Emergency treatment of complicated colorectal cancer

Aim: To find evidence to suggest the best approach in patients admitted as an emergency for complicated colorectal cancer. Methods: The medical records of 131 patients admitted as an emergency with an obstructing, perforated, or bleeding colorectal cancer to Noble’s Hospital, Isle of Man, and the Umberto I University Hospital, Rome, were retrospectively evaluated. Patients were divided in 3 groups on the basis of the emergency treatment they received, namely 1) immediate resection, 2) damage control procedure and elective or semielective resection, and 3) no radical treatment. Demographic variables, clinical data, and treatment data were considered, and formed the basis for the comparison of groups. Primary endpoints were 90-day mortality and morbidity. Secondary endpoints were length of stay, number of lymph nodes analyzed, rate of radical R0 resections, and the number of patients who had chemoradiotherapy. Results: Forty-two patients did not have any radical treatment because the cancer was too advanced or they were too ill to tolerate an operation, 78 patients had immediate resection and 11 had damage control followed by elective resection. There was no statistically significant difference between immediate resections and 2-stage treatment in 90-day mortality and morbidity (mortality: 15.4% vs 0%; morbidity: 26.9% vs 27.3%), number of nodes retrieved (16.6±9.4 vs 14.9±5.7), and rate of R0 resections (84.6% vs 90.9%), but mortality was slightly higher in patients who underwent immediate resection. The patients who underwent staged treatment had a higher possibility of receiving a laparoscopic resection (11.5% vs 36.4%). Conclusion: The present study failed to demonstrate a clear superiority of one treatment with respect to the other, even if there is an interesting trend favoring staged resection

Secreted miR-210-3p as non-invasive biomarker in clear cell renal cell carcinoma

The most common subtype of renal cell carcinoma (RCC) is clear cell RCC (ccRCC). It accounts for 70-80% of all renal malignancies representing the third most common urological cancer after prostate and bladder cancer. The identification of non-invasive biomarkers for the diagnosis and responsiveness to therapy of ccRCC may represent a relevant step-forward in ccRCC management. The aim of this study is to evaluate whether specific miRNAs deregulated in ccRCC tissues present altered levels also in urine specimens. To this end we first assessed that miR-21-5p, miR-210-3p and miR-221-3p resulted upregulated in ccRCC fresh frozen tissues compared to matched normal counterparts. Next, we evidenced that miR-210-3p resulted significantly upregulated in 38 urine specimens collected from two independent cohorts of ccRCC patients at the time of surgery compared to healthy donors samples. Of note, miR- 210-3p levels resulted significantly reduced in follow-up samples. These results point to miR-210-3p as a potential non-invasive biomarker useful not only for diagnosis but also for the assessment of complete resection or response to treatment in ccRCC management

Pd-Based Membranes for High Temperature Applications: Current Status

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Negative multiparametric magnetic resonance imaging for prostate cancer: what's next?

Multiparametric magnetic resonance imaging (mpMRI) of the prostate has excellent sensitivity in detecting clinically significant prostate cancer (csPCa). Nevertheless, the clinical utility of negative mpMRI (nMRI) is less clearMultiparametric magnetic resonance imaging (mpMRI) of the prostate has excellent sensitivity in detecting clinically significant prostate cancer (csPCa). Nevertheless, the clinical utility of negative mpMRI (nMRI) is less clear. OBJECTIVE: To assess outcomes of men with nMRI and clinical follow-up after 7 yr of activity at a reference center. DESIGN, SETTING, AND PARTICIPANTS: All mpMRI performed from January 2010 to May 2015 were reviewed. We selected all patients with nMRI and divided them in group A (naïve patients) and group B (previous negative biopsy). All patients without a diagnosis of PCa had a minimum follow-up of 2 yr and at least two consecutive nMRI. Patients with positive mpMRI were also identified to assess their biopsy outcomes. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: A Kaplan-Meier analysis was performed to assess both any-grade PCa and csPCa diagnosis-free survival probabilities. Univariable and multivariable Cox regression models were fitted to identify predictors of csPCa diagnosis. RESULTS AND LIMITATIONS: We identified 1545 men with nMRI, and 1255 of them satisfied the inclusion criteria; 659 belonged to group A and 596 to group B. Any-grade PCa and csPCa diagnosis-free survival probabilities after 2 yr of follow-up were 94% and 95%, respectively, in group A; in group B, they were 96%. After 48 mo of follow-up, any-grade PCa diagnosis-free survival probability was 84% in group A and 96% in group B (log rank p<0.001). Diagnosis-free survival probability for csPCa was unchanged after 48 mo of follow-up. On multivariable Cox regression analysis, increasing age (p=0.005) was an independent predictor of lower csPCa diagnosis probability, while increasing prostate-specific antigen (PSA) and PSA density (<0.001) independently predicted higher csPCa diagnosis probability. The prevalence of and positive predictive value for csPCa were 31.6% and 45.5%, respectively. Limitations include limited follow-up and the inability to calculate true csPCa prevalence in the study population. CONCLUSIONS: mpMRI is highly reliable to exclude csPCa. Nevertheless, systematic biopsy should be recommended even after nMRI, especially in younger patients with high or raising PSA levels

Attrition-resistant membranes for fluidized-bed membrane reactors: Double-skin membranes

Pd-Ag supported membranes have been prepared by coating a ceramic interdiffusion barrier onto a Hastelloy X (0.2 µm media grade) porous support followed by deposition of the hydrogen selective Pd-Ag (4–5 µm) layer by electroless plating. To one of the membranes an additional porous Al2O3-YSZ layer (protective layer with 50 wt% of YSZ) was deposited by dip-coating followed by calcination at 550 °C on top of the Pd-Ag layer, and this membrane is referred to as a double-skin membrane. Both membranes were integrated at the same time in a single reactor in order to assess and compare the performance of both membranes under identical conditions. The membranes have first been tested in an empty reactor with pure gases (H2 and N2) and afterwards in the presence of a catalyst (rhodium onto promoted alumina) fluidized in the bubbling regime. The membranes immersed in the bubbling bed were tested at 400 °C and 500 °C for 115 and 500 h, respectively. The effect of the protective layer on the permeation properties and stability of the membranes were studied. The double-skinned membraned showed a H2 permeance of 1.55·10−6 mol m−2 s−1 Pa−1 at 500 °C and 4 bar of pressure difference with an ideal perm-selectivity virtually infinite before incorporation of particles. This selectivity did not decay during the long term test under fluidization with catalyst particles.The presented work is funded within FERRET project as part of European Union's Seventh Framework Programme (FP7/2007-2013) for the Fuel Cells and Hydrogen Joint Technology Initiative under grant agreement n. 621181. Note: “The present publication reflects only the authors' views and the Union is not liable for any use that may be made of the information contained therein”

Techno-economic assessment of different routes for olefins production through the oxidative coupling of methane (OCM): Advances in benchmark technologies

his paper addresses the techno-economic assessment of two technologies for olefins production from naphtha and natural gas. The first technology is based on conventional naphtha steam cracking for the production of ethylene, propylene and BTX at polymer grade. The unused products are recovered in a boiler to produce electricity for the plant. The plant has been designed to produce 1 MTPY of ethylene. In the second case, ethylene is produced from natural gas through the oxidative coupling of methane (OCM) in which natural gas is fed to the OCM reactor together with oxygen from a cryogenic air separation unit (ASU). The overall reactions are kinetically controlled and the system is designed to work at about 750–850 °C and close to 10 bar. Since the overall reaction system is exothermic, different layouts for the reactor temperature control are evaluated. For the naphtha steam cracking plant, the energy analysis shows an overall conversion efficiency of 67% (with a naphtha-to-olefins conversion of 65.7%) due to the production of different products (including electricity), with a carbon conversion rate of 70%. The main equipment costs associated with naphtha steam cracking are represented by the cracker (about 30%), but the cost of ethylene depends almost entirely on the cost associated with the fuel feedstock. In case of the OCM plant, the overall energy conversion efficiency drops to maximally 30%. In the studied plant design, CO2 capture from the syngas is also considered (downstream of the OCM reactor) and therefore the final carbon/capture efficiency is above 20%. The cost of ethylene from OCM is higher than with the naphtha steam cracking plant and the CAPEX affects the final cost of ethylene significantly, as well as the large amount of electricity required.The authors are grateful to the European Union’s HORIZON2020 Program (H2020/2014-2020) for the financial support through the H2020 MEMERE project under the grant agreement n° 679933

