Cerebral hemodynamics on MR perfusion images before and after bypass surgery in patients with giant intracranial aneurysms

Preoperative assessment of the anatomy and dynamics of cerebral circulation for patients with giant intracranial aneurysm can improve both outcome prediction and therapeutic approach. The aim of our study was to use perfusion MR imaging to evaluate cerebral hemodynamics in such patients before and after extraintracranial high-flow bypass surgery. METHODS: Five patients with a giant aneurysm of the intracranial internal carotid artery underwent MR studies before, 1 week after, and 1 month after high-flow bypass surgery. We performed MR and digital subtraction angiography, and conventional and functional MR sequences (diffusion and perfusion). Surgery consisted of middle cerebral artery (MCA)-internal carotid artery bypass with saphenous vein grafts (n = 4) or MCA-external carotid artery bypass (n = 1). RESULTS: In four patients, MR perfusion study showed impaired hemodynamics in the vascular territory supplied by the MCA of the aneurysm side, characterized by significantly reduced mean cerebral blood flow (CBF), whereas mean transit time (MTT) and regional cerebral blood volume (rCBV) were either preserved, reduced, or increased. After surgery, angiography showed good canalization of the bypass graft. MR perfusion data obtained after surgery showed improved cerebral hemodynamics in all cases, with a return of CBF index (CBFi), MTT, and rCBV to nearly normal values. CONCLUSION: Increased MTT with increased or preserved rCBV can be interpreted as a compensatory vasodilatory response to reduced perfusion pressure, presumably from compression and disturbed flow in the giant aneurysmal sac. When maximal vasodilation has occurred, however, the brain can no longer compensate for diminished perfusion by vasodilation, and rCBV and CBFi diminish. Bypass surgery improves hemodynamics, increasing perfusion pressure and, thus, CBFi. Perfusion MR imaging can be used to evaluate cerebral hemodynamics in patients with intracranial giant aneurysm.BACKGROUND AND PURPOSE: Preoperative assessment of the anatomy and dynamics of cerebral circulation for patients with giant intracranial aneurysm can improve both outcome prediction and therapeutic approach. The aim of our study was to use perfusion MR imaging to evaluate cerebral hemodynamics in such patients before and after extraintracranial high-flow bypass surgery. METHODS: Five patients with a giant aneurysm of the intracranial internal carotid artery underwent MR studies before, 1 week after, and 1 month after high-flow bypass surgery. We performed MR and digital subtraction angiography, and conventional and functional MR sequences (diffusion and perfusion). Surgery consisted of middle cerebral artery (MCA)-internal carotid artery bypass with saphenous vein grafts (n = 4) or MCA-external carotid artery bypass (n = 1). RESULTS: In four patients, MR perfusion study showed impaired hemodynamics in the vascular territory supplied by the MCA of the aneurysm side, characterized by significantly reduced mean cerebral blood flow (CBF), whereas mean transit time (MTT) and regional cerebral blood volume (rCBV) were either preserved, reduced, or increased. After surgery, angiography showed good canalization of the bypass graft. MR perfusion data obtained after surgery showed improved cerebral hemodynamics in all cases, with a return of CBF index (CBFi), MTT, and rCBV to nearly normal values. CONCLUSION: Increased MTT with increased or preserved rCBV can be interpreted as a compensatory vasodilatory response to reduced perfusion pressure, presumably from compression and disturbed flow in the giant aneurysmal sac. When maximal vasodilation has occurred, however, the brain can no longer compensate for diminished perfusion by vasodilation, and rCBV and CBFi diminish. Bypass surgery improves hemodynamics, increasing perfusion pressure and, thus, CBFi. Perfusion MR imaging can be used to evaluate cerebral hemodynamics in patients with intracranial giant aneurysm

A fiscal stimulus with deep habits and optimal monetary policy

A New-Keynesian model with deep habits and optimal monetary policy delivers a larger-than-one multiplier and consumption crowding-in. Optimized Taylor-type rules dominate a conventional Taylor rule. Consumption is crowded out if the Taylor rule is sub-optimal or if commitment is absent

Development of gasoline-ethanol blends laminar flame speed correlations at full-load Si engine conditions via 1D simulations

Nowadays, most of the engineering development in the field of Spark-Ignited (SI) Internal Combustion Engines (ICEs) is supported by 3D-CFD simulations relying on flamelet combustion models. Such kind of models require laminar flame speed as an input to be specified by the user. While several laminar flame speed correlations are available in literature, for gasoline and pure ethanol at ambient conditions, there is a lack of correlations describing laminar flame speed of gasoline-ethanol blends, for different ethanol volume content, at conditions deemed to be representative of engine-like conditions. Toluene Reference Fuel surrogates with addition of ethanol (ETRF), suitable for representing gasoline-ethanol blends up to 85% vol. ethanol content are formulated. Thanks to these surrogates, 1D premixed laminar flame speed calculations are performed at selected engine-relevant conditions for a E5, E20 and E85 fuels. As a final outcome, three different laminar flame speed correlations based on the chemistry-based calculations are derived for E5, E20 and E85 gasoline-ethanol fuel blends focusing on typical full-load engine conditions. Such kind of correlations can be easily implemented in any 3D-CFD code to provide a chemistry-grounded estimation of laminar flame speed during combustion calculations. Such correlations are of practical use, since they might help in developing the next generation of bio-fuels powered internal combustion engines

Validation of a sectional soot model based on a constant pressure tabulated chemistry approach for PM, PN and PSDF estimation in a GDI research engine

Findings from the International Agency for Research on Cancer (IARC) classified particulate matter (PM) as carcinogenic to humans. While being a promising solution to reduce greenhouse gases (GHG) emissions and increase engine fuel economy, Gasoline Direct Injected (GDI) engines produce a number of particles (PN) of fine size higher than Port Fuel Injected (PFI) ones. As a consequence, the EU commission significantly tightened the emission standards for passenger cars, following which all gasoline engines will have to meet the euro-6d regulation coming into force in 2020. Efforts are made by the research community to understand the root causes leading to soot formation and possibly identify technical solutions to lower it. An important piece of the puzzle is the investigation of soot formation via 3D-CFD. To this aim, relevant efforts have been and are still being paid to adapt soot emissions models, originally developed for Diesel combustion, for GDI units. Among the many available models, one of the most advanced is the so-called Sectional Method. So far, studies presented in literature were not able to formulate a methodology to quantitatively match experimental PM, PN and PSDF without a dedicated soot model tuning. In the present work, a Sectional Method-based methodology to quantitatively predict GDI soot is presented and validated against PM, PN and PSDF measurements on a optically accessible GDI research unit. While adapting the model to GDI soot, attention is devoted to the modelling of soot precursor chemistry: a customized version of a pre-existing chemical kinetics mechanism, used to predict the formation of the key PAH (Polycyclic Aromatic Hydrocarbons) species, is presented and validated via 1D numerical simulations on a premixed flat flame burner dataset available in literature. The present work demonstrates that a Sectional Method-based approach can be a powerful tool to quantitatively predict engine-out soot emissions

Editorial: Advances in Endocrinology: Stem Cells and Growth Factors

Stem Cells investigation in Endocrinology: leading stem cell scientists and developmental endocrinologists, critically review both cutting-edge approaches to stem cell biology and the application of stem cells and their secretome to translational/precision medicine, endocrine diseases, including diabetes, tissue/organ repairs, energy metabolism, and metabolic disorders

Evidence-Based Dentistry: What's New?

The importance of evidence for every branch of medicine in teaching in order to orient the practitioners among the great amount of most actual scientific information's, and to support clinical decisions, is well established in health care, including dentistry

The application of ground-based and satellite remote sensing for estimation of bio-physiological parameters of wheat grown under different water regimes

Remote sensing technologies have been widely studied for the estimation of crop biometric and physiological parameters. The number of sensors and data acquisition methods have been increasing, and their evaluation is becoming a necessity. The aim of this study was to assess the performance of two remote sensing data for describing the variations of biometric and physiological parameters of durum wheat grown under different water regimes (rainfed, 50% and 100% of irrigation requirements). The experimentation was carried out in Policoro (Southern Italy) for two growing seasons. The Landsat 8 and Sentinel-2 images and radiometric ground-based data were acquired regularly during the growing season with plant biometric (leaf area index and dry aboveground biomass) and physiological (stomatal conductance, net assimilation, and transpiration rate) parameters. Water deficit index was closely related to plant water status and crop physiological parameters. The enhanced vegetation index showed slightly better performance than the normalized difference vegetation index when plotted against the leaf area index with R2 = 0.73. The overall results indicated that the ground-based vegetation indices were in good agreement with the satellite-based indices. The main constraint for effective application of satellite-based indices remains the presence of clouds during the acquisition time, which is particularly relevant for winter-spring crops. Therefore, the integration of remote sensing and field data might be needed to optimize plant response under specific growing conditions and to enhance agricultural production

Stop-event-related potentials from intracranial electrodes reveal a key role of premotor and motor cortices in stopping ongoing movements

In humans, the ability to withhold manual motor responses seems to rely on a right-lateralized frontal–basal ganglia–thalamic network, including the pre-supplementary motor area and the inferior frontal gyrus (IFG). These areas should drive subthalamic nuclei to implement movement inhibition via the hyperdirect pathway. The output of this network is expected to influence those cortical areas underlying limb movement preparation and initiation, i.e., premotor (PMA) and primary motor (M1) cortices. Electroencephalographic (EEG) studies have shown an enhancement of the N200/P300 complex in the event-related potentials (ERPs) when a planned reaching movement is successfully stopped after the presentation of an infrequent stop-signal. PMA and M1 have been suggested as possible neural sources of this ERP complex but, due to the limited spatial resolution of scalp EEG, it is not yet clear which cortical areas contribute to its generation. To elucidate the role of motor cortices, we recorded epicortical ERPs from the lateral surface of the fronto-temporal lobes of five pharmacoresistant epileptic patients performing a reaching version of the countermanding task while undergoing presurgical monitoring. We consistently found a stereotyped ERP complex on a single-trial level when a movement was successfully cancelled. These ERPs were selectively expressed in M1, PMA, and Brodmann's area (BA) 9 and their onsets preceded the end of the stop process, suggesting a causal involvement in this executive function. Such ERPs also occurred in unsuccessful-stop (US) trials, that is, when subjects moved despite the occurrence of a stop-signal, mostly when they had long reaction times (RTs). These findings support the hypothesis that motor cortices are the final target of the inhibitory command elaborated by the frontal–basal ganglia–thalamic network

ORTHOPEDIC JOINT STABILITY INFLUENCES GROWTH AND MAXILLARY DEVELOPMENT: CLINICAL ASPECTS

Orthopedic temporomandibular joint (TMJ) instability is very common among children and adults. It is often associated with pain in the cervicofacial region, and muscle contraction. To investigate whether muscle contraction can cause permanent posterior rotation of the head and whether treatment with splint and kinetotherapy is efficient, a literature review was carried out of patients with pain in the cervicofacial area. Additionally, the case of a 15-year old patient presenting with permanent posterior rotation of cranium, with no movement between the first two vertebra and pain in the cervicofacial area was reported. Kinetotherapy followed by rapid maxillary expansion improved the function of cervical vertebrae and reduced the cervicofacial pain within the first two weeks. Kinetotherapy, rapid maxillary expansion, and orthodontic treatment with a stable joint position could be a good therapy to control occipital-atlas function