Odontogenic orbital abscess is a rare but well-documented complication of sinusitis and infections spreading from dental apical lesion. We report a case of orbital abscess with periorbital ...cellulitis, in a 35-year-old man with positive recent dental history of a periapical dental infection arising from the second upper left premolar spread into maxillary sinus. The patient has shown facial edema, ocular pain, ophthalmoplegia, proptosis, and initial visual symptoms. A surgical intervention to drain the abscess and a revision of the dental lesion and maxillary sinus were required. A review of literature is also reported focusing on etiology and treatment options dealing with odontogenic orbital abscess and cellulitis.
Purpose
To combine peripheral blood indices and clinical factors in a prognostic score for metastatic castration-resistant prostate cancer (mCRPC) patients treated with radium-223 dichloride (
223
...RaRaCl
2
).
Patients and methods
Baseline neutrophil-to-lymphocyte ratio (NLR), derived NLR (donor), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic inflammation index (SII), Eastern Cooperative Oncology Group performance status (ECOG PS), Gleason score (GS) group, number of bone metastases, prostate-specific antigen (PSA), alkaline phosphatase (ALP), line of therapy, previous chemotherapy, and the presence of lymphadenopathies were collected from seven Italian centers between 2013 and 2020. Lab and clinical data were assessed in correlation with the overall survival (OS). Inflammatory indices were then included separately in the multivariable analyses with the prognostic clinical factors. The model with the highest discriminative ability (c-index) was chosen to develop the BIO-Ra score.
Results
Five hundred and nineteen mCRPC patients (median OS: 19.9 months) were enrolled. Higher NLR, dNLR, PLR, and SII and lower LMR predicted worse OS (all with a
p
< 0.001). The multivariable model including NLR, ECOG PS, number of bone metastases, ALP, and PSA (c-index: 0.724) was chosen to develop the BIO-Ra score. Using the Schneeweiss scoring system, the BIO-Ra score identified three prognostic groups (36%, 27.3%, and 36.6% patients, respectively) with distinct median OS (31, 26.6, and 9.6 months, respectively; hazard ratio: 1.62,
p
= 0.008 for group 2 vs. 1 and 5.77,
p
< 0.001 for group 3 vs. 1).
Conclusions
The BIO-Ra score represents an easy and widely applicable tool for the prognostic stratification of mCRPC patients treated with
223
RaRaCl
2
with no additional costs.
Auxins act as repressors of ripening inception in grape (véraison), while ethylene and abscisic acid (ABA) play a positive role as inducers of the syndrome. Despite the increasing amount of ...information made available on this topic, the complex network of interactions among these hormones remains elusive. In order to shed light on these aspects, a holistic approach was adopted to evaluate, at the transcriptomic level, the crosstalk between hormones in grape berries, whose ripening progression was delayed by applying naphtalenacetic acid (NAA) one week before véraison.
The NAA treatment caused significant changes in the transcription rate of about 1,500 genes, indicating that auxin delayed grape berry ripening also at the transcriptional level, along with the recovery of a steady state of its intracellular concentration. Hormone indices analysis carried out with the HORMONOMETER tool suggests that biologically active concentrations of auxins were achieved throughout a homeostatic recovery. This occurred within 7 days after the treatment, during which the physiological response was mainly unspecific and due to a likely pharmacological effect of NAA. This hypothesis is strongly supported by the up-regulation of genes involved in auxin conjugation (GH3-like) and action (IAA4- and IAA31-like). A strong antagonistic effect between auxin and ethylene was also observed, along with a substantial 'synergism' between auxins and ABA, although to a lesser extent.
This study suggests that, in presence of altered levels of auxins, the crosstalk between hormones involves diverse mechanisms, acting at both the hormone response and biosynthesis levels, creating a complex response network.
Hemodynamics interacts with the cellular components of human vessels, influencing function and healthy status. Locally acting hemodynamic forces have been associated-by a steadily increasing amount ...of scientific evidence-with nucleation and evolution of atherosclerotic plaques in several vascular regions, resulting in the formulation of the 'hemodynamic risk hypothesis' of the atherogenesis. At the level of coronary arteries, however, the complexity of both anatomy and physiology made the study of this vascular region particularly difficult for researchers. Developments in computational fluid dynamics (CFD) have recently allowed an accurate modelling of the intracoronary hemodynamics, thus offering physicians a unique tool for the investigation of this crucial human system by means of advanced mathematical simulations. The present review of CFD applications in coronary artery disease was set to concisely offer the medical reader the theoretical foundations of quantitative intravascular hemodynamics-reasoned schematically in the text in its basic (i.e., pressure and velocity) and derived quantities (e.g., fractional flow reserve, wall shear stress and helicity)-along with its current implications in clinical research. Moreover, attention was paid in classifying computational modelling derived from invasive and non-invasive imaging modalities with unbiased remarks on the advantages and limitations of each procedure. Finally, an extensive description-aided by explanatory figures and cross references to recent clinical findings-was presented on the role of near-wall hemodynamics, in terms of shear stress, and of intravascular flow complexity, in terms of helical flow.Hemodynamics interacts with the cellular components of human vessels, influencing function and healthy status. Locally acting hemodynamic forces have been associated-by a steadily increasing amount of scientific evidence-with nucleation and evolution of atherosclerotic plaques in several vascular regions, resulting in the formulation of the 'hemodynamic risk hypothesis' of the atherogenesis. At the level of coronary arteries, however, the complexity of both anatomy and physiology made the study of this vascular region particularly difficult for researchers. Developments in computational fluid dynamics (CFD) have recently allowed an accurate modelling of the intracoronary hemodynamics, thus offering physicians a unique tool for the investigation of this crucial human system by means of advanced mathematical simulations. The present review of CFD applications in coronary artery disease was set to concisely offer the medical reader the theoretical foundations of quantitative intravascular hemodynamics-reasoned schematically in the text in its basic (i.e., pressure and velocity) and derived quantities (e.g., fractional flow reserve, wall shear stress and helicity)-along with its current implications in clinical research. Moreover, attention was paid in classifying computational modelling derived from invasive and non-invasive imaging modalities with unbiased remarks on the advantages and limitations of each procedure. Finally, an extensive description-aided by explanatory figures and cross references to recent clinical findings-was presented on the role of near-wall hemodynamics, in terms of shear stress, and of intravascular flow complexity, in terms of helical flow.
Hepatocellular carcinoma (HCC) with portal vein tumoral thrombosis (PVTT) represents a major concern especially in the field of deceased donor liver transplantation (DDLT). However, when receiving ...transarterial radioembolization (TARE), a considerable percentage of such patients are able to achieve a radiologic complete response with adequate survival rates. In this pilot prospective study, we evaluated the effect of TARE in downstaging HCC patients with PVTT to meet criteria for DDLT. Between May 2013 and November 2016, patients were evaluated to be enrolled into our “Superdownstaging” protocol. Patients received yttrium‐90 TARE and were enlisted for DDLT in case of complete and sustained (6 months) radiological response. Patients with tumor thrombus in the main trunk and/or in the contralateral portal vein branch were excluded. TARE was effective in downstaging and receiving DDLT in 5/17 patients (29.4%). The 5‐year overall survival was significantly higher in patients who underwent DDLT compared with those who were not transplanted (60.0% versus 0.0%, P = 0.03). Three out of 5 patients developed recurrence within 1 year after LT. The current series showed a clear survival gain in those patients who were able to receive DDLT after TARE but careful selection for DDLT is however advised.
•Assumptions on blood rheology have negligible impact on CFD hemodynamic quantities linked to atherosclerotic coronary artery disease.•WSS and helical flow profiles are robust to blood rheological ...assumptions, independent of the degree of stenosis of the RCA.•Coronary luminal surface areas exposed to disturbed hemodynamics are robust to blood rheological assumptions.•Standardization is needed to use personalized CFD-based hemodynamic quantities in cardiology.
The combination of medical imaging and computational hemodynamics is a promising technology to diagnose/prognose coronary artery disease (CAD). However, the clinical translation of in silico hemodynamic models is still hampered by assumptions/idealizations that must be introduced in model-based strategies and that necessarily imply uncertainty. This study aims to provide a definite answer to the open question of how to properly model blood rheological properties in computational fluid dynamics (CFD) simulations of coronary hemodynamics.
The geometry of the right coronary artery (RCA) of 144 hemodynamically stable patients with different stenosis degree were reconstructed from angiography. On them, unsteady-state CFD simulations were carried out. On each reconstructed RCA two different simulation strategies were applied to account for blood rheological properties, implementing (i) a Newtonian (N) and (ii) a shear-thinning non-Newtonian (non-N) rheological model. Their impact was evaluated in terms of wall shear stress (WSS magnitude, multidirectionality, topological skeleton) and helical flow (strength, topology) profiles. Additionally, luminal surface areas (SAs) exposed to shear disturbances were identified and the co-localization of paired N and non-N SAs was quantified in terms of similarity index (SI).
The comparison between paired N vs. shear-thinning non-N simulations revealed remarkably similar profiles of WSS-based and helicity-based quantities, independent of the adopted blood rheology model and of the degree of stenosis of the vessel. Statistically, for each paired N and non-N hemodynamic quantity emerged negligible bias from Bland-Altman plots, and strong positive linear correlation (r > 0.94 for almost all the WSS-based quantities, r > 0.99 for helicity-based quantities). Moreover, a remarkable co-localization of N vs. non-N luminal SAs exposed to disturbed shear clearly emerged (SI distribution 0.95 0.93, 0.97). Helical flow topology resulted to be unaffected by blood rheological properties.
This study, performed on 288 angio-based CFD simulations on 144 RCA models presenting with different degrees of stenosis, suggests that the assumptions on blood rheology have negligible impact both on WSS and helical flow profiles associated with CAD, thus definitively answering to the question “is Newtonian assumption for blood rheology adequate in coronary hemodynamics simulations?”.
Parallelization of power electronic converter units is a way to meet the high current requirements of modern electrification applications. In case of voltage source converters, parallel operation can ...be attained only if the voltages of all the units are equal. In the current state of the art, this voltage synchronization can be achieved at the fundamental frequency, but not at modulation frequency, hence requiring bulky filters to limit circulating currents; this lowers the system performance in terms of cost, volume, weight and sustainability. In this paper, the authors propose a novel approach to synchronization, acting directly at the modulation frequency level, thus removing the need for any filter. This technique relies on the natural parasitic inductance and resistance of the wiring among parallel units. Specifically, this paper presents the first of two synchronization stages required to reach the sub-nanosecond synchronization necessary to completely remove the filters. At start-up, a low-bandwidth industrial communication line, based on the CAN protocol, is exploited to guarantee that the error in the synchronization of PWM signals among all the parallel units is lower than 0.1%. This limits the initial circulating current, supporting the subsequent control stage that achieves sub-nanosecond synchronization. The proposed concept is validated by experiments using a commercial MCU unit with an unadorned CAN peripheral.
The present study establishes a link between blood flow energy transformations in coronary atherosclerotic lesions and clinical outcomes. The predictive capacity for future myocardial infarction (MI) ...was compared with that of established quantitative coronary angiography (QCA)-derived predictors. Angiography-based computational fluid dynamics (CFD) simulations were performed on 80 human coronary lesions culprit of MI within 5 years and 108 non-culprit lesions for future MI. Blood flow energy transformations were assessed in the converging flow segment of the lesion as ratios of kinetic and rotational energy values (KER and RER, respectively) at the QCA-identified minimum lumen area and proximal lesion sections. The anatomical and functional lesion severity were evaluated with QCA to derive percentage area stenosis (%AS), vessel fractional flow reserve (vFFR), and translesional vFFR (ΔvFFR). Wall shear stress profiles were investigated in terms of topological shear variation index (TSVI). KER and RER predicted MI at 5 years (AUC = 0.73, 95% CI 0.65–0.80, and AUC = 0.76, 95% CI 0.70–0.83, respectively;
p
< 0.0001 for both). The predictive capacity for future MI of KER and RER was significantly stronger than vFFR (
p
= 0.0391 and
p
= 0.0045, respectively). RER predictive capacity was significantly stronger than %AS and ΔvFFR (
p
= 0.0041 and
p
= 0.0059, respectively). The predictive capacity for future MI of KER and RER did not differ significantly from TSVI. Blood flow kinetic and rotational energy transformations were significant predictors for MI at 5 years (
p
< 0.0001). The findings of this study support the hypothesis of a biomechanical contribution to the process of plaque destabilization/rupture leading to MI.
•In vivo measured coronary blood flow rate should be used in personalized CFD simulations•Four measurement techniques provided different individual flow rate estimates, propagating uncertainty to ...CFD-derived coronary hemodynamic profiles•Coronary luminal surface area exposed to low WSS is robust to differently measured inlet flow rates•Coronary helical flow topology is scarcely sensitive to differently measured inlet flow rates•Standardization is needed to use personalized CFD-based WSS profiles in cardiology
The translation of hemodynamic quantities based on wall shear stress (WSS) or intravascular helical flow into clinical biomarkers of coronary atherosclerotic disease is still hampered by the assumptions/idealizations required by the computational fluid dynamics (CFD) simulations of the coronary hemodynamics. In the resulting budget of uncertainty, inflow boundary conditions (BCs) play a primary role. Accordingly, in this study we investigated the impact of the approach adopted for in vivo coronary artery blood flow rate assessment on personalized CFD simulations where blood flow rate is used as inflow BC.
CFD simulations were carried out on coronary angiograms by applying personalized inflow BCs derived from four different techniques assessing in vivo surrogates of flow rate: continuous thermodilution, intravascular Doppler, frame count-based 3D contrast velocity, and diameter-based scaling law. The impact of inflow BCs on coronary hemodynamics was evaluated in terms of WSS- and helicity-based quantities.
As main findings, we report that: (i) coronary flow rate values may differ based on the applied flow derivation technique, as continuous thermodilution provided higher flow rate values than intravascular Doppler and diameter-based scaling law (p = 0.0014 and p = 0.0023, respectively); (ii) such intrasubject differences in flow rate values lead to different surface-averaged values of WSS magnitude and helical blood flow intensity (p<0.0020); (iii) luminal surface areas exposed to low WSS and helical flow topological features showed robustness to the flow rate values.
Although the absence of a clinically applicable gold standard approach prevents a general recommendation for one coronary blood flow rate derivation technique, our findings indicate that the inflow BC may impact computational hemodynamic results, suggesting that a standardization would be desirable to provide comparable results among personalized CFD simulations of the coronary hemodynamics.
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