bluuebunny/crossref_metadata_2025_split huggingface dataset:
Change from Hybrid to Fully Minimally Invasive and Robotic Esophagectomy is Possible without Compromises
Authors: Grimminger P. P. , Tagkalos E. , Hadzijusufovic E. , Corvinus F. , Babic B. , Lang H. 
Published: September 2018

Background The incidence of esophageal carcinoma is increasing in the western world, and esophageal resection is the essential therapy. Several studies report advantages of minimally invasive esophagectomies (MIEs) versus conventional open procedures (OPs). The benefits of the use of fully MIE or robot-assisted MIE (RAMIE) compared with the hybrid approaches (laparoscopic gastric preparation and open transthoracic esophagectomy) remain unclear.
Methods Between July 2015 and August 2017, the data of 75 patients with esophageal carcinoma were prospectively registered. Of the 75 patients, 25 treated with a hybrid MIE (hybrid), 25 with total MIE (MIE), and 25 with RAMIE. All patients were operated by the same specialized surgeon in our center with an identical anastomotic technique (circular stapler).
Results The overall 30- and 90-day mortality rates were 0 and 1.33% (1/75), respectively. Total hospital stay (p = 0.262), intensive care unit stay (p = 0.079), number of resected lymph nodes (p = 0.863), and R status (p = 0.132) did not differ statistically between the groups. However, pneumonia and wound infections occurred significantly and more frequently in the hybrid group compared with the minimally invasive groups (MIE and RAMIE) (p = 0.046 and p = 0.003, respectively).
Conclusion Comparable results regarding morbidity and short-term outcome could be achieved in the MIE and RAMIE groups compared with the hybrid group. The data indicate that the learning curve is low in surgeons changing the technique form hybrid esophagectomy to fully MIE. Additionally, the total minimally invasive approaches seem to be associated with a low incidence of complications such as pneumonia and wound infections.
Allgemeinpsychiatrie: gibt es das noch?
Authors: Bandelow B. , Wobrock T. , Falkai P. , Wedekind D. 
Published: September 2018

ZusammenfassungDie umfassenden Entwicklungen in der biologisch orientierten Psychiatrie haben konsequenterweise zu einer zunehmenden Spezialisierung des Fachgebiets geführt, die eine allgemeine Psychiatrie zunehmend aus dem Leistungsportofolio der klinischen Versorgung zu drängen droht. Psychiatrische Störungen gehören heute weltweit zu den Erkrankungen mit der höchsten und nachhaltigsten Einschränkung von Lebensqualität. Die immer noch große Anzahl chronifizierter Patienten stellen eine enorme gesundheitsökonomische und gesellschaftliche Herausforderung an eine Psychiatrie, die zunehmend evidenzbasiert und biologisch orientiert handelt. Eine effektive und effiziente Pharmakotherapie spielt hierbei eine wesentliche Rolle. Exemplarisch sollen hier neuere Entwicklungen anhand der leitliniengerechten Pharmakotherapie dreier großer Störungsgruppen, der Schizophrenie, der Depression und der Angststörungen dargestellt werden. Neben den klassischen Pharmaka spielen zunehmend Substanzen mit einem neuen Wirkprinzip dabei eine Rolle. In der Therapie der Schizophrenie wird in den neueren Leitlinien der Vorteil der Antipsychotika der zweiten Generation (sogenannten Atypika) weiter relativiert und mehr unter Aufhebung des generellen Klasseneffektes auf ein individuelles Therapieregime unter Abwägung des individuellen Risiko-Nutzen-Verhältnisses verwiesen. Während in der Therapie der generalisierten Angststörung zunehmend Pregabalin eingesetzt wird, ist in der Therapie der unipolaren Depression mit Agomelatin das erste Präparat auf dem Markt, das durch den Agonismus am Melatoninrezeptor antidepressiv wirkt. Bei den Stimulationsverfahren gewinnt zunehmend die Vagusnervstimulation (VNS) bei medikamentöser Therapieresistenz an Bedeutung.
Anhaltende wahnhafte Störungen
Authors: Marneros A. 
Published: September 2018

