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The current study was designed to compare oncological outcomes between oncoplastic (OBCS) and conventional breast-conserving surgery (BCS). Data collected retrospectively from two groups of patients diagnosed with breast cancer, cases group (OBCS) and control group (BCS), were analyzed. A total of 277 women were included in the analysis: 193 (69.7%) in the cases group and 84 (30.3%) in the control group. Resected volume was larger in the OBCS group (438.05 ± 302.26 cm3 vs 223.34 ± 161.75 cm3; p

B-cell lymphoblastic lymphoma (LBL) is a highly aggressive malignant proliferation of lymphoblasts of B-origin grouped with acute lymphoblastic leukemia. Multiple studies demonstrated the various sites of involvement in adult LBL. The involvement of the uterus as a site of relapse for such disease is rare. We herein report the case of relapsed B-cell LBL mimicking endometrial sarcoma. The patient is a 56-year-old female patient known to have B-cell LBL on chemotherapy. She presented with abdominal pain and fever. Positron emission tomodensitometry-computed tomography showed the presence of a uterine mass with bilateral iliac lymph node involvement. She underwent surgery with mass removal and pathology showed relapsed B-cell LBL.

Background Breast cancer is the most common cause of the majority of cancer-related deaths in women, among which triple-negative breast cancer is the most aggressive type of breast cancer diagnosed with limited treatment options. Thymoquinone (TQ), the main bioactive constituent of Nigella sativa, has been extensively studied as a potent anticancer molecule against various types of cancers. Honeybee products such as the royal jelly (RJ), the nutritive secretion fed to honeybee queens, exhibit a variety of biological activities besides its anticancer effect. However, the anticancer activity of the combination of TQ and RJ against breast cancer is still unknown. Aim To investigate cytotoxicity of RJ in FHs 74 Int cells and the anticancer effects of TQ, RJ, and their combinations in the MDA-MB-231 cell line. Methods Cells were treated with TQ, RJ, and their combinations for 24 h. Using 3-(4,5 dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, we determined the half-maximal inhibitory concentration of TQ. Trypan blue and 3-(4,5 dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays were then performed to assess the cell viability in response to different treatment conditions. Cell death and cycle regulation were investigated using propidium iodide deoxyribonucleic acid staining followed by flow cytometry in response to a single dose of TQ, RJ, and their combination. Immunostaining for cleaved caspase 3 and Ki67 expression was used to determine apoptosis induction and changes in cell proliferation. Results TQ alone inhibited cell viability in a dose-dependent manner at concentrations below and above the half-maximal inhibitory concentration. RJ exhibited relatively nontoxic effects against MDA-MB-231 cells and FHs 74 Int small intestinal cells at concentrations below 5 µg/mL. High doses of RJ (200 µg/mL) had greater toxicity against MDA-MB-231 cells. Interestingly, the inhibition of cell viability was most pronounced in response to 15 µmol/L TQ and 5 µg/mL RJ. A dose of 15 µmol/L TQ caused a significant increase in the PreG1 population, while a more pronounced effect on cell viability inhibition and PreG1 increase was observed in response to TQ and RJ combinations. TQ was the main inducer of caspase 3-dependent apoptosis when applied alone and in combination with RJ. In contrast, no significant regulation of Ki67 expression was observed, indicating that the decrease in cell viability was due to apoptosis induction rather than to inhibition of cell proliferation. Conclusion This study is the first to report enhanced anticancer effects of TQ and RJ combination against MDA-MB-231 breast cancer cells, which could confer an advantage for cancer therapy.

To illustrate the effectiveness of hysteroscopic endometrial resection in conservative treatment of early endometrial cancer/atypical hyperplasia in women of reproductive age. Review of outcomes of women of reproductive age who underwent fertility sparing treatment (hysteroscopic superficial endometrectomy followed by progestin therapy) in early endometrial cancer. Eight women with Stage I endometrial cancer and three with atypical endometrial hyperplasia underwent hysteroscopic superficial endometrial resection, followed by 1-year treatment with oral megestrol acetate. One patient had a synchronous endometrioid ovarian carcinoma. One patient with Grade 2 carcinoma opted for conservative treatment and had hysterectomy 3 months later for persisting disease. Ten patients showed no evidence of residual disease during a 12-month follow-up period with regular hysteroscopy. Five patients had seven pregnancies without assisted reproductive technology. One patient got pregnant after one attempt of in-vitro fertilization and oocyte donation. Pregnancy rate was 54.5%; two patients had two successful pregnancies and deliveries. Average time to pregnancy was 16 months from the end of treatment. All babies were delivered vaginally. Total superficial endometrial resection followed by progestin can be considered in patients with early endometrial cancer/atypical hyperplasia who still want to conceive. It does not seem to impair fertility nor pregnancy outcomes in women of reproductive age.

We present the case of a 30-year-old lady who underwent a core needle biopsy for a BIRADS 4 lesion of her left breast and was diagnosed as having a cellular fibroadenoma. The final diagnosis after excision returned to be a periductal stromal tumor (PST). An extremely rare entity, the PST is actually classified as a subtype of phyllodes tumor, with specific criteria that are only found upon histological examination of the specimen. Care should be taken when considering the diagnosis of fibroadenoma based only on clinical, radiological, and biopsy findings. Any nonclassical, clinical, or radiological findings should prompt a wide excision. Prognosis is generally good when clear margins are obtained and in the absence of malignant heterologous elements.

Introduction/Background* Role of checkpoint inhibitors in ovarian cancer is still unknown and results from ongoing clinical trials are still awaited. We aim in this study to assess the expression of PD-L1 using the Combined Positive Score (CPS) and to evaluate its impact on the overall survival in a cohort of 49 patients diagnosed with high-grade serous ovarian cancer. Methodology Medical charts were reviewed of 49 patients with high-grade serous ovarian cancer operated on at the gynecologic oncology department in Hotel-Dieu de France hospital, Lebanon, between 2015 and January 2020. Immunohistochemical staining was performed for PD-L1 (Agilent Dako, PDL-1 IHC 22C3) and for TP53 (Agilent Biogenex, clone D07, 1:100 dilution) on whole tissue sections from a representative block of formalin-fixed, paraffin-embedded tumor tissue. We looked for correlation between PD-L1 status and overall survival/recurrence. We also looked for correlation between PD-L1 status and TP-53 mutation. Result(s)* 55% of patients presented a positive PD-L1 status. No correlation was found between the PD-L1 status and the stage of the disease. Lymph node status was similar between the two cohorts, positive vs. negative CPS score (p = 0.927). Median follow-up was 36 months (range, 12 – 72 months). Survival rate was similar between the two cohorts, positive vs. negative PD-L1 status (88.9% vs. 72.7% respectively, p = 0.14). No correlation was found between recurrence rate and PD-L1 status (p = 0.184). Also, no correlation was found between PD-L1 status and TP-53 type (wild vs. mutated) (p = 0.154) Conclusion* PD-L1 status does not seem to have a prognostic impact in our series of patients with high-grade serous epithelial ovarian cancer. Also, patients with TP53 mutation do not present increased expression of PD-L1 in comparison to patients with TP53 wild-type.

