bluuebunny/crossref_metadata_2025_split huggingface dataset:
450. LINEAR STAPLED TECHNIQUE FOR ROBOTIC ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY AND GASTRECTOMY: TECHNIQUE, STEPWISE INTRODUCTION, REPRODUCIBILITY AND OUTCOMES
Authors: Bull Alexander , Abbassi Nima , Singh Pritam , Madhavan Anantha , Immanuel Arul , Preston Shaun 
Published: August 2023

Abstract

Background
Robotic-assisted surgery (RAS) for esophagectomy and gastrectomy is gaining in popularity. Compared to open oesophagectomy and conventional minimally invasive techniques, RAS is associated with decreased rates of complications, increased harvested lymph nodes and shorter length-of-stay. However, high anastomotic leak rates (20–27%) have been seen within randomised trials and case series, with up to 50% early in some published series. We present our technique and results of the staged introduction of a linear anastomosis.

Methods
The technique was initially developed by a single surgeon at open surgery; then adapted to thoracoscopic surgery and finally reproduced at RAS by several surgeons across two centres. Using a prospectively maintained database we reviewed the first forty-two cases utilising a modified linear anastomosis technique for oesophageal anastomosis. Outcomes, with particular focus on the anastomosis were reviewed. We also describe in detail the technical steps involved in our technique for a side-to-side linear semi-mechanical stapled anastomosis using a tri-stapler, with a 2-layer V-lock closure of the common enterotomy, during robotic surgery (video https://www.dropbox.com/s/ljf3zmuy68qry7b/Anastomosis%20technique_Short_Sound.mp4?dl=0).

Results
Forty patients had a two-stage esophagectomy, one with colonic reconstruction, and two, total gastrectomy. Median age was 62 (range 47–85). 93% (39/42) were adenocarcinomas, the remainder were squamous cell carcinomas. The anastomosis was performed via an open approach in the initial 11, thoracoscopically in 4, then robotically in 27 (including the two gastrectomies). The first 20 anastomoses were performed by one surgeon, who then taught four others. Two grade I anastomotic leaks occurred (4.7%), both were treated conservatively. There was no 30-, 90-day, or in hospital mortality. Non-anastomotic complications occurred in 14/42 (33.3%) of patients, most commonly respiratory (5/42, 11.9%).

Conclusion
We report a reproducible technique for semi-mechanical linear stapled anastomosis and its safe introduction into esophageal and gastric resections, including RAS. Anastomotic leak rates are below the internationally reported rates, even in the early phase of its introduction in open, thoracoscopic and RAS. With good training and mentorship this may help more centres safely introduce a RAS esophago-gastric programme, improve patient outcomes and reduce length of stay.
454. GASTROINTESTINAL QUALITY OF LIFE, BODY COMPOSITION AND INFLUENCING FACTORS, IN ESOPHAGEAL CANCER SURVIVORS FOLLOWING CURATIVE ESOPHAGECTOMY
Authors: Boyle Ellen , Elliott Jessie , Greene Christine , Murphy Conor , Donlon Noel , Donohoe Claire , Ravi Narayasamy , Reynolds John 
Published: August 2023

Abstract

Background
Recent improvements in treatment modalities for locally advanced esophageal cancer have resulted in markedly improved survival outcomes. This has resulted in an increasing population of esophageal cancer survivors. Surgery is the mainstay of treatment, which has a high risk of post-operative morbidity. This study focused on characterising health-related quality of life with a specific interest in the gastrointestinal quality of life of esophageal cancer survivors following curative esophagectomy.

Methods
This was a cross-sectional cohort study of patients who underwent oesophageal cancer surgery between 2010 and 2015. A multicomponent questionnaire was distributed to disease-free patients at least one year post completion of treatment. Body composition was assessed using surveillance computed tomography scans. Linear and logistic regression analyses were utilised to determine the impact of treatment and pathologic variables on survivorship issues.

