Background
Insufficient vascular supply is one of the main causes of anastomotic leak in colorectal surgery. Intraoperative indocyanine-green (ICG) angiography has been shown to provide information ...on tissue perfusion, identifying a well-perfused location for colonic and rectal transections, and thus possibly reducing the leak rate. Aim of this study was to evaluate the usefulness of intraoperative assessment of anastomotic perfusion using ICG angiography in patients undergoing left-sided colon or rectal resection with colorectal anastomosis.
Methods
This randomized trial involved 252 patients undergoing laparoscopic left-sided colon and rectal resection randomized 1:1 to intraoperative ICG or to subjective visual evaluation of the bowel perfusion without ICG. The primary aim was to assess whether ICG angiography could lead to a reduction in anastomotic leak rate. Secondary outcomes were possible changes in the surgical strategy and postoperative morbidity.
Results
After randomization, 12 patients were excluded. Accordingly, 240 patients were included in the analysis; 118 were in the study group, and 122 in the control group. ICG angiography showed insufficient perfusion of the colic stump, which led to extended bowel resection in 13 cases (11%). An anastomotic leak developed in 11 patients (9%) in the control group and in 6 patients (5%) in the study group (
p
= n.s.).
Conclusions
Intraoperative ICG fluorescent angiography can effectively assess vascularization of the colic stump and anastomosis in patients undergoing colorectal resection. This method led to further proximal bowel resection in 13 cases, however, there was no statistically significant reduction of anastomotic leak rate in the ICG arm.
Clinical trial
ClinicalTrials.gov NCT02662946.
Distributional semantics embodies the idea that the context in which a word occurs reveals the meaning of that word. In contemporary corpus linguistics, that idea takes shape in various types of ...quantitative context analysis. This monograph explores how count-based token-level semantic vector spaces, as an advanced form of such a quantitative methodology, can be applied to the study of polysemy, lexical variation, and lectometry. What can distributional models reveal about meaning? How can they be used to analyse the semantic relationship between near-synonyms? And how can they contribute to the study of lexical variation as a sociolinguistic variable? The book details the conceptual background of lexical semantic and lexical variation research, explains the mechanism of distributional modelling, and introduces distributional workflows and corpus linguistic tools to answer the questions. Combining a cognitive linguistic interest in meaning with a sociolinguistic interest in variation, it illustrates that distributional methodology with case studies on Dutch and Spanish lexical data, focusing on the value of distributional models for semantic analysis, the interaction of semasiological and onomasiological change, and sociolinguistic issues of lexical standardization and pluricentricity.
Background
A model that quantifies the risk of peritoneal recurrence would be a useful tool for improving decision-making in patients undergoing curative-aim gastrectomy for gastric cancer (GC).
...Methods
Five Italian centers participated in this study. Two risk scores were created according to the two most widely used pathologic classifications of GC (the Lauren classification and the presence of signet-ring-cell features). The risk scores (the PERI-Gastric 1 and 2) were based on the results of multivariable logistic regressions and presented as nomograms (the PERI-Gram 1 and 2). Discrimination was assessed with the area under the curve (AUC) of receiver operating curves. Calibration graphs were constructed by plotting the actual versus the predicted rate of peritoneal recurrence. Internal validation was performed with a bootstrap resampling method (1000 iterations).
Results
The models were developed based on a population of 645 patients (selected from 1580 patients treated from 1998 to 2018). In the PERI-Gastric 1, significant variables were linitis plastica, stump GC, pT3–4, pN2–3 and the Lauren diffuse histotype, while in the PERI-Gastric 2, significant variables were linitis plastica, stump GC, pT3–4, pN2–3 and the presence of signet-ring cells. The AUC was 0,828 (0.778–0.877) for the PERI-Gastric 1 and 0,805 (0.755–0.855) for the PERI-Gastric 2. After bootstrap resampling, the PERI-Gastric 1 had a mean AUC of 0.775 (0.721–0.830) and a 95%CI estimate for the calibration slope of 0.852–1.505 and the PERI-Gastric 2 a mean AUC of 0.749 (0.693–0.805) and a 95%CI estimate for the slope of 0.777–1.351. The models are available at
www.perigastric.org
.
