bluuebunny/crossref_metadata_2025_split huggingface dataset:
600. TREATMENT OUTCOME OF CLINICALLY UNRESECTABLE ESOPHAGEAL CANCER AFTER NEO-ADJUVANT CHEMOTHERAPY WITH DOCETAXEL, CISPLATIN AND 5-FLUOROURACIL
Authors: Chan Wing Lok , Wong Ian YH , Choi Horace Cheuk-Wai , Tsang Terence , Lam Adrian , Tse Rosa , Zhang Riki , Chan KK , Wong Claudia , Law Betty , Lam Ka-On , Chan Fion , Kwong Dora , Law Simon 
Published: September 2022

Abstract
Standard therapy for locally advanced unresectable esophageal cancer is neoadjuvant chemotherapy followed by definitive chemoradiotherapy (CRT). However, the prognosis was modest with the mean survival being around 1 year. Emerging evidence shows the efficacy results of using neo-adjuvant chemotherapy docetaxel-cisplatin-5FU (DCF) for locally advanced esophageal tumor.
We reviewed the long-term clinical outcomes and safety data of neo-adjuvant chemotherapy DCF and subsequent definitive treatment in locally advanced clinically unresectable esophageal cancer.
All patients with locally advanced clinically unresectable esophageal cancer without any distant metastases and received induction DCF (docetaxel 70 mg/ m2 D1, cisplatin 70  mg/ m2 D1, 5-fluorouracil 750  mg/ m2 on D1-5 Q3 weeks for 3 cycles) with an aim for conversion to definitive surgery or CRT were included.
Primary outcomes were overall survival (OS) and conversion rate (from unresectable to resectable tumor after DCF). Secondary outcomes include relapse pattern, safety data of chemotherapy and post-op complications.
Total 47 patients (median age 62yo, male: 41 (87.2%)) received neo-adjuvant DCF. 24 patients (41.4%) had subsequent surgery and 7 (14.9%) had definitive CRT.
The median OS was significantly longer in the surgical group than CRT group (40.2 vs. 9.1months, HR 3.33, 95%CI 1.22–9.07, p=0.02) and no definitive treatment (40.2 vs. 6.3months, HR 8.51, 95%CI 3.7–19.73, p&lt;0.001).
Patients with surgery had a lower risk of local relapse (100% vs. 33%, p&lt;0.001) but comparable risk of distant metastasis (47.8% vs. 58.6%, p=0.538) than those without surgery.
The incidence of G3/4 adverse events of DCF was 44.7%. 11 patients had post-op complications.
Neo-adjuvant chemotherapy with DCF and subsequent conversion surgery offered a chance of cure with long-term survival benefit and manageable toxicities in patients with locally advanced unresectable esophageal cancer.
613. DOUBLE LUMEN JEJUNAL FREE FLAP RECONSTRUCTION AFTER PROXIMAL ESOPHAGEAL RESECTION FOR MALIGNANCY
Authors: Chow Geoffrey , Hughes Timothy , Liu Changxing 
Published: September 2022

