Spleen Perfusion as an Index of Gender Impact on Sympathetic Nervous System Response to Exercise

Objective: Sympathetic nervous system (SNS) reaction to exercise is gender dependent. Nevertheless, clinically applicable methods to identify this difference are still missing. An organ largely sensitive to SNS is the spleen whose response to exercise can be easily evaluated, being included in the field of view of myocardial perfusion imaging (MPI). Here, we aimed to verify whether gender interferes with the spleen perfusion and its response to exercise.Methods: For this purpose, we evaluated 286 original scans of consecutive patients submitted to MPI in the course of 2019. Our standard procedure implies a single-day stress-rest sequence with a gap of ≥2 h between the administrations of 180 and 500 MBq of 99mTc-Sestamibi, respectively. Imaging is performed 30 min after radiotracer administration, with scan duration set at 25 and 35 s per view, respectively. Non-gated scans were reconstructed with the filtered back-projection method. A volume of interest was drawn on the spleen and heart to estimate the dose-normalized average counting rate that was expressed in normalized counts per seconds (NCPS).Results: In all subjects submitted to exercise MPI (n = 228), NCPS were higher during stress than at rest (3.52 ± 2.03 vs. 2.78 ± 2.07, respectively; p < 0.01). This effect was not detected in the 58 patients submitted to dipyridamole-stress. The response to exercise selectively involved the spleen, since NCPS in heart were unchanged irrespective of the used stressor. This same response was dependent upon gender, indeed spleen NCPS during stress were significantly higher in the 75 women than in the 153 men (3.86 ± 1.8 vs. 3.23 ± 1.6, respectively, p < 0.01). Again, this variance was not reproduced by heart. Finally, spleen NCPS were lower in the 173 patients with myocardial reversible perfusion defects (summed difference score ≥3) than in the remaining 55, despite similar values of rate pressure product at tracer injection.Conclusion: Thus, exercise interference on spleen perfusion can be detected during MPI. This effect is dependent upon gender and ischemia confirming the high sensitivity of this organ to SNS activation.

373 Utility of the early phase of DPD scintigraphy in the diagnosis of correlated TT-R cardiac amyloidosis

Aims The importance of cardiac scan with phosphonate-based radiotracers in the diagnosis of cardiac amyloidosis is now well established. Standard imaging is performed 3 h after tracer injection with a planar view on the cardiac region. This study sought to evaluate the predictive role of early-phase myocardial uptake (10 min after injection) of 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) compared compared with standard late acquisition, in patients with suspected hereditary transthyretin-related cardiac amyloidosis (TTR-CA). Methods and results Fifty five patients with suspected of TTR-CA with typical aspects of the relative apical sparing at two-dimensional speckle-tracking echocardiography, reported as a specific pattern for cardiac amyloidosis, were enrolled after having signed informed written consent. They have been subjected to a 99mTc-DPD cardiac scintigraphy with planar acquisition at 10 min and 3 h after tracer injection (13 Mbq/Kg). Patients with cardiac uptake on the planar images concluded the examination with a SPECT-CT (cardiac protocol) to assess the affected myocardial segments. On planar images the heart-to-mediastinum-ratio was measured. Subsequently, the diagnosis of amyloidosis has to be confirmed with morphologic examinations such as biopsy and genetic tests. Of the enrolled patients with clinical and echocardiographic aspect of TTR-CA, 22 were positive for cardiac amyloidosis. All of them showed tracer uptake in both early and late images. In patients with positive results, the early-phase showed a Heart-to-mediastinum-ratio >1.2. SPECT/CT showed involvement of almost two myocardial segments: in all patients the ventricular septum showed significant tracer uptake. Conclusions Our small group of patients showed that 99mTc-DPD myocardial uptake intensity on early-phase scintigraphy can be used to anticipate the results of late images in diagnosis of TTR cardiac amyloidosis.

