bluuebunny/crossref_metadata_2025 huggingface dataset:
516 THE CHARACTERIZATION OF DYSPLASIA IN BARRETT’S ESOPHAGUS—A PROSPECTIVE NATIONWIDE REGISTRY FROM THE RIBBON NETWORK
Authors: O Byrne L , O' Brien M , Muldoon C , Ryan C , Buckley M , Murphy T , Reynolds R , Patchett S , Kay E , Azam H , Robb W , Arumugasamy M , Mc Mathuna P , Leyden J , Gargan S , Doherty G , Sheahan K , Collins C , O Sullivan J , Donohoe C , Ravi N , O' Toole D , Reynolds J
Published: September 2020

Barrett’s Esophagus is the main pathological precursor to esophageal adenocarcinoma (EAC), dysplasia is known to be one of the principal predictors of progression to malignancy. The RIBBON Registry was established with six academic medical centers in the Republic of Ireland to identify and manage high risk Barrett’s Esophagus (BE) patients. From our database of over 4,000 patients our aim was to establish characteristics of those patients who progressed to dysplasia and furthermore to malignancy.

Methods

Data was gathered prospectively from December 2007—December 2019. Ethical approval was sought for the database at the time of establishment. Detailed endoscopic, pathological and clinical data was collected via a web-based data capture system at time of initial diagnosis and at each subsequent encounter. A data manager was appointed at each site and a national lead coordinating the project.

The Vienna Grading system was used to grade histology. Patients were included if they had an initial or subsequent diagnosis of Specialized intestinal metaplasia (SIM), Indefinite for dysplasia (IND) or Low-Grade Dysplasia (LGD).

Results

860 patients were included with a total of 3792 patient years, a male to female ratio of 2.9:1 and a median age at diagnosis of 63. 50 patients had an initial diagnosis of SIM with subsequent episodes of dysplasia while 510 patients had IND or LGD at diagnosis.

158 (18.37%) progressed to High grade dysplasia (HGD) and EAC. The overall incidence of EAC was 1.7% per year, HGD 2.4% per year and a combined rate of 4.2% per year. Median time to progression in SIM was 4.7 years, 1.1 years for IND and 9 months for LGD.

Conclusion

The overall progression of the group was much higher compared to looking at those who had SIM alone without dysplasia from the same registry (0.9% per year). Time to progression was significantly faster in the groups with initial dysplasia be that IND or LGD. In our centers those patients were followed up with repeat endoscopy as per international guidelines, the above results highlight the importance of this practice given the potential for malignancy.
534 WHICH IS THE BEST SURGICAL MANAGEMENT OF GASTROESOPHAGEAL REFLUX DISEASE (GERD) IN PATIENTS WITH SYSTEMIC SCLEROSIS WITH PULMONARY INVOLVEMENT?
Authors: Szachnowicz S , Marques F , Duarte A , Bianchi E , Nasi A , Queiroz N , Seguro F , Sallum R , Cecconello I
Published: September 2020

Systemic sclerosis (scleroderma) is frequently associated with both gastroesophageal reflux disease (GERD) and simultaneous esophageal dysmotility (ED). Antireflux surgery have to considerate the individual esophageal dysmotility degree of each patient. They need GERD treatment as a priority to help control worsening lung function, in patients developing pulmonary fibrosis or in lung transplantation patients. Another issue is the possibility that fundoplications in this patients can cause esophageal stasis, an event that can also disrupt lung function.

Methods

113 patients were referred for surgical treatment of GERD, related with pulmonary impairment. SS patients are the most critical, once the ED may be an obstacle to fundoplication. We divided this patients in three groups regarding the esophageal function. A- Partial fundoplication—without important affection of ED, checked by manometry, confirmed with a complete emptying of esophagus in barium swallow test. B- Laparoscopic gastric bypass for treatment of GERD (RYGBP)—aperistalsis or atonic esophageal body, with normal esophageal empty at barium test. C- Esophagectomy—Atonic esophageal body with important delayed emptying of esophagus in barium swallow test.

Results

We could follow up 4 patients in group A, 3 patients in group B and 2 patients in group C. Median follow-up was 75, 30 and 18 months for Groups A,B and C respectively. All 3 patients in the RYGB group resolved all the symptoms including heartburn and regurgitation, with a sensitive improve in lung function. Only 1 patients in the fundoplication group reported symptom improvement or resolution. The Patients at Group C have no complain of Dysphagia but referred regurgitation and difficulty feedingtill first year.

Conclusion

Laparoscopic RYGB as an anti-reflux procedure is safe and may provide an alternative to fundoplication in the treatment of GERD for systemic sclerosis patients with esophageal dysmotility. Both reflux control and dysphagia rates were improved in the RYGBP group compared with fundoplication and esophagectomy.. This finding suggests that RYGBP may be an option for the primary manage- ment of scleroderma-associated gastroesophageal reflux in patients without importnat impairing of esophageal emptying.
583 THE INTER- AND INTRA-OBSERVER RELIABILITY OF A NOVEL VIDEO-FLUOROSCOPY PROTOCOL FOR GASTRO-ESOPHAGEAL JUNCTION ANATOMY POST-FUNDOPLICATION
Authors: Gan S , Lee N , Tan S , Edwards S , Kiroff G , Myers J
Published: September 2020

Despite modifications in surgical technique, the occurrence of troublesome dysphagia after fundoplication remains difficult to predict. Objective measurements on video-fluoroscopy swallow study (VFSS) may hold the key to understanding post-fundoplication dysphagia. This study reports the inter- and intra-observer reliability of video-fluoroscopic anatomical measurements of the post-fundoplication gastro-esophageal junction (GEJ).

