Search Results (2,252)

Background and Clinical Significance: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disorder characterized by esophageal dysfunction and dense eosinophilic infiltration. EoE frequently evolves into a fibrostenotic phenotype, in which uncontrolled inflammation drives progressive tissue remodeling. This evolution increases the risk of complex structural complications—most commonly fixed rings and strictures, and, in rare advanced cases, deep mural injury or fistulization—substantially increasing both diagnostic and therapeutic complexity. Case Presentation: This report describes an uncommon presentation of EoE complicated by a blind-ending esophageal fistula, managed successfully through a multidisciplinary strategy integrating pharmacologic therapy, dietary modification, and endoscopic intervention. Conclusions: Nutritional support through gastrostomy, combined with multidisciplinary medical and endoscopic management, can lead to favorable outcomes in EoE complicated by esophageal fistula. Early recognition and individualized management are essential to optimize outcomes. Full article

Background: Digestive tract cancers, like most other cancers, are usually categorized based on cell or tissue of origin. Molecular clustering based on the transcriptome often produces the same classification. Methods: We developed a new method, Newmanization, to reduce underlying tissue signals from transcriptomic analysis. To test our method, we downloaded data on 1635 samples of digestive tract cancers from The Cancer Genome Atlas. The available data includes transcriptomic data by RNA-Seq, as well as binary mutation allele frequency data by whole exome sequencing. We compared, using silhouette widths and visualization by dimension reduction plots, the effectiveness of Newmanized transcriptome and mutation data to separate digestive tract cancers. Results: The Newmanized transcriptome clusters have clearer separation and larger average silhouette widths. Feature analysis of each cluster for Newmanized transcriptomic data and mutation data revealed that clusters determined with Newmanized data contained more mRNAs present at higher frequencies than clusters defined by mutation data. Conclusions: This suggests that the Newmanized method holds great potential for advancing personalized transcriptomic medicine. Full article

Gastroesophageal reflux disease (GERD) is a common chronic disorder of the upper gastrointestinal tract, traditionally explained by an acid-centric model in which gastric acid causes mucosal injury and symptoms. Proton pump inhibitors (PPIs) are the mainstay of therapy and effectively control symptoms in many patients. However, up to 50% of individuals remain symptomatic despite adequate acid suppression, suggesting that GERD is a multifactorial condition involving anti-reflux barrier dysfunction, impaired mucosal defense, immune activation, and alterations in the esophageal microbiota. This study is a narrative review aimed at evaluating current evidence on the interactions between acid suppression, esophageal microbial ecology, and host–microbe interactions in GERD, and at exploring the potential role of microbiota-targeted therapeutic strategies. The literature search was conducted using electronic databases (e.g., PubMed and Scopus), without formal time restrictions, prioritizing recent and clinically relevant studies. Evidence was qualitatively synthesized to provide an integrated overview. Recent studies suggest that the esophagus hosts a microbial ecosystem that may contribute to mucosal homeostasis. In GERD and Barrett’s esophagus, several studies report a shift toward Gram-negative anaerobic bacteria with potential pro-inflammatory activity. Long-term PPI therapy has been associated with increased gastric pH and changes in gastrointestinal microbiota composition, including a relative increase in taxa such as Streptococcus and Veillonella, and a reduction in short-chain fatty acid–producing bacteria. These alterations may be linked to dysbiosis and a possible increase in susceptibility to certain infections, although causality remains to be fully established. The main limitations of this review include its narrative design, the absence of systematic study selection, and the heterogeneity of the available evidence. Understanding the impact of acid suppression on microbial ecology may support the development of more integrated and personalized therapeutic strategies. Full article

Background: Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder worldwide. Management strategies include lifestyle modification, pharmacologic therapy, and surgical interventions. Diaphragmatic breathing exercises have been proposed as a non-pharmacological treatment aimed at improving lower esophageal sphincter function and reducing reflux episodes. Methods: A systematic search of PubMed/MEDLINE, Scopus, ScienceDirect, Google Scholar, and ClinicalTrials.gov was conducted from database inception to 10 March 2026 to identify randomized controlled trials evaluating diaphragmatic breathing in patients with GERD. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Random-effects meta-analyses were performed to estimate pooled mean differences for symptom scores and quality-of-life outcomes. Results: Ten randomized controlled trials including 476 patients were analyzed (mean age: 39.9 ± 11.3 years). Diaphragmatic breathing interventions were performed in 229 participants, with an average duration of 20.36 min per session over approximately 5.1 weeks. Meta-analysis demonstrated a modest improvement in GERD symptom scores favoring diaphragmatic breathing (SMD −0.74; 95% CI −1.36 to −0.12; p = 0.019), with substantial heterogeneity (I² = 79.7%). Subgroup analyses comparing breathing with medication and sham breathing controls produced similar trends. Quality-of-life outcomes did not demonstrate statistically significant improvement (MD −2.35; 95% CI −6.35 to 1.65; p = 0.25) and showed considerable heterogeneity (I² = 85.3%). Risk-of-bias assessment revealed “some concerns” in several studies, primarily related to randomization procedures and outcome reporting. Conclusions: Although pooled results demonstrated a statistically significant reduction in GERD symptom scores favoring diaphragmatic breathing, this finding must be interpreted with considerable caution given the substantial heterogeneity observed. The current evidence remains limited by methodological heterogeneity, and inconsistent outcome assessment is insufficient to support definitive clinical recommendations, and the observed benefit may not be generalizable across patient populations or clinical settings. Larger standardized randomized trials are required to determine the clinical role of diaphragmatic breathing in GERD management. Full article

Gastrointestinal (GI) malignancies—which comprise esophageal, gastric, colorectal, hepatobiliary, and pancreatic cancers—remain a leading global cause of oncologic morbidity and mortality. The prognosis for many patients (especially those diagnosed with advanced-stage disease) remains poor despite conventional therapies—namely, surgery, chemotherapy, and radiation. Immunotherapy, however, has emerged as a new strategy in oncology, and, in particular, the advent of cancer vaccines now provides an investigational approach to improving clinical outcomes in patients with GI malignancies. This review aims to provide a comprehensive overview of multiple vaccine-based strategies developed to better target GI cancers, spanning from early preclinical studies to the most recently completed clinical trials. We first introduce the main vaccine therapy classes and the immunologic rationale underlying each. We then summarize key findings from past and ongoing trials using a cancer-type-based approach, primarily focusing on vaccine safety and immunogenicity, and commenting on limitations in overall efficacy. Finally, we identify the challenges of applying mostly early-phase trials to clinical practice as well as future directions for integrating these vaccine-based approaches into personalized treatments for GI cancer patients. Full article

Background/Objective: Smoking is known to be associated with reflux-related mucosal damage and deleterious esophageal outcomes, yet no non-invasive imaging biomarkers of smoking-induced esophageal remodeling have been identified. We aimed to compare cervical esophageal ultrasound morphology between habitual smokers and non-smokers, in terms of esophageal wall thickness, number of sonographically discernable wall layers, and esophageal diameter, and investigate whether smoking is an independent predictor of these findings. Methods: In this cross-sectional study, 60 participants (30 smokers, 30 non-smokers) underwent high-resolution B-mode ultrasound of the cervical esophagus. Examinations were performed in transverse and longitudinal planes. Outcomes included esophageal wall thickness (mm), number of discernible wall layers, and esophageal diameters in transverse and longitudinal planes. Group comparisons used independent t-tests and chi-square tests. Multiple linear regression assessed independent associations with smoking status (adjusting for age and weight). Within smokers, Pearson correlation evaluated relationships between smoking duration and ultrasound outcomes; exploratory subgroup analyses compared smoking modalities. Results: Smokers were older and had higher weight and BMI than non-smokers. Compared with non-smokers, smokers had greater wall thickness (3.06 vs 2.61 mm), more discernible wall layers (5.03 vs 3.60), and larger transverse (11.68 vs 7.87 mm) and longitudinal (12.90 vs 8.26 mm) diameters (all p < 0.001). In regression analysis, smoking status independently predicted wall thickness (B = 0.411 mm, 95% CI 0.243–0.578; p < 0.001). Smoking duration showed significant correlations with the number of visible layers (r = 0.82; p < 0.001) and wall thickness (r = 0.42; p = 0.021). Conclusions: High-frequency ultrasound detected significant differences in cervical esophageal morphology between smokers and non-smokers. Smoking was independently associated with differences in the diameter, thickness, and number of visible layers of the cervical esophagus. Further studies with larger sample sizes, improved exposure assessment, and use of reference standards are needed. Full article