Conclusions
We developed the PERI-Gastric and the PERI-Gram as instruments to determine the risk of peritoneal recurrence after curative-aim gastrectomy. These models could direct the administration of prophylactic intraperitoneal treatments.
Gastric cancer is the world's third leading cause of cancer mortality. In spite of significant therapeutic improvements, the clinical outcome for patients with advanced gastric cancer is poor; thus, ...the identification and validation of novel targets is extremely important from a clinical point of view. We generated a wide, multilevel platform of gastric cancer models, comprising 100 patient-derived xenografts (PDX), primary cell lines, and organoids. Samples were classified according to their histology, microsatellite stability, Epstein-Barr virus status, and molecular profile. This PDX platform is the widest in an academic institution, and it includes all the gastric cancer histologic and molecular types identified by The Cancer Genome Atlas. PDX histopathologic features were consistent with those of patients' primary tumors and were maintained throughout passages in mice. Factors modulating grafting rate were histology, TNM stage, copy number gain of tyrosine kinases/
genes, and microsatellite stability status. PDX and PDX-derived cells/organoids demonstrated potential usefulness to study targeted therapy response. Finally, PDX transcriptomic analysis identified a cancer cell-intrinsic microsatellite instability (MSI) signature, which was efficiently exported to gastric cancer, allowing the identification, among microsatellite stable (MSS) patients, of a subset of MSI-like tumors with common molecular aspects and significant better prognosis. In conclusion, we generated a wide gastric cancer PDX platform, whose exploitation will help identify and validate novel "druggable" targets and optimize therapeutic strategies. Moreover, transcriptomic analysis of gastric cancer PDXs allowed the identification of a cancer cell-intrinsic MSI signature, recognizing a subset of MSS patients with MSI transcriptional traits, endowed with better prognosis. SIGNIFICANCE: This study reports a multilevel platform of gastric cancer PDXs and identifies a MSI gastric signature that could contribute to the advancement of precision medicine in gastric cancer.
Introduction
The COVID-19 pandemic has resulted in unparalleled changes to patient care, including the suspension of cancer surgery. Concerns regarding COVID-19-related risks to patients and ...healthcare workers with the re-introduction of major complex minimally invasive and open surgery have been raised. This study examines the COVID-19 related risks to patients and healthcare workers following the re-introduction of major oesophago-gastric (EG) surgery.
Patients and Methods
This was an international, multi-centre, observational study of consecutive patients treated by open and minimally invasive oesophagectomy and gastrectomy for malignant or benign disease. Patients were recruited from nine European centres serving regions with a high population incidence of COVID-19 between 1 May and 1 July 2020. The primary endpoint was 30-day COVID-19-related mortality. All staff involved in the operative care of patients were invited to complete a health-related survey to assess the incidence of COVID-19 in this group.
Results
In total, 158 patients were included in the study (71 oesophagectomy, 82 gastrectomy). Overall, 87 patients (57%) underwent MIS (59 oesophagectomy, 28 gastrectomy). A total of 403 staff were eligible for inclusion, of whom 313 (78%) completed the health survey. Approaches to mitigate against the risks of COVID-19 for patients and staff varied amongst centres. No patients developed COVID-19 in the post-operative period. Two healthcare workers developed self-limiting COVID-19.
Conclusions
Precautions to minimise the risk of COVID-19 infection have enabled the safe re-introduction of minimally invasive and open EG surgery for both patients and staff. Further studies are necessary to determine the minimum requirements for mitigations against COVID-19.
This research aims to investigate the innovative use of the subject clitic pronouns lo, la, le in attributive predications, e.g. O xabe lašo lo “The dinner is good,” in Romani spoken in the State of ...Veracruz, Mexico. The analysis of a 15-hour conversational corpus in Romani shows that the Romani copula si is used in variation with the subject clitic pronouns in l- in third person, affirmative clauses. In addition, 60 Romani-Spanish bilinguals from Veracruz responded to a contextualized copula choice task. Generalized linear mixed effect models were constructed to analyse the results. The analysis shows that the clitics are extremely dynamic in third person affirmative sentences and further reveals the linguistic variables that determine their use.
