Influence of the pressure wire on the fractional flow reserve calculation: CFD analysis of an ideal vessel and clinical patients with stenosis.

BACKGROUND AND OBJECTIVE: Fractional Flow Reserve (FFR) is generally considered the gold standard in hemodynamics to assess the impact of a stenosis on the blood flow. The standard procedure to measure involves the displacement of a pressure guide along the circulatory system until it is placed next to the lesion to be analyzed. The main objective of the present study is to analyze the influence of the pressure guide on the invasive FFR measurements and its implications in clinical practice. METHODS: We studied the influence of pressure wires on the measurement of Fractional Flow Reserve (FFR) through a combination of Computational Fluid Dynamics (CFD) simulations using 45 clinical patient data with 58 lesions and ideal geometries. The analysis is conducted considering patients that were subjected to a computer tomography and also have direct measurements using a pressure guide. Influence of the stenosis severity, degree of occlusion and blood viscosity has also been studied. RESULTS: The influence of pressure wires specifically affects severe stenosis with a lumen diameter reduction of 50 % or greater. This type of stenosis leads to reduced hyperemic flow and increased coronary pressure drop. Thus, we identified that the placement of wires during FFR measurements results in partial obstruction of the coronary artery lumen, leading to increased pressure drop and subsequent reduction in blood flow. The severity of low FFR values associated with severe stenosis may be prone to overestimation when compared to stenosis without severe narrowing. These results have practical implications, particularly in the interpretation of lesions falling within the "gray zone" (0,75-0,80). CONCLUSIONS: The pressure wire's presence significantly alters the flow on severe lesions, which has an impact on the FFR calculation. In contrast, the impact of the pressure wire appears to be reduced when the FFR is larger than 0.8. The findings provide critical information for physicians, emphasizing the need for cautious interpretation of FFR values, particularly in severe stenosis. It also offers insights into improving the correlation between FFRct models and invasive measurements by incorporating the influence of pressure wires.

Association between Eruption Sequence of Posterior Teeth, Dental Crowding, Arch Dimensions, Incisor Inclination, and Skeletal Growth Pattern.

BACKGROUND: We conducted research to investigate the effects of the eruption sequence of posterior teeth, arch dimensions, and incisor inclination on dental crowding. MATERIAL AND METHODS: A cross-sectional analytic study was performed on 100 patients (54 boys and 46 girls; mean ages: 11.69 and 11.16 years, respectively). Seq1 (canine-3-/second premolar-5-) or Seq2 (5/3) eruption sequences were recorded in maxilla, and Seq3 (canine-3-/first premolar-4-) or Seq4 (4/3) eruption sequences in mandible; tooth size, available space, tooth size-arch length discrepancy (TS-ALD), arch lengths, incisor inclination and distance, and skeletal relationship were noted. RESULTS: The most common eruption sequences in the maxilla and mandible were Seq1 (50.6%), and Seq3 (52.1%), respectively. In the maxilla, posterior tooth sizes were larger in crowded cases. In the mandible, anterior and posterior tooth sizes were larger in crowded patients. No relationship between incisor variables and the maxillo-mandibular relationship and dental crowding was found. A negative correlation between inferior TS-ALD and the mandibular plane was found. CONCLUSIONS: Seq1 and Seq 2 in the maxilla and Seq 3 and Seq 4 in the mandible were equally prevalent. An eruption sequence of 3-5 in the maxilla and 3-4 in the mandible is more likely to cause crowding.

Impact of Enhanced Phagocytosis of Glycated Erythrocytes on Human Endothelial Cell Functions.

