bluuebunny/crossref_metadata_2025 huggingface dataset:
Virtual robot arm controlled by hand gestures via Leap Motion Sensor
Authors: Rusanu O A , Cristea L , Luculescu M C , Cotfas P A , Cotfas D T
Published: June 2019

This paper proposes a LabVIEW instrument aimed to design and control a 3D virtual robot arm using hand gestures translated into commands with the help of Leap Motion Controller. In order to acquire signals and translate them into basic swipe gesture commands, a LabVIEW toolkit was used. The application is useful for providing assistance for people with disabilities who cannot move or lack strong muscle strength. They can use the virtual simulation for training purpose in order to achieve the ability to control a real robot arm. Moreover, they have a visual feedback that sustains and adjusts their movements. The 3D model is a robot arm placed on a flat surface. Translation along two perpendicular directions in the base plan is allowed and also the rotation of its joints. The virtual robot arm can provide several benefits regarding moving to a target, grasping it and bringing it to the patient.
Interpretation Patterns for The Distribution of The Turbidity of Soil Water Around TPA Supit Urang (Final Removal of Garbage) Using Geoelectric Resistivity Methods
Authors: Wiyono  , Lailatin N. , Jufriadi A.
Published: June 2019

We conducted measurements using the geoelectric method around the waste disposal site (Supit Urang landfill) in Malang City with 29 measurement data points with a distance between the measurement points of 100 meters. The results of the analysis of groundwater depth were obtained, namely the depth of the first layer variation from 0 meters to 5.34 meters, the second layer from 1.26 meters to 7.39 meters and the third layer from 3 meters to 88 meters. From the results of the study the measurement of groundwater resistivity types can provide an idea of the clarity of water where the closer to turbidity the resistivity value of the groundwater is smaller and vice versa the further the turbidity of the resistivity value. from greater ground water. From the results of the distribution pattern of resistivity we can describe the turbidity value of groundwater in the study area, which is around TPA Supit Urang (Malang City)
The Effect of Temperature to CTAB-assisted Solvothermal Synthesis of TiO2
Authors: Anwari N S , Aini N , Hardian A , Suendo V , Prasetyo A
Published: June 2019

Surface area has significant impact on the photocatalytic activity of semiconductor material. It was found that templates as structure directing agent played a role in regulating the surface area of materials. The most widely used as template is cetyltrimethylammonium bromide (CTAB) surfactant. In this research, TiO2 was prepared by solvothermal method used temperature variations of 150, 175, 200, and 225 ºC. The X-ray powder diffraction (XRD) data indicated that anatase phase of TiO2 was successfully obtained with I41/amd space group and as the synthesis temperature was increased, the crystallinity increases. The spectra infrared spectroscopy (IR) showed the broad peak situated at wavenumber 400-800 cm−1 which was assigned to the stretching Ti-O vibration. Raman spectra showed peaks at wavenumber 145, 197, 397, 516, and 639 cm−1 which were attributed to vibration modes of anatase. The scanning electron microscopy (SEM) image demonstrated the morphology particle has homogeneous distribution and irregular shape. Furthermore, Brunauer-Emmett-Teller (BET) specific surface area showed the CTAB-assisted TiO2 which was synthesized at 175 ºC has the highest surface area of 227.043 m2/g in this research among the others.
Fourier Transform Mid-Infrared (FTIR) Spectroscopy to Identify Tannin Compounds in The Panicle of Sorghum Mutant Lines
Authors: Wahyono Teguh , Astuti Dewi Apri , Gede Wiryawan I Komang , Sugoro Irawan , Jayanegara Anuraga
Published: June 2019

G5 and G8 are two sorghum mutant lines projected as sorghum varieties for ruminant’s feed. However, most of the sorghum panicles contains phenolic compounds, especially in the form of condensed tannins. The objective of this research was to investigate the phenolic and tannin compounds from the panicles of two sorghum mutant lines. The second objective was to identify tannin content by Fourier Transform Mid-Infrared (FTIR) Spectroscopy in the sorghum panicles. The two mutant lines were compared with Pahat variety. This research was arranged into a randomized complete block design with two factors. The first factor was the sorghum variety/mutant lines, whereas the second factor was the generative phase of harvesting time (flowering, soft dough and hard dough). The results showed that the panicles of G5 sorghum contained the lowest total phenol compounds (P<0.01). The average mean of G5 and G8 mutant lines produced lower total tannin content (27.3 and 18.2%, respectively) than Pahat variety (P<0.01). Generally, total phenol and total tannin in all variety/mutant lines increased with the increasing maturity stage (P<0.01). All the spectra of the sorghum panicle samples in different harvesting age investigated shared certain special similarities. A band due to alkane medium (C-H) stretch was observed at 2937-2854 cm−1. At 1521-1514 and 1446-1408 cm−1, a band due to the C-C aromatic compounds was observed. Based on those findings, it can be concluded that G5 and G8 mutant lines produced less total phenol and total tannin contents than Pahat variety. Meanwhile, FTIR could be used to describe the profile of tannin compounds qualitatively.
The Comparative Effect of Pomegranate Peel Extract and Dapagliflozin on Body Weight of Male Albino Wistar Rats with Type 2 Diabetes Mellitus
Authors: Ramadhani Devi Trisna , Rezkia Amradani Rafi Amanda , Ulfia Mila , Utami Suryaningtyas Margi , Indarto Dono , Wasita Brian
Published: June 2019

