Computational Fluid Dynamics in Cardiovascular Disease

Computational fluid dynamics (CFD) is a mechanical engineering field for analyzing fluid flow, heat transfer, and associated phenomena, using computer-based simulation. CFD is a widely adopted methodology for solving complex problems in many modern engineering fields. The merit of CFD is developing new and improved devices and system designs, and optimization is conducted on existing equipment through computational simulations, resulting in enhanced efficiency and lower operating costs. However, in the biomedical field, CFD is still emerging. The main reason why CFD in the biomedical field has lagged behind is the tremendous complexity of human body fluid behavior. Recently, CFD biomedical research is more accessible, because high performance hardware and software are easily available with advances in computer science. All CFD processes contain three main components to provide useful information, such as pre-processing, solving mathematical equations, and post-processing. Initial accurate geometric modeling and boundary conditions are essential to achieve adequate results. Medical imaging, such as ultrasound imaging, computed tomography, and magnetic resonance imaging can be used for modeling, and Doppler ultrasound, pressure wire, and non-invasive pressure measurements are used for flow velocity and pressure as a boundary condition. Many simulations and clinical results have been used to study congenital heart disease, heart failure, ventricle function, aortic disease, and carotid and intra-cranial cerebrovascular diseases. With decreasing hardware costs and rapid computing times, researchers and medical scientists may increasingly use this reliable CFD tool to deliver accurate results. A realistic, multidisciplinary approach is essential to accomplish these tasks. Indefinite collaborations between mechanical engineers and clinical and medical scientists are essential. CFD may be an important methodology to understand the pathophysiology of the development and progression of disease and for establishing and creating treatment modalities in the cardiovascular field

Computational Fluid Dynamics in Cardiovascular Disease

Computational fluid dynamics (CFD) is a mechanical engineering field for analyzing fluid flow, heat transfer, and associated phenomena, using computer-based simulation. CFD is a widely adopted methodology for solving complex problems in many modern engineering fields. The merit of CFD is developing new and improved devices and system designs, and optimization is conducted on existing equipment through computational simulations, resulting in enhanced efficiency and lower operating costs. However, in the biomedical field, CFD is still emerging. The main reason why CFD in the biomedical field has lagged behind is the tremendous complexity of human body fluid behavior. Recently, CFD biomedical research is more accessible, because high performance hardware and software are easily available with advances in computer science. All CFD processes contain three main components to provide useful information, such as pre-processing, solving mathematical equations, and post-processing. Initial accurate geometric modeling and boundary conditions are essential to achieve adequate results. Medical imaging, such as ultrasound imaging, computed tomography, and magnetic resonance imaging can be used for modeling, and Doppler ultrasound, pressure wire, and non-invasive pressure measurements are used for flow velocity and pressure as a boundary condition. Many simulations and clinical results have been used to study congenital heart disease, heart failure, ventricle function, aortic disease, and carotid and intra-cranial cerebrovascular diseases. With decreasing hardware costs and rapid computing times, researchers and medical scientists may increasingly use this reliable CFD tool to deliver accurate results. A realistic, multidisciplinary approach is essential to accomplish these tasks. Indefinite collaborations between mechanical engineers and clinical and medical scientists are essential. CFD may be an important methodology to understand the pathophysiology of the development and progression of disease and for establishing and creating treatment modalities in the cardiovascular field

The Populus holobiont: dissecting the effects of plant niches and genotype on the microbiome

Background: Microorganisms serve important functions within numerous eukaryotic host organisms. An understanding of the variation in the plant niche-level microbiome, from rhizosphere soils to plant canopies, is imperative to gain a better understanding of how both the structural and functional processes of microbiomes impact the health of the overall plant holobiome. Using Populus trees as a model ecosystem, we characterized the archaeal/bacterial and fungal microbiome across 30 different tissue-level niches within replicated Populus deltoides and hybrid Populus trichocarpa × deltoides individuals using 16S and ITS2 rRNA gene analyses. Results: Our analyses indicate that archaeal/bacterial and fungal microbiomes varied primarily across broader plant habitat classes (leaves, stems, roots, soils) regardless of plant genotype, except for fungal communities within leaf niches, which were greatly impacted by the host genotype. Differences between tree genotypes are evident in the elevated presence of two potential fungal pathogens, Marssonina brunnea and Septoria sp., on hybrid P. trichocarpa × deltoides trees which may in turn be contributing to divergence in overall microbiome composition. Archaeal/bacterial diversity increased from leaves, to stem, to root, and to soil habitats, whereas fungal diversity was the greatest in stems and soils. Conclusions: This study provides a holistic understanding of microbiome structure within a bioenergy relevant plant host, one of the most complete niche-level analyses of any plant. As such, it constitutes a detailed atlas or map for further hypothesis testing on the significance of individual microbial taxa within specific niches and habitats of Populus and a baseline for comparisons to other plant species

Temperature-induced changes in the wheat phosphoproteome reveal temperature-regulated interconversion of phosphoforms

Wheat (Triticum ssp.) is one of the most important human food sources. However, this crop is very sensitive to temperature changes. Specifically, processes during wheat leaf, flower, and seed development and photosynthesis, which all contribute to the yield of this crop, are affected by high temperature. While this has to some extent been investigated on physiological, developmental, and molecular levels, very little is known about early signalling events associated with an increase in temperature. Phosphorylation-mediated signalling mechanisms, which are quick and dynamic, are associated with plant growth and development, also under abiotic stress conditions. Therefore, we probed the impact of a short-term and mild increase in temperature on the wheat leaf and spikelet phosphoproteome. In total, 3822 (containing 5178 phosphosites) and 5581 phosphopeptides (containing 7023 phosphosites) were identified in leaf and spikelet samples, respectively. Following statistical analysis, the resulting data set provides the scientific community with a first large-scale plant phosphoproteome under the control of higher ambient temperature. This community resource on the high temperature-mediated wheat phosphoproteome will be valuable for future studies. Our analyses also revealed a core set of common proteins between leaf and spikelet, suggesting some level of conserved regulatory mechanisms. Furthermore, we observed temperature-regulated interconversion of phosphoforms, which probably impacts protein activity

Pattern of healthcare resource utilization and direct costs associated with manic episodes in Spain

<p>Abstract</p> <p>Background</p> <p>Although some studies indicate that bipolar disorder causes high health care resources consumption, no study is available addressing a cost estimation of bipolar disorder in Spain. The aim of this observational study was to evaluate healthcare resource utilization and the associated direct cost in patients with manic episodes in the Spanish setting.</p> <p>Methods</p> <p>Retrospective descriptive study was carried out in a consecutive sample of patients with a DSM-IV diagnosis of bipolar type I disorder with or without psychotic symptoms, aged 18 years or older, and who were having an active manic episode at the time of inclusion. Information regarding the current manic episode was collected retrospectively from the medical record and patient interview.</p> <p>Results</p> <p>Seven hundred and eighty-four evaluable patients, recruited by 182 psychiatrists, were included in the study. The direct cost associated with healthcare resource utilization during the manic episode was high, with a mean cost of nearly €4,500 per patient, of which approximately 55% corresponded to the cost of hospitalization, 30% to the cost of psychopharmacological treatment and 10% to the cost of specialized care.</p> <p>Conclusions</p> <p>Our results show the high cost of management of the patient with a manic episode, which is mainly due to hospitalizations. In this regard, any intervention on the management of the manic patient that could reduce the need for hospitalization would have a significant impact on the costs of the disease.</p

Pulsatile fontan hemodynamics and patient-specific surgical planning: a numerical investigation

