Case Report: Evaluating Biomechanical Risk Factors in Carotid Stenosis by Patient-Specific Fluid-Structural Interaction Biomechanical Analysis

Background: Carotid atherosclerosis is one of the main underlying inducements of stroke, which is a leading cause of disability. The morphological feature and biomechanical environment have been found to play important roles in atherosclerotic plaque progression. However, the biomechanics in each patient’s blood vessel is complicated and unique. Method: To analyse the biomechanical risk of the patient-specific carotid stenosis, this study used the fluid-structure interaction (FSI) computational biomechanical model. This model coupled both structural and hemodynamic analysis. Two patients with carotid stenosis planned for carotid endarterectomy were included in this study. The 3D models of carotid bifurcation were reconstructed using our in-house-developed protocol based on multisequence magnetic resonance imaging (MRI) data. Patient-specific flow and pressure waveforms were used in the computational analysis. Multiple biomechanical risk factors including structural and hemodynamic stresses were employed in post-processing to assess the plaque vulnerability. Results: Significant difference in morphological and biomechanical conditions between 2 patients was observed. Patient I had a large lipid core and serve stenosis at carotid bulb. The stenosis changed the cross-sectional shape of the lumen. The blood flow pattern changed consequently and led to a complex biomechanical environment. The FSI results suggested a potential plaque progression may lead to a high-risk plaque, if no proper treatment was performed. The patient II had significant tandem stenosis at both common and internal carotid artery (CCA and ICA). From the results of biomechanical factors, both stenoses had a high potential of plaque progression. Especially for the plaque at ICA branch, the current 2 small plaques might further enlarge and merge as a large vulnerable plaque. The risk of plaque rupture would also increase. Conclusions: Computational biomechanical analysis is a useful tool to provide the biomechanical risk factors to help clinicians assess and predict the patient-specific plaque vulnerability. The FSI computational model coupling the structural and hemodynamic computational analysis, better replicates the in vivo biomechanical condition, which can provide multiple structural and flow-based risk factors to assess plaque vulnerability

Carotid Bifurcation With Tandem Stenosis—A Patient-Specific Case Study Combined in vivo Imaging, in vitro Histology and in silico Simulation

A patient-specific carotid bifurcation with tandem stenosis found at both internal carotid artery (ICA) and common carotid artery (CCA) was studied. The in vivo pre-carotid endarterectomy (pre-CEA) multi-spectral magnetic resonance imaging (MRI) were performed and in vitro post-CEA carotid plaque tissue sample was collected. MR imaging data and tissue sample staining histology were used to recognize the plaque components. Further, the computational fluid dynamics (CFD) were performed on four MR-based reconstructed 3D carotid bifurcation models (the patient-specific geometry with tandem stenosis and three presumptive geometries by removing the stenosis part). The flow and shear stress behavior affected by the tandem stenosis was analyzed. From the results of MR segmentation and histology analysis, plaque lipid pool and calcification were found at both ICA and CCA. From the result of CFD simulation, the flow shear stress behavior suggested the tandem stenosis as a more “dangerous” situation than a single-stenosis artery. Besides, the CFD results deduced that the stenosis at the CCA location formed initially and led to the subsequent formation of stenosis at ICA. This study suggests that when planning CEA, CFD simulation on the presumptive models could help clinicians to estimate the blood flow behavior after surgery. Particular attention should be paid to the case of tandem stenosis, as the local hemodynamic environment is more complex and treatment of one stenosis may lead to a variation in the hemodynamic loading on the second plaque, which may result in either a higher risk of plaque rupture or restenosis

Extraction of coherent structures in a rotating turbulent flow experiment

The discrete wavelet packet transform (DWPT) and discrete wavelet transform (DWT) are used to extract and study the dynamics of coherent structures in a turbulent rotating fluid. Three-dimensional (3D) turbulence is generated by strong pumping through tubes at the bottom of a rotating tank (48.4 cm high, 39.4 cm diameter). This flow evolves toward two-dimensional (2D) turbulence with increasing height in the tank. Particle Image Velocimetry (PIV) measurements on the quasi-2D flow reveal many long-lived coherent vortices with a wide range of sizes. The vorticity fields exhibit vortex birth, merger, scattering, and destruction. We separate the flow into a low-entropy ``coherent'' and a high-entropy ``incoherent'' component by thresholding the coefficients of the DWPT and DWT of the vorticity fields. Similar thresholdings using the Fourier transform and JPEG compression together with the Okubo-Weiss criterion are also tested for comparison. We find that the DWPT and DWT yield similar results and are much more efficient at representing the total flow than a Fourier-based method. Only about 3% of the large-amplitude coefficients of the DWPT and DWT are necessary to represent the coherent component and preserve the vorticity probability density function, transport properties, and spatial and temporal correlations. The remaining small amplitude coefficients represent the incoherent component, which has near Gaussian vorticity PDF, contains no coherent structures, rapidly loses correlation in time, and does not contribute significantly to the transport properties of the flow. This suggests that one can describe and simulate such turbulent flow using a relatively small number of wavelet or wavelet packet modes.Comment: experimental work aprox 17 pages, 11 figures, accepted to appear in PRE, last few figures appear at the end. clarifications, added references, fixed typo

Leiomyosarcoma of the inferior vena cava: Radical surgery and vascular reconstruction

<p>Abstract</p> <p>Background</p> <p>Vascular leiomyosarcoma are rare tumors typically originating from the inferior vena cava (IVC). Due to nonspecific clinical signs most tumors are diagnosed at advanced stages. Complete surgical resection remains the only potential curative therapeutic option. Surgical strategy is particularly influenced by the level of the IVC affected. Due to the topographic relation to the renal veins level-II involvement of the IVC raises special surgical challenges with respect to the maintenance of venous outflow.</p> <p>Case presentation</p> <p>We herein report two cases of leiomyosarcoma of the IVC with successful en bloc resection and individualized caval reconstruction. One patient presented with a large intramural and intraluminal mass and received a complete circumferential resection. Reconstruction was performed by graft replacement of the caval segment affected. The other patient displayed a predominantly extraluminal tumor growth and underwent semicircumferential resection of the IVC including the confluence of the left renal vein. In this case vascular reconstruction was performed by cavoplasty and reinsertion of the left renal vein into the proximal portion of the IVC. Resection margins of both patients were tumor free and no clinical signs of venous insufficiency of the lower extremity occurred.</p> <p>Conclusion</p> <p>This paper presents two cases of successfully managed leiomyosarcomas of the vena cava and exemplifies two different options for vascular reconstruction in level II sarcomas and includes a thorough review of the literature.</p

Tangling clustering of inertial particles in stably stratified turbulence

We have predicted theoretically and detected in laboratory experiments a new type of particle clustering (tangling clustering of inertial particles) in a stably stratified turbulence with imposed mean vertical temperature gradient. In this stratified turbulence a spatial distribution of the mean particle number density is nonuniform due to the phenomenon of turbulent thermal diffusion, that results in formation of a gradient of the mean particle number density, \nabla N, and generation of fluctuations of the particle number density by tangling of the gradient, \nabla N, by velocity fluctuations. The mean temperature gradient, \nabla T, produces the temperature fluctuations by tangling of the gradient, \nabla T, by velocity fluctuations. These fluctuations increase the rate of formation of the particle clusters in small scales. In the laboratory stratified turbulence this tangling clustering is much more effective than a pure inertial clustering that has been observed in isothermal turbulence. In particular, in our experiments in oscillating grid isothermal turbulence in air without imposed mean temperature gradient, the inertial clustering is very weak for solid particles with the diameter 10 microns and Reynolds numbers Re =250. Our theoretical predictions are in a good agreement with the obtained experimental results.Comment: 16 pages, 4 figures, REVTEX4, revised versio

Transition phenomena in unstably stratified turbulent flows

We study experimentally and theoretically transition phenomena caused by the external forcing from Rayleigh-Benard convection with the large-scale circulation (LSC) to the limiting regime of unstably stratified turbulent flow without LSC whereby the temperature field behaves like a passive scalar. In the experiments we use the Rayleigh-B\'enard apparatus with an additional source of turbulence produced by two oscillating grids located nearby the side walls of the chamber. When the frequency of the grid oscillations is larger than 2 Hz, the large-scale circulation (LSC) in turbulent convection is destroyed, and the destruction of the LSC is accompanied by a strong change of the mean temperature distribution. However, in all regimes of the unstably stratified turbulent flow the ratio $\big[(\ell_x \nabla_x T)^2 + (\ell_y \nabla_y T)^2 + (\ell_z \nabla_z T)^2\big] /$ varies slightly (even in the range of parameters whereby the behaviour of the temperature field is different from that of the passive scalar). Here $\ell_i$ are the integral scales of turbulence along x, y, z directions, T and \theta are the mean and fluctuating parts of the fluid temperature. At all frequencies of the grid oscillations we have detected the long-term nonlinear oscillations of the mean temperature. The theoretical predictions based on the budget equations for turbulent kinetic energy, turbulent temperature fluctuations and turbulent heat flux, are in agreement with the experimental results.Comment: 14 pages, 14 figures, REVTEX4-1, revised versio

Isolation of Bordetella avium and Novel Bordetella Strain from Patients with Respiratory Disease

Bordetella avium is thought to be strictly an avian pathogen. However, 16S rRNA gene sequencing identified 2 isolates from 2 humans with respiratory disease as B. avium and a novel B. avium–like strain. Thus, B. avium and B. avium–like organisms are rare opportunistic human pathogens

Hysteresis phenomenon in turbulent convection

Coherent large-scale circulations of turbulent thermal convection in air have been studied experimentally in a rectangular box heated from below and cooled from above using Particle Image Velocimetry. The hysteresis phenomenon in turbulent convection was found by varying the temperature difference between the bottom and the top walls of the chamber (the Rayleigh number was changed within the range of $10^7 - 10^8$). The hysteresis loop comprises the one-cell and two-cells flow patterns while the aspect ratio is kept constant ($A=2 - 2.23$). We found that the change of the sign of the degree of the anisotropy of turbulence was accompanied by the change of the flow pattern. The developed theory of coherent structures in turbulent convection (Elperin et al. 2002; 2005) is in agreement with the experimental observations. The observed coherent structures are superimposed on a small-scale turbulent convection. The redistribution of the turbulent heat flux plays a crucial role in the formation of coherent large-scale circulations in turbulent convection.Comment: 10 pages, 9 figures, REVTEX4, Experiments in Fluids, 2006, in pres

Experimental investigation of the vortical activity in the close wake of a simplified military transport aircraft

This paper focuses on the experimental characterization of the vortex structures that develop in the aft fuselage region and in the wake of a simplified geometry of a military transport aircraft. It comes within the framework of the military applications of airflow influence on airdrop operations. This work relies on particle image velocimetry measurements combined with a vortex-tracking approach. Complex vortex dynamics is revealed, in terms of vortex positions, intensities, sizes, shapes and fluctuation levels, for both closed and opened cargo-door and ramp airdrop configurations

Unsteady Boundary-Layer Transition Measurements and Computations on a Rotating Blade under Cyclic Pitch Conditions

The presented work tackles the lack of experimental investigations of unsteady laminar-turbulent boundary-layer transition on rotor blades at cyclic pitch actuation, which are important for accurate performance predictions of helicopters in forward flight. Unsteady transition positions were measured on the blade suction side of a four-bladed subscale rotor by means of non-intrusive differential infrared thermography (DIT). Experiments were conducted at different rotation rates corresponding to Mach and Reynolds numbers at 75% rotor radius of up to M_75=0.21 and Re_75 =3.3×10^5 and with varying cyclic blade pitch settings. The setup allowed transition to be measured across the outer 54% of the rotor radius. For comparison, transition was also measured using conventional infrared thermography for steady cases with collective pitch settings only. The study is complemented by numerical simulations including boundary-layer transition modeling based on semi-empirical criteria. DIT results reveal the upstream and downstream motion of boundary-layer transition during upstroke and downstroke, a reasonable comparison to experimental results obtained using the already established sigma*c_p method, and noticeable agreement with numerical simulations. The result is the first systematic study of unsteady boundary-layer transition on a rotor suction side by means of DIT including a comparison to numerical computations