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

Clustering methods for Mode S stations: Evaluation and perspectives

Grouping of a set of Secondary Surveillance Radar (SSR) Mode S stations into functional entities called clusters has significant operational facets; it calls for a constrained optimization, an important significant constraint being the scarcity of Interrogation Identifier (II) codes. This clustering problem can be approached by two ways, i.e., integer programming methods and heuristic approaches. The definition of a general, usable decision support tool to build up and evaluate clustering strategies in any operational airspace, e.g. the one of a nation or, even more complicated, of a system such as the European one, is a very challenging task. This paper describes some steps toward this envisaged result proposing a mathematical formulation and a heuristic approach for the problem

Clustering and routing in waste management: A two-stage optimisation approach

This paper proposes a two-stage model to tackle a problem arising in Waste Management. The decision-maker (a regional authority) is interested in locating sorting facilities in a regional area and defining the corresponding capacities. The decision-maker is aware that waste will be collected and brought to the installed facilities by independent private companies. Therefore, the authority wants to foresee the behaviour of these companies in order to avoid shortsighted decisions. In the first stage, the regional authority divides the clients into clusters, further assigning facilities to these clusters. In the second stage, an effective route is defined to serve client pickup demand. The main idea behind the model is that the authority aims to find the best location–allocation solution by clustering clients and assigning facilities to these clusters without generating overlaps. In doing so, the authority tries to (i) assign the demand of clients to the facilities by considering a safety stock within their capacities to avoid shortages during the operational phase, (ii) minimise Greenhouse Gases emissions, (iii) be as compliant as possible with the solution found by the second stage problem, the latter aiming at optimising vehicle tour lengths. After properly modelling the problem, we propose a matheuristic solution algorithm and conduct extensive computational analysis on a real-case scenario of an Italian region. Validation of the approach is achieved with promising results

Investigation of a passive control system for limiting cavitation inside turbomachinery under different operating conditions

Abstract Herein, a new passive control system for limiting cavitation inside turbomachinery has been applied to a NACA0009 hydrofoil. The basic idea is to introduce slots nearby its leading edge, connecting pressure and suction sides of the hydrofoil, in order to increase locally the pressure on its suction side and to prevent cavitation from developing. The cavitating flow developed around a two-dimensional hydrofoil is here considered since it is an archetype of cavitation nearby the leading edges of the impeller vanes. Thus, the flow field developed at the leading edge of both the original and modified hydrofoil has been studied at different angles of attack in order to reproduce a wide range of operating conditions that occur inside turbomachinery. Eventually, a comparison of their performance in terms of polars (C L and C D ) and vapour volume fractions (α v ) is performed

Milk and butter. From the Neolithic to the current nutritional aspects

The evolution in the history of nutrition knowledge towards dairy products, is strictly related to the socio-cultural development of humans. In fact, milk and butter have accompanied humans since ancient times, which traces of the consumption of such products are dated back about the earliest times after the last (glaciation) ice age, while the application for extra nutritional uses, such as cosmetics and ceremonial rites, are reported in the writings of the Old Testament. Even in Italy, before the Roman Empire, were known rudimentary techniques of production and storage of dairy products. But only with the advent of the Etruscans, and the Romans later, that the use of milk and dairy products reach a wide diffusion in several applications. Since the advent of Christ until today, milk and its derivatives have maintained a privileged place in the human diet, but it is only with the advent of modern medicine and new findings in lipidic chemistry that emerged multiple biological and nutritional properties, very important for human health. After a short summary of the ancient history of the milk and butter, the role of dairy products in cancer, in hypercholesterolemia, and cardiovascular disease are reported. Moreover, the current opinions on saturated fatty acids, the role of polyunsaturated fatty acids and their lipid mediators obtained by the action of cyclooxygenase, lipoxygenase and the cytochrome P450 enzymes, are treated. Even if sometimes mistreated, the milk, but most of all its high fat content derivatives such as butter, is a rich source of biologically active compounds that foster a controversial action against neolplastic and cardiovascular disease. These compounds, mainly contained in the lipid fraction, for the more obvious relationships that exist between nutrition and health status, have been the subject in the last decades of intense scientific investigation in which there were expressed lights and shadows, but recognizing that not all fats are harmful and further thorough studies are necessary, in particular, on the derived lipid mediators. This will allow a significant progress based on new scientific evidences, further orienting researchers and clinicians on evidencebased nutritional science

