bluuebunny/crossref_metadata_2025_split huggingface dataset:
363 MANAGEMENT OF COMPLEX ADVERSE EVENTS AFTER PARAESOPHAGEAL HERNIA REPAIR: EXPERIENCE OF A HIGH-VOLUME REFERRAL CENTRE
Authors: Antoun A , Karam A , Trépanier M , Cools-Lartigue J , Ferri L , Mueller C 
Published: September 2020

Abstract

Adverse events after paraesophageal hernia repair (PEHR), including persistent dysphagia, acute and delayed recurrence, and gastroesophageal perforation, can present complex management challenges. Medical, endoscopic and surgical treatments may be used, but descriptions of when to employ these options and how to choose a surgical approach (e.g. open vs laparoscopic, transabdominal vs transthoracic), are limited. We sought to review the treatment and outcome for complex adverse events after PEHR.

Methods
All patients undergoing primary (elective or emergency) and revisional repair of PEH at a high volume specialized referral center were identified. Demographic data, operative details and outcomes were verified by chart review. Extracted data included patient characteristics, incidence of adverse events, and diagnostic and management strategies. Details of endoscopic and surgical interventions for complex recurrences were tabulated.

Results
369 patients with PEHR were identified from 2012-19. Most (345:94%) underwent the index PEHR at our centre, with 24(6%) referred from other institutions for management of adverse events. Post-operative dysphagia requiring invasive intervention occurred in 27(7.3%), and 23(6.2%) required re-operation (19 laparoscopically). Gastric or esophageal perforations diagnosed post-operatively occurred in 11(3.0%), of which 8(72.7%) required emergency reoperation (1 laparoscopic, 2 laparotomy, 2 thoracotomy and 3 by combined abdominal/thoracic approach). Of 69 recurrences, 11 presented with incarceration requiring emergency surgery (8 repaired laparoscopically, 2 converted to laparotomy, and 2 required combined laparotomy/thoracotomy). One perioperative death occurred in this series.

Conclusion
Complex adverse events after PEH repair comprise a unique challenge given the wide variety of management options. When faced with these challenges, one should consider utilizing a customized surgical approach that varies with patient condition, anatomical characteristics of the complication and surgeon preference.
366 CLINICAL NOMOGRAM MODEL FOR RECURRENT LARYNGEAL NERVE LYMPH NODE METASTASIS IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A RETROSPECTIVE MULTICENTER STUDY
Authors: Tian D , He X , Yang Y , Chen L 
Published: September 2020

Abstract

Recurrent laryngeal nerve lymph node metastasis (RLN LNM) is not rare in patients with esophageal cancer. We aimed to explore the risk factors for RLN LNM and to develop a nomogram predicting the likelihood of RLN LNM in esophageal squamous cell carcinoma (ESCC) patients.

Methods
We retrospectively reviewed patients with ESCC who underwent esophagectomy as well as recurrent laryngeal nerve lymph node dissection between May 2015 and February 2019 at two different institutions. The patients were divided into negative and positive groups according to the presence of RLN LNM. Risk factors for RLN LNM were evaluated by univariate and multivariate analyses. A nomogram was constructed for presentation of the final model.

Results
A total of 390 patients with ESCC were included in this study. The differences in tumor location, tumor differentiation, T stage, tumor size and carcinoembryonic antigen (CEA) between the negative (N = 270) and positive groups (N = 120) RLN LNM were significant (P &lt; 0.05). Multivariate analysis indicated that the tumor location (OR = 0.520, 95% CI: 0.361–0.749, P &lt; 0.001), tumor differentiation (OR = 2.279, 95% CI: 1.586–3.276, P &lt; 0.001), T stage (OR = 1.436, 95% CI: 1.029–2.003, P = 0.033), tumor size (OR = 1.781, 95% CI: 1.021–3.106, P = 0.042) and CEA (OR = 1.206, 95% CI: 1.003–1.450, P = 0.046) were independent risk factors for RLN LNM. A nomogram with these variables had good predictive accuracy (c-index: 0.716).

Conclusion
Tumor location, tumor differentiation, T stage, tumor size and CEA may predict the risk of RLN LNM. We created a nomogram predicting the likelihood of RLN LNM in patients with ESCC.
370 LAPAROSCOPIC HIATAL HERNIA REPAIR: INSIGHTS FROM A HIGH-VOLUME CENTER
Authors: Giulini L , Razia D , Mittal S 
Published: September 2020

Abstract

When a hiatal hernia (HH) becomes symptomatic, surgical repair is indicated. The surgical procedure can be safely carried out laparoscopically with good results. However, it is unclear whether the size of the hernia affects perioperative outcomes. The aim of this study was to assess whether laparoscopic repair of large hiatal hernias (L-HH) has comparable results to laparoscopic repair of small hernias (S-HH).

Methods
After approval from the Institutional Review Board, a prospectively maintained database was reviewed for data on patients who underwent primary laparoscopic HH repair at our center between August 2016 and December 2019. All procedures were performed by a single surgeon (SKM). HHs were defined as “large” when at least 50% of the stomach was herniated through the hiatus. Data on perioperative results and mid-term follow-up were analyzed. The Clavien-Dindo (CD) classification was used to define complications.

Results
Of 170 identified patients, 55 had L-HH; 115 had S-HH. Mean ages were 72 ± 10 for L-HH and 61 ± 11.3 years for S-HH (p &lt; 0.001). Median operative time was 95 (IQR, 80–110) and 75 minutes (IQR, 65–90) for L-HH and S-HH, respectively (p &lt; 0.001). L-HH patients had longer hospital stays (median 2 vs 1 days, IQR 1–2 for both; p = 0.001) and more complications (12/55 [21.8%] vs 4/115 [3.5%]; p &lt; 0.001) than S-HH patients. Two L-HH patients had CD grades IIIb and IVa. At follow-up (20.9 ± 8.7 months), gastroesophageal reflux disease quality of life scores were comparable between groups (6.4 ± 11.7 vs 5.2 ± 0; p = 0.9).

Conclusion
Laparoscopic HH repair is safe and feasible; however, is more technically challenging and is associated with longer operative time, longer hospital stay, and increased morbidity when performed as treatment for L-HH (ie, at least 50% of the stomach herniated through the hiatus). Nonetheless, good quality of life outcomes can be achieved at mid-term follow-up in both patients with S-HH and patients with L-HH who undergo treatment by an experienced surgeon.
386 LAPAROSCOPIC HELLERS MYOTOMY AND ANGLE OF HIS ACCENTUATION FOR ACHALASIA CARDIA: 10 YEARS EXPERIENCE FROM A SINGLE SURGICAL CENTRE.
Authors: Parshad R , Singla V , Suhani S , Bhattacharjee H , Makharia G , Sharma R 
Published: September 2020

Abstract

Achalasia is a rare disease with Laparoscopic Hellers cardio-myotomy (LHCM) being the gold standard surgical modality. An antireflux procedure is required along with myotomy to decrease the chances of reflux postoperatively. We have performed Angle of His Accentuation (AOH) as an anti-reflux procedure in 126 patients who underwent LHCM since 2010. This study presents the symptomatic and objective outcomes of LHCM with AOH.

Methods
Review of prospectively collected data of patients with Achalasia cardia undergoing LHCM with AOH from 2010–2019. Subjective symptoms were scored for dysphagia, heartburn, regurgitation and quality of life using scoring systems mentioned in table 1 and Achalasia specific health related Quality of life questionnaire (ASHRQoL). Objective tests included Timed Barium swallow, Endoscopy and high-resolution manometry. Patients were evaluated in pre and postoperative period at regular intervals. Success was defined as follows: Eckardt score of ≤3, Dysphagia score of 0/1, Regurgitation and heartburn score of 0, &gt;50% clearance on timed barium swallow, IRP &lt;15 and absence of esophagitis.

Results
126 patients were operated during the study period with no mortality or conversion. Mean age was 33.5(years), symptom duration 49.8(months), 31 had preoperative dilatation. The mean operative time was 131 (minutes). Subjective outcome was available in all patients & objective data in 66. At median follow of 31 months (IQR 15–59) outcomes significantly improved (Table 1) with 93% having dysphagia relief. 14 (11%) had new onset heartburn; 6(4.7%) needed regular proton pump inhibitors. ASHRQoL improved significantly (59.51 to 19.57). Pre&post-operative IRP, Timed Barium and endoscopy available in 66,39 and 62 patients improved significantly. 6(9.6%) patients had endoscopic evidence of esophagitis (LA-A 3, B/C 3).

Conclusion
Laparoscopic Heller myotomy with Angle of His accentuation is safe simple and effective procedure for Achalasia cardia. It provides significant relief of symptoms, improvement in quality of life and improvement in objective parameters. Post- operative heartburn and esophagitis is acceptable. We recommend Angle of His accentuation as an adjunct to Laparoscopic Heller myotomy.
387 LAPAROSCOPIC REDO HELLER’S MYOTOMY FOR ACHALASIA FOLLOWING WORSENING OF SYMPTOMS DUE TO AN INADEQUATE MYOTOMY AND INAPPROPRIATELY CHOSEN ANTIREFLUX PROCEDURE.
Authors: Parshad R , Verma E , Sharma R , Makharia G 
Published: September 2020

Abstract

This patient underwent Laparoscopic heller's cardiomyotomy and Nissen fundoplication for Achalasia cardia at another institute. Following surgery his dysphagia worsened. Dysphagia persisted despite balloon dilatation. Patient was evaluated at our institute with Barium swallow and CECT thorax which showed dilated oesophagus with tight wrap. Patient was planned for laparoscopic re exploration. At surgery he had a Nissen wrap and inadequate extension of myotomy across the GE junction.

Methods
The video describes the procedure of laparoscopic dismantling of the wrap with extension of Heller myotomy and a Toupet Fundoplication.

Results
Patient had an uneventful recovery and had significant improvement in dysphagia at a follow up of 7 months.

Conclusion
Nissen Fundoplication is not a good choice of antireflux procedure in achalasia cardia patients following Heller Myotomy and can contribute to dysphagia in the post operative period. Extension of myotomy across the GE junction is critical to the success of Heller myotomy. Re-do surgery is difficult but can be be accomplished through approach in experienced hands.

Video
https://drive.google.com/file/d/1dhs-PlUm-ahDGF63VxxM0htB0dRiAGYJ/view?usp=sharing
388 TREATMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY (TENTACLE—ESOPHAGUS) STUDY: FACTORS ASSOCIATED WITH ANASTOMOTIC LEAKAGE SEVERITY
Authors: Ubels S , Verstegen M , Bouwense S , Hannink G , Siersema P , Klarenbeek B , van Workum F , Rosman C 
Published: September 2020

Abstract

Anastomotic leakage is a common and severe complication after esophagectomy. It is largely unknown which characteristics contribute to leakage severity. We aimed to investigate which factors are associated with leakage severity and to create an anastomotic leakage severity classification.

Methods
The TENTACLE—Esophagus is a multinational retrospective cohort study in which patients with anastomotic leakage after esophagectomy in the period 2011–2019 were included. Detailed data regarding casemix (e.g. age, sex, physical condition, comorbidity, tumor characteristics), surgical procedure (e.g. McKeown, Ivor Lewis, Orringer, anastomotic technique, omental wrap, pleural flap), leakage characteristics (e.g. contamination, drainage at leakage diagnosis, leak circumference) and treatment were collected. The primary outcome is 90-day mortality. Regression analysis will be used to analyze which leakage characteristics are associated with 90-day mortality and to compose an evidence-based anastomotic leakage severity score. The study protocol is accessible at www.tentaclestudy.com.

Results
Detailed data of 1407 patients with anastomotic leakage from 70 centers in 20 countries were collected. Anastomotic leakage occurred 0–43 days after surgery and 90-day mortality rate was 11.1%. The TENTACLE—Esophagus study data is currently being validated and it is awaiting full analysis. The results and the evidence based anastomotic leakage severity classification system will be ready for presentation at the ISDE meeting.

Conclusion
This is the largest study that investigates which factors contribute to anastomotic leakage severity after esophagectomy. The evidence-based anastomotic leakage severity classification system can be used by clinicians to grade severity of a given leak and might aid clinicians in choosing the most appropriate treatment.
391 P53 AS A UTILITY MARKER FOR RISK ASSESSMENT IN BARRETT’S OESOPHAGUS
Authors: Bondugula K , Bisht T , Dennis Joseph L , Sundaram S , Chandramohan S , Jeswanth J 
Published: September 2020

Abstract

Staging and prognosis of a case of Barrett's oesophagus is done by identifying the presence and grade of dysplasia. However, this method is highly subjective and can yield inaccurate diagnoses and prognoses. Demonstration of accumulation of p53 protein may be the most accurate and definitive approach to prognosticating cases of Barrett's oesophagus. This study focuses on p53 protein as a biomarker by immunohistochemistry staining in slides of different progression and demonstrates its promising clinical application.

Methods
Of 6175 endoscopies, from 970 cases of oesophagitis, a pilot study was performed on 6 cases of pathologically proven Barrett’s oesophagus, including a case with low-grade dysplasia, a case with high grade dysplasia and one case of poorly differentiated adenocarcinoma. Formalin fixed paraffin embedded tissue sections of the above cases were stained for anti p53 antibodies. The elevated immunohistochemical expression was quantified microscopically and a comparative analysis was done.

Results
p53 staining analysis showed significant immunoreactivity in the case of adenocarcinoma of oesophagus with diffuse strong nuclear staining. Low grade dysplasia and high grade dysplasia showed strong nuclear staining in the involved epithelium with focal and variable intensity positivity in the metaplastic epithelium. Those of reflux oesophagitis showed no nuclear staining in the epithelium. This pattern of staining with histological correlation is in concordance with other similar studies done supporting p53 as one of the crucial biomarkers for increased risk for carcinoma.

Conclusion
Increased p53 expression shows association with the higher risk of histological progression in the Barrett’s- carcinoma sequence. With the available literature p53 immunohistochemical staining along with other biomarkers will help us to predict the high risk patients and help treating clinician follow up the high risk patients. p53 shows promising utility as a part of panel for Barrett’s oesophagus and the spectrum.
Uniportal versus multiportal video-assisted thoracoscopic surgery does not compromise the outcome of segmentectomy
Authors: Xie Dong , Wu Junqi , Hu Xuefei , Gonzalez-Rivas Diego , She Yunlang , Chen Qiankun , Zhu Yuming , Jiang Gening , Chen Chang 
Published: September 2020

Abstract

OBJECTIVES
The goal of this study was to compare the feasibility and safety of uniportal thoracoscopic segmentectomy (UTS) with that of multiportal thoracoscopic segmentectomy (MTS).

METHODS
From January 2014 to December 2015, a total of 1056 patients who underwent thoracoscopic segmentectomy were identified, including 375 and 681 who had simple and complex segmentectomies, respectively. A propensity matched analysis was applied to compare perioperative indicators. Survival outcomes, which included disease-free survival and overall survival, were assessed by Kaplan–Meier estimates and Cox hazards regression analysis.

RESULTS
Propensity matching generated 454 paired patients for the UTS and MTS cohorts; the perioperative results were comparable. Survival analysis indicated that the surgical approach (UTS versus MTS) was not an independent risk factor in either disease-free survival (P = 0.247) or overall survival (P = 0.870) of patients with invasive adenocarcinoma. A shorter operative time was observed in patients who had a UTS (P &lt; 0.001) or an MTS (P = 0.011) via a simple segmentectomy compared with those who had a complex segmentectomy. Moreover, 147 and 266 corresponding cases were selected to compare the UTS and MTS in the simple and complex segmentectomy groups, respectively. MTS showed slightly longer operative times (119 vs 108 min; P = 0.007) and drainage duration (P = 0.010) in the simple segmentectomy group. In contrast, UTS was associated with statistically longer operative times (141 vs 133 min; P = 0.016) in the complex segmentectomy group.

CONCLUSIONS
Although minor differences could be found in the simple and complex segmentectomy groups, respectively, these results were clinically irrelevant. Our study supports UTS as a feasible and safe surgical technique.
Markov chain models of refugee migration data
Authors: Huang Vincent , Unwin James 
Published: September 2020

AbstractThe application of Markov chains to modelling refugee crises is explored, focusing on local migration of individuals at the level of cities and days. As an explicit example, we apply the Markov chains migration model developed here to United Nations High Commissioner for Refugees data on the Burundi refugee crisis. We compare our method to a state-of-the-art ‘agent-based’ model of Burundi refugee movements, and highlight that Markov chain approaches presented here can improve the match to data while simultaneously being more algorithmically efficient.
The Tyranny of Distance: Assessing and Explaining the Apparent Decline in U.S. Military Performance
Authors: Hulme M Patrick , Gartzke Erik 
Published: September 2020

