Transformation tools enabling the implementation of nature-based solutions for creating a resourceful circular city

The linear pattern of production-consumption-disposal of cities around the world will continue to increase the emission of pollutants and stocks of waste, as well as to impact on the irreversible deterioration of non-renewable stocks of raw materials. A transition towards a circular pattern proposed by the concept of ‘Circular Cities’ is gaining momentum. As part of this urban transition, the emergent use of Nature-based Solutions (NBS) intends to shift public opinion and utilize technology to mitigate the urban environmental impact. In this paper, an analysis of the current research and practical investments for implementing NBS under the umbrella of Circular Cities is conducted. A combined appraisal of the latest literature and a survey of ongoing and completed National-European research and development projects provides an overview of the current enabling tools, methodologies, and initiatives for public engagement. It also identifies and describes the links between facilitators and barriers with respect to existing policies and regulations, public awareness and engagement, and scientific and technological instruments. The paper concludes introducing the most promising methods, physical and digital technologies that may lead the way to Sustainable Circular Cities. The results of this research provide useful insight for citizens, scientists, practitioners, investors, policy makers, and strategists to channel efforts on switching from a linear to a circular thinking for the future of cities

En-bloc resection of bladder tumors (ERBT) for pathological staging: the value of lateral margins analysis

In endoscopic resection of colorectal tumours, the pathological assessment of the lateral margins is a strong predictor of tumor recurrence after resection. The aims of the current study are to evaluate the value of the peritumoral margins assessment in ERBT on tumor recurrence

Transperineal Laser Ablation for Benign Prostatic Enlargement: A Systematic Review and Pooled Analysis of Pilot Studies

Transperineal laser ablation (TPLA) of the prostate is a new minimally invasive treatment option in men with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE). The aim of this systematic review was to investigate the efficacy and safety of TPLA in the management of BPE. The primary outcomes were the improvement in urodynamic parameters (maximum urinary flow (Q(max)) and postvoiding residue (PVR)) and LUTS relief, assessed using the IPSS questionnaire. The secondary outcomes were the preservation of sexual and ejaculatory functions, assessed with the IEEF-5 and MSHQ-EjD questionnaires, respectively, and rates of postoperative complications. We reviewed the literature for prospective or retrospective studies evaluating the use of TPLA in the treatment of BPE. A comprehensive search in PubMed, Scopus, Web of Science, and ClinicalTrials.gov was performed for English language articles published between January 2000 and June 2022. Pooled analysis of the included studies with available follow-up data for the outcomes of interest was additionally performed. After screening 49 records, six full-text manuscripts were identified, including two retrospective and four prospective non-comparative studies. Overall, 297 patients were included. All the studies independently reported a statistically significant improvement, from baseline, in Q(max), PVR, and IPSS score at each timepoint. Three studies additionally demonstrated that TPLA did not affect sexual function, reporting no change in the IEEF-5 score, and a statistically significant improvement in MSHQ-EjD score at each timepoint. Low rates of complications were recorded in all the included studies. Pooled analysis showed a clinically meaningful improvement in both micturition and sexual outcomes mean values at 1, 3, 6, and 12 months of follow-up, compared with baseline. Transperineal laser ablation of the prostate for the treatment of BPE showed interesting results in pilot studies. However, higher level and comparative studies are needed to confirm its efficacy in relieving obstructive symptoms and preserving sexual function

Abiraterone Acetate for Treatment of Metastatic Castration-resistant Prostate Cancer in Chemotherapy-naive Patients: An Italian Analysis of Patients' Satisfaction

This article highlights the possible role of \u201cpatient-reported outcomes\u201d in the evaluation of a new therapy. Abiraterone acetate is a novel treatment for metastatic prostate cancer characterized by good safety and oncologic efficacy. Few studies have investigated patients' satisfaction with treatment. Our data show that abiraterone acetate is associated with good satisfaction with treatment and that patient's satisfaction can be a predictor of good oncologic outcomes. Introduction Abiraterone acetate (AA) gives a significant improvement in survival for patients with metastatic castration-resistant prostate cancer (mCRPC) before and after chemotherapy and has a favorable effect on patients' health-related quality of life and pain. Only a few studies have investigated patient-reported outcomes (PROs) in AA treatment for mCRPC. The aim of this study was to investigate patients' satisfaction in men affected by mCRPC treated with AA. Materials and Methods This was a retrospective analysis of a database of consecutive chemonaive patients with progressive mCRPC. Patients were treated with AA until disease progression, death, or unacceptable toxicity. Evaluation was performed at baseline and every 4 weeks by means of physical examination and laboratory studies. Eastern Cooperative Oncology Group score, pain symptoms, treatment-related toxicity, prostate-specific antigen (PSA), and overall and progression-free survival were recorded. Satisfaction with treatment was investigated at 6 months by means of a 4-point arbitrary scale. Results One-hundred twenty-eight patients were enrolled. Patients' satisfaction with treatment was \u201cgreatly improved\u201d in 36.1% of patients and \u201cimproved\u201d in 32.4% of them. Patients with higher satisfaction had lower baseline and final PSA values (P < .05), lower PSA levels at 12 weeks (P = .080), and less pain symptoms and lower Brief Pain Inventory scores (P = .001). Satisfaction with treatment was significantly correlated with baseline PSA level (P = .018), presence of pain (P = .007), duration of androgen deprivation therapy >12 months (P = .025), and number of hormonal manipulations (P = .051). Progression-free survival significantly correlated with patient satisfaction (P < .001). Conclusion AA is safe and well tolerated in chemonaive mCRPC patients, ensures good oncological and PROs. Patient's satisfaction is a predictor of progression-free survival

Safety and efficacy of abiraterone acetate in chemotherapy-naive patients with metastatic castration-resistant prostate cancer: An Italian multicenter real life study

Background: To evaluate the safety and efficacy of abiraterone acetate (AA) in the real life clinical practice for men with chemotherapy-na\uefve metastatic castration-resistant prostate. Methods: A consecutive series of patients with mCRPC in 9 Italian tertiary centres treated with AA was collected. Demographics, clinical parameters, treatment outcomes and toxicity were recorded. The Brief Pain Inventory scale Q3 was tracked and patient treatment satisfaction was evaluated. Survival curves were estimated by the method of Kaplan-Meier and Cox regression and compared by the log-rank test statistic. Results: We included 145 patients (mean age 76.5y). All patients were on androgen deprivation therapy. Patients had prior radiotherapy, radical prostatectomy, both treatments or exclusive androgen deprivation therapy in 17%, 33%, 9% and 40%, respectively. 57% of the patients had a Gleason score higher more than 7 at diagnosis. 62% were asymptomatic patients. The median serum total PSA at AA start was 17 ng/mL (range 0,4-2100). The median exposure to AA was 10 months (range 1-35). The proportion of patients achieving a PSA decline 6550% at 12 weeks was 49%. Distribution of patient satisfaction was 32% greatly improved, 38% improved, 24% not changed, 5.5% worsened. Grade 3 and 4 toxicity was recorded in 17/145 patients 11.7% (70% cardiovascular events, 30% critical elevation of AST/ALT levels). At the last follow-up, median progression free and overall survival were 17 and 26.5 months, respectively. Both outcomes significantly correlated with the presence of pain, patient satisfaction, PSA baseline and PSA decline. Conclusions: The AA is effective and well tolerated in asymptomatic or slightly symptomatic mCRPC in a real life setting. The survival outcomes are influenced by the presence of pain, patient satisfaction, baseline PSA and PSA decline. Trial registration: The study was retrospectively registered at ISRCTN as DOI: 10.1186/ISRCTN52513758 in date April the 30th 2016

MRI-Derived Apparent Diffusion Coefficient of Peri-Prostatic Adipose Tissue Is a Potential Determinant of Prostate Cancer Aggressiveness in Preoperative Setting: A Preliminary Report

