Use of Laparoscopic and Laparotomic J-Plasma Handpiece in Gynecological Malignancies: Results From A Pilot Study in A Tertiary Care Center

Introduction: The J-Plasma has recently been introduced into the surgical community with different intrinsic characteristics aimed to further reduce the thermal effect and enhance precision when compared to standard radiofrequency. This study aimed to investigate the role of this new technology in different conditions of gynecological carcinomatosis characterized by the indication for regional peritonectomy and/or ablation, either in laparotomy (LPT) or in laparoscopy (LPS), in the context of a modern personalized approach to the surgical management of gynecological malignancies. Material and Methods: From January 2019 to April 2019, 12 patients were selected for this prospective pilot study at the Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome. In this single surgeon experience, the inclusion criteria were: histologically proven advanced ovarian/endometrial cancer, primary or interval debulking surgery, and intraoperative indication for regional peritonectomy. Six patients were treated by LPS (Group 1) and 6 by LPT (Group 2). Results: In Group 1 the indication for debulking surgery was in 4 cases an interval debulking surgery and 2 advanced endometrial cancer. All patients in Group 2 underwent primary debulking surgery for advanced ovarian cancer. The whole cohort achieved a complete tumor excision after surgery. The median OT and median EBL were 195 min and 100 ml in Group 1, and 420 min and 500 ml in Group 2. The median hospital stay was 4 days in Group 1 and 13 days in Group 2, respectively. No intra and postoperative complications were registered within 60 days after surgery. Conclusions: J-Plasma allows to approach delicate maneuvers on viscera, mesentery, and blood vessels with a high degree of safety and precision thanks to its limited vertical and lateral thermal spread, favoring the surgeon to push ever higher the cytoreduction/morbidity tradeoff. The use of J-Plasma in cytoreductive surgery could also increase the range of possible minimally invasive procedures, narrowing the technical distance with the open technique and thus contributing to designing a personalized surgical strategy for each patient in different scenarios of peritoneal carcinomatosis

Post Treatment Sexual Function and Quality of Life of Patients Affected by Cervical Cancer: A Systematic Review

Introduction: The aim of this study is to analyze the available scientific evidence regarding the quality of life (QoL) and sexual function (SF) in patients affected by cervical cancer (CC) after surgical and adjuvant treatments. Materials and Methods: Preliminary research was conducted via electronic database (MEDLINE, PubMed and Cochrane Library) with the use of a combination of the following keywords: SF, QoL, and CC. The principal findings considered in the present review were the study design, the number of patients included in each study, the information about the malignancy (histology and stage of disease), the questionnaires administered, and the principal findings concerning SF and QoL. Results: All studies were published between 2003–2022. The studies selected consisted of one randomized control study, seven observational studies (three prospective series), and nine case control studies. The scores used were focused on SF, QOL, fatigue, and psychological aspects. All studies reported a decreased SF and QOL. The most developed questionnaires were the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Female Sexual Function Index (FSFI), the Hospital Anxiety and Depression scale (HADS), and the Female Sexual Distress Scale (FSDS). Discussion: All studies reported a decreased SF and QOL. In addition to the perception of body image, several factors coexist in influencing the outcomes such as the physical, hormonal, psychological. Conclusions: Sexual dysfunction after CC treatment has a multifactorial aetiology which negatively affects the quality of life. For these reasons, it is important to follow and support patients with a multidisciplinary team (doctors, nurses, psychologists, dieticians) before and after therapy. This type of tailored therapeutic approach should become a standard. Women should be informed about possible vaginal changes and menopausal symptoms after surgery and on the positive effects of psychological therapy

Activity of chemotherapy in mucinous ovarian cancer with a recurrence free interval of more than 6 months: results from the SOCRATES retrospective study

<p>Abstract</p> <p>Background</p> <p>Mucinous ovarian carcinoma have a poorer prognosis compared with other histological subtypes. The aim of this study was to evaluate, retrospectively, the activity of chemotherapy in patients with platinum sensitive recurrent mucinous ovarian cancer.</p> <p>Methods</p> <p>The SOCRATES study retrospectively assessed the pattern of care of a cohort of patients with recurrent platinum-sensitive ovarian cancer observed in the years 2000–2002 in 37 Italian centres. Data were collected between April and September 2005. Patients with recurrent ovarian cancer with > 6 months of platinum free interval were considered eligible.</p> <p>Results</p> <p>Twenty patients with mucinous histotype and 388 patients with other histotypes were analyzed. At baseline, mucinous tumours differed from the others for an higher number of patients with lower tumor grading (p = 0.0056) and less advanced FIGO stage (p = 0.025). At time of recurrence, a statistically significant difference was found in performance status (worse in mucinous, p = 0.024). About 20% of patients underwent secondary cytoreduction in both groups, but a lower number of patients were optimally debulked in the mucinous group (p = 0.03). Patients with mucinous cancer received more frequently single agent platinum than platinum based-combination therapy or other non-platinum schedules as second line therapy (p = 0.026), with a response rate lower than in non-mucinous group (36.4% vs 62.6%, respectively, p = 0.04). Median time to progression and overall survival were worse for mucinous ovarian cancer. Finally, mucinous cancer received a lower number of chemotherapy lines (p = 0.0023).</p> <p>Conclusion</p> <p>This analysis shows that platinum sensitive mucinous ovarian cancer has a poor response to chemotherapy. Studies dedicated to this histological subgroup are needed.</p

