Smoothed particle hydrodynamics based FSI simulation of the native and mechanical heart valves in a patient-specific aortic model.

The failure of the aortic heart valve is common, resulting in deterioration of the pumping function of the heart. For the end stage valve failure, bi-leaflet mechanical valve (most popular artificial valve) is implanted. However, due to its non-physiological behaviour, a significant alteration is observed in the normal haemodynamics of the aorta. While in-vivo experimentation of a human heart valve (native and artificial) is a formidable task, in-silico study using computational fluid dynamics (CFD) with fluid structure interaction (FSI) is an effective and economic tool for investigating the haemodynamics of natural and artificial heart valves. In the present work, a haemodynamic model of a natural and mechanical heart valve has been developed using meshless particle-based smoothed particle hydrodynamics (SPH). In order to further enhance its clinical relevance, this study employs a patient-specific vascular geometry and presents a successful validation against traditional finite volume method and 4D magnetic resonance imaging (MRI) data. The results have demonstrated that SPH is ideally suited to simulate the heart valve function due to its Lagrangian description of motion, which is a favourable feature for FSI. In addition, a novel methodology for the estimation of the wall shear stress (WSS) and other related haemodynamic parameters have been proposed from the SPH perspective. Finally, a detailed comparison of the haemodynamic parameters has been carried out for both native and mechanical aortic valve, with a particular emphasis on the clinical risks associated with the mechanical valve.

Marangoni Flows in a Bilayer Liquid Microfilm Interface on Wave-Contoured Hot Substrates.

This study explores the thermal Marangoni hydrodynamics in an immiscible, binary-liquid thin-film system, which is open to the gas phase at the top and rests on a heated substrate with wavy topology. The sinusoidal contour of the heated (constant-temperature) substrate results in temperature gradients along the liquid-liquid and liquid-gas interfaces, causing fluctuations in the interfacial tension, ultimately leading to Marangoni hydrodynamics in the liquid-liquid films. This type of flow is notable in liquid film coatings on patterned surfaces, which are widely used in MEMS/NEMS applications (Weinstein, S. J.; Palmer, H. J. Liquid Film Coating: Scientific Principles and Their Technological Implications; 1997, pp 19-62; Palacio, M.; Bhushan, B. Adv. Mater. 2008, 20, 1194-1198) and biological cell sorting operations (Witek, M. A.; Freed, I. M.; Soper, S. A. Anal. Chem. 2019, 92, 105-131). We solve the coupled Navier-Stokes and energy equations by the perturbation technique to obtain approximate analytical solutions and an understanding of the thermal and hydrodynamic transport in the system domain. Our study explores the parametric influence of the relative thermal conductivity of the liquid layers (k), film thickness ratio (r), and the system's Biot number (Bi) on these transport phenomena. While the strength of the thermal Marangoni effect that is generated reduces with an increase in the relative thermal conductivity (k), the impact of r depends on the k value. We observe that for k > 1 the intensity of Marangoni flow increases with r; however, the opposite holds for k < 1. Furthermore, larger values of Bi induce higher resistance to the vertical conduction from the wavy substrate compared to the convection resistance offered at the top surface, destructively interfering with the ability of the patterned substrate to generate interfacial temperature fluctuations and hence weakening the Marangoni flow.

Socioeconomic Burden of Critically Ill Patients: A Descriptive Study.

Background The cost of critical illness treatment is generally recognized as expensive and increasing in India. Critical illness of the individual will affect the socioeconomic status of the individual and the family. The direct and indirect costs of intensive care and its impact on the socioeconomic status of critically ill patients and their families need to be estimated. The present study was carried out to evaluate the socioeconomic burden of critically ill patients admitted to ICUs in Eastern India. Methods A descriptive survey was conducted to measure the socioeconomic burden. One hundred fifteen critically ill patients and their family members were conveniently selected for the study. Critically ill patients admitted to ICUs and those who were bedridden for more than seven days along with anyone the family member, i.e., spouse, father, or mother, were included in the study to estimate the impact of long-term illness on the care providers in the family. Socio-demographic and socioeconomic burdens were analyzed through the interview method. Results Half (49.6%) of the critically ill patients were heads of the family, and their employment is the primary source of income for the family members. Most (60.9%) of the patients belonged to lower socioeconomic status. Critically ill patients spend a maximum (38169.6±3996.2) amount for pharmaceutical expenses. Eventually, the family members accompanying patients lost maximum working days because of the long length of hospital stay. Below upper-lower (p=0.046) class socioeconomic family, age less than 40 (p=0.018) years, and those families depending (p=0.003) on patients' income significantly reported higher socioeconomic burden. Conclusions Critical care hospitalization of patients increases the socioeconomic burden on the whole family, especially in lower-middle-income countries like India. It soberly affects younger age group patients with low socioeconomic status and families depending on the patient's income during their man days.

