bluuebunny/crossref_metadata_2025 huggingface dataset:
Breaking Intangible Barriers in English-as-an-Additional-Language Job Interviews: Evidence from Interview Training and Ratings
Authors: Travers Nick , Huang Li-Shih
Published: September 2020

This article reports a study that involved simulated job interviews with 27 high-proficiency English-as-an-additional-language (EAL) candidates and nine professional interviewers and that evaluated three conditions: a control group and two experimental groups (one receiving only personalized, training-focused feedback on interview skills immediately after the first interview, the other receiving both the same personalized feedback and a pragmatics-focused training session, also immediately after the first interview). As derived from the 2,106 scores generated, the quantitative results showed that both experimental groups significantly outperformed the control group. The qualitative results from content analysis of the interviewers’ 341 comments captured in video-stimulated recalls showed that various themes related to language ability featured most prominently in interviewer evaluations; the themes also differentiated above-average and below-average-rated candidates. The study underscores the extent to which communicative performance swayed interviewers’ judgements above other variables; these judgements in turn may prove a disadvantage for EAL candidates in their job interviews and thus merit the critical awareness and reflection of EAL candidates, interviewers, and trainers alike.
Web tools to fight pandemics: the COVID-19 experience
Authors: Mercatelli Daniele , Holding Andrew N , Giorgi Federico M
Published: September 2020

The current outbreak of COVID-19 has generated an unprecedented scientific response worldwide, with the generation of vast amounts of publicly available epidemiological, biological and clinical data. Bioinformatics scientists have quickly produced online methods to provide non-computational users with the opportunity of analyzing such data. In this review, we report the results of this effort, by cataloguing the currently most popular web tools for COVID-19 research and analysis. Our focus was driven on tools drawing data from the fields of epidemiology, genomics, interactomics and pharmacology, in order to provide a meaningful depiction of the current state of the art of COVID-19 online resources.
Revisiting genome-wide association studies from statistical modelling to machine learning
Authors: Sun Shanwen , Dong Benzhi , Zou Quan
Published: September 2020

Over the last decade, genome-wide association studies (GWAS) have discovered thousands of genetic variants underlying complex human diseases and agriculturally important traits. These findings have been utilized to dissect the biological basis of diseases, to develop new drugs, to advance precision medicine and to boost breeding. However, the potential of GWAS is still underexploited due to methodological limitations. Many challenges have emerged, including detecting epistasis and single-nucleotide polymorphisms (SNPs) with small effects and distinguishing causal variants from other SNPs associated through linkage disequilibrium. These issues have motivated advancements in GWAS analyses in two contrasting cultures—statistical modelling and machine learning. In this review, we systematically present the basic concepts and the benefits and limitations in both methods. We further discuss recent efforts to mitigate their weaknesses. Additionally, we summarize the state-of-the-art tools for detecting the missed signals, ultrarare mutations and gene–gene interactions and for prioritizing SNPs. Our work can offer both theoretical and practical guidelines for performing GWAS analyses and for developing further new robust methods to fully exploit the potential of GWAS.
Trigeminal neurovascular contact in SUNCT and SUNA: a cross-sectional magnetic resonance study
Authors: Lambru Giorgio , Rantell Khadija , O’Connor Emer , Levy Andrew , Davagnanam Indran , Zrinzo Ludvic , Matharu Manjit
Published: September 2020

Emerging data-points towards a possible aetiological and therapeutic relevance of trigeminal neurovascular contact in short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and perhaps in short lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). We aimed to assess the prevalence and significance of trigeminal neurovascular contact in a large cohort of consecutive SUNCT and SUNA patients and evaluate the radiological differences between them. The standard imaging protocol included high spatial and nerve-cistern contrast resolution imaging acquisitions of the cisternal segments of the trigeminal nerves and vessels. MRI studies were evaluated blindly by two expert evaluators and graded according to the presence, location and degree of neurovascular contact. The degree of contact was graded as with or without morphological changes. Neurovascular contact with morphological changes was defined as contact with distortion and/or atrophy. A total of 159 patients (SUNCT = 80; SUNA = 79) were included. A total of 165 symptomatic and 153 asymptomatic trigeminal nerves were analysed. The proportion of neurovascular contact on the symptomatic trigeminal nerves was higher (80.0%) compared to the asymptomatic trigeminal nerves (56.9%). The odds on having neurovascular contact over the symptomatic nerves was significantly higher than on the asymptomatic nerves [odds ratio (OR): 3.03, 95% confidence interval (CI) 1.84–4.99; P < 0.0001]. Neurovascular contact with morphological changes were considerably more prevalent on the symptomatic side (61.4%), compared to the asymptomatic side (31.0%) (OR 4.16, 95% CI 2.46–7.05; P < 0.0001). On symptomatic nerves, neurovascular contact with morphological changes was caused by an artery in 95.0% (n = 77/81). Moreover, the site of contact and the point of contact around the trigeminal root were respectively proximal in 82.7% (67/81) and superior in 59.3% (48/81). No significant radiological differences emerged between SUNCT and SUNA. The multivariate analysis of radiological predictors associated with the symptomatic side, indicated that the presence of neurovascular contact with morphological changes was strongly associated with the side of the pain (OR: 2.80, 95% CI 1.44–5.44; P = 0.002) even when adjusted for diagnoses. Our findings suggest that neurovascular contact with morphological changes is involved in the aetiology of SUNCT and SUNA. Along with a similar clinical phenotype, SUNCT and SUNA also display a similar structural neuroimaging profile, providing further support for the concept that the separation between them should be abandoned. Furthermore, these findings suggest that vascular compression of the trigeminal sensory root, may be a common aetiological factor between SUNCT, SUNA and trigeminal neuralgia thereby further expanding the overlap between these disorders.
Determination of Cr (VI) Content in Water-Soluble Dyes
Authors: Sathianarayanan M P , Nayak Rina , Hande Yogesh
Published: September 2020

Hexavalent chromium detection in the presence of high load of colorants is a challenge, and it is an important area of study. Colorants are a class of interfering substance in many spectroscopic analysis and chromatographic separation and detection. In this study, a method has been developed to separate out Cr (VI) and water-soluble dyes by using activated charcoal as an absorption medium. The extraction procedure was optimized with Cr (VI) standard solution for quantification. The efficacy of the extraction procedure for the removal of water-soluble dyes and detection of Cr (VI) was checked with a spike recovery study. Based on the spike recovery study, the method has been validated as per the international validation protocol. The method is simple, cost effective and has a detection limit down up to 3.0 mg/kg. The recovery rate of Cr (VI) in water-soluble dyes like reactive yellow HE 6G, reactive red 218, turquoise blue HGN, reactive navy blue RX and reactive black 5A was found to be more than 90% with a good repeatability and reproducibility.
Subclinical Tuberculosis Disease—A Review and Analysis of Prevalence Surveys to Inform Definitions, Burden, Associations, and Screening Methodology
Authors: Frascella Beatrice , Richards Alexandra S , Sossen Bianca , Emery Jon C , Odone Anna , Law Irwin , Onozaki Ikushi , Esmail Hanif , Houben Rein M G J
Published: September 2020

While it is known that a substantial proportion of individuals with tuberculosis disease (TB) present subclinically, usually defined as bacteriologically-confirmed but negative on symptom screening, considerable knowledge gaps remain. Our aim was to review data from TB prevalence population surveys and generate a consistent definition and framework for subclinical TB, enabling us to estimate the proportion of TB that is subclinical, explore associations with overall burden and program indicators, and evaluate the performance of screening strategies. We extracted data from all publicly available prevalence surveys conducted since 1990. Between 36.1% and 79.7% (median, 50.4%) of prevalent bacteriologically confirmed TB was subclinical. No association was found between prevalence of subclinical and all bacteriologically confirmed TB, patient diagnostic rate, or country-level HIV prevalence (P values, .32, .4, and .34, respectively). Chest Xray detected 89% (range, 73%–98%) of bacteriologically confirmed TB, highlighting the potential of optimizing current TB case-finding policies.
47 APPLICATION OF MACHINE LEARNING TO PREDICT NEOADJUVANT CHEMORADIOTHERAPY TREATMENT RESPONSE IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA USING COMPUTED TOMOGRAPHY
Authors: Hu Y , Xie C , Vardhanabhuti V , Fu J
Published: September 2020

Predicting the neoadjuvant chemoradiotherapy (NCRT) treatment response in esophageal squamous cell carcinoma (ESCC) patients remains challenging. This study aims to evaluate the value of CT imaging-based machine learning models for predicting pathologic complete response (pCR) in ESCC patients receiving NCRT and to establish correlations with their underlying biology via radiogenomics analysis.

Methods

We identified 231 eligible patients from two centers. Handcrafted radiomics features (analyzed by PyRadiomics) and deep learning features (analyzed by transfer learning using the convolutional neural network, Xception) were extracted from pretreatment CT images. A handcrafted radiomics model and deep learning model were built with support vector machine. The models were trained in the training cohort (n = 161) and validated in an external testing cohort (n = 70). The radiological model with better performance was incorporated into a nomogram. Pathway enrichment analysis in a subset of the cohort (n = 28) with gene expression profiles revealed the potential biological processes correlated with the radiological prediction.

Results

We constructed a seven-feature handcrafted radiomics model and an eight-feature deep learning model to predict NCRT response. The deep learning model outperformed its counterpart (AUC: 0.76 vs. 0.73; accuracy: 71.4% vs. 65.7%) and was used to establish a nomogram model incorporating cN staging, which showed good discrimination in the testing cohort (C-index = 0.76, accuracy = 72.9%). Radiogenomics analysis illustrated a potential association between the radiological prediction and underlying molecular processes involving multiple factors, including WNT and TGF- signaling pathways, the microenvironment, radiation response and mitotic nuclear division.

Conclusion

We developed a CT imaging-based machine learning model that showed satisfactory performance in NCRT response prediction for ESCC patients. Further radiogenomics analysis provided useful insights into the biological mechanisms of therapy resistance in ESCC. These findings could enhance the applications of radiological characteristics in precision oncology and clinical practice.
61 THE 5-YEAR RESULTS FOR ENDOSCOPIC TREATMENT OF SUPERFICIAL ESOPHAGEAL CANCER AT A NORWEGIAN UNIVERSITY HOSPITAL
Authors: Hauge T , Hauge T , Franco-Lie I , Johnson E
Published: September 2020

Superficial esophageal cancer (HGD = high grade dysplasia, T1a and T1b with no evidence of spread) accounts for about 20 % of all esophageal cancers. Traditionally, radical esophagectomy, with a significant degree of comorbidity has been the mainstay of treatment. Now most international guidelines, including the ESGE (European Society of Gastrointestinal Endoscopy) recommends endoscopic treatment as the first choice of treatment. The aim of this abstract was to present our data from 2014-2018.