Influence of eruptive style on volcanic gas emission chemistry and temperature

Gas bubbles form as magmas ascend in the crust and exsolve volatiles. These bubbles evolve chemically and physically as magma decompression and crystallization proceed. It is generally assumed that the gas remains in thermal equilibrium with the melt but the relationship between gas and melt redox state is debated. Here, using absorption spectroscopy, we report the composition of gases emitted from the lava lake of Kīlauea Volcano, Hawaii, and calculate equilibrium conditions for the gas emissions. Our observations span a transition between more and less vigorous-degassing regimes. They reveal a temperature range of up to 250 °C, and progressive oxidation of the gas, relative to solid rock buffers, with decreasing gas temperature. We suggest that these phenomena are the result of changing gas bubble size. We find that even for more viscous magmas, fast-rising bubbles can cool adiabatically, and lose the redox signature of their associated melts. This process can result in rapid changes in the abundances of redox-sensitive gas species. Gas composition is monitored at many volcanoes in support of hazard assessment but time averaging of observations can mask such variability arising from the dynamics of degassing. In addition, the observed redox decoupling between gas and melt calls for caution in using lava chemistry to infer the composition of associated volcanic gases

Halogen diffusion in a basaltic melt

The diffusion of the halogens fluorine, chlorine, and bromine was measured in a hawaiitic melt from Mt. Etna at 500 MPa and 1.0 GPa, 1250 to 1450 ºC at anhydrous conditions; the diffusion of F and Cl in the melt was also studied with about 3 wt% of dissolved water. Experiments were performed using the diffusion-couple technique in a piston cylinder. Most experiments were performed with only one halogen diffusing between the halogen-enriched and halogen-poor halves of the diffusion couple, but a few experiments with a mixture of halogens (F, Cl, Br) were also performed in order to investigate the possibility of interactions between the halogens during diffusion. Fluorine and chlorine diffusivity show a very similar behavior, slightly diverging at low temperature. Bromine diffusion is a factor of about 2 to 5 lower than the other halogens in this study. Diffusion coefficients for fluorine range between 2.3x10−11 and 1.4x10−10 m2s−1, for chlorine between 1.1x10−11 and 1.3x10−10 and for bromine between 9.4x10−12 and 6.8x10−11 m2s−1. No pressure effect was detected at the conditions investigated. In experiments involving mixed halogens, the diffusivities appear to decrease slightly (by a factor of ~ 3), and are more uniform among the three elements. However, activation energies for diffusion do not appear to differ between experiments with individual halogens or when they are all mixed together. The effect of water increases the diffusion coefficients of F and Cl by no more than a factor of 3 compared to the anhydrous melt (DF = 4.0x10−11 to 1.6x10−10 m2s−1; DCl = 3.0x10−11 to 1.9x10−10 m2s−1). Comparing our results to the diffusion coefficients of other volatiles in nominally dry basaltic melts, halogen diffusivities are about one order of magnitude lower than H2O, similar to CO2, and a factor of ~5 higher than S. The contrasting volatile diffusivities may affect the variable extent of volatile degassing upon melt depressurization and vesiculation, and can help our understanding of the compositions of rapidly grown magmatic bubbles

