Estudio comparativo de diferentes técnicas de implantación de stents en bifurcaciones coronarias

ResumenEl objetivo de este trabajo es el análisis comparativo de los cambios hemodinámicos locales producidos en una bifurcación coronaria por el implante de stents mediante 3 técnicas diferentes: stent simple en la arteria principal, stent simple en la arteria principal con orificio de comunicación con la arteria secundaria para el paso de un balón de inflado («kissing») y «culotte». Para ello se ha utilizado la geometría ideal de una bifurcación coronaria a 45 y 90°.En primer lugar se simularon los modelos en régimen estacionario mediante el código comercial ANSYS Fluent, y a continuación se validaron con las medidas experimentales tomadas en el laboratorio mediante velocimetría de imagen de partículas (particle image velocimetry [PIV]). Una vez obtenida una buena concordancia de resultados entre ambos estudios en régimen permanente, se abordó el flujo pulsátil. Los parámetros que se consideraron para comparar las diferentes técnicas en este régimen fueron los esfuerzos cortantes y la caída de presión promediados en el tiempo, así como el índice de esfuerzos cortantes oscilatorios (oscillatory shear index [OSI]). Las conclusiones finales fueron que el stent simple presenta los peores resultados, en términos de caída de presión, y la técnica «kissing», los mejores. Esto sería aplicable a los stents liberadores de fármacos, donde la reestenosis no es tan crucial como el restablecimiento del flujo sanguíneo. En cuanto al criterio basado en el valor menor de los esfuerzos cortantes (<0,4Pa) y un OSI elevado (>0,1), la técnica «culotte» presenta el peor comportamiento. Esto sería aplicable a los stents sin recubrimiento, en que la mejor opción sería el stent simple.AbstractThe objective of this work is to analyze the local hemodynamic changes caused in a coronary bifurcation by three different stenting techniques: simple stenting of the main vessel, simple stenting of the main vessel with kissing balloon in the side branch and culotte. To carry out this study an idealized geometry of a coronary bifurcation is used, and two bifurcation angles, 45° and 90°, are chosen as representative of the wide variety of real configurations. Both numerical simulations and experimental measurements are performed. First, steady simulations are carried out with the commercial code ANSYS Fluent, then, experimental measurements with PIV (Particle Image Velocimetry), obtained in the laboratory, are used to validate the numerical simulations. The steady computational simulations show a good overall agreement with the experimental data. Second, pulsatile flow is considered to take into account the transient effects. The time averaged wall shear stress, oscillatory shear index (OSI) and pressure drop obtained numerically are used to compare the behavior of the stenting techniques. As conclusions obtained, simple stenting technique shows the worst results in terms of pressure drop, and kissing the best ones. This criterion could be applied for DES (Drug Eluting Stents) where the restenosis is not as critical as the reestablishment of the blood flow. But considering the regions of low wall shear stress (<0.4Pa) and elevated OSI (>0.1), the culotte procedure shows the worst performance and the simple stent, the best. This could be applied to BMS (Bare Metal Stents)

Evaluación de acciones explosivas sobre estructuras de hormigón armado mediante elementos finitos

Explosive phenomena on concrete structures have catastrophic effects in many instances despite its reduced occurrence. The civil buildings are usually not designed to withstand this type of dynamic load, so a methodology to analyze the structural response on blast loads is recommended. This paper studies the behavior of reinforced concrete frame structures against these actions by lagrangian finite elements method with explicit time integration. Finite element models of segregated concrete and rebar are used to make possible the study of structure parts as columns and slabs, but is not possible to use these detailed models in complete structures because of excessive computational costs. Shell and beam elements models properly calibrated are needed to obtain a similar response. Conclusions and practical recommendations are provided for the use and calibration of models and realistic simulations.El fenómeno de explosión sobre estructuras de hormigón tiene efectos en muchos casos catastróficos a pesar de su reducida frecuencia. Las edificaciones civiles no suelen estar diseñadas para resistir este tipo de solicitación dinámica, por lo que conviene disponer de una metodología que permita analizar los efectos de las explosiones sobre las mismas. Este trabajo estudia el comportamiento de las estructuras reticuladas de hormigón armado frente a estas acciones, mediante métodos numéricos de elementos finitos lagrangianos con integración explícita en el tiempo. Se analizan de forma realista partes de la estructura como columnas y forjados usando modelos con hormigón y armaduras de forma segregada, pero las limitaciones computacionales los hacen inviables para estructuras completas. Se proponen modelos de elementos lámina y viga debidamente calibrados para obtener una respuesta similar. Se obtienen conclusiones para el uso y calibración de modelos y simulaciones realistas de edificios completos para estudios de seguridad

Mechanical characterization of the human thoracic descending aorta Experiments and modelling

This work presents experiments and modelling aimed at characterising the passive mechanical behaviour of the human thoracic descending aorta. To this end, uniaxial tension and pressurisation tests on healthy samples corresponding to newborn, young and adult arteries are performed. Then, the tensile measurements are used to calibrate the material parameters of the Holzapfel constitutive model. This model is found to adequately adjust the material behaviour in a wide deformation range; in particular, it captures the progressive stiffness increase and the anisotropy due to the stretching of the collagen fibres. Finally, the assessment of these material parameters in the modelling of the pressurisation test is addressed. The implication of this study is the possibility to predict the mechanical response of the human thoracic descending aorta under generalised loading states like those that can occur in physiological conditions and/or in medical device application

Brain-predicted age difference mediates the association between PROMIS sleep impairment, and self-reported pain measure in persons with knee pain

Knee pain, the most common cause of musculoskeletal pain (MSK), constitutes a severe public health burden. Its neurobiological causes, however, remain poorly understood. Among many possible causes, it has been proposed that sleep problems could lead to an increase in chronic pain symptomatology, which may be driven by central nervous system changes. In fact, we previously found that brain cortical thickness mediated the relationship between sleep qualities and pain severity in older adults with MSK. We also demonstrated a significant difference in a machine-learning-derived brain-aging biomarker between participants with low-and high-impact knee pain. Considering this, we examined whether brain aging was associated with self-reported sleep and pain measures, and whether brain aging mediated the relationship between sleep problems and knee pain. Exploratory Spearman and Pearson partial correlations, controlling for age, sex, race and study site, showed a significant association of brain aging with sleep related impairment and self-reported pain measures. Moreover, mediation analysis showed that brain aging significantly mediated the effect of sleep related impairment on clinical pain and physical symptoms. Our findings extend our prior work demonstrating advanced brain aging among individuals with chronic pain and the mediating role of brain-aging on the association between sleep and pain severity. Future longitudinal studies are needed to further understand whether the brain can be a therapeutic target to reverse the possible effect of sleep problems on chronic pain