Background: The aim of this study was to test the association between periprostatic adipose tissue (PPAT)-apparent diffusion coefficient (ADC) value recorded at multiparametric magnetic resonance imaging (mpMRI) and determinants of prostate cancer (PCa) aggressiveness in the preoperative setting. Methods: Data from 219 consecutive patients undergoing prostate biopsy (PBx) for suspicion of PCa, between January 2020 and June 2022, at our institution were retrospectively evaluated. Only patients who had mpMRI performed before PBx were included. The distribution of demographics and clinical features among PPAT-ADC values up to vs. above the median was studied using both parametric and non-parametric tests, according to variables. Linear and logistic regression models tested the association between PPAT-ADC values and determinants of PCa aggressiveness and the presence of intermediate-high risk PCa, respectively. Results: Of 132 included patients, 76 (58%) had PCa. Median PPAT-ADC was 876 (interquartile range: 654 - 1112) × 10-6 mm2/s. Patients with PPAT-ADC up to the median had a higher rate of PIRADS (Prostate Imaging-Reporting and Data System) 5 lesions (41% vs. 23%, p = 0.032), a higher percentage of PBx positive cores (25% vs. 6%, p = 0.049) and more frequently harbored ISUP (International Society of Urological Pathology) > 1 PCa (50% vs. 28%, p = 0.048). At univariable linear regression analyses, prostate-specific antigen (PSA), PSA density, PIRADS 5, and percentage of PBx positive cores were associated with lower PPAT-ADC values. PPAT-ADC up to the median was an independent predictor for intermediate-high risk PCa (odds ratio: 3.24, 95%CI: 1.17-9.46, p = 0.026) after adjustment for age and body mass index. Conclusions: Lower PPAT-ADC values may be associated with higher biopsy ISUP grade group PCa and a higher percentage of PBx-positive cores. Higher-level studies are needed to confirm these preliminary results

Transformation tools enabling the implementation of nature-based solutions for creating a resourceful circular city

The linear pattern of production-consumption-disposal of cities around the world will continue to increase the emission of pollutants and stocks of waste, as well as to impact on the irreversible deterioration of non-renewable stocks of raw materials. A transition towards a circular pattern proposed by the concept of 'Circular Cities' is gaining momentum. As part of this urban transition, the emergent use of Nature-based Solutions (NBS) intends to shift public opinion and utilize technology to mitigate the urban environmental impact. In this paper, an analysis of the current research and practical investments for implementing NBS under the umbrella of Circular Cities is conducted. A combined appraisal of the latest literature and a survey of ongoing and completed National-European research and development projects provides an overview of the current enabling tools, methodologies, and initiatives for public engagement. It also identifies and describes the links between facilitators and barriers with respect to existing policies and regulations, public awareness and engagement, and scientific and technological instruments. The paper concludes introducing the most promising methods, physical and digital technologies that may lead the way to Sustainable Circular Cities. The results of this research provide useful insight for citizens, scientists, practitioners, investors, policy makers, and strategists to channel efforts on switching from a linear to a circular thinking for the future of cities

Safety and efficacy of abiraterone acetate in chemotherapy-naive patients with metastatic castration-resistant prostate cancer: An Italian multicenter real life study

Background: To evaluate the safety and efficacy of abiraterone acetate (AA) in the real life clinical practice for men with chemotherapy-naïve metastatic castration-resistant prostate. Methods: A consecutive series of patients with mCRPC in 9 Italian tertiary centres treated with AA was collected. Demographics, clinical parameters, treatment outcomes and toxicity were recorded. The Brief Pain Inventory scale Q3 was tracked and patient treatment satisfaction was evaluated. Survival curves were estimated by the method of Kaplan-Meier and Cox regression and compared by the log-rank test statistic. Results: We included 145 patients (mean age 76.5y). All patients were on androgen deprivation therapy. Patients had prior radiotherapy, radical prostatectomy, both treatments or exclusive androgen deprivation therapy in 17%, 33%, 9% and 40%, respectively. 57% of the patients had a Gleason score higher more than 7 at diagnosis. 62% were asymptomatic patients. The median serum total PSA at AA start was 17 ng/mL (range 0,4-2100). The median exposure to AA was 10 months (range 1-35). The proportion of patients achieving a PSA decline â\u89¥50% at 12 weeks was 49%. Distribution of patient satisfaction was 32% greatly improved, 38% improved, 24% not changed, 5.5% worsened. Grade 3 and 4 toxicity was recorded in 17/145 patients 11.7% (70% cardiovascular events, 30% critical elevation of AST/ALT levels). At the last follow-up, median progression free and overall survival were 17 and 26.5 months, respectively. Both outcomes significantly correlated with the presence of pain, patient satisfaction, PSA baseline and PSA decline. Conclusions: The AA is effective and well tolerated in asymptomatic or slightly symptomatic mCRPC in a real life setting. The survival outcomes are influenced by the presence of pain, patient satisfaction, baseline PSA and PSA decline. Trial registration: The study was retrospectively registered at ISRCTN as DOI: 10.1186/ISRCTN52513758 in date April the 30th 2016