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Cities can host significant biological diversity. Yet, urbanisation leads to the loss of habitats and, potentially, to local extinctions. Understanding how multiple taxa respond to urbanisation globally is essential to promote and conserve biodiversity in cities and surrounding landscapes. Using a dataset with site-level occurrence and trait data of 5302 species from six terrestrial fauna taxonomic groups across 379 cities on 6 continents, we show that urbanisation produces taxon-specific changes in trait composition, with traits related to reproductive strategy consistently showing the strongest response. The effect of urbanisation on community trait composition is strongest at the largest spatial scale considered, and more closely linked to landscape composition (% urban) than arrangement (aggregation), although latitude and climatic variables remain a stronger influence. This study did not find evidence in support of a global urban taxa syndrome, but instead we suggest that there are four general urban trait syndromes, with resources associated with reproduction and diet likely to be driving patterns in traits associated with mobility and body size. Functional diversity measures showed a wide range of responses, leading to a shift in trait space that is most likely driven by the distribution and abundance of critical resources, and the urban trait syndrome displayed by individual species within a community. Further research is required to understand the interactions between the four general urban trait syndromes, resource distribution and abundance and changes in functional diversity of taxa at different spatial and temporal scales. Maximising opportunities to support species within taxa groups with different urban trait syndromes should be pivotal in conservation and management programmes within and among cities. This will reduce the likelihood of biotic homogenisation at the taxa level, and helps ensure that urban environments have the ecological capacity to respond to challenges such as climate change, further habitat fragmentation and loss, and other disruptions. These actions are critical if we are to reframe the role of cities in global biodiversity loss.

Cities worldwide are engaging in large-scale greening projects motivated by the wide range of documented ecological, economic, and social benefits of urban forests. Urban forested natural areas are a critical component of the total urban forest but are often overlooked and typically lack formal management frameworks. One approach to addressing this deficiency may be to borrow from traditional ecological management frameworks and practices (that is, silviculture). Although urban forested natural areas share similarities with rural forests, the impacts of urbanization on forest stand dynamics may require modification of these methods and in some cases development of novel silvicultural guidelines. We present an urban silviculture framework through which we synthesize emerging research and identify challenges and opportunities for advancing goal setting, assessments, and on-the- ground management strategies. Adapting silvicultural practices to cities can improve the long-term sustainability of urban forests and establish management approaches that address future conditions in forests across the urban–rural continuum.

Since the 1990s, recognition of urban biodiversity research has increased steadily. Knowledge of how ecological communities respond to urban pressures can assist in addressing global questions related to biodiversity. To assess the state of this research field in meeting this aim, we conducted a systematic review of the urban biodiversity literature published since 1990. We obtained data from 1209 studies that sampled ecological communities representing 12 taxonomic groups. While advances have been made in the field over the last 30 years, we found that urban biodiversity research has primarily been conducted in single cities within the Palearctic and Nearctic realms, within forest remnants and residential locations, and predominantly surveys plants and birds, with significant gaps in research within the Global South and little integration of multi-species and multi-trophic interactions. Sample sizes remain limited in spatial and temporal scope, but citizen science and remote sensing resources have broadened these efforts. Analytical approaches still rely on taxonomic diversity to describe urban plant and animal communities, with increasing numbers of integrated phylogenetic and trait-based analyses. Despite the implementation of nature-based solutions across the world's cities, only 5% of studies link biodiversity to ecosystem function and services, pointing to substantial gaps in our understanding of such solutions. We advocate for future research that encompasses a greater diversity of taxonomic groups and urban systems, focusing on biodiversity hotspots. Implementing such research would enable researchers to move forward in an equitable and multidisciplinary way to tackle the complex issues facing global urban biodiversity.

Rapid urbanization and the global loss of biodiversity necessitate the development of a research agenda that addresses knowledge gaps in urban ecology that will inform policy, management, and conservation. To advance this goal, we present six topics to pursue in urban biodiversity research: the socioeconomic and social–ecological drivers of biodiversity loss versus gain of biodiversity; the response of biodiversity to technological change; biodiversity–ecosystem service relationships; urban areas as refugia for biodiversity; spatiotemporal dynamics of species, community changes, and underlying processes; and ecological networks. We discuss overarching considerations and offer a set of questions to inspire and support urban biodiversity research. In parallel, we advocate for communication and collaboration across many fields and disciplines in order to build capacity for urban biodiversity research, education, and practice. Taken together we note that urban areas will play an important role in addressing the global extinction crisis.

Introduction Pelvic and sacral tumor surgery is traditionally characterized by several major complications. Bleeding is probably the most feared and dreadful complication. The aim of the study was to evaluate whether the intraoperative use of the intra-aortic balloon occlusion technique could decrease the perioperative blood loss. A secondary aim was to assess aortic balloon-related complications. Materials and methods From January 2014 to December 2017 15 patients (Group 1) treated with intra-aortic balloon inflation were prospectively enrolled and compared to a historical control group (Group 2) of 11 patients with similar surgeries. Number of blood units transfused, perioperative hemoglobin values, hours spent in intensive care unit (ICU), length of inpatient stay, and perioperative complications were evaluated. Results Intraoperatively, a mean of 6.1 blood units per patient (BUPP) was used in Group 1 and 16.2 BUPP in Group 2. Postoperatively the averages were 2,8 and 5,4 BUPP in Group 1 and 2, respectively. Patients in Group 1 had a faster recovery in hemoglobin values, as well as a shorter length of overall inpatient stay (28,9 vs 59 days) and of ICU stay (33.9 vs 74.6 h). The most relevant complications observed in Group 1 were two thrombosis at the incannulation site that required a surgical arterial thrombectomy. Conclusion The intra-aortic balloon occlusion is an effective technique to control bleeding during the resections of huge pelvic and sacral tumors. A proper training of a multidisciplinary team and an accurate patient selection are required to prevent major complications.

Urban forested natural areas are valuable ecological and social resources, but long-term sustainability of these habitats is challenged by environmental and social factors associated with urban ecosystems. Advances in city-scale assessments of urban forests have increased the resolution of forest community types and conditions, allowing for improved understanding of ecological function, such as natural regeneration, in these urban habitats. By applying metrics of tree regeneration that are commonly used for the management of rural forests, urban ecologists can test the potential for traditional forest management strategies within our cities. In this study, we compare urban and rural oak-hickory forest composition and structure and the capacity for natural regeneration in the New York metropolitan area. Specifically, we use two metrics of advance regeneration that describe the abundance of seedlings and saplings at different size classes to test whether this management for natural regeneration is a viable option. We found differences in recruitment dynamics between urban and rural forests that have implications for the sustainability of these forests and new management strategies. First, after controlling for forest community type, species composition in urban and rural sites was significantly different across multiple strata and within the seed bank. Species-specific capacity for natural regeneration was different in urban and rural sites, signaling the possibility of divergent successional trajectories. Second, while differences in species composition exist, both urban and rural sites were dominated by native species across all forest strata except for urban seed banks. Third, despite finding significantly lower average annual seedling abundance in urban (1.9 seedlings/m2 ) compared to rural (7.1 seedlings/m2 ) sites, we observed greater density of saplings in urban forests, and no significant difference in stocking index between sites. These findings suggest that early-establishment barriers to recruitment are greater in urban forest sites. However, once established, seedling transition into advance regeneration stages may not be different between site types, and advance regeneration may, in some cases, be more viable in urban forested natural areas. These results highlight functional differences between urban and rural forest recruitment dynamics that may impact on the future community composition of oak-hickory forests in the two landscape settings.

Fibulo-scapho-lunate fusion is a technique that allows residual movement in the wrist in case of wide bone resection replacing the distal radius by a vascularised fibular transfer. Some authors have used this technique with favourable results but the distal synthesis seems to not be standardised at all, many different osteosynthesis methods have been proposed. This paper reports a complete review of the present day literature about this subject and, evaluating the different proposed osteosynthesis techniques referred in literature, suggests a standardization of the synthesis methods with dorsal plating. We report some technical considerations and results of three cases operated with a stable dorsal osteosynthesis (twice with a double plate and once with a long plate). We evaluate the time of healing and the clinical result.

Purpose The aim of this multi-institutional retrospective study was to compare osteoarticular graft reconstruction (OA) and wrist arthrodesis (WA) after distal radius resection for giant cell tumor. Material and methods Sixty-seven patients affected by giant cell tumor of the distal radius underwent resection and reconstruction with OA (47 patients) or WA (20 patients). The mean age was 40 years (range, 13–74 years). Grafts included fresh-frozen allograft or nonvascularized fibular autograft. Complications requiring surgical revision were recorded. Clinical outcome was assessed with the Musculoskeletal Tumour Society Score (MSTS) and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results Fifteen patients developed a local recurrence after a median of 12 months (range, 6–137 months). Sixteen patients required revision surgery for complications. Of these, 10 were graft-related complications (7 in the OA group and 3 in the WA group). Among OA, 2 patients with painful instabilities and 4 with severe arthritis required conversion into WA after a mean of 26 months (range, 13–38 months) At a median follow-up of 105 months (range, 12–395 months), similar functional outcome (MSTS and DASH score) was observed between OA and WA. Conclusions Our results did not show any advantage of OA or WA over the other technique. A patient-by-patient decision should be taken both regarding the type of reconstruction (OA or WA) and the type of graft (allograft or autograft). The reconstructive choice should also consider the patient’s functional expectations. Type of study/level of evidence Therapeutic IV.

To examine industrial capabilities and practices in using process design optimization software tools, we conducted a series of over one hundred interviews with practitioners and industry experts in optimal process design, focusing on current techniques, workflows, and challenges. In this article, we analyze the findings of these interviews, providing a perspective into the status of optimal process design in the petrochemical and chemical industries. We first present the findings categorized by company type and personnel function, followed by industry-specific insights.

Summary Background Trabectedin is an alkylating drug with a unique mechanism of action causing single-strand and double-strand DNA breaks that activate DNA damage-response pathways. Based on our preclinical data, we hypothesised that poly(ADP-ribose) polymerase 1 (PARP1) inhibitors might be an ideal partner of trabectedin and aimed to assess the safety, identify the recommended phase 2 dose, and explore preliminary signs of activity of trabectedin and olaparib combination treatment in patients with bone and soft-tissue sarcoma. Methods We did an open-label, multicentre, phase 1b study, recruiting patients from the national Italian sarcoma network aged 18 years and older with histologically confirmed bone and soft-tissue sarcoma progressing after standard treatments with Eastern Cooperative Oncology Group performance status of 1 or less. In a classic 3 + 3 design, patients received a 24 h infusion of trabectedin on day 1 and olaparib orally twice a day in 21-day cycles across six dose levels (trabectedin 0·675–1·3 mg/m2 every 3 weeks; olaparib 100–300 mg twice a day from day 1 to 21). Intermediate dose levels were permitted to improve safety and tolerability. The primary endpoint was determination of the recommended phase 2 dose (the maximum tolerated dose). Safety and antitumour activity were assessed in all patients who received at least one dose of the study drugs. We report the results of the dose-escalation and dose-expansion cohorts. The trial is still active but closed to enrolment, and follow-up for patients who completed treatment is ongoing. This trial is registered with ClinicalTrials.gov, number NCT02398058. Findings Between Nov 17, 2014, and Jan 30, 2017, of 54 patients assessed for eligibility, we enrolled 50 patients: 28 patients in the dose-escalation cohort and 22 patients in the dose-expansion cohort. Patients received a median of four cycles of treatment (IQR 2–6; range 1–17 [the patients who received the highest number of cycles are still on treatment]) with a median follow-up of 10 months (IQR 5–23). Considering all dose levels, the most common grade 3–4 adverse events were lymphopenia (32 [64%] of 50 patients), neutropenia (31 [62%]), thrombocytopenia (14 [28%]), anaemia (13 [26%]), hypophosphataemia (20 [40%]), and alanine aminotransferase concentration increase (9 [18%]). No treatment-related life-threatening adverse events or deaths occurred. One (2%) patient interrupted treatment without progression without reporting any specific toxicity. Observed dose-limiting toxicities were thrombocytopenia, neutropenia for more than 7 days, and febrile neutropenia. We selected intermediate dose level 4b (trabectedin 1·1 mg/m2 every 3 weeks plus olaparib 150 mg twice a day) as the recommended phase 2 dose. Seven (14%; 95% CI 6–27) of 50 patients achieved a partial response according to Response Evaluation Criteria In Solid Tumors 1.1. Interpretation Trabectedin and olaparib in combination showed manageable toxicities at active dose levels for both drugs. Preliminary data on antitumour activity are encouraging. Two dedicated phase 2 studies are planned to assess activity of this combination in both ovarian cancer (EudraCT2018-000230-35) and soft-tissue sarcomas. Funding Italian Association for Cancer Research, Italian Sarcoma Group, Foundation for Research on Musculoskeletal and Rare Tumors, and Italian Ministry of Health.

Acromioclavicular joint (ACJ) injuries are common, but their incidence is probably underestimated. As the treatment of some sub-types is still debated, we reviewed the available literature to obtain an overview of current management. We analysed the literature using the PubMed search engine. There is consensus on the treatment of Rockwood type I and type II lesions and for high-grade injuries of types IV, V and VI. The treatment of type III injuries remains controversial, as none of the studies has proven a significant benefit of one procedure when compared with another. Several approaches can be considered in reaching a valid solution for treating ACJ lesions. The final outcome is affected by both vertical and horizontal post-operative ACJ stability. Synthetic devices, positioned using early open or arthroscopic procedures, are the main choice for young people. Type III injuries should be managed surgically only in cases with high-demand sporting or working activities. Cite this article: EFORT Open Rev 2017;2:432–437. DOI: 10.1302/2058-5241.2.160085.

Subcutaneous masses smaller than 5 cm can be malignant, in contrast with the international guidelines. Ultrasound (US) and magnetic resonance imaging (MRI) are useful to distinguish a potentially malignant mass from the numerous benign soft tissue (ST) lesions. Contrast-enhanced ultrasound (CEUS) was applied in ST tumors, without distinguishing the subcutaneous from the deep lesions. We evaluated CEUS and MRI accuracy in comparison to histology in differentiating malignant from nonmalignant superficial ST masses, 50% smaller than 5 cm. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) with their 95% confidence intervals (CI) were calculated. Of malignant cases, 44.4% measured ≤5 cm. At univariate analysis, no statistically significant differences emerged between benign and malignant tumors in relation with clinical characteristics, except for relationship with the deep fascia (p = 0.048). MRI accuracy: sensitivity 52.8% (CI 37.0, 68.0), specificity 74.1% (CI 55.3, 86.8), PPV 73.1% (CI 53.9, 86.3), and NPV 54.1% (CI 38.4, 69.0). CEUS accuracy: sensitivity 75% (CI 58.9, 86.3), specificity 37% (CI 21.5, 55.8), PPV 61.4% (CI 46.6, 74.3), and NPV 52.6% (CI 31.7, 72.7). CEUS showed a sensitivity higher than MRI, whereas PPV and NPV were comparable. Also, masses measuring less than 5 cm can be malignant and referral criteria for centralization could be revised.

