Early diagnosis of liver cancer: an appraisal of international recommendations and future perspectives

AbstractAll Societies, AASLD, EASL, APASL and JSH, identify patients with cirrhosis as a target population for surveillance, with minor differences for additional categories of patients, such as chronic hepatitis B and hepatitis C patients with advanced fibrosis. According to AASLD, liver disease related to metabolic diseases including diabetes and obesity is a recognized target of screening, since those conditions have been causally related to HCC. All societies endorse radiological non‐invasive techniques as the mainstay for early diagnosis of HCC, but discrepancies exist between Societies on the utilization of contrast‐enhanced ultrasound and utilization of serum markers for surveillance and diagnosis of HCC. The diagnostic algorithm of the international societies differ substantially in the anatomic paradigm of EASL and APASL which identify 1 cm size as the starting point for radiological diagnosis of HCC compared to APASL algorithm based on the dynamic pattern of contrast imaging, independently on tumour size. While strengthening prediction in individual patients is expected to improve cost‐effectiveness ratios of screening, the benefits of pre‐treatment patient stratification by clinical, histological and genetic scores remain uncertain and exclusion of patients with severe co‐morbidities and advanced age is still debated

The SSDC contribution to the improvement of knowledge by means of 3D data projections of minor bodies

The latest developments of planetary exploration missions devoted to minor bodies required new solutions to correctly visualize and analyse data acquired over irregularly shaped bodies. ASI Space Science Data Center (SSDC-ASI, formerly ASDC-ASI Science Data Center) worked on this task since early 2013, when started developing the web tool MATISSE (Multi-purpose Advanced Tool for the Instruments of the Solar System Exploration) mainly focused on the Rosetta/ESA space mission data. In order to visualize very high-resolution shape models, MATISSE uses a Python module (vtpMaker), which can also be launched as a stand-alone command-line software. MATISSE and vtpMaker are part of the SSDC contribution to the new challenges imposed by the "orbital exploration" of minor bodies: 1) MATISSE allows to search for specific observations inside datasets and then analyse them in parallel, providing high-level outputs; 2) the 3D capabilities of both tools are critical in inferring information otherwise difficult to retrieve for non-spherical targets and, as in the case for the GIADA instrument onboard Rosetta, to visualize data related to the coma. New tasks and features adding valuable capabilities to the minor bodies SSDC tools are planned for the near future thanks to new collaborations

Scar-Free Laparoscopy in BRCA-Mutated Women

Background and Objectives: BRCA 1 and 2 mutations have a cumulative risk of developing ovarian cancer at 70 years of 41% and 15%, respectively, while a cumulative risk of breast cancer by 80 years of age was 72% for BRCA1 mutation carriers and 69% for BRCA2 mutation carriers. The NCCN recommends risk-reducing salpingo-oophorectomy (RRSO), typically between 35 and 40 years, and upon completion of childbearing in BRCA1 mutation, while it is reasonable to delay RRSO for management of ovarian cancer risk until age 40–45 years in patients with BRCA2. In recent years there have been two main lines of evolution in laparoscopy. The former concerning the development of a single-site laparoscopic and the latter concerning the miniaturisation of laparoscopic instruments (mini/micro-laparoscopy). Materials and Methods: In this case report, we show our experience in prophylactic adnexectomy, on a mutated-BRCA patient, using the MiniLap® percutaneous surgical system. Results: This type of technique is safe and effective and does not require a particular learning curve compared to single-port laparoscopy. Conclusions: The considerable aesthetic advantage of the scars, we believe, albeit to a lesser extent, is useful to find in these patients burdened by an important stress loa

Comparison between percutaneous and laparoscopic microwave ablation of hepatocellular carcinoma

Background: Based on patient and tumor characteristics, some authors favor laparoscopic microwave ablation (LMWA) over the percutaneous approach (PMWA) for treatment of hepatocellular carcinoma (HCC). We compared the two techniques in terms of technique efficacy, local tumor progression (LTP) and complication rates. Study design: A retrospective comparative analysis was performed on 91 consecutive patients (102 HCC tumors) who underwent PMWA or LMWA between October 2014 and May 2019. Technique efficacy at one-month and LTP at follow-up were assessed by contrast-enhanced CT/MRI. Kaplan–Meier estimates and Cox regression were used to compare LTP-free survival (LTPFS). Results: At baseline analysis, LMWA group showed higher frequency of multinodular disease (p < .001) and average higher energy delivered over tumor size (p = .033); PMWA group showed higher rates of non-treatment-naïve patients (p = .001), patients with Hepatitis-C (p = .03) and BCLC-A1 disease (p = .006). Technique efficacy was not significantly different between the two groups (p = .18). Among effectively treated patients, 75 (83 tumors) satisfied ≥6 months follow-up, 54 (57 tumors) undergoing PMWA and 21 (26 tumors) LMWA. LTP occurred in 14/83 cases (16.9%): 12 after PMWA (21.1%) and 2 after LMWA (7.7%). At univariate analysis, technique did not correlate to LTPFS (p = .28). Subgroup analysis showed a trend toward worse LTPFS after PMWA of subcapsular tumors (p = .16). Major complications were observed in six patients (6.6%), 2 after PMWA and 4 after LMWA (3.2% vs 14.3%, p = .049). Conclusions: Technical approach did not affect LTPFS. Complications were reported more frequently after LMWA. Despite higher complication rates, LMWA seems a valid option for treatment of subcapsular tumors

A New Orbiting Deployable System for Small Satellite Observations for Ecology and Earth Observation

In this paper, we present several study cases focused on marine, oceanographic, and atmospheric environments, which would greatly benefit from the use of a deployable system for small satellite observations. As opposed to the large standard ones, small satellites have become an effective and affordable alternative access to space, owing to their lower costs, innovative design and technology, and higher revisiting times, when launched in a constellation configuration. One of the biggest challenges is created by the small satellite instrumentation working in the visible (VIS), infrared (IR), and microwave (MW) spectral ranges, for which the resolution of the acquired data depends on the physical dimension of the telescope and the antenna collecting the signal. In this respect, a deployable payload, fitting the limited size and mass imposed by the small satellite architecture, once unfolded in space, can reach performances similar to those of larger satellites. In this study, we show how ecology and Earth Observations can benefit from data acquired by small satellites, and how they can be further improved thanks to deployable payloads. We focus on DORA—Deployable Optics for Remote sensing Applications—in the VIS to TIR spectral range, and on a planned application in the MW spectral range, and we carry out a radiometric analysis to verify its performances for Earth Observation studies

The SSDC Role in the LICIACube Mission: Data Management and the MATISSE Tool

Light Italian Cubesat for Imaging of Asteroids (LICIACube) is an Italian mission managed by the Italian Space Agency (ASI) and part of the NASA Double Asteroid Redirection Test (DART) planetary defense mission. Its main goals are to document the effects of the DART impact on Dimorphos, the secondary member of the (65803) Didymos binary asteroid system, characterizing the shape of the target body and performing dedicated scientific investigations on it. Within this framework, the mission Science Operations Center will be managed by the Space Science Data Center (ASI-SSDC), which will have the responsibility of processing, archiving, and disseminating the data acquired by the two LICIACube onboard cameras. In order to better accomplish this task, SSDC also plans to use and modify its scientific webtool Multi-purpose Advanced Tool for Instruments for the solar system Exploration (MATISSE), making it the primary tool for the LICIACube data analysis, thanks to its advanced capabilities for searching and visualizing data, particularly useful for the irregular shapes common to several small bodies

VADER: Probing the Dark Side of Dimorphos with LICIACube LUKE

The ASI cubesat LICIACube has been part of the first planetary defense mission DART, having among its scopes to complement the DRACO images to better constrain the Dimorphos shape. LICIACube had two different cameras, LEIA and LUKE, and to accomplish its goal, it exploited the unique possibility of acquiring images of the Dimorphos hemisphere not seen by DART from a vantage point of view, in both time and space. This work is indeed aimed at constraining the tridimensional shape of Dimorphos, starting from both LUKE images of the nonimpacted hemisphere of Dimorphos and the results obtained by DART looking at the impacted hemisphere. To this aim, we developed a semiautomatic Computer Vision algorithm, named VADER, able to identify objects of interest on the basis of physical characteristics, subsequently used as input to retrieve the shape of the ellipse projected in the LUKE images analyzed. Thanks to this shape, we then extracted information about the Dimorphos ellipsoid by applying a series of quantitative geometric considerations. Although the solution space coming from this analysis includes the triaxial ellipsoid found by using DART images, we cannot discard the possibility that Dimorphos has a more elongated shape, more similar to what is expected from previous theories and observations. The result of our work seems therefore to emphasize the unique value of the LICIACube mission and its images, making even clearer the need of having different points of view to accurately define the shape of an asteroid.This work was supported by the Italian Space Agency (ASI) within the LICIACube project (ASI-INAF agreement AC No. 2019-31-HH.0) and by the DART mission, NASA contract 80MSFC20D0004

The Dimorphos ejecta plume properties revealed by LICIACube

The Double Asteroid Redirection Test (DART) had an impact with Dimorphos (a satellite of the asteroid Didymos) on 26 September 20221. Ground-based observations showed that the Didymos system brightened by a factor of 8.3 after the impact because of ejecta, returning to the pre-impact brightness 23.7 days afterwards2. Hubble Space Telescope observations made from 15 minutes after impact to 18.5 days after, with a spatial resolution of 2.1 kilometres per pixel, showed a complex evolution of the ejecta3, consistent with other asteroid impact events. The momentum enhancement factor, determined using the measured binary period change4, ranges between 2.2 and 4.9, depending on the assumptions about the mass and density of Dimorphos5. Here we report observations from the LUKE and LEIA instruments on the LICIACube cube satellite, which was deployed 15 days in advance of the impact of DART. Data were taken from 71 seconds before the impact until 320 seconds afterwards. The ejecta plume was a cone with an aperture angle of 140 ± 4 degrees. The inner region of the plume was blue, becoming redder with increasing distance from Dimorphos. The ejecta plume exhibited a complex and inhomogeneous structure, characterized by filaments, dust grains and single or clustered boulders. The ejecta velocities ranged from a few tens of metres per second to about 500 metres per second.This work was supported by the Italian Space Agency (ASI) in the LICIACube project (ASI-INAF agreement AC no. 2019-31-HH.0) and by the DART mission, NASA contract 80MSFC20D0004. M.Z. acknowledges Caltech and the Jet Propulsion Laboratory for granting the University of Bologna a licence to an executable version of MONTE Project Edition software. M.Z. is grateful to D. Lubey, M. Smith, D. Mages, C. Hollenberg and S. Bhaskaran of NASA/JPL for the discussions and suggestions regarding the operational navigation of LICIACube. G.P. acknowledges financial support from the Centre national d’études spatiales (CNES, France). A.C.B. acknowledges funding by the NEO-MAPP project (grant agreement 870377, EC H2020-SPACE-2019) and by the Ministerio de Ciencia Innovación (PGC 2018) RTI2018-099464-B-I00. F.F. acknowledges funding from the Swiss National Science Foundation (SNSF) Ambizione (grant no. 193346). J.-Y.L. acknowledges the support from the NASA DART Participating Scientist Program (grant no. 80NSSC21K1131). S.D.R. and M.J. acknowledge support from the Swiss National Science Foundation (project no. 200021_207359)

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries