bluuebunny/crossref_metadata_2025 huggingface dataset:
“Basically you wait for an ‘in’’’: community pharmacist views on their role in weight management in New Zealand
Authors: Gray Lesley , Chamberlain Rachel , Morris Caroline
Published: September 2018

ABSTRACT

INTRODUCTION
Obesity is now widely regarded as the main contributor to poor health globally, overtaking tobacco as the leading potentially modifiable risk to health. Community pharmacists are delivering an increasing number of extended services and are potentially well placed to contribute to obesity management strategies. No studies to date have investigated the views of community pharmacists in New Zealand about their role in weight management.

AIM
To explore the views of community pharmacists in one region of New Zealand about their role in weight management, including the perceived barriers and facilitators to their involvement.

METHODS
Qualitative, face-to-face, semi-structured interviews were undertaken with 11 community pharmacists from the Greater Wellington region. Interviews were transcribed verbatim and analysed thematically using an inductive approach.

RESULTS
Four key themes were identified from data analysis. These were: (i) perceptions of obesity; (ii) perceptions of weight management treatment options; (iii) the unique position of the community pharmacist; and (iv) barriers to involvement. The main barriers described included: (i) a lack of time and remuneration; (ii) the absence of an appropriate space within the pharmacy to discuss weight-related matters; (iii) and a lack of awareness of who to contact for specialist support.

DISCUSSION
Community pharmacists in Greater Wellington believe that they have a distinct role in their local community and can contribute to a multidisciplinary approach to reduce levels of obesity. Further work is required to determine the most appropriate role for community pharmacy in weight management and the training needs for pharmacy staff to optimally fulfil this role.
Characteristics of a stratified random sample of New Zealand general practices
Authors: Leitch Sharon , Dovey Susan M. , Samaranayaka Ari , Reith David M. , Wallis Katharine A. , Eggleton Kyle S. , McMenamin Andrew W. , Cunningham Wayne K. , Williamson Martyn I. , Lillis Steven , Tilyard Murray W.
Published: September 2018

ABSTRACT INTRODUCTION Practice size and location may affect the quality and safety of health care. Little is known about contemporary New Zealand general practice characteristics in terms of staffing, ownership and services. AIM To describe and compare the characteristics of small, medium and large general practices in rural and urban New Zealand. METHODS Seventy-two general practices were randomly selected from the 2014 Primary Health Organisation database and invited to participate in a records review study. Forty-five recruited practices located throughout New Zealand provided data on staff, health-care services and practice ownership. Chi-square and other non-parametric statistical analyses were used to compare practices. RESULTS The 45 study practices constituted 4.6% of New Zealand practices. Rural practices were located further from the nearest regional base hospital (rural median 65.0 km, urban 7.5 km (P < 0.001)), nearest local hospital (rural 25.7 km, urban 7.0 km (P = 0.002)) and nearest neighbouring general practitioner (GP) (rural 16.0 km, urban 1.0 km (P = 0.007)). In large practices, there were more enrolled patients per GP FTE than both medium-sized and small practices (mean 1827 compared to 1457 and 1120 respectively, P = 0.019). Nurses in large practices were more likely to insert intravenous lines (P = 0.026) and take blood (P = 0.049). There were no significant differences in practice ownership arrangements according to practice size or rurality. CONCLUSION Study practices were relatively homogenous. Unsurprisingly, rural practices were further away from hospitals. Larger practices had higher patient-to-doctor ratios and increased nursing scope. The study sample is small; findings need to be confirmed by specifically powered research.
Diagnosis and management of melanoma in a rural general practice
Authors: Townsend Tony
Published: September 2018

ABSTRACT
A review covering 5 years of melanoma detection and management in a small rural New Zealand practice is presented. The incidence of both in situ and invasive melanoma was approximately four-fold the national figures, which are among the highest in the world. Most melanomas can be managed in primary care but cost remains an issue.
A new biogeographical regionalisation of the Páramo biogeographic province
Authors: Jiménez-Rivillas Carlos , García Juan J. , Quijano-Abril Mario Alberto , Daza Juan M. , Morrone Juan J.
Published: September 2018

We identified biogeographical districts in the Páramo biogeographic province, in the north-western Andes of Colombia, Ecuador and Venezuela, including the Sierra Nevada de Santa Marta in Colombia, above 3000 m ASL. We applied a parsimony analysis of endemicity (PAE) to 8418 distributional data of 4644 vertebrate and angiosperm species, distributed in the north-western Andes and the Sierra Nevada de Santa Marta. Areas analysed were selected according to the hypotheses of several authors. We obtained a single most parsimonious cladogram, which shows 10 groups of areas (southern Ecuadorian, central Ecuadorian, northern Ecuadorian, Venezuelan, Los Picachos, Sierra Nevada, Santa Inés-Sonsón, Paramillo del Sinú, Cordillera Oriental and Quindío) and a single isolated area (Farallones de Cali). We propose that these areas conform 11 biogeographical districts. The biogeographical districts obtained adjust to the ‘cordilleran pattern’, where páramos of each cordillera are linked together. This study supports the hypothesis that during different glacial periods, páramos of these cordilleras were connected and, subsequently, separated during interglacial periods.
Jackknife approach to the estimation of mutual information
Authors: Zeng Xianli , Xia Yingcun , Tong Howell
Published: September 2018

