bluuebunny/crossref_metadata_2025 huggingface dataset:
RA06.07: PSYLLIUM SUPPLEMENTATION EFFECT ON ESOPHAGEAL FUNCTION TESTING AND SYMPTOMS IN PATIENTS WITH NON-EROSIVE GERD
Authors: Morozov Sergey , Isakov Vasily , Konovalova Mariya
Published: September 2018

Background

Epidemiological data showed negative correlation between heartburn frequency and amount of dietary fiber consumed. However no interventional study was performed to prove clinically beneficial effect of dietary fibers in gastroesophageal reflux disease (GERD) patients.

The aim of the study was to investigate the effect of dietary fiber on symptoms and esophageal function testing parameters in non-erosive GERD patients (NCT01882088)

Methods

Thirty six NERD patients were examined using food frequency questionnaire and in case of less than 20 g/day dietary fibre intake underwent high-resolution esophageal manometry and 24-hours esophageal pH-impedance. Language-specific GERD-Q questionnaire was used to assess symptoms. Repeated examinations were performed after 10 days of usual diet supplemented by psyllium 15.0 gram a day. Complete data of 30 NERD patients were available for the final analysis. Study design is shown in a figure 1. Wilcoxon matched pairs test was used to assess changes in the studied parameters

Results

The decrease in proportion of patients experiencing heartburn as well as GERD-Q score decrease were found. Minimal resting lower esophageal sphincter pressure increased from 5.41 ± 10.1 to 11.3 ± 9.4, P = 0.023. No change in residual LES pressure and mean resting pressure was found. Total number of gastroesophageal refluxes decreased from 67.9 ± 17.7 to 42.4 ± 13.5, P < 0.001 (Table 1).

Conclusion

Supplementation of diet with psyllium 5.0 gram TID in NERD patients led to significant increase of minimal esophageal resting pressure, decrease of number of gastroesophageal refluxes and frequency of heartburn per week. The work was supported by Federal Agency of Scientific Organizations of Russia (0529–2017-0057)

Disclosure

All authors have declared no conflicts of interest.
RA07.04: DIAGNOSTIC UTILITY OF ENDOBRONCHIAL ULTRASONOGRAPHY FOR THE TRACHEOBRONCHIAL INVASION OF ESOPHAGEAL CANCER
Authors: Nishino Takeshi , Yoshida Takahiro , Inoue Seiya , Goto Masakazu , Tangoku Akira
Published: September 2018

Background

Preoperative precise diagnosis of invasion to the trachea and bronchi from advanced esophageal cancer is important to estimate the prognosis and resectability. But it is difficult to diagnose the invasion to the tracheobronchial adventitia by conventional examination, like CT scan, MRI, bronchoscopy, etc. The purpose of this study is to clarify the diagnostic utility of endobronchial ultrasonography (EBUS) for the invasion to the trachea and bronchi of esophageal cancer.

Methods

We examined the diagnostic utility of EBUS in cadaver, by comparing echoic image and actual tracheobronchial structure using tracheal invasion model. The model was made by cauterizing adventitia with the electrical scalpel. The cancer image model was made by injecting the agarose gel into esophageal muscular layer. And we also examined for clinical T3 or T4b esophageal cancer cases using EBUS for the diagnosis of tracheobronchial invasion.

Results

Normal image of tracheal wall was shown as three layers (high-low-high echoic layers) by EBUS. Echoic image of the tracheal invasion model in cadaver showed disappearance of the deepest high echoic layer. Histological examination proved interruption of tracheal adventitia by cauterization. Echoic image of tumor image model showed disappearance of the deepest high echoic layer and clearly observed tumor like agarose gel through the tracheal wall. These indicated the deepest high echoic layer correspond with the tracheal adventitia layer. EBUS could be visualized esophageal cancer invasion to the tracheobronchial adventitia. We performed EBUS for 32 cases of T3 or T4b esophageal cancer had been suspected the tracheobronchial invasion. 9 cases were diagnosed as T3 without invasion to the trachea or bronchi and received neo-adjuvant therapy following surgery, and all cases of these were confirmed precise diagnosis of EBUS in histological findings. 23 cases were diagnosed as T4b with invasion to the trachea or bronchi and received definitive chemo-radiation, and one patient received esophagectomy and pharyngolaryngectomy for salvage surgery and also confirmed accuracy of preoperative diagnosis using EBUS in histological findings.

Conclusion

EBUS is useful to diagnose the tracheobronchial invasion of esophageal cancer. Precise diagnosis of the tracheobronchial invasion using EBUS will help us to perform R0 resection and improve the prognosis of cT4b esophageal cancer.

Disclosure

All authors have declared no conflicts of interest.
RA07.05: DIAGNOSTIC VALUE OF INTRAOPERATIVE ULTRASONOGRAPHY IN ASSESSING THORACIC RECURRENT LARYNGEAL NERVE LYMPH NODES IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Yang Hong
Published: September 2018

Background

To evaluate the ability of intraoperative ultrasonography (IU) to detect recurrent laryngeal nerve (RLN) nodal metastases in esophageal cancer patients.

Methods

Sixty patients with esophageal cancer underwent IU, computed tomography (CT), and endoscopic ultrasonography (EUS) to assess for RLN nodal metastasis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared.

Results

The sensitivities of IU, CT, and EUS in diagnosing right RLN nodal metastases were 71.4%, 14.3%, and 30.0%, respectively, and a significant difference among these three examinations was observed (c2 = 10.077, P = .006). The specificities of IU, CT, and EUS for diagnosing right RLN nodal metastasis were 67.4%, 97.8%, and 95.0%, respectively, and a significant difference was observed (c2 = 21.725, P < .001). No significant differences in either PPV or NPV were observed when diagnosing right RLN nodal metastases. For diagnosis of left RLN lymph nodal metastases, the sensitivities of IU, CT, and EUS were 91.7%, 16.7%, and 40.0% respectively. There was a significant difference among these diagnostic sensitivities (c2 = 14.067, P = .001). The specificities of IU, CT, and EUS for diagnosis of left RLN nodal metastases were 79.2%, 100%, and 82.5%, respectively and a significant difference was observed (c2 = 10.819, P = .004). No significant differences were observed in PPV or NPV for these examinations when diagnosing left RLN nodal metastases.

Conclusion

Intraoperative ultrasonography showed superior sensitivity compared with preoperative CT or EUS in detecting RLN lymph node metastasis in patients with thoracic esophageal cancer.

Disclosure

All authors have declared no conflicts of interest.
RA07.06: BASELINE FDG-PET/CT PARAMETERS AS PREDICTOR FOR RESIDUAL TUMOUR AFTER NEOADJUVANT CHEMORADIOTHERAPY IN OESOPHAGEAL CANCER PATIENTS
Authors: Valkema Maria , Noordman B , Wijnhoven Bas P L , Spaander M C W , Lagarde Sjoerd M , Ruurda Jelle , Nieuwenhuijzen Grard A P , Van Berge Henegouwen M I , Sosef M N , Siersema P D , Van Lanschot J J B , Valkema R
Published: September 2018

Background

An optimal model for predicting pathologic response after neoadjuvant chemoradiotherapy (nCRT) in oesophageal cancer has not been defined yet. FDG-PET/CT is frequently used in response assessments. The aim of this side study of the preSANO trial (NL41732.078.13) was to investigate if the FDG-PET parameters SUVmax, total lesion glycolysis (TLG) and metabolic tumour volume (MTV) were predictive for residual tumour in the resected specimen of oesophageal cancer patients treated with nCRT.

Methods

Patients underwent FDG-PET/CT at baseline according to the European Association of Nuclear Medicine guidelines 1.0 (2.3MBq/kg F-18-FDG; scanning 60 ± 5min.). All parameters were corrected for lean body mass. MTV was defined as the volume within a 41% of SULmax ( = SUV/lean body mass) isocontour threshold at tumour and lymph nodes. TLG was calculated as SULmean x MTV. Logarithmic transformation was performed because of non-normal distribution of TLG and MTV. Baseline PET parameters were compared to tumour regression grade in the resection specimen (TRG3–4 = > 10% residual tumour vs. TRG1 = complete response). Peroperatively irresectable tumours were recoded as TRG4. Analyses were performed using an independent-samples T-test.

Results

From a total of 207 patients who underwent FDG-PET/CT before nCRT, 197 were included for analysis (5 were non-FDG avid, 5 had incomplete data). Histological type of tumour: adenocarcinoma (AC) n = 154, squamous cell carcinoma (SCC) n = 42, and one adenosquamous carcinoma. Thirty-seven patients (19%) had TRG1 and 41 patients (21%) had TRG3–4. In complete responders (TRG1), SULmax, TLG and MTV (mean ± SD) were 9.6 ± 5.8, 85.3 ± 85.5 and 13.0 ± 9.9, respectively. In patients with TRG3–4, SULmax, TLG and MTV were 9.4 ± 5.4145.8 ± 164.6 and 21.9 ± 16.2, respectively. SULmax was not significantly different between both groups (P = 0.8), but log(TLG) and log(MTV) (P = 0.008 and P = 0.001) were. In adenocarcinomas, log(TLG) did not differ between groups (P = 0.1).

Conclusion

Initial FDG tumour mass, expressed as MTV, (rather than SULmax) is the most contributing factor in predicting residual disease after nCRT in both SCC and AC. The effect is stronger in SCC. Therefore, baseline FDG tumour mass should be included in a prediction model, besides other clinical and tumour parameters.

Disclosure

All authors have declared no conflicts of interest.
RA07.07: THE ROLE OF 18F-FLUORODEOXYGLUCOSE POSITRON-EMISSION TOMOGRAPHY ON SURVIVAL OF PATIENTS FOLLOWING NEOADJUVANT CHEMOTHERAPY AND SURGERY FOR ESOPHAGEAL CANCER
Authors: Aoyama Junya , Kawakubo Hirofumi , Mayanagi Shuhei , Fukuda Kazumasa , Suda Koichi , Nakamura Rieko , Wada Norihito , Kitagawa Yuko
Published: September 2018

Background

The occurrence of lymph node metastases (LNMs) is a critical factor for postoperative survival in patients with esophageal cancer. Generally F-fluorodeoxyglucose positron-emission tomography (FDG-PET) has a low sensitivity and a relatively high rate of false-negative for detecting LNMs. However, the role of FDG-PET in predicting the outcome is still unclear. The aim of this study is to assess the role of FDG-PET in predicting survival in patients with resectable thoracic esophageal squamous cell carcinoma (TESCC) treated with neoadjuvant chemotherapy (NAC).

Methods

Seventy-three patients with TESCC received NAC followed by surgery, and underwent FDG-PET before NAC in our hospital between January 2012 and November 2016. The number of PET-positive lymph nodes (LNs) and the maximum standardized uptake value (SUVmax) of the LNs were prospectively evaluated. The results of FDG-PET were compared with the pathological results and the prognosis.

Results

15 patients had no PET-positive LNs, 23 had one, 15 had two and 20 patients had three or more positive LNs. A significantly high proportion of the PET-positive LNs ≧3 group had ≧3 pathological LNMs than the PET-positive LNs ≦2 group (70.0 vs. 22.6%, P < 0.001). The PET-positive LNs ≧3 group also had a significantly lower 3-year overall survival rate (47.9 vs. 71.9%, P = 0.018). Univariate Cox's proportional hazard regression analyses revealed the PET-positive LNs ≧3 status (Hazard ratio = 2.68 [1.14–6.28], P = 0.024) and the SUVmax of the LNs ≧8 status (Hazard ratio = 2.45 [1.06–5.65], P = 0.036) were significant prognostic factors. On the other hand, the SUVmax of the primary tumor was not a significant prognostic factor.

Conclusion

We identified the PET-positive LNs ≧3 status and the SUVmax of the LNs ≧8 status in patients with resectable TESCC before NAC as potential adverse prognostic factors for survival.

Disclosure

All authors have declared no conflicts of interest.
RA07.08: SURGICAL AND PATHOLOGICAL IMPACT OF THE NOVEL CLASSIFICATION OF AN ANATOMY OF BRONCHIAL ARTERIES IN PATIENTS WHO UNDERWENT ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Amada En , Kawakubo Hirofumi , Mayanagi Shuhei , Nakamura Rieko , Wada Norihito , Suda Koichi , Takeuchi Hiroya , Kitagawa Yuko
Published: September 2018

Background

The first systematic classification of an anatomy of bronchial arteries (BAs) is reported by Cauldwell E. W. in 1948. However, it is not suitable for recognizing anatomy of BAs for esophageal surgery since it does not contain information of relative position of BAs and esophagus. So, the aim of this study is to device a novel classification of BAswhich correlates with surgical and pathological factors of esophageal cancer.

Methods

Eighty-six patients that have undergone curative esophagectomy from April 2012 to March 2016 for esophageal cancer whose epicenter is located in midthoracic esophagus were enrolled. Dynamic-enhanced computed tomography imaging (dCT) and clinico-pathological factors were analyzed. The right (rt-) BA which runs along the right side of esophagus is defined as Median (M) type and rt-BA which runs along the left side of esophagus is defined as Lateral (L) type. Also, the BA which arises from right side of aortic arch and runs down aortopulmonary window is defined as Tracheal (T) type and the others are defined as Bronchial (B) type. We classified patients by combination of M/L type and T/B type.

Results

dCT was performed in 81 cases. The number of patients with type of MT, MB, LT and LB were 19, 46, 12 and 4, respectively. Existence of rt-2nd-BA is significantly frequent in LB type and existence of lt-2nd-BA is significantly frequent in M type (P < 0.001, P = 0.012, respectively). Also, rt and lt BA forms common trunk significantly frequent in patients with LT type (P = 0.012). As for pathological factors, 38 patients had pathological lymph node metastasis. Among these patients, MT type patients have significantly more metastasis-positive lymph nodes (mLN) in #107 (P = 0.006) and LT type patients have significantly more mLN nodes in #105 (P = 0.039). Also, we compared pretreatment diagnosis of metastasis positive LNs (pre-mLNs) and pathological metastasis positive LNs. And we found that false- falsenegative cases of pretreatment diagnosis are significantly frequent in M type on #105 and cases with absence of lt-2nd-BA on #106recR (P = 0.038, P = 0.018, respectively).

Conclusion

Classifying an anatomy of BAs by relative position to esophagus and their origin is possibly helpful in esophageal surgery.

Disclosure

All authors have declared no conflicts of interest.
RA08.02: RELATIONSHIP BETWEEN ABDOMINAL FAT DISTRIBUTION AND VASCULAR INVASION AMONG PATIENTS WITH EARLY ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Yamamoto Yasunori , Ishiyama Akiyoshi , Namikawa Ken , Nakano Kaoru , Yamasaki Akira , Yoshimizu Shoichi , Yoshio Toshiyuki , Tsuchida Tomohiro , Fujisaki Junko , Okamura Akihiko , Watanabe Masayuki
Published: September 2018

Background

Excessive visceral fat might promote cancer development and progression because of metabolic disruption. A previous study has demonstrated that visceral obesity associated with lymphatic invasiveness and a poor response to preoperative treatment among patients who underwent esophagectomy for advanced esophageal squamous cell carcinoma (ESCC). This study aimed to clarify the impact of abdominal fat distribution on lymphatic and vessel invasion after endoscopic submucosal dissection (ESD) or esophagectomy for early ESCC (eESCC).

Methods

We enrolled the 106 patients who had undergone ESD or curative esophagectomy for pathological T1-muscularis mucosa (MM) and T1-submucosal layer (SM) lesions between January 2015 and December 2016. Using computed tomography volumetry, we measured areas of visceral (VFA) and subcutaneous (SFA) fat at the level of the umbilicus, and calculated the VFA/SFA ratio in each patient. We also measured body mass index (BMI). Lymphatic and vessel invasion by eESCC were compared with these parameters and between groups classified according to VFA/SFA ratios.

Results

Significantly more patients in the T1-MM group with high VFA/SFA had lymphatic invasion of eESCC compared with those who had low VFA/SFA (35.7% vs. 7.1%, P = 0.010). Metastatic lymph nodes were detected only in patients with high VFA/SFA who underwent esophagectomy. Values for BMI, VFA, and SFA were lower in patients with venous invasion than those without (BMI, 20 vs. 22.8, P = 0.076; VFA, 60.2 vs. 98.9 cm2, P = 0.042; SFA, 56.3 vs. 103.2 m2, P < 0.0001). In the T1-SM group, the SFA was lower in patients with lymphatic invasion than those without (74.4 vs. 115.2 m2, P = 0.010).

Conclusion

High VFA/SFA ratio was significantly associated with lymphatic invasion in patients with eESCC. Low values of BMI, VFA, and SFA was significantly associated with venous invasion in patients with eESCC. Abdominal fat distribution might influence lymphatic and vessel invasion by eESCC.

Disclosure

All authors have declared no conflicts of interest.
RA09.01: NORMAL LYMPH NODE APPEARANCE IN THE THORAX
Authors: Hansen Tomas , Nilsson Magnus , Lindholm Daniel , Sundström Johan , Hedberg Jakob
Published: September 2018

Background

Modern treatment of esophageal cancer is multimodal and highly dependent on detailed diagnostic assessment of clinical stage which includes nodal stage. Clinical appraisal of nodal stage requires knowledge of normal radiological appearance, information of which is scarce. We aimed to describe lymph node appearance on computed tomography (CT) investigations in a randomly selected cohort of healthy subjects.

Methods

In a sample of 426 healthy Swedish volunteers aged 50–64 years, CT scans were studied in detail concerning intrathoracic node stations relevant in clinical staging of esophageal cancer. With stratification for sex, the short axis of visible lymph nodes was measured and distribution of lymph node sizes was calculated as well as proportion of patients with visible nodes above 5 and 10 millimeters for each station. Probability of having any lymph node station above 5 and 10 millimeters was calculated with a logistic regression model adjusted for age and sex.

Results

In the 214 men (age 57.3 ± 4.1 years) and 212 women (57.8 ± 4.4years) included in the study, a total of 309 (72.5%) had a lymph node with a short axis of 5 mm or above was seen in one of the node stations investigated. When using 10 mm as a cutoff, nodes were visible in 29 (6.81%) patients. Men had three times higher odds of having any lymph node with short axis 5 mm or above (OR 3.03 95% CI 1.89–4.85, P < 0.001) as well as 10mm or above (OR 2.31 95% CI 1.02–5.23, P = 0.044) compared to women. Higher age was not associated with propensity for lymph nodes above 5 or 10 millimeters in this sample.

Conclusion

In a randomly selected cohort of patients between 50 and 64 years, almost ten percent of the men and four percent of the women had lymph nodes above ten millimeters, most frequently in the subcarinal station (station 107). More than half of the patients had nodes above five millimeters on computed tomography and men were much more prone to have this finding. The probability of finding lymph nodes in specific stations relevant of esophageal cancer is now described.

Disclosure

All authors have declared no conflicts of interest.
RA09.07: SURGICAL MANAGEMENT OF EARLY ESOPHAGEAL CANCER BASED ON LYMPH NODE METASTASIS RISK.
Authors: Duan Xiaofeng , Yu Zhentao
Published: September 2018

Background

Esophagectomy and lymph node dissection is still the main treatment for esophageal cancer. Endoscopic mucosal resection and submucosal dissection are increasingly becoming a treatment of choice to preserve the integrity of the esophagus and decrease the surgical trauma in early esophageal cancer. However, lymph node metastasos (LNM) risk is still a debate focus for the decision of treatment selection. Our objective was to evaluate the prevalence, pattern and risk factors of LNM in early stage esophageal cancer to improve surgical treatment allocation.

Methods

We identified patients with pathological T1 stage esophageal cancer who underwent esophagectomy and lymph node dissection. The pattern of LNM was analyzed and the risk factors related to LNM were assessed by univariate and multivariable logistic regression analysis.The nomogram model was used to estimate the individual risk of lymph node metastasis.

Results

In 143 patients, LNM rates were: all patients 17.5%, T1a 8.0%, and T1b 22.5% for T1b. Depth of tumor infiltration (P < 0.05), tumor size (P < 0.01), tumor location (P < 0.05), and tumor differentiation (P < 0.01) were independent risk factors related to LNM. These four parameters allowed the compilation of a nomogram to estimate the individual risk of LNM. Fig. Nomogram to estimate the individual risk of LNM. Each characteristic of the included parameters scores a specific number of points (points per parameter). The summarized total points score indicates the probability of LNM. For a middle esophageal cancer with middle differentiated (G2), 3 cm tumor (> 2.5cm) that invades the submucosa (pT1b), the calculated total scores is 129.5 = 87.5 + 21 + 0 + 21, hence the corresponding LNM risk is 20%.

Conclusion

T1 esophageal cancer has a relatively high LNM rate, and the depth of tumor infiltration, tumor size, tumor location and tumor differentiation are correlated with LNM. Nomograms that include factors can be used to predict individual LNM risk. The LNM risk and extent must be considered comprehensively in decision-making of a better surgical treatment and lymph node dissection strategy.

Disclosure

All authors have declared no conflicts of interest.
RA10.02: A NOVEL ROLE FOR THE COMPLEMENT CASCADE IN CHEMORADIATION THERAPY RESISTANT OESOPHAGEAL ADENOCARCINOMA
Authors: Cannon Aoife , Lavin Danica , Byrne Róisín , Reynolds John , O'Sullivan Jacintha , Lynam-Lennon Niamh
Published: September 2018

Background

Resistance to chemoradiation therapy (CRT) in oesophageal adenocarcinoma (OAC) is an important clinical challenge. Elucidating underlying mechanisms of treatment resistance is crucial to improving survival rates.

Methods

OAC tumour biopsies were collected prior to neoadjuvant CRT. Tumour conditioned media was generated by culturing human explants for 24 h. Response to treatment was determined pathologically using the Mandard Grading System. C3, CFB and MCP-1 mRNA expression was assessed by qPCR. Secreted C3, C3a and MCP-1 were measured by ELISA. An isogenic model of radioresistant OAC was established by chronically irradiating OE33 cells with clinically-relevant doses of 2 Gy X-ray radiation. C5aR and C3aR expression was determined by flow cytometry.

Results

We demonstrate, for the first time, that the central factor of the complement cascade, complement component 3 (C3), is expressed in OAC tumours and is increased in pre-treatment OAC biopsies from patients (n = 13) who have a subsequent poor response to neoadjuvant CRT (P < 0.05). In addition, C3 is secreted from ex vivo human OAC tumour explants (n = 13) and correlates with levels of the monocyte chemoattractant MCP-1 (P < 0.008) and complement factor B (CFB) a component of the alternative pathway of complement activation (P < 0.0001). In vitro, radioresistant OE33 R cells had increased mRNA levels of C3 (P < 0.01), CFB (P < 0.05) and MCP-1 (P < 0.05) compared to radiosensitive OE33 P cells. OEE3 R cells expressed increased levels of secreted C3 and the anaphylatoxin C3a, compared to radiosensitive OE33P cells (both P < 0.001). Furthermore, we demonstrate for the first time that the anaphylatoxin receptor C5aR is expressed by OAC cells, suggesting that OAC cells can respond to complement anaphylatoxins.

Conclusion

This study highlights, for the first time, a novel role for the complement cascade in the resistance of OAC to CRT and highlights C3 as a novel predictive marker of response to CRT in OAC.

Disclosure

All authors have declared no conflicts of interest.
VS01.05: RADICAL OPERATION OF ESOPHAGEAL CANCER UNDER 2D THORACOSCOPE
Authors: Jiang Jie , Yu Xiuyi , Geng Guojun , Liu Hongming
Published: September 2018

Description

To The basic operation procedure of esophageal cancer radical surgery.

Disclosure

All authors have declared no conflicts of interest.
VS01.09: ROBOTIC MCKEOWN ESOPHAGECTOMY: LESSONS LEARNED AFTER 50 CASES
Authors: Sallum Rubens , Takeda Flavio , Santo Marco , Duarte Andre , Cecconello Ivan
Published: September 2018

Description

Authors show the lessons learned after 50 robotic esophagectomies: the new positioning of the 4 robotic arms in the thorax avoiding collisions, fixation of the arches of the azygos vein arch (after section) and retraction of the trachea allowing the dissection of the left recurrent nerve lymph nodal chain, especially within the aortic arch. Abdominal dissection and cervical anastomosis are also presented. The film end with the results compared to Thoracoscopic Esophagectomy

Disclosure

All authors have declared no conflicts of interest.
VS02.02: LAPAROSCOPIC TRANS-HIATAL REPAIR FOR BOERHAAVE’S SYNDROME: A CASE REPORT
Authors: Masui Hideyuki , Kobayashi Hiroyuki , Kondo Masato , Kaihara Satoshi , Hosotani Ryo
Published: September 2018

Description

Introduction Spontaneous esophageal rupture, also known as Boerhaave's syndrome, is an uncommon and potentially life-threatening condition that requires urgent surgical management. We report a case of spontaneous esophageal rupture that was successfully treated by primary closure and drainage laparoscopically. Case report The patient was a 49 year-old man with a history of liver cirrhosis. He experienced sudden-onset epigastric pain triggered by vomiting after drinking alcohol, and transported to our hospital. On admission, a thoracic CT scanning revealed mediastinal emphysema without pleural effusion. We diagnosed BS and performed an emergency operation. We chose laparoscopic trans-hiatal approach as it was thought to be minimally invasive compared with open thoracic surgery. Five trocars were placed in a similar way of gastric cancer surgery. We identified laceration on the left wall of the lower esophagus under assistance of intra-operative upper endoscopy, and conducted drainage and repair by primary closure with continuous barbed suture. Finally, an omental pedicle flap was applied for over sutured site. The operation time was 214 minutes and the amount of blood loss was 50 cc. In the post-operative course, intra-mediastinal abscess was observed and he required antibiotic therapy. However, the patient was discharged on the 16th post-operative day without a serious complication such as anastomotic leakage. Discussion Primary esophageal repair is the gold standard in Boerhaave's syndrome and the approach is usually left thoracotomy. However, if there is no perforation into the thoracic cavity as in our case, less invasive approach should be considered such as laparoscopic trans-hiatal approach. We could observe the lower esophagus completely under a good field of view in this approach. There are several treatments, and it should always be tailored to the patient's condition. Laparoscopic trans-hiatal approach is considered to be useful for the treatment of lower esophageal wall rupture. It is difficult to conduct a comparative study of the various methods that can be used to treat spontaneous esophageal rupture in cases that require emergent surgery, as the number of cases is limited. Therefore, the further accumulation of cases is necessary.

Disclosure

All authors have declared no conflicts of interest.
VS02.04: TOTAL THORACOSCOPIC ENUCLEATION FOR GIANT ESOPHAGEAL LEYOMIOMA: A CONSECUTIVE SERIES
Authors: Riva Pietro , Gentile Damiano , Da Roit Anna , Basato Silvia , Alfieri Rita , Marano Salvatore , Castoro Carlo
Published: September 2018

Description

Giant esophageal leiomyomas (GEL) are challenging benign conditions to treat in a total minimally invasive way. Here we show the management of a complete thoracoscopic enucleation (TE) of three giant esophageal masses in three different patients. Not only the size of these masses but mostly the position of them made the indication for TE borderline.

Methods

Every patient underwent a full diagnostic pre-op workup with CT scan, PET and EUS guided biopsies to rule out any malignancy.

In this video, we show a full thoracoscopic approach with the patient on the left flank in a semi-prone/prone position and under general anesthesia without lung exclusion. We use a 3 trocars approach and low pressure(8mmHg) CO2 insufflation during the whole procedure. The dissection of the mass is carefully performed to keep the whole mucosal layer undamaged and minimizing the incision in the muscular layer. Careful reconstruction of the muscular layer is a mandatory step at the end of the procedure. Azygos vein resection is performed depending on the mass location. We extract the mass in a bag by enlarging the incision of the inferior scapular trocar.

The integrity of the mucosal layer was constantly checked during the procedure either by direct endoscopic vision or by insufflation of air through a nasogastric tube.

Results

All the patients had an uneventful post-operative course, upper-GI series showed no leak, no stricture nor dilatation of the esophagus. On POD 4 a soft diet was administered.

Conclusions

Esophageal leiomyomas are a rare condition; the ones larger than 10cm are defined as GEL and they represent the 17% of the total. While, in advanced centers, Total TE for small leiomyomas is a standard of care, GELs are usually managed by open surgery, and in many cases, esophagectomy has to be performed. In our series of five consecutive GELs, located in the upper esophagus, TE proved to be safe and effective in all the patients.

Disclosure

All authors have declared no conflicts of interest.
VS02.08: VIDEO PRESENTATION ON LAPAROSCOPIC REPAIR OF INCARCERATED LEFT HIATAL HERNIA AFTER MINIMALLY INVASIVE ESOPHAGECTOMY FOR DISTAL ESOPHAGEAL ADENOCARCINOMA
Authors: Myint Oo Aung
Published: September 2018

Description

63 years old Chinese gentleman with past medical history of ypT3 N0 adenocarcinoma of distal esophagus invovling the cardioesophageal junction status post neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy was presented to emergency department for severe epgiastric pain one and half year after surgery. Emergency CT scan showed the incarcerated hiatal hernia containing most of the small bowel mesentery, large portion of small bowel loops and part of trasnverse colon. There was a loop of small bowel which showed decreased enhancment and worrisome for ischemia. He underwent emergency diagnostic laparoscopy, laparoscopic reduction of hernia contents and repair of hiatal hernia. He resumed oral feeds and progressed to soft diet next day and discharged well on post operative day 3. This is the video showing the emergency repair of hiatal hernia in the pateient with previous minimally invasive esophagectomy for adenocarcinoma of distal esophagus.

To view this video please follow this link:

https://www.dropbox.com/sh/t9jvgk9w2y0nqhk/AABP9TcR0NDK9PcXjvV8TAWSa?dl=0

Disclosure

All authors have declared no conflicts of interest.
VS03.02: TOTALLY MINIMALLY INVASIVE IVORL LEWIS ESOPHAGECTOMY (TMIE) INDOCYANINE COLOR GREEN (ICG) FLUORESCENCE ANGIOGRAPHY ASSISTED
Authors: Cossu Andrea , Parise Paolo , Puccetti Francesco , Garutti Leonardo , Ferrari Carlo , Elmore Ugo , Rosati Riccardo
Published: September 2018

Description

Totally Minimally Invasive Ivor Lewis Esophagectomy has been proven feasible and safe in terms of overall mortality, morbidity and oncologic outcomes. Technical problems still exist in anastomotic fashioning and esophagogastric leakage represents the most feared complication. Its incidence is strictly related to technical difficulties and to the ischemia of the tissue involved in the anastomosis. We think angiography with Indocyanine Color Green can help the experienced surgeon to better evaluate the adequacy of the gastric tube therefore reducing the incidence of anastomotic leak.

Disclosure

All authors have declared no conflicts of interest.
VS03.07: RADICAL OPERATION OF ESOPHAGEAL CANCER UNDER 3D THORACOSCOPY
Authors: Jiang Jie , Yu Xiuyi , Geng Guojun , Liu Hongming
Published: September 2018

Description

The main steps of radical resection of esophageal carcinoma under 3D thoracoscope.

Disclosure

All authors have declared no conflicts of interest.
Solving (most) of a set of quadratic equalities: composite optimization for robust phase retrieval
Authors: Duchi John C , Ruan Feng
Published: September 2018

We develop procedures, based on minimization of the composition $f(x) = h(c(x))$ of a convex function $h$ and smooth function $c$, for solving random collections of quadratic equalities, applying our methodology to phase retrieval problems. We show that the prox-linear algorithm we develop can solve phase retrieval problems—even with adversarially faulty measurements—with high probability as soon as the number of measurements $m$ is a constant factor larger than the dimension $n$ of the signal to be recovered. The algorithm requires essentially no tuning—it consists of solving a sequence of convex problems—and it is implementable without any particular assumptions on the measurements taken. We provide substantial experiments investigating our methods, indicating the practical effectiveness of the procedures and showing that they succeed with high probability as soon as $m / n \ge 2$ when the signal is real-valued.
Germline-Restricted Chromosome (GRC) is Widespread among Songbirds
Authors: Torgasheva Anna A. , Malinovskaya Lyubov P. , Zadesenets Kira S. , Karamysheva Tatyana V. , Kizilova Elena A. , Pristyazhnyuk Inna E. , Shnaider Elena P. , Volodkina Valeria A. , Saiftdinova Alsu F. , Galkina Svetlana A. , Larkin Denis M. , Rubtsov Nikolai B. , M. Borodin Pavel
Published: September 2018

The genome of flying birds, the smallest among amniotes, reflects overweight of the extensive DNA loss over the unrestricted proliferation of selfish genetic elements, resulted in a shortage of repeated sequences and lack of B-chromosomes. The only exception of this rule has been described in zebra finch, which possesses a large germ-line restricted chromosome (GRC), transmitted via oocytes, eliminated from male postmeiotic cells and absent in somatic cell. It is considered as a rarity and its origin, content and function remain unclear. We discovered that all songbirds possess GRC: in various size and genetic content it is present in all fifteen songbird species investigated and absent from germ-line genomes of all eight species of other bird orders examined. Our data based on fluorescentin situhybridization of DNA probes derived from GRCs of four different Passeri species and their sequencing indicate that the GRCs show low homology between avian species. They contain fragments of the somatic genomes, which include various unique and repetitive sequences. We propose that the GRC has formed in the common ancestor of the extant songbirds and undergone subsequent divergence. GRC presence in the germ line of every songbird studied indicate that it could contain genetic element(s) indispensable for gametogenesis, which are yet to be discovered.
Systemic inflammation and risk of age-associated diseases in people living with HIV on long term suppressive antiretroviral therapy
Authors: Babu Hemalatha , Ambikan Anoop T , Gabriel Erin E , Akusjärvi Sara Svensson , Palaniapan Alangudi Natarajan , Sundaraj Vijila , Mupanni Naveen Reddy , Sperk Maike , Cheedarla Narayanaiah , Sridhar Rathinam , Tripathy Srikanth P , Nowak Piotr , Hanna Luke Elizabeth , Neogi Ujjwal
Published: September 2018

The ART program in low- and middle-income countries (LMIC) like India, has a public health approach with the standardized regimen for all people living with HIV (PLHIV). Based on the evidence from high-income countries (HIC), the successful implication and scale-up of ART in India, the risk of an enhanced and accentuated onset of premature-aging or age-related diseases could be observed in PLHIV. However, very limited data is available on residual inflammation and immune activation in the populations who are on first-generation anti-HIV drugs like zidovudine and lamivudine that had more toxic side effects. Therefore, the aim of the present study was to evaluate the levels of systemic inflammation and understand the risk of age-associated diseases in PLHIV on long-term suppressive ART using a large number of biomarkers of the inflammation and immune activation. Blood samples were obtained from therapy naïve PLHIV (Pre-ART, n=43), PLHIV on ART for >5 years (ART, n=53), and HIV-negative healthy controls (HIVNC, n=41). Samples were analyzed for 92 markers of inflammation, sCD14, sCD163, and telomere length. Several statistical tests were performed to compare the groups under study. Multivariate linear regression was used to investigate the associations. Despite a median duration of eight years of successful ART, sCD14 (p<0.001) and sCD163 (p=0.04) levels continued to be significantly elevated in ART group as compared to HIVNC. Eleven inflammatory markers, including 4E-BP1, ADA, CCL23, CD5, CD8A, CST5, MMP1, NT3, SLAMF1, TRAIL and TRANCE, were found to be significantly different (p<0.05) between the groups. Many of these markers are associated with age-related co-morbidities including cardiovascular disease, neurocognitive decline and some of these markers are being reported for the first time in the context of HIV-induced inflammation. Linear regression analysis showed a significant negative association between HIV-1-positivity and telomere length (p<0.0001). In ART-group CXCL1 (p=0.048) and TGF-α (p=0.026) have a significant association with increased telomere length and IL-10RA was significantly associated with decreased telomere length (p=0.042). This observation warrants further mechanistic studies to generate evidence to highlight the need for enhanced treatment monitoring and special interventions in HIV-infected individuals.
A post-transcriptional program of chemoresistance by AU-rich elements and TTP
Authors: Lee Sooncheol , Micalizzi Douglas , Truesdell Samuel S , Bukhari Syed IA , Boukhali Myriam , Lombardi-Story Jennifer , Kato Yasutaka , Choo Min-Kyung , Dey-Guha Ipsita , Nicholson Benjamin T. , Myers David T. , Lee Dongjun , Mazzola Maria A , Raheja Radhika , Langenbucher Adam , Haradhvala Nicholas J. , Lawrence Michael , Gandhi Roopali , Tiedje Christopher , Diaz-Munoz Manuel , Sweetser David A , Sykes David , Haas Wilhelm , Haber Daniel A. , Maheswaran Shyamala , Vasudevan Shobha
Published: September 2018

Background

Quiescence (G0) is a transient, cell cycle-arrested state. By entering G0, cancer cells survive unfavorable conditions such as chemotherapy and cause relapse. While G0 cells have been studied at the transcriptome level, how post-transcriptional regulation contributes to their chemoresistance remains unknown.

Results

We induced chemoresistant and quiescent (G0) leukemic cells by serum-starvation or chemotherapy treatment. To study post-transcriptional regulation in G0 leukemic cells, we systematically analyzed their transcriptome, translatome, and proteome. We find that our resistant G0 cells recapitulate gene expression profiles of in vivo chemoresistant leukemic and G0 models. In G0 cells, canonical translation initiation is inhibited; yet we find that inflammatory genes are highly translated, indicating alternative post-transcriptional regulation. Importantly, AU-rich elements (AREs) are significantly enriched in the up-regulated G0 translatome and transcriptome. Mechanistically, we find the stress-responsive p38 MAPK-MK2 signaling pathway stabilizes ARE mRNAs by phosphorylation and inactivation of mRNA decay factor, tristetraprolin (TTP) in G0. This permits expression of ARE-bearing TNFα and DUSP1 that promote chemoresistance. Conversely, inhibition of TTP phophorylation by p38 MAPK inhibitors and non-phosphorylatable TTP mutant decreases ARE mRNAs and sensitizes leukemic cells to chemotherapy. Furthermore, co-inhibiting p38 MAPK and TNFα—prior to or along with chemotherapy—substantially reduced chemoresistance in primary leukemic cells ex vivo and in vivo.

