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In the current study, we evaluated whether neoadjuvant chemoradiotherapy with reduced treatment volumes due to the exclusion of elective pelvic nodal irradiation is a feasible strategy for selected patients with locally advanced rectal cancer. Patients with T2 low-lying/T3, N0-N1 rectal lesions without evidence of disease in the lateral lymph nodes were prospectively recruited. All patients underwent pretreatment testing, including computed tomography imaging of the chest, abdomen, and pelvis with intravenous contrast, pelvic magnetic resonance imaging with intravenous contrast, and 18-fluorodeoxyglucose positron emission/computed tomography. The clinical target volume included the primary tumor and the mesorectum with vascular supply containing the perirectal and presacral nodes, with the upper border at the S2/S3 interspace. The total radiation dose was 50.4 Gy, and fluoropyrimidine-based chemotherapy was associated concomitantly. The primary endpoint of the study was the reduction of gastrointestinal (GI) toxicity, and the secondary endpoints were pathologic complete response, local control, overall survival, and disease-free survival. Fifty-two patients (30 men, 22 women) with a median age of 67 years (range, 45-85 years) were enrolled in the study. Acute grade 3 GI toxicity was 7.6%, and there were no cases of grade 4 toxicity. Three patients (5.7%) developed a local recurrence. No relapse occurred in the lateral lymph nodes. The local control rate at 5 years was 96.1%. With a median follow-up time of 72.9 months (range, 2.5-127.6 months), the 3- and 5-year overall survival rates were 89.4% and 87%, respectively. The 3- and 5-year disease-free survival rates were 82.4% and 82.4%, respectively. De-escalation of radiation therapy target volume reduces GI side effects without compromising efficacy in patients with rectal cancer. These results cannot be clearly extended to high-risk disease and need further evaluation in future randomized trials. [ABSTRACT FROM AUTHOR]

Abstract Background It is still unclear whether a positive surgical margin after resection of colorectal liver metastases remains a poor prognostic factor in the era of modern perioperative chemotherapy. The aim of this study was to evaluate whether preoperative chemotherapy has an impact on reducing local recurrence after R1 resection, and the impact of local recurrence on overall survival. Methods Between 2000 and 2014, a total of 421 patients underwent resection for colorectal liver metastases at our unit after preoperative chemotherapy. The overall number of analyzed resection areas was 1,428. Results The local recurrence rate was 12.8%, significantly higher after R1 resection than after R0 (24.5% vs 8.7%; P <.001). These results were also confirmed in patients with response to preoperative chemotherapy (23.1% after R1 vs 11.2% after R0; P <.001). At multivariate analysis, R1 resection was the only independent risk factor for local recurrence (P <.001). At the analysis of the 1,428 resection areas, local recurrence significantly decreased according to the increase of the surgical margin width (from 19.1% in 0 mm margin to 2.4% in ≥10 mm). At multivariable logistic regression analysis for overall survival, the presence of local recurrence showed a significant negative impact on 5-year overall survival (P <.001). Conclusion Surgical margin recurrence after modern preoperative chemotherapy for colorectal liver metastases was still significantly higher after R1 resection than it was after R0 resection. Local recurrence showed a negative prognostic impact on overall survival. R0 resection should be recommended whenever technically achievable, as well as in patients treated by modern preoperative chemotherapy. [ABSTRACT FROM AUTHOR]

Notwithstanding major evolutions in both class identity and broader structural processes, generically defined "middle classes" are still a target for both investors seeking effective remuneration strategies and urban governments striving to achieve urban competitiveness as well as increased "social cohesion" and "order" in cities. However, despite this enduring centrality, scholars have yet to truly develop a critical discussion around the transformations involving middle classes' subjectivities within urban regeneration discourses and strategies and how they are shaped/adjusted/filtered through the specific forms that their design and implementation assume within particular contexts. We argue that a better grasp of these subjectivities can be critical for a deeper understanding of these strategies, their rationales, tools, outcomes, and shortcomings. The paper intends to fill this gap by investigating such subjectivities through the collection and discussion of "residential narratives", by which we mean the collection of discourses and representations set forth by households and analyzed about a series of relevant dimensions: expectations, boundaries, and belonging. The narratives were collected in two European urban neighborhoods - one in Milan (Italy) and one in Marseille (France) - involved in variably governed urban regeneration processes centered on shaping and mobilizing middle-class subjectivities. Based on the presented results, the paper argues for a bottom-up institutionalist perspective on how we study urban regeneration discourses and strategies as class-making governing processes. • The mobilization of the middle classes in urban regeneration strategies depends on the cities' broader regulative contexts • Discourses, governance arrangements, and housing provision systems are key factors in the making of urban regeneration strategies • "Residential narratives" is key for understanding the way in which such strategies filter, shape and reshape middle-class identities [ABSTRACT FROM AUTHOR]

Pancreatectomy associated with superior mesenteric-portal vein (SMPV) resection is currently considered the standard of care for patients with pancreatic tumors involving the major peripancreatic veins. However, a standard approach for resection and reconstruction is not defined yet. The aim of this study is to analyze the feasibility and short-term results of an original Cattell-Braasch artery-first approach (CBAF) for the resection of SMPV during pancreatectomy. Of 144 pancreatectomies with vascular resection undertaken from 2008 to 2013 at Karolinska University Hospital, 45 (31.2 %) were performed combining a Cattell-Braasch maneuver with an artery-first approach (from 2011 to 2013). The mean patient age was 65.2 years. Thirty-seven (82.2 %) patients underwent pancreatoduodenectomy and 8 (17.8 %) total pancreatectomy. Histology showed pancreatic ductal adenocarcinoma in 42 patients (93.3 %). The median length of the resected SMPV segment was 4.6 cm (range 3-7). In all patients, a direct end-to-end anastomosis was performed without graft interposition. In nine cases (20 %), an arterial resection was also performed. There was no mortality in this series, and the morbidity rate was 35.5 %. Combined CBAF for the resection of SMPV during pancreatectomy seems to be safe and effective. The reconstruction of the resected vessels is possible in many cases without graft interposition, even if the resected vein segment is of considerable length. [ABSTRACT FROM AUTHOR]

Background: Survival with long-term follow-up following liver resection for unresectable colorectal liver metastases (CRLM) downsized by chemotherapy has rarely been reported. The aim of this study was to determine the chance of cure following liver resection for initially unresectable CRLM. Methods: Between January 2000 and December 2009, 61 patients underwent hepatectomy for unresectable liver-only CRLM downsized after chemotherapy. Cure was defined as a recurrence-free interval of at least 5 years after primary hepatectomy. Results: Resectability of CRLM was achieved after a mean number of 11 courses, and 42.6 % of patients underwent liver resection after ≥10 courses. Postoperative mortality was nil, and morbidity rate was 19.7 %. The 5- and 10-year actuarial overall survival rates were 42.6 and 16.0 %. Of 30 patients with a follow-up ≥5 years, 11 were alive, yielding a 5-year actual overall survival rate of 36.7 %, and 7 (23.3 %) were considered cured because they are alive without recurrence. On multivariate analysis, response to chemotherapy was the only independent predictor of both overall and disease-free survival. Conclusions: Cure can be achieved in about 23 % of patients resected for initially unresectable CRLM downsized by chemotherapy. Liver resection can be safely performed in selected patients even after multiple courses of chemotherapy. [ABSTRACT FROM AUTHOR]

Abstract: In this paper a simple method to obtain the analytical model of a flexible robot is presented, which turns out to be more efficient, from a computational point of view, than the classic assumed modes method. The presented method consists of using appropriate linear combinations of the modes of each link as basis functions to evaluate the deflection, in such a way as to minimize the dependency of the position of the generic link on the Lagrangian variables of the previous links. Hence, the number of terms of the inertia matrix and of the Coriolis and centrifugal vectors is significantly reduced. First, the model is derived, provided that the links are homogeneous and with constant cross-section, by analytically or otherwise by numerically calculating the parameters of the closed-form expression of the Lagrangian function of the generic link supposed free; afterwards, the analytical dynamic model of the whole robot is obtained by using an iterative interconnection algorithm, which can be easily implemented by using a symbolic manipulation language. The simplicity and efficiency of the proposed method is illustrated by considering the analytic expression of the kinetic energy of the end-effector in different cases and with significant comparison examples. [Copyright &y& Elsevier]

• The paper investigates the plurality of housing informality in contemporary Italy. • It analyses the complex nexus of informality with a variety of public institutions. • It presents five cases (e.g. squatting; Roma camps; illegal housing construction). • A selective tolerance driven by political interests emerges as the distinctive feature. • A variegated politics of housing informality is identified. The paper analyses the plurality of urban informal practices that characterize contemporary Italy in the sphere of housing, focusing on its complex connections with a variety of public institutions (e.g. laws, regulations, policies and practices). The paper discusses five cases of urban informality in Italy: the squatting of public housing in Milan; Roma camps in Rome; the borgate romane (large unauthorised neighbourhoods in the capital, which were built in the 1960s and 1970s and which have subsequently undergone a long and complex process of regularization); unauthorised construction, by the middle class, of second homes in coastal areas of Southern Italy; illegal subdivision of agricultural land as a standard mechanism for urban expansion in Casal di Principe, Naples. From these cases emerges a complex picture of hybrid institutions that shape and govern housing informalities. These hybrid institutions are composed of multifaceted networks of actors, policies, practices and rules that exist in tension with each other and contribute to favouring and shaping the production of informal space in different ways (e.g. through their action, inaction and structural features). Against the backdrop of this varied institutional framework, a selective tolerance driven mainly by politically-mediated interests emerges as the distinctive feature of the public approach to housing informality in Italy. The paper aims to develop an innovative research approach to informal housing in Italy by overcoming traditional boundaries between research 'objects' and by looking at political uses and forms of institutionalisation that are deployed across housing informalities. By doing so, it also contributes to the literature which analyses informality through the lenses of state theory. Simultaneously, it represents a call for international research to investigate the similarities in the patterns of housing informality – and their multifaceted politics – in Mediterranean welfare states. [ABSTRACT FROM AUTHOR]