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The “Brain Stress Timing” phenomenon and other misinterpretations of randomized clinical trial on aneurysmal subarachnoid hemorrhage

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Neural regeneration research 2019年第8期14卷 1364-1366页

作者： rafael Martinez-Perez Natalia rayo Agustin Montivero Jorge Marcelo mura Division of Neurosurgery Institute of Clinical Neurosciences Universidad Austral de Chile Valdivia Chile Division of Cerebrovascular and Skull Base Neurosurgery Institute of Neurosurgery Dr Asenjo Santiago Chile Western University London ON Canada

Clipping and coiling are currently the two alternatives in treatment of ruptured cerebral aneurysms. In spite of some meritorious analysis, further discussion is helpful to understand the actual state of art. retreatment and rebleeding rates clearly favors clipping, although short-term functional outcome seems to be beneficial for clipping, while this different is not such if we perform the comparison at a longer follow up. Longterm follow ups and cost analysis are mandatory to have a clear view of the current picture in treatment of subarachnoid hemorrhage. Treatment strategy should be made by a multi-disciplinary team in accredited centers with proficient experience in both techniques.

关键词： sAH subarachnoid hemorrhage coiling clipping ruptured aneurysm timing intracranial

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Analysis of a load application point in spline coupling teeth

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Journal of Zhejiang University-Science A(Applied Physics & Engineering) 2014年第4期15卷 302-308页

作者： Francesca CUrA Andrea mura Department of Mechanical and Aerospace Engineering Politecnico di Torino C.so Duca degli Abruzzi 24 10129 Torino Italy

The objective of this paper is to investigate the position of the resultant force in involute spline coupling teeth due to the contact pressure distribution for both ideal and misaligned conditions. In general, spline coupling teeth are in contact all along the involute profile and the load is far from uniform along the contact line. Theoretical models available in publications consider the resultant contact force as it is applied at the pitch diameter, and this study aims to evaluate the error introduced within the confines of a common approximation environment. This analysis is carried out through using finite element method （FEM） models, considering spline couplings in both ideal and misaligned conditions. results show that the differences between the load application diameter and pitch diameter are not very obvious in both ideal and misaligned conditions; however, this ap- proximation becomes more important for the calculation of the tooth stiffness.

关键词： Spline coupling Pitch force Teeth load Parallel offset

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Use of non-selective beta blockers in cirrhosis:The evidence we need before closing(or not) the window

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World Journal of Gastroenterology 2015年第8期21卷 2265-2268页

作者： Vincenzo La mura Giulia Tosetti Massimo Primignani Francesco Salerno U.O. Medicina Interna IRCCS-San Donato Dipartimento di Scienze Biomediche per la Salute Università degli studi di Milano U.O. Gastroenterologia-1 IRCCS-Ca’ Granda Ospedale Maggiore Policlinico

Non selective beta blockers(NSBBs)are used in primary and secondary prophylaxis of portal hypertensionrelated bleeding in patients with *** efficacy of NSBBs treatment is predicted by hemodynamic response in term of reduction of the hepatic venouspressure gradient(HVPG)below 12 mm Hg or at least20%of the basal *** a relevant number of patients who do not achieve this HVPG reduction during NSBBs therapy do not bleed during follow up;this evidence suggests an additional non-hemodynamic advantage of NSBBs treatment to modify the natural history of *** studies have questioned the efficacy and safety of NSBBs in patients with advanced stage of liver disease characterized by refractory ascites and/or spontaneous bacterial *** studies have suggested the existence of a defined and limited period to modify the natural history of cirrhosis by NSBBs:the"window hypothesis".According with this hypothesis,patients with cirrhosis benefit from the use of NSBBs from the appearance of varices up to the development of an advanced stage of ***,in patients with refractory ascites and/or spontaneous bacterial peritonitis the hemodynamic effects of NSBBs may expose to a high risk of further complications such as renal insufficiency and/or *** concerns and contrasting results counterbalance the evidence produced up to now on this issue and are the main topic of this editorial.

关键词： Bleeding prophylaxis End stage liver disease Non-s

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A stranger's journey

A stranger's journey

Artificial-intelligence-assisted mass fabrication of nanocantilevers from randomly positioned single carbon nanotubes

作者： David mura.