Methods

Thirty-one patients underwent structured VFSS 6–12 months after laparoscopic total or partial fundoplication. VFSS protocol included six views: standing AP, 2x standing oblique, 2x prone oblique (POb), and prone oblique with continuous drinking. The primary observer recorded two sets of 11 variables of GEJ anatomy (3 mo interval between set 1- set 2). Further datasets (one each) were obtained from two medical students trained in two 2-hour sessions. Inter-observer reliability was determined from datasets of three observers and intra-observer reliability from primary observer. Intraclass correlation coefficients (ICC) two-way mixed-effects model was used (ICC agreement: 0.40–0.59 “fair”; 0.60–0.74 “good”; 0.75–1.00 “excellent”).

Results

ICC for inter-observer reliability was good-excellent in 47/66 measurements. All measures of maximal esophageal diameter, maximal esophageal diameter cf. wrap opening diameter and posterior distal esophageal angulation were good-excellent (ICC range 0.74–0.78; 0.84–0.91; 0.68–0.80 respectively). Four parameters recorded 83% good-excellent ICC: wrap closing diameter, minimal wrap diameter, GEJ anterior displacement and degree of axis deviation (GEJ cf. esophagus) (ICC range 0.50–0.85; 0.58–0.93; 0.56–0.79; 0.41–0.77 respectively). Absolute and axial wrap length showed low reproducibility: “good” ICC in 25% of measurements. POb measurements were most reliable: good-excellent ICC 86% of times. Intra-observer reliability was excellent in 98% of measurements (ICC range 0.74–0.99).

Conclusion

Following a structured protocol, VFSS measurements of GEJ post-fundoplication anatomy are reliable between observers except for measures of absolute and axial wrap length. Measures from the POb view showed the greatest inter-observer reliability and may have higher clinical utility. Further studies using structured VFSS are warranted to determine the correlation between troublesome dysphagia and anatomical changes of the gastro-esophageal junction post-fundoplication.
106 THE HYBRID POSITION IS SUPERIOR TO THE PRONE POSITION FOR THORACOSCOPIC ESOPHAGECTOMY WITH UPPER MEDIASTINAL LYMPHADENECTOMY
Authors: Kikuchi H , Hiramatsu Y , Soneda W , Kawata S , Hirotsu A , Matsumoto T , Kamiya K , Takeuchi H
Published: September 2020

Thoracoscopic esophagectomy (TE) is becoming a common surgical method for esophageal cancer. TE is performed with the patient the left lateral decubitus position, prone position, or hybrid position combining the left lateral decubitus and prone positions. However, only few studies have compared the clinical utility of these TE positions.

Methods

In our institute, we introduced TE in the prone position (prone TE) in 2014, and have performed TE in the hybrid position (hybrid TE) since March 2017. The present study compared the short-term outcomes of prone TE versus hybrid TE. One-hundred-and-three patients with esophageal or esophagogastric junction cancer who underwent TE between March 2014 and December 2019 were included. Patients were divided into those who underwent prone TE (prone TE group; n = 43) and those who underwent hybrid TE (hybrid TE group; n = 60). Clinicopathological data were retrospectively reviewed and compared between groups.

Results

There were no differences between groups in age, tumor histology, and tumor location. Compared with the hybrid TE group, the prone TE group had a smaller tumor depth (P < 0.001), lower grade of lymph node metastasis (P = 0.003), and less severe tumor stage (P = 0.001). The operation time for the thoracoscopic procedure was shorter in the hybrid TE group (318.9 vs 249.2 min, P = 0.002). The rate of recurrent laryngeal nerve paralysis (Clavien-Dindo grade I–III) was significantly lower in the hybrid TE group (41.9% vs 11.7%, P < 0.001), whereas there were no differences between groups in the rates of anastomotic leakage, atelectasis, or pneumonia.

Conclusion

The most significant differences between prone TE and hybrid TE involved the upper mediastinal procedures. In hybrid TE, the motion of the assistant’s forceps causes less interference with the operative field, and the angle at which the operator's forceps approach the upper mediastinal lymph nodes enables the maintenance of appropriate traction. These advantages of hybrid TE appeared to result in a shorter operation time and less recurrent laryngeal nerve paralysis compared with prone TE.
146 LEVEL OF DYSPHAGIA AND QUALITY OF LIFE FOLLOWING ENDOSCOPIC TREATMENT OF LOW-GRADE DYSPLASIA AND SUPERFICIAL ESOPHAGEAL CANCER
Authors: Hauge T , Hauge T , Franco-Lie I , Amdal C , Johnson E
Published: September 2020

Low-grade dysplasia (LGD) and superficial esophageal cancer (high grade dysplasia, T1a and superficial T1b) can be endoscopically treated according to most international guidelines, including the European Society of Gastrointestinal Endoscopy from 2017. The aim was to assess the level of dysphagia and health-related quality of life (HRQOL) in patients who underwent endoscopic treatment.

Methods

From 2014–2018 all patients with LGD and superficial esophageal cancer were included. The patients underwent endoscopic mucosal resection (EMR) and/or radiofrequency ablation (RFA). In June 2019 the patients were contacted per mail for assessment of the level of dysphagia and HRQOL, using the Ogilvie score and the European Organisation for Research and Treatment of Cancer (EORTC) core-questionnaire QLQ-C30 together with the disease-specific module QLQ-OG25.

