bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deep Kronecker network
Authors: Feng Long , Yang Guang 
Published: August 2023

Summary
We develop a novel framework for the analysis of medical imaging data, including magnetic resonance imaging, functional magnetic resonance imaging, computed tomography and more. Medical imaging data differ from general images in two main aspects: (i) the sample size is often considerably smaller and (ii) the interpretation of the model is usually more crucial than predicting the outcome. As a result, standard methods such as convolutional neural networks cannot be directly applied to medical imaging analysis. Therefore, we propose the deep Kronecker network, which can adapt to the low sample size constraint and offer the desired model interpretation. Our approach is versatile, as it works for both matrix- and tensor-represented image data and can be applied to discrete and continuous outcomes. The deep Kronecker network is built upon a Kronecker product structure, which implicitly enforces a piecewise smooth property on coefficients. Moreover, our approach resembles a fully convolutional network as the Kronecker structure can be expressed in a convolutional form. Interestingly, our approach also has strong connections to the tensor regression framework proposed by Zhou et al. (2013), which imposes a canonical low-rank structure on tensor coefficients. We conduct both classification and regression analyses using real magnetic resonance imaging data from the Alzheimer’s Disease Neuroimaging Initiative to demonstrate the effectiveness of our approach.
264. A RETROSPECTIVE CHART REVIEW OF 85 PATIENTS UNDERGOING THE REFLUXSTOP PROCEDURE TO MANAGE GASTROESOPHAGEAL REFLUX DISEASE: SAFETY AND EFFICACY
Authors: Lehmann Thorsten , Simkus Mantas , Oehler Christoph 
Published: August 2023

Abstract

Background
RefluxStop is a novel surgical device that manages gastroesophageal reflux disease (GERD) by restoring the normal structure of the antireflux barrier. This is accomplished by reinstating the acute angle of His and anchoring the gastroesophageal sphincter adequately in the intraabdominal cavity. This study reports the safety and efficacy of 79 patients in the postoperative period.

Methods
A retrospective chart review was performed on 79 patients that underwent the RefluxStop procedure at a single institution between July 2021 and November 2022 to manage GERD symptoms after informed consent was obtained. Measures were evaluated to assess the feasibility, safety, and clinical outcomes during the follow-up period.

Results
79 patients (age 49.8 ± 14 years), 46 of which were male, had a mean BMI of 25.8 ± 4.5. Associated conditions noted included esophagitis (45.6%), Barrett’s esophagus (17.7%), and hiatal hernia (57%). Hiatal hernias were large in 35% of cases, with an overall average size of 2.9 cm. Baseline symptoms included general GERD symptoms (35.4%), heartburn (29.1%), cough (13.9%), regurgitation (11.4%), retrosternal burning (10.1%), hoarseness (5.1%), abdominal pain or pressure (3.8%), nausea (2.5%), and others. Baseline GERD health-related quality of life (GERD-HRQL) score was 21.5 ± 5.2 and patients were receiving proton pump inhibitors (PPIs) for a mean of 4.7 ± 6.8 years. After surgery (10.7 ± 3.1 months), all subjects experienced significant improvement in GERD-related symptoms including dysphagia. Only 2.5% of patients required use of PPIs and no subjects required postoperative esophageal dilatation or reoperation. Additionally, there were no severe perioperative complications. Postoperatively, the mean GERD-HRQL score was significantly reduced to 1.6 ± 3.2 (92.6% improvement).

Conclusion
This study adds to a growing body of evidence that the RefluxStop procedure is safe and effective in management of GERD patients. Notably, a considerable improvement in PPI usage and health-related quality of life parameters were appreciated. Additional studies are required to further validate the role of this procedure in disease management.
307. A REVIEW OF 31 SUPERFICIAL ESOPHAGEAL CANCER CASES WITHOUT HISTORY OF HABITUAL DRINKING OR SMOKING OBSERVED IN OUR HOSPITAL
Authors: Ishiyama Akiyoshi , Fukuyama Chika , Yamamoto Hiroyuki , Ikenoyama Yohei , Namikawa Ken , Tokai Yoshitaka , Yoshio Toshiyuki , Fujisaki Junko 
Published: August 2023

Abstract

Background
In Japan, alcohol consumption, smoking, and genetic an aldehyde dehydrogenase 2 polymorphisms are risk factors for most esophageal squamous cell carcinomas(ESCC). However, only a limited number of cases have been observed without these risk factors in daily practice.

Objective
This study aimed to evaluate the endoscopic findings of 31 lesions in 29 patients with ESCC who underwent endoscopic submucosal dissection (ESD) at our hospital without a history of habitual alcohol consumption or smoking (hereafter referred to as ‘risk factors’).
Patients and Methods: We retrospectively examined the endoscopic findings, final diagnoses, and patient and lesion backgrounds of 31 lesions from 29 patients of ESCC without risk factors who underwent ESD from January 2017 to December 2022 at our hospital.

Results
A total of 27 women and two men, median age 72 (44–87) years, were included; 10 patients were on proton pump inhibitors, 12 patients had a history of cancer, and 12 patients had a family history of cancer in the first degree. Additionally, three patients had multiple heterochronic lesions, one patient had a speckled esophagus, and two patients had grade B gastroesophageal reflux disease according to the revised Los Angeles classification. Occupied site; Ut/Mt/Lt = 4/24/3, circumferential; anterior/posterior/left/right wall = 0/16/10/5, macroscopic type; 0-IIa/0-IIb/0-IIc/mixed type = 4/10/15/2, median lesion length 17(5–45) mm, wall depth; EP/LPM/MM/SM1 = 11/18/1/1/1, all vascular invasions were negative. A total of 22 lesions had white-tone mucosa on their surface, suggesting superficial keratinization or hyperkeratinization. The lesions were diverse in shape. Additionally, seven lesions were observed which tended to run longitudinally with long axial lengths, all located on the posterior wall of Mt, and white adherent material was observed in six lesions. Iodine staining was performed in 30 lesions, all of which were unstained, and six of them had indistinct borders with inflammatory changes in the background. A total of three patients had synchronous/heterochronic multiple esophageal cancers.

Conclusion
The white adherents running longitudinally in the posterior wall of the Mt and its white tone in patients with no risk factors suggest the possibility of previously unrecognized lesions and the need for close endoscopic examination, along with iodine staining and biopsy.
322. FLUORESCENCE LYMPHOGRAPHY USING INDOCYANINE GREEN IN THE PREVENTION OF CHYLE LEAKAGE AFTER MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Aa Dillen , Henckens Sophie , Eshuis Wietse J , Berge Henegouwen Mark , Gisbertz Suzanne 
Published: August 2023

Abstract

Background
Chyle leakage is one of the most challenging complications in esophagectomy, with an incidence of 14–21%. The clinical implications for patients are prolonged thoracic drainage and hospital admission, additional reinterventions, unpleasant dietary restrictions, and decreased long-term survival. The anatomy and vulnerability of the thoracic duct render it prone to injury, and mainly side branches and collaterals are often hard to visualize. Fluorescence lymphography using indocyanine green (ICG) can accurately visualize the thoracic duct, which may possibly reduce the incidence of chyle leakage and intra-operative detected chyle leakage can be treated directly.

Methods
A prospective observational cohort study is performed. Patients aged over 18 years with resectable (cT1-4a, N0–3, M0) esophageal carcinoma undergoing a minimally invasive esophagectomy are included. The primary endpoint of the study is postoperative chyle leakage. Secondary endpoints are overall morbidity and mortality, nature of dietary restrictions, reinterventions, hospital costs, 2 year survival rate and quality of life. Twenty-five milligram of ICG is dissolved in 10 mL of sterile water, obtaining a solution of 2.5 mg ICG per mL. In the McKeown esophagectomy, before the thoracic phase, the surgeon administers a bilateral bolus of 2 mL ultrasound-guided into inguinal lymph nodes. In an Ivor Lewis esophagectomy, 2 mL of reconstituted ICG will be injected into the small bowel mesenteric root just under the peritoneum of the mesentery, at the level where the jejunostomy is placed. Additionally, 50 mL of cream is enterally administered through the just established feeding jejunostomy. Subsequently, the operating area is inspected for chyle leakage with fluorescence lymphography after thoracic duct ligation and just before terminating the procedure.

Results
We aim to include 50 patients to assess the feasibility of fluorescent lymphography using ICG and enteral cream to prevent chyle leakage after minimally esophagectomy. Inclusion is ongoing, at this time, 31 of 50 patients are included. Results will be expected before the congress.

Conclusion
It is hypothesized that as a result of this technique the patients will benefit from lower incidence of postoperative chyle leakage, shorter thoracic drainage, reduced hospital admission, reduced dietary restriction, less re-interventions, and improved overall survival.
343. T LYMPHOCYTE SUBSETS CHARACTERISTICS IN DIFFERENT CURATIVE EFFICACY OF NEOADJUVANT THERAPY FOR PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Nie Xin , He Shuya , He Wenwu , Li Zhiyu , Li Changding , Ni Kunhan , Leng Xuefeng , Han Yongtao , Wang Chenghao 
Published: August 2023

Abstract

Background
In patients with resectable esophageal squamous cell carcinoma(ESCC), neoadjuvant therapy increased the curative resection rate, disease-free survival, and overall survival. Up to 32% of patients with esophageal cancer show a pathological complete response after neoadjuvant therapy. However, the efficacy of neoadjuvant therapy varies among different patients. We aim to compare the differences in the characteristics of peripheral blood T lymphocyte subsets before and after neoadjuvant therapy in patients with different curative efficacy.