Introduction/Background* Radiation field planning in patients with locally advanced cervical cancer (LACC) undergoing primary definitive chemoradiotherapy is influenced by lymph node (LN) status. LN assessment by imaging methods has several known limitations including a high false negative rate. The present study aimed to compare the accuracy of LN staging by imaging and surgical staging in LACC patients, and to evaluate their impact on radiation field planning. Methodology A retrospective monocentric study of patients with LACC (International Federation of Gynecology and Obstetrics (FIGO 2018) stage IIA -IVA), undergoing primary definitive platinum-based chemoradiation therapy. Patients were included if LN assessment was available by both methods: surgical (paraaortic/pelvic) and imaging [Thorax/Abdomen Computed Tomography (CT) and/or pelvic Magnetic Resonance Imaging (MRI)]. Result(s)* A total of 58 patients met the inclusion criteria (table 1), 97% (n=56) had a preoperative CT and 88% (n=51) an MRI evaluation. All patients underwent surgical LN staging: 100% paraaortic, and 86% (n=50) additional pelvic lymphadenectomy. Histologically proven LN metastases after surgical LN staging were found in 76% of patients (n=44), 31% (n=18) paraaortic and 76% (n=38) pelvic. As a result of the surgical LN staging, 36% (n=21) of the patients were upstaged (n=11 to FIGO IIIC1 and n=10 to FIGO IIIC2), and 17% (n=10) had treatment modification (extended paraaortic field radiation). LN staging using CT and MRI exhibited a low negative predictive value (29% and 38%, respectively), with a higher positive predictive value (69% and 81%, respectively). Conclusion* In this cohort of LACC patients, paraaortic LN metastases were present in one third of the cases, while CT/MRI imaging underestimated metastatic LN involvement. We thus stress the value of surgical paraaortic LN staging in cases of negative LN imaging, which may lead to treatment modification in about one fifth of patients.

Introduction/Background* Borderline ovarian tumors (BOT) are low malignant potential lesions with a good prognosis that represent around 15% of all epithelial tumors of the ovary. In addition to that, 30% of patients with BOT are less than 40 years old which makes the preservation of fertility a key point in management. Molecular studies in ovarian cancer have shown a correlation between the genetic profile of the tumor and the patient‘s prognosis Methodology We report the case of a 25-year-old patient, G0P0A0, diagnosed with a mucinous borderline right ovarian tumor back in 2005. In 2009, during a routine control ultrasound, another ovarian cyst was identified on the right side. She was operated again of a cystectomy and peritoneal staging and histopathology confirmed the mucinous nature of the tumor. FIGO stage was IA in both cases. The two blocs of tumors underwent a full exome sequencing technique in order to identify possible key mutations. Result(s)* Both tumors had variations of EGFR, FGFR3, BRCA1, STK11, NTKR1 and PIK3CA genes. However, the first tumor also had a KRAS mutation that wasn’t found in the second lesion four years later. KRAS variants have been shown to be present in low grade ovarian cancer and well-differentiated tumors. Conclusion* Borderline tumors often recurs in form of borderline tumor but the genetic profile should not be the same as the primary tumor, as shown in our case report. Loss of KRAS could explain the recurrence of the disease. Seeing that the molecular profile of the tumor is in constant change, a continuity in the spectrum normal-benign-borderline-malignant could be hypothesized.

Prostate cancer (PCa) is by far the most commonly diagnosed cancer in men worldwide. Despite sensitivity to androgen deprivation, patients with advanced disease eventually develop resistance to therapy and may die of metastatic castration-resistant prostate cancer (mCRPC). A key challenge in the management of PCa is the clinical heterogeneity that is hard to predict using existing biomarkers. Defining molecular biomarkers for PCa that can reliably aid in diagnosis and distinguishing patients who require aggressive therapy from those who should avoid overtreatment is a significant unmet need. Mechanisms underlying the development of PCa are not confined to cancer epithelial cells, but also involve the tumor microenvironment. The crosstalk between epithelial cells and stroma in PCa has been shown to play an integral role in disease progression and metastasis. A number of key markers of reactive stroma has been identified including stem/progenitor cell markers, stromal-derived mediators of inflammation, regulators of angiogenesis, connective tissue growth factors, wingless homologs (Wnts), and integrins. Here, we provide a synopsis of the stromal-epithelial crosstalk in PCa focusing on the relevant molecular biomarkers pertaining to the tumor microenvironment and their role in diagnosis, prognosis, and therapy development.

Breast conservation rate is being increasingly used nowadays as a marker of breast cancer care among hospitals. Searching for the ideal technique to predict the feasibility of BCS is ongoing. For this matter, the preoperative MRIs of 169 patients operated with radical or conservative surgery were reviewed. We estimated the tumor volume (TV) and breast volume (BV) on enhanced 3D-MRI and compared the tumor-to-breast volume ratio (TV/BV) in both groups. The mean ratio was 9.5% in the mastectomy group and 1.7% in the BCS group. A tumor-to-breast volume ratio less than 4% seemed to favor the adoption of a conservative option. Our data suggest that preoperative 3D-MRI can orient the surgical approach by assessing the TV/BV ratio, increasing lumpectomy rates with clear margins and good cosmetic outcome.

Aim: To describe the activity in the ‘breast unit’ at the department of radiology during the coronavirus disease 19 lockdown in a university hospital treating coronovirus disease 19 patients in a Middle-Eastern developing country. Materials: This was a retrospective study conducted from March 9 until 11 May 2020, in the breast unit at the department of radiology of a central university hospital in a Middle-Eastern developing country. Data were collected from 205 patients visiting the breast unit during the lockdown period and compared with the activity in the same period in the previous year. Results: Reduction of the breast unit activity was estimated at 73%. In addition, 153 mammograms, 205 ultrasounds, and 16 breast MRIs were done. Indications for mammogram were screening (41.5%), follow-up (22%), clinical symptoms (20%) and breast cancer surveillance (16.5%). MRI was performed mostly for preoperative surgical management. The rate of positive biopsies was 41%. All staff members and patients have accommodated to new adjustments. Conclusion: Activity in the breast unit dropped during the lockdown period. Staff should continue to seek their own and their patient’s safety without diminishing the quality of healthcare.

Objectives We aim to compare the outcomes of patients with epithelial ovarian carcinoma treated with neoadjuvant chemotherapy to those with primary debulking surgery. Methods A retrospective case-control study was conducted at a Hotel-Dieu de France University Hospital. We reviewed the clinipathological data of 184 patients who were operated on for an epithelial ovarian cancer and we compared the outcomes of patients who received a neoadjuvant chemotherapy (n=94) with those treated with primary surgery(n=90). Results Patients in both groups had comparable age, menopausal status and comorbidities (p>0.05). Patients receiving neoadjuvant chemotherapy had more serous histology and high-grade lesions (58,1% vs. 41,9% (p=0.003), 58,8% vs. 41,2% (p=0.005), respectively). Bilateral adnexal involvement was more seen in the neoadjuvant group (57,4% vs. 42,6%, p=0.19). Patients receiving neoadjuvant chemotherapy were more likely to present lymph node involvement (61,1% vs. 38,9%, p=0.006). More bowel resection was done in the neoadjuvant group (62,4% vs. 37,6%, p=0.005). Postoperative complications were comparable between the two groups (p=0.441). Interval surgery group received more blood transfusion as primary surgery group (55,7% vs. 44,3%, p=0.004). Survival rate was 41,8% in the interval surgery group vs. 58,2% in the primary surgery group (p=0.000). Recurrence rate 60% in the interval surgery group vs. 40% in the primary surgery group (p=0.025). No difference in the recurrence interval was seen in both groups (p=0.272). Conclusion Patients with ovarian cancer receiving neoadjuvant chemotherapy seem to have more aggressive disease and do not have better outcomes in terms of survival and recurrence in comparison to primary surgery group.

Introduction ‘HPV impact profile’ questionnaire, created by the team of Merck and coll. was one of the first and most specific tools evaluating the psychological impact of the most frequent gynecological lesions linked to HPV. This study aimed to translate the ‘HIP’ questionnaire into Arabic and to study its validity in a sample of Lebanese females. Methods The HIP questionnaire was translated to Arabic following the scheme offered by Beaton et al. It was then administered to a sample of 118 Lebanese women infected with HPV or screened for HPV associated lesions, in parallel with the Hospital anxiety and depression scale (HADS) questionnaire. Results The internal consistency of the HIP questionnaire was weak as alpha Cronbach coefficients of most of the domains were low. Therefore, the study of the composite matrix resulted in the improvement of the internal consistency after elimination of some items. The ‘adapted domains’ were created after inversing the scores of items with positive implications and similar studies were conducted on these domains. Then, the Composite Reliability (CR) and the Average Variance Extracted (AVE) of all the domains were analyzed as well as the Heterotrait-monotrait ratio of correlation. Finally, a statistically significant correlation was found between the total scores of the HIP and professional status and religion. Conclusion The final version of the HIP presents good psychometric properties, allowing its use in clinical trials as well as in clinical practice in order to evaluate the quality of life in women with HPV.

Objectives to determine predictive factors of better survival and delayed recurrence in patients operated on for epithelial ovarian cancer. Methods we reviewed retrospectively all the data of 184 patients receiving complete cytoreductive surgery, whether as primary or interval debulking between January 2005 and ocotber 2019 at Hotel-Dieu de France University Hospital. Results Median age at surgery was 56 years. 41,8% benefited from a primary cytoreductive surgery while 42,9% of patients received their surgery after a neoadjuvant chemotherapy. 74% of patients were in stage III. High-grade serous epithelial ovarian cancer was the most encountered histology (69%). Bowel resection and upper abdominal surgery was needed in 46% and 39,1% of cases, respectively. Survival rate was 66% (122 out of 184 patients). No recurrence was noted in 53,8% of cases and 74,7% of recurrences occurred after 12 months. According to cox regression test, better survival was significantly correlated to younger age ( Conclusion Negative lymph node status, LNR

Objectives to determine the rate, the repartition and to predict the risk factors of lymph node metastasis in patients operated on for epithelial ovarian cancer. Methods we reviewed retrospectively the data of 185 patients diagnosed of epithelial ovarian cancer and operated on between January 2005 and October 2019 at Hotel-Dieu de France University Hospital. Results 88% of patients received a pelvic and paraaortic lymphadenectomy. Node involvement was noted in 56% of cases. 85% of patients presented lymph node metastasis in the pelvic lymph nodes and 83% in the paraaortic nodes. Lymph nodes metastases in both pelvic and paraaortic levels were encountered in 70% of cases. Isolated pelvic or aortic lymph node metastases were seen in 16% and 14% of cases respectively. The median number of removed pelvic and paraaortic lymph nodes was 27 and 30 nodes respectively. In the univariate analysis, the rate of positive lymph nodes was higher in patients with serous histology (65% (serous) vs. 33% (non-serous), p=0.000), high grade (68% vs. 26%, p=0.000), bilateral adnexal involvement (74% vs. 27%, p =0.000) and positive peritoneal cytology (79% vs. 26%, p=0.000). In multivariate logistic regression analysis, the rate was significantly higher in patients with bilateral adnexal involvement, higher grade and positive peritoneal cytology. Conclusion Serous histology, grade 3 tumors, positive peritoneal cytology and bilateral adnexal involvement seem to predictive factors of lymph node involvement in patients with ovarian cancers.

To evaluate the diagnostic value of diffusion-weighted imaging (DWI) in combination with conventional MRI in predicting metastatic axillary lymph nodes (ALN) in breast cancer (BC). We reviewed pathological findings and clinical breast MRI examinations of 169 patients with invasive BC who were evaluated at the Hotel-Dieu de France Hospital in 2009-2015. Morphological parameters and apparent diffusion coefficient (ADC) value were compared with pathological nodal status. Independent t-test/chi-square test and a Pearson correlation analysis were used. With pathological diagnosis as reference, MRI-based interpretations were 87.5% specific and 70.3% sensitive. On conventional MRI, the round shape of lymph nodes (LNs), loss of fatty hilum, irregular margins and hypo-intensity/heterogeneous intensity on T2-weighted sequence were statistically significantly different between metastatic and nonmetastatic groups (P < .001, each). Mean size of metastatic ALN was larger compared with negative ALN (13.9 mm vs. 10.9 mm, P < .001). LNs ≥ 12 mm were associated with higher risk of metastasis (P < .001). ADC value was not significantly different between both groups (P = .862). Conventional MRI using the ALN shape, signal intensity in T2-weighted sequences, loss of fatty hilum, regularity of the margins and size of the LNs can evaluate the axilla with high specificity. ADC value could not be used as a reliable parameter.

Background Placenta percreta is associated with high hemorrhagic risk and can be complicated with fatal thromboembolic events. Involving a multidisciplinary team in the treatment of these patients is mandatory to reduce morbidity and mortality. Case presentation This paper reports the case of a 22-year-old patient with placenta percreta who was referred to our tertiary care center for delivery. Few hours after undergoing a successful cesarean hysterectomy, the patient developed a pulmonary embolism and cardiac arrest. A transthoracic echocardiogram done in the intensive care unit (ICU) showed a thrombus in the right ventricle. After cardiac resuscitation, the patient underwent an urgent thoracotomy and a pulmonary artery thrombectomy; many clots were retrieved from the pulmonary artery. After weaning from extracorporeal circulation, an intraoperative transesophageal cardiac ultrasound enabled the medical team to detect a new free-floating thrombus in the right atrium and right ventricle, and consequently to perform an embolectomy and prevent the patient’s death. Conclusion This case emphasizes the role of multidisciplinary team in treating high-risk obstetric cases that could be complicated with massive and fatal thromboembolic events. The use of intraoperative transthoracic echocardiography helps in detecting a new thrombus and guides the anesthesiologist in the intra-operative monitoring.

Introduction/Background To report the epidemiological and histological features of ovarian tumors in Lebanon. Methodology This is a retrospective study evaluating the characteristics of borderline and malignant ovarian tumors diagnosed in 20 years (from 1997 to 2017) at the Hotel Dieu de France, University Hospital of Saint Joseph University in Beirut in Lebanon. The data was extracted from the computerized registers of the hospital´s pathology laboratory. Statistical analysis was performed using SPSS 24.0 software. Results 1137 ovarian lesions were reported, of which 695 (61.12%) were benign, 50 (4.4%) borderline, 361 (31.75%) malignant and 31 (2.73%) were unspecified. Of the 361 malignant lesions, 54 (4.75%) were metastases from another extra-ovarian primitive. Of the 652 benign neoplastic ovarian tumors, epithelial tumors, stromal and sex cords tumors, germ cell tumors and tumors from the dermoid cyst were 306 (46.93%), 70 (10.73%), 268 (41.1%) and 8 (1.24%). The most common benign neoplastic tumor was mature cystic teratoma representing 268 cases (41.1%), followed by 170 (26.07%) serous cystadenomas, and 80 (12.2%) mucinous cystadenomas. Of the 361 malignant ovarian tumors, 246 (68.1%) were malignant surface epithelial tumors. Germ cell malignancies, stromal tumor and sex cords, and metastatic carcinoma were 25 (6.9%), 22 (6.1%), and 54 (15%), respectively. High grade serous cystadenocarcinoma was the most common malignant tumor with 147 cases (40.7%). Conclusion The epidemiological characteristics of ovarian tumors in Lebanon are compatible with those published in Western countries and in Asia. This study is the first of its kind in Lebanon and is a database for further research. Disclosure Nothing to disclose.

Introduction/Background To determine the prevalence of deep vein thrombosis and pulmonary embolism after an extensive cytoreductive surgery for ovarian or fallopian tube cancer, the associated risk factors and to suggest preventive measures pre- and postoperatively to reduce these risks. Methodology A retrospective study was conducted at Hotel-Dieu de France University Hospital and included all patients older than 16 years and receiving a cytoreductive surgery for ovarian, fallopian tube or primary peritoneal cancer between 2004 and 2017. Results 123 patients were included. Mean age was 55 years. The prevalence of postoperative thromboembolic events in the studied population was 8.9%. Deep vein thrombosis and pulmonary embolism were found in 6.5% and 4.1% of cases respectively. A correlation was found between the presence of venous catheter and the occurrence of thromboembolic events with a p value=0.035 (OR=4, IC [1.019–16.197]). Also, partial colectomy with anastomosis, cholecystectomy and appendectomy were found to be risk factors (0.001, 0.021 and 0.045 respectively). We found a correlation between hospital and intensive care stay and the duration of immobilization as well as a correlation between weight and hospital stay (p value=0.02). Date of initiation of postoperative thromboprophylaxis was related to the amount of intraoperative bleeding (p=0.024). Conclusion Avoiding the placement of central venous catheter, reducing the patient weight preoperatively, encouraging the early mobilization, reducing the hospital stay as well as stay in intensive care unit, controlling and limiting the intra- and postoperative bleeding are measures that contribute to reduction of risk of thromboembolic events occurrence. Disclosure Nothing to disclose.

Introduction/Background To report the characteristics and outcomes of patients presenting ovarian metastases from a breast. Methodology It is a retrospective study reviewing the characteristics of ovarian metastases from a breast cancer diagnosed in 20 years (from 1997 to 2017) at Hotel-Dieu de France University hospital, a tertiary care center in Lebanon. Results We reviewed the data of 1137 patients with ovarian tumors. Ovarian metastases from a breast cancer were found in 13 cases. Mean age was 59 years. 46% of patients received CT-scan and only in 15% of cases a PET-CT scan was performed. The mean interval time between the primary diagnosis of breast cancer and the occurrence of ovarian metastasis was 52 months. The most common histologic type found was invasive lobular carcinoma (60% of cases). Extraovarian metastases were found in 69% of cases (9 out 13 patients). The extraovarian metastases concerned the following organs: uterus (3 cases), bone marrow (5 cases), liver (5 cases), lungs (3 cases), brain (3 cases), stomach (1 case), and adrenal gland (2 cases). All cases were treated surgically and received adjuvant chemotherapy. A cytoreductive surgery was performed in five cases. A unilateral or bilateral adnexectomy was done in one and seven cases respectively. Mean survival was 60 months. Recurrence was noted in 46% of cases (6 out 13 patients). Mean time to recurrence was 38 months. Conclusion Ovarian metastases from a breast cancer occur rarely and are associated with worse prognosis. Despite surgical and adjuvant therapy recurrence rate is very high. Disclosure Nothing to disclose.

Introduction/Background Telomeres are DNA structures protecting the linear ends of eukaryotic chromosomes against degradation and fusion, thereby maintaining genome stability. Telomerase is an enzyme that stabilizes the length of linear chromosomes by de novo synthesizing telomeric repeats during incomplete DNA replication, thus ensuring immortalization. This enzyme is expressed in 80% of cancers, including ovarian carcinoma. The human telomerase reverse transcriptase has been investigated as a detection marker for cancers in early stages, and a prognosis marker in late stages disease. The aim of this study is to investigate telomere length as a marker for survival and recurrence in ovarian carcinoma. Methodology 37 ovarian cancer biopsies have been isolated from Lebanese patients. The biopsies were subjected to DNA extraction, and then telomere length was assayed in cancer cells following the method elaborated by R. Cawthon (2002). Clinical data of each patient have been retrieved, including survival, recurrence, lymph node ratio, age, weight. Results The results obtained revealed a direct relation between telomere length and survival. In fact, patients with shorter survival rates (less than 1 year) exhibited 30% longer telomeres compared with patients with longer survival rates (3 to 5 years). Moreover, recurrence rates increased with longer telomeres. Higher ratios (35%) were detected in patients with early recurrence (less than 1 year) compared to patients with late or absent recurrence. However, no direct effect between telomere length and the other parameters was spotted. Conclusion Telomere length could be used as a prognostic marker in patients with ovarian cancer by predicting better survival and lower recurrence in case of shorter telomeres. This will be of a great value when making therapeutic decisions in a heterogeneous and aggressive disease as ovarian cancer. Disclosure Nothing to disclose.

Introduction/Background To review the surgical outcomes of cytoreductive surgery for ovarian cancer in a single institution. Methodology we reviewed all patients with ovarian cancer who received a cytoreductive surgery between January 2005 and December 2018 at Hotel-Dieu de France University Hospital, Lebanon. Results 161 patients were included. Mean age at surgery was 54 years (range 16–83 years). Cytoreductive surgery was primary in 40% of cases. Surgical resection included bowel resection (48%), diaphragmatic peritoneal resection (25%) and splenectomy (15%). 89% of patients received a pelvic and para-aortic lymphadenectomy. Node involvement was noted in 48% of cases. No recurrence was seen in 56% of cases and the mean interval of recurrence was estimated at 21 months. Overall survival was estimated at 40 months (range 2–165 months). According to cox regression test, we found that survival is significantly correlated to age, menopausal status, lymph node status, number of positive lymph nodes and lymph node ratio (LNR) (p=0.009, p=0.004, p=0.001, p=0.002 and p=0.004 respectively). Patients with LNR ≤0.03 had a survival of 50 months vs. 27 months in patients with LNR >0.03. Mean survival was estimated at 51 months in patients with only one positive LN vs. 26 months in patients with more than one positive LN. Lymphadenectomy neither increased the postoperative complications nor the transfusion rate and was only associated with longer operative time (p=0.7, p=0.85 and p=0.000 respectively). No impact on survival was detected whether the patient benefited from an upfront surgery or an interval one post neoadjuvant chemotherapy: 36 months vs 30 months respectively, (p=0.39). Conclusion Huge efforts including extensive cytoreductive surgeries are being performed at institutions in developing countries in order to improve survival and lower recurrence in ovarian cancer patients. Disclosure Nothing to disclose.

Introduction/Background Ovarian cancer is the leading cause of death from gynecological cancer for women. The standard treatment consists of an extensive cytoreductive surgery followed with adjuvant chemotherapy. This study aims to identify the common postoperative complications as well as to define predictive factors of their occurrence. Methodology This study was conducted at Hotel-Dieu University Hospital in Lebanon between October 2017 and October 2018. All patients older than 18-year-old who underwent cytoredcutive surgery for ovarian cancer were followed up from the postoperative admission in the intensive care unit till discharge from hospital or at least for 30 days. Correlations between perioperative characteristics and complications were searched and analyzed. Results 40 patients were included. The mean age was 55 years old. The mean surgical complexity score was 5. Major complications have occurred in 32% of cases. They were associated with neoadjuvant chemotherapy (p=0.009), elevated surgical complexity (p=0.037), need for intraoperative transfusion and stay at intensive care unit more than 48 hours (p=0.05). Complications were infectious, hemodynamic, pulmonary, digestive and surgical. Need for parenteral nutrition was significantly correlated with longer operative time and neoadjuvant chemotherapy. No correlation was found between occurrence of complications and the following parameters: age, stage, APACHE II score, Charlston Comorbidity index and preoperative albuminemia. Conclusion Cancer stage, neoadjuvant chemotherapy, high surgical complexity, need for transfusions, delayed extubation and stay at intensive care unit more than 48 hours were predictive factors of higher postoperative morbidity in patients receiving cytoreductive surgery for ovarian cancer. Disclosure Nothing to disclose.

Introduction/Background To evaluate the potential impact on survival of residual tumor volume after chemoradiation and prior to brachytherapy initiation determined by magnetic resonance imaging in patients treated for locally advanced cervical cancer. Methodology MRI examinations were prospectively performed in patients with advanced cervical cancer (Stages IB2-IVA) after chemoradiation completion and prior to brachytherapy initiation. Region of interest-based 3D volumetry was derived on the treatment planning system by tracing the entire residual tumor region in each T2-weighted MRI slice. All patients received external beam radiation (EBRT) with concomitant weekly Cisplatin followed by high-dose rate endocavitary brachytherapy using volume-based planning. Cumulative EBRT and BT doses were calculated as the total equivalent dose in 2 Gy fractions (EQD2). Potential prognostic factors were selected based on non-parametric tests and then analyzed for survival with a Cox regression model. Results Median post-therapy follow-up was 27.4 months (range, 3–57.8). Thirty-seven patients were included. According to the FIGO classification, 8% were stage IB, 75% stage II, 11% stage III, and 6% stage IV. Overall survival was 86.5%. Of the patients evaluated, 29.7% had complete radiological remission and 18.9% were considered having local failure or distant disease. At bivariate analysis, residual volume >2 mL, D90 CTV-HR 2 mL, respectively (p=0.005). Conclusion Our data suggest that residual tumor volume >2 mL at the time of brachytherapy is a predictor of poor survival. Disclosure Nothing to disclose.

Objectives To determine the accuracy of MRI in detecting axillary lymph nodes (ALNs) metastases preoperatively and to define predictive characteristics of ALN involvement in patients with invasive breast cancer. Methods Breast MR (3 Tesla) examinations of 169 patients with invasive breast cancer were reviewed at Hotel-Dieu de France Hospital. Morphological parameters in addition to apparent diffusion coefficient (ADC) value were compared with pathological nodal status. Results The sensitivity and specificity of MRI in detecting ALN involvement were 87.5% and 55.6% respectively. The negative and positive predictive value of MRI was 81.64% and 66.34% respectively. The mean size of metastatic ALN was larger than that of negative ALN (13.9 mm vs. 10.9 mm, p = 0.000). ALNs larger than 12 mm were associated with higher risk of metastases (p = 0.000). The asymmetry of size between ipsilateral and contralateral ALNs was more significant in positive ALNs on pathology (p= 0.008 vs. 0.043). In a univariate analysis, the round shape of ALN, loss of fatty hilum, irregular contours and hypo-intensity/heterogeneous intensity on T2-weighted sequence were significantly predictive of lymph node metastasis (p = 0.000 for the four characteristics). In a multivariate analysis, only the round shape of lymph node and the hypo-intensity/heterogeneous intensity on T2-weighted sequence were significantly associated with lymph node metastasis (p=0.01 and p=0,018 respectively). The ADC value of ALN did not aid the differentiation between benign and metastatic lymph nodes (p= 0.862). Conclusions Conventional MRI using the ALN shape and the signal intensity in T2-weighted sequences can evaluate the axilla with high sensitivity.

Objectives To illustrate the importance of preoperative MRI in the surgical treatment decision in patients with invasive breast cancer. Methods We reviewed retrospectively the preoperative MRI (3 Tesla) of 169 patients operated at Hotel-Dieu de France for invasive breast cancer. The sequences of 85 patients who underwent a radical treatment (mastectomy) were compared to those of 84 patients who benefited from conservative surgery. We estimated the tumor volume (TV) and breast volume (BV) on enhanced MRI and then we compared the tumor volume to breast volume ratio (TV/BV) in both groups. Results We reviewed retrospectively the preoperative MRI (3 Tesla) of 169 patients operated at Hotel-Dieu de France for invasive breast cancer. The sequences of 85 patients who underwent a radicaltreatment (mastectomy) were compared to those of 84 patients who benefited from conservative surgery.We estimated the tumor volume (TV) and breast volume (BV) on enhanced MRI and then we comparedthe tumor volume to breast volume ratio (TV/BV) in both groups. Conclusions Our data suggest that preoperative MRI can aid the surgical treatment decision in patients with invasive breast cancer by assessing the tumor to breast volume ratio as well as by providing a full mapping of multifocal and multicentric lesions in the breast tissue.

Objectives To report the impact on survival of residual tumor volume (RTV) prior to brachytherapy (BT) initiation determined by magnetic resonance imaging (MRI) in patients treated for locally advanced cervical cancer with definitive chemoradiotherapy (CRT). Methods MRI examinations were prospectively performed in patients with advanced cervical cancer (Stages IB2-IVA) after CRT completion and prior to BT initiation. RTV was delineated on each T2-weighted slice and volumetry was derived on the treatment planning system. All patients received external beam radiation (EBRT) with concomitant Cisplatin followed by volume-based BT planning. Cumulative EBRT and BT doses were calculated as the total equivalent dose in 2 Gy fractions (EQD2). Potential prognostic factors were selected based on non-parametric tests and then analyzed for survival with a Cox regression model. Results Median post-therapy follow-up was 27.4 months (range, 3–57.8). Thirty-seven patients were included. According to the FIGO classification, 8% were stage IB, 75% stage II, 11% stage III, and 6% stage IV. Overall survival was 86.5%. Of the patients evaluated, 29.7% had complete remission on pre-BT MRI and 18.9% were considered having local failure or distant disease. At bivariate analysis, RTV >2 mL, D90 CTV-HR 2 mL respectively (p=0.005). Conclusions Our preliminary data suggest that pre-BT RTV >2 mL is a predictor of poor survival.

Uvod: I přes velký pokrok v nedavne době je familiarni hypercholesterolemie (FH) stale jestě celosvětově podceňovane, nedostatecně diagnostikovane, a tedy i nedostatecně lecene onemocněni. O přesne prevalenci pacientů postižených familiarni hypercholesterolemii v regionu středni, východni a jižni Evropy (CESE) mame jen velmi malo informaci. Cilem studie bylo popsat na zakladě dostupných udajů epidemiologickou situaci v regionu CESE. Metody: Vsichni vedouci představitele projektu ScreenPro FH v jednotlivých oblastech byli požadani o poskytnuti lokalnich udajů, ktere se týkaji (a) expertniho odhadu prevalence FH, (b) již fungujicich zdravotnických zařizeni, (c) použitých diagnostických kriterii, (d) poctu pacientů již zavedených v mistni databazi a konecně (e) dostupnosti možnosti lecby (zejmena plazmaferezy). Výsledky: Vzhledem k odhadovane prevalenci FH přibližně 1 : 500 odhadujeme, že celkova populace FH heterozygotů v regionu CESE zahrnuje 588 363 osob. V mistnich databazich se vsak zobrazilo pouze 14 108 osob (2,4 %), přicemž mira zobrazeni se lisila v rozmezi od 0,1 % až 31,6 %. Pouze 4 země oznamily dostupnost LDL aferezy. Zavěr: Nase udaje svědci o velke populaci pacientů postižených heterozygotni formou FH v regionu CESE a zaroveň o nizkých podilech jejich zobrazeni. V ramci projektu ScreenPro FH jsou vsak nyni vytvařeny potřebne struktury a můžeme tak doufat v dosaženi přiznivějsich výsledků.

