bluuebunny/crossref_metadata_2025 huggingface dataset:
100 Years of Progress in Gas-Phase Atmospheric Chemistry Research
Authors: Wallington T. J. , Seinfeld J. H. , Barker J. R.
Published: November 2018

Remarkable progress has occurred over the last 100 years in our understanding of atmospheric chemical composition, stratospheric and tropospheric chemistry, urban air pollution, acid rain, and the formation of airborne particles from gas-phase chemistry. Much of this progress was associated with the developing understanding of the formation and role of ozone and of the oxides of nitrogen, NO and NO2, in the stratosphere and troposphere. The chemistry of the stratosphere, emerging from the pioneering work of Chapman in 1931, was followed by the discovery of catalytic ozone cycles, ozone destruction by chlorofluorocarbons, and the polar ozone holes, work honored by the 1995 Nobel Prize in Chemistry awarded to Crutzen, Rowland, and Molina. Foundations for the modern understanding of tropospheric chemistry were laid in the 1950s and 1960s, stimulated by the eye-stinging smog in Los Angeles. The importance of the hydroxyl (OH) radical and its relationship to the oxides of nitrogen (NO and NO2) emerged. The chemical processes leading to acid rain were elucidated. The atmosphere contains an immense number of gas-phase organic compounds, a result of emissions from plants and animals, natural and anthropogenic combustion processes, emissions from oceans, and from the atmospheric oxidation of organics emitted into the atmosphere. Organic atmospheric particulate matter arises largely as gas-phase organic compounds undergo oxidation to yield low-volatility products that condense into the particle phase. A hundred years ago, quantitative theories of chemical reaction rates were nonexistent. Today, comprehensive computer codes are available for performing detailed calculations of chemical reaction rates and mechanisms for atmospheric reactions. Understanding the future role of atmospheric chemistry in climate change and, in turn, the impact of climate change on atmospheric chemistry, will be critical to developing effective policies to protect the planet.
The Role of Hadley Circulation and Lapse-Rate Changes for the Future European Summer Climate
Authors: Brogli Roman , Kröner Nico , Sørland Silje Lund , Lüthi Daniel , Schär Christoph
Published: November 2018

By the end of the century, climate projections for southern Europe exhibit an enhanced near-surface summer warming in response to greenhouse gas emissions, which is known as the Mediterranean amplification. Possible causes for this amplified warming signal include a poleward Hadley cell expansion as well as tropospheric lapse-rate changes. In this work, regional climate model (RCM) simulations driven by three different global climate models (GCMs) are performed, representing the RCP8.5 emission scenario. For every downscaled GCM, the climate change signal over Europe is separated into five contributions by modifying the lateral boundary conditions of the RCM. This simulation strategy is related to the pseudo–global warming method. The results show that a poleward expansion of the Hadley cell is of minor importance for the Mediterranean amplification. During summer, the simulated Hadley circulation is weak, and projections show no distinct expansion in the European sector. The north–south contrast in lapse-rate changes is suggested as the most important factor causing the Mediterranean amplification. Lapse-rate changes are projected throughout Europe, but are weaker over the Mediterranean than over northern Europe (around 0.15 vs 0.3 K km−1 by the end of the century). The weaker lapse-rate changes result in a strong near-surface summer warming over the Mediterranean, since the upper-tropospheric warming is of similar magnitude throughout Europe. The differing lapse-rate changes can be understood as a thermodynamic response to lower-tropospheric humidity contrasts.
A Qualitative Investigation of the Experiences of People Who Panhandle
Authors: Cadaret Michael C. , Dykema Stephanie A. , Ahmed Sarah , Jwayyed Jenna S. , Youker Austin C. , Knutson Douglas
Published: November 2018

U.S. Census data from 2016 indicate that 12.7% of the population may be living in poverty, a total of 40.6 million people. The most visible among this group facing unemployment or underemployment are people who panhandle, characterized by soliciting requests for assistance on street corners or highway exits. If issues of poverty are to be addressed adequately, the characteristics of these populations need to be better understood. In this qualitative study, we sought to understand the experiences of people who panhandle through in-person interviews. Participants included 9 individuals (6 men and 3 women). A consensual qualitative research approach was used to analyze the transcribed interviews resulting in 7 domains. We discuss results in the context of the psychology of working theory. Implications include the integration of social justice and vocational psychology among counseling psychologists working with clients who panhandle.
Patient-focused medicines information: General practitioners’ and pharmacists’ views on websites and leaflets
Authors: Young Amber , Tordoff June , Leitch Sharon , Smith Alesha
Published: November 2018

Objectives:

To determine how often general practitioners (GPs) and pharmacists recommend patients obtain information about their medicines via websites and to explore factors that might improve the delivery of written information about medicines to patients.

Design:

Cross-sectional surveys.

Setting:

GPs and community pharmacists in New Zealand primary care.

Method:

Questionnaires were developed and sent to a sample of pharmacists and GPs. Data were collected using SurveyMonkey® and analysed to examine views about websites and leaflets informing patients about medicines.

Results:

In total, 143 GPs and 126 pharmacists responded. GPs and pharmacists did not routinely direct patients to medicine information websites. Most commonly, GPs did not provide medicine information leaflets due to time constraints and concerns about possibly confusing information. Both professions thought leaflets might cause patients to worry about side-effects. Pharmacists mainly withheld leaflets because the medicine has been taken previously or because leaflet indications differed to prescribed use. A summary leaflet, if available, would be the preferred option for improving leaflet provision.

Conclusion:

Providing digital medicine information is uncommon in New Zealand. Summarised, relevant information tailored to patient requirements might facilitate the provision of medicines information at the point of care.
Enhanced surface hydrophilicity of polylactic acid sutures treated by lipase and chitosan
Authors: Liu Shuqiang , Liu Mingfang , Wu Gaihong , Zhang Xiaofang , Yu Juanjuan , Zhang Yao , Wang Peng , Yin Xiaolong
Published: November 2018

Polylactic acid (PLA) surgical sutures are a new type of absorbable sutures that can be degraded and absorbed in the body. However, there is high hydrophobicity for the surface of PLA sutures, which leads to poor biocompatibility and cellular affinity. In order to increase the hydrophilicity, the PLA sutures were etched by lipase firstly, and then grafted with chitosan. The results indicate that the optimal conditions of treating PLA sutures by lipase were as follows: 45℃ reaction temperature, 4.5 g/L concentration of lipase and 8 h reaction time. The sutures were etched by lipase and then formed some grooves and a number of hydroxyl (-OH) bonds, which led to increased surface area and hydrophilicity, but a drop in mass and strength. The optimal conditions of grafting chitosan onto PLA sutures were as follows: 4 h reaction time and 3 g/L concentration of chitosan. The chitosan grafted and loaded on the surface of PLA sutures, and in some areas of the sutures the chitosan reunited, which led to a rough surface and large friction coefficient. Finally, the hydrophilicity of the PLA sutures, treated by lipase and then grafted with chitosan, was greatly improved.
Spillover Effects of Status Demotion on Customer Reactions to Loyalty Reward Promotions: The Role of Need for Status and Exclusivity
Authors: Hwang YooHee , Mattila Anna S.
Published: November 2018

Prior research demonstrates that status demotion in the loyalty reward program heightens negative emotions, particularly when demotion is due to changes in company policies. In this research, we argue that such negative emotions are likely to spillover to evaluations of post-demotion promotions. We further argue that such spillover effects should be attenuated among individuals high in need for status. Study 1 examines the joint effect of the cause of demotion and customers’ need for status on loyalty. In study 2, we investigate the impact of exclusivity cues in post-demotion promotions and show that exclusive promotions diminish the negative impact of policy-based demotions on post-promotion loyalty among individuals high (vs. low) in need for status. Travel and tourism companies might want to consider using geographical location as a proxy for need for status or priming status-seeking via exclusive promotions (“elevate your travel experience”) to alleviate demoted customers’ negative emotions.
A Potential Avenue for Academic Success: Hope Predicts an Achievement-Oriented Psychosocial Profile in African American Adolescents
Authors: Dixson Dante D. , Stevens David
Published: November 2018

In a sample of 117 African American students, we examined how well hope predicts five psychosocial variables—school belonging, academic self-concept, goal valuation, attitude toward teachers, and academic motivation/self-regulation—that altogether make up an achievement-oriented psychosocial profile. Results indicated that, after controlling for demographics and previous achievement, the subscales of hope accounted for a meaningful portion of all five psychosocial variables, ranging from 17.2% to 29.9%. The agency subscale of hope was a significant predictor of all five psychosocial variables, while pathways was only a significant predictor of goal valuation and academic self-concept. Given that several quick and effective universal hope interventions have been developed, these results suggest that hope may be a promising avenue to improve the achievement-related outcomes of African American students as well as aid in mitigating the achievement gap.
Matteo Ricci and Michel Foucault’s Readings of Epictetus
Authors: Huilin Yang
Published: November 2018

In The Hermeneutics of the Subject, Foucault constantly refers to Epictetus’ doctrines, using the relationship between “care of oneself” ( epimeleia heautou) and “know yourself” ( gnōthi seauton) to trace the transition of ancient Greek philosophy towards Christian thought and the emergence of the “modern mode of being subjects.” Interestingly, when China started to open to Western thought during the Qing Dynasty, Epictetus’ book Encheiridion was among the first of the Western classics translated and introduced to China by Matteo Ricci, who named it The Book of 25 Paragraphs or 25 Sayings. Matteo Ricci’s translation of Encheiridion into Chinese was an endeavor to bridge Western and Chinese educational traditions, and Ricci’s own monograph, The True Meaning of the Lord of Heaven, aimed to “persuade the Chinese literati and high officials by quoting Chinese classics.” By using Michel Foucault’s reading as a guide to understanding Epictetus, this article will reevaluate the influence of Epictetus on Ricci and on Ricci’s subsequent readings of Chinese philosophy, particularly the relationship between zhi (knowing) and xing (application). The goal of these intra-lingual and inter-lingual readings will be to suggest how the difference between a perception and an application might affect ethical practice as well as our current understandings of subjectivity.
The Making of a Literary-Theological Mind in China
Authors: Lo Ping-cheung
Published: November 2018

Yang Huilin is famous for his pioneering work in integrating theology with literary studies in China. To fully elucidate the significance of his work, in this article I analyze the early thought of Yang against the cultural context of his time. I submit that there are profound similarities and interesting differences between the American post-secular approach and the Chinese theological approach in literary studies.
The Image of Jesus in the Writings of Zhang Shizhang (Hottinger S. C. Chang)
Authors: Kenpa Chin
Published: November 2018

This article approaches the work of Zhang Shizhang (Hottinger S. C. Chang, 1896–?), a theologian and writer scarcely known in the academy today. Zhang wrote about Jesus’ life and portrayed him in the image of a revolutionary liberator, one in tune with the “Christian Socialism” that he was advocating. This image of a radical Jesus was particularly noteworthy in the context of the China of the time, and his major focus was on creative writing, producing two works connected to the Lives of Jesus genre: Role Model for Young People (1928) and The Revolutionary Carpenter (1938).
Retrospective analysis of cardiac index and lactate production on cardiopulmonary bypass for a congenital cardiac patient population
Authors: Clingan Sean , Reagor James , Lombardi John
Published: November 2018

Background:

Providing adequate metabolic support is the principal concern during cardiopulmonary bypass (CPB) with different strategies utilized to enhance oxygen delivery to the patient. Modifying temperature, hematocrit (Hct) and cardiac index (CI) during CPB are primary techniques which aid in this effort. Based upon surgeon preference, the study institution employs differing perfusion strategies (PS) during congenital cardiac surgery requiring CPB. One method utilizes a 2.4 L/min/m2 CI and nadir Hct of 28% (PS1) and the other a 3.0 L/min/m2 CI with a nadir Hct of 25% (PS2).

Methods:

Cardiopulmonary bypass cases during which the PS1 or PS2 strategies were applied were retrospectively examined, finding no significant difference in pre-CPB lactate, maximum lactate on CPB or maximum change in lactate on CPB.

Results:

While the post-CPB lactate was statistically significantly higher in the PS2 group (p=0.024), the magnitude of difference (0.15 mmol/L) was small.

Conclusions:

This study illustrates that, when oxygen delivery or tissue perfusion is suspected as the primary cause of lactate production during CPB, increasing the CI to a 3.0 rather than a 2.4 CI may be more advantageous than packed red blood cell administration.
Failure of tocilizumab in treating two patients with refractory SAPHO syndrome: a case report
Authors: Sun Xiao-Chuan , Liu Shuang , Li Chen , Zhang Shuo , Wang Mu , Shi Xiao-Hua , Hao Wei-Xin , Zhang Wen
Published: November 2018

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare autoinflammatory disease with no standard treatment. Interleukin (IL)-6 inhibitors represent a novel therapeutic option for rheumatoid arthritis and some autoinflammatory diseases. However, the clinical utility of IL-6 inhibitors in treating SAPHO syndrome has been poorly investigated. In the present report, we describe two patients with SAPHO syndrome that was unresponsive to conventional treatment. Tocilizumab, an anti-IL-6 receptor monoclonal antibody, was putatively administered according to positive IL-6 immunohistochemical staining in biopsied bone tissues. However, the disease continued to progress, and new-onset or worsening skin lesions were noted with transient neutropenia. These cases demonstrate that tocilizumab may not be an ideal option for treating SAPHO syndrome.
Supporting the participation of youth with physical disabilities: Parents' strategies
Authors: Killeen Hazel , Shahin Saeideh , Bedell Gary M , Anaby Dana R
Published: November 2018

Introduction

Little is known about strategies used by parents to explicitly promote the participation in meaningful occupations of transition-age youth. This descriptive study explored the type and scope of parents' strategies to facilitate the participation of youth living with a physical disability.

Methods

Twenty-two parents of youths (12 to 18 years) with mobility restriction reported strategies used at home, school, and in the community by completing the Participation and Environment Measure for Children and Youth at two time points. Content analysis was conducted. Strategies were extracted and coded, and sub-categories were identified and organised into the three domains (person, occupation, environment) of the Canadian Model of Occupational Performance – Engagement.

Findings

Overall, 241 strategies were reported, of which 130 were distinct. The strategies encompassed all three domains of the Canadian Model of Occupational Performance – Engagement, with an emphasis on youths' immediate physical environment and no reference to institutional policies at the macro level. The majority of strategies focused on facilitating youths' participation in the school setting through collaboration, advocacy, and involvement.

Conclusion

Findings can increase our understanding of the range of actions parents take in supporting participation of transition-age youth. Occupational therapists can build on those strategies and, through family-centred practice, jointly promote youth participation and inclusion.
Information systems: Basic notions
Authors: Pasquali S.
Published: November 2018

This paper deals with the basic structure of computers (hardware and software) and some of the software applications now offered by technology; these applications can make medical work easier. Some features of advanced software applications are presented here, such as expert systems, case-based reasoning technics, image management, and also call tracking systems and user interface systems. The aim of this paper is to offer an overall view of the opportunity of setting up an efficient information system inside a health structure.
Informatics in urodynamics
Authors: Olivo G. , Calisti A. , Carluccio G. , Poletti G. , Lotto A.
Published: November 2018

Urodynamics is a diagnostic technique which makes full use of informatics. In the urodynamic laboratory the computer collects data both during clinical evaluation and during tests. Wiest KG software, which has been utilised in our laboratory for over five years, is illustrated. The advent of microprocessors has led to the development of miniaturised diagnostic systems in the biomedical field, which can study essential body functions over long periods of time: Rigiscan and vesicourethral Holter. We may assume that, with the development of so-called expert systems, the computer will take over the crucial urodynamic investigation which leads to diagnosis.
Urethral prostheses. An overview
Authors: Tizzani A. , Bodo G. , De Zan A. , Piana P. , Casetta G.
Published: November 2018

The first report in Literature dealing with an endourethral prosthesis in the treatment of recurrent bulbar strictures dates back to 1988. Since then other prostheses with different design and materials have been proposed. The Urolume by A.M.S., the first ever, is used worldwide and its indications are better known due to a longer follow-up time. In 6 months epithelium covers the prosthesis and it is generally well tolerated, but some Authors do not agree with its use in the treatment of traumatic strictures. Titanium prostheses have been used in few cases. A temporary steel alloy prosthesis, the Urocoil, has been proposed recently. Not enough follow-up data are available about this and the new “thermic memory” prosthesis. The bigdegradable prosthesis, used till now only on rabbits, actually represents the new frontier in the treatment of urethral strictures.
Prostatic stents
Authors: Ferrando U. , Paradiso M. , Cauda F. , Arena G. , Morabito F. , Tasso M.
Published: November 2018

Endoscopic or surgical ablation of the benign prostatic gland is today a therapeutic gold standard but not the ideal treatment for several patient categories, such as the elderly and/or high risk for surgical complications. Many therapeutic procedures Proposed in the last few years as mininvasive or eligible for outpatients give improvement in symptomatic scores but are less effective as disobstructive treatment. The high success rate with minimal morbidity observed in the Authors’ experience with prostatic stents, suggests that this device may become first-line therapy for the medically compromised man with bladder outlet obstruction. In the Authors’ opinion irritative voiding symptoms and lack of long follow-up studies do not justify the use of these devices in younger men without retention.
Therapeutic effect of TRH. T on 26 patients with myelopathy. Neurophysiatric and urological results
Authors: Ventimiglia B. , Reggio A. , Patti F. , Colosi V. , Savoca F. , Nisticò C. , Almasi J. , Lopes M.
Published: November 2018

TRH.T is a tripeptide functioning as neurotransmitter which aids catecholamine, and especially norepinephrine, release. The neuromodulator action of TRH.T suggests that it could be helpful in the therapy of vesico-sphincteric dysfunctions. 26 patients with myelopathy were treated with TRH.T. The results show an improvement in both the neurological and urological picture. It would also seem possible that TRH.T could play an important role as a neurotransmitter and neuromodulator rather than a receptor-effector, especially in the lower urinary tract.
The use of self-expanding metallic Wallstents (SMW) in ab-extrinsic ureteral obstructions: Preliminary results
Authors: Rovereto B. , Quaretti P. , La Marca F. , Tronci A. , Cappelli D. , Fiordelise S. , Marcello G. , Paiusco A. , Valentino R.V.
Published: November 2018

We report the preliminary results of ureteral obstruction treatment with self-expanding metallic Wallstents (SMWs) in 3 women. The causes of the obstructions were: in the first case pelvic relapse of an ovario carcinoma, in the second retroperitoneal fibrosis, and in the third pelvic fibrosis due to uterine cancer radiotherapy. In one patient only one SMW was placed, while in the other two, two SMWs were placed in the same ureter. At follow-up sonography, urography, and CT scan the ureters showed no sign of obstruction. In our limited experience, the SMW device is effective, easy to insert and minimally invasive.
Pharmacocavernosometry as a functional diagnostic test of venous leakage
Authors: Passavanti G. , Pizzuti V. , Bragaglia A. , Costantini F.M. , Viggiani F. , Buonavia A. , Spinosa E. , Onorato F. , Mengoni F. , Paolini R.
Published: November 2018

During 1994, 20 patients underwent pharmacocavernosometry because of suspected venous leakage. Only two patients showed evident signs of this syndrome. However, in another 10 patients, who did not show cavernosometric signs of venous leakage, cavernosography manifested opacity of the pudendal veins. Therapy for the two above-mentioned cases was surgical ligation of the crural vessels and of the dorsal vein. Short-term results have been substantially satisfactory. Analysing these cases and taking into account the latest bibliographic references, a prevalently functional pathogenesis of venous leakage can be proposed. Pharmacocavernosometry, as a functional diagnostic exam, although limited, could be the best test presently available to diagnose this syndrome. Cavernosography, being a more anatomic exam, could appear much less significant. The therapy to be proposed is surgery, on its own or supported by pharmacoprosthesis.
Report on: “Urologic tumour markers”. Introduction
Authors: Sidoti O.
Published: November 2018

Despite a great amount of studies, no ideal marker has been found for urologic tumours. The controversial aspects regarding the clinical use of prostatic cancer markers, especially PSA, are focused on without going into detail, although some surveys are presented. The same approach is followed for the problems regarding germ cell tumours of the testis; a survey is presented as well. Lastly bladder and kidney tumours are taken into consideration, for which, despite the efforts of the most sophisticated research studies, a moving clinically-usable marker hasn't been isolated up to now.
Biochemical characteristics and biological profile of prostate specific antigen (PSA)
Authors: Seregni E. , Botti C. , Grasselli G. , Bombardieri E.
Published: November 2018