Methods

From 2014 to 2018 (and ongoing) we have registered all patients endoscopically treated for LGD (low grade dysplasia) and superficial esophageal cancer, including some cases with T1b. The patient material, including treatment modality, histology, time of follow-up, the need for surgery and its outcome were registered. The majority of follow-ups took place at our hospital. Data was also retrieved from cases of late follow-up at other hospitals.

Results

86 patients were endoscopically treated. The histology revealed LGD (24%), HGD (50%) and adenocarcinoma (21%). 15% were treated for a T1a tumor, 7% for T1b. 29% underwent endoscopic mucosal resection (EMR), 29% radiofrequency ablation (RFA) and 40% had both. The endoscopic treatment resulted in complete resolution of dysplasia in 64%, downstaging in 11%, whilst progression occurred in 11%. Five patients were operated for initial T1b or progression into T1b. The operation specimen showed no residual tumor in 3/5 patients. There were no serious complications. 90-days mortality was 1%.

Conclusion

Endoscopic treatment is a safe and efficient treatment option for superficial esophageal cancer. Few patients needed surgery and there was few and exclusively mild complications. This treatment modality will spare many patients for esophageal surgery with its associated high level of comorbidity.
481 EXPRESSION OF ANDROGEN RECEPTOR AND HER 2/NEU IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA AND ITS MICOENVIRONMENT
Authors: Surana R , Rajendran R , D D , Rajendran S , Chandramohan S
Published: September 2020

Esophageal cancer (EC) is the sixth most common cause of cancer-related deaths. Esophageal squamous cell carcinomas (ESCCs) have a higher incidence and worse prognosis in males, which may be dependent on the difference of environment of sex steroids. The influence of androgen receptor (AR) and HER 2/neu expression on hormone-related cancers are well known but their role in EC shows conflicting data. This warrants further investigation on their influence on tumor microenvironment of EC.

Methods

All the cases of biopsy proven primary ESCC which presented to the institute in the years 2016–2020 were included. Patients undergoing neoadjuvant therapy were excluded.

Epidemiological and pathological data were noted from the patient records. Paraffin embedded tissue samples of the patient were collected and immunohistochemical staining (IHC) for AR and HER 2/Neu was performed. The stained slides were then scored independently by three pathologists.

Scoring criteria:

AR nuclear staining of ≥5% of the lesional cells were considered positive. Cells showing weak to strong complete/basolateral/lateral membrane staining in ≥5 cell groups were scored positive for HER 2/neu.

Results

The study included 24 individuals, 16 males and 8 females with esophageal SCC. The tumor cells showed AR positivity in 12.5% and HER 2/neu positivity in 16.67% of the tissue samples by IHC. There was no significant gender difference in the expression of AR and HER 2/neu in this study. In addition AR expression was seen in 41.67% (N = 10) of adjacent stromal cells (in 66.67% (2 of 3) of the AR positive and 38.09% (8 of 21) of the AR negative specimens) with a p value of 0.028 (p < 0.05). There was no significant variation by gender.

Conclusion

There was a statistically significant expression of AR in the stromal cells of both AR positive and negative tumors. AR expression has been reported in the stroma of esophageal adenocarcinoma which was attributed to paracrine effects following androgen stimulation. To our knowledge, this is the first report of AR expression in the tumor microenvironment of esophageal SCCs. This study is limited by the small sample size and warrants further research.
503 QUALITY OF LIFE AS A PREDICTOR OF POST-ESOPHAGECTOMY SHORT TERM OUTCOMES AND SURVIVAL
Authors: Katz A , Ramirez-GraciaLuna J , Kammili A , Abureida F , Cools-Lartigue J , Spicer J , Mueller C , Ferri L
Published: September 2020

Most esophageal cancer patients present with symptoms that impact quality of life (QOL). In this study, we sought to determine the influence of QOL at diagnosis on postoperative outcomes and survival (OS).

Methods

A prospectively-collected esophagectomy database (2006–17) was queried to identify patients who completed Functional Assessment of Cancer Therapy-Esophageal module (FACT-E). Demographics/tumor/treatment details, operative variables, complications and OS were collected. Statistical analysis was done using Cox regression, logistic regression, ANOVA or Chi-square tests.

Results

Of 647 patients underwent esophagectomy in the study period, 359 how completed FACT-E at diagnosis were included in the study (age 64 ± 11, male 82%, stage I:9%, II:15%, III:69%, IV:7%, adenocarcinoma: 78%, neoadjuvant therapy: 70%). Clinical stage I was associated with better QOL at diagnosis (131 ± 2 vs 118 ± 28, p < 0.02). FACT-E > 125 was associated with lower peri-operative mortality (9% vs 1%, 0R = 6.1, P = 0.01), and when divided into quintiles, correlated directly with OS (Figure 1a), more over it was able to prognostically differentiate patients with locally-advanced disease (stage II + III) (Figure 1b) better than the clinical staging (Figure 1c).

Conclusion

QOL at diagnosis predicts peri-operative mortality and long-term survival. It can help to prognostically differentiate between patients with locally advanced disease. Attempts to improve QOL prior to surgery, such as with pre-habilitation, remain an attractive area of investigation.
77 CUTOFF VALUE OF SERUM C-REACTIVE PROTEIN ON THE FIFTH POSTOPERATIVE DAY IS EFFECTIVE TO RULE OUT ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY
Authors: Hubaud V , Bottet B , Chenesseau J , Gust L , Bouabdallah I , Brioude G , Trousse D , Thomas P , D'journo X
Published: September 2020

Anastomotic leakage is one of most severe complications after esophagectomy. There is no consensus on the best method of identification of such complications. Serum C-reactive protein measurement on postoperative day 5 (POD) has been reported to be reliable to rule-out leakage.

Methods

We prospectively assessed the medical records of consecutive post-esophagectomy patients from January 2019 to January 2020. We analyzed serum CRP and complete blood cell counts from the day before surgery to the POD5. A CRP level ≤ 150 mg/l at POD5 was considered sufficient to start oral feeding. In contrast a CRP level > 150 mg/l at POD5 lead to a computed tomography (CT) with oral contrast to rule-out the presence of an anastomotic leakage. Anastomotic leakage was classified according to ECCG classification. Sensibility, sensitivity, positive and negative predictive value of CRP were calculated.

Results

Over a 12-month period, 52 patients were included (Figure 1). Measurement of CRP on POD5 was ≤150 mg/l in 34 (64%) patients (32 without fistula and 2 with fistula diagnosed after POD5) and > 150 mg/L in 18 (36%) patients (8 without fistula and 10 with fistula). Twelve (23%) patients developed anastomotic fistula. The cutoff value of CRP ≤150 mg/l on the POD5 was associated with sensitivity 83%, specificity 80%, positive predictive value 56% and negative predictive value 94%. The CRP protocol allowed to avoid 30/52 (57%) unnecessary postoperative CT-scan.

Conclusion

On the basis of a high negative predictive value, a CRP level at POD5 ≤ 150 mg/l can be effective to eliminate an anastomotic leakage and to start oral feeding without any further exams. This information is useful in the context of ERAS protocols to reduce hospital discharge and decrease hospital costs.
541 UTILIZING THE INTERNATIONAL WEB-BASED ESODATA DATABASE TO AUDIT AND DOCUMENT EVOLUTION IN ECCG COMPLICATIONS INCIDENCE, DEFINITIONS AND QUALITY MEASURES
Authors: Kuppusamy M ,   International Esodata Study Group
Published: September 2020

The Esophageal Complications Consensus Group (ECCG) standardized the reporting of complications associated with esophagectomy in 2015. Since then, international data on patients’ perioperative outcomes have been prospectively recorded in the web-based Esodata.org dataset. This international collaboration provides a unique opportunity to utilize a standardized reporting platform to report current esophagectomy outcomes as well as the evolution of outcomes and quality measures associated with esophagectomy over time.

Methods

Esophagectomy data on complications and quality measures have prospectively been collected on the Esodata dataset since 2015. Between January 2017 and January 2019, 41 high volume centers recorded outcomes on 3,318 esophageal resections at their institutions. Current complication incidence, as well as trends in patient demographics, operative approaches and quality outcome measures were compared between the 2,407 esophagectomies done between 2015 and 2016 and the 3,318 patients recorded between 2017–2018. Overall results of 6,022 resections in the entire Esodata database as of January 2019 are also reported.

Results

Demographic outcomes of 6,022 patients included males 78.3%, mean-age 63.3, resections for cancer 96.6%. Operative demographics included minimally invasive procedures 52.8%, chest anastomosis 63.7%, neoadjuvant chemoradiotherapy 48.7% and R0 resections 93.5%. Quality measure outcomes included readmissions 9.7%, 30- and 90-day mortality 2.0% and 4.5%, transfusions 12%, escalation in care 22.1%, and discharge home 89.4%. For trends in complications, see Table 1. Trends in quality measures demonstrated improvements in readmissions 11.1–8.5%, blood transfusions 14.3–10.2%, escalation in care 24.5–20% but a decrease in patients being discharged home 91.4–87.8%. Anastomotic leak increased from 11.7% to 13.1% (NS) but leaks requiring surgery decreased 3.3–3.0%.

Conclusion

The ECCG complications, definitions and quality measures platform provided a standardized approach to not only benchmark outcomes including complications but also to assess trends in service delivery and outcomes over time. The International Esodata Study Group and the Esodata database provided a robust vehicle for assessing contemporary international demographics and outcomes, monitoring practice trends and carrying out future prospective studies.
605 STEPWISE APPROACH TO ROBOTIC SURGERY IN A HIGH-VOLUME CENTER WITHOUT PREVIOUS EXPERIENCE IN ROBOTIC ESOPHAGEAL SURGERY
Authors: Riva P , Pansa A , Da Roit A , Basato S , Marano S , Castoro C
Published: September 2020

Minimally Invasive esophagectomy has been introduced to reduce the trauma associated with open surgery while keeping the same oncological outcome. Robotic platforms could facilitate this.

Even with the increasing availability of surgical robots and the standardization of the technique, it can be difficult to convince high volume centers to change their surgical approach.

Our aim is to assess the impact of the learning curve for robotic surgery in a high-volume laparoscopic center.

Methods

We retrospectively analyzed a prospectively collected database in a tertiary referral center for esophagogastric surgery. We identified two groups composed by the patients who underwent Ivor-Lewis (IL) esophagectomy by a hybrid laparoscopic (HL) approach (standard laparoscopy + open thoracotomy) and those who underwent a hybrid robotic (HR) approach (robotic abdominal part + open thoracotomy) with the Davinci Xi surgical platform for lower esophageal or EGJ cancer from November 2018 to September 2019.

Data regarding post-operative stay, complications, leaks, total number of lymph nodes and length of surgery were analyzed. Complications were reported according to the ECCG classification.

Results

We selected 50 consecutive IL cases among which there were our first 17 HR cases. There were no differences in terms of demographics, comorbidities and neoadjuvant treatments between the two groups.

No statistical difference was observed in post-operative stay(median 12 vs 10 days in HL and HR respectively, p = 0.09), overall complication rate was 33% in HL and 35% in HR(p = 0.9), patients with leaks 1(3.03%) in HL and 1(5.88%) in HR(p = 0.6), total lymph nodes median of 38 in HL vs 30 in HR(p = 0.4). Only the total length of surgery was statistically longer in the HR group (median 446 vs 478 min, p = 0.01).

Conclusion

We showed that in the setting of a high-volume center with no previous robotic surgery expertise, robotically performing only the abdominal phase could represent an effective alternative to familiarize with the robotic system without compromising the clinical outcome and workflow.

We understand that the main advantages would be seen when using the robot during the thoracic part. After these first cases we will proceed to adopt it during the most demanding part of the operation.
95 DIRECT ORAL FEEDING AFTER A MINIMALLY INVASIVE ESOPHAGECTOMY: A SINGLE-CENTER PROSPECTIVE COHORT STUDY
Authors: Fransen L , Janssen T , Aarnoudse M , Nieuwenhuijzen G , Luyer M
Published: September 2020

A recent randomized controlled trial showed the safety and feasibility of direct oral feeding following a minimally invasive esophagectomy (MIE). However, significant differences were found regarding complication rate between hospitals, potentially influencing the effect of direct oral feeding. This study aimed to investigate the effect of direct oral feeding compared to the standard of care in a center with low anastomotic leakage and overall complication rates following a MIE.

Methods

Patients in this single-center prospective cohort study received either direct oral feeding (intervention group) after a MIE with intrathoracic anastomosis or nil-by-mouth for 5 days postoperative and tube feeding (standard of care). Primary outcome was time to functional recovery—defined as adequate pain control with oral analgesics, recovery of mobility, sufficient caloric intake, no intravenous fluid therapy and no signs of active infection—and length of hospital stay. Secondary outcomes included anastomotic leakage, pneumonia, cardiopulmonary complications and other (surgical) complications.

Results

Baseline characteristics were similar in the intervention (n = 85) and control (n = 111) group. Median time to functional recovery was respectively 7 versus 9 days in the intervention and control group (p < 0.001). Median length of hospital stay was respectively 8 versus 10 days in the intervention and control group (p < 0.001). Thirty-day postoperative complications were significantly lower in the intervention group (p = 0.037). Anastomotic leakage and pneumonia rates did not differ between the intervention and control group (respectively 11.8% vs. 10.8%, p = 0.834; 27.1% vs. 33.3%, p = 0.651). Chyle leakage only occurred in the control group (18.9%, p < 0.001). All other postoperative complications were similar between groups.

Conclusion

Direct oral feeding in a center with a low postoperative complication rate after a MIE results in a reduced time to functional recovery and a shorter length of hospital stay. Importantly, the 30-day postoperative complication rate was significantly lower in patients directly starting oral feeding.
132 ANTI-REFLUX SURGERY FOR CONTROLLING RESPIRATORY SYMPTOMS OF GASTRO-ESOPHAGEAL REFLUX DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Authors: Tustumi F , Bernardo W , Rocha J , Szachnowicz S , Seguro F , Bianchi E , Takeda F , Miranda Neto A , Sallum R , Cecconello I
Published: September 2020

Gastro-esophageal reflux disease (GERD) patients have a higher prevalence of airway symptoms, such as chronic cough, wheezing, and hoarseness. The therapeutic management of patients with these symptoms is controversial. Therefore, this study aims to perform a systematic review and meta-analysis evaluating the efficacy of anti-reflux surgery for controlling respiratory symptoms related to GERD.

Methods

A systematic review and meta-analysis was performed. Extraction of the data concerning proportions of participants who were not free of respiratory symptoms related to GERD (cough, wheezing, hoarseness) or not substantially improved at follow-ups (failure to cure) was performed.

Results

Of the screened articles, 61 were included for meta-analysis, with a cumulative sample size of 3,869 patients. Of all the included patients, after anti-reflux surgery, the general symptoms improvement was 80% (95% CI 75.2–84%). The numbers needed to harm (NNH) and the numbers needed to treat (NNT) were 15.21 and 1.23, respectively. Of the included patients, 83.4% (95% CI 78.3–87.5%) patients reported improvement in cough symptoms after surgery. For the wheezing symptom, 71.5% (95% CI 62.9–78.8%) reported improvement after surgery. Moreover, surgery presented better results in improving respiratory symptoms than medical therapy (risk difference: -0.46; 95% CI -0.77, −0.16).

Conclusion

Physicians should strongly consider surgical anti-reflux procedures for controlling respiratory symptoms in GERD patients after proper patient selection. Anti-reflux surgery has shown high efficacy in improving respiratory symptoms related to GERD, even when compared to medical therapy.
167 VOLATILE ORGANIC COMPOUND PROFILING FOR DETECTION OF ESOPHAGEAL CANCER IN EXHALED BREATH
Authors: Vissapragada R , Dharmawardhana N , Watson D , Yazbek R
Published: September 2020

Endoscopic surveillance for Barrett’s esophagus (BE) is invasive but remains the standard modality for early diagnosis of esophageal adenocarcinoma (EAC) and intervention. Human breath contains an array of volatile organic compounds (VOC) that change in disease conditions. VOC detection provides a potential source of biomarkers for non-invasive, real-time identification of EAC. This study aimed to characterize a VOC-profile applicable to the detection of EAC and to provide pilot data to design a future validation trial.

Methods

Breath samples were collected in our endoscopy unit from BE, EAC, and control patients. Samples were collected in FlexFoil bags (SKC ltd) using previously standardized methods. Hydrogen, methane and other VOCs were quantified by QuinTron BreathTracker® and selected-ion flow tube mass spectrometry (SIFT-MS, Syft®) respectively. 250 reported cancer-related VOCs were selected for analysis. Non-parametric tests were used to identify candidate VOCs, and logistic regression analysis was then applied to determine the best predictors for EAC. Receiver Operating Characteristic (ROC) Curves were developed to determine the sensitivity and specificity of the model.

Results

68 individuals were enrolled in the study (Controls, n = 37; BE, n = 21; EAC, n = 10). 8 VOCs were identified with significant concentration differences between the three groups: Trimethylbenzene (3 iso-forms), Dimethyl Sulfide, 4-isopropyl toluene, 1-butanol, trichloroethylene, hydrogen sulfide, methyl mercaptan, p-isopropenyl toluene. Logistic regression analysis of these 10 compounds demonstrated predictive probability of EAC from other groups with ROC curves calculating an area under the curve of 0.85.

Conclusion

Previous studies have supported the utility of VOCs in exhaled breath as non-invasive real-time tests for the identification of some other cancer types. This pilot study has identified potential VOCs which might identify individuals with EAC. A larger study will be needed to validate and confirm these findings.
260 FAILURE TO CURE IN PATIENTS UNDERGOING ESOPHAGEAL CARCINOMA SURGERY: HOSPITAL OF SURGERY INFLUENCES PROSPECTS FOR CURE. A NATIONWIDE COHORT STUDY.
Authors: Voeten D , Werf L , Wijnhoven B , Hillegersberg R , Berge Henegouwen M
Published: September 2020

Failure to cure is a composite outcome measure that could be used for hospital comparison in surgical esophageal carcinoma care. It was first described by Clavien et al. in 1992 and was defined as the event where the procedural purpose was not fulfilled. The aim of the current study was to describe failure to cure in terms of incidence, hospital variation, and as an outcome parameter for salvage esophagectomy (surgical resection after definitive chemoradiotherapy).

Methods

All patients registered in the Dutch Upper GI Cancer Audit (DUCA) who underwent potentially curative esophageal carcinoma surgery between 2011 and 2018, were included in this nationwide cohort study. Failure to cure was defined as: 1) no esophagectomy due to intra-operative metastasis or locally irresectable tumour, 2) macroscopically or microscopically incomplete resection (pR1, R2), or 3) 30-day or in-hospital mortality. Association of patient, tumor and hospital characteristics with failure to cure was analyzed using multivariable logistic regression in the total population and in salvage surgery patients. Hospital variation was evaluated using multivariable regression and displayed in a case-mix corrected funnelplot.

Results

Some 6,045 patients from 22 hospitals were included of whom 701 (11.6%) had failure to cure (hospital variation [5.9%–19.0%]). Higher age, more preoperative weight loss, higher ASA-score, junctional tumors, higher T-stage and N-stage, no neoadjuvant chemoradiotherapy, and resection before 2014 were associated with failure to cure. After case-mix correction, 2 hospitals had statistically significant lower than expected failure to cure percentages, and 2 hospitals had higher percentages (figure1). In the patients undergoing salvage esophagectomy (n = 151), the failure to cure percentage was 32.5%. This was 27.6% in high-volume hospitals (>40 annual esophagectomies) and 47.6% in medium-volume hospitals (20–40 annual esophagectomies) (p = 0.03).

Conclusion

This was the first study to describe failure to cure for oesophageal carcinoma patients. The incidence of failure to cure was 11.6%, which is an important prognostic parameter for patients that should be used for expectation management. Given the significant hospital variation in the incidence of failure to cure, improvement is needed. Since salvage procedures are more often successful in high-volume hospitals, further centralization of this technically challenging procedure is warranted.
293 NITROUS OXIDE CRYOBALLOON ABLATION IS A SAFE, EFFECTIVE AND DURABLE ENDOSCOPIC TREATMENT FOR DYSPLASTIC TREATMENT-NAïVE AND PREVIOUSLY-ABLATED NEOPLASTIC BARRETT’S ESOPHAGUS
Authors: Dbouk M , Brewer O , Shin E , Ngamruengphong S , Voltaggio L , Montgomery E , Canto M
Published: September 2020

Nitrous oxide cryoballoon (CB) ablation can effectively and safely eradicate dysplasia and intestinal metaplasia (IM) in patients with dysplastic BE but the durability of treatment effect is unknown. We evaluated the safety, efficacy and durability of CB ablation for complete eradication of dysplasia and IM

Methods

We analyzed the outcomes of consecutive BE patients treated with CB at a single academic medical center for dysplastic BE. We excluded patients with adenocarcinoma and those treated primarily with radiofrequency ablation (RFA). CB ablation was applied to all visible BE using the CB focal ablation system and default cryogen dose of 10 seconds, after eradication of neoplastic-type lesions with endoscopic mucosal resection (EMR). Primary endpoints were complete eradication of dysplasia (CE-D) and intestinal metaplasia (CE-IM) at 1, 2, 3, 4 years. Kaplan-Meir analysis was performed to assess durability where any recurrence was considered a failure.

