Biomechanical characterization of tissue types in murine dissecting aneurysms based on histology and 4D ultrasound-derived strain.

Abdominal aortic aneurysm disease is the local enlargement of the aorta, typically in the infrarenal section, causing up to 200,000 deaths/year. In vivo information to characterize the individual elastic properties of the aneurysm wall in terms of rupture risk is lacking. We used a method that combines 4D ultrasound and direct deformation estimation to compute in vivo 3D Green-Lagrange strain in murine angiotensin II-induced dissecting aortic aneurysms, a commonly used mouse model. After euthanasia, histological staining of cross-sectional sections along the aorta was performed in areas where in vivo strains had previously been measured. The histological sections were segmented into intact and fragmented elastin, thrombus with and without red blood cells, and outer vessel wall including the adventitia. Meshes were then created from the individual contours based on the histological segmentations. The isolated contours of the outer wall and lumen from both imaging modalities were registered individually using a coherent point drift algorithm. 2D finite element models were generated from the meshes, and the displacements from the registration were used as displacement boundaries of the lumen and wall contours. Based on the resulting deformed contours, the strains recorded were grouped according to segmented tissue regions. Strains were highest in areas containing intact elastin without thrombus attachment. Strains in areas with intact elastin and thrombus attachment, as well as areas with disrupted elastin, were significantly lower. Strains in thrombus regions with red blood cells were significantly higher compared to thrombus regions without. We then compared this analysis to statistical distribution indices and found that the results of each aligned, elucidating the relationship between vessel strain and structural changes. This work demonstrates the possibility of advancing in vivo assessments to a microstructural level ultimately improving patient outcomes.

Influence of tension-band plates on the mechanical loading of the femoral growth plate during guided growth due to coronal plane deformities.

Introduction: Correction of knee malalignment by guided growth using a tension-band plate is a common therapy to prevent knee osteoarthritis among other things. This approach is based on the Hueter-Volkmann law stating that the length growth of bones is inhibited by compression and stimulated by tension. How the locally varying mechanical loading of the growth plate is influenced by the implant has not yet been investigated. This study combines load cases from the gait cycle with personalized geometry in order to investigate the mechanical influence of the tension-band plates. Methods: Personalized finite element models of four distal femoral epiphyses of three individuals, that had undergone guided growth, were generated. Load cases from the gait cycles and musculoskeletal modelling were simulated with and without implant. Morphological features of the growth plates were obtained from radiographs. 3D geometries were completed using non-individual Magnetic Resonance Images of age-matched individuals. Boundary conditions for the models were obtained from instrumented gait analyses. Results: The stress distribution in the growth plate was heterogenous and depended on the geometry. In the insertion region, the implants locally induced static stress and reduced the cyclic loading and unloading. Both factors that reduce the growth rate. On the contralateral side of the growth plate, increased tension stress was observed, which stimulates growth. Discussion: Personalized finite element models are able to estimate the changes of local static and cyclic loading of the growth plate induced by the implant. In future, this knowledge can help to better control growth modulation and avoid the return of the malalignment after the treatment. However, this requires models that are completely participant-specific in terms of load cases and 3D geometry.

Using averaged models from 4D ultrasound strain imaging allows to significantly differentiate local wall strains in calcified regions of abdominal aortic aneurysms.

Abdominal aortic aneurysms are a degenerative disease of the aorta associated with high mortality. To date, in vivo information to characterize the individual elastic properties of the aneurysm wall in terms of rupture risk is lacking. We have used time-resolved 3D ultrasound strain imaging to calculate spatially resolved in-plane strain distributions characterized by mean and local maximum strains, as well as indices of local variations in strains. Likewise, we here present a method to generate averaged models from multiple segmentations. Strains were then calculated for single segmentations and averaged models. After registration with aneurysm geometries based on CT-A imaging, local strains were divided into two groups with and without calcifications and compared. Geometry comparison from both imaging modalities showed good agreement with a root mean squared error of 1.22 ± 0.15 mm and Hausdorff Distance of 5.45 ± 1.56 mm (mean ± sd, respectively). Using averaged models, circumferential strains in areas with calcifications were 23.2 ± 11.7% (mean ± sd) smaller and significantly distinguishable at the 5% level from areas without calcifications. For single segmentations, this was possible only in 50% of cases. The areas without calcifications showed greater heterogeneity, larger maximum strains, and smaller strain ratios when computed by use of the averaged models. Using these averaged models, reliable conclusions can be made about the local elastic properties of individual aneurysm (and long-term observations of their change), rather than just group comparisons. This is an important prerequisite for clinical application and provides qualitatively new information about the change of an abdominal aortic aneurysm in the course of disease progression compared to the diameter criterion.