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Microsystems & Nanoengineering 2023年第2期9卷 333-343页

作者： Yukihiro Tadokoro Keita Funayama Keisuke Kawano Atsushi mura Jun Hrotani Yutaka Ohno Hiroya Tanaka Toyota Central r&D Labs. Inc.NagakuteAichiJapan Toyota research Institute of North America Ann ArborMIUSA Nagoya University NagoyaAichiJapan

Nanoscale cantilevers(nanocantilevers)made from carbon nanotubes(CNTs)provide tremendous benefits in sensing and electromagnetic *** nanoscale structure is generally fabricated using chemical vapor deposition and/or dielectrophoresis,which contain manual,time-consuming processes such as the placing of additional electrodes and careful observation of single-grown ***,we demonstrate a simple and Artificial Intelligence(Al)-assisted method for the effcient fabrication of a massive CNT-based *** used randomly positioned single CNTs on the *** trained deep neural network recognizes the CNTs,measures their positions,and determines the edge of the CNT on which an electrode should be clamped to form a *** experiments demonstrate that the recognition and measurement processes are automatically completed in 2 s,whereas comparable manual processing requires 12 *** the small measurement error by the trained network(within 200 nm for 90%of the recognized CNTs),more than 34 nanocantilevers were successfully fabricated in one *** high accuracy contributes to the development of a massive field emitter using the CNT-based nanocantilever,in which the output current is obtained with a low applied *** further showed the benefit of fabricating massive CNT-nanocantilever-based field emitters for neuromorphic *** activation function,which is a key function in a neural network,was physically realized using an individual CNT-based field *** introduced neural network with the CNT-based field emitters recognized handwritten images *** believe that our method can accelerate the research and development of CNT-based nanocantilevers for realizing promising future applications.

关键词： cantilever carbon network

Therapeutic and clinical aspects of portal vein thrombosis in patients with cirrhosis

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World Journal of Hepatology 2015年第29期7卷 2906-2912页

作者： Massimo Primignani Giulia Tosetti Vincenzo La mura U.O. Gastroenterologia ed Epatologia IRCCS-Ca’ GrandaOspedale Maggiore Policlinico U.O. Medicina Interna IRCCS-San DonatoDipartimento di Scienze Biomediche per la SaluteUniversità degli studi di Milano

Portal vein thrombosis(PVT) is a frequent complication in cirrhosis, particularly in advanced stages of the disease. As for general venous thromboembolism, risk factors for PVT are slow blood flow, vessel wall damage and hypercoagulability, all features of advanced cirrhosis. Actually, the old dogma of a hemorrhagic tendency in cirrhosis has been challenged by new laboratory tools and the clinical evidence that venous thrombosis also occurs in cirrhosis. The impaired hepatic synthesis of both pro- and anticoagulants leads to a rebalanced hemostasis, more liable to be tipped towards thrombosis or even bleeding. Conventional anticoagulant drugs(low molecular weight heparin or vitamin K antagonists) may be used in cirrhosis patients with PVT, particularly in those eligible for liver transplantation, to prevent thrombosis progression thus permitting/facilitating liver transplant. However, several doubts exist on the level of anticoagulation achieved as estimated by coagulation tests, on the efficacy of treatment monitoring and on the correct timing for discontinuation in non-transplant candidates, while in transplant candidates there is expert consensus on continuing anticoagulation until transplantation. The recent introduction of direct acting oral anticoagulant drugs(DOACs) in other clinical settings generates much interest on their possible application in patients with cirrhosis and PVT. However, DOACs were not evaluated yet in patients with liver disease and cannot be recommended for the present time.

关键词： Portal vein thrombosis Coagulopathy Hypercoagulopathy Direct acting oral anticoagulantdrugs Cirrhosis

Flow and heat transfer behaviour of nanofluids in microchannels

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Progress in Natural Science:Materials International 2018年第2期28卷 225-234页

作者： James Bowers Hui Cao Geng Qiao Qi Li Gan Zhang Ernesto mura Yulong Ding SSE Engineering Centre Birmingham Centre for Energy Storage & School of Chemical Engineering University of Birmingham Global Energy Interconnection research Institute Europe GmbH

Flow and heat transfer of aqueous based silica and alumina nanofluids in microchannels were experimentally investigated. The measured friction factors were higher than conventional model predictions at low reynolds numbers particularly with high nanoparticle concentrations. A decrease in the friction factor was observed with increasing reynolds number, possibly due to the augmentation of nanoparticle aggregate shape arising from fluid shear and alteration of local nanoparticle concentration and nanofluid viscosity. Augmentation of the silica nanoparticle morphology by fluid shear may also have affected the friction factor due to possible formation of a core/shell structure of the particles. Measured thermal conductivities of the silica nanofluids were in approximate agreement with the Maxwell-Crosser model, whereas the alumina nanofluids only showed slight enhancements. Enhanced convective heat transfer was observed for both nanofluids, relative to their base fluids(water), at low particle concentrations. Heat transfer enhancement increased with increasing reynolds number and microchannel hydraulic diameter. However, the majority of experiments showed a larger increase in pumping power requirements relative to heat transfer enhancements, which may hinder the industrial uptake of the nanofluids, particularly in confined environments, such as Micro Electro-Mechanical Systems(MEMS).

关键词： Nanofluid Microchannel Heat transfer Pressure drop Friction factor Thermal conductivity Viscosity

Intrahepatic vascular changes in non-alcoholic fatty liver disease: potential role of insulin-resistance and endothelial dysfunction

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World Journal of Gastroenterology 2017年第37期23卷 6777-6787页

作者： Marcos Pasarín Juan G Abraldes Eleonora Liguori Beverley Kok Vincenzo La mura Hepatic Hemodynamic Laboratory Liver UnitHospital ClinicIDIBAPS(Institut d'Investigacions Biomèdiques August Pi i Sunyer) University of Barcelona Cirrhosis Care Clinic Division of Gastroenterology(Liver Unit)CEGIIR University of Alberta Internal Medicine IRCCS San Donato Department of Biomedical Sciences for HealthUniversity of Milan

Metabolic syndrome is a cluster of several clinical conditions characterized by insulin-resistance and high cardiovascular risk. Non-alcoholic fatty liver disease is the liver expression of the metabolic syndrome, and insulin resistance can be a frequent comorbidity in several chronic liver diseases, in particular hepatitis C virus infection and/or cirrhosis. Several studies have demonstrated that insulin action is not only relevant for glucose control, but also for vascular homeostasis. Insulin regulates nitric oxide production, which mediates to a large degree the vasodilating, antiinflammatory and antithrombotic properties of a healthy endothelium, guaranteeing organ perfusion. The effects of insulin on the liver microvasculature and the effects of Ir on sinusoidal endothelial cells have been studied in animal models of non-alcoholic fatty liver disease. The hypotheses derived from these studies and the potential translation of these results into humans are critically discussed in this review.

关键词： Non-alcoholic fatty liver disease Endothelial dysfunction Insulin resistance Metabolic syndrome

Cirrhosis and portal hypertension: The importance of risk stratification, the role of hepatic venous pressure gradient measurement

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World Journal of Hepatology 2015年第4期7卷 688-695页

作者： Vincenzo La mura Antonio Nicolini Giulia Tosetti Massimo Primignani Fondazione IrCCS Ca’ Granda Ospedale Maggiore Policlinico 20100 Milano Italy

Portal hypertension is the main prognostic factor in cirrhosis. The recent emergence of potent antiviral drugs and new algorithm of treatment for the management of complications due to portal hypertension have sensibly changed our perception of cirrhosis that can be now considered as a multistage liver disease whose mortality risk can be reduced by a tailored approachfor any stage of risk. Experts recommend to move toward a pathophysiological classification of cirrhosis that considers both structural and functional changes. The hepatic venous pressure gradient HVPG, is the reference gold standard to estimate the severity of portal hypertension in cirrhosis. It correlates with both structural and functional changes that occur in cirrhosis and carries valuable prognostic information to stratify the mortality risk. This article provides a general overview of the pathophysiology and natural course of cirrhosis and portal hypertension. We propose a simplified classification of cirrhosis based on low, intermediate and high mortality stage. The prognostic information provided by HVPG is presented according to each stage. A comparison with prognostic models based on clinical and endoscopic variables is discussed in order to evidence the additional contribute given by HVPG on top of other clinical and instrumental variables widely used in clinical practice.

关键词： Cirrhosis Portal hypertension Hepaticvenous pressure gradient Variceal bleeding Prognosis