bluuebunny/crossref_metadata_2025_split huggingface dataset:
712 NASOGASTRIC TUBE DRAINAGE AND PYLORIC INTERVENTIONS FOR DELAYED GASTRIC EMPTYING AFTER OESOPHAGEAL RESECTION: A NATIONAL ANALYSIS OF SPECIALIST UK CENTRES
Authors: Bull Charles , Pucher Philip H , Gossage James 
Published: September 2021

Abstract

Nasogastric tubes (NGTs) and pyloric intervention in oesophagectomy are used to lessen the impact of gastric tube distention and delayed gastric emptying. However, their utility remains unclear, with mixed evidence and some studies suggesting they may increase morbidity and patient discomfort. We performed a national survey of tertiary oesophageal surgery centres to assess current practice and surgeon equipoise for a potential prospective trial.

Methods
An electronic survey was distributed to all oesophageal resection centres in England, Wales and Scotland. Included questions assessed centres’ use of NGTs, current practice for removal and dietary progression, and use of pyloric interventions. Variations in practice were assessed, and compared to nationally reported annual centre volumes and length of stay.

Results
Seventy-nine percent (31/39) of all centres responded to the survey. All centres reported routinely using an NGT. Most centres (19/31, 61%) did not perform pyloric intervention or routine post-operative radiological assessment (22/31, 71%). Criteria for NGT removal and dietary progression was highly variable, with every centre reporting different practice criteria. There were no trends for practices when comparing high vs low volume centres, or above vs at-or-below median length of stay. 21/31 (68%) centres were willing to take part in a trial to assess NGT use and pyloric interventions.

Conclusion
NGTs remain standard practice despite mixed evidence for their efficacy and an absence of standardisation in their use. Use of pyloric intervention varies widely, with no clear link to outcomes. Surgeons recognise the need for a trial to assess requirement for NGTs and pyloric intervention after oesophageal resection.
744 THE USE OF IMMUNOFLUORESCENCE TO EVALUATE THE PERFUSION OF THE GASTRIC PLASTY DURING OESOPHAGECTOMY.
Authors: Abelló David , Navío Ana , Aguilar Karen Stephanie , Avelino Lourdes , Cholewa Hanna , Mingol Fernando , Bruna Marcos , Vaqué Javier , García-Granero Eduardo 
Published: September 2021

Abstract

Anastomotic leakage in oesophageal cancer surgery is one of the most serious complications and occurs mainly at the cervical level between 10–30% according to series. The use of immunofluorescence could help to select a better vascularized area in which to perform the anastomosis more safely. We present the initial experience (between July and December 2020) of our group.

Methods
Prospective and descriptive study of patients with oesophageal neoplasia who underwent a 3 stage oesophagectomy with cervical anastomosis using immunofluorescence with indocyanine green (dose: 7,5 mg) for quick evaluation of vascularization in the theoretical anastomosis zone in gastric plasty. Intravenous injection of the indocyanine green dilution was performed intraoperatively in a peripheral line, once the plasty was positioned in place to perform the anastomosis. The route of ascent was transmediastinal in all cases. 9 patients with a mean age of 61 ± 7.6 years were included in the study.

Results
The mean heart rate was 83 ± 16 bpm, the mean systolic blood pressure was 111 ± 17 mmHg. The time and mean speed it took for the fluorescence to reach the marked area to perform the anastomosis was 30 ± 28 seconds and 1.83 cm/sec; and at the apex of the plasty it was 93 ± 79 seconds and 0.75 cm/sec. In all patients in whom the anastomosis was performed in the area where ICG arrived between 30 and 90 seconds, there was no leakage. In two patients, due to anatomical needs, the anastomosis was performed in areas where ICG took more than 100 seconds and in the postoperative period leaked.

Conclusion
Immunofluorescence is a technique that allows an immediate visual image to evaluate the vascularization of the gastric plasty during an esophagectomy. It allows characterizing the adequate vascularization of the future anastomotic area, being able to help decide the best place to carry out the anastomosis. Studies with a larger number of cases are needed to be able to define the range in which to establish the anastomosis or change the surgical strategy.
774 TEAM DYNAMICS AND CLINICIAN’S PERSONAL BELIEVES IN TREATMENT OPTIONS INFLUENCE MULTIDISCIPLINARY TREATMENT DECISION-MAKING DURING AN ONCOLOGIC UPPER GASTROINTESTINAL MULTIDISCIPLINARY TEAM-MEETING
Authors: Luijten Josianne , Westerman Marjan , Vissers Pauline , Verhoeven Rob , Nieuwenhuijzen Grard 
Published: September 2021

Abstract

The probability of undergoing treatment with curative intent according to the hospital of diagnosis has been shown to vary considerately for esophagogastric cancer affecting survival negatively. Little is known which factors attribute to this variation. The aim of this study is to investigate the possible differences in clinical decision-making (CDM) during the multidisciplinary team meeting (MDTM).