Single ventricle heart defects, where systemic and pulmonary venous returns mix in the single functional ventricle, represent the most complex form of congenital heart defect, affecting 2 babies per 1000 live births. Surgical repairs, termed "Fontan Repairs," reroute the systemic venous return directly to the pulmonary arteries, thus preventing venous return mixing and restoring normal oxygenation saturation levels. Unfortunately, these repairs are only palliative and Fontan patients are subjected to a multitude of chronic complications. It has long been suspected that hemodynamics play a role in determining patient outcome. However, the number of anatomical and functional variables that come into play and the inability to conduct large scale clinical evaluations, due to too small a patient population, has hindered decisive progress and there is still not a good understanding of the optimal care strategies on a patient-by-patient basis. Over the past decades, image-guided computational fluid dynamics (CFD) has arisen as an attractive option to accurately model such complex biomedical phenomena, providing a high degree of freedom regarding the geometry and flow conditions to be simulated, and carrying the potential to be automated for large sample size studies. Despite these theoretical advantages, few CFD studies have been able to account for the complexity of patient-specific anatomies and in vivo pulsatile flows. In this thesis, we develop an unstructured Cartesian immersed-boundary flow solver allowing for high resolution, time-accurate simulations in arbitrarily complex geometries, at low computational costs. Combining the proposed and validated CFD solver with an interactive virtual-surgery environment, we present an image-based surgical planning framework that: a) allows for in depth analysis of the pre-operative in vivo hemodynamics; b) enables surgeons to determine the optimum surgical scenario prior to the operation. This framework is first applied to retrospectively investigate the in vivo pulsatile hemodynamics of different Fontan repair techniques, and quantitatively compare their efficiency. We then report the prospective surgical planning investigations conducted for six failing Fontan patients with an interrupted inferior vena cava and azygous continuation. In addition to a direct benefit to the patients under consideration, the knowledge derived from these surgical planning studies will also have a larger impact for the clinical management of Fontan patients as they shed light onto the impact of caval offset, vessel flaring and other design parameters upon the Fontan hemodynamics depending on the underlying patient anatomy. These results provide useful surgical guidelines for each anatomical template, which could benefit the global surgical community, including centers that do not have access to patient-specific surgical planning interfaces.Ph.D.Committee Chair: Yoganathan, Ajit; Committee Co-Chair: Sotiropoulos, Fotis; Committee Member: del Nido, Pedro; Committee Member: Fogel, Mark; Committee Member: Giddens, Don; Committee Member: Kanter, Kirk; Committee Member: Taylor, W. Rober

Rôle délétère de CD38 dans la myopathie de Duchenne et bénéfices thérapeutiques de son inhibition

Duchenne muscular dystrophy (DMD) is the most common rare disease, affecting about one in 3500 newborn boys in the world. This genetic disease originates from the loss of function of a gene carried by the X chromosome, encoding dystrophin, a protein of the subsarcolemmal cytoskeleton complex. Dystrophin is normally expressed in all muscle types and its absence leads to membrane fragility. The disease is manifested by progressive degeneration of skeletal, smooth and cardiac muscles, which leads to the patient death at about 30 years of age, due to cardiac or respiratory failure.Two major consequences of the absence of dystrophin are a muscular abnormal high cytoplasmic Ca2+ concentration linked to an excessive ryanodine receptors activation, and a deficit in cellular NAD+ levels leading to impaired energetic metabolism. This Ca2+ dysregulation will induce many pathophysiological Ca2+-dependent processes which, coupled with energetic impairment, leads to muscle cells necrosis or apoptosis.Interestingly, the enzyme CD38, is an important NAD+ consumer through its production of two-second messengers, namely NAADP and cyclic ADPR, known to be positive modulators of ryanodine receptors. Actually, CD38 contribution to DMD pathophysiology is not known. We hypothesized that CD38 activity could be deleterious in this pathology, and thus that its inhibition could be beneficial in DMD.We performed experiments in the mdx mouse, which is the main DMD rodent model. The first highlight of our study is that CD38 is actually more expressed and more active in the mdx mouse compared to WT, showing its high potential as therapeutic target in DMD. We then performed as proof of concept pharmacological experiments with a CD38 inhibitor. We found that mdx mice treated displayed endurance (grid time) and strength (grip test) restored to normal values. In order to study the long term role of CD38 in the mdx mouse, we then generated double mutant by crossing mdx mice with CD38-/- mice. We first evaluated the impact of CD38 on NAD+ consumption, by measuring NAD+ levels in various muscle tissues in mdx and in mdx/CD38-/-mice. Our data showed a dramatic deficit of NAD+ levels in all muscles extracted from mdx mice, whereas NAD+ levels were fully restored to normal values in mdx/CD38-/-mice. We also observed a considerable reduction in the pathological spontaneous Ca2+ activity in cardiomyocytes extracted from mdx/CD38-/- mice, associated with a normalization of RyR sensitivity. To further evaluate the beneficial effects of targeting CD38 in DMD, we then measured key histological and functional parameters in the mdx/CD38-/- mouse. The data obtained in mdx/CD38-/- mice demonstrated that deletion of CD38 in mdx mice strongly improves the structural and functional phenotype since we have a clear reduction in the onset of fibrosis and a very significant improvement of skeletal and respiratory function and a full recovery of the cardiac function. Finally, we show that deleting CD38 in mdx mice also prevented isoproterenol-induced heart failure and hypertrophy, a protocol which simulates the onset of cardiomyopathy in DMD patients.All these data strongly support the hypothesis that CD38 is a major contributor of the DMD phenotype and that a reduction in CD38 activity could prevent or delay the cellular damages resulting from both a deficit in NAD+ levels and a disruption of Ca2+ homeostasis in DMD. Last but not least, our study shows that the treatment of human myotubes derived from DMD patient with an anti-CD38 antibody reduces excessive Ca2+ release in these cells. This result strongly suggest that our innovative strategy could be rapidly applied in DMD patients, thanks to the recent development of human therapeutic anti-CD38 antibodies.La dystrophie musculaire de Duchenne (DMD) est une maladie génétique touchant le gène DMD sur le chromosome X, entraînant l'absence d'une protéine du cytosquelette : la dystrophine. Son incidence à la naissance est d’environ un nouveau-né sur 3500 garçons. La dystrophine étant normalement exprimée dans tous les types musculaires, son absence se manifeste par une dégénérescence progressive des muscles squelettiques, lisses et cardiaque, conduisant au décès du patient vers l'âge de 30 ans par insuffisance cardiaque ou respiratoire.Deux caractéristiques majeures de la DMD sont, d'une part, une concentration calcique cytoplasmique anormalement élevée, liée notamment à une activation excessive des récepteurs à la ryanodine (RyRs) et, d'autre part, un déficit en NAD+ entraînant une altération du métabolisme énergétique. Cette dérégulation majeure de l’homéostasie calcique, couplée au déficit énergétique, conduisent in fine à la mort cellulaire.L'enzyme CD38 est justement un consommateur important de NAD+, afin de produire deux seconds messagers, le NAADP et l'ADPR cyclique, connus pour être des modulateurs positifs des RyRs. Le rôle de CD38 n’étant pas connu dans la DMD, et son activité pouvant être délétère dans cette pathologie, nous avons donc émis l'hypothèse que son inhibition pourrait être bénéfique sur ces deux aspects importants de la pathologie.Afin de vérifier cette hypothèse, nous avons réalisé plusieurs expériences chez la souris mdx, le modèle murin de la DMD. Tout d’abord, notre étude montre que CD38 est plus exprimée et plus active chez la souris mdx que chez la souris WT, renforçant ainsi l’intérêt de la cibler dans la DMD. Afin de tester le potentiel thérapeutique de notre stratégie, nous avons traités des souris mdx avec un inhibiteur de CD38. Chez les souris traitées, l’endurance est améliorée et la force musculaire restaurée. Afin d’approfondir le rôle de CD38 chez la souris mdx sur le long terme, nous avons ensuite généré un double mutant en croisant des souris mdx avec des souris CD38-/-. Nous avons d'abord évalué l'impact de CD38 sur la consommation de NAD+, en mesurant les taux de NAD+ dans différents muscles : nos résultats montrent un déficit majeur de NAD+ dans tous les tissus de souris mdx, et une restauration à des valeurs normales chez la souris mdx/CD38-/-. Nous observons également une réduction considérable de l'activité calcique spontanée dans les cardiomyocytes de souris mdx/CD38-/-, associée à une normalisation de la sensibilité des RyRs dans ces cellules. Pour étudier les effets fonctionnels de l'inhibition de CD38 dans la DMD, nous avons ensuite évalué des paramètres clés de cette pathologie. Les données obtenues chez la souris mdx/CD38-/- montrent une importante amélioration du phénotype histologique et fonctionnel, avec une réduction de la fibrose musculaire accompagnée de bénéfices importants sur les performances musculaires et respiratoires ainsi qu’un rétablissement total de la fonction cardiaque. Enfin, dans un protocole de stress bêta-adrénergique, la délétion de CD38 chez la souris mdx a également permis de prévenir les dommages histologiques et l'hypertrophie cardiaque induits par l'isoprotérénol, qui simule l'apparition d'une cardiomyopathie chez les patients atteints de DMD.Notre étude montre que CD38, plus active et plus exprimée chez la souris mdx, contribue de manière importante à son phénotype dystrophique. Une réduction de son activité permet de réduire l’excès de Ca2+, de rétablir le niveau de NAD+, et d’obtenir des bénéfices fonctionnels importants chez la souris. Enfin, notre étude sur des myotubes humains issus de patients DMD montre qu’un anticorps anti-CD38 réduit l’excès de Ca2+ libéré, soulignant ainsi que notre stratégie innovante ciblant CD38 pourrait être rapidement disponible pour les patients, grâce au développement d’anticorps thérapeutiques anti-CD38 déjà sur le marché