Quantifying the dependence between two random variables is a fundamental issue in data analysis, and thus many measures have been proposed. Recent studies have focused on the renowned mutual information (MI) [Reshef DN, et al. (2011)Science334:1518–1524]. However, “Unfortunately, reliably estimating mutual information from finite continuous data remains a significant and unresolved problem” [Kinney JB, Atwal GS (2014)Proc Natl Acad Sci USA111:3354–3359]. In this paper, we examine the kernel estimation of MI and show that the bandwidths involved should be equalized. We consider a jackknife version of the kernel estimate with equalized bandwidth and allow the bandwidth to vary over an interval. We estimate the MI by the largest value among these kernel estimates and establish the associated theoretical underpinnings.
Erroneous ribosomal RNAs promote the generation of antisense ribosomal siRNA
Authors: Zhu Chengming , Yan Qi , Weng Chenchun , Hou Xinhao , Mao Hui , Liu Dun , Feng Xuezhu , Guang Shouhong
Published: September 2018

Ribosome biogenesis is a multistep process, during which mistakes can occur at any step of pre-rRNA processing, modification, and ribosome assembly. Misprocessed rRNAs are usually detected and degraded by surveillance machineries. Recently, we identified a class of antisense ribosomal siRNAs (risiRNAs) that down-regulate pre-rRNAs through the nuclear RNAi pathway. To further understand the biological roles of risiRNAs, we conducted both forward and reverse genetic screens to search for more suppressor of siRNA (
susi
) mutants. We isolated a number of genes that are broadly conserved from yeast to humans and are involved in pre-rRNA modification and processing. Among them, SUSI-2(ceRRP8) is homologous to human RRP8 and engages in m1A methylation of the 26S rRNA. C27F2.4(ceBUD23) is an m7G-methyltransferase of the 18S rRNA. E02H1.1(ceDIMT1L) is a predicted m6(2)Am6(2)A-methyltransferase of the 18S rRNA. Mutation of these genes led to a deficiency in modification of rRNAs and elicited accumulation of risiRNAs, which further triggered the cytoplasmic-to-nuclear and cytoplasmic-to-nucleolar translocations of the Argonaute protein NRDE-3. The rRNA processing deficiency also resulted in accumulation of risiRNAs. We also isolated SUSI-3(RIOK-1), which is similar to human RIOK1, that cleaves the 20S rRNA to 18S. We further utilized RNAi and CRISPR-Cas9 technologies to perform candidate-based reverse genetic screens and identified additional pre-rRNA processing factors that suppressed risiRNA production. Therefore, we concluded that erroneous rRNAs can trigger risiRNA generation and subsequently, turn on the nuclear RNAi-mediated gene silencing pathway to inhibit pre-rRNA expression, which may provide a quality control mechanism to maintain homeostasis of rRNAs.
Repairable cascaded slide-lock system endows bird feathers with tear-resistance and superdurability
Authors: Zhang Feilong , Jiang Lei , Wang Shutao
Published: September 2018

Significance

Bird feathers have aroused tremendous attention for their contributions to the unique flight capability of birds against wind and even through bushes. Many studies have attempted to explore the mechanism underlying feathers’ superdurability. However, it is not yet clear why feathers are so superdurable. In this study, we discovered and characterized the sophisticated cascaded slide-lock system of bird feathers, which is composed of flexible hooklets, a slide rail, and spines at the end of the slide rail as terminating structures. This finding demonstrates that the superdurability of bird feathers against tears originates from their cascaded slide-lock system, not from the “hook–groove system” proposed centuries ago.
Evolutionary journey of the retroviral restriction gene
Fv1
Authors: Young George R. , Yap Melvyn W. , Michaux Johan R. , Steppan Scott J. , Stoye Jonathan P.
Published: September 2018

Both exogenous and endogenous retroviruses have long been studied in mice, and some of the earliest mouse studies focused on the heritability of genetic factors influencing permissivity and resistance to infection. The prototypic retroviral restriction factor,
Fv1
, is now understood to exhibit a degree of control across multiple retroviral genera and is highly diverse within
Mus
. To better understand the age and evolutionary history of
Fv1
, a comprehensive survey of the Muroidea was conducted, allowing the progenitor integration to be dated to ∼45 million years. Intact coding potential is visible beyond
Mus
, and sequence analysis reveals strong signatures of positive selection also within field mice,
Apodemus
.
Fv1
’s survival for such a period implies a recurring and shifting retroviral burden imparting the necessary selective pressures—an influence likely also common to analogous factors. Regions of
Fv1
adapt cooperatively, highlighting its preference for repeated structures and suggesting that this functionally constrained aspect of the retroviral capsid lattice presents a common target in the evolution of intrinsic immunity.
Self-organization into ferroelectric and antiferroelectric crystals via the interplay between particle shape and dipolar interaction
Authors: Takae Kyohei , Tanaka Hajime
Published: September 2018

Significance

Controlling ferroelectricity and antiferroelectricity of a crystalline solid is one of the central issues in material science and technological applications because the dielectric, electromechanical, and thermoelectric properties crucially depend on the type of dipolar order. However, still missing is a simple particle-based physical model that shows self-organization into a lattice structure of desired dipolar order in a controlled manner. Here we elucidate the importance of competition between anisotropic steric and dipolar interactions in such self-organization. We also reveal that the interplay between the two types of anisotropy with different origins is a key to cross-coupling properties of solids such as mechanical switchability of ferroelectric and antiferroelectric phases. These findings will provide a useful guide for designing materials with dipolar order.
Collimated ultrabright gamma rays from electron wiggling along a petawatt laser-irradiated wire in the QED regime
Authors: Wang Wei-Min , Sheng Zheng-Ming , Gibbon Paul , Chen Li-Ming , Li Yu-Tong , Zhang Jie
Published: September 2018

