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.

Development of Advanced Combustions using Cylinder Pressure Signal

Zero-carbon powertrains development has become one of the main challenges for automotive industries around the world. Following this guideline, several approaches such as powertrain electrification, advanced combustions, and hydrogen internal combustion engines have been aimed to achieve the goal. Low Temperature Combustions, characterized by a simultaneous reduction of fuel consumption and emissions, represent one of the most studied solutions moving towards a sustainable mobility. Previous research demonstrate that Gasoline partially premixed Compression Ignition combustion is one of the most promising LTC. Mainly characterized by the high-pressure direct-injection of gasoline and the spontaneous ignition of the premixed air-fuel mixture, GCI combustion has shown a good potential to achieve the high thermal efficiency and low pollutants in compression ignited engines required by future emission regulations. Despite its potential, GCI combustion might suffer from low combustion controllability and stability, because gasoline spontaneous ignition is significantly affected by slight variations of the local in-cylinder thermal conditions. Therefore, to properly control GCI combustion assuring the maximum performance, a deep knowledge of the combustion process, i.e., gasoline auto-ignition and the effect of the control parameters on the combustion and pollutants, is mandatory. This PhD dissertation focuses on the study of GCI combustion in a light-duty compression ignited engine. Starting from a standard 1.3L diesel engine, this work describes the activities made moving toward the full conversion of the engine. A preliminary study of the GCI combustion was conducted in a “Single-Cylinder” engine configuration highlighting combustion characteristics and dependencies on the control parameters. Then, the full engine conversion was performed, and a wide experimental campaign allowed to confirm the benefits of this advanced combustion methodologies in terms of pollutants and thermal efficiency. The analysis of the in-cylinder pressure signal allowed to study in depth the GCI combustion and develop control-oriented models aimed to improve the combustion stability.