bluuebunny/crossref_metadata_2025_split huggingface dataset:
434. INCREASING TUMOUR INFILTRATING LYMPHOCYTES THROUGH EXERCISE ALONE—A PILOT RCT IN ESOPHAGEAL ADENOCARCINOMA
Authors: Rayner Charles , Allen Sophie , Seymour Tadd , Preston Shaun , Frampton Adam , Bartlett David , Annels Nicola , Abbassi-Ghadi Nima 
Published: August 2023

Abstract

Background
The immune system is highly responsive and positively adapts to exercise. A single bout of exercise results in the mobilisation of highly functional effector CD8+ T cells and NK-cells into the circulation. Murine cancer models have shown that exercise reduces tumour burden by increasing the frequency of tumour-infiltrating lymphocytes (TILs). There are no studies assessing the impact of an exercise programme on the levels of TILs in patients’ solid tumours in any cancer.

Methods
We recently completed a 16-week randomised prehabilitation exercise program (NCT02950324) in esophageal cancer patients before esophagogastric cancer resection. Exercise training was a low-to-moderate intensity twice supervised, thrice home-based weekly program. Tumour specimens obtained at the time of resection were formalin fixed paraffin embedded (FFPE) for multispectral immunohistochemical analysis. Tumour tissues were stained with primary antibodies for CD68, CD57, CD8, CD4, FoxP3, Granzyme B, PDL1 and pancytokeratin. Cell populations and spatial relationships were analysed using the Phenoimager HT (Akoya Biosciences) and QuPath.

Results
Although our exercise program was ~33% of the physical activity guidelines for cancer patients, physical fitness and well-being were maintained rather than significantly reduced in the intervention group compared to the control group. Multispectral analysis observed that 3.2% ± 1.1% of cells in the tumours were CD8+ T cells compared to 1.4% ± 0.5% in the control group (p &lt; 0.001). Furthermore, we observed positive associations between increased frequencies of CD8 + TILs (Fig 1C: r = 0.562, p = 0.016), Granzyme B+/CD8 + TILs (r = 0.637, p = 0.003) and larger increases in exercise induced aerobic capacity. This data suggests that the more exercise can increase aerobic fitness, the greater the likelihood of increasing functional TILs.

Conclusion
New approaches to improve outcomes following surgery for esophageal adenocarcinoma are required. One such approach is immunotherapy. However, immunotherapy is relatively ineffective in esophageal adenocarcinoma due to the lack of CD8+ T cells and NK cells in the tumours. Increasing TILs through exercise programmes that are designed to focus on maintaining or improving aerobic capacity may improve patients’ response to immunotherapy and positively impact prognosis and survival.
436. USEFULNESS OF INTRAOPERATIVE CONTINUOUS NERVE MONITORING IN TRANSMEDIASTINAL MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Nakamichi Naosuke , Fujiwara Hitoshi , Shiozaki Atsushi , Konishi Hirotaka , Inoue Hiroyuki , Nishibeppu Keiji , Ohashi Takuma , Shimizu Hiroki , Arita Tomohiro , Yamamoto Yusuke , Morimura Ryo , Kuriu Yoshiaki , Ikoma Hisashi , Kubota Takeshi , Otsuji Eigo 
Published: August 2023

Abstract

Introduction
We have previously reported that continuous intraoperative nerve monitoring (CIONM) is useful in reducing postoperative left recurrent laryngeal nerve paralysis (RLNP) in transmediastinal esophagectomy (TME). In this study, we investigated the relationship between the paralysis risk types on CIONM and postoperative RLNP.

Methods
A total of 161 patients who underwent TME for esophageal malignancies and esophagogastric junctional cancer with CIONM between October 2017 and July 2022. The relationship between clinical background factors, changes in amplitude during surgery, and left RLNP (endoscopic vocal cord findings on postoperative day 7) was retrospectively investigated. Furthermore, the relationship between LOS types (segmental or diffuse) and left RLNP was examined.

Results
The median age was 70 years, with 127 male and 34 female patients. At the end of transcervical procedure, 46 patients had amplitude less than 100 μV (LOS: loss of signal) and 78 patients had amplitude ≤50% of baseline. Postoperatively, 76.1% of LOS cases and 46.2% of cases with amplitudes ≤50% of baseline had left RLNP. The amplitude reduction types (LOS, baseline≤50%), primary tumor in the cervical/upper thoracic/middle thoracic esophagus, and males were significantly associated with left RLNP (p &lt; 0.001). When examined by LOS type, RLNP was more common in segmental LOS than in diffuse LOS.

Conclusion
The pattern of amplitude reduction on CIONM is useful in predicting postoperative left RLNP. We will continue to increase the number of cases and verify the further effectiveness of CIONM for TME.
442. REFLUXSTOP PROCEDURE AS A NOVEL TECHNIQUE FOR MANAGEMENT OF GASTROESOPHAGEAL REFLUX DISEASE: TWO-YEAR FOLLOW-UP DATA AT A HOSPITAL IN SWITZERLAND
Authors: Borbély Yves , Kroell Dino , Martinelli Claudine Di Pietro , Haltmeier Tobias , Prevost Gian 
Published: August 2023

Abstract

Background
RefluxStop is a nonactive implantable medical device that aims to reduce gastroesophageal reflux disease (GERD) symptoms without compression of the food passageway. It restores the normal anatomy of the lower esophageal sphincter, gastroesophageal flap valve, and angle of His. This study presents data from two-year follow-up of patients managed with the RefluxStop procedure at a tertiary level hospital.

Methods
A total of 45 patients with GERD were treated with RefluxStop between January 2019 and December 2022 at a single institution in Switzerland. Two-year follow-up was recently completed for 20 of these patients. Reported outcome measures include GERD health-related quality of life (GERD-HRQL) score, proton pump inhibitor (PPI) usage, and intra- or postoperative adverse events (AEs).

Results
Patients were aged 49 ± 13.6 years with a body mass index of 27 ± 2.9 kg/m2. The mean size of hiatal hernia was 2.81 ± 1.97 cm. GERD-HRQL score at baseline was 21 ± 9.28 with two-year postoperative follow-up demonstrating a 85.7% reduction to 3 ± 3.66. All patients showed significant improvement in primary GERD symptoms such as heartburn and regurgitation, with one exception. This patient was converted to Toupet fundoplication but experienced recurrent symptoms. Of the 19 patients managed by RefluxStop, only one patient (5.2%) required use of PPIs for refractory symptoms. Serious AEs were experienced by 3 patients at one-year follow-up, none of which were device-related.

Conclusion
The effectiveness of RefluxStop as a novel technique to manage GERD was demonstrated by this study. Further investigation via ongoing prospective studies, such as head-to-head trials comparing RefluxStop to fundoplication techniques, are already in preparation.
455. SIGNIFICANCE OF NUTRITIONAL EVALUATION USING GLIM CRITERIA IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Ogata Takashi , Kanematsu Kyohei , Tanabe Emi , Onuma Shizune , Morita Junya , Nagasawa Shinsuke , Yamada Takanobu , Oshima Takashi 
Published: August 2023

Abstract
Background:
464. MINIMALLY INVASIVE IVOR LEWIS ESOPHAGECTOMY IN THE ELDERLY PATIENT: A MULTICENTER RETROSPECTIVE MATCHED-COHORT STUDY
Authors: Scarton Alessia , Capovilla Giovanni , Uzun Eren , Moletta Lucia , Hadzijusufovic Edin , Provenzano Luca , Salvador Renato , Pierobon Elisa Sefora , Zanchettin Gianpietro , Tagkalos Evangelos , Berlth Felix , Lang Hauke , Valmasoni Michele , Grimminger Peter P 
Published: August 2023

Abstract

Background
Several studies reported the advantages of minimally invasive esophagectomy over the conventional open approach, particularly in terms of postoperative morbidity and mortality. The literature regarding the elderly population is however scarce and it is still not clear whether elderly patients may benefit from a minimally invasive approach as the general population. We sought to evaluate whether thoracoscopic/laparoscopic (MIE) or fully robotic (RAMIE) Ivor-Lewis esophagectomy significantly reduces postoperative morbidity in the elderly population.

Methods
We analyzed data of patients who underwent open esophagectomy or MIE/RAMIE at Mainz University Hospital and at Padova University Hospital between 2016 and 2021. Elderly patients were defined as those ≥75 years old. Clinical characteristics and the postoperative outcomes were compared between elderly patients who underwent open esophagectomy or MIE/RAMIE. A 1-to-1 matched comparison was also performed. The difference in overall survival (OS) and disease free survival (DFS) between the two group was also evaluated. Patients &lt;75 years old were evaluated as a control group.

Results
Among elderly patients MIE/RAMIE were associated with a lower morbidity (39.7% vs. 62.7%, p = 0.005), less pulmonary complications (32.8 vs. 56.9%, p = 0.003) and a shorter hospital stay (13 vs. 18 days, p = 0.03). Comparable findings were obtained after matching. Among &lt;75 years-old patients, a reduced morbidity (31.2% vs. 43.5%, p = 0.01) and less pulmonary complications (22% vs. 36%, p = 0.001) were detected in the MI group. No difference was detected in the OS of the &gt;75y MI group (26 months) and the &gt;75y open group (19 months)(p = 0.84). The DFS was also similar (26 months vs. 13 months, p = 0.25).

Conclusion
Therefore, minimally invasive esophagectomy improves the postoperative course of elderly patients reducing the overall incidence of postoperative complications, particularly of pulmonary complications.
470. DO RADIOLOGISTS ALWAYS USE ORAL CONTRAST DURING CT SCANNING FOR POST-ESOPHAGECTOMY ANASTOMOTIC LEAK: SURVEY OF PROTOCOLS IN THE UK
Authors: Panackal Rohit , Sudlow Alexis , Kulasegaran Suheelan , Kumar Bhaskar 
Published: August 2023

Abstract

Background
Anastomotic leak (AL) is a life-threatening complication following esophagectomy. Early and accurate diagnosis is key. Although computerized tomography (CT) scan is a widely employed diagnostic modality, there is no consensus on whether oral contrast should be used in addition to IV contrast. We sought to survey protocols regarding the use of oral contrast amongst specialist radiologists when using CT scan to diagnose AL.

Methods
An online questionnaire was sent to 27 consultant gastrointestinal (GI) radiologists with a subspecialist esophageal interest from 11 tertiary centres. Participants were primarily asked for their preferred imaging modality to diagnose AL, choice of contrast if a CT scan was used (assuming no contraindications for IV contrast) and an explanation for their preferred choice of investigation.

Results
The response rate was 96.3% (n = 26). Most participants (16 [61.5%]) used CT scan as first choice modality, while six (23.1%) used fluoroscopy and two (15.3%) used CT scan and fluoroscopy. With CT scan, half the participants preferred using both oral and IV contrast to IV contrast alone. No participants chose oral contrast alone. Some participants who used oral contrast felt it helped differentiate between normal post-surgical changes and true leaks. Limitations of using oral contrast included concerns of missed leaks involving the anterior aspect of the esophagus and lowered enhancement of the esophageal mucosa.

Conclusion
The majority of radiologists favor using oral contrast in addition to IV contrast for CT scan for suspected AL. In spite of this, practice is variable even amongst radiologists from the same unit. The lack of consensus emphasizes the need for further research to establish best practice and formulation of guidelines.
484. ROBOTIC ASSISTED PRONE ESOPHAGECTOMY USING VERSIUS PLATFORM: A PROMISING APPROACH
Authors: Maurice Karim , Moussa Hatem , Hawary Ramy , Nabil Ahmed , Hamour Dina , Mikhail Sameh , Shazly Mostafa 
Published: August 2023

Abstract

Background
Esophagectomy for cancer is a complex procedure with high morbidity. Minimally invasive approach offers the benefits of minimal access across the different fields required during this operation. Robotic surgery is becoming an integral part of modern practice. It holds the potential of more precision especially in narrow thoracic space. Currently, Many Robotic platforms exist. This video aims to demonstrate the feasibility of Robotic Mc Keown esophagectomy in the prone position using Versius platform.

Methods
56 years old male patient presented with grade I dysphagia of 3 months duration. His complete assessment revealed an 11 cm long invasive non keratinizing squamous cell carcinoma located in the mid esophagus (cT3N1M0). Marked regressive course of the lesion occurred with neoadjuvant chemoradiation. Robotic assisted Mc Keown esophagectomy was performed in the prone position. Thoracic phase was performed with the robotic approach. Bed side units and Port placement is illustrated in the video. The abdominal phase was accomplished laparoscopically. Finally, the stomach was pulled up and the esophagogastric anastomosis was done in the neck.

Results
No intraoperative adverse events were encountered. The improved vision, dexterity and articulation of instruments facilitated the identification of the thoracic duct, ligation of azygos vein tributaries and dissection of the recurrent laryngeal lymph nodes. Instrument clash was insignificant due to patient’s wide chest cavity and optimal positioning of ports and bed side units improving ergonomics. The operative time of the thoracic phase was 310 min. Blood loss was 300 mL. The postoperative course was uneventful except for chest infection which improved on conservative measures. The length of stay was 18 days. Pathology revealed complete clinical response with 0/25 lymph node yield.

