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Fluorescence imaging is a well-known method for both the in vivo and in vitro identification of specific cells or tissues. This imaging tool is gaining importance in the intraoperative detection and preservation of parathyroid glands during endocrine surgery owing to the intrinsic properties of parathyroid tissue. The aim of this paper is to provide an overview of the basics of the technology, its history, and the recent surgical intraoperative applications of near-infrared imaging methods. Moreover, a literature review of the utilization of fluorescence devices in thyroid surgery suggests that the use of near-infrared imaging seems to be beneficial in reducing postoperative hypoparathyroidism, which is one of the most frequent complications of thyroid surgery.

Adrenal incidentalomas, mostly adrenal adenomas, affect 3%–10% of the global population. Adrenocortical carcinoma (ACC) is rare, with an incidence of 0.7–2 cases per million. Adrenocortical oncocytic neoplasms (ACONs) account for about 10% of ACC cases, often discovered incidentally, with 17–34% being functionally active.We report a case of a woman in her 60s with treatment-resistant hypertension, diabetes and psychotic delirium. Imaging revealed a 6 cm left adrenal mass with marginally elevated metanephrines. Laparoscopic adrenalectomy was performed. Histology confirmed ACON. Positive margins necessitated adjuvant chemotherapy and radiotherapy. Postoperatively, psychiatric symptoms and hypertension resolved, indicating the tumour’s secretory nature.This case highlights the diverse ACONs hormonal secretions, leading to complex clinical presentations, including metabolic and psychiatric symptoms. ACONs secretory nature may not be reflected in standard hormonal panels.ACONs challenging diagnosis and management emphasise the need for a multidisciplinary approach and further research.

Background: Hypoparathyroidism is one of the most frequent complications of thyroid surgery, especially when associated with lymph node dissection in cases of thyroid cancer. Fluorescence-guided surgery is an emerging tool that appears to help reduce the rate of this complication. The present review aims to highlight the utility of fluorescence imaging in preserving parathyroid glands during thyroid cancer surgery. Methods: We performed a systematic review of the literature according to PRISMA guidelines to identify published studies on fluorescence-guided thyroid surgery with a particular focus on thyroid cancer. Articles were selected and analyzed per indication and type of surgery, autofluorescence or exogenous dye usage, and outcomes. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess the methodological quality of the included articles. Results: Twenty-five studies met the inclusion criteria, with three studies exclusively assessing patients with thyroid cancer. The remaining studies assessed mixed cohorts with thyroid cancer and other thyroid or parathyroid diseases. The majority of the papers support the potential benefit of fluorescence imaging in preserving parathyroid glands in thyroid surgery. Conclusions: Fluorescence-guided surgery is useful in the prevention of post-thyroidectomy hypoparathyroidism via enhanced early identification, visualization, and preservation of the parathyroid glands. These aspects are notably beneficial in cases of associated lymphadenectomy for thyroid cancer.

BackgroundAccurate parathyroid gland (PG) identification is a critical yet challenging component of cervical endocrine procedures. PGs possess strong near-infrared autofluorescence (NIRAF) compared with other tissues in the neck. This property has been harnessed by image- and probe-based near-infrared fluorescence detection systems, which have gained increasing popularity in clinical use for their ability to accurately aid in PG identification in a rapid, noninvasive, and cost-effective manner. All NIRAF technologies, however, cannot differentiate viable from devascularized PGs without the use of contrast enhancement. Here, we aim to provide an overview of the rapid evolution of these technologies and update the surgery community on the most recent advancements in the field.MethodsA PubMed literature review was performed using the key terms “parathyroid,” “near-infrared,” and “fluorescence.” Recommendations regarding the use of these technologies in clinical practice were developed on the basis of the reviewed literature and in conjunction with expert surgeons’ opinions.ResultsThe use of near-infrared fluorescence detection can be broadly categorized as (1) using parathyroid NIRAF to identify both healthy and diseased PGs, and (2) using contrast-enhanced (i.e., indocyanine green) near-infrared fluorescence to evaluate PG perfusion and viability. Each of these approaches possess unique advantages and disadvantages, and clinical trials are ongoing to better define their utility.ConclusionsNear-infrared fluorescence detection offers the opportunity to improve our collective ability to identify and preserve PGs intraoperatively. While additional work is needed to propel this technology further, we hope this review will be valuable to the practicing surgeon.

L. Sciotto: None. S. Andrade Lopes: None. C. De Vito: None. F.R. Jornayvaz: None. K. Gariani: None. M.S. Demarchi: None. S. Leboulleux: None. F. Triponez: None. M. Mavromati: None. Pheochromocytomas are rare tumors arising from the adrenal medulla. Their diagnosis can be suspected in case of symptoms related to catecholamine secretion or to the tumor mass. Other reasons leading to diagnosis include screening, in case of a known germline pheochromocytoma, or incidental findings. The objective of our study was to describe clinical characteristics of pheochromocytomas according to the circumstances of diagnosis in a cohort of patients operated between November 2007 and October 2022 in a tertiary academic center. Fifty-four patients (28 female; median age: 47 years, SD: 16.3) with 58 pheochromocytomas, with a median diameter of 35 mm (SD: 23.5), were included. High blood pressure and elevated catecholamines were present in 32 (59%) and 52 (96%) patients, respectively. Germline mutations were present in 13 patients (24%) with 6 mutations already known and 7 newly discovered (RET mutation in 7 cases, VHL mutation in 4 cases, SDHB mutation in 1 case and MLH1 mutation (Lynch syndrome) in 1 case). Reasons leading to diagnosis were symptoms related to catecholamine secretion or tumor size in 22 patients (41%), periodic screening because of a known germline mutation in 6 patients (11%) and incidental in 26 patients (48%). Increased metanephrines were found in 52 patients (96%); metanephrines were normal in one patient with incidental pheochromocytoma and were not measured in one patient with incidental pheochromocytoma diagnosed only on histology. Compared to symptomatic pheochromocytomas, patients with incidental pheochromocytomas had similar median age (47 for symptomatic versus 49 years for incidental findings). Those with germline mutations leading to the diagnosis were younger (median age 31 years). High blood pressure was less frequent in patients with incidental pheochromocytoma (42%), compared to screened pheochromocytomas (50%) and symptomatic pheochromocytomas (82%). Incidental pheochromocytomas were smaller (median diameter (30 mm, SD: 13.2) compared to symptomatic (40 mm, SD:28.5). Twenty nine of the 48 patients without known germline mutation prior to surgery underwent genetic testing. A mutation was found in 7 of them (24%): 2 with symptomatic pheochromocytomas and 5 with incidental ones. Median age at diagnosis of these patients was 46 years (SD: 15.3) and median diameter of the pheochromocytoma was 34 mm (SD:18.6); 5 of these patients had high blood pressure. In conclusion, iIncidental finding is the most frequent mode of discovery of pheochromocytomas, accounting for 48% of cases in our cohort. Incidental pheochromocytomas are smaller and less frequently associated to high blood pressure. Patients with known germline mutations associated to pheochromocytomas that have periodic screening, are diagnosed at a younger age. Sunday, June 2, 2024

Background: Postoperative neck hematoma is an infrequent but potentially fatal complication following thyroidectomy. The main aim of this study was to evaluate the impact of direct oral anticoagulants (DOACs) on the occurrence of this complication. Methods: Patients who underwent thyroidectomy between January 2020 and December 2022 in nine high-volume thyroid surgery centers in Europe were retrospectively evaluated. Based on taking direct oral anticoagulants, patients were divided into two groups: the DOAC Group and the Control Group. Propensity score matching 1:1 was performed between the two groups, which were then compared through a univariate analysis. Results: The total number of patients enrolled based on the inclusion/exclusion criteria was 8985. Following propensity score matching, the study population consisted of 316 patients: 158 in the DOAC Group and 158 in the Control Group. In the DOAC Group, the overall incidence of neck hematoma was 5.70% (4.43% for neck hematomas managed conservatively, and 1.27% for those that required surgical revision of hemostasis). No statistically significant difference was found between the two groups in terms of the incidence of this complication. Hospital readmission due to neck hematoma was not observed in any patient. No statistically significant difference was found between the two groups in terms of the timing of the onset of neck hematomas that required surgical revision of hemostasis. Conclusions: This study showed that direct oral anticoagulants, in the field of thyroid surgery, have no impact on the occurrence of postoperative neck hematoma. Therefore, based on our findings, it can be concluded that thyroidectomy can be safely performed in patients taking this class of drugs.

Background and Objectives. Recent guidelines have downgraded the routine use of the intra-aortic balloon pump (IABP) in patients with cardiogenic shock (CS) due to ST-elevation myocardial infarction (STEMI). Despite this, its use in clinical practice remains high. The aim of this study was to evaluate the prognostic impact of the IABP in patients with STEMI complicated by CS undergoing primary PCI (pPCI), focusing on patients with anterior MI in whom a major benefit has been previously hypothesized. Materials and Methods. We enrolled 2958 consecutive patients undergoing pPCI for STEMI in our department from 2005 to 2018. Propensity score matching and mortality analysis were performed. Results. CS occurred in 246 patients (8.3%); among these patients, 145 (60%) had anterior AMI. In the propensity-matched analysis, the use of the IABP was associated with a lower 30-day mortality (39.3% vs. 60.9%, p = 0.032) in the subgroup of patients with anterior STEMI. Conversely, in the whole group of CS patients and in the subgroup of patients with non-anterior STEMI, IABP use did not have a significant impact on mortality. Conclusions. The use of the IABP in cases of STEMI complicated by CS was found to improve survival in patients with anterior infarction. Prospective studies are needed before abandoning or markedly limiting the use of the IABP in this clinical setting.

Obtaining CPU cycles on an HPC cluster is nowadays relatively simple and sometimes even cheap for academic institutions. However, in most of the cases providers of HPC services would not allow changes on the configuration, implementation of special features or a lower-level control on the computing infrastructure, for example for testing experimental configurations. The variety of use cases proposed by several departments of the University of Torino, including ones from solid-state chemistry, computational biology, genomics and many others, called for different and sometimes conflicting configurations; furthermore, several R&D activities in the field of scientific computing, with topics ranging from GPU acceleration to Cloud Computing technologies, needed a platform to be carried out on. The Open Computing Cluster for Advanced data Manipulation (OCCAM) is a multi-purpose flexible HPC cluster designed and operated by a collaboration between the University of Torino and the Torino branch of the Istituto Nazionale di Fisica Nucleare. It is aimed at providing a flexible and reconfigurable infrastructure to cater to a wide range of different scientific computing needs, as well as a platform for R&D activities on computational technologies themselves. We describe some of the use cases that prompted the design and construction of the system, its architecture and a first characterisation of its performance by some synthetic benchmark tools and a few realistic use-case tests.

The management of noninfarct-related arteries in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) is still debated. We evaluated the prognostic impact of staged complete revascularization with percutaneous coronary intervention (PCI) in STEMI patients with MVD admitted to our hospital from 2005 to 2013. Patients undergoing staged complete revascularization (n = 300) were compared with 1:1 propensity score–matched patients with culprit lesion–only treatment (n = 300). We considered a composite primary end point of all-cause death, myocardial infarction, and urgent PCI. Secondary end points included components of the primary, cardiovascular death, any PCI excluding staged PCI. We also performed an analysis including only patients surviving at least 5 days. The median follow-up was 553 days. The primary end point occurred in 10.3% of patients in the staged complete revascularization group and in 16.3% of patients in the culprit lesion–only group (hazard ratio 0.61, 95% CI 0.38 to 0.95, p = 0.031). Although this difference was no longer significant when considering only the survivors at day 5, all-cause and cardiovascular mortalities were still reduced in the staged complete revascularization group. Complete revascularization was associated with a better outcome (hazard ratio 0.35, 95% CI 0.17 to 0.63, p = 0.005) if performed within 30 days of STEMI. In conclusion, compared with culprit lesion–only revascularization, in STEMI patients with MVD undergoing primary PCI, an approach of staged complete revascularization was associated with a better outcome.

Despite the growing importance of planetary Space Weather forecasting and radiation protection for science and robotic exploration and the need for accurate Space Weather monitoring and predictions, only a limited number of spacecraft have dedicated instrumentation for this purpose. However, every spacecraft (planetary or astronomical) has hundreds of housekeeping sensors distributed across the spacecraft, some of which can be useful to detect radiation hazards produced by solar particle events. In particular, energetic particles that impact detectors and subsystems on a spacecraft can be identified by certain housekeeping sensors, such as the Error Detection and Correction (EDAC) memory counters, and their effects can be assessed. These counters typically have a sudden large increase in a short time in their error counts that generally match the arrival of energetic particles to the spacecraft. We investigate these engineering datasets for scientific purposes and perform a feasibility study of solar energetic particle event detections using EDAC counters from seven European Space Agency Solar System missions: Venus Express, Mars Express, ExoMars‐Trace Gas Orbiter, Rosetta, BepiColombo, Solar Orbiter, and Gaia. Six cases studies, in which the same event was observed by different missions at different locations in the inner Solar System are analyzed. The results of this study show how engineering sensors, for example, EDAC counters, can be used to infer information about the solar particle environment at each spacecraft location. Therefore, we demonstrate the potential of the various EDAC to provide a network of solar particle detections at locations where no scientific observations of this kind are available.