bluuebunny/crossref_metadata_2025_split huggingface dataset:
352 QUALITY OF LIFE OF PATIENTS UNDERGOING SURGERY FOR ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CANCER
Authors: Lidoriki I , Schizas D , Mylonas K , Alexandrou A , Karavokyros I , Liakakos T 
Published: September 2020

Abstract

The assessment of patients’ quality of life is increasingly gaining ground as an effective approach to evaluate treatment efficacy and patients satisfaction in the clinical setting. The aim of this study was to investigate the association between patients’ preoperative nutritional status and quality of life, as well as to examine quality of life changes at six months postoperatively in patients undergoing surgery for esophageal and gastroesophageal junction cancer.

Methods
The study sample consisted of 93 patients with esophageal (n = 14) and gastroesophageal junction cancer (n = 79) who were admitted for surgery in the xxxxx between September 2015 and July 2019. Out of them, 77 patients underwent esophagectomy while 16 patients underwent total gastrectomy. The preoperative evaluation of patients’ nutritional status was based on Patient Generated Subjective Global Assessment (PG-SGA) and Skeletal Muscle Index (SMI) derived from analysis of CT scans, while the assessment of patients’ quality of life (QoL) was based on EORTC QLQ-C30 questionnaire (version 3.0). Patients’ follow-up was done six months postoperatively.

Results
Forty three patients (46.2%) were diagnosed with sarcopenia. The prevalence of malnutrition was 64%. Sarcopenic patients scored lower on Global Health (59.94 ± 19.21 vs 65.68 ± 20.08, p = 0.050), Physical Functioning (77.63 ± 23.08 vs 86.58 ± 15.26, p = 0.003) and higher on Fatigue (35.80 ± 25.19 vs 25.73 ± 22.31, p = 0.008) compared with non-sarcopenic patients. Μalnourished patients exhibited more impaired QoL, except Emotional Functioning, compared to well-nourished patients. Physical Functioning (79.9 ± 18.3 vs 88.2 ± 12.9, p = 0.004) and Social Functioning (67.7 ± 22.6 vs 83.1 ± 20.8, p &lt; 0.001) were lower, while Pain (19.9 ± 19.0 vs 13.9 ± 17.9, p = 0.050), Diarrhea (19.4 ± 22.2 vs 9.7 ± 19.5, p = 0,011) and Financial Difficulties (21.0 ± 21.1 vs 12.9 ± 23.7, p = 0.031) were higher at six months postoperatively compared to the preoperative levels.

Conclusion
Sarcopenia and malnutrition affected several parameters of health related QoL in patients undergoing surgery for esophageal and gastroesophageal junction cancer. Moreover, various components of the QoL significantly declined at six months postoperatively. These results indicate that preoperative nutritional assessment is necessary in order to prevent further deterioration of nutritional and functional status, which, in turn may worsen patients’ QoL.
371 LARGE HIATAL HERNIAS: WATCH AND WAIT, OR SURGICAL REPAIR?
Authors: Giulini L , Razia D , Mittal S 
Published: September 2020

Abstract

Laparoscopic-assisted hiatal hernia (HH) repair has been reported to be safe and feasible. However, uncertainty exists regarding whether asymptomatic large HHs (L-HH) should be treated or if a watch-and-wait strategy should be used. The latter might expose the patient to the risk of progression and gastric incarceration. In this study, we investigated this issue by analyzing perioperative outcomes of patients who underwent HH repair at our high-volume center.

Methods
After obtaining approval from the Institutional Review Board, we queried a prospectively maintained database for data on patients who underwent primary minimally invasive HH repair between August 2016 and December 2019. All procedures were performed by a single surgeon (SKM). Hernias were classified in 4 groups: small (S-HH [sliding]), moderate (M-HH [&lt;50% herniated stomach]), large (L-HH [50%–75% herniated stomach]) and giant (G-HH [≥75% herniated stomach]). Data on preoperative assessment, surgical procedure, and postoperative morbidity were analyzed and compared across groups. Complications were defined according to the Clavien-Dindo (CD) classification.