Challenging Visualization of Sentinel Lymph Nodes in Upper Urinary Tract Urothelial Carcinoma

Purpose: The purpose of this study was to assess the possibility of detecting sentinel lymph nodes (SLNs) and to perform analysis of lymphatic outflow in patients with suspicion of upper tract urothelial carcinoma (UTUC) with the use of a radioisotope-based technique. Methods: During 2018–2021, a prospective study was conducted on 19 patients with the suspicion of UTUC and for whom diagnostic ureterorenoscopy (URS) was planned. Technetium-99m (99mTc) nanocolloid radioactive tracer injection and a tumor biopsy were performed for staging procedures. Three-dimensional (3D) reconstruction and fusion of images were performed for better localization of lymph nodes (LNs). Detection of SLNs and the analysis of the radiotracer outflow was conducted with the use of single-photon emission-computed tomography/computed tomography (SPECT/CT) lymphangiography. Results: The mean age of the patients was 73.4 years; 7 (36%) were male. Pathological staging from the biopsy was T0—8 (42%), Ta—7 (36%), T1—4 (21%). SLNs were detected in two of 19 cases (10%). In one patient a single SLN (5.3%) was visualized, and in another case (5.3%), multiple (double) radioactive lymph nodes were visualized. In 17 out of the 19 (89.5%) cases, no lymphatic outflow was observed, and out of these five cases (26.3%) of gravitational leakage of injected radiotracer to the retroperitoneal space was noted. Conclusions: We demonstrated that detection of SLNs in the upper urinary tract is possible yet challenging. Radiotracer injection in the upper urinary tract during ureterorenoscopy is difficult to perform, and the expected result of injection is unsatisfactory. Lymphatic outflow from the tumor site to the first LNs in our studied group of patients is visible in 10.5% of cases. SPECT/CT lymphangiography in cases of UTUC may provide valuable information about a patient’s individual anatomy of the lymphatic system and the position of the first lymph nodes draining lymph with potential metastatic cells from the tumor.

Experimental and Simulation Analysis of Physical Water Model through Tracer Injection under Various Baffles and Turbulence Inhibitor Conditions for Developing the Fluid Flow Parameters and Inclusion Removal Rates in Tundish

Tundish is a critical part involved in the continuous casting process, which ensures the constant flow of liquid metal and with performing different functions. In odd-numbered multistrand tundish, the confirmation consistency of the fluid flow among all the strands is one of major concerns. In this study, five-strand tundish with a set of weirs and a baffle is utilized for investigation concerning fluid flow parameters and inclusion removal analysis. The simulation is carried out in ANSYS FLUENT 19.2 software through the defined numerical model, and the experimental analysis is performed on a scaled physical water model through tracer injection. Four different baffles are designed along with two different types of turbulence inhibiter for the tundish to enhance the fluid flow parameters and inclusion removal rates. The inclusion sizes were varied from 10 to 100 µm with a difference of 20 µm respectively for studying the inclusion removal rate concerning inclusion sizes. From the outcomes obtained like the residence time distribution (RTD) curves and others, it was concluded that the fourth baffle version with the first turbulence inhibiter, which are equipped in tundish version TV8 is the most beneficial tundish version for the enhancement in fluid flow and inclusion removal rates as compared to other tundish versions in this study.

Tachycardia and hypertension enhance tracer efflux from the spinal cord

Background Disruption of cerebrospinal fluid (CSF)/interstitial fluid (ISF) exchange in the spinal cord is likely to contribute to central nervous system (CNS) diseases that involve abnormal fluid accumulation, including spinal cord oedema and syringomyelia. However, the physiological factors that govern fluid transport in the spinal cord are poorly understood. The aims of this study were to determine the effects of cardiac pulsations and respiration on tracer signal increase, indicative of molecular movement following infusion into the spinal cord grey or white matter. Methods In Sprague Dawley rats, physiological parameters were manipulated such that the effects of spontaneous breathing (generating alternating positive and negative intrathoracic pressures), mechanical ventilation (positive intrathoracic pressure only), tachycardia (heart atrial pacing), as well as hypertension (pharmacologically induced) were separately studied. Since fluid outflow from the spinal cord cannot be directly measured, we assessed the molecular movement of fluorescent ovalbumin (AFO-647), visualised by an increase in tracer signal, following injection into the cervicothoracic spinal grey or white matter. Results Tachycardia and hypertension increased AFO-647 tracer efflux, while the concomitant negative and positive intrathoracic pressures generated during spontaneous breathing did not when compared to the positive-pressure ventilated controls. Following AFO-647 tracer injection into the spinal grey matter, increasing blood pressure and heart rate resulted in increased tracer movement away from the injection site compared to the hypotensive, bradycardic animals (hypertension: p = 0.05, tachycardia: p < 0.0001). Similarly, hypertension and tachycardia produced greater movement of AFO-647 tracer longitudinally along the spinal cord following injection into the spinal white matter (p < 0.0001 and p = 0.002, respectively). Tracer efflux was strongly associated with all blood vessel types. Conclusions Arterial pulsations have profound effects on spinal cord interstitial fluid homeostasis, generating greater tracer efflux than intrathoracic pressure changes that occur over the respiratory cycle, demonstrated by increased craniocaudal CSF tracer movement in the spinal cord parenchyma.