Results

59 out of the 86 patients alive (69%) completed the questionnaires after a median follow-up of 28 months (8–65 months). 24% of the patients answering the questionnaires underwent EMR, 31% RFA and 44% both EMR and RFA. There was no significant difference (p > 0.05) regarding the level of dysphagia, weight loss, global QoL and emotional status, neither with respect to a non-cancerous reference population nor between the treatment groups. For the other variables in QLQ-C30 and QLQ-OG25, the patients experienced significant lower HRQOL. 12% had minor problems eating solid food (Ogilvie score 1), of whom all underwent EMR.

Conclusion

The majority of patients endoscopically treated for LGD and superficial esophageal cancer experienced no dysphagia after a median follow-up of 28 months. The patients experienced significant lower HRQOL when being compared to an age-matched non-cancerous reference population. There was no difference regarding the level of dysphagia, weight loss, global QoL and emotional status.
195 RANDOMISED TRIAL OF LAPAROSCOPIC NISSEN VS. ANTERIOR 180 DEGREE PARTIAL FUNDOPLICATION—LATE CLINICAL OUTCOMES AT 15–20 YEARS
Authors: Rudolph-Stringer V , Bright T , Devitt P , Game P , Jamieson G , Watson D
Published: September 2020

Laparoscopic Nissen fundoplication for gastro-oesophageal reflux is followed by troublesome side effects in some patients. Partial fundoplications are proposed for reflux control with less side effects. We reported earlier outcomes from a randomised control trial of Nissen vs. anterior 180° partial fundoplication, with a good outcome following anterior 180° partial fundoplication at up to 10 years follow-up. For this study we determined very late clinical outcomes at up to 20 years follow-up.

Methods

107 patients were randomised to Nissen vs. anterior 180° partial fundoplication. 15–20 year follow-up data was available for 79 (41 Nissen, 38 anterior). Outcome was assessed using a standardised clinical questionnaire that included 0–10 analogue scores and yes/no questions to evaluate reflux symptoms, side-effects and overall satisfaction with surgery.

Results

Heartburn (mean score 3.2 vs 1.4, p = 0.001) and proton pump inhibitor use (41.7% vs 17.1%, p = 0.023) were higher, dysphagia for solids (mean score 1.8 vs 3.3, p = 0.015) was less, and ability to belch was better preserved (84.2% vs 65.9%, p = 0.030) after anterior fundoplication. Overall outcome measures were similar for both groups (mean satisfaction score 8.4 vs 8.0, p = 0.444; 86.8% vs 90.2% satisfied with outcome). Six patients underwent revision from anterior to Nissen fundoplication for reflux, and 5 from Nissen to partial fundoplication for dysphagia. Two further patients underwent revision following Nissen fundoplication for reflux and paraoesophageal hernia respectively.

Conclusion

At up to 20 years follow-up Nissen and anterior 180-degree partial fundoplication achieve similar rates over overall success, but with a demonstrable trade-off between better reflux symptom control vs. more side-effects after Nissen fundoplication.
249 TEXTBOOK SURGICAL OUTCOMES IN ESOPHAGEAL CANCER: THE INFLUENCE OF NATIONAL KEY PERFORMANCE INDICATORS.
Authors: Al Azzawi M , Bolger J , Whooley J , Trench L , Allen J , Bolger E , Downey E , Arumugusamy M , Robb W
Published: September 2020

High quality surgery remains the cornerstone of treating esophageal malignancy. Recent work from the Dutch Upper-gastrointestinal Cancer Audit have defined ten surgical and perioperative “textbook” parameters that correlate with improved overall survival in patients undergoing esophageal resection. In 2013, national key performance indicators were introduced in Ireland against which esophageal cancer resection was to be benchmarked. This project examines the effect of introducing the KPIs on the proportion of patients attaining “textbook” outcomes for esophagectomy.

Methods

A retrospective review of all esophagectomies and from January 2010 until June 2019 was performed. Clinical, pathological, perioperative, morbidity and mortality outcomes were recorded. 10 “textbook” parameters were studied pre- and post-KPI introduction.

Results

269 underwent esophagectomy, 77 pre-KPI and 192 post-KPI. There were no significant differences in age (67.6 vs 66.4 years, p = 0.6), gender (72% male, 28% female vs 67% male, 23% female, p = 0.43), ASA grade (p = 0.6) or tumour stage (p = 0.37) pre- and post-KPI. In the pre-KPI era, 13/77 (17%) patients achieved all ten textbook parameters, compared with 79/192, (41%, p = 0.001) post-KPI. This compares favourably to DUCA “textbook” data. There was an improvement in adequate lymphadenectomy (56% vs 83%, p = 0.002), a reduction in margin positivity (21% vs 7%, p = 0.001) and reduced peri-operative mortality (6% vs 2%, p = 0.03) post-KPI.

Conclusion

There has been a significant improvement in perioperative outcomes in esophagectomy following the introduction of national KPIs in our unit. The number of patients achieving “textbook” outcomes is comparable with international standards. The identification of textbook parameters allows further focus for future quality improvement initiatives.
271 OESOPHAGO-GASTRIC CANCER SURVIVAL IN SCOTLAND: LESSONS LEARNT FROM ESTABLISHING A NATIONAL NETWORK
Authors: McGregor R , Couper G , Lamb P , Petty R , MacDonald A , Forshaw M
Published: September 2020

Oesophageal cancer is the 9th most common cancer in Scotland, with 972 new cases in 2017. It remains the 4th most common cause of cancer death, with an estimated 5 year survival of 12.1%.

Scotland’s oesophago-gastric cancer network consists of 3 regional divisions, serving a population of 5.44 million. In 2017, survival data indicated survival differences across the 3 networks. This work analyses these outcomes and provides insight into the challenges faced by national collaboration.

