Glider and satellite monitoring of the variability of the suspended particle distribution and size in the Rhône ROFI

An experiment was carried out in the Gulf of Lions (NW Mediterranean) in February 2014 to assess the temporal and spatial variability of the distribution and size of suspended particulate matter (SPM) in the Rhône Region of Freshwater Influence (ROFI). A set of observations from an autonomous underwater glider, satellite ocean color data, and meteorological and hydrological time-series data highlighted the high variability of the Rhône River surface turbid plume and presence of a bottom nepheloid layer (BNL) that depended on wind and river discharge conditions. While continental winds pushed the surface plume offshore, marine winds pressed the plume at the coast and favored the sedimentation of as well as nourishment of the BNL. Moderate storm events favored breakage of the plume stratification and along-shelf transport of Rhône River particles. The spectral slopes of glider and satellite-derived light backscattering coefficients, γ, were used as a proxies of the SPM size distribution. The results clearly showed that the change of the SPM size in the nepheloid layers was induced by the flocculation of fine sediments, which became finer seaward throughout the ROFI, as well as the effect of rough weather in the breakup of flocs

Glider and satellite monitoring of the variability of the suspended particle distribution and size in the Rhône ROFI

An experiment was carried out in the Gulf of Lions (NW Mediterranean) in February 2014 to assess the temporal and spatial variability of the distribution and size of suspended particulate matter (SPM) in the Rhône Region of Freshwater Influence (ROFI). A set of observations from an autonomous underwater glider, satellite ocean color data, and meteorological and hydrological time-series data highlighted the high variability of the Rhône River surface turbid plume and presence of a bottom nepheloid layer (BNL) that depended on wind and river discharge conditions. While continental winds pushed the surface plume offshore, marine winds pressed the plume at the coast and favored the sedimentation of as well as nourishment of the BNL. Moderate storm events favored breakage of the plume stratification and along-shelf transport of Rhône River particles. The spectral slopes of glider and satellite-derived light backscattering coefficients, γ, were used as a proxies of the SPM size distribution. The results clearly showed that the change of the SPM size in the nepheloid layers was induced by the flocculation of fine sediments, which became finer seaward throughout the ROFI, as well as the effect of rough weather in the breakup of flocs

Glider-based active acoustic monitoring of currents and turbidity in the coastal zone

The recent integration of Acoustic Doppler Current Profilers (ADCPs) onto underwater gliders changes the way current and sediment dynamics in the coastal zone can be monitored. Their endurance and ability to measure in all weather conditions increases the probability of capturing sporadic meteorological events, such as storms and floods, which are key elements of sediment dynamics. We used a Slocum glider equipped with a CTD (Conductivity, Temperature, Depth), an optical payload, and an RDI 600 kHz phased array ADCP. Two deployments were carried out during two contrasting periods of the year in the Rhone River region of freshwater influence (ROFI). Coastal absolute currents were reconstructed using the shear method and bottom tracking measurements, and generally appear to be in geostrophic balance. The responses of the acoustic backscatter index and optical turbidity signals appear to be linked to changes of the particle size distribution in the water column. Significantly, this study shows the interest of using a glider-ADCP for coastal zone monitoring. However, the comparison between suspended particulate matter dynamics from satellites and gliders also suggests that a synoptic view of the processes involved requires a multiplatform approach, especially in systems with high spatial and temporal variability, such as the Rhone ROFI area

Differentiation of hepatocellular adenoma by subtype and hepatocellular carcinoma in non-cirrhotic liver by fractal analysis of perfusion MRI

Background: To investigate whether fractal analysis of perfusion differentiates hepatocellular adenoma (HCA) subtypes and hepatocellular carcinoma (HCC) in non-cirrhotic liver by quantifying perfusion chaos using four-dimensional dynamic contrast-enhanced magnetic resonance imaging (4D-DCE-MRI). Results: A retrospective population of 63 patients (47 female) with histopathologically characterized HCA and HCC in non-cirrhotic livers was investigated. Our population consisted of 13 hepatocyte nuclear factor (HNF)-1 alpha-inactivated (H-HCAs), 7 beta-catenin-exon-3-mutated (b(ex3)-HCAs), 27 inflammatory HCAs (I-HCAs), and 16 HCCs. Four-dimensional fractal analysis was applied to arterial, portal venous, and delayed phases of 4D-DCE-MRI and was performed in lesions as well as remote liver tissue. Diagnostic accuracy of fractal analysis was compared to qualitative MRI features alone and their combination using multi-class diagnostic accuracy testing including kappa-statistics and area under the receiver operating characteristic curve (AUC). Fractal analysis allowed quantification of perfusion chaos, which was significantly different between lesion subtypes (multi-class AUC = 0.90, p < 0.001), except between I-HCA and HCC. Qualitative MRI features alone did not allow reliable differentiation between HCA subtypes and HCC (kappa = 0.35). However, combining qualitative MRI features and fractal analysis reliably predicted the histopathological diagnosis (kappa = 0.89) and improved differentiation of high-risk lesions (i.e., HCCs, b(ex3)-HCAs) and low-risk lesions (H-HCAs, I-HCAs) from sensitivity and specificity of 43% (95% confidence interval [CI] 23-66%) and 47% (CI 32-64%) for qualitative MRI features to 96% (CI 78-100%) and 68% (CI 51-81%), respectively, when adding fractal analysis. Conclusions: Combining qualitative MRI features with fractal analysis allows identification of HCA subtypes and HCCs in patients with non-cirrhotic livers and improves differentiation of lesions with high and low risk for malignant transformation

