22 research outputs found
Giant leiomyoma of the gastroesophageal junction: technique and results of endoscopic full-thickness resection
No full textDavide Bona, Alberto Aiolfi, Stefano Siboni, Daniele Bernardi, Luigi BonavinaDepartment of Surgery, IRCCS Policlinico San Donato, University of Milano School of Medicine, Milano, ItalyAbstract: Four consecutive patients with a giant leiomyoma originating from the posterior aspect of the gastroesophageal junction were treated with full-thickness endoscopic retroflex dissection. A complete removal of the lesion was obtained in all cases. No complications were observed except for some degree of air filtration causing symptomatic pneumoperitoneum in one patient. Retroflex endoscopic full-thickness resection of giant leiomyoma at the gastroesophageal junction is feasible and safe.Keywords: gastroesophageal junction, leiomyoma, endoscopic submucosal dissection, pneumoperitoneu
ASO author reflections: does thoracic duct resection impact long-term survival after esophagectomy?
No full textASO Author Reflections: Effect of Anastomotic Leak on Long-Term Survival After Esophagectomy: Multivariate Meta-analysis and Restricted Mean Survival Times Examination
No full textImpact of pulmonary complications following esophagectomy on long-term survival: multivariate meta-analysis and restricted mean survival time assessment
No full textPulmonary complications (PC) are common after esophagectomy and their impact on long-term survival is not defined yet. The present study aimed to assess the effect of postoperative PCs on long-term survival after esophagectomy for cancer. Systematic review of the literature through February 1, 2023, was performed. The included studies evaluated the effect of PC on long-term survival. Primary outcome was long-term overall survival (OS). Cancer-specific survival (CSS) and disease-free survival (DFS) were secondary outcomes. Restricted mean survival time difference (RMSTD), hazard ratio (HR), and 95% confidence intervals (CI) were used as pooled effect size measures. Eleven studies were included (3423 patients). Overall, 674 (19.7%) patients developed PC. The RMSTD analysis shows that at 60-month follow-up, patients not experiencing PC live an average of 8.5 (95% CI 6.2–10.8; p < 0.001) months longer compared with those with PC. Similarly, patients not experiencing postoperative PC seem to have significantly longer CSS (8 months; 95% CI 3.7–12.3; p < 0.001) and DFS (5.4 months; 95% CI 1.6–9.1; p = 0.005). The time-dependent HRs analysis shows a reduced mortality hazard in patients without PC at 12 (HR 0.6, 95% CI 0.51–0.69), 24 (HR 0.64, 95% CI 0.55–0.73), 36 (HR 0.67, 95% CI 0.55–0.79), and 60 months (HR 0.69, 95% CI 0.51–0.89). This study suggests a moderate clinical impact of PC on long-term OS, CSS, and DFS after esophagectomy. Patients not experiencing PC seem to have a significantly reduced mortality hazard up to 5 years of follow-up. Graphical abstract: (Figure presented.
Effect of gastric ischemic conditioning prior to esophagectomy: systematic review and meta-analysis
No full textIschemia at the anastomotic site is thought to be a protagonist in the development of anastomosis-related complications while different strategies to overcome this problem have been reported. Gastric ischemic conditioning (GIC) prior to esophagectomy has been described with this intent. Evaluate the effect of GIC on anastomotic complications after esophagectomy. Scopus, Web of Science, MEDLINE, and PubMed were investigated up to March 31st, 2023. We considered articles that appraised short-term outcomes after GIC vs. no GIC in patients undergoing esophagectomy. Anastomotic leak (AL), anastomotic stricture (AS), and gastric conduit necrosis (GCN) were primary outcomes. Risk ratio (RR) and standardized mean difference (SMD) were used as pooled effect size measures, whereas 95% confidence intervals (95% CIs) were used to calculate related inference. Fourteen studies (1760 patients) were included. Of those, 732 (41.6%) underwent GIC, while 1028 (58.4%) underwent one-step esophagectomy. Compared with no GIC, GIC was related to a reduced RR for AL (R RR = 0.63; 95% CI 0.47–0.86; p < 0.01) and AS (RR = 0.51; 95% CI 0.29–0.91; p = 0.02), whereas no differences were found for GCN (RR = 0.56; 95% CI 0.19–1.61; p = 0.28). Postoperative pneumonia (RR = 1.09; p = 0.99), overall complications (RR = 0.87; p = 0.19), operative time (SMD − 0.58; p = 0.07), hospital stay (SMD 0.66; p = 0.09), and 30-day mortality (RR = 0.69; p = 0.22) were comparable. GIC prior to esophagectomy seems associated with a reduced risk for AL and AS. Further studies are necessary to identify the subset of patients who can benefit from this procedure, the optimal technique, and the timing of GIC prior to esophagectomy
Short-term Outcomes of Different Techniques for Gastric Ischemic Pre-Conditioning Before Esophagectomy
No full textBackground: Ischemia at the anastomotic site plays a critical role determinant in the development of anastomosis-related complications after esophagectomy. Gastric ischemic conditioning (GIC) before esophagectomy has been described to improve the vascular perfusion at the tip of the gastric conduit with a potential effect on anastomotic leak (AL) and stenosis (AS) risk minimization. Laparoscopic (LapGIC) and angioembolization (AngioGIC) techniques have been reported. Purpose: Compare short-term outcomes among different GIC techniques. Materials and Methods: Systematic review and network meta-analysis. One-step esophagectomy (noGIC), LapGIC, and AngioGIC were compared. Primary outcomes were AL, AS, and gastric conduit necrosis (GCN). Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrIs) were used to assess relative inference. Results: Overall, 1760 patients (14 studies) were included. Of those, 1028 patients (58.4%) underwent noGIC, 593 (33.6%) LapGIC, and 139 (8%) AngioGIC. AL was reduced for LapGIC versus noGIC (RR=0.68; 95% CrI 0.47-0.98) and AngioGIC versus noGIC (RR=0.52; 95% CrI 0.31-0.93). Similarly, AS was reduced for LapGIC versus noGIC (RR=0.32; 95% CrI 0.12-0.68) and AngioGIC versus noGIC (RR=1.30; 95% CrI 0.65-2.46). The indirect comparison, assessed with the network methodology, did not show any differences for LapGIC versus AngioGIC in terms of postoperative AL and AS risk. No differences were found for GCN, pulmonary complications, overall complications, hospital length of stay, and 30-day mortality among different treatments. Conclusions: Compared to noGIC, both LapGIC and AngioGIC before esophagectomy seem equivalent and associated with a reduced risk for postoperative AL and AS