Missing Jejunal Perforation During Small Bowel Measurement in Patient Operated by Laparoscopic One-Anastomosis Gastric Bypass.

BACKGROUND: Obesity surgery is justified as it produces sustained weight loss, increases life expectancy, and reduces the complications of obesity. For this reason, increasing numbers of patients are undergoing this surgery [1]. Complications following surgical treatment of severe obesity vary based upon the procedure performed and, although it is currently below 7% in more experienced centers, it may increase in more complex surgeries (such as revision surgery) and can be as high as 40% [2, 3]. Patients with early postoperative complications may be managed in specialist centers by the bariatric surgeon during the hospital stay [4]. Missing bowel injury may occur primarily during insertion of a Veress needle and trocar, use of electrosurgery and laser beams, suturing, and adhesiolysis [5]. Less frequently, the bowel perforation is due to the measurement of the loop and goes unnoticed. Perforation of the intestines due to any reason is a severe condition that can clinically present with free intraabdominal air, purulent or even fecal peritonitis, and abdominal compartment syndrome [6]. High clinical suspicion is crucial for early diagnosis. Early recognition of bowel injury and early intervention is crucial to reduce its morbidity and mortality [5]. METHODS: We present a case of a 50-year-old male patient with a BMI of 36.1 kg/m2, hypertension, and dyslipidemia who was proposed for bariatric surgery. A laparoscopic one-anastomosis gastric bypass (OAGB) was performed with no intraoperative incidents. Few hours after the surgery, the patient manifests intense abdominal pain and tachycardia (120 bpm) so we decided to order an abdominal CT scan that showed signs of jejunal perforation (pneumoperitoneum, oral contrast extravasation, and small air bubbles next to the jejunum wall). RESULTS: Emergency laparoscopy was done and showed generalized peritonitis caused by a 4-mm perforation in the mesenteric border of the jejunum with everted mucosa that was located 150 cm from the loop of Treitz. We decided to place three infraumbilical trocars to help us with washing, viewing, and surgical repair. We performed a 2-0 barbed simple suture of the perforation and extensive washing of the entire cavity with 10 L of serum. We left three drains. The patient made an uneventful recovery and was discharged 72 h after surgery with an established oral diet. CONCLUSIONS: Missing intestinal perforation is an uncommon injury during bariatric surgery, but its early diagnosis is important to avoid endangering the patient's life. Simple postoperative tachycardia in obese patients should be taken seriously as it is a warning signal. Laparoscopic reoperation in these early diagnosed cases is safe and effective, since it allows visualization and washing of the entire cavity. Bowel injuries, which may occur as a result of the insertion of an insufflation needle or trocar, are a rare complication of laparoscopy. In the case we present, the perforation occurred during the small bowel measurement so we insist on the extreme caution that surgeons must take during every detail of the surgical technique. The use of atraumatic forceps, handling of the bowel strictly at the antimesenteric side, and the infusion of sufficient methylene blue in the anastomosis testing are gestures that can help reduce the risk.

Extracellular ferritin contributes to neuronal injury in an in vitro model of ischemic stroke.

Previous clinical and experimental studies have shown that neurological decline and poor functional outcome after acute ischemic stroke in humans are associated with high ferritin levels in serum and cerebrospinal fluid (CSF) within 24 h of ischemic stroke onset. The aim of the present study was to find out if and how high extracellular ferritin concentrations can increase the excitotoxicity effect in a neuronal cortical culture model of stroke. Extracellular ferritin (100 ng/ml) significantly increased the excitotoxic effect caused by excessive exogenous glutamate (50 µM and 100 µM) by leading to an increase in lipid peroxidation, a reduction in mitochondrial membrane potential, and a decrease in neuron viability. Extracellular apoferritin (100 ng/ml), the iron-free form of the protein, does not increase the excitotoxicity of glutamate, which proves that iron was responsible for the neurotoxic effect of the exogenous ferritin. We present evidence that extracellular ferritin iron exacerbates the neurotoxic effect induced by glutamate excitotoxicity and that the effect of ferritin iron is dependent of glutamate excitotoxicity. Our results support the idea that body iron overload is involved in the severity of the brain damage caused by stroke and reveal the need to control systemic iron homeostasis.

Thin-Wall Machining of Light Alloys: A Review of Models and Industrial Approaches.

Thin-wall parts are common in the aeronautical sector. However, their machining presents serious challenges such as vibrations and part deflections. To deal with these challenges, different approaches have been followed in recent years. This work presents the state of the art of thin-wall light-alloy machining, analyzing the problems related to each type of thin-wall parts, exposing the causes of both instability and deformation through analytical models, summarizing the computational techniques used, and presenting the solutions proposed by different authors from an industrial point of view. Finally, some further research lines are proposed.

Impact of Chemical Post-Processing in Fused Deposition Modelling (FDM) on Polylactic Acid (PLA) Surface Quality and Structure.

The application of techniques to improve the surface finish of pieces obtained by fused deposition modelling, as well as other functional aspects, is of great interest nowadays. Polylactic acid, a biodegradable material, has been considered a possible substitute for petroleum-based polymers. In this work, different chemical post-processing methods are applied to polylactic acid pieces obtained by fused deposition modelling and some characteristics are studied. Structural, thermal, and crystallinity property changes are analyzed according to the treatments applied. This can prevent degradation, eliminate the glass transition phase of the material, and thereby increase the thermal resistance by about 50 °C. An improvement in the roughness of the pieces of up to 97% was also found.

Evaluation of Reliefs' Properties on Design of Thermoformed Packaging Using Fused Deposition Modelling Moulds.

The increased consumption of food requiring thermoformed packaging implies that the packaging industry demands customized solutions in terms of shapes and sizes to make each packaging unique. In particular, food industry increasingly requires more transparent packaging, with greater clarity and a better presentation of the product they contain. However, in turn, the differentiation of packaging is sought through its geometry and quality, as well as the arrangement of food inside the packaging. In addition, these types of packaging usually include ribs in the walls to improve their physical properties. However, these ribs also affect the final aesthetics of the product. In accordance with this, this research study analyses the mechanical properties of different relief geometries that can affect not only their aesthetics but also their strength. For this purpose, tensile and compression tests were carried out using thermoformed PET sheets. The results provide comparative data on the reliefs studied and show that there are differences in the mechanical properties according to shape, size and disposition in the package.

Custom Design of Packaging through Advanced Technologies: A Case Study Applied to Apples.

In the context of food packaging design, customization enhances the value of a product by meeting consumer needs. Personalization is also linked to adaptation, so the properties of the packaging can be improved from several points of view: functional, aesthetic, economic and ecological. Currently, functional and formal properties of packaging are not investigated in depth. However, the study of both properties is the basis for creating a new concept of personalized and sustainable product. In accordance with this approach, a conceptual design procedure of packaging with personalized and adapted geometries based on the digitization of fresh food is proposed in this work. This study is based on the application of advanced technologies for the design and development of food packaging, apples in this work, in order to improve the quality of the packaging. The results obtained show that it is possible to use advanced technologies in the early stages of product design in order to obtain competitive products adapted to new emerging needs.

Quantification of methane emissions in a Mediterranean landfill (Southern Spain). A combination of flux chambers and geostatistical methods.

In this study, landfill gas emissions from a landfill located in southern Spain were estimated using static surface flux chambers and applying and comparing four geostatistical methods; ordinary kriging, lognormal kriging, intrinsic random functions of order K and indicator kriging. This paper presents the methodology used to calculate methane (and carbon dioxide) emissions from a landfill in southern Spain. Static flux chambers were used to estimate emissions through the sealing layer of a landfill assuming that the geospatial mean best expresses the average value of these emissions. This study considers several geostatistical methods for obtaining the corresponding spatial estimation, using measurements obtained from static flux chambers and finding the best proven results. The most appropriate geostatistical analysis method was found to be indicator kriging and lognormal kriging because of the simplicity of its implementation and the transformation of the flux measurements. Methane surface emissions (100 g·m-2·d-1) and visualization of the hotspots were significant enough to result in the placement of a new cover across the entire landfill. This additional cover had an immediate impact on the effectiveness of the recovery system and increased LFG collection flow rates by 15% with an increase in CH4 concentration in the collected gas from 50% to 60%.

Experimental Study of Macro and Microgeometric Defects in Drilled Carbon Fiber Reinforced Plastics by Laser Beam Machining.

Plastic matrix composite materials are an excellent choice for structural applications where high strength-weight and stiffness-weight ratios are required. These materials are being increasingly used in diverse industrial sectors, particularly in aerospace. Due to the strict tolerances required, they are usually machined with drilling cycles due to the type of mounting through rivets. In this sense, laser beam drilling is presented as an alternative to conventional drilling due to the absence of tool wear, cutting forces, or vibrations during the cutting process. However, the process carries with it other problems that compromise the integrity of the material. One of these is caused by the high temperatures generated during the interaction between the laser and the material. In this work, variance analysis is used to study the influence of scanning speed and frequency on macro geometric parameters, surface quality, and defects (taper and heat affected zone). Also, in order to identify problems in the wall of the drill, stereoscopic optical microscopy (SOM) and scanning electron microscopy (SEM) techniques are used. This experimental procedure reveals the conditions that minimize deviations, defects, and damage in machining holes.

Evaluation of the Functional Performance in Turned Workpieces: Methodology and Application to UNS A92024-T3.

Turning of light alloys as aluminum-based UNS A92024-T3 is broadly implemented in the manufacture of critical aircraft parts, so ensuring a good functional performance of these pieces is essential. Moreover, operational conditions of these pieces include saline environments where corrosion processes are present. In this paper, a methodology for the evaluation of the functional performance in turned pieces is proposed. Specimens affected and not affected by corrosion are compared. In addition, performance in service through tensile stress tests of these parts is considered. The results show that turning improves the functional performance of UNS A92024-T3 alloy and that corrosion can enhance the mechanical properties of this alloy.

[Revision bariatric surgery after endoscopic sleeve gastroplasty]. / Revisión quirúrgica bariátrica tras gastroplastia vertical endoscópica.

BACKGROUND: Attempts are being made in recent years to replace open surgery with endoscopic techniques in some obese patients when medical treatment fails, as they are considered to be less-invasive procedures. To date, there is little scientific evidence regarding their effectiveness. CLINICAL CASES: The cases are reported of 2 patients who attended our surgery looking for an effective bariatric surgical treatment after failed endoscopic sleeve gastroplasty. CONCLUSIONS: Laparoscopic sleeve gastrectomy after failure of an endoscopic technique does not offer great variation from the standard technique.

TGF-ß antagonist attenuates fibrosis but not luminal narrowing in experimental tracheal stenosis.

OBJECTIVE: Acquired tracheal stenosis (ATS) is an unusual disease often secondary to prolonged mechanical trauma. Acquired tracheal stenosis pathogenesis involves inflammation and subsequent fibrosis with narrowing of the tracheal lumen. Transforming growth factor-ß1 (TGF-ß) represents a pivotal factor in most fibrotic processes, and therefore a potential target in this context. The aim of this study is to analyze the role of TGF-ß as a target for anti-fibrotic interventions in tracheal stenosis. METHODS: Human stenotic tracheobronchial tissues from patients with benign airway stenosis and normal controls from pneumonectomy specimens were analyzed. Tracheal stenosis was induced in adult NZ rabbits by a circumferential thermal injury to the mucosa during open surgery and re-anastomosis. Rabbits were treated postoperatively with a peritracheal collagen sponge containing a TGF-ß peptide antagonist (p17) or vehicle. Fibrosis was determined by Masson's trichrome staining, and smooth muscle cell α-actin+ (α-SMA+ Confirm accuracy.) myofibroblasts, connective tissue growth factor (CTGF), and p-Smad2/3 expression by immunohistochemistry. RESULTS: Human and rabbit stenotic tissues showed extensive submucosal fibrosis, characterized by significantly increased α-SMA+ myofibroblasts and CTGF expression. In human stenotic lesions, increased p-Smad2/3+ nuclei were also observed. p17 treatment significantly reduced the fibrotic thickness, as well as the density of α-SMA+ myofibroblasts and CTGF+ cells in rabbit stenotic lesions, but failed to improve the luminal area. CONCLUSION: ATS is characterized by a TGF-ß dependent fibrotic process, but reduction of the fibrotic component by TGF-ß1 antagonist therapy was not sufficient to improve tracheal narrowing, suggesting that fibrosis may not be the main contributor to luminal stenosis. LEVEL OF EVIDENCE: NA. Laryngoscope, 127:561-567, 2017.

Intermittent hypobaric hypoxia induces neuroprotection in kainate-induced oxidative stress in rats.

