bluuebunny/crossref_metadata_2025_split huggingface dataset:
793. MODIFIED HELLER DOR FOR ACHALASIA
Authors: Lisboa Fernando , Ferreira Luis Fernando , Diniz Gabriel 
Published: September 2024

Abstract

Introduction
Achalasia is an esophageal disorder that involves a failure in the relaxation of the lower esophageal sphincter, which leads to dysphagia and other symptoms. The objective of the present study is to report the surgical technique performed in a patient with achalasia, in which the Heller myotomy technique was performed together with Dor fundoplication.

Method
The technique performed was a modified Heller-Dor with long myotomy Surgical intervention began with the introduction of the trocars plus pneumoperitoneum, a narrow of distal esohagus and enlargement of the diaphragmatic crura, mas found. Continuing with dissection of the esophageal hiatus with ultrasonic forceps, release of phreno-esophageal membrane. The esophagus was elongated in the mediastinum and brought 7 centimeters to the abdomen. After that, there was approximation of the diaphragmatic crura with 1 point of Ethibond 2-0. Following the dissection of the eophagogastric junction and identification of the posterior and anterior vagus nerve, releasing the “fat pad” for correct identification of the esophagogastric junction. So, the myotomy in the esophagus 6 centimeters above the cardia and 3 centimeters below, was performed. Follow, the gastric fundus was sutured to the anterior border of the esophagus and left diaphragmatic pillar with 2-0 Ethibond, until the esophagus gastric junction in running suture. The anterior suture, covering the myotomy the edge of the muscular layer of the esophagus as the same way.

Conclusion
Finally, with regard to the treatment of achalasia, Heller cardiomyotomy plus Dor fundoplication, has been shown to be efficient for improvement of dysphagia symptoms and to avoid symptoms related to emergence of reflux after myotomy.
https://drive.google.com/file/d/176L7Jo0tFMylWvhsgtscESHHFbOONl4A/view?usp=sharing
795. REVIEW OF CLINICAL CHARACTERISTICS AND PROGNOSIS OF MULTIPLE PRIMARY ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Wenyi Liu , Yu Zhentao 
Published: September 2024

Abstract

Background
Multiple Primary Esophageal Squamous Cell Carcinoma (MPESCC) is a rare and highly aggressive type of tumor, classified into Synchronous Multiple Primary Esophageal Squamous Cell Carcinoma (S-MPESCC) and Metachronous Multiple Primary Esophageal Squamous Cell Carcinoma (M-MPESCC). MPESCC has garnered increasing attention in recent years due to its complex pathogenesis, poor prognosis, and unclear treatment protocols. Compared to solitary esophageal squamous cell carcinoma (SESCC), patients with MPESCC typically show higher rates of lymph node and distant metastasis, leading to a poorer prognosis. This review aims to summarize the clinical characteristics, common treatment methods, and prognosis of MPESCC by analyzing existing literature, providing references for clinical practice.

Methods
The clinical characteristics of MPESCC patients differ significantly from those of SESCC patients, relevant literature was collected for meta-analysis of the following data of the patients: Gender and Age, Medical History, Pathological Features, Lymph Node and Distant Metastasis, Tumor Distribution. Treatment Methods include Surgical Treatment, Radiotherapy and Chemotherapy. Postoperative recurrence and metastasis are also included in the statistics.

Results
Tumors in MPESCC patients exhibit significant differences in pathological staging and grading, which makes treatment more challenging. Patients with MPESCC have significantly higher rates of lymph node and distant metastasis compared to those with SESCC. MPESCC tumors can appear in multiple locations within the esophagus, with pathological characteristics that may vary between sites. Surgery remains the primary treatment method for MPESCC. Due to the high risk of recurrence and metastasis in MPESCC patients, regular endoscopic and imaging examinations are necessary postoperatively to detect and address any recurrent or new tumors early.

Conclusion
MPESCC is a complex type of esophageal cancer with a poor prognosis. It’s clinical characteristics and treatment strategies differ significantly from those of SESCC. Multidisciplinary comprehensive treatment and close postoperative follow-up are crucial for improving the prognosis of patients with MPESCC. Further research is needed to optimize treatment protocols and enhance patient survival rates.
805. BOCHDALEK HERNIA - CASE REPORT
Authors: Lisboa Fernando , Ferreira Luis Fernando , Diniz Gabriel , Alves Emerson 
Published: September 2024

Abstract

Introduction
Bochdalek hernia is a rare type of diaphragmatic hernia congenital and is quite uncommon in adulthood, representing only 0.17-6% of all diaphragmatic hernias.
The objective of the present study is to report the technique surgery performed on a patient with a bochdalek hernia.

Methods
The information was obtained through medical record review, interview with the patient and literature review.

Results/Discussion
A 49-year-old female patient was admitted to a hospital in Natal (RN- Brazil) with vomiting for seven months, average of 3-4 vomits daily after meals, associated with dysphagia, epigastric pain and weight loss of 26 kg during this period.
The physical examination, she was dehydrated, emaciated and with a flaccid abdomen and painless. Laboratory exams, she presented high levels of ureia and hypokalemia. CT scan of the chest and abdomen with contrast showed a hernia right posterolateral diaphragm with insinuation of the transverse colon and portion distal part of the stomach, in addition to significant gastric stasis, without signs of ischemia.
Vigorous hydration was carried out and fasting was maintained, in addition, was inserted nasogastric tube and began parenteral nutrition. After ten days of parenteral nutrition and correction of hydro electrolyte disorders, there was an improvement in symptoms with laboratory normalization. So, she undergo a surgical intervention by videolaparoscopy.
Surgical intervention took place with the pneumoperitoneum with Veress needle and trocars inserted (2 10-inch trocars). mm and 3 of 5 mm). Introduction of 30° optics. Cavity inventory identified massive right posterolateral diaphragmatic hernia, containing transverse colon and part of the stomach. Hepatic retractor was positioned to retracted the right hepatic lobe.
Completely reduced the hernia through the Bochdalek foramen, after undoing content adhesions with the diaphragm. Afterwards, the closing of the defect with 2-0 Ethibond thread and a biocompatible mesh placed over the suture (Phasix) 10x10 cm and fixed with the same thread in separate stitches. Left drain blake type number 24 Fr, was left in the right hemithorax. The procedure was done uneventful.

Conclusions
Bochdalek hernia is a structural defect in the diaphragm, which can cause the passage of practically any intra-abdominal organ to the chest. Surgical repair of the defect is the only existing treatment option.
In this case, we have a late presentation and in a complicated form.
We opted for clinical stabilization of the patient, with nutrition and timely videolaparoscopy on the tenth day of hospitalization. The correction of hernia laparoscopically allows wide access to the workplace and with good mobility for dissection of the hernial sac, in addition to unquestionable acceleration of postoperative recovery and reduction of surgical trauma and size of the incisions. This way, we have a shorter hospitalization time with early return to the patient's daily activities.
813. SELF-DILATATION FOR THE MANAGEMENT OF REFRACTORY BENIGN OESOPHAGEAL STRICTURES: OUTCOMES FROM THE LARGEST EUROPEAN TERTIARY CENTRE EXPERIENCE TO DATE
Authors: Ioannidis Giannis , Pilavaki Pampina , Basra Ruman , Gertner Julian , Aslam Nasar , Duku Margaret , Thorpe Sally , Haidry Rehan , Ahmad Omer , Sweis Rami , Graham David , Banks Matthew , Lovat Laurence , Sehgal Vinay 
Published: September 2024

Abstract

Background
Benign oesophageal strictures are commonly encountered in endoscopy and are often effectively managed with endoscopic dilatation. However, up to 40% of patients may develop refractory benign oesophageal strictures (RBES), necessitating frequent endoscopic interventions that are often challenging, pose a greater risk of complications, and negatively impact quality of life. Oesophageal self-dilatation (SD) offers an alternative treatment that potentially reduces the need for repeat hospital visits while allowing patients greater autonomy in managing their condition. We describe the efficacy and safety of oesophageal SD at a tertiary referral centre.

Methods
We retrospectively reviewed the electronic records of patients with RBES (n=43) who were referred for SD to our centre between 2013 and 2024. The primary outcomes were the endoscopic dilatation-free interval (EDFI; longest period of time patients did not require endoscopic dilatation) and the number of endoscopic procedures performed within 12 months of starting SD. Secondary outcomes included the technical success rate of learning SD, improvement in the Dakkak and Bennett dysphagia score, and complications. Results are reported as median (interquartile range).

Results
41/43 patients (median age 57 years) with various RBES aetiologies (32% peptic, 19.5% post-radiation, 12% post-surgical, 11.6% post-endoscopic resection, 24.9% other) and locations (24.4% proximal, 29.3% middle, 34.1% lower, 12.2% multi-segment) successfully learned SD. Median follow-up was 23.2 months. The EDFI increased from 68.5 (41-106) to 161 (121-279) days (P&lt;0.001) while endoscopic interventions decreased from 7 (4.7-10) to 1 (0.75-3) (P&lt;0.001) within 12 months before and after SD. The all-time EDFI was 405 days (130-705) and dysphagia score improved from 2 at baseline to 0 after SD. One patient experienced clinically significant haematemesis and one presumed SD-related oesophageal perforation.

Conclusion
To our knowledge, we have described the largest European case series of oesophageal SD that has been published to date. Oesophageal SD appears to be an effective, well-tolerated, and safe approach in managing often complex patients with RBES providing a viable alternative to conventional endoscopic interventions. However, the occurrence of adverse events highlights the importance of careful patient selection and ongoing monitoring. Further research is warranted to validate these findings and identify predictive factors for treatment success.
Surgical treatment of chronic aortic dissection with liver dysfunction due to constrictive pericarditis caused by IgG4-related disease: a case report
Authors: Shimada Akie , Yamamoto Taira , Dohi Shizuyuki , Endo Daisuke , Tabata Minoru 
Published: September 2024

Abstract

Background
Severe liver failure with ascites may be associated with cardiac disease and may be the primary manifestation of constrictive pericarditis or aortic dissection. We report a case of a patient with a chief complaint of ascites for whom close examination revealed that the liver injury was attributed to constrictive pericarditis and chronic aortic dissection, with immunoglobulin G4 (IgG4)-related disease (IgG4-RD) as the primary cause.

Case summary
A 72-year-old man presented to the emergency department with scrotal oedema and ascites. Initially, the patient was hospitalized in the Department of Hepatology. However, computed tomography (CT) revealed aortic dissection (DeBakey type II), pericardial thickening, and impaired right ventricular dilatation. Therefore, we performed an ascending aortic replacement. IgG4 staining of the aortic wall revealed an IgG4/IgG-positive cell ratio of 35%. Pathological examination did not confirm the diagnosis of IgG4-related aortitis; however, the patient was diagnosed with IgG4-RD because of decreased blood IgG4 levels in response to steroid medication and the presence of heterogeneous thickened lesions in the pericardium. The patient took prednisolone 5 mg/day for 1 month post-operatively. His IgG4 level decreased but re-elevated above the baseline value after discontinuation of oral medication.

Discussion
Liver cirrhosis was suspected given the ascites, although a CT scan on admission confirmed insufficiency of systemic circulation due to cardiac constrictive pericarditis with aortic dissection. Despite the complexity of various pathologies in this patient, collaborative efforts and effective communication within the medical team enabled successful aortic surgery, averting life-threatening complications.
Endometriosis and long-term cardiovascular risk: a nationwide Danish study
Authors: Havers-Borgersen Eva , Hartwell Dorthe , Ekelund Charlotte , Butt Jawad H , Østergaard Lauge , Holgersson Christine , Schou Morten , Køber Lars , Fosbøl Emil L 
Published: September 2024

Abstract

Background and Aims
Endometriosis, a systemic gynaecological disease affecting 10% of women in reproductive age, shares pathophysiological characteristics with cardiovascular disease. However, data on the relationship between endometriosis and cardiovascular outcomes are scarce, prompting this study to address the knowledge gap.

Methods
Using Danish nationwide registries, women diagnosed with endometriosis (1977–2021) were identified and matched with controls in a 1:4 ratio based on year of birth. The primary outcome was a composite of acute myocardial infarction and ischaemic stroke. The secondary outcomes were arrhythmias, heart failure, and mortality.

Results
In total, 60 508 women with endometriosis and 242 032 matched controls were included (median age 37.3 years). Women with endometriosis were more comorbid and used more medications than controls. The incidence rates of the composite outcomes were 3.2 [95% confidence interval (CI) 3.2–3.3] and 2.7 (95% CI 2.7–2.8) per 1000 person-years among women with and without endometriosis, respectively. Women with endometriosis had a significantly higher associated rate of the composite outcome compared with controls [unadjusted hazard ratio (HR) 1.18 (95% CI 1.14–1.23), adjusted HR 1.15 (95% CI 1.11–1.20)]. Likewise, women with endometriosis were also at significantly increased associated risk of arrhythmias [unadjusted HR 1.24 (95% CI 1.20–1.28) and adjusted HR 1.21 (95% CI 1.17–1.25)] and heart failure [unadjusted HR 1.16 (95% CI 1.09–1.22) and adjusted HR 1.11 (95% CI 1.05–1.18)] but at decreased risk of mortality [unadjusted HR 0.95 (95% CI 0.92–0.97) and adjusted HR 0.93 (95% CI 0.91–0.96)].

Conclusions
Women with endometriosis have a higher associated long-term risk of cardiovascular outcomes compared with controls. Despite subtle absolute risk differences, the high prevalence of endometriosis underscores the importance of these findings.
Confidence in diagnosing and managing care for cognitive impairment in primary care: a survey comparing barriers by primary care clinician type
Authors: JaKa Meghan M , Rossom Rebecca C , Borson Soo , O’Connor Patrick J , Zibley Laura J , von Sternberg Thomas L , Crain A Lauren , Ekstrom Heidi L , Crouse Bethany , Werner Ann M , Hanson Leah R 
Published: September 2024

Abstract

Background
As cognitive impairment (CI) prevalence rises and primary care screening becomes commonplace, it is critical to understand how to support clinicians. We describe clinician-reported barriers to diagnosing and managing care for patients with CI in a health system with standardized screening. We also explore whether barriers differ by clinician type-physician or advanced-practice clinician (APC).

Methods
Theory-informed surveys were administered to primary care clinicians in a large integrated health system. The survey assessed barriers, confidence in diagnosing CI and managing CI care, beliefs about the consequences of diagnosing CI, and usability of the electronic health record (EHR) to diagnose and manage CI care; it also included open-ended response items. Descriptive statistics and content analysis were used to describe perceived barriers. Differences by clinician type were compared using chi-square.

Results
Of the 408 eligible clinicians, 249 started the survey and 247 completed the primary outcomes (61% response rate). Many said they were only a little or not at all confident in diagnosing (70%) and managing care for (60%) CI, with specific gaps in confidence in distinguishing types of dementia and having CI-related conversations with patients or family/care partners. APCs reported lower confidence than physicians. Other barriers were lack of time, low usability of EHR, and lack of family/care partner availability. These did not differ by clinician type. Open-ended responses suggest clinicians would like more support for CI care.

Conclusion
Low levels of confidence among other barriers suggest an urgent need to develop and implement effective multifaceted strategies to improve CI care.
Dissecting the Pandora’s box: preliminary phylogenomic insights into the internal and external relationships of stink bugs (Hemiptera: Pentatomidae)
Authors: Genevcius Bruno C 
Published: September 2024

Abstract
Stink bugs are invaluable models for macroevolutionary investigations owing to their astonishing ecological and morphological diversity. Nevertheless, such studies have been hampered by the absence of a solid phylogenetic hypothesis. Morphological and molecular studies based on Sanger data have found no consensus for the position of Pentatomidae, and the deep relationships within the family have been poorly resolved. These persistent uncertainties have cast the systematics of stink bugs into the metaphorical realm of a Pandora’s Box. Here, I conduct the first phylogenomic study focusing on pentatomids. Using public data, I aimed at testing the power of genome-scale data to resolve phylogenetic relationships within the family and to address the controversial position of the family within Pentatomoidea. Based on a dataset of 40 taxa and over 1,900 proteins, my results indicate the Pentatomidae as the sister group of all remaining families of Pentatomoidea, with an uncertainty of whether Plataspididae is included in this clade. Within Pentatomidae, my analyses confirm some previous findings, such as the monophyly of Asopinae and the relationship between Nezarini and Antestiini. On the other hand, most of the deep relationships within the family were strikingly different from previous works, for example, the Podopinae as the sister group of the Paleartic Carpocorini. My analyses confirm that the addition of massive amounts of data to phylogenetic studies may help achieve better supported trees for the stink bugs and allies. I argue that a solid and stable phylogeny-based classification will only be achieved with increased employment of -omics data.
China, the IMF, and Sovereign Debt Crises
Authors: Ferry Lauren L , Zeitz Alexandra O 
Published: September 2024

Abstract
The rise of China as a major bilateral lender has transformed the financial landscape for developing countries and, consequently, the process of resolving debt crises. We examine how China’s loans impact the response of the International Monetary Fund (IMF) to countries in debt distress. We argue that China’s lending approach and its absence from creditor forums, notably the Paris Club, can complicate the IMF’s efforts in managing debt crises. When China is a major lender, the IMF cannot rely on the Paris Club to coordinate bilateral creditors, and concerns about coordination, free-riding, and borrowers’ outside options can make it more difficult to agree on an IMF program. Therefore, we expect that countries that have borrowed more from China will undergo more protracted negotiations with the IMF in a debt crisis. We test our argument using data on the number of negotiating trips by IMF staff to borrowing countries to prepare IMF loans from 2000 to 2019. We find that countries with higher levels of outstanding debt to China require a greater number of IMF negotiating trips if they are in debt distress at the time. Our findings highlight the impact of Chinese lending on the sovereign debt regime and contribute to debates about China’s engagement with multilateralism.
When Is Digital Censorship Permissible? A Conversation Norms Account
Authors: Kim Tami 
Published: September 2024

Abstract
How do people decide what should—and should not—be censored? Seven studies investigate the psychology of digital censorship regarding user-generated content. Study 1 is inductive, identifying three dimensions—content, intent, and outcomes—along which consumers believe censorship decisions regarding user-generated content should be made. Despite the prevailing practice of content-based digital-censorship decisions—that is, censorship based on whether the focal content includes negative, concrete attributes such as obscene language and violence—people’s acceptance of censorship decisions is determined, in part, by the degree to which the creator’s intent is considered (an “intent-sensitivity hypothesis”; studies 2A–D) even when failing to censor would engender negative consequences. The current research contends that this effect stems from people’s belief that when online platforms make censorship decisions regarding user-generated content, they should abide by conversation norms. Thus, people demonstrate less intent sensitivity in contexts in which doing so is not as conversationally normative—for instance, when platforms are used for professional, rather than social, purposes (study 3). Furthermore, people do not expect the platform to exhibit intent sensitivity in less conversationally intimate contexts (study 4).