Methods
A mixed method study design consisting of quantitative and qualitative data was conducted in which thematic content analysis of the current sub-study focused on the 16 MDTM observations and transcripts of 30 semi-structured interviews with clinicians was performed. Interviews were transcribed ad verbatim and coded. Seven focus groups were held to enrich, further explore and validate the gathered data.

Results
Clinician’s personality traits including ambition and the intention to be innovative were mentioned as facilitators, whereas hierarchy was mentioned as a barrier in CDM. Physician’s believes in a certain treatment and previous experiences with treatment outcomes and team dynamics within the MDTM influenced CDM. A continuum was identified in which at one end hospitals tended to be more guideline and evidence minded and at the other end of the continuum hospitals tended to search for boundaries maximizing chances of curation. All hospitals took patient characteristics in consideration.

Conclusion
Mechanisms influencing decision-making consisted of following guidelines, using evidence-based medicine, searching for boundaries, and taking patient characteristics into consideration. Nevertheless, the extend in which hospitals involved these mechanisms in their CDM differed. Variation in team dynamics was observed and awareness should be created that these factors attribute to CDM during an MDTM.
812 PROGRAMMED CELL DEATH PROTEIN 1/PROGRAMMED DEATH LIGAND 1 AND HLA-CLASS I ARE POTENTIAL THERAPEUTIC TARGETS IN ESOPHAGEAL NEUROENDOCRINE CARCINOMA
Authors: Masthita Satoshi Ya , Abe Hiroyuki , Yamashita Hiroharu , Yagi Koichi , Seto Yasuyuki , Ushiku Tetsuo 
Published: September 2021

Abstract

Esophageal neuroendocrine carcinoma (NEC) is a rare and aggressive subtype with a poor prognosis.
Pembrolizumab was recommended for the treatment of PD-L1 positive tumors in esophageal cancer and the combined positive score (CPS) was reported to be a better predictor of efficacy compared to the tumor proportion score (TPS).
We investigated the expression profile of potential therapeutic targets (PD-L1, HLA class I, Mismatch repair (MMR) proteins) and tumor infiltrating lymphocytes (TILs) in esophageal NEC.

Methods
15 NECs of the esophagus including mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) with squamous cell carcinoma (SCC) component were investigated in the study. The expression of PD-L1 (quantitatively evaluated by CPS and TPS), HLA class I, and MMR protein expression were examined immunohistochemically. TIL abundance was examined semiquantitatively by observation of H&E slides.

Results
Nine (60%) showed a CPS ≥ 1, five (33%) showed a CPS ≥10, and five cases showed a TPS ≥1. Survival analysis showed a significantly longer overall survival in the CPS ≥1 group than in the CPS &lt;1 group. Deficiency of MMR protein was not observed in any cases. HLA-Class I expression was retained in 10 (67%), and loss of HLA-Class I was significantly correlated with frequent lymph node metastasis, high TNM Stage, and low TIL. Three showed both PD-L1 CPS ≥ 10 and high TIL.

Conclusion
In esophageal NEC, PD-L1 positivity and preserved HLA-Class I expression were frequently observed, and PD-L1 CPS ≥ 1 was significantly associated with the better prognosis of esophageal NEC. Therefore, the PD-1/PD-L1 pathway and HLA-class I are thought to be potential therapeutic targets in esophageal neuroendocrine carcinoma.
831 VIDEO PRESENTATION LAPAROSCOPIC PARA-CONDUIT HERNIA REPAIR AFTER MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Tay K , Teng T , Aung M 
Published: September 2021

Abstract

The para-conduit hernia is a rare occurrence post minimally invasive esophagectomy. We present a case of asymptomatic para-conduit hernia diagnosed via surveillance CT scan and repaired successfully via a laparoscopic approach.

Methods
N/A.

Results
N/A.

Conclusion
N/A.

Video
https://drive.google.com/file/d/1v6ePGYbLe6BtI6l6B0nOaihLtXv6Mk-S/view?usp=sharing.
833 CLINICAL PATHWAY DEVELOPMENT AND IMPLEMENTATION FOR THE MANAGEMENT OF CHYLE LEAK FOLLOWING OESOPHAGECTOMY: THE OXFORD EXPERIENCE
Authors: Mastoridis S , Zanna A , Owen R , Antonowicz S , Sgromo B 
Published: September 2021

Abstract

Thoracic chyle leakage is a major and frequently encountered complication following oesophagectomy. The incidence of chyle leakage depends on the definition used and been reported to be as high as 20% among patients undergoing oesophagectomy. The sequalae can be severe and include hypovolemia, electrolyte disturbance, malnutrition, immune suppression, and increased mortality, thereby making prompt diagnosis and optimum management essential. Nevertheless, controversy remains surrounding the nature and timing of interventions.

Methods
Retrospective audit was performed of 227 consecutive patients undergoing oesophagectomy between October 2014 and April 2018 at the Oxford Oesophagogastric Centre. Following pathway implementation, data are being prospectively collected along with surveys of the experience and satisfaction of stakeholders.

Results
Chyle leak was treated in 29 (12.8%) post-operative patients. Females were over twice as likely to be treated for chyle leak (OR 2.31, P = 0.042), while age and length of operation showed no association. Chyle leak was associated with a failure to complete the ERAS pathway (P = 0.005), an increased length of stay (P = 0.0001) with the median length of stay being 4 days greater among the chyle leak group, and increased rates of readmission (P = 0.032).

Conclusion
Our data highlight the significant morbidity associated with thoracic chyle leakage. Upon review of best available evidence, a clinical pathway was developed for the early diagnosis and standardised management of chyle leak (Figure 1). The goal of the pathway is that patients achieve predetermined outcome within a specified time frame. Here we present our development and experience of the Oxford Oesophagogastric Chyle Leak Pathway and describe the particular challenges and interim outcomes of its implementation.
99 ESOPHAGECTOMY FOR THE PATIENTS WITH SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION
Authors: Kato Fumihiko , Daiko Hiroyuki , Kanamori Jun , Inamoto Yoshihiro , Fukuda Takahiro , Hayashi Koji , Tachimori Yuji , Koyanagi Kazuo 
Published: September 2021

Abstract

The number of long-term survivors after allogeneic hematopoietic stem cell transplantation (HSCT) has increased recently. Esophageal squamous cell carcinoma occurs at a particularly high incidence as a secondary cancer after HSCT. However, standard treatment for these patients has not been established yet. The objectives of this study were to investigate outcomes of esophagectomy for esophageal carcinoma developed in HSCT patients, and to provide the appropriate perioperative management.

Methods
Ten HSCT patients underwent esophagectomy for esophageal squamous cell carcinoma between December 2007 and September 2017. The surgical outcomes and long-term prognosis of these patients were reviewed retrospectively.

Results
In the former group, 5 of the 7 patients (71.4%) developed pneumonia after esophagectomy, with two of them requiring intubation because of respiratory failure. None of the three patients of the latter group, who received broad-spectrum antibiotics for more than 7 days after the surgery, developed any postoperative complications. The estimated survival probability of these patients at 5 years after the surgery was 53.3%.

Conclusion
HSCT patients have an extremely high risk of developing pneumonia after esophagectomy, and the condition can easily become serious. Therefore, broad-spectrum antibiotics should be administered prophylactically to prevent severe pneumonia during the perioperative period in these patients.
Rehabilitating the ELT conditional system
Authors: Burton Graham 
Published: September 2021

Abstract
The commonly used categorical system for conditionals (zero, first, second, and third) has been repeatedly demonstrated to be inadequate because it is unable to account for many conditional types attested in actual usage. ELT coursebooks and pedagogic grammars are criticized for ignoring the evidence and persisting with its use, but the reality appears to be that, from the point of view of syllabus designers and materials writers, the usefulness and practicality that the system offers outweighs any concerns related to its accuracy. This paper attempts to resolve this tension by showing how the existing system can be improved rather than simply abandoned. It proposes a revised categorization system that better reflects the reality of conditional usage and takes into account evidence on how learners’ knowledge of conditional forms expands and develops as they progress through proficiency levels, but that nonetheless can be practically employed in multi-level teaching materials and courses.
Distance as explanatory factor for sexual health centre utilization: an urban population-based study in the Netherlands
Authors: Twisk Denise E , Meima Bram , Nieboer Daan , Richardus Jan Hendrik , Götz Hannelore M 
Published: September 2021

Abstract

Background
The central sexual health centre (SHC) in the greater Rotterdam area in the Netherlands helps finding people unaware of their STI/HIV status. We aimed to determine a possible association between SHC utilization and travel distance in this urban and infrastructure-rich area. Insight in area-specific utilization helps adjust outreach policies to enhance STI testing.

