bluuebunny/crossref_metadata_2025_split huggingface dataset:
O89 TWENTY-FIVE YEARS OF LAPAROSCOPIC TREATMENT FOR ESOPHAGEAL ACHALASIA: OUR EXPERIENCE ON 1001 LAPAROSCOPIC HELLER-DOR OPERATIONS
Authors: Salvador R , Capovilla G , Provenzano L , Moletta L , Pierobon E , Nicoletti L , Nezi G , Valmasoni M , Merigliano S , Costantini M 
Published: November 2019

Abstract

Background
In the last decade of the past century, primary Laparoscopic Heller-Dor (LHD) for Achalasia progressively became the procedure of choice in the new millennium. The aim of this study was to assess the long-term outcome of LHD to treat Achalasia at a single high-volume institution during the past 25 years.

Methods
1000 patients underwent LHD from 1992-2017 by 6 staff surgeons alternatively. Patients who had already been treated with surgical or endoscopic myotomy were ruled out. Symptoms were collected and scored using a detailed questionnaire; barium-swallow, endoscopy, manometry were performed, before and after surgery while, 24-hour pH monitoring were performed 6 months after surgery.

Results
LHD was the primary treatment for 1000 patients (M:F=536:464); the median age was 46 (IQR 36-54), 183 (18.3%) had a history of endoscopic treatments (pneumatic dilation or botox injections, or both).
The surgical procedure was completed laparoscopically in all but 7 patients (0.7%) and there was one perioperative death for heart attack.
There were 25 perforations (2.5%): 22 were recognized and repaired during the operation, 3 were detected by postoperative contrast swallow.
The outcome was positive in 902 patients (90.2%). In patients who had a previous treatment the failures were 25/183 (13.7%) while in the primary treatment group the failures were 73/817 (8.9%) (p=0.055). All the 98 patients whose LHD failed subsequently underwent one or more endoscopic pneumatic dilations, which ameliorated their recurrent symptoms in all but 11 patients (10 of whom required reoperation). The overall success rate of the combination of LHD and endoscopic dilations (where necessary) was 98.4%.
At univariate analysis, manometric pattern (p=0.001), sigmoid megaesophagus (p=0.003) and a chest pain score (p=0.002) were the only factors predictive of a positive final results. At multivariate analysis, these three factors were independently associated to good outcome.
Postoperative 24-hour pH-monitoring was abnormal in 50/590 patients (8.5%)
Two patients developed an esophageal cancer during the follow-up time.

Conclusions
In a university tertiary referral center LHD can durably relieve achalasia symptoms. Preoperative manometric pattern, a presence of a sigmoid esophagus and the chest pain score represent the strongest predictor of outcome.
P90 TRACTION ON THE SEPTUM DURING TRANSORAL SEPTOTOMY FOR ZENKER DIVERTICULUM IMPROVES THE FINAL OUTCOME
Authors: Provenzano L , Salvador R , Cutrone C , Moletta L , Pierobon E , Nicoletti L , Capovilla G , Valmasoni M , Merigliano S , Costantini M 
Published: November 2019

Abstract

Background
Transoral Diverticulostomy/Septotomy has become a popular treatment for patients with Zenker Diverticulum (ZD) because of the low complication rates, reduced procedure time, and shorter hospital stay. However, the outcome of this procedure is not, so far, as positive as the open techniques. In order to improve the results of transoral septotomy (TS), a modification of the technique by tractioning the septum with stiches, has been introduced. In this study we aimed to compare the final outcome of a Modify Transoral Septotomy (MTS) with those of the Traditional Transoral Septotomy (TTS) in patients with ZD.

Methods
Seventy-seven consecutive patients with ZD underwent Transoral Septotomy between 2010-2019. Patients who had already been treated with surgical or endoscopic procedures were excluded.
TTS was performed with the classic technique. Since 2015, we adopted a MTS, by positioning 2 sutures at the lateral edges of the septum, for traction. Symptoms were collected and scored using a detailed questionnaire; barium-swallow (to assess the size of the pouch), endoscopy and manometry were performed before and after surgical treatment. Failures were defined when a patient needed an additional procedure for recurrent symptoms.

Results
Of the 52 patients representing the study population (M:F=49:28), 25 had TTS and 52 had MTS. The patients’ demographic and clinical parameters (sex, age, symptom-score, duration of symptoms, diverticulum size) were similar in both groups. Only two intraoperative mucosal lesions were detected and mortality was nil. The median time of the procedure was 25 min (IQR:22-35) in the TTS and 30 min (IQR:25-36) in the MTS (p<0.07). The median follow-up was 85 months in the TTS and 24 months in the MTS. All the patients in both groups had a reduction in the symptom score after the procedure but the failure rate was 32% (8/25) in the TTS and 1.9% (1/52) in the MTS (p<0.01).
At the univariate and multivariate analyses, the surgical procedure was the only factor predictive of a positive final result.

Conclusions
Transoral Septotomy improves the final outcome of this treatment in patients with ZD.
P91 PHARYNGO-OESOPHAGEAL PERFORATION FOLLOWING CERVICAL SPINE SURGERY: A SINGLE CENTRE EXPERIENCE
Authors: Lucia Moletta , Giovanni Capovilla , Laura Gavagna , Giorgia Cornaviera , Marco Taufer , Elisa Sefora Pierobon , Renato Salvador , Mario Costantini , Stefano Merigliano , Michele Valmasoni 
Published: November 2019

Abstract

Aim
Pharyngo-oesophageal perforation is a rare, life-threatening complication of cervical spine surgery. Only isolated cases are reported in the English literature and correct management of these patients remains poorly defined. The aim of this study is to review our experience to better clarify the appropriate treatment of this dreadful complication.

Background and Methods
Data regarding demographics, clinical course, diagnosis, management and outcomes of 13 patients (8 M, 5F, mean age 49 years) with oesophageal perforation after cervical spine surgery were collected during the period from 2002 to 2019.

Results
Pharyngo-oesophageal perforation occurred at a median of 8 days (range 0-4745 days) after cervical spine surgery. Clinical manifestations included neck abscess in 7 cases, fever in 3 cases, dysphagia and regurgitation in 3 cases. In 2 patients conservative management with fasting and antibiotics was attempted but, in both cases, a subsequent surgical intervention was required. All patients underwent surgical treatment. A step-up approach with initial surgical drainage of a purulent cervical collection was performed in 7 patients, delaying definitive surgery after resolution of cervical infection. Definitive surgical treatment with total or partial removal of spine fixation devices, autologous bone graft insertion or plate/cage replacement, anatomical suture of the fistula and suture line reinforcement with myoplasty (either with sternocleidomastoid or pectoralis major muscle flap) was performed in 10 patients. Perforation recurred in two cases, requiring further surgical management. At a median follow-up of 23 months (range 5-149 months) all patients exhibited permanent resolution of the perforation.

Conclusions
Pharyngo-oesophageal perforation following cervical spine surgery is a rare but dreadful complication: prompt recognition and treatment of these injuries is critical to minimize morbidity and mortality. Partial or total removal of the fixation devices, direct suture of the oesophageal defect and coverage with tissue flaps seems to be an effective surgical approach in these patients.
P93 BELSEY MARK IV: STILL A VALID OPTION. SINGLE CENTER EXPERIENCE OF 100 CONSECUTIVE CASES
Authors: Sander Ovaere , Lieven Depypere , Hans Van Veer , Philippe Nafteux , Willy Coosemans 
Published: November 2019

Abstract

Aim
To share the single-center experience of a tertiary referral center using the Belsey Mark IV operation in the treatment of large primary hiatal hernias (PHH) and recurrent hernias after failed antireflux surgery.

Background & Methods
We conducted a retrospective analysis of all patients with PHH or recurrent hernia after antireflux surgery operated between May 1, 2012 and December 31, 2016 who received a Belsey-Mark IV antireflux procedure. Data on patient demographics, surgical history, pre-operative work-up, indication, short- and long-term complications graded by the Clavien-Dindo classification (CDC) and recurrence rate, defined as clinical symptoms confirmed with barium swallow test, were collected and analyzed.

Results
A total of 100 consecutive cases were included in this analysis. Median age at time of surgery was 67 years (range 0 - 86). Seventy-two were female. Indications were: PHH Type I (n = 2), Type II (n = 1); Type III (n = 55), Type IV (n = 3), redo after previous antireflux surgery (n = 39). Median follow-up was 23 months (range 4-80). Major peri-operative short-term morbidity (defined as CDC 3-4) was present in 14 cases, with respiratory complications being the most prevalent. Fundoplication leakage was present in five cases and managed conservatively in three of those. Hernia recurrence rate was 31% in the redo group (12/39) and 10% in the PHH group (6/61). Median time-to-recurrence was 22 months (range 2-78). Post thoracotomy pain syndrome requiring treatment (CDC 2) was present in 12 cases. One patient deceased due to respiratory complications after emergency Belsey Mark IV repair following early recurrence after laparoscopic Nissen fundoplication and two reinterventions.

Conclusion
The Belsey Mark IV repair is a safe and effective procedure in experienced hands, with well-defined risks and an acceptable recurrence rate, given the nature of the condition and patient’s comorbidities.
O94 GASTRIC CONDUIT NECROSIS AFTER ESOPHAGECTOMY: RISK PREDICTION, MANAGEMENT AND OUTCOMES
Authors: van Boxel Gijsbert I , van der Veen Arjen , Feike Kingma B , Borggreve Alicia S , Ruurda Jelle P , van Hillegersberg Richard 
Published: November 2019

Abstract

Background
Acute gastric conduit necrosis (AGCN) is a serious early complication of esophagectomy that can result in loss of the gastric conduit. The reported incidence is relatively low: 0.5-3.2%. Literature is thus scarce. However, vascular comorbidity has been shown to be a risk factor. This study aimed to assess the arterial calcification scores, clinical presentation, management, and outcome of patients who suffered from AGCN following esophagectomy in a high volume centre for esophageal cancer surgery.

Methods
Patients who underwent esophagectomy for esophageal cancer were selected (Jan-2011 till Feb-2019) from a prospectively maintained single-centre database that contains the patient characteristics, treatment details, and postoperative outcomes of all patients undergoing esophagogastric surgery. For the AGCN cases, additional information regarding their clinical course was retrieved from the electronic patient files. Arterial calcification scores were established by measuring calcifications at 4 arterial locations on preoperative computed tomography (CT) scans.

Results
From a total of 466 esophagectomies performed in the inclusion period, AGCN occurred in 8 cases (1.7%). Resection of the gastric conduit was required in 5 of these patients, of whom 3 patients had a fatal outcome. The other patients were successfully treated by conservative treatment involving a nil by mouth regimen (n=2) or a self-expanding metal stent (n=1). There was a high prevalence of supra-aortic (75%) and thoracic (87.5%) calcifications in the patients suffering from AGCN.

Conclusion
AGCN is a rare but serious complication following esophagectomy, with a high mortality. Patients with generalized vascular disease may be at particular risk of developing this complication.
P96 THE CURRENT ROLE OF ADJUVANT THERAPY IN PATIENTS FOLLOWING NEO-ADJUVANT CHEMOTHERAPY AND R0 RESECTION FOR LOWER OESOPHAGEAL AND GOJ ADENOCARCINOMA
Authors: Bott R , Zylstra J , Wilkinson M , Knight W , Baker C , Kelly M , Maisey N , Beckmann K , Van Hemelrijck M , Gossage J , Allum W , Smyth E , Cunningham D , Davies A 
Published: November 2019

Abstract

Aim
The aim of this study was to assess the survival benefit of adjuvant therapy in R0 resection patients following neo-adjuvant chemotherapy and surgery for lower oesophageal and GOJ adenocarcinoma.

Background & Methods
The role of adjuvant therapy in oesophago-gastric adenocarcinoma patients treated by neo-adjuvant chemotherapy is contentious. In UK practice surgical resection margin status is often used to stratify patients into receiving adjuvant treatment. Two prospectively collected institutional databases were combined. Patients were classified by the adjuvant therapy received. Crude and adjusted Cox regression analyses compared overall and recurrence free survival according to the adjuvant treatment, stratified by resection margin status. Recurrence patterns were assessed as a secondary outcome.

Results
A total of 616 patients were included (373 R0, 243 R1). In hospital mortality following surgery was 1% and these patients were excluded from analysis (n=7). In the R0 resection group 220 patients (59%) had no adjuvant treatment and 137 patients (37%) had adjuvant chemotherapy. On adjusted analysis pathological N status (p<0.0001), poor differentiation (p=0.005) and poor response to neo-adjuvant chemotherapy (p=0.001) were independently associated with poor survival. The benefit of adjuvant chemotherapy did not reach independent significance (HR 0.65 95% CI 0.40-1.06; p=0.087) compared to no treatment. However, it was observed that responders to neo-adjuvant chemotherapy (Mandard 1-3) were more likely to demonstrate a survival benefit from adjuvant chemotherapy (HR 0.42 95%CI 0.15-1.11; p=0.081) than those who are deemed to be non-responders (Mandard 4&5, HR 0.71 95%CI 0.39-1.32; p= 0.280).

