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The esophagogastric junction (EGJ) is a complex anti-reflux barrier whose integrity relies on both the intrinsic lower esophageal sphincter (LES) and extrinsic crural diaphragm. During hiatal hernia repair, it is unclear whether the crural closure or the fundoplication is more important to restore the anti-reflux barrier. The objective of this study is to analyze changes in LES minimum diameter (Dmin) and distensibility index (DI) using the endoluminal functional lumen imaging probe (FLIP) during hiatal hernia repair. Following implementation of a standardized operative FLIP protocol, all data were collected prospectively and entered into a quality database. This data were reviewed retrospectively for all patients undergoing hiatal hernia repair. FLIP measurements were collected prior to hernia dissection, after hernia reduction, after cruroplasty, and after fundoplication. Additionally, subjective assessment of the tightness of crural closure was rated by the primary surgeon on a scale of 1 to 5, 1 being the loosest and 5 being the tightest. Between August 2018 and February 2020, 97 hiatal hernia repairs were performed by a single surgeon. FLIP measurements collected using a 40-mL volume fill without pneumoperitoneum demonstrated a significant decrease in LES Dmin (13.84 ± 2.59 to 10.27 ± 2.09) and DI (6.81 ± 3.03 to 2.85 ± 1.23 mm2/mmHg) after crural closure (both p

Background Treatment of Zenker’s diverticulum has evolved from open surgery to endoscopic techniques, including flexible and rigid endoscopic septotomy, and more recently, peroral endoscopic myotomy (Z-POEM). This study compared the effectiveness of flexible and rigid endoscopic septotomy with that of Z-POEM. Methods Consecutive patients who underwent endoscopic septotomy (flexible/rigid) or Z-POEM for Zenker’s diverticulum between 1/2016 and 9/2019 were included. Primary outcomes were clinical success (decrease in Dakkak and Bennett dysphagia score to ≤ 1), clinical failure, and clinical recurrence. Secondary outcomes included technical success and rate/severity of adverse events. Results 245 patients (110 females, mean age 72.63 years, standard deviation [SD] 12.37 years) from 12 centers were included. Z-POEM was the most common management modality (n = 119), followed by flexible (n = 86) and rigid (n = 40) endoscopic septotomy. Clinical success was 92.7 % for Z-POEM, 89.2 % for rigid septotomy, and 86.7 % for flexible septotomy (P = 0.26). Symptoms recurred in 24 patients (15 Z-POEM during a mean follow-up of 282.04 [SD 300.48] days, 6 flexible, 3 rigid [P = 0.47]). Adverse events occurred in 30.0 % rigid septotomy patients, 16.8 % Z-POEM patients, and 2.3 % flexible septotomy patients (P Conclusions There was no difference in outcomes between the three treatment approaches for symptomatic Zenker’s diverticulum. Rigid endoscopic septotomy was associated with the highest rate of complications, while flexible endoscopic septotomy appeared to be the safest. Recurrence following Z-POEM was similar to flexible and rigid endoscopic septotomy. Prospective studies with long-term follow-up are required.

The Endoluminal Functional Lumen Imaging Probe (Endoflip) can be used to provide objective measurements of the gastroesophageal junction during fundoplication, and recent publications have suggested that this device could improve surgical outcomes. However, the impact of operative variables has not been clearly reported. The aim of this study is to determine the effect of these variables on functional lumen imaging probe (FLIP) measurements. Following implementation of a standardized operative FLIP protocol, all data were collected prospectively and entered into a quality database. This database was queried for patients undergoing hiatal hernia repair and fundoplication. The protocol utilized various balloon volumes (30 and 40 ml), patient positions (flat and reverse Trendelenburg) and amounts of insufflation (15 mmHg pneumoperitoneum and no pneumoperitoneum). Between August 2018 and February 2020, 97 fundoplications were performed by a single surgeon. Multivariable analysis without interactions demonstrated that a 40 ml volume fill resulted in significantly higher minimum diameter (Dmin), cross-sectional area (CSA), intra-balloon pressure (IBP) and distensibility index (DI) compared to a 30 ml volume fill (p