Results

70 patients (HGD = 64%; 65.7% = treatment-naive) were followed up for median of 27.4 months. CE-D and CE-IM at 1 year were 96.7% and 73.8%, respectively. The median number of CB sessions to achieve CE-IM at 1 year was 3 (IQR 2-3.5). The rates of CE-D and CE-IM allowing for re-treatment with CB or “touch-up” APC were above 90% at 2, 3 and 4 years, with no difference between treatment-naïve and previously-ablated patients. The durability of CB response in patients who achieved CE-D or CE-IM at 1 year followed until last follow-up or recurrence of dysplasia or IM are presented in Figure 1.

Conclusion

Recurrence rate of IM after initial CB eradication is low patient with no patients progressing to cancer or beyond their baseline dysplasia grade. CB ablation has high efficacy, safety, and durability for eradicating dysplasia and intestinal metaplasia in dysplastic BE as a primary or rescue therapy.
326 DEFINITIVE CHEMORADIOTHERAPY COMPARED TO NEOADJUVANT CHEMORADIOTHERAPY WITH ESOPHAGECTOMY FOR LOCO-REGIONAL ESOPHAGEAL CANCER: NATIONAL POPULATION-BASED COHORT STUDY
Authors: Kamarajah S , Phillips A , Hanna G , Low D , Markar S
Published: September 2020

Ongoing randomized controlled trials seek to evaluate the potential organ-preservation strategy of definitive chemoradiotherapy as a primary treatment for esophageal cancer. This population-based cohort study aimed to assess survival following definitive chemoradiotherapy (DCR) with or without salvage esophagectomy (SALV) in the treatment of esophageal cancer.

Methods

Data from the National Cancer Database (NCDB) from 2004 to 2015, was used to identify patients with non-metastatic esophageal cancer receiving either DCR (n = 5,977) or neoadjuvant chemoradiotherapy with planned esophagectomy (NCRS) (n = 13,555). Propensity score matching (PSM) and multivariable analyses were used to account for treatment selection bias. Subset analyses compared patients receiving salvage esophagectomy after DCR (SALV) with NCRS.

Results

Comparison of baseline demographics of the unmatched cohort revealed that patients receiving NCRS were younger, had a lower burden of medical comorbidities, lower proportion of squamous cell carcinoma (SCC) and more positive lymph nodes. Following matching, NCRS was associated with significantly improved survival compared with DCR (HR: 0.60, 95% Confidence Interval (CI): 0.57—0.63, p < 0.001), which persisted in subset analyses of patients with adenocarcinoma (HR: 0.60, 95%CI: 0.56—0.63, p < 0.001) and SCC (HR: 0.58, 95%CI: 0.53—0.63, p < 0.001). There was no difference in overall survival between SALV and NCRS (HR: 1.00, 95%CI: 0.90—1.11, p = 1.0).

Conclusion

Surgery remains an integral component of the management of patients with esophageal cancer. Neoadjuvant therapy followed by planned esophagectomy appears to remain the optimum curative treatment regime in patients with loco-regional esophageal cancer.
339 OPTIMAL CUTOFF VALUE OF INTEGRATED LOWER ESOPHAGEAL SPHINCTER RELAXATION PRESSURE FOR ACHALASIA USING STARLET HIGH-RESOLUTION MANOMETRY SYSTEM
Authors: Masuda T , Yano F , Omura N , Tsuboi K , Hoshino M , Yamamoto S , Sakashita Y , Akimoto S , Fukushima N , Kashiwagi H
Published: September 2020

The Starlet high-resolution manometry (HRM) system is currently used in Japan. HRM provides integrated relaxation pressure (IRP) of which value represents adequacy of lower esophageal sphincter (LES) relaxation. The upper limit of normal IRP for the Starlet was proposed as 26 mmHg using healthy subjects. However, few studies have addressed whether this cutoff may well-distinguish patients diagnosed with/without achalasia. We propose the optimal cutoff of IRP for detecting achalasia using the Starlet.

Methods

Patients who underwent HRM test using the Starlet system at our institution between July 2018 and December 2019 were included. Of these, we excluded patients who had a history of achalasia surgery and/or endoscopic intervention, or whose HRM testing of poor quality. Achalasia was diagnosed if impaired esophageal emptying was evident based on timed barium esophagogram, upper endoscopy, and/or computed tomography. The optimal cutoff value of IRP was estimated using the receiver operating characteristic curve analysis. We further investigate difference in IRP values between achalasia subtypes to identify characteristics of patients who are more likely to be misdiagnosed.

Results

In total, 145 patients met study criteria. The mean age in our cohort was 52.5 ± 15.5 years, 89 patients (61.4%) were men. Of these, 42 patients (29.0%) were diagnosed with achalasia. In achalasia patients, IRP values extended to a wide-range from minimal 18.7 to maximal 63.9 mmHg. The optimal cutoff value of IRP was 24.7 mmHg with sensitivity 90.5% and specificity 90.3% (AUC 0.96 [95% CI; 0.92¬ to 0.99]). Patients with achalasia type I based on Chicago classification were most likely to have IRP value below the threshold of 25 mmHg (4/19 patients [21.1%]).

Conclusion

The optimal cutoff value of IRP to distinguish achalasia was ≥25 mmHg using the Starlet HRM system. This value was nearly close to the upper limit of normal IRP value of 26 mmHg in healthy volunteers. Achalasia type I was more likely to have normal IRP value indicating that comprehensive foregut assessment (eg, timed barium esophagogram, upper endoscopy, and computed tomography) is still valuable for management of achalasia.
379 A STUDY TO UNRAVEL THE THERANOSTIC PARADIGM FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA IN INDIAN POPULATION
Authors: Rithvika R , Pavithra V , Rajendiran S , Sundaram S , Chandramohan S , Cheemakurthi R
Published: September 2020

Esophageal squamous cell carcinoma (ESCC) is the dominant histological subtype in esophageal cancers (EC) and is one of the most aggressive cancers without effective therapy, Currently, Human papillomavirus (HPV) is suggested to be a potential risk factor for EC in addition to the classic predisposing factors, alcohol and tobacco, We have sought to investigate p16 a well-known biomarker for HPV and theranostic factors (EGFR & BRAF) that may have an impact on survival of ESCC.

