bluuebunny/crossref_metadata_2025_split huggingface dataset:
P75 CRITICAL APPRAISAL OF THE IMPACT OF OESOPHAGEAL STENTS IN THE MANAGEMENT OF OESOPHAGEAL ANASTOMOTIC LEAKS AND BENIGN OESOPHAGEAL PERFORATIONS: AN UPDATED SYSTEMATIC REVIEW
Authors: Sivesh K Kamarajah , James Bundred , Gary Spence , Andrew Kennedy , Bobby V M Dasari , Ewen A Griffiths 
Published: November 2019

Abstract

Aims
This updated systematic review aimed to assess the safety and effectiveness of oesophageal stents in these two scenarios.

Background
Endoscopic placement of oesophageal stents may be used in benign oesophageal perforation and oesophageal anastomotic leakage to control sepsis and reduce mortality and morbidity by avoiding thoracotomy.

Methods
A systematic literature search of all published studies reporting use of metallic and plastic stents in the management of postoperative anastomotic leaks, spontaneous and iatrogenic oesophageal perforations were identified. Primary outcomes were technical (deploying ≥1 stent to occlude site of leakage with no evidence of leakage of contrast within 24-48 hours) and clinical success (complete healing of perforation or leakage by placement of single or multiple stents irrespective of whether the stent was left in situ or was removed). Secondary outcomes were stent migration, perforation and erosion and mortality rates. Subgroup analysis were performed for plastic versus metallic stents and anastomotic leaks versus perforations separately.

Results
A total of 66 studies (n=1752 patients) were included. Technical and clinical success rates were 96% and 87%, respectively. Plastic stents had significantly higher migration rates (24% vs 16%, p=0.001) and repositioning (11% vs 3%, p<0.001) and lower technical success (91% vs 95%, p=0.032) than metallic stents. In patients with anastomotic leaks, plastic stents were associated with higher stent migration (26% vs 15%, p=0.034), perforation (2% vs 0%, p=0.013), repositioning (10% vs 0%, p<0.001) and lower technical success (95% vs 100%, p=0.002). In patients with perforations only, plastic stents were associated with significantly lower technical success (85% vs 99%, p<0.001).

Conclusions
Covered metallic oesophageal stents appear to be more effective than plastic stents in the management of oesophageal perforation and anastomotic leakage. However, quality of evidence of generally poor and high-quality randomised trial is needed to further evaluate best management option for oesophageal perforation and anastomotic leakage.
P77 SIGNIFICANCE OF NEOADJUVANT DOWNSTAGING IN CARCINOMA OF THE ESOPHAGUS AND GASTRO-ESOPHAGEAL JUNCTION
Authors: Kamarajah S K , Navidi M , Wahed S , Immanuel A , Hayes N , Griffin S M , Phillips A W 
Published: November 2019

Abstract

Aim
The aim of this study was to determine the importance of cTNM and ypTNM, and impact of downstaging of disease in patients with esophageal or gastro-eesophageal junction (GOJ) carcinoma who received neoadjuvant treatment followed by surgery.

Background
Most locally advanced esophageal cancers are treated with neoadjuvant therapy (chemotherapy or chemoradiotherapy). TNM staging is used prior (cTNM) and after (ypTNM) neoadjuvant treatment and surgery.

Methods
Data from consecutive patients with esophageal cancer from a single center were evaluated. Patients with either adenocarcinoma or squamous cell carcinoma of the esophagus who were treated with neoadjuvant chemo(radio) therapy followed by transthoracic esophagectomy and two-field lymphadenectomy were included. Comparison of outcomes with those primarily treated with surgery was made. The cTNM and ypTNM were applied and compared according to the American Joint Commission on Cancer (AJCC) 8th edition staging system.

Results
This study included 1115 patients of which 486 patients received surgery alone and 629 patients received neoadjuvant therapy and resection. Of patients receiving neoadjuvant therapy, 9 (1%) had cTNM stage 2 and 451 (72%) had a cTNM stage 3. Rates of downstaging were similar in esophageal adenocarcinoma and SCC (54% vs 62%, p=0.4). Downstaging was associated with significantly longer survival than patients with no change for both adenocarcinoma (median: 48 vs 15 months, p<0.001) and SCC (median: NR vs 17 months, p<0.001). On adjusted Cox regression, downstaging was associated with significantly longer survival in patients for esophageal adenocarcinoma but not SCC.