Results
In total, 170 patients met inclusion criteria. Mean age was 58.5 ± 11, 61.9 ± 11.3, 70.7 ± 10.3, and 72.6 ± 9.7 years for S-HH (n = 46), M-HH (n = 69), L-HH (n = 20), and G-HH (n = 35), respectively (p &lt; 0.001). The mean operative time (minutes) increased by group as the HH size increased (69.6 ± 20.9, 83.5 ± 26.1, 99 ± 29.1, and 98.6 ± 24.9, respectively; p &lt; 0.001). Eight of 35 patients with G-HH (22.9%) were treated urgently due to gastric incarceration. Postoperative complications were significantly more common after L-HH and G-HH repair (Figure 1). CD complications Grade II, IIIb, and IVa were observed only in patients with L-HH or G-HH. There was no mortality.

Conclusion
Patients with L-HH and G-HH are significantly older than those with S-HH or M-HH; this reflects the likely progressive nature of this pathology. Laparoscopic HH repair is associated with higher morbidity in patients with L-HH and G-HH. Furthermore, patients with G-HH are at risk of gastric incarceration, which requires emergency surgery. Our findings suggest that in patients with M-HH (even asymptomatic), a watch-and-wait strategy should be discouraged. Surgical repair, in experienced hands, is preferred.
372 ESOPHAGEAL BODY PERISTALSIS CORRELATES FOR DYSPHAGIA AND REGURGITATION: AN ASSESSMENT BASED ON BARIUM ESOPHAGRAM
Authors: Giulini L , Razia D , Mittal S 
Published: September 2020

Abstract

Because it offers real-time assessment, barium esophagram should be the modality of choice when studying esophageal peristalsis. However, no standard reporting method is available for BE results. Presently, peristaltic disorders are defined according to high-resolution manometry (HRM), but HRM findings do not correlate with clinical symptoms. The aim of this study was to stratify esophageal peristaltic function via standardized evaluation of BE, and to define the association between esophageal peristalsis and dysphagia and regurgitation.

Methods
After IRB approval, a prospectively maintained database was reviewed for patients who underwent both HRM and BE from 08/01/2016 to 12/31/2019. Patients with conditions associated with outflow impairment were excluded. BEs were re-examined in blinded fashion and assigned subjective scores (0, 1, or 2) for dilation grade (DG) and contractility grade (CG). Patients were categorized according to the sum of the DG and CG: Group A = 0, Group B = 1–2, and Group C = 3–4. Mean distal contractile integral (DCI), number of failed contractions on HRM, and number of patients with dysphagia/regurgitation in each group were analyzed and compared.

Results
In all, 124 patients were included. The mean DCI (mmHg*cm*s) was 2539.1 ± 1357.8 in Group A, 884.4 ± 916.9 in Group B, and 77.4 ± 192.3 in Group C (p &lt; 0.001). The mean number of failed contractions were 0.7 ± 1.3, 3.4 ± 3.4, and 8.6 ± 3.2, respectively (p &lt; 0.001). Table 1 shows the distribution of patients with dysphagia or regurgitation across groups. The proportion of patients with dysphagia in Group C was higher than in Groups A or B (OR 3.75, p = 0.02; and OR 2.58, p = 0.07, respectively). Similarly, Group C was significantly more often associated with regurgitation than in Groups A or B (OR 4.69, p = 0.009; and OR 4.42, p = 0.005).

Conclusion
The combined DG and CG allowed us to identify the patients with a grade of peristaltic disfunction that was significantly more associated with dysphagia or regurgitation (Group C). However, in order to achieve a clearer definition of the different peristaltic disfunction levels according to their propensity to cause dysphagia or regurgitation, a more objective assessment of both DG and CG should be provided; therefore, further studies are required.
373 ESOPHAGEAL BODY PERISTALSIS IN PATIENTS WITH NORMAL LOWER ESOPHAGEAL SPHINCTER: ARE VIDEO ESOPHAGOGRAM AND HIGH-RESOLUTION MANOMETRY IN AGREEMENT?
Authors: Razia D , Giulini L , Bremner R , Mittal S 
Published: September 2020

Abstract

Peristaltic disorders of the esophageal body have been categorized according to how they appear on high-resolution manometry. Abnormalities in peristalsis may lead to abnormal esophageal clearance and dysphagia. The aim of our retrospective analysis was to study bolus transit patterns on barium esophagogram in patients with various grades of esophageal body peristalsis as diagnosed by high-resolution manometry.

Methods
After Institutional Review Board approval, we queried an esophageal center database to identify patients with normal lower esophageal sphincter parameters. Patients with jackhammer esophagus, esophageal spasm, previous foregut surgery, hiatal hernia, and fragmented peristalsis were excluded. Remaining patients were divided into 11 groups based on their percentages of normal swallows out of 10 swallows (0%–100% swallows normal, DCI &gt; 450 mmHg.s.cm). All previously obtained video esophagograms were re-evaluated in blinded fashion. Bolus transit time through the esophagus was measured in upright and prone positions, using live time stamps at the entry and exit of the bolus. ANOVA and χ2 were used.

Results
In total, 146 patients were included in the analysis. 73 (50%) were men. Mean age and body mass index were 58.4 ± 14.7 years and 22.8 ± 10.4 kg/m2, respectively. Bolus transit time in prone-position swallows increased in tandem with increases in number of abnormal swallows (11.3 ± 3.7, 22 ± 15.5, 29.5 ± 24.3, 42.7 ± 39.5, 42.4 ± 46.9, 64 ± 70.8, 59.4 ± 34.6, 58.8 ± 37.9, 110 ± 66.6, 83.2 ± 49.6 and 105.6 ± 72.5 seconds, p &lt; 0.0001) but no difference was noted in upright-position bolus transit time (p = 0.317). There was a dropoff in level of significance at Group 5 (60% swallows normal) compared to Group 11 (absent contractility), after which there were no inter-group differences (Fig. 1).

Conclusion
Bolus transit time in prone-position swallows progressively increases as percentage of normal swallows decreases. Further work associated with symptoms to define a cutoff between normal and ineffective peristalsis would be useful.
380 TREATMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY (TENTACLE—ESOPHAGUS) STUDY: OUTCOME OF VARIOUS LEAKAGE TREATMENTS
Authors: Van Workum F , Verstegen M , Ubels S , Hannink G , Klarenbeek B , Rosman C , Bouwense S 
Published: September 2020

Abstract

Anastomotic leakage (AL) is a common and severe complication after esophagectomy. It is largely unknown which initial treatments are most effective for what type of leak. We aimed to investigate the effectiveness of initial treatments of AL in daily clinical practice.

Methods
The TENTACLE—Esophagus is a multinational retrospective cohort study, in which patients with AL after esophagectomy with gastric tube reconstruction in the period 2011–2019 were included. Detailed data regarding casemix, surgery, leak characteristics (e.g. organ failure, leak circumference, contamination, drains present) and treatment (e.g. hours from diagnosis to treatment, treatment modalities) were collected. Primary outcome was 90-day mortality and secondary outcomes included length of stay and leak healing time. Regression analysis will be used to analyze the effectiveness of primary treatments after correction for patient-, surgery- and leak characteristics. The full study protocol is accessible at www.tentaclestudy.com.