Aims and objectives/purpose/research questions:
Among the questions that remain open is whether bilingualism leads to simplification of alternatives in language in order to reduce cognitive load. ...This hypothesis has been supported by evidence showing that bilinguals generalize the Spanish copula estar ‘to be’ faster than monolinguals. Yet, other studies found no such clear trend. While conceptual transfer could account for the conflicting evidence in the literature, its role has not been demonstrated. Our study aims to fill this gap by testing simplification in Spanish copula choice among bilinguals and, in particular, the role of transfer.
Design/methodology/approach:
We used a contextualized copula choice task, comprising 28 sentences.
Data and analysis:
Sixty Romani–Spanish bilinguals from Mexico responded to the questionnaire in both Spanish and Romani. A control group of 62 Mexican Spanish monolinguals responded in Spanish. We constructed generalized linear mixed-effects models to analyse the results.
Findings/conclusions:
Analysis of the results reveals greater extension of estar among bilinguals for individual-level predicates as well as for traits not susceptible to change. Comparison of the responses of bilinguals (in Romani and in Spanish) and of Spanish monolinguals indicates that Romani could be reinforcing the generalization of estar in the Spanish responses of bilinguals.
Originality:
To our knowledge, this is the first study to examine copula choice in bilingual mode. In addition, it brings evidence from an under-researched community with little normative pressure.
Significance/implications:
Our study shows that conceptual transfer may be driving the extension of estar among bilinguals.
Abstract Background The real incidence of epiphrenic diverticulum is unknown, and only 15% to 20% of cases are symptomatic. Methods From January 1994 to May 2009, 20 patients were treated ...laparoscopically for this condition. Results The most common operation performed was transhiatal diverticulectomy with myotomy and partial fundoplication. No case was converted to open surgery. Esophageal leak occurred in 1 patient (5%). The postoperative courses were uneventful in the remaining 19 patients. After a median follow-up period of 52 months (range, 1–141 months), 1 patient had died of squamous cell carcinoma, 1 had mild solid-food dysphagia, 1 had chest pain, and 1 had heartburn. Manometry was performed postoperatively in 7 patients; all had normal lower esophageal sphincter pressure. In 5 patients who underwent 24-hour postoperative pH monitoring, pathologic reflux was absent. Conclusions In patients with symptomatic epiphrenic diverticulum, laparoscopic surgery is feasible, providing good access to the distal esophagus and inferior mediastinum. Long-term outcomes are satisfactory.
Aim
Surgical myotomy of the lower esophageal sphincter has a 5-year success rate of approximately 91 %. Peroral endoscopic myotomy can provide similar results for controlling dysphagia. Some patients ...experience either persistent or recurrent dysphagia after myotomy. We present here a retrospective analysis of our experience with redo myotomy for recurrent dysphagia in patients with achalasia.
Methods
From March 1996 to February 2015, 234 myotomies for primary or recurrent achalasia were performed in our center. Fifteen patients (6.4 %) had had a previous myotomy and were undergoing surgical redo myotomy (
n
= 9) or endoscopic redo myotomy (
n
= 6) for recurrent symptoms.
Results
Patients presented at a median of 10.4 months after previous myotomy. Median preoperative Eckardt score was 6. Among the nine patients undergoing surgical myotomy, three esophageal perforations occurred intraoperatively (all repaired immediately). Surgery lasted 111 and 62 min on average (median) in the surgical and peroral endoscopic myotomy (POEM) groups, respectively. No postoperative complications occurred in either group. Median postoperative stay was 3 and 2.5 days in the surgical and POEM groups, respectively. In the surgical group, Eckardt score was <3 for seven out of nine patients after a mean follow-up of 19 months; it was <3 for all six patients in the POEM group after a mean follow-up of 5 months.
Conclusions
A redo myotomy should be considered in patients who underwent myotomy for achalasia and presenting with recurrent dysphagia. Preliminary results using POEM indicate that the technique can be safely used in patients who have undergone previous surgical myotomy.
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