Sodium Glucose Co-Transporter 2 (SGLT2) inhibitor is the second line of type 2 diabetes mellitus (T2DM) treatment. From in silico and in vitro studies, ellagic acid in pomegranate fruits has a similar effect to the SGLT2 inhibitor. This study aimed to investigate the effect of pomegranate peel extract (PPE) on body weight (BW) of male rats with T2DM. Male Albino Wistar rats, which aged 8 weeks and weighed 150-200 g were induced with single dose of 230 mg/kgBW nicotinamide and 65 mg/kgBW streptozotocin intraperitoneally. The control group consisted of 14 rats with T2DM and randomly divided into the negative control (NC) and the positive control (PC) treated with 0.18 mg/kgBW/day dapaglifozin. Twenty one rats with T2DM were divided into 3 treatment groups (T1-3) and given with 50, 100, and 200 mg/kgBW/day PPE respectively for 14 days. Collected data were analyzed using ANOVA and LSD post hoc tests with p value <0.05. The mean fasting blood glucose levels of all rat groups were 262.04±4.24 mg/dL and the mean BW was 182.86±4.75 g after induction. After 7 days treatment, the mean BW in T1 (188.14±6.40), T2 (186.85±4.94) and T3 (189.85±5.95) groups were significantly higher than that of in the NC group (179.14±3.02) but only the mean BW in the T3 group significantly different from the PC group (184.00±6.40; p = 0.034). The same results were also observed in 14 days treatment. Administration of PPE is able to resume BW in rats model with T2DM, better than dapaglifozin.
Influence of Mixed Cultures of Saccharomyces cerevisiae and Acetobacter aceti for Hydrolysis of Tannins in the Cabbage Fermentation (Brassica oleracea L.var.capitata)
Authors: Salamah Alfi , Srihardyastutie Arie , Prasetyawan Sasangka , Safitri Anna
Published: June 2019

This study aims to hydrolysis tannins contained in cabbage (Brassica oleracea L.var.capitata) using a mixture of S.cerevisiae and A.aceti cultures with submerged fermentation method. Determination of the best conditions for tannins hydrolysis carried out by stratified optimization with variation of the volume mixed inculums (5%, 10%, 15% and 20% (v/v) in 100 mL distilled water) and pH values (4, 5, 6 and 7). Cabbage fermentation using a mixture of S. cerevisiae and A. aceti cultures with a ratio of 1:1 (v/v) and anaerobic incubation for 4 days at room temperature (25 ± 2 °C). The content of tannins before fermentation is 290.876 mg/100 g FW. After fermentation the tannins content decreased until the mixtures inoculum concentration was 15% and increased at 20%. The increase of tannins content due to the presence of high acetic acid on the fermentation medium so can inhibit tannase enzyme activity. The optimum volume of mixed inoculums at 15% produced tannins in the filtrate of 227.342 mg/100 mL and 193.619 mg/100 g FW biomass. Hydrolisis tannins can be carried out in acidic conditions. The optimum pH value at pH 4 produces tannins of 107.742 mg/100 g FW in biomass. Hydrolysis tannnins can be catalyzed by tannase produced from S.cerevisiae and acetic acid by A.aceti.
Effect of Support on the Hydrodeoxygenation of Phenol using Ni-based Metal Catalysts: Ni/SiO2, Ni/ZrO2, and Ni/Al2O3
Authors: Lestari Arda Rista , Suratmo  , Ulfa Siti Mariyah
Published: June 2019

Hydrodeoxygenation (HDO) reaction is a fundamental step for producing bio-oil from lignocellulosic biomass. One of the major components from biomass is lignin which can be hydrolysed into phenolic derivatives. Here, we reported the preparation of Ni-based metal catalysts with the variation of a metal oxide for HDO of phenol. The Ni loading for each metal oxides is 15% (w/w), supported on SiO2, ZrO2, and Al2O3. The XRD analysis showed that Ni metal was detected in the SiO2 support at 2θ = 44.26°, 51.72°, 76.5°; Ni in ZrO2 at 2θ = 44.55°, 51.9°, 76.4°; and Ni in Al2O3 at 2θ = 44.12°, 51.72°, and 76.78°. The catalytic test for HDO reaction was carried out in the autoclave oil batch reactor, heated for 2 hours at 200°C with H2 gas atmosphere. Based on GC-MS analysis, the reaction at 200°C usingNi-SiO2 gave the highest product conversion, that is 52.2% with the selective formation of 2-methyl-1-butanol (52.2%). On the other hand, the reaction using Ni/ZrO2 only produce 17.64% of the products with selective formation of cyclohexanone (35.35%). The result showed that products distribution is significantly affected by the type of the support.
Developing of Particulate Matter Filtering System for Motorcycle by Reusing Engine Thermal Energy Emission
Authors: Wardoyo Arinto Y. P. , Dharmawan Hari A.
Published: June 2019

