Experimental and numerical characterization of the viscoelastic behaviour of cartilages and soft tissues of the human nose

Dissertação de mestrado integrado em Engenharia BiomédicaThe facial plastic surgery, and particularly the area of rhinoplasty, is undoubtedly a growing up market. Surgical techniques have been evolving to respond to very specific patient desires not only for functional reasons, but also to resolve aesthetic issues. Actually, it is moving plenty of money around the world, being a great scientific and commercial opportunity among researchers. The human nose is composed of three major portions separated by two well-defined regions of transition (K-area and S-area) that are very complicated to deal with in postoperative periods. The viscoelastic behaviour of soft biological tissues, especially that of nasal cartilages and adjacent subcutaneous/fatty tissues, is barely known. There are no studies on the viscoelastic characterization of the mechanical properties of nasal septum (NS), upper lateral cartilages (ULC), and lower lateral cartilages (LLC) in creep and relaxation (basic viscoelasticity features) neither on the determination of frequency- and temperature-dependent properties of these tissues through dynamic mechanical analysis (DMA) in tension and compression. General information on thermal degradations through differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA) is also missing. Therefore, part of this work intends to fill this lack of the literature giving some insights into the cartilage internal composition and architecture, as well as the specificity of the activated mechanisms under constant stress or strain. Furthermore, numerical simulations were performed based on a hyper-viscoelastic mathematical formulation using a home-made open-source finite element (FE) solver (V-Biomech) in order to find a set of basic constitutive parameters that allow to replicate the experimental creep and relaxation behaviours of nasoseptal cartilage specimens from distinct regions of the quadrilateral cartilage (QLC). Thus, a complete standard biphasic poro-hyper-viscoelastic constitutive law was developed and validated. Finite Element Models (FEM) are gaining relevance to analyse soft biological components. As example, numerical simulations of the viscoelastic behaviours of the specimens harvested from anterior part of the QLC were performed to understand which of the constitutive parameters were more sensitive to achieve the best numerical-experimental agreement. The tools to reproduce these simulations in a more complex geometry (the whole nasal structure, with bony and cartilaginous components) were also developed and presented. The work still goes on it.A cirurgia plástica facial, e em particular a área da rinoplastia, é indubitavelmente um mercado em crescimento. As técnicas cirúrgicas têm evoluído no sentido de dar resposta aos desejos mais específicos de cada paciente não só por razões funcionais, mas também para resolução de problemas estéticos. Atualmente, é uma área que movimenta muito dinheiro em todo o mundo, tornando-se numa evidente oportunidade científica e comercial. O nariz humano está dividido em três regiões principais separadas por duas zonas de transição (áreas K e S) que são muito difíceis de manipular em períodos de recuperação pós-cirurgia. O comportamento viscoelástico de tecidos moles, especialmente o das cartilagens nasais e dos tecidos subcutâneo/adiposo adjacentes, é pouco conhecido. Atualmente, não existem estudos sobre a caracterização de propriedades mecânicas da cartilagem septal nem das cartilagens laterais superiores ou inferiores em fluência e relaxação (características de comportamentos viscoelásticos). A determinação de propriedades mecânicas em função da frequência de oscilação e da temperatura para estes mesmos materiais através de uma análise de DMA em tensão e compressão, assim como informações gerais sobre fenómenos de degradação térmica por DSC e TGA, também não são reportados. Assim sendo, parte desta dissertação pretende preencher esta lacuna da literatura, contribuindo para a compreensão da composição e arquitetura internas da cartilagem e da especificidade dos mecanismos ativados sob influência de uma tensão ou deformação constantes. Além disso, foram levadas a cabo simulações numéricas baseadas numa formulação matemática de híper-viscoelasticidade num software de elementos finitos desenvolvido na Instituição (V-Biomech) e foram encontrados os valores dos parâmetros que permitem replicar o comportamento experimental de fluência e relaxação de cartilagens de diferentes regiões do septo nasal. Assim, uma lei constitutiva que agrega conceitos de híper-elasticidade, viscoelasticidade e permeabilidade, acoplando o distinto comportamento de materiais sólidos e fluidos, foi desenvolvida e validada. Além das simulações do comportamento viscoelástico das amostras colhidas a partir da região anterior do septo, um conjunto de outras ferramentas para aplicação dos mesmos conceitos numa geometria mais complexa foi também desenvolvido e apresentado. Um trabalho que ainda continua

Recellularization of auricular cartilage via elastase-generated channels

Decellularized tissue matrices are promising substrates for tissue generation by stem cells to replace poorly regenerating tissues such as cartilage. However, the dense matrix of decellularized cartilage impedes colonisation by stem cells. Here, we show that digestion of elastin fibre bundles traversing auricular cartilage creates channels through which cells can migrate into the matrix. Human chondrocytes and bone marrow-derived mesenchymal stromal cells efficiently colonise elastin-treated scaffolds through these channels, restoring a glycosaminoglycan-rich matrix and improving mechanical properties while maintaining size and shape of the restored tiss

Cost-effective 3D scanning and printing technologies for outer ear reconstruction: Current status

Current 3D scanning and printing technologies offer not only state-of-the-art developments in the field of medical imaging and bio-engineering, but also cost and time effective solutions for surgical reconstruction procedures. Besides tissue engineering, where living cells are used, bio-compatible polymers or synthetic resin can be applied. The combination of 3D handheld scanning devices or volumetric imaging, (open-source) image processing packages, and 3D printers form a complete workflow chain that is capable of effective rapid prototyping of outer ear replicas. This paper reviews current possibilities and latest use cases for 3D-scanning, data processing and printing of outer ear replicas with a focus on low-cost solutions for rehabilitation engineering

CAD-CAM workflow for the fabrication of bioscaffolds and porous auricular constructs with polycaprolactone using Ultimaker 2+

In recent years, the application of three-dimensional fabrication to fabricate customized porous scaffolds for cell culture has received much attention from the field of tissue engineering and plastic surgery. In this study, we applied a more publicly accessible 3D printer, Ultimaker 2+ with biodegradable polymer-polycaprolactone (PCL) to fabricate both three-dimensional bioscaffolds and auricular constructs (both solid and porous) prepared to fill the gap as potential solutions for both cartilage defects and microtia respectively by managing of the CAD-CAM workflow. As an overview, the modified CAD-CAM workflow was regarded as the uniform preparation fabricating types of scaffolds to identify the general printability of PCL with Ultimaker 2+. For bioscaffolds, limit test was performed on original scaffold, the resolution for printing scaffolds by PCL was identified as 600 microns by applying method of uniform scaling and limit approaching. For customized auricular constructs, we extract the model from MRI/CT scan and use its mirror image for the general shape of model building in a relatively customized way to fabricate solid auricular constructs. Boolean operation was then applied for fabricating the inner porous microstructure to fabricate porous auricular constructs. As there were no significant differences among three groups of filaments regarding the respective dimensions for both bioscaffolds (n=9 for each group: PCL, PLA and ABS) and customized auricular constructs(n=5 for both solid auricular constructs and porous auricular constructs) indicated by the P value(P>0.05) from ANOVA, The printing compatibility of PCL regarding each specific domain of scaffolds were identified. In Conclusion, our study had indicated a consistent CAD-CAM workflow for Ultimaker 2+ with PCL to fabricate three-dimensional bioscaffolds, solid auricular constructs and porous auricular constructs which could be potentially applied to fill the gap of cartilage engineering and microtia reconstruction through in-vitro cell culture, surgical simulation and in-situ cell culture respectively

Mapping of the electrical activity of human atria. Multiscale modelling and simulations