Results
Detailed data of 1407 patients with AL from 70 centers in 20 countries is currently being validated and is awaiting final analysis. Preliminary results showed that AL was diagnosed 0–43 days after surgery and 90-day mortality rate was 11.1%. Primary treatments included re-operation (23.0%), stenting (16.8%), radiological drainage (10.5%), tube placement through the defect in the leak cavity (8.7%) and endoVAC placement (3.4%). Re-operations (n = 323) were drainage only (54.6%), oversewing the leak (15.5%), anastomotic resection and re-anastomosis (5,3%), repair with muscle flap (2.5%), disconnection and esophagostomy (11.8%) and other or unknown procedures (10.3%).

Conclusion
This is the largest study on effectiveness of AL treatments. The final results of initial leak treatments, which will be available for presentation at the ISDE meeting, could provide an evidence based basis that can be used by clinicians to determine the preferred primary treatment strategy in patients with a given type of AL.
405 TUMOR BUDDING AS A PROGNOSTIC MARKER FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Suresh A , Nag A , S R , M A 
Published: September 2020

Abstract

Carcinomas of the esophagus are the sixth most common malignancy worldwide in males. Esophageal cancer occurs in two histological types: SCC and adenocarcinoma, 90% is SCC in developing countries.
The presence of tumor budding (TB) at the tumor–host interface of gastrointestinal cancers has been recognized as a hallmark of unfavorable disease biology. TB is defined as the presence of isolated malignant cells or small clusters of up to five cells at the tumor invasive front.

Methods
The study done by taking formalin fixed paraffin blocks of 13 esophagectomy specimens from the year 2014-2019. TB score was calculated at the invasive front of the tumor in 200x magnification. 10 fileds were screened and a hotspot was found.
&lt;5 buds were taken as a low grade budding.
≥5 buds were taken as a high grade budding.

Results
The study showed that 53.85% were found to be males & 46.15% were females. In pT staging, T3 was the most common.
61.5% of the cases showed high grade budding while low grade budding was seen in only 38.5%. This tells us 69.2% fell under T3 stage of which 88.89% had high grade TB while only 11.11% had low grade budding.
Of the 4 present cases of LVI, 75% had high grade TB & 25% had low grade budding.
Of the 3 margin involved cases, 67% had high grade TB while 33% had low grade budding.

Conclusion
To conclude, TB is a valuable prognostic factor and indicator of aggressive diseases. Presence of TB correlates to unfavorable clinico-pathological features. It also provides an important value of risk stratification.
1. Risk stratification
2. High grade TB benefit from esophagectomy.
Stochastic Gain and Loss of Novel Transcribed Open Reading Frames in the Human Lineage
Authors: Dowling Daniel , Schmitz Jonathan F , Bornberg-Bauer Erich 
Published: September 2020

Abstract
In addition to known genes, much of the human genome is transcribed into RNA. Chance formation of novel open reading frames (ORFs) can lead to the translation of myriad new proteins. Some of these ORFs may yield advantageous adaptive de novo proteins. However, widespread translation of noncoding DNA can also produce hazardous protein molecules, which can misfold and/or form toxic aggregates. The dynamics of how de novo proteins emerge from potentially toxic raw materials and what influences their long-term survival are unknown. Here, using transcriptomic data from human and five other primates, we generate a set of transcribed human ORFs at six conservation levels to investigate which properties influence the early emergence and long-term retention of these expressed ORFs. As these taxa diverged from each other relatively recently, we present a fine scale view of the evolution of novel sequences over recent evolutionary time. We find that novel human-restricted ORFs are preferentially located on GC-rich gene-dense chromosomes, suggesting their retention is linked to pre-existing genes. Sequence properties such as intrinsic structural disorder and aggregation propensity—which have been proposed to play a role in survival of de novo genes—remain unchanged over time. Even very young sequences code for proteins with low aggregation propensities, suggesting that genomic regions with many novel transcribed ORFs are concomitantly less likely to produce ORFs which code for harmful toxic proteins. Our data indicate that the survival of these novel ORFs is largely stochastic rather than shaped by selection.
How Self-Employed Older Adults Differ by Age: Evidence and Implications From the Health and Retirement Study
Authors: Halvorsen Cal J 
Published: September 2020

Abstract

Background and Objectives
There has been increased attention in recent years on self-employment in later life, with about 1 in 5 workers past of the age of 50 working for themselves. This study aims to build upon previous documentation of the characteristics of self-employed older adults by estimating how these characteristics vary by age.

Research Design and Methods
Using 7 waves of the Health and Retirement Study with a sample of more than 16,000 working older adults, this study considers how the association between self-employment and sociodemographic characteristics; indicators of human, social, and financial capital; and risk tolerance differ between adults aged 50–61 and 62 years and older. Binary logistic regression and seemingly unrelated estimation are used to estimate and compare the characteristics by age group.

Results
Compared to wage-and-salary work and controlling for all other factors in the models, the oldest self-employed group was more likely to identify as Black, report lower health, and receive health insurance from several sources than the younger group. Further, the older group reported lower individual earnings from work yet higher total household income (less individual earnings) and was also less likely to formally volunteer at the highest commitment levels.

Discussion and Implications
With some exceptions, these results indicate that the diversity of self-employed older adults within traditional retirement age is greater than among those before this age. Implications regarding how access to key safety net programs, such as Social Security retirement benefits and Medicare, may lead to this finding are discussed.
Advocate General advises CJEU on copyright liability of online sharing platforms
Authors: Smith Graham 
Published: September 2020

Abstract
Opinion of Advocate General Saugmandsgaard Øe in Joined Cases C-682/18 Peterson v Google LLC, YouTube LLC, YouTube Inc and Google Germany GmbH and C-683/18 Elsevier Inc v Cyando AG, EU:C:2020:586, 16 July 2020
Characterization of genomic alterations in Chinese colorectal cancer patients
Authors: Huang Wei , Li Hui , Shi Xiaoliang , Lin Minglin , Liao Cun , Zhang Shuirong , Shi Weiwei , Zhang Lin , Zhang Xiaolong , Gan Jialiang 
Published: September 2020

AbstractObjectiveColorectal cancer is one of the most prevalent types of cancer worldwide. Right-sided and left-sided colorectal cancer (RCC and LCC) patients respond differently to treatment. We aimed to identify the different mutational profile between RCC and LCC and provided evidence for future precision therapy.MethodsA total of 630 Chinese colorectal cancer patients, including 467 (74.1%) LCC and 163 (25.9%) RCC, were enrolled in this cohort. Both formalin-fixed paraffin-embedded tumor tissues and matching blood samples were collected and deep sequenced targeting 450 cancer genes for genomic alteration analysis. Tumor mutational burden was measured by an algorithm developed in-house. Correlation analysis was performed by Fisher’s exact test.ResultsThe most common mutated genes were TP53 (77.0%), APC (71.7%), KRAS (50.0%), SMAD4 (19.8%), PIK3CA (18.3%), FBXW7 (17.5%), TCF7L2 (12.5%), SOX9 (11.3%), LRP1B (10.8%), ARID1A (10.3%) and FAT4 (10.3%). The mutation frequencies of TP53 and APC in LCC were significantly higher than that of RCC, while the mutation frequency of PIK3CA was lower than that of RCC. Six gene fusions were specifically detected in RCC patients. Colorectal cancer sites were associated with gender (P = 4.15 × 10−5) and tumor differentiation (P = 0.059). In LCC, the gender-associated genes were FAT4, EP300, FAT1, LRP1, ARID1B, AR, FYN and TAF1, while in RCC, they were ARID1A, SMARCA4, LRP1 and GRIN2A. The mutations of 18 genes were associated with tumor differentiation (8 for LCC and 10 for RCC). High tumor mutational burden was more common in RCC. Our results implied more potential targeted drug therapy opportunities for RCC.ConclusionWe describe the different molecular characteristics of LCC and RCC. Our result supported a better prognosis of RCC than LCC in Chinese colorectal cancer patients.
Long-Term Prognostication for 20 114 Women With Small and Node-Negative Breast Cancer
(T1abN0)
Authors: Jaraj David , Höijer Jonas , Widman Linnea , Ahlgren Johan , Arnesson Lars-Gunnar , Einbeigi Zakaria , Klintman Marie , Vikhe Patil Eva , Sund Malin , Fredriksson Irma , Bergh Jonas , Andreas Pettersson 
Published: September 2020

