Effect of complete mesocolic excision (cme) on long-term survival after right colectomy for cancer: multivariate meta-analysis and restricted mean survival time estimation.

INTRODUCTION: Debate exists concerning the impact of complete mesocolic excision (CME) on long-term oncological outcomes. The aim of this review was to condense the updated literature and assess the effect of CME on long-term survival after right colectomy for cancer. METHODS: PubMed, MEDLINE, Scopus, and Web of Science were searched through July 2023. The included studies evaluated the effect of CME on survival. The primary outcome was long-term overall survival. Restricted mean survival time difference (RMSTD), hazard ratio (HR), and 95% confidence intervals (CI) were used as pooled effect size measures. GRADE methodology was used to summarize the certainty of evidence. RESULTS: Ten studies (3665 patients) were included. Overall, 1443 (39.4%) underwent CME. The RMSTD analysis shows that at 60-month follow-up, stage I-III CME patients lived 2.5 months (95% CI 1.1-4.1) more on average compared with noCME patients. Similarly, stage III patients that underwent CME lived longer compared to noCME patients at 55-month follow-up (6.1 months; 95% CI 3.4-8.5). The time-dependent HRs analysis for CME vs. noCME (stage I-III disease) shows a higher mortality hazard in patients with noCME at 6 months (HR 0.46, 95% CI 0.29-0.71), 12 months (HR 0.57, 95% CI 0.43-0.73), and 24 months (HR 0.73, 95% CI 0.57-0.92) up to 27 months. CONCLUSIONS: This study suggests that CME is associated with unclear OS benefit in stage I-III disease. Caution is recommended to avoid overestimation of the effect of CME in stage III disease since the marginal benefit of a more extended resection may have been influenced by tumor biology/molecular profile and multimodal adjuvant treatments.

Molecular Ruthenium Cyclopentadienone Bifunctional Catalysts for the Conversion of Sugar Platforms to Hydrogen.

Molecular ruthenium cyclopentadienone complexes were employed for the first time as pre-catalysts in the homogeneously catalysed Aqueous Phase Reforming (APR) of glucose. Shvo's complex resulted the best pre-catalyst (loading 2 mol %) with H2 yields up to 28.9 % at 150 °C. Studies of the final mixture allowed to identify the catalyst's resting state as a mononuclear dicarbonyl complex in the extracted organic fraction. In situ NMR experiments and HPLC analyses on the aqueous fraction gave awareness of the presence of sorbitol, fructose, 5-hydroxymethylfurfural and furfural as final fate or intermediates in the transformations under APR conditions. These results were summarized in a proposed mechanism, with particular emphasis on the steps where hydrogen was obtained as the product. Benzoquinone positively affected the catalyst activation when employed as an equimolar additive.

From Traditional to New Benchmark Catalysts for CO2 Electroreduction.

In the last century, conventional strategies pursued to reduce or convert CO2 have shown limitations and, consequently, have been pushing the development of innovative routes. Among them, great efforts have been made in the field of heterogeneous electrochemical CO2 conversion, which boasts the use of mild operative conditions, compatibility with renewable energy sources, and high versatility from an industrial point of view. Indeed, since the pioneering studies of Hori and co-workers, a wide range of electrocatalysts have been designed. Starting from the performances achieved using traditional bulk metal electrodes, advanced nanostructured and multi-phase materials are currently being studied with the main goal of overcoming the high overpotentials usually required for the obtainment of reduction products in substantial amounts. This review reports the most relevant examples of metal-based, nanostructured electrocatalysts proposed in the literature during the last 40 years. Moreover, the benchmark materials are identified and the most promising strategies towards the selective conversion to high-added-value chemicals with superior productivities are highlighted.

Comparison of video-assisted pleurectomy/decortication surgery plus hyperthermic intrathoracic chemotherapy with VATS talc pleurodesis for the treatment of malignant pleural mesothelioma: A pilot study.

Hyperthermic intrathoracic chemotherapy (HITHOC) adjunct to surgery for Malignant Pleural Mesothelioma (MPM) has no definite role. The primary objective of this pilot-trial was to evaluate the feasibility for future large studies. The study design was a prospective randomized three-centric pilot trial. We recruited patients diagnosed with MPM and prospectively assigned them to two groups: Group A: Video Assisted Thoracic Surgery (VATS) talc pleurodesis or Group B: Video-assisted P/D plus HITHOC. From November-2011 to July-2017 24 males and 3 females, with a median age of 68-years were enrolled (recruitment rate 5 patients/year). Preoperative stage was I-II, and 18 had epithelioid type. 14 patients were in the Group A. Operative mortality was 0. Follow-up ranged 6-80 months. The median overall survival time started to diverge at 20 months, being 19 months (95% CI 12-25) in Group A and 28 months (95% CI 0-56) in Group B. Survival rate for the epithelioid type was 15 months (95% CI 0-34) in Group A and 45 months (95% CI 0-107) in the Group B. These findings suggest that video-assisted P/D plus HITHOC may improve survival time in MPM patients undergoing surgical treatment and support the need for a larger multicenter randomized clinical trial.

