bluuebunny/crossref_metadata_2025_split huggingface dataset:
259 FEATURES PREDICTING WORSE POSTOPERATIVE HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH ESOPHAGEAL CANCER: RESULTS FROM THE CROSS-TRIAL
Authors: Van Der Wilk B , Eyck B , Timman R , Kranenburg L , Lagarde S , Wijnhoven B , Busschbach J , Lanschot J 
Published: September 2020

Abstract

Currently, trials are investigating active surveillance in esophageal cancer compared to standard esophagectomy after neoadjuvant chemoradiotherapy (nCRT). If non-inferiority is reported, on patients the choice will be imposed choice between active surveillance or immediate esophagectomy. The aim of this study was to identify clinical- and tumor characteristics that are predictive for a worse health-related quality of life (HR-QoL) after esophagectomy.

Methods
HR-QoL was measured using EORTC-QLQ-C30 and QLQ-OES24 questionnaires prior treatment and three, six, nine and twelve months postoperatively. Subgroups were predefined from patients with different clinical (global HR-QoL, WHO-status) and tumor characteristics (histology, disease stage and location of the tumor). High and low global HR-QoL were defined as global health scores ≥75 and &lt; 75, respectively. Cohen’s d effect-sizes were determined, 0.5–0.8 was considered a medium and &gt; 0.8 considered a large effect. The primary endpoints were physical functioning and eating problems. Secondary endpoints were global HRQOL, fatigue and emotional problems. Exploratory, the effect of age and gender on HR-QoL was assessed.

Results
In total, 363 patients received HR-QoL questionnaires. Patients who reported a high global HR-QoL prior treatment had a significantly worse deterioration in HR-QoL after esophagectomy than patients who reported a low HR-QoL prior treatment, on all endpoints except for physical functioning. Corresponding Cohen’s d scores were 0.85 for eating problems, −1.25 for global HR-QoL, 0.75 for fatigue and 0.65 for emotional problems. No additional differences between subgroups were identified. All predefined subgroups had impaired HR-QoL up to twelve months postoperatively for both physical functioning and fatigue with a medium to large Cohen’s d effect size.

Conclusion
Patients reporting high global HR-QoL prior treatent have worse deteriotation in HR-QoL than patients reporting low global HR-QoL prior treatment. No additional characteristics were identified that were predictive for worse HR-QoL after esophagectomy. This emphazises the need for shared-decision making in case active surveillance proves non-inferior compared to standard esophagectomy. All subgroups had deterioration in physical functioning and eating problems up to twelve months postoperatively.
273 PREDICTORS OF RESPONSE TO PPI THERAPY: REAL CLINICAL PRACTICE DATA FROM RUSSIAN FEDERATION
Authors: Bakulin I , Bordin D , Bakulina N , Zhuravleva M , Skazyvaeva E , Skalinskaya M , Ponomarenko E 
Published: September 2020

Abstract

The first-line medical therapy for GERD is commonly PPI. However, clinical practice data showed that about half of patients were refractory to PPI. In 20–50% of cases symptoms of GERD and/or endoscopic lesions of esophagus mucosa persisted during treatment with PPI for 8 weeks. The aim of the study was to identify predictors of the response to PPI therapy in patients with GERD according to the data of real clinical practice of Russian megalopolises.

Methods
The study included 1433 patients with GERD from Moscow, Moscow region and St. Petersburg. There were 595 (42%) men and 838 (58%) women with the average age 48 ± 16 years (from 7 to 91 years). The study design included 3 visits with an interval of 4 weeks, during which complaints and anamnestic data were gathered, anthropometry, upper endoscopy, tests for H. pylori infection and adherence evaluation were performed. For anti-secretory effect rabeprazole was prescribed for most of the patients (n = 1333, 96%). The obtained data were analyzed by SPSS.

Results
The proportion of patients with overweight and obesity dominated (904; 62.7%). In 614 (47.8%) patients EE was found, in 618 (48.1%)—NERD. In patients with EE infected with H. pylori, B-D grades were observed 1.3 times more often than in patients without H. pylori (p &lt; 0.05, 95% CI = 1.02–1.54). The clinical symptoms were more pronounced in patients with obesity and current smokers (p &lt; 0.05). The lowest percentage of mucous healing after 4 weeks of PPI therapy was observed in patients with EE grade D. In 95% patients with high adherence to PPI therapy clinical remission was achieved.

