Radioguided Parathyroidectomy with Portable Mini Gamma-Camera for the Treatment of Primary Hyperparathyroidism

Background. A proper localisation of pathological parathyroid glands is essential for a minimally invasive approach in the surgical treatment of primary hyperparathyroidism (PHP). The recent introduction of portable mini gamma-cameras (pMGCs) enabled intraoperative scintigraphic scanning. The aim of our study is to evaluate the efficacy of this new method and compare it with the preoperative localisation surveys. Methods. 20 patients were studied; they were evaluated preoperatively by neck ultrasound and Tc-sestaMIBI-scintigraphy and intraoperatively with the pMGC IP Guardian 2. The results obtained from the three evaluations were compared. Results. The pMGC presented a sensitivity of 95%, a specificity of 98.89%, and a diagnostic accuracy of 98.18%, which were higher than those of preoperative ultrasound (sensitivity 55%; specificity 95%; diagnostic accuracy 87%) and scintigraphy with Tc-sestaMIBI (sensitivity 73.68%; specificity 96.05%; diagnostic accuracy 91.58%). Conclusions. The pMGC can be used effectively as an intraoperative method to find the correct location of the pathological parathyroid glands. The pMGC is more reliable than the currently used preoperative and intraoperative localisation techniques

The Management of Acute Colonic Diverticulitis in the COVID-19 Era: A Scoping Review.

Background and Objective: During the COVID-19 pandemic, health systems worldwide made major changes to their organization, delaying diagnosis and treatment across a broad spectrum of pathologies. Concerning surgery, there was an evident reduction in all elective and emergency activities, particularly for benign pathologies such as acute diverticulitis, for which we have identified a reduction in emergency room presentation with mild forms and an increase with more severe forms. The aim of our review was to discover new data on emergency presentation for patients with acute diverticulitis during the Covid-19 pandemic and their current management, and to define a better methodology for surgical decision-making. Method: We conducted a scoping review on 25 trials, analyzing five points: reduced hospital access for patients with diverticulitis, the preferred treatment for non-complicated diverticulitis, the role of CT scanning in primary evaluation and percutaneous drainage as a treatment, and changes in surgical decision-making and preferred treatment strategies for complicated diverticulitis. Results: We found a decrease in emergency access for patients with diverticular disease, with an increased incidence of complicated diverticulitis. The preferred treatment was conservative for non-complicated forms and in patients with COVID-related pneumonia, percutaneous drainage for abscess, or with surgery delayed or reserved for diffuse peritonitis or sepsis. Conclusion: During the COVID-19 pandemic we observed an increased number of complicated forms of diverticulitis, while the total number decreased, possibly due to delay in hospital or ambulatory presentation because of the fear of contracting COVID-19. We observed a greater tendency to treat these more severe forms by conservative means or drainage. When surgery was necessary, there was a preference for an open approach or a delayed operation

Guidelines for the Treatment of Abdominal Abscesses in Acute Diverticulitis: An Umbrella Review

Background: This systematic umbrella review aims to investigate and provide an analysis of guidelines regarding the treatment of diverticular abscesses. Material and methods: A systematic literature search was performed using the Cochrane Overviews of Reviews model and the 'Clinical Practice Guidelines'; at the end of initial search, only 12 guidelines were included in this analysis. The quality of the guidelines was assessed by adopting the "Appraisal of Guidelines for Research and Evaluation II" (AGREE II). The comparative analysis of these guidelines has highlighted the presence of some differences regarding the recommendations on the treatment of diverticular abscesses. In particular, there are some controversies about the diameter of abscess to be used in order to decide between medical treatment and percutaneous drainage. Different guidelines propose different abscess diameter cutoffs, such as 3 cm, 4-5 cm, or 4 cm, for distinguishing between small and large abscesses. Conclusions: Currently, different scientific societies recommend that diverticular abscesses with diameters larger than 3 cm should be considered for percutaneous drainage whereas abscesses with diameters smaller than 3 cm could be appropriately treated by medical therapy with antibiotics; only a few guidelines suggest the use of percutaneous drainage for abscesses with a diameter greater than 4 cm. The differences among guidelines are the consequence of the different selection of scientific evidence. In conclusion, our evaluation has revealed the importance of seeking new scientific evidence with higher quality to either confirm, reinforce or potentially weaken the existing recommendations from different societies

