RESUMO
As frequency of endovascular treatments for intracranial aneurysms increases, there is a growing need to understand the mechanisms for coil embolization failure. Computational fluid dynamics (CFD) modeling often simplifies modeling the endovascular coils as a homogeneous porous medium (PM), and focuses on the vascular wall endothelium, not considering the biomechanical environment of platelets. These assumptions limit the accuracy of computations for treatment predictions. We present a rigorous analysis using X-ray microtomographic imaging of the coils and a combination of Lagrangian (platelet) and Eulerian (endothelium) metrics. Four patient-specific, anatomically accurate in vitro flow phantoms of aneurysms are treated with the same patient-specific endovascular coils. Synchrotron tomography scans of the coil mass morphology are obtained. Aneurysmal hemodynamics are computationally simulated before and after coiling, using patient-specific velocity/pressure measurements. For each patient, we analyze the trajectories of thousands of platelets during several cardiac cycles, and calculate residence times (RTs) and shear exposure, relevant to thrombus formation. We quantify the inconsistencies of the PM approach, comparing them with coil-resolved (CR) simulations, showing the under- or overestimation of key hemodynamic metrics used to predict treatment outcomes. We fully characterize aneurysmal hemodynamics with converged statistics of platelet RT and shear stress history (SH), to augment the traditional wall shear stress (WSS) on the vascular endothelium. Incorporating microtomographic scans of coil morphology into hemodynamic analysis of coiled intracranial aneurysms, and augmenting traditional analysis with Lagrangian platelet metrics improves CFD predictions, and raises the potential for understanding and clinical translation of computational hemodynamics for intracranial aneurysm treatment outcomes.
Assuntos
Aneurisma IntracranianoRESUMO
PURPOSE: Intravascular endoscopy can aid in the diagnosis of coronary atherosclerosis by providing direct color images of coronary plaques. The procedure requires a blood-free optical path between the catheter and plaque, and achieving clearance safely remains an engineering challenge. In this study, we investigate the hemodynamics of saline flushing in partially occluded coronary arteries to advance the development of intravascular forward-imaging catheters that do not require balloon occlusion. METHODS: In-vitro experiments and CFD simulations are used to quantify the influence of plaque size, catheter stand-off distance, saline injection flowrate, and injection orientation on the time required to achieve blood clearance. RESULTS: Experiments and simulation of saline injection from a dual-lumen catheter demonstrated that flushing times increase both as injection flow rate (Reynolds number) decreases and as the catheter moves distally away from the plaque. CFD simulations demonstrated that successful flushing was achieved regardless of lumen axial orientation in a 95% occluded artery. Flushing time was also found to increase as plaque size decreases for a set injection flowrate, and a lower limit for injection flowrate was found to exist for each plaques size, below which clearance was not achieved. For the three occlusion sizes investigated (90, 95, 97% by area), successful occlusion was achieved in less than 1.2 s. Investigation of the pressure fields developed during injection, highlight that rapid clearance can be achieved while keeping the arterial overpressure to < 1 mmHg. CONCLUSIONS: A dual lumen saline injection catheter was shown to produce clearance safely and effectively in models of partially occluded coronary arteries. Clearance was achieved across a range of engineering and clinical parameters without the use of a balloon occlusion, providing development guideposts for a fluid injection system in forward-imaging coronary endoscopes.
Assuntos
Vasos Coronários , Hemodinâmica , Modelos Cardiovasculares , Solução Salina , Solução Salina/administração & dosagem , Vasos Coronários/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Humanos , Simulação por Computador , Circulação Coronária , Placa Aterosclerótica , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Desenho de Equipamento , Cateteres Cardíacos , Endoscopia/instrumentação , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/fisiopatologia , Oclusão Coronária/terapia , Fatores de TempoRESUMO
Patients with advanced heart failure are implanted with a left ventricular assist device (LVAD) as a bridge-to-transplantation or destination therapy. Despite advances in pump design, the risk of stroke remains high. LVAD implantation significantly alters intraventricular hemodynamics, where regions of stagnation or elevated shear stresses promote thrombus formation. Third generation pumps incorporate a pulsatility mode that modulates rotational speed of the pump to enhance in-pump washout. We investigated how the timing of the pulsatility mode with the cardiac cycle affects intraventricular hemodynamic factors linked to thrombus formation. Computational fluid dynamics simulations with Lagrangian particle tracking to model platelet behavior in a patient-specific left ventricle captured altered intraventricular hemodynamics due to LVAD implantation. HeartMate 3 incorporates a pulsatility mode that modulates the speed of the pump every two seconds. Four different timings of this pulsatility mode with respect to the cardiac cycle were investigated. A strong jet formed between the mitral valve and inflow cannula. Blood stagnated in the left ventricular outflow tract beneath a closed aortic valve, in the near-wall regions off-axis of the jet, and in a large counterrotating vortex near the anterior wall. Computational results showed good agreement with particle image velocimetry results. Synchronization of the pulsatility mode with peak systole decreased stasis, reflected in the intraventricular washout of virtual contrast and Lagrangian particles over time. Temporal synchronization of HeartMate 3 pulsatility with the cardiac cycle reduces intraventricular stasis and could be beneficial for decreasing thrombogenicity.
Assuntos
Coração Auxiliar , Hemodinâmica , Modelos Cardiovasculares , Humanos , Ventrículos do Coração , Simulação por Computador , Trombose/fisiopatologia , Insuficiência Cardíaca/fisiopatologiaRESUMO
The Circle of Willis (CoW) is a ring-like network of blood vessels that perfuses the brain. Flow in the collateral pathways that connect major arterial inputs in the CoW change dynamically in response to vessel narrowing or occlusion. Vasospasm is an involuntary constriction of blood vessels following subarachnoid hemorrhage (SAH), which can lead to stroke. This study investigated interactions between localization of vasospasm in the CoW, vasospasm severity, anatomical variations, and changes in collateral flow directions. Patient-specific computational fluid dynamics (CFD) simulations were created for 25 vasospasm patients. Computed tomographic angiography scans were segmented capturing the anatomical variation and stenosis due to vasospasm. Transcranial Doppler ultrasound measurements of velocity were used to define boundary conditions. Digital subtraction angiography was analyzed to determine the directions and magnitudes of collateral flows as well as vasospasm severity in each vessel. Percent changes in resistance and viscous dissipation were analyzed to quantify vasospasm severity and localization of vasospasm in a specific region of the CoW. Angiographic severity correlated well with percent changes in resistance and viscous dissipation across all cerebral vessels. Changes in flow direction were observed in collateral pathways of some patients with localized vasospasm, while no significant changes in flow direction were observed in others. CFD simulations can be leveraged to quantify the localization and severity of vasospasm in SAH patients. These factors as well as anatomical variation may lead to changes in collateral flow directions. Future work could relate localization and vasospasm severity to clinical outcomes like the development of infarct.
Assuntos
Circulação Cerebrovascular , Círculo Arterial do Cérebro , Modelos Cardiovasculares , Vasoespasmo Intracraniano , Humanos , Círculo Arterial do Cérebro/fisiopatologia , Círculo Arterial do Cérebro/diagnóstico por imagem , Vasoespasmo Intracraniano/fisiopatologia , Vasoespasmo Intracraniano/diagnóstico por imagem , Feminino , Masculino , Pessoa de Meia-Idade , Hidrodinâmica , Idoso , Circulação Colateral , AdultoRESUMO
BACKGROUND: Computational fluid dynamics (CFD) simulations are a powerful tool for studying cerebral aneurysms, capable of evaluating hemodynamics in a way that is infeasible with imaging alone. However, the difficulty of incorporating patient-specific information and inherent obstacles of in vivo validation have limited the clinical usefulness of CFD of cerebral aneurysms. In this work we investigate the effect of using standardized blood viscosity values in CFD simulations of cerebral aneurysms when compared to simulations of the same aneurysms using patient-specific viscosity values derived from hematocrit measurements. PURPOSE: The objective of this work is to determine the level of error, on average, that is, caused by using standardized values of viscosity in CFD simulations of cerebral aneurysms. By quantifying this error, we demonstrate the need for incorporating patient-specific viscosity in future CFD investigations of cerebral aneurysms. METHODS: CFD simulations of forty-one cerebral aneurysms were conducted using patient-specific boundary conditions. For each aneurysm two simulations were conducted, one utilizing patient-specific blood viscosity derived from hematocrit measurements and another using a standardized value for blood viscosity. Hemodynamic parameters such as wall shear stress (WSS), wall shear stress gradient (WSSG), and the oscillatory shear index (OSI) were calculated for each of the simulations for each aneurysm. Paired t-tests for differences in the time-averaged maps of these hemodynamic parameters between standardized and patient-specific viscosity simulations were conducted for each aneurysm. Bland-Altman analysis was used to examine the cohort-wide changes in the hemodynamic parameters. Subjects were broken into two groups, those with higher than standard viscosity and those with lower than standard viscosity. An unpaired t-test was used to compare the percent change in WSS, WSSG, and OSI between patient-specific and standardized viscosity simulations for the two cohorts. The percent changes in hemodynamic parameters were correlated against the direction and magnitude of percent change in viscosity, aneurysm size, and aneurysm location. For all t-tests, a Bonferroni-corrected significance level of 0.0167 was used. RESULTS: 63.2%, 41.5%, and 48.7% of aneurysms showed statistically significant differences between patient-specific and standardized viscosity simulations for WSS, WSSG, and OSI respectively. No statistically significant difference was found in the percent changes in WSS, WSSG, and OSI between the group with higher than standard viscosity and those with lower than standard viscosity, indicating an increase in viscosity can cause either an increase or decrease in each of the hemodynamic parameters. On a study-wide level no significant bias was found in either direction for WSS, WSSG, or OSI between the simulation groups due to the bidirectional effect of changing viscosity. No correlation was found between percent change of viscosity and percent change of WSS, WSSG, or OSI, meaning an after-the-fact correction for patient-specific viscosity is not feasible. CONCLUSION: Standardizing viscosity values in CFD of cerebral aneurysms has a large and unpredictable impact on the calculated WSS, WSSG, and OSI when compared to CFD simulations of the same aneurysms using a patient-specific viscosity. We recommend implementing hematocrit-based patient-specific blood viscosity values for all CFD simulations of cerebral aneurysms.
Assuntos
Aneurisma Intracraniano , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Viscosidade , Hidrodinâmica , Hemodinâmica , Estresse Mecânico , Modelos CardiovascularesRESUMO
Endoscopy is the gold standard for characterizing pediatric airway disorders, however, it is limited for quantitative analysis due to lack of three-dimensional (3D) vision and poor stereotactic depth perception. We utilize structure from motion (SfM) photogrammetry, to reconstruct 3D surfaces of pathologic and healthy pediatric larynges from monocular two-dimensional (2D) endoscopy. Models of pediatric subglottic stenosis were 3D printed and airway endoscopies were simulated. 3D surfaces were successfully reconstructed from endoscopic videos of all models using an SfM analysis toolkit. Average subglottic surface error between SfM reconstructed surfaces and 3D printed models was 0.65 mm as measured by Modified Hausdorff Distance. Average volumetric similarity between SfM surfaces and printed models was 0.82 as measured by Jaccard Index. SfM can be used to accurately reconstruct 3D surface renderings of the larynx from 2D endoscopy video. This technique has immense potential for use in quantitative analysis of airway geometry and virtual surgical planning.
Assuntos
Laringe , Humanos , Criança , Projetos Piloto , Laringe/diagnóstico por imagem , Laringe/cirurgia , Endoscopia/métodos , Sistema Respiratório , Imageamento Tridimensional/métodos , Fotogrametria/métodosRESUMO
Robin Sequence (RS) is a potentially fatal craniofacial condition characterized by undersized jaw, posteriorly displaced tongue, and resultant upper airway obstruction (UAO). Accurate assessment of UAO severity is crucial for management and diagnosis of RS, yet current evaluation modalities have significant limitations and no quantitative measures of airway resistance exist. In this study, we combine 4-dimensional computed tomography and computational fluid dynamics (CFD) to assess, for the first time, UAO severity using fluid dynamic metrics in RS patients. Dramatic intrapopulation differences are found, with the ratio between most and least severe patients in breathing resistance, energy loss, and peak velocity equal to 40:1, 20:1, and 6:1, respectively. Analysis of local airflow dynamics characterized patients as presenting with primary obstructions either at the location of the tongue base, or at the larynx, with tongue base obstructions resulting in a more energetic stenotic jet and greater breathing resistance. Finally, CFD-derived flow metrics are found to correlate with the level of clinical respiratory support. Our results highlight the large intrapopulation variability, both in quantitative metrics of UAO severity (resistance, energy loss, velocity) and in the location and intensity of stenotic jets for RS patients. These results suggest that computed airflow metrics may significantly improve our understanding of UAO and its management in RS.
Assuntos
Laringe , Síndrome de Pierre Robin , Humanos , Lactente , Hidrodinâmica , Síndrome de Pierre Robin/diagnóstico por imagem , Traqueia , Tomografia Computadorizada por Raios X , Constrição PatológicaRESUMO
Cerebral aneurysms are a serious clinical challenge, with â¼half resulting in death or disability. Treatment via endovascular coiling significantly reduces the chances of rupture, but the techniquehas failure rates of â¼20 %. This presents a pressing need to develop a method fordetermining optimal coildeploymentstrategies. Quantification of the hemodynamics of coiled aneurysms using computational fluid dynamics (CFD) has the potential to predict post-treatment outcomes, but representing the coil mass in CFD simulations remains a challenge. We use the Finite Element Method (FEM) for simulating patient-specific coil deployment for n = 4 ICA aneurysms for which 3D printed in vitro models were also generated, coiled, and scanned using ultra-high resolution synchrotron micro-CT. The physical and virtual coil geometries were voxelized onto a binary structured grid and porosity maps were generated for geometric comparison. The average binary accuracy score is 0.8623 and the average error in porosity map is 4.94 %. We then conduct patient-specific CFD simulations of the aneurysm hemodynamics using virtual coils geometries, micro-CT generated oil geometries, and using the porous medium method to represent the coil mass. Hemodynamic parameters including Neck Inflow Rate (Qneck) and Wall Shear Stress (WSS) were calculated for each of the CFD simulations. The average relative error in Qneck and WSS from CFD using FEM geometry were 6.6 % and 21.8 % respectively, while the error from CFD using a porous media approximation resulted in errors of 55.1 % and 36.3 % respectively; demonstrating a marked improvement in the accuracy of CFD simulations using FEM generated coil geometries.
Assuntos
Aneurisma Intracraniano , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Hidrodinâmica , Análise de Elementos Finitos , Hemodinâmica , Resultado do TratamentoRESUMO
Similar to previous iterations, this action research study examined student perceptions of K-12 online learning as part of an action research project working to improve a graduate course on using internet-based instruction in the classroom. Additionally, since the data were collected prior to the COVID-19 pandemic, additional analysis of the qualitative data shines a light on why K-12 education struggled with the transition to remote teaching in the spring of 2020. Qualitative analysis of student artifacts, particularly student blog posts, revealed a general lack of awareness about the scope of online learning at the time, an evolving consensus of whether online learning was suitable for various ages, and how adults support online learning. Recommendations for future iterations of the course take these themes into account, along with how the pandemic may have already changed the opinions of future students in the course.
RESUMO
Flow in side-wall cerebral aneurysms can be ideally modelled as the combination of flow over a spherical cavity and flow in a curved circular pipe, two canonical flows. Flow in a curved pipe is known to depend on the Dean number De, combining the effects of Reynolds number, Re, and of the curvature along the pipe centreline, κ. Pulsatility in the flow introduces a dependency on the Womersley number Wo. Using stereo PIV measurements, this study investigated the effect of these three key non-dimensional parameters, by modifying pipe curvature (De), flow-rate (Re), and pulsatility frequency (Wo), on the flow patterns in a spherical cavity. A single counter-rotating vortex was observed in the cavity for all values of pipe curvature κ and Re, for both steady and pulsatile inflow conditions. Increasing the pipe curvature impacted both the flow patterns in the pipe and the cavity, by shifting the velocity profile towards the cavity opening and increasing the flow rate into the cavity. The circulation in the cavity was found to collapse well with only the Dean number, for both steady and pulsatile inflows. For pulsatile inflow, the counter-rotating vortex was unstable and the location of its centre over time was impacted by the curvature of the pipe, as well as the Re and the Wo in the freestream. The circulation in the cavity was higher for steady inflow than for the equivalent average Reynolds and Dean number pulsatile inflow, with very limited impact of the Womersley in the range studied.
RESUMO
The flow in a spherical cavity on a curved round pipe is a canonical flow that describes well the flow inside a sidewall aneurysm on an intracranial artery. Intracranial aneurysms are often treated with a flow-diverting stent (FDS), a low-porosity metal mesh that covers the entrance to the cavity, to reduce blood flow into the aneurysm sac and exclude it from mechanical stresses imposed by the blood flow. Successful treatment is highly dependent on the degree of reduction of flow inside the cavity, and the resulting altered fluid mechanics inside the aneurysm following treatment. Using stereoscopic particle image velocimetry, we characterize the fluid mechanics in a canonical configuration representative of an intracranial aneurysm treated with a FDS: a spherical cavity on the side of a curved round pipe covered with a metal mesh formed by an actual medical FDS. This porous mesh coverage is the focus of Part 2 of the paper, characterizing the effects of parent vessel Re, De and pulsatility, Wo, on the fluid dynamics, compared with the canonical configuration with no impediments to flow into the cavity that is described in Part 1 (Chassagne et al., J. Fluid Mech., vol. 915, 2021, A123). Coverage with a FDS markedly reduces the flow Re in the aneurysmal cavity, creating a viscous-dominated flow environment despite the parent vessel Re > 100. Under steady flow conditions, the topology that forms inside the cavity is shown to be a function of the parent vessel De. At low values of De, flow enters the cavity at the leading edge and remains attached to the wall before exiting at the trailing edge, a novel behaviour that was not found under any conditions of the high-Re, unimpeded cavity flow described in Part 1. Under these conditions, flow in the cavity co-rotates with the direction of the free-stream flow, similar to Stokes flow in a cavity. As De increases, the flow along the leading edge begins to separate, and the recirculation zone grows with increasing De, until, above De ≈ 180, the flow inside the cavity is fully recirculating, counter-rotating with respect to the free-stream flow. Under pulsatile flow conditions, the vortex inside the cavity progresses through the same cycle - switching from attached and co-rotating with the free-stream flow at the beginning of the cycle (low velocity and positive acceleration) to separated and counter-rotating as De reaches a critical value. The location of separation within the harmonic cycle is shown to be a function of both De and Wo. The values of aneurysmal cavity Re based on both the average velocity and the circulation inside the cavity are shown to increase with increasing values of De, while Wo is shown to have little influence on the time-averaged metrics. As De increases, the strength of the secondary flow in the parent vessel grows, due to the inertial instability in the curved pipe, and the flow rate entering the cavity increases. Thus, the effectiveness of FDS treatment to exclude the aneurysmal cavity from the haemodynamic stresses is compromised for aneurysms located on high-curvature arteries, i.e. vessels with high De, and this can be a fluid mechanics criterion to guide treatment selection.
RESUMO
Most national standards for assessment of water quality include physical and chemical indicators relevant to specific pollutants and stressors. However, biological communities reflect not only current conditions of aquatic resources but also change in conditions over time and impacts from multiple stressors. Assessing the health of the aquatic community (that is, bioassessments) has proven to be critical in protecting and maintaining healthy surface waters under the mandates of regulatory frameworks, such as the Clean Water Act in the USA and the Water Framework Directive of the European Union. Whereas, in Thailand water standards, bioassessment is lacking in favor of chemical criteria, only coliform bacteria measurement can be considered a surrogate biological parameter. Our paper argues that incorporating bioassessment will improve water resource condition evaluations and recommends the use of the benthic macroinvertebrate assemblage as a bioassessment framework in Thailand. We discuss the implementation of a bioassessment program that consists of two major components, (a) a scientifically valid technical approach and (b) consideration of technical resources for a cost-effective program. The technical design comprises (1) classification of streams into similar groupings, (2) design of a biological survey, (3) a well-documented sampling protocol, (4) calibration of biological metrics for data analysis, (5) development of criteria for determination of ecological condition, and (6) communication of the results to citizens and policymakers. A cost-effective way to develop a bioassessment program that will improve Thailand's ability to measure water quality and to make good decisions to attain healthy quality status is to establish partnerships by coordinating efforts and sharing data and technology with adjacent regional environmental offices or provinces. This collaboration would be fostered through a long-term national water resources management strategy and clear definition of goals and desired outcomes that are critical components of the overall National Plan for Ecological Health.
Assuntos
Monitoramento Ambiental/métodos , Água Doce/análise , Microbiologia da Água , Abastecimento de Água/análise , Tailândia , Abastecimento de Água/normasRESUMO
Flow-diverting stents (FDS) are used to treat cerebral aneurysms. They promote the formation of a stable thrombus within the aneurysmal sac and, if successful, isolate the aneurysmal dome from mechanical stresses to prevent rupture. Platelet activation, a mechanism necessary for thrombus formation, is known to respond to biomechanical stimuli, particularly to the platelets' residence time and shear stress exposure. Currently, there is no reliable method for predicting FDS treatment outcomes, either a priori or after the procedure. Eulerian computational fluid dynamic (CFD) studies of aneurysmal flow have searched for predictors of endovascular treatment outcome; however, the hemodynamics of thrombus formation cannot be fully understood without considering the platelets' trajectories and their mechanics-triggered activation. Lagrangian analysis of the fluid mechanics in the aneurysmal vasculature provides novel metrics by tracking the platelets' residence time (RT) and shear history (SH). Eulerian and Lagrangian parameters are compared for 19 patient-specific cases, both pre- and post-treatment, to assess the degree of change caused by the FDS and subsequent treatment efficacy.
Assuntos
Plaquetas/fisiologia , Aneurisma Intracraniano/terapia , Stents , Simulação por Computador , Hemodinâmica , Humanos , Modelos BiológicosRESUMO
Thailand currently lacks formal bioassessment approaches and protocols to assist management decisions for water quality. The aim of this research is to develop a practical method of rapid bioassessment for a professional level by using benthic macroinvertebrate assemblages for streams in Thailand. Eleven reference and nine test sites were sampled in the headwater streams of the Loei River and adjacent areas to explore the development of a practical protocol. Specific physico-chemical parameters were selected to provide ecological information supplemental to the biological indicators. The biological research was designed around the USEPA Rapid Bioassessment Protocols (RBPs) using the multi-habitat approach. Four fixed-count subsamplings (100, 200, 300 and 500 organisms) were randomly conducted using a standardized gridded pan to evaluate an appropriate level for bioassessment in Thai streams. A 300 organism subsample is adequate for bioassessment purposes in Thai stream (evaluated by calculating dissimilarity values and ordination techniques). A systematic selection of candidate reference sites, metric selection, and index calibration was part of this research. Multimetric and multivariate analyses were examined as a foundation for bioassessment in Thailand. The multimetric approach appears to be more practical for a rapid bioassessment technique. Nine core metrics were identified for biological index score including number of total taxa, Diptera taxa, Ephemeroptera, Plecoptera, Trichoptera, and Coleoptera taxa, (%) Plecoptera, (%) Tolerant organisms, Beck's Biotic Index, (%) Intolerant organisms, Shredders taxa and Clingers taxa were calibrated for the final index. As a result of multimetric and multivariate analyses, family level identification data effectively discriminated reference condition and broad-scale environmental gradients. Hampered by incomplete taxonomic knowledge of benthic macroinvertebrates in Thailand, family-level identification may be sufficient taxonomic resolution for rapid bioassessment in Thailand.
Assuntos
Monitoramento Ambiental/métodos , Invertebrados/metabolismo , Rios , Animais , Biodiversidade , Invertebrados/crescimento & desenvolvimento , TailândiaRESUMO
We developed a systematic process to evaluate state/tribal bioassessment programs to provide information about the rigor of the technical approach. This is accomplished via on-site interviews to produce an evaluation that assigns one of four levels of rigor as an outcome. Level 4 is the most rigorous and reflects a technical capacity to accurately determine incremental condition and support management programs. The remaining three levels are less able to assess incremental condition and are appropriate for only some management support needs. Accurately determining impairment and diagnosing pollution-specific stressors are fundamental tasks that states/tribes must accomplish to provide management support. This goal is fulfilled to varying degrees by most states/tribes. The evaluation employs a checklist and a sliding scale of rigor for 13 technical elements. Feedback is provided to each state/tribe via a technical memorandum that describes the technical components of the monitoring program, highlights strengths, and recommends improvements for specific technical issues. This can be used to refine the bioassessment and monitoring programs to better support management programs. The results of 14 state/tribal evaluations are included here. The majority (nine states, one tribe) revealed that most operate at level 2 with developmental activities that will elevate the level of program rigor already underway. Two states operate level 4 programs and each have numeric biocriteria and refined designated uses in their water quality standards. This is the ultimate goal of the process of engaging states in the development of bioassessment programs in the U.S.
Assuntos
Monitoramento Ambiental/métodos , Monitoramento Ambiental/normas , Avaliação de Programas e Projetos de Saúde/métodos , Animais , Eficiência Organizacional , Monitoramento Ambiental/legislação & jurisprudência , Poluentes Ambientais , Humanos , Estados Unidos , United States Environmental Protection AgencyRESUMO
Perianeurysmal hemodynamics play a vital role in the initiation, growth and rupture of intracranial aneurysms. In vitro investigations of aneurysmal hemodynamics are helpful to visualize and measure blood flow, and aiding surgical planning approaches. Improving in vitro model creation can improve the feasibility and accuracy of hemodynamic investigations and surgical planning, improving clinical value. In this study, in vitro models were created from three-dimensional rotational angiography (3DRA) of six patients harboring intracranial aneurysms using a multi-step process involving 3D printing, index of refraction matching and silicone casting that renders the models transparent for flow visualization. Each model was treated with the same commercially-available, patient-specific, endovascular devices (coils and/or stents). All models were scanned by synchrotron X-ray microtomography to obtain high-resolution imaging of the vessel lumen, aneurysmal sac and endovascular devices. Dimensional accuracy was compared by quantifying the differences between the microtomographic reconstructions of the fabricated phantoms and the original 3DRA obtained during patient treatment. True-scale in vitro flow phantoms were successfully created for all six patients. Optical transparency was verified by using an index of refraction matched working fluid that replicated the mechanical behavior of blood. Synchrotron imaging of vessel lumen, aneurysmal sac and endovascular devices was successfully obtained, and dimensional errors were found to be O(100⯵m). The creation of dimensionally-accurate, optically-transparent flow phantoms of patient-specific intracranial aneurysms is feasible using 3D printing technology. Such models may enable in vitro investigations of aneurysmal hemodynamics to aid in treatment planning and outcome prediction to devise optimal patient-specific neurointerventional strategies.
Assuntos
Hemodinâmica/fisiologia , Aneurisma Intracraniano/fisiopatologia , Modelos Cardiovasculares , Imagens de Fantasmas , Impressão Tridimensional , Angiografia Cerebral/métodos , Humanos , Aneurisma Intracraniano/cirurgiaRESUMO
Central venous catheters (CVCs) are routinely filled with a heparin lock while not in use to avoid thrombus formation near the tip. However, heparin leakage is known to occur, and the lock effectiveness remains in question. It was recently shown that convective fluxes from the blood flow in the host vein transport the majority of locking solution away from the tip of hemodialysis catheters immediately after instillation. Combined with the low diffusivity of heparin, this results in concentrations of heparin at the catheter tip that are orders of magnitude lower than at instillation for the majority of the interdialytic phase, diminishing the antithrombotic effectiveness of the lock. In this study, heparin losses from three different CVCs with different tip designs are measured in a pulsatile flow loop. Planar laser-induced fluorescence and particle image velocimetry measurements of heparin concentration and fluid velocity are recorded downstream of the catheters and combined to evaluate heparin losses from each of the different catheter designs. Additionally, locking solution losses are measured from one catheter (Hickman) subjected to three different flow conditions. Heparin losses are shown to depend weakly on flow condition but be highly dependent on catheter design. Convective losses from the Hickman catheter, with no side holes, are minimal (1-2%), although losses from the other two catheter types, both with a number of side holes, are significantly higher (7%). These results indicate the potential to maintain a high concentration of locking solution during the interdialytic phase with proper catheter design, particularly focusing on side hole distribution and shape.