Conclusion
Adjuvant chemotherapy may have a survival benefit in R0 resection patients following surgery, but this is likely to be limited to patients exhibiting a good response to neo-adjuvant chemotherapy.
P98 UNSATURATED LIPIDS ARE SIGNIFICANTLY UPREGULATED IN OESOPHAGEAL ADENOCARCINOMA
Authors: Pranav H Patel , Sacheen Kumar , Luisa Doria , Renata Soares , Zsolt Bodai , Mina Adam , Nima Abbassi-Ghadi , Zoltan Takats , George B Hanna 
Published: November 2019

Abstract

Aim
This work aims to determine the glycerophospholipid (GPL) abundance between Oesophageal adenocarcinoma (OA) and proximal non-cancerous tissue at multiple levels using Desorption Electrospray Ionisation Mass spectrometry (DESI-MS) tissue imaging.

Background & Methods
The prevalence of Oesophageal cancer in the United Kingdom has steadily risen since the 1970s. The prognosis for most patients is poor, with two thirds presenting with incurable disease. The abundance of lipids in OA has been shown to be atypical of normal cellular metabolism.1 This work utilises mass spectrometry imaging to identify variations in lipid abundance between OA and normal oesophagus (NO).
Tissue was sampled from specimens dissected immediately post-resection from the tumour and at 5-centimetre intervals in the proximal oesophagus. DESI-MS tissue imaging, an ambient form of Mass Spectrometry, was performed to identify GPLs.2 DESI-MS images were correlated with Hematoxylin and Eosin staining (current gold standard). Principle component analysis with a supervised model classified tissue types by sensitivity and specificity.

Results
Tissue analysis confirmed unsaturated Phosphatidylglycerols and Phosphatidic acids were most abundant in OA compared to NO (p<0.001). Tissue analysis by a Partial Least Square (PLS) supervised linear regression model classified cancer and non-cancer tissue with 85% sensitivity and 88% specificity.
The abundance of several unsaturated GPL classes decreased proportionally in tissue sections at 5 and 10 centimetres from the primary tumour. Gene set enrichment has demonstrated potential dysregulation of this pathway in the literature.

Conclusions
This work highlights an important variant of lipid metabolism in OA, identified by DESI-MS. There is a significant overabundance of unsaturated Phosphatidylglycerol’s in OA compared to proximal NO. In addition, the unsaturated GPL classes found in the cancer become increasingly saturated at 5cm and 10cm from the tumour site. This variation in lipid molecular structure suggests a novel pathway for potential therapeutic modulation.
P99 A STRUCTURED TRAINING PATHWAY TO IMPLEMENT ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE): LEARNING CURVE RESULTS FROM A HIGH VOLUME CENTER
Authors: BF Kingma , E Hadzijusufovic , PC van der Sluis , H Lang , JP Ruurda , R van Hillegersberg , PP Grimminger 
Published: November 2019

Abstract

Aim
The aim of this study was to describe the results of a structured training pathway that was developed to implement robot-assisted minimally invasive esophagectomy (RAMIE) in new centers.

Background & Methods
To safely and effectively implement RAMIE in new centers, the learning process needs to be optimized. In this context, a structured training pathway was created (Table 1). The results of this training pathway were investigated by evaluating consecutive patients who underwent RAMIE by a single surgeon who followed the structured training pathway. These patients were included from the trainee center’s prospective database. Cumulative sum (CUSUM) learning curves were plotted for thoracic operating time and intraoperative blood loss. Perioperative outcomes were compared between patients who underwent surgery before and after a learning curve plateau occurred.

Results
Between 2017-2018, the trainee team adhered to the structured training pathway and a total of 70 patients were included. The learning curves showed plateaus after 22 cases. In cases 23-70, the operating time was shorter for both the thoracic phase (median 215 vs. 249 minutes, P=0.001) and overall procedure (median 394 vs. 440 minutes, P=0.005), intraoperative blood loss was less (median 210 vs. 400 milliliters, P=0.029), and lymph node yield was higher (median 32 vs. 23 nodes, P=0.001) when compared to the first 22 cases. No significant differences were found for conversion rates, postoperative complications, length of hospital stay, radicality, or mortality.

Conclusions
The structured RAMIE training pathway results in a short learning curve and is an effective way to introduce RAMIE without compromising the oncological outcomes and complication rates. The pathway is therefore advised to surgeons who are willing to adopt this technique.
How bacteria recognise and respond to surface contact
Authors: Kimkes Tom E P , Heinemann Matthias 
Published: November 2019

ABSTRACTBacterial biofilms can cause medical problems and issues in technical systems. While a large body of knowledge exists on the phenotypes of planktonic and of sessile cells in mature biofilms, our understanding of what happens when bacteria change from the planktonic to the sessile state is still very incomplete. Fundamental questions are unanswered: for instance, how do bacteria sense that they are in contact with a surface, and what are the very initial cellular responses to surface contact. Here, we review the current knowledge on the signals that bacteria could perceive once they attach to a surface, the signal transduction systems that could be involved in sensing the surface contact and the cellular responses that are triggered as a consequence to surface contact ultimately leading to biofilm formation. Finally, as the main obstacle in investigating the initial responses to surface contact has been the difficulty to experimentally study the dynamic response of single cells upon surface attachment, we also review recent experimental approaches that could be employed to study bacterial surface sensing, which ultimately could lead to an improved understanding of how biofilm formation could be prevented.
Spectral Multipliers of Self-Adjoint Operators on Besov and Triebel–Lizorkin Spaces Associated to Operators
Authors: Bui The Anh , Duong Xuan Thinh 
Published: November 2019

Abstract
Let $X$ be a space of homogeneous type and let $L$ be a nonnegative self-adjoint operator on $L^2(X)$ that satisfies a Gaussian estimate on its heat kernel. In this paper we prove a Hörmander-type spectral multiplier theorem for $L$ on the Besov and Triebel–Lizorkin spaces associated to $L$. Our work not only recovers the boundedness of the spectral multipliers on $L^p$ spaces and Hardy spaces associated to $L$ but also is the 1st one that proves the boundedness of a general spectral multiplier theorem on Besov and Triebel–Lizorkin spaces.
Cartan Triples
Authors: Donsig Allan P , Fuller Adam H , Pitts David R 
Published: November 2019

AbstractWe introduce the class of Cartan triples as a generalization of the notion of a Cartan MASA in a von Neumann algebra. We obtain a one-to-one correspondence between Cartan triples and certain Clifford extensions of inverse semigroups. Moreover, there is a spectral theorem describing bimodules in terms of their support sets in the fundamental inverse semigroup and, as a corollary, an extension of Aoi’s theorem to this setting. This context contains that of Fulman’s generalization of Cartan MASAs and we discuss his generalization in an appendix.
medExtractR: A targeted, customizable approach to medication extraction from electronic health records
Authors: Weeks Hannah L , Beck Cole , McNeer Elizabeth , Williams Michael L , Bejan Cosmin A , Denny Joshua C , Choi Leena 
Published: November 2019

Abstract

Objective
We developed medExtractR, a natural language processing system to extract medication information from clinical notes. Using a targeted approach, medExtractR focuses on individual drugs to facilitate creation of medication-specific research datasets from electronic health records.

Materials and Methods
Written using the R programming language, medExtractR combines lexicon dictionaries and regular expressions to identify relevant medication entities (eg, drug name, strength, frequency). MedExtractR was developed on notes from Vanderbilt University Medical Center, using medications prescribed with varying complexity. We evaluated medExtractR and compared it with 3 existing systems: MedEx, MedXN, and CLAMP (Clinical Language Annotation, Modeling, and Processing). We also demonstrated how medExtractR can be easily tuned for better performance on an outside dataset using the MIMIC-III (Medical Information Mart for Intensive Care III) database.

Results
On 50 test notes per development drug and 110 test notes for an additional drug, medExtractR achieved high overall performance (F-measures &gt;0.95), exceeding performance of the 3 existing systems across all drugs. MedExtractR achieved the highest F-measure for each individual entity, except drug name and dose amount for allopurinol. With tuning and customization, medExtractR achieved F-measures &gt;0.90 in the MIMIC-III dataset.

Discussion
The medExtractR system successfully extracted entities for medications of interest. High performance in entity-level extraction provides a strong foundation for developing robust research datasets for pharmacological research. When working with new datasets, medExtractR should be tuned on a small sample of notes before being broadly applied.

Conclusions
The medExtractR system achieved high performance extracting specific medications from clinical text, leading to higher-quality research datasets for drug-related studies than some existing general-purpose medication extraction tools.