Abstract

Background
Although small, node-negative breast cancer (ie, T1abN0) constitutes 20% of all newly diagnosed breast cancers, data on prognosis and prognostic factors are limited.

Methods
We conducted a population-based cohort study including 20 114 Swedish women treated for T1abN0 breast cancer from 1977 onward. Patient and tumor data were collected from Swedish breast cancer registries. Cohort subjects were followed through linkage to the Cause of Death Register. We calculated the cumulative incidence of breast cancer–specific and overall death and used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results
During a median follow-up of 9.1 years (range = 0-38), 915 women died of breast cancer and 5416 of any cause. The 10-, 20-, and 30-year cumulative incidences of breast cancer death were 3.4% (95% CI = 3.1% to 3.7%), 7.6% (95% CI = 7.1% to 8.2%), and 10.5% (95% CI = 9.6% to 11.4%), respectively. The multivariable hazard ratios and 95% confidence intervals of breast cancer death were 0.92 (95% CI = 0.88 to 0.97) for each additional calendar year of diagnosis, 4.38 (95% CI = 2.79 to 6.87) for grade 3 vs grade 1 tumors, 0.43 (95% CI = 0.31 to 0.62) for progesterone receptor–positive vs progesterone receptor–negative disease, and 2.01 (95% CI = 0.99 to 4.07) for HER2-positive vs HER2-negative disease. Women with grade 3 vs grade 1 tumors had a 56% increased risk of death from any cause (HR = 1.56, 95% CI = 1.30 to 1.88).

Conclusions
The risk of breast cancer death in T1abN0 disease continues to increase steadily beyond 10 years after diagnosis, has improved over time, and varies substantially by tumor characteristics.
Plant phenols contents and their changes with nitrogen availability in peatlands of northeastern China
Authors: Wu Di , Wang Xian-Wei , Xu Shi-Qi , Chen Chong-Juan , Mao Rong , Liu Xue-Yan 
Published: September 2020

Abstract

Aims
Climate warming and increasing nitrogen (N) deposition have influenced plant nutrient status and thus plant carbon (C) fixation and vegetation composition in boreal peatlands. Phenols, which are secondary metabolites in plants for defense and adaptation, also play important roles in regulating peatland C dynamics due to their anti-decomposition properties. However, how the phenolic levels of different functional types of plants vary depending on nutrient availability remain unclear in boreal peatlands.

Methods
Here, we investigated total phenols contents (TPC) and total tannins contents in leaves of 11 plant species in 18 peatlands of the Great Hing’an Mountains area in northeastern China, and examined their variations with leaf N and phosphorus (P) and underlying mechanisms.

Important Findings
Shrubs had higher TPC than graminoids, indicating less C allocation to defense and less uptake of organic N in faster-growing and nonmycorrhizal graminoids than in slower-growing and mycorrhizal shrubs. For shrubs, leaf TPC decreased with increasing N contents but was not influenced by changing leaf phosphorus (P) contents, which suggested that shrubs would reduce the C investment for defense with increasing N availability. Differently, leaf TPC of graminoids increased with leaf N contents and decreased with leaf P contents. As graminoids are more N-limited and less P-limited, we inferred that graminoids would increase the defensive C investment under increased nutrient availability. We concluded that shrubs would invest more C in growth than in defense with increasing N availability, but it was just opposite for graminoids, which might be an important mechanism to explain the resource competition and encroachment of shrubs in boreal peatlands in the context of climate warming and ever-increasing N deposition.