Prognostic Impact of Mesenteric Lymph Node Status on Digestive Resection Specimens During Cytoreductive Surgery for Ovarian Peritoneal Metastases.

BACKGROUND: The most common mode of ovarian cancer (OC) spread is intraperitoneal dissemination, with the peritoneum as the primary site of metastasis. Cytoreductive surgery (CRS) with chemotherapy is the primary treatment. When necessary, a digestive resection can be performed, but the role of mesenteric lymph nodes (MLNs) in advanced OC remains unclear, and its significance in treatment and follow-up evaluation remains to be determined. This study aimed to evaluate the prevalence of MLN involvement in patients who underwent digestive resection for OC peritoneal metastases (PM) and to investigate its potential prognostic value. METHODS: This retrospective, descriptive study included patients who underwent CRS with curative intent for OC with PM between 1 January 2007 and 31 December 2020. The study assessed MLN status and other clinicopathologic features to determine their prognostic value in relation to overall survival (OS) and progression-free survival (PFS). RESULTS: The study enrolled 159 women with advanced OC, 77 (48.4%) of whom had a digestive resection. For 61.1% of the patients who underwent digestive resection, MLNs were examined and found to be positive in 56.8%. No statistically significant associations were found between MLN status and OS (p = 0.497) or PFS ((p = 0.659). CONCLUSIONS: In anatomopathologic studies, MLNs are not systematically investigated but are frequently involved. In the current study, no statistically significant associations were found between MLN status and OS or PFS. Further prospective studies with a systematic and standardized approach should be performed to confirm these findings.

Prognostic value of preoperative serological biomarkers in patients undergoing cytoreductive surgery for ovarian cancer peritoneal metastases.

Objectives: Peritoneal metastases of ovarian cancer (PMOC) are common at initial presentation. Cytoreductive surgery (CRS) of curative intent has been proven to be efficient in increasing the overall survival (OS) and the disease-free survival (DFS) of these patients. Nevertheless, CRS is associated with high postoperative morbidity, which makes patient selection a major concern. Appropriate prognostic factors that can predict patient outcomes after surgery are still lacking. Preoperative biomarkers and their ratios have been shown to be predictive of patient prognosis for various solid tumors. We aimed to study their correlation with the prognosis of patients undergoing CRS for PMOC. Methods: This retrospective study included patients with PMOC operated by CRS. Preoperative biomarkers and other clinicopathological characteristics were studied to determine their prognostic value in terms OS and DFS. Results: 216 patients were included. Patients with preoperative hemoglobin (Hb) <11.7 g/dL had a poorer prognosis in terms of OS (p=0.0062) and DFS (p=0.0077). Additionally, increased neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) >0.32, and platelet-to-lymphocyte ratio (PLR) >214.5 were associated with worse OS (p=0.022, p=0.0028, and p=0.0018, respectively) and worse DFS (p=0.028, p=0.003, and p=0.019, respectively). Multivariate analysis showed that the variables mentioned above were independent predictive factors for OS and DFS. Conclusions: Preoperative Hb level, NLR, MLR, and PLR are prognostic factors for OS and DFS in PMOC patients operated by curative CRS.

Prognostic value of peritoneal scar-like tissue in patients with peritoneal metastases of ovarian origin presenting for curative-intent cytoreductive surgery.

BACKGROUND: Complete cytoreductive surgery (CRS), remain the gold standard in the treatment of peritoneal metastases of ovarian cancer (PMOC). Given the increasing rate of neoadjuvant chemotherapy in patients with high PCI, prior abdominal surgeries, inflammation and fibrotic changes, the benefit of removing any "peritoneal scar-like tissues" (PST) during CRS, hasn't been thoroughly investigated. Our objective in this retrospective cohort was to identify the proportion of malignant cells positivity in PST of patients with PMOC, undergoing curative-intent CRS ± HIPEC. METHODS: This is a retrospective study, conducted at our comprehensive cancer center, including patients with PMOC, presenting for curative-intent CRS. During CRS, benign-looking peritoneal lesions, lacking the typical hard nodular, aggressive, and invasive morphology, were systematically resected or electro fulgurated. PSTs were analyzed for the presence of tumoral cells by our pathologist. Correlations between the presence of PST and their positivity, and the different patients' variables, were studied. RESULTS: In 51% of patients, PST harbored malignant cells. Those were associated with poorly differentiated serous tumors, a high PCI (> 8) and a worse DFS: 17 months in the positive PST group versus 29 months in the negative PST group (p = 0.05), on univariate analysis. Multivariate analysis revealed that PCI > 8 and poorly differentiated primary tumor histology were correlated with a worse DFS, and that higher PCI and advanced FIGO were correlated with a worse OS. CONCLUSION: Benign-looking PST harbors malignancy in 51% of cases. The benefit of their systematic resection and their prognostic value should be further investigated in larger cohorts.

Deep epigastric lymph nodes implication in patients' recurrence pattern after cytoreductive surgery in ovarian peritoneal metastases.

INTRODUCTION: Although complete cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) offers a good prognosis in patients with peritoneal metastasis of ovarian cancer (PMOC), recurrences are quite common. These recurrences can be intra-abdominal or systemic in nature. Our objective was to study and illustrate the global recurrence pattern in patients operated for PMOC, shedding light on a previously overlooked lymphatic basin at the level of the epigastric artery, the deep epigastric lymph nodes (DELN) basin. PATIENTS AND METHODS: This was a retrospective study including patients with PMOC who underwent surgery with curative-intent, from 2012 until 2018, at our cancer center, and who presented with any type of disease recurrence on follow-up. CT-scans, MRIs and PET-scans were reviewed in order to determine solid organs and lymph nodes (LN) recurrences. RESULTS: During the study period, 208 patients underwent CRS ± HIPEC, 115 (55.3%) presented with organ or lymphatic recurrence over a median follow-up of 81 months. Sixty percent of these patients had radiologically enlarged LN involvement. The pelvis/pelvic peritoneum was the most common intra-abdominal organ recurrence site (47%), while the retroperitoneal LN was the most common lymphatic recurrence site (73.9%). Previously overlooked DELN were found in 12 patients, with 17.4% implication in lymphatic basin recurrence patterns. CONCLUSION: Our study revealed the potential role of the DELN basin, previously overlooked in the systemic dissemination process of PMOC. This study sheds light on a previously unrecognized lymphatic pathway, as an intermediate checkpoint or relay, between the peritoneum, an intra-abdominal organ, and the extra-abdominal compartment.

Road Risk-Index Analysis Using Satellite Products.

This paper proposes a service called intelligent routing using satellite products (IRUS) that can be used in order to analyze risks to the road infrastructure during bad weather conditions, such as heavy rainfall, storms, or floods. By diminishing movement risk, rescuers can arrive safely at their destination. To analyze these routes, the application uses both data provided by Sentinel satellites from the Copernicus program and meteorological data from local weather stations. Moreover, the application uses algorithms to determine the night driving time. From this analysis we obtain a risk index for each road provided by Google Maps API and then we present the path alongside the risk index in a friendly graphic interface. In order to obtain an accurate risk index, the application analyzes both recent and past data (up to 12 months).

The limitations for expression recognition in computer vision introduced by facial masks.

Facial Expression recognition is a computer vision problem that took relevant benefit from the research in deep learning. Recent deep neural networks achieved superior results, demonstrating the feasibility of recognizing the expression of a user from a single picture or a video recording the face dynamics. Research studies reveal that the most discriminating portions of the face surfaces that contribute to the recognition of facial expressions are located on the mouth and the eyes. The restrictions for COVID pandemic reasons have also revealed that state-of-the-art solutions for the analysis of the face can severely fail due to the occlusions of using the facial masks. This study explores to what extend expression recognition can deal with occluded faces in presence of masks. To a fairer comparison, the analysis is performed in different occluded scenarios to effectively assess if the facial masks can really imply a decrease in the recognition accuracy. The experiments performed on two public datasets show that some famous top deep classifiers expose a significant reduction in accuracy in presence of masks up to half of the accuracy achieved in non-occluded conditions. Moreover, a relevant decrease in performance is also reported also in the case of occluded eyes but the overall drop in performance is not as severe as in presence of the facial masks, thus confirming that, like happens for face biometric recognition, occluded faces by facial mask still represent a challenging limitation for computer vision solutions.

Assertive, Selective, Scalable IoT-Based Warning System.

With the evolution of technology, developed systems have become more complex and faster. Thirty years ago, there were no protocols or databases dedicated to developing and implementing IoT projects. We currently have protocols such as MQTT, AMQP, CoAP, and databases such as InfluxDB. They are built to support a multitude of data from an IoT system and scale very well with the system. This paper presents the design and implementation of an IoT alert system that uses MQTT and InfluxDB to collect and store data. We design a scalable system to display assertive alerts on a Raspberry Pi. Each user can select a subset of alerts in our system using a web interface. We present a bibliographic study of SoTA, the proposed architecture, the challenges posed by such a system, a set of tests for the performance and feasibility of the solution, and a set of conclusions and ideas for further developments.

Implementing Replication of Objects in DOORS-The Object-Oriented Runtime System for Edge Computing.

Aiming for simplicity and efficiency in the domain of edge computing, DOORS is a distributed system expected to scale up to hundreds of nodes, which encapsulates application state and behavior into objects and gives them the ability to exchange asynchronous messages. DOORS offers semi-synchronous replication and the ability to explicitly move objects from one node to another, as methods to achieve scalability and resilience. The present paper gives an outline of the system structure, describes how DOORS implements object replication, and describes a basic set of measurements, yielding an initial set of conclusions for the improvements of the design.

Evaluation of Task Scheduling Algorithms in Heterogeneous Computing Environments.

This work establishes a set of methodologies to evaluate the performance of any task scheduling policy in heterogeneous computing contexts. We formally state a scheduling model for hybrid edge-cloud computing ecosystems and conduct simulation-based experiments on large workloads. In addition to the conventional cloud datacenters, we consider edge datacenters comprising smartphone and Raspberry Pi edge devices, which are battery powered. We define realistic capacities of the computational resources. Once a schedule is found, the various task demands can or cannot be fulfilled by the resource capacities. We build a scheduling and evaluation framework and measure typical scheduling metrics such as mean waiting time, mean turnaround time, makespan, throughput on the Round-Robin, Shortest Job First, Min-Min and Max-Min scheduling schemes. Our analysis and results show that the state-of-the-art independent task scheduling algorithms suffer from performance degradation in terms of significant task failures and nonoptimal resource utilization of datacenters in heterogeneous edge-cloud mediums in comparison to cloud-only mediums. In particular, for large sets of tasks, due to low battery or limited memory, more than 25% of tasks fail to execute for each scheduling scheme.

Absence of residual fluorescence in the surgical bed at near-infrared fluorescence imaging predicts negative margins at final pathology in patients treated with breast-conserving surgery for breast cancer.

INTRODUCTION: Positive margins after breast-conserving surgery (BCS) for breast cancer (BC) remain a major concern. In this study we investigate the feasibility and accuracy of indocyanine green (ICG) fluorescence imaging (FI) for the in vivo assessment of surgical margins during BCS. MATERIALS AND METHODS: Patients with BC admitted for BCS from October 2015 to April 2016 were proposed to be included in the present study (NCT02027818). ICG (0.25 mg/kg) was intravenously injected at induction anesthesia and ICG-FI of the surgical beds was correlated with final pathology results. RESULTS: Fifty patients consented to participate and thirty-five patients were retained for final analysis, 15 patients having been excluded for, respectively, incomplete video records data for signal to background ratio (SBR) calculation (11) and in situ tumors (4). The final pathological assessment of 35 breast specimens identified 5 (14.7%) positive margins. Intraoperative ICG-FI revealed hyperfluorescent signals in 15 (42.9%) patients and an absence of fluorescent signals in 20 (57.1%). Median SBR in patients with involved margins was 1.8 (SD 0.7) and was 1.25 (SD 0.6) in patients with clear margins (p = 0.05). The accuracy, specificity, positive and negative predictive value of ICG-FI for breast surgical margin assessment were 71%, 60%, 29% and 100%, respectively. CONCLUSION: ICG-FI of BC surgical beds has a high negative predictive value for surgical margin assessment during BCS. The absence of residual fluorescence in the surgical bed of patients with fluorescent tumors predicts negative margins at final pathology and allows the surgeon to avoid further intraoperative analysis.

ICG-fluorescence imaging for detection of peritoneal metastases and residual tumoral scars in locally advanced ovarian cancer: A pilot study.

BACKGROUND AND OBJECTIVES: No intraoperative imaging techniques exist for detecting tumor nodules or tumor scar tissues in patients treated with upfront or interval cytoreductive surgery (CS) after neoadjuvant chemotherapy (NAC). The aims of this study were to evaluate the role of indocyanine green (ICG) fluorescence imaging (FI) for the detection of peritoneal metastases (PM) and evaluate whether it can be used to detect remnant tumor cells in scar tissue. METHODS: Patients with PM from ovarian cancer admitted for CS were included. ICG, at 0.25 mg per kg of patient weight, was injected intraoperatively after explorative laparotomy before CS. RESULTS: A total of 108 peritoneal lesions, including 25 scars, were imaged in 20 patients. Seventy-three were malignant (67.6%) and 35 benign (32.4%). The mean Tumor to Background Ratio (ex vivo) was 1.8 (SD 1.3) in malignant and 1.0 (SD 0.79) in benign nodules (P = 0.007). Of 25 post-NAC scars, the mean Tumor to Background Ratio (TBR) (in vivo) was 2.06 (SD 1.15) in malignant and 1.21 (SD 0.50) in benign nodules (P = 0.26). The positive predictive value of ICG-FI to detect tumor cells in scars was 57.1%. CONCLUSIONS: ICG-FI is accurate to demonstrate PM in ovarian cancer but unable to discriminate between benign and malignant post-NAC.

Property gamma factors and the Hochschild cohomology problem.

The main result of this article is that the kth continuous Hochschild cohomology groups H(k)(M,M ) and H(k)(M, B(H)) of a von Neumann factor subset, dbl equals B(H) of type II(1) with property Gamma are 0 for all positive integers k. The method of proof involves the construction of hyperfinite subfactors with special properties and a new inequality of Grothendieck type for multilinear maps. We prove joint continuity in the parallel. parallel (2) norm of separately ultraweakly continuous multilinear maps and combine these results to reduce to the case of completely bounded cohomology, which is already solved.