Accuracy of Ex-vivo Fluorescence Confocal Microscopy in Margin Assessment of Solid Tumors: A Systematic Review.

Fluorescence confocal microscopy (FCM) is a novel technology that enables rapid high-resolution digital imaging of non-formalin-fixed tissue specimens and offers real-time positive surgical margin identification. In this systematic review, we evaluated the accuracy metrics of ex vivo FCM for intraoperative margin assessment of different tumor types. A systematic search of MEDLINE via PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus was performed for relevant papers (PROSPERO ID: CRD42022372558). We included 14 studies evaluating four types of microscopes in six different tumor types, including breast, prostate, central nervous system, kidney, bladder, and conjunctival tumors. Using the Quality Assessment of Diagnostic Accuracy Studies tool, we identified a high risk of bias in patient selection (21%) and index test (36%) of the included studies. Overall, we found that FCM has good accuracy metrics in all tumor types, with high sensitivity and specificity (>80%) and almost perfect concordance (>90%) against final pathology results. Despite these promising findings, the quality of the available evidence and bias concerns highlight the need for adequately designed studies to further define the role of ex vivo FCM in replacing the frozen section as the tool of choice for intraoperative margin assessment.

Management of patients who opt for radical prostatectomy during the coronavirus disease 2019 (COVID-19) pandemic: an international accelerated consensus statement.

OBJECTIVE: Coronavirus disease-19 (COVID-19) pandemic caused delays in definitive treatment of patients with prostate cancer. Beyond the immediate delay a backlog for future patients is expected. The objective of this work is to develop guidance on criteria for prioritisation of surgery and reconfiguring management pathways for patients with non-metastatic prostate cancer who opt for surgical treatment. A second aim was to identify the infection prevention and control (IPC) measures to achieve a low likelihood of coronavirus disease 2019 (COVID-19) hazard if radical prostatectomy (RP) was to be carried out during the outbreak and whilst the disease is endemic. METHODS: We conducted an accelerated consensus process and systematic review of the evidence on COVID-19 and reviewed international guidance on prostate cancer. These were presented to an international prostate cancer expert panel (n = 34) through an online meeting. The consensus process underwent three rounds of survey in total. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. The Consensus opinion was defined as ≥80% agreement and this was used to reconfigure the prostate cancer pathways. RESULTS: Evidence on the delayed management of patients with prostate cancer is scarce. There was 100% agreement that prostate cancer pathways should be reconfigured and measures developed to prevent nosocomial COVID-19 for patients treated surgically. Consensus was reached on prioritisation criteria of patients for surgery and management pathways for those who have delayed treatment. IPC measures to achieve a low likelihood of nosocomial COVID-19 were coined as 'COVID-19 cold' sites. CONCLUSION: Reconfiguring management pathways for patients with prostate cancer is recommended if significant delay (>3-6 months) in surgical management is unavoidable. The mapped pathways provide guidance for such patients. The IPC processes proposed provide a framework for providing RP within an environment with low COVID-19 risk during the outbreak or when the disease remains endemic. The broader concepts could be adapted to other indications beyond prostate cancer surgery.

Overview of a combined computational-experimental evaluation for the assessment of panoramic sunroof impact characteristics for ejection mitigation.

OBJECTIVE: To meet increasing customer demand, many vehicle manufacturers are now offering a panoramic sunroof option in their vehicle lineup. Currently, there is no regulatory or consumer test aimed at assessing the potential for ejection mitigation of roof glazing, which leaves manufacturers to develop internal performance standards to guide designs. The goal of this study was to characterize the variety of occupant-to-roof impacts involving unbelted occupants in rollover crashes to determine the ranges of possible effective masses and impact velocities. This information can be used to define occupant retention requirements and performance criteria for roof glazing in occupant ejection protection. METHODS: This study combined computational (MADYMO and LS-Dyna) simulations of occupant kinematics in rollover crashes with laboratory rollover crash tests using the dynamic rollover test system (DRoTS) and linked them through controlled anthropomorphic test device (ATD)-to-roof ("drop") impact tests. The DRoTS and the ATD drop tests were performed to explore impact scenarios and estimate dummy-to-roof impact impulses. Next, 13 sets of vehicle kinematics and deformation data were extracted from a combination of vehicle dynamics and finite element model simulations that reconstructed variations of rollover crash cases from the field data. Then occupant kinematics data were extracted from a full-factorial sensitivity study that used MADYMO simulations to investigate how changes in anthropometry and seating position would affect occupant-roof impacts across all 13 cases. Finite element (FE) simulations of ATD and Global Human Body Models Consortium (GHBMC) human body model (HBM) roof impacts were performed to investigate the most severe cases from the MADYMO simulations to generate a distribution of head-to-roof impact energies. RESULTS: From the multiparameter design of experiment and experimental study, kinematics and energy output were extracted and analyzed. Based on dummy-to-roof impact force and dummy-to-roof impact velocity, the most severe rollover scenarios were identified. In the DRoTS experiments followed by the drop tests, the range of identified impact velocities was between 2 and 5.8 m/s. However, computational simulations of the rollover crashes showed higher impact velocities and similar effective masses. The largest dummy-to-roof impact velocity was 11 m/s. CONCLUSIONS: This study combined computational and experimental analyses to determine a range of possible unbelted occupant-to-roof impact energies. These results can be used to determine design parameters for an impactor for the assessment of the risk of roof glazing ejection for unbelted occupants in rollover crashes.