Methods
The study population consists of all residents aged 15–45 years in the greater Rotterdam area (2015–17). We linked SHC consultation data from STI tested heterosexual clients to the population registry. The association between SHC utilization and distance was investigated by multilevel modelling, adjusting for sociodemographic and area-specific determinants. The data were also stratified by age (aged &lt; 25 years) and migratory background (non-Western), since SHC triage may affect their utilization. We used straight-line distance between postal code area centroid and SHC address as a proxy for travel distance.

Results
We found large area variation in SHC utilization (range: 1.13–48.76 per 1000 residents). Both individual- and area-level determinants determine utilization. Travel distance explained most area variation and was inversely associated with SHC utilization when adjusted for other sociodemographic and area-specific determinants [odds ratio (OR) per kilometre: 0.95; 95% confidence interval (CI): 0.93–0.96]. Similar results were obtained for residents &lt;25 years (OR: 0.95; 95% CI: 0.94–0.96), but not for non-Western residents (OR: 0.99; 95% CI: 0.99–1.00).

Conclusions
Living further away from a central SHC shows a distance decline effect in utilization. We recommend to enhance STI testing by offering STI testing services closer to the population.
Hyperosmotic medium partially restores the growth defect and the impaired production of sterigmatocystin of an Aspergillus nidulans ΔpmtC mutant in a HogA-independent manner
Authors: Le Thi Huynh Tram , Le Thy Nhan , Yoshimi Akira , Abe Keietsu , Imanishi-Shimizu Yumi , Shimizu Kiminori 
Published: September 2021

ABSTRACT
The protein O-mannosyltransferase catalyzes O-mannosylation in the endoplasmic reticulum by transferring mannose to the seryl or threonyl residues of substrate proteins. We previously reported a deletion mutant of O-mannosyltransferase C (ΔpmtC) in Aspergillus nidulans with impaired vegetative growth and sterigmatocystin (ST) production. In this study, we investigated whether osmotic conditions contribute to the developmental processes and ST biosynthesis of the ΔpmtC deletion mutant. We found that hyphal growth and ST production partially improved in the presence of NaCl, KCl or sorbitol as osmotic stabilizers. Conidiation of the ΔpmtC deletion mutant was not restored under osmotic stress conditions when the hogA gene was deleted. The hogA gene encodes a protein required for the cellular response to osmotic pressure. However, the yield of ST and the vegetative growth of the ΔhogA ΔpmtC double deletant was restored by high osmolarity in a HogA-independent manner.
Absence makes the mind grow stronger – Educating in a pandemic and beyond
Authors: Fahnert Beatrix 
Published: September 2021

ABSTRACT
With more than one academic year into the pandemic, it is timely to consider the lessons we learnt, and how they could shape education in the future. Papers from around the globe, reflecting on the directions we took and could take, were published in the FEMS Microbiology Letters virtual Thematic Issue ‘Educating in a pandemic and beyond' in October 2021. Its content is reviewed here to facilitate discussions within the professional community. Online platforms and tools, that allowed a rapid emergency response, are covered, as well as enhancing student engagement, complementing and blending in-person activities with online elements for more flexible and accessible learning opportunities, the need for educator training, and improving science literacy overall and microbiology literacy specifically. As we go forward, in order to benefit from blended and flexible learning, we need to select our approaches based on evidence, and mindful of the potential impact on learners and educators. Education did not only continue during the pandemic, but it evolved, leading us into the future.
Forest Fragmentation Slows the Decomposition of Coarse Woody Debris in a Subtropical Forest
Authors: Wu Chunsheng , Shu Chunjie , Zhang Zhijian , Li Yanyan , Zhang Yi , Liu Yuanqiu 
Published: September 2021

