Green and sustainable public procurement—an instrument for nudging consumer behavior. A case study on romanian green public agriculture across different sectors of activity

Green Public Procurement (GPP) became an efficient instrument to achieve the objectives of environmental policy expressed by the European Commission in its Communications. At the same time, it must be addressed by the public authorities as a complex process, in which all purchased goods and services must integrate perfectly into an entire puzzle-like system of legislation, the construction field, innovation, healthcare, food, and education. Scientific references published in the Web of Science (WoS) mainly between 2017 and 2020 were investigated, and they analyze the implications of green public procurement in various fields, as presented by scientific communities. This article brings as a novelty in this context the identification of some barriers in the adoption of these processes, so that they can be overcome. Based on good practices and international standards and trends, the article shows how aspects related to the implementation of green procurement in society can be taken into account. In the second stage, we added a case study on Romanian green agriculture and discussions regarding inter-correlation between different fields and GPP.info:eu-repo/semantics/publishedVersio

Biological Impact of Unilateral Oophorectomy. Does the Number of Ovaries Really Matter? [Biologische auswirkungen der einseitigen ovarektomie: Kommt es wirklich auf die anzahl der eierstöcke an?]

Although unilateral oophorectomies are performed more often than bilateral ones in women of reproductive age, their clinical consequences have been less intensively investigated. Experimental models in animals have shown that compensa- tory mechanisms occur after a unilateral oophorectomy (UO). This review aims to summarize the available evidence on the biological effects of unilateral oophorectomy on wom- en. Evaluated outcomes include age at onset of menopause, risk of cardiovascular and neurological disease, risk of mortal- ity and fertility outcome after spontaneous conception or in vitro fertilization (IVF). Results were compared with findings reported after bilateral oophorectomy and/or ovarian excision and/or women with intact ovaries. An electronic database search was performed using PubMed and Scopus, followed by a manual search to identify controlled studies that com- pared women after UO with women with two intact ovaries. In particular, a systematic review of fertility outcomes after IVF was performed, and the data were summarized in a table. Women who underwent UO had a similar age at menopause and similar clinical pregnancy rate compared to women with two ovaries. However, decreased ovarian reserve affecting the quantity but not the quality of the ovarian pool after IVF was observed in the UO group. Furthermore, an increased risk of neurological disease and even an increased risk of mortality was observed in women with single ovary. These data need to be confirmed by further studies, and a plausible mecha- nism of action must be identified. At present, patients who undergo UO can be reassured with regard to their reproduc- tive potential and their age at onset of menopause

Is natural orifice specimen extraction surgery really safe in radical surgery for colorectal cancer?

Scop: Chirurgia rectală robotică este în prezent o procedură nouă pentru cancerele rectale. Extracția eșantionului cu orificiu natural transanal (NOSE) este o tehnică nouă de îndepărtare a specimenului din cavitatea abdominală prin anus, în loc de o incizie suplimentară după o intervenție chirurgicală colorectală laparoscopică sau robotică. Siguranța NOSE rămâne controversată. Acest studiu și-a propus să investigheze siguranța precoce a NOSE transanal în tratamentul cancerului de colon sigmoid și rectal superior din următoarele aspecte: caracteristici clinice și patologice, indicatori inflamatori și imunitari și complicații postoperatorii. Prezentare de caz: O femeie de 61 de ani, diagnosticată anterior cu cancer rectal, cu antecedente de 6 luni de hematochezie și alternanta diaree-constipatie. Diagnosticul de cancer rectal a fost pus pe baza biopsiei colonoscopice care a confirmat un nodul circumferenţial neregulat de adenocarcinom bine diferenţiat la 10 cm de marginea anală. Rezecția anterioară joasă asistata robotic, urmata de extracția specimenului transanal a fost efectuată după obținerea consimțământului informat. Procedura a fost efectuată cu succes și pacienta a avut o evolutie postoperatorie fără complicații. Diagnosticul patologic postoperator a evidențiat un adenocarcinom moderat diferențiat de 4x4x0,6 cm3 și margine circumferențiala libera. Concluzii: Rezectia de rect robotica plus extractia transanala a specimenului pentru cancerul rectal poate fi efectuata în siguranță și poate fi o abordare eficientă în contrast cu abordarea deschisă sau laparoscopică.Background: Robotic rectal surgery is currently a novel procedure for rectal cancers. Transanal natural orifice specimen extraction (NOSE) is a novel technique to remove the specimen from the abdominal cavity through the anus instead of an additional incision following laparoscopic or robotic colorectal surgery. The safety of NOSE remains controversial. This study aimed to investigate the early safety of transanal NOSE in the treatment of sigmoid colon and upper rectal cancer from the follow aspects: clinical and pathological characteristics, inflammatory and immune indicators and postoperative complications. Case presentation: A 61-year-old women, previously diagnosed with rectal cancer with came 6 months history of hematochezia and altered bowel habit. A diagnosis of rectal cancer was made in view of colonoscopic biopsy which confirmed an irregular circumferential lump of well differentiated adenocarcinoma at 10 cm from the anal verge. Robotic low anterior resection (LAR) plus transanal natural orifice specimen extraction (NOSE) was performed after obtaining informed consent. The procedure was performed successfully and the patient convalesced nicely without any complications. The postoperative pathological diagnosis revealed a 4x4x0.6 cm3 moderately differentiated adenocarcinoma and circumferential clearance. Conclusions: Robotic LAR plus transanal NOSE for rectal cancer can be performed safely and may be an effective approach in contrast to open or laparoscopic approach

