bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of miRNAs in Breast Cancer-induced Bone Disease
Authors: Haider Marie-Therese , Zarrer Jennifer , Smit Daniel J. , Hesse Eric , Taipaleenmäki Hanna
Published: September 2021

Bone is the most common site of breast cancer recurrence. Despite the increasing
knowledge about the metastatic process and treatment advances, the disease still
remains incurable once the cancer cells actively proliferate in bone. Complex
interactions between cancer cells and cells of the bone microenvironment (BME)
regulate the initiation and progression of metastatic tumor growth in bone. In
particular, breast cancer cells shift the otherwise tightly balanced bone
remodeling towards increased bone resorption by osteoclasts. Cellular
interactions in the metastatic BME are to a large extent regulated by secreted
molecules. These include various cytokines as well as microRNAs (miRNAs), small
non-coding RNAs that post transcriptionally regulate protein abundance in
several cell types. Through this mechanism, miRNAs modulate physiological and
pathological processes including bone remodeling, tumorigenesis and metastasis.
Consequently, miRNAs have been identified as important regulators of cellular
communication in the metastatic BME. Disruption of the crosstalk between cancer
cells and the BME has emerged as a promising therapeutic target to prevent the
establishment and progression of breast cancer bone metastasis. In this context,
miRNA mimics or antagonists present innovative therapeutic approaches of high
potential for interfering with pathological bone – cancer cell
interactions. This review will discuss the role of miRNAs in the tumor-BME
crosstalk in vivo and will emphasize how this could be targeted by miRNAs
to improve therapeutic outcome for patients with breast cancer bone
metastases.
The Role of microRNAs in Osteoporosis Diagnostics
Authors: Hackl Matthias , Semmelrock Elisabeth , Grillari Johannes
Published: September 2021

MicroRNAs (miRNAs) are short (18–24 nucleotides) non-coding RNA sequences
that regulate gene expression via binding of messenger RNA. It is estimated that
miRNAs co-regulate the expression of more than 70% of all human genes,
many of which fulfil important roles in bone metabolism and muscle function.
In-vitro and in-vivo experiments have shown that the targeted loss of miRNAs in
distinct bone cell types (osteoblasts and osteoclasts) results in altered bone
mass and bone architecture. These results emphasize the biological relevance of
miRNAs for bone health.

MiRNAs are not only considered as novel bone biomarkers because of their
biological importance to bone metabolism, but also on the basis of other
favorable properties: 1) Secretion of miRNAs from cells enables
“minimally invasive” detection in biological fluids such as
serum. 2) High stability of miRNAs in serum enables the retrospective analysis
of frozen blood specimens. 3) Quantification of miRNAs in the serum is based on
the RT-PCR - a robust method that is considered as the gold standard for the
analysis of nucleic acids in clinical diagnostics.

With regard to osteoporosis, it has been shown that many of the known risk
factors are characterized by distinct miRNA profiles in the affected tissues: i)
age-related loss of bone mass, ii) sarcopenia, iii) changes in estrogen
metabolism and related changes Loss of bone mass, and iv) diabetes. Therefore,
numerous studies in recent years have dealt with the characterization of miRNAs
in the serum of osteoporosis patients and healthy controls, and were able to
identify recurring miRNA patterns that are characteristic of osteoporosis. These
novel biomarkers have great potential for the diagnosis and prognosis of
osteoporosis and its clinical outcomes.

The aim of this article is to give a summary of the current state of knowledge on
the research and application of miRNA biomarkers in osteoporosis.
Homöopathie und Biochemie – zum 200. Geburtstag von
Wilhelm Schüßler
Authors: Baschin Marion
Published: September 2021

Der 200. Geburtstag von Wilhelm Schüßler wird zum Anlass
genommen, verbindende und trennende Aspekte zwischen den therapeutischen
Ansätzen der Homöopathie und der Biochemie zu beleuchten.
Schüßler hat seinen Ansatz aus der Homöopathie heraus
entwickelt und sich in den ersten Jahren nach der Formulierung seiner
„Abgekürzten Therapie“ um eine Verbindung zwischen
seinen Überlegungen und der Lehre Hahnemanns bemüht. Dies kann
für die Nutzung der sogenannten Schüßler-Salze in der
Praxis Impulse geben.
The Interval Between Matches Significantly Influences Injury Risk in Field Hockey
Authors: Mason Joel , Rahlf Anna Lina , Groll Andreas , Wellmann Kai , Junge Astrid , Zech Astrid
Published: September 2021

Fixture congestion increases injury risk in football, but how it impacts other sports is unclear. The aim of this study was to identify associations between match density and injury incidence in field hockey players. Injury data from a prospective cohort study of professional and youth players was analysed in two ways. Inter-match intervals were clustered into<2424-hours, 3–7-days, and 13 + days, and injury rate ratios (IRR) were calculated to identify differences between clusters in match injuries. Separately, a Lasso-penalised Poisson regression model was used to determine the association between match load across the previous 24-hours, 3-days, 7-days and 14-days, and match and training injuries. Injury rates in matches within 24-hours of the previous match were mostly significantly higher when compared to matches after 3–7-days (IRRs: 3.78; 6.77, P = 0.003; 0.005). While a higher match exposure in the preceding 24-hour and 3-day periods was associated with higher combined match and training injury rates (β̂ = 0.0001; 0.0018), a higher match exposure in the previous 7-and 14-day periods was associated with a reduced injury rate (β̂ = –0.0001; –0.0005). Due to the increased injury risk in matches 3-days and especially 24-hours following the previous fixture, match distribution should be cautiously planned.
Stereoselective Synthesis of the C19–C39 Fragment of Bastimolide A
Authors: Ghosh Subhash , Kumar Nemilikonda Sravan , Ramulu B. Janaki
Published: September 2021

