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Only in recent years has archaeology begun to examine in a coherent manner the transformation of the landscape from classical through to medieval times. In Landscapes of Change, leading scholars in the archaeology of the late antique and early medieval periods address the key results and directions of Roman rural fieldwork. In so doing, they highlight problems of analysis and interpretation whilst also identifying the variety of transformations that rural Europe experienced during and following the decline of Roman hegemony. Whilst documents and standing buildings predominate in the urban context to provide a coherent and tangible guide to the evolving urban form and its society since Roman times, the countryside in many ages remains rather shadowy - a context for the cultivation, gathering and movement of food and other resources, inhabited by farmers, villagers and miners. Whilst the Roman period is adequately served through occasional extant remains and through the survey and excavation of villas and farmsteads, as well as the writings of agronomists, the medieval one is generally well marked by the presence of still extant villages across Europe, often dependent on castles and manors which symbolise the so-called 'feudal' centuries. But the intervening period, the fourth to tenth centuries, is that with the least documentation and with the fewest survivals. What happened to the settlement units that made up the Roman rural world? When and why do new settlement forms emerge? Landscapes of Change is essential reading for anyone wanting an up-to-date summary of the results of archaeological and historical investigations into the changing countryside of the late Roman, late antique and early medieval world, between the fourth and tenth centuries AD. It questions numerous aspects of change and continuity, assessing the levels of impact of military and economic decay, the spread and influence of Christianity, and the role of Germanic, Slav and Arab settlements in disrupting and redefining the ancient rural landscapes. Contents: Preface; Landscapes of change in late antiquity and the early middle ages: themes, directions and problems, Neil Christie; Elites, exhibitionism and the society of the late Roman villa, Sarah Scott; Interpreting the transformation of late Roman villas: the case of Hispania, Alexandra Chavarría Arnau; From Vicus to village: Italian landscapes, AD 400-1000, Paul Arthur; Vandal, Byzantine and Arab rural landscapes in North Africa, Anna Leone and David Mattingly; Problems in interpreting rural and urban settlement in southern Greece, AD 365-700, G.D.R. Sanders; Balkan ghosts? Nationalism and the question of rural continuity in Albania, William Bowden and Richard Hodges; Cataclysm on the lower Danube: the destruction of a complex Roman landscape, Andrew Poulter; The origin of the village in early medieval Gaul, Patrick Périn; The late antique landscape of Britain, AD 300-700, Ken Dark; The archaeology of early Anglo-Saxon settlements: past, present and future, Helena Hamerow; Index.

Equipoise still exists regarding routine mesh cruroplasty during laparoscopic paraesophageal hernia (PEH). We aimed to determine whether selective mesh cruroplasty is associated with differences in recurrence and patient-reported outcomes. We compared symptom outcomes (n = 688) and radiographic recurrences (n = 101; at least 10% [or 2 cm] of stomach above hiatus) for 795 non-emergent PEH repair with fundoplication (n = 106 with mesh). Heartburn, regurgitation, epigastric pain, and anti-reflux medication use decreased significantly in both groups while postoperative dysphagia (mesh; p = 0.14), and bloating (non-mesh; p = 0.32), were unchanged. Radiographic recurrence rates were similar (15 mesh [22%] versus 86 non-mesh [17%]; p = 0.32; median 27 [IQR 14, 53] months), but was associated with surgical dissatisfaction (13% vs 4%; p = 0.007). Selective mesh cruroplasty was not associated with differences in symptom outcomes or radiographic recurrence rates during laparoscopic PEH repair. Radiographic recurrence was associated with dissatisfaction, emphasizing the need for continued focus on reducing recurrences. •Equipoise exists regarding routine use of mesh for crural reinforcement during laparoscopic paraesophageal hernia repair.•Selective use of mesh in nearly 800 patients was associated with similar rates of symptom resolution and hernia recurrence.•Hernia recurrence was associated with patient dissatisfaction; better methods to reduce hernia recurrence are needed.

Introduction Patients undergoing non-elective paraesophageal hernia repair (PEHR) have worse perioperative outcomes. Because they are usually older and sicker, however, these patients may be more prone to adverse events, independent of surgical urgency. Our study aimed to determine whether non-elective PEHR is associated with differential postoperative outcome compared to elective repair, using propensity-score weighting. Methods We abstracted data for patients undergoing PEHR ( n  = 924; non-elective n  = 171 (19 %); 1997–2010). Using boosted regression, we generated a propensity-weighted dataset. Odds of 30-day/in-hospital mortality and major complications after non-elective surgery were determined. Results Patients undergoing non-elective repair were significantly older, had more adverse prognostic factors, and significantly more major complications (38 versus 18 %; p  < 0.001) and death (8 versus 1 %; p  < 0.001). After propensity weighting, median absolute percentage bias across 28 propensity-score variables improved from 19 % (significant imbalance) to 5.6 % (well-balanced). After adjusting propensity-weighted data for age and comorbidity score, odds of major complications were still nearly two times greater (OR 1.67, CI 1.07–2.61) and mortality nearly three times greater (OR 2.74, CI 0.93–8.1) than for elective repair. Conclusions Even after balancing significant differences in baseline characteristics, non-elective PEHR was associated with worse outcomes than elective repair. Symptomatic patients should be referred for elective repair by experienced surgeons.

Robotic lung resection for lung cancer has gained popularity over the last 10 years. As with many surgical techniques, there are improvements in outcomes associated with increased operative volume. We sought to investigate lymph-node harvest and upstaging rates for robotic lobectomies performed at hospitals with varying robotic experience. The National Cancer Data Base was queried for patients with early stage non-small cell lung cancer who received lobectomy between 2010 and 2015. Hospitals were stratified into volume categories based on the number of robotic resections performed, as a proxy for robotic experience: low at  ≤ 12, low–middle 13–26, middle–high 27–52, and high volume at greater than or equal to 53. Lymph-node counts and nodal upstaging were compared among these volume categories. 8360 robotic lobectomies were performed. Mean lymph-node counts were for low, low–middle, middle–high, and high-volume robotic lobectomies were 9.8, 11.4, 12.9, and 12.6, respectively ( P   < 0.001), while nodal-upstaging rates were 10.3%, 10.2%, 12.8%, and 13.4%, respectively ( P  < 0.001). Compared to low-volume hospitals, on multivariable analysis, high-volume robotic centers had increased nodal harvest ( P  < 0.001) and nodal-upstaging rates ( P  < 0.001). Robotic lobectomies performed at high-volume hospitals have greater lymph-node harvest and upstaging than low-volume hospitals.

Lung nodule and ground-glass opacity localization for diagnostic and therapeutic purposes is often a challenge for thoracic surgeons. While there are several adjuncts and techniques in the surgeon’s armamentarium that can be helpful, accurate localization persists as a problem without a perfect solution. The last several decades have seen tremendous improvement in our ability to perform major operations with minimally invasive procedures and resulting lower morbidity. However, technological advances have not been as widely realized for lung nodule localization to complement minimally invasive surgery. This review describes the latest advances in lung nodule localization technology while also demonstrating that more efforts in this area are needed.

Staging for esophagogastric adenocarcinoma lacked sufficient prognostic accuracy and was revised. We compared survival prognostication between American Joint Committee on Cancer (AJCC) 6th and 7th editions. We abstracted data for 836 patients who underwent minimally invasive esophagectomy for esophagogastric adenocarcinoma (n = 256 neoadjuvant). Monotonicity and strength of survival trends, by stage, were assessed (log-rank test of trend chi-square statistic) and compared using permutation testing. Overall survival (Cox regression) and model fit (Akaike Information Criterion) were determined. A greater log-rank test of trend statistic indicated stronger survival trends by stage in AJCC 7th (152.872 vs 167.623; permutation test P < .001) edition. Greater Cox likelihood chi-square value (162.957 vs 173.951) and lower Akaike Information Criterion (4,831.011 vs 4,820.016) indicated better model fit. Superior performance was also shown after neoadjuvant therapy. AJCC 7th edition staging for esophagogastric adenocarcinoma provides superior prognostic stratification after minimally invasive esophagectomy, overall and after neoadjuvant therapy compared with AJCC 6th edition.

Twenty-three contributions by leading archaeologists from across Europe explore the varied forms, functions and significances of fortified settlements in the 8th to 10th centuries AD. These could be sites of strongly martial nature, upland retreats, monastic enclosures, rural seats, island bases, or urban nuclei. But they were all expressions of control - of states, frontiers, lands, materials, communities - and ones defined by walls, ramparts or enclosing banks. Papers run from Irish cashels to Welsh and Pictish strongholds, Saxon burhs, Viking fortresses, Byzantine castra, Carolingian creations, Venetian barricades, Slavic strongholds, and Bulgarian central places, and coverage extends fully from northwest Europe, to central Europe, the northern Mediterranean and the Black Sea. Strongly informed by recent fieldwork and excavations, but drawing also where available on the documentary record, this important collection provides fully up-to-date reviews and analyses of the archaeology of the distinctive settlement forms that characterized Europe in the Early Middle Ages.

Background This retrospective study aims to assess the usefulness of SUV max from FDG-PET imaging as a prognosticator for primary biopsy-proven stage I NSCLC treated with SBRT. Methods This study includes 95 patients of median age 77 years, with primary, biopsy-confirmed peripheral stage IA/IB NSCLC. All patients were treated with 60Gy in 3 fractions with a median treatment time of six days. Local, regional, and distant failures were evaluated independently according to the terms of RTOG1021. Local, regional, and distant control, overall- and progression-free survival were estimated by the Kaplan-Meier method. Cox proportional hazards regression was performed to determine whether SUV max , age, KPS, gender, tumor size/T stage, or smoking history influenced outcomes. SUV max was evaluated as both a continuous and as a dichotomous variable using a cutoff of <5 and ≥5. Results Median follow-up for the cohort was 16 months. Median OS and PFS were 25.3 and 40.3 months, respectively. SUV with a cutoff value of 5 predicted for OS and PFS (p = .024 for each) but did not achieve significance for LC (p = .256). On Cox univariate regression analysis, SUV as a dichotomous variable predicted for both OS and PFS (p = .027 and p = .030, respectively). Defined as a continuous variable, SUV max continued to predict for OS and PFS (p = .032 and p = .003), but also predicted LC (p = .045) and trended toward significance for DC (p = .059). SUV max did not predict for OS as a dichotomous or continuous variable. It did, however, predict for PFS as a continuous variable (p = .008), neared significance for local control (p = .057) and trended towards, significance for distant control (p = .092). Conclusions SUV max appears to be a statistically and clinically significant independent prognostic marker for progression-free survival in patients with stage I NSCLC treated with SBRT. Prospective studies to more accurately define the role of tumor FDG uptake in the prognosis of NSCLC are warranted.

Twenty-three contributions by leading archaeologists from across Europe explore the varied forms, functions and significances of fortified settlements in the 8th to 10th centuries AD. These could be sites of strongly martial nature, upland retreats, monastic enclosures, rural seats, island bases, or urban nuclei. But they were all expressions of control - of states, frontiers, lands, materials, communities - and ones defined by walls, ramparts or enclosing banks. Papers run from Irish cashels to Welsh and Pictish strongholds, Saxon burhs, Viking fortresses, Byzantine castra, Carolingian creations, Venetian barricades, Slavic strongholds, and Bulgarian central places, and coverage extends fully from northwest Europe, to central Europe, the northern Mediterranean and the Black Sea. Strongly informed by recent fieldwork and excavations, but drawing also where available on the documentary record, this important collection provides fully up-to-date reviews and analyses of the archaeology of the distinctive settlement forms that characterized Europe in the Early Middle Ages.

Photodynamic therapy (PDT) has been used to palliate advanced, obstructing, or bleeding esophageal cancers (ECs) and Barrett's high-grade dysplasia (HGD). Few investigators, though, have described using PDT to cure either disease. We performed a retrospective review from 1997-2005 of 50 patients with HGD or EC. All patients refused surgical resection or were physiologically unfit. They were instead treated using PDT with curative intent. Clinical follow-up, long-term survival, complications, and recurrence were evaluated. Thirteen patients (26%) had Barrett's HGD, 6 (12%) had small, intramural carcinomas, 16 (32%) had T1 N0 tumors, 14 (28%) had T2 N0 tumors, and 1 (2%) had a small, polypoid T3 lesion. The mean length of follow-up was 28.1 months. Sixteen patients (32%) are alive without recurrence, 15 (30%) are living with residual or recurrent disease and have received additional PDT, and the remainder (38%) died of recurrent EC or other causes and had known recurrence. Sixteen (32%) patients received adjuvant chemotherapy, radiation, or both. Esophageal stricture occurred in 21 (42%) patients. There was no procedure-related mortality. PDT may represent a reasonable alternate to esophagectomy for high-risk patients with HGD or superficial esophageal cancer. Due to superior survival and local control, we still favor esophagectomy for patients without physiologic impairment. However, PDT appears to potentially cure approximately one-third of superficial esophageal cancers and provide local control of high-grade dysplasia in a similar subset of patients.