bluuebunny/crossref_metadata_2025 huggingface dataset:
Nitrogen loading increases both algal and non-algal turbidity in subtropical shallow mesocosms: Implication for nutrient management
Authors: He Hu , Zhang Lei , Ning Xiaoyu , Mao Zhigang , Jeppesen Erik
Published: August 2023

Excess nitrogen (N) loading in summer often boosts phytoplankton growth and increase algal turbidity. In eutrophic shallow lakes, the increased algal production may also augment the abundance of deposit-feeding tubificid worms and thereby sediment resuspension and non-algal turbidity. However, few studies have explored the effects of high N loading on this benthic process in eutrophic shallow lakes. Here, we conducted an outdoor mesocosm experiment in a summer-winter season (177 days) on the shore of subtropical Lake Taihu, China. Each mesocosm contained a 10 cm layer of lake sediment and 450 L of lake water. Nitrate was added weekly to three of the mesocosms, while another three functioned as controls. Our results showed that N addition significantly increased algal particles as water chlorophyll a (Chl-a) increased significantly following N addition. Moreover, significantly higher levels of inorganic suspended solids (ISS) were observed in the mesocosms with added N, indicating elevation of non-algal turbidity as well by the N addition. We attribute the latter to increased sediment resuspension as the abundance of tubificid worms was significantly higher in the N addition mesocosms. Accordingly, our study indicates that high N loading in subtropical shallow lakes may boost both algal and non-algal turbidity in part via benthic-pelagic coupling processes. Our results suggest that alleviation of eutrophication in shallow eutrophic lakes may require a strategic approach to adequately control both N and phosphorus.
A Fully Digital Auricular Splint Workflow for Post-Keloid Excision
Authors: Maria Rahmat , Kok Yee Onn , Teoh Khim Hean
Published: August 2023

Ear keloids are challenging lesions to treat due to high recurrence rates postexcision. Conservative compression techniques as adjunct treatment have been reported to be effective. An innovative technique of using computer-aided design/computed-aided manufacturing to print a customized auricular splint improves efficiency and comfort level for patients compared with conventional methods. The ear is scanned using an intraoral scanning 2 weeks postsurgery. A two-piece auricular splint is designed on the digital model, incorporating perforated projections for three nylon screws for retention of the splint. The splint is printed with clear acrylic material, postprocessed, and finished. The patient is taught to assemble the components of the splint and instructed to wear for at least 8 hours daily. The surgery site reviewed for any ulceration, pain, or recurrence of keloid for 6 months. During the 6-month review, the excision scar remained flat and pink. The patient also reports unrestricted daily activities. The digital workflow increases comfort for the patient and reduces the number of hours required to produce a customized auricular splint compared with conventional methods. A fully digital workflow for a printed auricular splint should be considered for adjunctive treatment to excision of ear keloids.
High-Fidelity Perforator Visualization for Cadaver Dissection in Surgical Training
Authors: Wong Allen Wei Jiat , Kok Yee Onn , Chew Khong Yik , Tan Bien Keem
Published: August 2023

In the first half of the third century B.C., Herophilus and Erasistratus performed the first systematic dissection of the human body. For subsequent centuries, these cadaveric dissections were key to the advancement of anatomical knowledge and surgical techniques. To this day, despite various instructional methods, cadaver dissection remained the best way for surgical training. To improve the quality of education and research through cadaveric dissection, our institution has developed a unique method of perforator-preserving cadaver injection, allowing us to achieve high-fidelity perforator visualization for dissection studies, at low cost and high efficacy. Ten full body cadavers were sectioned through the base of neck, bilateral shoulder, and hip joints. The key was to dissect multiple perfusing arteries and draining veins for each section, to increase “capture” of vascular territories. The vessels were carefully flushed, insufflated, and then filled with latex dye. Our injection dye comprised of liquid latex, formalin, and acrylic paint in the ratio of 1:2:1. Different endpoints were used to assess adequacy of injection, such as reconstitution of eyeball volume, skin turgor, visible dye in subcutaneous veins, and seepage of dye through stab incisions in digital pulps. Dissections demonstrated the effectiveness of the dye, outlining even the small osseous perforators of the medial femoral condyle flap and subconjunctival plexuses. Our technique emphasized atraumatic preparation, recreation of luminal space through insufflation, and finally careful injection of latex dye with adequate curing. This has allowed high-fidelity perforator visualization for dissection studies.
Spontaneous Vertebral Artery Arteriovenous Fistula with Neurofibromatosis Type I and Its Management with Covered Stent
Authors: Diyora Batuk , Purandare Anup , Devani Kavin , Palave Prakash
Published: August 2023

Vertebro-vertebral fistulas (VVFs) are uncommon vascular pathology. It can be either primary (spontaneous) or secondary (iatrogenic or mechanical trauma). Spontaneous vertebral arteriovenous malformation is often associated with connective tissue disorders. Cases associated with neurofibromatosis type I (NF I) are even rarer. Management of VVF with covered stent is an emerging option for construction of vertebral artery. It not only preserves the flow of the parent artery but also has immediate exclusion of the fistula from the parent artery. A 30-year-old pregnant female patient presented with cervical bruit and left upper limb radiculopathy. She was a known case of NF I. Magnetic resonance imaging cervical spine revealed multiple flow voids compressing the cervical spinal cord and nerve roots. Digital subtraction angiography revealed a vertebral artery arteriovenous fistula. She underwent endovascular treatment in the form of a covered stent. Her clinical symptoms immediately improved. She was asymptomatic at the 1-year follow-up.
Invasive Streptococcus pyogenes: A Short Literature Review
Authors: Tanrıverdi Çaycı Yeliz , Altındiş Mustafa
Published: August 2023

