Cooperative 3D Air Quality Assessment with Wireless Chemical Sensing Networks

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Comments and illustrations of the WFUMB CEUS liver guidelines: Rare benign focal liver lesion, part I.

Improved detection and characterization of common focal liver lesions (FLL) are the main topics of the World Federation for Ultrasound in Medicine and Biology (WFUMB) guidelines on the use of contrast-enhanced ultrasound (CEUS). On stateof-the-art CEUS imaging, to create a library of rare FLL, especially concerning their atypical imaging characteristics, might be helpful for improving clinical diagnostic efficiency. In this review, we aim to summarize the ultrasound and CEUS features of rare benign FLL. Currently there are limited reports and images published

Comments and illustrations of the WFUMB CEUS liver guidelines: Rare benign focal liver lesion, part II.

It is important to be familiar with the typical imaging features of the uncommon or even extremely rare focal liver lesions (FLL). Current guidelines of the World Federation for Ultrasound in Medicine and Biology (WFUMB) is aimed at assessing the usefulness of contrast enhanced ultrasound (CEUS) in the management of various FLL. In this review, we aim to summarize the ultrasound and CEUS characteristics with literature review of some extremely rare benign FLL, which might be helpful for improving diagnostic efficiency clinically

Transarterial Chemoembolization for Hepatocellular Carcinoma in Clinical Practice: Temporal Trends and Survival Outcomes of an Iterative Treatment

BACKGROUND: Transarterial chemoembolization (TACE) is one of the most frequently applied treatments for hepatocellular carcinoma (HCC) worldwide. In this study, we aimed at evaluating whether and how TACE application and repetition, as well as the related outcome, have changed over the last three decades in Italy. METHODS: Data of 7,184 patients with HCC were retrieved from the Italian Liver Cancer (ITA.LI.CA) database. Patients were divided according to the period of diagnosis in six cohorts: P1 (1988–1993), P2 (1994–1998), P3 (1999–2004), P4 (2005–2009), P5 (2010–2014), and P6 (2015–2019). All the analyses were repeated in the overall patient population and in Barcelona Clinic Liver Cancer (BCLC) B patients, who are the subgroup of HCC patients originally supposed to receive TACE according to guidelines. TACE was defined as either the first or the main (more effective) treatment. RESULTS: The proportion of patients receiving TACE as first or main therapy declined over time, and less than 50% of BCLC B patients were treated with chemoembolization from P3 onward. Conversely, TACE was widely used even outside the intermediate stage. Survival of TACE-treated patients progressively increased from P1 to P6. Although TACE was performed only once in the majority of patients, there was an increasing proportion of those receiving 2 or ≥3 treatments sessions over time. The overall survival (OS) of patients undergoing repeated treatments was significantly higher compared to those managed with a single TACE (median OS 40.0 vs. 65.0 vs. 71.8 months in 1, 2, and ≥3 TACE groups, respectively; p < 0.0001). However, after a first-line TACE, the adoption of curative therapies provided longer survival than repeating TACE (83.0 vs. 42.0 months; p < 0.0001), which in turn was associated with better outcomes compared to systemic therapies or best supportive care (BSC). CONCLUSIONS: Despite a decline in the percentage of treated patients over time, TACE has still an important role in the management of HCC patients. The survival of TACE-treated patients gradually improved over time, probably due to a better patient selection. Iterative TACE is effective, but an upward shift to curative therapies provides better outcomes while transition to systemic therapies and BSC leads to a worse prognosis

Liver and spleen shear-wave elastography in the diagnosis and severity staging of Philadelphia-negative myeloproliferative diseases and myelofibrosis

Introduzione: La stiffness epato-splenica, misurata attraverso la transient elastography (TE), è stata associata con la fibrosi midollare nei pazienti con malattia mieloproliferativa (MPNs). La rigidità dei tessuti può essere valutata con la shear-wave elastography (SWE), con due tecniche: point (pSWE) e bidimensionale (2DSWE). Obiettivi dello studio sono: 1) identificare le differenze di TE fra i pazienti con MPNs, i cirrotici e volontari sani (HV); 2) valutare specifiche caratteristiche di TE in pazienti con MF, PV ed ET; 3) stabilire una correlazione con il grado di fibrosi midollare. Metodi: in questo studio monocentrico, MPN, cirrotici ed HV hanno eseguito elastometria epato-splenica con pSWE e 2DSWE. Risultati: 236 pazienti sono stati inclusi in questo studio: 64 con MF (27.1%), 33 con PV (14%), 46 con ET (19.4%), 75 HV (32%) e 18 (8%) cirrotici. Al confronto con gli HV, i pazienti con MF hanno maggiore stiffness splenica (pSWE 40.9 vs 26.3 kPa, p<0.001; 2DSWE 34.9 vs 20.1 kPa, p<0.001) ed epatica (pSWE 7.72 vs 5.52 kPa, p<0.001; 2DSWE 6.96 vs 5.01 kPa, p<0.001). Al confronto con i pazienti con PV ed ET, quelli con MF hanno maggiori valori di stiffness epatici (p<0.001) e splenici (p<0.001). In fibrosi di basso (0-1) (n=81 , 60.4%) vs alto grado (2-3) (n=42, 39.6%), sono evidenti valori di stiffness maggiori nei pazienti con fibrosi di alto grado sia per il fegato (pSWE 5.2 vs 6.65 kPa; 2DSWE 5.1 vs 6.05 kPa) che nella milza (pSWE 27.2 vs 37.9 kPa, 2DSWE 21.7 vs 30.75 kPa – p<0.001) Conclusioni: La TE distingue i pazienti con MF sia dai sani che dalle altre MPNs. Valori di TE sono significativamente associati con caratteristiche rilevanti che includono la fibrosi midollare in tutte le MPNs. I valori di stiffness epatici e splenici sono pertanto rilevanti nella diagnosi e management delle MPNs.Introduction: Spleen and liver stiffness, investigated by transient elastography (TE), have been associated with marrow fibrosis in patients with Ph-negative myeloproliferative neoplasms (MPNs). Tissue stiffness can be assessed by shear wave elastography (SWE), the two most common techniques being point (pSWE) and bidimensional (2DSWE). Aims of this study are: 1) to identify TE differences between MPN pts, cirrhotics and healthy volunteers (HV); 2) to evaluate specific TE features in pts with MF, PV and ET; 3) to establish a correlation with bone marrow fibrosis grade. Methods: In this monocentric study, MPN and cirrhotic pts and HV received elastometric evaluation of spleen and liver stiffness by pSWE and 2DSWE. Results: A total of 236 pts were included in this study: MPN pts were affected by MF (64, 27.1%), PV (33, 14%) or ET (46, 19.4%), in addition to 75 (32%) healthy controls and 18 (8%) cirrhotic volunteers. Compared to HV, MF patients had greater spleen (pSWE 40.9 vs 26.3 kPa, p<0.001; 2DSWE 34.9 vs 20.1 kPa, p<0.001), and liver stiffness (pSWE 7.72 vs 5.52 kPa, p<0.001; 2DSWE 6.96 vs 5.01 kPa, p<0.001). Compared to PV and ET pts, MF pts had higher spleen (p<0.001) and liver stiffness (p<0.001). In low (0-1) (n=81 , 60.4%) versus high grade fibrosis (2-3) (n=42, 39.6%), is evident a higher stiffness in patients with higher grades of bone marrow fibrosis both for liver (pSWE 5.2 vs 6.65 kPa; 2DSWE 5.1 vs 6.05 kPa) and spleen (pSWE 27.2 vs 37.9 kPa, 2DSWE 21.7 vs 30.75 kPa – p<0.001 in both tests). Conclusions: TE evaluation distinguishes MF pts from HV and ET/PV. TE data were significantly associated with prognostically relevant features including marrow fibrosis in all MPNs. Overall, spleen/liver stiffness may help in MPN diagnosis and may provide clinical guidance