Conclusion
The prevalence of two main GERD phenotypes—EE and NERD—were approximately equal in the population of Russian megalopolises patients. The predictors of response to PPI therapy were normal BMI and WC, non-smoking, mild grade of EE, the choice of rabeprazole among PPI, 8-week duration of PPI treatment and high patients’ adherence to the PPI therapy.
276 SCRNA SEQUENCING OF SINGLE EAC ORGANOID REVEALS HETEROGENEITY OF STEM CELL LIKE POPULATIONS
Authors: Derouet M , Wilson G , Darling G , Yeung J 
Published: September 2020

Abstract

Tumor heterogeneity is one of the main contributor of poor response to treatment and metastasis. Esophageal adenocarcinoma (EAC) is known to be second only to melanoma in terms of heterogeneity. Robust in vitro models of EAC are lacking. In our patient derived organoid (PDO) culture, we identified different organoid morphologies from the same patient. We decided to investigate the transcriptional programs of the different organoid morphologies.

Methods
EAC organoids were established from endoscopic biopsies from 4 different patients. Based on their morphology, individual organoids were isolated and dissociated into single cell suspensions. The 10X Genomics platform was used for single cell RNA sequencing.

Results
The two morphologies identified by histology were cystic and intestinal. For the two intestinal populations the samples could be divided into stem-like (905/1646 and 1472/1926) and differentiated populations. Interestingly, we observed differences in the number of cycling cells in these Lgr5+ stem-like populations (905/905 and 337/1926). For the cystic samples the two populations could also be divided into stem-like populations (758/923 and 284/784) and differentiated populations. We also observed cell cycle differences in the Lgr5+ stem-like populations in these samples. RNA velocity analyses on each sample verified a differentiation trajectory from the stem-like to the differentiated cells.

Conclusion
Studying EAC organoids provides us with the ability to profile the transcriptional programs of progenitor-like cells, which are difficult to isolate from gross tumor. We demonstrate that we can isolate individual organoids and study them at single-cell resolution to evaluate the different types of organoid generating cells based on their morphology.
299 EXAMINATION OF ALBUMIN/GLOBULIN RATIO IN ESOPHAGEAL CANCER
Authors: Okubo T , Ogawa R , Hayakawa S , Sagawa H , Tanaka T , Takahashi H , Matsuo Y , Takiguchi S 
Published: September 2020

Abstract

Albumin and globulin make up the majority of serum proteins and are strongly involved in inflammation. In recent years, reports on cancer and inflammation have been scattered, and there are reports indicating that the albumin / globulin ratio (A/G ratio) may be a predictor of prognosis in patients with cancer. Here, we examined the A/G ratio and clinicopathological factors in curative cases of esophageal cancer.

Methods
A retrospective study was conducted on 122 patients who underwent radical surgery for esophageal cancer in our department from January 2013 to December 2017. We analyzed the correlation between A/G ratio and blood biochemical test values, and the relationship between postoperative complications and prognosis. With respect to prognosis, the cut-off value was set to 1.6 from the ROC curve, and divided into a high-value group and a low-value group, and comparatively examined.

Results
There were 106 males and 16 females. The median age at surgery was 69 years. Neoadjuvant chemotherapy was performed in 65 patients. A negative correlation was found between the A/G ratio and inflammatory markers. On the other hand, a positive correlation was observed between the A/G ratio and the value of a marker for nutritional indicators. In the prognostic study, the low-value group had a significantly worse prognosis than the high-value group. The group with an A/G ratio of less than 1.6 after chemotherapy had a poor prognosis. The A/G ratio was lower in the group with pneumonia after surgery.

Conclusion
The A/G ratio reflects the preoperative inflammatory response and nutritional status, suggesting that it is a useful factor for predicting postoperative complications and prognosis in patients with curative esophageal cancer.
301 IS IT WORTH USING MESH FOR THE TREATMENT OF GIANT HIATAL HERNIA? A SYSTEMATIC REVIEW AND META-ANALYSIS.
Authors: de Campos V , Palacio D , Glina F , Tustumi F , Bernardo W , de Sousa A 
Published: September 2020

Abstract

The use of mesh associated with cruroplasty is still controversial in giant hernias, due to possible complications of the prosthesis reported in the literature, such as infection, chest migration, shrinkage, esophageal and aortic erosion, stenosis and obstruction. This systematic review and meta-analysis aimed to compare the use or not of mesh as a reinforcement in the laparoscopic repair of giant hernias and to determine which technique has the best results in recurrence and complication rates.

Methods
A search was conducted using databases and included prospective and randomized studies. The studies should include patients with giant hernias who have undergone laparoscopic treatment comparatively analyzed between cruroplasty and suture associated with prosthetic reinforcement.