Vehicle particulate matter emission in terms of PM0.1 and PM2.5 have significantly increased their role in morbidity and mortality. In this research, we have developed a new method for particle matter filtering system to reduce the particulate concentration by optimizing the released combustion energy in the exhaust system. We reused the released energy to reduce particle emission by placing a metal net made of different materials such as aluminum, brass, stainless steel, and nickel in the compartment of the exhaust system. The system generated a radiation energy used to reduce particle concentration. The filter efficiency depended on the filter net material. The filter net made of aluminum gave the highest efficiency in reducing particle emissions. The efficiency reached 55% for the PM2.5 and 46% for PM0.1.
Several Implementation Methods of Signal Processing Algorithm Based on FPGA
Authors: Xin Wang , Zhi-Qiang Hu , Da-Qing Jiang , Zhi-Xiao Sun , Yu Zhang , Yong Liu
Published: June 2019

Field Programmable Gate Array (FPGA) devices are widely used in the field of Digital Signal Processing (DSP), and the algorithm of DSP has been used in many fields such as speech signal processing, audio signal processing, image processing, information system, control system and so on. In the development and design of modern digital systems, the use of programmable logic devices is becoming more and more common. There are many ways to implement signal processing algorithm based on FPGA: the first one is to design with VHDL or Verilog HDL language; the second one is to use mature IP core encapsulated by FPGA company; the third one is to design with EDA tools such as MATLAB fdatool/Simulink/DSP Builder/Modelsim/Quartus II. Taking the digital filter as an example, this paper uses these three methods to realize the filtering algorithm, and introduces the detailed design steps and the final simulation verification.
Influence of Waveform Symmetry on Output Performance of Piezoelectric Inertia Actuator Controlled by Composite Method
Authors: Qi H Y
Published: June 2019

The waveform symmetry has a great influence on the piezoelectric inertia actuator. In this paper, the waveform symmetry based on the composite method is explained and its influence on the output performance is discussed in relation to four aspects: frequency characteristics, voltage characteristics, load capacity, driving capacity. The designed prototype is fabricated and a series of experiments are carried on. Experiments show the waveform symmetry based on the composite method is widened effectively relative to the traditional driving method. The high-speed of the actuator is obtained under 60% and 40%.The large-load is achieved under 90% and 10%. When the saw-tooth driving waveform voltage is 30 Vp-p for 800 Hz and a sinusoidal friction regulation waveform voltage is 6 Vp-p for 39 kHz, the maximum velocities in the forward and reverse direction are 1.48 mm/s and 1.39 mm/s. Meanwhile, the maximum vertical loads of the actuator are 540 g and 510 g. The actuator driven by different symmetrical composite waveforms will make it ideal for miniature devices.
Committee calls for UK to target net zero emissions by 2050
Authors: Levy Adam
Published: June 2019

The UK should aim to eliminate net greenhouse gas emissions by 2050. That is according to a report released last month by the Committee on Climate Change (CCC)
Alferov memories
Authors: Shore Alan , Noviello Fabio
Published: June 2019

In reply to the news story about the death of the Nobel-prize-winning physicist Zhores Alferov (April p11).
Leading by example: going green in the lab
Authors: Skuse Benjamin
Published: June 2019

With so much research focused on creating technologies that reduce our collective carbon footprint, the embarrassing realization that research labs themselves are some of the worst environmental offenders is only now starting to sink in. Benjamin Skuse examines the problem and what is being done to solve it
Nuclear fusion in a table-top device
Authors: Jarman Sam
Published: June 2019

Neutrons characteristic of nuclear fusion have been produced sustainably by a plasma confinement device that is small enough to fit on a table top.
Squid skin inspires new kind of 'adaptive' space blanket
Authors: Dumé Belle
Published: June 2019

Researchers at the University of California, Irvine, in the US, have made a material for new and improved “space blankets” inspired by the properties of squid skin.
Interpolation and the weak Lefschetz property
Authors: Nagel Uwe , Trok Bill
Published: June 2019

Our starting point is a basic problem in Hermite interpolation theory—namely, determining the least degree of a homogeneous polynomial that vanishes to some specified order at every point of a given finite set. We solve this problem in many cases if the number of points is small compared to the dimension of their linear span. This also allows us to establish results on the Hilbert function of ideals generated by powers of linear forms. The Verlinde formula determines such a Hilbert function in a specific instance. We complement this result and also determine the Castelnuovo–Mumford regularity of the corresponding ideals. As applications, we establish new instances of conjectures by Chudnovsky and by Demailly on the Waldschmidt constant. Moreover, we show that conjectures on the failure of the weak Lefschetz property by Harbourne, Schenck, and Seceleanu as well as by Migliore, Miró-Roig, and the first author are true asymptotically. The latter also relies on a new result for Eulerian numbers.
DOZ047.06: The MicroRNA levels in exhaled breath condensate of patients with esophageal atresia and tracheoesophageal fistula
Authors: Soyer T , Birben E , Soyer Ö U , Türer Ö B , Tunçer F , Kahveci M , Tuğcu G D , Yalçın E , Doğru D , Özçelik U , Kiper N , Şekerel B , Tanyel F C
Published: June 2019

Aim

MicroRNAs (miRNAs) are noncoding RNAs that play a role in regulation of inflammation and cancer. It has been shown that miRNA-21 and 24 are downregulated in the exhaled breath condensate (EBC) of children with chronic inflammatory lung disease and asthma. A prospective study was performed to evaluate the miRNA-21 and 24 levels in the EBC of patients with esophageal atresia and tracheoesophageal fistula (EA-TEF).

Methods

Patients operated for EA-TEF were evaluated for age, sex, type of anomaly, surgical treatment, and respiratory problems. 500–1000 μl of EBC was obtained from all patients with Ecoscreen. miRNA-21 and 24 levels in EBC were analyzed with ELISA. The results of the study group were compared with a control group (CG) consisting of healthy children with no history of respiratory problems and allergy (n = 17). miRNA levels were compared with respiratory problems and gastroesophageal reflux (GER).

Results

Nineteen patients with EA-TEF with a mean age of 7.8 ± 3.2 years were enrolled in the study. The male–female ratio was 10:9. The mean age of the CG was 9.1 ± 3.6 years (P > 0.05). Distal fistula (78.9%) was the most common type of anomaly. 76.5% of cases required esophageal dilatations for strictures and 15.8% of them had fistula recurrence. Fifteen of the cases with EA were diagnosed as hyperreactive airway disease and require medical treatment. When miRNA levels were compared with CG (median = 0.68), EA cases had significantly decreased levels of miRNA-21 (median = 0.64, P < 0.05). There was no difference between groups for miRNA-24 levels (P > 0.05). The miRNA levels were also compared in patients with EA, according to positive pH testing for GER, use of proton pump inhibitor (PPI) treatment, and need for fundoplication. Patients with GER in pH test (median = 0.66) and fundoplication (median = 0.66) had increased levels of miRNA-21 than patients without reflux (median = 0.63) and surgical treatment (median = 0.64) (P < 0.05). The levels of miRNA-21 and 24 did not show any significant difference in patients with and without PPI treatment (P > 0.05).

Conclusion

The decreased levels of miRNA-21 in EBC suggest a hyperreactive airway problem in EA patients. Increased miRNA levels in EBC are associated with GER and its surgical treatment.
DOZ047.105: Minimally invasive surgical approach for posterior tracheobronchopexy to treat severe tracheobronchomalacia
Authors: Kamran A , Hamilton T E , Zendejas B , Jennings R W , Smithers C J
Published: June 2019

Purpose

Posterior tracheobronchopexy directly addresses membranous airway intrusion in severe tracheobronchomalacia (TBM). Our experience of posterior tracheobronchopexy through an open approach in a large series of patients has been previously reported by us. This study aimed to review lessons learned from our initial series of posterior tracheobronchopexy through a minimally invasive surgical approach.

Methods

A retrospective review of all patients with symptomatic TBM who underwent video-assisted or robot video-assisted thoracoscopic posterior tracheobronchopexy between October 2016 and January 2019 was carried out.

Results

Fourteen patients underwent video-assisted (n = 4) or robotic video-assisted (n = 10) thoracoscopic posterior tracheobronchopexy (age range: 8 months–19 years). Two patients had a history of esophageal atresia (type C) repair; none of the other patients had undergone prior operations. Two patients required open conversion to achieve the desired precision of suture placement. Operative times ranged from 4.5 to 15 hours, depending on the additional procedures performed. The intraoperative bronchoscopic evaluation demonstrated marked improvement in airway patency of all patients at the conclusion of each case. Patients were hospitalized 2 to 7 days, with 0 to 4 days for ICU observation. One patient with bronchopulmonary dysplasia and diffuse TBM, including segmental bronchi, required longer hospitalization and prolonged mechanical ventilation support. Follow-up after surgery ranged from 1 to 27 months. Three patients required subsequent anterior aortopexy and tracheopexy. In these three cases, dynamic tracheobronchoscopy showed that posterior tracheopexy remained intact; nonetheless, anterior airway support was still required to prevent dynamic anterior airway collapse.

Conclusions

The thoracoscopic approach for posterior tracheobronchopexy, while challenging, can be applied in children with severe TBM. As experience is gained, more complicated procedures and reoperative cases are possible. The simultaneous use of flexible bronchoscopy is mandatory to confirm precision by providing luminal visualization during suture placement. Thoracoscopic surgery with robotic assistance can eliminate some technical limitations of the video-assisted approach by providing an easier platform for very complicated suturing angles.
DOZ047.107: Increased quality of life burden related to obstructive sleep apnea in children with aerodigestive disease
Authors: Wootten C T , Lipscomb B , Acra S , Fazili M
Published: June 2019

Objective

The aim of this study was to determine the impact of sleep-disordered breathing on quality of life (QOL) in children with aerodigestive disease compared to children without aerodigestive disease.

Methods

Retrospective, IRB-approved, single-institution review of OSA-18 survey results administered to an unselected population of pediatric otolaryngology patients, some of whom had also been seen in the multidisciplinary aerodigestive clinic, was carried out.

Results

476 non-aerodigestive patients and 43 aerodigestive patients were compared using total OSA-18 score and the summed scores from the 5 domains that comprise the OSA-18: (1) sleep disturbance, (2) physical suffering, (3) emotional distress, (4) daytime problems, and (5) caregiver concern. Sleep-related QOL was significantly worse for children with aerodigestive disease compared to those without aerodigestive disease across domains of sleep disturbance (P = 0.011), physical suffering (P = 0.028), and caregiver concern (P = 0.016). Total OSA-18 scores were in the mild impact range, and they did not differ significantly between the two populations.

