quit >5 years prior to esophagectomy, and 82 (11%) were current smokers or had quit within the month preceding esophagectomy. MPM occurred in 213 (29%). After univariate regression, age, gender, pack-year history, operative duration, and FEV1 were included in a multivariable model. While age remained associated wtih MPM, preoperative tobacco cessation of any interval was not associated with outcomes.

Conclusion

Our previous publication showed increased complication risk for smokers undergoing esophagectomy compared to non-smokers. However, among ever-smokers, no specific interval of preoperative cessation demonstrated decreased MPM. In a setting of active tobacco cessation programs, patients who have not completely achieved abstinence may still be offered surgery with equivalent perioperative outcomes.
133 SURGICAL MANAGEMENT OF ESOPHAGEAL STENOSIS DUE TO CORROSIVE SUBSTANCES
Authors: Tustumi F , Seguro F , Szachnowicz S , Bianchi E , Morrell A , Silva M , Duarte A , Sousa J , Laureano G , Rocha J , Sallum R , Cecconello I
Published: September 2020

Corrosive ingestion is a significant challenge for healthcare support. Limited data is available regarding the best treatment, and there is still a lack of consensus about the optimal surgical approach and its outcomes. This study aims to show a single-institution experience of surgical treatment of esophageal stenosis due to corrosive substance ingestion and review the current literature.

Methods

A retrospective review, including demographics, psychiatric profile, surgical procedures, and outcomes, is described. A systematic review of the literature was performed in PubMed.

Results

In total, 27 surgical procedures for esophageal stenosis due to corrosive substances ingestion were performed from 2010 to 2019. Depression and drug abuse were diagnosed in 30% and 22% of the included patients, respectively. The incidence rate of cancer in patients with corrosive esophageal stenosis is 701.7–874.1 per 1,000,000 person-years, and the cancer latency between corrosion ingestion to carcinoma is 10–58 years. Esophagectomy and esophageal bypass were performed in 13 and 14 patients, respectively. No 30-day mortality was recorded.

Conclusion

The surgical intervention either by esophagectomy or esophageal bypass seems to show a high success rate. However, the outcomes depend on a high-quality multidisciplinary network of esophageal and thoracic surgeons, intensivists, psychologists, psychiatrists, and nutritional teams.
182 PREOPERATIVE COMBINATION OF PEMBROLIZUMAB WITH CHEMORADIATION FOR PATIENTS WITH LOCALLY ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA:MID-TERM RESULTS OF NCT03604991
Authors: Li H , Li C , Zheng Y , Zhao S , Chen X , Han Y , Xiang J , Wu Y
Published: September 2020

Esophageal squamous cell carcinoma (ESCC) ranks the most common subtype of esophageal cancer in Asia. Neoadjuvant chemoradiotherapy (CRT) followed by radical resection is thought to be the most effective therapeutic plan for locally advanced ESCC. This study aims to evaluate the safety and feasibility of preoperative Immunotherapy with concurrent CRT in treating locally advanced ESCC.

Methods

The 20 enrolled patients will receive preoperative immune therapy (Pembrolizumab) with concurrent CRT. Neoadjuvant CRT includes carboplatin (AUC = 2, once a week for 5 weeks), paclitaxel (50 mg/m2, once a week for 5 weeks) and radiotherapy (23 fraction of 1.8 Gy, 5 fraction a week). Pembrolizumab (2 mg/kg) will be given on day 1 and day 22 of neoadjuvant therapy. Within 4–6 weeks after the completion of preoperative therapy, patients will undergo esophagectomy. PET-CT was obtained at baseline and prior to surgery. The primary end point of the study was safety. We also evaluated the feasibility, pathologic complete response (PCR) and radiographic response.

Results

All the 20 patients have received pembrolizumab with concurrent CRT successfully, neoadjuvant pembrolizumab plus CRT had an acceptable side-effect profile and the most common side effect during neoadjuvant therapy was decreased WBC, 1 patient died for esophageal bleeding 2 weeks after neoadjuvant therapy; 1 patient was dis covered to have liver metastasis and discontinued the study treatment; 15 patients undergo esophagectomy within 4–6 weeks after neoadjuvant therapy, 9 patients achieved PCR and 6 patients were partial response, the PCR rate was 52.9%(9/17) of all tumors and 60% of resected tumor(9/15);so far 3 patients were still waiting for surgery.

Conclusion

Neoadjuvant pembrolizumab with concurrent CRT was safe, did not delay surgery and induced a PCR in 52.9% of all tumors and 60% of resected tumor, supporting a further study to confirm whether patient can benefit from neoadjuvant pembrolizumab with concurrent CRT. (ClinicalTrials.gov number, NCT03604991.)
282 CERVICAL ESOPHAGECTOMY USING “LARYNX ROTATION METHOD” CAN OBTAIN GOOD CLINICAL OUTCOMES.
Authors: Nakajima Y , Ogiya K , Endo H , Okada T , Hoshino A , Kawada K , Saeki I , Takahashi S
Published: September 2020

In the treatment of cervical esophageal carcinoma (CEC), preservation of laryngeal function is required as well as curability. Therefore, chemoradiotherapy (CRT) is often selected for larynx-preservation. In our department, larynx-preserving surgery using “larynx-rotation method” is aggressively carried out even when the oral side of the tumor margin extends beyond the esophageal orifice. In this study, we analyzed the clinical outcomes of the resectable CEC and examined ``Which therapeutic modality should be selected, surgery or CRT?''

Methods

In the present study, 40 patients whose primary tumor was resectable Stage II/III CEC treated in our department since 2008, whose advanced primary tumor lesion was limited within cervical esophagus, and who undergo surgery or curative CRT were enrolled. The clinical outcomes were retrospectively analyzed.

Results

The Op group included 25 patients. All of the Op group patients could preserve the larynx. In the CRT group, 2 patients were performed pharyngo-laryngo-cervical esophagectomy as the salvage surgery. 1- and 3-year progression-free survival rate was 80.1 and 69.3% in the Op group, and 63.0 and 31.5% in the CRT group. 1-, 3- and 5-year overall survival rate was 95.8, 80.9 and 67.4% in the Op group and 78.6, 64.3 and 46.9% in the CRT group, respectively. Although there was no significant difference, the Op group showed relatively better clinical outcomes.

Conclusion

Cervical esophagectomy using “larynx-rotation method” could obtain good therapeutic outcomes while preserving the larynx. Especially in case cervical esophagectomy is sufficient as the curative resection, because the surgical invasion is little and the postoperative quality of life is good while preserving the larynx and the whole stomach, surgery is considered useful treatment modality.