Abstract
Malignancies located at the level of the upper esophageal sphincter pose a challenge due to the proximity to pharyngeal, laryngeal, and upper esophageal anatomic structures. Poorly differentiated tumors in this area can pose both diagnostic and therapeutic dilemmas, and patients with prior neck radiation may require surgery. In cases that are treated with laryngectomy, pharyngectomy, and proximal esophagectomy, jejunal free flap reconstruction can restore gastrointestinal continuity and function.
A single institution early experience with multidisciplinary complex head and neck reconstruction requiring pharyngectomy and proximal esophagectomy was reviewed. Charts were reviewed for demographic details, operative details, and 30 day perioperative occurrences. Radiographic, clinical, and endoscopic records were reviewed. Method and approach for jejunal harvest and abdominal complications were obtained. Location of microvascular anastomoses were recorded for implantation of the jejunum. Length of small bowel utilized was recorded along with details of operative technique and methods for both proximal and distal anastomoses. Pre-operative and post-operative pathology reports were reviewed and compared.
The initial 4 cases of pharyngeal and esophageal resection requiring jejunal free flap reconstruction were reviewed. Mean age was 65.3 (50-74), mean BMI was 31.7 (21.7-49.8), and 75% of patients were female. Median length of stay was 13.5 days (8-14) after the index operation. Flap survival rate was 100%, and there was 0% leak rate. Three patients had previous neck surgery, 75% survived to 30 days with 1 patient opting for palliative care. All flaps were harvested using a laparoscopic approach. There were no abdominal donor site related complications. Pathology 50% SCC, mucoid epidermoid carcinoma, and anaplastic thyroid carcinoma.
Reconstruction of complex pharyngeal and proximal esophageal defects after oncologic resection for malignancy involving the proximal esophagus abutting the upper esophageal sphincter poses a complex challenge. These proximal esophageal defects are managed effectively with jejunal free flap reconstruction utilizing microvascular anastomoses. A double lumen jejunal free flap should be considered to restore pharygo-esophageal continuity, provides good pharyngeal size match, and can also be safely performed in patients with a re-operative field or prior neck radiation.
615. TREATMENT PATTERN AND OUTCOMES OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY
Authors: Jeon Yeong Jeong , Jung Younggi , Kim Hong Kwan , Shim Young Mog 
Published: September 2022

Abstract
Anastomotic leak (AL) is one of the most common complications after esophagectomy and is frequently associated with repeated interventions; nothing by mouth (NPO), endoscopic vacuum therapy (EVT), or surgery. This study aimed to evaluate treatment pattern and its outcomes for patients with AL after esophagectomy.
We retrospectively reviewed patients who underwent esophagectomy at a single center from 2003 to 2020. A total of 3096 patients were reviewed and 181 (5.8%) patients with AL, excluding graft necrosis, were included in this study. We classified patients with AL according to the site of the anastomosis; 114 (63%) patients with cervical anastomosis (CA) and 67 (37%) patients with intrathoracic anastomosis (TA).
The incidence of AL was 11.9% and 3.2% in patients with CA and TA, respectively (p &lt; 0.001). For patients with CA, 87 (76.3%), 15 (13.2%) and 12 (10.5%) patients were treated with NPO, EVT and surgery, respectively. Consequently, more than 90% of CA patients achieved oral diet at discharge regardless of management. For patients with TA, 36 patients underwent NPO (53.7%), of which 34 achieved oral diet. In addition, 25 patients were treated with EVT (37.3%), and 19 achieved oral diet. However, only 2 out of 6 patients treated with surgery achieved oral intake and 2 required subsequent EVT.
In patients with CA, the incidence rate of AL was higher, nevertheless, success rate of oral diet was higher than in patients with TA regardless of management. For AL in patients with TA, EVT applied more frequent than in patient with CA, and seems to be effective therapy.
617. OESOPHAGO-GASTRIC JUNCTION-PLASTY: PARAESOPHAGEAL HERNIA REPAIR + ANTI REFLUX SURGERY REVISITED
Authors: Di Maggio Francesco , Botha Abrie 
Published: September 2022

Abstract
VIDEO DESCRIPTION: Our technique for large paraoesophageal hernia repair and gastropexy shown step by step. This approach takes components of a series of historical anti-reflux operations and can be seen as a hybrid of Hill, Toupet and Nissen with anterior and posterior hiatus repair.
1. Sac approached infero-posteriorly on the right crus after phreno-esophageal ligament identified and separated at the V.
2. Sac separated from the pleura in the mediastinum.
3. Sac dissected from right to left along the edge of the hiatus.
4. Short gastric taken, posterior component of the sac dissected.
5. Sac reduced and completely excised.
6. OGJ identified.
7. Hiatus repair: posterior and (mainly) anterior.
8. Mobilised fundus slid behind the oesophagus.
9. Angle of His reconstituted.
10. Lateral and posterior fundo-pexy (Toupet).
11. Mediastinal drain.
SEE DESCRIPTION: Esophago-Gastric Junction-plasty with anterior and posterior hiatal repair is an anatomical anti-reflux procedure which can be performed for large paraoesophageal hernias.
625. PROPENSITY SCORE-MATCHED COMPARISON OF OUTCOMES BETWEEN POSTERIOR MEDIASTINAL AND RETROSTERNAL ROUTES OF RECONSTRUCTION FOLLOWING THREE-PHASE ESOPHAGECTOMY
Authors: Wong Claudia , Zhang Rui Qi , Chan Desmond , Wong Ian , Law Betty , Chan Fion , Law Simon 
Published: September 2022