Background and Objectives: Intraoperative assessment of tissue perfusion remains a decisive but imperfect step in abdominal surgery. Surgeons still rely heavily on visual judgement when choosing bowel transection lines, constructing anastomoses, judging intestinal viability, or assessing graft reperfusion, even though these decisions are directly linked to anastomotic leak, conduit ischemia, postoperative liver dysfunction, and graft failure. Hyperspectral imaging (HSI) is an emerging contrast-free optical technology that generates quantitative maps of tissue oxygenation, hemoglobin distribution, water content, and near-infrared perfusion. The present review was designed to evaluate whether clinical intraoperative HSI has matured sufficiently to support a focused systematic review topic in abdominal surgery and to synthesize the currently available human evidence. Methods: A literature search was conducted up to 20 February 2026 using combinations of the terms “hyperspectral imaging”, “HSI”, “abdominal surgery”, “colorectal”, “hepatectomy”, “transplantation”, “pancreatoduodenectomy”, “esophagectomy”, “mesenteric ischemia”, and “intraoperative”. Eligible records were original human clinical studies evaluating intraoperative HSI in abdominal or transplant-related operations with perfusion, oxygenation, or tissue viability as a central endpoint. Review articles, animal studies, non-surgical diagnostic studies, and single-patient case reports were excluded. Data were synthesized narratively because of major heterogeneity in indications, designs, devices, timing of measurements, and reported outcomes. Results: Thirteen studies published between 2019 and 2024 met the eligibility criteria, representing 391 patients. The literature covered colorectal resection, acute mesenteric ischemia, esophageal reconstruction with gastric or colonic conduits, pancreatoduodenectomy, pancreas transplantation, major hepatectomy, liver transplantation, and minimally invasive system validation. Across colorectal studies, HSI frequently demonstrated discordance between visually selected and objectively perfused transection lines, with clinically relevant strategy changes in a substantial proportion of patients. In ischemic and transplant settings, HSI discriminated poorly perfused tissue, identified low near-infrared perfusion values associated with early allograft dysfunction, and quantified reperfusion patterns after clamping or implantation. The evidence base was dominated by prospective single-center feasibility studies with small to moderate sample sizes, and no randomized trials were identified. Conclusions: Clinical intraoperative HSI in abdominal surgery is a genuinely niche yet rapidly expanding topic with a sufficient number of human studies to support a relevant systematic review. Current evidence consistently supports feasibility, quantitative perfusion discrimination, and plausible intraoperative utility, especially in colorectal and transplant-related surgery. However, the field remains methodologically heterogeneous, and the next research priority is multicenter standardization with clinically anchored thresholds and outcome-driven comparative studies. Full article

Miniprobe endoscopic ultrasonography (mEUS) combines high-resolution imaging of the gastrointestinal (GI) wall and bile ducts with ease of applicability during routine endoscopy. This narrative review aims to provide an overview of known and emerging fields of application for mEUS in gastrointestinal endoscopy. After its initial development in pancreatobiliary scenarios in the early 1990s, mEUS has been recently reconsidered a third-space endoscopic technique that is progressively developing and spreading for the treatment of early gastrointestinal neoplastic lesions. The high spatial resolution of mEUS provides an accurate assessment of the degree of submucosal invasion in early esophageal, gastric, and colorectal neoplasia, while the small caliber of catheters allows for mEUS employment in settings where standard echoendoscopes are impractical (e.g., severe stenoses or proximal colonic lesions). Beyond cancer staging, mEUS offers point-of-care characterization of subepithelial lesions by defining the layer of origin and echo-pattern, eventually defining endoscopic resectability, but definitive diagnosis remains histological. In pancreatobiliary diseases, miniprobe intraductal ultrasonography (IDUS) shows its strongest application for indeterminate biliary strictures when endoscopic retrograde cholangiopancreatography (ERCP)-based sampling strategies and brushing cytology show inconclusive diagnoses, and in choledocholithiasis, particularly for the detection of small stones/sludge and confirmation of duct clearance. IDUS is also valuable for the staging of ampullary tumors, for longitudinal extension mapping in hilar cholangiocarcinoma and for selected portal biliopathy scenarios. Overall, mEUS and IDUS are high-resolution adjuncts that can meaningfully refine local decision-making in the treatment of superficial epithelial/subepithelial tumors or lesions involving the bile ducts. Limitations include shallow penetration, lack of tissue acquisition capability, a relative increase in post-ERCP pancreatitis risk for intraductal use, and substantial cost with limited availability in lower-volume centers. Full article

