Performance and Safety of EUS Ablation Techniques for Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis

Background: Pancreatic cystic lesions (PCL) represent an increasingly diagnosed condition with significant burden to patients’ lives and medical resources. Endoscopic ultrasound (EUS) ablation techniques have been utilized to treat focal pancreatic lesions. This systematic review with meta-analysis aims to assess the efficacy of EUS ablation on PCL in terms of complete or partial response and safety. Methods: A systematic search in Medline, Cochrane and Scopus databases was performed in April 2023 for studies assessing the performance of the various EUS ablation techniques. The primary outcome was complete cyst resolution, defined as cyst disappearance in follow-up imaging. Secondary outcomes included partial resolution (reduction in PCL size), and adverse events rate. A subgroup analysis was planned to evaluate the impact of the available ablation techniques (ethanol, ethanol/paclitaxel, radiofrequency ablation (RFA), and lauromacrogol) on the results. Meta-analyses using a random effects model were conducted and the results were reported as percentages with 95% confidence intervals (95%CI). Results: Fifteen studies (840 patients) were eligible for analysis. Complete cyst resolution after EUS ablation was achieved in 44% of cases (95%CI: 31–57; 352/767; I2 = 93.7%), and the respective partial response rate was 30% (95%CI: 20–39; 206/767; I2 = 86.1%). Adverse events were recorded in 14% (95%CI: 8–20; 164/840; I2 = 87.2%) of cases, rated as mild in 10% (95%CI: 5–15; 128/840; I2 = 86.7%), and severe in 4% (95%CI: 3–5; 36/840; I2 = 0%). The subgroup analysis for the primary outcome revealed rates of 70% (95%CI: 64–76; I2 = 42.3%) for ethanol/paclitaxel, 44% (95%CI: 33–54; I2= 0%) for lauromacrogol, 32% (95%CI: 27–36; I2 = 88.4%) for ethanol, and 13% (95%CI: 4–22; I2 = 95.8%) for RFA. Considering adverse events, the ethanol-based subgroup rated the highest percentage (16%; 95%CI: 13–20; I2 = 91.0%). Conclusion: EUS ablation of pancreatic cysts provides acceptable rates of complete resolution and a low incidence of severe adverse events, with chemoablative agents yielding higher performance rates

Stratigraphic control on earthquake-induced liquefaction: A case study from the Central Po Plain (Italy)

Studies on earthquake-induced liquefaction tied to high-resolution stratigraphic analysis have been rarely undertaken. We report the results of a multidisciplinary study from the Quistello\u2013Moglia area, in the central Po Plain (northern Italy). In this region, combined stratigraphic, sedimentological, geotechnical, and geochemical data allowed assessment of liquefaction potential and identification of the primary source for liquefaction, following the second main shock (Mw\ua0~\ua06) of the 2012 Po Plain earthquake. Using Cone Penetration Test (CPT)-based simplified procedures for liquefaction hazard evaluation, we assessed the highest liquefaction potential of Holocene, fluvial-channel and related (crevasse/levee) fine sand-silt facies encased in thick, mud-prone floodplain and swamp successions. The liquefaction potential, and the intensity of the manifestations induced on the ground surface, decreased for the vertically-amalgamated, sheet-like Pleistocene sandy fluvial units encountered at depths greater than 13\ua0m. Floodplain and swamp deposits were virtually non-liquefiable. In the Quistello area, the compositional characterization of sands that were liquefied and extruded during the 2012 earthquake reveals the diagnostic geochemical fingerprint of sediment carried by the Po River, as opposed to the Apennine composition of surficial sediments. These data rule out proximity of liquefied layers to the surface, and attest the buried, meandering Po River system at depths of ~\ua07\u201310\ua0m most likely representing the source for the liquefied sand that vented to the surface. Similarly, at Moglia, liquefied sands were likely sourced from loose and saturated, ribbon-shaped, fluvial sand bodies encased in mud, though at shallower (4\u20137\ua0m) depths. Pronounced liquefaction phenomena in alluvial plain systems are commonly believed to be associated primarily with elongate topographic ridges following paleo-river courses. Here, we document that under favorable stratigraphic conditions liquefaction may also occur away from surficial channel\u2013levee systems, in areas dominated superficially by overbank fines. Combining subsurface stratigraphic analysis with geotechnical data, thus, is critical to investigate liquefaction patterns and delineate liquefaction hazard zones

Computational and experimental study of seismic site effects on Amatrice hill

Amatrice is considered the town symbol of the destructive effects induced by 2016 Central Italy seismic sequence. As a result of the two main shocks (August 24th, M=6.0 and October 30th, M=6.5) the ancient urban area of the municipality, located on a hilly promontory, was heavily damaged. Old buildings, but also renovated and new buildings, suffered many cracks and collapses. Subsoil geological, geophysical and geotechnical data were collected in the area and seismic data were also available. By using and interpreting the subsoil data, a 3D-GIS model was developed, that is the basic geometrical model for SiSeRHMap hybrid-analysis. Several 2D sections crossing the seismic station sites were extracted from this model and analyzed by 2D-FEM numerical approaches. Comparison of numerical results and seismic experimental data allowed to: i) validate the subsoil model used in the simulations; ii) show the significant role of the topographic effects in the area under study; and iii) point out the variability of the 2D numerical results depending on the direction of the analyzed cross-sections

Cancer registry study of malignant hepatic vascular tumors: hepatic angiosarcomas and hepatic epithelioid hemangioendotheliomas

Background: Malignant vascular tumors (MVTs) are rare and often misdiagnosed due to wide range of clinical presentations, varied histology, and exquisite imagining features. We aim to characterize two different types of MVTs of the liver: hepatic angiosarcomas (HA) and hepatic epithelioid hemangioendotheliomas (HEHE). Methods: Data on HA and HEHE between 1975 and 2016 were extracted from the SEER database and analyzed. Results: A total of 366 patients with HA were identified where 64.2% were male and 79% of White race. The median age at diagnosis was 64 ± 16.2 years. Distant metastasis was found in 24% of patients, regional disease in 22.1%, and localized disease in 21.3%. The median overall survival for HA was 2 months. For HEHE, 120 cases were identified, 32.5% were male and 80% of White race. The median age of diagnosis was 51 ± 16.8 years. Distant metastasis was found in 37.5% of patients, regional disease in 27.5%, and localized disease in 20%. The median overall survival was 182 months. Conclusion: Patients’ demographics such as race, age, and gender may assist in elucidating distinct subtypes of MVTs. HA is an aggressive tumor despite intervention. Patients with HEHE tumors have significantly better survival compared to patients with HA. Further studies are needed to deepen our knowledge about the histopathology of these tumors, the outcomes of liver transplantation as a therapeutic alternative, and available molecular targets for MVTs

Comparative Risk of Serious Infections With Biologic and/or Immunosuppressive Therapy in Patients With Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis

Background & aimsWe performed a systematic review and meta-analysis to evaluate the comparative risk of serious infections with tumor necrosis factor (TNF) antagonists, non-TNF targeted biologics, tofacitinib, and immunosuppressive agents in patients with inflammatory bowel diseases (IBDs).MethodsIn a systematic search of publications, through March 18, 2018, we identified 15 observational studies (>500 person-years) of patients with IBD treated with TNF antagonists, non-TNF targeted biologics, tofacitinib, and/or immunosuppressive agents (thiopurines, methotrexate) that reported risk of serious infections. Only studies with active comparators were included, to allow appropriate comparative synthesis. We performed random-effects meta-analysis and estimated relative risk (RR) and 95% CIs.ResultsCompared with anti-TNF monotherapy, risk of serious infection increased with the combination of anti-TNF and an immunosuppressive agent (in 6 cohorts: RR, 1.19; 95% CI, 1.03-1.37), with anti-TNF and a corticosteroid (in 4 cohorts: RR, 1.64; 95% CI, 1.33-2.03), or with all 3 drugs (in 2 cohorts: RR, 1.35; 95% CI, 1.04-1.77); there was minimal heterogeneity among studies. In contrast, monotherapy with an immunosuppressive agent was associated with a lower risk of serious infections than monotherapy with a TNF antagonist (7 cohorts: RR, 0.61; 95% CI 0.44-0.84) or a TNF antagonist with an immunosuppressive agent (2 cohorts: RR, 0.56; 95% CI, 0.39-0.81). Infliximab-based therapy was associated with a lower risk of serious infections compared with adalimumab-based therapy in patients with ulcerative colitis (4 cohorts: RR, 0.57; 95% CI, 0.33-0.97), but not Crohn's disease (4 cohorts: RR, 0.91; 95% CI, 0.49-1.70). Few data were available on the comparative safety of biologic agents that do not inhibit TNF and tofacitinib.ConclusionsCombination therapies for IBD that include TNF antagonists, especially with corticosteroids, are associated with a higher risk of serious infection, whereas monotherapy with an immunosuppressive agent is associated with a lower risk, compared with monotherapy with a TNF antagonist. Studies are needed to evaluate the comparative safety of non-TNF targeted biologics and small molecules for treatment of IBD