bluuebunny/crossref_metadata_2025_split huggingface dataset:
736 PL11.04 HEALTH-RELATED QUALITY OF LIFE OF PATIENTS WITH ESOPHAGEAL CANCER FOLLOWING ESOPHAGECTOMY TREATED WITH NEOADJUVANT CHEMORADIOTHERAPY OR CHEMOTHERAPY: EUROPEAN MULTICENTER STUDY
Authors: Schuring Nannet , Markar Sheraz , Hagens Eliza R C , Jezerskyte Egle , Sprangers Mirjam A G , Johar Asif , Gisbertz Suzanne S , Berge Henegouwen Mark I 
Published: September 2021

Abstract

Curative treatment for patients with esophageal cancer consists of neoadjuvant treatment and radical surgical resection. Two different strategies exist; patients can either be treated with perioperative chemotherapy (CT) or neoadjuvant chemoradiotherapy (CRT). Both strategies improve 5-year survival rates, it is however not known if these treatments affect long-term Health-Related Quality of Life (HR-QoL) differently. The aim of this study was to compare HR-QoL between patients following CT and CRT followed by esophagectomy for esophageal cancer.

Methods
The LASER study database comprises data of a multicenter European study, with focus on HR-QoL among disease-free patients at least one year following an esophagectomy for esophageal or junctional cancer. Included patients completed the LASER, EORTC-QLQ-C30 and EORTC-QLQ-OG25 questionnaires. From this database we extracted patients either treated with CT or CRT for analysis. The primary endpoint was the mean difference in all long-term HR-QoL domains and LASER key symptom scores, using univariable and multivariable logistic regression analysis. The secondary endpoint was to compare the reported HR-QoL domain scores in the study population to the reference values of the general population.

Results
Among the 565 included patients, 349 (61.8%) received CRT, and 216 (38.2%) were treated with CT. The mean age was 63.7 years (±SD 8.6), and mean time since surgery was 4.3 years (±SD 1.7). After multivariable analysis, patients treated with CT reported worse outcomes on ‘Social Functioning’ (∆means 4.56, p-value&lt;0.05), more symptomatology on domains ‘Insomnia’ (∆means 5.65 p-value&lt;0.05) and ‘Diarrhea’ (∆means 5.93 p-value&lt;0.05) of the QLQ-C30 questionnaire, and more symptomatology on domains ‘Reflux’ (∆means 7.40, p-value&lt;0.05), ‘Odynophagia’(∆means 4.66 p-value&lt;0.05) and ‘Pain and discomfort’(∆means 4.34, p-value&lt;0.05) of the QLQ-OG25 questionnaire. No differences were observed for the LASER key symptoms.

Conclusion
Significant differences in favor of CRT were observed in several long-term HR-QoL domains for patients following esophagectomy for cancer. However, none of the observed differences in the reported long-term HR-QoL domains between patients treated with CT or with CRT, were clinically relevant (∆means≠ ≥ 10 points). Selection of neoadjuvant therapy should therefore be based on patient characteristics.
747 IS 99MTC BONE SCINTIGRAPHY NECESSARY IN THE PREOPERATIVE WORKUP FOR PATIENTS WITH POTENTIALLY RESECTABLE ESOPHAGEAL SQUAMOUS CELL CANCER?
Authors: Wei Xiufeng , Li Yin , Qin Jianjun , Zhang Ruixiang , Chen Xiankai , Xie Hounai , Xu Lei , Yang Yafan , Kang Xiaozheng , Qi Shu , Wang Zhen 
Published: September 2021

Abstract

99mTc bone scintigraphy(BS) is still the most widely used method to evaluate bone metastasis in China. The aim of this study was to investigate the necessity of the 99mTc bone scintigraphy in the preoperative workup for patients with potentially resectable esophageal squamous cell cancer (ESCC,cT1-4aN0–3).

