Portal hypertension: a comparison between portal-venous pressure measurement and ARFI measurement of liver and spleen stiffness

PURPOSE. Portal pressure is measured invasively as Hepatic Venous Pressure Gradient (HVPG) in the angiography room. Liver stiffness measured by Fibroscan was shown to correlate with HVPG values below 12 mmHg. This is not surprising, since in cirrhosis the increase of portal pressure is not directly linked with liver fibrosis and consequently to liver stiffness. We hypothesized that, given the spleen’s privileged location upstream to the whole portal system, splenic stiffness could provide relevant information about portal pressure. Aim of the study was to assess the relationship between liver and spleen stiffness measured by Virtual Touch™ (ARFI) and HVPG in cirrhotic patients. METHODS. 40 consecutive patients (30 males, mean age 62y, mean BMI=26, mean Child-Pugh A6, mean platelet count=92.000/mmc, 19 HCV+, 7 with ascites) underwent to ARFI stiffness measurement (10 valid measurements in right liver lobe both surface and centre, left lobe and 20 in the spleen) and HPVG, blindly to each other. Median ARFI values of 10 samplings on every liver area and of 20 samplings on spleen were calculated. RESULTS. Stiffness could be easily measured in all patients with ARFI, resulting a mean of 2,61±0,76, 2,5±0,62 and 2,55±0,66 m/sec in the liver areas and 3.3±0,5 m/s in the spleen. Median HPVG was 14 mmHg (range 5-27); 28 patients showed values ≥10 mmHg. A positive significant correlation was found between spleen stiffness and HPVG values (r=0.744, p<0.001). No significant correlation was found between all liver stiffness and HVPG (p>0,05). AUROC was calculated to test spleen stiffness ability in discriminating patients with HVPG ≥10. AUROC = 0.911 was obtained, with sensitivity of 69% and specificity of 91% at a cut-off of 3.26 m/s. CONCLUSION. Spleen stiffness measurement with ARFI correlates with HVPG in patients with cirrhosis, with a potential of identifying patients with clinically significant portal hypertension.

Study and experimental characterization of the laser welding process for the manufacturing of electric powertrain components in the automotive industry

The PhD project that will be presented in this thesis is focused on the study and optimization of the production process for the manufacturing of electrical powertrain components in the automotive field using the laser beam welding process (LBW). The objective is to define, through experimental activities, an optimized process condition for applications in the electrical field that can be generalized, that is, which guarantees its reproducibility as the types of connections vary and which represents the basis for extending the method to future applications in e-mobility sector. The work developed along two lines of research, the convergence of which made it possible to create prototypes of battery modules based on different types of lithium-ion cells and stator windings for electric motors. On the one hand, the different welding configurations involving the production of batteries based on pouch cells and therefore the welding of aluminum and copper in dissimilar configuration were studied, while for the prismatic cells only one configuration was analyzed. On the other hand, the welding of pure copper hairpins with rectangular shape in edge joint configuration was studied for the production of stator windings. The experimental tests carried out have demonstrated the feasibility of using the LBW process for the production of electric powertrain components entirely designed and developed internally as the types of materials and welding configurations vary; the methodologies required for the characterization methods, necessary for the end-of-line tests, for the evaluation of the properties of the different joint configurations and components (battery and electric motor) were also defined with the aim of obtaining the best performance. The entire doctorate program was conducted in collaboration with Ferrari Auto S.p.A. and the direct industrial application of the issues addressed has been faced.