The INTERNATIONAL MISSION study: minimally invasive surgery in ovarian neoplasms after neoadjuvant chemotherapy.

OBJECTIVES: The aim of this retrospective multicenter study was to investigate the extent, feasibility, and outcomes of minimally invasive surgery at the time of interval debulking surgery in different gynecological cancer centers. METHODS/MATERIALS: In December 2016, 20 gynecological cancer centers were contacted by e-mail, to participate in the INTERNATIONAL MISSION study. Seven centers confirmed and five were included, with a total of 127 patients diagnosed with advanced epithelial ovarian cancer after neoadjuvant chemotherapy and minimally invasive interval surgery. Only women with a minimum follow-up time of 6 months from interval surgery or any cancer-related event before 6 months were included in the survival analysis. Baseline characteristics, chemotherapy, and operative data were evaluated. Survival analysis was evaluated using the Kaplan-Meier method. RESULTS : All patients had optimal cytoreduction at the time of interval surgery: among them, 122 (96.1%) patients had no residual tumor. Median operative time was 225 min (range 60 - 600) and median estimated blood loss was 100 mL (range 70 - 1320). Median time to discharge was 2 days (1-33) and estimated median time to start chemotherapy was 20 days (range 15 - 60). Six (4.7%) patients experienced intraoperative complications, with one patient experiencing two serious complications (bowel and bladder injury at the same time). There were six (4.7%) patients with postoperative short-term complications: among them, three patients had severe complications. The conversion rate to laparotomy was 3.9 %. Median follow-up time was 37 months (range 7 - 86): 74 of 127 patients recurred (58.3%) and 31 (24.4%) patients died from disease. Median progression-free survival was 23 months and survival at 5 years was 52 % (95% CI: 35 to 67). CONCLUSIONS: Minimally invasive surgery may be considered for the management of patients with advanced ovarian cancer who have undergone neoadjuvant chemotherapy, when surgery is limited to low-complexity standard cytoreductive procedures.

4K versus 3D total laparoscopic hysterectomy by resident in training: a prospective randomised trial.

Background: The introduction of ultra-high-definition laparoscopic cameras (4K), by providing stronger monocular depth perception, could challenge the existing 3D technology. There are few available studies on this topic, especially in gynaecological setting. Objectives: Prospective, single institution, randomised clinical trial (NCT04209036). Materials and Methods: The two laparoscopes utilised were the 0°ULTRA Telescopes with 4K technology and the 0°3D-HD by Olympus. The surgeons were all trainees and in their last year of residency and who had obtained the certificate of first or second level of the Gynaecological Endoscopic Surgical Education and Assessment program - GESEA program. Twenty-nine patients with benign uterine pathology were enrolled. Main outcome measures: To compare if the use three-dimensional (3D) versus ultra-high-definition laparoscopic vision system (4K) for total laparoscopic hysterectomy performed by trainees was associated with a shorter operative time. Results: The 3D vision system did not prove to be superior to the 4K vision system. Operators reported significantly more vision-related side effects when using 3D than 4K. Completing the GESEA training program was the only factor with a positive and statistically significant impact on the overall time of the procedure, especially when greater dexterity and tissue handling were required. Conclusions: Neither technology used proved superior to the other, although operators showed a preference for 4K over 3D due to the lower number of visual side effects. Attendance at courses on laparoscopic simulators and training programs allowed trainees to demonstrate excellent surgical skills.

Mechanistic insights into the formation of polyion complex aggregates from cationic thermoresponsive diblock copolymers.

HYPOTHESIS: The formation of polyion complexes (PICs) comprising thermoresponsive polymers is intended to result in the formation of aggregates that undergo significant structural changes with temperature. Moreover the observed modifications might be critically affected by polymer structure and PICs composition. EXPERIMENTS: Different block copolymers based on cationic poly(3-acrylamidopropyltrimethylammonium chloride) and thermoresponsive poly(N-isopropylacrylamide) were synthesized by aqueous RAFT/MADIX polymerization at room temperature. Addition of poly(acrylic acid) in a controlled fashion led to the formation of PICs aggregates. The structural changes induced by temperature were characterized by differential scanning calorimetry, Nuclear Magnetic Resonance spectroscopy and scattering methods. FINDINGS: Thermoresponsive PICs undergo significant structural changes when increasing temperature above the cloud point of the thermoresponsive block. The reversibility of these phenomena depends strongly on the structural parameters of the block copolymers and on PICs composition.

Raster microdiffraction with synchrotron radiation of hydrated biopolymers with nanometre step-resolution: case study of starch granules.

X-ray radiation damage propagation is explored for hydrated starch granules in order to reduce the step resolution in raster-microdiffraction experiments to the nanometre range. Radiation damage was induced by synchrotron radiation microbeams of 5, 1 and 0.3 µm size with ∼0.1 nm wavelength in B-type potato, Canna edulis and Phajus grandifolius starch granules. A total loss of crystallinity of granules immersed in water was found at a dose of ∼1.3 photons nm(-3). The temperature dependence of radiation damage suggests that primary radiation damage prevails up to about 120 K while secondary radiation damage becomes effective at higher temperatures. Primary radiation damage remains confined to the beam track at 100 K. Propagation of radiation damage beyond the beam track at room temperature is assumed to be due to reactive species generated principally by water radiolysis induced by photoelectrons. By careful dose selection during data collection, raster scans with 500 nm step-resolution could be performed for granules immersed in water.

Correlation between structure and rheology of a model colloidal glass.

The microstructure and rheological properties of a model colloidal system was probed in the vicinity of the glass transition by small-angle and ultra small-angle x-ray scattering, dynamic light scattering (DLS) and bulk rheology. The volume fraction of the particles was deduced by modeling the structure factor and the absolute scattered intensity in a self-consistent way. The glass transition (phi(G)) was identified from the frequency dependence of the shear moduli in the linear regime. The experimentally observed behavior was then compared with the viscoelastic properties derived from mode-coupling theory (MCT) using the experimental structure factor as input to the theory. The ensemble-averaged intermediate scattering functions from DLS measurements were also compared with those calculated from the MCT and reasonable agreement was obtained.

Expanding the Living Donor Pool "Second Act": Laparoscopic Donor Nephrectomy and ABO-Incompatible Kidney Transplantation Improve Donor Recruitment.

BACKGROUND: To safely expand our living donor pool, we recently decided to work on 3 areas: analysis of causes of exclusion of potential donors, the results of which we recently published, introduction of laparoscopic donor nephrectomy (LDN), and ABO-incompatible (ABOi) transplantation. We sought to determine the impact of the new strategy on living donor recruitment and transplantation during over a 10-year period at a single institution. METHODS: From January 2005 to September 2014, we evaluated 131 living donors. Of these, 80 (61%) were genetically related, 51 (39%) unrelated, 119 (91%) ABO compatible (ABOc), 12 ABOi (9%). The analysis was divided into 2 eras: era 1, 2005-2010 (n = 53) included the use of open lumbotomy and acceptance of ABOc only; and era 2, 2011-2014 (n = 78), which saw the introduction of LDN and ABOi transplantation. RESULTS: Forty-five (34%) potential candidates successfully donated, 67 (51%) were excluded, and 19 (15%) were actively undergoing evaluation. Overall, 53 potential donors were evaluated in era 1 (8.8 donors/year), 78 in era 2 (19.5 donors/year). There were fewer excluded donors in era 2 vs era 1 (62% era 1 vs 44% era 2), and living donor kidney transplantation (LDKT) significantly increased in era 2 vs era 1 (3.3/year era 1 vs 7.1/year era 2). The establishment of an ABOi LDKT program led to a 15% increase of evaluations in era 2 (12/78 donors). CONCLUSIONS: LDN along with ABOi LDKT allowed for an improvement in recruitment of living donors and corresponding LDKT.

Liquid crystalline polymer-Co nanorod hybrids: structural analysis and response to a magnetic field.

This work deals with the structural analysis of side-chain liquid crystalline polysiloxanes, doped with magnetic cobalt nanorods, and their orientational properties under a magnetic field. These new materials exhibit the original combination of orientational behavior and ferromagnetic properties at room temperature. Here we show that, within the liquid crystal polymer matrix, the cobalt nanorods self-assemble in bundles made of nanorod rows packed in a 2-dimensional hexagonal lattice. This structure accounts for the magnetic properties of the composites. The magnetic and orientational properties are discussed with respect to the nature of the polymer matrix.

[Fibroma of the tendon sheath. Description of a case]. / Fibroma delle guaine tendinee. Descrizione di un caso.

One case of fibroma of tendon sheath is described. This tumor is a distinct entity with a characteristic location and histological appearance. The lesion must be distinguished from giant cell tumor of tendon sheath, nodular fasciitis and fibrous histiocytoma. Recurrence rate is 24%. Local excision is the treatment of choice for primary and recurrent lesions.