Ultrasound and clinical preoperative characteristics for discrimination between ovarian metastatic colorectal cancer and primary ovarian cancer: A case-control study

The aim of this study was to describe the clinical and sonographic features of ovarian metastases originating from colorectal cancer (mCRC), and to discriminate mCRC from primary ovarian cancer (OC). We conducted a multi-institutional, retrospective study of consecutive patients with ovarian mCRC who had undergone ultrasound examination using the International Ovarian Tumor Analysis (IOTA) terminology, with the addition of evaluating signs of necrosis and abdominal staging. A control group included patients with primary OC. Clinical and ultrasound data, subjective assessment (SA), and an assessment of different neoplasias in the adnexa (ADNEX) model were evaluated. Fisher's exact and Student's t-tests, the area under the receiver-operating characteristic curve (AUC), and classification and regression trees (CART) were used to conduct statistical analyses. In total, 162 patients (81 with OC and 81 with ovarian mCRC) were included. None of the patients with OC had undergone chemotherapy for CRC in the past, compared with 40% of patients with ovarian mCRC (p < 0.001). The ovarian mCRC tumors were significantly larger, a necrosis sign was more frequently present, and tumors had an irregular wall or were fixed less frequently; ascites, omental cake, and carcinomatosis were less common in mCRC than in primary OC. In a subgroup of patients with ovarian mCRC who had not undergone treatment for CRC in anamnesis, tumors were larger, and had fewer papillations and more locules compared with primary OC. The highest AUC for the discrimination of ovarian mCRC from primary OC was for CART (0.768), followed by SA (0.735) and ADNEX calculated with CA-125 (0.680). Ovarian mCRC and primary OC can be distinguished based on patient anamnesis, ultrasound pattern recognition, a proposed decision tree model, and an ADNEX model with CA-125 levels

High-grade ovarian serous carcinoma patients exhibit profound alterations in lipid metabolism

Ovarian cancer is a very severe type of disease with poor prognosis. Treatment of ovarian cancer is challenging because of the lack of tests for early detection and effective therapeutic targets. Thus, new biomarkers are needed for both diagnostics and better understanding of the cellular processes of the disease. Small molecules, consisting of metabolites or lipids, have shown emerging potential for ovarian cancer diagnostics. Here we performed comprehensive lipidomic profiling of serum and tumor tissue samples from high-grade serous ovarian cancer patients to find lipids that were altered due to cancer and also associated with progression of the disease. Ovarian cancer patients exhibited an overall reduction of most lipid classes in their serum as compared to a control group. Despite the overall reduction, there were also specific lipids showing elevation, and especially alterations in ceramide and triacylglycerol lipid species were dependent on their fatty acyl side chain composition. Several lipids showed progressive alterations in patients with more advanced disease and poorer overall survival, and outperformed CA-125 as prognostic markers. The abundance of many serum lipids correlated with their abundance in tumor tissue samples. Furthermore, we found a negative correlation of serum lipids with 3-hydroxybutyric acid, suggesting an association between decreased lipid levels and fatty acid oxidation. In conclusion, here we present a comprehensive analysis of lipid metabolism alterations in ovarian cancer patients, with clinical implications.Peer reviewe

Efficacy of individualised starting dose (isd) and fixed starting dose (fsd) of niraparib per investigator assessment (ia) in newly diagnosed advanced ovarian cancer (oc) patients

Niraparib is a poly(ADP-ribose) polymerase inhibitor approved for maintenance treatment of patients with newly diagnosed or recurrent OC that responded to platinumbased chemotherapy and treatment in heavily-pretreated recurrent OC. Here we report efficacy in patients receiving the FSD and ISD in the PRIMA/ENGOT-OV26/GOG-3012 trial (NCT02655016)

Deregulation of hydroxybutyric acid metabolism provides diagnostic and prognostic biomarkers in ovarian high-grade serous carcinomas

Ovarian cancer is a heterogeneous disease of low prevalence but poor survival. Early diagnosis is critical for patients’ survival but often challenging because ovarian cancer symptoms are unclear and appear only in advanced stages of the disease. Finding more robust disease markers is therefore a clinical priority. Metabolomics is an emerging diagnostic tool that enables the detection of biomarkers reflecting alterations of tumor metabolism, a hallmark of cancer. We performed metabolomics profiling of serum and tumor tissue of high grade serous ovarian cancer (HGSOC) patients, and report novel diagnostic and prognostic biomarkers which indicate deregulation of hydroxybutyric acid (HBA) metabolism. The accumulation of HBA metabolites was associated with lower expression of succinic semialdehyde dehydrogenase (encoded by ALDH5A1), and with the presence of an epithelial-to-mesenchymal-transition (EMT) gene signature, implying a role for these metabolic alterations in cancer cell migration and invasion. In conclusion, our work reports the first comprehensive metabolomic investigation of HGSOC and proposes a new set of metabolites that can be used as diagnostic and prognostic biomarkers of the disease.This work was supported by the Academy of Finland post-doctoral fellow grants: MH decision 138201 and PG 265966. TA was supported by Academy of Finland (grants 272437, 269862, 279163, 292611) and Cancer Society of Finland. EIA is participant in the Charité Clinical Scientist Program funded by the Charité Universitätsmedizin Berlin and the Berlin Institute of Health