Background/Objectives: Glypican-1 (GPC1) is a heparan sulfate proteoglycan that plays a critical role in regulating various signaling pathways and tumor development. Overexpression of GPC1 promotes tumor cell proliferation and invasiveness, and is associated with poor clinical outcomes. Therefore, anti-GPC1 monoclonal antibodies (mAbs) have been developed in various modalities for tumor therapy. Methods: We developed novel anti-GPC1 mAbs using a flow cytometry-based high-throughput screening approach, the Cell-Based Immunization and Screening (CBIS) method. Results: A clone G₁Mab-28 (IgG₁, κ) reacted with GPC1-overexpressed Chinese hamster ovary-K1 (CHO/GPC1), but not parental CHO-K1, in flow cytometry. Furthermore, G₁Mab-28 recognizes the endogenous GPC1-expressing human esophageal squamous cell carcinoma KYSE770 cell line. Furthermore, G₁Mab-28 specifically recognized only CHO/GPC1, but not the other GPC family-overexpressed CHO-K1. The dissociation constant values of G₁Mab-28 for CHO/GPC1 and KYSE770 were determined to be 3.3 × 10⁻⁸ M and 4.6 × 10⁻⁹ M, respectively. Moreover, G₁Mab-28 is suitable for Western blotting and immunohistochemistry. Conclusions: G₁Mab-28, established by the CBIS method, is versatile for basic research and is expected to contribute to antibody-based tumor therapy. Full article

Measles remains a major global public health challenge as declining vaccination coverage fuels outbreaks worldwide. Although pneumonia is the most recognized respiratory complication, spontaneous air leak syndrome—including pneumomediastinum, subcutaneous emphysema, and pneumoperitoneum—is rarely documented. We report the case of a 9-year-old previously healthy girl with no documented measles–rubella vaccination who presented with fever, maculopapular exanthem, Koplik spots, and persistent cough. Measles was confirmed by both immunoglobulin M enzyme-linked immunosorbent assay and real-time reverse transcription polymerase chain reaction. She developed sudden cervicothoracic swelling and chest pain. Chest radiography revealed pneumomediastinum and subcutaneous emphysema; computed tomography confirmed extensive air leak including pneumoperitoneum. Flexible bronchoscopy and upper gastrointestinal endoscopy excluded structural airway and esophageal injury. Laboratory evaluation revealed elevated hepatic transaminases, gamma-glutamyl transferase, lactate dehydrogenase, and D-dimer. Conservative management with high-flow supplemental oxygen and clinical surveillance led to progressive resolution. The patient was discharged on hospital day three, asymptomatic and breathing room air. This case highlights the spectrum of air leak complications in measles and supports conservative management in hemodynamically stable pediatric patients when structural injury has been excluded. Full article

