bluuebunny/crossref_metadata_2025_split huggingface dataset:
261. THE PROGNOSTIC IMPACT OF PRE-OPERATIVE NUTRITIONAL INDICATORS OF THE PATIENTS WITH ESOPHAGEAL CANCER
Authors: Kao Chia-Cheng , Chen Ke-Cheng , Huang Pei-Ming , Lin Mong-Wei , Kuo Shuenn-Wen , Cheng Chia-Hsien , Hsu Feng-Ming , Huang Ta-Chen , Hsu Hsao-Hsun , Lee Jang-Ming 
Published: August 2023

Abstract

Background
Esophagectomy with or without concurrent chemoradiotherapy had been the treatment of choice for the patients with clinically operable esophageal cancer. In addition to the standard TNM status of the disease, it is unknown about whether pre-operative nutrition indicators, inclusive of hemoglobin value and albumin level before treatment, will have impact on post-operative survival outcome of these patients.

Methods
This is a retrospective study from a single medical center. We retrospectively reviewed and analyze the survival impact of various pre-operative nutritional indicators of esophageal cancer patients who received esophagectomy. Pre-operative indicators included age, gender, receiving concurrent chemoradiotherapy or not, alcohol, betel nuts and cigarette usage or not, lung function test, Hemoglobin value, Albumin level and white blood cell level. The survival impact of these parameters was evaluated with univariate as well as multi-variate analysis.

Results
Our study had totally retrospectively reviewed 1213 patients, which received esophagectomy between 1996 to 2022. Ratio of Male to Female is 1112 to 111, and 325 patients are older than 65 years old. Before operation, 746 among 1213 patients had received concurrent chemoradiotherapy. In univariate analysis, we found that Pre-operative Hemoglobin value (cut-off point 11.9) and Albumin level (cut-off point 4.1) had statistically significant difference on overall survival, with increased risk of mortality by the presence of lower level of Hb and albumin with P-value &lt;0.001. The survival difference persisted after adjusted with TNM status under multi-variate analysis.

Conclusion
Our study showed that Pre-operative Hemoglobin value and Albumin level can be a significant prognosis factor of esophageal cancer patients who received esophagectomy. This significant result highlight the importance of nutritional status in caring the patients of esophageal cancer and suggested the possibility of improvement of survival by intervention of malnutrition during the course of treatment for esophageal cancer.
263. DUPILUMAB EFFICACY AND SAFETY TO 52 WEEKS IN ADULT AND ADOLESCENT PATIENTS WITH EOSINOPHILIC ESOPHAGITIS: RESULTS FROM LIBERTY EOE TREET
Authors: Dellon Evan , Rothenberg Marc E , Collins Margaret , Hirano Ikuo , Chehade Mirna , Bredenoord Albert J , Lucendo Alfredo J , Spergel Jonathan M , Sun Xian , Hamilton Jennifer D , Mortensen Eric , Glotfelty Lila , Shabbir Arsalan 
Published: August 2023

Abstract

Background
In Parts A and B of the 3-part, phase 3 LIBERTY EoE TREET study (NCT03633617), dupilumab 300 mg weekly (DPL qw) vs placebo (PBO) demonstrated significant efficacy and acceptable safety up to 24 weeks in adults and adolescents with eosinophilic esophagitis (EoE). Patients who completed Parts A and B entered Part C and received DPL qw to 52 weeks. Here we present 52-week results from patients who completed Part B and continued to Part C.

Methods
Of 80 DPL qw patients in Part B, 74 continued DPL qw in Part C (DPL/DPL). Of 79 PBO pts in Part B, 37 patients received DPL qw in Part C (PBO/DPL). Part B co-primary endpoints were proportion of patients achieving peak esophageal intraepithelial eosinophil (eos) count ≤6 eos/high- power field (hpf) and absolute change from Part B baseline in Dysphagia Symptom Score (DSQ) score at Week 24. Key secondary endpoints are listed in the Table. In Part C, all co-primary and secondary endpoints were assessed at Week 52 as secondary endpoints. Safety was also assessed.

Results
At Week 52, 84.6% of DPL/DPL and 67.6% of PBO/DPL patients achieved peak eos count ≤6 eos/hpf; mean (SD) absolute change from Part B baseline in DSQ score was −30.26 (15.39) for DPL/DPL and − 27.25 (11.46) for PBO/DPL patients. At Week 52, 100% of DPL/DPL and 78.4% of PBO/DPL patients achieved peak eos count &lt;15 eos/hpf, 30.8% of DPL/DPL and 16.2% of PBO/DPL patients achieved peak eos count ≤1 eos/hpf, and compared to Part B baseline, peak eos count, EREFS, and HSS grade and stage scores were reduced (Table). DPL demonstrated an acceptable safety profile.

Conclusion
DPL qw demonstrated persistent improvements in clinical, symptomatic, histologic, and endoscopic features of EoE up to 52 weeks and had an acceptable safety profile. PBO patients from Part B who received DPL in Part C showed similar efficacy to dupilumab qw patients of Part B.
269. CURRENT STATUS OF THE INTRODUCTION PROCESS OF MINIMALLY INVASIVE TRANSCERVICAL ESOPHAGECTOMY (MICE), TYPICALLY IDEAL 2A STRUGGLES
Authors: Klarenbeek Bastiaan , Veenendaal Linde , Rosman Camiel 
Published: August 2023

Abstract

Background
The introduction of a novel complex surgical technique is a challenging process and can be associated with a long learning curve and learning-associated morbidity. In order to introduce Minimally Invasive transCervical Esophagectomy (MICE) in a safe way, the IDEAL framework was a used.

Method
MICE is an innovative surgical technique, combining a single-port transcervical mediastinal dissection with a laparoscopic transhiatal esophagectomy. MICE could reduce pulmonary complications and the consequences of anastomotic leakage, without compromising oncological radicality. Our five-step approach of the ‘pre-clinical stage 0’ made the IDEAL framework more applicable as a practical guideline and led to a safe ‘first-in-human procedure, IDEAL stage 1’. Currently we are prospectively collecting data of a single-center Radboudumc cohort, going through the learning curve and finetuning the surgical technique, which is typical for IDEAL stage 2A ‘Development’.

Results
In another abstract, the clinical outcomes of our single-center Radboudumc learning curve cohort will be presented. By the time of the 2023 ISDE conference, around 70 cases will be included. As a result of technical difficulties during the learning curve and succinct evaluation with peers and patients, several changes to the MICE procedure have been made, like: indications, cervical incision, continuous NIM, sequence of abdominal/cervical approach, camera system, extraction and reconstruction, conversion, surgical team.

Conclusion
The surgical technique of MICE evolved during the collection of a singe-centre Radboudumc learning curve cohort. These changes are typical for the ‘IDEAL development stage 2A’, thorough evaluation of these changes might help limiting learning associated morbidity.
277. SIMPLE METHOD: INGUINAL LYMPHANGIOGRAPHY FOR POSTOPERATIVE CHYLOTHORAX
Authors: Ken Ito , Hirotaka Ishida , Akira Jingu , Ryosuke Nogawa , Yoshikatu Saito , Hideki Ota , Hidekazu Matsumoto , Ishiyama Tomoharu 
Published: August 2023

Abstract

Background
Chylothorax is a well-known complication of esophageal cancer surgery, with an incidence of approximately 1–3%. The main cause is intraoperative damage to the thoracic duct, which is often discovered after postoperation. If conservative treatment is chosen, lymphangiography with Lipiodol is the diagnostic and embolization procedure for exposed areas. Itkin et al. reported that improvement rate is approximately 70%. Pedal lymphangiography has been used in the past, but we perform lymphangiography from the inguinal lymph node.

Method
We inject lipiodol under ultrasound guidance.
A total of 6–10 mL injected into each bilateral inguinal lymph node.
The lipiodol drain upstream from the main lumbar lymphatic trunk and contrasts into the thoracic duct under fluoroscopy.
CT scans would be useful in the case that contrasts were unclear.

Result
If it is possible to inject lipiodol into the inguinal lymph nodes, even the thoracic ducts can be easily detected. With the classical method, an incision must be made between the first and second toes under local anesthesia, and minute lymph ducts must be identified and injected. However, if the inguinal lymph nodes are small, the drug tends to leak easily. Leakage is immediately detectable by fluoroscopy, so large leakage is unusual. If the drug is absorbed slowly, it remains subcutaneously after several months and can be identified as an artifact on abdominal X-rays or CT.

Conclusion
Lymphangiography from the inguinal lymph node is a relatively safe and simple method of examination, compared to the intervention from the dorsal foot. No skin incision on the dorsal foot is required, only an echo guided puncture is necessary. The examination time is short, and the patient burden is low. The procedure is not particularly difficult, so it can be performed even at small hospitals.
279. ENDOSCOPIC RENDEZVOUS TECHNIQUE FOR RECANALIZATION OF COMPLETE ESOPHAGEAL OBLITERATION
Authors: Tangkullayanone Watsaphon , Swangsri Jirawat 
Published: August 2023

Abstract

Background
Radiation-induced esophageal stricture is a common late complication following radiation treatment for esophageal cancer or head and neck cancer. Currently, treatments for esophageal stricture are typically minimally invasive, as opposed to surgical reconstruction. However, this condition can significantly impact a patient’s quality of life during treatment including multiple sessions of dilatation, prolonged use of a nasogastric tube or gastrostomy status. In severe cases, complete esophageal obliteration can occur. The patients’ symptoms experienced are more severe than those in ordinary cases, marking endoscopic interventions more challenging and having a higher failure rate.
This case report aims to demonstrate the use of the rendezvous technique in endoscopic treatment for the recanalization of the esophagus.

Methods
A 61-year-old female presented with dysphagia for two years. The patient had a history of hypopharyngeal cancer and underwent concurrent chemoradiation. During surveillance, the patient’s symptoms had worsened, and she was unable to eat or even swallow her own saliva. Endoscopic findings had shown complete esophageal obliteration, and a gastrostomy was performed. An endoscopic intervention was planned to use a two-team approach involving antegrade and retrograde endoscopy. The obstruction part was located at the upper thoracic esophagus using both endoscopes and esophagography. A retrograde guidewire was cannulated from the distal esophagus under fluoroscopic guidance. The guidewire position was checked from multidimensional fluoroscopic views to avoid false tract cannulation. Once the guidewire was nearly passed through the esophageal fibrotic septum, a stricturoplasty was performed from the antegrade endoscope. The guidewire was retrieved from the antegrade endoscope out of the oral cavity, and the esophagus was dilated with Savary-Gilliard dilators and a CRE balloon. A nasogastric tube was placed under direct endoscopic view.

Results
The procedure was successful, and the patency to the esophageal lumen was achieved. The patient’s symptoms improved, there was a decrease in saliva pooling. The patient was scheduled for serial dilatation of the esophagus to maintain luminal patency.

Conclusion
Endoscopic rendezvous technique is a safe therapeutic option for short-segment complete esophageal obliteration. Despite the complex procedure and multidisciplinary approach required, this technique can recanalize the esophageal lumen and avoid the need for surgical reconstruction.
312. H ANASTOMOSIS IN MECKOWN ESOPHAGECTOMY FOR THE REDUCED ANASTOMOTIC LEAKAGE, OBSTRUCTION, AND GASTROESOPHAGEAL REFLUX
Authors: Wu Na , Xia Qi , Hu Yang 
Published: August 2023

Abstract

Background
Anastomotic Leakage, obstruction, and gastroesophageal reflux are the major conditions to be taken into account during restoration of alimentary transit in Meckown esophagectomy. There are numerous types of anastomosis techniques to achieve different emphases while the optimal one has not been established. The outcomes of the novel H anastomosis and the conventional end to end layered anastomosis were explored in a prospective cohort study.

Methods
Patients with resectable esophageal cancer underwent Meckown esophagectomy applying end to end layered anastomosis (Conventional group) or H anastomosis (H group) were included. Besides demographic information, the incidence of anastomotic leakage and other major complications were also recorded. The incidence and severity of postoperative digestive symptoms were assessed by a standard questionnaire including Mellow-Pinkas score for dysphagia and reflux frequency at 6 months after surgery. 24 h-PH and impedance surveillance was also performed on patients receiving H anastomosis.

Results
Of the 122 eligible patients, 88 received end to end layered anastomosis and 34 underwent H anastomosis respectively. 3(3.4%) patients underwent anastomotic leakage in Conventional group and 1(2.9%) in H group (P = 0.897) The incidences of other perioperative complications were comparable between two groups. The H anastomosis was associated with lower incidence of gastroesophageal reflux (17.2% vs 35.8%, P = 0.117) and higher proportion of patients without food solidity limitation (Mellow-Pinkas score = 0) (79.4% versus 69.1% P = 0.305). The DeMeester score extracted from 24 h-PH and impedance surveillance showed the H anastomosis achieved 70% objective reflux free rate.

Conclusion
H anastomosis is a refinement of intussusception anastomosis and layered anastomosis to preserve the anti-reflux function of one-direction valve formed by intussuscepted tissues, leakage free from the different locations of layers of anastomosis and obstruction prevention from the removal of intussuscepted muscular layer of esophagus and seromuscular layer of stomach. A multicenter randomized trial comparing the outcomes of the H anastomosis and end to end anastomosis is in process to validate these conclusions.
318. THE INFLUENCE OF AGE IN OESOPHAGEAL CANCER TREATMENT DECISIONS: A MACHINE-LEARNING APPROACH
Authors: Thavanesan Nav , Farahi Arya , Walters Zoe , Underwood Timothy , Vigneswaran Ganesh 
Published: August 2023

Abstract

Background
Although patient age plays a crucial role in determining curative treatment options for Oesophageal cancer (OC), the exact extent of its influence is not well defined. We used a computational machine learning (ML) approach to model the impact of age in combination with other key decision drivers, such as tumour and patient characteristics, on the likelihood of receiving different types of curative treatment.

Methods
Retrospective analysis of 399 OC patients undergoing curative treatment between 2010–2020 at our tertiary unit. A random forests (RF) classifier model was trained to predict curative treatment decisions for OC patients (neoadjuvant chemotherapy (NACT) and surgery, neoadjuvant chemoradiotherapy (NACRT) and surgery or surgery alone). Variable importance and Partial Dependence analyses were used to assess the importance of age in the model, its influence on treatment decisions, and how that relationship was affected with other decision driver co-variates.

Results
Variable importance analysis confirmed age as most important in the RF model, (26% of total model performance). Partial dependence analysis demonstrate that predicted base probabilities for receiving surgery and NACT changed significantly in older patients. Patients above 70 years had a substantially higher probability of receiving curative surgery and lower probability of NACT. Moreover, the probability of receiving Surgery and NACT is driven by disease characteristics (T and N staging) in patients &lt;70 years but age becomes increasingly important in predicting a surgical decision &gt;70 years. The base probability of surgery and NACRT decisions was also influenced by performance status and age, but only age for NACT patients.

Conclusion
We have successfully applied ML modelling combined with partial dependence analysis to delineate the relationship between age and OC MDT treatment decisions. Age heavily influences curative decisions in OC patients but plays a greater role in patients with specific tumour characteristics. This study provides the basis for exploring subconscious decision drivers and allows teams to address any health inequality.
333. HIGH CERVICAL ANASTOMOSIS USING NARROW GASTRIC TUBE CAN REDUCE LEAKAGE AFTER MCKEOWN ESOPHAGECTOMY
Authors: Guo Xufeng 
Published: August 2023

Abstract

Background
Anastomotic leakage is one of the most serious complications after esophagectomy. High cervical anastomosis with narrow gastric tube has the potential to reduce the leakage after McKeown esophagectomy.

Methods
A total of 533 patients who received McKeown radical resection for esophageal cancer in Shanghai Chest Hospital from March 2018 to March 2023 were included in this study, including 281 patients in the normal anastomosis (NA) group and 252 patients in the high anastomosis (HA) group. Potential confounding factors in baseline characteristics were balanced by 1:1 propensity score matching (PSM). We compared the pathological and perioperative results before and after matching between the HA group and NA group, and finally used univariate and multivariate logistic analysis to analyze the independent risk factors of anastomotic leakage.

Results
After matching, 190 patients remained in both groups. In the comparison of pathological and surgical results, we found that the HA group had an advantage in lymph node harvest (Before matching: 21.3 ± 9.7 vs. 15.8 ± 7.5, p &lt; 0.001; After matching: 21.1 ± 10.0 vs. 15.8 ± 7.7, p &lt; 0.001). There were no significant differences in operation time, blood loss and R0 resection rate between the two groups after matching. The grade of tumor differentiation in HA group was better than that in NA group (p &lt; 0.001), and the pathological staging was earlier than that in NA group (p &lt; 0.001). Overall postoperative complications, including pulmonary infection (p &lt; 0.001), anastomotic leakage (p &lt; 0.001), recurrent laryngeal nerve paralysis (p = 0.031), and pleural effusion (p &lt; 0.001), were significantly lower in the HA group than those in the NA group. Multivariate analysis indicated that age &gt; 65 [odds ratio (OR) = 1.433, 95% confidence interval (CI) 1.248–1.753; p = 0.003], T4a (OR = 1.19, 95% CI 1.023–1.629; p = 0.016), Neoadjuvant treatment (OR = 0.075, 95% CI 0.038–0.150; p &lt; 0.001) and HA (OR = 0.631, 95% CI 0.213–0.707; p = 0.014) were independent predictors for anastomotic leakage.

Conclusions
For patients undergoing McKeown esophagectomy, high anastomosis can effectively reduce the incidence of anastomotic leakage and reduce overall perioperative complications. It is a recommended optimized surgical procedure.
339. CYTOPLASMIC TRANSLOCATION OF BCLAF1 REGULATES SIX1 MRNA STABILITY THROUGH YTHDF2 TO PROMOTE AEROBIC GLYCOLYSIS IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Zhang Peipei , Zhang Weiguang , Jiang Junfei , Kang Mingqiang 
Published: August 2023

Abstract

Background
Esophageal cancer is highly prevalent in China, with esophageal squamous cell carcinoma (ESCC) being the predominant pathological type. However, the unclear pathogenesis of ESCC presents a challenge for identifying effective targets for molecular targeted therapy. RNA methylation is an important epigenetic regulatory mechanism that may play a key role in carcinogenesis. Our research has identified BCLAF1 as an oncogene in ESCC and contributes to cancer progression through an m6A-dependent mechanism.

