bluuebunny/crossref_metadata_2025_split huggingface dataset:
628. GUSTAVE ROUSSY IMMUNE SCORE IS A PROGNOSTIC MARKER IN PATIENTS WITH ESOPHAGEAL CANCER AFTER NEOADJUVANT THERAPY: A MULTICENTER RETROSPECTIVE STUDY
Authors: Fang Pinhao , Zhou Jianfeng , Yuan Yong 
Published: September 2024

Abstract

Background
GRIm-Score (Gustave Roussy Immune Score), a novel nutritional and inflammatory-based prognostic score, is an unfavorable prognostic factor in patients with esophageal carcinoma (EC). However, the prognostic importance of GRIm-Scores after neoadjuvant chemo-radiotherapy in these patients remains unclear.

Methods
A retrospective study including 432 EC patients undergoing surgical resection was performed. The GRIm-Score was calculated by lactate dehydrogenase (LDH), neutrophil-lymphocyte ratio (NLR), and albumin (ALB). The over survival (OS) and disease-free survival (DFS) were analyzed for the current study with Cox regression analyses, Kaplan-Meier methods, and propensity score matching (PSM).

Results
There were 374 (86.6%) men and 58 (13.4%) women with a mean age of 62.1 ± 7.7 years (range: 39-80 years). After PSM, cohorts consisted of 55 patients in the high GRIm-Score group and 55 in the low GRIm-Score group. Patient with a high GRIm-Score had poor OS (Cohort: p = 0.001; PSM: p = 0.007) and DFS (Cohort: p = 0.001; PSM: p = 0.008). The GRIm-Score, instead of NLR, LDH, or ALB in multivariate analyses, was an independent prognostic factor for OS (p = 0.019) before PSM. However, after PSM, it was a powerful independent prognostic factor for both OS (p = 0.028) and DFS (p = 0.039). Subgroup analyses showed that GRIm-Score could identify cases with worse OS or DFS among pT3-4 patients, indicating the complementary role of GRIm-Score in the decision-making of adjuvant therapy.

Conclusion
The GRIm-Score was an independent prognostic marker in patients with EC undergoing surgical resection after neoadjuvant therapy. Our study is also the first to discuss the prognostic value of GRIm-Score in patients with EC after neoadjuvant treatment.
647. INDOCYANINE GREEN (ICG) IDENTIFICATION OF A CISTERNA CHYLI LEAK FOLLOWING RADICAL OESOPHAGO-GASTRECTOMY WITH 2-FIELD LYMPHADENECTOMY: DESCRIPTION OF A NEW TECHNIQUE
Authors: Paine Heidi , Razi Kasra , Abbassi-Ghadi Nima , Preston Shaun R 
Published: September 2024

Abstract

Background
Chyle leak is a rare but feared complication post oesophago-gastrectomy, with far-reaching clinical and resource impacts including infection, re-admission and prolonged hospital stay, invasive procedures, and potentially missing the adjuvant therapy window. Low volume leaks can be managed medically via low-fat diet, nutritional support, and somatostatin analogues. Those of higher volume, or where medical management has failed, require radiological or surgical techniques. Where described, these techniques address leaks from a thoracic duct source and are therefore not applicable in patients having undergone oesophago-gastrectomy with radical two- or three- field lymphadenectomy, or where the suspected leak source is from abdominal lymphatics.

Methods
We report the case of a 78-year-old male diagnosed with cT4a N1 M0 oesophageal adenocarcinoma of the gastro-oesophageal junction. Following neoadjuvant chemotherapy, he underwent robotic-assisted two-phase oesophago-gastrectomy with two-field lymphadenectomy, in which the thoracic duct was identified and ligated. He returned one week post discharge with a left chylothorax. Drinage and medical management were unsuccessful, as were two radiological and one laparoscopic attempt at embolization of the leak. We describe a novel technique utilising indocyanine green (ICG) to identify and facilitate control of a cisterna chyli leak post-oesophago-gastrectomy with radical lymphadenectomy.

Results
Laparoscopy was performed and indocyanine green injected into the proximal jejunum submucosa, draining via mesenteric lymphatics to the cisterna chyli. Subsequent thoracoscopy revealed a prominent lymphatic channel around the left crus which was ligated. However, further leak was seen through the hiatus upon administration of high-fat jejunostomy feed. Re-laparoscopy revealed a leak from the cisterna chyli which was successfully ligated with ethibond sutures, leading to cessation of chyle leak and successful discharge of the patient, who subsequently received adjuvant therapy within the treatment window.

Conclusion
We describe a safe and effective novel technique for management of chyle leak from abdominal lymphatics or the cisterna chyli following oesophago-gastrectomy with radical two-field lymphadenectomy.
https://drive.google.com/file/d/1nCNnowdJVPlV0GOleXVNVMshuU19kCb/view?usp=sharing
743. HIATUS HERNIA AND GASTRO-OESOPHAGEAL REFLUX DISEASE. DOES SIZE MATTER?
Authors: Barghash Mohammed , Obayi Emmanuel , Itaman Usifoh , Furber Zoe , Caul Amy , Othman Ahmad , Mansour Moustafa 
Published: September 2024

Abstract

Background
Hiatus hernia occurs when part of the stomach bulges into the thoracic cavity through the hiatal opening of the diaphragm. In our study, we aimed to assess the impact of the hiatal hernia size on DeMeester score, symptom correlation, and presence of pathological reflux on PH studies. The study also looked at the impact of various characteristics including age, smoking, alcohol consumption, body mass index (BMI), and presence of oesophagitis and/or dysmotility on DeMeester score, symptom correlation, and presence of pathological reflux on PH studies.

Methods
The study was conducted in an Upper Gastrointestinal surgery unit located in the North West of England. All patients aged over 18 who underwent laparoscopic fundoplication for gastro-oesophageal reflux disease between January 2017 and June 2023 were included. Patients who underwent fundoplication for para-oesophageal hiatus hernia, those who had fundoplication as a complementary step to Heller’s cardio-myotomy, or those who underwent revisional surgery were excluded.

Results
A total of 115 patients with a median age of 54 were included. Patients’ age was found to have a statistically significant association with hiatus hernia size above 2 cm, DeMeester score, and Symptom Association Probability with a P value of 0.011, 0.021, and 0.030 respectively. Hiatus hernia size above 2 cm was found to have a statistically significant association with pathological reflux (P=0.017). Smoking association with DeMeester score was found to be significant (P=0.027). Hiatus hernia size was not found to have a statistically significant association with DeMeester score, Symptom Index, or Symptom Association Probability (P=0.115, 0.315, 0.904) respectively.

Conclusion
Hiatus hernia size above 2 cm was found to have a statistically significant association with pathological reflux on PH studies but not statistically associated with elevated DeMeester score above 14.72 or symptom correlation indices. Thorough endoscopic assessment in addition to detailed oesophageal physiological studies are mandatory to evaluate patients with gastro-oesophageal reflux disease prior to considering surgery.
744. LEFT THORACOABDOMINAL ESOPHAGECTOMY: ITS VALIDITY IN MODERN ESOPHAGEAL SURGERY
Authors: Dellaportas Dionysios , Margaris Ioannis , Latsonas Panagiotis , Pikouli Anastasia , Vlachos Iakovos , Papaconstantinou Dimitrios , Pararas Nikolaos , Nastos Constantinos , Myoteri Despoina , Pikoulis Emmanuel 
Published: September 2024

Abstract

Background
The optimal surgical approach for the treatment of esophageal and gastroesophageal junction tumors remains elusive. An open left thoracoabdominal approach may prove particularly useful in certain clinical scenarios, mainly because of its versatility and excellent exposure provided. The aim of this study is to present our experience and evaluate the early outcomes related to an open left thoracoabdominal esophagectomy (LTE).

Methods
A retrospective cohort study of prospectively collected data was conducted from two institutions performing esophageal surgery. Patients with distal esophageal or junctional tumors who underwent an open LTE between November 2018 and December 2023 were included. Primary outcomes were 30-day and in-hospital mortality, postoperative complications, and surrogates of oncological efficacy, including resection margin status and lymph node yield. Complications were recorded using the definitions provided by the Esophagectomy Complications Consensus Group and scored according to the Clavien-Dindo classification. Circumferential resection margin status was based on the definition used by the College of American Pathologists.

Results
During the study period 22 patients underwent an open LTE with a standard two-field lymphadenectomy. Eight patients (36%) suffered from postoperative complications, with pulmonary complications being the most common (7 patients; 32%). Severe complications (Clavien-Dindo ≥3) occurred in 3 patients. One patient experienced a clinical anastomotic leak. None of the patients required a reoperation or a step-up to a higher level of care. The 30-day and in-hospital mortality were zero. On histological examination, 6 patients (27%) had tumor cells at the surgical margin, most commonly the circumferential resection margin. A mean number of 27 lymph nodes were retrieved.

Conclusion
This small series demonstrates the applicability of an open left thoracoabdominal approach in everyday surgical practice for the treatment of distal esophageal and gastroesophageal junction tumors. Our results imply that open LTE can be implemented in select patients with acceptable morbidity and oncological efficacy.
769. CLINICAL EVALUATION OF CRYOBALLOON ABLATION FOR BARRETTS OESOPHAGUS: A UK FIRST MULTI-CENTRE EXPERIENCE
Authors: Aslam Nasar , Gernter Julain , Duku Margaret , Britton James , Ang Yeng , Sehgal Vinay 
Published: September 2024

Abstract

Introduction
The Cryoballoon Focal Ablation System (CbFAS) (Pentax Medical Inc) is an innovative device designed for the endoscopic ablation of Barrett's-related neoplasia. This system has been shown to provide advantages such as reduced stricture rates and improved patient tolerance compared to the conventional standard of care, radiofrequency ablation (RFA).
We report early outcomes from a prospective UK first multi-centre registry of consecutive patients who underwent Cryoablation for the endoscopic eradication (EET) of Barrett’s-related neoplasia.

Methods
Patients were prospectively enrolled from two tertiary referral centres for Barrett’s Oesophagus (BE). Inclusion criteria included patients with a BE segment no longer than 5cm with histologically-proven dysplasia on biopsy or endoscopic resection specimens suitable for EET of BE after MDT review. Cryoablation sessions were conducted at 3-month intervals until endoscopic eradication was complete. The standardised protocol involved administering 8 seconds per ablation for all enrolled patients with the CbFAS. Our primary outcome was complete eradication of BE. Secondary outcomes included the number of ablations performed, adverse events, device malfunction, stricture rate, patient tolerance, and endoscopist satisfaction which was evaluated using a 10-point Likert scale (1=poor, 10=excellent).

Results
Between January 2020 and December 2023, a total of 16 patients (35 treatment sessions) were treated. The median BE length was C0M2. Complete eradication of BE was achieved in 89% (8/9) of patients who had completed treatment. No instances of device malfunction or intraoperative adverse events were recorded. A stricture rate of 12.5% (2/16) was observed, both of which were successfully managed through endoscopic dilatation. All patients were recorded as tolerating the procedure well with sedation. The median endoscopist satisfaction score was 9 (+/- 2.4) with only one recorded instance of difficulty attributed to balloon positioning.

Conclusions
These preliminary results from the UK cryoablation registry suggest that cryoablation with the CbFAS is a safe and effective therapy for BE-related dysplasia. The stricture rate appears to be comparable to that observed with RFA and similar studies. With the planned enrolment of further centres and suitable patients, this registry will further enhance our understanding of the long-term efficacy and safety profile of cryoablation using the CbFAS.
792. EVALUATION OF EXTENSIVE MYOTOMY ASSOCIATED WITH DOR-MODIFIED ANTERIOR FUNDOPLICATION (PINOTTI) FOR SHORT- AND LONG-TERM TREATMENT OF ACHALASIA: A COHORT STUDY
Authors: Lisboa Fernando , Gomes Nathan , Ferreira Luis Fernando , Diniz Gabriel , Alves Emerson , Franca Henrique 
Published: September 2024

Abstract

Introduction
Achalasia is the main esophageal motility disorder and has a significant negative impact on the patient's quality of life. The management of achalasia primarily aims to reduce LES pressure. Surgical treatment involves a
Heller myotomy, combined with a fundoplication to prevent reflux.

Method
Prospective cohort study with 79 patients in two hospitals, one public and one private, in the city of Natal, Brazil. To evaluate the effectiveness of the surgical technique developed with the intention of treating achalasia, a long myotomy associated with the modified Dor anterior fundoplication (Pinotti). All patients were evaluated postoperatively as follows: 1) first week after surgery they were interviewed by the master surgeon; 2) thirty days after surgery they were interviewed regarding symptoms of achalasia in the postoperative period.

Results
Seventy nine (79) patients were submitted for a long myotomy procedure associated with modified Dor anterior fundoplication (Pinotti).
Seventy nine (79) patients were followed up. Although, seventy three (73) patients had improvement in symptoms related to achalasia and are clinically satisfied. Six (6) patients had recurrence of achalasia symptoms, such as dysphagia.

Conclusion
The long myotomy associated with the modified Dor anterior fundoplication (Pinotti) was the standard procedure in the study and obtained good results in 89,83% of the cases followed during the control of achalasia symptoms with a minimum rate of adverse effects in the postoperative period
811. POOLED 1-YEAR SAFETY AND QUALITY-OF-LIFE DATA AFTER REFLUXSTOP SURGERY AT TWO LARGE HOSPITALS IN SWITZERLAND: A RETROSPECTIVE CHART ANALYSIS
Authors: Zehetner Joerg , Fringeli Yannick , Linas Ioannis , Kröll Dino , Haltmeier Tobias , Borbély Yves 
Published: September 2024

Abstract

Background
The standards of care in reflux disease management are proton pump inhibitor (PPI) therapy and conventional antireflux surgery, however, both options carry the caveats of medication irresponsiveness and troublesome postoperative sequelae, respectively. More specifically, PPIs respond inadequately in up to 40% of cases and Nissen fundoplication is associated with postoperative dysphagia in a significant proportion of patients. RefluxStop is an innovative technology that was adopted at our two respective institutions following promising safety and effectiveness data from its CE mark trial. We present the pooled safety and quality-of-life data of our 1-year experience with RefluxStop surgery.

Methods
Between September 2018 and August 2023, RefluxStop surgery was performed on 121 patients as part of routine clinical care at two hospitals, both of which are high-volume centers for antireflux surgery. The procedure involves crural repair with hiatal hernia reduction, reconstruction of the flap valve and angle of His, narrow esophagogastric (90-110°) plication, and device implantation in an external pouch on the gastric fundus (Figure 1). A retrospective chart analysis was conducted to document perioperative adverse events (AEs) and quality-of-life improvements via Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) score. Higher GERD-HRQL scores are indicative of more severe disease.

Results
Baseline patient characteristics included mean age 54.7 years, female sex (52.9%), body mass index 27.2±4.1 kg/m2, large hiatal hernia &gt;3 cm (46.3%) of median (IQR) size 3 (2-5) cm, abnormal esophageal motility (60.3%), and Barrett’s esophagus (27.3%). At 1-year follow-up, patients experienced a median (IQR) reduction of 90.5% (81.4-100%) in total GERD-HRQL score. Intraoperative AEs included conversion to laparotomy for adhesiolysis with bleeding (n=1), bleeding short gastric arteries leading to return to the operating room the next day (n=1), and esophageal perforation repaired intraoperatively (n=1). Postoperative AEs are summarized in Table 1.

Conclusion
The results of this pooled retrospective chart analysis support the promising early data of the RefluxStop CE mark trial. Few and predictable AEs occurred during the study period while significant improvements in quality of life were observed, as evidenced by 90.5% (81.4-100%) reductions in GERD-HRQL score. Notably, this pooled cohort of patients was comprised of substantial proportions of difficult-to-treat patients (i.e., abnormal esophageal motility in 60.3%, large hiatal hernia &gt;3 cm in 46.3%), providing evidence for wider implementation of RefluxStop surgery in real-world settings. Additional evaluation is required to further delineate the role of this promising innovative antireflux surgery.
Reproducibility of cardiac computed tomography classifications of hypoattenuated thickening and peridevice leak following left atrial appendage closure
Authors: Kramer Anders , Lo Russo Gerardo , Alarouri Hasan S , Collins Jeremy D , Møller Jensen Jesper , Nielsen-Kudsk Jens Erik , Alkhouli Mohamad , Korsholm Kasper 
Published: September 2024

Abstract

Aims
To assess the reproducibility of interpreting hypoattenuated thickening (HAT) and peridevice leak (PDL) using cardiac computed tomography (CT) imaging following Watchman FLX left atrial appendage closure (LAAC).

Methods and results
In this multicentre retrospective reproducibility study, 100 anonymized post-LAAC cardiac CT scans were evaluated within the same cardiac phase by an experienced and a novice rater blinded to prior evaluations. All scans were evaluated twice by each rater, assessing overall HAT and PDL categories as well as specific associated findings based on suggested algorithms for post-LAAC interpretation. Inter- and intra-rater agreement and reliability were evaluated using absolute agreement, Cohen’s kappa, and Kendall’s tau for categorical variables, and mean difference, Bland–Altman plots, limits of agreement (lower and upper), and intra-class correlation coefficients (ICCs) for continuous variables. Within overall categories of both HAT and PDL, substantial agreement (kappa ≥0.61) and reliability (Kendall’s tau-b ≥ 0.75) were observed. Specifically, identifying high-grade HAT (kappa ≥0.78) and distal patency (kappa ≥0.85) displayed the highest agreement within HAT and PDL interpretation. Meanwhile, measuring the height of the proximal screw hub cove represented the least reliable HAT assessment among both inter- and intra-rater comparisons (ICC &lt; 0.75), while suspected leak mechanism represented the least reproducible PDL measure.

Conclusion
Despite only minimal training of one rater, overall high levels of inter- and intra-rater agreement and reliability were observed across the chosen algorithms for interpretation of HAT and PDL following Watchman FLX LAAC. The prognostic implications of the included variables are to be explored in future trials and registries.
Rest, replace, and recover: TandemHeart to transcatheter aortic valve replacement—a case report
Authors: Haq Syed H , Shah Sidra R , Eapen David , Kleman Anna , Knous Mallory , Laird Amanda , Cole William , Patel Sandeep M 
Published: September 2024

Abstract

Background
Severe aortic stenosis (AS) can present insidiously, with the end stages resulting in significant valvular–induced cardiomyopathy and can lead to cardiogenic shock (CS). Such cases result in a myriad of complex manifestations and are often associated with a poor prognosis. These patients require emergent cardiac evaluation and valvular intervention. Unfortunately, the immediate nature of the CS provides little time for a detailed valvular evaluation. Possible management involves use of mechanical circulatory support (MCS) prior to urgent transcatheter aortic valve replacement (TAVR).

Case summary
The patient was a 70-year-old female who developed refractory CS, and acute decompensated heart failure was complicated by AV block secondary to severe AS. Due to progressively worsening haemodynamics, the need for MCS for cardiovascular support and eventual valve replacement resulted in the decision to pursue TandemHeart® (TH; LivaNova Inc, Pittsburgh, PA, USA). We discuss the novel implementation of the TH as a means of bridging to TAVR.

Discussion
TandemHeart system provides the benefits of improving haemodynamic support in CS while allowing unencumbered access to the stenotic valve for balloon aortic valvuloplasty (BAV) or TAVR. In our evaluation, we discuss the utilization and benefits associated with TH to TAVR in allowing for cardiac rest, replacement of the valve, and recovery of left ventricular function.
The Debate on the Role of Orders in France, 1787–1789
Authors: Fitzsimmons Michael P 
Published: September 2024

Abstract
The attitude towards the three orders of the kingdom (the clergy, the nobility and the commoners) on the eve of the French Revolution remains little examined and has often been misunderstood. Orders became controversial in the aftermath of the meeting of the Assembly of Notables in 1787, which had been called to address a major fiscal crisis. The failure by the Notables to yield fiscal privileges gave rise to the perception that the Notables had placed their interests above the good of the state. Demand for the convocation of the Estates General grew, with the most critical issue being the form of voting. It had been done by order when the body last met in 1614, but in 1788–9 the Third Estate demanded a doubling of its representation and voting by head. The debate was intense and prolonged, but it focused only on orders as a basis for voting—there was little animus directed at orders themselves. When the Estates General opened, it immediately fell into a deadlock that went on for weeks, until clerical and noble deputies entered the National Assembly on 27 June and tacitly acceded to vote by head. Distinction of orders did not fall into desuetude, however. The Assembly continued to observe it in its seating until the meeting of the night of August 4. Although the Assembly itself abandoned distinction of orders, distinction of orders continued to exist in society. It was abolished in an almost incidental fashion in October 1789, and the abolition laid the foundation for two of the bitter divides of the Revolution.
Arthropod Phylotranscriptomics With a Special Focus on the Basal Phylogeny of the Myriapoda
Authors: Su Zhi-Hui , Sasaki Ayako , Minami Hiroaki , Ozaki Katsuhisa 
Published: September 2024

Abstract
Arthropoda represents the most diverse animal phylum, but clarifying the phylogenetic relationships among arthropod taxa remains challenging given the numerous arthropod lineages that diverged over a short period of time. In order to resolve the most controversial aspects of deep arthropod phylogeny, focusing on the Myriapoda, we conducted phylogenetic analyses based on ten super-matrices comprised of 751 to 1,233 orthologous genes across 64 representative arthropod species, including 28 transcriptomes that were newly generated in this study. Our findings provide unambiguous support for the monophyly of the higher arthropod taxa, Chelicerata, Mandibulata, Myriapoda, Pancrustacea, and Hexapoda, while the Crustacea are paraphyletic, with the class Remipedia supported as the lineage most closely related to hexapods. Within the Hexapoda, our results largely affirm previously proposed phylogenetic relationships among deep hexapod lineages, except that the Paraneoptera (Hemiptera, Thysanoptera, and Psocodea) was recovered as a monophyletic lineage in some analyses. The results corroborated the recently proposed phylogenetic framework of the four myriapod classes, wherein Symphyla and Pauropoda, as well as Chilopoda and Diplopoda, are each proposed to be sister taxa. The findings provide important insights into understanding the phylogeny and evolution of arthropods.