This paper describes the synthesis of the C19–C39 fragment of the antimalarial natural product bastimolide A via addition of a functionalized C19–C26 alkyne fragment to a C27–C39 aldehyde fragment. Opening of a terminal epoxide and Noyori asymmetric reduction were used as key steps in the synthesis.
10.24.2 Product Subclass 2: Pyrimido[1,2-a]indoles and Related Benzo-Fused Ring Systems
Authors: Harris P. A.
Published: September 2021

Methods for the synthesis of pyrimido[1,2-a]indoles and the related indolo[1,2-a]quinazoline and indolo[2,1-a]quinazoline ring systems are reviewed in this chapter. Although limited reports have been published to date, a variety of differing approaches to these heterocycles have been described.
First experimental results from the high-energy petawatt PETAL laser system
Authors: Kim Meeri
Published: September 2021

Even a moderately relativistic laser intensity led to unexpectedly high energies, above those expected from early numerical simulations, for proton acceleration.
Trio of ternary MAX phases expand possibilities for 2D ferromagnetic materials fabrication
Authors: Patrick Chris
Published: September 2021

New ternary MAX phases exhibit ferromagnetic behavior close to room temperature and may be suitable for designing 2D monolayers with magnetic applications.
Anisotropic non-split zero-energy vortex bound states in a conventional superconductor
Authors: Kim Howon , Nagai Yuki , Rózsa Levente , Schreyer Dominik , Wiesendanger Roland
Published: September 2021

Vortices in topological superconductors are predicted to host Majorana bound states (MBSs) as exotic quasiparticles. In recent experiments, the spatially non-split zero-energy vortex bound state in topological superconductors has been regarded as an essential spectroscopic signature for the observation of MBSs. Here, we report the observation of anisotropic non-split zero-energy vortex bound states in a conventional elemental superconductor with a topologically trivial band structure using scanning tunneling microscopy and spectroscopy. The experimental results, corroborated by quasi-classical theoretical calculations, indicate that the non-split states directly reflect the quasiparticle trajectories governed by the surface electronic structure. Our study implies that non-split zero-energy states are not a conclusive signature of MBSs in vortex cores, in particular for superconducting systems not being in the quantum limit, stimulating a revision of the current understanding of such states.
Real-time stabilization of the alkali-metal transverse axis orientation in nuclear spin comagnetometer by biaxial differential detection
Authors: Lei Guanqun , Wu Wenfeng , Zhao Xinghua , Chai Zhen , Liu Zhanchao , Yuan Heng
Published: September 2021

Axis orientation stability has a great effect on the long-term drift performance of nuclear spin comagnetometers that utilize alkali atoms to detect the magnetic moment of nuclear spin ensembles. Previous studies have analyzed the sensitivity influence of the misalignment angle and demonstrated a post-processing calibration method in the transverse polarized comagnetometer, but there is no study on the traditional longitudinally polarized setup. We propose an innovative biaxial differential detection method to monitor the misalignment angle in the longitudinally polarized comagnetometer and then eliminate it on-line. By monitoring the amplitude difference of a reference magnetic field’s projections in a rotated measurement frame, an error signal with good linearity is obtained. Experiments showed that any misalignment angle within (−π/4, π/4) can be successfully compensated to near 0 within about 1.5 s, which is fast enough compared to the drift rate of a practical device. The new detection method is robust and insensitive to many factors, such as direct component drift and scale factor inequality, so the method can be widely used in similar devices that acquire high accurate alignment of the axis orientation, such as the spin exchange relaxation-free magnetometer.
Influence of the dissociation unit on pressure and temperature distribution in arc chamber of ACB during the breaking process
Authors: Yin Nairui , Liu Hongwu , Shi Zongqian , Guan Ruiliang
Published: September 2021

To void breakdown between busbars, the dissociation unit is applied in the arc chamber of an air circuit breaker (ACB) to cool down the hot gas exhausted from the vent of the arc chamber in the interrupting process. Cooling efficiency and flow resistance of the dissociation unit have important roles, which can greatly affect the safety of the low voltage switcher and interrupting performance of the arc chamber. The most common structure style of the dissociation unit is a multilayer metal wire mesh, and it has a complex microstructure. Then, it is unreasonable to directly simulate the dissociation unit due to the huge cost of calculation. In this study, the porous medium model is introduced and a combination of two different porous materials is applied to simplify the simulation model of the dissociation unit. Based on the porous model and simplified arc chamber model, the ACB with the dissociation unit is analyzed. The cooling effect and flow resistance of the dissociation unit are evaluated in the breaking process. By comparing experimental and simulated pressures in the arc chamber, this simulation approach is verified.
Impact of applied biaxial stress on the piezoelectric, elastic, and dielectric properties of scandium aluminum nitride alloys determined by density functional perturbation theory
Authors: Daoust P. , Côté Michel , Desjardins P. , Masut R. A.
Published: September 2021

The effects of biaxial in-plane stress on the elastic, dielectric, and piezoelectric (PE) properties of c-axis textured thin film wurtzite phase scandium aluminum nitride (w-ScxAl1−xN) alloys have been calculated with density functional perturbation theory. The in-plane stress σR was kept below 1 GPa covering compressive and tensile values and applied to alloy supercells represented with special quasi-random structures. An increasingly tensile biaxial stress (σR > 0) produces higher displacement-response internal-strain coefficients for the constituent atoms of the alloy and the related PE properties are more sensitive to σR when the fraction x increases. A significant rise of the relative dielectric permittivity ϵr,33η and softening of the stiffness coefficient c33E are also reported with σR > 0. The effective thin film PE strain coefficient d33,f and coupling coefficient k33,f2 show a relative increase of 22% and 26%, respectively, at σR = 1 GPa and x = 0.438. Both tensile σR and x tend to decrease the c/a cell parameter ratio of the wurtzite structure with a significant impact on the PE coefficients. Based on the decomposition of the stiffness, dielectric, and PE coefficients as well as the structural data, it is suggested that tensile biaxial stress enhances the hexagonal character of w-ScxAl1−xN in a qualitatively similar manner as the scandium nitride fraction x does. The manufacture and PE characterization of a beneficially stressed thin film of w-ScxAl1−xN on a substrate of w-InyAl1−yN with adjusted x, y values are suggested to confirm the calculated values of d33,f.
Final report on the CIPM key comparison CCAUV.V-K5
Authors: Bruns Th , Nordmann D , Ripper G P , Winther J H , Hof C , Ruiz S , Pineda G da Silva , Nozato H , Zuo A , Dickinson L , Veldman C S , Kozlyakovskiy A , Shan C , Ivashchenko A , Allen R A
Published: September 2021

Main text

The results of the ﬁfth CIPM key comparison (KC) in the area of vibration, here concerning sinusoidal acceleration, are presented.

This comparison was intended to build the foundation for subsequent regional key comparisons over the extended frequency range from 10 Hz to 20 kHz. Measurement results reported by 14 participants for magnitude and phase shift of complex charge sensitivity of single ended and back-to-back accelerometers were compared. A key comparison reference value has been deﬁned for each type of artifact, and the respective Degrees of Equivalence are reported. The ﬁnal report has been peer-reviewed and approved for publication by the CCAUV, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database https://www.bipm.org/kcdb/.

The final report has been peer-reviewed and approved for publication by the CCAUV, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
A Single-Blinded Prospective Study on Using Botulinum Toxin Type A for Reducing Alar Mobility
Authors: Zhong Yehong , Cao Dejun , Zhou Sizheng , Duan Huichuan , Wei Min , Yu Zheyuan
Published: September 2021

Background

With widespread utilization of instant social media, people desire a minimally invasive treatment to improve alar dynamic aesthetic, but few practical procedures on reducing alar mobility have been conducted.

Objectives

This study aimed to verify the effects of botulinum toxin on reducing nasal alar mobility and provide a supplemental treatment of rhinoplasty.

Methods

This single-blind prospective study included a cohort of 20 participants with the desire to improve their alar dynamic aesthetic. The experimental group was injected with 3U botulinum toxin type A at dilator naris anterior, dilator naris vestibularis, levator labii superioris alaeque nasi, and dilator naris, and the control group received the equivalent of saline. Standardized facial movement (from rest to maximum smile without revealing teeth) was recorded with a 3-dimensional imaging system. The changes between rest and maximum smile statuses represented alar mobility and were generated by MOBILITY=WIDTHsmile−WIDTHrestWIDTHrest×100 % . Alar mobility and root mean square analysis were employed for postoperative evaluations.

Results

In the experimental group, alar flaring mobility decreased from 10.05% ± 6.40% to 4.91% ± 3.48%(P < 0.05), and alar base mobility decreased from 16.83% ± 5.69% to 12.50% ± 4.89% (P < 0.05), whereas no significant changes in alar mobility were found in the control group. In root mean square analysis, changes in the experimental group were significantly higher than in the control group (P < 0.05).

Conclusions

Botulinum toxin type A can effectively restrain alar mobility without any significant adverse events and improve alar dynamic esthetic, which can serve as a minimally invasive method or supplemental treatment for rhinoplasty.

Level of Evidence: 2
Omics Notebook: robust, reproducible and flexible automated multiomics exploratory analysis and reporting
Authors: Blum Benjamin C , Emili Andrew
Published: September 2021

Mass spectrometry is an increasingly important tool for the global interrogation of diverse biomolecules. Unfortunately, the complexity of downstream data analysis is a major challenge for the routine use of these data by investigators from broader training backgrounds. Omics Notebook is an open-source framework for exploratory analysis, reporting and integrating multiomic data that are automated, reproducible and customizable. Built-in functions allow the processing of proteomic data from MaxQuant and metabolomic data from XCMS, along with other omics data in standardized input formats as specified in the documentation. In addition, the use of containerization manages R package installation requirements and is tailored for shared high-performance computing or cloud environments.

Availability and implementation

Omics Notebook is implemented in Python and R and is available for download from https://github.com/cnsb-boston/Omics_Notebook with additional documentation under a GNU GPLv3 license.

Supplementary information

Supplementary data are available at Bioinformatics Advances online.
DoE-Based Analytical Quality Risk Management for Enhanced AQbD Approach to Economical and Eco-Friendly RP-HPLC Method for Synchronous Estimation of Multiple FDC Products of Antihypertensive Drugs
Authors: Prajapati Pintu , Patel Ankita , Shah Shailesh
Published: September 2021

According to the literature review, numerous chromatographic methods have been published for estimation of fixed-dose combination products of telmisartan but no reverse-phase high-pressure liquid chromatographic (RP-HPLC) method has been published yet for synchronous estimation of fixed-dose combination (FDC) products of telmisartan to save time, cost and solvent for analysis. Hence, an economical and eco-friendly RP-HPLC method has been developed for synchronous estimation of multiple FDC products of antihypertensive drugs using the quality risk management (QRM) and DoE-based enhanced analytical quality by design approach. The analytical-QRM was started with the identification of potential method risk parameters followed by their risk assessment by risk priority number ranking and filtering. The identified critical method parameters were optimized using the DoE-based central composite design. The method operable design range was navigated and the control strategy was framed for control and mitigation of risk throughout the life-cycle of the developed method. The method was developed using Shimpack Octadecyl silane (ODS) C18 column and acetonitrile-1.0%v/v triethylamine in water (pH 6.0; 45 + 55, %v/v). The developed method was validated as per the International Council for Harmonization Q2 (R1) guideline. The developed method was applied for the analysis of seven different antihypertensive dosage forms. The developed RP-HPLC method can be used as an eco-friendly, robust and economical alternative analytical tool to several published methods for estimation of FDC products of antihypertensive drugs in the pharmaceutical industry.
A Verifiable Symmetric Searchable Encryption Scheme Based on the AVL Tree
Authors: Wang Qing , Zhang Xi , Qin Jing , Ma Jixin , Huang Xinyi
Published: September 2021

Verifiable symmetric searchable encryption is a keyword search technology that supports verification of search results. Many schemes improve search performance by dividing each keyword label into segments and storing them in a Trie-tree at the expense of high storage. And the index will degenerate into a linear linked list when all keyword labels have the same prefix except for the last segment. But it will greatly affect the search efficiency. In this paper, we propose a verifiable symmetric searchable encryption scheme based on the AVL Tree (abbreviated as VSSE-AVL), which uses complete keyword labels to build the index. Compared with the Trie-tree index, VSSE-AVL not only balances storage and search performance, but also avoids degradation. To verify the correctness and completeness of empty search results, we store path information in each leaf node and node with only one child node. Considering the substitution attack, we bind the file identifier and the file so that the client will find out once the server returns inconsistent search results. Rigorous security analysis shows VSSE-AVL satisfies privacy and verifiability. Compared with the verifiable SSE-2 with the same security, the experimental evaluation shows that our proposed scheme performs better on storage, search and verification.
112 ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY CAN BE PERFORMED EVEN IN LEARNING CURVE PERIOD; PROPENSITY SCORE MATCH ANALYSIS
Authors: Tsunoda Shigeru , Obama Kazutaka , Hisamori Shigeo , Nishigori Tatsuto , Mizuno Rei , Ganeko Riki , Okuchi Yoshihisa , Sakai Yoshiharu
Published: September 2021

Da Vinci Surgical System Xi was introduced in our institution in 2017. Since then we started robot-assisted minimally invasive esophagectomy (RAMIE) as private practice. Japanese national insurance system started to reimburse RAMIE in 2018. Since then, the number of RAMIE is explosively increasing. Currently the indication of RAMIE in our institution purely depends on machine availability. However, the real clinical benefit of RAMIE over conventional minimally invasive esophagectomy (MIE) remains unknown.

Methods

Between January 2015 and January 2020, data of 156 consecutive patients with esophageal carcinoma undergoing esophagectomy was retrospectively reviewed. After exclusion of 12 salvage esophagectomy for patients after definitive chemoradiotherapy (>50Gy), 10 mediastinoscopic esophagectomy, 5 esophagectomy without upper mediastinal dissection, 2 two-stage esophagectomy and 1 total pharyngo-laryngo-esophagectomy, 126 patients (46 RAMIE and 80 MIE) were included in the analysis. The 1:1 propensity score match analysis was performed to compare the short-term outcomes between RAMIE and MIE.

Results

After matching, 45 RAMIE and 45 MIE were analyzed. RAMIE took significantly longer thoracic operation time (370 min vs. 288 min; P < 0.0001). Intraoperative blood loss (80 g vs. 50 g; P = 0.0759), harvested thoracic nodes (22 vs 25; P = 0.1188), harvested upper mediastinal nodes (12 vs 12; P = 0.4233) were similar. RAMIE showed less severe postoperative morbidity (Clavien-Dindo Grade III or higher) (9% vs. 22%; P = 0.0810) and lower incidence of recurrent laryngeal nerve palsy (Clavien-Dindo Grade II or higher) (7% vs. 18%; P = 0.1076). There was no postoperative death in both groups.

Conclusion

Although this result contains our early learning curve period of RAMIE, short term outcome of RAMIE is acceptable from a safety point of view.
29 SIZE OF THE THORACIC INLET SPACE AS A PREDICTOR OF CERVICAL ANASTOMOTIC LEAK AFTER RETROSTERNAL RECONSTRUCTION FOLLOWING ESOPHAGECTOMY
Authors: Sato Shinsuke , Nakatani Eiji , Higashizono Kazuya , Nagai Erina , Taki Yusuke , Nishida Masato , Watanabe Masaya , Oba Noriyuki
Published: September 2021

Although anastomotic leak is a common postoperative complication following an esophagectomy, it is not well known whether anatomical factors increase the risk for anastomotic leak after the procedure. The purpose of this study was to clarify whether a narrow thoracic inlet is an independent predictor of cervical anastomotic leak after retrosternal reconstruction following esophagectomy.