Results
Gastrointestinal symptoms were common, with persistent eating symptoms independently predictive of overall poor HR-QL on multivariable analysis (P = 0.026, odds ratio [OR] 1.05 [95% confidence interval [95% CI] 1.01–1.10]). Persistent eating symptoms were independently associated with impaired physical and role function (both P &lt; 0.001). Cervical anastomosis was associated with increased risk of dumping syndrome (P = 0.013, OR 0.34 [95% CI 0.14–0.80]), while squamous histology was independently associated with increased Gastrointestinal Symptom Rating Scale (P = 0.027) and Sigstad dumping syndrome scores (P = 0.034).

Conclusion
Persistent gastrointestinal and nutritional issues are common after esophagectomy. These eating symptoms are associated with impaired health-related quality of life. Further research is warranted to investigate how patient pathways can be enhanced to minimise the long-term impact of curative treatment for patients with esophageal cancer.
465. COMPLETE RESPONSE IN BARRETT’S HIGH-GRADE DYSPLASIA WITH THE UTILISATION OF RADIOFREQUENCY ABLATION: A SYSTEMATIC REVIEW
Authors: Prasad Pooja , Brown Joshua , Sellars Hannah , Phillips Alexander 
Published: August 2023

Abstract

Background
Radiofrequency ablation (RFA) is increasingly utilised as part of the endoscopic treatment of Barrett’s esophagus (BE) with high-grade dysplasia as a recognised alternative to surgical resection. The aim of this review is to summarise the current evidence on the utility of RFA in achieving complete clearance of HGD within BE and any resultant treatment complications with this endoscopic therapeutic option.

Methods
A search of the major reference databases (PubMed, Medline, Cochrane) was performed with no time limits up to December 2022. Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if the patient cohort included patients with HGD undergoing RFA, regardless of whether other endoscopic and/or surgical techniques were subsequently utilised and analysed.

Results
Fourteen studies comprising 1411 patients were included. Among this cohort, 850 patients with HGD underwent at least one session of RFA. Complete eradication of HGD was noted in 800/850 (94.1%) of patients. The pooled estimates of complete eradication of HGD and intestinal metaplasia (IM) were 92.5% (95% CI 87.6%–96.2%) and 81.8% (95% CI 74.9%–87.9%), respectively. The incidence of adverse events related to RFA was low, with esophageal stricture being the most common (10.6%). Long-term follow-up reported in the included studies showed sustained eradication of HGD with recurrence noted in 22 (2.6%) of patients.

Discussion
RFA is a safe and effective treatment option for patients with HGD within BE. However, data from larger patient cohorts, ideally within a trial setting, are needed, to establish the long-term treatment efficacy and identify cohorts that may not benefit from this procedure or require multiple treatments.
469. LONG-TERM QUALITY OF LIFE FOLLOWING ESOPHAGECTOMY FOR CANCER: RESULTS FROM A PILOT STUDY UTILIZING NOVEL TECHNOLOGY FOR PATIENT-REPORTED OUTCOMES
Authors: Prasad Pooja , Jaretzke Helen , Sellars Hannah , Brown Joshua , Chmelo Jakub , Phillips Alexander 
Published: August 2023

Abstract

Background
The physiological impact of an esophagectomy has long-term ramifications upon patient’s health-related quality of life (HR-QOL) and psychosocial functioning. Capturing long-term QoL can identify patients who may benefit from rehabilitative interventions to mitigate the lasting symptoms following esophagectomy. We sought to develop and pilot a remote method of digitally capturing QoL up to 10 years following esophagectomy. The aim of this study is to determine post-esophagectomy QoL ≥ 5 years, as part of this pilot.

Methods
A novel software to remotely capture QoL was piloted in November 2022, utilising electronic forms on digital devices including tablets to record data. Patients were contacted by a dedicated data manager to complete HR-QOL questionnaires (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires C30 and OG25 modules). This was completed either at the time of routine outpatient visits or remotely by patients, assessing HR-QOL up to 10 years post-esophagectomy. Linear mixed models were constructed to assess the mean score difference among patients at 5 years and beyond, post-esophagectomy.