Identification and Prioritisation of Mine Pollution Sources in a Temperate Watershed Using Tracer Injection and Synoptic Sampling

Identifying and prioritising mine sites for remediation is challenging due to inherently complex hydrological systems and multiple potential sources of mine pollution dispersed across watersheds. Understanding mine pollution dynamics in wet temperate watersheds is particularly challenging due to substantial variability in precipitation and streamflows, which increase the importance of diffuse sources. A tracer dilution and synoptic sampling experiment was conducted in a mined watershed in Scotland to identify the main sources of mine pollution, the relative importance of point and diffuse sources of pollution, and the potential benefits of mine site remediation to stream water quality. Using high spatial resolution metal loading datasets, the major Zn and Cd source areas were identified as point sources of mine water predominantly located in the upper part of the watershed. In contrast, the main sources of Pb were diffuse sources of mine tailings and wastes located in the lower part of the watershed. In the latter case, mobilisation of Pb occurred primarily from a section of braided wetland and an uncapped tailings area. Importantly, diffuse sources of mine pollution were found to be the dominant source of Pb, and an important source of Zn and Cd, even under steady-state streamflow conditions. Mass balance calculations suggest that treatment of the main mine water sources in the upper watershed and capping of the tailings deposit in the lower watershed could reduce stream trace metal concentrations by approximately 70%. These data support the development of conceptual models of mine pollution dynamics in wet temperate watersheds. These conceptual models are important as they: (1) help prioritise those mine sites and features for remediation that will deliver the most environmental and socio-economic benefit, and; (2) provide a means to quantify the importance of diffuse pollution sources that may increase in importance in the future as a result of changes in precipitation patterns in temperate watersheds.

Optimization of Tracer Injection Schemes for Improved History Matching

Interwell tracers are powerful reservoir surveillance tools that provide direct reservoir flow paths and dynamics, which, when integrated with near real-time production optimization, can greatly improve recovery factor, and return on investment, the so-called "Advanced Tracers System" (ATS). Applying full field ATS is attractive for resource-holders, especially for those with large waterflood operations. However, to scale up ATS to cover large fields with potentially tens to hundreds of injectors and producers, the required unique tracer variations ("barcodes") and materials and associated analysis may increase rapidly. Here, we explore different tracer injection schemes that can acquire the most information while using reduced numbers of tracers, thereby controlling costs in field operations. We tested the designs of various modified tracer injection schemes with reservoir simulations. Numerical experiments were performed on synthetic fields with multiple injector and producer wells in waterflooding patterns. Two tracer injection schemes were considered: In Scheme 1, all injectors were injected with unique tracers representing the most information-rich case. In Scheme 2, some injectors were injected with the same tracers ("recycling" the same barcodes), and some injectors received no tracer injection ("null" barcodes). Production and tracer breakthrough data was collected for history matching after waterflooding simulations on the synthetic fields. The ensemble smoother with multiple data assimilation with tracers algorithm was used for history matching. We calculated the root-mean-square errors (RMSE) between the reference data and the history matched production simulation data. To improve the statistics, 20 independent testing reference synthetic fields were constructed by randomizing the number and locations of high permeability zones crossing different injectors and producers. In all cases, the history matching algorithms largely reduced the RMSE thereby enhancing reservoir characterization. Analyzing the statistical significance with p-values among testing cases, first, as expected, the data mismatch is highly significantly lower after history matching than before history matching (p &lt; 0.001). Second, the data mismatch is even lower when history matching with tracers (both in Scheme 1 and 2) than without tracers (p &lt; 0.05), demonstrating clearly that tracers can provide extra information for the reservoir dynamics. Finally, and most importantly, history matching with tracers in Scheme 1 or in Scheme 2 result in statistically the same data mismatch (p &gt; 0.05), indicating the cost-saving "recycling" and "null" tracer barcodes can provide equally competent reservoir information. To the best of our knowledge, this is the first study that evaluated the history matching qualities deriving from different tracer injection schemes. We showed that through optimal designs of the tracer injections, we can acquire very similar information with reduced tracer materials and barcodes, thus reducing costs and field operational complexities. We believe this study facilitates the deployment of large-scale reservoir monitoring and optimization campaigns using tracers such as ATS.