Diabetes is associated with a high mortality rate due to vascular complications. Chronic hyperglycemia in diabetes leads to enhanced oxidative stress and glycation. Here, we explored the impact of glycation on human erythrocyte characteristics and capacity to affect endothelial cell function following erythrophagocytosis. Native and glucose-mediated glycated erythrocytes were prepared and characterized in terms of structural and deformability modifications. Erythrocyte preparations were tested for their binding and phagocytosis capacity as well as the potential functional consequences on human endothelial cell lines and primary cultures. Oxidative modifications were found to be enhanced in glycated erythrocytes after determination of their deformability, advanced glycation end-product content and eryptosis. Erythrophagocytosis by endothelial cells was significantly increased when incubated in the presence of glycated erythrocytes. In addition, higher iron accumulation, oxidative stress and impaired endothelial cell permeability were evidenced in cells previously incubated with glycated erythrocytes. When cultured under flow conditions, cellular integrity was disrupted by glycated erythrocytes at microvessel bifurcations, areas particularly prone to vascular complications. This study provides important new data on the impact of glycation on the structure of erythrocytes and their ability to alter endothelial cell function. Increased erythrophagocytosis may have a deleterious impact on endothelial cell function with adverse consequences on diabetic vascular complications.

Use of Transcutaneous Electrical Nerve Stimulation (TENS) for the Recovery of Oral Function after Orthognathic Surgery.

The oral functions of patients are markedly diminished immediately after orthognathic surgery, and novel approaches are needed to accelerate their recovery. The aim of this study was to examine the usefulness of weekly applications of transcutaneous electrical nerve stimulation (TENS) for this purpose, based on the evidence of its effectiveness in other types of patients with muscle alterations. Maximum jaw opening, bite force, pain, and facial inflammation were compared between patients receiving TENS and those receiving sham-TENS for 30 min at baseline and weekly over a four-week period after orthognathic surgery and were also compared between the before and after of each procedure. TENS was applied at 220 Hz, applying the maximum intensity tolerated by each individual patient. The TENS procedure was identical for all patients, but the device was not turned on in the sham-TENS group. Patients were blinded to their group membership. Results were analyzed separately in skeletal class II and III patients. Improvements in jaw opening and inflammation were significantly greater in the TENS than in the sham-TENS group, attributable to the muscle relaxation achieved with the procedure. Research is warranted on the benefits of a more frequent application of TENS.

Haemodynamic-dependent arrest of circulating tumour cells at large blood vessel bifurcations as new model for metastasis.

Homing of circulating tumour cells (CTC) at distant sites represents a critical event in metastasis dissemination. In addition to physical entrapment, probably responsible of the majority of the homing events, the vascular system provides with geometrical factors that govern the flow biomechanics and impact on the fate of the CTC. Here we mathematically explored the distribution of velocities and the corresponding streamlines at the bifurcations of large blood vessel and characterized an area of low-velocity at the carina of bifurcation that favours the residence of CTC. In addition to this fluid physics effect, the adhesive capabilities of the CTC provide with a biological competitive advantage resulting in a marginal but systematic arrest as evidenced by dynamic in vitro recirculation in Y-microchannels and by perfusion in in vivo mice models. Our results also demonstrate that viscosity, as a main determinant of the Reynolds number that define flow biomechanics, may be modulated to limit or impair CTC accumulation at the bifurcation of blood vessels, in agreement with the apparent positive effect observed in the clinical setting by anticoagulants in advanced oncology disease.

Mini implants osseointegration, molar intrusion and root resorption in Sinclair minipigs.

AIM: The use of mini implants to create a passive intraoral anchorage point has been mainly tested in clinical trials. In this study, an experimental integrated approach evaluated mini implant loading protocols (immediate vs. delayed loading) on bone remodelling and mini implant stability and the consequent degree of dental intrusion and apical root resorption. METHODS: A total of 40 Absoanchor® mini implants with 1.2mm diameter and 8mm length were placed in a total of 5 minipigs, 8 per animal, 2 in each hemiarch. Each implant was attached through a lingual button to the vestibular side of the second and fourth premolars with a nitinol coil spring of 150g force. The analysis of morphological aspects included the degree of dental movement, mini implant stability, and new bone formation over the mini implant heads. Bone mini-implant interface and modifications of dental root in response to intrusion were studied by light and electron microscopy. RESULTS: The rate of mini implant success was>98%, mainly in those subjected to immediate loading. This loading protocol promoted a high degree of osseointegration along with a high degree of intrusive dental movement, particularly of the second premolars. However, the radiological and histological studies showed a low degree of root resorption. Associated with the high intrusive movement, the penetration of the root apexes produced an inner cortical surface deformation of the maxillary sinus floor by remodeling and bone growth. CONCLUSION: In minipigs immediate loading of smooth mini implants promoted a high degree of intrusive movement particularly of the second premolars, stimulated bone growth and osseointegration, but extensive root resorption was not observed.

Determination of hemodynamic risk for vascular disease in planar artery bifurcations.

Understanding hemodynamics in blood circulation is crucial in order to unveil the mechanisms underlying the formation of stenosis and atherosclerosis. In fact, there are experimental evidences pointing out to the existence of some given vessel configurations that are more likely to develop the above mentioned pathologies. Along this manuscript, we performed an exhaustive investigation in a simplified model aiming to characterize by means of physical quantities those regions and configurations in vessel bifurcations that are more likely to develop such pathologies. The two-fold analysis is based, on the one hand, on numerical simulations (via CFD) and, on the other hand, on experiments realized in an ad-hoc designed polydimethylsiloxane (PDMS) channel with the appropriate parameters and appropriate fluid flows. The results obtained demonstrate that low velocity regions and low shear stress zones are located in the outer walls of bifurcations. In fact, we found that there is a critical range of bifurcation angles that is more likely to vascular disease than the others in correspondence with some experimental evidence. The effect of the inflow velocity on this critical range is also analyzed.

Changes in joint space dimension after the correction of Class II division 1 malocclusion.

OBJECTIVE: The aim of this prospective longitudinal investigation was to compare the relationship between the temporomandibular joint (TMJ) condyles and the temporal fossae by means of tomography before and after the orthodontic correction of Class II, division 1 malocclusion using the activator appliance. MATERIALS AND METHODS: The final sample consisted of 26 consecutively treated Class II, division 1 patients (19 boys and 7 girls with an average pre-treatment age of 11 years) who underwent orthodontic treatment by means of an activator appliance. Before treatment all patients were free of signs and symptoms associated to TMJ disorders. Bilateral tomographic records before and after treatment were taken and analyzed. Outlines of the condyle and temporal fossa were automatically determined by an edge-detection protocol, and the minimum joint space dimension was automatically measured every 2 degrees. For further analysis, the joint space was divided into anterior, superior, and posterior joint spaces. RESULTS: The average treatment time with the activator appliance was 366 days. In all subjects, activator treatment resulted in a Class I dental arch relationship. After activator treatment, no differences were found in the joint space measurements in any direction. Comparisons between the right and left condyles were not significantly different. CONCLUSIONS: Joint space dimension in Class II division I children was similar before and after treatment in both TMJs.

Longitudinal evaluation of jaw muscle activity and mandibular kinematics in young patients with Class II malocclusion treated with the Teuscher activator.

OBJECTIVES: A longitudinal study was performed to evaluate the jaw muscle activity and mandibular kinematics after Teuscher activator treatment and at 2 years after orthodontic treatment completion. MATERIAL AND METHODS: Twenty-seven children with Class II division 1 malocclusion were evaluated before treatment (T0; mean: 11.6 years), after functional treatment (T1; mean: 12.8 years), and 2 years after orthodontic treatment (T2; mean: 18 years). Bilateral surface electromyographic activities of the anterior temporalis, posterior temporalis, masseter, and suprahyoid muscle areas were analyzed at rest and during clenching, swallowing, and mastication. Kinematic recordings of the mandibular maximum opening, lateral shift, right and left lateral excursions, and protrusion were evaluated. RESULTS: Compared to T0, the left masseter activity during clenching was decreased at T1 but increased at T2, similar to the other evaluated muscles. The suprahyoid activity during swallowing was increased at T1 but decreased at T2. The masseter activity during mastication was increased at T1 and further increased at T2. The left and right lateral excursions and protrusion did not show significant changes throughout the experiment. CONCLUSIONS: Teuscher activator and subsequent fixed orthodontic treatment improved jaw muscle function; however, a long period was needed to attain complete neuromuscular adaptation.