AbstractThere is a growing sense that US military effectiveness has been on the wane in recent years. Is this the case? If so, what are the reasons for the decay in American combat performance? We first examine the available systematic evidence for American military decline, showing that the United States has indeed experienced a drop in the quality of outcomes of its military contests. Observers have offered a number of explanations for declining American military success, most predominantly an increase in intrastate conflict after the Second World War. After showing that a decline in performance is observed even after fully excluding intrastate conflict, we propose an alternative explanation: the increasing distance from home at which the United States has been fighting. Distance is tyrannical: it saps military strength and increases the cost of contests, even as it reduces US expertise and motivations to prevail. We then show that the distance from home at which the United States fights is the best predictor of the outcome of the conflict. We conclude by noting some avenues for future research and policy implications as the world returns to great power competition.
Candidate serum metabolite biomarkers of residual feed intake and carcass merit in sheep
Authors: Goldansaz Seyed Ali , Markus Susan , Berjanskii Mark , Rout Manoj , Guo An Chi , Wang Zhiquan , Plastow Graham , Wishart David S 
Published: September 2020

AbstractMutton and lamb sales continue to grow globally at a rate of 5% per year. However, sheep farming struggles with low profit margins due to high feed costs and modest carcass yields. Selecting those sheep expected to convert feed efficiently and have high carcass merit, as early as possible in their life cycle, could significantly improve the profitability of sheep farming. Unfortunately, direct measurement of feed conversion efficiency (via residual feed intake [RFI]) and carcass merit is a labor-intensive and expensive procedure. Thus, indirect, marker-assisted evaluation of these traits has been explored as a means of reducing the cost of its direct measurement. One promising and potentially inexpensive route to discover biomarkers of RFI and/or carcass merit is metabolomics. Using quantitative metabolomics, we profiled the blood serum metabolome (i.e., the sum of all measurable metabolites) associated with sheep RFI and carcass merit and identified candidate biomarkers of these traits. The study included 165 crossbred ram-lambs that underwent direct measurement of feed consumption to determine their RFI classification (i.e., low vs. high) using the GrowSafe System over a period 40 d. Carcass merit was evaluated after slaughter using standardized methods. Prior to being sent to slaughter, one blood sample was drawn from each animal, and serum prepared and frozen at −80 °C to limit metabolite degradation. A subset of the serum samples was selected based on divergent RFI and carcass quality for further metabolomic analyses. The analyses were conducted using three analytical methods (nuclear magnetic resonance spectroscopy, liquid chromatography mass spectrometry, and inductively coupled mass spectrometry), which permitted the identification and quantification of 161 unique metabolites. Biomarker analyses identified three significant (P &lt; 0.05) candidate biomarkers of sheep RFI (AUC = 0.80), seven candidate biomarkers of carcass yield grade (AUC = 0.77), and one candidate biomarker of carcass muscle-to-bone ratio (AUC = 0.74). The identified biomarkers appear to have roles in regulating energy metabolism and protein synthesis. These results suggest that serum metabolites could be used to categorize and predict sheep for their RFI and carcass merit. Further validation using a larger (3×) and more diverse cohort of sheep is required to confirm these findings.
Shiny Black and Layers of White: Japanned Papier Mâché, Race and the British Empire
Authors: Levy Haskell Gavi 
Published: September 2020

Abstract
Race, class and empire in nineteenth-century England inflected understandings of japanned papier mâché, influencing both its brief popularity and its abrupt demise in the 1860s. Although the material was rarely used as an explicit signifier in nineteenth-century literature or theory, or indeed mentioned at all, its inclusion in the Great Exhibition suggests its cultural and industrial centrality. This article proposes that this disparity results not from an absence of meaning, but from too great a complexity and too clear a set of implications. As an imitation of an East Asian form, japanned papier mâché represented an Orientalizing fantasy; as a shiny black surface, japanned papier mâché tapped into both desires and anxieties surrounding racial Blackness; as a backdrop for depictions of recognizably British landscapes and architecture; and as a distinctively British industry, japanned papier mâché offered a kind of national identity-fashioning. Tying a ubiquitous but understudied material of the English mid-nineteenth century to broader histories of the British empire, this article demonstrates the tidy encapsulation of the fraught and complex 1850s and 1860s into the materiality, forms and failure of japanned papier mâché.