Vascular device interaction with the endothelium

Copyright @ 2008 Elsevier. This is the post-print version of the article.Cerebral stents and Intra Aortic Balloon Pumps (IABP) are examples of mechanical devices that are inserted into arteries to restore flows to clinically healthy states. The stent and the IABP ‘correct’ the arterial flow by static dilation and by cyclical occlusion respectively. As this presentation shows, these functions are effectively modelled by current engineering practice. As interventions however, by their very nature they involve physical contact between a non-biological structure and the sensitive endothelial surface. The possible damage to the endothelium is not currently well addressed and we also consider this issue. Cerebral stents generally have two primary clinical objectives: to mechanically dilate a stenosed artery and to have minimal detrimental impact upon local blood flow characteristics. These objectives are well served at the arterial scale as these devices are evidently effective in opening up diseased arteries and restoring vital flows. However, at the near-wall micro-scale the picture is less satisfactory, as thin stent wires apply stresses to the endothelium and glycocalyx and the local flow is disturbed rather than being ideally streamlined. This causes further interaction with this endothelium topography. Wall Shear Stress (WSS) is the measure commonly used to indicate the interaction between fluid and wall but it is a broad brush approach that loses fidelity close to the wall. We will present simulation results of blood flow through a stented cerebral saccular aneurysm under these limitations of WSS. The Intra Aortic Balloon Pump (IABP) is a widely used temporary cardiac assist device. The balloon is usually inserted from the iliac artery, advanced in the aorta until it reaches the desired position; with its base just above the renal bifurcation and the tip approximately 10cm away from the aortic valve. The balloon is inflated and deflated every- (1:1), every other- (1:2) or every second (1:3) cardiac cycle. Balloon inflation, which takes place during early diastole, causes an increase in the pressure of the aortic root which leads to an increase in coronary flow. Balloon deflation which takes place during late diastole achieves one of the main IABP therapeutic effects by reducing left ventricular afterload. Unavoidably, the balloon contacts the inner wall of the aorta with every inflation/deflation cycle. This repeated event and possible contact with atherosclerotic plaque have been reported to be responsible for balloon rupture. However, there has not been a methodical study to investigate the mechanical effects of balloon-wall interaction. For example, during inflation the balloon approaches the endothelium as it displaces a volume of blood proximally and distally. This squeezing process generates shear stresses, which hasn't yet been quantified. Similarly, when the balloon moves away from the endothelium during deflation, it generates micro pressure differences that may impose stretching (pulling) stresses on the endothelium cells. Both of the above cases indicate that a very high spatial resolution is required in order to fully understand the process of interaction between device and endothelium, and to interpret the effects at the cellular level

Is it time for integration of surgical skills simulation into the United Kingdom undergraduate medical curriculum? A perspective from King’s College London School of Medicine

PURPOSE: Changes in undergraduate medical curricula, combined with reforms in postgraduate education, have training implications for surgical skills acquisition in a climate of reduced clinical exposure. Confidence and prior experience influences the educational impact of learning. Currently there is no basic surgical skills (BSS) programme integrated into undergraduate curricula in the United Kingdom. We explored the role of a dedicated BSS programme for undergraduates in improving confidence and influencing careers in King's College London School of Medicine, and the programme was evaluated. METHODS: A programme was designed in-line with the established Royal College of Surgeons course. Undergraduates were taught four key skills over four weeks: knot-tying, basic-suturing, tying-at-depth and chest-drain insertion, using low-fidelity bench-top models. A Likert-style questionnaire was designed to determine educational value and influence on career choice. Qualitative data was collected. RESULTS: Only 29% and 42% of students had undertaken previous practice in knot-tying and basic suturing, respectively. 96% agreed that skills exposure prior to starting surgical rotations was essential and felt a dedicated course would augment undergraduate training. There was a significant increase in confidence in the practice and knowledge of all skills taught (p<0.01), with a greater motivation to be actively involved in the surgical firm and theatres. CONCLUSION: A simple, structured BSS programme can increase the confidence and motivation of students. Early surgical skills targeting is valuable for students entering surgical, related allied, and even traditionally non-surgical specialties such as general practice. Such experience can increase the confidence of future junior doctors and trainees. We advocate the introduction of a BSS programme into United Kingdom undergraduate curricula

Chimerism after organ transplantation

Recent evidence suggests that passenger leukocytes migrate after organ transplantation and produce persistent chimerism, which is essential for sustained survival of the allograft. Here, we describe how this hematolymphopoietic chimerism provides an important framework for interpretation of post-transplant phenomena and for initiation of therapeutically oriented transplantation research

Diffuse Gamma Rays: Galactic and Extragalactic Diffuse Emission

"Diffuse" gamma rays consist of several components: truly diffuse emission from the interstellar medium, the extragalactic background, whose origin is not firmly established yet, and the contribution from unresolved and faint Galactic point sources. One approach to unravel these components is to study the diffuse emission from the interstellar medium, which traces the interactions of high energy particles with interstellar gas and radiation fields. Because of its origin such emission is potentially able to reveal much about the sources and propagation of cosmic rays. The extragalactic background, if reliably determined, can be used in cosmological and blazar studies. Studying the derived "average" spectrum of faint Galactic sources may be able to give a clue to the nature of the emitting objects.Comment: 32 pages, 28 figures, kapproc.cls. Chapter to the book "Cosmic Gamma-Ray Sources," to be published by Kluwer ASSL Series, Edited by K. S. Cheng and G. E. Romero. More details can be found at http://www.gamma.mpe-garching.mpg.de/~aws/aws.htm

On the unification of dwarf and giant elliptical galaxies

The near orthogonal distributions of dwarf elliptical (dE) and giant elliptical (E) galaxies in the mu_e-Mag and mu_e-log(R_e) diagrams have been interpreted as evidence for two distinct galaxy formation processes. However, continuous, linear relationships across the alleged dE/E boundary at M_B = -18 mag - such as those between central surface brightness (mu_0) and (i) galaxy magnitude and (ii) light-profile shape (n) - suggest a similar, governing formation mechanism. Here we explain how these latter two linear trends necessitate a different behavior for dE and E galaxies, exactly as observed, in diagrams involving mu_e (and also _e). A natural consequence is that the distribution of dEs and Es in Fundamental Plane type analyses that use the associated intensity I_e, or _e, are expected to appear different. Together with other linear trends across the alleged dE/E boundary, such as those between luminosity and color, metallicity, and velocity dispersion, it appears that the dEs form a continuous extension to the E galaxies. The presence of partially depleted cores in luminous (M_B < -20.5 mag) Es does however signify the action of a different physical process at the centers (< ~300 pc) of these galaxies.Comment: 5 pages from the proceedings of the 2004 conference "Penetrating bars through masks of cosmic dust: the Hubble tuning fork strikes a new note". Edited by D. L. Block, I. Puerari, K. C. Freeman, R. Groess, and E. K. Bloc

Quadratic Word Equations with Length Constraints, Counter Systems, and Presburger Arithmetic with Divisibility

Word equations are a crucial element in the theoretical foundation of constraint solving over strings, which have received a lot of attention in recent years. A word equation relates two words over string variables and constants. Its solution amounts to a function mapping variables to constant strings that equate the left and right hand sides of the equation. While the problem of solving word equations is decidable, the decidability of the problem of solving a word equation with a length constraint (i.e., a constraint relating the lengths of words in the word equation) has remained a long-standing open problem. In this paper, we focus on the subclass of quadratic word equations, i.e., in which each variable occurs at most twice. We first show that the length abstractions of solutions to quadratic word equations are in general not Presburger-definable. We then describe a class of counter systems with Presburger transition relations which capture the length abstraction of a quadratic word equation with regular constraints. We provide an encoding of the effect of a simple loop of the counter systems in the theory of existential Presburger Arithmetic with divisibility (PAD). Since PAD is decidable, we get a decision procedure for quadratic words equations with length constraints for which the associated counter system is \emph{flat} (i.e., all nodes belong to at most one cycle). We show a decidability result (in fact, also an NP algorithm with a PAD oracle) for a recently proposed NP-complete fragment of word equations called regular-oriented word equations, together with length constraints. Decidability holds when the constraints are additionally extended with regular constraints with a 1-weak control structure.Comment: 18 page

Beyond Node Degree: Evaluating AS Topology Models

This is the accepted version of 'Beyond Node Degree: Evaluating AS Topology Models', archived originally at arXiv:0807.2023v1 [cs.NI] 13 July 2008.Many models have been proposed to generate Internet Autonomous System (AS) topologies, most of which make structural assumptions about the AS graph. In this paper we compare AS topology generation models with several observed AS topologies. In contrast to most previous works, we avoid making assumptions about which topological properties are important to characterize the AS topology. Our analysis shows that, although matching degree-based properties, the existing AS topology generation models fail to capture the complexity of the local interconnection structure between ASs. Furthermore, we use BGP data from multiple vantage points to show that additional measurement locations significantly affect local structure properties, such as clustering and node centrality. Degree-based properties, however, are not notably affected by additional measurements locations. These observations are particularly valid in the core. The shortcomings of AS topology generation models stems from an underestimation of the complexity of the connectivity in the core caused by inappropriate use of BGP data