Severe hypoxia induces oxidative stress, which can lead to brain injury. In this study, we wanted to determine whether intermittent hypobaric hypoxia induces oxidative stress in the brain. In adult rats exposed to 380 mmHg in a hypobaric chamber for 3 h/day for 6 days, we determined the levels of malondialdehyde and nitric oxide derivatives in the brain, which indicated that there was no oxidative stress. The levels of N-acetylaspartate indicated that there was no neuronal loss or mitochondrial dysfunction and finally because apoptotic proteins such as caspase-3 and nuclear factor-kappa B (NF-κB) were not activated, apoptosis was probably not induced. The increase in the expression of erythropoietin (EPO) in the brain of rats exposed to hypoxia confirms the efficacy of the method used to induce hypoxia in the brain. Because EPO have antioxidant effects on the brain, the results suggest that intermittent hypoxia can increase the antioxidant capacity of the brain. This effect of intermittent hypoxia was studied using the systemic administration of kainate, as a model of brain oxidative stress. Kainate treatment induces oxidative stress in the brain, which is measured by an increase in lipid peroxidation and nitric oxide. Furthermore, in rats treated with kainate, both caspase-3 and NF-κB activity increased. However, in rats previously exposed to intermittent hypobaric hypoxia, 3 h per day for 6 days, the effect of kainate treatment resulted in the reduction of both oxidative stress and apoptotic activity. This study demonstrates that intermittent hypobaric hypoxia can increase brain antioxidant capacity in rats and induces neuroprotection in kainate-induced oxidative injury.

Infective endocarditis after the Ross procedure.

The Ross procedure is presumed to have a lower incidence of infective endocarditis during follow-up compared to other traditional aortic replacement procedure. We describe 4 cases of infective endocarditis during follow-up of 96 patients who underwent the Ross procedure in our institution. All episodes occurred in patients with a previously dysfunctioning graft. One patient required surgery during the active phase of the infective endocarditis. Clinical outcome was successful in all patients and no one died during follow-up. In conclusion, the incidence of infective endocarditis in patients operated on using the Ross procedure is not negligible. The potential beneficial effect of the Ross procedure with respect to a higher resistance to infection should be evaluated in large prospective series.

Beneficial effects of fructose 1,6-biphosphate on hypothermia-induced reactive oxygen species injury in rats.

The release of reactive oxygen species has been described in hypothermic cells and tissues. Fructose 1,6-biphosphate (F1,6-BP) protects tissue stored at cold temperatures. We study the effect of F1,6-BP in vivo administration on anaesthetized rats exposed to cold stress (4 degrees C chamber for 30 min) and rewarming, to see if it alters cold-induced oxidative injury. Body temperatures show that the animals reached moderate hypothermia (26.80+/-0.62 degrees C) after 30 min of cold exposition. A decrease in mean arterial pressure was found. One group of animals was then rewarmed. Both hypothermia and rewarming increased the production of thiobarbituric acid-reactive substances, an index of lipid peroxidation, and reduced the antioxidant levels of plasmatic sulfhydryl groups, as well as decreasing the enzymatic activities of Cu,Zn-superoxide dismutase (Cu,Zn-SOD), catalase and GSH peroxidase in erythrocytes. Administration of F1,6-BP increased sulfhydryl groups and limited lipid peroxidation in plasma. It furthermore enhanced Cu,Zn-SOD and GSH peroxidase antioxidant activity in erythrocytes and preserved mean arterial pressure. Therefore, F1,6-BP has therapeutic potential based on its ability to reduce free-radical injury resulting from acute cold exposure and rewarming in vivo.

Enhanced antioxidant defenses and resistance to TNF-alpha in a glycolysis-depleted lung epithelial cell line.

Glycolysis-depleted cells, obtained by stable transfection of fructose 2,6-bisphosphatase in mink lung epithelial cells (Mv1Lu), were less sensitive to serum withdrawal- and TNF-alpha-induced apoptosis than cells transfected with the empty vector pcDNA3 (control cells). We compared the differences in the redox status of the two transfectants and the changes produced by TNF-alpha treatment. The activities of the antioxidant enzymes catalase and glutathione peroxidase, as well as the content of reduced glutathione (GSH) and the activity of the nuclear transcription factor kappa B (NF-kappa B), were higher in pFBPase-2 clones than in control cells in all the conditions tested. TNF-alpha challenge sharpened the differences in glutathione peroxidase activity, GSH/GSSG ratios, and NF-kappa B activation between transfectants. These data indicate that glycolysis restriction at the PFK step protects cells against apoptotic stimuli by increasing the GSH content and NF-kappa B activity. This acquired feature may compromise antineoplastic treatments based on glycolytic depletion.