Neuropathic inguinal pain: neurectomy associated with open prosthetic hernioplasty for the prevention of post-operative pain.

INTRODUCTION: Inguinal hernia is one of the most common surgical diseases in the world. Today, this disease is treated by surgical technique only. Among the late complications after surgery, the most frequent is the appearance of chronic post-operative pain after surgical treatment. The incidence of this complication is about 28% of patients undergoing hernioplasty suffering a varying degree of chronic pain, severe enough to interfere with normal daily activities. OBJECTIVES: In this study we evaluated the onset of the neuropathic pain as a complication of inguinal prosthetic hernioplasty surgery. METHODS: This is a prospective observational study run between September 2019 and August 2020. All patients, during the first visit conducted in an outpatient clinic, were recruited in a specific database. Subsequently, surgery was planned in election on one day surgery, patients were administered a specific questionnaire aiming at the identification of any pain and its exact location. The Inguinal Pain Questionnarie (IPQ) was used. During the surgical procedure the selective neurectomy of the 3 nerves has been documented, the entire population of patients has undergone a standardized surgical treatment. At the end of surgery, a follow-up was carried out administering two questionnaires (IPQ Short Form Modified and the IPQ Short Form Paresthesia Modified) concerning the possible chronic post-operative pain and the eventual paresthesia. The questionnaires were administered at first, third and sixth month from the date of surgery. RESULTS: A total of 266 patients were screened from September 2019 to October 2020. Fiftyseven male patients were included in the study with a confirmed diagnosis of primary inguinal hernia. Clinical data, baseline characteristics and outcomes are described. Preoperatively, at the time of IPQ administration, 1.8% of patients had a pain score of 6, 10% of 5, 21% of 4, 31% of 3, 28% with a score of 2 and 7% of patients with a score of 1. In all cases the ileoinguinals and ileohypogastric nerves found were subjected to neurectomy, in 19% of cases also the genitofemoral nerve was subjected to surgical resection. At the end of the follow-up, the first questionnaire (IPQ Short Form Modified) results did show that, among the total of patients who had an open prosthetic hernioplasty with extensive nerves resection in the inguinal canal, 84% of them indicated a pain score equal to 0 (no pain) after 6 months of treatment and only 1.7% indicated a score equal to 4. Analyzing the second questionnaire on paresthesia (IPQ Short Form Paresthesia Modified), 79% of patients indicated a score equal to 0 by describing no paresthesia and no changes in sensitivity; 15.7% score 1; 3.5% score 2; 1.7% score 3. CONCLUSIONS: Based on our experience and according to the modern literature, we would advise prophylactic total neurectomy of the inguinal canal nerves during prosthetic inguinal hernioplasty. KEY WORDS: Abdominal Surgery, Chronic pain, Inguinal hernioplasty, Neurectomy, Paresthesia.

A Rare Case of Negative Serum Calcitonin in Metastatic Medullary Thyroid Carcinoma: Diagnosis, Treatment, and Follow-Up Strategy.

BACKGROUND Medullary thyroid carcinoma is a rare tumor and represents less than 5% of all thyroid cancers. Tumor size and the presence of possible metastases are strictly related to serum calcitonin level, which also suggests prognosis. A serum calcitonin level above the normal range is highly suspicious for medullary cancer. This tumor has no characteristic patterns on ultrasound and fine-needle aspiration, so serum calcitonin level is the only significant element for diagnosis. The literature contains 47 cases of serum calcitonin-negative medullary thyroid cancer with heterogeneous behavior, ranging from non-aggressive to aggressive form. CASE REPORT We report a rare case of a young man with negative serum calcitonin but with lateral cervical node metastases from medullary thyroid carcinoma. At the beginning, diagnosis was not achieved due to normal range of serum calcitonin and a negative thyroid ultrasonography for large nodules. Nevertheless, in another medical center he underwent a neck biopsy of the lateral cervical mass. The histologic findings showed metastases of medullary thyroid cancer. Therefore, a total thyroidectomy plus cervical lymphadenectomy was performed. During the follow-up, due to unusefulness of serum markers, and as CEA levels were negative pre- and post-operatively, an ¹8F-DOPA PET scan was performed. In 3 years of follow-up, there is still no evidence of disease relapse. CONCLUSIONS Our case shows how a normal serum level of calcitonin cannot exclude medullary thyroid cancer. Early diagnosis is crucial because it influences appropriate surgical therapy and patient outcome. The current lack of an optimal strategy for the diagnosis and postoperative follow-up for patients with negative serum calcitonin tumor presents a diagnostic challenge for physicians.

Conversion From Open to Laparoscopic Surgery in Strangulated Hernia Repair: Toward a Gold Option Proposal.

INTRODUCTION: Strangulation is a common presentation of acute abdominal wall hernias that usually requires emergency surgery. The aim of this report is to propose a "reverse strategy" combining an open mesh-based anterior approach followed by a "conversion" to laparoscopy for the treatment of strangulated hernias. MATERIALS AND METHODS: A 68-year-old male patient came to the emergency room of our university hospital with a non-reducible left groin hernia. The CT scan demonstrated a left groin strangulated hernia with doubtful viability of the involved bowel loop. We decided to perform a transversal inguinotomy followed by a laparoscopic approach through the inguinal ring. RESULTS: The patient was discharged after four days in perfect general condition, with normal bowel function and no postoperative pain. CONCLUSION: We propose this unconventional conversion from open to laparoscopic surgery as a new indication for the laparoscopic approach in emergency hernia surgery. We hope it can be used as a gold option for the surgical treatment of strangulated hernia in selected cases.

Subtotal cholecystectomy for Mirizzi syndrome: Should we ever remove the stone? A case report.

INTRODUCTION AND IMPORTANCE: Mirizzi Syndrome is a rare complication of cholelithiasis.In this case report the Authors present an original surgical approach for the treatment of complicated gallbladders, based on open subtotal cholecystectomy, leaving in situ the stone. This is the first case showing safety and reliability of the present strategy at a four-year follow-up. CASE PRESENTATION: A 68-year-old patient came to our emergency room with abdominal pain, leukocytosis and fever. At surgical exploration he presented a sclerotic retraction of the gallbladder together with an intrahepatic abscess, that forced us first to perform an open subtotal cholecystectomy, resecting the gallbladder cranially and leaving in situ the stone. CLINICAL DISCUSSION: The post-operative course was uneventful. The four-year clinical, US and CT scan follow-up was negative and the patient referred a normal quality of life. The present strategy could be considered an intraoperative rescue option in such a complex operative scenario in which is impossible to safely remove the stone. CONCLUSION: This case report demonstrates how in selected cases, when absolutely necessary and unavoidable without high risks, the stone can be left in situ as an eventual stone resection would be extremely risky.

Proactive Management of Intraoperative Hypotension Reduces Biomarkers of Organ Injury and Oxidative Stress during Elective Non-Cardiac Surgery: A Pilot Randomized Controlled Trial.

BACKGROUND: Intraoperative hypotension is associated with increased postoperative morbidity and mortality. METHODS: We randomly assigned patients undergoing major general surgery to early warning system (EWS) and hemodynamic algorithm (intervention group, n = 20) or standard care (n = 20). The primary outcome was the difference in hypotension (defined as mean arterial pressure < 65 mmHg) and as secondary outcome surrogate markers of organ injury and oxidative stress. RESULTS: The median number of hypotensive episodes was lower in the intervention group (-5.0 (95% CI: -9.0, -0.5); p < 0.001), with lower time spent in hypotension (-12.8 min (95% CI: -38.0, -2.3 min); p = 0.048), correspondent to -4.8% of total surgery time (95% CI: -12.7, 0.01%; p = 0.048).The median time-weighted average of hypotension was 0.12 mmHg (0.35) in the intervention group and 0.37 mmHg (1.11) in the control group, with a median difference of -0.25 mmHg (95% CI: -0.85, -0.01; p = 0.025). Neutrophil Gelatinase-Associated Lipocalin (NGAL) correlated with time-weighted average of hypotension (R = 0.32; p = 0.038) and S100B with number of hypotensive episodes, absolute time of hypotension, relative time of hypotension and time-weighted average of hypotension (p < 0.001 for all). The intervention group showed lower Neuronal Specific Enolase (NSE) and higher reduced glutathione when compared to the control group. CONCLUSIONS: The use of an EWS coupled with a hemodynamic algorithm resulted in reduced intraoperative hypotension, reduced NSE and oxidative stress.

H2 Production by Methane Oxy-Reforming: Effect of Catalyst Pretreatment on the Properties and Activity of Rh-Ce0.5Zr0.5O2 Synthetized by Microemulsion.

Green hydrogen introduction in hard-to-abate processes is held back by the cost of substituting steam reforming plants with electrolyzers. However, green hydrogen can be integrated in properly modified reforming processes. The process proposed here involves the substitution of steam reforming with oxy-reforming, which is the coupling of the former with catalytic partial oxidation (CPO), exploiting the pure oxygen coproduced during electrolysis to feed CPO, which allows for better heat exchange thanks to its exothermic nature. With the aim of developing tailored catalysts for the oxy-reforming process, Ce0.5Zr0.5O2 was synthetized by microemulsion and impregnated with Rh. The Ce-based supports were calcined at different temperatures (750 and 900 °C) and the catalysts were reduced at 750 °C or 500 °C. Tuning the calcination temperature allowed for an increase in the support surface area, resulting in well-dispersed Rh species that provided a high reducibility for both the metal active phase and the Ce-based support. This allowed for an increase in methane conversion under different conditions of contact time and pressure and the outperformance of the other catalysts. The higher activity was related to well-dispersed Rh species interacting with the support that provided a high concentration of surface OH* on the Ce-based support and increased methane dissociation. This anticipated the occurrence and the extent of steam reforming over the catalytic bed, producing a smoother thermal profile.

Intracorporeal versus Extracorporeal Anastomosis for Laparoscopic Right Hemicolectomy: Short-Term Outcomes.

Laparoscopic right hemicolectomy represents an effective therapeutic approach for right colon cancer (RCC). The primary aim of this study was to evaluate bowel function recovery, length of hospital stay, operative time, and the number of general and anastomosis-related postoperative complications from intracorporeal anastomosis (ICA) vs. extracorporeal anastomosis (ECA); the secondary outcome was the number of lymph nodes retrieved. This observational study was conducted on 108 patients who underwent right hemicolectomy for RCC; after surgical resection, 64 patients underwent ICA and 44 underwent ECA. The operative time was slightly longer in the ICA group than in the ECA group, even though the difference was not significant (199.31 ± 48.90 min vs. 183.64 ± 35.80 min; p = 0.109). The length of hospital stay (7.53 ± 1.91 days vs. 8.77 ± 3.66 days; p = 0.036) and bowel function recovery (2.21 ± 1.01 days vs. 3.45 ± 1.82 days; p < 0.0001) were significantly lower in the ICA group. There were no significant differences in postoperative complications (12% in ICA group vs. 9% in ECA group), wound infection (6% in ICA group vs. 7% in ECA group), or anastomotic leakage (6% in ICA group vs. 9% in ECA group). We did not observe a significant difference between the two groups in the number of lymph nodes collected (19.46 ± 7.06 in ICA group vs. 22.68 ± 8.79 in ECA group; p = 0.086). ICA following laparoscopic right hemicolectomy, compared to ECA, could lead to a significant improvement in bowel function recovery and a reduction in the length of hospital stay in RCC patients.

Nanostructured Copper-Based Electrodes Electrochemically Synthesized on a Carbonaceous Gas Diffusion Membrane with Catalytic Activity for the Electroreduction of CO2.

In this work, four different 4 cm2-sized nanostructured Cu-based electrocatalysts have been designed by a one-step electrodeposition process of Cu metal on a three-dimensional carbonaceous membrane. One consisted of Cu0, and the other three were obtained by further simple oxidative treatments. Morphological, structural, and electrochemical investigations on the four materials were carried out by scanning electron microscopy, Raman spectroscopy, X-ray diffraction, linear sweep voltammetry, and potential-controlled electrolysis. All the electrocatalysts showed promising catalytic activities toward CO2 electroreduction in liquid phase, with a remarkable selectivity toward acetic acid achieved when using the oxidized materials. In particular, the best electrocatalytic activity was observed for the Cu2O-Cu0 catalyst, working at a relatively low potential (-0.4 V vs RHE), which exhibited a stable and low current density of 0.46 mA cm-2 and a productivity of 308 µmol gcat-1 h-1. These results were attributed to the nanostructured morphology that is characterized by many void spaces and by a high surface area, which should guarantee a large number of CuI and Cu0 catalytic active sites. Moreover, kinetic analyses and preliminary studies about catalyst regeneration highlighted the stability of the best-performing catalyst.

Effects of infections on the pathogenesis of cancer.