Correction: Anesthetic Challenges During Whole Lung Lavage: A Case Report.

[This corrects the article DOI: 10.7759/cureus.33659.].

Correction: Anesthetic Challenges During Whole Lung Lavage: A Case Report.

[This corrects the article DOI: 10.7759/cureus.33659.].

Anesthetic Challenges During Whole Lung Lavage: A Case Report.

Pulmonary alveolar proteinosis is an uncommon lung disease characterized by the accumulation of surfactant in the lungs. Treatment is done by whole lung lavage. One-lung ventilation in diseased lungs is a challenge to anesthesiologists due to the rapid desaturation and hemodynamic fluctuations encountered during the procedure. A 24-year-old female, a known patient of pulmonary alveolar proteinosis, who had undergone previous lung lavage presented with a dry cough and shortness of breath. Our management of the case included complete lung isolation with a double-lumen tube (DLT), one-lung ventilation, and an appropriate hemodynamic management strategy during the procedure.

A Systematic Review of the Utility of Bromocriptine in Acute Peripartum Cardiomyopathy.

In formerly healthy females, acute heart failure (HF) of an unknown cause that develops during the last weeks of gestation or in the first months after childbirth is known as peripartum cardiomyopathy (PPCM). This study aimed to establish the therapeutic value of combining bromocriptine with conventional HF treatment on left ventricular ejection fraction (LVEF), death, thromboembolic events, left ventricular (LV) dysfunction recurrence in subsequent pregnancies in PPCM women, and newborn children's outcomes. We conducted a systematic review to find clinical studies that described the utility of bromocriptine in addition to conventional HF treatment compared to conventional HF treatment only in the management of acute PPCM. Four databases comprising records from July 10, 2001, to July 10, 2021, were analyzed, including PubMed (MEDLINE), Google Scholar, Scopus, and the Cochrane Library. We discovered 4,717 potentially eligible records across all the databases. According to our eligibility criteria, we included six studies consisting of 263 patients in this review. Bromocriptine combined with conventional HF therapy led to an 11.37% increase in LVEF (mean difference: 11.37; 95% confidence interval [CI]: 9.55-13.19; p-value = 0.001) after six months compared to conventional HF treatment only. Notably, bromocriptine combined with conventional HF treatment reduced mortality associated with PPCM, and no thromboembolism events were recorded in the 263 patients. PPCM is a severe condition affecting women globally. In this study, the combination of bromocriptine with conventional HF treatment enhanced the LVEF of women with acute PPCM and their clinical outcomes.

Unravelling the apoptotic mechanisms in T-lymphocytes in an animal model for pollen induced airway allergy and studying the impact of specific immunotherapy.

Asthma is a chronic inflammatory disorder of the airways, increasing in prevalence worldwide. Reduced T cell apoptosis may interfere with the down-regulation of an immune response resulting in T cell accumulation contributing to the chronic inflammation of asthma. Most studies focused so far on apoptosis of eosinophils but the detailed role of T lymphocytes apoptosis in allergic diseases is unclear yet. The present experimental study was designed to discern the modulation of various apoptotic proteins of splenic T lymphocytes in a previously established rat model of Alstonia scholaris pollen induced airway allergy. Flowcytometry, immunoblotting, and immunofluorescence imaging techniques were employed for the present investigation. Annexin-V studies registered early apoptotic rate of lymphocytes with allergen sensitization and challenge which was corrected following mucosal immunotherapy. The study demonstrates that allergen sensitization and challenge reduced apoptosis of splenic T-lymphocytes via Fas mediated extrinsic pathway, Bax/Bcl2 regulated intrinsic pathway and also perforin/granzyme mediated pathway which were normalized following allergen specific intranasal immunotherapy. Inadequate T cell apoptosis in asthma appears to interfere with normal T cell elimination, resulting in T cell accumulation, which contributes to chronic inflammation and may be the major underlying cause for tissue damage which can be modulated by intranasal immunotherapy. Thus the apoptosis inducing effect of allergen immunotherapy necessitates more studies to elaborate on its effects on various effector cells of airway inflammation.

Allergen immunotherapy modulates sensitivity of Treg cells to apoptosis in a rat model of allergic asthma.

