Outcomes of minimally invasive partial nephrectomy among very elderly patients: Report from the resurge collaborative international database

The aim of the study was to perform a comprehensive investigation of clinical outcomes of robot-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN) in elderly patients presenting with a renal mass.The REnal SURGery in Elderly (RESURGE) collaborative database was queried to identify patients aged 75 or older diagnosed with cT1-2 renal mass and treated with RAPN or LPN. Study outcomes were: overall complications (OC); warm ischemia time (WIT) and 6-month estimated glomerular filtration rate (eGFR); positive surgical margins (PSM), disease recurrence (REC), cancer-specific mortality (CSM) and other-cause mortality (OCM). Descriptive statistics, Kaplan-Meier, smoothed Poisson plots and logistic and linear regression models (MVA) were used.Overall, 216 patients were included in this analysis. OC rate was 34%, most of them being of low Clavien grade. Median WIT was 17 minutes and median 6-month eGFR was 54 ml/min/1.73 m(2). PSM rate was 5%. After a median follow-up of 20 months, the 5-year rates of REC, CSM and OCM were 4, 4 and 5%, respectively. At MVA predicting perioperative morbidity, RAPN relative to LPN (odds ratio [OR] 0.33; p <0.0001) was associated with lower OC rate. At MVA predicting functional outcomes, RAPN relative to LPN was associated with shorter WIT (estimate [EST]-4.09; p <0.0001), and with higher 6-month eGFR (EST 6.03; p = 0.01).In appropriately selected patients with small renal masses, minimally-invasive PN is associated with acceptable perioperative outcomes. The use of a robotic approach over a standard laparoscopic approach can be advantageous with respect to clinically relevant outcomes, and it should be preferred when available

Turbulence in Rivers

The study of turbulence has always been a challenge for scientists working on geophysical flows. Turbulent flows are common in nature and have an important role in geophysical disciplines such as river morphology, landscape modeling, atmospheric dynamics and ocean currents. At present, new measurement and observation techniques suitable for fieldwork can be combined with laboratory and theoretical work to advance the understanding of river processes. Nevertheless, despite more than a century of attempts to correctly formalize turbulent flows, much still remains to be done by researchers and engineers working in hydraulics and fluid mechanics. In this contribution we introduce a general framework for the analysis of river turbulence. We revisit some findings and theoretical frameworks and provide a critical analysis of where the study of turbulence is important and how to include detailed information of this in the analysis of fluvial processes. We also provide a perspective of some general aspects that are essential for researchers/ practitioners addressing the subject for the first time. Furthermore, we show some results of interest to scientists and engineers working on river flows

Distribution chain effects on quality parameters of organically grown tomatoes

In order to evaluate the effects of short, compared to medium or long distribution chains, on some quality parameters of organically grown fresh tomatoes, a post-harvest experiment was carried out by reproducing in the lab the most common temperature, relative humidity conditions and storage-transport times occurring in the real distribution chain of organic horticultural fresh products. Organically grown tomatoes of the cv. Nerina harvested at three different ripening stages (mature green, turning, red) were subjected to conditions corresponding to a short (1 day at room temperature), a medium (cold storage for 2 days, followed by ripening at room temperature) and a long distribution chain (cold storage for 6 or 9 days, followed by ripening at room temperature). In addition fruits harvested at the three different ripening stage were also subjected to optimal storage condition (8°C, turning and red tomatoes; 13°C green tomatoes, all at 95% R.H.) for 16 days. At the end of the post-harvest experiment fruits were analyzed for volatile aroma compounds, organic acids, ascorbic acid, soluble sugars, texture, phenolic compounds. Conditions of medium and long distribution chain (harvest at the green stage and cold storage-transport) did not have a significant detrimental effect when compared to short chain on the formation of some key tomato odorants, such as the lipid-derived aroma compounds (among which (3Z)-3-hexenal, hexanal) and the carotenoid-derived volatiles (among which damascenone, b-ionone). On the other hand, conditions of medium and long chain greatly inhibited the formation of other aroma compounds (such as 1-nitro-2-phenylethane and 2-isobutylthiazole, related to the amino acid metabolism), which showed markedly higher levels in vine ripened fruits (or at the end of the short chain experiment). Another significant effect was observed on firmness: fruits subjected to medium or long chain tended to show a reduced firmness when compared to vine ripened tomatoes, at harvest or at the end of the short chain. On the contrary biosynthesis of ascorbic acid was scarcely affected by the distribution chain conditions: green harvested tomatoes, subjected to cold storage and ripened at room temperature afterwards, were able to accumulate an amount of ascorbic acid similar to that observed in vine ripened fruits. Acknowledgement: The present study was performed within the project BIOVITA (W.P.3.1- Supply chain of horticultural products) funded by the Italian Ministry of Agriculture, Food and Forestry Policy

Commercial fertilizers and organoleptic quality of organically grown apple fruits (cv Golden delicious)

In the organic production only organic fertilizers can be used to supply the soil with nitrogen. The mineralization of these products is slow causing a problem with the nitrogen supply when the demands of the plants is high. Italy is the main producer of organic apples in Europe (about 42,000 MT on 115,000 MT in 2006). More then 60% of the organic apples produced in Italy are grown in Alto Adige region (North-East of Italy). In this region problems with nitrogen supply to apple plants in spring are common. In spring the demand of nitrogen of the apple trees in Alto Adige is high, but the weather conditions are often bad and the temperature of the soil is slow. In these conditions the mineralization of the organic fertilizers starts slowly, the trees own reserves may become exhausted, the nitrogen supply from the mineralization of the soil organic matter is not yet sufficient. Therefore, it is important to supply the plants timely in spring with fertilizer nitrogen. The objective of this work was to determine the effect of various commercial fertilizers used for organic apple growing and the conditions of their use on the organic acid and sugar composition and on the formation of volatile compounds in fruits of Golden delicious cultivar. The fruits were grown in the experimental fields of the Centro di Sperimentazione Agraria e Forestale Laimburg, in Alto Adige region. In addition, fruits from a plot without the use of fertilizer (“control”) and a plot where a mineral fertilizer (“ammonium sulphate”) were grown in Laimburg, harvested and analyzed for comparison. Malic, oxalic and citric acid were the organic acids detected; fructose, glucose and sucrose the sugars identified and quantified. Higher levels of organic acids and sugars were found in the “control “and “ammonium sulphate” samples. The different conditions of fertilization seemed to significantly affect the formation of some aroma volatile compounds. Considering the three main key odorants, butyl acetate level was higher in the “compost + biogas slurry” sample and in the “control”; a higher level of hexyl acetate was found in the “control” only. For both compounds lower levels were found in the “ammonium sulphate” sample and in one of the organic fertilizer “Azocor 105” treatment. No differences were found in the level of 2-methylbutyl acetate. Aknowledgement: Work carried out in the project “Qualità nutrizionale ed organolettica e impatto ambientale di produzioni biologiche. Un caso studio: il melo”, funded by Ministero delle Politiche Agricole Alimentari e Forestal

Tomato (Lycopersicon esculentum, cv CXD271BIO) yield and quality during converion from conventional to organic production

The conversion of a conventional farm to the methods of the organic farming is a very critical stage of technical and economical investment. From an agronomical point of view, usually the conversion needs a very different length of time with respect to that set by the regulation, because the organic farming is based on the soil fertility and, in general, on the preservation at the equilibrium of the farm’s ecosystem. These elements affect time and method of the conversions that, although based on clear principles, can require different interventions and solutions and give different results in different times depending on the starting conditions of fertility, farm organization, operating possibilities and knowledge. A research project has been funded by the Lazio Region (central Italy) into the Interregional Programme Agriculture Quality with the general objective to monitor the soil characteristics and biodiversity, the quality of the products as well as to study the economical aspects in a farm sited in Lazio Region (Central Italy) during a 3 years conversion period from conventional to organic. Generally, in the geographical area interested by this study the organic farms have not a livestock. For this reason the conversion plan was focused on the rotation and the use of green manure. This work concerns the results of the first year of the conversion (certification body: Suolo e Salute srl). In particular, the results of the determination of the yield and some quality characteristics of processing tomato (Lycopersicon esculentum, cv. CXD271bio) are presented. Moreover, the results were compared to those from a neighboring farm managed with the conventional method, having the same characteristics of the soil. The tomato samples from two field replicates of both the farms were analysed for the following parameters: moisture and soluble solids content, titratable acidity, colour, texture, composition in organic acids, carotenoids and antioxidant capacity with FRAP and TEAC methods. Data were analysed by Anova and multiple comparison test (Duncan at P0.05). Although it is clear that it will be possible to draw meaningful conclusions only at the end of the project, the results of the first year of the study indicate that the yield of the farm in conversion was higher than that of the conventional one (20,575 kg/ha, 1.235 kg/plant VS. 17,202 kg/ha 17.202, 1.032 kg/plant). A significant effect of the field replicates on all the quality parameters was observed. The samples of tomato from the farm in conversion showed higher values of the colour parameters, size, moisture content, while lower levels were found for the soluble solids content, titratable acidity, malic acid and antioxidant capacity determined by TEAC method. Acknowledgement: Study carried out in the project “Valutazione di schemi di conversione all’agricoltura biologica e biodinamica in aziende tipo della Regione Lazio” by Agenzia Regionale per lo Sviluppo e l’Innovazione dell’Agricoltura del Lazio (ARSIAL, Regional Agency for the Development and the Innovation of the Agriculture of Lazio) – Lazio Regio

TRIAL FIBRILLATION AND COGNITIVE IMPAIRMENT

The co-inhibitory immune receptor carcinoembryonic antigen-related cell-adhesion molecule 1 (CEACAM1) and its self-ligand CEACAM1 can suppres

ATRIAL FIBRILLATION AND MILD COGNITIVE IMPAIRMENT: WHAT CORRELATION?

ATRIAL FIBRILLATION AND MILD COGNITIVE IMPAIRMENT: WHAT CORRELATION?Aim. Atrial fibrillation (AF), in addition to macroembolic complications, may also produce multiple cerebral ischemic areas due to microembolic phenomena and transient hypoperfusion, eventually leading to a progressive cognitive impairment and even to acclaimed vascular dementia. The aim of this study was to evaluate the prevalence of cognitive impairment in patients with AF. The reported results concern data obtained at the moment of recruitment. Methods. The authors studied 42 patients with a history of non valvular AF (paroxysmal, persistent, recurrent or permanent) and 40 homogenous controls in sinus rhythm without previous AF. All subjects underwent anamnesis, physical examination, biochemical and instrumental tests. To investigate the cognitive status, subjects underwent the following neuropsychological rating scales: Mini Mental State Examination (MMSE), Clinical Dementia Rating Scale (CDR),Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL) Global Deterioration Scale (GLDS), Geriatric Depression Scale (GDS) and Hachinski Ischemic Score (HIS). Results. AF Patients had worse scores versus controls at GLDS (P=0.0001), HIS (P=0.001), CDR (P=0.07) and GDS (P=0.07); no significant differences were found for MMSE even after correction for age and education. AF patients treated with warfarin showed better scores at CDR (P=0.04),GLDS (P=0.03) and GDS (P=0.007), compared to those in aspirin-treatment. Corrected MMSE scores did not differ. Conclusion. The authors identified a slight cognitive impairment in the AF group; patients with paroxysmal, persistent or recurrent AF showed worse cognitive performances than permanent ones, suggesting a possible microembolic pathogenesis. Anticoagulation therapy could play a protective role, however more evidence is needed