BACKGROUND The coronavirus 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). This project has evaluated if the schedule of LC screening or procedures has been interrupted /delayed because of the COVID-19 pandemic. MATERIAL AND METHODS An international survey evaluated the impact of COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave. RESULTS Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia and Africa (73.7%, 17.1%, 5.3%, 2.6% and 1.3% per continent, respectively). Eighty-seven per cent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening program, 50% cancelled curative and/or palliative treatments for LC, and 44.0% cancelled the liver transplantation program. Forty-five out 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service prior to COVID-19 pandemic (n=19/37). CONCLUSION The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with LC. Modifications in screening, diagnostic and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision making.

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Tinakula is the first seafloor massive sulfide deposit described in the Jean Charcot troughs and is the first such deposit described in the Solomon Islands—on land or the seabed. The deposit is hosted by mafic (basaltic-andesitic) volcaniclastic rocks within a series of cinder cones along a single eruptive fissure. Extensive mapping and sampling by remotely operated vehicle, together with shallow drilling, provide insights into deposit geology and especially hydrothermal processes operating in the shallow subsurface. On the seafloor, mostly inactive chimneys and mounds cover an area of ~77,000 m2 and are partially buried by volcaniclastic sand. Mineralization is characterized by abundant barite- and sulfide-rich chimneys that formed by low-temperature (<250°C) venting over ~5,600 years. Barite-rich samples have high SiO2, Pb, and Hg contents; the sulfide chimneys are dominated by low-Fe sphalerite and are high in Cd, Ge, Sb, and Ag. Few high-temperature chimneys, including zoned chalcopyrite-sphalerite samples and rare massive chalcopyrite, are rich in As, Mo, In, and Au (up to 9.26 ppm), locally as visible gold. Below the seafloor, the mineralization includes buried intervals of sulfide-rich talus with disseminated sulfides in volcaniclastic rocks consisting mainly of lapillistone with minor tuffaceous beds and autobreccias. The volcaniclastic rocks are intensely altered and variably cemented by anhydrite with crosscutting sulfate (± minor sulfide) veins. Fluid inclusions in anhydrite and sphalerite from the footwall (to 19.3 m below seafloor; m b.s.f.) have trapping temperatures of up to 298°C with salinities close to, but slightly higher than, that of seawater (2.8–4.5 wt % NaCl equiv). These temperatures are 10° to 20°C lower than the minimum temperature of boiling at this depth (1,070–1,204 m below sea level; m b.s.l.), suggesting that the highest-temperature fluids boiled below the seafloor. The alteration is distributed in broadly conformable zones, expressed in order of increasing depth and temperature as (1) montmorillonite/nontronite, (2) nontronite + corrensite, (3) illite/smectite + pyrite, (4) illite/smectite + chamosite, and (5) chamosite + corrensite. Zones of argillic alteration are distinguished from chloritic alteration by large positive mass changes in K2O (enriched in illite/smectite), MgO (enriched in chamosite and corrensite), and Fe2O3 (enriched in pyrite associated with illite/smectite alteration). The δ18O and δD values of clay minerals confirm increasing temperature with depth, from 124° to 256°C, and interaction with seawater-dominated hydrothermal fluids at high water/rock ratios. Leaching of the volcanic host rocks and thermochemical reduction of seawater sulfate are the primary sources of sulfur, with δ34S values of sulfides, from –0.8 to 3.4‰, and those of sulfate minerals close to seawater sulfate, from 19.3 to 22.5‰. The mineralization and alteration at Tinakula are typical of a class of ancient massive sulfide deposits hosted mainly by permeable volcaniclastic rocks with broad, semiconformable alteration zones. Processes by which these deposits form have never been documented in modern seafloor massive sulfide systems, because they mostly develop below the seafloor. Our study shows how hydrothermal fluids can become focused within permeable rocks by progressive, low-temperature fluid circulation, leading to a large area (>150,000 m2) of alteration with reduced permeability close to the seafloor. In our model, overpressuring and fracturing of the sulfate- and clay-cemented volcaniclastic rocks produced the pathways for higher-temperature fluids to reach the seafloor, present now as sulfate-sulfide veins within the footwall. In the geologic record, the sulfate (anhydrite) is not preserved, leaving a broad zone of intense alteration with disseminated and stringer sulfides typical of this class of deposits.

The case of a 35-year-old male with portal vein erosion and acute life-threatening abdominal hemorrhage as a complication of acute pancreatitis is reported. Erosion of arterial walls is the most common complication of pancreatitis and pancreatic pseudocysts, and erosion of the portal vein leading to a fistula between the pancreas and the portal vein is very rare. Diagnosis was made by multislice spiral computed tomography, and nonsurgical treatment was elected, leading to complete recoverage.