Resting state functional thalamic connectivity abnormalities in patients with post-stroke sleep apnoea: a pilot case-control study

OBJECTIVE: Sleep apnoea is common after stroke, and has adverse effects on the clinical outcome of affected cases. Its pathophysiological mechanisms are only partially known. Increases in brain connectivity after stroke might influence networks involved in arousal modulation and breathing control. The aim of this study was to investigate the resting state functional MRI thalamic hyper connectivity of stroke patients affected by sleep apnoea (SA) with respect to cases not affected, and to healthy controls (HC). PATIENTS AND METHODS: A series of stabilized strokes were submitted to 3T resting state functional MRI imaging and full polysomnography. The ventral-posterior-lateral thalamic nucleus was used as seed. RESULTS: At the between groups comparison analysis, in SA cases versus HC, the regions significantly hyper-connected with the seed were those encoding noxious threats (frontal eye field, somatosensory association, secondary visual cortices). Comparisons between SA cases versus those without SA, revealed in the former group significantly increased connectivity with regions modulating the response to stimuli independently to their potentiality of threat (prefrontal, primary and somatosensory association, superolateral and medial-inferior temporal, associative and secondary occipital ones). Further significantly functionally hyper connections were documented with regions involved also in the modulation of breathing during sleep (pons, midbrain, cerebellum, posterior cingulate cortices), and in the modulation of breathing response to chemical variations (anterior, posterior and para-hippocampal cingulate cortices). CONCLUSIONS: Our preliminary data support the presence of functional hyper connectivity in thalamic circuits modulating sensorial stimuli, in patients with post-stroke sleep apnoea, possibly influencing both their arousal ability and breathing modulation during sleep

Clinical and Experimental Projects on Chemotherapy of Bladder Tumours

Our clinical and experimental experience with chemotherapy of bladder tumours is reviewed. The routes of drug administrations, drug dosages and combinations, are presented. Adjuvant radiotherapy and chemoprophylaxis of certain tumours are discussed.S. Afr. Med. J., 48, 631 (1974

Clinical and experimental projects on chemotherapy of bladder tumours

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[The role of eggs in the diet: nutraceutical and epigenetic aspects].

The use of eggs in human diet has been object of many prejudices which are not yet completely disappeared The evolution of knowledge in the field of nutrition has, partially, countered these prejudices by highlighting the biological importance of several compounds present in the eggs. The nutritional and commercial revaluation of the eggs are passed through the enrichment of the lipid fraction in omega3 polyunsaturated fatty acids (PUFA omega3) which, have shown positive effects against cardiovascular diseases and development of the central nervous system and retina. The enrichment of eggs lipid with omega3 fatty acids is carried out by the integration of feeding hens with oils rich in omega3 fatty acids such as plant or marine oils. The results showed that the accumulation of omega3 in the egg yolk lipids is strongly affected by the type of oil used as supplement and by the amounts of oils administrated to the hens

The role of eggs in the diet: nutraceutical and epigenetic aspects

The use of eggs in human diet has been object of many prejudices which are not yet completely disappeared The evolution of knowledge in the field of nutrition has, partially, countered these prejudices by highlighting the biological importance of several compounds present in the eggs. The nutritional and commercial revaluation of the eggs are passed through the enrichment of the lipid fraction in ω3 polyunsaturated fatty acids (PUFA ω3) which, have shown positive effects against cardiovascular diseases and development of the central nervous system and retina. The enrichment of eggs lipid with ω3 fatty acids is carried out by the integration of feeding hens with oils rich in ω3 fatty acids such as plant or marine oils. The results showed that the accumulation of ω3 in the egg yolk lipids is strongly affected by the type of oil used as supplement and by the amounts of oils administrated to the hens