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

Automatic identification of sites prone to topographic seismic amplification effects by the current seismic codes

Current seismic codes provide proxies to estimate seismic amplification effects expected in correspondence of some morphological features. To make possible any empirical validation of these proxies, these features must be univocally identified on the basis of an automatic procedure. To this purpose, based on geomorphological considerations, a GIS-based numerical approach has been developed. The results of a morphometric analysis allowed the correct identification and mapping of the landforms of concern, at a detail corresponding to the resolution of the available digital elevation model (DEM). Some case-studies are provided to show the feasibility of the proposed approach. © 2023 The Author

Cognitive analytics management of the customer lifetime value: an artificial neural network approach

Purpose: The purpose of this study is to show that the use of CAM (cognitive analytics management) methodology is a valid tool to describe new technology implementations for businesses. Design/methodology/approach: Starting from a dataset of recipes, we were able to describe consumers through a variant of the RFM (recency, frequency and monetary value) model. It has been possible to categorize the customers into clusters and to measure their profitability thanks to the customer lifetime value (CLV). Findings: After comparing two machine learning algorithms, we found out that self-organizing map better classifies the customer base of the retailer. The algorithm was able to extract three clusters that were described as personas using the values of the customer lifetime value and the scores of the variant of the RFM model. Research limitations/implications: The results of this methodology are strictly applicable to the retailer which provided the data. Practical implications: Even though, this methodology can produce useful information for designing promotional strategies and improving the relationship between company and customers. Social implications: Customer segmentation is an essential part of the marketing process. Improving further segmentation methods allow even small and medium companies to effectively target customers to better deliver to society the value they offer. Originality/value: This paper shows the application of CAM methodology to guide the implementation and the adoption of a new customer segmentation algorithm based on the CLV

Mapping 1D seismic amplification effects in the range of periods of engineering interest based on geological data

Regional scale seismic hazard assessment including the effect of local seismo-stratigraphical conditions is a basic tool for seismic risk estimates. A novel physically based procedure is proposed for using geological maps to extensively estimate expected seismic amplification effects relative to spectral ordinates of main engineering interest (<0.8 s). Automatic GIS based analysis of geological maps, statistical data relative to the seismic/geotechnical properties of geological units and numerical modelling are combined to determine the probability distribution of expected amplification effects by accounting for uncertainty affecting the relevant parameters. To evaluate the feasibility of the proposed procedure, it has been applied to the Tuscany Region in Central Italy. Unbiasedness of outcomes has been tested by considering detailed microzonation studies available for the considered area. Results of the proposed approach could be easily implemented in extensive seismic risk analyses where detailed seismic microzonation studies are lacking

Urgent Carotid Surgery: Is It Still out of Debate?

Patients with symptomatic tight carotid stenosis have an increased short-time risk of stroke and an increased long-term risk of ischaemic vascular events compared with the general population. The aim of this study is to assess the safety, efficacy, and limitations of urgent CEA or CAS, in patients with carotid stenosis greater than 70% and clinically characterized by recurrent TIA or brain damage following a stroke (<2.5 cm). This study involved 28 patients divided into two groups. Group A consisted of sixteen patients who had undergone CEA, and group B consisted of twelve patients who had undergone CAS. Primary endpoints were mortality, neurological morbidity (by NIHSS) and postoperative hemorrhagic cerebral conversion, at 30 days. Ten patients (62.5%) of group A experienced an improvement in their initial neurological deficit while in 4 cases (26%) the deficit remained stable. Two cases of neurologic mortality are presented. At 1 month, 9 patients (75%) of group B experienced an improvement in their initial neurological deficit while 3 patients (25%) had a neurological impairment. Urgent or deferred surgical or endovascular treatment have a satisfactory outcome considering the profile in very high-risk patient population. Otherwise in selected patients CEA seems to be preferred to CAS

Inertial Sensors in Swimming: Detection of Stroke Phases through 3D Wrist Trajectory.

Monitoring the upper arm propulsion is a crucial task for swimmer performance. The swimmer indeed can produce displacement of the body by modulating the upper limb kinematics. The present study proposes an approach for automatically recognize all stroke phases through three-dimensional (3D) wrist\u2019s trajectory estimated using inertial devices. Inertial data of 14 national-level male swimmer were collected while they performed 25 m front-crawl trial at intensity range from 75% to 100% of their 25 m maximal velocity. The 3D coordinates of the wrist were computed using the inertial sensors orientation and considering the kinematic chain of the upper arm biomechanical model. An algorithm that automatically estimates the duration of entry, pull, push, and recovery phases result from the 3D wrist\u2019s trajectory was tested using the bi-dimensional (2D) video-based systems as temporal reference system. A very large correlation (r = 0.87), low bias (0.8%), and reasonable Root Mean Square error (2.9%) for the stroke phases duration were observed using inertial devices versus 2D video-based system methods. The 95% limits of agreement (LoA) for each stroke phase duration were always lower than 7.7% of cycle duration. The mean values of entry, pull, push and recovery phases duration in percentage of the complete cycle detected using 3D wrist\u2019s trajectory using inertial devices were 34.7 (\ub1 6.8)%, 22.4 (\ub1 5.8)%, 14.2 (\ub1 4.4)%, 28.4 (\ub1 4.5)%. The swimmer\u2019s velocity and arm coordination model do not affect the performance of the algorithm in stroke phases detection. The 3D wrist trajectory can be used for an accurate and complete identification of the stroke phases in front crawl using inertial sensors. Results indicated the inertial sensor device technology as a viable option for swimming arm-stroke phase assessment

Tetris Genioplasty: A New Paradigm for Chin Asymmetries Correction

The chin plays a crucial role as a fundamental structural component that contributes to the overall aesthetics and harmony of the face. Recognizing its central position, medical science has seen the evolution of numerous surgical techniques over the years, all aimed at correcting the range of structural irregularities that can affect the chin. In this contribution, the authors introduce an innovative osteotomy technique, aimed at cases of chin asymmetry in which the skeletal median diverges from the dental median. This technique, called “Tetris genioplasty”, involves performing the classic rectangular osteotomy, but includes an additional vertical osteotomy in order to obtain two distinct segments. Finally, these segments are translocated and repositioned to obtain a realignment between the skeletal median and the dental median. The results were entirely satisfactory for the patients, aligning perfectly with the expected appearance after the operation. Furthermore, no complications were reported, proving the success and safety of the procedure. The Tetris genioplasty aligns itself with this progressive trend by offering a minimally invasive method that nevertheless is able to achieve excellent results with a high impact on the patient’s quality of life, presenting a promising path in the pursuit of optimal aesthetic results with minimized patient morbidity and greater overall safety

Aquatic Therapy after Incomplete Spinal Cord Injury: Gait Initiation Analysis Using Inertial Sensors

: Populations with potential damage to somatosensory, vestibular, and visual systems or poor motor control are often studied during gait initiation. Aquatic activity has shown to benefit the functional capacity of incomplete spinal cord injury (iSCI) patients. The present study aimed to evaluate gait initiation in iSCI patients using an easy-to-use protocol employing four wearable inertial sensors. Temporal and acceleration-based anticipatory postural adjustment measures were computed and compared between dry-land and water immersion conditions in 10 iSCI patients. In the aquatic condition, an increased first step duration (median value of 1.44 s vs. 0.70 s in dry-land conditions) and decreased root mean squared accelerations for the upper trunk (0.39 m/s2 vs. 0.72 m/s2 in dry-land conditions) and lower trunk (0.41 m/s2 vs. 0.85 m/s2 in dry-land conditions) were found in the medio-lateral and antero-posterior direction, respectively. The estimation of these parameters, routinely during a therapy session, can provide important information regarding different control strategies adopted in different environments

Acute effects of a high volume vs. High intensity bench press protocol on electromechanical delay and muscle morphology in recreationally trained women

The purpose of the present investigation was to compare the acute responses on muscle architecture, electromechanical delay (EMD) and performance following a high volume (HV: 5 sets of 10 reps at 70% of 1 repetition maximum (1RM)) and a high intensity (HI: 5 sets of 3 reps at 90% of 1RM) bench press protocol in women. Eleven recreationally trained women (age = 23.3 ± 1.8 y; body weight = 59.7 ± 6.0 kg; height = 164.0 ± 6.3 cm) performed each protocol in a counterbalanced randomized order. Muscle thickness of pectoral (PEC MT) and triceps muscles (TR MT) were collected prior to and 15 min post each trial. In addition, EMD of pectoral (PEC EMD) and triceps (TR EMD) muscles were calculated during isometric bench press maximum force tests performed at the same timepoints (IBPF). Significantly greater increases in PEC MT (p &lt; 0.001) and TR MT (p &lt; 0.001) were detected following HV compared to HI. PEC EMD showed a significantly greater increase following HV compared to HI (p = 0.039). Results of the present study indicate that the HV bench press protocol results in greater acute morphological and neuromuscular changes compared to a HI protocol in women. Evaluations of muscle morphology and electromechanical delay appear more sensitive to fatigue than maximum isometric force assessments