Abstract
The retrosternal (RS) and posterior mediastinal (PM) routes can be chosen for gastric conduit reconstruction following three-phase esophagectomy with cervical anastomosis. It is controversial if the choice of reconstruction route would affect the operative outcome. This study aims to evaluate the surgical outcome by comparing the routes of reconstruction.
Between 2002 and 2019, patients who underwent esophagectomy with cervical anastomosis and gastric conduit reconstruction via the retrosternal (RS) or posterior mediastinal (PM) route for esophageal squamous cell cancer were included. Clinicopathological data were analyzed from a prospectively managed database. Postoperative morbidity and mortality rates, presence of recurrent tumor invasion of the conduit and overall survival were compared between the two groups. Further analyses were made after propensity score matching (PSM).
There were 89 patients in the RS and 266 in PM groups. R0 resection rates were 47.2% and 89.1% in the RS and PM groups, respectively (p&lt;0.01). Anastomotic leak occurred more frequently in RS group at 16.9% vs. 6.8%, (p=0.007) while cardiac complications were fewer; 19% vs. 32%, (p=0.02). 90-day mortality rates were &lt;4% in both groups. Median survival was 20 and 64 months in RS and PM groups respectively (p&lt;0.01). PSM yielded 60 patients in each group. Postoperative morbidities, and survival, were similar. Mediastinal tumor recurrences infiltrated the gastric conduit only in the PM group in 6.8% of patients.
When corrected for selection biases, RS and PM routes did not differ in post-operative morbidity and mortality rates. Placing the gastric conduit in the RS route could avoid invasion by mediastinal tumor recurrence. RS is the preferred route of reconstruction after a three-phase esophagectomy.
644. PREDICTORS OF ADVERSE CLINICAL EVENTS FOR CAUSTIC INGESTION IN ADULTS: A 20-YEAR CROSS-SECTIONAL STUDY
Authors: Tam Dick-Sang , Wong Ian Yu-Hong , Chan Kwan-Kit , Wong Claudia Lai-Yin , Law Tsz-Ting , Chan Fion Siu-Yin , Law Simon Ying-Kit 
Published: September 2022

