For decades, the stomach was considered a sterile organ, due to the acid environment. However, starting from the discovery of Helicobacter pylori, this concept has progressively refined. By damaging the hydrochloric acid-secreting glands, H. pylori infection primes the progression from acute to chronic inflammation in gastric mucosa resulting in atrophic gastritis, intestinal metaplasia, dysplasia and ultimately gastric cancer (GC). Due to the challenging identification of culturing bacteria, the carcinogenic role of gastric microbial community, other than H. pylori, remains underestimated. More recently, a growing body of evidence has pointed out the dynamism of gastric microbiota as a crucial step for GC development, besides elucidating some additional activity in modulating the efficacy of cancer treatments. In turn, anticancer therapies can shape gastric microbiota with consequent dysbiosis and a potential correlation with drug-related toxicity. In conclusion, the current review aims to deepen the role of gut microbiota as a key factor in gastric disease at multiple levels, from carcinogenesis to the metastatic phase. It also provides novel insights on gastric microbiota as potential target for tailoring multimodal strategies, either surgical or oncological, to finally provide our patients with more individualized treatment options.

Anastomotic leakage represents one of the most dreadful complications following esophagectomy. Although preoperative body composition has been identified as an independent predictor of prognosis for esophageal cancer patients after esophagectomy, its actual contribution to subsequent anastomotic leakage development is still unclear. The aim of the study was to further explore such a relationship. We conducted a multicenter retrospective study from a prospectively acquired database on consecutive patients who underwent Ivor Lewis esophagectomy in four italian high volume centers from May 2014. All patients who were evaluated with at least one preoperative CT scan were enrolled. Body composition parameters including total abdominal muscle area (TAMA), visceral fat area (VFA) and subcutaneous fat area (SFA) were determined based on two consecutive axial CT images extending upwards from the level of the third lumbar vertebra; sarcopenia was defined using predetermined sex specific values: 52.4 cm2/m2 for men, 38.5 cm2/m2 for women. Perioperative variables (ASA, neoadjuvant treatment, tumour site, anastomosis type were systematically collected. 237 patients were enrolled. Preoperative BMI: 25.16 kg/m2; 23.6% of patients suffered from anastomotic leakage. According to CT morphometric assessment, 64.1% were classified as sarcopenic; these patients were more vulnerable in terms of postoperative death (within 90 days, P = 0.028). The mean VFA/TAMA and VFA/SFA ratios were 2.93 ± 1.87 and 0.93 ± 0.59, respectively. Both these ratios demonstrated a linear correlation with the Clavien Dindo classification of postoperative complications (R = 0.311 and 0.239, respectively); specifically, patients with anastomotic leakage had significantly higher VFA/TAMA (3.56 ± 1.86 vs. 2.75 ± 1.83, P = 0.006) and VFA/SFA (1.18 ± 0.68 vs. 0.87 ± 0.54, P = 0.003) ratios. In patients suffering from anastomotic leakage, the highest VFA/TAMA ratio values were found in those experiencing type III (P = 0.044). No significant correlation was found between preoperative BMI and subsequent anastomotic leakage development (P = 0.154). Analytical morphometric assessment represents a useful non invasive tool for preoperative risk stratification. The concurrent association of sarcopenia and visceral obesity seems to be the best predictor of anastomotic leakage, far better than simple BMI evaluation, and potentially modifiable if targeted with prehabilitation programs.

Background: Multimodality treatment is considered the standard approach for advanced oesophageal and junctional cancer (OJC). CROSS (Chemo-Radiotherapy for Oesophageal tumours followed by Surgery Study) is one of the referral regimens. This work aims to analyse our experience with CROSS. Patients and methods: From January 2013 to December 2015 consecutive fit patients with resectable, (T3-4,N0,M0, anyT,N +, M0) OJC were enrolled to receive neoadjuvant concurrent chemo-radiotherapy (5 courses of carbo-taxol and radio 41,4 Gy in 23 fractions). Patients showing no progression were then evaluated for oesophagectomy. We recorded patients' characteristics, toxicity, response to therapy, postoperative and oncological outcomes. Statistical analysis was performed using SPSS Statistics. Results: 47 patients; M:F = 39:8; median age 65 (40-81), ECOG-PS low (0-1). Adenocarcinoma was the most common histology (63,8%); 66% of tumours were located within the lower and junctional oesophagus. Toxicity was mild in 74,5% patients; 11 pts (23.4%) experienced severe toxicity and 8 (17%) did not complete neoadjuvant therapy. Ten patients (21,2%) didn't undergo surgery due to progression (5), unfitness (2), death (3). Thirty-seven patients underwent resection: through thoraco-abdominal (4), Ivor Lewis (25) and Mc Keown (8) oesophagectomy. Postoperative morbidity and mortality were 29.7% (11) and 8,1% (3). Complete pathological responses were 7 (18,9%). Actuarial overall and disease-free survivals at 30 months were 73.% and 73.5% (median follow-up 11.5 months). Recurrence rate was 25% (9). Survival and recurrence rates were not associated to downstaging (p= 0,611 and p= 0,68). Conclusions: CROSS regimen is considered safe and effective; our experience suggests a careful patients' selection to improve results.

