Nonoperative management of acute complicated diverticulitis with pericolic and/or distant extraluminal air: A systematic review.

INTRODUCTION: Colonic Diverticular Disease (CDD) is a multifactorial inflammatory disease. Acute diverticulitis (AD), with extraluminal free air (both pericolic and distant), represents about 15% of radiological scenarios and remains a therapeutic challenge for surgeons. Currently, the WSES guidelines suggest trying a conservative strategy both in the presence of pericolic and distant free extraluminal air, even if both have respectively weak recommendation based on low/very low-quality evidence. METHODS: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Embase databases were used to identify articles of interest. RESULTS: A total of 2380 patients with AD and extraluminal free air (both pericolic and distant) who underwent nonoperative management (NOM) were analyzed. Of the 2380 patients, 2095(88%) were successfully treated with NOM, while 285 (12%) patients failed. A total of 1574 (93.1%) patients with pericolic extraluminal free air had a successful NOM with 6.9% (117) failure rates, while 135 (71.1%) patients with distant extraluminal free air had a successful NOM with 28.9% (55) failure rates. Regarding distant recurrence, we recorded a rate of 18.3% (261/1430), while a rate of 11.3% (167/1472) was recorded for patients undergoing elective surgery. CONCLUSION: NOM for patients with AD and extraluminal free air (both pericolic and distant) seems to be feasible and safe despite a higher failure rate in the distant subgroup, which remains the most challenging clinical scenario to deal with through conservative treatment.

The effect of motor context on semantic processing: A TMS study.

BACKGROUND: Strong embodiment theories claimed that action language representation is grounded in the sensorimotor system, which would be crucially to semantic understanding. However, there is a large disagreement in literature about the neural mechanisms involved in abstract (symbolic) language comprehension. OBJECTIVE: In the present study, we investigated the role of motor context in the semantic processing of abstract language. We hypothesized that motor cortex excitability during abstract word comprehension could be modulated by previous presentation of a stimuli which associated a congruent motor content (i.e., a semantically related gesture) to the word. METHODS AND RESULTS: We administered a semantic priming paradigm where postures of gestures (primes) were followed by semantically congruent verbal stimuli (targets, meaningful or meaningless words). Transcranial Magnetic Stimulation was delivered to left motor cortex 100, 250 and 500 ms after the presentation of each target. Results showed that Motor evoked potentials of hand muscle significantly increased in correspondence to meaningful compared to meaningless words, but only in the earlier phase of semantic processing (100 and 250 ms from target onset). CONCLUSION: Results suggested that the gestural motor representation was integrated with corresponding word meaning in order to accomplish (and facilitate) the lexical task. We concluded that motor context resulted crucial to highlight motor system involvement during semantic processing of abstract language.