Determinants of Success in Private Equity-Venture Capital Investments

This paper investigates the determinants of performance of the investments of private equity and venture capital (PEVC) funds in Brazil. We use two unique databases: the First Brazilian Private Equity and Venture Capital Census and the Guia-GVcepe Endeavor, with information on this industry for the period 1999 to 2007. As measures of performance we use the percentage and number of exits through IPO, acquisition by a company or by another investor. Our results indicate that the factors influencing the performance of investments are: size of the fund, number of investments, the practice of co-investment, experience and foreign origin of the managing organization, focus on late stage, intensity of contact between managers and portfolio companies and the number of seats on the boards of the invested companies. The number of successes grows with the number of investments at a declining rate. This can indicate 1) a limit to the ability of managers or 2) that a large number of investments allows for greater diversification of risk, directing investments to companies of high risk but with a high upside

Cribriform pattern does not have a significant impact in Gleason Score ≥7/ISUP Grade ≥2 prostate cancers submitted to radical prostatectomy

The aim of this study was to correlate cribriform pattern (CP) with other parameters in a large prospective series of Gleason score ≥7/ISUP grade ≥2 prostate cancer (PC) cases undergoing radical prostatectomy (RP)

Impact of uni- or multifocal perineural invasion in prostate cancer at radical prostatectomy

Background: Aim of this study was to correlate perineural invasion (PNI) with other clinical-pathological parameters in terms of prognostic indicators in prostate cancer (PC) cases at the time of radical prostatectomy (RP). Methods: Prospective study of 288 consecutive PC cases undergoing RP. PNI determination was performed either in biopsy or in RP specimens classifying as uni- and multifocal PNI. The median follow-up time was 22 (range, 6-36) months. Results: At biopsy PNI was found in 34 (11.8%) cases and in 202 (70.1%) cases at the time of surgery. Among those identified at RP 133 (46.1%) and 69 (23.9%) cases had uni- and multi-PNI, respectively. Presence of PNI was significantly (P<0.05) correlated with unfavorable pathological parameters such higher stage and grade. The percentage of extracapsular extension in PNI negative RP specimens was 18.6% vs. 60.4% of PNI positive specimens. However, the distribution of pathological staging and International Society of Urological Pathology (ISUP) grading did not vary according to whether PNI was uni- or multifocal. The risk of biochemical progression increased 2.3 times in PNI positive cases was significantly associated with the risk of biochemical progression (r=0.136; P=0.04). However, at multivariate analysis PNI was not significantly associated with biochemical progression [hazard ratio (HR): 1.87, 95% confidence interval (CI): 0.68-3.12; P=0.089]. Within patients with intermediate risk disease, multifocal PNI was able to predict cases with lower mean time to biochemical and progression free survival (chi-square 5.95; P=0.04). Conclusions: PNI at biopsy is not a good predictor of the PNI incidence at the time of RP. PNI detection in surgical specimens may help stratify intermediate risk cases for the risk of biochemical progression

Protocol of the Italian Radical Cystectomy Registry (RIC): a non-randomized, 24-month, multicenter study comparing robotic-assisted, laparoscopic, and open surgery for radical cystectomy in bladder cancer

Bladder cancer is the ninth most common type of cancer worldwide. In the past, radical cystectomy via open surgery has been considered the gold-standard treatment for muscle invasive bladder cancer. However, in recent years there has been a progressive increase in the use of robot-assisted laparoscopic radical cystectomy. The aim of the current project is to investigate the surgical, oncological, and functional outcomes of patients with bladder cancer who undergo radical cystectomy comparing three different surgical techniques (robotic-assisted, laparoscopic, and open surgery). Pre-, peri- and post-operative factors will be examined, and participants will be followed for a period of up to 24\u2009months to identify risks of mortality, oncological outcomes, hospital readmission, sexual performance, and continence