La fibrilación auricular es una de las arritmias cardíacas más comunes observadas en la práctica clínica. Por lo tanto, es de vital importancia desarrollar nuevas tecnologías destinadas a diagnosticar y acabar con este tipo de arritmia, para mejorar la calidad de vida de los pacientes y reducir los costes de los sistemas nacionales de salud. En los últimos años ha aumentado el uso de las nuevas técnicas de mapeo auricular, basadas en sistemas multi-electrodo para mapear la actividad eléctrica en humanos. Dichas técnicas permiten localizar y ablacionar los impulsores de la fibrilación auricular, como son las fuentes focales o los rotores. Sin embargo, todavía existe incertidumbre sobre su precisión y los procedimientos experimentales para su análisis están limitados debido a su carácter invasivo. Por lo tanto, las simulaciones computacionales son una herramienta muy útil para superar estas limitaciones, al permitir reproducir con fidelidad las observaciones experimentales, dividir el problema bajo estudio en sub-estudios más simples, y realizar investigaciones preliminares imposibles de llevar a cabo en el práctica clínica. Esta tesis doctoral se centra en el análisis de la precisión de los sistemas de mapeo multi-electrodo a través de modelos y simulaciones computacionales. Para ello, desarrollamos modelos realistas multi-escala con el objetivo de simular actividad eléctrica auricular reentrante, en primer lugar en una lámina de tejido auricular, y en segundo lugar en las aurículas completas. Posteriormente, analizamos los efectos de las configuraciones geométricas multi-electrodo en la precisión de la localización de los rotores, mediante el uso de agrupaciones multi-electrodo con distancias inter-electrodo equidistantes, así como a través de catéteres de tipo basket con distancias inter-electrodo no equidistantes. Después de calcular los electrogramas unipolares intracavitarios, realizamos mapas de fase, detecciones de singularidad de fase para rastrear los rotores, y mapas de frecuencia dominantes. Finalmente, descubrimos que la precisión de los sistemas de mapeo multi-electrodo depende de su posición dentro de la cavidad auricular, de la distancia entre los electrodos y el tejido, de la distancia inter-electrodo, y de la contribución de las fuentes de campo lejano. Además, como consecuencia de estos factores que pueden afectar a la precisión de los sistemas de mapeo multi-electrodo, observamos la aparición de rotores falsos que podrían contribuir al fracaso de los procesos de ablación de la fibrilación auricular.Atrial fibrillation is one of the most common cardiac arrhythmias seen in clinical practice. Therefore, it is of vital importance to develop new technologies aimed at diagnosing and terminating this kind of arrhythmia, to improve the quality of life of patients and to reduce costs to national health systems. In the last years, new atrial mapping techniques based on multi-electrode systems are increasingly being used to map the atrial electrical activity in humans and localise and target atrial fibrillation drivers in the form of focal sources or rotors. However, significant concerns remain about their accuracy and experimental approaches to analyse them are limited due to their invasive character. Therefore, computer simulations are a helpful tool to overcome these limitations since they can reproduce with fidelity experimental observations, permit to split the problem to treat into more simple substudies, and allow the possibility of performing preliminary investigations impossible to carry out in the clinical practice. This PhD thesis is focused on the analysis for accuracy of the multielectrode mapping systems through computational models and simulations. For this purpose, we developed realistic multiscale models in order to simulate atrial electrical reentrant activity, first in a sheet of atrial tissue and, then, in the whole atria. Then, we analysed the effects of the multi-electrode geometrical configurations on the accuracy of localizing rotors, by using multi-electrode arrays with equidistant inter-electrode distances, as well as multi-electrode basket catheters with non-equidistant inter-electrode distances. After computing the intracavitary unipolar electrograms, we performed phase maps, phase singularity detections to track rotors, and dominant frequency maps. We finally found out that the accuracy of multi-electrode mapping systems depends on their position inside the atrial cavity, the electrode-to-tissue distance, the inter-electrode distance, and the contribution of far field sources. Furthermore, as a consequence of these factors, false rotors might appear and could contribute to failure of atrial fibrillation ablation procedures.La fibril·lació auricular és una de les arítmies cardíaques més comuns observades en la pràctica clínica. Per tant, és de vital importància desenvolupar noves tecnologies destinades a diagnosticar i acabar amb aquest tipus d'arítmia, per tal de millorar la qualitat de vida dels pacients i reduir els costos dels sistemes nacionals de salut. En els últims anys, ha augmentat l'ús de les noves tècniques de mapeig auricular, basades en sistemes multielèctrode per a mapejar l'activitat elèctrica auricular en humans. Aquestes tècniques permeten localitzar i ablacionar els impulsors de la fibril·lació auricular, com són les fonts focals o els rotors. No obstant això, encara hi ha incertesa sobre la seua precisió i els procediments experimentals per al seu anàlisi estan limitats a causa del seu caràcter invasiu. Per tant, les simulacions computacionals són una eina molt útil per a superar aquestes limitacions, en permetre reproduir amb fidelitat les observacions experimentals, dividir el problema sota estudi en subestudis més simples, i realitzar investigacions preliminars impossibles de dur a terme en el pràctica clínica. Aquesta tesi doctoral es centra en l'anàlisi de la precisió del sistemes de mapeig multielèctrode mitjançant els models i les simulacions computacionals. Per a això, desenvolupàrem models realistes multiescala per tal de simular activitat elèctrica auricular reentrant, en primer lloc en una làmina de teixit auricular, i en segon lloc a les aurícules completes. Posteriorment, analitzàrem els efectes de les configuracions geomètriques multielèctrode en la precisió de la localització dels rotors, mitjançant l'ús d'agrupacions multielèctrode amb distàncies interelèctrode equidistants, així com catèters de tipus basket amb distàncies interelèctrode no equidistants. Després de calcular els electrogrames unipolars intracavitaris, vam realitzar mapes de fase, deteccions de singularitat de fase per a rastrejar els rotors, i mapes de freqüència dominants. Finalment, vam descobrir que la precisió dels sistemes de mapeig multielèctrode depèn de la seua posició dins de la cavitat auricular, de la distància entre els elèctrodes i el teixit, de la distància interelèctrode, i de la contribució de les fonts de camp llunyà. A més, com a conseqüència d'aquests factors, es va observar l'aparició de rotors falsos que podrien contribuir al fracàs de l'ablació de la fibril·lació auricular.Martínez Mateu, L. (2018). Mapping of the electrical activity of human atria. Multiscale modelling and simulations [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/104604TESI

Improving the forward model for electrical impedance tomography of brain function through rapid generation of subject specific finite element models

Electrical Impedance Tomography (EIT) is a non-invasive imaging method which allows internal electrical impedance of any conductive object to be imaged by means of current injection and surface voltage measurements through an array of externally applied electrodes. The successful generation of the image requires the simulation of the current injection patterns on either an analytical or a numerical model of the domain under examination, known as the forward model, and using the resulting voltage data in the inverse solution from which images of conductivity changes can be constructed. Recent research strongly indicates that geometric and anatomical conformance of the forward model to the subject under investigation significantly affects the quality of the images. This thesis focuses mainly on EIT of brain function and describes a novel approach for the rapid generation of patient or subject specific finite element models for use as the forward model. After introduction of the topic, methods of generating accurate finite element (FE) models using commercially available Computer-Aided Design (CAD) tools are described and show that such methods, though effective and successful, are inappropriate for time critical clinical use. The feasibility of warping or morphing a finite element mesh as a means of reducing the lead time for model generation is then presented and demonstrated. This leads on to the description of methods of acquiring and utilising known system geometry, namely the positions of electrodes and registration landmarks, to construct an accurate surface of the subject, the results of which are successfully validated. The outcome of this procedure is then used to specify boundary conditions to a mesh warping algorithm based on elastic deformation using well-established continuum mechanics procedures. The algorithm is applied to a range of source models to empirically establish optimum values for the parameters defining the problem which can successfully generate meshes of acceptable quality in terms of discretization errors and which more accurately define the geometry of the target subject. Further validation of the algorithm is performed by comparison of boundary voltages and image reconstructions from simulated and laboratory data to demonstrate that benefits in terms of image artefact reduction and localisation of conductivity changes can be gained. The processes described in the thesis are evaluated and discussed and topics of further work and application are described

Novel Cardiac Mapping Approaches and Multimodal Techniques to Unravel Multidomain Dynamics of Complex Arrhythmias Towards a Framework for Translational Mechanistic-Based Therapeutic Strategies

[ES] Las arritmias cardíacas son un problema importante para los sistemas de salud en el mundo desarrollado debido a su alta incidencia y prevalencia a medida que la población envejece. La fibrilación auricular (FA) y la fibrilación ventricular (FV) se encuentran entre las arritmias más complejas observadas en la práctica clínica. Las consecuencias clínicas de tales alteraciones arrítmicas incluyen el desarrollo de eventos cardioembólicos complejos en la FA, y repercusiones dramáticas debido a procesos fibrilatorios sostenidos que amenazan la vida infringiendo daño neurológico tras paro cardíaco por FV, y que pueden provocar la muerte súbita cardíaca (MSC). Sin embargo, a pesar de los avances tecnológicos de las últimas décadas, sus mecanismos intrínsecos se comprenden de forma incompleta y, hasta la fecha, las estrategias terapéuticas carecen de una base mecanicista suficiente y poseen bajas tasas de éxito. Entre los mecanismos implicados en la inducción y perpetuación de arritmias cardíacas, como la FA, se cree que las dinámicas de las fuentes focales y reentrantes de alta frecuencia, en sus diferentes modalidades, son las fuentes primarias que mantienen la arritmia. Sin embargo, se sabe poco sobre los atractores, así como, de la dinámica espacio-temporal de tales fuentes fibrilatorias primarias, específicamente, las fuentes focales o rotacionales dominantes que mantienen la arritmia. Por ello, se ha desarrollado una plataforma computacional, para comprender los factores (activos, pasivos y estructurales) determinantes, y moduladores de dicha dinámica. Esto ha permitido establecer un marco para comprender la compleja dinámica de los rotores con énfasis en sus propiedades deterministas para desarrollar herramientas basadas en los mecanismos para ayuda diagnóstica y terapéutica. Comprender los procesos fibrilatorios es clave para desarrollar marcadores y herramientas fisiológica- y clínicamente relevantes para la ayuda de diagnóstico temprano. Específicamente, las propiedades espectrales y de tiempo-frecuencia de los procesos fibrilatorios han demostrado resaltar el comportamiento determinista principal de los mecanismos intrínsecos subyacentes a las arritmias y el impacto de tales eventos arrítmicos. Esto es especialmente relevante para determinar el pronóstico temprano de los supervivientes comatosos después de un paro cardíaco debido a fibrilación ventricular (FV). Las técnicas de mapeo electrofisiológico, el mapeo eléctrico y óptico cardíaco, han demostrado ser recursos muy valiosos para dar forma a nuevas hipótesis y desarrollar nuevos enfoques mecanicistas y estrategias terapéuticas mejoradas. Esta tecnología permite además el trabajo multidisciplinar entre clínicos y bioingenieros, para el desarrollo y validación de dispositivos y metodologías para identificar biomarcadores multi-dominio que permitan rastrear con precisión la dinámica de las arritmias identificando fuentes dominantes y atractores con alta precisión para ser dianas de estrategias terapeúticas innovadoras. Es por ello que uno de los objetivos fundamentales ha sido la implantación y validación de nuevos sistemas de mapeo en distintas configuraciones que sirvan de plataforma de desarrollo de nuevas estrategias terapeúticas. Aunque el mapeo panorámico es el método principal y más completo para rastrear simultáneamente biomarcadores electrofisiológicos, su adopción por la comunidad científica es limitada principalmente debido al coste elevado de la tecnología. Aprovechando los avances tecnológicos recientes, nos hemos enfocado en desarrollar, y validar, sistemas de mapeo óptico de alta resolución para registro panorámico cardíaco, utilizando modelos clínicamente relevantes para la investigación básica y la bioingeniería.[CA] Les arítmies cardíaques són un problema important per als sistemes de salut del món desenvolupat a causa de la seva alta incidència i prevalença a mesura que la població envelleix. La fibril·lació auricular (FA) i la fibril·lació ventricular (FV), es troben entre les arítmies més complexes observades a la pràctica clínica. Les conseqüències clíniques d'aquests trastorns arítmics inclouen el desenvolupament d'esdeveniments cardioembòlics complexos en FA i repercussions dramàtiques a causa de processos fibril·latoris sostinguts que posen en perill la vida amb danys neurològics posteriors a la FV, que condueixen a una aturada cardíaca i a la mort cardíaca sobtada (SCD). Tanmateix, malgrat els avanços tecnològics de les darreres dècades, els seus mecanismes intrínsecs s'entenen de forma incompleta i, fins a la data, les estratègies terapèutiques no tenen una base mecanicista suficient i tenen baixes taxes d'èxit. La majoria dels avenços en el desenvolupament de biomarcadors òptims i noves estratègies terapèutiques en aquest camp provenen de tècniques valuoses en la investigació de mecanismes d'arítmia. Entre els mecanismes implicats en la inducció i perpetuació de les arítmies cardíaques, es creu que les fonts primàries subjacents a l'arítmia són les fonts focals reingressants d'alta freqüència dinàmica i AF, en les seves diferents modalitats. Tot i això, se sap poc sobre els atractors i la dinàmica espaciotemporal d'aquestes fonts primàries fibril·ladores, específicament les fonts rotacionals o focals dominants que mantenen l'arítmia. Per tant, s'ha desenvolupat una plataforma computacional per entendre determinants actius, passius, estructurals i moduladors d'aquestes dinàmiques. Això va permetre establir un marc per entendre la complexa dinàmica multidomini dels rotors amb ènfasi en les seves propietats deterministes per desenvolupar enfocaments mecanicistes per a l'ajuda i la teràpia diagnòstiques. La comprensió dels processos fibril·latoris és clau per desenvolupar puntuacions i eines rellevants fisiològicament i clínicament per ajudar al diagnòstic precoç. Concretament, les propietats espectrals i de temps-freqüència dels processos fibril·latoris han demostrat destacar un comportament determinista important dels mecanismes intrínsecs subjacents a les arítmies i l'impacte d'aquests esdeveniments arítmics. Mitjançant coneixements previs, processament de senyals, tècniques d'aprenentatge automàtic i anàlisi de dades, es va desenvolupar una puntuació de risc mecanicista a la aturada cardíaca per FV. Les tècniques de cartografia òptica cardíaca i electrofisiològica han demostrat ser recursos inestimables per donar forma a noves hipòtesis i desenvolupar nous enfocaments mecanicistes i estratègies terapèutiques. Aquesta tecnologia ha permès durant molts anys provar noves estratègies terapèutiques farmacològiques o ablatives i desenvolupar mètodes multidominis per fer un seguiment precís de la dinàmica d'arrímies que identifica fonts i atractors dominants. Tot i que el mapatge panoràmic és el mètode principal per al seguiment simultani de paràmetres electrofisiològics, la seva adopció per part de la comunitat multidisciplinària d'investigació cardiovascular està limitada principalment pel cost de la tecnologia. Aprofitant els avenços tecnològics recents, ens centrem en el desenvolupament i la validació de sistemes de mapes òptics de baix cost per a imatges panoràmiques mitjançant models clínicament rellevants per a la investigació bàsica i la bioenginyeria.[EN] Cardiac arrhythmias are a major problem for health systems in the developed world due to their high incidence and prevalence as the population ages. Atrial fibrillation (AF) and ventricular fibrillation (VF), are amongst the most complex arrhythmias seen in the clinical practice. Clinical consequences of such arrhythmic disturbances include developing complex cardio-embolic events in AF, and dramatic repercussions due to sustained life-threatening fibrillatory processes with subsequent neurological damage under VF, leading to cardiac arrest and sudden cardiac death (SCD). However, despite the technological advances in the last decades, their intrinsic mechanisms are incompletely understood, and, to date, therapeutic strategies lack of sufficient mechanistic basis and have low success rates. Most of the progress for developing optimal biomarkers and novel therapeutic strategies in this field has come from valuable techniques in the research of arrhythmia mechanisms. Amongst the mechanisms involved in the induction and perpetuation of cardiac arrhythmias such AF, dynamic high-frequency re-entrant and focal sources, in its different modalities, are thought to be the primary sources underlying the arrhythmia. However, little is known about the attractors and spatiotemporal dynamics of such fibrillatory primary sources, specifically dominant rotational or focal sources maintaining the arrhythmia. Therefore, a computational platform for understanding active, passive and structural determinants, and modulators of such dynamics was developed. This allowed stablishing a framework for understanding the complex multidomain dynamics of rotors with enphasis in their deterministic properties to develop mechanistic approaches for diagnostic aid and therapy. Understanding fibrillatory processes is key to develop physiologically and clinically relevant scores and tools for early diagnostic aid. Specifically, spectral and time-frequency properties of fibrillatory processes have shown to highlight major deterministic behaviour of intrinsic mechanisms underlying the arrhythmias and the impact of such arrhythmic events. Using prior knowledge, signal processing, machine learning techniques and data analytics, we aimed at developing a reliable mechanistic risk-score for comatose survivors of cardiac arrest due to VF. Cardiac optical mapping and electrophysiological mapping techniques have shown to be unvaluable resources to shape new hypotheses and develop novel mechanistic approaches and therapeutic strategies. This technology has allowed for many years testing new pharmacological or ablative therapeutic strategies, and developing multidomain methods to accurately track arrhymia dynamics identigying dominant sources and attractors. Even though, panoramic mapping is the primary method for simultaneously tracking electrophysiological parameters, its adoption by the multidisciplinary cardiovascular research community is limited mainly due to the cost of the technology. Taking advantage of recent technological advances, we focus on developing and validating low-cost optical mapping systems for panoramic imaging using clinically relevant models for basic research and bioengineering.Calvo Saiz, CJ. (2022). Novel Cardiac Mapping Approaches and Multimodal Techniques to Unravel Multidomain Dynamics of Complex Arrhythmias Towards a Framework for Translational Mechanistic-Based Therapeutic Strategies [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/182329TESI