Methods

A total of 212 patients who underwent esophagectomy with gastric conduit retrosternal reconstruction between January 2013 and March 2019 were included in this study. Computed tomography was used to measure the thickness of the sternum (TS), the thickness of the clavicle (TC), the interclavicular distance, the sternum-trachea distance (STD), the sternum-vertebral body distance (SVD), and the sternum-trachea distance/sternum-vertebral body distance ratio (STD/SVD ratio). The correlation between various factors was analyzed using Spearman’s correlation coefficient. Tree-based analysis was performed to define cutoff values. Multivariate logistic regression was used to analyze the association between various predictors and anastomotic leak.

Results

Anastomotic leak occurred in 26 patients (12.26%). Tree-based analysis identified an optimal TS cutoff value of 20.84 mm, a TC cutoff value of 23.63, and a STD/SVD ratio cut off value of 0.2138 to predict anastomotic leak. There were significant associations between the STD, STD/SVD ratio and thoracic inlet area (STD × ICD). According to multivariate analysis, STD/SVD ratio, TS, TC, and diabetes mellitus were significantly associated with increased incidence of anastomotic leak.

Conclusion

STD/SVD ratio, TS, TC, and diabetes mellitus were associated with higher rates of cervical anastomotic leak after retrosternal gastric conduit reconstruction following esophagectomy. In patients with a small thoracic inlet, posterior mediastinal reconstruction and intrathoracic anastomosis should be considered.
343 EFFECTS OF PREOPERATIVE PNI (PROGNOSTIC NUTRITIONAL INDEX) AND POSTOPERATIVE INFLAMMATORY RESPONSE ON PROGNOSIS IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Fujiwara Yoshinori , Higashida Masaharu , Kubota Hisako , Okamoto Yuko , Mineta Syumei , Okada Toshimasa , Tsuruta Atsushi , Ueno Tomio
Published: September 2021

The effects of preoperative nutritional status and postoperative inflammatory response on esophageal cancer patients on prognosis were unclear. In the present study, we evaluated the preoperative nutritional parameters and postoperative inflammatory responses and analyzed relationship between these parameters and cancer prognosis.

Methods

One hundred and eleven esophageal squamous cell carcinoma patients were analyzed with pathological TNM StageI-IV. Preoperative nutritional parameters: PNI (Prognostic Nutritional Index) was calculated from following formula:10 x Albumin(g/dl) +0.005 x peripheral lymphocyte counts (/mm3). Preoperative NLR (Neutrophil/Lymphocyte ratio) was defined as absolute neutrophil counts divided by the absolute lymphocyte counts. The highest CRP level was evaluated as postoperative inflammatory responses. Cut-off values of these continuous parameters were calculated by ROC, and univariate and multivariate analysis using Cox model for overall survival (OS) were examined in the parameters.

Results

Overall three or five years survivals were 60.9%, 56.28%, respectively. Cut-off value of PNI, CRP, NLR, Intraoperative blood loss were 44.8, 21.7 mg/dl,2.27,159 mL, respectively. High PNI group was significantly better survival than low group (3 years OS, 65.94 vs 45.82%, p < 0.05). No association between PNI and prognosis was noted for patients with pStageI, but the low PNI patients of pStageII-IV were extremely poor prognosis (p < 0.01). High CRP group was tendency to be worse survival than low group (3 years OS, 65.97 vs 38.82%, p = 0.062). The patients of low blood loss group was significantly better survival than high group (p < 0.05).NLR was not associated with OS. Cox model showed that pTNM, tumor location, and PNI were independent prognostic factors.

Conclusion

Preoperative nutritional status affected the prognosis of esophageal cancer patients. But, postoperative inflammatory response was not affected the prognosis of these patients. Preoperative nutritional interventions may improve the prognosis of patients with esophageal cancer.
500 THE PATHOLOGICAL GASTROESOPHAGEAL REFLUX IN PATIENTS WITH CYSTIC FIBROSIS
Authors: Bordin Dmitry , Valitova Elen , Baymakanova Gulsara , Krasovskiy Stanislav , Berezina Olga
Published: September 2021

The presence of gastroesophageal reflux in patients after lung transplantation rises the risk of posttransplantant complications. The aim of our study was to evaluate the severity of gastroesophageal reflux (GER) in patients with cystic fibrosis before lung transplantation.

Methods

14 patients with cystic fibrosis, who refferred to our Centre, were included in this study, mean age 28,86 ± 2,5 (6 males and 8 females). The diagnosis of cystic fibrosis was established at the age of 1–5 y.o. according to clinic, sweet test and genetic tests. All patients were performed upper endoscopy, X-ray, esophageal manometry and 24 h impedance monitoring. PPI treatment was excluded for 7 days before monitoring. Pathologic GER was established when total number of refluxes in distal esophagus was more than 75, the total number of refluxes in proximal esophagus was more than 20% of those in the distal part.

Results

According to endoscopy, none of patients had erosions of the esophagus. Five patients had ineffective motility and one—diffuse esophageal spazm. 56% of patients had pathologic number of refluxes in distal esophagus. 80% subjects had pathologic refluxes in proximal esophagus. The mean number of total refluxes in distal part was 54,93 ± 5,7, in proximal part—27,64 ± 2,6 (it is 40% of those in distal part). The distribution of acid and non-acid refluxes in patients with pathologic refluxes was 2:1. We didn’t reveal any correlation between number of refluxes, ineffective motility and gastric emptying.

Conclusion

despite normal upper endoscopy, 56% of patients with cystic fibrosis have pathologic gastroesophageal reflux. Besides, the study showed high propagation of GER to proximal esophagus in 80% of subjects, which may play role in posttransplantation period.
599 MEDIASTINITIS SECONDARY TO ESOPHAGEAL PERFORATION: IT’S TOO LATE?
Authors: Russo Emanuele , Sorice Mario , Busiello Luigi , Morte Aniello Della , Polimeno Emilia , Beneduce Lucia , Guggino Gianluca
Published: September 2021

Mediastinitis secondary to esophageal perforation is a rare, progressive, and destructive disease that may often lead to an imminent risk of death. We describe a single center experience showing how early diagnosis and prompt intervention can reduce mortality and complications.

Methods

From February 2016 to December 2019, 15 consecutive patients were referred to the Emergency Unit of The AORN Cardarelli (Naples) with clinical and radiological (CT scan) diagnosis of acute mediastinitis secondary to oesophageal perforation (post endoscopy or after foreign body ingestion) and furthermore, referred to the Thoracic Surgery Unit, they underwent to early surgical treatment (cervicotomy and\or thoracotomy and chest drainage.

Results

For early detected case (occurred within 24 hours) an emergency thoracotomy/cervicotomy was performed with surgical repair. For late detected (referred from other hospitals) a Surgical esclusion (abdominal plus cervical) and toilette thoracotomy was performed in emergency. Reconstruction occurred in 5 cases with a median of 46 days after firts care. All patient were admitted to ICU unit and susbsequentily to the thoracic surgery ward. 30 days mortality occurred in two cases. Median hospital staying was 28 days, in six cases a redo surgery was necessary. Empiric antibiotic treatment was started before operation and reviewed under Infectivologist.

Conclusion

Mediastinitis secondary to esophageal perforation has a fulminating course with a potential risk of sepsis, pericarditis, and multiple organ failure. A prompt identification and an invasive treatment is the best and most successful option to reduce mortality and improve patient’s recovery.
629 IRRADIATED ESOPHAGEAL SQUAMOUS CELL CARCINOMA CELLS INDUCED THE INCREASE OF TREG BY TGF-β
Authors: Wang Yuan , Li Tao , Lyu Jiahua , Xiao Ling , Liu Yudi , Liu Xiao , Li Ke , Zhang Rongke , Chen Taiyu , Zhang Hangyue , Tang Chunhan
Published: September 2021

The infiltration of CD4 + CD25 + Foxp3+ regulatory T cells (Treg) in the tumor microenvironment is one of the main reasons for radiation resistance and tumor recurrence after radiotherapy. It has been established that Treg is more resistant to radiation than other T cells, but the proliferation of immune cells after radiotherapy is affected by other factors, including tumor cells. We studied the effect and mechanism of esophageal squamous cell carcinoma on Treg cells after radiation.

Methods

After low-dose irradiation, TE-1 cells were co-cultured with normal peripheral blood lymphocytes for 48 hours. Flow cytometry was used to detect Treg/CD4 + T cell frequency. The mRNA expression of TGF-β1 and TGF-β2 in TE-1 was detected by qPCR, and the protein content of TGF-β1 and TGF-β2 in the medium was detected by ELISA.

Results

Compared with non-irradiation group, the expression of TGF-β1 and TGF-β2 in TE-1 cells of irradiation group increased, and the protein content of TGF-β1 and TGF-β2 in culture medium increased, the difference was statistically significant(P < 0.001). Flow cytometry showed that CD4 + CD25+/CD4 + Tcell and CD4 + CD25 + Foxp3+/CD4 + Tcell were increased in the radiotherapy group after co-culture, and the difference was statistically significant (P < 0.001).

Conclusion

The expression of TGF-β1 and TGF-β2 in esophageal squamous cell carcinoma cells increased after irradiation, and the frequency of Treg induced by co-culture increased, suggesting that esophageal squamous cell carcinoma cells after radiotherapy can induce the increase of Treg cells, which may be achieved mainly through the mechanism of increasing the secretion of TGF-β1 and TGF-β2.
658 BETTER SURVIVAL IN FEMALES THAN MALES AFTER RESECTION OF OESOPHAGEAL OR GASTROESOPHAGEAL JUNCTION CANCER: A COHORT STUDY IN SWEDEN
Authors: Zhang Ji , Bellocco Rino , Ye Weimin , Johansson Jan , Nilsson Magnus , Lindblad Mats
Published: September 2021

Accumulating evidence points to a better survival in female patients after a curative oesophageal cancer surgery. However, there is a need for more well-designed and sufficiently powered studies for limitations in previous studies. Better understanding of sex differences in the postoperative survival may be helpful for a sex-specific treatment.

Methods

This is a population-based cohort study including all patients in Sweden with oesophageal cancer that underwent a curative surgical treatment between 2006 and 2017. Sex difference in postoperative survival was explored with excess mortality rate ratio (EMRR) and absolute difference of excess mortality rate along the whole follow-up time, using flexible parametric model. Age at the time of surgery, Charlson comorbidity index, ASA score, tumor stage, post-operative complications, marital status, education level and hospital volume were considered as covariates in the analysis model. Stratification analysis by clinical stages, perioperative neoadjuvant treatment and post-operative complications was also performed.

Results

In all, there were 1301 patients resected for oesophageal adenocarcinoma and 305 patients for oesophageal squamous cell carcinoma. For both oesophageal adenocarcinoma and oesophageal squamous cell carcinoma, female patients had a lower excess mortality rate than males (adjusted EMRR: 0.77, 95% CI: 0.58–1.01, P = 0.059; 0.53, 95% CI: 0.33–0.85, P = 0.009, respectively). This sex difference was particularly strong shortly after surgery then gradually decreased over the ensuing years (Figure) and was more profound in the early clinical stages, and in patients receiving neoadjuvant treatment and without post-operative complications.

Conclusion

Female patients seem to have a better survival shortly after esophagectomy for patients with oesophageal adenocarcinoma and oesophageal squamous cell carcinoma, and the sex difference thereafter weakened. Our results may imply a different response to oesophageal cancer surgery between the sexes, and associated pre- and post-operative treatment, thus a sex-specific strategy may be considered in further work.
67 STRATEGY FOR DEFINITIVE TREATMENT AND PRESERVING QUALITY OF LIFE IN UPPER CERVICAL ESOPHAGEAL CARCINOMA
Authors: Goto Satoru , Koji Otsuka , Fujimasa Koichiro , Saito Akira , Komoto Masahiro , Kato Rei , Motegi Kentaro , Watanabe Ryohei , Date Hiromi , Yamashita Takeshi , Ariyoshi Tomotake , Yamazaki Kimiyasu , Aoki Takeshi , Murakami Masahiko
Published: September 2021

In radical surgery for upper cervical esophageal carcinoma, questions such as whether the larynx should be preserved depending on the distance from the esophageal orifice to the tumor margin and risk of aspiration during swallowing arise. We report the clinical outcomes of our strategy for upper cervical esophageal carcinoma based on the goals of curability and larynx preservation.

Methods

At our institution, resectable upper cervical esophageal carcinoma in which the tumor margin on the oral side is within 3 cm of the esophageal orifice is treated with chemoradiotherapy followed by larynx-preserving esophagectomy. The reason for initially using chemoradiotherapy is to make the surgical margin on the oral side completely negative and as distal as possible for definitive treatment and to improve quality of life (QOL). From 2016 to 2019, there were 24 patients who were diagnosed with upper cervical esophageal carcinoma within 3 cm of the esophageal orifice and received chemoradiotherapy and larynx-preserving esophagectomy.

Results

All patients were eligible for chemoradiotherapy and larynx-preserving esophagectomy. Pathologically, all surgical margins on the oral side were negative and all operations were curative. In particular, 6 patients with a tumor margin within 1 cm of the esophageal orifice underwent successful curative, larynx-preserving esophagectomy with the following additional techniques: incision of the cricopharyngeus muscle, lifting of the trachea and larynx, and rotation of the larynx to the left. Regarding surgical complications, 4 patients had temporary recurrent nerve paralysis with aspiration pneumonia and 1 patient had minor anastomotic leakage.

Conclusion

The combination of chemoradiotherapy and esophagectomy with a larynx-preserving technique is a useful treatment strategy for upper cervical esophageal carcinoma in terms of both definitive treatment and QOL.
672 OESOPHAGOGASTRIC ANASTOMOTIC LEAK IN THE THORAX TREATED WITH COVERED METAL STENTS: SAFE AND HIGHLY SUCCESSFUL
Authors: Siddaiah-subramanya Manjunath , Hodson James , Ghoneim Abdulrahman , Ibrahim Ibrahim , Kamarajah Sivesh , Whiting John , Griffiths Ewen
Published: September 2021

Anastomotic leak (AL) develops in 5–22% of cases following oesophagectomy, and results in additional morbidity, and reduction in overall survival. The management of AL has evolved significantly with advances in endoscopic therapies. Covered cylindrical metal stents have been increasingly used, and insertion techniques have improved over time. We aimed to investigate the effectiveness and safety of modern metal stents in the management of AL.

Methods

All patients who underwent oesophagectomy with thoracic anastomosis between 2006–2020, and subsequently developed AL were retrospectively identified. Initially, treatment details and patient outcomes were assessed for the subgroup of patients where the AL was initially managed using a stent. In all cases, these were cylindrical covered metal stents. Those patients that progressed to surgery after treatment with a stent were then excluded, with the remainder compared to the subgroup of patients that underwent conservative (i.e., non-interventional) treatment for AL.

Results

Of 63 patients with AL, primary management was with stents in 32 (57%). Technical success was achieved in all stenting procedures, although three patients (9%) developed complications (stent migration). After stenting, six cases (19%) subsequently required escalation to operative management (thoracotomy). The remainder (N = 23) were then compared to those managed conservatively (N = 26) and were found to have a significantly longer length of hospital stay (median: 37 vs. 20 days, p = 0.003). The AL healing rate was 96% in both groups (p = 1.000); one conservatively managed patient died before healing, and one stented patient refused further treatment.

Conclusion

Endoscopic treatment of oesophageal AL with cylindrical covered metal stents is safe, with a high technical success rate, and low rates of stent-related morbidity. Treatment with stents also avoids the need for operative management including oesophageal disconnection in the majority of cases, whilst leading to successful healing of the AL. However, treatment with stents does significantly increase hospital stay over conservative management, particularly where multiple procedures are required.
712 NASOGASTRIC TUBE DRAINAGE AND PYLORIC INTERVENTIONS FOR DELAYED GASTRIC EMPTYING AFTER OESOPHAGEAL RESECTION: A NATIONAL ANALYSIS OF SPECIALIST UK CENTRES
Authors: Bull Charles , Pucher Philip H , Gossage James
Published: September 2021

Nasogastric tubes (NGTs) and pyloric intervention in oesophagectomy are used to lessen the impact of gastric tube distention and delayed gastric emptying. However, their utility remains unclear, with mixed evidence and some studies suggesting they may increase morbidity and patient discomfort. We performed a national survey of tertiary oesophageal surgery centres to assess current practice and surgeon equipoise for a potential prospective trial.