Abstract
Caustic ingestion is an uncommon but potentially life-threatening condition. It can lead to various complications. There are limited epidemiological studies on caustic ingestion, especially in the Asian population. This study aims to review the clinical characteristics of corrosive ingestion in Hong Kong adults and look for predictors of adverse clinical events.
Patients admitted for caustic ingestion at a tertiary referral center in Hong Kong between January 2001 and December 2021 were studied. Patients’ demographic and clinical characteristics, types of caustic substances ingested, Zargar endoscopic grading and clinical outcomes were obtained. Adverse clinical events are defined as the presence of any of the following outcomes: intensive-care-unit (ICU) admission, gastrointestinal (GI) complications (including stricture, ischemia, gangrene, perforation and fistulation), need for surgical or endoscopic intervention, in-hospital mortality, or length of hospital stay (LOS) more than 14 days. Relationships between patients’ factors and different outcomes were then evaluated.
Among 69 patients, 45 (65.2%) were suicidal intent. Eight (11.6%) patients required emergency surgery (7 gastrectomies, and 1 esophagectomy). The most common GI complication was esophageal stricture (n=12, 17.4%). Eleven patients underwent endoscopic dilatation; 4 required elective esophagectomy. Patients with diabetes mellitus had a higher Zargar grading (OR=4.259, p=0.040). Adverse clinical events were associated with acid ingestion (OR=4.110, p=0.015) and suicidal intent (OR=3.635, p=0.027). Subgroup analysis showed that diabetes (OR=4.062, p=0.040), acid ingestion (OR=4.222, p=0.016) and suicidal intent (OR=15.932, p=0.009) had higher risks for ICU admission. The morbidity and mortality rates were 29.0% and 7.2% respectively.
Caustic ingestion remains an important clinical problem in daily practice, with potential risks of developing severe complications. Suicidal attempt, acid ingestions and history of diabetes are predictors of adverse clinical events.
652. EVOLUTION OF BARRETT’S ESOPHAGUS IN PATIENTS WHO UNDERWENT UPPER DIGESTIVE TRACT SURGERY: RETROSPECTIVE STUDY AT HIGH VOLUME CENTER
Authors: Szachnowicz Sergio , Dardin Felipe Augusto , Gallon Eduardo , Duarte André Fonseca , Sallum Rubens Antonio Aissar , Cecconello Ivan 
Published: September 2022

Abstract
Continuous episodes of Gastroesophageal reflux (GER) attack the esophageal mucosa and may lead to the unusual replacement of the squamous cell epithelium for the glandular columnar cell epithelium, with goblet cells. The intestinal metaplasia, in the esophageal mucosa characterizes Barrett's Esophagus (BE). BE occurs in 10 to 15% of chronic and long-term reflux patients. In addition, BE's epithelium is susceptible to chronic inflammation with risks for dysplasia and adenocarcinoma.
We analyzed the impact of unconventional techniques on the evolution of Barrett's esophagus extension, as: Antrectomy (n = 1), Roux-en-Y Bypass (n = 5), Cardiomyotomy (n = 6), Esophagectomy (n = 10), Gastrectomy (n = 12), Lind fundoplication (n = 12). For this purpose, a retrospective study with BE patients treated at our service was carried out, evaluating the extension of Barrett's epithelium between the first and the last endoscopy of each patient.
The greatest mean absolute regression of the BE extension was seen in esophagectomy, equivalent to 2.87 cm; esophagectomy combined with gastrectomy, 1.15 cm; and gastrectomy, with 0.97 cm. Antrectomy and procedures involving Roux-en-Y, in our series, did not reduce the extent of the columnar epithelium, actually showing progression or formation of Barrett's Esophagus. It is worth mentioning that Lind fundoplication, once the main treatment for GERD, obtained a mean regression of 0.37 cm in the BE extension, however it was not the treatment with the best result, and 17% of the evaluated patients showed lesion progression.
The majority of evaluated procedures as alternative procedures for the treatment of reflux in patients with BE can be effective in controlling the evolution and even contributing to its regression.
654. DO PATIENTS WITH "EARLY" ESOPHAGEAL CANCER NEED NEOADJUVANT THERAPY?
Authors: Venkataramani Karthik , Karimundackal George , Jiwnani Sabita , Niyogi Devayani , Tiwari Virendra Kumar , Pramesh CS 
Published: September 2022