ZusammenfassungAnhaltende wahnhafte Störungen sind eine Gruppe von psychischen Störungen, die als einziges prominentes Symptom einen in der Regel monothematischen Wahn haben. Andere psychische Funktionen oder Bereiche der Persönlichkeit sind primär nicht in Mitleidenschaft gezogen. Die Kategorie der anhaltenden wahnhaften Störungen hat in den modernen diagnostischen Systemen die alte Kategorie der Paranoia abgelöst. Es wird diskutiert, ob die moderne Psychiatrie eine solche Kategorie noch benötigt oder ob es sich bei den genannten Störungen um eine Unterform schizophrener Erkrankungen handelt. Die verfügbaren Daten sprechen eindeutig für die Autonomie und Autochthonie der anhaltenden wahnhaften Störungen. Sie unterscheiden sich auf verschiedenen Ebenen signifikant von schizophrenen Störungen. Ihre Entstehung bleibt jedoch ein Rätsel. Die Befunde der verschiedenen Erklärungsansätze, wie etwa phänomenologisch-dynamische, psychodynamische, persönlichkeitspsychologische, neuropsychologische oder biologisch-genetische, haben noch keine Generalisierungsvalenz. Obwohl man sicher sein kann, dass anhaltende wahnhafte Störungen als eine autonome Störung bezeichnet werden können, stellen die besonders schwierige Prognose und Therapie sowie die rätselhafte Entstehung eine besondere Herausforderung für Klinik und Forschung dar.
Psychotische Depression: Unterscheidungsmerkmale zur nicht-psychotischen Depression
Authors: Pilhatsch M. , Jabs B. , Bauer M. 
Published: September 2018

ZusammenfassungPsychotische Major Depressionen zeichnen sich gegenüber schweren depressiven Episoden ohne psychotische Symptome nicht nur durch das Vorliegen bestimmter inhaltlicher Denkstörungen oder Wahrnehmungsstörungen aus, sondern zeigen auch in ihren klinischen Erscheinungsbildern, ihren Verläufen, ihrer ätiologischen und epidemiologischen Faktoren sowie ihrer Therapiemöglichkeiten einige Besonderheiten. Im Vergleich mit einer schweren nicht-psychotischen Depression ist der Krankheitsverlauf hinsichtlich Symptomausprägung, Rezidivneigung, Residualsymptomen, Episodendauer, Gesamtbeeinträchtigung, Komorbiditäten und Mortalität schwerwiegender. Im vorliegenden Artikel werden epidemiologische Daten, Studien zu Verlauf, Symptomkonstellationen, Neurobiologie und Therapie auf die Frage hin untersucht, ob es sich bei der psychotischen Depression um eine eigenständige Krankheitsentität handelt und eine Stellung zwischen den affektiven und den schizophrenen Psychosen in einem gedachten „schizoaffektiven Spektrum“ einnimmt.
Kicking foot swing planes and support leg kinematics in rugby place kicking: Differences between accurate and inaccurate kickers
Authors: Bezodis Neil E. , Atack Alexandra , Willmott Alexander P. , Callard Jon E. B. , Trewartha Grant 
Published: September 2018

AbstractPlace kicking is a complex whole‐body movement that contributes 45% of the points scored in international Rugby Union. This study compared the kicking foot swing plane characteristics of accurate and inaccurate kickers, underpinned by differences in their support leg and pelvis kinematics at support foot contact, to identify key technique characteristics. Motion capture data (240 Hz) were collected from 33 experienced kickers, and distinct groups of accurate (n = 18) and inaccurate (n = 8) kickers were identified based on their performance characteristics. All accurate kickers were capable of kicking successfully from at least 33.3 m, whereas all inaccurate kickers would have missed left from distances greater than 30.7 m. The accurate group exhibited a moderately shallower swing plane inclination (50.6 ± 4.8° vs. 54.3 ± 2.1°) and directed the plane moderately further to the right of the target (20.2 ± 5.4° vs. 16.7 ± 4.1°). At support foot contact, the accurate group placed their support foot moderately less far behind the ball (0.08 ± 0.08 m vs. 0.12 ± 0.04 m) and positioned their centre of mass moderately further to the support leg side (0.77 ± 0.07 m vs. 0.72 ± 0.01 m) due to a moderately greater stance leg lean (29.3 ± 4.1° vs. 26.8 ± 3.2°). The kicking foot swing plane is highly planar in rugby place kicking but its orientation differs between accurate and inaccurate kickers. These plane characteristics may be controlled by support foot placement and support leg and pelvis kinematics at support foot contact.
FA05.05: PROLONGED LAPAROSCOPIC GASTRIC ISCHEMIC CONDITIONING PRIOR TO ESOPHAGECTOMY IN PATIENTS OF ESOPHAGEAL CANCER: FEASIBILITY AND CLINICAL SIGNIFICANCE
Authors: Raja Kalayarasan 
Published: September 2018

Abstract

Background
The studies on gastric ischemic preconditioning in improving blood flow to the distal gastric conduit and reducing the incidence of anastomotic complications have yielded variable results. Lack of adequate time interval between gastric ischemic preconditioning and esophagectomy has been postulated as one of the reasons for lack of clinical benefit. Hence the present study was done to evaluate the feasibility and clinical outcome of prolonged gastric ischemic conditioning prior to esophagectomy.

Methods
Patients with locally advanced squamous cell carcinoma of the esophagus planned for neoadjuvant chemoradiotherapy followed by esophagectomy and gastric pull through were included in the prospective study. Prior to initiation of neoadjuvant therapy laparoscopic feeding jejunostomy with ischemic preconditioning by the ligation of left and the short gastric vessel was performed. All patients underwent thoracolaparoscopic esophagectomy with two field esophagectomy and cervical esophagogastric anastomosis using modified Orringer technique. Radiological assessment of the caliber of the right gastroepiploic artery (RGEA) and Immunohistologic analysis of Hypoxia-inducible factor – 1 alpha (HIF-1alpha) expression in the fundus to determine the degree of neovascularization was performed after ischemic preconditioning. The feasibility of laparoscopic gastric mobilization post ischemic preconditioning and cervical anastomotic leak rate was documented and compared with patients who did not undergo ischemic preconditioning.

Results
Fifteen patients underwent thoracolaparoscopic esophagectomy after a median time of 124 days post laparoscopic gastric ischemic preconditioning. Minor adhesions present in the gastrosplenic region did not interfere with laparoscopic gastric mobilization. The mean pre-ischemic conditioning diameter of RGEA increased from 2.18 mm to 2.25 mm post ischemic conditioning (P = 0.21). The median HIF-1 alpha index post ischemic conditioning was 0.6. The cervical anastomotic leak rate was less in patients who underwent ischemic preconditioning (1/14, 7.1%) compared to the patients who did not undergo ischemic preconditioning (6/16, 37.5%), although the difference was not statistically significant (P = 0.24)

Conclusion
Prolonged gastric ischemic preconditioning prior to esophagectomy is safe and does not interfere with laparoscopic gastric mobilization. It can potentially reduce cervical anastomotic complications post neoadjuvant chemoradiotherapy.

Disclosure
All authors have declared no conflicts of interest.
FA06.02: OPTIMAL EXTENT OF LYMPH NODE DISSECTION FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Chen Long-Qi , Yang Yu-Shang 
Published: September 2018

Abstract

Background
The possible presence of occult tumor dissemination is the rationale of radical systematic lymphadenectomy. Theoretically, the more extent of lymphadenectomy, the more similar survival outcomes between node-negative and node-positive patients. Accordingly, there will be a certain number of examined lymph nodes (NELN) for patients with only one tumor-positive lymph node that can equal their survival with the node-negative patients, and this cut-off point should be define the minimal requirement for an adequate extent of lymphadenectomy. The aim of this report was to determine the optimal number of examined lymph nodes (NELN) dissection for esophageal squamous cell carcinoma (ESCC) by this novel method.

Methods
We retrospectively reviewed 589 ESCC patients from June 2011 and July 2012. Among them, 372 patients were pathologically confirmed with node-negative (N 0 + ), and 217 patients with only one tumor-positive lymph node (N 1 + ). Comparison of overall survival were performed using the Kaplan-Meier method. Cox regression hazard model was used for multivariate analysis to assess the independent influence of NELN on overall survival.

Results
The median survival for N 0 + and N 1 + patients was 32 versus 23 months (HR 1.61; 95% CI 22.86- 29.148; P = 0.000). Survival analyses revealed that the NELN positively correlated with overall survival (OS) both for patients with N 0- (P = 0.024) and N 1 + (P = 0.046), and an independent prognostic predictor only for N 0 + patients (hazard ratio 0.984; P = 0.032). When the cut-off point of NELN was set as a value less than 18, stratum analysis within the Kaplan–Meier method showed that NELN did not affect the results that N 1 + patients have a worse overall survival as compared with N 0 + patients (P < 0.05). However, stratum analysis showed that no significant difference in OS was observed between N 1 + and N 0 + patients when the NELN was greater than 18.

Conclusion
The NELN should be considered a mandatory requirement for improving the OS of ESCC patients. The minimum of 18 lymph nodes removed for ESCC is rational and should be complied with.

