Do equal land and water rights benefit the poor?: Targeted irrigation development: The case of the Andhi Khola Irrigation Scheme in Nepal

Irrigation programs / Water rights / Poverty / Households / Surveys / Water allocation / Water distribution / Water users’ associations / Farmers / Landlessness / Land ownership

Isolated Liver and Limb Perfusion in Preclinical and Clinical Studies: gene therapy and biochemotherapeutic strategies

__Abstract__ The liver is the major site of metastatic spread of primary colorectal cancer, whereas 3% of all patients with colorectal cancer will develop resectable liver metastases. If a resection with curative intent is done, a five year survival rate of 25-30% has been demonstrated in a large number of studies. The natural history of untreated patients with comparable liver involvement shows a five year survival rate of 0-3% (8). As noted above, the majority of patients with evidence of liver metastases are irresectable, because of extra-hepatic disease or excessive liver involvement. There is no standard treatment for unresectable hepatic metastases confined to the liver, so novel treatment modalities have to be developed. In order to achieve a better control of intrahepatic disease and to reduce systemic toxicity of the applied therapy, locoregional therapies have been developed. These therapies include hepatic arterial embolization (9), intratumoral injections of ethanol, acetic acid, biological agents, stereotactic or intra-arterial radiotherapy, intralesional laser therapy, cryotherapy, radiofrequency ablation and regional infusion or perfusion of chemotherapeutic drugs

Multidisciplinary decision-making in older patients with cancer, does it differ from younger patients?

Background: In order to tailor treatment to the individual patient, it is important to take the patients context and preferences into account, especially for older patients. We assessed the quality of information used in the decision-making process in different oncological MDTs and compared this for older (>70 years) and younger patients. Patients and methods: Cross-sectional observations of oncological MDTs were performed, using an observation tool in a University Hospital. Primary outcome measures were quality of input of information into the discussion for older and younger patients. Secondary outcomes were the contribution of different team members, discussion time for each case and whether or not a treatment decision was formulated. Results: Five-hundred and three cases were observed. The median patient age was 63 year, 32% were >70. In both age groups quality of patient-centered information (psychosocial information and patient's view) was poor. There was no difference in quality of information between older and younger patients, only for comorbidities the quality of information for older patients was better. There was no significant difference in the contributions by team members, discussion time (median 3.54 min) or number of decision reached (87.5%). Conclusion: For both age groups, we observed a lack of patient-centered information. The only difference between the age groups was for information on comorbidities. There were also no differences in contributions by different team members, case discussion time or number of decisions. Decision-making in the observed oncological MDTs was mostly based on medical technical information. (c) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Fifty tumor necrosis factor-based isolated limb perfusions for limb salvage in patients older than 75 years with limb-threatening soft tissue sarcomas and other extremity tumors

BACKGROUND: Isolated limb perfusion (ILP) with tumor necrosis factor (TNF) and melphalan is highly effective in treating limb-threatening soft tissue sarcoma (STS) and other bulky tumors. Because of fear of TNF-associated toxicity, ILP with TNF is not offered to older patients in some cancer centers, although especially in older patients, every attempt to avoid an amputation that may end their independence must be considered. METHODS: Out of 306 TNF-based ILPs, 50 ILPs were performed for limb salvage in 43 patients >75 years old (range, 75-91 years): 29 STS and 14 melanoma patients. RESULTS: In the STS patients, a response rate of 76% and a limb-salvage rate of 76% were achieved; in the melanoma patients, a 100% response rate and a 93% limb-salvage rate were achieved. Local toxicity was mild. The three postoperative deaths that occurred in the total series of 306 TNF-based ILPs in Rotterdam (75 years old after leakage-free perfusions and were not related to TNF but to extremely high-risk profiles in these three patients. CONCLUSIONS: Older patients should not be withheld a TNF-based ILP for limb salvage, because the procedure is safe and highly effective in these patients

Editorial: Fire regimes in desert ecosystems: Drivers, impacts and changes

Although not commonly associated with fire, many desert ecosystems across the globe do occasionally burn, and there is evidence that fire incidences are increasing, leading to altered fire regimes in this biome. The increased prevalence of megafires (wildfires \u3e 10,000 ha in size and typically damaging) in most global biomes is linked to climate change, although those occurring in deserts have received far less attention, from both a research and policy perspective, than that of forested ecosystems (Linley et al., 2022). Understanding the drivers of desert fires, from climate to landscape patterns of hydrology and soil, and how these may be changing in the face of anthropogenic pressures, such as invasive species, livestock grazing, and global climate change, is imperative. This Research Topic has published nine papers addressing these drivers, how they have changed, and their impacts on desert biodiversity

Nitric oxide synthase inhibition results in synergistic anti-tumour activity with melphalan and tumour necrosis factor alpha-based isolated limb perfusions

Nitric oxide (NO) is an important molecule in regulating tumour blood flow and stimulating tumour angiogenesis. Inhibition of NO synthase by L-NAME might induce an anti-tumour effect by limiting nutrients and oxygen to reach tumour tissue or affecting vascular growth. The anti-tumour effect of L-NAME after systemic administration was studied in a renal subcapsular CC531 adenocarcinoma model in rats. Moreover, regional administration of L-NAME, in combination with TNF and melphalan, was studied in an isolated limb perfusion (ILP) model using BN175 soft-tissue sarcomas. Systemic treatment with L-NAME inhibited growth of adenocarcinoma significantly but was accompanied by impaired renal function. In ILP, reduced tumour growth was observed when L-NAME was used alone. In combination with TNF or melphalan, L-NAME increased response rates significantly compared to perfusions without L-NAME (0–64% and 0–63% respectively). An additional anti-tumour effect was demonstrated when L-NAME was added to the synergistic combination of melphalan and TNF (responses increased from 70 to 100%). Inhibition of NO synthase reduces tumour growth both after systemic and regional (ILP) treatment. A synergistic anti-tumour effect of L-NAME is observed in combination with melphalan and/or TNF using ILP. These results indicate a possible role of L-NAME for the treatment of solid tumours in a systemic or regional setting. © 2000 Cancer Research Campaig

Corrigendum to “Authors’ reply—Does the RAPIDO trial suggest a benefit of post-operative chemotherapy after preoperative chemoradiation in rectal cancer? No, it does not”: [ESMO Open 8 (2023) 101645]

The authors regret that in the original publication reference 1 was given in correctly. The correct reference is as follows: 1. J. Socha, W. Michalski, K. Bujko, Does the RAPIDO trial suggest a benefit of post-operative chemotherapy after preoperative chemoradiation in rectal cancer? No, it does not., ESMO Open, Volume 8, Issue 5, 2023, 101644, https://doi.org/10.1016/j.esmoop.2023.101644The authors would like to apologise for any inconvenience caused.</p