Benchmarks in Liver Resection for Intrahepatic Cholangiocarcinoma

Introduction: Benchmarking in surgery has been proposed as a means to compare results across institutions to establish best practices. We sought to define benchmark values for hepatectomy for intrahepatic cholangiocarcinoma (ICC) across an international population. Methods: Patients who underwent liver resection for ICC between 1990 and 2020 were identified from an international database, including 14 Eastern and Western institutions. Patients operated on at high-volume centers who had no preoperative jaundice, ASA class &lt;3, body mass index &lt;35 km/m2, without need for bile duct or vascular resection were chosen as the benchmark group. Results: Among 1193 patients who underwent curative-intent hepatectomy for ICC, 600 (50.3%) were included in the benchmark group. Among benchmark patients, median age was 58.0 years (interquartile range [IQR] 49.0–67.0), only 28 (4.7%) patients received neoadjuvant therapy, and most patients had a minor resection (n = 499, 83.2%). Benchmark values included ≥3 lymph nodes retrieved when lymphadenectomy was performed, blood loss ≤600 mL, perioperative blood transfusion rate ≤42.9%, and operative time ≤339 min. The postoperative benchmark values included TOO achievement ≥59.3%, positive resection margin ≤27.5%, 30-day readmission ≤3.6%, Clavien-Dindo III or more complications ≤14.3%, and 90-day mortality ≤4.8%, as well as hospital stay ≤14 days. Conclusions: Benchmark cutoffs targeting short-term perioperative outcomes can help to facilitate comparisons across hospitals performing liver resection for ICC, assess inter-institutional variation, and identify the highest-performing centers to improve surgical and oncologic outcomes.</p

Benchmarks in Liver Resection for Intrahepatic Cholangiocarcinoma

Introduction: Benchmarking in surgery has been proposed as a means to compare results across institutions to establish best practices. We sought to define benchmark values for hepatectomy for intrahepatic cholangiocarcinoma (ICC) across an international population. Methods: Patients who underwent liver resection for ICC between 1990 and 2020 were identified from an international database, including 14 Eastern and Western institutions. Patients operated on at high-volume centers who had no preoperative jaundice, ASA class &lt;3, body mass index &lt;35 km/m2, without need for bile duct or vascular resection were chosen as the benchmark group. Results: Among 1193 patients who underwent curative-intent hepatectomy for ICC, 600 (50.3%) were included in the benchmark group. Among benchmark patients, median age was 58.0 years (interquartile range [IQR] 49.0–67.0), only 28 (4.7%) patients received neoadjuvant therapy, and most patients had a minor resection (n = 499, 83.2%). Benchmark values included ≥3 lymph nodes retrieved when lymphadenectomy was performed, blood loss ≤600 mL, perioperative blood transfusion rate ≤42.9%, and operative time ≤339 min. The postoperative benchmark values included TOO achievement ≥59.3%, positive resection margin ≤27.5%, 30-day readmission ≤3.6%, Clavien-Dindo III or more complications ≤14.3%, and 90-day mortality ≤4.8%, as well as hospital stay ≤14 days. Conclusions: Benchmark cutoffs targeting short-term perioperative outcomes can help to facilitate comparisons across hospitals performing liver resection for ICC, assess inter-institutional variation, and identify the highest-performing centers to improve surgical and oncologic outcomes.</p

The Centrality of Mathematics in the History of Western Thought

This article explores the interplay of mathematics and philosophy in Western thought as well as applications to other fields

ERS: A simple scoring system to predict early recurrence after surgical resection for hepatocellular carcinoma.

peer reviewed[en] BACKGROUND: Surgical resection (SR) is a potentially curative treatment of hepatocellular carcinoma (HCC) hampered by high rates of recurrence. New drugs are tested in the adjuvant setting, but standardised risk stratification tools of HCC recurrence are lacking. OBJECTIVES: To develop and validate a simple scoring system to predict 2-year recurrence after SR for HCC. METHODS: 2359 treatment-naïve patients who underwent SR for HCC in 17 centres in Europe and Asia between 2004 and 2017 were divided into a development (DS; n = 1558) and validation set (VS; n = 801) by random sampling of participating centres. The Early Recurrence Score (ERS) was generated using variables associated with 2-year recurrence in the DS and validated in the VS. RESULTS: Variables associated with 2-year recurrence in the DS were (with associated points) alpha-fetoprotein (100: 3), size of largest nodule (≥40 mm: 1), multifocality (yes: 2), satellite nodules (yes: 2), vascular invasion (yes: 1) and surgical margin (positive R1: 2). The sum of points provided a score ranging from 0 to 11, allowing stratification into four levels of 2-year recurrence risk (Wolbers' C-indices 66.8% DS and 68.4% VS), with excellent calibration according to risk categories. Wolber's and Harrell's C-indices apparent values were systematically higher for ERS when compared to Early Recurrence After Surgery for Liver tumour post-operative model to predict time to early recurrence or recurrence-free survival. CONCLUSIONS: ERS is a user-friendly staging system identifying four levels of early recurrence risk after SR and a robust tool to design personalised surveillance strategies and adjuvant therapy trials