Objective Streptococcus pyogenes also called Group A streptococci (GAS) is an important pathogen known since past years and infects millions of people around the world every year and can cause death. Although it often causes pharyngitis and skin infections, it can also spread to the bloodstream and cause invasive GAS (iGAS) infections. In this review, studies on the epidemiology of GAS and iGAS and vaccine studies were reviewed.

Methods A comprehensive search of databases was conducted up to April 1, 2023 to related studies, in English using the following terms: S. pyogenes, GAS, invasive S. pyogenes infections, iGAS, S. pyogenes vaccine. The data extraction was conducted by two investigators using the same methodology.

Results There has been an increase in iGAS infections in various countries in the last year and they have been followed closely. Although the reason for the increase in iGAS cases cannot be determined exactly, it is thought that the recent removal of coronavirus disease 2019 restrictions and the increase in the number of individuals susceptible to GAS and to viral respiratory pathogens is thought to have caused this situation. Another important issue with GAS is the vaccine studies. Vaccines are based on two different targets: M protein-based and non-M protein-based. Phase-I clinical trials have been initiated for some vaccines.

Conclusion The increase in recent iGAS infections will draw attention to this agent and accelerate vaccine studies.
Prognostic Factors of Mortality and Functional Outcome for Acute Subdural Hematoma: A Review Article
Authors: Beucler Nathan
Published: August 2023

Acute subdural hematoma (ASDH) is the most frequent intracranial traumatic lesion requiring surgery in high-income countries. To date, uncertainty remains regarding the odds of mortality or functional outcome of patients with ASDH, regardless of whether they are operated on. This review aims to shed light on the clinical and radiologic factors associated with ASDH outcome. A scoping review was conducted on Medline database from inception to 2023. This review yielded 41 patient series. In the general population, specific clinical (admission Glasgow Coma Scale [GCS], abnormal pupil exam, time to surgery, decompressive craniectomy, raised postoperative intracranial pressure) and radiologic (ASDH thickness, midline shift, thickness/midline shift ratio, uncal herniation, and brain density difference) factors were associated with mortality (grade III). Other clinical (admission GCS, decompressive craniectomy) and radiologic (ASDH volume, thickness/midline shift ratio, uncal herniation, loss of basal cisterns, petechiae, and brain density difference) factors were associated with functional outcome (grade III). In the elderly, only postoperative GCS and midline shift on brain computed tomography were associated with mortality (grade III). Comorbidities, abnormal pupil examination, postoperative GCS, intensive care unit hospitalization, and midline shift were associated with functional outcome (grade III). Based on these factors, the SHE (Subdural Hematoma in the Elderly) and the RASH (Richmond Acute Subdural Hematoma) scores could be used in daily clinical practice. This review has underlined a few supplementary factors of prognostic interest in patients with ASDH, and highlighted two predictive scores that could be used in clinical practice to guide and assist clinicians in surgical indication.
Primary Retroperitoneal Masses: A Pictorial Essay
Authors: Gupta Abhishek , Manchanda Alpana , Singh Sapna , Singh Rajdeep , Khurana Nita , Durgad Aishwarya S.
Published: August 2023

Primary retroperitoneal masses include a diverse and uncommon group of lesions that arise within the retroperitoneal space, but do not originate from any retroperitoneal organs. The majority of the lesions are malignant and imaging plays a pivotal role in the detection, staging, and preoperative planning. The evaluation of primary retroperitoneal masses is often challenging owing to the unfamiliarity with the common imaging features of various diseases affecting it. This article describes the multidetector computed tomography appearance of some primary retroperitoneal masses.
Phase-field modeling of interaction between void and grain boundaries and its swelling effect
Authors: Han G. M.
Published: August 2023

The interaction of irradiated voids and grain boundaries in zirconium is systematically studied by using a composite multiphase-field model that couples the evolution of irradiated voids and grain boundaries. In phase-field modeling, the polycrystalline evolution phase-field governing equation and void evolution phase-field governing equation are coupled together for modeling. In the numerical solution, the aforementioned two sets of equations are coupled to solve the absorption of vacancies and interstitial atoms by grain boundaries. First, we studied the influence of the existence of voids on the evolution of polycrystalline grains when the voids did not evolve. Thereafter, we examined the influence of the grain boundaries on the evolution of the voids when the grain boundaries did not evolve. Finally, we analyzed the interaction process between the grain boundaries and voids at the same time. The preceding simulation research can reproduce the pinning effect of the void on the grain boundary and the phenomenon that the grain boundary acts on the void evolution process to form a “void-denuded zone” near the grain boundary. The interaction mechanism between grain boundaries and voids is revealed through systematic simulation research. On this basis, the influence of the interaction process between the grain boundary and the void on the swelling behavior is further discussed.
Metabolomics analysis shows the differences in metabolites in deer antler bases of red deer and sika deer
Authors: Zhang Zhenxiang , Li Zhaonan , Bao Changhong , He Caixia , Jin Wenjie , Li Changzhong , Li Xiaoan , Chen Yanxia
Published: August 2023

Context Deer antler base is a part of deer antler and a traditional Chinese medicine, which is effective in treating mammary gland hyperplasia and other diseases. However, deer antler base is very hard and not easy to crush, resulting in its under-utilisation and a waste of resources. At present, the potential mechanism of deer antler base in the treatment of diseases is still unclear. Aim To encourage its utilisation and research, it is crucial to comprehend its composition and identify the key effective components. Methods To explore the differences in metabolites between antler bases of different deer species, red and sika deer antler bases were used as samples, and metabolites from both deer antler base samples were screened and identified by Ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Key results In all, 151 metabolites were identified in both red deer and sika deer antler bases. Metabolite types did not differ between the antler bases of red and sika deer, while there was some difference in metabolite abundance. After principal-component analysis (PCA) and partial least-squares discriminant analysis (PLS-DA); a total of 43 metabolites with significant differences were identified. KEGG annotation showed that pathways with the most metabolites enrichment were mainly related to lipid and amino acid metabolism. The pathways significantly annotated with differential metabolites were mainly related to amino acid metabolism. Conclusions On the basis of untargeted metabolomics analysis, this study systematically showed the differences in metabolites composition and abundance in antler bases between two deer species from a metabolomics perspective. The composition and abundance of metabolites in red deer antler base were similar to those in sika deer antler base, but the endogenous metabolites in different deer antler bases had some differences. Implications The present study found that there was no significant difference in endogenous metabolites in antler bases between red deer and sika deer, which indicates that deer antler bases of different deer species may have similar medicinal value. It will provide some theoretical basis for research, development, and utilisation of antler bases.
Love me, love my dog: Cohabitation, dogs and romantic relationships among college students
Authors: Tallichet Suzanne E. , Perkins Elizabeth B. , Chang I. Joyce , Long-Mills Em , Knox David
Published: August 2023

This research focused on the impact of having one or more dogs on romantic relationships among college-age cohabiting couples. One hundred and eighteen romantic cohabitants, among whom either or both partners had a dog, from three universities completed an anonymous, voluntary 41-item survey. Quantitative data included the bulk of the items analyzed using Version 25 of the IBM Statistical Package for Social Sciences (SPSS) program. Qualitative data were generated using three open-ended questions and analyzed using a thematic analysis approach. Over three-fourths (77%) of the respondents reported a positive effect, 17% reported a neutral impact, and 6% reported a negative outcome. The positive effects included “companionship” (97%), “relationship enhancer” (88%), and “like having a child together” (76%). Negative outcomes included jealousy, less time spent together, and stress. Men were significantly more likely to report that their partner was jealous of the dog, while women were significantly more likely to talk to their dogs about problems. Whites, more than racial-ethnic minorities, typically reported a more positive than negative effect of dogs on their romantic relationships. The study emphasizes the positive impact of a dog(s) on the romantic relationship of cohabiting couples and reveals some of the negative impacts of living with one or more dogs on young cohabitating couples’ relationships. The findings provide relatively new insights into the influence of gender and race-ethnicity on dogs and cohabiting couples and suggest areas for further research.
Investigating the effect of circuit cutting in QAOA for the MaxCut problem on NISQ devices
Authors: Bechtold Marvin , Barzen Johanna , Leymann Frank , Mandl Alexander , Obst Julian , Truger Felix , Weder Benjamin
Published: August 2023

Noisy intermediate-scale quantum (NISQ) devices are restricted by their limited number of qubits and their short decoherence times. An approach addressing these problems is quantum circuit cutting. It decomposes the execution of a large quantum circuit into the execution of multiple smaller quantum circuits with additional classical postprocessing. Since these smaller quantum circuits require fewer qubits and gates, they are more suitable for NISQ devices. To investigate the effect of quantum circuit cutting in a quantum algorithm targeting NISQ devices, we design two experiments using the quantum approximate optimization algorithm (QAOA) for the Maximum Cut (MaxCut) problem and conduct them on state-of-the-art superconducting devices. Our first experiment studies the influence of circuit cutting on the objective function of QAOA, and the second evaluates the quality of results obtained by the whole algorithm with circuit cutting. The results show that circuit cutting can reduce the effects of noise in QAOA, and therefore, the algorithm yields better solutions on NISQ devices.
Decoding short-range order in cation-disordered rocksalt materials using Metropolis non-negative matrix factorisation
Authors: Hua Xiao , Dean Thomas , Cussen Serena A , Goodwin Andrew L
Published: August 2023

We present a methodology for accessing the cation short-range ordering (SRO) in disordered rocksalt (DRX) materials by decomposing their pair distribution function (PDF) pattern in terms of a set of basis PDFs, pre-determined via Metropolis non-negative matrix factorisation analysis. These basis PDFs, underpinned by structure modelling, point to specific SRO types that subsequently enable identification and quantification of their presence in the DRX structure. Rapid identification of the evolution of SRO addresses a key bottleneck in the analysis and understanding of high energy density characteristics of DRX materials.
Vortex dynamics and on the mechanism of vertical force enhancement in inclined stroke flapping wings
Authors: Shanmugam Deepthi , Vengadesan Sankaranarayanan
Published: August 2023

The rigorous numerical investigation of the class of inclined stroke plane flapping wings has brought to light the vertical force enhancement due to dipole jet interaction. In this study, the class of inclined stroke plane flapping wings with varying inter-plane distances and stroke inclinations are studied for vertical force generation. The configurations with stroke plane angles of 60° and 75° are found to produce significantly high vertical forces. Further, wake structures of the tandem flapping wing in an inclined stroke plane show various types of dipole vortex shedding and dipole jet interactions. The identified types of dipole jet interactions help in the understanding of vertical force trends of the forewing, hindwing, and hence the tandem wing configuration as a whole. It reveals the potential dipole jet interaction producing the highest vertical force in tandem wing configurations. In all, the study can classify the flows of the tandem wing configurations based on vortex shedding during hovering conditions and understand its vertical force enhancements. This not only helps in getting physical insights into the vortex dynamics of inclined stroke plane flapping wings but also in the design optimisation of the tandem wing configurations in biomimetic Micro Air vehicles (MAVs).
Investigation on the performance of wire electrical discharge machining (WEDM) using aluminium matrix composites (AMCs) micro-channel
Authors: Ansari Mahamood , Khan Imtiaz Ali
Published: August 2023

This study focuses on microchannel fabrication of Al-10% SiC composite using Wire-EDM process with the applications of single variable and multi variable, optimization. This work was targeted keeping in considerations the wider scope of microchannel applications in the fields such as medical, aerospace, automobile, etc. In this research work, the experiment was conducted to achieve high precision and quality surface finish in terms of minimum surface roughness (SR), high material removal rate (MRR), low tool wear rate (TWR) and optimum spark gap (SG). The used experiments were design on the basis of Taguchi design of experiment approach. Four input process parameters were considered namely, pulse on time (Ton), sparking voltage (SV), wire tension (WT), and wire feed rate (WFR). For the experimentation task, the workpeice (Aluminum and silicon carbide (10% Wt SiCmicro)) material, in a desired shape was fabricated through stir casting process. The tool electrode applied for the experiment purpose had specification as, 0.25 mm diameter brass alloy wire (copper 63 percent and zinc 37 percent). For single variable optimization ANOVA (analysis of variance) was applied while as, for multi variables optimization, grey relational analysis (GRA) was applied. The results of the study indicated that, on the basis of single variable optimization, the highest contribution of Ton resulted in case of the performance measures, MRR and SR while as, for TWR and SG, the highest contribution of sparking voltage, observed. Furthermore, the findings of the study indicated that, on the basis of multi variables optimization, the optimal combination of input process parameters is, pulse on time 125μs, sparking voltage 10 volt, wire tension 12 kgf, and wire feed rate 4 m min−1. These results also get support from the previous research works. The findings of this study be useful for microchannel manufacturing and other related industrial applications.
Natural gas-hydrogen hybrid combustion retrofit method and practice for F-class heavy-duty combustion engines
Authors: Zeng Guofang , Xu Zhiwei , Zhang Zhaozhao , Bai Hongtao
Published: August 2023

In order to reduce carbon emissions, enhance the operational flexibility of gas turbine power plants, and fill the gap in practical engineering transformation of natural gas-hydrogen blended combustion in heavy-duty gas turbines, a hydrogen blending retrofit was conducted on an F-class heavy-duty gas turbine combined heat and power unit. This served to examine the problems of combustion chamber tempering, combustion pulsation, and NOx emission increase caused by direct hydrogen-doped combustion in the combustion chamber. In this paper, the gas turbine body and hydrogen mixing system were reformed respectively. Retrofit schemes were proposed that were suitable for two operating conditions: 5%–15% and 15%–30% hydrogen blending. Experimental tests were conducted as a means of evaluating the performance of the retrofitted gas turbine and its compatibility with the boiler and steam turbine. The results of the retrofit showed there to be stable combustion, and there was no significant increase in average burner temperatures or occurrence of flashback. The gas turbine power output mostly remained unchanged and NOx emissions met the regulatory standards. The waste heat boiler flue gas temperature was controlled within the range of 84.9–88.2 °C, meaning that the safe operation of the steam turbine was not affected. The hydrogen blending rate was 0.2 Vol%/s, which indicates a smooth and precise control of the hydrogen blending process. It was estimated that the annual reduction in CO2 emissions would be 11,000 tons and 28,400 tons following respective hydrogen blending at 15% and 30%. A reliable retrofit scheme for hydrogen blending in gas turbines based on practical engineering transformation is presented in this study, which has significant reference value.
Nanocavity enhanced photon coherence of solid-state quantum emitters operating up to 30 K
Authors: Brash A J , Iles-Smith J
Published: August 2023

Solid-state emitters such as epitaxial quantum dots have emerged as a leading platform for efficient, on-demand sources of indistinguishable photons, a key resource for many optical quantum technologies. To maximise performance, these sources normally operate at liquid helium temperatures (

∼

4
 

K

), introducing significant size, weight and power requirements that can be impractical for proposed applications. Here we experimentally resolve the two distinct temperature-dependent phonon interactions that degrade indistinguishability, allowing us to demonstrate that coupling to a photonic nanocavity can greatly improve photon coherence at elevated temperatures up to

30
 

K

that are compatible with compact cryocoolers. We derive a polaron model that fully captures the temperature-dependent influence of phonons observed in our experiments, providing predictive power to further increase the indistinguishability and operating temperature of future devices through optimised cavity parameters.
DecentTree: scalable Neighbour-Joining for the genomic era
Authors: Wang Weiwen , Barbetti James , Wong Thomas , Thornlow Bryan , Corbett-Detig Russ , Turakhia Yatish , Lanfear Robert , Minh Bui Quang
Published: August 2023

Motivation

Neighbour-Joining is one of the most widely used distance-based phylogenetic inference methods. However, current implementations do not scale well for datasets with more than 10 000 sequences. Given the increasing pace of generating new sequence data, particularly in outbreaks of emerging diseases, and the already enormous existing databases of sequence data for which Neighbour-Joining is a useful approach, new implementations of existing methods are warranted.

Results

Here, we present DecentTree, which provides highly optimized and parallel implementations of Neighbour-Joining and several of its variants. DecentTree is designed as a stand-alone application and a header-only library easily integrated with other phylogenetic software (e.g. it is integral in the popular IQ-TREE software). We show that DecentTree shows similar or improved performance over existing software (BIONJ, Quicktree, FastME, and RapidNJ), especially for handling very large alignments. For example, DecentTree is up to 6-fold faster than the fastest existing Neighbour-Joining software (e.g. RapidNJ) when generating a tree of 64 000 SARS-CoV-2 genomes.

Availability and implementation

DecentTree is open source and freely available at https://github.com/iqtree/decenttree. All code and data used in this analysis are available on Github (https://github.com/asdcid/Comparison-of-neighbour-joining-software).
Capabilities, institutions and regional economic development: a proposed synthesis
Authors: Frenken Koen , Neffke Frank , van Dam Alje
Published: August 2023

The capability framework in evolutionary economic geography views regional economic development as a process of related diversification through the acquisition of capabilities that render a regional economy more complex. Using this framework, we synthesize seven theoretical notions that hitherto remained rather disconnected: relatedness, complementarity, variety, complexity, diversification, agents of structural change and related variety. We formulate a constructive critique of the capability framework, relaxing the overly restrictive assumption that the presence of capabilities in a region is both necessary and sufficient for complex products to be produced in a region. Instead, we argue that the complexity of a regional economy depends primarily on the institutions that support firms to coordinate production in complex value chains within and across regions. The augmented framework allows for closer integration of evolutionary and relational approaches in economic geography, providing new links between the literature on clusters, innovation systems and global production networks.
15. EFFECT OF ARTIFICIAL CAPNOTHORAX VS NON-CAPNOTHORAX DURING THORACOSCOPIC ESOPHAGECTOMY ON CIRCULATING TUMOR CELLS AND SURVIVAL IN ESOPHAGEAL CANCER
Authors: Gu Yi-Min , Wang Wen-ping , Chen Long-Qi
Published: August 2023

Background

To investigate the effect of artificial capnothorax on circulating tumor cells and survival after minimally invasive esophagectomy for esophageal cancer.

Methods

This prospective, multicenter, randomized controlled trial was conducted in a tertiary hospital in China. Between August 2019 and January 2020, 110 patients with resectable esophageal cancer were randomized to undergo non-capnothorax esophagectomy (n = 55) or capnothorax procedures. The analysis was based on the intention-to-treat principle. The final follow-up occurred in November 2022. The main outcomes were changes in folate receptor-positive circulating tumor cells, 3-year overall survival, and disease-free survival rates.

Results

A total of 110 patients were included in the intention-to-treat analysis. After surgery, the incidence of patients with incremental changes in FR + CTC levels was 18.6% (8/43) in the capnothorax group and 2.7% (1/37) in the non-capnothorax group (P = 0.033) (mean changes, −3.9 ± 3.4 [FU/3 mL] vs −2.4 ± 2.9 [FU/3 mL], respectively; P = 0.039). There were significant differences in the 3-year overall survival rate (81.6% [95%, 72.4–92.0] vs 65.2% [95%, 59.3–78.8]; P = 0.002) and disease-free survival rate (81.6% [95%, 72.4–93.0] vs 61.6% [95%, 50.1–75.7]; P = 0.015) between the two groups. Multivariate analysis indicated that the artificial pneumothorax approach was a prognostic factor for overall survival (HR: 2.347, 95% CI: 1.053–5.235; P = 0.037) and disease-free survival (HR: 1.325, 95% CI: 1.210–1.451; P < 0.001).

Conclusions

Artificial capnothorax during surgery resulted in increased dissemination of circulating tumor cells and worse survival outcomes in patients with esophageal cancer. Esophagectomy under non-capnothorax should be a recommended procedure.
18. ASSOCIATION OF TUMOR PATHOLOGICAL COMPLETE RESPONSE WITH THE USE OF METFORMIN DURING NEOADJUVANT CHEMORADIOTHERAPY IN ESOPHAGEAL CANCER PATIENTS: RETROSPECTIVE STUDY
Authors: Yun Taeyoung , Kang Chang Hyun , Park Ji Hyeon , Na Bubse , Na Kwon Joong , Park Samina , Lee Hyun Joo , Park In Kyu , Kim Young Tae
Published: August 2023

Background

Metformin is a standard treatment for type 2 diabetes mellitus (DM). Previous in vitro and in vivo studies have reported the association of metformin’s additive anticancer response with chemotherapy in esophageal cancer. However, no clinical studies have been reported. Therefore, this study is to aim the administration of metformin use can improve clinical outcomes of esophageal cancer patient with neoadjuvant combined chemotherapy and radiation (CCRT).

Methods

A total of 209 patients with esophageal cancer and underlying DM who underwent neoadjuvant CCRT before surgical resection were included from 1998 to 2022. There were 22 patients with metformin medication (10.5%) and 186 patients without metformin (89%). Univariable and multivariable regression analysis were done for complete response effect of metformin medication. Moreover, early clinical outcomes such as, overall survival and disease free survival were compared between the two groups.

Results

The complete response rate was higher for the metformin group (45.5% vs 22.6%; p = 0.019) and the recurrence rate was significantly lower (21.1% vs 45.7%, p = 0.040). The metformin group was associated with complete response rate in univariate logistic regression analysis (odds ratio [OR] = 2.86 [1.15–7.08], p = 0.023) and multivariable analysis (odds ratio [OR] = 2.84 [1.12–7.23], p = 0.028). Median follow-up duration was 19.8 months for metformin group, 17.3 months for non-metformin group. Overall 2-year survival rate and disease free survival was higher for metformin group than non-metformin group, (40% vs 26.5%, p = 0.380, 31.6% vs 24.3%, p = 0.095), however, not significant.

Conclusion

An association of metformin use with complete response rate in neoadjuvant CCRT esophageal cancer patients has been shown. The potential of metformin’s tumor response after neoadjuvant CCRT for esophageal cancer has been demonstrated in our study. Further prospective study should be needed for clinical evidence.
20. ADDITIONAL NEOADJUVANT IMMUNOTHERAPY DOESN’T INCREASE THE RISK OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY: A MULTICENTER RETROSPECTIVE COHORT STUDY
Authors: Hong Zhinuan , Weng Kai , Jiang Junfei , Kang Mingqiang
Published: August 2023

Background

Neoadjuvant chemoimmunotherapy (nICT) is a promising therapy model for locally advanced esophageal squamous cell carcinoma (LA-ESCC), which brought good pathological response. However, there is still a lack of large cohot to confirm the impact of additional impact of additional neoadjuvant immunotherapy on short-term outcomes. The objective of this study lies on assessing the additional neoadjuvant immunotherapy making a difference in patients’ short-term outcomes, particularly the risk of anastomotic leakage (AL) and pathological response.

Methods

Patients with LA-ESCC who received neoadjuvant chemotherapy(nCT)/nICT combination with radical esophagectomy were enrolled from three medical centers in China. Baseline data were matched using propensity score matching (1:1, caliper = 0.01) and inverse probability processing weighting(IPTW). Conditional logistic regression and weighted logistic regression analysis were used to further evaluate whether additional neoadjuvant immunotherapy would increased the risk of postoperative AL.

Results

A total of 331 patients LA-ESCC receiving nCT or nICT were enrolled. The application of PSM as well as IPTW ensured baseline data equilibrium. After matching, there were no significant difference in the AL incidence between the two groups (p = 0.68, after PSM; p = 0.97 after IPTW), and the incidence of AL was 15.85% vs. 18.29%, and 14.79% vs. 15.01%, respectively. Weighted logistic regression analysis showed that additional neoadjuvant immunotherapy wasn’t responsible for AL. The nICT group had dramatically higher pCR in primary tumor than the nCT group (9.76% vs. 28.05% after PSM and 7.72% vs. 21.17% after IPTW).

Conclusions

Additional neoadjuvant immunotherapy can benefit pathological reactions without increasing the risk of AL and pulmonary complications. We require further randomized controlled research to validate whether additional neoadjuvant immunotherapy would make a difference in other complications, and determine whether pathologic benefits could translate into prognostic benefits, which would require longer follow-up.
41. HIGH COMPREHENSIVE COMPLICATION INDEX AFTER MINIMALLY INVASIVE ESOPHAGECTOMY ASSOCIATED WITH POOR SHORT-TERM AND LONG-TERM OUTCOME: A PROPENSITY SCORE MATCHING ANALYSIS
Authors: Chen Dinghang , Cai Junlan , Weng Kai , Hong Zhinuan
Published: August 2023

Introduction

The comprehensive complication index (CCI) is a new index to comprehensively and systematically evaluate complication severity. The objective of this study was to evaluate the predictive ability of CCI on short—and long-term overall survival(OS) in patients with esophageal squamous cell carcinoma (ESCC) undergoing minimally invasive esophagectomy (MIE) based on a propensity Score Matching (PSM) analysis.

Methods

A total of 356 patients treated with radical MIE from 2013 to 2017 were included, and the primary outcome was OS, and the secondary outcomes were postoperative hospital stay and hospital costs. Firstly, the optimla cut-off value of CCI was determined by X-tile. PSM was used to balance the baseline characteristics. Second, we compared postoperative hospital stay and hospital costs between high- and low-CCI group. Third, the Kaplan–Meier survival curve was used to analyze survival difference. Fourth, univariate and multivariate Cox analysis was used to explore the independent risk factors of OS.

Results

The CCI > 24.2 was defined as high-CCI group and CCI≦24.2 was defined as low-CCI group. The high-CCI group had more hospital costs and longer hospital stay than the low-CCI group both before and after PSM (p < 0.001). The K-M analysis indicated that patients with high CCI had worse prognosis both before and after PSM (before matching: P < 0.001; after matching: P = 0.04). CCI was determined as independent prognostic factor both before and after PSM (before PSM, P = 0.002; after PSM, P = 0.025).

Conclusion

The CCI could quantify postoperative complications after esophagectomy. High CCI is associated with longer hospital stay and hospitalization costs, and is an independent risk factor for poor OS.
142. EFFECTS OF PPIS AND P-CAB ON RESPONSES ACCORDING TO OUTCOMES OF SYMPTOM, ENDOSCOPY, AND HISTOLOGY IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS
Authors: Fujiwara Yasuhiro , Kanamori Atsushi , Sawada Akinari , Tanaka Fumio
Published: August 2023

Background and Aim

Acid-suppressive drugs such as proton pump inhibitors and potassium-competitive acid blockers (PPIs/P-CABs) are often used to treat eosinophilic esophagitis (EoE). Treatment response is based on outcomes including, symptoms, endoscopy, and histology; however, the detailed response rate to PPI/P-CAB is unknown. We aimed to examine the response rate to PPIs/P-CABs and prevalence of topical corticosteroid (TCS) therapy as the second-line treatment for EoE, and compare efficacy between PPIs and P-CAB.

Methods

In total, 236 patients with histologically confirmed EoE who received PPI/P-CAB as the first-line treatment were included. We assessed the symptoms, endoscopic reference score (EREFS), and histology (eosinophils per high-power field, eos/hpf) 8 weeks after PPI/P-CAB administration. Complete normalization was defined as disappearance of symptoms, EREFS score 0, or 0–1 eos/hpf and response as disappearance or improvement of symptoms, EREFS score ≤ 2, or < 15 eos/hpf. The prevalence of TCS therapy in each response group was assessed.

Results

Complete normalization of PPI/P-CAB was achieved in 25%, 50%, 36%, and 8% of patients for symptoms, endoscopy, histology, and all three outcomes, respectively. The response rates of PPI/P-CAB were 81%, 87%, 87%, 75%, and 60% for symptoms, endoscopy, histology, and all three outcomes, respectively. There were no significant differences in compete normalization and response rate of any outcomes between PPIs and P-CAB. TCS use was significantly lower (8%) in patients who achieved response of all three outcomes than in other groups, and was dependent on the number of outcomes with non-response.

Conclusions

Complete normalization of symptoms, endoscopy, and histology using PPI/P-CAB is uncommon. Based on treatment efficacy by response/non-response, TCS was the secondary treatment in cases with an increase in the number of non-response outcomes. Treatment efficacy of PPIs and P-CAB was similar.
148. COMPARISON OF EARLY POSTOPERATIVE OUTCOME BETWEEN OPEN AND MINIMALLY INVASIVE TRANSTHORACIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A RETROSPECTIVE STUDY
Authors: Swangsri Jirawat , Patraithikul Premkamol , Parakonthun Thammawat , Methasate Asada
Published: August 2023

Background

Esophagectomy is a highly invasive surgical procedure for esophageal cancer, with open thoracotomy associated with a significant risk of pulmonary complications. Minimally invasive techniques, such as minimally invasive esophagectomy (MIE), are expected to reduce these complications and enhance postoperative recovery. This study aimed to compare the early postoperative outcomes of patients who underwent open esophagectomy versus MIE.

Methods

We conducted a retrospective study using a single-center database from January 1, 2010, to February 28, 2023, including patients aged 18–90 years with a resectable lesion of the esophagus or esophagogastric junction who underwent either open transthoracic esophagectomy or MIE (thoracoscopic/robotic-assisted). Patient data, surgical procedures, interventions, and early outcomes (within 30 days of operation) were collected and analyzed. The study included a total of 76 patients, with 50 patients in open esophagectomy group and 26 patients in MIE group. The primary outcome was the incidence of pulmonary complications during the hospital stay, and logistic regression was used for data analysis.

Results

The overall incidence of pulmonary complications was 37 cases (74%) in the open esophagectomy group and 14 cases (53.8%) in the MIE group, with the incidence of pulmonary infection occurring in 19 cases (38%) and 8 cases (30.8%), respectively. Perioperative mortality was 1 cases (2%) in the open esophagectomy group and 0 cases (0%) in the MIE group. After adjusting for age, sex, BMI, smoking, COPD, and operative time, the open esophagectomy group had a 4.29 times higher risk of pulmonary complications than the MIE group (odds ratio 4.29, 95% confidence interval 1.30–14.16; p = 0.017).