Methods

Upper GI Cancer Quality Performance Indicators (QPIs) for patients diagnosed between January 1st 2013 and December 2015 were collected by clinical audit staff in each NHS Board and submitted centrally to the Information Services Division (ISD). Twelve QPIs are assessed and include: % discussed at MDT, % undergoing neo-adjuvant chemotherapy/CRT, 30/90 day mortality, length of stay, and R1 resection rates. Quality assurance of the dataset was assessed by analysing 20% of records submitted. Both univariate (log rank testing and Kaplan–Meier survival curves) and multivariate survival analysis (Cox’s proportional hazards model) were then performed on all patients across the networks.

Results

—Quality assurance of the dataset was high—96% accuracy of those records analysed.—Univariate analysis showed that increased age, higher deprivation scores, poor performance status, high tumour grade, an R1 resection, and a poor Charlson comorbidity index, had worse survival. Gender was not a significant survival factor. There was no difference at either network or health board level for all patients with oesophageal cancer.—multi-variate analysis revealed survival differences across the networks for radical treatment of oesophageal adenocarcinoma. In addition, the survival of patients receiving radical radiotherapy in one network appeared better than chemoradiotherapy for SCC.

Conclusion

This body of work highlights the challenges and pitfalls of establishing a national clinical network. Importantly, data collection and accuracy are high. Moreover, unlike other national collaboratives, data submission is compulsory. Whilst survival differences were detected across the clinical networks, further in depth analysis revealed confounding factors e.g. 23% of oesophageal cancers were stage “unknown”. The algorithm used at ISD did not capture stage T4a or b accounting for most of these patients.
329 GASTRECTOMY VERSUS ESOPHAGECTOMY FOR GASTROESOPHAGEAL-JUNCTION TUMORS: SHORT- AND LONG-TERM OUTCOMES FROM A NATIONAL AUDIT
Authors: Jezerskyte E , Mertens A , van Dieren S , Eshuis W , van Berge Henegouwen M , Gisbertz S
Published: September 2020

Both a total gastrectomy and an esophagectomy may be technically possible in a patient with a gastroesophageal (GEJ) carcinoma. The aim of this study was to investigate the morbidity, mortality, pathology results and long-term survival in patients following an esophagectomy or a total gastrectomy for GEJ cancer.

Methods

A retrospective comparative cohort study of prospectively collected data from the Dutch Upper-GI Cancer Audit combined with survival data of the medical insurance database of the Netherlands was performed. Patients with a GEJ carcinoma in whom a total gastrectomy or an esophagectomy was performed, between 2011–2016 were included. Primary outcome was 3-year overall survival. Postoperative morbidity, mortality, 3-year conditional survival, reinterventions, radicality of surgery, (y)pTNM stage and lymph node yield were secondary endpoints.

Results

A total of 999 patients were included: 918 underwent an esophagectomy and 81 underwent a gastrectomy. Postoperative morbidity (54.9% vs 49.4%, p = 0.336), mortality (30-day; 2.3% vs 3.7%, p = 0.436; 90-day: 1.9% vs 2.5%, p = 0.662) and 3-year conditional survival (38.3% vs 30.3%, p = 0.553) did not differ significantly between groups. A longer ICU-stay (median 2 [IQR1–4] vs 1 days [IQR0–2], p < 0.001) and a lower lymph node yield (median 17 [IQR 12–23] vs 21 [IQR 16–31], p < 0.001) were seen following esophagectomy. The 3-year overall survival was 37.4% after esophagectomy and 28.4% after gastrectomy (HR 1.047, 95%CI 0.795–1.380, p = 0.742).

Conclusion

Patients with GEJ tumors after an esophagectomy required longer ICU-stay and had comparable short-term morbidity and mortality when compared to a total gastrectomy. Long-term overall and conditional survival was not significantly different between groups. The two procedures are therefore largely comparable from an oncological viewpoint, and the choice for either procedure might also be based on other outcomes such as quality of life.
353 ADJUVANT CAPECITABINE AND CISPLATIN VERSUS SURGERY ALONE IN PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA: MULTICENTER RANDOMIZED PHASE 3 TRIAL
Authors: Yun J , Lee G , Kang D , Cho J , Zo J , Kim K , Park S , Na K , Im Y , Kim S , Shim Y
Published: September 2020

There is limited evidence for effectiveness of adjuvant chemotherapy in esophageal squamous cell carcinoma. We conducted a multi-center randomized controlled trial to assess whether adjuvant Capecitabine and Cisplatin improve survival compared with surgery only among patients with resectable esophageal squamous cell carcinoma.

Methods

This is a multicenter randomized controlled trials conducted at five hospitals in Korea from Mar 2005 to Dec 2018. Patients were eligible if they underwent curative resection for esophageal squamous cell carcinoma and diagnosed with pathologic T2–3 or N1 stage, according to 6th edition of TNM cancer staging system. Patients who were diagnosed with cervical esophageal cancer, had previous history of cancer, or received neoadjuvant therapy were excluded. Intervention group received 4 cycles of adjuvant chemotherapy (Capecitabine 1,000 mg/m2 b.i.d for 14 days and intravenous Cisplatin 75 mg/m2 at Day1, every 3 weeks). The primary endpoint was disease free survival.