Several studies have shown an inverse relationship between acute infections and cancer development. On the other hand, there is a growing evidence that chronic infections may contribute significantly to the carcinogenesis. Factors responsible for increased susceptibility to infections may include modifications of normal defence mechanisms or impairment of host immunity due to altered immune function, genetic polymorphisms, ageing and malnourishment. Studies have demonstrated that children exposed to febrile infectious diseases show a subsequent reduced risk for ovarian cancer, melanoma and many other cancers, while common acute infections in adults are associated with reduced risks for melanoma, glioma, meningioma and multiple cancers. Chronic inflammation associated with certain infectious diseases has been suggested as a cause for the development of tumours. Mechanisms of carcinogenesis due to infections include cell proliferation and DNA replication by mitogen-activated protein kinase pathway, production of toxins that affect the cell cycle and lead to abnormal cell growth and inhibition of apoptosis. This review was aimed to summarize the available evidence on acute infections as a means of cancer prevention and on the role of chronic infections in the development and progression of cancer.

Familial adenomatous polyposis and changes in the gut microbiota: New insights into colorectal cancer carcinogenesis.

Patients with familial adenomatous polyposis (FAP), an autosomal dominant hereditary colorectal cancer syndrome, have a lifetime risk of developing cancer of nearly 100%. Recent studies have pointed out that the gut microbiota could play a crucial role in the development of colorectal adenomas and the consequent progression to colorectal cancer. Some gut bacteria, such as Fusobacterium nucleatum, Escherichia coli, Clostridium difficile, Peptostreptococcus, and enterotoxigenic Bacteroides fragilis, could be implicated in colorectal carcinogenesis through different mechanisms, including the maintenance of a chronic inflammatory state, production of bioactive tumorigenic metabolites, and DNA damage. Studies using the adenomatous polyposis coliMin/+ mouse model, which resembles FAP in most respects, have shown that specific changes in the intestinal microbial community could influence a multistep progression, the intestinal "adenoma-carcinoma sequence", which involves mucosal barrier injury, low-grade inflammation, activation of the Wnt pathway. Therefore, modulation of gut microbiota might represent a novel therapeutic target for patients with FAP. Administration of probiotics, prebiotics, antibiotics, and nonsteroidal anti-inflammatory drugs could potentially prevent the progression of the adenoma-carcinoma sequence in FAP. The aim of this review was to summarize the best available knowledge on the role of gut microbiota in colorectal carcinogenesis in patients with FAP.

Microemulsion Derived Titania Nanospheres: An Improved Pt Supported Catalyst for Glycerol Aqueous Phase Reforming.

Glycerol aqueous phase reforming (APR) produces hydrogen and interesting compounds at relatively mild temperatures. Among APR catalysts investigated in literature, little attention has been given to Pt supported on TiO2. Therefore, herein we propose an innovative titania support which can be obtained through an optimized microemulsion technique. This procedure provided high surface area titania nanospheres, with a peculiar high density of weak acidic sites. The material was tested in the catalytic glycerol APR after Pt deposition. A mechanism hypothesis was drawn, which evidenced the pathways giving the main products. When compared with a commercial TiO2 support, the synthetized titania provided higher hydrogen selectivity and glycerol conversion thanks to improved catalytic activity and ability to prompt consecutive dehydrogenation reactions. This was correlated to an enhanced cooperation between Pt nanoparticles and the acid sites of the support.

Oral and Parenteral vs. Parenteral Antibiotic Prophylaxis for Patients Undergoing Laparoscopic Colorectal Resection: An Intervention Review with Meta-Analysis.

This study aims to systematically assess the efficacy of parenteral and oral antibiotic prophylaxis compared to parenteral-only prophylaxis for the prevention of surgical site infection (SSI) in patients undergoing laparoscopic surgery for colorectal cancer resection. Published and unpublished randomized clinical trials comparing the use of oral and parenteral prophylactic antibiotics vs. parenteral-only antibiotics in patients undergoing laparoscopic colorectal surgery were collected searching electronic databases (MEDLINE, CENTRAL, EMBASE, SCIENCE CITATION INDEX EXPANDED) without limits of date, language, or any other search filter. The outcomes included SSIs and other infectious and noninfectious postoperative complications. Risk of bias was assessed using the Cochrane revised tool for assessing risk of bias in randomized trials (RoB 2). A total of six studies involving 2252 patients were finally included, with 1126 cases in the oral and parenteral group and 1126 cases in the parenteral-only group. Meta-analysis results showed a statistically significant reduction of SSIs (OR 0.54, 95% CI 0.40 to 0.72; p < 0.0001) and anastomotic leakage (OR 0.55, 95% CI 0.33 to 0.91; p = 0.02) in the group of patients receiving oral antibiotics in addition to intravenous (IV) antibiotics compared to IV alone. Our meta-analysis shows that a combination of oral antibiotics and intravenous antibiotics significantly lowers the incidence of SSI compared with intravenous antibiotics alone.