Methods
Paraffin specimens and immunohistochemistry (IHC) were used to analyze the correlation between BCLAF1 and ESCC patient prognosis. Edu proliferation, clone formation, scratch, transwell, flow cytometry, and Seahorse assays were conducted to investigate the impact of BCLAF1 on ESCC cells. Subcutaneous xenograft tumor and lung metastasis models in nude mice were performed to assess the role of BCLAF1 in vivo. Immunofluorescence (IF), mass spectrometry, and co-immunoprecipitation analyses were utilized to study the binding relationship between YTHDF2 and BCLAF1. MeRIP-seq, RIP-seq, and RNA-seq analyses determined the RNA profile bound by YTHDF2. Rescue experiments were employed to examine the BCLAF1/YTHDF2/SIX1 axis.

Results
IHC and IF assays confirmed that BCLAF1 is mainly located in the cytoplasm of ESCC tissues and cells. BCLAF1 is associated with poor prognosis of ESCC patients and also promote malignant progression of ESCC in vitro and in vivo. Mechanistic studies have revealed that BCLAF1 can interact with the m6A reader protein YTHDF2 without affecting its stability, and could affect the binding capacity of YTHDF2 to downstream target SIX1 mRNA in an m6A-dependent manner. Knockdown of YTHDF2 can upregulate the level of SIX1 mRNA and promote aerobic glycolysis in ESCC, which could be rescued by the overexpression of BCLAF1.

Conclusion
BCLAF1 is a potent oncogene, and its encoded protein undergoes non-classical cytoplasmic translocation in ESCC. Cytoplasmic BCLAF1 directly interacts with YTHDF2 to regulate its function as a reader protein that recognizes and binds m6A sites, enhancing the stability of downstream targets such as SIX1 mRNA, activating the aerobic glycolysis pathway, and ultimately leading to malignant progression of ESCC.
352. GENERATION OF PATIENT-DERIVED ESOPHAGEAL ADENOCARCINOMA ORGANOIDS FROM CIRCULATING TUMOR CELLS
Authors: Aiyar Niharikaa , Shathasivam Premalatha , Rispoli Thaiane , Naeem Mansur , Akhter Akhi , Elimova Elena , Bach Yvonne , Allison Frances , Darling Gail , Wilson Gavin , Yeung Jonathan 
Published: August 2023

Abstract

Background
Esophageal adenocarcinoma (EAC) is diagnosed in nearly 40% of patients when their cancer has already metastasized. Circulating tumor cells (CTCs) play a critical role in the metastatic cascade and need to be investigated in the context of EAC, but these must be expanded due to their scarcity in blood. Organoid models have been shown to recapitulate tumor heterogeneity and in vivo drug sensitivity. Thus, we aim to generate and characterize CTC-derived organoids from EAC patients.

Methods
CTCs were isolated from 32 blood samples obtained from 13 EAC patients using two methods: (1) Ficoll-based density gradient centrifugation followed by CD45+ cell depletion using magnetic-activated cell sorting (MACS) and/or (2) immunodensity separation using the RosetteSep CTC Enrichment Cocktail (Stemcell Technologies). Isolated CTCs were embedded and grown in Matrigel domes. Cultures were dissociated into single cells which were magnetically labelled and captured on a microfluidic chip. The captured cells were stained with DAPI, anti-CD45, anti-CK11, anti-CK13, and anti-CK18 antibodies. These cells were then visualized and quantified using fluorescence microscopy.

Results
Organoids were generated from twenty-one out of thirty-two samples, after two to six weeks in culture, with an average of 20.76 ± 6.435 organoids per sample. These EAC CTC derived organoids underwent a growth arrest once they reached an arbitrary size but were able to regenerate upon dissociation and re-seeding. However, no increase in the size or number of organoids was observed post-passaging. Of the nine CTC-derived organoid samples characterized using microfluidic capture and immunostaining, all nine had the presence of CD45 negative, CK positive, and DAPI positive cells.

Conclusion
In this study, we validated commonly used CTC isolation methods and were able to demonstrate that CTCs isolated can be cultured to generate organoids. Additional investigation is required to overcome the growth arrest which occurs during culture.