AIM: To study the apoptosis of Foxp3+ Treg cells following Alstonia scholaris pollen sensitization-challenge and following allergen immunotherapy. MATERIALS & METHODS: Wistar rats were sensitized-challenged with Alstonia scholaris pollen and were further given intranasal immunotherapy. For the analysis of the apoptotic proteins on Treg cells by flow cytometry, multiple gating procedures were followed. RESULTS: Allergen sensitization-challenge increases Annexin-V, Fas, FasL, caspases-8, 9, 3 cytochrome-C, APAF-1, Bax, perforin-1 and granzyme-B on Treg cells which is decreased following intranasal immunotherapy. On the other hand, Bcl-2 expression is decreased in allergy and increased by immunotherapy. CONCLUSION: Apoptosis of Treg cells is increased following allergen sensitization-challenge via extrinsic, intrinsic and perforin/granzyme pathways and allergen immunotherapy decreased the sensitivity to apoptosis of Treg cells.

Thermodynamic formulation of the barrier for heterogeneous pinned nucleation: Implication to the crossover scenarios associated with barrierless and homogeneous nucleation.

The effect of contact line pinning on nucleation is reported using continuum thermodynamics. Based on the principle of the free-energy maximization, closed-form expressions in the dimensionless form for the free-energy of the three-phase metastable system and the thermodynamic barrier are formulated with respect to the system geometry and the substrate wettability. The condition of maximality limits the dynamic contact angle within the cluster-phase-phobic regime. The dimensionless nucleation barrier or the potency factor can be divided into two components related to the system geometry and the pinning effect. Depending on the relative value of the equilibrium and the critical dynamic contact angle, the contact line pinning can either have favorable or adverse effects. Associated pinning-depinning transition can also lead to the crossovers related to barrierless and homogeneous nucleation. Contact line tension is found to have a considerable effect during these transitional scenarios. Complete wetting transition associated with barrierless nucleation can take place due to the presence of tensile (negative) line tension. On the other hand, complete drying transition related to homogeneous nucleation can occur when line tension is compressive (positive) in nature. The pinning has a favorable effect only when the substrate wettability is within the cluster-phase-philic regime. There can be favorable, adverse, or no pinning effects when the substrate wettability is within the cluster-phase-phobic regime. Although the contact line is pinned, the minimum value of the potency factor is obtained when equilibrium and dynamic contact angles are equal.

Modulation of regulatory T cells by intranasal allergen immunotherapy in an experimental rat model of airway allergy.

Allergic airway diseases such as asthma and allergic rhinitis are increasing in prevalence worldwide. The theory of an altered Th1/Th2 balance in allergic diathesis has recently been termed a "procrustean paradigm" as it failed to explain many preclinical findings. Regulatory T cells (Treg) have now been shown to be critical in T-cell homeostasis and in the maintenance of peripheral tolerance to allergens. Allergen specific immunotherapy (SIT) has been shown to induce regulatory T cells in allergic patients. Among various types of SIT, intranasal immunotherapy had not been studied in detail for the treatment of allergic airway diseases. So, there was a need to study the contribution of regulatory T cells and their mechanistic pathways following intranasal immunotherapy in-vivo. It had been previously shown that intranasal allergen immunotherapy using Alstonia scholaris pollen extract abrogates allergic airway inflammation with decline in IgE and Th2 cytokine levels. The present study for the first time offers a multi-targeted approach towards attenuation of airway allergy by the generation of CD4+CD25+Foxp3+T cells and other subsets of Treg cells like Tr1 cells, Th3 cells, CTLA4+Treg cells, and also modulation of various Treg cell surface molecules like GITR, OX40, CD39 and CD73 by intranasal immunotherapy in the same animal model. This animal experiment will thus help to chart out newer molecular targets for treating allergic asthma or rhinitis.

Single-mode instability of a ferrofluid-mercury interface under a nonuniform magnetic field.

This work reports an experimental and a numerical study of the interfacial instability in a mercury-ferrofluid system caused by a spatially nonuniform magnetic field against the action of gravity and interfacial tension. The interface evolution is observed to be continuous till its movement is hindered by a physical boundary. In contrast to the behavior of the ferrofluid interface under uniform field, we noted the instability growth to be monotonic under a field gradient. A steepness in the growth curve is noticed during the later stages of the instability, indicating a high magnitude of the growth velocities. Some unique phenomena, such as similarity of the growth at the initial stage, a slope transition in the growth curve at a later stage, and wrapping and pinning of the interface are observed, both in experiments and simulations.

Thermokinetics of heterogeneous droplet nucleation on conically textured substrates.

Within the framework of the classical theory of heterogeneous nucleation, a thermokinetic model is developed for line-tension-associated droplet nucleation on conical textures considering growth or shrinkage of the formed cluster due to both interfacial and peripheral monomer exchange and by considering different geometric configurations. Along with the principle of free energy extremization, Katz kinetic approach has been employed to study the effect of substrate conicity and wettability on the thermokinetics of heterogeneous water droplet nucleation. Not only the peripheral tension is found to have a considerable effect on the free energy barrier but also the substrate hydrophobicity and hydrophilicity are observed to switch over their roles between conical crest and trough for different growth rates of the droplet. Besides, the rate of nucleation increases and further promotes nucleation for negative peripheral tension as it diminishes the free energy barrier appreciably. Moreover, nucleation inhibition can be achievable for positive peripheral tension due to the enhancement of the free energy barrier. Analyzing all possible geometric configurations, the hydrophilic narrower conical cavity is found to be the most preferred nucleation site. These findings suggest a physical insight into the context of surface engineering for the promotion or the suppression of nucleation on real or engineered substrates.

Mechanism of Bursting Taylor Bubbles at Free Surfaces.

Collapse of a Taylor bubble inside a pipe at the free surface of a liquid is studied experimentally using speed imaging camera and illumination and subsequent image analysis. Three different fluids, water, glycerin, and silicone oil, are employed in the experiments. For all conditions studied herein, the bubble punctures at the free surface to form two thin films, i.e., one covering the cross-section of the tube near the free surface and one along the tube wall in the vertical direction. Surface tension acts to collapse the first film, which widens the punctured hole in the outward radial direction, thereby feeding the liquid in the vertical film. After the shrinking of the radial film, gravity causes the collapse of the vertical film, which generates a tiny jet of liquid at the end of collapse. Experiments with different fluids show a drastic change in shape and thickness of the vertical film that leads to higher drainage time. Analysis of time scale for the drainage of the horizontal film exhibits a favorable match with experiments. Finally, evolution of the vertical film is analyzed using a simple hydrodynamic model to estimate the order magnitude of time taken to collapse, which compares well with processed image data from experiments.

Inclusion of line tension effect in classical nucleation theory for heterogeneous nucleation: A rigorous thermodynamic formulation and some unique conclusions.

A rigorous thermodynamic formulation of the geometric model for heterogeneous nucleation including line tension effect is missing till date due to the associated mathematical hurdles. In this work, we develop a novel thermodynamic formulation based on Classical Nucleation Theory (CNT), which is supposed to illustrate a systematic and a more plausible analysis for the heterogeneous nucleation on a planar surface including the line tension effect. The appreciable range of the critical microscopic contact angle (θc), obtained from the generalized Young's equation and the stability analysis, is θ∞ < θc < θ' for positive line tension and is θM < θc < θ∞ for negative line tension. θ∞ is the macroscopic contact angle, θ' is the contact angle for which the Helmholtz free energy has the minimum value for the positive line tension, and θM is the local minima of the nondimensional line tension effect for the negative line tension. The shape factor f, which is basically the dimensionless critical free energy barrier, becomes higher for lower values of θ∞ and higher values of θc for positive line tension. The combined effect due to the presence of the triple line and the interfacial areas (f(L) + f(S)) in shape factor is always within (0, 3.2), resulting f in the range of (0, 1.7) for positive line tension. A formerly presumed appreciable range for θc(0 < θc < θ∞) is found not to be true when the effect of negative line tension is considered for CNT. Estimation based on the property values of some real fluids confirms the relevance of the present analysis.

Diabetes in rural individuals of different nutritional status and the alarming situation demands focus more on its under-nutrition association.

OBJECTIVE: To study the relationship of nutritional-status with diabetes. DESIGN: The socioeconomics/anthropometrics, blood-glucose/systemic-hypertension are evaluated in consecutively-selected diabetic-patients. SETTING: Semi-urban/rural India. SUBJECTS: Hyperglycaemic patients (total 90/male 37). RESULTS: Blood-glucose (PP-mean ± SE) in individuals is overweight - 38.89% (226.94 ± 9.59), normal-weight - 50% (217.58 ± 1.34), underweight - 11.11% (305.50 ± 21.35) indicating most hyperglycaemia in undernourished-group (F = 6.357, p < 0.003). This group occupies higher glucose-groups in ≤140, 141-270, and ≥270 mg/dL. The blood-glucose negatively correlates with waist(r = -0.282; p < 0.01) and hip (r = -0.254; p < 0.05) circumference indicating the under-nutrition association with glucose-homeostasis (F = 7.6-8.2, p < 0.001). The higher glucose is noticed in more number of individuals in lower (<40 years) age-group (χ(2 )= 12.86; p < 0.002/ρ = -0.355; p < 0.001). The prevalence of hypertension is 28% (underweight = 20%, overweight = 27%, normal = 30%). The group of 141-270 mg/dL glucose has 45% and rest groups together have 23% hypertensive individuals relating directly, hypertension and diabetic-onset. CONCLUSIONS: Diabetes, explored in <40 years group and even more in female should be extensively studied accounting WHO categorization (1985/TRS/727) of malnutrition related diabetes (MRDM). Further, different interactive risk-factors should be properly addressed and the global-malnutrition/gender-based inequities be eradicated.

