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

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

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

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

Expression of aryl hydrocarbon receptor (AHR) and AHR-interacting protein in pituitary adenomas: pathological and clinical implications.

peer reviewedaudience: researcher, professionalGermline mutations of the aryl hydrocarbon receptor (AHR)-interacting protein (AIP) gene confer a predisposition to pituitary adenomas (PA), usually in the setting of familial isolated PA. To provide further insights into the possible role of AIP in pituitary tumour pathogenesis, the expression of AIP and AHR was determined by real-time RT-PCR and/or immunohistochemistry (IHC) in a large series of PA (n=103), including 17 with AIP mutations (AIP(mut)). Variable levels of AIP and AHR transcripts were detected in all PA, with a low AHR expression (P<0.0001 versus AIP). Cytoplasmic AIP and AHR were detected by IHC in 84.0 and 38.6% of PA respectively, and significantly correlated with each other (P=0.006). Nuclear AHR was detected in a minority of PA (19.7%). The highest AIP expression was observed in somatotrophinomas and non-secreting (NS) PA, and multivariate analysis in somatotrophinomas showed a significantly lower AIP immunostaining in invasive versus non-invasive cases (P=0.019). AIP expression was commonly low in other secreting PA. AIP immunostaining was abolished in a minority of AIP(mut) PA, with a frequent loss of cytoplasmic AHR and no evidence of nuclear AHR. In contrast, AIP overexpression in a subset of NS PA could be accompanied by nuclear AHR immunopositivity. We conclude that down-regulation of AIP and AHR may be involved in the aggressiveness of somatotrophinomas. Overall, IHC is a poorly sensitive tool for the screening of AIP mutations. Data obtained on AHR expression suggest that AHR signalling may be differentially affected according to PA phenotype

Expression of aryl hydrocarbon receptor (AHR) and AHR-interacting protein in pituitary adenomas: pathological and clinical implications.

Germline mutations of the aryl hydrocarbon receptor (AHR)-interacting protein (AIP) gene confer a predisposition to pituitary adenomas (PA), usually in the setting of familial isolated PA. To provide further insights into the possible role of AIP in pituitary tumour pathogenesis, the expression of AIP and AHR was determined by real-time RT-PCR and/or immunohistochemistry (IHC) in a large series of PA (n=103), including 17 with AIP mutations (AIP(mut)). Variable levels of AIP and AHR transcripts were detected in all PA, with a low AHR expression (P<0.0001 versus AIP). Cytoplasmic AIP and AHR were detected by IHC in 84.0 and 38.6% of PA respectively, and significantly correlated with each other (P=0.006). Nuclear AHR was detected in a minority of PA (19.7%). The highest AIP expression was observed in somatotrophinomas and non-secreting (NS) PA, and multivariate analysis in somatotrophinomas showed a significantly lower AIP immunostaining in invasive versus non-invasive cases (P=0.019). AIP expression was commonly low in other secreting PA. AIP immunostaining was abolished in a minority of AIP(mut) PA, with a frequent loss of cytoplasmic AHR and no evidence of nuclear AHR. In contrast, AIP overexpression in a subset of NS PA could be accompanied by nuclear AHR immunopositivity. We conclude that down-regulation of AIP and AHR may be involved in the aggressiveness of somatotrophinomas. Overall, IHC is a poorly sensitive tool for the screening of AIP mutations. Data obtained on AHR expression suggest that AHR signalling may be differentially affected according to PA phenotype

Randomized trial on adjuvant treatment with FOLFIRI followed by docetaxel and cisplatin versus 5-fluorouracil and folinic acid for radically resected gastric cancer

Some trial have demonstrated a benefit of adjuvant fluoropirimidine with or without platinum compounds compared with surgery alone. ITACA-S study was designed to evaluate whether a sequential treatment of FOLFIRI [irinotecan plus 5-fluorouracil/folinic acid (5-FU/LV)] followed by docetaxel plus cisplatin improves disease-free survival in comparison with 5-FU/LV in patients with radically resected gastric cancer. Patients with resectable adenocarcinoma of the stomach or gastroesophageal junction were randomly assigned to either FOLFIRI (irinotecan 180 mg/m(2) day 1, LV 100 mg/m(2) as 2 h infusion and 5-FU 400 mg/m(2) as bolus, days 1 and 2 followed by 600 mg/m(2)/day as 22 h continuous infusion, q14 for four cycles) followed by docetaxel 75 mg/m(2) day 1, cisplatin 75 mg/m(2) day 1, q21 for three cycles (sequential arm) or De Gramont regimen (5-FU/LV arm). From February 2005 to August 2009, 1106 patients were enrolled, and 1100 included in the analysis: 562 in the sequential arm and 538 in the 5-FU/LV arm. With a median follow-up of 57.4 months, 581 patients recurred or died (297 sequential arm and 284 5-FU/LV arm), and 483 died (243 and 240, respectively). No statistically significant difference was detected for both disease-free [hazard ratio (HR) 1.00; 95% confidence interval (CI): 0.85-1.17; P = 0.974] and overall survival (OS) (HR 0.98; 95% CI: 0.82-1.18; P = 0.865). Five-year disease-free and OS rates were 44.6% and 44.6%, 51.0% and 50.6% in the sequential and 5-FU/LV arm, respectively. A more intensive regimen failed to show any benefit in disease-free and OS versus monotherapy

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