Since its identification in seminai fluid in 1971, a tot more knowledge has been obtained about the biology and expression of prostate specific antigen (PSA). PSA is a glycoprotein consisting of 93% aminoacids and 7% carbohydrates with a molecular weight of about 30000 dalton. Functionally and structurally PSA is a kallikrein-like serine protease and its physiological role is the degradation of the major proteins of the seminal coagulum (semenogelin I and II, fibronectin) leading to semen liquefaction. The PSA gene is located on the 13q region of chromosome 19 and has a high degree of homology (more than 80%) with the gene of human glandular kallikrein (hGK1). PSA production and expression are preferentially but not exclusively associated with the normal, benign hyperplastic and cancerous tissues of the prostate. In fact, it has been demonstrated that PSA is also present in the accessory male sex glands of Cowper, Littre and Morgagni and other extra-prostatic neoplasms, such as salivary gland tumours and breast cancer. Many factors may influence PSA synthesis and production and among them the most important are androgen and growth factor stimulation. Advances have recently been made on the molecular isoforms of PSA. In the seminai fluid PSA seems partially bound to a serpine (protein C inhibitor), whilst in the serum PSA is predominantly associated to α-antichymotrypsin (ACT) and in low quantity to α2-macroglobulin (α2M). All these findings will have implications on clinical applications of PSA as a tumour marker for prostate cancer.
PSA and radicai prostatectomy
Authors: Zattoni F.
Published: November 2018

PSA represents a very reliable marker in the evaluation of prostatic cancer patients. Particularly in those who have undergone radicai prostatectomy, finding dosable values of serum PSA, that theoretically shouldn't occur, must be regarded as the persistence, at least, of residuai prostatic tissue. An increase of such concentrations raises doubts of locai recurrence or metastatic disease. Every effort must be made to demonstrate this event as soon as possible in order to apply an adjuvant treatment. Non-disappearance of serum PSA at 3 months after surgery has to be inevitably considered as a lack of surgical radicality.
Tumour markers in renal cell carcinoma. Literature review
Authors: Mostacci R. , Grosso G. , Pecoraro G.
Published: November 2018

The authors evaluated whether tumour markers can be considered useful in prognosis and therapeutical planning of renal cell carcinoma. This review has focused on those cytochemical and laboratory markers which are not only related to prognosis, but also give more information on therapeutical planning, particularly with regard to immuno and chemotherapy.
Techniques of internai urinary diversion without bowel interruption
Authors: Trinchieri A.
Published: November 2018

Internai urinary diversions date back more than 100 years to when ureterosigmoidostomy was introduced by Simon. Urinary diversion to the rectum is a simple technique of continent urinary diversion but can cause troublesome complications such as electrolyte imbalance, pyelonephritis and renal function deterioration. Improvement of the techniques of internai urinary diversion have reduced the risk of such complications. When the urethra cannot be preserved, internai urinary diversion provides a viable alternative to external diversion.
Immunotherapy of advanced renal cell carcinoma
Authors: De Braud F. , De Pas T. , Maffezzini M.
Published: November 2018

Although many different treatments have been evaluated in the last thirty years, advanced renal cell carcinoma still has a poor prognosis, characterised by a survival rate which is less than 5% at 3 years from diagnosis. Many different therapeutic approaches have been carried out in addition to cytotoxic chemotherapy, which shows obvious limits such as an overall response rate that does not go above 10-15%. One of the more promising treatments that has been studied the most is undoubtedly immunotherapy. We present a literature review aimed at summing up all the results obtained until now with immunotherapy of renal cell carcinoma, whether alone or in combination with cytotoxic chemotherapy. Unanswered questions of major concern are stressed, such as treatment choice, dosage, the most convenient schedules with particular regard to the cost-benefit issue.
High-dose, continuous infusion Interleukin-2 in the treatment of metastatic renal cell carcinoma: Experience of the C.R.O., Aviano
Authors: Sorio R. , Merlo A. , Sacco C. , Morassut S. , Bortolussi R. , Talamini R. , Calzavara G. , Galligioni E.
Published: November 2018

Interleukin-2 (IL-2, Proleukin, Chiron Therapeutics Inc., Emeryville, CA) has been approved in Italy for the therapy of patients affected by metastatic renal cell carcinoma (RCC) with a good performance status. The basis for approval in the USA and Europe was a series of clinical trials demonstrating that high-dose IL-2, although significantly toxic, can obtain approximately 20% objective responses and improve survival. Between July 1988 and September 1993, 50 patients were treated with high-dose IL-2 in continuous infusion (according to the West protocol), first as part of a European multicentric study, and subsequently as standard treatment. Responses were seen in 9 of the 45 evaluable patients, and, at the last control (December 1995), an improvement in the survival of responding or unchanged patients was clear. This statement may seem excessive but is based on clinical evidence showing a change in the natural history of some of our patients, which is unusual in patients with solid tumors, and in particular RCC patients.
Subcutaneous Interleukin-2 and Interferon in metastatic renal cell carcinoma: Our experience
Authors: Franceschi T. , Bassetto M.A. , Pasini F. , Nortilli R. , Cetto G.
Published: November 2018

Low-dose subcutaneous Interleukin-2 (IL-2), alone or in combination with Interferon (IFN), is an active regimen in metastatic renal cell carcinoma. Efficacy is comparable to higher-dose continuous intravenous infusion and toxicity is much lower. However response rate is only 15-25%. In our experience the results obtained with the combination of IL-2 + IFN were disappointing: of the 15 treated patients, only one had a brief partial response. These poor results may be ascribed to the protocol used and the selection of patients. On the other hand, the best published reports in literature with the combination of IL-2 + IFN have showed poor results in “poor prognosis” patients. Chemo-immunotherapeutic regimens have been proposed; however the association of IL-2 + IFN + 5-fluorouracil obtained promising results only in “good prognosis” patients. Based on preclinical studies, we treated 7 patients with unfavourable prognosis features with a combination of IL-2 + IFN + doxorubicin. With severe hematological toxicity, we obtained one partial response and two stable disease, lasting a mean of 14 months. Though preliminary, this finding seems encouraging because it was obtained in poor prognosis patients.
Our experience in the surgical treatment of renal carcinoma metastases
Authors: Cozzoli A. , Cancarini G. , Cunico S. Cosciani
Published: November 2018

The authors report their experience in the surgical treatment of synchronous and metachronous metastases from renal cell carcinoma. From January 1986 to December 1992, 47 nephrectomised patients (11.6%) out of 403 underwent contemporary or subsequent metastasectomy. Metastases were synchronous in 18 cases (38.3%), while metachronous metastases appeared in 29 (61.7%) after a mean disease-free interval of 28 months. After a mean follow-up of 36 months, out of the 18 cases with synchronous metastases, 9 died, 4 are in progression and 5 are still alive and NED; of the 29 patients with metachronous metastases, 3 died, 6 are in progression and 20 are still alive and NED. In conclusion, while the presence of synchronous metastases is an unfavourable prognostic factor even after their removal, results after surgery of metachronous metastases are encouraging.
ICS-standardization of assessment and terminology of functional characteristics of bladder replacements
Authors: Moroni M. , Muto G. , Bardari F.
Published: November 2018

As present knowledge about the physiological characteristics of intestinal urinary reservoirs is rather limited with regard to normal and abnormal reservoir sensation, compliance, activity, continence and other specifications, some definitions are understandably imprecise and vague. The report by the International Continence Society has been drawn up in an attempt to standardise assessment of intestinal urinary reservoirs and reporting of results, in order to gather more information about the relevant physiological characteristics and to establish precise definitions of normal and abnormal conditions.
Intestinal segments employed
Authors: Reggiani A. , Bacchetti P.
Published: November 2018

The main features of intestinal segments employed in different bladder reconstruction techniques after radical cystectomy for bladder cancer are considered both from a morphological and functional standpoint. In particular, short and long-term metabolic complications following the use of various tracts of intestine are analyzed.
Ureteroileal reimplantation in bladder substitutions: Direct technique
Authors: Muto G. , Moroni M. , Bardari F.
Published: November 2018

We evaluated renal function, scarring and bacteruria after ileal bladder substitution with and without antireflux ureteral reimplantation. A total of 160 ileal bladder replacements were performed from April 1990 to April 1994. 78 patients underwent bilateral antireflux ureteroileal anastomosis (group A) while a direct end-to-side reimplantation was used in 82 patients (group B). All patients were evaluated by urodynamic study, i.v.p., retrograde and voiding cystogram, urine culture and DMSA renal scanning. Anastomotic strictures occurred in 8 patients of group A: one bilateral and seven monolateral, for a total of nine obstructed units (5.8%). The strictures were treated with balloon dilatation in 3 cases and surgical reimplantation in 6. In group B, 3 monolateral strictures were observed (1.8%) and were treated successfully by balloon dilatation and stenting for 6 to 8 weeks. We also observed 6 refluxes in group A (1.8%) and 12 in group B (3.7%). All the patients with reflux were asymptomatic and none had acute urinary tract infection, fever, flank pain or pyelonephritis. DMSA scintigraphy did not detect any parenchymal damage or additional scar. Compared to the antireflux technique, the incidence of ureteral obstruction with direct reimplantation is lower. Although the incidence of reflux in group B is higher, no renal deterioration was observed at a mean follow-up of 52 months.
Enlarging enterocystoplasty in neurologic bladder and interstitial cystitis
Authors: Fanciullacci F. , Barana L.
Published: November 2018

Enlarging enterocystoplasty (EA) is widely used to restore bladder function in patients with neurologic bladder or severe fibrosis of the bladder wall. Results are excellent regarding the creation of a suitably sized and compliant reservoir, while voiding and urinary continence depend on the functional conditions of the original bladder. Intermittent catheterism (CI) or restoration of sphincteric function are often necessary. The indications, choice of intestinal segment, EA functional assessment criteria and results are discussed.
Seminal-sparing cystectomy and ileocapsuloplasty
Authors: Muto G. , Moroni M. , Bardari F.
Published: November 2018