Methods
This was a prospective cross-section clinical trial (ChiCTR1800020304). There were a total of 471 patients who were diagnosed ESCC in Thoracic Surgery Clinic from October 2018 to September 2020. Of these 471 patients, 385 patients with cT1-4aN0–3 who were potentially candidates for surgical resection were consecutively enrolled into the study. BS was performed preoperatively. The treatment strategy could be changed if the bone metastasis was confirmed. The primary endpoint was the incidence rate of the treatment regimen being changed because of bone metastasis. The secondary endpoint was the rate of positive BS findings.

Results
In all 385 patients, there are only 2(0.5%) patients changed their treatment regimen because of bone metastasis proved by BS. The rate of positive BS findings is 1%. The number of patients with false positive and false negative was 2(0.5%) and 2 (0.5%), respectively. The BS diagnostic performance for bone metastasis was as follows: sensitivity, 50%; specificity, 99.5%; positive predictive value, 50%; negative predictive value, 99.5% and accuracy, 99.0%. There were no significant difference of bone metastasis among the Age, Sex, Tumor location and Clinical stage.

Conclusion
99mTc bone scintigraphy is unnecessary in the preoperative workup for patients with potentially resectable esophageal squamous cell cancer.
755 LAPAROSCOPIC REPAIR OF GIANT PARAESOPHAGEAL HERNIAS: A SINGLE CENTER EXPERIENCE AND LITERATURE REVIEW
Authors: Neo Sheue Li , Voon Kelvin , Nagalingam Premnath 
Published: September 2021

Abstract

Paraesophageal hernias comprise about 5–10% of all hiatal hernias. Majority of patients are asymptomatic while some may present with reflux symptoms, obstruction or bleeding. There are numerous controversies on the indications of surgery, operative approach, hernial sac excision, fundoplication and on the use of a mesh.

Methods
We present a series of 3 patients with giant paraesophgeal hernia diagnosed in year 2020 in our institution, followed by a literature review. This study aims to assess the indications and effectiveness of laparoscopic paraesophageal hernia repair with routine sac excision, primary crural repair and fundoplication in the treatment of giant paraesophageal hernia.

Results
There were 3 patients in this study. Their mean age was 49. All patients had type IV hiatal hernia and the mean hernia defect was 8 cm in diameter. Laparoscopic paraesophageal hernia repair, sac excision and anterior 180 degree fundoplication was successfully done for all patients without conversion to open surgery. There was no intraoperative or post-op complications. Mean length of stay post-op was 2 days. At one year follow-up, all patients achieved complete resolution of symptoms without new onset reflux or dysphagia.

Conclusion
Laparoscopic paraesophageal hernia repair with routine sac excision, primary crural repair and fundoplication is safe and effective in treating giant paraesophageal hernias. Tension free repair is the key to success. A 180-degree anterior partial wrap may be able to reduce the incidence of dysphagia.
766 PROPHYLAXIS OF POST-FUNDOPLICATION SIDE EFFECTS AFTER LAPAROSCOPIC NISSEN EXTRA SOFT FUNDOPLICATION.
Authors: Haidarzhi Yevhen , Nykonenko Andrii 
Published: September 2021

Abstract

Laparoscopic Nissen Fundoplication (LNF) is well-established surgical treatment of GERD with best long-term postoperative outcomes in controlling reflux. Usually it is associated with a high risk of dysphagia, flatulence, inability to belch, bloating, which appear due to total over-tight wrap around esophagus. Partial fundoplication can avoid these effects, but unfortunately does not have the same long-term postoperative reflux control. So, new approach to prophylaxis of post-fundoplication side effects during LNF is needed.

Methods
Modified extra-soft LNF for GERD during 2016–2020 years were proposed in 75 patients. Prior to the fundoplication wrap formation the operation was performed according to the standard procedure. The proposed surgical techniques were: performing of an extra mobilization of the stomach (mandatory fundus and more ½ part of a large curvature) by crossing the gastro-splenic ligament completely and the gastro-colonic ligament partially and formation of a short extra-soft fundoplication wrap around the esophagus less 1.5 cm in the length with no more than 3 non-absorbable sutures with obligatory fixation to the esophagus. We examined twelve months follow-up.

Results
Along with the disappearance of GERD symptoms, no post-fundoplication dysphagia, flatulence, inability to belch and bloating were marked in any patient. Routine application of the above-described techniques allowed us to perform a modified LNF in all 75 patients by the extra mobilization of the stomach and formation of an extra-soft total fundoplication wrap with obligatory fixation to the esophagus without mandatory use of a thick (56–60 Fr) gastric fundoplication tube.

Conclusion
According to our study, in comparison with standard LNF, the proposed surgical techniques is effective in the prevention of post-fundoplication complications (dysphagia, flatulence, inability to belch, bloating) and support routine use of this modified Laparoscopic Nissen Extra Soft Fundoplication in treatment of GERD.
777 IS ADJUVANT CHEMOTHERAPY FOR ESOPHAGEAL CANCER WITH RESIDUAL DISEASE AFTER TRIMODALITY THERAPY FUTILE? A NATIONWIDE MULTICENTRIC SURVEY
Authors: Lintis Alexandru , Gronnier Caroline , Eveno Clarisse , Piessen Guillaume 
Published: September 2021

Abstract

For patients with resectable locally advanced esophageal cancer (EC), trimodality therapy associating neoadjuvant chemoradiation and surgery is the standard of care. However, the risk of recurrence for patients with residual disease (RD) remains high and there is no established adjuvant treatment modality in this setting. Adjuvant immunotherapy recently exhibited promising results but ACT could also play a beneficial role. This study evaluated the potential benefit of ACT in RD after trimodality therapy for EC.

Methods
A multicenter database for the surgical treatment of EC collected data from 30 university hospitals (2000–2010). Patients with RD in completely resected EC after trimodality therapy where included and separated in an ACT group and a non-ACT group. Demographics, tumor and treatment characteristics, morbidity, overall and recurrence-free survival (OS and RFS) where compared. Uni and multivariate analysis were performed to identify factors associated with OS. Survival analysis of patients treated with and without ACT was performed in a propensity score matched study.

Results
From 2944 patients included, 484 had RD after trimodality therapy, and 9.3% (n = 45) were treated with ACT. There were no major differences in demographics, preoperative tumor and treatment characteristics between groups. Major complications where higher in the non-ACT group (31 vs 20%, p = 0.018). ACT group had more nodal involvement (78 vs 45%, p &lt; 0.001). OS and RFS were significantly worse in the ACT group (median: 36.0 vs 46.7mo, p &lt; 0.001 and 25.5 vs 47.9mo, p = 0.029 respectively). After multivariate analysis, ACT was independently associated with worse OS (HR = 3.69, p &lt; 0.001). In the propensity matched study, OS and RFS remained worse in ACT group.

Conclusion
This study supports current recommendations concerning ACT abstention in EC with RD after trimodality therapy. In light of the promising results of the BMS Checkmate 577 study, adjuvant immunotherapy in this setting should therefore be considered as the first choice of treatment.
783 C-REACTIVE PROTEIN VERSUS DRAIN AMYLASE; THEIR RELIABILITY IN RULING OUT ANASTOMOTIC LEAKAGE AFTER MINIMALLY INVASIVE IVOR-LEWIS ESOPHAGECTOMY
Authors: Stuart S , Kuypers T , Martijnse I , Heisterkamp J , Matthijsen R 
Published: September 2021

Abstract

One of the most feared complications of the esophagectomy for esophageal cancer is anastomotic leakage (AL). Early diagnosis is vital for timely initiation of therapeutic interventions as well as prompting early feeding in the absence of AL. The aim of this study is to investigate the role of serum C-reactive protein (CRP) and drain amylase levels in the early detection of AL.

