A near-infrared spectroscopy computational model for cerebral hemodynamics

A homogenized cerebrospinal fluid model for diffuse optical tomography in the neonatal head

Diffuse optical tomography is a non-invasive and non-irradiating medical imaging technique that is particularly suitable for cerebral monitoring of newborns since it can be used at the bedside of the patient. Here, a new model for optical tomography in the neonatal brain is presented that takes into account the presence of arachnoid trabeculae in the cerebrospinal fluid (CSF). It is known that the classical diffusion approximation (DA) for light propagation is at the limit of validity in the CSF layer due to the low values of the absorption and scattering coefficients. The new model is obtained by the DA of the homogenized radiative transfer equation and is rigorously justified. Numerical results in two and three dimensions attest for the improved sensitivity of the new model to the presence of perturbations in the brain layer.

Effect of blast loading on the risk of rib fractures: a preliminary 3D numerical investigation

Blast is a complex phenomenon which needs to be understood, especially in a military framework, where this kind of loading can have severe consequences on the human body. Indeed, the literature lists a number of studies which try to investigate the dangerousness of such a phenomenon, both at experimental and numerical level, and the injuries that could occur when the fighters or police officers are stroke by blast wave. When focusing on primary blast effect, this paper analyses the effect of this loading on the occurrence of rib fracture, using previously developed injury risk curves.

Optical brain imaging and its application to neurofeedback

Besides passive recording of brain electric or magnetic activity, also non-ionizing electromagnetic or optical radiation can be used for real-time brain imaging. Here, changes in the radiation's absorption or scattering allow for continuous in vivo assessment of regional neurometabolic and neurovascular activity. Besides magnetic resonance imaging (MRI), over the last years, also functional near-infrared spectroscopy (fNIRS) was successfully established in real-time metabolic brain imaging. In contrast to MRI, fNIRS is portable and can be applied at bedside or in everyday life environments, e.g., to restore communication and movement. Here we provide a comprehensive overview of the history and state-of-the-art of real-time optical brain imaging with a special emphasis on its clinical use towards neurofeedback and brain-computer interface (BCI) applications. Besides pointing to the most critical challenges in clinical use, also novel approaches that combine real-time optical neuroimaging with other recording modalities (e.g. electro- or magnetoencephalography) are described, and their use in the context of neuroergonomics, neuroenhancement or neuroadaptive systems discussed.

A multiscale absorption and transit model for oral delivery of hydroxychloroquine: Pharmacokinetic modeling and intestinal concentration prediction to assess toxicity and drug-induced damage in healthy subjects

Hydroxychloroquine (HCQ) is commonly used in the treatment of malaria and rheumatic diseases. Recently it has also been identified as possible therapeutic option in combating COVID-19. However, the use of HCQ is known to induce cytotoxicity. In 2020, we developed a multiscale absorption and transit (MAT) toolkit to simulate the dissolution, transport, absorption, distribution, metabolism, and elimination of orally administered drugs in the human GIT at multiple levels. MAT was constructed by integrating the spatially accurate first-principles driven high-fidelity drug transport, dissolution, and absorption model in the human stomach and GIT using the recently published Quasi-3D framework. The computational results showed that MAT was able to match the experimental concentration results better than the traditional compartmental models. In this study, we adapted MAT, to predict the pharmacokinetics of orally delivered HCQ in healthy subjects. The computational results matched the experimental concentration results. The simulated stomach and intestinal fluid and enterocyte concentrations were compared with the in vitro CC50 values. While the peak enterocyte concentrations were several orders lower than the in vitro CC50 values, the peak stomach and the intestinal fluid concentrations were only one order smaller than the in vitro CC50 values. In particular, the peak stomach and the duodenum fluid concentrations were just 3× smaller than the in vitro CC50 values. This implies that the lumen walls are much more susceptible to cytotoxicity-based damage than the enterocyte layers. We envision that MAT can be used to optimize the dosing regimen of HCQ by maximizing its bioavailability, while simultaneously minimizing the cytotoxic damage.