Kinesiographic and sonographic changes in young Class II patients treated with functional appliances.

INTRODUCTION: The aim of this prospective, longitudinal, case-series study was to analyze the effect of orthodontic treatment by means of an activator appliance on the temporomandibular joint disc-condyle complex. METHODS: The sample included 27 consecutively treated subjects with Class II Division 1 malocclussions (21 boys, 6 girls) who underwent orthodontic therapy with activators. The average pretreatment age was 11 years 2 months. Before treatment, all subjects were free of signs and clinical symptoms of temporomandibular joint disorders. The average treatment time with the activator appliance was 366 days; then all patients had Class I dental relationships. Kinesiographic and sonographic records before and after orthodontic treatment with the activator appliance were used to evaluate the disc-condyle complex. Univariate statistics were used in these outcome measurements to evaluate differences before and after treatment. RESULTS: After treatment, the maximum opening increased significantly (4.81 mm), but the lateral and protrusive excursions did not change. The sonographic study showed no differences in temporomandibular joint sounds before and after treatment. CONCLUSIONS: These results suggest that orthodontic treatment with an activator in a child without signs and clinical symptoms of temporomandibular joint disorders before treatment is not a risk factor for the development of temporomandibular pathology or mandibular dysfunction.

Respuesta endocrina asociada a la eficiencia de tres tratamientos hormonales en vacas con quistes foliculares / Endocrine response associated to efficiency of three hormone treatments in cows with follicular cysts

Para valorar la eficiencia del tratamiento hormonal en relación al estado endocrino de vacas con quistes foliculares, se formaron tres grupos de 20 vacas cada uno. Todos los animales seleccionados mostraron celos infértiles y se les diagnosticaron quistes foliculares por palpación rectal, después de un tratamiento superovulatorio con FSH. Los grupos fueron tratados con una sola dosis de 100 µg de acetato de fertirelín (grupo GnRH); 5000 UI de gonadotropina coriónica humana (grupo HCG)o 25 mg de hormona luteinizante (grupo LH). Se tomó una muestra sanguínea de cada animal antes de aplicar la hormona respectiva, y posteriormente cada cinco días hasta el día 20 postratamiento, cuando nuevamente se realizó una palpación para evaluar la luteinización de los folículos. Las concentraciones plasmáticas de progesterona (P4) y estradiol (E2) determinadas a través de radioinmunoanálisis con antisueros altamente específicos funcionaron como indicador endocrino de la respuesta ovárica. El ensayo de P4 se calibró para detectar de 0.1 a 12 ng/ml de plasma y su variación intra e interensayo fue de 7.47 por ciento y 12.1 por ciento, respectivamente. El ensayo de E2, detecta de 10 a 640 pg/ml de plasm y su variación intra e interensayo fue de 1.38 por ciento y 11.0 por ciento, respectivamente. El porcentaje de hembras que regularizaron su ciclo estral fue de 68.4 por ciento, 83.3 por ciento y 66.6 por ciento para GnRH, HCG y LH, respectivamante. El primer celo regular presentado por los animales para el mismo orden de tratamientos se observó a los 19.23 ñ 7.19, 18.2 ñ 8.86 y 21.0 ñ 4.02 días después de la aplicación de la hormona correspondiente. Los días postratamiento en que se alcanzó el valor máximo de P4 fueron 12.3 ñ 3.3. días para GnRH, 8.93 ñ 4.01 días para HCG y 12.72 ñ 2.61 días para LH; los niveles de P4 en esos días fueron 3.12 ñ 0.69 ng/ml, 3.22 ñ 2.08 ng/ml y 4.21 ñ 1.65 ng/ml, respectivamente, La concentración media en el plasma de E2 postratamiento, en los animales que mantuvieron ninfomanía, fue significativamente mayor (186.96 ñ 189.97 vs 80.06 ñ 115.9, P<0.05) que en los animales que regularizaron su ciclo. Con base en los patrones hormonales postratamiento, se proponen mecanismos de respuesta, asociados con la eficiencia clínica del tratamiento