Assuntos
Anticoagulantes/análise , Cateteres Venosos Centrais , Heparina/análise , Diálise Renal , HumanosRESUMO
PURPOSE: Image-based computational fluid dynamics (CFD) is widely used to predict intracranial aneurysm wall shear stress (WSS), particularly with the goal of improving rupture risk assessment. Nevertheless, concern has been expressed over the variability of predicted WSS and inconsistent associations with rupture. Previous challenges, and studies from individual groups, have focused on individual aspects of the image-based CFD pipeline. The aim of this Challenge was to quantify the total variability of the whole pipeline. METHODS: 3D rotational angiography image volumes of five middle cerebral artery aneurysms were provided to participants, who were free to choose their segmentation methods, boundary conditions, and CFD solver and settings. Participants were asked to fill out a questionnaire about their solution strategies and experience with aneurysm CFD, and provide surface distributions of WSS magnitude, from which we objectively derived a variety of hemodynamic parameters. RESULTS: A total of 28 datasets were submitted, from 26 teams with varying levels of self-assessed experience. Wide variability of segmentations, CFD model extents, and inflow rates resulted in interquartile ranges of sac average WSS up to 56%, which reduced to < 30% after normalizing by parent artery WSS. Sac-maximum WSS and low shear area were more variable, while rank-ordering of cases by low or high shear showed only modest consensus among teams. Experience was not a significant predictor of variability. CONCLUSIONS: Wide variability exists in the prediction of intracranial aneurysm WSS. While segmentation and CFD solver techniques may be difficult to standardize across groups, our findings suggest that some of the variability in image-based CFD could be reduced by establishing guidelines for model extents, inflow rates, and blood properties, and by encouraging the reporting of normalized hemodynamic parameters.
Assuntos
Angiografia Cerebral/métodos , Circulação Cerebrovascular , Hemodinâmica , Aneurisma Intracraniano/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Velocidade do Fluxo Sanguíneo , Humanos , Imageamento Tridimensional , Aneurisma Intracraniano/fisiopatologia , Artéria Cerebral Média/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Interpretação de Imagem Radiográfica Assistida por Computador , Fluxo Sanguíneo Regional , Reprodutibilidade dos Testes , Estresse MecânicoRESUMO
BACKGROUND: Computational modeling of intracranial aneurysms provides insights into the influence of hemodynamics on aneurysm growth, rupture, and treatment outcome. Standard modeling of coiled aneurysms simplifies the complex geometry of the coil mass into a homogeneous porous medium that fills the aneurysmal sac. We compare hemodynamics of coiled aneurysms modeled from high-resolution imaging with those from the same aneurysms modeled following the standard technique, in an effort to characterize sources of error from the simplified model. MATERIALS: Physical models of two unruptured aneurysms were created using three-dimensional printing. The models were treated with coil embolization using the same coils as those used in actual patient treatment and then scanned by synchrotron X-ray microtomography to obtain high-resolution imaging of the coil mass. Computational modeling of each aneurysm was performed using patient-specific boundary conditions. The coils were modeled using the simplified porous medium or by incorporating the X-ray imaged coil surface, and the differences in hemodynamic variables were assessed. RESULTS: X-ray microtomographic imaging of coils and incorporation into computational models were successful for both aneurysms. Porous medium calculations of coiled aneurysm hemodynamics overestimated intra-aneurysmal flow, underestimated oscillatory shear index and viscous dissipation, and over- or underpredicted wall shear stress (WSS) and WSS gradient compared with X-ray-based coiled computational fluid dynamics models. CONCLUSIONS: Computational modeling of coiled intracranial aneurysms using the porous medium approach may inaccurately estimate key hemodynamic variables compared with models incorporating high-resolution synchrotron X-ray microtomographic imaging of complex aneurysm coil geometry.