bluuebunny/crossref_metadata_2025_split huggingface dataset:
75 LONG-TERM OUTCOME OF LAPAROSCOPIC HELLER–DOR OPERATION: RESULTS AT A MEDIAN 20-YEAR FOLLOW UP.
Authors: Costantini A , Salvador R , Provenzano L , Capovilla G , Nicoletti L , Pierobon E , Moletta L , Valmasoni M , Merigliano S , Costantini M 
Published: September 2020

Abstract

Since its introduction in 1993, Laparoscopic Heller-Dor (LHD) operation has been the gold standard treatment for esophageal achalasia. Little is known, however, of the natural story of the operated patients in the long run. The aim of this study was to assess the long-term outcome of patients who underwent LHD more than 20 years ago, in order to provide benchmark data to which new techniques should compare.

Methods
All the patients who underwent LHD from 1992 to 1999 at our Institution were evaluated. Patients with previous endoscopic treatment with pneumatic dilations (PD) or Botox were included, whereas patients with previous myotomy were ruled out. Symptoms were prospectively collected and scored using a detailed questionnaire. Barium swallow, endoscopy and manometry were performed before and 6–12 months after the operation, when also pH-metry was performed. Endoscopy was then suggested every 2 years. Treatment failure was defined as a postoperative symptom score &gt; 10th percentile of the preoperative score (i.e. &gt; 8) or the need for further treatment.

Results
Eighty-seven patients with a minimum 10-year follow-up were evaluated (median f/u 20 years). One patient died for esophageal cancer 11.5 years after LHD; 8 patients died 11–24 years after LHD for unrelated causes. All were highly satisfied with the results of the operation. Symptoms recurred in 23 patients (26.4%) 1 month to 13.5 years after LHD: all received 1 to 6 PD, effective in 16: 3 required revisional myotomy and 3 need periodic PD. Good long-term outcome was recorded in 73.6% of patients, and in 92% with combined treatment. Post-operative reflux (pH and/or endoscopy-proven) developed in 10 patients only (11.5%).

Conclusion
LHD can durably relieve symptoms in the majority of patients, though some of them may require complementary PD to maintain effective symptom control. LHD confirms to be an excellent long-term treatment for achalasia and these results represent the reference point for all other treatments.
465 VISUALISATION OF THORACIC DUCT DURING ESOPHAGECTOMY BY REAL-TIME FLUORESCENT IMAGING—A TECHNIQUE IN EVOLUTION
Authors: Thammineedi S 
Published: September 2020

Abstract

Recognition and repair of thoracic duct and it’s injury make the management of chyle leak difficult. Traditional methods like lymphoscintigraphy, lymphangiography and preoperative oral cream ingestion to identify the thoracic duct find limited use in intraoperative identification with poor contrast and precision. Near-infrared (NIR) fluorescence by indocyanine green dye (ICG) provides a feasible, real-time imaging of thoracic ductal anatomy during thoracoscopic surgery, thereby potentially reducing injury of thoracic duct.

Methods
We describe successful identification of the thoracic duct in real-time during minimally invasive esophagectomy by Indocyanine green (ICG) lymphangiography in a series of 10 patients with carcinoma esophagus post chemoradiotherapy. Intraoperative fluorescence lymphangiography was performed by injecting 2.5 to 7.5 mg of ICG. into small bowel mesentery in 5, groin in 2 and both mesentery and groin in 3.

Results
Time required for appearance of ICG fluorescence in thoracic duct ranged from 60 to 120 min. Thoracic duct was successfully identified and delineated in 8 cases, and not detected in 2 cases. There were no chyle leaks in the postoperative period, and all the patients were discharged uneventfully.

Conclusion
ICG fluorescence lymphangiography provides a feasible, reliable, and real-time imaging of thoracic duct during esophagectomy, thereby potentially reducing the thoracic duct injuries. In this series the non detection of thoracic duct in cases and the appearance of fluorescence at varied interval of time might be due to erratic expression of ICG fluorescence owing to extensive fibrosis in thorax secondarily to chemoradiation. This study should serve as a bench mark for larger studies in future.
505 SURPRISING LACK OF CORRELATION BETWEEN INTEGRATED RELAXATION PRESSURE LEVEL AND SYMPTOM SEVERITY IN PATIENTS WITH ACHALASIA
Authors: Nguyen A , Zhang J , Ward M , Podgaetz E , Leeds S , Ramesh M , Souza R , Spechler S , Konda V 
Published: September 2020

Abstract

With high resolution manometry (HRM), achalasia is defined as an elevated integrated relaxation pressure (IRP) and the absence of normal esophageal peristalsis. Since achalasia symptoms are attributed in part to incomplete LES relaxation, IRP values might be expected to directly correlate with symptom severity. The aim of this study was to evaluate the relationship between IRP values and symptom severity assessed by the Eckardt score in patients with achalasia.

Methods
We searched the database of our Center for Esophageal Diseases for patients who had HRM showing achalasia (IRP &gt; 15 mmHg and absent peristalsis) between May 2017 and August 2019. All patients with achalasia seen in our Center routinely complete the Eckardt score questionnaire evaluating the severity of achalasia symptoms in each of four categories (dysphagia, chest pain, regurgitation and weight loss). Pearson correlation coefficient was used to assess the relationship between median IRP and Eckardt score; an R2 value &gt;0.5 was considered clinically meaningful.

Results
We identified 91 subjects with achalasia (mean age 62.9 ± 16.5 years; 39 men, 52 women; 27 Type 1, 28 Type 2, 36 Type 3). We found no clinically meaningful correlation between median IRP and the total Eckardt score (R2 = 0.043) (Figure 1). Furthermore, we found no clinically meaningful correlation between median IRP and any individual component of the Eckardt score (dysphagia R2 = 0.008, chest pain R2 = 0.001, regurgitation R2 = 0.035, weight loss R2 = 0.049). Finally, in subgroup analyses we found no clinically meaningful correlation between median IRP and Eckardt scores (total or any of its individual components) for any of the 3 achalasia subtypes.

Conclusion
We found no clinically meaningful correlation between IRP and total Eckardt score, or between IRP and any individual component of the Eckardt score for patients with achalasia of any type. This suggests that once the IRP value exceeds 15 mmHg, further elevations in IRP have little effect on symptoms, and that factors other than IRP such as esophageal body dysmotility and hypersensitivity might contribute to symptom perception in achalasia.
525 SURGICAL MORBIDITY AND MORTALITY FROM THE NEORESII TRIAL: STANDARD VS. PROLONGED TIME TO SURGERY AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER
Authors: Nilsson K , Klevebro F , Rouvelas I , Lindblad M , Szabo E , Halldestam I , Smedh U , Wallner B , Johansson J , Johnsen G , Kjus Ahlin E , Johannessen H , Hjortland G , Bartella I , Schröder W , Bruns C , Nilsson M 
Published: September 2020

Abstract

For carcinoma of the esophagus or esophagogastric junction the time to surgery (TTS) has traditionally been 4-6 weeks after completed neoadjuvant chemoradiotherapy (nCRT). However, the optimal timing is not known. A majority of previous non-randomized studies addressing this issue, have not detected any significant differences in complication rates comparing patients operated with standard TTS compared to prolonged TTS. The aim of this sub-study was to investigate if prolonged TTS after completed nCRT improves postoperative outcomes.

Methods
A multicenter clinical trial was performed with randomized allocation to standard TTS (4–6 weeks) or prolonged TTS (10–12 weeks). All patients received nCRT according to the CROSS regimen. Patients were enrolled between 2015–2019 from 10 University Hospitals in Sweden, Norway and Germany. The primary endpoint of this sub-study was overall postoperative complications defined as Clavien-Dindo grade II-V. Secondary endpoints included complication severity according to Clavien-Dindo grade IIIb-V, postoperative 90-day mortality and length of hospital stay. The study was registered in Clinicaltrials.gov (NCT02415101).

Results
In total 248 patients were randomized. There were no significant differences between standard TTS and prolonged TTS regarding overall complications Clavien-Dindo II-V (59.0% vs. 69.8%, P = 0.092) or Clavien-Dindo IIIb-V (31.6% vs. 35.0%, P = 0.603). Furthermore, there were no significant differences regarding anastomotic leak (P = 0.601), conduit necrosis (P = 0.524), chyle leak (P = 0.427), pneumonia (P = 0.548) or respiratory failure (P = 0.723). The 90-day postoperative mortality was 4.3% (5 patients) in the standard TTS, and 3.8% (4 patients) in the prolonged TTS arm (P = 1.0). Median length of hospital stay was 15 days in the standard TTS arm and 17 days in the prolonged TTS arm (P = 0.220).

