bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in mechanical power output in rowing by varying stroke rate and gearing
Authors: Held Steffen , Siebert Tobias , Donath Lars 
Published: June 2019

AbstractEach stretch‐shortening‐cycle (SSC) in elite sports (e.g. jumping, cycling), is characterised by utilising optimal movement‐parameters (e.g. muscle shortening velocity), for maximum power (jump height, cycle velocity). It is however unclear if relevant SSC movement‐parameters in rowing, such as stroke rate and gearing, have to be maximised to obtain maximum power output or if an optimum relation emerges. Thus, we measured rowing‐power (Prow), leg‐power (Pleg) and work‐per‐stroke (WPS) at of varying stroke rates (20–45 spm), gearings (lever‐changes 0.87–0.90 m) and drag factors (100–180 Ws3/m3) during rowing. Experienced sub‐elite young athletes performed sprint‐series on (single scull, n = 69, 20 ± 2 years, 186 ± 7 cm, 84 ± 9 kg) and off the water (rowing‐ergometer, n = 30, 19 ± 3 years, 185 ± 11 cm, 77 ± 19 kg). Prow increased with stroke rate for ergometer‐test (r = 0.97, p < 0.001) and boat measurement (r = 0.98, p < 0.001) by 2.7%/stroke and 4.4%/stroke, respectively. Interestingly, stroke rate had a high impact on WPS (r = 0.79, p < 0.001) during boat measurement, compared to no (or specifically no high) impact on WPS (r = −0.10, p = 0.166) during ergometer‐measurements. Drag factor (ergometer: r = 0.83, p < 0.001) and gearing (boat: r = 0.60, p < 0.001) yielded moderate to high correlations to Prow. These results indicate that no optimum stroke rate, gearing and drag factor exist for maximum power in rowing (sprint‐measurement‐range). Accordingly, the measurements yielded maximum power for maximum stroke rate, gearing, and drag factor.
DOZ047.01: Risk factors for anastomotic strictures in the first year after esophageal atresia repair: data from a prospective multicentric cohort
Authors: Aumar M , Rousseau V , Bonnard A , Sfeir R , Gelas T , Boubnova J , Jacquier C , Irtan S , Breton A , Guinot A , Lamireau T , Fouquet V , Habonimana E , Schneider A , Elbaz F , Ranke A , Polimerol M L , Allal H , Michel J L , Buisson P , Petit T , Sapin E , Lopez M , Levard G , Schmitt F , Lardy H , Borderon C , Jaby O , Breaud J , Pelatan C , Auber F , Tolg C , De Vries P , Pouzac M , Grosos C , Geiss S , Laplace C , Pierache A , Gottrand F , Michaud L 
Published: June 2019

Abstract

Objectives and study
Anastomotic stricture (AS) is a frequent complication of the surgery for œsophageal atresia (OA) during the first year of life. The primary objective of this study was to evaluate the prevalence of AS before 1 year old in infants with type A and C OA who were operated on. Secondary objectives were to determine risk factors for AS in OA, for recurrent and refractory AS, and to establish if AS is associated with antireflux surgery.

Methods
A prospective national multicentric study was conducted including all infants born with OA between 2008 and 2015. Patients deceased before one year old, OA types B and E, and patients for whom data about AS were missing were excluded from the study. Data were collected at birth and at 12 months of age. Anastomosis under tension was defined by the surgeon and a delayed anastomosis was defined by an anastomosis after 15 days of life. Recurrent stricture was defined by the need of ≥3 dilations and refractory stricture was defined by the need of ≥5 dilations. Univariate and multivariate statistical analyses were conducted.

Results
Of the 1258 eligible patients (84%), 1054 were included in the study from 38 centers. The prevalence of AS in the first year of life was 23.3% [20.7–28.9]. Anastomosis under tension (AUT) and delayed anastomosis (DA) were found to be independent risk factors for AS (respectively 2.5 [1.73–3.45] and 3.7 [1.95–7.2] (OR [CL 95%])) in the total population. Neither sex, birth weight, prematurity, intrauterine growth retardation, associated malformations, type A OA, nor the type of surgical approach was a risk factor for AS. In type C OA, DA was the only risk factor for AS (OR: 3.1 [1.65–5.86]). The group with AS had 2.5-fold more fundoplication compared to the patients without AS (P = 0.0005) in the total population and in type C OA. AUT and DA were found to be independent risk factors for recurrent stricture (OR: 2.4 [1.47–3.9] and 4.7 [2.2–10.4], respectively) and DA was the only risk factor for refractory stricture (OR: 6.23 [2.4–16.2]).