Aim of this retrospective study is to verify, in a group of elderly patients who underwent gastric resection for cancer, the clinico-pathological factors predictive of mortality, postoperative morbidity and long-term survival, and to compare the results with those of a group of patients younger than the cut-off value.

There is a fundamental mismatch between the computational basis of spreadsheets and our knowledge of the real world. In spreadsheets, numeric data are represented as exact numbers and their mutual relations as functions, whose values (output) are computed from given argument values (input). However, in the real world, data are often inexact and uncertain in many ways, and the relationships, that is, constraints, between input and output are far more complicated. This article shows that interval constraint solving, an emerging AI-based technology, provides a more versatile and useful foundation for spreadsheets. The new computational basis is 100-percent downward compatible with the traditional spreadsheet paradigm. The idea has been successfully integrated with Microsoft EXCEL as the add-in INTERVAL SOLVER that seamlessly upgrades the arithmetic core of EXCEL into interval constraint solving. The product has been downloaded by thousands of end users all over the world and has been used in various applications in business computing, engineering, education, and science. There is an intriguing chance for a major breakthrough of the AI technology on the spreadsheet platform: Tens of millions of EXCEL users are making important decisions based on spreadsheet calculations.

This paper documents LIA InC++ library for local interval arithmetic in C++. Themain innovation of the library is the idea of extending traditional interval arithmeticwith "complement" intervals and discontinuous intervals. By these extensions it ispossible to evaluate not only ranges of possible values (i.e., intervals) but ranges ofimpossible values as well. LIA InC++ contains classes for interval types andoverloaded definitions for primitive interval arithmetic operators and functions....

This document discusses theoretical and practical problems of evaluating intervalarithmetic (IA) functions globally, and presents a C++ library called GIA InC++(Global Interval Arithmetic in C++) for the task. In this implementation both algebraicand numerical IA techniques are employed. Our goal has been to provide the user withan easy to use, portable evaluator that can be applied in practical applications withoutdeep understanding of interval analysis. The paper can be used as a user's...

Cascaded function evaluation, i.e., evaluation of a set of mutually dependent arithmeticfunctions is the basic computational task performed by current spreadsheet programs.When generalizing such computations into interval arithmetic both algebraic andnumerical problems are encountered. This paper presents an implementation of cascadedinterval function evaluation as a C++ library called CIF InC++. This library provides theuser with an easy to use, portable interval function evaluator that...

This paper discusses, how to extend C++ language with classes for interval function evaluation and constraint satisfaction. Three portable general purpose libraries for the tasks are being implemented: INT++, IAF++ and INC++. The main innovation of these systems is combination of algebraic and numerical IA techniques with constraint satisfaction techniques for evaluating interval functions globally and for obtaining better than local solutions for interval constraint satisfaction problems. Our practical goal is to provide the main stream programmer with easy to use, portable C++ libraries that can be used in applications without deep understanding of interval analysis.

ABSTRACT This paper,presents,a general,purpose,C++ library ICE InC++ for,solving,interval constraint satisfaction problems,by local and,some,global tolerance propagation,schemes. The library makes,use,of algebraic techniques for solving and simplifying solutions functions corresponding to individual constraint equations, and applies numerical interval branch-and-boundalgorithms,for evaluating interval functions globally. The practical goal of the work,is to provide,C++ programmers,with an interval constraint satisfaction library that can,be used without deeper understanding of interval analysis. ii PREFACE

This paper presents a series of C++ libraries for interval function evaluation and constraint satisfaction. Classical interval arithmetic (IA) (Moore, 1966) is extended by open ended intervals, the notion of infinity and by "complement" and discontinuous intervals. Both algebraic and numerical IA techniques are combined for obtaining the actual range of interval functions efficiently and for determining better than local solutions for interval constraint satisfaction problems. Our practical goal is a set of portable C++ libraries that can be used in applications without deep understanding of interval analysis.