Results
Of the 768 articles analyzed, 8 were selected for systematic review, and 7 were included in the meta-analysis. The meta-analysis showed no statistically significant differences in favor of any of the intervention methods (mesh versus suture cruroplasty) for the different outcomes evaluated: recurrence (RD -0.06, CI [−0.13,0.01], I2 22%, p 0.27); postoperative complications (RD 0.04, CI [−0.01,0.9], I2 5%, p 0.30); deaths (RD -0.01, CI [−0.04, 0.02], I2 0%, p 74); intraoperative complications (RD -0.03, CI [−0.07, 0.1]); reoperation (RD -0.04, CI [− 0.10, 0.02], p 0.14).

Conclusion
There is no evidence supporting that routine mesh reinforcement in laparoscopic repair of giant hernias decreases recurrence and other complications. Systematic review registration number at PROSPERO: CRD42019147468.
327 IS LOCAL ENDOSCOPIC RESECTION A VIABLE THERAPEUTIC OPTION FOR EARLY CLINICAL STAGE T1A AND T1B OESOPHAGEAL ADENOCARCINOMA? A PROPENSITY-MATCHED ANALYSIS
Authors: Kamarajah S , Phillips A , Hanna G , Low D , Markar S 
Published: September 2020

Abstract

The role of endoscopic resection (ER) in the management of subsets of clinical T1N0 oesophageal adenocarcinoma is controversial. The aim of this study was to evaluate the outcome of ER versus oesophagectomy in node negative cT1a and cT1b oesophageal adenocarcinoma.

Methods
Data from the National Cancer Database (2010-2015), was used to identify patients with clinical T1aN0 (n = 2,545) and T1bN0 (n = 1,281) oesophageal adenocarcinoma that received either ER (cT1a, n = 1,581; cT1b, n = 335) or oesophagectomy (cT1a, n = 964; cT1b, n = 946). Propensity score matching (PSM) and Cox multivariable analyses were used to account for treatment selection bias.

Results
ER for cT1a and cT1b disease was performed more commonly over time. The rates of node-positive disease in patients with cT1a and cT1b oesophageal adenocarcinoma were 4% and 15%, respectively. In the matched cohort for cT1a cancers, ER had similar survival to oesophagectomy (HR: 0.85, 95% CI: 0.70-1.04, p = 0.1). The corresponding 5-year survival for ER and oesophagectomy were 70% and 74% (p = 0.1), respectively. For cT1b cancers, there was no statistically significant difference in overall survival between the treatment groups (HR: 0.87, 95% CI: 0.66-1.14, p = 0.3). The corresponding 5-year survival for ER and oesophagectomy were 53% vs. 61% (p = 0.3), respectively.

Conclusion
This study demonstrates ER has comparable long-term outcomes for clinical T1aN0 and T1bN0 oesophageal adenocarcinoma. However, 15% of patients with cT1b oesophageal cancer were found to have positive nodal disease. Future research should seek to identify the subset of T1b cancers at high risk of nodal metastasis and thus would benefit from oesophagectomy with lymphadenectomy.
340 EXPANDING THE ROLE OF POEM TO ESOPHAGEAL EPIPHRENIC DIVERTICULA—FEASIBLE, SAFE AND EFFECTIVE.
Authors: Sudarshan M , Sanaka M , Adhikari S , Murthy S , Thota P , Gabbard S , Ahmad U , Raja S 
Published: September 2020

Abstract

Epiphrenic diverticula (ED) is a rare disorder which can be associated with significant surgical morbidity. Presence of an esophageal motility disorder, often achalasia, is classically associated with ED with some arguing that symptoms are primarily attributed to the motility disorder rather than the diverticula itself. The role of peroral endoscopic myotomy (POEM) is expanding for palliation of achalasia. The objective of our study is to investigate the outcomes of POEM in patients with epiphrenic diverticula.

Methods
A retrospective analysis of a prospectively maintained database was conducted in a tertiary care institution between April 2014 and July 2019. A total of 217 patients receiving a POEM during the study time period were identified with 13 patients having ED. Video recordings of POEM with and without ED were compared for technical differences. Patient demographics, prior esophageal procedures and epiphrenic diverticula characteristics were collected. Primary outcome was post-operative Eckardt scores. We also explored integrated resting pressure (IRP) on manometry, barium column height and width, complications and patient reported outcomes. Standard statistical methods were applied using R.