Methods
All 109 patients who underwent a minimally invasive Ivor-Lewis procedure in our hospital between January 2018 and October 2020 were retrospectively included in this study. Data on CRP and drain amylase levels were collected during the first 5 postoperative days (POD) and were available for analyses. Mean CRP and median drain amylase levels between patients with and without AL were compared and ROC curves on POD 3, 4 and 5 were plotted to calculate cut-off values for CRP.

Results
In 13 of 109 patients (12%) AL was diagnosed with a median time to diagnosis of 8 days. Mean CRP was significantly higher in patients with AL on POD 3, 4 and 5. Cut-off values of 48, 113 and 90 mg/L had a high sensitivity of 100%, 92% and 92% on POD 3, 4 and 5. No difference in median drain amylase levels was observed.

Conclusion
CRP levels with a cut-off point of 113 mg/L on POD 4 do not improve earlier detection of AL, but has a high sensitivity for excluding AL while the value of drain amylase in the first 5 days after surgery is limited.
791 RECURRENT HIATAL HERNIA A HIGH PREDICTOR OF PATHOLOGIC REFLUX AND NEED FOR REINTERVENTION
Authors: Greenberg Jacques , Reyes Fernando Valle , Christianson Blake , Margolis Daniel , Thiesmeyer Jessica , Edelmuth Rodrigo , Egan Caitlin , Finnerty Brendan , Fahey Thomas J , Zarnegar Rasa 
Published: September 2021

Abstract

Anti-reflux surgery (ARS) has been postulated to have high failure rates, which may approach 50% depending upon hiatal hernia size. Most failures are thought to be related to wrap disruption or hiatal hernia recurrence. Recently, diaphragmatic mesh augmentation has been shown to reduce hiatal hernia recurrence. We aimed to determine factors that influence recurrence based on vigilant imaging and diagnostic pH studies, and the need for surgical reintervention.

Methods
A prospectively maintained database of all patients undergoing index robotic ARS (including Hill, Nissen, Toupet, and Linx procedures) with Phasix ST ® mesh was queried. Between December 2016 and July 2020, 134 patients were identified of which 92 met inclusion criteria for post-operative barium esophagram performed at routine intervals (6, 12, or 24-months) or for recurrent symptoms. Median follow-up time was 11.4 months. Clinical characteristics, manometry, pH studies, as well as surgical approach was evaluated. Radiographic recurrences were then associated with endoscopic confirmation and rates of surgical re-intervention.

Results
Radiographic recurrence &gt;2 cm was noted in 9 (9.8%) patients, of which 44% were symptomatic, compared to 36% of those without radiographic recurrence (p = 0.620). Endoscopy confirmed recurrence in 67% of patients with radiographic recurrence versus 0% without (p = 0.001). When all radiographic recurrences, including those &lt;2 cm, were evaluated, 17 (18%) were identified, of which 53% of patients were symptomatic. Endoscopic and pH studies confirmed recurrences in 75% and 71% of these patients, respectively. Overall reintervention rates were 23% in the setting of any radiographic recurrence versus 1.3% without (p = 0.001).

Conclusion
Recurrence rates following robotic ARS and hiatal hernia repair with mesh augmentation appear low with nearly 1-year follow-up. Prior to surgical reintervention, endoscopic and pH studies are warranted to confirm symptomatic recurrence. Recurrent hiatal hernias, including those &lt;2 cm, can lead to abnormal pH studies that merit reintervention at rates higher than those without evidence of recurrence. Longer term follow-up is required to optimally delineate true recurrence patterns.
850 OBJECTIVE IDENTIFICATION OF OESOPHAGEAL ADENOCARCINOMA USING MASS SPECTROMETRY IMAGING
Authors: Antonowicz Stefan , Nima Abbassi-Ghadi , McKenzie James , Kumar Sacheen , Huang Juzheng , Jones Emrys , Strittmatter Nicole , Pitts Gemma , Kudo Hiromi , Goldin Rob , Hoare Jonathan , Veselkov Kirill , Takats Zoltan , Hanna George 
Published: September 2021

Abstract

Outcomes for oesophageal adenocarcinoma continue to be poor, as patients are often diagnosed too late for curative treatment. New tools to assist early and rapid diagnosis are needed. Tissue phospholipids quantified by mass spectrometry imaging (MSI) can objectively diagnose non-oesophageal cancers from control tissue in minutes. However, whether MSI can objectively identify oesophageal adenocarcinoma is unknown and represents a significant challenge, as this microenvironment is complex with phenotypically similar tissue-types.

Methods
Desorption electrospray ionisation mass spectrometry imaging (DESI-MSI) and bespoke chemometrics were used to assess the phospholipidomes of oesophageal adenocarcinoma and relevant control tissues, in surgical (discovery) and endoscopic (validation) cohorts. Structural annotations verified by tandem MS fragmentation patterns were performed to understand the characteristics of the key differential phospholipids. Bioinformatics, quantitative polymerase chain reaction, and immunohistochemistry were performed to describe the reprogramming of phospholipogenesis in oesophageal adenocarcinoma. Finally, genetic silencing experiments were performed to understand whether this genetic reprogramming impacts the oesophageal adenocarcinoma phospholipid signature.

Results
Multivariable models based on tissue phospholipids from 117 patients were highly discriminant for oesophageal adenocarcinoma both in discovery (area-under-curve = 0.97) and validation cohorts (AUC = 1). Cancer samples were enriched for polyunsaturated phosphatidylglycerols with longer acyl chains, with stepwise enrichment in pre-malignant tissues. Expression of fatty acid and glycerophospholipid synthesis genes was significantly upregulated, and characteristics of fatty acid acyls matched phospholipid acyls. Mechanistically, reducing ACLY expression in oesophageal adenocarcinoma cells shortened GPL chains, therefore linking de novo lipogenesis to the oesophageal adenocarcinoma phospholipidome.

Conclusion
DESI-MSI (i) objectively identified invasive oesophageal adenocarcinoma from a number of pre-malignant tissues (ii) described the characteristics of cancer phospholipids, which have unknown function (iii) unveiled a new mechanism of phospholipidomic reprogramming. These results call for accelerated diagnosis studies using DESI-MSI in the upper gastrointestinal endoscopy suite, as well as functional studies to determine how polyunsaturated phosphatidylglycerols are generated, and how they contribute to oesophageal carcinogenesis.
856 NODAL METASTASES AFTER NEOADJUVANT CHEMORADIATION AND R0 RESECTION IN ESOPHAGEAL ADENOCARCINOMA: PATTERNS AND PROGNOSIS
Authors: Harrington Caitlin , Carr Rebecca , Sihag Smita , Adusumilli Prasad , Bains Manjit , Bott Matthew , Isbell James , Park Bernard , Rocco Gaetano , Rusch Valerie , Jones David , Molena Daniela 
Published: September 2021

Abstract

Although the pattern of nodal metastasis and the prognosis of number and location of positive nodes have been well described with esophageal cancer undergoing upfront surgery, little is known about nodal metastasis after neoadjuvant treatment. The aim of this study is to assess the pattern of nodal metastases in esophageal adenocarcinoma treated with neoadjuvant chemoradiation and surgery and evaluate its effect on prognosis.

Methods
All patients with esophageal adenocarcinoma who had undergone neoadjuvant chemoradiation and an R0 esophagectomy between 2010 and 2018 at our institution were included (n = 577). Pathology reports were reviewed for sites of lymph node metastases. Patients were excluded if nodal stations were not listed separately (n = 40). Age, sex, race, tumor location, TRG, pT stage, number of positive lymph nodes, number of positive nodal stations, and specific nodal stations were analyzed for risk of recurrence using univariable Cox regression, and significant covariates were included in multivariable Cox regression model.

Results
Of 537 patients, 193(36%) had pathologic nodal metastases. 153 patients(28%) had single-station disease: 135(88%) at the paraesophageal station, 16(10%) at the left gastric, 1 at the subcarinal and 1 at the paratracheal station(0.65% each). 32 patients(6.0%) had two-station and 8(1.5%) had three-station disease. The majority of patients with multiple positive nodal stations had positive nodes in the paraesophageal(90%) and/or left gastric artery stations(60%). On multivariable analysis, the number of positive nodal stations (HR 1.59, CI 1.35–1.84, p &lt; 0.001), subcarinal (HR 2.78, CI 1.54–5.03, p &lt; 0.001), and paraesophageal stations (HR 2.0, CI 1.58–2.54, p &lt; 0.001) were associated with increased risk of recurrence.

Conclusion
Patients who have undergone neoadjuvant and R0 esophagectomy for adenocarcinoma often have lymph node metastases at time of surgery, most commonly at the paraesophageal station. The number of nodal stations, along with subcarinal and paraesophageal metastases, were associated with increased risk of recurrence.
Understanding the use of heart failure online health forums: a qualitative study
Authors: Farnood Annabel , Johnston Bridget , Mair Frances S 
Published: September 2021

Abstract

Aims
Heart failure is a major public health challenge and is described as an epidemic. Many people resort to the internet as a source of health information and online health forums have become an increasingly common way to obtain information and support regarding health-related issues. This study aims to explore what information people concerned about heart failure seek from online health forums, and how this shapes decision-making, trust, and interactions with healthcare professionals.

Methods and results
Widely available internet search engines (Google, Yahoo, and Bing) were used to identify online health forums, accessed by people seeking information on heart failure. Comments posted between 2016 and 2019 were screened, downloaded, and analysed thematically. Normalization Process Theory provided the underlying conceptual lens to inform analysis. Ten online health forums were identified, and 204 individual posts analysed. Three themes were identified [(information and support needs; online diagnosis; and relationship with healthcare professionals (HCPs)]. The most common purpose for using online health forums was to plug information/knowledge gaps surrounding diagnosis or treatments (e.g. discussion of results, medication/health insurance queries). They were used as a tool to aid decision-making regarding, (i) whether to seek further medical attention and (ii) lifestyle choices, medications, and other advice surrounding concerns. Negative experiences with HCPs were discussed, and sometimes online health forums appeared to promote distrust with HCPs.

Conclusion
Online health forums offer a supportive platform and help fill key informational gaps. However, online forums may amplify distrust with HCPs.
Divergent assembly processes? A comparison of the plant and soil microbiome with plant communities in a glacier forefield
Authors: Junker Robert R , He Xie , Otto Jan-Christoph , Ruiz-Hernández Victoria , Hanusch Maximilian 
Published: September 2021

ABSTRACT
Community assembly is a result of dispersal, abiotic and biotic characteristics of the habitat as well as stochasticity. A direct comparison between the assembly of microbial and ‘macrobial’ organisms is hampered by the sampling of these communities in different studies, at different sites or on different scales. In a glacier forefield in the Austrian Alps, we recorded the soil and plant microbiome (bacteria and fungi) and plants that occurred in the same landscape and in close proximity in the same plots. We tested five predictions deduced from assembly processes and revealed deviating patterns of assembly in these community types. In short, microbes appeared to be less dispersal limited than plants and soil microbes, and plants strongly responded to abiotic factors whereas the leaf microbiome was plant species specific and well buffered from environmental conditions. The observed differences in community assembly processes may be attributed to the organisms’ dispersal abilities, the exposure of the habitats to airborne propagules and habitat characteristics. The finding that assembly is conditional to the characteristics of the organisms, the habitat and the spatial scale under consideration is thus central for our understanding about the establishment and the maintenance of biodiversity.