Conclusions

These studies uncover post-transcriptional regulation underlying chemoresistance in leukemia. Our data reveal the p38 MAPK-MK2-TTP axis as a key regulator of expression of ARE bearing mRNAs that promote chemoresistance. By disrupting this pathway, we developed an effective combination therapy against chemosurvival.
The effect of physiological and measurement noise on the estimate of individual muscle force from indirect measurements of muscle activity
Authors: Zonnino Andrea , Sergi Fabrizio
Published: September 2018

Several forward dynamics estimators have been proposed to quantify individual muscle force using non-invasive measurements of muscle activity. None of them, however, addresses the inaccuracy that arises when measurements are available only from a subset of the muscles involved in the movement under analysis. We present a novel estimator that integrates a forward dynamics estimation approach with knowledge of the optimal contraction strategy to obtain accurate estimates of individual muscle force when measurements of muscle activity are not available for all muscles. A following in-silico characterization showed that when trying to estimate forces form the forearm muscles acting around the wrist joint, our novel estimator is able to decrease the mean estimation bias by about 25% of the true value of muscle force. With a sensitivity analysis, we show that the model-based estimator is robust against physiological variability in muscle co-contraction strategy.
Redundant and cryptic enhancer activities of the Drosophilayellowgene
Authors: Kalay Gizem , Lachowiec Jennifer , Rosas Ulises , Dome Mackenzie R. , Wittkopp Patricia
Published: September 2018

cis-regulatory sequences known as enhancers play a key role in regulating gene expression. Evolutionary changes in these DNA sequences contribute to phenotypic evolution. The Drosophilayellowgene, which is required for pigmentation, has emerged as a model system for understanding howcis-regulatory sequences evolve, providing some of the most detailed insights available into how activities of orthologous enhancers have diverged between species. Here, we examine the evolution ofyellow cis-regulatory sequences on a broader scale by comparing the distribution and function ofyellowenhancer activities throughout the 5’ intergenic and intronic sequences ofDrosophila melanogaster,Drosophila pseudoobscura, andDrosophila willistoni. We find thatcis-regulatory sequences driving expression in a particular tissue are not as modular as previously described, but rather have many redundant and cryptic enhancer activities distributed throughout the regions surveyed. Interestingly, cryptic enhancer activities of sequences from one species often drove patterns of expression observed in other species, suggesting that the frequent evolutionary changes inyellowexpression observed among Drosophila species may be facilitated by gaining and losing repression of pre-existingcis-regulatory sequences.
Accordion-like collagen fibrils suggested by P-SHG image modeling : implication in liver fibrosis
Authors: Rouède D. , Schaub E. , Bellanger J-J. , Ezan F. , Tiaho F.
Published: September 2018

Second-order non-linear optical anisotropy parameter ρ = χ33 / χ31 is calculated for collagen-richt issues considering both a single dominant molecular hyperpolarizability tensor element β333 = β at single helix level and a priori known submicrometric triple helical organization of collagen molecules. Modeling is further improved by taking account of Poisson photonic shot noise of the detection system and simple supra-molecular fibrillar arrangements in order to accurately simulate the dispersion of ρ values in collagen-rich tissues such as tendon, skin and liver vessels. From combined P-SHG experiments and modeling, we next correlate experimental and theoretical statistical distributions of ρ. Our results highlight that the dispersion of experimental ρ values is mainly due to (i) Poisson photonic shot noise in tendon and skin, which proves to have a preponderant effect in P-SHG experiments (ii) variance of supercoil angles of accordion-like fibrils in vessels that is further reduced during the development of liver fibrosis therefore contributing to the rigidity of the tissue. These results open new avenue for future modeling correlating the dispersion of ρ values in P-SHG experiments and the fibrillar architecture as well as the mechanical stiffness of patho-physiological extracellular matrices in collagen tissues.
Speech-based identification of L-DOPA ON/OFF state in Parkinson’s Disease subjects
Authors: Norel R. , Agurto C. , Rice J.J. , Ho B.K. , Cecchi G.A.
Published: September 2018

Background

Parkinson’s disease patients (PDP) are evaluated using the unified Parkinson’s disease rating scale (UP-DRS) to follow the longitudinal course of the disease. UP-DRS evaluation is performed by a neurologist, and hence its use is limited in the evaluation of short-term (daily) fluctuations. Subjects taking L-DOPA as part of treatment to reduce symptoms exhibit motor fluctuations as a common complication.

Objectives

The aim of the study is to assess the use of speech analysis as a proxy to continuously monitor PDP medication state.

Methods

We combine acoustic, prosody, and semantic features to characterize three speech tasks (picture description, reverse counting and diadochokinetic rate) of 25 PDP evaluated under different medication states: “ON” and “OFF” L-DOPA.

Results

Classification of medication states using features extracted from audio recordings results in cross-validated accuracy rates of 0.88, 0.84 and 0.71 for the picture description, reverse counting and diadochokinetic rate tasks, respectively. When adding feature selection and semantic features, the accuracy rates increase to 1.00, 0.96 and 0.83 respectively; thus reaching very high classification accuracy on 3 different tasks.

Conclusions

We show that speech-based features are highly predictive of medication state. Given that the highest performance was obtained with a very naturalistic task (picture description), our results suggest the feasibility of accurate, non-burdensome and high-frequency monitoring of medication effects.
The speed-accuracy tradeoff reveals flexible access to accumulating sensory evidence during human decision making
Authors: Nelli Stephanie , Itthipuripat Sirawaj , Rungratsameetaweemana Nuttida , Serences John T.
Published: September 2018

Decisions made about identical perceptual stimuli can be radically different under changing task demands. For example, the need to make a fast decision undermines the accuracy of that decision, a well-documented effect termed the speed-accuracy tradeoff (SAT). Models of the SAT are generally based on theories of decision making in which responses are triggered only after sensory evidence accumulation terminates at a set threshold. Within this accumulate-to-bound framework, speed pressure operates by lowering the response threshold, allowing for faster responses at the expense of accumulated sensory evidence. To empirically examine the mechanisms necessary for adaptively adjusting the speed and accuracy of decisions, we used an event-related potential that indexes sensory evidence accumulation in the human brain. Instead of lowering response thresholds, we found that speed pressure adaptively shifts responses to occur close to where the rate of evidence accumulation peaks. Moreover, responses are not triggered automatically by the termination of the accumulation process, as sensory evidence continues to build after speeded decisions. Together these results suggest that response processes adaptively access accumulating sensory evidence depending on task demands and support parallel over serial models of decision making.