Extra-neural metastases in pediatric diffuse midline gliomas, H3 K27-altered: presentation of two cases and literature review

IntroductionPediatric diffuse midline gliomas (DMG), H3 K27- altered, are the most aggressive pediatric central nervous system (CNS) malignancies. Disease outcome is dismal with a median survival of less than one year. Extra-neural metastases are an unusual occurrence in DMG and have been rarely described.Methods and resultsHere, we report on two pediatric patients affected by DMG with extra-neural dissemination. Their clinical, imaging, and molecular characteristics are reported here. An 11-year-old male 5 months after the diagnosis of diffuse intrinsic pontine glioma (DIPG) developed metastatic osseous lesions confirmed with computed tomography (CT) guided biopsy of the left iliac bone. The patient died one month after the evidence of metastatic progression. Another 11-year-old female was diagnosed with a cerebellar H3K27- altered DMG. After six months, she developed diffuse sclerotic osseous lesions. A CT-guided biopsy of the right iliac bone was non-diagnostic. She further developed multifocal chest and abdominal lymphadenopathy and pleural effusions. Droplet digital polymerase chain reaction (ddPCR) on pleural effusion revealed the presence of H3.3A mutation (c.83A>T, p.K28M). The patient died 24 months after the diagnosis of DMG and 3 months after the evidence of metastatic pleural effusion.DiscussionExtra-neural metastasis of DMG is a rare event and no standard therapy exists. An accurate and early diagnosis is necessary in order to develop a personalized plan of treatment. Further research is needed to gain further insights into the molecular pathology of DMG, H3K27- altered and improve the quality of life and the final outcome of patients with this deadly disease

Multi-Level Open End Windings Multi-Motor Drives

A multi-level open-end winding converter topology for multiple-motor drives is presented featuring a main multi-level inverter processing the power delivered to the motors and an active filter based on an auxiliary two-level inverter. The main inverter operates at the fundamental frequency in order to achieve low switching power losses, while the active filter is Pulse Width Modulation (PWM) operated to suitably shape the motor currents. The proposed configuration features less phase current distortion than conventional multi-level inverters operating at the fundamental frequency, while achieving a higher efficiency compared to PWM multi-level inverters. Experimental results confirm the effectiveness of such a configuration on both multiple motors-single converter and multiple motor-multiple converter drives

Influence of EGFR mutational status on metastatic behavior in non squamous non small cell lung cancer

Epidermal Growth Factor Receptor (EGFR) mutated Non Small Cell Lung Cancers (NSCLCs) are a molecularly subgroup of patients with peculiar clinic-pathological characteristics. Previous studies have suggested a possible interaction between oncogene status and metastatic behavior in non squamous NSCLCs with conflicting results. The aim of this study was to compare the different metastatic patterns, at baseline and during the course of the disease, in a cohort of 137 Caucasian patients with non-squamous NSCLC according to the EGFR mutational status and survival differences according to the different metastatic behavior. We observed unique metastatic distributions between EGFR-mutated and EGFR wild type non-squamous NSCLCs. These data support the hypothesis that tumor bio-molecular characteristics and genotype may influence the metastatic process in NSCLC and might help the development of enrichment strategies for tumor genotyping in these tumors, especially in the presence of limited tissue availability

Central nervous system involvement in ALK-rearranged NSCLC : promising strategies to overcome crizotinib resistance

ABSTRACT: Introduction: ALK rearranged Non Small Cell Lung Cancers (NSCLCs) represent a distinct subgroup of patients with peculiar clinic-pathological features. These patients exhibit dramatic responses when treated with the ALK tyrosine kinase inhibitor Crizotinib, albeit Central Nervous System (CNS) activity is much less impressive than that observed against extracranial lesions. CNS involvement has become increasingly observed in these patients, given their prolonged survival. Several novel generation ALK inhibitors have been developing to increase CNS penetration and to provide more complete ALK inhibition. Areas covered: The CNS activity of Crizotinib and novel generation ALK inhibitors will be summarized in this review, evaluating the strengths and weaknesses of the therapeutic strategies developed to date in this specific subgroup of NSCLCs with a look towards the future. Expert commentary: In the next few years, the results of ongoing comparative head-to-head trials will provide the definitive conclusions on the optimal treatment sequence in ALK-rearranged NSCLCs. Moreover, ongoing clinical trials with novel-generation ALK inhibitors will produce more evidences on the best approach in the growing number of ALK-positive NSCLCs with CNS involvement

Models for Battery Health Assessment: A Comparative Evaluation

Considering the importance of lithium-ion (Li-ion) batteries and the attention that the study of their degradation deserves, this work provides a review of the most important battery state of health (SOH) estimation methods. The different approaches proposed in the literature were analyzed, highlighting theoretical aspects, strengths, weaknesses and performance indices. In particular, three main categories were identified: experimental methods that include electrochemical impedance spectroscopy (EIS) and incremental capacity analysis (ICA), model-based methods that exploit equivalent electric circuit models (ECMs) and aging models (AMs) and, finally, data-driven approaches ranging from neural networks (NNs) to support vector regression (SVR). This work aims to depict a complete picture of the available techniques for SOH estimation, comparing the results obtained for different engineering applications