Conclusion
Robotic assisted esophagectomy is feasible and can be safely performed using Versius robotic platform. The enhanced visualization and articulation enabled meticulous dissection of the recurrent laryngeal lymph nodes. Patient positioning, optimal port and bed side units placement were keys to achieving minimal instrument clash. Further research is needed to confirm these findings and to compare the long-term oncological outcomes and cost effectiveness of this modality.
Video links:
https://we.tl/t-rpkTHvNlXI
or
https://drive.google.com/drive/folders/1tOsFPrEBUHBpVn8C9jF7BGoNxlYPuBjq?usp=sharing.
493. IRON DEFICIENCY AFTER ONCOLOGICAL ESOPHAGECTOMY AND GASTRECTOMY
Authors: Sallakhi Aria , Baumgartl Isabella Alexandra , Andresen Julian Ramin , Khater Hagar , Gibas Georg , Medibach Amadea , Marolt Cordula , Radlspöck Wolfgang , Zacherl Johannes 
Published: August 2023

Abstract
Removal of the entire stomach or parts of it may affect iron absorption and storage. These conditions mainly caused by altering the acid environment, bypassing the duodenal passage during reconstruction or by chronic inflammatory processes. In addition, patients with esophageal or gastric cancer often have an iron deficiency preoperatively due to malnutrition, gastrointestinal hemorrhage, or inflammatory processes. Sometimes these iron deficiencies lead to microcytic hypochromic deficiency anemia.
Between January 2015 and December 2019, 103 (=66%) esophagectomy patients and 54 (=34%) (sub)total gastrectomy patients were included. Fe, transferrin and ferritin were collected prospectively to be used for retrospective descriptive analysis: preoperatively and three, six, twelve, 18 and 24 months after the operations. The exclusion criteria were: Age below 18, primary bone marrow disease, hereditary forms of anemia, postoperative tumor recurrence, R1/R2 situation. Iron supplementation was not used in the first postoperative year, and thereafter only in cases of a severe iron deficiency. The severity of iron deficiency was classified by ferritin, according to iron deficiency stages I—III.
18% of patients with oncological esophagectomy and 45% of patients with oncological (sub)total gastrectomy have an iron deficiency two years after the operations. This is manifested mainly by pathologically decreased ferritin levels. There is only a significant difference between the groups, with respect to ferritin (p = 0.021) and transferrin levels (p = 0.028), after 2 postoperative years. 75% of esophagectomy patients with iron deficiency were in stage I, 12.5% in stage II and 12.5% in stage III of iron deficiency. 56% of iron deficiency patients with (sub)total gastrectomy were in stage I, 22% in stage II and 22% in stage III.
Patients with (sub)total gastrectomy are more likely to have iron deficiency than patients with esophagectomy during the 24-month postoperative follow-up period. Due to the duodenal bypassing in the (sub)total gastrectomy group a higher prevalence of iron deficiency could have been expected. Most patients have storage iron deficiency (= stage I). Only few patients with iron deficiency have the more severe and decompensated form of iron deficiency, iron deficiency anemia (= stage III).
Atypical presentation and percutaneous repair of ascending aortic pseudoaneurysm: a case report
Authors: Tobías-Castillo Pablo E , Oristrell Gerard , Reyes-Juárez José Luis , Martí-Aguasca Gerard 
Published: August 2023

Abstract

Background
Ascending aortic pseudoaneurysms (AAPs) are an unusual complication of cardiac or aortic surgery and are associated with a high risk of complications and mortality. Guidelines recommend surgical repair. There is few data concerning percutaneous occlusion of AAP. We present a case of syncope due to vascular and heart chamber compression by a large post-surgical AAP that was filled through a focal leak. Ascending aortic pseudoaneurysm was successfully occluded percutaneously.

Case summary
A 66-year-old man with a mechanical aortic prosthesis and a Dacron tube in the ascending aorta presented with syncope due to compression of the right atrium and superior vena cava by a large peritube collection. A computed tomography angiography (CTA) showed a large AAP that was filled through a small focal dehiscence of the tube proximal suture. Patient was dismissed for surgery due to high surgical risk. Then, AAP was successfully occluded percutaneously via a 6-French radial access and local anaesthesia.