Halogen diffusion in a basaltic melt

The diffusion of the halogens fluorine, chlorine, and bromine was measured in a hawaiitic melt from Mt. Etna at 500 MPa and 1.0 GPa, 1250 to 1450 ºC at anhydrous conditions; the diffusion of F and Cl in the melt was also studied with about 3 wt% of dissolved water. Experiments were performed using the diffusion-couple technique in a piston cylinder. Most experiments were performed with only one halogen diffusing between the halogen-enriched and halogen-poor halves of the diffusion couple, but a few experiments with a mixture of halogens (F, Cl, Br) were also performed in order to investigate the possibility of interactions between the halogens during diffusion. Fluorine and chlorine diffusivity show a very similar behavior, slightly diverging at low temperature. Bromine diffusion is a factor of about 2 to 5 lower than the other halogens in this study. Diffusion coefficients for fluorine range between 2.3x10−11 and 1.4x10−10 m2s−1, for chlorine between 1.1x10−11 and 1.3x10−10 and for bromine between 9.4x10−12 and 6.8x10−11 m2s−1. No pressure effect was detected at the conditions investigated. In experiments involving mixed halogens, the diffusivities appear to decrease slightly (by a factor of ~ 3), and are more uniform among the three elements. However, activation energies for diffusion do not appear to differ between experiments with individual halogens or when they are all mixed together. The effect of water increases the diffusion coefficients of F and Cl by no more than a factor of 3 compared to the anhydrous melt (DF = 4.0x10−11 to 1.6x10−10 m2s−1; DCl = 3.0x10−11 to 1.9x10−10 m2s−1). Comparing our results to the diffusion coefficients of other volatiles in nominally dry basaltic melts, halogen diffusivities are about one order of magnitude lower than H2O, similar to CO2, and a factor of ~5 higher than S. The contrasting volatile diffusivities may affect the variable extent of volatile degassing upon melt depressurization and vesiculation, and can help our understanding of the compositions of rapidly grown magmatic bubbles.NSERC Discovery grant INGV-DPC 2004-2006 Projects (V3_6 – Etna)Published3570-35802.3. TTC - Laboratori di chimica e fisica delle rocceJCR Journalreserve

Mafic and ultra-mafic enclaves from Ustica island lava: inferences on deep magmatic processes

Ustica Island, southern Tyrrhenian Sea, is constituted of Quaternary alkaline volcanics. Avariety of enclaves representative of deep to supra-crustal settings were recently found in a hawaiitic lava flow. Enclaves consist of: (i) Ultramafic meta-cumulates, i.e. clinopyroxenites and wherlites characterized by variably deformed porphyroclastic to granoblastic textures. (ii) Mafic cumulates, i.e. gabbros (F amphibole) and troctolites, the first often characterized by frequent amphibole breakdown coronas (olivine+Tiaugite+ plagioclase+magnetite+ilmenite+rhfnite) in response to an H2O decrease during the ascent, while the troctolites interpreted as meta-cumulates. (iii) Microsyenites, consist of anorthoclase and Fe-clinopyroxene organized in a granular subipidiomorphic texture. Amphibole is absent in Ustica lavas and is found only in some old, now exposed, sub-intrusive volcanic bodies. This evidence suggests a late appearance of amphibole on the liquidus, at a high crystal content that inhibits further ascent of the magma. The importance of the amphibole as a medium pressure liquidus phase in Ustica mafic magmas is in the bearings on the geochemistry of lavas e.g. in buffering Na and Ti abundances, in trace elements partitioning, etc. Density measurements pointed out higher values for clinopyroxenites (3160 to 3300 kg/m3) than for gabbros (ca. 2900 kg/ m3). Given the density contrast between enclaves and host lavas (2790 kg/m3) and assuming appropriate rheological models, we calculated a minimum ascent rate of 0.01 m/s, corresponding to an ascent time in the range of 5–29 days for a depth of entrapment of 25 km

The effect of CO2 and H2O on Etna and Fondo Riccio (Phlegrean Fields) liquid viscosity, glass transition temperature and heat capacity

Viscosity (η), glass transition (Tg) and heat capacity (Cp) of Etna trachybasalt and Fondo Riccio latite (Phlegrean Fields, Italy)were determined at lowand high temperatures for dry, hydrous and CO2 bearing samples. High temperature experiments have been performed in the range of 1499 to 1700 K by concentric cylinder measurements, while low temperature experiments were carried out in the interval between 633 and 1093 K using the micropenetration technique. Glass transition temperature and glassy and liquid heat capacitieswere investigated using differential scanning calorimetry (DSC) up to 955 K. The H2O content in the melts ranged from nominally dry to 6.32 wt.%, while CO2 ranged from 229 to 1907 ppm. We combined low- and high-temperature viscosities and parameterized them by the use of a modified Vogel– Fulcher–Tamman equation,which accommodates the non-Arrhenian temperature dependence of melt viscosity. Experimental measurements showthat melt viscosity decreaseswith increasing temperature and water and CO2 contents. For latitic samples at 893 K, the introduction of CO2 (up to 732 ppm) decreases the liquid viscosity up to one order of magnitude with respect to the measured viscosity for H2O-bearing liquid. Moreover, the results of calorimetric measurements indicate that the glass transition temperature decreaseswith increasing volatile content (H2O+CO2). The glass transition temperature decreases by about 25 K by adding up to 1907 ppmof CO2 in the trachybasaltic samples. No appreciable effect on glassy [Cpg (Tg)] and liquid (Cpliq) heat capacities was observed with the addition of water and CO2. Structural and volcanological implications (i.e. volatile speciation and melt fragility) for water and CO2 dissolution in silicate melts are discussed in light of the presented results