A Mechanical Fluid Assessment of Anatomical Models of the Total Cavopulmonary Connection (TCPC)

BACKGROUND: Understanding the hemodynamics of the total cavopulmonary connection (TCPC) may lead to further optimization of the connection design and surgical planning, which in turn may lead to improved surgical outcome. While most experimental and numerical investigations have mainly focused on somewhat simplified geometries, the investigation of the flow field of true TCPC configurations is necessary for a true understanding. METHODS: This study details a manufacturing methodology yielding more accurate in vitro models that would provide a better understanding of the TCPC hemodynamics and adequate data for the validation of anatomical CFD simulations. This approach is illustrated on two different TCPC templates: an intra-atrial TCPC with a single superior vena cava (SVC) and a bilateral SVC with an extra-cardiac conduit. Power loss, flow visualization, digital particle image velocimetry (DPIV) flow measurements as well as computational fluid dynamics simulations are performed to characterize the anatomic flow structure. Additional parametric glass models of the TCPC were manufactured to help understand the fluid dynamics of the anatomical models and support the computational model validation effort. RESULTS/CONCLUSIONS: Both anatomic configurations revealed very different fluid dynamics underlining once again the need for at least one comprehensive experimental campaign per TCPC template for a good understanding of the flow phenomena. The absence of caval offset in the anatomical intra-atrial model resulted in important flow turbulence, which was enhanced by the large connection area and yielded high pressure drops and power losses. On the other hand, the bilateral SVC, which featured a smooth extra-cardiac conduit and wider vessels, led to power losses that were one order of magnitude lower than those of the anatomic intra-atrial model and a smooth flow field with lower levels of instability. The simplified glass models demonstrated that the diameter of the connecting vessels and of the pulmonary arteries in particular, was a parameter of prime importance. Finally, this study also reports on a combined experimental and numerical validation methodology, suggesting a cautious approach for the straightforward use of available CFD tools and pointing out the need for developing high resolution CFD techniques specifically tailored to tackle the complexities of cardiovascular flows.M.S.Committee Chair: Ajit Yoganathan; Committee Member: Don Giddens; Committee Member: Shiva Sharm