Understanding Analysts' Earnings Expectations: Biases, Nonlinearities, and Predictability
No full textThis paper studies the asymmetric behavior of negative and positive values of analysts' earnings revisions and links it to the conservatism principle of accounting. Using a new three-state mixture of lognormal models that accounts for differences in the magnitude and persistence of positive, negative, and zero revisions, we find evidence that revisions to analysts' earnings expectations can be predicted using publicly available information such as lagged interest rates and past revisions. We also find that our forecasts of revisions to analysts' earnings estimates help to predict the actual earnings figure beyond the information contained in analysts' earnings expectations. Copyright The Author 2009. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: [email protected]., Oxford University Press.
La influencia de la actitud del consumidor en la intención de uso de altavoces inteligentes en las personas de 18 a 35 años en Lima Metropolitana
No full textThe study aims to determine how consumer attitude is related to the intention to use smart speakers in people between 18 and 35 years old in Metropolitan Lima. A quantitative, correlational, and random sampling method was used. The sample is made up of 101 people between 18 and 35 years old in Metropolitan Lima who use smart speakers. For data collection, the survey was used as a technique, and the questionnaire as an instrument, which was adapted from the author (Aiolfi, 2023) , and measuring intention to use with 3 items, consumer attitude with 3 items and the dimensions Perceived Usefulness, Perceived Ease of Use, Perceived Privacy Risk, Innovation, Perceived Enjoyment, Social Attraction and Task Technology Adjustment. with 26 items, all on a Likert scale from 1 to 5. Cronbach's alpha tests, factor analysis, tests normality, Spearman evaluation coefficient and multiple linear regression tests were used to analyze the data. The work concluded that consumer attitude is related to the intention to use smart speakers in people between 18 and 35 years old in Metropolitan Lima.El estudio tiene como objetivo determinar de qué manera se relaciona la actitud del consumidor en la intención de uso de altavoces inteligentes en las personas de 18 a 35 años en Lima Metropolitana. Se utilizó un método cuantitativo, de tipo correlacional, y de muestreo aleatorio. La muestra la conforman 101 personas de 18 a 35 años en Lima Metropolitana que utilizan altavoces inteligentes. Para la recolección de datos se utilizó como técnica la encuesta y como instrumento el cuestionario, el que se adaptó del autor (Aiolfi, 2023) y midiéndose la intención de uso con 3 ítems, la actitud del consumidor con 3 ítems y las dimensiones Utilidad Percibida, Facilidad de uso percibida, Riesgo de privacidad percibido, innovación, disfrute percibido, atracción social y ajuste de la tecnología de tareas con 26 ítems, todo en escala de Likert del 1 al 5. Para el análisis de los datos se utilizaron pruebas alfa de Cronbach, de análisis de factores, prueba de normalidad, coeficiente de correlación de Spearman y pruebas de regresión lineal multiple. El trabajo concluyó que la actitud del consumidor se relaciona con la intención de uso de altavoces inteligentes en las personas de 18 a 35 años en Lima Metropolitana
Long-term adherence to CPAP treatment in patients with obstructive sleep apnea: importance of educational program
No full textBiomarkers associated with anastomotic leakage after esophagectomy: a systematic review
No full textPurpose: Anastomotic leakage (AL) is one of the most important complications that occurs after upper gastrointestinal surgery, registering rates of 20–30% after esophagectomy. The role of systemic inflammatory biomarkers to predict anastomotic leaks is controversial and needs systematization. Methods: A systematic review based on the PRISMA guidelines criteria was performed. PubMed, Scopus, and Embase were queried using MESH Terms and All Fields key words to identify studies investigating a range of immune-inflammatory factors in predicting AL. Results: Twenty-four studies were included in this review. The total number of included patients was 5903, ranging in each study from 42 to 612. The included studies reported patients that underwent different techniques of esophagectomy (Ivor Lewis, McKeown, Orringer or thoracoabdominal esophagectomy) and 23 out of 24 studies included patients that underwent neoadjuvant treatment. While different biomarkers at different timepoints were analyzed, most studies have indicated postoperative biomarkers, between day 3 and day 5 to reach statistical significance. Conclusions: Systemic inflammatory biomarkers represent potential risk stratification and predicting tools for AL after esophageal surgery, but more studies need to be conducted to validate their clinical utility. © The Author(s) 2025