Methods

An electronic survey was distributed to all oesophageal resection centres in England, Wales and Scotland. Included questions assessed centres’ use of NGTs, current practice for removal and dietary progression, and use of pyloric interventions. Variations in practice were assessed, and compared to nationally reported annual centre volumes and length of stay.

Results

Seventy-nine percent (31/39) of all centres responded to the survey. All centres reported routinely using an NGT. Most centres (19/31, 61%) did not perform pyloric intervention or routine post-operative radiological assessment (22/31, 71%). Criteria for NGT removal and dietary progression was highly variable, with every centre reporting different practice criteria. There were no trends for practices when comparing high vs low volume centres, or above vs at-or-below median length of stay. 21/31 (68%) centres were willing to take part in a trial to assess NGT use and pyloric interventions.

Conclusion

NGTs remain standard practice despite mixed evidence for their efficacy and an absence of standardisation in their use. Use of pyloric intervention varies widely, with no clear link to outcomes. Surgeons recognise the need for a trial to assess requirement for NGTs and pyloric intervention after oesophageal resection.
744 THE USE OF IMMUNOFLUORESCENCE TO EVALUATE THE PERFUSION OF THE GASTRIC PLASTY DURING OESOPHAGECTOMY.
Authors: Abelló David , Navío Ana , Aguilar Karen Stephanie , Avelino Lourdes , Cholewa Hanna , Mingol Fernando , Bruna Marcos , Vaqué Javier , García-Granero Eduardo
Published: September 2021

Anastomotic leakage in oesophageal cancer surgery is one of the most serious complications and occurs mainly at the cervical level between 10–30% according to series. The use of immunofluorescence could help to select a better vascularized area in which to perform the anastomosis more safely. We present the initial experience (between July and December 2020) of our group.

Methods

Prospective and descriptive study of patients with oesophageal neoplasia who underwent a 3 stage oesophagectomy with cervical anastomosis using immunofluorescence with indocyanine green (dose: 7,5 mg) for quick evaluation of vascularization in the theoretical anastomosis zone in gastric plasty. Intravenous injection of the indocyanine green dilution was performed intraoperatively in a peripheral line, once the plasty was positioned in place to perform the anastomosis. The route of ascent was transmediastinal in all cases. 9 patients with a mean age of 61 ± 7.6 years were included in the study.

Results

The mean heart rate was 83 ± 16 bpm, the mean systolic blood pressure was 111 ± 17 mmHg. The time and mean speed it took for the fluorescence to reach the marked area to perform the anastomosis was 30 ± 28 seconds and 1.83 cm/sec; and at the apex of the plasty it was 93 ± 79 seconds and 0.75 cm/sec. In all patients in whom the anastomosis was performed in the area where ICG arrived between 30 and 90 seconds, there was no leakage. In two patients, due to anatomical needs, the anastomosis was performed in areas where ICG took more than 100 seconds and in the postoperative period leaked.

Conclusion

Immunofluorescence is a technique that allows an immediate visual image to evaluate the vascularization of the gastric plasty during an esophagectomy. It allows characterizing the adequate vascularization of the future anastomotic area, being able to help decide the best place to carry out the anastomosis. Studies with a larger number of cases are needed to be able to define the range in which to establish the anastomosis or change the surgical strategy.
774 TEAM DYNAMICS AND CLINICIAN’S PERSONAL BELIEVES IN TREATMENT OPTIONS INFLUENCE MULTIDISCIPLINARY TREATMENT DECISION-MAKING DURING AN ONCOLOGIC UPPER GASTROINTESTINAL MULTIDISCIPLINARY TEAM-MEETING
Authors: Luijten Josianne , Westerman Marjan , Vissers Pauline , Verhoeven Rob , Nieuwenhuijzen Grard
Published: September 2021

The probability of undergoing treatment with curative intent according to the hospital of diagnosis has been shown to vary considerately for esophagogastric cancer affecting survival negatively. Little is known which factors attribute to this variation. The aim of this study is to investigate the possible differences in clinical decision-making (CDM) during the multidisciplinary team meeting (MDTM).

Methods

A mixed method study design consisting of quantitative and qualitative data was conducted in which thematic content analysis of the current sub-study focused on the 16 MDTM observations and transcripts of 30 semi-structured interviews with clinicians was performed. Interviews were transcribed ad verbatim and coded. Seven focus groups were held to enrich, further explore and validate the gathered data.

Results

Clinician’s personality traits including ambition and the intention to be innovative were mentioned as facilitators, whereas hierarchy was mentioned as a barrier in CDM. Physician’s believes in a certain treatment and previous experiences with treatment outcomes and team dynamics within the MDTM influenced CDM. A continuum was identified in which at one end hospitals tended to be more guideline and evidence minded and at the other end of the continuum hospitals tended to search for boundaries maximizing chances of curation. All hospitals took patient characteristics in consideration.

Conclusion

Mechanisms influencing decision-making consisted of following guidelines, using evidence-based medicine, searching for boundaries, and taking patient characteristics into consideration. Nevertheless, the extend in which hospitals involved these mechanisms in their CDM differed. Variation in team dynamics was observed and awareness should be created that these factors attribute to CDM during an MDTM.