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BACKGROUND Cytoreductive surgery (CRS) and hypertermic intraperitoneal chemotherapy (HIPEC) represent the most effective strategy to manage peritoneal metastases (PM). This systematic review and meta-analysis aimed to assess the impact of body composition on clinical outcomes in patients with PM. METHODS A systematic literature search was performed using Medline, Web of Science and EMBASE databases from inception to the 20st August 2020. Data were independently extracted by 3 authors. Newcastle-Ottawa Scale was used to assess quality and risk of bias of studies. Pooled analyses were performed using Mantel-Haenszel method to estimate overall effect size with mean differences or odd ratios (ORs) and 95% confidence interval (CI). The primary outcome was postoperative complication (POC) rate, while secondary outcomes were severe POC and postoperative mortality. RESULTS A total of 4 studies were included in the systematic review and meta-analysis, including 582 patients. A significant association between low skeletal muscle mass and POC was found (OR 1.45, 95% CI 1.04 to 2.03; p = 0.03), while no differences were found in terms operative time, estimated blood loss, length of hospital stay, and postoperative mortality (p > 0.05). CONCLUSIONS Low skeletal muscle mass at diagnosis is a valid prognostic factor for POC development in colorectal and PM patients undergoing CRS. Prospective and larger studies are needed to better investigate the role of CT scan derived body composition and to understand how to implement this tool in clinical practice.

Introduction The International Thymic Malignancy Interest Group (ITMIG) classifies thymoma recurrences on the basis of the topographic location, but its effectiveness in prognosis prediction has not been well investigated yet. Aims of this study are to analyze survival outcome of patients surgically treated for thymoma recurrence according to the ITMIG recurrence classification and to investigate possible alternatives. Methods From January 1, 1990, to January 7, 2017, data on 135 surgically treated patients for thymoma recurrence from three high-volume centers were collected and retrospectively analyzed. Patients were classified according to the ITMIG classification as local, regional, and distant. The ITMIG classification and alternative classifications were correlated to overall survival (OS). Results According to the ITMIG classification, recurrence was local in 17 (12.5%), regional in 97 (71.8%), and distant in 21 (15.7%) patients, with single localization in 38 (28.2%) and multiple localizations in 97 (71.8%). The 5- and 10-year OS were 79.9% and 49.7% in local, 68.3% and 52.6% in regional, and 66.3% and 35.4% in distant recurrences, respectively, but differences were not statistically significant (p = 0.625). A significant difference in survival was present considering single versus multiple localizations: 5- and 10-year OS of 86.2% and 81.2% versus 61.3% and 31.5% (p = 0.005, hazard ratio = 7.22, 95% confidence interval: 0.147–0.740), respectively. Combining the localization number with the recurrence site, ITMIG locoregional single recurrence had a statistically significant better survival compared with patients with ITMIG locoregional multiple recurrence or ITMIG distant recurrence (p = 0.028). Similarly, a significant difference was present considering intrathoracic single versus intrathoracic multiple versus distant recurrence (p = 0.024). Conclusions The ITMIG classification for thymoma recurrence did not have significant survival differences comparing local, regional, and distant recurrences. Integrating this classification with the number of the localizations may improve its effectiveness in prognosis prediction.

Introduction The standard treatment for epithelial early stage ovarian cancer (eEOC) includes laparotomic surgical staging, according to ESGO-ESMO guidelines. In the last decade, many investigators have assessed the safety and feasibility of minimally invasive surgery (MIS) staging in properly selected patients. However, survival data related to different surgical approaches (open versus MIS) are extremely limited. The aim of this study is to analyze the long-term oncological outcomes in eEOC patients treated with MIS. Materials and methods This is a multicenter observational retrospective study conducted in two tertiary oncological centers. We selected all consecutive women who underwent a laparoscopic or robotic staging for eEOC. Results From January 2008 to December 2016, 254 eEOC patients underwent a MIS staging (188 laparoscopic staging and 66 robotic staging). Overall, 18.1% of patients were upstaged due to pathological findings. A total of 203 (79.9%) patients received platinum-based adjuvant chemotherapy. After a median follow-up of 61 months (range 13–118), 39 (15.3%) patients experienced recurrence. The 5-years progression free survival (PFS) and overall survival rates were 84.0% and 93.8%, respectively. In the univariate analysis, favorable variables influencing PFS were young age (≤45 years), non-serous histotype, tumor grade 1-2, and FIGO stage IA/IB. In the multivariate analysis, only grade 3 was shown to keep its negative independent prognostic value (HR = 3.47; p = 0.004), whereas FIGO stage ≥ IC showed a trend toward significance (HR = 1.75; p = 0.099). Conclusion This retrospective study represents the longest follow-up of eEOC patients managed by MIS. The MIS is a valuable therapeutic option in appropriately selected patients, although a randomized controlled trial is needed.

This study explored environmental variables and buildings characteristics in 22 elderly care centers (ECCs) in Portugal. Indoor environmental parameters were measured twice for a total of 141 sampling sites. Each site was assessed for PM10, PM2.5, total volatile organic compounds (TVOC), formaldehyde, CO, CO2, total bacteria and fungi. Thermal comfort (TC) parameters were measured according to ISO 7730:2005 and a building characterization was performed. The overall PM2.5 mean concentration of the 22 ECC was above international reference levels in summer and winter seasons. TVOC, bacteria, CO and CO2 showed significantly higher indoor levels compared to outdoor, in both seasons. Indoor PM10, TVOC, bacteria and CO2 present significant differences between seasons. TVOC, bacteria and CO2 show significant variation between ECC rooms and 4% of fungi samples were positive for pathogenic Aspergillus species. The winter predicted mean vote (PMV) index showed a ‘slightly cool’ thermal sensation scale which may potentiate respiratory tract infections. The predicted percent of dissatisfied people (PPD) and PMV indices show significant differences by season. The building variables ‘Insulation’, ‘Heating Ventilation’ and ‘Windows frames’ were significantly associated to chemical, biological and TC parameters. ‘Bacteria’, ‘Fungi’, ‘Temperature’, Relative Humidity’, and ‘PPD index’ are the mostly affected by building characteristics. Insulating ceilings, walls, and windows could improve winter season TC, providing health benefits to ECC residents. We are indebted to all of the participants in the GERIA Project as well as to the professionals and elderly residents in the ECCs and the authorities from which they depend. Our current research is supported by GERIA Project (www.geria.webnode.com): PTDC/SAU-SAP/116563/2010 and a PhD Grant (SFRH/BD/72399/2010) from Foundation for Science and Technology (Fundação para a Ciência e Tecnologia – FCT). SB and RM work was supported by a grant funded by AIRC (Associazione Italiana per la Ricerca sul Cancro).

Three sets of commonly used autosomal short tandem repeat (STR) markers (containing 15, 10 and 9 markers) and 14 databases from populations belonging to Africa, America, Asia and Europe were used to investigate how the selection of the population database and the number of considered markers would influence the statistical evidence that is usually produced to favour paternity. The study was based on a sample of 100 randomly chosen Finnish paternity trios collected during paternity testing case work and without any exclusion after use of 15 STR markers. Paternity index, power of evidence, typical paternity index and Random man excluded were computed and descriptive statistics were provided separately for trios (mother, child, alleged father) and duos (obtained from trios but not considering the genetic information of the mother). This was done for all combinations of markers and databases. In trio cases the differences between results obtained are not statistically significant. However, especially in duo cases the use of 15 STR markers is recommended.