Conclusion
Surgical factors at the time of first repair of OA are the only risk factors for AS.
DOZ047.08: Endoscopic management of esophageal stenosis in patients with congenital esophageal atresia: experience of a single tertiary care center in Italy
Authors: Deganello Saccomani M , Bortolotti V , Gastaldi A , Camoglio F S , Piacentini G , Banzato C 
Published: June 2019

Abstract

Objective and Study
Esophageal stenosis is the most common morbidity associated with congenital esophageal atresia (EA). There is no consensus regarding the endoscopic management of strictures in terms of timing and techniques of dilations. The aim of this study is to describe the endoscopic management of esophageal stenosis in children with EA admitted to our tertiary care center.

Methods
A retrospective descriptive single-center study was conducted. Data were collected of all patients diagnosed with EA admitted to the ‘Women's and Children's Hospital’ of Verona, Italy, between 2004 and 2017.

Results
Thirty-seven patients with EA were admitted to our center between 2004 and 2017. Twenty of them were excluded for insufficient data. All patients underwent surgical correction within 2 months of life. An endoscopic control with upper gastrointestinal endoscopy was performed in all of them. Eleven (65%) subjects had tracheoesophageal fistula. All of them had type C EA. Three (18%) had long-gap EA. Eleven patients (65%), 8 with Type C EA and 3 with Type A EA, underwent endoscopic dilation. Semirigid Savary-Giliard bougies were used in most of them. Pneumatic dilation with balloon was performed only in one case. Nine (81%) needed more than one dilation due to anastomotic stricture recurrence. In 3 of the 11 subjects (27%) more than 3 dilations were necessary. Two of them had long-gap EA. The median age of first endoscopic dilation was 3 months (range: 1–12 months). The median age of the last dilation was 6 months (range: 1–18 months). One of the 11 patients who underwent dilations (Type C EA with long gap) underwent surgical retreatment due to fistula recurrence. Six of the 17 subjects (35%) enrolled developed long-term complications.

Conclusion
Our data confirmed that anastomotic stricture is frequent in patients with EA who underwent surgical correction. Endoscopic management of stenosis is a safe and effective procedure that leads to a limited number of complications. Side effects are more likely to occur in patients with long-gap EA. Timing of dilations and endoscopic technique should be defined by international guidelines in order to improve patient's outcome.
DOZ047.101: Preclinical studies of tissue engineering for long-gap esophageal atresia in pigs. A systematic literature review
Authors: Garrido M , Phylactopoulos D-E , De Coppi P , Bonfanti P 
Published: June 2019

Abstract

Introduction
Current approaches for esophageal substitution in long-gap esophageal atresia (LGEA) are associated with complications that impact quality of life. Tissue-engineered (TE) esophagus appears as a promise to overcome these issues. The pig has been used as large-animal model to test TE esophagus before its clinical application. Different approaches have been reported. This study aims at conducting a systematic review of TE approaches for complete esophageal defects in pigs.

Materials and Methods
This work was registered in PROSPERO (ID 127838). A systematic literature review was performed following SYRCLE’s guidelines, using the CAMARADES-NC3Rs platform (SyRF). PubMed and OpenGrey databases were reviewed identifying articles on complete esophagus defects in pigs restored by TE. The analyses of bias and 3Rs were based on the ARRIVE guidelines.

Results
In the period 2009–2018, 14 articles were identified using pigs as a model for a TE approach in complete esophageal defects. Animal age/weight/sex, size/localization of the defect, TE strategy, follow-up, and outcomes greatly differ among different studies. Few studies report strategies to improve 3Rs and internal validation.

Discussion
Further studies in LGEA preclinical models should be performed in an attempt to create a defect in the intrathoracic esophagus. Methodological design may help to avoid bias and define strategies related to the 3Rs. TE approaches with best results include the use of different cell populations seeded in scaffolds that are maturated in bioreactors before their implantation. The next questions to be addressed are developing techniques to avoid stent migration and promoting regeneration of the enteric nervous system.
DOZ047.102: Previously undescribed association of esophageal atresia, congenital microgastria, and pyloric atresia: a difficult case of ‘pure’ atresia.
Authors: Laughlin D Mc , Sue T , Thambipillai S P 
Published: June 2019

Abstract
This study reports the case of a male infant born at full term with antenatal suspicion for esophageal atresia (EA). At birth inability to pass a feeding tube and a gasless abdomen on plain film X-ray led to the diagnosis of pure EA according to international guidelines. In the first week of life a stomach could not be identified at surgery for open gastrostomy and a feeding jejunostomy was formed. Subsequent investigations including CT scan did not detect the presence of a stomach. Cervical esophagostomy was performed at 8 weeks old as there was no expectation of achieving an esophageal anastomosis and a deviated septum had complicated the placement of nasal tubes for management of the proximal esophageal pouch. At 6 months of age esophageal replacement with a jejunal pull-up graft was undertaken as staged surgery. At mobilization of a large midline liver to expose the hiatus, a microstomach was revealed, in association with a type 2 pyloric atresia (PA) and a distal tracheoesophageal fistula (TEF). Following ligation of the TEF by lateral thoracotomy, the TEF and microstomach were resected and the jejunal pull-up graft was completed. Discharge home was achieved 1 month post-op. Oral intake was established for solids by 1 year of age. The patient is thriving at 4 years of age with additional overnight jejunal feeds. A unifying genetic diagnosis has not been made to date. Congenital microgastria or PA has been described to co-exist with EA but never previously have all these anomalies been reported occurring together. This unique scenario permitted the distal TEF to be clinically silent and present as a pure atresia. In turn congenital microgastria together with a diagnosis of pure EA obscured the presence of PA, which classically presents with vomiting of feeds and massive gastric distension. Investigations, and in particular cross-sectional imaging, were on the whole unhelpful. This case illustrates that correct diagnosis in this complex case ultimately could only be made at the time of definitive surgery.
DOZ047.108: Utilizing dynamic CT imaging to map tissue regeneration in a porcine model of esophageal loss
Authors: Jensen T , Sharma I , Fodor W , Sundaram S , Roffidal T , Finck C 
Published: June 2019

Abstract
Esophageal atresia (EA) is a congenital defect in which the esophagus is not fully connected. Current treatments to bring together long gaps between the esophagus have very high complication rates and the replacement tissue does not possess the correct structure or physiologic properties. Tissue engineering and regenerative medicine have been suggested as a new patient-specific treatment for EA utilizing the patient's own cells and a tubular scaffold. Our group recently published on the successful regeneration of an esophagus using a retrievable scaffold seeded with amniotic derived MSCsFurther evaluation with dynamic computed tomography has suggested that the regenerative process entails ingrowth of native esophageal cells from both proximal and distal ends including robust vascular ingrowth. This confirms our gene expression findings and lends support to our hypothesis that the regenerative process is driven by vascular ingrowth. The role of the cells seeded on esophageal scaffolds and how this affects the regenerative process is the focus of current investigation with animal studies that are ongoing.
DOZ047.122: Inadequate response of atretic esophagus during acidic gastroesophageal reflux
Authors: Scaillon M , Cadranel S 
Published: June 2019

Abstract

Patients with atretic esophagus (OA) are candidates to severe gastroesophageal reflux. In a previous study, we observed that in OA operated children the complete transmission of contractions during the whole day and during acid reflux periods is poor compared to controls (C). Investigate the motor response of OA during periods of meal (M) and periods of acid reflux (GOR) in OA patients.

Methods
Prolonged monitoring of esophageal motor function recorded with three sensors: P1 above and P2, P3 below the suture, combined with pH-metry between P2 and P3. Number/min and amplitude of contractions and transmissions between P1-2-3 or P2-3 are compared during total time, meal and reflux periods and between OA with or without GOR.

Population
13 operated patients (OA) mean age 7.75 years and 10 controls (C).

Results
Contractions/min in OA at P1 M = 1.4 SD 1.2 versus GOR = 0.8 SD 1.1: P < 0.05 at P2 M = 2.0 SD 1.4 versus GOR = 1.4 SD1.4: P < 0.05 at P3 M = 2.2 SD 1.3 versus GOR = 1.5 SD1.4: P < 0.05 Complete transmission (P1-2-3) in OA during M compared with total time (T) is increased (29 vs. 32%: P < 0.5), but not during GOR (29 vs. 28%: NS). No difference in distal transmission (P2-3) between C and OA during M (68.8 vs. 63.2) but difference during GOR (69.8 vs. 43 P < 0.01). Contractions/min are not different during M between 7/13 patients with normal (OAN) and 6/13 with abnormal (OAR) reflux index but differ during GOR: P2 OAN = 2.1 vs. P2 OAR = 0.6, P < 0.01; P3 OAN = 2.2 vs. OAR = 0.6, P < 0.05. Complete transmission (P1-2-3) in OAN is not different during M or GOR but different in OAR (M: 74.2 SD 33.5 vs. GOR 54.7 SD 30.5: P < 0.005); distal transmission (P2-3) is not different between OAN and OAR during M and RGO periods.

Conclusion
Esophageal motility remains impaired in the operated OA. GOR stimulations produce weaker responses than meals. In OAR alterations of response to GOR are more important in terms of decreased number of distal contractions and total transmission suggesting a motility disorder but also an altered sensitivity reducing primary peristaltic response to reflux.
DOZ047.17: Characterization of esophageal motility in children with operated esophageal atresia using high-resolution impedance manometry and pressure flow analysis
Authors: Courbette O , Omari T , Aspirot A , Faure C 
Published: June 2019

Abstract

Background
Esophageal dysmotility is common in patients with esophageal atresia (EA). High-resolution impedance manometry (HRIM) and pressure flow analysis (PFA) allow characterization of biomechanical bolus flow and swallow properties. The aim of this study was to characterize esophageal motility and bolus flow propulsion in children who underwent surgical EA repair.

Patients and Methods
HRIM was used in 14 children with EA (type C, n = 13; type A, n = 1). Study was performed at a median (range) age of 11 years (5–17). The HRIM recordings were analyzed using conventional esophageal pressure topography and PFA (AIMplot software deployed via the open access Swallow Gateway application) and were compared with 13 patient controls (median age 14 years, range 5.75–17; P = NS vs patients) who underwent HRIM considered as normal according to Chicago classification and for whom the manometry results did not lead to treatment changes. Medical charts were reviewed for medical/surgical history and symptoms were assessed by standardized questionnaires.

Results
Esophageal peristaltic motor patterns were abnormal in all EA patients and were subdivided in two groups: Group A with presence of distal contraction in ≥ 50% of the swallows (n = 6) and Group B with presence of distal contractions in < 50% of the swallows (n = 8). IRP4s was similar in EA and controls. Bolus transport was impaired as shown by the higher impedance ratio (IR) in EA than in controls (0.47 vs 0.22, P < 0.001). In Group A, proximal and distal contractile integrals were lower than in controls (P < 0.001) and distal contractile velocity was shorter in EA (P < 0.01). IR was lower in Group A than in Group B (P < 0.01). In this sample, symptoms of dysphagia and presence of gastric metaplasia or esophagitis were not correlated with any of the measures determined.

Conclusions
Bolus transport as measured by impedance ratio is severely altered in EA patients but is not predictive of symptoms. The presence of residual distal contractions is associated with a more efficient bolus propulsion. Whether this is associated with a better outcome warrants further studies.
DOZ047.18: Diagnosing reflux aspiration in esophageal atresia: role of microbiome and pepsin
Authors: Krishnan U , Singh H , Kaakoush N , Leach S 
Published: June 2019

Abstract

Background
Children with esophageal atresia (EA) often suffer from gastroesophageal reflux disease (GERD) and it's complications, including reflux aspiration. Reflux aspiration can be difficult to diagnose in these patients who often have other causes for their respiratory symptoms. Tracheal pepsin has been studied as a marker of reflux aspiration in other conditions but not in EA. The role of the airway microbiome in the diagnosis of reflux aspiration has not been studied previously.

Aims
The aim of this study was to examine the composition of the airway (tracheal aspirate) microbiome of EA patients and correlate the results of the microbial analysis with the presence of gastric pepsin in the airways as a marker of reflux aspiration.

Methods
A cohort of children with EA was prospectively recruited at Sydney Children's Hospital in 2018. The EA group were subdivided into children with GERD, eosinophilic esophagitis (EoE), and those with no disease. Tracheal aspirates were collected. The bacterial component (16S rRNA gene) of the microbiome was amplified. Pepsin was assayed using a monoclonal antibody specific for pepsin A by the ELISA technique.

Results
There were 26 EA patients. The mean age was 6.96 years (0.7–18) and 15 (58%) were female. Eighteen (69%) children were on proton pump inhibitors for GERD and 8 (30%) were on swallowed steroids for EoE. GERD, defined as reflux esophagitis on biopsy and/or abnormal result on pH/impedance testing, was present in 7 (27%) and EoE defined as >15 eosinophils/HPF was seen in 5 (19%) children. Tracheal pepsin was detected in a significant proportion of EA patients and correlation between the pepsin results and the airway microbial analysis was seen in some of the EA patients who were pepsin positive.