The esophagogastric junction (EGJ) is a complex anti-reflux barrier whose integrity relies on both the intrinsic lower esophageal sphincter (LES) and extrinsic crural diaphragm. During hiatal hernia repair, it is unclear whether the crural closure or the fundoplication is more important to restore the anti-reflux barrier. The objective of this study is to analyze changes in LES minimum diameter (DFollowing implementation of a standardized operative FLIP protocol, all data were collected prospectively and entered into a quality database. This data were reviewed retrospectively for all patients undergoing hiatal hernia repair. FLIP measurements were collected prior to hernia dissection, after hernia reduction, after cruroplasty, and after fundoplication. Additionally, subjective assessment of the tightness of crural closure was rated by the primary surgeon on a scale of 1 to 5, 1 being the loosest and 5 being the tightest.Between August 2018 and February 2020, 97 hiatal hernia repairs were performed by a single surgeon. FLIP measurements collected using a 40-mL volume fill without pneumoperitoneum demonstrated a significant decrease in LES DCruroplasty results in a significant decrease in LES distensibility and may be more important than fundoplication in restoring EGJ competency. Additionally, subjective estimation of crural tightness correlates well with objective FLIP evaluation, suggesting surgeon assessment of cruroplasty is reliable.

Background:To improve patients’ breathlessness and relieve their distress and anxiety. Methods:PROACTIVE group targets the lung cancer patients without significant breathlessness. These high-risk patients with their families will have proactive education on the measures for self-management on breathlessness so as to reduce its impact in due course. Patient’s self- efficacy in mastering breathlessness are related to their predominant place of care at their last 6 months of life, their frequency of unplanned hospital admission and emergency unit attendance for the management of breathlessness.THERAPEUTIC group recruits those cancer patients with significant breathlessness. The patient will have an Individual Comprehensive Breathlessness Assessment. Personalized pharmacological and non-pharmacological Interventions will be used. The care-givers will be empowered by providing relevant information and training up of their caring skills. Patient’s self-rating symptom control, stress and confident scores were regularly monitored on every visit. The absolute changes of self-rating scores during their disease course were recorded. Results:Total 292 patients have been recruited (Proactive 227; Therapeutic 65) and retrospective analyzed. In the Proactive group, 76.5% patients remained in community as their predominant place of care at their last 6 months of life. Their mean frequencies of unplanned hospital admission and emergency unit attendance per patient are 1.1 and 1.44, respectively (Corresponding local data were 2.5 and 3.4). In the Therapeutic group, 85% patients had moderate to high level breathlessness score at presentation which greatly affects their quality of life {significant emotion stress (34%) and unconfident feeling (50%)}. 78% patients had 3 or less attendances due to their rapid clinical deterioration. The interventions are effective in improving or stabilizing both breathless patient’s physical (44%/26%) and psychological status {emotional stress (17%/46%) and confident score (24%/28%)} despite their disease progressing.Conclusion:This Integrated Breathless Service Program is effective in improving both patients’ physical and psychological status. Adopting a proactive approach can equip the high-risk patients and their care-givers with knowledge and skills for handling breathlessness when in need. Hence this facilitates timely intervention especially when cancer patients tend to deteriorate rapidly that sometimes the therapeutic interventions may not have time to practice.

The Endoluminal Functional Lumen Imaging Probe (Endoflip) can be used to provide objective measurements of the gastroesophageal junction during fundoplication, and recent publications have suggested that this device could improve surgical outcomes. However, the impact of operative variables has not been clearly reported. The aim of this study is to determine the effect of these variables on functional lumen imaging probe (FLIP) measurements.Following implementation of a standardized operative FLIP protocol, all data were collected prospectively and entered into a quality database. This database was queried for patients undergoing hiatal hernia repair and fundoplication. The protocol utilized various balloon volumes (30 and 40 ml), patient positions (flat and reverse Trendelenburg) and amounts of insufflation (15 mmHg pneumoperitoneum and no pneumoperitoneum).Between August 2018 and February 2020, 97 fundoplications were performed by a single surgeon. Multivariable analysis without interactions demonstrated that a 40 ml volume fill resulted in significantly higher minimum diameter (Dmin), cross-sectional area (CSA), intra-balloon pressure (IBP) and distensibility index (DI) compared to a 30 ml volume fill (p 0.001). While reverse Trendelenburg positioning resulted in a significantly higher Dmin, IBP and CSA compared to the flat position (all p 0.05), there was little impact of positioning on DI. Lastly, pneumoperitoneum significantly increased IBP (p 0.001) but did not affect Dmin (p = 0.697) or CSA (p = 0.757), which resulted in a significant decrease in DI (p 0.001) when compared to measurements without pneumoperitoneum. Multivariable analysis allowing for interactions demonstrated significant two-way interactions between balloon volume and pneumoperitoneum (p = 0.047), as well as patient position and pneumoperitoneum (p 0.001).Surgeons should consider balloon volume and the presence or absence of pneumoperitoneum when interpreting distensibility during or after fundoplication. Additionally, we suggest a formal standardized protocol for FLIP measurements to utilize a 40 ml volume fill in reverse Trendelenburg without pneumoperitoneum.

Abstract This paper presents the results of an integrated sequence stratigraphy approach using seismic, well log and biostratigraphic data to build sequence stratigraphic framework and its implication in petroleum system understanding for the southwestern part of the Malay Basin. Seismic data were used to interpret third order Sequence Boundaries (SB) and Maximum Flooding Surfaces (MFS) based on reflector terminations. Well log analyses were carried out to support the interpretations and were cascaded down to define the third order sequences and associated system tracts (LST, TST and HST). Biostratigraphic data were also used to validate the SB, MFS and the paleo-environments. This study has subdivided the sedimentary successions into six 3rd order sequences namely Sequence 1 to Sequence 6. Each of the sequence is bounded by sequence boundary, which has been calibrated with the Malay Basin Chronostratigraphic Chart (PETRONAS, 2007). Two source rocks are present for the study area- the deeper synrift section with source rocks deposited in a lacustrine environment (Late Oligocene age) and the shallower source rock deposited in a marine inner neritic environment (Early Miocene age). The migration pathway for the deeper section is through faults, and from lateral migration for the shallow section. The study also indicates that the potential reservoirs are thinning basinward (southwest to northeast). The potential reservoirs are interpreted to be the fluvial, lacustrine and shallow marine sands. Data from several key drilled wells suggests that reservoir is at low risk in the sand-prone areas of the southeastern part compared to the northern part which is more shale-prone. Based on the present study, it is inferred that trap integrity is the main risk for petroleum system. While a good top seal is provided by the main regional shales in deeper section, the seal at the shallow sections are from thin and discontinuous intra-formational shales that are present in every sequence. The presence of younger faults cutting through the reservoir may cause the potential for hydrocarbon leakage. The present study has identified five potential plays and also established the regional sequence stratigraphic framework in southwestern of Malay Basin.

Abstract The paper presents the results of intergrated sequence stratigraphic study carried out for the Areas 3 & 6 in Rovuma basin, offshore Mozambique. Five depositional sequences have been recognized that cover from Triassicto recent. A conceptualized petroleum system model is presented and the upside potential traps in this area are also highlighted and discussed. Introduction Areas 3 & 6 are located in the southern part of Rovuma basin that partly located in coastal and deepwater area in the North Republic of Mozambique (Figure 1), approximately 1,600 km northeast of Maputo, the capital of Republic of Mozambique (ENH, 1994). PETRONAS Carigali Mozambique (Rovuma Basin) Ltd (PCMRB) is the Operator for Areas 3 & 6 and Empresa Nacional de Hidrocarbonetos (ENH) is the partner. The Rovuma basin has been proven to be hydrocarbon bearing from previous discoveries made in the area. Three significant commercial gas discoveries have been reported in the Rovuma basin; Mnazi Bay-1 (1982), Windjammer-1(2010) and Barquentine-1 (2010) (IHS Energy, 2010). All discoveries are made in the Rovuma delta area about 150 to 200 kms to the north of study area. Area 3 & 6 are considered as an underexplored acreage as of to date there are no wells drilled in the area, the nearest well is Mocimboa-1 which is located about 150km to the north. To evaluate the hydrocarbon potential of Rovuma basin, specifically in Areas 3 & 6, a regional study using sequence stratigraphic approach was carried out by (PCMRB) in 2010. The main objective of this study is to establish a sequence stratigraphic framework for Areas 3 & 6, and to provide the regional geological understanding in term of tectonic settings, basin evolutions and total petroleum systems. In addition, the study is also designed to identify any available play types and to develop new play concepts in the area. The results of the study will be used as a foundation to facilitate future detailed exploration activity in the blocks.

The goal of this paper is to establish that there exists a strong relationship between current issues of data models in Database Management and representations of knowledge in Artificial Intelligence. The different data modelling techniques that have been used in the two research areas are surveyed and classified into Predicate Calculus-based, Network, and Procedural ones. The similarities and differences between them are presented.