Methods
This study enrolled 269 ESCC patients who received neoadjuvant treatment followed by esophagectomy planned 4–6 weeks after preoperative therapy. The postoperative pathological results divided patients into the main pathological response (MPR) and non-MPR groups. Compare the differences in peripheral blood T lymphocyte subsets before neoadjuvant therapy, and analyze the trend of changes in T lymphocyte subsets before neoadjuvant therapy, before surgery, in the short term after surgery, and at the initial follow-up after surgery.

Results
Before receiving neoadjuvant therapy, the peripheral blood CD4/CD8(p = 0.001) and helper T cell rate (THrate)(p = 0.006) in the MPR group were significantly higher than those in the non-MPR group. In contrast, the suppressor T cell rate(TSrate) was lower(p = 0.029) in the MPR group. After neoadjuvant therapy, the CD4/CD8 in both groups reached similar classes, but the THrate decreased dramatically and TSrate increased more in the MPR group. At the first follow-up after surgery, the peripheral blood CD4/CD8, THrate, and TSrate of both groups of patients tended to be at the same level.

Conclusion
T lymphocyte subsets in the peripheral blood significantly differed among patients with different neoadjuvant treatment efficacy. High levels of CD4/CD8, THrate, and low levels of TSrate before receiving neoadjuvant therapy may have better curative efficacy.
371. THE FEASIBILITY OF MINIMALLY INVASIVE SALVAGE ESOPHAGECTOMY
Authors: Tsunoda Shigeru , Nishigori Tatsuto , Hisamori Shigeo , Okumura Shintaro , Maekawa Hisatsugu , Fujita Yusuke , Kasahara Keiko , Morimoto Tomonori , Kinoshita Hiromitsu , Sakamoto Takashi , Mihara Kaito , Okamura Ryosuke , Itatani Yoshiro , Hoshino Nobuaki , Hida Koya , Obama Kazutaka 
Published: August 2023

Abstract

Background
The mortality of salvage esophagectomy following definitive chemoradiotherapy for esophageal cancer is reported to be high and the feasibility of a minimally invasive approach for salvage esophagectomy remains unknown. The aim of the study is to investigate the feasibility of a minimally invasive approach for salvage esophagectomy.

Methods
Consecutive 34 patients including 6 pharyngolaryngectomy with total esophagectomy who underwent salvage esophagectomy for esophageal cancer after chemoradiotherapy of 50Gy or greater between 2011 and 2023 were retrospectively reviewed. Postoperative complications were graded according to the Clavien-Dindo classifications. Our strategy for salvage esophagectomy is as follows; subcarinal dissection and upper mediastinal dissection were omitted unless lymph node involvement was suspected to preserve the tracheal perfusion. Cervical supercharge for the conduit is actively considered if the perfusion is uncertain.

Results
The median age was 64 (45–78). Clinical T stages were T1/T2/T3/T4: 2/8/19/5. The thoracic approaches are conventional thoracoscopy (n = 23), robot-assisted thoracoscopy (n = 9), and mediastinoscopy (n = 2), and no patients underwent open thoracotomy. Cervical supercharge was performed in 16 (47%) patients. The median operation time and blood loss were 673 min and 101 g, respectively. Severe postoperative complications (≧Grade III) occurred in 4 (12%) patients and any postoperative complications (≧Grade II) occurred in 19 (56%) patients, including 6 (18%) anastomotic leakage and 5 (15%) pneumonia. There was no mortality. The 3- and 5-year overall survival rate was 82% and 69%, respectively.

Conclusion
The minimally invasive approach for salvage esophagectomy was safe and feasible in terms of short- and long-term outcomes.
416. FEASIBILITY STUDY ON THE INTRA-OPERATIVE USE OF IMPEDANCE PLANIMETRY (ENDOFLIP) TO ASSESS PYLORIC FUNCTION DURING ESOPHAGECTOMY
Authors: Bolger Jarlath , Wakeam Elliot , Yeung Jonathan 
Published: August 2023

Abstract

Background
Esophagectomy remains the cornerstone of curative treatment of esophageal cancer. Despite this, the optimal management of the pylorus remains unclear. In open surgery, a pyloroplasty, pyloromyotomy or finger fracture of the pylorus has been standard. In minimally invasive surgery, pyloric procedures are frequently excluded. Approximately 16% of patients will subsequently require endoscopic dilation of their pylorus due to issues with conduit function. Conversely, those with a pyloric procedure have significantly higher rates of dumping. The aim of this feasibility study is to determine whether intra-operative impedance planimetry (EndoFLIP) assessment of the pylorus may help identify those who will benefit from an up-front pyloric procedure.

Methods
20 consecutive patients undergoing esophagectomy for esophageal cancer were consented and enrolled. At the conclusion of the operative procedure, when assessing the anastomosis and conduit endoscopically, the EndoFLIP catheter was passed with the endoscope. Diameter of the pyloric lumen and distensibility index (DI) were recorded for a range of balloon pressures.

Results
There were significant variations in lumen diameter and DI between patients. Mean lumen diameter with 30 mL balloon volume is 8.3 mm (5.1–11.3), with 40 mL balloon volume is 12.5 mm (11.6–13.8), and with 50 mL balloon volume is 14.9 mm (13.9–15.9). Mean DI at 30 mL is 5.77 (1.35–13.5), at 40 mL is 8.64 (4.59–17.0) and at 50 mL is 12.7 (3.56–38.0).

Conclusion
EndoFLIP assessment of pyloric function is feasible during esophagectomy. There are significant variations in pyloric measurements between patients. This may allow personalised management of the pylorus for patients undergoing minimally invasive esophagectomy.
441. COMBINING LARYNGEAL ULTRASONOGRAPHY (LUSG) WITH VOICE ASSESSMENT OR INTRA-OPERATIVE NERVE MONITORING RESULTS ACCURATELY CONFIRMS NORMAL VOCAL CORD FUNCTION AFTER ESOPHAGECTOMY
Authors: Fung Man Him Matrix , Wong Ian , Chan Fion Siu-Yin , Law Tsz-Ting , Chan Kwan-Kit , Wong Claudia Lai-Yin , Lang Brian Hung-Hin , Law Simon Ying-Kit 
Published: August 2023

Abstract

Background
Conventional diagnosis of vocal cord paresis (VCP) after esophagectomy relies on flexible laryngoscopy (FL), which is invasive. As most patients had normal post-operative VC function, a non-invasive alternative such as laryngeal ultrasonography (LUSG) may avoid unnecessary FL. LUSG was well-known to be accurate for post-thyroidectomy VC evaluation, but its accuracy following esophagectomy was unclear. This prospective study assessed the feasibility and accuracy of LUSG to evaluate VC function on day-1 after esophagectomy.

Methods
Consecutive patients from a tertiary teaching hospital who underwent elective esophagectomy were prospectively recruited. All patients received FL and LUSG pre-operative and on post-operative Day-1, each performed by an independent, experienced blinded assessor. Exclusion criteria include pre-operative VCP and lost to VC evaluation at any time points. The primary outcome was the accuracy of LUSG in the diagnosis of VCP on Day-1 post-esophagectomy. The accuracy of intermittent intra-operative nerve monitoring (IIONM) and voice assessment (VA) after surgery for the diagnosis of VCP were also analyzed.

Results
Twenty-six patients were eligible for analysis. The median age was 70 years (66–73). Majority were male (84.6%) and had squamous cell carcinoma. (88.5%). Twenty-five (96.2%) received three-phase esophagectomy. Twenty-four (96%) had anastomosis at the neck at the same stage. There were three (11.5%) temporary and one (3.8%) permanent unilateral VCP. Sensitivity, specificity and accuracy of LUSG were 75.0%, 100.0% and 98.1% respectively, which were superior to IIONM alone (50%, 90.3%, 87.9%) or VA alone (50%, 90.9%, 84.6%). Combining LUSG with VA or IIONM improved sensitivity and negative predictive value to 100.0% and could avoid 77% FLs.

Conclusion
LUSG is an accurate method to evaluate VC function in the early post-operative period after esophagectomy. Combining LUSG with VA or IIONM results accurately confirms normal VC function after esophagectomy, and can avoid a majority of FLs.
446. VOCAL FOLD AUGMENTATION REDUCES PNEUMONIA INCIDENCE IN PATIENTS WITH IATROGENIC RECURRENT LARYNGEAL NERVE PALSY AFTER ESOPHAGECTOMY
Authors: Li Ricardo , Wong Ian , Zhang Riki , Wong Claudia , Chan K K , Law Betty , Chan S Y , Law Simon 
Published: August 2023

Abstract

Background
Recurrent laryngeal nerve (RLN) palsy is a significant complication associated with esophagectomy, resulting in a high incidence of pneumonia and a poor quality of life. Vocal fold augmentation (VFA) can help alleviate the associated symptoms of dysphonia. We aimed to investigate the impact of VFA on pneumonia incidence in patients suffering from RLN palsy after esophagectomy.

Methods
This is a retrospective cohort study. Patients who underwent esophagectomy at our center from 2003 to 2022, and experienced right, left or bilateral RLN palsy postoperatively were selected from a prospectively managed database. VFA consisted of medialisation thyroplasty, injection laryngoplasty, arytenoid adduction or a combination of these procedures. Pneumonia was defined as lung changes on chest x-ray, along with clinical evidence of infection within six months after esophagectomy. Pearson’s chi-squared test was used to assess the difference in pneumonia rates. Univariate and multivariate logistic regression analyses were used to identify associations between variables and the outcome of pneumonia.

Results
A total of 107 esophagectomy patients with RLN palsy were included. The overall palsy rate was 14.5%. 41 patients (38.3%) underwent VFA. Of the patients who underwent VFA, 13 (31.7%) underwent medialization thyroplasty, 26 (63.4%) underwent injection laryngoplasty, 1 (2.4%) underwent injection laryngoplasty and medialization thyroplasty, and 1 (2.4%) underwent injection laryngoplasty and arytenoid adduction. Pneumonia rate (14.6%) for patients who underwent VFA was significantly lower than that of patients without VFA (47.0%, P &lt; 0.001). On univariate and multivariate analyses, patients who underwent VFA were less likely to suffer from pneumonia compared to those without VFA (OR = 0.194, P = 0.001).

Conclusion
Vocal fold augmentation reduces pneumonia incidence in patients with recurrent laryngeal nerve palsy after esophagectomy.
Mesalazine-induced myopericarditis: a case series
Authors: Andrei Valentina , D’Ettore Nicoletta , Scheggi Valentina , di Mario Carlo 
Published: August 2023

Abstract

Background
Inflammatory bowel diseases (IBD) are characterized by chronic inflammation of the gastrointestinal tract but can have multiorgan involvement. Mesalazine (5-ASA) is a key therapeutic agent in IBD. Mesalazine has rare but potentially life-threatening side effects such as cardiac injury.

Case summary
We present two cases of myopericarditis, documented also with cardiac magnetic resonance, that we attributed to 5-ASA hypersensitivity: the first is a young woman with ulcerative colitis who developed myopericarditis after the initiation of 5-ASA, with a good clinical response after discontinuation; the second is a 79-year-old man who developed symptoms of heart failure after the diagnosis of IBD and the introduction of 5-ASA.

Discussion
Mesalazine may cause rare but potentially life-threatening cardiac injury, which can be difficult to distinguish from acute IBD-induced cardiac inflammation.
In search of markets and technology: the role of cross-border knowledge for domestic productivity
Authors: Arvanitis Spyros , Seliger Florian , Woerter Martin 
Published: August 2023

Abstract
Internationalization of research and development (R&D) is a double-edged sword: on the one hand, it is understood as a driving force of global innovation performance; on the other hand, from a national perspective it is often perceived as a threat to domestic efforts. Against this background, we compare the contribution of domestic and international knowledge sourcing to the productivity of Swiss firms. We find a positive productivity effect of knowledge-sourcing activities in geographically close countries (in the European Union [EU]). Domestic knowledge alone or from other world regions does not yield positive productivity effects. We provide evidence that companies that source international knowledge to generate innovative products benefit disproportionately from knowledge sourcing in the EU and that both knowledge- and market-seeking motives may be relevant to this result.
Coupled lateral and longitudinal trajectory tracking control with a modified vehicle kinematics model for autonomous vehicles
Authors: Li Sijie , Sun Zhanbo , Liu Yafei , Ji Ang , Zhang Shuaifei , Chen Linbin 
Published: August 2023

Abstract
The paper proposes a coupled lateral and longitudinal trajectory tracking control algorithm based on model predictive control (MPC) to enhance the precision and stability of trajectory tracking of autonomous vehicles. The coupled MPC controller is developed based on a modified vehicle kinematics model, which simultaneously takes the steering angle and the longitudinal speed as control variables. The modified vehicle model and the coupled MPC controller are verified by CarSim and MATLAB/Simulink co-simulation experiments. Simulation results demonstrate that, at the cost of 12 percent increase in average computational time, the proposed coupled MPC controller leads to an approximate 48 percent reduction in tracking error compared to the benchmarking coupled lateral and longitudinal MPC controller based on the classic kinematics model.