Total retroperitoneal en bloc resection of multivisceral-peritoneal packet (TROMP operation): a novel surgical technique for advanced ovarian cancer

BACKGROUND

A Total Retroperitoneal en bloc resection Of Multivisceral-Peritoneal packet (TROMP operation) is a no-touch isolation technique in a retroperitoneal space to resect the parietal peritoneum and the affected organs in advanced ovarian cancer. The study prescribed and analysed the results of this novel technique for primary cytoreductive surgery.

METHODS

The study included 208 patients operated between January 2015 and December 2017 in Charité, Berlin. The TROMP operation was performed in 58 patients, whereas the other 150 patients were operated with the conventional cytoreductive method.

RESULTS

The complete tumor resection rate accounts for 87.9% in TROMP group and 61.3% in the conventional surgery group. (p=0.001). This difference was even stronger in the sub-group of very advanced stages (T3c+T4) (85.1% of TROMP group and in only 53.1% in the conventional surgery group, p=0.001). The duration of the primary cytoreductive surgery was about 33 minutes shorter in TROMP group (median: 335 minutes vs 368 minutes; TROMP vs conventional, respectively) in spite of the fact that the most advanced cytoreductive procedures were performed statically significant more in TROMP operation arm in comparison with the conventional surgery arm. There was no statistically significant difference between the groups regarding the postoperative complication, blood loss or the length of stay in intensive care unit.

CONCLUSION

Total retroperitoneal en bloc resection of multivisceral-peritoneal packet (TROMP operation) is a feasible and very effective technique of surgical therapy in advanced ovarian cancer. This technique increased the complete tumor resection rate to 87.9% without increasing the blood loss, postoperative complications or the duration of surgery. A prospective randomized study is advised to validate these results.

Nerve Sparing Radical Hysterectomy: Short-Term Oncologic, Surgical, and Functional Outcomes

There is an obvious prevalence of disparity in opinions concerning the technique of nerve-sparing radical hysterectomy and its application, despite agreement on the need to spare the pelvic autonomic nerve system during such a radical operation. Understanding the precise three-dimensional anatomy of paracolpium and its close anatomical relationship to the components of the pelvic autonomic nervous system is the key in performing the nerve-sparing radical hysterectomy. A total of 42 consecutive patients with primary cervical cancers, who were operated upon in our institution between January 2017 and June 2019, were analyzed, concerning surgical, urinary functional, and short-term oncologic outcomes. Two thirds of the patients had locally advanced tumors (T > 40 mm or pT ≥ IIA2) with a median tumor size of 44.1 mm. The nerve-sparing radical hysterectomy was combined with the complete recovery of bladder function in 90% of patients directly after surgery and in 97% of patients in the first 2 weeks. The recurrence rate in a median follow-up time of 18 months was 9.5%. The nerve-sparing radical hysterectomy approach, which depends on the comprehensive understanding of the precise entire anatomy of paracolpium, was found to be feasible and applicable, even in locally advanced tumors, with good functional results and convincing short-term oncologic outcomes.

A Comprehensive Study of Hydrolyzed Polyacrylamide as a Binder for Silicon Anodes

Silicon anodes have a high theoretical capacity for lithium storage, but current composite electrode formulations are not sufficiently stable under long-term electrochemical cycling. The choice of polymeric binder has been shown to impact stability and capacity of silicon anodes for electrochemical energy storage. While several promising polymeric binders have been identified, there is a knowledge gap in how various physicochemical properties-including adhesion, mechanical integrity, and ion diffusion-impact electrochemical stability and performance. In this work, we comprehensively investigate the physical properties and performance of a molecular-weight series (3-20 × 10⁶ g/mol) of partially hydrolyzed polyacrylamide (HPAM) in silicon anodes. We quantify the mechanical strength, electrolyte uptake, adhesion to silicon, copper, and carbon, as well as electrochemical performance and stability and find that HPAM satisfies many of the properties generally believed to be favorable, including good adhesion, high strength, and electrochemical stability. HPAM does not show any electrolyte uptake regardless of any molecular weight studied, and thin films of mid- and high-molecular-weight HPAM on silicon surfaces suppress lithiation of silicon. The resulting composite electrodes exhibit an electrochemical storage capacity greater than 3000 mAh/g initially and 1639 mAh/g after 100 cycles. We attribute capacity fade to failure of mechanical properties of the binder or an excess of the solid electrolyte interphase layer being formed at the Si surface. While the highest-molecular-weight sample was expected to perform the best given its stronger adhesion and bulk mechanical properties, we found that HPAM of moderate molecular weight performed the best. We attribute this to a trade-off in mechanical strength and uniformity of the resulting electrode. This work demonstrates promising performance of a low-cost polymer as a binder for Si anodes and provides insight into the physical and chemical properties that influence binder performance.