Significance

Even though bright X-rays below mega-electron volt photon energy can be obtained from X-ray free electron lasers and synchrotron radiation facilities, it remains a great challenge to generate collimated bright gamma-ray beams over 10 mega-electron volts. We propose a scheme to efficiently generate such beams from submicron wires irradiated by petawatt lasers, where electron accelerating and wiggling are achieved simultaneously. With significant quantum electrodynamics effects existing even with petawatt lasers, our full 3D simulations show that directional gamma rays can be generated with thousand-fold higher brilliance and thousand-fold higher photon energy than those from synchrotron radiation facilities. In addition, the photon yield efficiency approaches 10%, 100,000-fold higher than those typical from betatron radiation and Compton scattering based on laser-wakefield accelerators.
Language origins
Authors: Wacewicz Sławomir , Żywiczyński Przemysław
Published: September 2018

In this paper, we complement proximate or ‘how’ explanations for the origins of language, broadening our perspective to include fitness-consequences explanations, i.e. ultimate, or ‘why’ explanations. We identify theplatform of trustas a fundamental prerequisite for the development of a language-like system of symbolic communication. The platform of trust is a social niche in which cheap but honest communication with non-kin is possible, because messages tend to be trusted as a default. We briefly consider the place of the platform of trust on the road map as laid out in the Mirror System Hypothesis. We then turn to recent research on turn-taking in primates, which has been proposed as a precursor of the cooperative structuring of conversation in humans. We suggest, instead, that human turn-taking, in its full richness that makes it an interesting explanatory target, may only appear in a communicative system that is already founded on a community-wide, cooperative platform of trust.
Reflections on the differential organization of mirror neuron systems for hand and mouth and their role in the evolution of communication in primates
Authors: Coudé Gino , Ferrari Pier Francesco
Published: September 2018

It is now generally accepted that the motor system is not purely dedicated to the control of behavior, but also has cognitive functions. Mirror neurons have provided a new perspective on how sensory information regarding others’ actions and gestures is coupled with the internal cortical motor representation of them. This coupling allows an individual to enrich his interpretation of the social world through the activation of his own motor representations. Such mechanisms have been highly preserved in evolution as they are present in humans, apes and monkeys. Recent neuroanatomical data showed that there are two different connectivity patterns in mirror neuron networks in the macaque: one is concerned with sensorimotor transformation in relation to reaching and hand grasping within the traditional parietal-premotor circuits; the second one is linked to the mouth/face motor control and the new data show that it is connected with limbic structures. The mouth mirror sector seems to be wired not only for ingestive behaviors but also for orofacial communicative gestures and vocalizations. Notably, the hand and mouth mirror networks partially overlap, suggesting the importance of hand-mouth synergies not only for sensorimotor transformation, but also for communicative purposes in order to better convey and control social signals.
From evolutionarily conserved frontal regions for sequence processing to human innovations for syntax
Authors: Wilson Benjamin , Petkov Christopher I.
Published: September 2018

Empirical advances have been made in understanding how human language, in its combinatorial complexity and unbounded expressivity,
may have evolved from the communication systems present in our evolutionary ancestors. However, a number of cognitive processes
and neurobiological mechanisms that support language may not have evolved specifically for communication, but rather from
abilities that support perception and cognition more generally. We review recent evidence from comparative behavioural and
neurobiological studies on structured sequence learning in human and nonhuman primates. These studies support the notion that
certain sequence learning abilities are evolutionarily conserved and engage corresponding inferior frontal brain regions across
the species, regions also involved in processing language in humans. Alongside the cross-species similarities is evidence for
human specialisations, illuminating the likely evolutionary pathways towards language in modern humans. We argue that cognitive
abilities that were in place for animals to learn combinatorial relationships in the sensory world were available and co-opted for
language in humans.
Plasticity, innateness, and the path to language in the primate brain
Authors: Hecht Erin
Published: September 2018

Many researchers consider language to be definitionally unique to humans. However, increasing evidence suggests that language emerged via a series of adaptations to neural systems supporting earlier capacities for visuomotor integration and manual action. This paper reviews comparative neuroscience evidence for the evolutionary progression of these adaptations. An outstanding question is how to mechanistically explain the emergence of new capacities from pre-existing circuitry. One possibility is that human brains may have undergone selection for greater plasticity, reducing the extent to which brain organization is hard-wired and increasing the extent to which it is shaped by socially transmitted, learned behaviors. Mutations that made these new abilities easier or faster to learn would have undergone positive selection, and over time, the neural changes once associated with individual neural plasticity would tend to become heritable, innate, and fixed. Clearly, though, language is not entirely “innate;” it does not emerge without the requisite environmental input and experience. Thus, a mechanistic explanation for the evolution of language must address the inherent trade-off between the evolutionary pressure for underlying neural systems to be flexible and sensitive to environmental input vs. the tendency over time for continually adaptive behaviors to become reliably expressed in an early-emerging, canalized, less flexible manner.
USP38 critically promotes asthmatic pathogenesis by stabilizing JunB protein
Authors: Chen Siyuan , Yun Fenglin , Yao Yikun , Cao Mengtao , Zhang Yifan , Wang Jingjing , Song Xinyang , Qian Youcun
Published: September 2018

Th2 immune response is critical for allergic asthma pathogenesis. Molecular mechanisms for regulating Th2 immunity are still not well understood. Here we report that the ubiquitin-specific protease USP38 is crucial for Th2-mediated allergic asthma. TCR stimulation up-regulated the USP38 level, and USP38 in turn mediated the protein stabilization of JunB, a transcription factor specific for Th2 development. Consequently, USP38 was specifically required for TCR-induced production of Th2 cytokines and Th2 development both in vitro and in vivo, and USP38-deficient mice were resistant to asthma pathogenesis induced by OVA or HDM. Mechanistically, USP38 directly associated with JunB, deubiquitinated Lys-48–linked poly-ubiquitination of JunB, and consequently blocked TCR-induced JunB turnover. USP38 represents the first identified deubiquitinase specifically for Th2 immunity and the associated asthma.
CAPON Is a Critical Protein in Synaptic Molecular Networks in the Prefrontal Cortex of Mood Disorder Patients and Contributes to Depression-Like Behavior in a Mouse Model
Authors: Gao Shangfeng , Zhang Tong , Jin Lei , Liang Dong , Fan Guangwei , Song Yunnong , Lucassen Paul J , Yu Rutong , Swaab Dick F
Published: September 2018