The aim in managing stage pT1 bladder cancer is to anticipate tumour progression when cystectomy is still curative. The concern over major life-style alterations attributed to a radical operation has largely been eliminated by the development of a “nerve-sparing” technique and bladder replacement or continent diversion. Impotence after cystectomy derives from injury to the pelvic nerve plexus that provides autonomic innervation to the corpora cavernosa. The dangerous moments of “nerve-sparing” cystectomy can be avoided by leaving both the seminal vesicles and the prostatic capsule in place. We present our series of 24 “seminal-sparing” cystectomies performed between April 1990 and April 1996 in highly selected patients with recurrent T1 bladder cancer. All the patients could achieve erections that were adequate for sexual intercourse and neither local recurrences nor distant metastases have been observed at a mean follow-up of 38 months.
Familial prostatic adenocarcinoma in the A.U.S.L territory of Imola
Authors: Vagliani G. , Perrone A. , Salvi G. , Misuriello G. , Di Silverio A. , Fini M.
Published: November 2018

From 1987 to 1992, over 6,000 men aged between 50 and 79 years underwent mass screening for early diagnosis of prostatic carcinoma. They were also given an “epidemiological” questionnaire drawn up by a Urologist, which included information regarding civil status, fertility, working conditions, eating and smoking habits as well as tumours in the family. With regard to the latter, it appeared that 11% of patients with cancer have a positive family history against 2.2% in healthy men and 1.8% in individuals with benign prostatic hypertrophy. In order to investigate this aspect, 46 next of kin (brothers, sons) of patients with prostatic carcinoma (mean age 60 years, range 44–76) were enrolled in the study and subjected to DRE, TRUS and PSA assay. Patients with an alteration of one or more of the above-mentioned parameters (6 patients) underwent an echoguided biopsy (of nodule or normal). Only one (aged 52 years, PSA 12.1, DRE negative, TRUS small hypoechogenic area, prostatic volume 80 cc) had grade 2 PIN. Prostatectomy performed on the patient in another hospital showed that he had fibromyo-glandular hyperplasia. Results are discussed and compared with those reported in literature.
Clinical value of TRUS hypoechoic peripheral zone lesion
Authors: Fontana D. , Porpiglia F. , Fasolis F. , Tarabuzzi G. , Morra I. , Rocca A.
Published: November 2018

To evaluate the hypoechoic peripheral zone lesions detected at trans-rectal ultrasound (TRUS) in patients with normal PSA, we carried out a retrospective study on 12 men who underwent transrectal ultrasound-guided biopsy. None of them showed prostatic cancer at first mapping. We therefore did a follow-up with TRUS, PSA and digital rectal exploration (DRE). 9 patients underwent mapping again. The only patient who was positive for prostatic cancer had PSA > 4 ng/ml, negative TRUS and DRE. Our results confirmed the low predictive value of hypoechoic peripheral zone lesions and the change in TRUS Patterns. We therefore consider that patients with just a TRUS suspicion which is negative at first mapping, can be monitorized with PSA while TRUS should only be used for biopsy.
Metastatic renal cell carcinoma: Current problems with treatment and early diagnosis
Authors: Acanfora F. , Genesi D. , Sereno F. , Fonio P. , Gandini G. , Barasolo E.
Published: November 2018

A critical review was made on three consecutive male patients with a diagnosis of advanced renal cancer. The first patient, aged 45 years, had left renal cancer with lung and lymph-node metastases; the second, aged 55 years, had right renal cancer with hepatic metastasis and vena-cava thrombosis (from the infrahepatic tract to the iliac junction); the third, aged 65 years, had right renal cancer with vena-cava thrombosis up to the sovrahepatic veins. None or the patients underwent surgery. They underwent chemoembolisation and systemic immunotherapy: the first two with Interleukin 2 and interferon and the third with Interleukin and Tegafur. There was no response to therapy and the disease progressed causing death within 6 months. Observation of these patients showed, in the authors’ opinion, the necessity for new strategies regarding the early diagnosis and treatment of renal cell carcinoma.
Role of bladder wash cytology in negative cystoscopy for papillary and solid bladder cancer
Authors: Schiavone D. , Ficarra V. , Zanon G. , Motta L. , D'Amico A. , Pianon R.
Published: November 2018

The aim of this work is to verify the role of bladder wash cytology in negative endoscopic controls. We have evaluated 308 bladder wash cytologies retrospectively. 69 biopsies have been analysed and 51 of these have also been studied with flow cytometry. Bladder wash cytology was negative in 223 cases, positive in 25, uncertain in 52 and in 8 cases the analysis could not be evaluated. This study demonstrates that bladder wash cytology shows a good correlation with histological examination and endoscopy. It is particularly interesting to note that when cystoscopy is negative, the probability of the cytological examination being positive is very low (2%); this probability is totally annulled when indication for endoscopic control is represented by irritative disturbances.
Role of retroperitoneal lymph node dissection in clinical stage I Leydig cell tumours
Authors: Di Tonno F. , D'INCà G. , Bertoldin R. , Vianello F. , Di Pietro R. , Lavelli D. , Guazzieri S.
Published: November 2018

Leydig Cell Tumours (LCT) account for 3% of all testicular tumours; 10% are malignant and are refractory to radio- and chemotherapy. The role of Retroperitoneal Lymph Node Dissection in clinical stage I LCT is therefore a particularly debated one. From March ‘83 to December ‘95, 10 patients with LCT were subjected to orchiectomy (1 of them bilaterally because of a metachronous tumour). In 10 out of 11 specimens the following pathological features – a) size larger than 50 mm, b) infiltration of spermatic cord, c) lymphatics and veins, d) capsule, e) necrosis, f) cellular pleomorphism, g) numerous mitoses, h) nuclear atypia – were absent. The only patient in which b) and d) were present was subjected to RPLND. After a follow-up ranging from 17 to 157 months all patients are disease-free. Abstention from RPLND in clinical stage I LCT therefore seems the more rational choice when the above- listed pathologic features are absent.
Liposarcoma of the spermatic cord: A rare urological cancer
Authors: Lusuardi L. , Galantini A. , Fornasini F. , Pisetta F.
Published: November 2018

Malignant paratesticular tumours are uncommon. Of these, liposarcoma of the spermatic cord is a rare tumour type with good prognosis, found above all in the elderly. Most have a low level of malignancy and relapses tend to be localised. Choice treatment is radical orchiectomy and patients should be followed closely since local recurrence is not uncommon. This study briefly reviews the literature on spermatic cord liposarcoma and reports an additional case that was treated for a relapse by radical. orchiectomy.
Bladder neck sparing radical prostatectomy. Impact on continence and local recurrence
Authors: Fiaccavento G. , Belmonte P. , Di Meglio G. , Zucconelli R.
Published: November 2018

Radical prostatectomy is the treatment of choice for stage A e B prostatic carcinoma and optional in locally advanced forms. This surgical treatment, however, can lead to various problems such as preservation of sexual function, urinary continence and local recurrence. We present our experience to show how preservation of bladder neck fibres can influence urinary continence without affecting local recurrence. The latter was found in 13.8% of patients, while 90.7% were continent within 24 hours after removal of the catheter.
Correction of stress incontinence and cystocele through the utilization of strips of polypropylene
Authors: Bertolin R. , Croci A. , Pierini P.
Published: November 2018

In order to correct stress incontinence and/or cystocele we propose the well-known Burch technique modified by utilizing polypropylene strips (about 5 cm in length and 2 cm in width) for the suspension of the vagina to Cooper's ligaments, and, depending on the degree of cystocele and/or the severity of the uterine pathology, possibly associated hysterectomy and stabilization of the vaginal cupula to the uterosacral and round ligaments (always using the above-mentioned polypropylene strips). The aim of this technique is to avoid the complication considered by many authors to be the most frequent cause of failure in the surgery of stress incontinence and cystocele: tension of the suspension structures and threads. These strips may be used through either laparoscopic or laparotomic approach. The results we obtained could be described as satisfying; complications were rare.
Laparoscopic lymphadenectomy for prostatic cancer: Evaluation of first 100 cases
Authors: Muto G. , Leggero R. , Piras D. , Bardari F. , Moroni M.
Published: November 2018

The authors have correlated PSA and Gleason score with lymph node involvement in prostatic cancer. The aim of this work is to evaluate the indications for laparoscopic lymphadenectomy in patients with prostatic cancer in clinical stage A - B - C. Results showed that for high PSA values (> 30 ng/ml) and Gleason score (> 7), there was a significant rate of lymph node metastasis. The authors therefore believe that the gold standard for detecting neoplastic involvement in these selected cases could be laparoscopic lymphadenectomy.
Ten years of orthotopic neobladder
Authors: Croci A. , Allegri C. , Bertolin R. , Pierini P.
Published: November 2018

We present our ten years experience of orthotopic substitution of the bladder affected by infiltrating urothelial carcinoma in order to estimate a relatively small number of patients but with a long follow-up and to outline the reasons for our technical choices. Since January 1986 we have performed 70 orthotopic substitutions of the bladder, using the Carney I at the beginning and then passing on to the Carney II “detubularized” neobladder and in the following years the ileo-cecal bladder, the VIP till the “J” neobladder now preferred by the authors. Technically we have identified a series of parameters that we have used to evaluate the different types of neobladder. This examination shows that all the neobladders utilized are valid, but the “J” type corresponds much better to the current concept of ideal neobladder. We have illustrated and explained critically the patient selection principles and the results we obtained.
Emergency ESWL in ureteral lithiasis
Authors: Frego E. , Scanzi M. , Botturi A. , Cunico S. Cosciani
Published: November 2018

Extracorporeal shock wave lithotripsy (ESWL) may be considered first-choice treatment for upper ureteral stones; for lower ureteral stones, an endoscopie approach gives a high success rate but also higher morbidity. Over a period of 18 months in our Department, 275 consecutive patients with ureteral stones underwent ESWL. In 40 patients (14.5%) ESWL was performed within 48 hours of onset of acute renai colie; stone diameters were 7.5 mm average (range 5-20 mm). Ten patients (25%) were treated after ultrasonography and abdomen X-rays, while 30 patients also underwent an I.V.P. Shock waves required for fragmentation were 1503 on average (range 437-2650). All patients were treated after sedation-analgesia. All patients had remission of clinical symptoms after ESWL and one month later were all stone-free at X-ray and ultrasonographic control. Just one complication was observed: a small perineal hematoma that required no treatment. On the basis of our data, emergency ESWL is suggested as a non-invasive, easy-to-perform, well-tolerated treatment giving immediate remission of clinical symptoms. When unsuccessful, it does not preclude endoscopy or open surgery. Emergency ESWL has proved to be the treatment of choice due to the high percentage of total stone elimination, lack of anesthesia, few complications and excellent patient compliance.