AGR - 3 Socially Responsible Neuropsychology (SRN) in Action: Navigating Relevant Socio-Cultural and Educational Factors in Frontotemporal Dementia

Objective

Socio-cultural factors obscure diagnostic specificity for neurodegenerative disorders, particularly among minority or foreign-born patients with limited access to education. Our objective with the following case presentation is to illustrate the utility of a Socially Responsible Neuropsychology (SRN) model in guiding clinical practice through the comprehensive incorporation of significant, yet common, socio-cultural factors throughout the neuropsychological assessment.

Method

The present case involved a 79-year-old Spanish-speaking Mexican woman with two years of education, who underwent two serial neuropsychological assessments, as well as, structural/functional neuroimaging to monitor acute onset of telegraphic speech following the kidnapping of her husband. The SRN model guided clinical decision-making in understanding the onset and progression of symptoms within the context of medical-psychiatric comorbidities intertwined with socio-cultural and educational factors.

Results

Mild vascular neurocognitive disorder and complicated grief were the initial diagnostic impressions as supported by structural neuroimaging. Neuropsychological assessment over time, however, revealed progressive global cognitive decline whereas psychiatric symptomatology remained stable. In the presence of equivocal converging evidence from available neuroimaging studies (PET vs MRI), strong suspicion for the language variant of frontotemporal neurocognitive disorder was considered given the onset and progressive decline of expressive/receptive language, executive and memory abilities, and qualitative evidence for progressive behavioral disihibition.

Conclusion

Telegraphic speech in an elderly Latina woman that initially appeared most consistent with vascular neurocognitive disorder in the context of complex trauma with possible conversion disorder, was deemed most consistent with a neurodegenerative process after careful consideration of the time course and evolution of the neurocognitive profile over time within an SRN model.

C-14 Socially Responsible Neuropsychology (SRN) in Action: Assessment of a Highly Educated Bilingual Latina Older Adult

Objective

Early identification of cognitive symptoms pathognomonic of Alzheimer’s disease (AD) in highly educated bilingual adults remains challenging. We present a clinical case illustrating the application of an SRN model in a 70-year-old highly educated, balanced bilingual Latina eventually diagnosed with moderate-severe stages of AD following an event of severe confusion and disorientation.

Method

An SRN model was applied to promote equitable care through evidence-based consideration of cognitive aging-reserve and its putative manifestation in neurodegenerative disorders. The patient underwent a neuropsychological assessment and structural/functional neuroimaging. Her educational background, linguistic proficiencies, acculturation level, social/behavioral comportment, and limitations in available neuropsychological tools/norms were integrated to reflect the complexity in conducting a reliable bilingual assessment and formulating differential diagnoses.

Results

The SRN model guided clinical decision-making to determine the appropriate target language for bilingual assessment, and to identify reliable normative anchors of impairment relative to premorbid estimates, resulting in incorporation of validated Spanish measures/norms. Neuroimaging revealed bilateral parietal-temporal hypometabolism, which was generally consistent with neuropsychological findings, and the patient was diagnosed with major neurocognitive disorder due to AD.

Conclusions

Given the advanced nature of this patient’s cognitive decline by the time of assessment, it was hypothesized that the combination of bilingualism and high education further masked the precipitous decline atypically observed in AD individuals with high cognitive reserve. Cognitive reserve theories, nonetheless, continue to be anchored strictly within a monocultural-monolingual framework. This complex case, therefore, highlights the urgent need to incorporate bilingualism in current models of cognitive reserve to boost sensitivity in detecting early expression of bilingual AD.

Tilted-potential photonic crystal cavities for integrated quantum photonics

We propose and investigate a new type of photonic crystal (PhC) cavity for integrated quantum photonics, which provides tailored optical modes with both confined and extended spatial components. The structures consist of elongated PhC cavities in which the effective index of refraction is varied quasi-linearly along their axis, implemented by systematic lateral shifts of the PhC holes. The confined modes have approximately Airy-function envelopes, exhibiting single peaks and extended tails, which is useful for optimizing single photon extraction and transmission in integrated quantum photonic devices. The measured spectrally resolved near-field patterns of such devices show the expected spatial and resonance wavelength behavior, in agreement with numerical simulations of the Airy-Bloch modes. The effects of fabrication-induced disorder on the mode features are also analyzed and discussed. Selective excitation of specific Airy-Bloch modes using integrated, site-controlled quantum dots as localized light sources is demonstrated. Based on the tilted-potential cavity, multiple-QD single photon emitters exploiting wavelength division multiplexing are proposed.

Ovarian cancer relapse: From the latest scientific evidence to the best practice

Ovarian cancer (OC) is the fifth most common cause of cancer death in women worldwide. Despite treatment options have continued to improve in recent years, the recurrence rate is still high; in fact around 80% of patients relapses within 18 months. Recently, the scientific landscape is agree in asserting that the ovarian cancer is not a single disease but the outcome of patients depends from the molecular and biological characterization of tumor tissue. In this scenario, molecular targeted therapy given alone or in combination with chemotherapy is showing significant results. We review the different options for the treatment of ovarian cancer recurrence, including the role of surgery, in order to try outlining a possible treatment algorithm evaluating the recent scientific literature and the most important trials.

Assessing HPV vaccination perceptions with online social media in Italy

OBJECTIVE

Because of the widespread availability of the internet and social media, people often collect and disseminate news online making it important to understand the underlying mechanisms to steer promotional strategies in healthcare. The aim of this study is to analyze perceptions regarding the human papillomavirus (HPV) vaccine in Italy.

METHODS

From August 2015 to July 2016, articles, news, posts, and tweets were collected from social networks, posts on forums, blogs, and pictures about HPV. Using other keywords and specific semantic rules, we selected conversations presenting the negative or positive perceptions of HPV. We divided them into subgroups depending on the website, publication date, authors, main theme, and transmission modality.

RESULTS

Most conversations occurred on social networks. Of all the conversations regarding HPV, more than 50% were about vaccination. With regard to conversations exclusively on the HPV vaccine, 47%, 32%, and 21% were positive, negative and neutral, respectively. Only 9% of the conversations mentioned the vaccine trade name and, in these conversations, perception was almost always negative. We observed many peaks in positive conversation trends compared with negative trends. The peaks were related to the web dissemination of particular news regarding HPV vaccination.

CONCLUSIONS

In this study we have shown how mass media influences the diffusion of both negative and positive perceptions about HPV vaccines and suggest better ways to inform people about the importance of HPV vaccination.

197 Effect of follicle-stimulating hormone administered during different time intervals in superovulation protocols in beef cattle

Multiple ovulation and embryo transfer (MOET) is a biotechnology widely used for genetic improvement in cattle; however, there is great variability in donor response. Differences between management, genotype, environmental conditions, among other factors, can affect MOET results. The traditional protocols consist of 8 twice-daily FSH applications in decreasing dosages over 4 days. Reducing donor handling during MOET is an alternative for embryo production. The aim of this research was to evaluate a simplified protocol, testing single daily administrations of FSH over 4 days, without modifying the total dose calculated for treatment. The study was conducted in northern Mexico. Beef cattle donors (n=30) were used, 15 with control treatment (CT) and 15 with simplified treatment (ST). All donors were examined beforehand, focusing on the reproductive tract and body score condition, i.e. 5 to 7 (scale of 1-9). Intravaginal devices (IVD) Dispocel Max (Von Franken, Buenos Aires, Argentina) with 1.2g of progesterone were inserted and 2.5mg of oestradiol benzoate (Internacional Prode, Mexico) IM was applied on Day 0; FSH (Folltropin-V, Vetoquinol, Lure, France), applications were started on day 4. For CT, the FSH administration was done twice daily (at a 12-h interval), in 8 decreasing doses, and 150µg of D-cloprostenol (D-CLO; Prostagenol-D, International Prode, Guadalajara, Mexico) was administered IM in the morning and afternoon of Day 6. In the ST, donors were treated with once-daily injections of decreasing doses of FSH over 4 days, and 150µg of D-CLO was administered IM on Days 6 and 7. The IVD were removed on Day 7 and oestrus was detected using heat detection patches. Artificial insemination was performed using conventional frozen semen at 12, 20, and, in case of persistent heat, 30h after oestrus detection. Embryo collection was performed 7 days after insemination. The ovarian response was assessed by counting the corpora lutea (CL) detected by ultrasound. Embryo collection was performed by closed method. Analysis of variance was used with the GLM procedure in SAS software (version 9.3; SAS Institute Inc., Cary, NC, USA), to evaluate the results of ST compared with CT (α-level=0.05). The cattle breed and ranch identification were considered in the analyses. The number of CL in ST and CT was 6.8±1.6 and 8.8±1.5, respectively. The number of oocytes/embryos recovered in ST and CT were 7.3±3.0 and 11.4±2.7, respectively. The number of viable embryos (transferred or frozen) in ST and CT were 2.6±1.7 and 4.7±1.6, respectively. The number of unfertilized oocytes were 2.8±1.5 in ST and 4.2±1.3 in CT. The number of degenerated embryos in the ST were 2.0±1.1 and 1.0±1.0 in the CT. There were no significant differences between groups (P>0.05) for all variables analysed. Although the number of transferable embryos was numerically higher in the CT group, differences were not significant. Nevertheless, ST can be an alternative superovulation protocol, because working once a day saves time and facilitates the implementation of the MOET technique.

Lithium effect on the electronic properties of porous silicon for energy storage applications: a DFT study

Theoretical studies on the effect of Li on the electronic properties of porous silicon are still scarce; these studies could help us in the development of Li-ion batteries of this material which overcomes some limitations that bulk silicon has. In this work, the effect of interstitial and surface Li on the electronic properties of porous Si is studied using the first-principles density functional theory approach and the generalised gradient approximation. The pores are modeled by removing columns of atoms of an otherwise perfect Si crystal, dangling bonds of all surfaces are passivated with H atoms, and then Li is inserted on interstitial positions on the pore wall and compared with the replacement of H atoms with Li. The results show that the interstitial Li creates effects similar to n-type doping where the Fermi level is shifted towards the conduction band with band crossings of the said level thus acquiring metallic characteristics. The surface Li introduces trap-like states in the electronic band structures which increase as the number of Li atom increases with a tendency to become metallic. These results could be important for the application of porous Si nanostructures in Li-ion batteries technology.

Carbon monoxide sensing properties of B-, Al- and Ga-doped Si nanowires

Silicon nanowires (SiNWs) are considered as potential chemical sensors due to their large surface-to-volume ratio and their possible integration into arrays for nanotechnological applications. Detection of harmful gases like CO has been experimentally demonstrated, however, the influence of doping on the sensing capacity of SiNWs has not yet been reported. For this work, we theoretically studied the surface adsorption of a CO molecule on hydrogen-passivated SiNWs grown along the [111] crystallographic direction and compared it with the adsorption of other molecules such as NO, and O₂. Three nanowire diameters and three dopant elements (B, Al and Ga) were considered, and calculations were done within the density functional theory framework. The results indicate that CO molecules are more strongly adsorbed on the doped SiNW than on the pristine SiNW. The following trend was observed for the CO adsorption energies: E _A[B-doped] > E _A[Al-doped] > E _A[Ga-doped] > E _A[undoped], for all diameters. The electronic charge transfers between the SiNWs and the adsorbed CO were estimated by using a Voronoi population analysis. The CO adsorbed onto the undoped SiNWs has an electron-acceptor character, while the CO adsorbed onto the B-, Al-, and Ga-doped SiNWs exhibits an electron-donor character. Comparing these results with the ones obtained for the NO and O₂ adsorption, the larger CO adsorption energy on B-doped SiNWs indicates their good selectivity towards CO. These results suggest that SiNW-based sensors of toxic gases could represent a clear and advantageous application of nanotechnology in the improvement of human quality of life.

Lithium effects on the mechanical and electronic properties of germanium nanowires

Semiconductor nanowire arrays promise rapid development of a new generation of lithium (Li) batteries because they can store more Li atoms than conventional crystals due to their large surface areas. During the charge-discharge process, the electrodes experience internal stresses that fatigue the material and limit the useful life of the battery. The theoretical study of electronic and mechanical properties of lithiated nanowire arrays allows the designing of electrode materials that could improve battery performance. In this work, we present a density functional theory study of the electronic band structure, formation energy, binding energy, and Young's modulus (Y) of hydrogen passivated germanium nanowires (H-GeNWs) grown along the [111] and [001] crystallographic directions with surface and interstitial Li atoms. The results show that the germanium nanowires (GeNWs) with surface Li atoms maintain their semiconducting behavior but their energy gap size decreases when the Li concentration grows. In contrast, the GeNWs can have semiconductor or metallic behavior depending on the concentration of the interstitial Li atoms. On the other hand, Y is an indicator of the structural changes that GeNWs suffer due to the concentration of Li atoms. For surface Li atoms, Y stays almost constant, whereas for interstitial Li atoms, the Y values indicate important structural changes in the GeNWs.

Physiological and ultrastructural characterisation of a desiccation-tolerant filmy fern, Hymenophyllum caudiculatum: Influence of translational regulation and ABA on recovery

The filmy fern Hymenophyllum caudiculatum can lose 60% of its relative water content, remain dry for some time and recover 88% of photochemical efficiency after 30 min of rehydration. Little is known about the protective strategies and regulation of the cellular rehydration process in this filmy fern species. The aim of this study was to characterise the filmy fern ultrastructure during a desiccation-rehydration cycle, and measure the physiological effects of transcription/translation inhibitors and ABA during desiccation recovery. Confocal and transmission electron microscopy were used to compare changes in structure during fast or slow desiccation. Transcription (actinomycin D) and translation (cycloheximide) inhibitors and ABA were used to compare photochemical efficiency during desiccation recovery. Cell structure was conserved during slow desiccation and rehydration, constitutive properties of the cell wall, allowing invagination and folding of the membranes and an important change in chloroplast size. The use of a translational inhibitor impeded recovery of photochemical efficiency during the first 80 min of rehydration, but the transcriptional inhibitor had no effect. Exogenous ABA delayed photochemical inactivation, and endogenous ABA levels decreased during desiccation and rehydration. Frond curling and chloroplast movements are possible strategies to avoid photodamage. Constitutive membrane plasticity and rapid cellular repair can be adaptations evolved to tolerate a rapid recovery during rehydration. Further research is required to explore the importance of existing mRNAs during the first minutes of recovery, and ABA function during desiccation of H. caudiculatum.

Anterior colporrhaphy plus inside-out tension-free vaginal tape for associated stress urinary incontinence and cystocele: 10-year follow up results

AIMS

We report the success rate and complications rate of combined ultralateral anterior Colporrhaphy plus Tension-free Vaginal Tape (TVT-O) in a long-term (10 year) follow-up prospective survey.

METHODS

Patients previously treated for associated stress urinary incontinence (SUI) and cystocele were subjected to annual follow-up for 10 year with a complete urogynecologic evaluation. Furthermore, an urodynamic assessment and a quality of life questionnaire (ICIQ-UI SF) were recorded at the 5th and 10th year of follow up.

RESULTS

Fifty patients treated between June 2004 and May 2006 were included in the analysis. Five patients did not return to 5-yr follow-up: two patients developed a median tape erosion and three patients withdraw. At 10-yr follow-up two more patients withdraw for a total of seven patients lost to follow-up. After 10 years patients objectively cured from cystocele were 41 (95%) while patients objectively cured from SUI were 39 (91%). At 10th year follow-up 38 patients (89%) result cured from both SUI and cystocele, 3 (7%) patients result cured only from prolapse, 1 (2%) patient only from SUI, and 1 (2%) patient result objectively failed for both SUI and cystocele. The ICIQ-UI SF scores at 10th year follow-up was 6.2 ± 3.7. The late complication rate at 10th year follow-up was 32% (OAB symptoms 20%; Mixed incontinence 2%; Bladder outlet obstruction 0%; Dyspareunia 6%; Chronic pelvic pain 0%; Vaginal tape erosion 4%; Detrusor hyperactivity 0%).

CONCLUSIONS

The combined procedures shown proved to be an effective and safe procedure to treat concomitant SUI and cystocele.