Abstract
Forest fragmentation is increasing rapidly around the world, and edge effects caused by fragmented forests can influence ecosystem functions and ecological processes, including coarse woody debris (CWD) decomposition. Understanding the influencing mechanisms of edge effect on CWD decomposition is needed to assess the effects of forest fragmentation on carbon cycling and storage. We measured rates of mass loss of CWD of Cinnamomum camphora (L.) Presl. and Pinus taiwanensis Hayata over two years at two distances (0−5 m versus 60 m) from a forest edge at two altitudes (215 and 1,400 m a.s.l.), in a subtropical forest. In addition, we determined the microbial community of each CWD segment and the soil beneath via phospholipid fatty acids (PLFAs). Mass loss of CWD 60 m from the forest edge was 15% greater than that at the edge (0–5 m). Mass loss was positively correlated with the abundance of microbial and fauna community and moisture content of the decaying CWD. Distance from edge explained 17.4% of the total variation of the microbial abundance in CWD. The results indicate that the reduced abundance of microbial and fauna communities and moisture content at forest edges influenced rates of decomposition of CWD. Long-term experiments with more tree species and more forest types are needed to better assess edge effects generally.
The molecular architecture ofDrosophila melanogasterdefense againstBeauveria bassianaexplored through evolve and resequence and quantitative trait locus mapping
Authors: Shahrestani Parvin , King Elizabeth , Ramezan Reza , Phillips Mark , Riddle Melissa , Thornburg Marisa , Greenspan Zachary , Estrella Yonathan , Garcia Kelly , Chowdhury Pratik , Malarat Glen , Zhu Ming , Rottshaefer Susan M , Wraight Stephen , Griggs Michael , Vandenberg John , Long Anthony D , Clark Andrew G , Lazzaro Brian P 
Published: September 2021

AbstractLittle is known about the genetic architecture of antifungal immunity in natural populations. Using two population genetic approaches, quantitative trait locus (QTL) mapping and evolve and resequence (E&R), we explored D. melanogaster immune defense against infection with the fungus Beauveria bassiana. The immune defense was highly variable both in the recombinant inbred lines from the Drosophila Synthetic Population Resource used for our QTL mapping and in the synthetic outbred populations used in our E&R study. Survivorship of infection improved dramatically over just 10 generations in the E&R study, and continued to increase for an additional nine generations, revealing a trade-off with uninfected longevity. Populations selected for increased defense against B. bassiana evolved cross resistance to a second, distinct B. bassiana strain but not to bacterial pathogens. The QTL mapping study revealed that sexual dimorphism in defense depends on host genotype, and the E&R study indicated that sexual dimorphism also depends on the specific pathogen to which the host is exposed. Both the QTL mapping and E&R experiments generated lists of potentially causal candidate genes, although these lists were nonoverlapping.
Impact of socio-economic characteristics on energy consumption behaviors of suburban rural residents: evidence from on-site surveys in the Guanzhong Plain of China
Authors: Liu Xiaojun , Zhang Min , Luo Xi , Wang Peng , Mu Ting , Ming Hui , Hu Deze , Zhao Tianliang , Yang Yanzi 
Published: September 2021

Abstract
Traditionally, residents in rural areas of Guanzhong Plain used to burn bulk coal for cooking and space heating, creating serious environmental challenges. With the stable development of rural economy in China, more and more rural residents have begun to adopt clean and green energy consumption mode, starting from suburban rural areas. Therefore, the energy consumption behaviors of residents in suburban rural areas exhibit the dual characteristics of urban and rural energy consumption. This study conducted an on-site survey of energy consumption behaviors of residents and their influencing factors in typical suburban rural areas in the Guanzhong Plain. A total of 554 valid questionnaires were obtained in this investigation, which were used to assess the behaviors and habits of local residents with respect to different energy consumption activities, such as cooking, space cooling/heating, laundry, etc. The results showed that the energy consumption behaviors of residents in investigated suburban rural areas were different from either traditional Chinese rural areas or typical Chinese urban areas, in terms of energy type and usage habits. The two most significant household characteristics affecting energy consumption behavior are income level and family structure.
Plasma cell generation during T-cell-dependent immune responses
Authors: Ise Wataru , Kurosaki Tomohiro 
Published: September 2021

Abstract
Plasma cells are terminally differentiated from activated B cells and are specialized for secreting antibodies, which are essential effector molecules in humoral immunity to neutralize invading pathogens. Upon challenge with T-cell-dependent antigens, plasma cells can be generated during the primary extrafollicular response, the germinal center (GC) response or the secondary memory response. Recent studies have revealed that plasma cell generation is regulated not only by several key transcription factors but also by epigenetic modifications. In addition, the differentiation of GC B cells toward a plasma cell fate is associated with affinity for antigens and is determined by the strength of contact with T follicular helper cells.