Disclosure
All authors have declared no conflicts of interest.
FA07.03: TRACHEO-BRONCHO-ESOPHAGEAL FISTULAE: THE NEW EPIDEMIC?
Authors: Gust Lucile , Trousse Delphine , Brioude Geoffrey , Dutau Herve , Doddoli Christophe , Benoit D’Journo Xavier , Thomas Pascal 
Published: September 2018

Abstract

Background
Acquired Tracheo-broncho-esophageal fistulae of the adult are uncommon, severe and require a complex management associating medical, endoscopic and surgical treatment.

Methods
From January 2013 to December 2017, we conducted a monocentric, retrospective study on the etiology, the diagnosis and the management of acquired tracheo-broncho-esophageal fistulae.

Results
During the last 5 years, 29 consecutive acquired tracheo-broncho-esophageal fistulae were diagnosed in our department (23 men and 6 women), of which 2 malignant fistulae. Sixteen appeared in the early postoperative period after esophagectomy (From 7 to 63 days), and two more later at post-operative day 150 and 154 days. The other 10 tracheo-broncho-esophageal fistulae had variable etiologies: post-radiation (5), traumatic (4), severe reflux. Clinical presentation were of variable severity as well. Six patients were asymptomatic, the fistula diagnosed on systematic radiological or endoscopic examinations. The other patients had respiratory and infectious symptoms, going from iterative pneumopathy to acute respiratory distress with septic shock. The management was complex and specific to each patient, but 3 situations can be described:
1. Endoscopic treatment (7)
2. Surgical treatment, more or less followed by an endoscopic treatment (7)
3. Multiple endoscopic treatment, followed by surgery (13).
Regardless of the treatment, the mortality rate was extremely high, 12 patients out of 27 dying in the early follow-up (44,4%).

Conclusion
The incidence of acquired tracheo-broncho-esophageal fistulae seems to be increasing, especially after esophagectomy. Their treatment is different than from the usual anastomotic fistula. Multimodal management is associated with patient death in about half of the cases. Endoscopic treatment allows the stabilisation of patients in a precarious clinical situation, but where the immediate results can be satisfactory it can later on lead to chronic and harmful situations. Surgery remains the cornerstone of the treatment.

Disclosure
All authors have declared no conflicts of interest.
FA07.05: VLS ONE-WAY VALVE: A MINIMALLY INVASIVE SURGERY FOR GASTROESOPHAGEAL REFLUX
Authors: Macaione Ina , Longo Antonio , Crafa Francesco , Fiorentino Eugenio 
Published: September 2018

Abstract

Background
Fundoplication, the standard antireflux surgery, suffers from the risks of side effects; to improve the results an alternative surgery, less invasive and more effective, was proposed by Longo. The aim of our study is to evaluate whether the technique of the ‘anterior one-way valve’ has resulted in lower complications and better functional results than total or partial fundoplication.

Methods
Between 2004 and 2009, 70 patients were operated with the Longo technique in Vienna. The technique consists of the transversal invagination of the anterior gastric wall: from the Z line to 8–10 cm caudally and from the lesser curvature to the angle of His. An anti-reflux valve, dome-shaped, is obtained on the cardias. An anterior hiatoplasty is added in case of diaphragmatic hiatus dilatation. The one-way valve impedes the reflux and at the same time it doesn’t cause gas-bloat syndrome or dysphagia. Moreover, the technique pulling down the esophagus in the abdominal cavity, prevents the hiatal hernia relapse.

Results
No patient required redo-surgery, presented a gas-bloat syndrome in the perioperative phase and after a long interval, neither symptoms of dysphagia at long terms. All the patients showed a general improvement in QoL up to 40.3%. The intervention reduced esophageal acid exposure and the esophagitis improved in all the patients. Patients with GERD recurrence at 5 years showed in 1 case grade B esophagitis and in 2 cases injuries attributed to grade A.

Conclusion
The technique of the anterior one-way valve creates a one-way valve system without any interference on the dynamics of the LES, allowing both the relaxation after swallowing, with almost no postoperative dysphagia, and TLESR with inherent possibility of belching and vomiting. The results are effective on the general state of health of the patients and on the objective check of gastroesophageal reflux endoscopically detected. The advantages of this new approach are made evident by the simplicity and speed of the operation associated with a mortality rate of 0%, low morbidity, no gas bloat syndrome or dysphagia.

