Boundary-layer Flows Past an Hemispherical Roughness Element: DNS, Global Stability and Sensitivity Analysis

We investigate the full three-dimensional instability mechanism arising in the wake of an hemispherical roughness element immersed in a laminar Blasius boundary layer. The inherent three-dimensional flow pattern beyond the critical Reynolds number is characterized by coherent vortical structures called hairpin vortices. Direct numerical simulation is used to analyze the formation and the shedding of hairpin packets inside the shear layer. The first bifurcation characteristics are investigated by global stability tools. We show the spatial structure of the linear direct and adjoint global eigenmodes of the linearized Navier-Stokes operator and use structural sensitivity analysis to locate the region where the instability mechanism acts. Results show that the “wavemaker” driving the self-sustained instability is located in the region immediately past the roughness element, in the shear layer separating the outer flow from the wake region

Shortening of generation cycles in inbred lines of maize (Zea mays L.) through embryo rescue technique

Embryo rescue techniques have been used as an approach to raise hybrids from incompatible crosses. Thesetechniques have also proved to be valuable tools for maize improvement, since they allow reducing the durationof the generation cycles for speed breeding. The aim of this study was to identify an efficient embryo rescueprotocol to evaluate the response of maize (Zea mays L.) embryo culture and compare its generation time (seedto seed) with the generation time of plants obtained by mature seed germination. To this purpose, we evaluatedthe germination efficiency, in vitro protocol efficiency, and days to flowering of three advanced maize inbred linesdeveloped at the National Institute of Agricultural Technology of Argentina. A greenhouse traditional strategywas used as control. The embryo rescue technique allowed obtaining nearly four generations per year comparedto the two generations obtained in greenhouse. All the plants obtained by the embryo rescue technique weremorphologically normal and fertile. The results confirmed the possibility of using embryo rescue strategies tosignificantly reduce the duration of the generation cycles in maize

Immune thrombotic thrombocytopenic purpura: Personalized therapy using ADAMTS-13 activity and autoantibodies

Recently, treatment of immune-mediated thrombotic thrombocytopenic purpura (ITTP) has changed with the advent of caplacizumab in clinical practice. The International Working Group (IWG) has recently integrated the ADAMTS-13 activity/autoantibody monitoring in consensus outcome definitions. We report three ITTP cases during the coronavirus disease 2019 pandemic, that received a systematic evaluation of ADAMTS-13 activity and autoantibodies. We describe how the introduction of caplacizumab and ADAMTS-13 monitoring could change the management of ITTP patients and discuss whether therapeutic choices should be based on the clinical response alone. ADAMTS-13 activity/antibodies were assessed every 5 days. Responses were evaluated according to updated IWG outcome definitions. These kinetics, rather than clinical remission, guided the therapy, allowing early and safe caplacizumab discontinuation and sensible administration of rituximab. Caplacizumab was cautiously discontinued after achieving ADAMTS-13 complete remission. These cases illustrate that prospective ADAMTS-13 evaluation and use of updated IWG definitions may improve real-life patients’ management in the caplacizumab era

Bosentan treatment for Raynauds phenomenon and skin fibrosis in patients with Systemic Sclerosis and pulmonary arterial hypertension: an open-label, observational, retrospective study.

Raynaud's phenomenon (RP) and cutaneous fibrosis are the distinctive manifestations of scleroderma, in which Endothelin-1 plays a fundamental pathogenetic role. Bosentan, an Endothelin-1 receptor antagonist used for the treatment of pulmonary arterial hypertension, retards the beginning of new sclerodermic digital ulcers (DU). This open-label, observational, retrospective study verified the effect of Bosentan on RP and skin fibrosis in sclerodermic outpatients affected by pulmonary arterial hypertension without DU. Fourteen subjects (13 women, 1 man; mean age 60 ± 7.5 years; ten with limited and four with diffuse scleroderma) were observed at baseline (T0) and after four (T1), twelve (T2), twenty-four (T3) and forty-eight (T4) weeks during treatment with Bosentan. They were evaluated for daily quantity and duration of RP attacks and skin thickness (using modified Rodnan total skin score, MRSS). Videocapillaroscopic evaluation was performed at TO and T4. Bosentan decreased significantly the number and duration of RP attacks, beginning at T2 (p<0.05). Videocapillaroscopy showed significant improvement of microcirculatory patterns at T4 (p<0.05). MRSS decreased throughout the study, reaching the statistical significance at T3 and T4 (p<0.01) in the whole cohort. The present data suggest that Bosentan is effective in stabilmng the microcirculation involvement and in improving skin fibrosis irrespective of scleroderma patterns