Discussion
In patients with syncope and previous cardiac surgery, aortic complications should be ruled out. Although transthoracic echocardiography may be useful, CTA is the recommended diagnostic test for ruling out post-surgical AAP and allows the characterization of the number, localization, and size of the leaks. In selected patients with high surgical risk and favourable anatomic characteristics, a percutaneous closure could be indicated.
Case Report: emergent percutaneous directional thrombectomy in a patient with cardiogenic shock and large mobile thrombus in the right atrium
Authors: Blasco-Turrión Sara , Plaza-Martín María , Amat-Santos Ignacio J 
Published: August 2023

Abstract

Background
New percutaneous techniques for the management of acute pulmonary embolism (PE) are emerging, but there is lack of data regarding the approach of mobile thrombus in the right chambers, with the added risk of potential thrombus dislodgement that may prevent from mechanical circulatory support devices to be implanted in unstable patients.

Case summary
We present the case of a 65-year-old male with cardiogenic shock of unknown aetiology, severe biventricular dysfunction, and large mobile thrombus in the right atrium. Mechanical circulatory support devices could not be implanted, and current thromboaspiration systems were either too small or not available at that time. However, the patient’s condition deteriorated rapidly with thrombus in transit, hence, a novel approach was required: using a deflectable 14 Fr sheath, directional thrombectomy was performed, achieving complete extraction of the thrombi and allowing for circulatory support with extracorporeal membrane oxygenation (ECMO) to be implanted with outstanding results and progressive weaning of all intensive care measures.

Discussion
Despite the growing interest in the development of percutaneous strategies for acute PE, there is no evidence-based guidelines regarding the treatment of mobile right heart thrombus. Even though some cases of percutaneous right heart thrombectomy have been reported, it is still a challenging scenario, given the potential risk of thrombus dislodgement and atrial perforation. We describe a novel technique of percutaneous directional thrombectomy in a patient with cardiogenic shock of unknown aetiology and large mobile thrombi in the right atrium as a bridge to ECMO proving to be a feasible alternative to treat thrombus in transit.
Refining prediction of stroke in sinus node dysfunction patients without atrial fibrillation using a P-combined score: a multi-centre study
Authors: Dong Haoyu , Zhang Yan , Sun Dongxu , Wang Gaopin , Zhang Qinglong , Hidru Tesfaldet H , Yang Yiheng , Wang Shihao , Wei Yushan , Liu Fei , Zhang Jinpu , Xia Yunlong , Yang Xiaolei 
Published: August 2023

Abstract

Aims
Isolated sinus node dysfunction (ISND) is a sinus node dysfunction without atrial fibrillation. A high risk of ischaemic stroke (IS) has been reported in ISND populations. However, current guidelines do not recommend anticoagulation in ISND management. P-wave indicates ISND-related atrial remodelling. P-wave indices and the CHA2DS2-VASc score may contribute to risk stratification for ISND-related IS.

Methods and results
In this multi-centre longitudinal cohort, ISND patients were divided into development (n = 1185) and external validation (n = 988) cohorts. Ischaemic stroke prediction capacity of the P-combined score was assessed with regard to discrimination, calibration, and clinical effectiveness. The cut-off value of the score was confirmed by using a restricted cubic spline curve. One hundred and twenty-four (10.46%) ISND patients developed IS [1.63%/year; 95% confidence interval (CI): 1.49–1.78%/year] after a median 3.02-year follow-up in the development cohort. The P-wave terminal force in electrocardiogram-lead V1 (PTFV1) was the only significantly abnormal P-wave index (adjusted hazard ratio: 2.56; 95% CI: 1.72–3.80). Therefore, we incorporated the PTFV1 with the CHA2DS2-VASc score to generate a P-combined score. For a 5-year IS risk, the P-combined score improved Harrell’s C-statistic (95% CI) from 0.678 (0.618–0.738) to 0.716 (0.657–0.774) and 0.747 (0.677–0.816) to 0.808 (0.747–0.868) in the development and validation cohorts, respectively, along with calibration and decision curve analyses. The cut-off value of the score was 3 in the development cohort and well-discriminated in the validation cohort.

Conclusion
Chinese ISND patients have a higher IS risk than the general population. Compared with the CHA2DS2-VASc score, the PTFV1-combined CHA2DS2-VASc score shows a better risk-stratification capacity for ISND-related IS.