Results

136 patients were randomly assigned to adjuvant chemotherapy group (n = 68) or surgery alone group (n = 68). Seven patients who rejected chemotherapy after randomization were excluded from the final analysis. The cumulative incidence of recurrence within 18 months after surgery was significantly lower in the adjuvant chemotherapy group compared to the surgery alone group (Hazard Ratio (HR), 0.45; 95% Confidence Interval (CI), 0.22–0.91). After long-term follow-up (median 3.3 years, maximum 14 years), disease free survival and overall survival were not different between two groups. (HR, 0.77; 95% CI, 0.49–1.18 and HR, 0.85; 95% CI, 0.55–1.34, respectively.)

Conclusion

Adjuvant chemotherapy after curative resection in patients with esophageal squamous cell carcinoma reduced early recurrence but this does not extend to long-term disease free and overall survival due to limited sample size. Additional randomized controlled trials with larger sample would be necessary to confirm the effectiveness of adjuvant chemotherapy in esophageal squamous cell carcinoma.
357 HAND-SEWN VERSUS STAPLED CERVICAL ESOPHAGOGASTRIC ANASTOMOSIS FOR ESOPHAGEAL CARCINOMA: STUDY OF CLINICAL OUTCOMES FROM A HIGH VOLUME CENTER OF INDIA
Authors: Purkayastha J
Published: September 2020

Esophageal cancer is a dreaded disease because of its adverse effects on swallowing and therefore the quality of life. Surgical resection offers the best outcome. The mainstay of any esophageal surgery is a well healed anastomosis without any leakage or stricture. Various techniques of anastomosis have been described. Hand sewn suture have been used since long. Surgical staplers have been recently introduced. We hereby describe a comparative study between these two surgical techniques.

Methods

Patients undergoing total esophagectomy with neck anastomosis between January 2013 and March 2019 were analysed. Esophagectomy was done by either trans-thoracic or trans-hiatal approach. The stomach was utilized as conduit and anastomosis was done in the neck in all patients. The gastric conduit was pulled into the neck by the posterior mediastinal route. End to side hand sewn anastomosis (HA) was done in 85 patients using 3-0 non absorbable sutures as a single full thickness layer. Side to side stapler anastomosis (SA) was done by posterior vertical and anterior horizontal firing of 45 mm blue linear stapler in 61 patients.

Results

The primary outcome measure was anastomotic leak. The secondary outcome measures included operative time, anastomosis time, blood loss, anastomotic stricture, mean intensive care unit(ICU) stay, ambulation, removal of intercostal drains, starting of feeding jejunostomy and oral feeds, mean hospital stay. Statistical analysis was done using SPSS. There was 9 cases anastomotic leak in the HA group while in the SA group there were none. Anastomotis stricture occurred in 12 patients in HA group while 3 werein the SA group and it’s statistically significant. The anastomotic time, ICU stay, time of starting oral feeds and mean hospital stay were statistically significant.

Conclusion

A well-healed anastomosis is the mainstay of the successful outcome of esophagectomy. Anastomotic leaks and strictures were the main complications of esophageal surgery. Various techniques of anastomosis have been described over the years. HA has been the standard of care since the inception of esophageal surgery. As technology developed SA got introduced and was found to have certain advantages over HA as shown in our study. SA may be used as preferred technique for esophago-gastrostomy.
364 IMPACT ON SURGICAL AND ONCOLOGIC OUTCOMES OF NEOADJUVANT CHEMOTHERAPY VERSUS SURGERY ALONE IN ELDERLY PATIENTS WITH LOCALLY INVASIVE GASTROESOPHAGEAL CANCER
Authors: Antoun A , Kammili A , Naghawi H , Alcindor T , Asselah J , Vanhuyse M , Cools-Lartigue J , Ferri L , Mueller C
Published: September 2020

Neoadjuvant chemotherapy (nCT) has an increasingly important role in the treatment of locally invasive gastric and esophageal adenocarcinoma. However, its outcomes have not been examined in cohorts of exclusively elderly patients who may not experience the same benefits as younger patients and are more vulnerable to adverse events from the treatment. The purpose of this study is to determine the impact of nCT on outcomes among elderly patients with gastric and gastroesophageal adenocarcinoma.

Methods

All patients who underwent curative-intent surgery for gastric and gastroesophageal adenocarcinoma between 2010 and 2018 at a high-volume multidisciplinary referral center were identified from a prospectively collected database. Early stage tumours at diagnosis (T1N0 or T2N0) and emergency resections were excluded. Patient characteristics, surgical outcomes and oncologic outcomes were verified by chart review and death dates verified using provincial registry data. Comparison was made for all variables between patients who were treated with nCT and those who were treated with surgery alone (SA). Subgroup analysis among patients aged 70+ was conducted to determine differences in outcomes among elderly patients.

Results

Of 766 cases in the database, 354 met inclusion criteria (SA: 99 vs nCT: 255). Of those who received nCT, 77 (30.3%) were ≥ 70 years of age. When compared to younger patients, this cohort experienced significantly more high-grade toxicity from chemotherapy (<70: 32 (18.1%); 70+: 25 (32.5%); p = 0.017), but completion rates and timely progression to surgery were similar between groups (Table 1). Multivariate analysis among elderly patients showed that patients who had nCT had similar overall survival (HR 1.04, 95% CI 0.35-1.19) and disease-free survival (HR 1.04, 95% CI 0.41-1.36) to those who were treated with SA.

Conclusion

Neoadjuvant chemotherapy administered to elderly patients with locally advanced gastroesophaeal adenocarcinoma results in higher rates of high-grade toxicity with no difference in long term oncologic outcomes when compared to surgery alone. Consideration should be given to upfront surgery for elderly patients with resectable gastric and gastroesophageal tumours at presentation.
367 TOWARDS PERSONALIZED INDUCTION THERAPY FOR ESOPHAGEAL ADENOCARCINOMA: ORGANOIDS DERIVED FROM ENDOSCOPIC BIOPSY RECAPITULATE THE PRE-TREATMENT TUMOR
Authors: Derouet M , Allen J , Wilson G , Ng C , Radulovich N , Kalimuthu S , Tsao M , Darling G , Yeung J
Published: September 2020

Esophageal adenocarcinoma has few known recurrent mutations and therefore robust, reliable and reproducible patient-specific models are needed for personalized treatment. Patient-derived organoid culture is a strategy that may allow for the personalized study of esophageal adenocarcinoma and the development of personalized induction therapy.

Methods

We developed a protocol to establish EAC organoids from endoscopic biopsies of treatment naïve esophageal adenocarcinomas. Organoids were then characterized using histology and whole exome sequencing. Organoids were then exposed to clinically used chemotherapy and response assessed.

Results

Our success rate for establishing the endoscopic organoid was 60%. Histologic characterization (we used p53 and cytokeratin7 as markers) and molecular characterization of organoids by whole exome sequencing demonstrated recapitulation of the tumors’ histology and genomic (60% of the mutations were shared between the organoids and the endoscopic biopsies) characteristics. Drug testing using clinically appropriate chemotherapeutics and targeted therapeutics showed an overlap between the patient’s tumor response and the corresponding organoids’ response.

Conclusion

In conclusion, organoids can be successfully cultured from endoscopic biopsies of esophageal adenocarcinoma and recapitulate the originating tumor. This model demonstrates promise as a tool to better personalize therapy for esophageal adenocarcinoma patients.
From Quantity to Quality: Delivering a Home-Based Parenting Intervention Through China’s Family Planning Cadres
Authors: Sylvia Sean , Warrinnier Nele , Luo Renfu , Yue Ai , Attanasio Orazio , Medina Alexis , Rozelle Scott
Published: September 2020

A key challenge in developing countries interested in providing early childhood development (ECD) programmes at scale is whether these programmes can be effectively delivered through existing public service infrastructures. We present the results of a randomised experiment evaluating the effects of a home-based parenting programme delivered by cadres in China’s Family Planning Commission (FPC)—the former enforcers of the one-child policy. We find that the programme significantly increased infant skill development after six months and that increased investments by caregivers alongside improvements in parenting skills were a major mechanism through which this occurred. Children who lagged behind in their cognitive development and received little parental investment at the onset of the intervention benefited most from the programme. Household participation in the programme was associated with the degree to which participants had a favourable view of the FPC, which also increased due to the programme.
Life and Limb: New Estimates of Casualty Aversion in the United States
Authors: Fazal Tanisha M
Published: September 2020

Dramatic improvements in US military medicine have produced an equally dramatic shift in the kinds of battle casualties the US military has sustained in its most recent wars. Specifically, there has been a notable increase in the ratio of nonfatal to fatal casualties. Most studies of casualty aversion in the United States, however, have focused on fatal casualties. Using a series of survey experiments, I investigate whether respondents are equally sensitive to fatal and nonfatal casualties, differences between populations with and without close military ties, and whether views on casualties are conditioned by respondents’ level of knowledge about casualties or the individual costs of war they expect to incur. I find that, while the general public is generally insensitive to different types of casualties, respondents with close ties to the military are better able to distinguish among kinds of casualties. This advantage, however, is not due to respondents with close military ties being better informed about war casualties. Instead, those who bear the costs of war directly appear better able to distinguish among those costs.
A systematic literature review of Native American and Pacific Islanders’ perspectives on health data privacy in the United States
Authors: Taitingfong Riley , Bloss Cinnamon S , Triplett Cynthia , Cakici Julie , Garrison Nanibaa’ , Cole Shelley , Stoner Julie A , Ohno-Machado Lucila
Published: September 2020

Background

Privacy-related concerns can prevent equitable participation in health research by US Indigenous communities. However, studies focused on these communities' views regarding health data privacy, including systematic reviews, are lacking.

Methods

We conducted a systematic literature review analyzing empirical, US-based studies involving American Indian/Alaska Native (AI/AN) and Native Hawaiian or other Pacific Islander (NHPI) perspectives on health data privacy, which we define as the practice of maintaining the security and confidentiality of an individual’s personal health records and/or biological samples (including data derived from biological specimens, such as personal genetic information), as well as the secure and approved use of those data.

Results

Twenty-one studies involving 3234 AI/AN and NHPI participants were eligible for review. The results of this review suggest that concerns about the privacy of health data are both prevalent and complex in AI/AN and NHPI communities. Many respondents raised concerns about the potential for misuse of their health data, including discrimination or stigma, confidentiality breaches, and undesirable or unknown uses of biological specimens.

Conclusions

Participants cited a variety of individual and community-level concerns about the privacy of their health data, and indicated that these deter their willingness to participate in health research. Future investigations should explore in more depth which health data privacy concerns are most salient to specific AI/AN and NHPI communities, and identify the practices that will make the collection and use of health data more trustworthy and transparent for participants.
Determination of Ethanol Concentration in Kombucha Beverages: Single-Laboratory Validation of an Enzymatic Method, First Action Method 2019.08
Authors: Ivory Ruth , Delaney Elaine , Mangan David , McCleary Barry V
Published: September 2020

