A gastric conduit is most frequently used for reconstruction in oesophageal surgery, and ischemia of the conduit is the most fragile aspect of the esophagogastric anastomosis with as consequence the anastomotic leakage. In order to avoid it, the concept of ischaemic conditioning of the stomach previous to surgery has been designed. The basis of ischemic conditioning is that interrupting vascularization of the stomach before making the anastomosis eases the gastric fundus adaptation to ischemic conditions. It consists of the interruption of the principal feeding arteries of the stomach (except the right gastroepiploic artery) weeks before esophagectomy. Previously published literature contemplates two different techniques: angiographic embolization or laparoscopic ligation or division of vessels. In this study, the anatomic and physio-pathologic background of ischemic preconditioning is described and the published current evidence is reviewed.

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The aim of this study was to compare the availability of diurnal and nocturnal light in two residences for aged persons (R1 and R2, Palma de Mallorca, Illes Balears, Spain). We found that the R1 inmates were exposed to lower amounts of light during waking time and higher amounts during sleeping time. The main traits of the circadian rhythms and the quality of sleep in the inmates of the two residences were found to be positively related to the availability of light during waking time and negatively to the increased light exposure during bed time. In addition, the sleep of R1 inmates suffered higher disturbances as a consequence of the different policy for nocturnal diapers check and change. Altogether, these two factors may explain the differences observed in the two residences regarding the circadian rhythms, health status and quality of life. Two conclusions stem from these results: (1) the circadian rhythms of aged people are particularly sensitive to the contrast between diurnal and nocturnal light and (2) the nursing staff of institutions for aged people must receive specific formation on the best practices for maintaining the circadian health of aged people.