Classification of Molecular Subtypes of High-Grade Serous Ovarian Cancer by MALDI-Imaging.

Despite the correlation of clinical outcome and molecular subtypes of high-grade serous ovarian cancer (HGSOC), contemporary gene expression signatures have not been implemented in clinical practice to stratify patients for targeted therapy. Hence, we aimed to examine the potential of unsupervised matrix-assisted laser desorption/ionization imaging mass spectrometry (MALDI-IMS) to stratify patients who might benefit from targeted therapeutic strategies. Molecular subtyping of paraffin-embedded tissue samples from 279 HGSOC patients was performed by NanoString analysis (ground truth labeling). Next, we applied MALDI-IMS paired with machine-learning algorithms to identify distinct mass profiles on the same paraffin-embedded tissue sections and distinguish HGSOC subtypes by proteomic signature. Finally, we devised a novel approach to annotate spectra of stromal origin. We elucidated a MALDI-derived proteomic signature (135 peptides) able to classify HGSOC subtypes. Random forest classifiers achieved an area under the curve (AUC) of 0.983. Furthermore, we demonstrated that the exclusion of stroma-associated spectra provides tangible improvements to classification quality (AUC = 0.988). Moreover, novel MALDI-based stroma annotation achieved near-perfect classifications (AUC = 0.999). Here, we present a concept integrating MALDI-IMS with machine-learning algorithms to classify patients according to distinct molecular subtypes of HGSOC. This has great potential to assign patients for personalized treatment

Microguards and micromessengers of the genome

The regulation of gene expression is of fundamental importance to maintain organismal function and integrity and requires a multifaceted and highly ordered sequence of events. The cyclic nature of gene expression is known as ‘transcription dynamics’. Disruption or perturbation of these dynamics can result in significant fitness costs arising from genome instability, accelerated ageing and disease. We review recent research that supports the idea that an important new role for small RNAs, particularly microRNAs (miRNAs), is in protecting the genome against short-term transcriptional fluctuations, in a process we term ‘microguarding’. An additional emerging role for miRNAs is as ‘micromessengers’—through alteration of gene expression in target cells to which they are trafficked within microvesicles. We describe the scant but emerging evidence that miRNAs can be moved between different cells, individuals and even species, to exert biologically significant responses. With these two new roles, miRNAs have the potential to protect against deleterious gene expression variation from perturbation and to themselves perturb the expression of genes in target cells. These interactions between cells will frequently be subject to conflicts of interest when they occur between unrelated cells that lack a coincidence of fitness interests. Hence, there is the potential for miRNAs to represent both a means to resolve conflicts of interest, as well as instigate them. We conclude by exploring this conflict hypothesis, by describing some of the initial evidence consistent with it and proposing new ideas for future research into this exciting topic

Tumor Growth Rate Estimates Are Independently Predictive of Therapy Response and Survival in Recurrent High-Grade Serous Ovarian Cancer Patients

This study aimed to assess the predictive value of tumor growth rate estimates based on serial cancer antigen-125 (CA-125) levels on therapy response and survival of patients with recurrent high-grade serous ovarian cancer (HGSOC). In total, 301 consecutive patients with advanced HGSOC (exploratory cohort: n = 155, treated at the Medical University of Vienna; external validation cohort: n = 146, from the Ovarian Cancer Therapy–Innovative Models Prolong Survival (OCTIPS) consortium) were enrolled. Tumor growth estimates were obtained using a validated two-phase equation model involving serial CA-125 levels, and their predictive value with respect to treatment response to the next chemotherapy and the prognostic value with respect to disease-specific survival and overall survival were assessed. Tumor growth estimates were an independent predictor for response to second-line chemotherapy and an independent prognostic factor for second-line chemotherapy use in both univariate and multivariable analyses, outperforming both the predictive (second line: p = 0.003, HR 5.19 [1.73–15.58] vs. p = 0.453, HR 1.95 [0.34–11.17]) and prognostic values (second line: p = 0.042, HR 1.53 [1.02–2.31] vs. p = 0.331, HR 1.39 [0.71–2.27]) of a therapy-free interval (TFI) < 6 months. Tumor growth estimates were a predictive factor for response to third- and fourth-line chemotherapy and a prognostic factor for third- and fourth-line chemotherapy use in the univariate analysis. The CA-125-derived tumor growth rate estimate may be a quantifiable and easily assessable surrogate to TFI in treatment decision making for patients with recurrent HGSOC