Methods

We have analyzed 68 tissue biopsies which were histopathologically confirmed as ESCC. The paraffin embedded biopsies were subjected to immunohistochemistry (IHC) staining of EGFR and p16. The intensity of membrane staining for EGFR were scored as:0,1+,2+,3+, scores 2+ and 3+ were taken as over expression and score 1 as low expression. IHC for p16 was observed positive if it was brown colour in nucleus and cytoplasm.

Then, mutational analysis for BRAF V600E was performed on a non biased data base by using PCR technique and confirming it through bidirectional Sanger sequencing.

Results

In total of 68 biopsies:

Immunohistochemistry,

- 56 biopsies (82.3%) overexpressed EGFR of which high grade ESCC’s showed greater expression than low grade.

- 42 biopsies (61.7%) expressed p16

- 23 biopsies (33.8%) showing positivity for both p16 & EGFR thereby explaining p16 mediated EGFR upregulation

Mutational analysis:

Two middle aged female patients showed mutants:

- Mutation of ACAGAAAAA was detected in V600E codon for one

- Mutation of TCTGTATCA was detected in exon 11 of G466V for another

- However IHC for p16 & EGFR of these two patients turned negative.

Conclusion

Our study reveals comprehensive mutational profile (EGFR, p16 and BRAF) on ESCC, shedding light on potential molecular mechanisms associated with its development and possible therapeutic regimens. Taken together with our findings, we propose a prospective study of a large sized population especially including middle aged female patients to further validate the role of this profile as indicators to unravel the theranostic values. To our knowledge this study is the first of it’s kind in India.
402 ADVANCEMENT COLOPLASTY: A NOVEL SURGICAL TECHNIQUE FOR POST COLOPLASTY UPPER PARTIAL NECROSIS/SUPRASTERNAL STRICTURE
Authors: Sm C , M K , H S , M K
Published: September 2020

Upper Partial Necrosis or Suprasternal Stricture after pharyngocolic anastomosis is a difficult situation to manage. Here we present a video presentation of a novel technique of Advancement Coloplasty.

Methods

Video Presentation of Advancement Coloplasty.

Results

Video Presentation of Advancement coloplasty.

Conclusion

There are a variety of complex options including microvascular free jejunal grafts. We are describing an innovative technique of advancing the existing colon conduit for neoanastomosis. This is the video of the advancement coloplasty explained in a stepwise approach.

Video

https://drive.google.com/file/d/1YrTnQgjT5TPkAXK8EQRswjPZo-baBICL/view?usp=sharing
Joint liability and adaptation to climate change: evidence from Burkinabe cooperatives
Authors: Castaing Pauline
Published: September 2020

In semi-arid lands, the resilience of farmers facing climate change is uncertain. The main objective of this paper is to explore whether mutual assistance within a group of cotton farmers implies reduced adoption of risk-mitigating strategies. I investigate the case of Burkina Faso where cotton farmers collectively purchase inputs from the cotton wholesale companies and pay for their purchase under the constraint of joint liability. Specifically, I try to understand whether this joint liability is correlated with the adoption of strategies which reduce exposure to climatic risks. I proxy peer pressure by the size of the network and find it to be associated with reduced investment in both incremental and transformational self-protection against weather shocks.
Assessing the quality of clinical and administrative data extracted from hospitals: the General Medicine Inpatient Initiative (GEMINI) experience
Authors: Verma Amol A , Pasricha Sachin V , Jung Hae Young , Kushnir Vladyslav , Mak Denise Y F , Koppula Radha , Guo Yishan , Kwan Janice L , Lapointe-Shaw Lauren , Rawal Shail , Tang Terence , Weinerman Adina , Razak Fahad
Published: September 2020

Objective

Large clinical databases are increasingly used for research and quality improvement. We describe an approach to data quality assessment from the General Medicine Inpatient Initiative (GEMINI), which collects and standardizes administrative and clinical data from hospitals.

Methods

The GEMINI database contained 245 559 patient admissions at 7 hospitals in Ontario, Canada from 2010 to 2017. We performed 7 computational data quality checks and iteratively re-extracted data from hospitals to correct problems. Thereafter, GEMINI data were compared to data that were manually abstracted from the hospital’s electronic medical record for 23 419 selected data points on a sample of 7488 patients.

Results

Computational checks flagged 103 potential data quality issues, which were either corrected or documented to inform future analysis. For example, we identified the inclusion of canceled radiology tests, a time shift of transfusion data, and mistakenly processing the chemical symbol for sodium (“Na”) as a missing value. Manual validation identified 1 important data quality issue that was not detected by computational checks: transfusion dates and times at 1 site were unreliable. Apart from that single issue, across all data tables, GEMINI data had high overall accuracy (ranging from 98%–100%), sensitivity (95%–100%), specificity (99%–100%), positive predictive value (93%–100%), and negative predictive value (99%–100%) compared to the gold standard.

Discussion and Conclusion

Computational data quality checks with iterative re-extraction facilitated reliable data collection from hospitals but missed 1 critical quality issue. Combining computational and manual approaches may be optimal for assessing the quality of large multisite clinical databases.