Disclosure
All authors have declared no conflicts of interest.
FA07.06: PERSISTENT DYSPHAGIA IS A RARE PROBLEM AFTER LAPAROSCOPIC NISSEN FUNDOPLICATION
Authors: Nikolic Milena , Schwameis Katrin , Semmler Georg , Asari Reza , Semmler Lorenz , Steindl Ariane , Mosleh Berta , Schoppmann Sebastian 
Published: September 2018

Abstract

Background
Although around 30% of patients with gastroesophageal-reflux disease (GERD) are insufficiently treated with medical therapy, only 1% opt for surgical therapy. One of the reasons behind this multifactorial phenomenon is the described adverse effect of long term dysphagia or gastric bloating syndrome after surgical treatment. Aim of this study was to evaluate the most common side effects associated with anti-reflux surgery, as well as long term outcomes in a large cohort of highly surgically standardized patients after laparoscopic Nissen fundoplication (LNF).

Methods
Out of a prospective patients database including all patients that underwent anti-reflux surgery between 01/2003 and 01/2017 at our institution, 350 consecutive patients after highly standardized LF were included in this study. A standardized interview was performed by one physician assessing postoperative gastrointestinal symptoms, proton pump inhibitor intake (PPI), GERD-Health-related-Quality-of-Life (GERD-HRQL), Alimentary Satisfaction (AS), and patients overall satisfaction.

Results
After a median follow-up of 4 years, persistent dysphagia (PD) after LNF was observed in 8 (2%) patients, while postoperative gas-bloat syndrome in 45 (12.7%) cases. Endoscopic dilatation was needed in 7 (2%) patients due to dysphagia, and 19 (5%) patients underwent revision surgery due to recurrence of GERD. The postoperative GERD-HRQL total score was significantly reduced (2 (IQR, 0–4.3) vs. 19 (IQR, 17–32); P < 0.000) and the median alimentary satisfaction (AS) was 9/10. Heartburn relief was achieved in 83% of patients. Eighty-three percent of patients were free of PPI intake after follow up, whereas 4% of the patients reported irregular PPI-use.

Conclusion
LNF is a safe and effective surgical procedure with low postoperative morbidity rates and efficient GERD-related symptom relief. PD does not represent a relevant clinical issue when LNF is performed in a surgical standardized way. These results should be the benchmark to which long-term outcomes of new surgical anti-reflux procedures are compared.

Disclosure
All authors have declared no conflicts of interest.
FA08.03: PREOPERATIVE SARCOPENIA INFLUENCES THE RISK OF POSTOPERATIVE PNEUMONIA IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Tamura Tatsuro , Sakurai Katsunobu , Toyokawa Takahiro , Kubo Naoshi , Amano Ryosuke , Tanaka Hiroaki , Muguruma Kazuya , Yashiro Masakazu , Maeda Kiyoshi , Hirakawa Kosei , Ohira Masaichi 
Published: September 2018

Abstract

Background
Exact measurement of muscle mass is enabled by body composition analyzer, and it is reported that a body composition affects the perioperative outcomes. In this study, we investigated the relationship between depletion of preoperative muscle mass (sarcopenia) and postoperative outcomes in patients with esophageal cancer treated esophagectomy.

Methods
A total 58 esophageal cancer patients who underwent esophagectomy between January 2014 and January 2018 were enrolled. Preoperative muscle mass was evaluated by InBody-3.0 and S-10 which is body composition analyzer and expressed as muscle mass index; MMI (kg/m2) by dividing the muscle mass by the height in meters squared. The cut off values of MMI were the gender-specific lowest 20%, and we defined low MMI as sarcopenia. Postoperative complications were graded according to the Clavien-Dindo classification, univariate and multivariate analysis were performed for postoperative pneumonia. About the pneumonia, we defined that invasive shadow was observed by X-ray or CT and bacteria detected by sputum culture.

Results
By the definition of sarcopenia in this study, sarcopenia was determined in 11 patients (19%). Sarcopenia was significantly correlated with lower body weight (P < 0.001), lower body mass index (P < 0.001), the VC% (P = 0.0178). In other factors, there is no significant difference between sarcopenia and non-sarcopenia groups. Compared with non-sarcopenic patients, sarcopenic patients had a higher risk of postoperative pneumonia and chylothorax (P = 0.0144 and P = 0.0105). For other complications, the differences were not significant. In univariate analysis, sarcopenia (P = 0.0144), hypoalbuminemia (P = 0.0236), operative blood loss (P = 0.0436) were associated with postoperative pneumonia. Multivariate analysis revealed that sarcopenia (P < 0.001) and longer operation time (P = 0.0354) were independent predictors of postoperative pneumonia.

Conclusion
Preoperative sarcopenia was identified as independent risk factor for postoperative pneumonia after esophagectomy. Preoperative nutrition and rehabilitation therapy may contribute to the prevention of pneumonia after surgery.

Disclosure
All authors have declared no conflicts of interest.