Results
Among 13 patients with ED (median age 74.2, 69% male), 7 small and 6 large diverticula were identified. No post-operative complications were noted. The median Eckardt score significantly decreased from 8 [IQR 5–9] pre POEM to 0 [IQR 0–2] post POEM, with similar improvements in median IRPs (24.5 mmHg [IQR 16.9–31.3] vs. 4.3 mmHg [IQR 2.4–7.6], 1 min barium column height (9.2 cm [IQR 6.3–17.9] vs. 3.2 cm [IQR 0–7.1] and 1 min barium column width (3.3 cm [IQR 2.7–3.5] vs. 0.75 cm [IQR 0–3.7]. Post-operative pH studies were conducted in 7 (53.8%) patients demonstrating a DeMeester score of more than 14.72 in 5 (71.4%) patients.

Conclusion
We demonstrate that POEM is technically feasible, safe and associated with excellent outcomes in patients with small and large diverticula. In our study cohort no further surgical therapy was required to address the diverticula. Reflux was managed medically. Considering its low morbidity profile POEM should be considered for therapy in selected patients with epiphrenic diverticula.
350 EFFECTS OF EXERCISE TRAINING AFTER ESOPHAGECTOMY ON PHYSICAL FITNESS, QUALITY OF LIFE AND TREATMENT OUTCOMES
Authors: Simonsen C , Thorsen-Streit S , Sundberg A , Sigmundsdóttir Djurhuus S , Ehlers Mortensen C , Qvortrup C , Klarlund Pedersen B , Svendsen L , de Heer P , Frank Christensen J 
Published: September 2020

Abstract

Treatment for cancer of the gastro-esophageal junction (GEJ) can result in considerable and persistent decrements of physical fitness and health-related quality of life (HRQoL). Accordingly, a strong rationale exits to design interventions aiming at maintaining physical fitness and HRQoL during treatment. We aimed to investigate feasibility and safety of postoperative exercise training for patients with cancer of GEJ.

Methods
This follow-up of the PRESET pilot study (NCT02722785) included 49 patients with stage I-III GEJ cancer. The patients were allocated to postoperative exercise or usual care and followed for 1 year. The exercise group was prescribed 12 weeks of twice a week concurrent aerobic and resistance training. We evaluated the effects of exercise training on cardiorespiratory fitness, muscle strength and HRQoL. To assess safety, we recorded treatment outcomes including adherence to adjuvant chemotherapy, hospitalizations and 1-year overall survival.

Results
The exercise group improved muscle strength (+23.0 kg Leg press 1RM [95% CI, 12.4 to 33.5]) and cardiorespiratory fitness (+30.7 watt [95% CI, 16.3 to 45.1]). The exercise group had an improved HRQoL at 1-year follow-up (+14.9 points [95% CI, 4.5 to 25.3]). Exercise was safe with no differences in rate of patients receiving adjuvant therapy 87.5% vs. 84.2% (RR 1.04 [95% CI, 0.74 to 1.44]), rate of hospitalizations 36.8% vs. 26.1% (RR 1.41 [95% CI, 0.57 to 3.49]) or 1-year overall survival 80.0% vs. 79.3% (HR 0.87 [95% CI, 0.25 to 3.07]) for exercise and usual care, respectively.

Conclusion
Exercise in the postoperative period is safe and may improve HRQoL and physical fitness in patients with GEJ cancer. No differences in prognostic endpoints were observed.
374 VIDEO ESOPHAGOGRAM CORRELATES OF DYSPHAGIA IN PATIENTS WITH NORMAL LOWER ESOPHAGEAL SPHINCTER
Authors: Razia D , Giulini L , Bremner R , Mittal S 
Published: September 2020

Abstract

Dysphagia is a common foregut symptom. However, there is poor association between non-obstructive dysphagia and esophageal body peristaltic parameters in patients with normal lower esophageal sphincters (LES). The objective of this retrospective study was to study bolus transit patterns noted on barium esophagogram in patients experiencing dysphagia.

Methods
After IRB approval, we queried our esophageal database for patients with normal manometric LES. Jackhammer esophagus, esophageal spasm, previous foregut surgery, and unavailable foregut symptom questionnaires were exclusion criteria. Patients were grouped based on reported dysphagia: 0 = None; 1 = Mild; 2 = Moderate; 3 = Severe/very severe. All barium esophagograms were re-evaluated. Bolus esophageal transit time was studied with patients in both upright and prone positions, using live time stamps at bolus entry/exit. “Barium residue” was defined as persistent contrast on the esophageal wall after bolus exit. “Retrograde escape” referred to barium escaping proximally from the bolus into previously cleared esophagus. ANOVA and χ2 were used.

