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ObjectivesThe 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/MaterialsIn 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).ConclusionsMinimally 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.

The aim of this study was to examine the determinants of successful and unsuccessful fast-break (FB) actions in elite and sub-elite basketball games. Fifteen 1 -division (elite) and fifteen 3 -division (sub-elite) Italian men's championship games were analysed across two seasons (2012/2013 and 2013/2014). A binary logistic regression analysis was performed, and the fast-break outcome (successful vs. unsuccessful) was adopted as the dependent variable separately in both elite and sub-elite games. FB execution (initiation, advance and completion phases), typology (primary and secondary break) and the number of players involved (equal number or superiority) were used as independent variables. The results showed that the rate of success of FB actions was 63.5% and 59.7% in elite and sub-elite games, respectively. Moreover, successful FBs were more likely to be completed in the lane in relation to unsuccessful ones in both elite and sub-elite games (p<0.05). Finally, descriptive statistics showed that both elite and sub-elite teams executed FBs similarly. This study highlighted that completion zone was the only predictor of a successful fast break in basketball, while the typology and number of players involved did not predict fast break effectiveness. Moreover, elite and sub-elite teams executed fast break actions similarly. These findings might be useful for basketball coaches to optimize the training of FB actions.

Metal Additive Manufacturing (MAM) is a non-traditional technology recently introduced to manufacture multifunctional mechanical components. In fact, recent developments in Laser Powder Bed Fusion (LPBF) process have enabled the production of materials characterized by high density and high thermal conductivity properties, such as copper alloys and pure copper, making the technology attractive for thermal science. In nuclear fusion energy applications, mechanical components often encounter extremely high heat fluxes. An innovative solution using unconventional integrated cooling channels is therefore required to safely manage the components. However, the high surface roughness in 3D-printed parts represents an intrinsic limitation of the LPBF technology: the cooling channels show high-pressure drops due to the high viscous dissipation generated by the rough surface. To address this challenge, a lab-scale prototype of an e-beam extraction grid for a fusion experiment with an original integrated cooling system was designed and manufactured. Additionally, a novel heating mask was designed and manufactured to reproduce the realistic heat load distribution on the grid during the experimental tests. The prototype was built using additive manufacturing with a CuCrZr copper alloy. The grid underwent heat treatment via solution annealing and age hardening, to increase thermal conductivity from about 100 W m −1 K −1 to almost 300 W m −1 K −1 . The prototype was tested at three different constant heat fluxes by varying the water flow rate while measuring the pressure and the maximum temperatures of the grid. A CFD numerical model was also calibrated to estimate the thermo-hydraulic performance of the prototype under test conditions. The experimental and numerical results are presented in terms of overall thermal performance, maximum temperature, and pressure drop.

Introduction/BackgroundLymphadenectomy is an integral part of operative staging and treatment of gynaecological malignancies. Since its introduction over 25 years ago, laparoscopic lymphadenectomy has proven to be feasible, safe and oncologically adequate in comparison to open surgery while morbidity is lower and hospital stay is considerably shorter.MethodologyIn this retrospective study we analysed our prospectively collected data of laparoscopic pelvic and/or paraaortic lymphadenectomies performed between 1994 and 2018 by one team of gynaecological oncology surgeons. Data was analysed with regards to operation time, intra- and postoperative complications, number of harvested lymph nodes and influence of BMI. Previously published data of the first 650 patients treated after introduction of the method between 1994 and 2003 (period 1) was compared with the data of the latest 524 patients treated between 2014 and 2018 (period 2).ResultsIndications for pelvic and/or paraaortic lymphadenectomies in the 2535 patients were cervical cancer, endometrial cancer, vulvar cancer with positive groin nodes, early ovarian cancer, vaginal cancer, uterine carcinosarcoma and others in a number of 1893, 361, 62, 99, 28, 13 and 79 patients, respectively. The learning curve for the two procedures was already completed during the first 650 cases. Since 1999 a steady and oncologically adequate number of lymph nodes were harvested in both areas independent of patients‘ BMI. OR-time for paraaortic lymph node dissection was shorter in period 2 (69 vs 100 min). In contrast to period 1 (2.9%), there were no intraoperative complications in period 2, whereas postoperative complications are similarly frequent (5.8 vs 7.6%).ConclusionIn this large cohort of patients who underwent laparoscopic lymphadenectomy the oncological equivalency and minimal morbidity of this approach was once again demonstrated. With growing experience intraoperative complication rates can be minimised. Teaching and integration of new team members does not impair surgical results when performed under supervision.DisclosureNothing to disclose.