The reconstruction of the proximal humerus following a tumor resection remains a big challenge for the orthopedic surgeon, due to the complex anatomy and biomechanics of the shoulder joint. The main goals, after a resection with adequate margins, are the stability of the glenohumeral joint and the restoration of passive and active mobility. The proximal humerus reconstruction can be performed with an allograft and/or an endoprosthetic replacement. The resected tendons should be resutured to the prosthesis or the allograft to improve the functional results. The shoulder joint reconstruction with a reverse shoulder prosthesis seems to allow the best functional results, in particular if the circumflex nerve and the deltoid muscle are spared.

Primary bone tumours are rare, accounting for < 0.2% of malignant neoplasms registered in the EUROCARE (European Cancer Registry based study on survival and care of cancer patients) database. Different bone tumour subtypes have distinct patterns of incidence, and each has no more than 0.3 incident cases per 100 000 per year. Osteosarcoma (OS) and Ewing sarcoma (ES) have a relatively high incidence in the second decade of life, whereas chondrosarcoma (CS) is more common in older age.

Metastatic tumors often cause pathologic or impending fractures. These lesions require a stable fixation that allows an early postoperative weight bearing and a durable follow-up. During years, orthopedic devices have been built up in several different materials to enhance the properties and combine elevate strength with an elastic modulus as closer as possible to the elastic modulus ofbone. Carbon fiber-polyaryl-ether-ether-ketone (CF-PEEK) composite biomaterials have excellent properties in terms of mechanical strength, flexibility, and compliance, with low elastic modulus. Being these materials composite, they could be designed in order to optimize mechanical properties. Their properties of radiolucency and low interference with magnetic resonance imaging allow good follow-up of fracture healing or the evolution of the lytic lesions; low interaction levels with radiation therapies allow better planning and more effective therapies. Plates, nails, and spinal stabilization systems are available on the market to be used in all conditions where an elastic radiotransparent device is required. Even not experienced surgeons could use CF-PEEK implants with few tips. In this chapter, some cases are shown to demonstrate technical feasibility and imaging results.

Introduction Musculoskeletal Soft Tissue Tumours (STT) are frequent heterogeneous lesions. Guidelines consider a mass larger than 5 cm and deep with respect to the deep fascia potentially malignant. Contrast Enhanced Ultrasound (CEUS) can detect both vascularity and tumour neoangiogenesis. We hypothesised that perfusion patterns and vascularisation time could improve the accuracy of CEUS in discriminating malignant tumours from benign lesions. Materials and methods 216 STT were studied: 40% benign lesions, 60% malignant tumours, 56% in the lower limbs. Seven CEUS perfusion patterns and three types of vascularisation (arterial-venous uptake, absence of uptake) were applied. Accuracy was evaluated by comparing imaging with the histological diagnosis. Univariate and multivariate analysis, Chi-square test and t-test for independent variables were applied; significance was set at p Results CEUS pattern 6 (inhomogeneous perfusion), arterial uptake and location in the lower limb were associated with high risk of malignancy. CEUS pattern has PPV 77%, rapidity of vascularisation PPV 69%; location in the limbs is the most sensitive indicator, but NPV 52%, PPV 65%. The combination of CEUS-pattern and vascularisation has 74% PPV, 60% NPV, 70% sensitivity. No correlation with size and location in relation to the deep fascia was found. Conclusion US with CEUS qualitative analysis could be an accurate technique to identify potentially malignant STT, for which second line imaging and biopsy are indicated in Referral Centers. Intense inhomogeneous enhancement with avascular areas and rapid vascularisation time could be useful in discriminating benign from malignant SST, overall when the lower limbs are involved.

Introduction Carbon fiber reinforced (CFR) implants have been proposed for the treatment of fractures or impending fractures of the long bones in the oncology patient. Aim of this study is to present the largest cohort of oncology patients operated by CFR nailing by the Italian Orthopaedic Society (SIOT) Bone Metastasis Study Group. Methods 53 adult oncology patients were operated on with a CFR-PEEK nail. All the data from adjuvants therapies were collected. Bone callus formation, response to radiotherapy, relapse or progression of the osteolysis were recorded. Hardware survival and failure, breakage and need for implant revision were also analysed. Results Anatomical implantation of nails include humerus (n = 35), femur (n =11) and tibia (n = 7). The most frequent tumors affecting the bone were myeloma (n = 13), breast (n = 11), lung (n = 8), and renal cell cancer (n = 7). Acrylic cement reinforcement was used in 2 patients. One patient was subjected to electrochemotherapy after nail insertion. Intraoperative and early postoperative complications occurred in 13.2% and 7.54% of patients respectively. Eight patients had local progression and one developed a stress fracture proximally to the distal static screw. Radiographic union occurred in 14 patients; one screw loosening was recorded. Discussion There is currently a lack of solid evidence on the clinical use of CFR nails in oncologic patients. This is the first and largest study of CFR nailing, with the longest available follow up. Conclusions Implant related complications and surgery-related morbidity should be taken into account in the decision-making process for the surgical management of these patients. These data can improve the surgeon-patient communication and guide further studies on patients’ survival and complications with respect to surgery.

Bone metastases are a frequent and debilitating consequence for many tumors, of which breast, lung, prostate, and kidney cancer are the most common. The dialog among cancer cells, bone microenvironment, and immune system regulates bone metastasis formation. Indeed, bone and immune system are strictly linked to each other because bone regulates the hematopoietic stem cells from which all cells of the immune system derive. Many immunoregulatory cytokines influence the fate of bone cells and promote the growth of tumor cells in bone, contributing to sustain the vicious cycle of bone metastasis. Bone is an attractive soil for cancer cells, which can remain dormant for years or directly form bone lesions. The fate of cancer cells after their arrival to bone marrow depends on a complex cross-talk among cancer, bone, and immune cells in the microenvironment. This review provides an overview of the different steps occurring during bone metastatic process, with particular attention to the osteoimmunology field. Furthermore, we will revise the current available clinical approaches for the therapy of bone metastatic patients.

Knowledge of allometric equations can enable urban forest managers to meet desired economic, social, and ecological goals. However, there remains limited regional data on young tree growth within the urban landscape. The objective of this study is to address this research gap and examine interactions between age, bole size and crown dimensions of young urban trees in New Haven, CT, USA to identify allometric relationships and generate predictive growth equations useful for the region. This study examines the 10 most common species from a census of 1474 community planted trees (ages 4–16). Regressions were applied to relate diameter at breast height (dbh), age (years since transplanting), tree height, crown diameter and crown volume. Across all ten species each allometric relationship was statistically (p 0.70. Crown volume exhibited a good fit for each of the shade tree species (R2 > 0.85), while the coefficients of determination for the ornamentals varied (0.38 0.66). Allometric relationships can be used to develop spacing guidelines for commonly planted urban trees. These correlations will better equip forest managers to predict the growth of urban trees, thereby improving the management and maintenance of New England's urban forests.

Osteoarthritis is characterized by loss of articular cartilage also due to reduced chondrogenic activity of mesenchymal stem cells (MSCs) from patients. Adipose tissue is an attractive source of MSCs (ATD-MSCs), representing an effective tool for reparative medicine, particularly for treatment of osteoarthritis, due to their chondrogenic and osteogenic differentiation capability. The treatment of symptomatic knee arthritis with ATD-MSCs proved effective with a single infusion, but multiple infusions could be also more efficacious. Here we studied some crucial aspects of adipose tissue banking procedures, evaluating ATD-MSCs viability, and differentiation capability after cryopreservation, to guarantee the quality of the tissue for multiple infusions. We reported that the presence of local anesthetic during lipoaspiration negatively affects cell viability of cryopreserved adipose tissue and cell growth of ATD-MSCs in culture. We observed that DMSO guarantees a faster growth of ATD-MSCs in culture than trehalose. At last, ATD-MSCs derived from fresh and cryopreserved samples at −80°C and −196°C showed viability and differentiation ability comparable to fresh samples. These data indicate that cryopreservation of adipose tissue at −80°C and −196°C is equivalent and preserves the content of ATD-MSCs in Stromal Vascular Fraction (SVF), guaranteeing the differentiation ability of ATD-MSCs.

Musculoskeletal tumours are rare, with a wide variety of presentations. Three “up to date” topics are focused, two in imaging, one in management. Contrast Enhanced UltraSound is promising also as a guidance for tru-cut biopsy and magnetic resonance with functional imaging studies (DCE, DWI, MRI-spectroscopy) could help in diagnosis and treatment. Piedmont and Valle d’Aosta Oncological Network could be an organizational model for musculoskeletal tumours in an interdisciplinary organization.

BACKGROUND: We recently developed a clinical decision support tool, capable of estimating the likelihood of survival at 3 and 12 months following surgery for patients with operable skeletal metastases. After making it publicly available on www.PATHFx.org , we attempted to externally validate it using independent, international data. METHODS: We collected data from patients treated at 13 Italian orthopaedic oncology referral centers between 2010 and 2013, then applied to PATHFx, which generated a probability of survival at three and 12-months for each patient. We assessed accuracy using the area under the receiver-operating characteristic curve (AUC), clinical utility using Decision Curve Analysis (DCA), and compared the Italian patient data to the training set (United States) and first external validation set (Scandinavia). RESULTS: The Italian dataset contained 287 records with at least 12 months follow-up information. The AUCs for the three-month and 12-month estimates was 0.80 and 0.77, respectively. There were missing data, including the surgeon's estimate of survival that was missing in the majority of records. Physiologically, Italian patients were similar to patients in the training and first validation sets. However notable differences were observed in the proportion of those surviving three and 12-months, suggesting differences in referral patterns and perhaps indications for surgery. CONCLUSIONS: PATHFx was successfully validated in an Italian dataset containing missing data. This study demonstrates its broad applicability to European patients, even in centers with differing treatment philosophies from those previously studied.

Soft tissue tumours (STT) require accurate diagnosis in order to identify potential malignancies. Preoperative planning is fundamental to avoid inadequate treatments. The role of contrast-enhanced computed tomography (CT) for local staging remains incompletely assessed. Aims of the study were to evaluate CT accuracy in discriminating active from aggressive tumours compared to histology and evaluate the role of CT angiography (CTA) in surgical planning. This retrospective cohort series of 88 cases from 1200 patients (7 %) was locally studied by contrast-enhanced CT and CTA in a referral centre: 74 malignant tumours, 14 benign lesions. Contrast-enhancement patterns and relationship of the mass with major vessels and bone were compared with histology on surgically excised samples. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were evaluated in discriminating active from aggressive tumours. Sensitivity in differentiating aggressive tumours from active lesions was 89 %, specificity 84 %, PPV 90 %, NPV 82 %. The relationship between mass and major vessels/bone was fundamental for surgical strategy respectively in 40 % and in 58 % of malignant tumours. Contrast-enhanced CT and CTA are effective in differentiating aggressive masses from active lesions in soft tissue and in depicting the relationship between tumour and adjacent bones and major vessels. • Accurate delineation of vascular and bony involvement preoperatively is fundamental for a correct resection. • CT plays a critical role in differential diagnosis of soft tissue masses. • Contrast-enhanced CT and CT angiography are helpful in depicting tumoral vascular involvement. • CT is optimal for characterization of bone involvement in soft tissue malignancies.

Several authors have reported an association between mutations of the cystic fibrosis transmembrane conductance regulator gene (CFTR) and chronic pancreatitis. CFTR gene transcription and protein efficiency are influenced by two polymorphic loci, (TG)m and M470V, other than the T5 allele, whose role is already well-established. The TG11/T5 haplotype is commonly found in healthy subjects, while the TG12/T5/V470 and TG13/T5/V470 haplotypes are present in congenital bilateral absence of the vas deferens (CBAVD) patients. While the T5 allele is a mutation that is over-represented in patients with chronic pancreatitis, no data are available concerning the possible allelic preference at the other two polymorphic loci, (TG)m and M470V, in these patients. For this reason, we screened 39 patients with chronic pancreatitis for the most common CFTR mutations found so far in the Italian population; in addition, we examined the length of the polypyrimidine (poly-T) tract in intron 8, the (TG)m length and the M or V codon at position 470. CFTR mutations were found in 3 patients. Poly-T variant typing identified genotype T5/T7 in 5 patients and T5/T9 in 1 patient. Direct sequencing of intron 8 in patients with the T5 variant revealed the TG12/T5/V470//TG11/T7/V470 genotype in 5 patients and TG10/T9//TG11,T5 genotype in 1 patient. In patients with chronic pancreatitis, the T5 allele is frequently associated with TG12 and V470, a haplotype already reported in CBAVD cases and quite uncommon in healthy subjects.

A total of 42 patients were submitted to a clinical, behavioural and neuropsychological evaluation with the objective of eventual surgical treatment of epilepsy refractory to the usual clinical therapies. Prolonged video-EEG monitoring, MRI hippocampal volume measurement, lateralization of speech and memory using the amobarbital (Wada) test were used. Of 18 operated cases, 12 were submitted to temporal lobectomy, with a follow-up of 6-30 months; 8 patients had significant improvement in seizures control; 2 patients had partial improvement in seizure frequency and intensity; 2 patients had no improvement in seizure control. One patient underwent right frontal lobectomy with total remission of seizures and 5 had callosotomy with varying degrees of success. There was no mortality. Morbidity included one subdural hematoma, one transient hemiparesis, one episode of mania, one lobar pneumonia and frequent immediately post-operative muscular tension headaches. These early results indicate good results of temporal lobectomy patients investigated through a non-invasive presurgical evaluation. No total, 42 pacientes foram submetidos a avaliação clínica, comportamental e neuropsicológica com o objetivo de eventual tratamento cirúrgico de epilepsia refratária aos tratamentos clínicos usuais. Monitorização de vídeo-EEG digital prolongado, avaliação do volume hipocampal por RM, lateralização de fala e memória pelo teste do Amobarbital (teste de Wada) foram utilizados. Dos 18 pacientes operados 12 foram submetidos a lobectomia temporal, com seguimento de 6-30 meses (média 17 meses), sendo que 8 encontram-se com melhora significativa do controle de crises, 2 com melhora parcial e em 2 não foi observada mudança substancial na intensidade e frequência de crises. Uma paciente foi submetida a lobectomia frontal direita com remissão total de crises. Cinco pacientes foram submetidos a calosotomia com graus variáveis de sucesso. Não houve mortalidade. A morbidade incluiu um hematoma subdural, uma hemiparesia transitória, um episódio de mania, uma pneumonia lobar e cefaléia tensional muscular frequente no pós-operatório imediato. Estes resultados preliminares indicam uma boa resposta do tratamento cirúrgico de epilepsia em um novo centro, com pacientes selecionados através de monitorização não invasiva.

Over the last two decades, there has been a substantial increase in street tree plantings across the United States. Many cities have set ambitious planting goals, relying on volunteer community groups to meet them. Existing research demonstrates that community stewardship increases the survival of urban street trees. There is a lack of research, however, on how defining characteristics of community groups affect the survival and growth of the trees they plant. This study explores the significance of community group size (# participants), type (apartment, block watch, church, concerned neighbors, park, public housing, school, and social service), planting longevity (# years active), experience level (# trees planted), and neighborhood (geo-political boundaries). Measured for this study were 1393 trees planted from 1995 to 2007, by 134 groups, through the Urban Resources Initiative’s Community Greenspace program in New Haven, Connecticut, U.S. There was an overall survival rate of 76%. Highest survival and growth was found among trees planted by groups with more planting experience, greater longevity, and more participants. Higher tree survival and growth was observed when trees were planted by groups working in line with their mission (e.g., park groups in parks). Lowest survival and growth was found among yard trees planted by public housing groups. Existing canopy cover and neighborhood percent homeownership had little effect on survival or growth. This research can offer guidance for city managers by suggesting which planting groups require particular assistance in conducting successful, lasting street tree plantings.

11018Background: Given that trabectedin (T) causes single- and double-strand breaks along DNA, we hypothesized to combine trabectedin with the selective PARP1-inhibitor olaparib (O) to induce irrep...

Background Soft tissue sarcomas are a rare and heterogeneous group of malignancies that are derived from the mesenchymal cell lines. In the last few decades, the management of these lesions has been improved by the introduction of dedicated Multi Disciplinary Teams (MDTs) where most bone and soft tissue tumours are now treated. 1 Following the recent changes to management outlined by the NICE/IOGs, we believe it is pertinent to review the current thinking on soft tissue tumour management. 2 We also discuss the principles of diagnosis and treatment and the role of adjuvant therapy. Methods This is a retrospective review. In the preparation of this paper, we have referred to recent NICE guidelines in this field and have performed a Medline search of the existing literature. Results The key to success is early and appropriate patient referral. Whilst the responsibility for performing surgery has shifted away from the generalist and towards the super-specialist, improvements in survivability can be achieved by promoting basic knowledge within the medical profession as a whole. Conclusions Both excision and biopsy of a soft tissue sarcoma by a non-specialist surgeon have been shown to increase the risk of tumour recurrence and all invasive procedures should now be performed within the MDT setting.

Cerebral palsy (CP) is a static neurologic condition resulting from a brain lesion occurring before the completion of brain development. The goal of management is not cure, but increasing patients' functionality and improving their capabilities and maintaining their locomotion, cognitive development, social interaction and independence. The best results are obtained with an early and intensive management that includes physical and occupational therapy, medical and surgical treatments, mechanical aids and the management of concomitant conditions.To assess the neuromotor improvement in patients with spastic CP after surgical treatment at the National Rehabilitation Institute.Patients with a diagnosis of spastic CP who presented at the Pediatric Rehabilitation outpatient service were referred to the Joint CP Clinic from January 2007 to January 2008, and underwent surgical treatment of the pelvic limbs. They were assessed 3 times and underwent neuromotor tests with gross motor function measure (GMFM), which was rated with the gross motor function classification system (GMFCS).Most of the patients had improvement in the muscle tone and contracture assessments as well as in the GMFM, and their self-mobility increased one level.Significant improvements were seen in the muscle tone and contractures after surgery; the GMFM and the self-mobility levels in the GMFCS also improved. Multiple level surgery together with a postoperative physical therapy program results in considerable improvements in the gross motor function measure of patients with spastic CP.

10570 Background: In soft tissue sarcomas (STS) after complete (marginal/wide/radical margins) surgery, surveillance should be tailored to individual patient’s (pts) risk that depends on histotype,...

Background: Liposarcoma (LS) is the most common histological type of sarcoma. There are five subtypes (well differentiated, myxoid, dedifferentiated, pleomorphic, mixed type). Material and methods: Description of the case of a patient with anemia, pain and swelling in the left flank by LS abdominal conditioning. Results: A 59 year-old Portuguese female with history of gastric sleeve, 1 year ago, was admitted with throbbing pain in the right flank associated with distention and swelling bulky for 1 month of evolution. Reported nausea, asthenia and anorexia. Previous analysis revealed haemoglobin of 7.2 mg/dl. After admission and red blood cell transfusion, abdominal tomography does reveal a large mass (25 12cm) adjacent to the anastomosis. The deterioration of the patient’s condition lead to excision of abdominal mass adherent to the spleen (splenectomy block), whose history revealed pleomorfic liposarcoma. Postoperative pancreatic fistula has treated conservatively. Asymptomatic at the time discharge. In oncology where it is decided not to radiotherapy or chemotherapy. Conclusions: The LS grows slowly and it’s diagnosed only when it becomes larger. The recommended treatment is complete resection even if necessary adjacent organs. Radiotherapy or chemotherapy is not effective in increasing survival. No conflict of interest.

The authors report their experience with short- and medium-term microdiskectomy for the treatment of lumbar disc herniation. It is based on 760 operations performed between 1985 and July 1999: expulsed hernias and those of large size with intense pain symptoms and/or neurologic deficit were treated. During the same period of time, the authors used enzymatic and percutaneous nucleolysis according to Onik for smaller hernias. The incidence of satisfactory results was high (90.1%), in agreement with the results published in the literature. There was a low incidence of complications (4.6%), and of these 2.8% had a benign spontaneous evolution; 1% was prevented during surgery, 0.5% was prevented with subsequent surgery, while only 0.2% was the cause of definitive failure. Unsatisfactory results were constituted by the sequelae of complications (1 discitis, 4 liquoral cysts, 1 error in level not diagnosed intraoperatively), stenosis of the lateral recess not diagnosed pre- or intraoperatively, and thus not treated; in 6.1% of cases there was no plausible justification. The microsurgical technique above all reduces the duration of hospitalization (5 days on the average, but with 91% of cases dismissed on day 3), and allows for a rapid return to work activity (after 63 days for patients who are not employees, but with a return after 20 days in 95% of cases).

Com o intuito de estudar a atividade eletrencefalográfica em vigilia da demência senil de tipo Alzheimer (DA) e da doença de Parkinson (DP) foi iniciado estudo prospectivo e controlado. Foram comparados 6 pacientes com DA e 11 pacientes com DP, com um grupo controle composto por 12 pacientes com depressão maior crônica leve a moderada (DSM-III-R, 1987). Nos três grupos, através de análise espectral, foi obtida a mediana da frequência da energia da atividade dominante posterior. O grupo controle apresentou atividade posterior com frequência de 8,79 ± 0,52 (m±dp). No grupo com DA este valor foi 6,65 ± 0,80 (m±dp) e no grupo com DP 7,69± 1,39 (m±dp). A hipótese experimental de que pacientes com DA e DP diferem dos controles em relação à atividade de fundo (definida como anormal sendo

In order to evaluate the EEG activity during wakefulness in senile dementia of the Alzheimer type (AD) and Parkinson's disease (PD), a prospective controlled study was performed. We compared 6 AD and 11 PD patients with a control group of 12 patients with mild to moderate major chronic depression (DSM-III-R, 1987). The median of the frequencies and the power of the posterior dominant activity was obtained in the three groups using spectral analysis. The posterior activity had a frequency of 8.79 +/- 0.52 (mean +/- sd) in the control group, 6.65 +/- 0.80 (mean +/- sd) in the AD group and 7.69 +/- 1.39 (mean +/- sd) in the PD group. The experimental hypothesis that patients with AD and PD differ from controls in relation to the background activity (defined as abnormal8) was confirmed by the chi square test (p = 0.01) and the t test showed that the mean of the frequency of the posterior power was significantly lower in AD (p = 0.01) and PD (p = 0.05) patients, compared with the controls. The results indicate that this abnormality could be correlated with the degree of cortical damage and natural history of these disorders.

10086 Background: Neoadjuvant chemotherapy (NACT) has a well established role in multidisciplinary treatment of soft tissue sarcomas (STS). Unfortunately no sure predictive factors have been identified in order to screen those patients who are going to benefit from NACT. Topoisomerase IIα (topo IIα) is a positive target for anthracyclines. Bcl-2 is a molecular target for alchilants. P-glycoprotein gp170 is a member of multidrug resistance (MDR) complex. This study aimed to evaluate if topo IIα, gp170, bcl-2, tumor burden and histology could predict the response to NACT in locally advanced STS of the extremities. Methods: Twenty-nine patients with STS of the extremities (median age 61 yrs, range 35-82) received a median of 3 cycles of Epirubicine and Ifosfamide as NACT. Topo IIα, gp170, bcl-2 were assessed by IHC either on pre-treatment biopsies and on post-treatment surgical specimens. Bioptical specimens were categorized in low and high expression according to a cut-off corresponding to the median value ...