Results
Of 220 eligible patients completing the HR-QOL questionnaires, 8 patients (10.9%) were 5 years on following an esophagectomy. Physical and emotional functioning remained adversely impacted at 5 years post-esophagectomy with lower overall scores across these domains. Symptoms including pain, heartburn and bilious reflux persisted at 5 years post-esophagectomy. Patients engaged with the novel software utilised to capture HR-QOL with 100% of those approached completing questionnaires.

Discussion
Functioning and symptoms adversely affecting HR-QOL persist into survivorship following esophagectomy. Given the clinically relevant deterioration in the longer term, there is a need to develop post-treatment rehabilitation interventions that can be embedded as part of peri-operative patient optimisation and recovery.
472. STATEWIDE TRENDS IN ESOPHAGECTOMY APPROACH: DATA FROM A REGIONAL THORACIC QUALITY COLLABORATIVE
Authors: Reddy Rishindra , Mollberg Nathan , Adams Kumari , Popoff Andrew , Lam Geoffrey , Lall Shelly , Lagisetty Kiran 
Published: August 2023

Abstract

Background
Esophagectomy patients continue to have high morbidity and mortality. Regional quality collaboratives have been shown to improve care around cardiac surgery. Our statewide cardiac surgery collaborative (33 programs) created thoracic surgery collaborative 10 years ago, sharing data to improve care at all locations. There were 17 programs participating in sharing lung cancer surgery data, and 10 programs sharing esophageal cancer surgery data. We reviewed trends in esophagectomy approach and perioperative outcomes from the quality collaborative.

Methods
Prospectively collected data from patients with loco-regional esophageal cancer who underwent esophagectomy between 2014 to 2022 were analyzed. We evaluated 3 separate 3-year cohorts. Pre-operative assessment, surgical approach lymph node harvest, post-operative outcomes, and length of stay (LOS) were analyzed using linear regression and chi squared tests.

Results
Annual esophagectomy volume ranged from 114 to 145 cases per year. There was significant increase in use of preoperative CT scans (p = 0.02) and a trend towards higher use of endoscopic resection as part of the staging paradigm (p = NS). There was a notable shift towards more minimally invasive esophagectomy approaches (p &lt; 0.0001) with robotic assisted minimally invasive esophagectomy being the most common in the recent cohort (Figure). Lymph node harvest trended towards higher yield over time, but was only significant with the open trans-thoracic approaches (p &lt; 0.01). There were no significant differences noted in rates of positive margin or in length of stay.

Conclusion
Regional quality collaboratives allow for tracking of esophageal cancer care at a broader level than single institutions. We noted increased use of minimally invasive techniques, specifically robotic assisted over the past decade with trends towards improved lymph node dissection. Despite the increase use of minimally invasive surgery, length of stay did not change.
476. PATIENTS WITH TRACHEOSTOMY HAVE HIGHER INCIDENCE OF ESOPHAGEAL REFLUX AND DON’T PRESENT TYPICAL SYMPTOMS
Authors: Bianchi Edno Tales , Cardoso Paulo , Szachnowicz Sergio , Nasi Ary , Tustumi Francisco , Seguro Francisco , Duarte Andre , Sallum Rubens 
Published: August 2023

Abstract

Background
Lung diseases have a strong relationship with gastroesophageal reflux disease (GERD). It has been previously demonstrated that conditions such as tracheal stenosis, asthma and even lung transplantation may worsen with reflux and these patients have few symptoms of GERD.
With the COVID-19 pandemic, the number of people who needed mechanical ventilation and tracheostomy increased.
Our objective was to demonstrate the prevalence of gastro-oesophageal reflux (GER) in patients with tracheostomy and describe its characteristics.

Method
Esophageal manometry and 24 h pH-metry was performed in 137 consecutive patients with a tracheostomy already in a chronic phase, independent of symptoms. Inquire on respiratory and digestive symptoms was also carried out at the time of the examination.
Prevalence of gastroesophageal reflux was identified in this population and description of the groups with reflux and without it, as well as comparison between them.

Results
Of the 137 patients, 49 were male, the average age was 40.94 ± 17.3 and the BMI was 26.3 ± 4.85. The prevalence of GER was 45.2%. Characteristics were similar between the groups with and without reflux.
In the reflux group, the mean DeMeester score was 36.5 ± 20.8 and the presence of lower sphincter hypotonia was found in 31% of the patients and was not correlated with reflux (p = 0.285).
48% had heartburn symptoms and only 30% had a combination of heartburn and regurgitation. There was no association with higher DeMeester score and presence of symptons (p = 0,14).

Conclusion
The presence of tracheostomy is related to an increased prevalence of reflux, even without typical symptoms most of the time. The mechanism for this is still unknown, perhaps the altered respiratory dynamics has a role. These patients should be investigated with functional exams if they develop any condition that may be affected by reflux.
486. FOR SYNCHRONOUS ESOPHAGEAL CARCINOMA AND PULMONARY LESION: IS IT APPROPRIATE TO PERFORM COMBINED RESECTION?
Authors: Liu Yixin , Yang Yushang , Chen Longqi 
Published: August 2023

Abstract

Background
Reports on esophageal cancer with concurrent lung lesion cases are rare and mostly individual cases. Furthermore, the safety and feasibility of combined resection for patients with synchronous pulmonary lesions and esophageal cancer had always been a controversial topic. In the current study, we retrospectively analyzed the clinical data of patients who underwent simultaneous surgical resection for esophageal cancer with concurrent lung lesions, and explored their clinical characteristics, treatment outcomes, especially postoperative complications and prognosis.

Method
Patients who underwent esophagectomy between February 2009 and December 2022 were retrospectively reviewed at our center, and those with combined lung resection at the same setting were matched in a 1:1 propensity score matched (PSM) ratio to esophagectomy-alone patients. The main postoperative complications (including pneumonia, anastomotic leakage, pleural effusion, and other complications) and overall survival were compared.

Results
Of the 7152 esophagectomies, 222 cases of combined resection for synchronous pulmonary lesion (including 105 pneumatoceles, 71 benign nodules, and 46 malignant nodules) were eligible, and 1:1 ratio PSM esophagectomy-alone patients were matched. Wedge resection was the most frequent procedures (181, 81.5%). No significant differences were found in the incidence of postoperative complication between combined resection and esophagectomy-alone: pneumonia (21.2% vs. 20.7%), anastomotic leakage (7.2% vs. 6.3%), pleural effusion (15.3% vs. 13.1%). Moreover, different type of pulmonary lesions and extent of pulmonary resection also unaffected the incidence of postoperative complications. Survival analysis showed no significant difference for combined surgery or esophagectomy-alone.

Conclusion
In this large sample size study, combined resection dose not elevate the incidence of postoperative complications and weaken the overall survival for patients with synchronous esophageal carcinoma and pulmonary lesion. Therefore, for patients with clinically diagnosed esophageal cancer combined with lung lesions requiring surgery, the risk of concurrent resection may be acceptable.
The association between perception of noise from a mechanical heart valve and symptoms of anxiety and depression
Authors: Dehli Lena N , Norekvål Tone M , Haaverstad Rune , Eide Geir Egil , Oterhals Kjersti 
Published: August 2023

Abstract

Aims
Patients with symptomatic aortic valve stenosis are efficiently treated by aortic valve replacement (AVR), using a biological or mechanical valve. For some patients with mechanical valves, the metallic clicking sound may be problematic. The aim of this study was to investigate the perceived disturbance from the sound of a mechanical valve and the association between noise perception and symptoms of anxiety and depression.

Methods and results
The study had a cross-sectional design. In April 2013, all patients who had undergone AVR at one university hospital during the period 2000–12 were invited by post to participate. The primary variables were assessed using a valve-specific questionnaire and the Hospital Anxiety and Depression Scale. Of the 912 (77%) respondents, 245 had mechanical valves. Of these, 59 (24%) were women, the mean (standard deviation) age was 61 (11) years, and the mean time since surgery was 7 (3) years. The valve-specific questionnaire showed that 84% of the patients could sometimes or often hear the valve sound. A moderate positive correlation was found between valve prosthesis noise disturbance and anxiety, r = 0.35 (P = 0.001), and depression, r = 0.27 (P = 0.001). In a multiple linear regression analysis, valve noise perception was only significantly associated with anxiety among several other bio-psychosocial factors.

Conclusion
This study shows an association between valve noise disturbance and symptoms of anxiety and highlights the importance of preparing all patients for the sound from the mechanical valves that arises after surgery.
Plasticity and the adaptive evolution of switchlike reaction norms under environmental change
Authors: Crowther Claudia , Bonser Stephen P , Schwanz Lisa E 
Published: August 2023

AbstractPhenotypic plasticity is often posited as an avenue for adaptation to environmental change, whereby environmental influences on phenotypes could shift trait expression toward new optimal values. Conversely, plastic trait expression may inhibit adaptation to environmental change by reducing selective pressure on ill-adapted traits. While plastic responses are often assumed to be linear, nonlinear phenotype–environment relationships are common, especially in thermally sensitive traits. Here we examine nonlinear plasticity in a trait with great ecological and evolutionary significance: sexual phenotype in species with environmental sex determination (ESD). In species with ESD, development switches between male and female at an environmental threshold (the inflection point). The inflection point is a key trait for adaptive responses to changing environments and should evolve toward the new optimum in order to maintain evolutionarily stable sex ratios. We used an individual-based theoretical model to investigate how two forms of plasticity in the ESD reaction norm—the nonlinear slope of the reaction norm and a linear shift in the inflection point—influence the evolution of the inflection point under climate warming. We found that steeper reaction norm slopes (high nonlinear plasticity) promoted evolution toward new optimal phenotypes (higher inflection points). In contrast, increased linear plasticity in the inflection point (shift) hindered adaptive evolution. Additionally, populations in moderate warming scenarios showed greater adaptive evolution of the inflection point compared with populations in extreme warming scenarios, suggesting that the proximity of existing phenotypes to new optimal phenotypes influences evolutionary outcomes. Unexpectedly, we found greater population persistence under high climate variability, due to the increased production of rare-sex individuals in unusually cold years. Our results demonstrate that different forms of phenotypic plasticity have crucially different effects on adaptive evolution. Plasticity that prevented sex ratio bias hindered the evolution of the inflection point, while plasticity that exacerbated sex ratio bias promoted adaptation to environmental change.
Integrative tissue, cellular and molecular responsiveness of an innovative ex vivo model of the Staphylococcus aureus‐mediated bone infection
Authors: Mariano Lorena Castro , Grenho Liliana , Fernandes Maria Helena , de Sousa Gomes Pedro 
Published: August 2023

AbstractOsteomyelitis is a pathological condition of the bone, frequently associated with the presence of infectious agents – namely Staphylococcus aureus – that induce inflammation and tissue destruction. Recent advances in the understanding of its pathophysiology and the identification of innovative therapeutic approaches were gathered from experimental in vitro and in vivo systems. However, cell culture models offer limited representativeness of the cellular functionality and the cell–cell and cell‐matrix interactions, further failing to mimic the three‐dimensional tissue organization; and animal models allow for limited mechanistic assessment given the complex nature of systemic and paracrine regulatory systems and are endorsed with ethical constraints. Accordingly, this study aims at the establishment and assessment of a new ex vivo bone infection model, upon the organotypic culture of embryonic chicken femurs colonized with S. aureus, highlighting the model responsiveness at the molecular, cellular, and tissue levels. Upon infection with distinct bacterial inoculums, data reported an initial exponential bacterial growth, followed by diminished metabolic activity. At the tissue level, evidence of S. aureus‐mediated tissue destruction was attained and demonstrated through distinct methodologies, conjoined with decreased osteoblastic/osteogenic and increased osteoclastic/osteoclastogenic functionalities—representative of the osteomyelitis clinical course. Overall, the establishment and characterization of an innovative bone tissue infection model that is simple, reproducible, easily manipulated, cost‐effective, and simulates many features of human osteomyelitis, further allowing the maintenance of the bone tissue's three‐dimensional morphology and cellular arrangement, was achieved. Model responsiveness was further demonstrated, showcasing the capability to improve the research pipeline in bone tissue infection‐related research.