Abstract
Surgery remains the treatment of choice for early esophageal carcinoma (T1/2&N0). However, the available staging modalities have variable accuracy for T&N stages, with considerable understaging of T3/N+ disease depriving them of neoadjuvant therapy (NAT) which has been shown to improve survival and is the standard of care. As adjuvant therapy is ineffective in esophageal cancers, it is critical to identify factors associated with under staging in early esophageal carcinoma and consider NAT in this subset.
We conducted a retrospective analysis of a prospectively maintained database of patients undergoing esophagectomy for esophageal cancer at a tertiary referral cancer center from 2011 to 2019. Patients with T1/2&N0, staged with EUS and PET-CT and undergoing upfront surgery were included in the analysis. Patients who underwent upfront surgery due to limited fitness for systemic therapy, non-invasive disease, non-epithelial histology and endoscopic resections were excluded from analysis. Data with respect to epidemiology, staging, perioperative outcomes and follow up was extracted and analyzed using SPSS 26.0
68/1496 patients (4.5%) who underwent esophagectomy had upfront surgery for T1/2&N0 disease. Squamous cancers (93%) of the middle third were the most common. EUS had an accuracy of 67% & 83% for T&N stage respectively with 10.2% & 17% upstaging to T3 & N+ respectively. 3-year overall survival (OS) of all patients undergoing upfront surgery was 75.2%, of the understaged subset was 48.2%, (95% CI 20%-71%) and patients with T3/N+ disease treated with NAT followed by surgery was 55.7%, (95% CI 52.9%-58.4%). Multivariate analysis showed T2 on EUS, tumor size &gt;3.5cm and SUVmax &gt;3.05 to be predictors of understaging
Current staging modalities are associated with 20% upstaging to T3 or N+ disease. T2 tumors with size greater than 3.5cm and SUV&gt;3.05 are frequently associated with understaging and these tumors have poorer outcomes. Patients with these tumor characteristics may benefit from neoadjuvant therapy followed by surgery.
Incessant non-sustained ventricular tachycardia immediately after MitraClip placement: a case report
Authors: Funabashi Sayaka , Amaki Makoto , Yamagata Kenichiro , Izumi Chisato 
Published: September 2022

Abstract

Background
MitraClip therapy has become an alternative therapy for primary and secondary mitral regurgitation (MR) in patients at high surgical risk. However, this procedure is associated with several complications.

Case summary
The patient was a 93-year-old male with severe MR caused by prolapse of the mid-posterior mitral leaflet (P2) and atrial enlargement. His heart failure (HF) continued to worsen, requiring hospitalization. Considering his high surgical risk, the heart team chose MitraClip treatment. After one clip was placed in the centre of the mitral valve (P2 lateral side), MR severity was reduced from severe to trivial. However, immediately after grasping, incessant non-sustained ventricular tachycardia (VT) with a heart rate of 150 beats/min occurred. Since there were no significant ST-T changes on electrocardiogram and no left ventricular (LV) wall motion abnormalities on echocardiography, ischaemic heart disease was ruled out, and pacing with a temporary pacemaker, potassium level correction, and intravenous amiodarone administration were performed. The frequency of VT decreased but it did not disappear. Diuretics were administered for HF, and VT disappeared within a few hours, with no recurrence, probably due to a decrease in the LV chamber size after diuresis.

Discussion
The VT waveform showed a right bundle branch block pattern with a superior axis. Furthermore, a negative lead I and a transition zone with an abrupt change from V4 to V5 indicated that PVC/VT arose from the posterior papillary muscle area. The probable cause was mechanical extension of the posterior medial papillary muscle as a result of leaflet grasping, with resolution following appropriate volume management.
Climate Change before the European Court of Human Rights: Capturing Risk, Ill-Treatment and Vulnerability
Authors: Heri Corina 
Published: September 2022

Abstract
Human rights law is increasingly being mobilized to litigate against the effects of anthropogenic climate change. This now includes proceedings before the European Court of Human Rights, which is currently considering its first five climate cases. The present article contends that an examination of climate change as a human rights issue by the Strasbourg Court, although requiring transformations of existing case law, is not only possible but also normatively desirable. It does so while examining two interlinked topics that could prove crucial to this type of case. The first is the assessment of risk – that is, the ability of the European Convention on Human Rights (ECHR) to capture impending harms through the doctrine of positive obligations. Second, the article frames climate claims as a matter for Article 3 of the ECHR (the prohibition of torture and inhuman and degrading treatment). This right has gone largely ignored in the relevant scholarship and the Court’s environmental cases to date. The resulting discussion of positive climatic obligations is interlinked with a discussion of climate-related vulnerabilities, which could potentially shape state obligations and lower the procedural and substantive hurdles that imperil the success of climate cases before the Court.
M2 Muscarinic Receptor-Dependent Contractions of Airway Smooth Muscle are Inhibited by Activation of β-Adrenoceptors
Authors: Alkawadri Tuleen , Wong Pei Yee , Fong Zhihui , Lundy Fionnuala T , McGarvey Lorcan P , Hollywood Mark A , Thornbury Keith D , Sergeant Gerard P 
Published: September 2022