Conclusion
This study demonstrates ypTNM stage is provides a better estimate of prognosis compared to clinical stage. Downstaged patients may have an improved outcome over those with comparable pathological stage that did not receive neoadjuvant treatment.
P78 CRITICAL APPRAISAL OF THE IMPACT OF SURGICAL REPAIR OF TYPE II - IV PARAOESOPHAGEAL HERNIA ON PULMONARY IMPROVEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Sivesh K Kamarajah , Charlie Boyle , Anantha Madhavan , Maziar Navidi , Alexander W Phillips 
Published: November 2019

Abstract

Aim
This systematic review and meta-analysis aimed at characterising impact of PEH repair on patient reported improvement in pulmonary symptoms

Background
Paraoesophageal hernia (PEH) comprising Type II - IV hiatal hernia often present with pulmonary symptoms such as shortness of breath. However, impact of surgical repair on improvement in pulmonary symptoms is unclear

Methods
This systematic review identified studies reported pulmonary symptoms in patients with undergoing surgical repair for Type II - IV PEH. Primary outcome was improvement in pulmonary symptoms. Secondary outcomes were improvement in other patient-reported outcomes such as heartburn, regurgitation, chest pain, and dysphagia and intraoperative and postoperative outcomes.

Results
This systematic review identified 27 studies, of which 21 studies were included in final meta-analysis. There was significant improvement in patient reported pulmonary symptoms following PEH repair (OR: 8.40, CI95%: 4.91 - 14.35, p<0.001), with improvement in all types of PEH. This was noticed in both patients who had noticed pulmonary symptoms prior to surgery and those that did not complain of these symptoms.

Conclusion
PEH repair is a major upper gastrointestinal procedure, which may be associated with high morbidity. However, pulmonary impairment from PEH warrant surgical repair with acceptable low laparoscopic conversion rates, morbidity, mortality and recurrence rates.
P81 IMPACT OF LYMPHADENECTOMY ON SURVIVAL AFTER UNIMODALITY TRANSTHORACIC ESOPHAGECTOMY FOR ADENOCARCINOMA OF THE ESOPHAGUS
Authors: K Hardy , SK Kamarajah , A Madhavan , M Navidi , A Immanuel , SM Griffin , AW Phillips 
Published: November 2019

Abstract

Aim
The aim of this study was to determine the impact of lymph node yield and location on prognosis in patients with esophageal cancer.

Background
Absolute lymph node yield has been used as a surrogate for the extent of lymphadenectomy for esophagectomy. Ensuring adequate lymphadenectomy requires adequate removal of nodes from surgical fields, thus knowledge of lymph node location is vital to establish the impact of a radical lymphadenectomy.

Methods
Data from consecutive patients with potentially curable adenocarcinoma of the esophagus or gastro-esophageal junction were reviewed. Patients were treated with transthoracic esophagectomy and two-field lymphadenectomy. Outcomes according to lymph node yield were determined. In addition analysis was carried out based on the hypothesis that retained positive nodes would lead to disease recurrence. The prognosis of carrying out less radical lymphadenectomies was calculated according to three groups: Group 1- exclusion of proximal thoracic nodes, Group 2- a minimal abdominal lymphadenectomy and Group 3- a minimal abdominal and thoracic lymphadenectomy.

Results
357 patients were included. Median survival was 78 months(CI 53-103 months). Absolute lymph node retrieval was not related to survival (p=0.920). An estimated additional four (2-6) cancer related deaths was projected if Group 1 nodes were omitted, 15 (11-19) additional deaths if Group 2 nodes omitted, and four (2-6) deaths if Group 3 nodes omitted. A minimal lymphadenectomy (Groups 1,2 and 3) was projected to lead to 19 (15-23) additional cancer related deaths.

Conclusions
Extensive lymphadenectomy allows accurate staging. In patients who do not receive neoadjuvant chemotherapy it may confer a survival benefit. The absolute number of lymph nodes retrieved may not be a good surrogate for extent of lymphadenectomy and correlation with location is required.
P85 QUANTIFICATION OF INTRAOPERATIVE FLUORESCENCE ANGIOGRAPHY TO ASSESS ANASTOMOTIC PERFUSION DURING GASTROINTESTINAL SURGERY: A SYSTEMATIC REVIEW
Authors: Slooter¹ M D , Mansvelders¹ M , Bloemen P R , Gisbertz¹ S S , Bemelman¹ W A , Tanis¹ P J , Hompes¹ R , van Berge Henegouwen¹ M I , de Bruin D M 
Published: November 2019

Abstract

Aim
In this systematic review we aimed to identify all quantitative fluorescent parameters of intraoperative fluorescence angiography (IFA) during gastrointestinal surgery to pave way for a threshold that could predict anastomotic leakage (AL).

Background &Methods
In the last decade quantification of IFA using indocyanine green is attempted to objectively evaluate anastomotic perfusion during gastrointestinal surgery.
In this systematic review, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search of PubMed and Embase was performed. Articles were included when IFA was performed to assess gastrointestinal perfusion in both animal and human and analysed the fluorescence signal using quantitative fluorescent parameters. A fluorescent parameter was defined as ‘quantitative’ when a diagnostic numeral threshold for AL could potentially be produced.

Results
Some 1317 articles were identified, of which 23 were included in this review. Eight applied IFA during upper and fifteen during lower gastrointestinal surgery. The quantitative fluorescent parameters were divided into four categories: (1) time to fluorescence (n=19), (2) contrast-to-background ratio (n=3), (3) pixel intensity (n=3), and (4) numeral classification score (n=2). The first category was subdivided into (a) time to fluorescent enhancement (n=7) and (b) fluorescent-time curves (n=12). Thirteen studies correlated the fluorescent parameters to the occurrence of AL. Cut-off values for AL were derived for time to fluorescent enhancement (speed in gastric conduit wall) and derivatives of the fluorescent-time curves (Fmax, T1/2, TR, and slope).

Conclusion
Of the four categories, time to fluorescent enhancement seems the most promising quantitative parameter for clinical usage, as development of a cut-off value is possible on a large scale in the near future and no software is required. Future research might want to focus on fluorescent-time curves, as many different parameters can be derived and the fluorescence intensity can be bypassed. However, consensus on study set-up, and calibration of the different fluorescent imaging systems and software programs is mandatory to allow future data aggregation.
P88 EXTENDING MYOTOMY BOTH DOWNWARDS AND UPWARDS IMPROVES THE FINAL OUTCOME IN MANOMETRIC PATTERN III ACHALASIA PATIENTS
Authors: Moletta L , Salvador R , Capovilla G , Provenzano L , Pierobon E , Nicoletti L , Nezi G , Valmasoni M , Merigliano S , Costantini M 
Published: November 2019

Abstract

Background
Achalasia is at present classified in 3 manometric patterns. Pattern III is the most unfrequent pattern and is correlated with the worst outcome after all available treatments. We aimed to investigate the final outcome after classic laparoscopic myotomy (CLM) as compared with a longer laparoscopic myotomy both downwards and upwards with (LLM) in patients with pattern III achalasia.

Methods
The study population consisted of 61 consecutive patients with pattern III achalasia who underwent laparoscopic myotomy between 1997-2017. Patients who had already been treated with surgical or endoscopic procedures were ruled out. Symptoms were collected and scored using a detailed questionnaire; barium-swallow, endoscopy, manometry were performed, before and after surgical treatment. In CLM the total length of the myotomy was ≤ 9 cm, while myotomies extended both downwards and upwards to a length >9 cm were defined as LLM.

Results
Of the 61 patients representing the study population, 24 had CLM and 37 had LLM. In addition, all the patients add an anterior, partial fundoplication (Dor). The patients’ demographic and clinical parameters (sex, symptom-score, duration of symptoms, esophageal-diameter) were similar in both groups. One mucosal perforation was detected and repaired intraoperatively in the LLM group. The median length of the myotomy was 8 cm (IQR:8-9) in the CLM and 10 cm (IQR:10-12) in the LLM (p<0.001). The median of follow-up was 94 months (IQR:52-126) in the CLM and 24 months (IQR:16-40) in the LLM.
As a whole, the two groups had a different drop in their symptom score: 22 (17-26) versus 4 (0-8), and 20 (18-27) versus 3 (0-6) for the CLM and LLM respectively (p<0.01). Moreover, failures were 8/24 (33.3%) in the CLM and 4/37 (10.8%) in the LLM (p<0.05). An abnormal acid exposure was detected after the treatment in 4 patients of CLM and in 3 of LLM (p=n.s.).

Conlcusions
The extension of the length of the myotomy both downwards and upwards improves the final outcome of the laparoscopic Heller-Dor procedure in patients with pattern III achalasia. On the other hand, a longer myotomy does not influence the development of postoperative gastroesophageal reflux.
P95 LAPAROSCOPIC ASSISTED LEFT THORACOABDOMINAL OESOPHAGECTOMY (LLTA); AN INNOVATIVE APPROACH FOR TUMOURS OF THE GASTRO-OESOPHAGEAL JUNCTION
Authors: Reyhani A , Zylstra J , Davies A , Gossage J 
Published: November 2019

Abstract

Aim
To report a novel approach for tumours located at the gastro-oesophageal junction (GOJ) using a laparoscopic abdominal phase combined with a left thoracoabdominal approach.

Background and Methods
The standard left thoracoabdominal approach offers excellent exposure and access to GOJ and lower oesophagus. It also involves a single position for the procedure, shortening the operation time. The disadvantages are a large incision, dividing the costochondral junction, and a low level thoracotomy. Laparoscopic Left Thoracoabdominal Oesophagectomy (LLTA) is performed with the patient in the same right lateral decubitus position, but rolled away from the operator at 45xxx. allowing laparoscopic gastric mobilisation and lymphadenectomy. The thoracic phase uses an anterolateral left thoracotomy through the higher 5th intercostal space, giving a higher intrathoracic anastomosis, just below the aortic arch. No disruption of the costochondral junction is made. Consecutive patients treated for GOJ tumours with LLTA operated on during 2013-2019 were analysed and compared to national standards (NOGCA).

Results
This series of 70 consecutive patients had a mean age of 63 years. Median operation time was 235 minutes. Median inpatient hospital stay was 10 days (NOGCA 9 (11-17)). The majority were adenocarcinoma; predominantly located in the GOJ (Siewert Type1 (37.14%), Type2 (45.71%), Type3 (2.86%)); 90% of the tumours were T3 or T4. Postoperative morbidity was low (Clavien-Dindo 0 in 50% of the patients). The median number of total lymph nodes excised was 27.77 (NOGCA &gt;15). Positive nodes were predominantly located in the lesser-curve (40%), Para-oesophageal 34.29%; Sub-carinal 2.86%. Positive circumferential resection margins (&lt;1mm) were present in 28.57% of patients (NOGCA 25.1%). In-Hospital and 30 day mortality was 1.43% (NOGCA 2.7%). Recurrence after LLTA was 24.29% at a mean 371 days (local 5.7%, systemic 15.7%, mixed 2.86%).

Conclusion
This series demonstrates a novel, safe and reproducible left sided approach for cancer of the GOJ. There is good exposure at the hiatus, without the division of the costochondral junction and low thoracotomy.
Gender gap in research: a bibliometric study of published articles in primary health care and general internal medicine
Authors: Sebo Paul , Maisonneuve Hubert , Fournier Jean Pascal 
Published: November 2019

Abstract

Background
Many studies examined gender inequalities in research, but only a few data are available for general biomedical journals. We assessed the prevalence of female first authorship in general biomedical journals and examined its variations across a number of author, article and journal characteristics.