Kombucha is a fermented, lightly effervescent sweetened black or green tea drink. It is marketed as a functional beverage based on its proposed health benefits. Kombucha is produced by fermenting tea using a “symbiotic colony of bacteria and yeast” (SCOBY). Kombucha is marketed as a non-alcoholic beverage, however due to the production process employed, there is a high possibility that the Kombucha products will contain low levels of ethanol. Kombucha is sold in a raw and unpasteurized form and, if kept at temperatures above 4 °C, the possibility exists that it will continue to ferment, producing ethanol. This possibility of continued fermentation may lead to an increase in ethanol content from levels below 0.5%ABV at time of production to higher levels at time of consumption. Thus, there is a potential for levels rising to greater than 0.5%ABV, the threshold for certification as a non-alcoholic beverage. It is essential that Kombucha manufacturers have the capacity to accurately and quickly test for ethanol in their products.  The Ethanol Assay Kit is an enzymatic test kit developed by Megazyme for the determination of ethanol in a variety of samples. The kit has been validated in a single laboratory for use with Kombucha fermented drinks, fruit juices, and low-alcohol beer samples. The commercially available Ethanol Assay Kit (Megazyme catalogue no. K-ETOH) contains all components required for the analysis. Quantification is based on the oxidation of ethanol to acetaldehyde by alcohol dehydrogenase and further oxidation of acetaldehyde by acetaldehyde dehydrogenase with conversion of NAD+ to NADH. The single laboratory validation (SLV) outlined in this document was performed on a sample set of eight different commercial Kombucha products purchased in Ireland, a set of five Cerilliant aqueous ethanol solutions, two BCR low-alcohol beer reference materials, two alcohol-free beer samples, and two fruit juice samples against SMPR 2016.001 (1). Parameters examined during the validation included Working range, Selectivity, Limit of Detection (LOD), Limit of Quantification (LOQ), Trueness (bias), Precision (reproducibility and repeatability), Robustness, and Stability. The Ethanol Assay is a robust, quick and easy method for the measurement of ethanol in Kombucha. Our data suggests this method is also reliable for similar matrices, such as low-alcohol beer and fruit juice. The assay meets all requirements set out in in AOAC SMPR 2016.001.
Single-Laboratory Validation for the Determination of Cocoa Flavanols and Procyanidins (by Degree of Polymerization DP1–7) in Cocoa-Based Products by Hydrophilic Interaction Chromatography Coupled with Fluorescence Detection: First Action 2020.05
Authors: Bussy Ugo , Hewitt Gregory , Olanrewaju Yusuf , May Brian R , Anderson Nicholas , Ottaviani Javier I , Kwik-Uribe Catherine
Published: September 2020

Background

Flavanols and procyanidins are complex bioactives found in many foods such as cocoa. As their consumption is associated with health benefits, cocoa flavanols and procyanidins are receiving increasing attention from consumers, industry, researchers, and regulators.

Objective

The objective of this study is to validate a method using hydrophilic interaction chromatography (HILIC) with fluorescence detection (FLD) and a commercially available reference material for the determination of flavanols and procyanidins (CF) in cocoa-based products.

Methods

Method performances were evaluated for cocoa matrices with CF content that ranged from 0.8 to 500 mg/g, which included low CF matrices (milk and dark chocolate, cocoa powder, and liquor) and high CF matrices (cocoa extract and dietary supplement products). The method was validated in a single-laboratory by determining sensitivity, selectivity, linearity, stability, robustness, accuracy, and precision for each of the matrices.

Results

The method was validated for cocoa matrices with CF content that ranged from 0.8 to 500 mg/g. Accuracy ranged from 86 to 99% and repeatability (RSDr) from 1.5 to 8.6% for CF.

Conclusions

Analytical performances acquired through this single-laboratory validation study for a wide range of cocoa-based matrices demonstrate that this method is fit-for-purpose for the determination of flavanols and procyanidins in cocoa-based products.

Highlights

Hydrophilic interaction chromatography (HILIC) with fluorescence detection was successfully used to determine total CF content in multiple product types. Single-laboratory method validation results demonstrate that the method is fit for purpose for cocoa-based matrices containing <0.8 to 500 mg/g of CF.
Unraveling the sugar code: the role of microbial extracellular glycans in plant–microbe interactions
Authors: Wanke Alan , Malisic Milena , Wawra Stephan , Zuccaro Alga
Published: September 2020

To defend against microbial invaders but also to establish symbiotic programs, plants need to detect the presence of microbes through the perception of molecular signatures characteristic of a whole class of microbes. Among these molecular signatures, extracellular glycans represent a structurally complex and diverse group of biomolecules that has a pivotal role in the molecular dialog between plants and microbes. Secreted glycans and glycoconjugates such as symbiotic lipochitooligosaccharides or immunosuppressive cyclic β-glucans act as microbial messengers that prepare the ground for host colonization. On the other hand, microbial cell surface glycans are important indicators of microbial presence. They are conserved structures normally exposed and thus accessible for plant hydrolytic enzymes and cell surface receptor proteins. While the immunogenic potential of bacterial cell surface glycoconjugates such as lipopolysaccharides and peptidoglycan has been intensively studied in the past years, perception of cell surface glycans from filamentous microbes such as fungi or oomycetes is still largely unexplored. To date, only few studies have focused on the role of fungal-derived cell surface glycans other than chitin, highlighting a knowledge gap that needs to be addressed. The objective of this review is to give an overview on the biological functions and perception of microbial extracellular glycans, primarily focusing on their recognition and their contribution to plant–microbe interactions.
RIN13-mediated disease resistance depends on the SNC1–EDS1/PAD4 signaling pathway in Arabidopsis
Authors: Liu Xiaoxiao , Liu Hui , He Jingjing , Zhang Siyuan , Han Hui , Wang Zhangying , Liu Wen-Cheng , Liang Yun-Kuan , Gao Zhiyong
Published: September 2020

Plants have evolved an innate immune system to protect themselves from pathogen invasion with the help of intracellular nucleotide-binding leucine-rich repeat (NLR) receptors, though the mechanisms remain largely undefined. RIN13 (RPM1-interacting protein 13) was previously reported to enhance disease resistance, and suppress RPM1 (a CNL-type NLR)-mediated hypersensitive response in Arabidopsis via an as yet unknown mechanism. Here, we show that RIN13 is a nuclear-localized protein, and functions therein. Overexpression of RIN13 leads to autoimmunity with high accumulation of salicylic acid (SA), constitutive expression of pathogenesis-related genes, enhanced resistance to a virulent pathogen, and dwarfism. In addition, genetic and transcriptome analyses show that SA-dependent and SA-independent pathways are both required for RIN13-mediated disease resistance, with the EDS1/PAD4 complex as an integration point. RIN13-induced dwarfism was rescued completely by either the pad4-1 or the eds1-2 mutant but partially by snc1-r1, a mutant of the TNL gene SNC1, suggesting the involvement of EDS1/PAD4 and SNC1 in RIN13 functioning. Furthermore, transient expression assays indicated that RIN13 promotes the nuclear accumulation of PAD4. Collectively, our study uncovered a signaling pathway whereby SNC1 and EDS1/PAD4 act together to modulate RIN13-triggered plant defense responses.
Under pressure: A systematic review of stress and its impact among graduate students
Authors: Cho Seongkyung , Hayter Christopher S
Published: September 2020

Despite increasing interest related to the role of graduate students in economic and social development, science policy scholars have overlooked the role of stress and its broader impact on the conduct of science. To motivate future empirical research, this study systematically reviews the literature on antecedents and the impact of stress among graduate students, examining thirty-four journal articles published from 2000 to 2018. We find that not only do multiple definitions of stress exist, but also that scholars have neglected broader theoretical implications and comparative dimensions of the phenomenon. While this outcome can be explained partially by the paucity of different national and disciplinary perspectives, these factors nonetheless hinder the design and implementation of effective interventions that can help graduate students reduce and manage stress levels and thus improve the conduct of science. We introduce a conceptual model of our findings and discuss implications for future research and policy.
Determinants of physical activity maintenance during the Covid-19 pandemic: a focus on fitness apps
Authors: Yang Yanxiang , Koenigstorfer Joerg
Published: September 2020

There are various health benefits of regular physical activity (PA) and health risks of sedentariness. The Covid-19 pandemic may have decreased PA and increased sedentariness for several reasons (e.g., closure of gyms, family-related time constraints, and reduced outdoor mobility). Yet, to date, there are no longitudinal studies that examined whether the pandemic affects PA levels and what factors help people remain physically active during lockdown. This study aims to investigate changes in U.S. residents’ PA during (vs. before) the Covid-19 pandemic and predictors of changes, with a focus on PA smartphone applications (apps) and their features (i.e., motivational, educational, or gamification related). The study utilized a two-wave longitudinal survey design with an online panel. Healthy adults (N = 431) from 45 U.S. states self-reported their PA levels before and during lockdown. PA app use and app feature ratings were assessed. t-tests and regression analyses were conducted. Moderate PA, vigorous PA, and PA measured in metabolic equivalent of task (MET) minutes per week decreased during lockdown (all p < .01). Controlling for PA before lockdown and individuals’ PA intentions, PA app use was positively related to overall change in PA, measured in MET minutes per week (β = 15.68, standard error = 7.84, p < .05). PA decreased less with increasing app use frequency. When app features were added to the model, a buffering effect for gamification features was identified. The Covid-19-caused lockdown decreased U.S. residents’ PA levels by 18.2%. The use of PA apps may help buffer the decline, and gamification-related app features may be particularly helpful in this context.
Long-Read Genome Sequence Resource of Ascochyta versabilis Causing Leaf Spot Disease in Pseudostellaria heterophylla
Authors: Kuang Yunbo , Wang Zhe , Abah Felix , Hu Hongli , Wang Baohua , Wang Zonghua , Zhang Huiping , Ye Zuyun , Bao Jiandong
Published: September 2020

Ascochyta versabilis is the fungal pathogen that causes the severe leaf spot disease of Pseudostellaria heterophylla (Miq.) Pax, a vital Chinese herbal plant. Here, we deployed PacBio single-molecule real-time long-read sequencing technology to generate a near-complete genome assembly for the A. versabilis KC1 strain and obtained a total of 9.80 Gb raw reads. These reads were processed into a 41.05 Mb genome assembly containing 95 contigs with N50 of 1.70 Mb and a maximum length of 3.93 Mb. A total of 10,457 gene models, of which 1,004 encode putatively secreted proteins, were identified in the genome. This high-quality genome assembly and gene annotation resource will facilitate the institution of functional genetic studies aimed at providing a better insight into the infection mechanisms of A. versabilis to support the development of effective control strategies for leaf spot disease of P. heterophylla.
Exploring Tropical Infections: A Focus on Scrub Typhus
Authors: Gill Navdip , Vaughan Stephen , Somayaji Ranjani
Published: September 2020

Scrub typhus is caused byOrientia tsutsugamushiand has a near global prevalence. It is associated with local and systemic manifestations that lead to morbidity and mortality. Given the nonspecific presentation of fever in a returning traveler, a high index of suspicion and thorough skin examination for eschar are critical to establishing a diagnosis. Early treatment is crucial to avoid severe outcomes, further highlighting the need to include scrub typhus in differential diagnosis. An accompanying narrative case explores the epidemiology, diagnosis, and management of scrub typhus.