Spatiotemporal EEG microstate analysis in drug-free patients with Parkinson's disease

The clinical diagnosis of Parkinson's disease (PD) is very difficult, especially in the early stage of the disease, because there is no physiological indicator that can be referenced. Drug-free patients with early PD are characterized by clinical symptoms such as impaired motor function and cognitive decline, which was caused by the dysfunction of brain's dynamic activities. The indicators of brain dysfunction in patients with PD at an early unmedicated condition may provide a valuable basis for the diagnosis of early PD and later treatment. In order to find the spatiotemporal characteristic markers of brain dysfunction in PD, the resting-state EEG microstate analysis is used to explore the transient state of the whole brain of 23 drug-free patients with PD on the sub-second timescale compared to 23 healthy controls. EEG microstates reflect a transiently stable brain topological structure with spatiotemporal characteristics, and the spatial characteristic microstate classes and temporal parameters provide insight into the brain's functional activities in PD patients. The further exploration was to explore the relation between temporal microstate parameters and significant clinical symptoms to determine whether these parameters could be used as a basis for clinically assisted diagnosis. Therefore, we used a general linear model (GLM) to explore the relevance of microstate parameters to clinical scales and multiple patient attributes, and the Wilcoxon rank sum test was used to quantify the linear relation between influencing factors and microstate parameters. Results of microstate analysis revealed that there was an unique spatial microstate different from healthy controls in PD, and several other typical microstates had significant differences compared with the normal control group, and these differences were reflected in the microstate parameters, such as longer durations and more occurrences of one class of microstates in PD compared with healthy controls. Furthermore, correlation analysis showed that there was a significant correlation between multiple microstate classes' parameters and significant clinical symptoms, including impaired motor function and cognitive decline. These results indicate that we have found multiple quantifiable feature tags that reflect brain dysfunction in the early stage of PD. Importantly, such temporal dynamics in microstates are correlated with clinical scales which represent the motor function and recognize level. The obtained results may deepen our understanding of the brain dysfunction caused by PD, and obtain some quantifiable signatures to provide an auxiliary reference for the early diagnosis of PD.

Advanced MRI analysis to detect white matter brain injury in growth restricted newborn lambs

Background

Fetal growth restriction (FGR) is a serious pregnancy complication associated with increased risk of adverse neurodevelopment and neuromorbidity. Current imaging techniques, including conventional magnetic resonance imaging (MRI), are not sensitive enough to detect subtle structural abnormalities in the FGR brain. We examined whether advanced MRI analysis techniques have the capacity to detect brain injury (particularly white matter injury) caused by chronic hypoxia-induced fetal growth restriction in newborn preterm lambs.

Methods

Surgery was undertaken in twin bearing pregnant ewes at 88–90 days gestation (term = 150 days) to induce FGR in one fetus. At 127 days gestation (~32 weeks human brain development), FGR and control (appropriate for gestational age, AGA) lambs were delivered by caesarean section, intubated and ventilated. Conventional and advanced brain imaging was conducted within the first two hours of life using a 3T MRI scanner. T1-weighted (T1w) and T2-weighted (T2w) structural imaging, magnetic resonance spectroscopy (MRS), and diffusion MRI (dMRI) data were acquired. Diffusion tensor imaging (DTI) modelling and analysis of dMRI data included the following regions of interest (ROIs): subcortical white matter, periventricular white matter, cerebellum, hippocampus, corpus callosum and thalamus. Fixel-based analysis of 3-tissue constrained spherical deconvolution (CSD) of the dMRI data was performed and compared between FGR and AGA lambs. Lambs were euthanised immediately after the scans and brain histology performed in the regions of interest to correlate with imaging.

