Combined transarterial chemoembolization and thermal ablation in candidates to liver transplantation with hepatocellular carcinoma: pathological findings and post-transplant outcome.

OBJECTIVES: Evaluating the pathological response and the survival outcomes of combined thermal ablation (TA) and transarterial chemoembolization (TACE) as a bridge or downstaging for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) > 3 cm. MATERIALS AND METHODS: A retrospective review encompassed 36 consecutive patients who underwent combined TA-TACE as bridging or downstaging before LT. Primary objectives included necrosis of the target lesion at explant pathology, post-LT overall survival (OS) and post-LT recurrence-free survival (RFS). For OS and RFS, a comparison with 170 patients subjected to TA alone for nodules <3 cm in size was also made. RESULTS: Out of the 36 patients, 63.9% underwent TA-TACE as bridging, while 36.1% required downstaging. The average node size was 4.25 cm. All cases were discussed in a multidisciplinary tumor board to assess the best treatment for each patient. Half received radiofrequency (RF), and the other half underwent microwave (MW). All nodes underwent drug-eluting beads (DEB) TACE with epirubicin. The mean necrosis percentage was 65.9% in the RF+TACE group and 83.3% in the MW+TACE group (p-value = 0.099). OS was 100% at 1 year, 100% at 3 years and 94.7% at 5 years. RFS was 97.2% at 1 year, 94.4% at 3 years and 90% at 5 years. Despite the different sizes of the lesions, OS and RFS did not show significant differences with the cohort of patients subjected to TA alone. CONCLUSIONS: The study highlights the effectiveness of combined TA-TACE for HCC>3 cm, particularly for bridging and downstaging to LT, achieving OS and RFS rates significantly exceeding 80% at 1, 3 and 5 years.

Occurrence of tar balls on the beaches of Fernando de Noronha Island, South Equatorial Atlantic.

This work reports on the widespread occurrence of tar balls on a pebble beach of Sueste Bay on Fernando de Noronha Island, a Brazilian national marine park and a preserve in the South Equatorial Atlantic. Environmental regulations preclude regular visitors to the Sueste Bay beach, and the bay is a pristine area without any possible or potential sources of petroleum in the coastal zone. In this work, these tar balls were observed for the first time as they occurred as envelopes around beach pebbles. They are black in color, very hard, have a shell and coral fragment armor, and range in average size from 2 to 6 cm. The shape of the majority of the tar balls is spherical, but some can also be flattened ellipsoids. The polycyclic aromatic hydrocarbon analyses of the collected samples revealed the characteristics of a strongly weathered material, where only the most persistent compounds were detected: chrysene, benzo(b,k)fluoranthene, dibenzo(a,h)antracene and benzo(a)pyrene.

Mapping of surface radiogenic heat production from in situ gamma spectrometry and chemical data of exhumed mantle peridotites at the St. Peter and St. Paul archipelago (equatorial Atlantic).

This work presents the first mapping of the radiogenic heat production (RHP) and the respective radiogenic heat flow (RHF) of the Saint Peter and Saint Paul Archipelago (SPSPA) located at 1°N in the Equatorial Atlantic Ocean. Using radiogenic heat producing elements (RPE) we inferred a radiogenic heat production ranging 0.08-0.68 µW/m3 (Median: 0.21 µW/m3 and Geometric mean: 0.25 µW/m3) by whole-rock chemical analysis and between 0.08 and 0.48 µW/m3 (Median: 0.19 µW/m3; Geometric mean: 0.19 µW/m3) by in situ Gamma radiation spectrometry. The mean of radiogenic heat production of mylonite rocks from SPSPA (0.22 µW/m3) is significantly higher than predicted values for ultramafic rocks as those largely outcropping in the SPSPA. This is probably due to the pervasive alteration of these rocks and the incorporation of little magma fractions during mylonitization. By converse, the average surface radiogenic heat flow (49.7 µW/m2) is lower than that predicted for the oceanic lithosphere, suggesting that the upper mantle contribution to the heat flow is also low in the SPSPA region. Based on the acquired data and the peculiar tectonics of the SPSPA we propose that the lithospheric mantle around the SPSPA area is colder than that surrounding the Equatorial Atlantic region.