Anatomical and physiological investigation of pathways mediating the effects of electrical stimulation of the external auricle of the ear on autonomic nervous system activity in rats

The Auricular Branch of the Vagus Nerve (ABVN) is a sensory nerve that innervates select areas of the external auricular dermatome. Electrical stimulation of the auricular region innervated by the ABVN influences the autonomic nervous system, observed by changes in control of the heart in humans and animals. However, the pathways and mechanisms for these effects are unknown. This thesis investigated in rats the pathways mediating the effects of electrical stimulation of the external auricle, comparing an ABVN innervated site of the external ear (the tragus) to an area not reported to receive ABVN innervation, the earlobe. Injection of the neuronal tracer cholera toxin B chain (CTB) into the right tragus (n=4) and right earlobe (n=4) revealed a large degree of similarity in sensory afferent termination sites. Afferent terminals were predominantly labelled ipsilateral to the injection site, with the densest labelling within laminae III-IV of the dorsal horn of the upper cervical spinal cord. In the medulla oblongata, CTB labelled afferents were observed in the paratrigeminal nucleus, cuneate nucleus, and to a minor extent in the nucleus tractus solitarius. Efforts were made to identify the targets of labelled afferents using immunofluorescence for choline acetyltransferase, calbindin, parvalbumin, glutamate decarboxylase 67 and neurokinin receptor 1 expressing cells, but inputs to each cell type were rare. Physiological recordings of the responses to ear stimulation were made in an anaesthetic free Working Heart Brainstem Preparation (WHBP) of the rat. Autonomic profiles of WHBP rats were first examined. Recordings made from rats at night time, revealed more robust sympathetic activity in comparison to day time rats, thus subsequent experiments were conducted in rats at night time. Electrical stimulation (100 Hz, 2.5 mA) was delivered for 5 minutes into the auricular stimulation sites in the WHBP. Direct recording from the sympathetic chain revealed a central sympathoinhibition from both tragus and earlobe stimulation. Sectioning of upper cervical afferent nerve roots silenced the sympathoinhibitory effects of tragus stimulation. Considering the predominance of afferent labelling in the cervical spinal cord dorsal horn and that cervical afferent nerve section reduced the sympathoinhibition evoked by tragus stimulation, this suggests that the autonomic effects of auricular stimulation are conveyed through somatosensory afferents rather than the ABVN