Conclusion
The timing of surgery after completed nCRT for carcinoma of the esophagus or esophagogastric junction is not of major importance with regard to short-term postoperative outcomes.
78 INTESTINAL METAPLASIA IN THE ESOPHAGEAL REMNANT IS RARE AFTER IVOR LEWIS ESOPHAGECTOMY
Authors: Corsini E , Mitchell K , Zhou N , Antonoff M , Mehran R , Rajaram R , Rice D , Roth J , Sepesi B , Swisher S , Vaporciyan A , Walsh G , Hofstetter W 
Published: September 2020

Abstract

Most patients undergoing esophagectomy will experience intermittent reflux of gastric and biliary content into the remnant esophagus over the course of their lives. The incidence of new or recurrent intestinal metaplasia (IM) following chemoradiation and surgery has not been well-described. Furthermore, post-resection guidelines do not exist regarding surveillance for IM in the esophageal remnant. We hypothesized that the incidence of IM in patients who underwent active post-treatment surveillance would be low.

Methods
Patients undergoing Ivor Lewis esophagectomy after concurrent chemoradiation for a diagnosis of esophageal adenocarcinoma at a single institution from 2006–2018 were identified. Pathology records were reviewed for the presence of IM on pretreatment biopsies, surgical specimen, or post-resection biopsies. Categorical variables were compared using Pearson’s chi-square test or Fisher’s exact test, where appropriate, and continuous variables were compared using Kruskal-Wallis test. Time-to-event outcomes were assessed using the Kaplan–Meier method.

Results
621 patients were included, and 242 (39%) were known to have had IM prior to esophagectomy. An additional 26 (4%) patients without a preexisting diagnosis of IM were found to have IM in the surgical specimen. During a median follow-up of 62 months, development of new IM was rare, occurring only in 12 (2%) patients, 7 of whom had a prior history of IM(Table); incidence was 0.6 cases per patient-years. Of these 12, 3 (25%) developed local adenocarcinoma recurrence. Overall, local recurrence of adenocarcinoma was uncommon, and occurred at similar rates in patients with and without a history of IM(p = 0.774).

Conclusion
Despite several factors predisposing to mucosal damage following esophagectomy, occurrence of new IM after trimodality therapy in our patient population appears to be rare, even among patient with a previous history of metaplasia.
526 MICROSATELLITE INSTABILITY IN GASTRO-ESOPHAGEAL ADENOCARCINOMAS
Authors: Katz A , Evaristo G , Issac M , Ramirez-GraciaLuna J , Park M , Camilleri-Broët S , Marcus V , Vinh Thai D , Bailey S , Sangwan V , Fiset P , Bass A , Ferri L 
Published: September 2020

Abstract

Microsatellite instability (MSI) in gastro-esophageal adenocarcinomas (GEAs) is associated with poor response to chemotherapy; however, this association is poorly understood. The aim of this study is to better understand the clinical relevance and mutational landscape of MSI in GEA.

Methods
In order to assess the status of mismatch repair (MMR) proteins, we performed immunohistochemistry for MLH1, MSH2, MSH6, PMS2 and BRAF V600E on tissue microarrays constructed from 161 patients with esophageal adenocarcinoma and 65 patients with gastric adenocarcinoma, operated between 2011 to 2019. MMR- deficient (MMR-D) status was confirmed using full sections of tumors. Demographics, tumor, and treatment details, operative variable and overall survival were evaluated. Genomic characterization of 3 MSI-H and 10 MSS patients was performed using deep targeted sequencing of 234 potential oncogenic genes. Statistical analysis was performed using Cox regression, logistic regression, ANOVA or Chi-square tests.