Results
In all, 150 patients met inclusion criteria. 76 (50.1%) were women. Mean age and body mass index were 58.4 ± 14.7 years and 22.9 ± 10.4 kg/m2, respectively. The number of patients in each dysphagia group (0, 1, 2, and 3) were 82(54.7%), 29(19.3%), 25(16.7%) and 14(9.3%), respectively. The difference in mean bolus transit time among dysphagia groups was statistically significant in prone-position swallows (39.3 ± 36.7, 75 ± 74.8, 98.8 ± 85 and 69.6 ± 43.7 seconds; p &lt; 0.001) but not in upright-position swallows (14.6 ± 22, 12.4 ± 8.1, 14.3 ± 8.8 and 12.6 ± 8.2 seconds; p = 0.929; Fig. 1). The prevalence of residual contrast and retrograde escape in prone swallows were comparable among patients reporting dysphagia (p = 0.444, p = 0.173).

Conclusion
Bolus transit time in prone-position barium swallows is simple to assess, and correlates with dysphagia reported by patients with normal lower esophageal sphincters. However, further studies with comprehensive dysphagia score are needed.
Shipping the good agricultural products out: the differentiated impact of per-unit duties on developing countries
Authors: Emlinger Charlotte , Guimbard Houssein 
Published: September 2020

AbstractWe investigate the impact of per-unit duties (i.e. tariffs expressed in US dollars per unit of imported product) on world agricultural trade patterns. Using detailed data on trade and tariffs, we show first that they induce higher export unit values, confirming that the Alchian–Allen conjecture can be extended to per-unit duties. Second, we show that this effect is higher for developed countries, which can be explained by their specialization on high-priced products. Third, we find that the restrictive effect of per-unit duties on trade is higher for developing countries.
Longitudinal Associations Between Perceived Control and Health for American and Japanese Aging Adults
Authors: Toyama Masahiro , Fuller Heather R 
Published: September 2020

Abstract

Background and Objectives
Research suggests longitudinal and reciprocal relationships between perceived control over life circumstances and health for Western populations; yet, such associations have not been fully understood for non-Western populations. The present study addresses cultural differences in these associations for American and Japanese aging adults.

Research Design and Methods
For respondents aged 40 and older at 2 waves (Time 1 [T1] and Time 2 [T2]) of Midlife in the United States (N = 4,455) and Midlife in Japan (N = 827), cross-lagged path models were analyzed for T1 perceived control predicting change in each health measure (i.e., self-rated health, number of chronic health conditions, and functional limitations) from T1 to T2; and the matched T1 health measure predicting change in perceived control from T1 and T2. In these analyses, the effects of T1 age, T1 perceived control, and each T1 health measure were compared cross-nationally.

Results
A cross-national difference emerged in that T1 perceived control predicted change in chronic health conditions only for Americans. Similar tendencies were found between the 2 nationalities for T1 perceived control predicting changes in self-rated health and functional limitations. Reciprocal relationships between perceived control and health measures were found for Americans, but neither age nor any of the T1 health measures predicted change in perceived control for the Japanese respondents.

Discussion and Implications
The findings suggest cultural differences and similarities between the 2 nationalities, which have implications for potential health benefits of enhancing perceived control among American and Japanese aging adults. Building on these findings, the present study also indicates future directions of research.
Contribution of Staphylococcal Enterotoxin B toStaphylococcus aureusSystemic Infection
Authors: Bae Justin S , Da Fei , Liu Ryan , He Lei , Lv Huiying , Fisher Emilie L , Rajagopalan Govindarajan , Li Min , Cheung Gordon Y C , Otto Michael 
Published: September 2020

AbstractStaphylococcal enterotoxin B (SEB), which is produced by the major human pathogen, Staphylococcus aureus, represents a powerful superantigenic toxin and is considered a bioweapon. However, the contribution of SEB to S. aureus pathogenesis has never been directly demonstrated with genetically defined mutants in clinically relevant strains. Many isolates of the predominant Asian community-associated methicillin-resistant S. aureus lineage sequence type (ST) 59 harbor seb, implying a significant role of SEB in the observed hypervirulence of this lineage. We created an isogenic seb mutant in a representative ST59 isolate and assessed its virulence potential in mouse infection models. We detected a significant contribution of seb to systemic ST59 infection that was associated with a cytokine storm. Our results directly demonstrate that seb contributes to S. aureus pathogenesis, suggesting the value of including SEB as a target in multipronged antistaphylococcal drug development strategies. Furthermore, they indicate that seb contributes to fatal exacerbation of community-associated methicillin-resistant S. aureus infection.