Five carbon- and nitrogen-bearing species in a hot giant planet's atmosphere

The atmospheres of gaseous giant exoplanets orbiting close to their parent stars (hot Jupiters) have been probed for nearly two decades. They allow us to investigate the chemical and physical properties of planetary atmospheres under extreme irradiation conditions. Previous observations of hot Jupiters as they transit in front of their host stars have revealed the frequent presence of water vapour and carbon monoxide in their atmospheres; this has been studied in terms of scaled solar composition under the usual assumption of chemical equilibrium. Both molecules as well as hydrogen cyanide were found in the atmosphere of HD 209458b, a well studied hot Jupiter (with equilibrium temperature around 1,500 kelvin), whereas ammonia was tentatively detected there and subsequently refuted. Here we report observations of HD 209458b that indicate the presence of water (H2O), carbon monoxide (CO), hydrogen cyanide (HCN), methane (CH4), ammonia (NH3) and acetylene (C2H2), with statistical significance of 5.3 to 9.9 standard deviations per molecule. Atmospheric models in radiative and chemical equilibrium that account for the detected species indicate a carbon-rich chemistry with a carbon-to-oxygen ratio close to or greater than 1, higher than the solar value (0.55). According to existing models relating the atmospheric chemistry to planet formation and migration scenarios, this would suggest that HD 209458b formed far from its present location and subsequently migrated inwards. Other hot Jupiters may also show a richer chemistry than has been previously found, which would bring into question the frequently made assumption that they have solar-like and oxygen-rich compositions.Comment: As part of the Springer Nature Content Sharing Initiative, it is possible to access a view-only version of this paper by using the following SharedIt link: https://rdcu.be/cifr

A chemical survey of exoplanets with ARIEL

Thousands of exoplanets have now been discovered with a huge range of masses, sizes and orbits: from rocky Earth-like planets to large gas giants grazing the surface of their host star. However, the essential nature of these exoplanets remains largely mysterious: there is no known, discernible pattern linking the presence, size, or orbital parameters of a planet to the nature of its parent star. We have little idea whether the chemistry of a planet is linked to its formation environment, or whether the type of host star drives the physics and chemistry of the planet’s birth, and evolution. ARIEL was conceived to observe a large number (~1000) of transiting planets for statistical understanding, including gas giants, Neptunes, super-Earths and Earth-size planets around a range of host star types using transit spectroscopy in the 1.25–7.8 μm spectral range and multiple narrow-band photometry in the optical. ARIEL will focus on warm and hot planets to take advantage of their well-mixed atmospheres which should show minimal condensation and sequestration of high-Z materials compared to their colder Solar System siblings. Said warm and hot atmospheres are expected to be more representative of the planetary bulk composition. Observations of these warm/hot exoplanets, and in particular of their elemental composition (especially C, O, N, S, Si), will allow the understanding of the early stages of planetary and atmospheric formation during the nebular phase and the following few million years. ARIEL will thus provide a representative picture of the chemical nature of the exoplanets and relate this directly to the type and chemical environment of the host star. ARIEL is designed as a dedicated survey mission for combined-light spectroscopy, capable of observing a large and well-defined planet sample within its 4-year mission lifetime. Transit, eclipse and phase-curve spectroscopy methods, whereby the signal from the star and planet are differentiated using knowledge of the planetary ephemerides, allow us to measure atmospheric signals from the planet at levels of 10–100 part per million (ppm) relative to the star and, given the bright nature of targets, also allows more sophisticated techniques, such as eclipse mapping, to give a deeper insight into the nature of the atmosphere. These types of observations require a stable payload and satellite platform with broad, instantaneous wavelength coverage to detect many molecular species, probe the thermal structure, identify clouds and monitor the stellar activity. The wavelength range proposed covers all the expected major atmospheric gases from e.g. H2O, CO2, CH4 NH3, HCN, H2S through to the more exotic metallic compounds, such as TiO, VO, and condensed species. Simulations of ARIEL performance in conducting exoplanet surveys have been performed – using conservative estimates of mission performance and a full model of all significant noise sources in the measurement – using a list of potential ARIEL targets that incorporates the latest available exoplanet statistics. The conclusion at the end of the Phase A study, is that ARIEL – in line with the stated mission objectives – will be able to observe about 1000 exoplanets depending on the details of the adopted survey strategy, thus confirming the feasibility of the main science objectives.Peer reviewedFinal Published versio

VizieR Online Data Catalog: Code to compute spectral line profile indicators (Lanza+, 2018)

A computer code (procedure) written in Interactive Data Language (IDL) to compute the spectral line profile indicators used in the above research article starting from the fits files provided by the data reduction software (DRS) of HARPS or HARPS-N. The procedure takes the cross-correlation function (CCF) files provided by the DRS as an input. An example for the input files and the corresponding output file is provided with the sole purpose of allowing to test the proper compilation and running of the procedure. Details on an auxiliary source file (mpfit.pro) required for compilation are provided in the header of the procedure file and in Appendix A of the above mentioned article. Interested users are warmly recommended to read them before compiling and running the procedure. (Notes: 4 data files)

The GAPS Programme with HARPS-N at TNG . XIV. Investigating giant planet migration history via improved eccentricity and mass determination for 231 transiting planets

We carried out a Bayesian homogeneous determination of the orbital parameters of 231 transiting giant planets (TGPs) that are alone or have distant companions; we employed differential evolution Markov chain Monte Carlo methods to analyse radial-velocity (RV) data from the literature and 782 new high-accuracy RVs obtained with the HARPS-N spectrograph for 45 systems over 3 years. Our work yields the largest sample of systems with a transiting giant exoplanet and coherently determined orbital, planetary, and stellar parameters. We found that the orbital parameters of TGPs in non-compact planetary systems are clearly shaped by tides raised by their host stars. Indeed, the most eccentric planets have relatively large orbital separations and/or high mass ratios, as expected from the equilibrium tide theory. This feature would be the outcome of planetary migration from highly eccentric orbits excited by planet-planet scattering, Kozai-Lidov perturbations, or secular chaos. The distribution of α = a/aR, where a and aR are the semi-major axis and the Roche limit, for well-determined circular orbits peaks at 2.5; this agrees with expectations from the high-eccentricity migration (HEM), although it might not be limited to this migration scenario. The few planets of our sample with circular orbits and α> 5 values may have migrated through disc-planet interactions instead of HEM. By comparing circularisation times with stellar ages, we found that hot Jupiters with a5 ≲ Q'p ≲ 109, and that stellar Q's ≳ 106 - 107 are required to explain the presence of eccentric planets at the same orbital distance. As aby-product of our analysis, we detected a non-zero eccentricity e = 0.104-0.018+0.021 for HAT-P-29; we determined that five planets that were previously regarded to be eccentric or to have hints of non-zero eccentricity, namely CoRoT-2b, CoRoT-23b, TrES-3b, HAT-P-23b, and WASP-54b, have circular orbits or undetermined eccentricities; we unveiled curvatures caused by distant companions in the RV time series of HAT-P-2, HAT-P-22, and HAT-P-29; we significantly improved the orbital parameters of the long-period planet HAT-P-17c; and we revised the planetary parameters of CoRoT-1b, which turned out to be considerably more inflated than previously found. Full Tables 1, 2, 5-9 are only available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (http://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/602/A10

The GAPS Programme with HARPS-N at TNG. XV. A substellar companion around a K giant star identified with quasi-simultaneous HARPS-N and GIANO measurements

Context. Identification of planetary companions of giant stars is made difficult because of the astrophysical noise, that may produce radial velocity variations similar to those induced by a companion. On the other hand any stellar signal is wavelength dependent, while signals due to a companion are achromatic. Aims: Our goal is to determine the origin of the Doppler periodic variations observed in the thick disk K giant star TYC 4282-605-1 by HARPS-N at the Telescopio Nazionale Galileo (TNG) and verify if they can be due to the presence of a substellar companion. Methods: Several methods have been used to exclude the stellar origin of the observed signal including a detailed analysis of activity indicators and bisector and the analysis of the photometric light curve. Finally, we have conducted an observational campaign to monitor the near-infrared (NIR) radial velocity with GIANO at the TNG in order to verify whether the NIR amplitude variations are comparable with those observed in the visible. Results: Both optical and NIR radial velocities show consistent variations with a period at 101 days and similar amplitude, pointing to the presence of a companion orbiting the target. The main orbital properties obtained for our giant star with a derived mass of M = 0.97 ± 0.03M☉ are M_Psini = 10.78 ± 0.12M_J; P = 101.54 ± 0.05 days; e = 0.28 ± 0.01 and a = 0.422 ± 0.009 AU. The chemical analysis shows a significant enrichment in the abundance of Na I, Mg I, Al I, and Si I while the rest of the analyzed elements are consistent with the solar value demonstrating that the chemical composition corresponds with an old K giant (age = 10.1 Gyr) belonging to local thick disk. Conclusions: We conclude that the substellar companion hypothesis for this K giant is the best explanation for the observed periodic radial velocity variation. This study also shows the high potential of multi-wavelength radial velocity observations for the validation of planet candidates. Based on observations collected at the Italian Telescopio Nazionale Galileo (TNG), operated on the island of La Palma by the Fundación Galileo Galilei of the INAF (Istituto Nazionale di Astrofisica) at the Spanish Observatorio del Roque de Los Muchachos of the Instituto de Astrofísica de Canarias, in the frame of the programme Global Architecture of Planetary Systems (GAPS)