Results
Among the 28 (12%) MMR-D immunophenotype patients identified: 25 showed a combined MLH1/PMS2 loss, one case with MSH2/MSH6 loss and two cases with isolated MSH6 or MSH2 loss. Patients in the MMR-D were older (74 ± 14 vs 67 ± 11 years, p = 0.01) and with more Siewert-III and sub-cardia tumors [64%(18) vs 40%(79), p = 0.002] compared to MMR-Stable patients. All other variables including sex, stage and grade were not significantly different. MMR-D immunophenotype was associated with better overall survival (Median survival of 5.7vs2.3 years, p &lt; 0.04) (Figure 1A). Genomic analysis linked patients with D-MMR with a higher mutational burden with some potentially targetable mutations (Figure 1B).

Conclusion
The significant proportion of MMR-D immunophenotype identified in this gastroesophageal cohort and the different pattern of overall survival and genetic mutations associated with this phenotype, highlight the importance of further characterization and understanding the mechanisms and role of MMR status in GEAs.
207 ESOPHAGEAL BIOPSY AND SWAB MICROBIAL CHARACTERIZATION WITH HEALTH AND ESOPHAGEAL DISEASE IN CHINA
Authors: Li M , Shao D , Song G , Meng F , Hao C , Li X , Wei W 
Published: September 2020

Abstract

Little is known about the esophageal microbiota and esophageal health or disease in China, especially esophageal squamous cell precancerous lesions. And there is currently no optimal sampling method for esophageal microbiota. Consequently, we compared microbial signature between and within esophageal biopsy and swab specimens from participants in healthy or with esophageal diseases.

Methods
A total of 236 subjects were recruited in the Linxian Cancer Hospital (Henan, China), including 5 groups as 70 healthy cases, 70 esophagitis cases, 70 low grade intraepithelial neoplasia (LGIN) cases, 19 high grade intraepithelial neoplasia (HGIN) cases and 7 esophageal squamous cell carcinoma (ESCC) cases. Sterile biopsies and swabs were used to collect paired samples from the same participants under the endoscopy examination. DNA was extracted with the MoBio PowerSoil Kit. Data from 16S rRNA gene sequencing were processed using QIIME2 and R to evaluate differences in alpha and beta diversity and taxonomic relative abundances.

Results
Alpha diversity was not significantly different between specimens (biopsy = 116.2, swab = 118.0, P &gt; 0.05). In swabs, there were differences of observed OTUs among groups but not Shannon index, detailly, there was an inconspicuous decreasing from Health (125.0) to ESCC (114.0). About beta diversity, no distinct clustering by specimen was observed for weighted Unifrac distance and unweighted Unifrac distance. The 10 dominant genera were similar between specimens and among groups. Specially, Streptococcus was the most abundant except ESCCs; Fusobacterium was in the top ten only in ESCCs. And there was a decreasing of Prevotella 7 and an increasing of Haemophilus as progression.

Conclusion
Esophageal biopsy and swab specimens could yield similar bacterial composition. Both can be used to find clues of microbiota and disease. And esophageal microbial composition and progression characterizations could provide new idea and basis for large scale, prospective cohort studies in the future.
314 LONG-TERM QUALITY OF LIFE FOLLOWING TRANSTHORACIC AND TRANSHIATAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Jezerskyte E , Saadeh L , Hagens E , Sprangers M , Noteboom L , van Laarhoven H , Eshuis W , Hulshof M , van Berge Henegouwen M , Gisbertz S 
Published: September 2020

Abstract

Both a transthoracic (TTE) and a transhiatal (THE) esophagectomy may be possible in patients with a distal esophageal or gastroesophageal junction (GEJ) cancer. A number of studies report conflicting results in long-term health-related quality of life (HR-QoL) following these operations. This study investigates long-term HR-QoL in TTE and THE in a tertiary referral center.

Methods
Disease-free patients after a TTE or THE for distal esophageal or GEJ carcinoma with a follow-up &gt;2 years were included. Patients who visited the outpatient clinic of a tertiary referral center in the Netherlands between 2014–2018 were asked to complete the EORTC QLQ-C30 and EORTC QLQ-OG25 questionnaires. Outcome measures were all 31 HR-QoL domains.

Results
During the study period, 132 patients underwent a TTE and 56 a THE. A better HR-QoL score was found for “problems with hair loss” (mean score 85.0 vs 114.4, p = 0.016) following TTE. Patients after minimally invasive TTE had better scores in ´physical functioning´ compared to minimally invasive THE (mean score 103.2 vs 88.6, p = 0.020). Patients following neoadjuvant therapy and TTE reported better “social functioning” compared to patients after neoadjuvant therapy and THE (mean scores 76.1 vs 59.9, p = 0.040).

Conclusion
Long-term HR-QoL results are largely comparable in disease-free patients following TTE or THE for distal esophageal or GEJ carcinoma. Some domains in the whole cohort and in subgroups differed at the advantage of a TTE. These findings may aid in providing information to esophageal or GEJ cancer patients on what can be expected following treatment.
Agroholdings and land rental markets: a spatial competition perspective
Authors: Graubner Marten , Ostapchuk Igor , Gagalyuk Taras 
Published: September 2020

AbstractWith the emergence of large, horizontally integrated farm enterprises especially in Eastern European countries, the question arises whether these agroholdings exercise market power in (local) land markets. Using a theoretical framework of spatial competition that accounts for the presence of multi-farm agroholdings, we derive equilibrium prices under alternative spatial competition settings. Based on the investigation of Ukrainian farms, we provide theoretical explanations and empirical support for farms affiliated with an agroholding possessing (ceteris paribus) more land and setting higher land rental prices compared to independent farms. The results indicate that agroholdings may act as price leaders in local land markets.
No Abuse Potential of Silexan in Healthy Recreational Drug Users: A Randomized Controlled Trial
Authors: Seifritz Erich , Möller Hans-Jürgen , Volz Hans-Peter , Müller Walter E , Hopyan Talar , Wacker Anna , Schläfke Sandra , Kasper Siegfried 
Published: September 2020

Abstract

Background
Silexan is a lavender essential oil with established anxiolytic and calming efficacy. Here we asked whether there is a potential for abuse in human patients.

Methods
We carried out a phase I abuse liability single-center, double-blind, 5-way crossover study in healthy users of recreational central nervous system depressants. They received single oral doses of 80 mg (therapeutic dose) and 640 mg Silexan, 2 mg and 4 mg lorazepam (active control) and placebo in randomized order, with 4- to 14-day washout periods between treatments. Pharmacodynamic measures included validated visual analogue scales assessing positive, negative, and sedative drug effects and balance of effects; a short form of the Addiction Research Center Inventory; and a drug similarity assessment. The primary outcome measure was the individual maximum value on the drug liking visual analogue scale during 24 hours post-dose.

Results
Forty participants were randomized and 34 were evaluable for pharmacodynamic outcomes. In intraindividual head-to-head comparisons of the drug liking visual analogue scale maximum value, both doses of Silexan were rated similar to placebo whereas differences were observed between Silexan and lorazepam and between placebo and lorazepam (P &lt; .001). These data were supported by all secondary measures of positive drug effects and of balance of effects. Differences between placebo and both doses of Silexan were always negligible in magnitude. Moreover, Silexan showed no sedative effects and was not perceived to be similar to commonly used drugs that participants had used in the past.

Conclusions
Silexan did not exhibit any abuse potential in a standard abuse potential detection screen study and is unlikely to be recreationally abused.
Achieving Sustainable Development Goal 17? An Empirical Investigation of the Effectiveness of Aid Given to Boost Developing Countries’ Tax Revenue and Capacity
Authors: Seelkopf Laura , Bastiaens Ida 
Published: September 2020

Abstract
Developing economies need to increase their tax revenue. The international community is keenly aware of this challenge and recently dedicated substantial resources and advocacy to assist countries in mobilizing domestic tax revenue as part of the Sustainable Development Goals. Considering, however, the extensive research that foreign aid is often ineffective, it is not obvious that this tax assistance will help developing countries raise revenue. In this article, we assess the impact of international assistance programs for tax purposes (i.e., tax aid) on tax revenue generation, indirect taxation reform, and informality across the developing world. We analyze panel data of 137 developing countries between 1972 and 2013 from the AidData, International Centre for Tax and Development, and World Development Indicators, and World Bank Project Data datasets. We also assess survey data from the World Bank's Enterprise Survey and World Values Survey. Our findings indicate that tax aid does not robustly increase the number of taxpayers, especially in the short run. However, tax aid is effective in generating domestic tax revenue in precisely the way international agencies advocate, namely a strong reliance on the value-added tax.
The data underlying this article are available on the ISQ Dataverse, at https://dataverse.harvard.edu/dataverse/isq.