Conclusion

Our study demonstrates that MIE is associated with a lower incidence of pulmonary complications, reduced blood loss, and shorter ICU stays compared to open esophagectomy. Rates of anastomosis leakage, vocal cord paralysis, and hospital stays were comparable. These findings support the feasibility and safety of MIE, potentially improving surgical outcomes and enhancing postoperative recovery for the treatment of esophageal cancer.
166. ROBOTIC-ASSISTED BILATERAL EPIPHRENIC DIVERTICULECTOMY WITH HELLER MYOTOMY AND DOR FUNDOPLICATION: A SURGICAL TECHNIQUE
Authors: Patraithikul Premkamol , Swangsri Jirawat
Published: August 2023

Background

Epiphrenic diverticula are rare esophageal diseases often associated with motility disorders such as achalasia. We present a case of bilateral epiphrenic diverticula in a patient with achalasia type III who presented with dysphagia. This video demonstrates the surgical technique of robotic-assisted bilateral epiphrenic diverticulectomy with Heller myotomy and Dor fundoplication, highlighting the six essential surgical steps.

Methods

A 72-year-old female presented with dysphagia for 3 years. An esophagogastroduodenoscopy revealed two epiphrenic diverticula without food content retention. A barium swallow revealed two epiphrenic diverticula, measuring 3.3 cm and 1.2 cm in diameter, on right and left side walls of distal esophagus, respectively. Esophageal manometry showed the lower esophageal sphincter (LES) pressure was 25.6 mmHg (normal <15 mmHg). Subsequently, both the acid exposure time and the DeMeester score indicated normal levels of acid exposure. The patient underwent robotic-assisted surgery. The diverticulectomy was performed using stapling device under endoscopic guidance, followed by standard myotomy. Additionally, Dor fundoplication was performed to complete procedure.

Results

Postoperatively, the patient recovered well. An upper gastrointestinal study demonstrated an adequate myotomy without evidence of leak or residual epiphrenic diverticula. Further postoperative evaluation, including esophageal manometry, showed normal LES pressure of 12.8 mmHg, the postoperative acid exposure time of 0.0%, and the DeMeester score of 0.20, that indicating normal levels of acid exposure. The patient resumed a liquid diet on postoperative day 4 and a soft diet on postoperative day 7. Based on these results, the patient’s dysphagia was resolved, and there was an absence of gastroesophageal reflux symptoms.

Conclusion

Bilateral epiphrenic diverticula are extremely rare, and require complex procedure. Robotic-assisted surgery has the potential to enhance the facilitation of surgical treatment for this condition. The robotic tools are precise and maneuverable, making it possible to perform intricate surgical procedures in tight angles and confined spaces, such as the hiatal area. This technique offers several advantages over conventional laparoscopic surgery, and should therefore be considered for the treatment of bilateral epiphrenic diverticula.
180. ENHANCED RECOVERY PROTOCOL VERSUS CONVENTIONAL CARE IN ESOPHAGECTOMY PATIENTS WITH ESOPHAGEAL CARCINOMA: ADVANTAGES ON THE PATIENT-REPORTED OUTCOMES
Authors: Huang Yixuan , Xie Qin , Wang Kangning , Gong Ruoyan , Shi Qiuling , Han Yongtao , Fang Qiang
Published: August 2023

Background

The subjective metrics regarding quality of life are unclear in comparison of an enhanced recovery after surgery (ERAS) protocol with conventional care in esophagectomy patients with esophageal carcinoma, while the objective metrics are controversial. This study was to investigate the advantages of ERAS over conventional care on the Health-related Quality of Life (HRQoL) from patient-reported outcomes (PROs), and explore the key components of ERAS for benefit duration.

Methods

This was a single-center, retrospective study with prospective PROs data from esophagectomy patients with esophageal cancer between April 2019 and June 2021. The objective metrics included perioperative complications and postoperative length of stay (PLOS). PROs data were assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 quality of life questionnaire and the QLQ-OES18 esophageal cancer module from pre-surgery to six months after surgery. Mixed-effects models were used to longitudinally compare the HRQoL scores between the two programs.

Results

348 conventional care and 109 ERAS patients were analyzed. The ERAS group had less pneumonia, arrhythmia, and PLOS than the conventional group. The ERAS group outperformed the conventional group in six QLQ-C30 domains, especially physical functioning (p = 0.0115), role functioning (p = 0.0002), and fatigue (p = 0.0428). QLQ-OES18 revealed that the ERAS group had less dysphagia (p < 0.0001), trouble talking (p = 0.0006) and better eating (p < 0.0001) than the conventional group. The above advantages persisted three months after surgery. For cervical circular stapled anastomosis the initial items and duration of benefit were reduced in ERAS group than in conventional group.

Conclusion

The ERAS protocol has significant advantages over the conventional care in lowering postoperative symptom burden and improving HRQoL on PROs in esophagectomy patients with esophageal cancer, and the benefit persists up to three months after surgery. For the cervical anastomosis the optimal technique may be a key component of ERAS maintaining the items and duration of advantages on PROs.