Background Clinical trials conducted in Lebanon are increasing. However, little is known about the performance of research ethics committees (RECs) in charge of reviewing the research protocols. This study aimed to assess the level of adherence to the ethics surrounding the conduct of clinical trials and perceptions of team members regarding roles of the RECs during the conduct of clinical trials in Lebanon. The research question was: Are RECs adherent to the ethics surrounding the conduct of clinical trials (chapters II and IV in ‘Standards and Operational Guidance for Ethics Review of Health-related Research with Human Participants’ in Lebanon?’ Methods This was a quantitative and descriptive questionnaire-based study conducted among RECs of university hospitals in Lebanon. The questionnaire had to be completed online and included general questions in addition to items reflecting the different aspects of a REC performance and effectiveness. All the questionnaire was assigned a total score of 175 points. General information and questions assigned point values/scores were analysed using descriptive statistics: frequency and percentage, mean score ± standard deviation. Results Ten RECs participated in the study (52 persons: four chairs, one vice-president, 47 ordinary members). Forty-seven (90.4%) had previous experience with clinical research and 30 (57.7%) had a diploma or had done a training in research ethics. Forty-one percent confirmed that they were required to have a training in research ethics. All RECs had a policy for disclosing and managing potential conflicts of interest for its members, but 71.8% of participants reported the existence of such a policy for researchers. Thirty-three point three percent reported that the RECs had an anti-bribery policy. The questionnaire mean score was 129.6 ± 22.3/175 points reflecting thus an excellent adherence to international standards. Conclusion Inadequate training of REC members and the lack of anti-bribery policies should be resolved to improve their performance. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2397-2) contains supplementary material, which is available to authorized users.

Objective To report the outcomes of women with placenta percreta who were surgically treated by a specialized technique based on gynecologic oncology experience, and to demonstrate its safety in preventing ureteral lesions and reducing blood loss. Methods In the present retrospective study, data from patients with placenta percreta radically treated at Hotel-Dieu de France, Beirut, Lebanon, between December 2012 and January 2017 were reviewed. Demographic, pathology, and delivery data, medical history, per-operative and postoperative information, and neonatal data were assessed. Operative and postoperative outcomes were compared between emergency and scheduled cases. Results Data from 35 patients were reviewed. Median gestational age at delivery was 34 weeks. Cesarean hysterectomy was scheduled in 20 (60%) cases. No ureteral lesions were noted. The median estimated blood loss was 1 L and a median of 3 units of red blood cells units was transfused. Emergency and scheduled cases presented comparable estimated blood loss, intra-operative transfusion, bladder injury incidence, and surgery duration (all P>0.05). The mean delivery weight was 2100 g; admission to the neonatal intensive care unit was needed for 30 (86%) neonates. Conclusion The surgical technique developed for placenta percreta was found to be effective (operative and postoperative outcomes) and safe (prevention of ureteral lesions).

This paper proposes a new active bonding mechanism that achieves rigid, reversible, and nonback-drivable coupling between modular mobile robots in a chain formation. The first merit of this interface lies in its ability to operate in three independent modes. In the drive mode, the motor torque is routed to drive the module. In the clamp mode, the motor torque is redirected toward an active joint that enables one module to rotate relative to its neighbors in the formation. In the neutral mode, the motor's rotation achieves alignment between the interface's components prior to the initiation of the drive and clamp modes. The second merit stems from the dual-rod slider rocker (DRSR) mechanism, which toggles between the interface's three modes of operation. The design details of the interface are presented, as well as the optimal kinematic synthesis and dynamic analysis of the DRSR mechanism. Simulation and experimental results validate the DRSR's unique kinematics, as well as the rigidity and the three operation modes of the docking interface.

Intima-media thickness (IMT) is a well-described marker of cardiovascular disease. In this study we aim to determine whether low-density lipoprotein (LDL) levels and disease-related mutation status can predict IMT in patients with severe familial hypercholesterolemia (FH) referred for or on LDL apheresis.Genetic screening, lipid profile testing, and IMT measurements were performed on a series of 33 severe FH patients (19 homozygous) on LDL apheresis treatments (LDL 447 ± 151 mg/dL, age range 6-60 years). Data were then compared with literature IMT-LDL data for normal subjects, mild FH patients, and severe FH patients (18, 41, and 6 studies, respectively).Age-adjusted IMT was linearly related to LDL levels over a wide range of values (500 mg/dL), except for the severe FH no-apheresis cohort. Alternatively, our severe FH population (mostly on apheresis) did follow the mild FH/control age-adjusted IMT-LDL relation.In severe FH, measuring LDL levels is more predictive of increased IMT than genetic screening.

e17055 Background: Telomeres are DNA structures protecting the linear ends of eukaryotic chromosomes against degradation and fusion, thereby maintaining genome stability. Telomerase is an enzyme that stabilizes the length of linear chromosomes by de novo synthesizing telomeric repeats during incomplete DNA replication, thus ensuring immortalization. This enzyme is expressed in 80% of cancers, including ovarian carcinoma. The human telomerase reverse transcriptase has been investigated as a detection marker for cancers in early stages, and a prognosis marker in late stages disease. The aim of this study is to investigate telomere length as a marker for survival and recurrence in ovarian carcinoma. Methods: 37 ovarian cancer biopsies have been isolated from Lebanese patients. The biopsies were subjected to DNA extraction, and then telomere length was assayed in cancer cells following the method elaborated by R. Cawthon (2002). The results obtained were expressed as ratios (36B4 is a single copy gene) Ct Telomere/Ct 36B4. Clinical data of each patient have been retrieved, including survival, recurrence, lymph node ratio, age, weight. Results: The results obtained revealed a direct relation between telomere length and survival. In fact, patients with shorter survival rates (less than 1 year) exhibited 30% longer telomeres compared with patients with longer survival rates (3 to 5 years). Moreover, recurrence rates increased with longer telomeres. Higher ratios (35%) were detected in patients with early recurrence (less than 1 year) compared to patients with late or absent recurrence. However, no direct effect between telomere length and the other parameters was spotted. Conclusions: telomere length could be used as a prognostic marker in patients with ovarian cancer by predicting better survival and lower recurrence in case of shorter telomeres. This will be of a great value when making therapeutic decisions in a heterogeneous and aggressive disease as ovarian cancer.

SUMMARYIn this paper the tip-over stability of mobile robots during manipulation with redundant arms is investigated in real-time. A new fast-converging algorithm, called the Circles Of INitialization (COIN), is proposed to calculate globally optimal postures of redundant serial manipulators. The algorithm is capable of trajectory following, redundancy resolution, and tip-over prevention for mobile robots during eccentric manipulation tasks. The proposed algorithm employs a priori training data generated from an exhaustive resolution of the arm's redundancy along a single direction in the manipulator's workspace. This data is shown to provide educated initial guess that enables COIN to swiftly converge to the global optimum for any other task in the workspace. Simulations demonstrate the capabilities of COIN, and further highlight its convergence speed relative to existing global search algorithms.

"Transfusion-related acute lung injury" (TRALI) is a post-transfusion lesional pulmonary edema, potentially severe, better defined since the conference of Toronto in 2004. The incidence of TRALI reported in France remains low in part because of its ignorance by physicians. The objective of our study was to evaluate retrospectively transfusion accidents with respiratory complications that occurred in Nancy University Hospital and reported to the haemovigilance between 1996 and 2006, from the software "Traceline" listing all the blood transfusion complications from signs observed. The analysis of the files has been performed by applying rigorously diagnostic criteria of Toronto. Forty-one cases of respiratory complications were found in 34,573 blood products. Ten cases of TRALI were diagnosed while only one case had been reported to the haemovigilance. The remaining nine cases were previously labeled transfusion-associated circulatory overload (TACO). No cases of TRALI have been identified in the ICU. Our work can find an incidence of TRALI 10 times greater than previously reported. Ignorance of TRALI and the lack of consensus definition before 2004 are not sufficient to explain these results. This study demonstrates the potential interest of database and computerized declaration system based on the symptoms observed. It highlights the vulnerability of the current haemovigilance too dependent on a single medical observer. Although TRALI are recognized as serious complications, sometimes requiring resuscitative care, our work was not isolated severe TRALI in ICU. Physician awareness of TRALI to the identification and to the declaration, including ICU should be continued. Finally, the diagnostic criteria for TRALI must be adapted to the ICU.

Valvular heart disease frequently occurs as a consequence of premature atherosclerosis in individuals with familial hypercholesterolemia (FH). Studies have primarily focused on aortic valve calcification in heterozygous FH, but there is paucity of data on the incidence of valvular disease in homozygous FH. We performed echocardiographic studies in 33 relatively young patients (mean age: 26 years) with homozygous FH (mean LDL of 447 mg/dL, 73% on LDL apheresis) to look for subclinical valvulopathy. Twenty-one patients had evidence of valvulopathy of the aortic or mitral valves, while seven subjects showed notable mitral regurgitation. Older patients were more likely to have aortic valve calcification (>21 versus ≤21 years: 59% versus 12.5%; p = 0.01) despite lower LDL levels at the time of the study (385 versus 513 mg/dL; p = 0.016). Patients with valvulopathy were older and had comparable LDL levels and a lower carotid intima-media thickness. Our data suggests that, in homozygous FH patients, valvulopathy (1) is present across a wide age spectrum and LDL levels and (2) is less likely to be influenced by lipid-lowering treatment. Echocardiographic studies that focused on aortic root thickening and stenosis and regurgitation are thus likely an effective modality for serial follow-up of subclinical valvular heart disease.

Purpose. To study the distribution of breast mammogram density in Lebanese women and correlate it with breast cancer (BC) incidence.Methods. Data from 1,049 women who had screening or diagnostic mammography were retrospectively reviewed. Age, menopausal status, contraceptives or hormonal replacement therapy (HRT), parity, breastfeeding, history of BC, breast mammogram density, and final BI-RADS assessment were collected. Breast density was analyzed in each age category and compared according to factors that could influence breast density and BC incidence.Results. 120 (11.4%) patients had BC personal history with radiation and/or chemotherapy; 66 patients were postmenopausal under HRT. Mean age was52.58±11.90years. 76.4% of the patients (30–39 years) had dense breasts. Parity, age, and menopausal status were correlated to breast density whereas breastfeeding and personal/family history of BC and HRT were not. In multivariate analysis, it was shown that the risk of breast cancer significantly increases 3.3% with age (P=0.005), 2.5 times in case of menopause (P=0.004), and 1.4 times when breast density increases (P=0.014).Conclusion. Breast density distribution in Lebanon is similar to the western society. Similarly to other studies, it was shown that high breast density was statistically related to breast cancer, especially in older and menopausal women.

With increasing demand on reliable robotic platforms that can alleviate the burden of daily painstaking tasks, researchers have focused their effort towards developing robotic platforms that possess a high level of autonomy and versatility in function. These robots, capable of operating either individually or in a group, also possess the structural modular morphology that enables them to adapt to the unstructured nature of a real environment. Over the past two decades, significant work has been published in this field, particularly in the aspects of autonomy, mobility and docking. This paper reviews the primary methods in the literature related to the fields of modular and reconfigurable mobile robotics. By bringing together aspects of modularity, including docking and autonomy, and synthesizing the most relevant findings, there is optimism that a more complete understanding of this field will serve as a starting ground for innovation and integration of such technology in the urban environment.

This paper presents a self-calibrating mathematical model and simulation results of the direct piezoelectric effect of a new tilt-sensor that measures inclination angles around two orthogonal axes. Using a fundamental description of the mechanical stress generated in suspended beams under static loading, we propose a model of the sensor's direct piezoelectric effect that is only a trigonometric function of its genetic behavior in two orthogonal planes. The significance of the proposed approach lies in the independence of the model from the structural dimensions of the piezo-system and the electro-mechanical properties of the piezoelectric layer. The effect of these structural properties and other external stimuli on the proposed model is implicitly contained, and inherently carried by the genetic data which is curve-fitted using a polynomial approximation. The feasibility of the proposed method and the accuracy of the model are verified by cross-comparison with simulation results. These simulations are performed on a CAD model of the piezoelectric tilt sensor for a case-study operation range of 0 - 90° . An overall considerable accuracy level was noted between the simulated and modeled data over the full operation range, with an average relative peak error of 1.9%.

In this paper, we study the scheduling architecture that enables an assembly of mobile modules to reconfigure into a humanoid formation with a manipulator arm. The investigated problem arises from the articulated nature of the formation which involves multiple degrees of freedom, thus requiring a control approach that synchronizes the actuators' motion during shape metamorphosis. Using the principles of motion kinematics and caterpillar tracks modeling, we present a coherent solution which we further validate on a sample three-module formation of STORM (Self-configurable and Transformable Omni-directional Robotic Modules). Simulation results on MSC ADAMS CAR validate the feasibility of the synchronization architecture, and offer further insight into the dynamic dependencies of coupled motions.

In this paper, the stability of mobile robots during object manipulation with redundant arms is investigated. A new fast-converging MIMO control algorithm, called the Circles of INitialization (COIN), is introduced to calculate globally optimal postures of redundant manipulators. The algorithm is employed in real-time to prevent mobile robots tip-over during dynamic eccentric manipulation. This is achieved with tip-load measurement by adapting the position of the base relative to the line of action, and recalculating the global joint posture that offsets the risk of toppling. This closed-loop control scheme to maximize the arm's payload and stabilize the robot's posture is applied to serial redundant manipulators with n-joints.