Aberrant regulation and activity of synaptic proteins may cause synaptic pathology in the prefrontal cortex (PFC) of mood disorder patients. Carboxy-terminal PDZ ligand of NOS1 (CAPON) is a critical scaffold protein linked to synaptic proteins like nitric oxide synthase 1, synapsins. We hypothesized that CAPON is altered together with its interacting synaptic proteins in the PFC in mood disorder patients and may contribute to depression-like behaviors in mice subjected to chronic unpredictable mild stress (CUMS). Here, we found that CAPON-immunoreactivity (ir) was significantly increased in the dorsolateral PFC (DLPFC) and anterior cingulate cortex in major depressive disorder (MDD), which was accompanied by an upregulation of spinophilin-ir and a downregulation of synapsin-ir. The increases in CAPON and spinophilin and the decrease in synapsin in the DLPFC of MDD patients were also seen in the PFC of CUMS mice. CAPON-ir positively correlated with spinophilin-ir (but not with synapsin-ir) in mood disorder patients. CAPON colocalized with spinophilin in the DLPFC of MDD patients and interacted with spinophilin in human brain. Viral-mediated CAPON downregulation in the medial PFC notably reversed the depression-like behaviors in the CUMS mice. These data suggest that CAPON may contribute to aspects of depressive behavior, possibly as an interacting protein for spinophilin in the PFC.
Asymptomatic Visceral Leishmania infantum Infection in US Soldiers Deployed to Iraq
Authors: Mody Rupal M , Lakhal-Naouar Ines , Sherwood Jeffrey E , Koles Nancy L , Shaw Dutchabong , Bigley Daniel P , Co Edgie-Mark A , Copeland Nathanial K , Jagodzinski Linda L , Mukbel Rami M , Smiley Rebecca A , Duncan Robert C , Kamhawi Shaden , Jeronimo Selma M B , DeFraites Robert F , Aronson Naomi E
Published: September 2018

Background

Visceral leishmaniasis (VL), due to Leishmania infantum, is a persistent intracellular parasitic infection transmitted by the bite of infected sand flies. Symptomatic VL has been reported in U.S. soldiers with Iraq deployment. Untreated symptomatic VL can be fatal; asymptomatic VL (AVL) may establish a lifelong risk of reactivation. We report prevalence and AVL risk factors in Operation Iraqi Freedom (OIF) deployers during 2002–11.

Methods

Healthy soldiers exposed to VL endemic areas in Iraq and 50 controls who never traveled to endemic regions were recruited through military healthcare facilities (2015–17). Responses to a risk factor survey and blood samples were obtained. Leishmania research diagnostics utilized included enzyme-linked immunosorbent assay (ELISA), rk39 test strips, quantitative polymerase chain reaction (PCR), and interferon gamma release (IGRA) assays. Statistical analyses included Fisher exact test, Pearson χ2 test, Mann-Whitney U test, and logistic regression.

Results

200 deployed subjects were enrolled, mostly males (84.0%), of white ethnicity (79.0%), and median age 41 (range 24–61) years. 64% were seropositive for Phlebotomus alexandri saliva antibodies. Prevalence of AVL (any positive test result) was 39/200 (19.5%, 95% confidence interval 14.4%–25.8%). Two (1.0%) PCR, 10 (5%) ELISA, and 28 (14%) IGRA samples were positive. Travel to Ninewa governorate increased risk for AVL (P = .01).

Conclusion

AVL was identified in 19.5% of OIF deployers; travel to northwest Iraq correlated with infection. Further studies are needed to inform risk for reactivation VL in US veterans and to target additional blood safety and surveillance measures.
PS01.127: SURGICAL RECONSTRUCTION OF ESOPHAGO-INTESTINAL CONTINUITY IN PATIENTS WITH SURGICAL CONDUIT FAILURE AFTER ESOPHAGEAL RESECTION AND RECONSTRUCTION
Authors: Alghamdi Zeead , Dong Lee Geun , Sik Gong Chung , Seob Lee In , Su Kim Beom , Wook Kim Chan , Key Kim Eun , Hee Kim Yong
Published: September 2018

Background

Surgical restoration of gastrointestinal tract integrity for failed esophageal conduit is technically challenging with significant morbidity and mortality. The purpose of this study was to evaluate the feasibility and safety of restored esophago-intestinal integrity for the failed reconstructed esophagus.

Methods

From January 1990 to July 2017, a total of 1923 patients underwent esophageal cancer surgery. 29 patients (1.5%) presented with a clinical picture of failed conduits secondary to frank conduit necrosis, tracheoesophageal fistula, conduit stricture, and conduit cancer. We retrospectively analyzed 22 patients who planned to go for surgical reconstruction for a failed esophageal conduit.