The microclimatic parameters (Ta, RH, E, and CO 2 ) reflect the indoor quality of the environment. Their relationship, connected with the design of the building, can facilitate the growth of photo/heterotrophic organisms and therefore facilitate the increase of the relative CO 2 production. Taking this into account, the impact of biological proliferation in a historical building is discussed for the Mithraeum of “Casa di Diana” in the archaeological site of Ostia Antica, which is subjected to guided tours. In this work, for the first time, we propose a study on biological monitoring to evaluate the contribution of bioactivity to air quality, with the objective to increase the comfort of visitors and to open the site for more than one day per week, suggesting possible tools providing a good compromise between building conservation and human comfort. In the sense, it has been possible to distinguish the contribution of the plants from the one deriving from humans: high values of carbon dioxide have been recorded during the night and its scarce removal during the day (air flow). The window present is not sufficient to eliminate the CO 2 , involving concentrations of CO 2 relatively high in comparison to the proposed limits and guidelines defined by law. The obtained results strongly encouraged the elimination of flora in order to increase the comfort of visitors and to open the house for more than one day per week. Although, this process involves an important economic effort, the present study allows making an objective decision which has an important value in a cultural heritage management. Graphical Abstract CO 2 contribute by bioactivity as damage to human health

This study aimed to analyse live and stoppage time phases, their ratio, and action played on half and full court in college basketball games. Differences were assessed for the entire games and between halves. Moreover, differences of the live/stoppage time ratio were analysed between games and game-based conditioning drills. Ten games as well as fifteen defensive, fourteen offensive and six scrimmage-type drills of the same division I men's college team (13 players) were analysed using time-motion analysis technique. Live and stoppage time were classified in five classes of duration: 1-20, 21-40, 41-60, 61-80, >80 seconds. Half court actions started and finished in the same half court. Full court actions were classified as transfer (TR) phases when at least 3 teammates crossed the mid-court line. TR phases were then classified in 5 classes of frequency: 1TR, 2TR, 3TR, 4TR, and >4TR. The results revealed no statistically significant differences between games or between halves for the considered parameters. The only significant difference was observed for live/stoppage time ratio between halves (p<0.001). Furthermore, a significant difference of the live/stoppage ratio was found between games and game-based drills (p<0.01). Post-hoc analysis demonstrated significant differences of scrimmage-type drills in comparison to games, and defensive and offensive drills (p<0.05), whereas no differences emerged for the other pairwise comparisons. The absence of differences between games in the analysed parameters might be important to characterize the model of performance in division I men's college games. Furthermore, these results encourage coaches to use game-based conditioning drills to replicate the LT/ST ratio documented during games.

Introduction/BackgroundLaparoscopic/robotic radical hysterectomy (RH) has been considered oncologically adequate to open RH for patients with early cervical cancer. However, a recent prospective randomised trial (LACC) demonstrates significant inferiority of minimally-invasive approach. Thereupon we have updated our prospective database of combined laparoscopic-vaginal RH with respect to oncologic outcome.MethodologyBetween 1994 and 2018 1952 consecutive patients with invasive cervical cancer have been treated using minimally-invasive surgery at the Universities of Jena, Charité Berlin (Campus CCM and CBF) and Cologne and Asklepios Clinic Hamburg. 389 patients with inclusion criteria identical to LACC trial were identified. In contrast to laparoscopic/robotic technique used in LACC trial all patients in our cohort underwent combined transvaginal-laparoscopic approach that does not use any uterine manipulator and comprises creation of a tumor-adapted vaginal cuff by transvaginal approach.ResultsInitial FIGO stage was IA1 LVSI+, IA2 and IB1 in 32 (8%), 43 (11%) and 314 (81%) respectively, and histology was squamous cell cancer in 263 (68%), adenocarcinoma in 117 (30%) and adenosquamous tumor in 9 (2%). LVSI was confirmed in 106 patients (27%). Median number of harvested lymph nodes was 24 (2–86). Lymph nodes were tumor-free in 379 (97%) of patients. Following radical hysterectomy 71 (18%) of patients underwent adjuvant chemoradiation (CRT) or radiation (RT). After a median follow up of 99 (1–288) months 3, 4.5 and 10-ys DFS were 96.8%, 95.8%, 93.1% and 3, 4.5 and 10-year OS were 98.5%, 97.8%, 95.8%, respectively. Recurrences were diagnosed in 50% (n=10) loco-regional. Interestingly, 9/20 recurrences occurred later than 39 months following surgery.ConclusionCombined laparoscopic-vaginal technique for RH with consequent avoidance of possible spillage and manipulation of tumor cells provides excellent oncologic outcome for patients with early cervical cancer. Our retrospective data suggest that laparoscopic-vaginal surgery respecting laparoscopic oncologic hygiene is oncologic safe and should be validated in further randomised trials.DisclosureNothing to disclose.Abstract EP384 Figure 1Use of uterine manipulator in cervical cancerAbstract EP384 Figure 2Incision of vaginal wall using uterine manipulator - tumour spillage may occure

Among cardiovascular diseases, hypertension is one of the main risk factors predisposing to fatal complications. Oxidative stress and chronic inflammation have been identified as potentially responsible for the development of endothelial damage and vascular stiffness, two of the primum movens of hypertension and cardiovascular diseases. Based on these data, we conducted an open-label randomized study, first, to evaluate the endothelial damage and vascular stiffness in hypertense patients; second, to test the effect of supplementation with a physiological antioxidant (melatonin 1 mg/day for 1 year) in patients with essential hypertension vs. hypertensive controls. Twenty-three patients of either gender were enrolled and randomized 1:1 in two groups (control and supplemented group). The plasmatic total antioxidant capacity (as a marker of oxidative stress), blood pressure, arterial stiffness, and peripheral endothelial function were evaluated at the beginning of the study and after 1 year in both groups. Our results showed that arterial stiffness improved significantly (p = 0.022) in supplemented patients. The endothelial function increased too, even if not significantly (p = 0.688), after 1 year of melatonin administration. Moreover, the supplemented group showed a significative reduction in TAC levels (p = 0.041) correlated with the improvement of arterial stiffness. These data suggest that melatonin may play an important role in reducing the serum levels of TAC and, consequently, in improving arterial stiffness.

Renin-angiotensin system (RAS) regulates adipogenic response with adipocyte hypertrophy by increasing oxidative stress. Recent studies have shown the role of peroxisome proliferator-activated receptor-δ (PPARδ) agonist in attenuation of angiotensin II-induced oxidative stress. The aim of this study was to explore a potential mechanistic link between PPARδ and the cytoprotective enzyme heme oxygenase-1 (HO-1) and to elucidate the contribution of HO-1 to the adipocyte regulatory effects of PPARδ agonism in an animal model of enhanced RAS, the Goldblatt 2 kidney 1 clip (2K1C) model. We first established a direct stimulatory effect of the PPARδ agonist (GW 501516) on the HO-1 gene by demonstrating increased luciferase activity in COS-7 cells transfected with a luciferase-HO-1 promoter construct. Sprague-Dawley rats were divided into four groups: sham-operated animals, 2K1C rats and 2K1C rats treated with GW 501516, in the absence or presence of the HO activity inhibitor, stannous mesoporphyrin (SnMP). 2K1C animals had increased visceral adiposity, adipocyte hypertrophy, increased inflammatory cytokines, increased circulatory and adipose tisssue levels of renin and Ang II along with increased adipose tissue gp91 phox expression (P<0.05) when compared with sham-operated animals. Treatment with GW 501516 increased adipose tissue HO-1 and adiponectin levels (P<0.01) along with enhancement of Wnt10b and β-catenin expression. HO-1 induction was accompanied by the decreased expression of Wnt5b, mesoderm specific transcript (mest) and C/EBPα levels and an increased number of small adipocytes (P<0.05). These effects of GW501516 were reversed in 2K1C animals exposed to SnMP (P<0.05). Taken together, our study demonstrates, for the first time, that increased levels of Ang II contribute towards adipose tissue dysregulation, which is abated by PPARδ-mediated upregulation of the heme-HO system. These findings highlight the pivotal role and symbiotic relationship of HO-1, adiponectin and PPARδ in the regulation of metabolic homeostasis in adipose tissues.