FEASIBILITY STUDY OF AN INNOVATIVE URBAN ELECTRIC-HYBRID MICROCAR

Alessandro Ferraris,Federico Micca,Alessandro Messana,Andrea Giancarlo Airale,Massimiliana Carello 한국자동차공학회 2019 International journal of automotive technology Vol.20 No.2

This paper presents the feasibility study of a new platform for electric-hybrid quadricycles, developed by addressing important concepts like passive safety and comfort, which often represent a shortcoming in this vehicle category. Starting from packaging of energy storage system and macroscopic subsystems as the main technological constraint, the study has been entirely developed in a virtual environment, with finite element verifications on preliminary models, and a subsequent cooperation phase between computer aided design and finite element analysis softwares, with a guideline for the main tests being that each could feasibly be carried out on a complete vehicle model in order to validate the original assumptions. The resulting design, with a body curb mass of less than 100 kg, was capable of integrating optimal static stiffness characteristics and crash performance, together with improved vehicle dynamics thanks to an innovative suspension archetype.

Tozzi classification of diaphragmatic surgery in patients with stage IIIC–IV ovarian cancer based on surgical findings and complexity

Roberto Tozzi,Federico Ferrari,Joost Nieuwstad,Riccardo Garruto Campanile,Hooman Soleymani Majd 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.2

Objective: To introduce a systematic classification of diaphragmatic surgery in patients with ovarian cancer based on disease spread and surgical complexity. Methods: For all consecutive patients who underwent diaphragmatic surgery during Visceral-Peritoneal debulking (VPD) in the period 2009–2017, we extracted: initial surgical finding, extent of liver mobilization and type of procedure. Combining these features, we aimed to classify the surgical procedures necessary to tackle different presentation of diaphragmatic disease. We also report histology, intra- and post-operative specific complication rate based on the classification. Results: A total of 170 patients were included in this study, 110 (64.7%) had a peritonectomy, while 60 (35.3%) had a full thickness resection with pleurectomy. We identified 3 types of surgical procedures. Type I treated 28 out of 170 patients (16.5%) who only had anterior diaphragm disease, needed no liver mobilization, included peritonectomy and had no morbidity recorded. Type II pertained to 105 out of 170 patients (61.7%) who had anterior and posterior disease, needed partial and sometimes full liver mobilization, had a mix of peritonectomy and full thickness resection, and experienced 10% specific morbidity. Type III included 37 out of 170 patients (21.7%) who needed full mobilization of the liver, always had full thickness resection, and suffered 30% specific morbidity. Conclusion: Diaphragmatic surgery can be classified in 3 types. The adoption of this classification can facilitate standardization of the surgery, comparison of data and define the expertise required. Finally, this classification can be a benchmark to establish the training required to treat diaphragmatic disease.

Rectosigmoid resection during Visceral-Peritoneal Debulking (VPD) in patients with stage IIIC-IV ovarian cancer: morbidity of gynecologic oncology vs. colorectal team

Roberto Tozzi,Gaetano Valenti,Daniele Vinti,Riccardo Garruto Campanile,Massimo Cristaldi,Federico Ferrari 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.3

Objective: This study investigates the specific morbidity of rectosigmoid resection (RSR)during Visceral-Peritoneal Debulking (VPD) in a consecutive series of patients with stage IIIC-IVovarian cancer and compares the results of the colo-rectal vs. the gynaecologic oncology team. Methods: All patients with the International Federation of Gynecology and Obstetrics(FIGO) stage IIIC–IV ovarian cancer who had VPD and RSR were included in the study. Between 2009 and 2013 all operations were performed by the gynecologic oncology teamalone (group 1). Since 2013 the RSR was performed by the colorectal team together withthe gynecologic oncologist (group 2). All pre-operative information and surgical detailswere compared to exclude significant bias. Intra- and post-operative morbidity events wererecorded and compared between groups. Results: One hundred and sixty-two patients had a RSR during VPD, 93 in group 1 and 69in group 2. Groups were comparable for all pre-operative features other than: albumin (1<2)hemoglobin (2<1) and up-front surgery (1>2). Overall morbidity was 33% vs. 40% (p=0.53),bowel specific morbidity 11.8% vs. 11.5% (p=0.81), anastomotic leak 4.1% vs. 6.1% (p=0.43)and re-operation rate 9.6% vs. 6.1% (p=0.71) in groups 1 and 2, respectively. None of themwere significantly different. The rate of bowel diversion was 36.5% in group 1 vs. 46.3% ingroup 2 (p=0.26). Conclusions: Our study failed to demonstrate any significant difference in the morbidity rateof RSR based on the team performing the surgery. These data warrant further investigation asthey are interesting with regards to education, finance, and medico-legal aspects.

Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma

Jvan Casarin,Giorgio Bogani,Elisa Piovano,Francesca Falcone,Federico Ferrari,Franco Odicino,Andrea Puppo,Ferdinando Bonfiglio,Nicoletta Donadello,Ciro Pinelli,Antonio Simone Laganà,Antonino Ditto,Mari 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.5

Objective: Uterine serous carcinoma (USC) is a rare highly aggressive disease. In the presentstudy, we aimed to investigate the survival implication of the systematic lymphadenectomy inpatients who underwent surgery for apparent early-stage USC. Methods: Consecutive patients with apparent early-stage USC surgically treated at sixItalian referral cancer centers were analyzed. A comparison was made between patients whounderwent retroperitoneal staging including at least pelvic lymphadenectomy “LND” vs. those who underwent hysterectomy alone “NO-LND”. Baseline, surgical and oncologicaloutcomes were analyzed. Kaplan- Meier curves were calculated for disease-free survival(DFS) and disease-specific survival (DSS). Associations were evaluated with Cox proportionalhazard regression and summarized using hazard ratio (HR). Results: One hundred forty patients were analyzed, 106 LND and 34 NO-LND. NO-LNDgroup (compared to LND group) included older patients (median age, 73 vs.67 years) andwith higher comorbidities (median Charlson Comorbidity Index, 6 vs. 5) (p<0.001). Nodifferences in terms of recurrence rate (LND vs. NO-LND, 33.1% vs. 41.4%; p=0.240) wereobserved. At Cox regression analysis lymphadenectomy did not significantly influenceDFS (HR=0.59; 95% confidence interval [CI]=0.32–1.08; p=0.09), and DSS (HR=0.14; 95%CI=0.02–1.21; multivariable analysis p=0.07). Positive node was independently associatedwith worse DFS (HR=6.22; 95% CI=3.08–12.60; p<0.001) and DSS (HR=5.51; 95% CI=2.31–13.10; p<0.001), while adjuvant chemotherapy was associated with improved DFS (HR=0.38;95% CI=0.17–0.86; p=0.02) and age was independently associated with worse DSS (HR=1.07;95% CI=1.02–1.13; p<0.001). Conclusions: Although lymphadenectomy did not show survival benefits in patients whounderwent surgery for apparent early-stage USC, the presence of lymph node metastasis was the main adverse prognostic factors, supporting the prognostic role of the retroperitonealstaging also in this histological subtype.

Feasibility of laparoscopic diaphragmatic peritonectomy during Visceral-Peritoneal Debulking (VPD) in patients with stage IIIC-IV ovarian cancer

Roberto Tozzi,Hooman Soleymani Majd,Riccardo Garruto Campanile,Federico Ferrari 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.5

Objective: To describe the surgical technique and evaluate the safety, feasibility and efficacyof laparoscopic diaphragmatic peritonectomy during Visceral-Peritoneal Debulking (VPD) inpatients with stage IIIC-IV ovarian cancer (OC). Methods: This report is part of a Service Evaluation Protocol (Trust number 3267) onlaparoscopy in patients with OC following neo-adjuvant chemotherapy. Between April 2015and November 2017, all patients underwent to exploratory laparoscopy and a selected courtwas offered laparoscopic VPD. Laparoscopic diaphragmatic surgery was considered if therewas no full thickness involvement. Primary endpoints of this part of the study were the safety,feasibility and efficacy of laparoscopic diaphragmatic peritonectomy. We report the surgicaltechnique and outcomes. Results: Ninety-six patients underwent diaphragmatic surgery during the study period. Fiftypatients (52.1%) had intra-operative exclusion criteria and/or full thickness diaphragmaticresection, 46 (47.9%) had peritonectomy and were included in the study. Laparoscopicdiaphragmatic peritonectomy was performed in 21 patients (45.4%, group 1), while in 25patients (54.6%, group 2) laparotomy was necessary. Extent of disease and complexityof surgery were similar. Reasons for conversions were disease coalescing the liver to thediaphragm preventing safe mobilization (22 patients) and accidental pleural opening (3patients). Overall, intra- and post-operative morbidity was lower in group 1 and pulmonaryspecific morbidity was very low. Conclusion: Diaphragmatic peritonectomy can be safely accomplished by laparoscopy inalmost half of the patients with OC whose disease is limited to the diaphragmatic peritoneum.