Comparison of trace element chemistry in human bones interred in two private chapels attached to Franciscan friaries in Italy and Denmark:an investigation of social stratification in two medieval and post-medieval societies

Individuals buried in two 17th–18th Century private chapels, each attached to a Franciscan Friary—one in Italy the other in Denmark—have been studied and sampled for trace element analysis. This selection of individuals allows a comparison of the trace element inventory of members of noble families against friars and townspeople, as well as a comparison between two very similar situations in Denmark and Italy. The relevance of this study is to see if and how differences in social status, and therefore likely differences in dietary habits, are reflected in the trace element chemistry of the bones. Samples of cortical and trabecular tissues have been procured from a long bone, preferentially the femur. The samples have been thoroughly decontaminated. 87 samples from 69 individuals have been analysed for Ca, Mn, Fe, Cu, Sr, Ba, and Pb by ICP-MS and Hg by CV-AAS. Sex and age at death have been established by anthropological analysis for all members of the two noble families. We find systematic differences between the noble family members and the friars (or townspeople) in both Italy and Denmark. The noble families are in both cases low in Sr and Ba compared to the friars and townspeople, which is interpreted as a dietary signal resulting from higher meat consumption than in the comparative groups. Lead concentrations are found to be higher in the noble family members than in the comparative groups, and the Pb concentration seems to increase with age in the Italian noble family, where both young and middle-aged individuals were investigated. Mercury concentrations are higher in some of the Italian noble family members compared to friars and townspeople; whereas in Denmark it seems that Hg was equally available to the noble family members and the friars alike. This is the first comprehensive and comparative study of post-medieval noble families in Denmark and Italy. The results show that there are distinct similarities in the trace element distribution patterns in the noble family members irrespective of country, which is tentatively suggested to be due to their higher social status. [Figure not available: see fulltext.]

Is there a role for palliative gastrectomy in asymptomatic metastatic gastric cancer?

Background: Surgery has an established role in gastric cancer for the palliation of major symptoms such as bleeding or obstruction. In other malignancies (like colorectal, kidney and breast cancer), resection of the primary tumor, even in presence of metastatic disease, appears to have a positive prognostic impact also in paucisymptomatic or asymptomatic patients and several randomized trials are ongoing Material and Methods: We retrospectively evaluated the data of patients treated from 2009 to 2014 at our Institution who fulfilled the following selection criteria: histologically confirmed gastric or gastroesophageal junction adenocarcinoma, locally advanced (unresectable) or metastatic disease and palliative treatment with at least one line of systemic chemotherapy. Primary end point of the analysis was overall survival (OS) from the start of first-line chemotherapy, estimated using the Kaplan–Meier method. Two-tailed log-rank test was used for survival comparison between groups and statistical significance was set at p < 0.05 Results: We identified 153 patients: five patients were excluded since they received palliative surgery because of symptoms referred to the primarytumor. Of the 148 patients analyzed, 62 (42%) underwent primary tumor resection in the absence of impending symptoms: tumor was located at the gastroesophageal junction in 26 patients and in the stomach in 122 patients. Median OS was 10.4 months for resected patients and 10.7 months for not resected ones (p = 0.523; HR 1.128, 95% CI 0.780–1.630). The difference was not significant even comparing resected patients with synchronous metastases (i.e. with metastatic disease ab initio or developing distant metastases within 3 months after an apparently radical surgery) with those who did not undergo any intervention (median OS: 12.3 and 10.7 months, respectively, p = 0.596; HR 0.874, 95% CI 0.532–1.437). Taking into account the 121 patients treated with homogeneous first-line chemotherapy (douplet or triplet regimes comprising a platinum derivative and a fluoropyrimidine), there was no significant difference in median OS between resected and not resected patients (11.9 and 10.7 months, respectively, p = 0.744; HR 0.931, 95% CI 0.608–1.426) and between resected patients with synchronous metastases and not resected patients (13.8 and 10.7 months, respectively; p = 0.458; HR 0.824, 95% CI 0.494–1.375) Conclusions: In pauci- or asymptomatic patients with metastatic gastroesophageal cancer treated with first-line chemotherapy, surgery on the primary tumor does not seem to play a role in improving OS comparing to systemic therapy alone

Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery

IF 3.365International audienceAIMTo investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes.METHODSThis is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy (RG), laparoscopic gastrectomy (LG), open gastrectomy (OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided.RESULTSThe present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1: 1: 2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients (RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery (P = 0.42) and stage of the disease (P = 0.16). Intraoperative blood loss was significantly lower in the LG (95.93 +/- 119.22) and RG (117.91 +/- 68.11) groups compared to the OG (127.26 +/- 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG (27.78 +/- 11.45), LG (24.58 +/- 13.56) and OG (25.82 +/- 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay (P < 0.0001). A similar complications rate was found (P = 0.13). The leakage rate was not different (P = 0.78) between groups.CONCLUSIONLaparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery