Longterm peripheral baroreflex and chemoreflex function after bilateral eversion carotid endarterectomy

Introduction The “eversion” technique for carotid endarterectomy (e-CEA), that involves the transection of the internal carotid artery at the carotid bulb and its eversion over the atherosclerotic plaque, has been associated with an increased risk of postoperative hypertension possibly due to a direct iatrogenic damage to the carotid sinus fibers. The aim of this study is to assess the long-term effect of the e-CEA on arterial baroreflex and peripheral chemoreflex function in humans. Methods A retrospective review was conducted on a prospectively compiled computerized database of 3128 CEAs performed on 2617 patients at our Center between January 2001 and March 2006. During this period, a total of 292 patients who had bilateral carotid stenosis ≥70% at the time of the first admission underwent staged bilateral CEAs. Of these, 93 patients had staged bilateral e-CEAs, 126 staged bilateral s- CEAs and 73 had different procedures on each carotid. CEAs were performed with either the eversion or the standard technique with routine Dacron patching in all cases. The study inclusion criteria were bilateral CEA with the same technique on both sides and an uneventful postoperative course after both procedures. We decided to enroll patients submitted to bilateral e-CEA to eliminate the background noise from contralateral carotid sinus fibers. Exclusion criteria were: age >70 years, diabetes mellitus, chronic pulmonary disease, symptomatic ischemic cardiac disease or medical therapy with b-blockers, cardiac arrhythmia, permanent neurologic deficits or an abnormal preoperative cerebral CT scan, carotid restenosis and previous neck or chest surgery or irradiation. Young and aged-matched healthy subjects were also recruited as controls. Patients were assessed by the 4 standard cardiovascular reflex tests, including Lying-to-standing, Orthostatic hypotension, Deep breathing, and Valsalva Maneuver. Indirect autonomic parameters were assessed with a non-invasive approach based on spectral analysis of EKG RR interval, systolic arterial pressure, and respiration variability, performed with an ad hoc software. From the analysis of these parameters the software provides the estimates of spontaneous baroreflex sensitivity (BRS). The ventilatory response to hypoxia was assessed in patients and controls by means of classic rebreathing tests. Results A total of 29 patients (16 males, age 62.4±8.0 years) were enrolled. Overall, 13 patients had undergone bilateral e-CEA (44.8%) and 16 bilateral s-CEA (55.2%) with a mean interval between the procedures of 62±56 days. No patient showed signs or symptoms of autonomic dysfunction, including labile hypertension, tachycardia, palpitations, headache, inappropriate diaphoresis, pallor or flushing. The results of standard cardiovascular autonomic tests showed no evidence of autonomic dysfunction in any of the enrolled patients. At spectral analysis, a residual baroreflex performance was shown in both patient groups, though reduced, as expected, compared to young controls. Notably, baroreflex function was better maintained in e-CEA, compared to standard CEA. (BRS at rest: young controls 19.93 ± 2.45 msec/mmHg; age-matched controls 7.75 ± 1.24; e-CEA 13.85 ± 5.14; s-CEA 4.93 ± 1.15; ANOVA P=0.001; BRS at stand: young controls 7.83 ± 0.66; age-matched controls 3.71 ± 0.35; e-CEA 7.04 ± 1.99; s-CEA 3.57 ± 1.20; ANOVA P=0.001). In all subjects ventilation (VÝ E) and oximetry data fitted a linear regression model with r values > 0.8. Oneway analysis of variance showed a significantly higher slope both for ΔVE/ΔSaO2 in controls compared with both patient groups which were not different from each other (-1.37 ± 0.33 compared with -0.33±0.08 and -0.29 ±0.13 l/min/%SaO2, p<0.05, Fig.). Similar results were observed for and ΔVE/ΔPetO2 (-0.20 ± 0.1 versus -0.01 ± 0.0 and -0.07 ± 0.02 l/min/mmHg, p<0.05). A regression model using treatment, age, baseline FiCO2 and minimum SaO2 achieved showed only treatment as a significant factor in explaining the variance in minute ventilation (R2= 25%). Conclusions Overall, we demonstrated that bilateral e-CEA does not imply a carotid sinus denervation. As a result of some expected degree of iatrogenic damage, such performance was lower than that of controls. Interestingly though, baroreflex performance appeared better maintained in e-CEA than in s-CEA. This may be related to the changes in the elastic properties of the carotid sinus vascular wall, as the patch is more rigid than the endarterectomized carotid wall that remains in the e-CEA. These data confirmed the safety of CEA irrespective of the surgical technique and have relevant clinical implication in the assessment of the frequent hemodynamic disturbances associated with carotid angioplasty stenting.

Spectral-Element and Adjoint 3D Full-Wave Tomography for the Lithosphere of Central Italy

The primary objective of this thesis is to obtain a better understanding of the 3D velocity structure of the lithosphere in central Italy. To this end, I adopted the Spectral-Element Method to perform accurate numerical simulations of the complex wavefields generated by the 2009 Mw 6.3 L’Aquila event and by its foreshocks and aftershocks together with some additional events within our target region. For the mainshock, the source was represented by a finite fault and different models for central Italy, both 1D and 3D, were tested. Surface topography, attenuation and Moho discontinuity were also accounted for. Three-component synthetic waveforms were compared to the corresponding recorded data. The results of these analyses show that 3D models, including all the known structural heterogeneities in the region, are essential to accurately reproduce waveform propagation. They allow to capture features of the seismograms, mainly related to topography or to low wavespeed areas, and, combined with a finite fault model, result into a favorable match between data and synthetics for frequencies up to ~0.5 Hz. We also obtained peak ground velocity maps, that provide valuable information for seismic hazard assessment. The remaining differences between data and synthetics led us to take advantage of SEM combined with an adjoint method to iteratively improve the available 3D structure model for central Italy. A total of 63 events and 52 stations in the region were considered. We performed five iterations of the tomographic inversion, by calculating the misfit function gradient - necessary for the model update - from adjoint sensitivity kernels, constructed using only two simulations for each event. Our last updated model features a reduced traveltime misfit function and improved agreement between data and synthetics, although further iterations, as well as refined source solutions, are necessary to obtain a new reference 3D model for central Italy tomography.

Secondary Microseisms Characterization and Green’s Function Extraction at the Larderello-Travale Geothermal Field (Italy)

Over the past ten years, the cross-correlation of long-time series of ambient seismic noise (ASN) has been widely adopted to extract the surface-wave part of the Green’s Functions (GF). This stochastic procedure relies on the assumption that ASN wave-field is diffuse and stationary. At frequencies <1Hz, the ASN is mainly composed by surface-waves, whose origin is attributed to the sea-wave climate. Consequently, marked directional properties may be observed, which call for accurate investigation about location and temporal evolution of the ASN-sources before attempting any GF retrieval. Within this general context, this thesis is aimed at a thorough investigation about feasibility and robustness of the noise-based methods toward the imaging of complex geological structures at the local (∼10-50km) scale. The study focused on the analysis of an extended (11 months) seismological data set collected at the Larderello-Travale geothermal field (Italy), an area for which the underground geological structures are well-constrained thanks to decades of geothermal exploration. Focusing on the secondary microseism band (SM;f>0.1Hz), I first investigate the spectral features and the kinematic properties of the noise wavefield using beamforming analysis, highlighting a marked variability with time and frequency. For the 0.1-0.3Hz frequency band and during Spring- Summer-time, the SMs waves propagate with high apparent velocities and from well-defined directions, likely associated with ocean-storms in the south- ern hemisphere. Conversely, at frequencies >0.3Hz the distribution of back- azimuths is more scattered, thus indicating that this frequency-band is the most appropriate for the application of stochastic techniques. For this latter frequency interval, I tested two correlation-based methods, acting in the time (NCF) and frequency (modified-SPAC) domains, respectively yielding esti- mates of the group- and phase-velocity dispersions. Velocity data provided by the two methods are markedly discordant; comparison with independent geological and geophysical constraints suggests that NCF results are more robust and reliable.

Spectral asymptotic properties of semi-regular non-commutative harmonic oscillators

The study carried out in this thesis is devoted to spectral analysis of systems of PDEs related also with quantum physics models. Namely, the research deals with classes of systems that contain certain quantum optics models such as Jaynes-Cummings, Rabi and their generalizations that describe light-matter interaction. First we investigate the spectral Weyl asymptotics for a class of semiregular systems, extending to the vector-valued case results of Helffer and Robert, and more recently of Doll, Gannot and Wunsch. Actually, the asymptotics by Doll, Gannot and Wunsch is more precise (that is why we call it refined) than the classical result by Helffer and Robert, but deals with a less general class of systems, since the authors make an hypothesis on the measure of the subset of the unit sphere on which the tangential derivatives of the X-Ray transform of the semiprincipal symbol vanish to infinity order. Abstract Next, we give a meromorphic continuation of the spectral zeta function for semiregular differential systems with polynomial coefficients, generalizing the results by Ichinose and Wakayama and Parmeggiani. Finally, we state and prove a quasi-clustering result for a class of systems including the aforementioned quantum optics models and we conclude the thesis by showing a Weyl law result for the Rabi model and its generalizations.