Conclusion

While the focus of many aerodigestive programs is on the pathophysiological relationship between the upper digestive tract, the laryngotracheal airway, and the lungs, the present study elucidates a significant impact of upper airway obstruction during sleep on the QOL of children with aerodigestive disease. In recognition of this impact, certain airway centers have added a multidisciplinary approach to upper airway obstruction to their aerodigestive treatment armamentarium. At the minimum, airway treatment centers should consider systematic screening of all children with aerodigestive disease for QOL burden related to OSA.
DOZ047.109: Impact of positive expiratory pressure breathing on gastroesophageal reflux: preliminary report in children with esophageal atresia and tracheoesophageal fistula and residual tracheomalacia
Authors: Porcaro F , Tambucci R , Petreschi F , Leone P , Malamisura M , Caldaro T , De Angelis P , Cutrera R
Published: June 2019

Introduction

The usefulness of positive expiratory pressure (PEP) through a PEP valve to enhance expiratory flow and improve cough efficiency is well known in children with tracheoesophageal fistula (TEF) and residual tracheomalacia. Gastroesophageal reflux (GER) is one of the most frequent complications encountered in patients with repaired esophageal atresia (EA) ± TEF. The impact of airway clearance techniques with a PEP valve on GER is not well defined in this group of patients. The aim of this prospective study was to determine the effects of PEP chest physiotherapy on GER burden measured by multichannel intraluminal impedance and pH monitoring (MII-pH) in EA/TEF children. Since the study is still ongoing, preliminary results are hereby presented.

Methods

EA/TEF patients with tracheomalacia received three 20-min sessions of PEP chest therapy during the 24-hour MII-pH monitoring performed as a routine care. All children were off acid suppression therapy. The PEP session, performed after a 3-hour fasting period, consisted of 10 cycles lasting 1 minute of breathing with a PEP valve, followed by the forced expiratory technique and coughing. Esophageal acid exposure time (AET) and number of reflux episodes (RE) during each PEP session were measured as primary outcomes. Baseline impedance (BI) was also evaluated. MII-pH was defined abnormal if AET was >7% and/or the total RE was >70.

Results

From January and December 2018, 5 consecutive male EA/TEF children (mean age 8.5 years; range 3–14 years) were enrolled. All of them showed low distal BI (1040 ± 143.2) and normal MII-pH findings (AET: 1.8 ± 2.9%; number of RE: 20.2 ± 9.0). Over the period of the PEP sessions, no significant changes in AET (0.0 ± 0.0), RE (0.6 ± 0.5), and BI were detected compared with the background monitoring.

Conclusions

Although the limited number of participants prevents any definitive conclusions, our preliminary results indicate that PEP chest physiotherapy does not exacerbate GER in EA/TEF children. Continuation of the study across a larger sample of EA/TEF patients is needed to better define the effects of this simple chest physiotherapy technique on GER burden.
DOZ047.117: Complex tracheostoma reconstruction using pectoralis major myocutaneous flap
Authors: Valika T , Ida J , Thompson D M
Published: June 2019

Objective

This study aimed to describe complex tracheostoma reconstructions utilizing a pectoralis major myocutaneous flap.

Results

We present the case of two children who required extensive tracheostoma reconstructions. Both patients had chronic tracheostomies. The first child, aged 4, had underlying neuromuscular disorder. Her neck anatomy resulted in the formation of a keyhole stoma with erosion of the underlying cricoid cartilage. She underwent tracheostoma reconstruction using costal cartilage graft and use of a pectoralis major myocutaneous flap to recreate the superior aspect of the stoma. The second child, aged 5, had long-standing trach and underwent laryngotracheal reconstruction. In the postoperative setting, the patient developed a wound infection that resulted in breakdown of the overlying wound. A pectoralis major myocutaneous flap was required in the defect to recreate the wound bed. Both patients had successful wound bed creation and required no further procedures.

Conclusion

Chronic tracheostomies can result in superficial skin or tracheal breakdown, resulting in tracheostomy complications. Tracheostoma reconstruction is classically managed with debridement and local tissue flaps with use of either overlying skin or surrounding musculature. In patients with chronic wound breakdown, local tissue reconstruction can be challenging due to the fragility of the surrounding tissue. Use of virgin tissue outside the wound bed provides the best chance of recovery. The pectoralis major myocutaneous flap has the ability to be the ideal tissue source for extensive tracheostoma reconstruction. The flap is the workhorse of many head and neck oncologic procedures. The flap can provide adequate bulk from muscle and fat, overlying skin, and is within the surgical field to provide a robust blood supply. We advocate for the role of this flap in use with patients with chronic wound issues, poor wound healing, and failed prior stoma reconstructions.
DOZ047.118: Surgical treatment of children with button battery injury
Authors: Razumovsky A , Stepanenko N , Kulikova N , Strizhova D
Published: June 2019

Introduction

The foreign body of the esophagus—button battery causes severe changes of the esophagus. Ingestion of large-sized button batteries (≥20 mm) in children younger than 4 years is associated with increased morbidity and mortality. The most serious complication is the perforation of the esophagus or tracheoesophageal fistula (TEF), which may require a long-term multistage surgical treatment. Other issues that can be caused by button battery injury are esophageal stenosis and laryngeal paralysis. There are 40 children with esophageal injuries who were treated in Filatov Children Hospital between 2011 and 2019. Among them, several children did not need surgical treatment at all (40%), but five patients (12.5%) needed colon transposition. Button battery injury also causes reversible or irreversible damage of the recurrent laryngeal nerve, which required complex reconstructive operations on the larynx and trachea.

Patients and Methods

We retrospectively analyzed 40 patients with different types of injury after button battery removal. The average age of the patients was 1 year and 8 months. A total of 16 patients (40%) have had no esophageal or laryngeal pathology after button battery removal. Six patients (15%) developed esophageal stenosis. Two patients (5%) had esophageal perforations. Sixteen patients (40%) developed TEF. Bivocal chord paralysis was identified in 10 patients (25%).

Results

Esophageal dilations were performed in five patients (12.5%). Eight patients (20%) underwent laparoscopic fundoplication and gastrostomy. Spontaneous TEF closure formed in four patients (10%). Ten patients (25%) underwent different types of reconstructive surgeries in different periods after battery removal. Among eight patients (20%) who underwent early reconstructive surgeries three (7.5%) developed different complications, which require esophageal replacements. Tracheostomy was performed in 11 children (27.5%), five (12.5%) of whom required reconstructive surgery on the larynx. There was no mortality in our observation.

Conclusion

In this study, we conclude that TEF after button battery removal can close spontaneously and should not be operated in the acute period. Fundoplication and gastrostomy and tracheostomy can be procedures of choice in these patients. Also recurrent nerve injuries can be unstable. They can cause severe injuries of esophagus, trachea, and larynx, which can require esophageal replacement and vocal chord lateralization procedures with long-term and multiple-stage treatment.
DOZ047.120: The role of proton-pump inhibitors in eosinophilic esophagitis: focus on esophageal atresia children
Authors: Tambucci R , Rea F , Malamisura M , Torroni F , Romeo E F , Faraci S , Angelino G , di Abriola G F , Guerra L , Caldaro T , Contini A C I , Balassone V , Riccardi C , Mennini M , Fiocchi A , Valfrè L , Dall’Oglio L , De Angelis P
Published: June 2019

Introduction

Since recently, after detection of eosinophilic predominant inflammation of esophagus a trial with proton-pump inhibitors (PPIs) was needed to individuate children with PPI-responsive esophageal eosinophilia (PPI-REE), only those non-responders received eosinophilic esophagitis (EoE) diagnosis. In 2018 updated international consensus suggested removing the PPI trial as a diagnostic criterion and consider PPIs as a treatment together with diets and topical steroids. The role of PPIs is evaluated in children with esophageal atresia (EA) and EoE versus EoE from general population.

Method

A retrospective chart review of both children with EA and EoE followed-up from at January 2005 has been performed. According to ESPGHAN guidelines published in 2014 patients showing eosinophilic inflammation received high-dose PPI trial to identified PPI-REE. Those non-responders were labeled as EoE and underwent to dietary and/or topical steroid treatment. Demographics and disease characteristics of EA patients with EoE were analyzed and compared with those with EoE from general population.

Results

Overall, 370 EA and 118 EoE patients were analyzed. Of them 15 EA-EoE patients were detected. Consequently, in our cohorts, 4.0% of EA patients developed EoE. Male-to-female prevalence ratio was of 2.55 with no difference in gender prevalence between groups. At diagnosis EoE-EA children were significantly younger compared to EoE group (mean: 5.1 vs 10.8 years; P < 0.0001). Peak EOS/HPF at diagnosis did not differ between groups (50.1 ± 26 vs 59.8 ± 29 EOS/HPF). No difference was observed in allergy prevalence between groups (53.8 vs 68.0%). PPI-REE was significantly more prevalent in EA-EoE group that in EoE group (66.6% vs 19.4%; P = 0.0004).

Conclusion

Similar gender distribution and high prevalence of allergy suggest that common genetic susceptibility factors for EoE exist. However, high prevalence of PPI-REE coupled early EoE onset might also suggest that other factors (e.g. esophageal motility disorders) might play a physiopathological role in EoE development in EA children. Our study suggests that a stepwise approach with PPIs as a first-line treatment for EoE management in EA children should still be considered.
DOZ047.25: Do growth and nutrition influence quality of life in adolescents with esophageal atresia?
Authors: Birketvedt K , Mikkelsen A , Møinichen U I , Henriksen C , Diseth T H , Boye B , Malt U , Mørkrid L , Jsselstijn H I , Emblem R
Published: June 2019

Aim

Adolescents with esophageal atresia (EA) may experience reduced quality of life (QOL) and impaired physical or general health. The aim of this study was to assess health-related QOL in adolescents in relation to physical development.

Methods

One hundred and twenty-four EA patients born 1996–2002 and their mothers were identified and enrolled. Twenty-six patients died, 6 excluded; thus 102 were invited. Clinical data were retrieved from medical records. Present physical development was assessed according to national growth references, by height for age (SDS-HFA) and body mass index (SDS-BMI). Energy intake (kcal/kg) was estimated by analysis of 4-day dietary records. Any anamnestic symptoms of gastroesophageal reflux (GER) were registered. EAT-10 questionnaire (modified) was used to assess swallowing difficulties. Participation in any organized spare time activities was registered. Health-related QOL assessment was performed by the age-specific PedsQL 4.0 generic cores scales including proxy-reports. Correlation is reported by Spearman' R.

Main Results

Among the 102 patients, 13 older than 18 years were excluded and 34 refused. 55/102 (54%) adolescents with their mothers were included after informed consent (59% boys). Median SDS-HFA was −0.53 (−4.56–1.77), median SDS-BMI 0.16 (−3.91–3.10). Median energy intake was low, 32 kcal/kg (20–69 kcal/kg), compared to the normal range for this age group (43–59 kcal/kg). Only 31/55 (56%) participated in organized activities compared to 80% in a corresponding healthy group. The PedsQL total score and sub score physical health (both for adolescent and for proxy) correlated significantly to GER symptoms (r = -0.461, P < 0.001) and dysphagia assessed by EAT-10 (r = −0.329, P = 0.015). The PedsQL total score did not correlate with SDS-HFA, SDS-BMI, energy intake, or participation in organized activities.

Conclusion

The presence of dysphagia and GER symptoms seem to influence health-related QOL, with a negative impact on the physical domain. Physical development and energy intake were not related to quality of life.
DOZ047.40: Bronchopulmonary and vascular anomalies are frequent in children with esophageal atresia
Authors: Lejeune S , Mee A L , Petyt L , Mordacq C , Sfeir R , Gottrand F , Fayoux P , Deschildre A , Michaud L , Thumerelle C
Published: June 2019

Introduction

Esophageal atresia (EA) is frequently associated with other malformations although few data are available.

Objective

Describe tracheobronchial, pulmonary and/or vascular malformations in patients with EA using chest CT scans.

Methods

Monocentric retrospective study in children with EA, born between 1996 and 2013, who had a CT scan during their follow-up, reviewed by a pediatric radiologist.

Results

Among 234 children with EA, 48 patients underwent a CT scan available for interpretation, among which 69% were performed to explore persistent respiratory symptoms. Thirty-nine children (81%) were type III EA, 13 (27%) had a VACTERL association. Six patients (13%) had a pulmonary malformation: 4 lobar agenesis, 1 right pulmonary aplasia, and 1 congenital cystic adenomatoid malformation. All these patients presented with at least one associated malformation. Combined with the results of laryngotracheal endoscopy (n = 30), 43 patients (90%) had a tracheobronchial anomaly: tracheomalacia for 40 (83%), tracheal stenosis for 12 (25%), right tracheal bronchus for 2 (4%), communicating bronchopulmonary foregut malformation for 1 (2%). Combined with the results of echocardiography (n = 47), 7 patients (15%) had an isolated vascular anomaly, 8 (17%) had an isolated congenital heart disease and 7 (15%) had both. CT scans permitted the diagnosis of 6 pulmonary malformations (13%), 15 tracheobronchial anomalies (31%), and 2 vascular anomalies (4%). Only one patient (2%) in our study presented with an isolated EA.

Conclusion

Our study confirms the association of tracheobronchial, pulmonary, and vascular anomalies in patients with EA. Contrast-enhanced CT scan is complementary to echocardiography and laryngotracheal endoscopy in the exploration of persistent respiratory symptoms.
DOZ047.52: A single institutional experience with congenital H-type tracheoesophageal fistula
Authors: Durakbasa C U , Oskayli M C , Ozatman E , Ugurlu D , Mutus H M , Aydoner S , Erkoc G , Pirim A
Published: June 2019

Aim

This study presents a single institutional experience with H-type tracheoesophageal fistula (H-TEF).

Methods

Esophageal atresia (EA) patients who underwent primary surgery in a single center between 2006 and 2018 were retrospectively evaluated.

Results

Among 110 EA patients, 7 (6.4%) had H-TEF. There were 5 males and 2 females. The primary complaints were choking, cyanosis, and/or apnea with feeding, swallowing difficulty, recurrent bronchopneumonia, or bile in endotracheal tube. The relevant symptoms began during neonatal period with varying degrees of severity in all. The initial diagnosis was proximal esophageal web as demonstrated by contrast swallow and endoscopy in one patient; H-TEF was diagnosed during the course of treatment for the web. Hydrocephalus with severe neurological sequela unrelated to H-TEF and cardiac malformation were present in one. Contrast esophagography was employed in three patients for diagnosis two of which were diagnostic. All underwent diagnostic bronchoscopy. Delayed diagnosis (after 30 days of life) occurred in five (71%). The median age at operation was 3.8 months (11 days–33 months). The level of the fistulas was between C5 and T3. Preoperative bronchoscopic cannulation was successful in all but one. The operation was done via a right cervical approach in six patients and thoracotomy in one. All patients were followed up for at least one year and there was one recurrence detected five months after the first operation. She underwent a secondary surgery with a successful outcome. Right vocal cord paralysis was detected postoperatively in the patient with hydrocephalus.

Conclusions

H-TEF is a rare subtype of EA malformations with a delay in diagnosis in most cases. Suggestive clinical findings, especially neonatal respiratory symptoms should always be regarded as an indication for further investigations. Although contrast esophagograms may reveal the diagnosis, bronchoscopy is the gold standard diagnostic test in our practice. It should be done preoperatively in every patient not only for diagnostic confirmation but also for cannulation of the fistula to ease the operation. H-TEF might be considered a relatively innocent EA variant but its surgery is not devoid of complications. The patients should be followed up for recurrence and recurrent laryngeal nerve injury on the long term.
DOZ047.54: Fundoplication outcomes in children with esophageal atresia
Authors: Chung E , van Lennep M , Saoji R , Jiwane A , Oomen M W N , van Wijk M P , Krishnan U
Published: June 2019

Background

In esophageal atresia (EA) patients, cumulative risk of having a fundoplication ranges from 0% to 45%, with long gap patients with recurrent strictures at even higher risk. However, there are no controlled trials evaluating the outcomes postfundoplication. We hypothesized that children with EA undergoing fundoplication will suffer from more postoperative dysphagia compared to non-EA patients as the fundoplication increases the resistance to esophageal bolus flow, which is already hampered by abnormal motility.

Aims

Our study aimed to compare outcomes in EA patients with age- and sex-matched control patients postfundoplication.

Methods

This was an international multicenter retrospective cohort study. All EA patients who had fundoplication between 2006 and 2017 during this period were included. Data were also collected from age- and sex-matched children without EA who underwent fundoplication.

Results

A total of 40 EA patients had fundoplication during this period. Of the EA patients 82.5% were type C, and 82.5% were long gap. Table 1 compares EA patients with controls. Significantly more EA patients were failing to thrive, on nasogastric/gastrostomy feeds at time of surgery and needed gastrostomy placement at time of fundoplication compared to controls. A total of 17.5% of EA patients developed infection and 22.5% a leak postfundoplication. EA patients had postoperative dysphagia and oral aversion significantly more often than controls. Of 90% of EA patients had recurrence of gastrointestinal or respiratory symptoms, 35% had recurrent strictures, 5% had a new diagnosis of eosinophilic esophagitis postfundoplication. Median time to symptom recurrence was 64 days (12–165 days), 90% were back on PPI and 7.5% had redofundoplication.

Conclusions

Our study is the first to examine postfundoplication outcomes in EA patients and compare these with a matched control group. EA patients had significantly more dysphagia and oral aversion postfundoplication and majority were back on PPI within two months of surgery. Based on these data, the role of fundoplication in EA patients should be reconsidered. Prospective data are urgently needed.
DOZ047.99: A unique case of ‘esophageal trachea’ requiring a multistep sequential surgical reconstruction
Authors: Tambucci R , Wautelet O , François G , Haenecour A , Goubau C , Scheers I , de Toeuf C , Schmitz S , Menten R , Pirotte T , D’hondt B , Reding R , Poncelet A
Published: June 2019

Introduction

Communicating bronchopulmonary foregut malformations (CBPFMs) have been defined by Srikanth et al. in 1992 as a fistula between a portion of respiratory tissue and esophagus/stomach. Four types of CBPFMs have been described, none of those contemplating a complete communication between the distal trachea and esophagus.

Case Report

This study reports a case of a full-term neonate presenting with a VACTERL association and a tracheoesophageal malformation characterized by the presence of a long common duct including both the middle esophagus and distal trachea, which consists in esophageal tissue, without any cartilaginous rings 3–4 cm above the carina. A few days after birth, the esophagus and trachea have been surgically separated, keeping the common duct on the tracheal side and creating a residual long-gap esophageal atresia (LGEA). The resulting severe tracheomalacia has been simultaneously treated by posterior splinting using an autologous pericardium patch, as well as by anterior aortopexy. A terminal esophagostomy and a gastrostomy have been created to postpone esophageal reconstruction. Since the age of 18 months, delayed repair of LGEA has been performed by using a multistep strategy consisting of a combination of Kimura extrathoracic esophageal elongations and distal stump Foker external traction. Since no cartilaginous rings were present, refractory tracheomalacia has been further treated by a tracheoplasty through a combined median sternotomy and tracheoscopy approach at the age of 3 years by using a semitubular rigid Gore-Tex® prosthesis for an anterior external stenting. Today, 9 months after last surgery, complete weaning from respiratory support has been stably achieved, as well as full oral feeding.

Conclusions

This is the first description of an ‘esophageal trachea’, which may be considered as a new anatomic variant of CBPFMs. Multidisciplinary medical and surgical expertise was needed to manage this particular case, in order to properly plan multiple sequential surgical approaches. Native esophageal reconstruction should always be considered, even because colonic or gastric transposition might further affect severe tracheomalacia, resulting in more challenging treatment.
Positive Effects of the Tea Catechin, (−)-Epigallocatechin-3-Gallate, on Gut Prophenoloxidase and the Survival of Ectropis obliqua (Lepidoptera: Geometridae)
Authors: Long Yanhua , Zhang Yong , Zhao Tianyu , Zhou Xiaomin , Wang Yun , Chen Yiran , Yang Yunqiu
Published: June 2019

Ectropis obliqua Prout is the main pest of the tea plant Camellia sinensis (L.) O. Kuntze in China, affecting an annual area of more than one million acres. (−)-Epigallocatechin-3-gallate (EGCG) is the major catechin in tea leaves. Here, we show that EGCG is highly efficient in increasing the survival rate of E. obliqua larvae. We also compared the gut peroxidase (PO) activity between EGCG-fed and control larvae. EGCG-fed larvae had significantly greater PO activity levels than control larvae. Western blotting validated these results. Gut PO activity levels of larvae fed an artificial diet gradually decreased and disappeared completely by day 5. We hypothesize that the increased survival rate of EGCG-fed larvae was associated with increased PO activity. This research provides evidence that E. obliqua larvae have adapted to, and may even benefit from, secondary compounds found in tea leaves.