Conclusions
This study is the first to examine the role of the microbiome and pepsin in tracheal aspirates as markers of reflux aspiration in children with EA. These results require validation in larger cohorts.
DOZ047.42: The value of rigid tracheobronchoscopy for the diagnosis of tracheomalacia in esophageal atresia patients
Authors: Aanen I P , Pullens B , van Rosmalen J , Wijnen R M H 
Published: June 2019

Abstract

Aim of the Study
The aim of this study is to evaluate routine airway endoscopy prior to the closure of the trachea-esophageal fistula (TOF) and esophageal atresia (EA) repair in a tertiary medical center concerning pre- and postoperative tracheomalacia.

Methods
We evaluated all patients with EA born between 2013 and 2016 who underwent routine rigid tracheobronchoscopy (TBS) before primary repair of the EA at our center. Inclusion criteria included peroperative rigid TBS performed by an otolaryngologist. Exclusion criteria included impossibility to determine pre- and or postoperative TM (because of logistic or medical reasons). Demographic data, comorbidities, surgical intervention, TBS findings, and subsequent surgical management were analyzed.

Main Results
Twenty-four patients with EA were included in this study. Eight of the 24 patients developed postoperative TM. Of these 8 patients with TM, 5 were diagnosed at the preoperative TBS (62.5%). Of the 16 patients without postoperative TM, there were 6 patients (37.5%) with peroperative diagnosed TM. So the sensitivity and specificity of routine airway endoscopy prior to EA-repair are, respectively, 62.5% (CI 30.4%–86.5%) and 62.5% (CI 38.5%–81.6%).
Concerning postoperative TM, there is a significant higher appearance in females versus males (P-value 0.021). There was no significant causality between mean gestational age, birth weight, type of EA, type of surgery (open or thoracoscopic), presence of gastroesophageal reflux disease, and the appearance of postoperative TM.

Conclusions
Preoperative TBS can be useful for the evaluation of tracheoesophageal fistula but has a low sensitivity and specificity to detect postoperative TM.
DOZ047.44: Coblation supraglottoplasty for symptomatic laryngomalacia
Authors: Saravanamuthu T , Tajne N , Tarnoom S , Kamakoti K 
Published: June 2019

Abstract

Background
Laryngomalacia is the commonest cause of congenital laryngeal stridor and supraglottoplasty is the mainstay of surgical treatment for symptomatic laryngomalacia. A variety of techniques used for ablating redundant tissue in the supraglottis. Novel supraglottoplasty surgical technique is needed to achieve better safety and efficacy. The purpose of this study is to evaluate the outcome and effectiveness of supraglottoplasty.

Methods
A total of 71 patients with laryngomalacia were studied retrospectively. Of 20 patients with symptomatic laryngomalacia underwent supraglottoplasty and 48 patients were treated conservatively. Two patients refused surgical management. Of 80% underwent successive apnea technique, rest under ETGA. The number of patients who underwent supraglottoplasty technique 14 was of coblation, 3 were of cold steel, 1 was of coagulation, 1 was of laser, and 1 was of microdebrider. The patients were kept under observation in intensive care unit (ICU) from 1 to 3 days then in step downward for 3 to 5 days. No child was intubated in the postoperative period. The patient's demographic information, symptoms, comorbidities, type of laryngomalacia, synchronous airway lesions, and final outcomes were examined.

Results
The common indications for surgery were feeding problems and failure to thrive along with inspiratory stridor. Most common type of laryngomalacia was type 2 (71%). Good weight gain happened for 18 patients, one patient had to be continued on gastrostomy feeding, one patient did not gain weight. Majority of the patients continued to have some amount of noisy breathing and eventually settled in 3 months postoperatively. No perioperative deaths and no long-term complications occurred, 2 patients were readmitted for increasing stridor and treated with nebulizations and improved.

Conclusions
Supraglottoplasty is an effective and safe treatment for symptomatic laryngomalacia and has the potential to provide better breathing and feeding outcomes. Among all the techniques, in our retrospective study, we found that successive apnea technique and coblator ablation is safe and effective methods in supraglottoplasty because it gives good exposure of supraglottis, no concern of airway fire, less collateral damage. The advantage is easy instrumentation with single wand for ablation, coagulation, and aspiration. Multicenter cooperative studies of comparison between coblator and conventional approaches would lend further evidence-based support for this surgical method.