Background: Esophageal squamous cell carcinoma (ESCC) remains a highly lethal malignancy with limited therapeutic options, in part due to frequent activation of nuclear factor erythroid 2-related factor 2 (NFE2L2 or NRF2). Gain-of-function mutations in NRF2 disrupt its negative regulation by Kelch-like ECH-associated protein 1 (KEAP1), resulting in sustained NRF2 signaling that promotes tumor growth and resistance to chemotherapy and radiation. We previously identified the FDA-approved drug pyrimethamine (PYR) as an NRF2 inhibitor and demonstrated that inhibition of dihydrofolate reductase (DHFR) represents the primary mechanism underlying its NRF2-suppressive activity, supporting its advancement into a Phase I window-of-opportunity clinical trial (NCT 05678348). Meanwhile, in NRF2^W24C-KYSE70 and NRF2^D77V-KYSE180 cells, PYR promoted NRF2^Mut ubiquitination and proteasomal degradation and shortened its half-life. This study aims to explore additional modes of action by which PYR inhibits NRF2. Methods: Cell cycle analysis was performed by flow cytometry. Cell proliferation, apoptosis and chemosensitivity were assessed by Live-Cell Analysis System, while radiosensitivity was evaluated using X-ray irradiation and the CellTiter-Glo assay. Molecular interactions between NRF2 and KEAP1 were examined through Co-IP and PLA, and the direct binding of PYR to KEAP1 was quantified using ITC and SPR. Molecular docking and dynamic simulations were employed to predict potential PYR-binding pockets within the Kelch domain. Results: Using genetically defined isogenic ESCC cell models, we show that activation of mutant NRF2 (NRF2^Mut) or wild-type NRF2 (NRF2^WT) produces distinct, context-dependent effects on squamous differentiation, proliferation, and therapeutic response. We further demonstrate that PYR restores sensitivity to chemotherapy and ionizing radiation in NRF2^Mut ESCC cells. Mechanistically, short-term PYR treatment promotes KEAP1-dependent proteasome-mediated degradation of NRF2^W24C. Biochemical and biophysical assays indicate that PYR enhances the interaction between KEAP1 and NRF2^W24C in a manner associated with KEAP1-dependent proteasomal degradation. Computational modeling further suggests that PYR may engage a pocket within the Kelch domain to facilitate the NRF2^W24C-KEAP1 interaction. Conclusions: These findings show that PYR functionally restores KEAP1-mediated NRF2 degradation of select NRF2^Mut through a glue-like effect and overcomes therapy resistance in ESCC. Although the proposed glue-like mechanism remains hypothetical, this work supports further investigation into the NRF2–KEAP1 interaction and may inform the development of KEAP1-targeted strategies for NRF2^Mut cancers, including ESCC. Full article

Background: Esophagectomy remains the definitive curative treatment for esophageal cancer but is historically burdened by significant procedure-related morbidity. Anastomotic leakage (AL) is still the “Achilles’ heel” of esophageal surgery, serving as a primary benchmark for surgical quality due to its profound impact on patient recovery, healthcare costs, and long-term oncological outcomes. While surgical expertise and perioperative care have matured, reported AL rates remain persistently high. This necessitates a shift in focus from purely technical modifications toward integrated, data-driven preventive strategies. Purpose: Five years after our initial review, this update synthesizes the rapid evolution in AL prevention. We evaluate the transition from empirical surgical pragmatism to evidence-based protocols, integrating recent breakthroughs in real-time perfusion monitoring, prophylactic endoluminal technologies, and multidisciplinary patient optimization. This work provides a contemporary “roadmap” for navigating the complexities of esophageal reconstruction. Conclusions: The prevention of AL has evolved into a multimodal “bundle” that begins well before the index operation. This review highlights the critical shift toward quantitative perfusion assessment via indocyanine green fluorescence angiography, which is increasingly replacing subjective visual inspection as the standard for anastomotic site selection. We discuss the emerging role of gastric ischemic preconditioning as a biological strategy to enhance conduit vascularity, alongside the paradigm of proactive management using preemptive endoluminal vacuum therapy to mitigate septic sequelae in high-risk cases. Furthermore, we examine technical refinements in conduit construction and conditioning—focusing on the ‘tension-perfusion’ relationship—and the essential role of structured prehabilitation within enhanced recovery after surgery frameworks. While the quality of evidence remains heterogeneous, the move toward standardized reporting and objective monitoring marks a new era of precision in esophageal surgery. Full article

Background: Esophageal cancer (EC) is an aggressive malignancy with low survival rates, making accurate prognosis critical for guiding treatment decisions. Traditional prognostic methods, while essential, often lack precision and comprehensive data insights. This study aims to apply machine learning (ML) approaches to investigate EC prognosis by identifying key factors associated with 5-year survival. Methods: Multiple ML algorithms—Random Forest (RF), Artificial Neural Networks (ANN), K-Nearest Neighbors (KNN), AdaBoost, and Naïve Bayes—were applied to a dataset from the SEER database. Model development included exploratory data analysis, internal validation, and 5-fold cross-validation. Traditional survival analysis methods, such as Cox regression and Kaplan–Meier (KM) analysis, were integrated to further explore relationships between key predictor and outcome variables. Additionally, time-series analysis was conducted to examine survival trends over time and identify influencing factors. Results: RF demonstrated the highest predictive performance among the models tested. Key prognostic factors identified included surgery, summary stage, tumor size, metastasis, AJCC M stage, and age. An exploratory analysis of temporal trends further showed changes in survival outcomes across diagnosis years. Conclusions: The findings highlight the potential of ML approaches to analyze prognostic patterns in EC. Integrating ML models with traditional statistical analyses helped identify key prognostic factors such as surgery, summary stage, and metastasis, while the exploratory temporal analysis provided additional context regarding survival trends over time. While promising, further external validation and addressing time-series challenges are necessary. Overall, this study demonstrates the potential of ML to support the identification of prognostic factors in EC and may contribute to more informed clinical decision-making. Full article

Introduction: Frailty syndrome is an increasingly recognized condition that affects a considerable proportion of elderly patients, particularly those undergoing major surgeries. In this meta-analysis, we aimed to systematically review and pool data from cohort studies to assess the effect of frailty on the clinical outcomes of patients undergoing esophagectomy for esophageal cancer. Methods: Major online medical databases such as PubMed, Embase, Scopus, and Web of Science were searched to gather all studies on the clinical outcomes of patients with frailty syndrome who underwent esophagectomy due to esophageal cancer. The study included articles published up to March 2026. Finally, 15 articles matched the required criteria and were included in this meta-analysis. Results: The pooled odds ratio for surgery-related mortality in patients with frailty syndrome and esophageal cancer undergoing esophagectomy has been established at 4.03 (Lower Limit: 2.20; Upper Limit: 7.38; p-value < 0.05). The pooled odds ratio for surgery-related postoperative pneumonia in patients with frailty syndrome and esophageal cancer undergoing esophagectomy has been established at 1.86 (Lower Limit: 1.16; Upper Limit: 2.98; p-value < 0.05). The pooled odds ratio for surgery-related postoperative cardiac complications in patients with frailty syndrome and esophageal cancer undergoing esophagectomy has been established at 1.73 (Lower Limit: 1.54; Upper Limit: 1.94; p-value < 0.05). Conclusions: Frailty is a powerful predictor of mortality in patients undergoing esophagectomy, with frail individuals facing nearly four times higher odds of death. This underscores the urgent need to integrate frailty assessments into standard preoperative screening to enhance risk stratification and optimize perioperative decision-making. A multidisciplinary approach is essential to improving resilience, recovery, and long-term survival in frail esophageal cancer patients. Future large-scale prospective trials should focus on standardizing assessment tools and evaluating the lasting impact of tailored interventions to ultimately enhance patient outcomes. Full article

Background: Disparities in esophageal cancer (EC) outcomes persist, partially due to inequitable access to high-quality surgical care, particularly for socioeconomically disadvantaged populations. This study evaluates the impact of social determinants of health (SDHs) on achieving textbook oncological outcomes (TOOs) and survival in operable EC patients. Methods: Using the National Cancer Database (2010–2021), we analyzed 26,367 stage I–IV A esophageal adeno- and squamous cell carcinoma patients undergoing esophagectomy after neoadjuvant chemoradiation. An SDH score (0–4) was derived from income, education, rurality, and hospital type. TOOs were defined as R0 resection, ≥20 lymph nodes examined, no 30-day mortality, and no prolonged hospitalization. Multivariable logistic and Cox regression models assessed predictors of TOOs and survival. Results: Overall, 19% achieved TOOs. Median survival time was 6.4 years for TOO+ versus 3.2 years for TOO−. Patients with favorable SDH had longer survival than those with unfavorable SDHs (median 4.0 vs. 3.5 years), but this disparity was largely confined to TOO− patients. Across stages II–III, low income and treatment at community hospitals were consistently associated with higher mortality among TOO− patients (HRs ~1.08–1.21), whereas SDH factors were largely attenuated among TOO+ patients. Stage-stratified analyses demonstrated that SDH effects were minimal in stage I and IV disease but pronounced in intermediate stages, especially in TOO− patients. Conclusions: TOOs are a powerful modifier of survival disparities in esophageal cancer. While SDH strongly influences outcomes among patients with suboptimal care pathways, achieving high-quality, textbook oncologic care attenuates these effects. Efforts to improve TOO achievement and expand access to high-quality centers may reduce socioeconomic inequities in survival. Full article