Spontaneous formation of biocompatible vesicles in aqueous mixtures of amino acid-based cationic surfactants and SDS/SDBS.

The spontaneous formation of vesicles by six amino acid-based cationic surfactants and two anionic surfactants (sodium dodecylbenzene sulfonate (SDBS) and sodium dodecyl sulfate (SDS)) is reported. The head-group structure of the cationic surfactants is minutely altered to understand their effect on vesicle formation. To establish the regulatory role of the aromatic group in self-aggregation, both aliphatic and aromatic side-chain-substituted amino acid-based cationic surfactants are used. The presence of aromaticity in any one of the constituents favors the formation of vesicles by cationic/anionic surfactant mixtures. The formation of vesicles is primarily dependent on the balance between the hydrophobicity and hydrophilicity of both cationic and anionic surfactants. Vesicle formation is characterized by surface tension, fluorescence anisotropy, transmission electron microscopy, dynamic light scattering, and phase diagrams. These vesicles are thermally stable up to 65 °C, determined by temperature-dependent fluorescence anisotropy. According to the MTT assay, these catanionic vesicles are nontoxic to NIH3T3 cells, thus indicating their wider applicability as delivery vehicles to cells. Among the six cationic surfactants examined, tryptophan- and tyrosine-based surfactants have the ability to reduce HAuCl(4) to gold nanoparticles (GNPs), which is utilized to obtain in-situ-synthesized GNPs entrapped in vesicles without the need for any external reducing agent.

Self-aggregation of synthesized novel bolaforms and their mixtures with sodium dodecyl sulfate (SDS) and cetyltrimethylammonium bromide (CTAB) in aqueous medium.

Bolaforms B(1), B(2), and B(3) of the formulas, Br(-)Me(3)N(+)(CH(2))(10)N(+)Me(3)Br(-), Br(-)Me(3)N(+)(CH(2))(10)OH, and Br(-)Me(3)N(+)(CH(2))(10)COO(-)Na(+), respectively, were synthesized, and their properties in the bulk as well as at the air/aqueous NaBr (10 mM) solution interface have been studied. Their interactions with sodium dodecyl sulfate (SDS) and cetyltrimethylammonium bromide (CTAB) also have been investigated. Tensiometry, conductometry, spectrophotometry, and microcalorimetry techniques were used for characterization and estimation. Both pure bolaforms and their mixtures with SDS and CTAB have been found to self-aggregate, forming micelles in solution. The mixed systems of bolaform and SDS have been observed to form both micelles and vesicles. Their mutual interactions were synergistic, which at the interface was more spontaneous than in the bulk. The interfacial and bulk compositions of the mixed binary systems (bolaform and SDS or CTAB) with their associated interaction parameters have been estimated from the Rosen interaction model and the regular solution theory of Rubingh, respectively. The formed vesicles have been found to entrap the water-soluble dye, bromophenol blue, and the dye solubilized vesicles of B(1)-SDS and B(2)-SDS completely eluted out of the sephadex column proving their formation. A rough estimation of the size and polydispersity index of the formed micelles and vesicles has been made from DLS measurements.

Simulation of drop movement over an inclined surface using smoothed particle hydrodynamics.

Smoothed particle hydrodynamics (SPH) is used to numerically simulate the movement of drops down an inclined plane. Diffuse interfaces have been assumed for tracking the motion of the contact line. The asymmetric shape of the three-dimensional drop and the variation of contact angle along its periphery can be calculated using the simulation. During the motion of a liquid drop down an inclined plane, an internal circulation of liquid particles is observed due to gravitational pull which causes periodic change in the drop shape. The critical angle of inclination required for the inception of drop motion is also evaluated for different fluids as a function of drop volume. The numerical predictions exhibit a good agreement with the published experimental results.