Streamwise-travelling viscous waves in channel flows

The unsteady viscous flow induced by streamwise-travelling waves of spanwise wall velocity in an incompressible laminar channel flow is investigated. Wall waves belonging to this category have found important practical applications, such as microfluidic flow manipulation via electro-osmosis and surface acoustic forcing and reduction of wall friction in turbulent wall-bounded flows. An analytical solution composed of the classical streamwise Poiseuille flow and a spanwise velocity profile described by the parabolic cylinder function is found. The solution depends on the bulk Reynolds number R, the scaled streamwise wavelength (Formula presented.), and the scaled wave phase speed U. Numerical solutions are discussed for various combinations of these parameters. The flow is studied by the boundary-layer theory, thereby revealing the dominant physical balances and quantifying the thickness of the near-wall spanwise flow. The Wentzel–Kramers–Brillouin–Jeffreys (WKBJ) theory is also employed to obtain an analytical solution, which is valid across the whole channel. For positive wave speeds which are smaller than or equal to the maximum streamwise velocity, a turning-point behaviour emerges through the WKBJ analysis. Between the wall and the turning point, the wall-normal viscous effects are balanced solely by the convection driven by the wall forcing, while between the turning point and the centreline, the Poiseuille convection balances the wall-normal diffusion. At the turning point, the Poiseuille convection and the convection from the wall forcing cancel each other out, which leads to a constant viscous stress and to the break down of the WKBJ solution. This flow regime is analysed through a WKBJ composite expansion and the Langer method. The Langer solution is simpler and more accurate than the WKBJ composite solution, while the latter quantifies the thickness of the turning-point region. We also discuss how these waves can be generated via surface acoustic forcing and electro-osmosis and propose their use as microfluidic flow mixing devices. For the electro-osmosis case, the Helmholtz–Smoluchowski velocity at the edge of the Debye–Hückel layer, which drives the bulk electrically neutral flow, is obtained by matched asymptotic expansion

Extracorporeal membrane oxygenator as a bridge to successful surgical repair of bronchopleural fistula following bilateral sequential lung transplantation: a case report and review of literature

<p>Abstract</p> <p>Background</p> <p>Lung transplantation (LTx) is widely accepted as a therapeutic option for end-stage respiratory failure in cystic fibrosis. However, airway complications remain a major cause of morbidity and mortality in these patients, serious airway complications like bronchopleural fistula (BPF) are rare, and their management is very difficult.</p> <p>Case presentation</p> <p>A 47-year-old man with end-stage respiratory failure due to cystic fibrosis underwent bilateral sequential lung transplantation. Severe post-operative bleeding occurred due to dense intrapleural adhesions of the native lungs. He was re-explored and packed leading to satisfactory haemostasis. He developed a bronchopleural fistula on the 14^thpost-operative day. The fistula was successfully repaired using pericardial and intercostal vascular flaps with veno-venous extracorporeal membrane oxygenator (VV-ECMO) support. Subsequently his recovery was uneventful.</p> <p>Conclusion</p> <p>The combination of pedicled intercostal and pericardial flaps provide adequate vascular tissue for sealing a large BPF following LTx. Veno-venous ECMO allows a feasible bridge to recovery.</p

Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke

BACKGROUND: There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes. AIMS: We evaluated the cumulative incidence, the clinical relevance in terms of increased disability and mortality, and risk factors for complications. METHODS: From January 2011 to December 2017, 4799 patients were enrolled by 36 centers in the Italian Registry of Endovascular Stroke Treatment. Data on demographic and procedural characteristics, complications, and clinical outcome at three months were prospectively collected. RESULTS: The complications cumulative incidence was 201 per 1000 patients undergoing endovascular thrombectomy. Ongoing antiplatelet therapy (p < 0.01; OR 1.82, 95% CI: 1.21-2.73) and large vessel occlusion site (carotid-T, p < 0.03; OR 3.05, 95% CI: 1.13-8.19; M2-segment-MCA, p < 0.01; OR 4.54, 95% CI: 1.66-12.44) were associated with a higher risk of subarachnoid hemorrhage/arterial perforation. Thrombectomy alone (p < 0.01; OR 0.50, 95% CI: 0.31-0.83) and younger age (p < 0.04; OR 0.98, 95% CI: 0.97-0.99) revealed a lower risk of developing dissection. M2-segment-MCA occlusion (p < 0.01; OR 0.35, 95% CI: 0.19-0.64) and hypertension (p < 0.04; OR 0.77, 95% CI: 0.6-0.98) were less related to clot embolization. Higher NIHSS at onset (p < 0.01; OR 1.04, 95% CI: 1.02-1.06), longer groin-to-reperfusion time (p < 0.01; OR 1.05, 95% CI: 1.02-1.07), diabetes (p < 0.01; OR 1.67, 95% CI: 1.25-2.23), and LVO site (carotid-T, p < 0.01; OR 1.96, 95% CI: 1.26-3.05; M2-segment-MCA, p < 0.02; OR 1.62, 95% CI: 1.08-2.42) were associated with a higher risk of developing symptomatic intracerebral hemorrhage compared to no/asymptomatic intracerebral hemorrhage. The subgroup of patients treated with thrombectomy alone presented a lower risk of symptomatic intracerebral hemorrhage (p < 0.01; OR 0.70; 95% CI: 0.55-0.90). Subarachnoid hemorrhage/arterial perforation and symptomatic intracerebral hemorrhage after endovascular thrombectomy worsen both functional independence and mortality at three-month follow-up (p < 0.01). Distal embolization is associated with neurological deterioration (p < 0.01), while arterial dissection did not affect clinical outcome at follow-up. CONCLUSIONS: Complications globally considered are not uncommon and may result in poor clinical outcome. Early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits