The Association Between Peri-Hemorrhagic Metabolites and Cerebral Hemodynamics in Comatose Patients With Spontaneous Intracerebral Hemorrhage: An International Multicenter Pilot Study Analysis.

Background and Objective: Cerebral microdialysis (CMD) enables monitoring brain tissue metabolism and risk factors for secondary brain injury such as an imbalance of consumption, altered utilization, and delivery of oxygen and glucose, frequently present following spontaneous intracerebral hemorrhage (SICH). The aim of this study was to evaluate the relationship between lactate/pyruvate ratio (LPR) with hemodynamic variables [mean arterial blood pressure (MABP), intracranial pressure (ICP), cerebral perfusion pressure (CPP), and cerebrovascular pressure reactivity (PRx)] and metabolic variables (glutamate, glucose, and glycerol), within the cerebral peri-hemorrhagic region, with the hypothesis that there may be an association between these variables, leading to a worsening of outcome in comatose SICH patients. Methods: This is an international multicenter cohort study regarding a retrospective dataset analysis of non-consecutive comatose patients with supratentorial SICH undergoing invasive multimodality neuromonitoring admitted to neurocritical care units pertaining to three different centers. Patients with SICH were included if they had an indication for invasive ICP and CMD monitoring, were >18 years of age, and had a Glasgow Coma Scale (GCS) score of ≤8. Results: Twenty-two patients were included in the analysis. A total monitoring time of 1,558 h was analyzed, with a mean (SD) monitoring time of 70.72 h (66.25) per patient. Moreover, 21 out of the 22 patients (95%) had disturbed cerebrovascular autoregulation during the observation period. When considering a dichotomized LPR for a threshold level of 25 or 40, there was a statistically significant difference in all the measured variables (PRx, glucose, glutamate), but not glycerol. When dichotomized PRx was considered as the dependent variable, only LPR was related to autoregulation. A lower PRx was associated with a higher survival [27.9% (23.1%) vs. 56.0% (31.3%), p = 0.03]. Conclusions: According to our results, disturbed autoregulation in comatose SICH patients is common. It is correlated to deranged metabolites within the peri-hemorrhagic region of the clot and is also associated with poor outcome

Bounds for cohomological deficiency functions of projective schemes over Artinian rings

Let $X$ be a projective scheme over an artinian commutative ring $R_0$ and let \Cal{F} be a coherent sheaf of \Cal{O}_X-modules. We give bounds on the so called cohomological deficiency functions \Delta^i_{X, \Cal{F}} and the cohomological postulation numbers \nu^i_{X, \Cal{F}} of the pair (X, \Cal{F}). As bounding invariants we use the "cohomology diagonal" \big( h^j_{X, \Cal{F}}(-j) \big)_{j\le i} at and below level $i$ and the $i$-th "cohomological Hilbert polynomial" p^i_{X, \Cal{F}} of the pair (X, \Cal{F}). Our bounds present themselves as a quantitative and extended version of the vanishing theorem of Severi\,--\,Enriques\,--\,Zariski\,--\,Serre

Bounds for cohomological Hilbert-functions of projective schemes over Artinian rings

Let X be a projective scheme over an artinian commutative ring $R_0$. Let \Cal F be a coherent sheaf of \Cal O_X-modules. We present a sample of bounding results for the so called cohomological Hilbert functions \centerline{h^i_{X, \Cal F} : \Bbb Z \to \Bbb N_0, n \mapsto h^i_{X, \Cal F} (n) = length_{R_0} H^i (X, \Cal F (n))} of \Cal F. Our main interest is to bound these functions in terms of the so called cohomology diagonal (h^j_{X, \Cal F} (-j))^{\dim (\Cal F)}_{j = 0} of \Cal F. Our results present themselves as quantitative versions of the vanishing theorems of Castelnuovo-Serre and of Severi-Enriques-Zariski-Serre. In particular we get polynomial bounds for the (Castelnuovo) regularity at arbitrary levels and for the (Severi) coregularity at any level below the global subdepth \delta (\Cal F) := \min{depth(\Cal F_x) | x \in X, x closed} of \Cal F. We also show that the cohomology diagonal of \Cal F provides minimal bounding systems for the mentioned regularities and coregularities. As a fundamental tool we use an extended version of the method of linear systems of general hyperplane sections

Symptomatic unilateral renal angiomyolipoma in a child with tuberous sclerosis

We report a case of unilateral renal angiomyolipoma in a 10-year-old boy with tuberous sclerosis. The case is worthy of attention because the symptoms occurred at an early age and because the lesion was unilateral, the latter confirmed at 11-year follow-up. The presentation and treatment are discussed, and the pertinent literature is reviewed. The case demonstrates that it is of clinical importance to monitor renal involvement in children with tuberous sclerosis. Copyright (C) 2001 S. Karger AG, Basel

Long-term follow-up in children treated for retroperitoneal malignant tumours.

Thirty-two long-term survivors after treatment with surgery, radiotherapy and chemotherapy for neuroblastoma (NRB) and Wilms' tumour (WT) were re-evaluated after a period of more than 10 years (mean 16 yr 1 mo, range 27 yr 2 mo/10 yr 5 mo). In addition to routine clinical and laboratory studies, all patients underwent auxometry, echocardiography, spinal X-ray, abdominal US and kidney radionuclide scans. Neither obvious physical signs nor cutaneous toxicity were noted at inspection. No dysmenorrhoea or sexual disorders were mentioned. Haematological data turned out to be all in the normal range, except for TIBC/UIBC ratio (out of range in 70 % of cases); gammaGt (62.5 %); A/G ratio (12.5 %); ALT (37.5 %). Auxometrical data were all in the normal range; in particular, results of mean weight and height were just slightly over the 50 degrees centile. Spinal X-rays revealed mild kyphotic deformities (68.9 %), pelvic obliquity and tilting (62.5 %), rotation of the vertebral bodies (34.3 %) and compensatory curves of the spine (21.8 %). No impairment of cardiac functions was noted at echocardiography. No alteration of the hepatic structure was detectable at US scans. Marked impairment of the renal function (20 % and 1.5 % residual function) was detected at radionuclide imaging in 2 NRB patients who had not undergone nephrectomy, with the kidney having almost disappeared in one. In conclusion, the study emphasises the need for careful and prolonged follow-up for the detection of sequelae than can appear even many years after the initial treatment, and the wisdom and the need for a continued search for less aggressive protocols; as long as the cure rate is not compromised, less aggressive protocols should aim for a satisfactory overall survival with a reduced incidence of sequelae and hence a better quality of life

Post glacial recolonisation routes for Picea abies K. in Italy as suggested by the analysis of sequence-characterized amplified region (SCAR) markers

The routes through which Norway spruce recolonized the Alps after the last ice age were investigated at the genetic level. Seven populations along the Alpine range plus one Apennine population were characterized for seven sequence-characterized amplified region (SCAR) loci, detecting an overall F(ST) = 0.118. This rather high value for forest species reflects an uneven distribution of genetic variability, and was analysed through different statistical methods. Alternative hypotheses were tested under the isolation-by-distance model and using the analysis of molecular variance (AMOVA) frame. We conclude that the hypothesis of the existence of a glacial refugium in the Apennines should be rejected, while a putative relict population is identified in the Maritime Alps. The Alpine range of Norway spruce appears to be split in two parts across a north-south line. The results are discussed in comparison with data based on morphological markers, isozymes, chloroplast microsatellites and mitochondrial markers