Results

The median age was 62.5 (14–72) years old, and all of the patients were males. The underlying pathology was esophageal squamous cell carcinoma for all patients. The interval between the first esophagectomy and the surgery for failed conduits was 14 days for conduit necrosis (n = 9), 43 days for TEF (n = 7), 1256 days for conduit stricture and 1520.5 days for conduit cancer(n = 4). Of the 22 patients, 18 patients (81.8%) underwent a successful surgical restoration of the esophago-intestinal integrity. Three of the remaining 4 patients who planned for reconstructive surgery died of pneumonia-related complications within 30 days and one patient elects to have a cervical esophagostomy.Among reconstructed patients, 14 patients had failed gastric conduit and 4 had failed colon conduit. For the gastric group, restoration of the gastrointestinal continuity achieved using esophagocolostomy in 12 patients, free jejunal flap in 1 patient and colon with a free jejunal flap in 1 patient. While in the colon group, restoration was accessible using free jejunal flaps in 2 patients, ileocolon in 1 patient and gastric conduit in 1 patient. During post-operative follow-up, 7 patients died with pneumonia or mediastinitis related complications, 3 died of cancer progression, and 1 unknown origin. The median survival time after conduit reconstruction was 36 months.

Conclusion

Once a failed esophageal conduit is diagnosed, the decision of surgical reconstruction of gastrointestinal continuity can be feasible with a relatively good outcome if efficiently treated. In our study, reconstruction was possible in 81.8% of patients with a median survival time of 36 months after esophago-intestinal integrity restoration.

Disclosure

All authors have declared no conflicts of interest.
PS01.138: EXPERIENCE FROM 102 PATIENTS WITH CONTINUOUS INTRAOPERATIVE VAGUS NERVE STIMULATION DURING MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Yu Hong Wong Ian , King Yin Tsang Raymond , Kwan Kit Chan Desmond , Lai Yin Wong Claudia , Ting Law Tsz , King Hung Tong Daniel , Siu Yin Chan Fion , Ying Kit Law Simon
Published: September 2018

Background

The incidence of recurrent laryngeal nerve (RLN) injury after esophagectomy can be as high as 60–70% especially when lymphadenectomy is performed along bilateral RLN. Vocal cord paralysis is associated with increased pulmonary complication rate, longer hospital stay, and impaired quality-of-life. The authors have modified the Continuous Intraoperative Nerve Monitoring (CIONM) method for minimally invasive esophagectomy. This study reviews our experience in the first 102 patients.

Methods

From May 2014 to January 2018, patients who underwent thoracoscopic esophagectomy were recruited. CIONM and intermittent nerve stimulation were routinely used during left RLN lymphadenectomy. For right RLN dissection, only intermittent nerve stimulation was used because of much lower chance of nerve injury. Routine direct laryngoscopy was performed on postoperative day one to assess the vocal cord status. Patients with RLN palsy are referred to otorhinolaryngologist for assessment and treatment. Surgical outcome, especially RLN palsy and recovery rates were documented.

Results

102 patients were recruited and 73 patients had more than one year follow up. Twenty-two patients had RLN palsy (21.6%); right side in 3, left side in 18, and bilateral in one. Thirty-eight patients (37%) had only unilateral or no RLN dissection performed. This was because of R2 resection negating the benefits of RLN dissection (15.6%), poor pulmonary exposure (9.8%), other technical difficulties (7.8%), preoperative vocal cord palsy (2%), intraoperative complications (1%) and uncertain contralateral nerve integrity (1%). For those 90 patients with successful CIONM, 20 RLN palsy (22.2%), 10 of whom underwent injection thyroplasty within 2–80 days. Thyroplasty was not performed in 12 patients as they had good compensation from the contralateral cord (58.3%), early recovery within 2 weeks (16.7%) tracheostomized status (16.7%) or refusal (8.3%). Thirteen patients (59%) recovered within 2–72 weeks (Median 6 weeks). For the 73 patients with more than 1 year follow up, only 4 has residual vocal cord paralysis, making a genuine cord palsy rate of 5.5%.

Conclusion

Lymphadenectomy along bilateral RLN is technically demanding. CIONM is a sensitive tool to guide surgeons for safer dissection. Proper patient selection, postoperative assessment and treatment protocol can reduce the morbidity of RLN injury. Majority of the vocal cord paralysis is temporary

Disclosure

All authors have declared no conflicts of interest.
PS01.155: ANALYSIS ON THE INCIDENCE AND RISK FACTOR OF READMISSION AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER FOR ESOPHAGEAL CANCER
Authors: Yong Park Seong , Joon Kim Dae , Won Suh Jee , Eun Byun Go
Published: September 2018

Background

Esophageal complications consensus group (ECCG) recommended that readmissions to primary or secondary hospital within 30 days of discharge after esophagectomy can be an important quality outcome indicator for esophagectomy. This retrospective study was performed to investigate the frequencies and risk factors for readmission after esophagectomy.

Methods

We retrospectively reviewed 291 patients who received the esophagectomy and mediastinal lymphadenectomy for curative aim from January 2006 to June 2017.

Results

The mean age was 63.02 ± 8.02 years and male patients were 264 (90.7%). Thirty-nine (13.4%) patients readmit within 30 days after discharge. The mean readmission day after discharge was 14.76 ± 8.84. The common causes of readmission were anastomotic stricture requiring the ballooning (12, 30.7%), wound problem (7, 17.9%), pneumonia (6, 15.4%), and poor oral intake (4, 10.2%). Other causes of readmission were delayed gastric emptying (3), jejunostomy tube problem (2), ileus (2), pain (1), pneumothorax (1) and pleural effusion (1). On multivariate analysis, anastomotic leakage (odd ratio = 2.872, P = 0.022) were related to readmission, whereas age, pathologic stage, vocal cord palsy and neoadjuvant therapy were not related to readmission. In 30 patients with postoperative anastomotic leakage, the frequency of readmission due to wound problem (13.3% vs. 1.1%, P = 0.003) and anastomotic stricture (13.3% vs. 3.4%, P = 0.034) were significantly higher.

Conclusion

The incidence of readmission within 30 days after discharge was 13.4% and postoperative anastomotic leakage was related to the readmission, and it might be related to the wound problem and anastomotic stricture.

Disclosure

All authors have declared no conflicts of interest.
PS01.176: OPEN VERSUS HYBRID VERSUS MINIMALLY INVASIVE ESOPHAGECTOMY FOR PATIENTS WITH ESOPHAGEAL CANCER: A PROPENSITY SCORE MATCHED ANALYSIS
Authors: Visser Els , Edholm David , Smithers Mark , Thomas Janine , Brosda Sandra , Krause Lutz , Thomson Iain , Gotley David , Barbour Andrew
Published: September 2018

Background

MIE is becoming more common and is considered safe. There are few studies supporting laparoscopy in favor of laparotomy for the abdominal part of a three-field esophagectomy and long term survival data are scarce. The objective was to compare open esophagectomy (OE), with hybdrid thoracoscopic-laparotomic esophagectomy (HMIE) and minimally invasive esophagectomy (MIE) with regard to surgical outcomes, postoperative complications and survival.

Methods

A prospective database of esophageal resection for cancer at a single centre identified 243 OE, 688 HMIE and 80 MIE procedures. Propensity scores were used to match 80 patients in each group adjusting for age, gender, weight, clinical stage, neoadjuvant treatment, and year of surgery.

Results

Respiratory complications were more common after OE (49%) than after MIE (31%, P = 0.02). Median operative time was longer for MIE (330 minutes) versus HMIE or OE (both 300 minutes, P < 0.001). Median length of stay was shorter following MIE (12 days) compared with HMIE (14 days) and OE (15 days), P = 0.001. There were no significant differences between groups with respect to other complications, median number of lymph nodes examined (22–23 for all groups), or R0 resection rate (range 85–91%) for all groups. There was no difference in 5-year overall survival between groups.

Conclusion

Compared with OE and HMIE, MIE was associated with shorter length of stay and fewer respiratory complications, but longer operative time. Thus, there may be additional benefit for MIE without comprising oncological outcomes.

Disclosure

All authors have declared no conflicts of interest.
PS01.208: SURVEY ON THE MANAGEMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGEAL RESECTION WITH GASTRIC TUBE RECONSTRUCTION
Authors: Hagens Eliza , Anderegg Maarten , Van Berge Henegouwen Mark I , Gisbertz Suzanne
Published: September 2018

Background

For patients with locally advanced esophageal cancer, radical esophageal resection with gastric tube reconstruction preceded by chemo(radio)therapy offers the best chance for cure. Anastomotic leakage (AL) is one of the most severe complications following esophageal surgery, leading to significant morbidity, prolonged hospital stay, considerable costs, decreased quality of life and increased mortality. Management is complicated and not standardized. The objective is to gain insight into the different opinions on AL management among upper gastrointestinal surgeons and to verify the need for a diagnostic and treatment guideline.

Methods

Surgeons with particular interest in esophageal surgery, were invited to participate in an online questionnaire. The survey consisted of questions pertaining to the surgeons’ experience, operation characteristics, management routine and their opinion on international guidelines on the diagnosis and therapy of AL.

Results

Of the 331 invited physicians, 40% participated in the survey. 90.7% Use laboratory diagnostics and 62.8% imaging and/or endoscopy postoperatively on routine basis. In case of suspected AL, the first choice of diagnostic imaging modalities was mostly a CT scan (35.7%) or a dynamic swallow investigation (33.3%). In case of AL, indepently of the clincal manifestations (local symptoms only, medianstinal manifestations or In case of gastric conduit necrosis) the treatment strategies differed widely between surgeons (table 1). Over 70% of the responders agree that there is a need for a solid international guideline on AL management.

Conclusion

There is no general consensus in the management of AL. There is a need for an international guideline regarding the optimal management of AL.

Disclosure

All authors have declared no conflicts of interest.
PS02.012: AN IMPORTANT COMPLICATION OF MINIMALLY INVASIVE ESOPHAGECTOMIES: HIATAL HERNIA
Authors: Eroglu Atila , Aydin Yener , Ulas Ali , Daharli Coskun
Published: September 2018

Background

Development of hiatal hernia after esophageal resection is a known complication. However, due to the spread of minimally invasive esophagectomy, complications of hiatal hernia seems to increase. This study aimed to present our cases with hiatal hernia after Ivor Lewis minimally invasive esophagectomy.

Methods

After Ivor Lewis minimally invasive esophagectomy, five cases of hiatal hernia were observed. Patients' age, sex, symptoms, diagnosis, herniated organs, surgical method, morbidity and mortality rates and hospital stay were reviewed.

Results

Three of the patients were male and two were female. The mean age of the patients was 56.2 years (35–71 years). Hiatal hernia was detected after an average of 1.4 years with minimal invasive esophagectomies (5 months, 1 year, 1 year, 18 months and 3 years respectively). Three of the cases were symptomatic and two cases were asymptomatic. Thorax CT was used in all cases, and two cases were additionally imaged with barium esophagography. Herniated organs were: omentum in 5 cases, transverse colon in 4 cases, small bowel in two cases. All cases were laparoscopically approached. Diaphragmatic defects were repaired using nonabsorbable sutures in all cases. No complication and mortality was observed in patients. The mean length of hospital stay was 4.9 days (range, 3 to 10 days).

Conclusion

Hiatal hernia is more frequently seen in minimally invasive esophagectomies than open esophagectomies. Patients undergoing minimal esophagectomy should be closely monitored for hiatal hernia postoperatively. These cases can also be treated by minimally invasive laparoscopy.

Disclosure

All authors have declared no conflicts of interest.
PS02.024: PRIMA-1 INDUCES P53-MEDIATED APOPTOSIS BY UPREGULATING NOXA IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA WITH TP53 MISSENSE MUTATION
Authors: Furukawa Haruna , Makino Tomoki , Yamasaki Makoto , Tanaka Koji , Miyazaki Yasuhiro , Takahashi Tsuyoshi , Kurokawa Yukinori , Nakajima Kiyokazu , Takiguchi Shuji , Mori Masaki , Doki Yuichiro
Published: September 2018

Background

TP53 is associated with the resistance of cytotoxic treatment and patient prognosis, and the mutation rate of TP53 in esophageal squamous cell carcinoma (ESCC) is extraordinarily high, at over 90%. PRIMA-1 (p53 re-activation and induction of massive apoptosis) has recently been reported to restore wild type activity to mutant p53 and induce massive p53-dependent apoptosis. APR-246 (methylated PRIMA-1) has been tested in a phase I/II clinical trial with promising results; however, the effects and mechanism in ESCC remain unknown. This study was designed to assess the antitumor effect of PRIMA-1 treatment in both ESCC cell lines with different TP53 status and an ESCC xenograft model and uncover the molecular mechanism of PRIMA-1.

Methods

After evaluating the TP53 mutation status of a panel of eleven ESCC cell lines by Sanger sequencing, we assessed the in vitro effect of PRIMA-1 administration on cells with different p53 status by conducting cell viability and apoptosis assays. The expression levels of proteins in TP53-related pathways were examined by Western blotting, while knockdown studies were conducted to investigate the mechanism underlying PRIMA-1’s function. An ESCC xenograft model was further used to evaluate the therapeutic effect of PRIMA-1 in vivo.

Results

PRIMA-1 markedly inhibited cell growth and induced apoptosis by upregulating Noxa expression in ESCC cell lines with a TP53 missense mutation, whereas no apoptosis was induced in ESCC with wild type TP53 and with TP53 frameshift and nonsense mutations. Importantly, the knockdown of Noxa cancelled the apoptosis induced by PRIMA treatment in ESCC cell lines with a TP53 missense mutation. PRIMA-1 administration, compared with placebo, showed a significant antitumor effect by inducing Noxa in the xenograft model of an ESCC cell line with a TP53 missense mutation.

Conclusion

PRIMA-1 exhibits a significant antitumor effect, inducing massive apoptosis through the upregulation of Noxa in ESCC with a TP53 missense mutation.

Disclosure

All authors have declared no conflicts of interest.
PS02.125: NEOADJUVANT CHEMOTHERAPY PLUS SURGERY FOR NON-T4 CSTAGE II/III ESOPHAGEAL CANCER: A SINGLE INSTITUTION EXPERIENCE IN JAPAN
Authors: Ikebe Masahiko , Ohta Mitsuhiko , Sugiyama Masahiko , Morita Masaru , Toh Yasushi
Published: September 2018

Background

In Japan, following the results of JCOG 9907 trial, neoadjuvant chemotherapy (NAC) and radical surgery has been a standard treatment for Non-T4 cStage II/III esophageal cancer. Since 2009 we have also positioned NAC as standard treatment. We examined treatment outcomes and problems in our institute.

Methods

From 2009 to 2015, there were 64 patients with non-T4 stage II/III esophageal cancer treated with chemotherapy who are planned to undergo curative surgery. The standard NAC regimen consists of 2 courses of CDDP/5-FU (CF) therapy. As standard surgical procedure, subtotal esophagectomy, cervical anastomosis, three regional lymph node dissection were performed.

Results

The number of patients was 23/41 cases of cStage II/III respectively. 53 patients (88%) completed two courses of NAC. At the end of first course, NAC was terminated due to adverse events in 4 cases and due to the increasing tendency of tumors in 7 cases. NAC-induced adverse events of grade 3 or higher consists of myelosuppression in 27 cases (42%), appetite loss in 5 cases and so on. Surgery was performed in 61 cases (95%), of which R0 operation in 56 cases (88%), R1 operation in 3 cases and R2 operation in 2 cases. Three patients did not undergo surgery due to progressive disease. There were 7 cases (11%) of postoperative complications of Grade 3 or higher, but there was no in-hospital death. In the histological therapeutic effect, there were 5/41/7/4/3 cases for Grade 0/1a/1b/2/3, respectively. Three-year and five-year overall survival rate of all 64 patients were 68% and 47%. In 56 patients who underwent R0 surgery, they were 76% and 61% respectively.

Conclusion

From the viewpoint of adverse events and postoperative complications, NAC plus radical surgery for cStage II/III esophageal cancer could be performed safely. Considering that more than 60% of the patients belong to cStage III, this treatment strategy resulted in relatively favorable prognosis.

Disclosure

All authors have declared no conflicts of interest.
PS02.151: ESOPHAGEAL CANCER RESECTION AND AZYGOS LOBE
Authors: Nobuhisa Tetsuji
Published: September 2018

Background

Azygos lobe is a congenital variation of the upper lobe of the right lung and is seen in 1% of the population. Esophagectomy is usually performed through a right thoracotomy, so the 1% of the esophagectomy require a treatment for the change from azygos lobe. We report a case of the thoracoscopic approach in the prone position in patient admitted for esophageal carcinoma and azygos lobe.

Methods

We herein describe a 71-year-old male with esophageal carcinoma associated with azygos lobe. The procedures of our surgical techniques were as follows: (1) The patient was placed in prone position. (2) Two 12mm-trocars and two 5mm-trocar were used. (3) Subtotal esophagectomy and lymphadenectomy was performed with the arch of the azygos vein cutting by using the right-sided thoracoscopic approach in addition to the laparotomy. (4) Retrosternal esophagogastrostomy was performed for reconstruction.