Methods
This study was nested within a larger project designed to analyze the bibliometric characteristics of scientific articles. We retrieved 767 randomly selected articles published in 2016 in high impact factor journals of primary healthcare (n = 9) and general internal medicine (n = 9). We extracted the following data: author (gender, number of publications and affiliation of the first author), paper (number of authors, number of participants and study design) and journal characteristics (journal discipline and 2015 impact factor). We compared the proportion of articles authored by women and men using univariate and multivariate logistic regressions adjusted for intra-cluster correlations.

Results
The female authorship proportion was 48% (63% for primary healthcare and 33% for general internal medicine, P-value &lt; 0.001). In multivariate analysis, women published fewer articles (&lt;5 versus &gt;15 publications: OR 1.6 [95% CI 1.1–2.4]), were more often affiliated with institutions in the Western world (OR 2.2 [95% CI 1.2–3.9]), were more likely to publish qualitative studies (versus systematic reviews or experiments: OR 2.7 [95% CI 1.5–4.8]) and to publish in primary healthcare journals (OR 1.7 [95% CI 1.1–2.7]).

Conclusions
The underrepresentation of women in articles published by general internal medicine journals, in articles from the non-Western world and in systematic reviews and trials should be addressed.
Is there a relationship between length of resection and lymph-node ratio in colorectal cancer?
Authors: Zanghì Antonio , Cavallaro Andrea , Lo Menzo Emanuele , Curella Botta Serena , Lo Bianco Salvatore , Di Vita Maria , Cardì Francesco , Cappellani Alessandro 
Published: November 2019

Abstract

Background
The prognosis of colorectal cancer depends on the number of positive lymph nodes (LN+) and the total number of lymph nodes resected (rLN). This represents the lymph-node ratio (LNR). The aim of our study is to assess how the length of the resected specimen (RL) influences the prognostic values of the LNR.

Methods
We conducted a retrospective study of all the patients operated on for colorectal cancer from 2000 to 2015 at our institution. Pathology details were analysed. The total number of rLN, the number of LN+, and the LNR were calculated and measured against the RL. The receiver-operating characteristic (ROC) curve of patients with LN+ was calculated.

Results
Of the 670 patients included in our study, 337 were men (50.3%) and the mean age was 69.2 years. The correlation with prognosis of the LNR is greater than that of the LNR adjusted to RL (LNR/RL), both in subjects with positive nodes (n = 312) and in all cases (n = 670). The LNR presents a higher prognostic value than LNR/RL and RL in patients with LN+ except for metastatic recurrence, for which the predictive value appears slightly higher for LNR/RL. The statistical significance of the maximal divergence in Kaplan–Meier survival plots was demonstrated for the LNR (P = 0.043), not for LNR/RL (P = 0.373) and RL alone (P = 0.314).

Conclusion
An increase in RL causes an increase in the number of harvested lymph nodes without affecting the number of LN+, thus representing a confounding factor that could alter the prognostic value of the LNR. Prospective larger-scale studies are needed to confirm these findings.
A Small Horizontally Transferred Gene Cluster Contributes to the Sporulation of Alternaria alternata
Authors: Wang Mingshuang , Fu Huilan , Ruan Ruoxin 
Published: November 2019

Abstract
Horizontal gene transfer (HGT) has been identified as an important source of genomic innovation in fungi. However, how HGT drove the evolution of Alternaria alternata, a necrotrophic fungus which can be ubiquitously isolated from soil and various plants and decaying plant materials is largely known. In this study, we identified 12 protein-encoding genes that are likely acquired from lineages outside Pezizomycotina. Phylogenetic trees and approximately unbiased comparative topology tests strongly supported the evolutionary origin of these genes. According to their predicted functions, these HGT candidates are involved in nitrogen and carbohydrate metabolism. Especially, five genes of them were likely transferred as a physically linked cluster from Tremellales (Basidiomycota). Functionally knocking out the five-gene cluster in an A. alternata isolate causing citrus brown spot resulted in an 80% decrease in asexual spore production in the deletion mutant. We further knocked out each of these five genes in this cluster and the resultant single-gene deletion mutants exhibited a various degree of reduction in spore production. Except for conidiation, functions of these genes associated with vegetative growth, stress tolerance, and virulence are very limited. Our results provide new evidence that HGT has played important roles over the course of the evolution of filamentous fungi.