Abstract
Beta-adrenoceptor (β-AR) agonists inhibit cholinergic contractions of airway smooth muscle (ASM), but the underlying mechanisms are unclear. ASM cells express M3 and M2 muscarinic receptors, but the bronchoconstrictor effects of acetylcholine are believed to result from activation of M3Rs, while the role of the M2Rs is confined to offsetting β-AR-dependent relaxations. However, a profound M2R-mediated hypersensitization of M3R-dependent contractions of ASM was recently reported, indicating an important role for M2Rs in cholinergic contractions of ASM. Here, we investigated if M2R-dependent contractions of murine bronchial rings were inhibited by activation of β-ARs. M2R-dependent contractions were apparent at low frequency (2Hz) electric field stimulation (EFS) and short (10s) stimulus  intervals. The β1-AR agonist, denopamine inhibited EFS-evoked contractions of ASM induced by reduction in stimulus interval from 100 to 10 s and was more effective at inhibiting contractions evoked by EFS at 2 than 20 Hz. Denopamine also abolished carbachol-evoked contractions that were resistant to the M3R antagonist 4-DAMP, similar to the effects of the M2R antagonists, methoctramine and AFDX-116. The inhibitory effects of denopamine on EFS-evoked contractions of ASM were smaller in preparations taken from M2R −/− mice, compared to wild-type (WT) controls. In contrast, inhibitory effects of the β3-AR agonist, BRL37344, on EFS-evoked contractions of detrusor strips taken from M2R −/− mice were greater than WT controls. These data suggest that M2R-dependent contractions of ASM were inhibited by activation of β1-ARs and that genetic ablation of M2Rs decreased the efficacy of β-AR agonists on cholinergic contractions.
A Chromosome-level Genome Assembly of the Highly Heterozygous Sea UrchinEchinometrasp. EZ Reveals Adaptation in the Regulatory Regions of Stress Response Genes
Authors: Ketchum Remi N , Davidson Phillip L , Smith Edward G , Wray Gregory A , Burt John A , Ryan Joseph F , Reitzel Adam M 
Published: September 2022

AbstractEchinometra is the most widespread genus of sea urchin and has been the focus of a wide range of studies in ecology, speciation, and reproduction. However, available genetic data for this genus are generally limited to a few select loci. Here, we present a chromosome-level genome assembly based on 10x Genomics, PacBio, and Hi-C sequencing for Echinometra sp. EZ from the Persian/Arabian Gulf. The genome is assembled into 210 scaffolds totaling 817.8 Mb with an N50 of 39.5 Mb. From this assembly, we determined that the E. sp. EZ genome consists of 2n = 42 chromosomes. BUSCO analysis showed that 95.3% of BUSCO genes were complete. Ab initio and transcript-informed gene modeling and annotation identified 29,405 genes, including a conserved Hox cluster. E. sp. EZ can be found in high-temperature and high-salinity environments, and we therefore compared E. sp. EZ gene families and transcription factors associated with environmental stress response (“defensome”) with other echinoid species with similar high-quality genomic resources. While the number of defensome genes was broadly similar for all species, we identified strong signatures of positive selection in E. sp. EZ noncoding elements near genes involved in environmental response pathways as well as losses of transcription factors important for environmental response. These data provide key insights into the biology of E. sp. EZ as well as the diversification of Echinometra more widely and will serve as a useful tool for the community to explore questions in this taxonomic group and beyond.