Results

Operative time was 375 min. Blood loss was 170 g, and no perioperative transfusion was required. Postoperative recovery was uneventful. Histology showed the resection margins were clear. Surgical findings were as follows: (1) The azygos lobe was easily found in the upper mediastinum. (2) The azygos vein and the membrane was into the apex of the lung. (3) Cutting both of them, whole esophagus was clear without the arch of the azygos vein. (4) Esophagus was effectively stripped with no disturbance of the arch of the azygos vein.

Conclusion

The described procedure for esophageal carcinoma and azygos lobe is a minimally invasive alternative to the conventional thoracotomy that looks promising.

Disclosure

All authors have declared no conflicts of interest.
PS02.177: EFFECT OF PREHABILITATION ON FITNESS IN PATIENTS UNDERGOING NEOADJUVANT TREATMENT AND OESOPHAGOGASTRIC CANCER SURGERY: A RANDOMISED CONTROLLED TRIAL
Authors: Allen Sophie , Brown Vanessa , Prabhu Pradeep , Rockall Timothy , Preston Shaun , Sultan Javed
Published: September 2018

Background

Neoadjuvant chemotherapy (NAC) and surgery improves 5-year survival in patients with locally-advanced oesophagogastric (OG) cancer. NAC reduces fitness as assessed by cardiopulmonary exercise (CPX) testing. We aim to demonstrate improvement in CPX test performance in patients undergoing a 15-week ‘prehabilitation’ programme during and after NAC, compared those receiving ‘standard care’.

Methods

A single-centre, parallel-arm randomised controlled trial was conducted in patients undergoing NAC for OG cancer. Patients were assigned to a 15-week prehabilitation programme comprising twice weekly supervised aerobic and resistance training, a thrice weekly home exercise plan, and 6 Medical Coaching sessions (Prehab), or standard care (Control). CPX was performed at baseline (before NAC; Test 1), 2 weeks following NAC completion (Test 2), and during the preoperative week (Test 3). The primary outcome (anaerobic threshold (AT)) is powered for 48 patients (24 per group). Secondary outcomes include peak oxygen uptake (pVO2) and work rate (WR).

Results

Since December 2016, 46 patients have been recruited, with a 15% drop-out rate (7/46). All patients received NAC. To date, complete dataset is available for 27 subjects (Prehab n = 15; Control n = 12). Groups were matched for baseline demographics and AT/pVO2/WR (P = ns). At baseline: Mean AT 13.3 ± 2.91ml/kg/min, pVO2 797.85 ± 168.04ml/min/m2, and WR 148.63 ± 40.18watts. Effects of NAC (Tests 1 to 2): All subjects had a mean decline in AT (Prehab -1.41ml/kg/min vs. Control -1.69 ml/kg/min) with no difference in WR decline (Prehab -9.87watts vs. Control -9.66watts; P = 0.98). At Test 2, there was a trend towards pVO2 improvement with Prehab (+ 20.2ml/min/m2) whereas pVO2 in Controls deteriorated (-81.98ml/min/m2; P = 0.06). Effects of NAC and 5-week ‘recovery period’ (Tests 1 to 3): There was a tendency towards a smaller AT decrease from baseline with Prehab subjects (-0.6ml/kg/min) compared with Controls (-1.5ml/kg/min; P = 0.30). Compared with Test 1, Prehab patients demonstrated a non-significant trend towards improvement in pVO2 (+ 20.2ml/min/m2) and WR (+ 1.86watts) following a period of recovery. Controls observed a decrease in both parameters (pVO2 -16.48ml/min/m2, WR -3.5watts).

Conclusion

A prehabilitation programme is feasible during and after NAC. Interim analysis demonstrates a trend towards return of baseline pVO2 in patients receiving prehabilitation. Trial completion is warranted and the full dataset will be available by June 2018.

Disclosure

All authors have declared no conflicts of interest.
PS02.208: THE SHIELDING METHOD WITH POLYGLYCOLIC ACID SHEETS AND FIBRIN GLUE FOR PREVENTING ESOPHAGEAL STRICTURE AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION: A HISTORICAL CONTROL STUDY
Authors: Iizuka Toshiro , Kikuchi Daisuke , Suzuki Yugo , Hoteya Shu
Published: September 2018

Background

There have been several reports that steroid administration are effective at preventing strictures after ESD. However, adverse events after steroid use are of great concern. We have reported that shielding with polyglycolic acid (PGA) sheets and fibrin glue can be useful for prevention of stricture after ESD. We conducted a retrospective analysis of efficiency of shielding with PGA sheets and fibrin glue for prevention of esophageal stricture compared with intralesional steroid injection.

Methods

ESD was performed on a total of 608 lesions in 553 patients for superficial esophageal cancer from January 2012 to March 2017. Of these, 45 lesions were enrolled in the study group (PGA sheets and fibrin glue) and 40 lesions were enrolled in the control group (intralesional steroid injection). The incidence of postoperative stricture at 6 weeks and the number of sessions of endoscopic balloon dilatation (EBD) required to resolve any strictures were evaluated. Among them, patients with additional surgery were excluded in both groups when investing the outcome.

Results

The post-ESD stricture rate was 10.5% in the study group (4/38 patients), which was not significantly lower than the stricture rate of 10.8% in the historical control group (4/37 patients; P = 0.63). The mean number of EBD was 1.2 ± 4.2 in the study group and 0.68 ± 2.2 in the control group, which was not significant (P = 0.47).

Conclusion

PGA sheets and fibrin glue appear to be a promising option for the prevention of esophageal stricture similar to the effect of intralesional steroid injection.

Disclosure

All authors have declared no conflicts of interest.