Peritoneal carcinomatosis

Several gastrointestinal and gynecological malignancies have the potential to disseminate and grow in the peritoneal cavity. The occurrence of peritoneal carcinomatosis (PC) has been shown to significantly decrease overall survival in patients with liver and/or extraperitoneal metastases from gastrointestinal cancer. During the last three decades, the understanding of the biology and pathways of dissemination of tumors with intraperitoneal spread, and the understanding of the protective function of the peritoneal barrier against tumoral seeding, has prompted the concept that PC is a loco-regional disease: in absence of other systemic metastases, multimodal approaches combining aggressive cytoreductive surgery, intraperitoneal hyperthermic chemotherapy and systemic chemotherapy have been proposed and are actually considered promising methods to improve loco-regional control of the disease, and ultimately to increase survival. The aim of this review article is to present the evidence on treatment of PC in different tumors, in order to provide patients with a proper surgical and multidisciplinary treatment focused on optimal control of their locoregional disease. (C) 2013 Baishideng Publishing Group Co., Limited. All rights reserved

Values of natural and human-made wetlands: A meta-analysis

The values of goods and services provided by wetland ecosystems are examined through a meta-analysis of an expanded database of wetland value estimates and with a focus on human-made wetlands. This study extends and improves upon previous meta-analyses of the wetland valuation literature in terms of the number of observations, geographical coverage, wetland class and integrity, and the measurement of the effects of scarcity and anthropogenic pressure. We find that water quality improvement, nonconsumptive recreation, and provision of natural habitat and biodiversity are highly valued services. Substitution effects are observed through the negative correlation between values and abundance of other wetlands. Wetland values are found to increase with anthropogenic pressure. An extended metaregression model with cross effects shows that the valuation of specific services varies with the type of wetland producing them. Human-made wetlands are highly valued for biodiversity enhancement, water quality improvement, and flood control

Algoritmo terapeutico per il trattamento delle metastasi del sacro. Raccomandazioni del gruppo di studio SIOT sulle metastasi ossee

La metastasi ossea è un evento estremamente frequente nella storia naturale della patologia neoplastica maligna, preceduto per frequenza soltanto dalle sedi di localizzazione epatica e polmonare, e predilige lo scheletro assile rispetto a quello appendicolare 1 . Si stima infatti che circa il 5-10% dei pazienti oncologici sviluppi metastasi vertebrali nel corso della malattia 2 ; nel rachide, il segmento più colpito è il tratto toracico, seguito da quello lombare, cervicale e dalla giunzione lombosacrale 3 . I tumori che più frequentemente metastatizzano a livello osseo sono i carcinomi mammario, polmonare, renale, tiroideo e prostatico, mentre più raro è il riscontro di metastasi da melanoma o localizzazioni vertebrali da tumori della sistema linfoemopoietico come il linfoma 3-7. La diffusione metastatica all’osso avviene prevalentemente per via ematica, ed in rare occasioni per contiguità, soprattutto ad opera di tumori localmente aggressivi come il carcinoma del colon-retto a livello del sacro 8 9 (Fig. 1), o il tumore di Pancoast nel rachide toracico. Le metastasi sacrali sono lesioni relativamente rare; tuttavia negli ultimi anni il loro riscontro è aumentato, parallelamente all’incremento dell’aspettativa di vita dei pazienti oncologici, sottoposti a protocolli di trattamento sempre migliori 10. Ciononostante, le metastasi sacrali sono raramente diagnosticate precocemente per via della sintomatologia sfumata che caratterizza il coinvolgimento del sacro nelle fasi iniziali, ed anche alla ridotta sensibilità dell’esame radiologico convenzionale nell’individuare processi sostitutivi a tale livello 11. La valutazione e il trattamento di un paziente con metastasi sacrali richiede un approccio multidisciplinare, da effettuarsi in centri specializzati con esperienza consolidata. Le lesioni metastatiche del sacro non sono state largamente indagate in letteratura, e per il loro trattamento non sono ancora disponibili linee guida condivise, proprio per la mancanza di evidenza scientifica significativa sull’argomento. Per tale motivo, questo è stato scelto di presentare l’algoritmo terapeutico del trattamento delle metastasi del sacro nel contesto di una raccomandazione clinica, che tiene conto dell’esperienza clinica di centri di alta specializzazione sull’argomento

Economic Impacts of Climate Change on Vegetative Agriculture Markets in Israel

We integrate the combined agricultural production effects of forecasted changes in CO2, temperature and precipitation into a multi-regional, country-wide partial equilibrium positive mathematical programming model. By conducting a meta-analysis of 2103 experimental observations from 259 agronomic studies we estimate production functions relating yields to CO2 concentration and temperature for 55 crops. We apply the model to simulate climate change in Israel based on 15 agricultural production regions. Downscaled projections for CO2 concentration, temperature and precipitation were derived from three general circulation models and four representative concentration pathways, showing temperature increase and precipitation decline throughout most of the county during the future periods 2041–2060 and 2061–2080. Given the constrained regional freshwater and non-freshwater quotas, farmers will adapt by partial abandonment of agriculture lands, increasing focus on crops grown in controlled environments at the expense of open-field and rain-fed crops. Both agricultural production and prices decline, leading to reduced agricultural revenues; nevertheless, production costs reduce at a larger extent such that farming profits increase. As total consumer surplus also augments, overall social welfare rises. We find that this outcome is reversed if the positive fertilization effects of increased CO2 concentrations are overlooked