Results

FGR and AGA lamb (body weight, mean (SD): 2.2(0.5) vs. 3.3(0.3) kg, p = .002) MRI brain scans were analysed. There were no statistically significant differences observed between the groups in conventional T1w, T2w or MRS brain data. Mean, axial and radial diffusivity, and fractional anisotropy indices obtained from DTI modelling also did not show any statistically significant differences between groups in the ROIs. Fixel-based analysis of 3-tissue CSD, however, did reveal a decrease in fibre cross-section (FC, p < .05) but not in fibre density (FD) or combined fibre density and cross-section (FDC) in FGR vs. AGA lamb brains. The specific tracts that showed a decrease in FC were in the regions of the periventricular white matter, hippocampus and cerebellar white matter, and were supported by histological evidence of white matter hypomyelination and disorganisation in corresponding FGR lamb brain regions.

Conclusions

The neuropathology associated with FGR in neonatal preterm lambs is subtle and imaging detection may require advanced MRI and tract-based analysis techniques. Fixel-based analysis of 3-tissue CSD demonstrates that the preterm neonatal FGR brain shows evidence of macrostructural (cross-sectional) deficits in white matter subsequent to altered antenatal development. These findings can inform analysis of similar brain pathology in neonatal infants.

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FGR brain injury can be subtle, and not easily detected on conventional imaging.

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Fixel-based analysis showed differences in fibre content of FGR lamb brain tracts.

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Histological stain confirmed myelination deficits in corresponding brain regions.

Feasibility of low dose chest CT for virtual bronchoscopy navigation in a porcine model

Background

Virtual bronchoscopy navigation (VBN) is widely used for assistance in the histological examination of lung nodules. However, little is known about the optimal CT radiation dose for VBN. Therefore, we performed an animal study to evaluate the feasibility of low dose CT (LDCT) for VBN.

Methods

Ten pigs underwent standard dose CT (as a reference) and four different LDCT protocols: LDCT 1, 120 kVp, 15 mAs; LDCT 2, 120 kVp, 8 mAs; LDCT 3, 100 kVp, 7 mAs; and LDCT 4, 100 kVp, 4 mAs. As targets for the VBN, 10 mm virtual lesions were created in the central and peripheral bronchi. To assess the performance of the VBN, the navigation direction (direction of reconstructed pathways to the target) and the number of branching’s (the number of peripheral bronchi to the target) were evaluated.

Results

The mean effective doses significantly differed across the four LDCTs (P <  0.001). For both central and peripheral virtual targets, there were significant differences in the accuracy of the navigation direction and the number of branching’s of the VBNs across the four LDCTs (P <  0.001 for all). Regarding the accuracy of the navigation direction and the number of branching’s, the areas under the curves of the ROCs were 0.9352 and 0.9324, respectively, for central virtual targets, and 0.8696 and 0.8783, respectively, for peripheral virtual targets. Youden’s index indicated that the optimal effective CT scan dose for both central and peripheral virtual targets was 0.238 mSv.

Conclusions

LDCT is feasible for VBN.

A Quasi-3D compartmental multi-scale approach to detect and quantify diseased regional lung constriction using spirometry data

Spirometry is a widely used pulmonary function test to detect the airflow limitations associated with various obstructive lung diseases, such as asthma, chronic obstructive pulmonary disease, and even obesity-related complications. These conditions arise due to the change in the airway resistance, alveolar compliance, and inductance values. Currently, zero-dimensional compartmental models are commonly used for calibrating these resistance, compliance, and inductance values, ie, solving the inverse spirometry problem. However, zero-dimensional compartments cannot capture the flow physics or the spatial geometry effects, thereby generating a low fidelity prediction of the diseased lung. Computational fluid dynamics (CFD) models offer higher fidelity solutions but may be impractical for certain applications due to the duration of these simulations. Recently, a novel, fast-running, and robust Quasi-3D (Q3D) wire model for simulating the airflow in the human lung airway was developed by CFD Research Corporation. This Q3D method preserved the 3D spatial nature of the airways and was favorably validated against CFD solutions. In the present study, the Q3D compartmental multi-scale combination is further improved to predict regional lung constriction of diseased lungs using spirometry data. The Q3D mesh is resolved up to the eighth lung airway generation. The remainder of the airways and the alveoli sections are modeled using a compartmental approach. The Q3D geometry is then split into different spatial sections, and the resistance values in these regions are obtained using parameter inversion. Finally, the airway diameter values are then reduced to create the actual diseased lung model, corresponding to these resistance values. This diseased lung model can be used for patient-specific drug deposition predictions and the subsequent optimization of the orally inhaled drug products.

Leukotriene B4 indicates lung injury and on-going inflammatory changes after severe trauma in a porcine long-term model

BACKGROUND

Recognizing patients at risk for pulmonary complications (PC) is of high clinical relevance. Migration of polymorphonuclear leukocytes (PMN) to inflammatory sites plays an important role in PC, and is tightly regulated by specific chemokines including interleukin (IL)-8 and other mediators such as leukotriene (LT)B4. Previously, we have reported that LTB4 indicated early patients at risk for PC after trauma. Here, the relevance of LTB4 to indicating lung integrity in a newly established long-term porcine severe trauma model (polytrauma, PT) was explored.

METHODS

Twelve pigs (3 months old, 30 ± 5kg) underwent PT including standardized femur fracture, lung contusion, liver laceration, hemorrhagic shock, subsequent resuscitation and surgical fracture fixation. Six animals served as controls (sham). After 72h lung damage and inflammatory changes were assessed. LTB4 was determined in plasma before the experiment, immediately after trauma, and after 2, 4, 24 or 72h. Bronchoalveolar lavage (BAL)-fluid was collected prior and after the experiment.

RESULTS

Lung injury, local gene expression of IL-8, IL-1β, IL-10, IL-18 and PMN-infiltration into lungs increased significantly in PT compared with sham. Systemic LTB4 increased markedly in both groups 4h after trauma. Compared with declined plasma LTB4 levels in sham, LTB4 increased further in PT after 72h. Similar increase was observed in BAL-fluid after PT.

CONCLUSIONS

In a severe trauma model, sustained changes in terms of lung injury and inflammation are determined at day 3 post-trauma. Specifically, increased LTB4 in this porcine long-term model indicated a rapid inflammatory alteration both locally and systemically. The results support the concept of LTB4 as a biomarker for PC after severe trauma and lung contusion.

A quasi-3D wire approach to model pulmonary airflow in human airways

The models used for modeling the airflow in the human airways are either 0-dimensional compartmental or full 3-dimensional (3D) computational fluid dynamics (CFD) models. In the former, airways are treated as compartments, and the computations are performed with several assumptions, thereby generating a low-fidelity solution. The CFD method displays extremely high fidelity since the solution is obtained by solving the conservation equations in a physiologically consistent geometry. However, CFD models (1) require millions of degrees of freedom to accurately describe the geometry and to reduce the discretization errors, (2) have convergence problems, and (3) require several days to simulate a few breathing cycles. In this paper, we present a novel, fast-running, and robust quasi-3D wire model for modeling the airflow in the human lung airway. The wire mesh is obtained by contracting the high-fidelity lung airway surface mesh to a system of connected wires, with well-defined radii. The conservation equations are then solved in each wire. These wire meshes have around O(1000) degrees of freedom and hence are 3000 to 25 000 times faster than their CFD counterparts. The 3D spatial nature is also preserved since these wires are contracted out of the actual lung STL surface. The pressure readings between the 2 approaches showed minor difference (maximum error = 15%). In general, this formulation is fast and robust, allows geometric changes, and delivers high-fidelity solutions. Hence, this approach has great potential for more complicated problems including modeling of constricted/diseased lung sections and for calibrating the lung flow resistances through parameter inversion.

Modeling of light propagation in the human neck for diagnoses of thyroid cancers by diffuse optical tomography

Diffuse optical tomography using near-infrared light in a wavelength range from 700 to 1000 nm has the potential to enable non-invasive diagnoses of thyroid cancers; some of which are difficult to detect by conventional methods such as ultrasound tomography. Diffuse optical tomography needs to be based on a physically accurate model of light propagation in the neck, because it reconstructs tomographic images of the optical properties in the human neck by inverse analysis. Our objective here was to investigate the effects of three factors on light propagation in the neck using the 2D time-dependent radiative transfer equation: (1) the presence of the trachea, (2) the refractive-index mismatch at the trachea-tissue interface, and (3) the effect of neck organs other than the trachea (spine, spinal cord, and blood vessels). There was a significant influence of reflection and refraction at the trachea-tissue interface on the light intensities in the region between the trachea and the front of the neck surface. Organs other than the trachea showed little effect on the light intensities measured at the front of the neck surface although these organs affected the light intensities locally. These results indicated the necessity of modeling the refractive-index mismatch at the trachea-tissue interface and the possibility of modeling other neck organs simply as a homogeneous medium when the source and detectors were far from large blood vessels.

Particle transport in the human respiratory tract: formulation of a nodal inverse distance weighted Eulerian-Lagrangian transport and implementation of the Wind-Kessel algorithm for an oral delivery

This paper is the first in a series wherein efficient computational methods are developed and implemented to accurately quantify the transport, deposition, and clearance of the microsized particles (range of interest: 2 to 10 µm) in the human respiratory tract. In particular, this paper (part I) deals with (i) development of a detailed 3D computational finite volume mesh comprising of the NOPL (nasal, oral, pharyngeal and larynx), trachea and several airway generations; (ii) use of CFD Research Corporation's finite volume Computational Biology (CoBi) flow solver to obtain the flow physics for an oral inhalation simulation; (iii) implement a novel and accurate nodal inverse distance weighted Eulerian-Lagrangian formulation to accurately obtain the deposition, and (iv) development of Wind-Kessel boundary condition algorithm. This new Wind-Kessel boundary condition algorithm allows the 'escaped' particles to reenter the airway through the outlets, thereby to an extent accounting for the drawbacks of having a finite number of lung generations in the computational mesh. The deposition rates in the NOPL, trachea, the first and second bifurcation were computed, and they were in reasonable accord with the Typical Path Length model. The quantitatively validated results indicate that these developments will be useful for (i) obtaining depositions in diseased lungs (because of asthma and COPD), for which there are no empirical models, and (ii) obtaining the secondary clearance (mucociliary clearance) of the deposited particles. Copyright © 2015 John Wiley & Sons, Ltd.

SIMULATION STUDY TO COMPARE THE RELATIONSHIP BETWEEN THE BLAST-INDUCED OBJECTIVE INDICES AND THE SURVIVAL RATE OF SUBJECTS WITH PRIMARY BLAST LUNG INJURY

When an injury due to blast overpressure (BOP) is generated, it is important to estimate the severity of the injury using information about the blast conditions and to supply proper treatments according to the degree of the damage. However, there have been no investigations that have tried to verify the relationship between the blast-related objective indices and the degree of blast-induced injury. In this study, the correlations between the survival rate of the subjects with BOP-induced lung damage and each of four blast-induced indices, first principal strain, first principal strain rate, first principal stress and pulmonary inner pressure, were investigated using a simplified thorax model by introducing the concept of the V ACC –V LUNG ratio graph which represents the volume ratio between the seriously-damaged meshes and the overall meshes of the thorax model in respect to each index. Experimental results demonstrated that the decay parameters of the sigmoidal curve-fitted graphs of the first principal stress are the most effective of the analyzed indices for the estimation of the survival rate in patients with blast-induced lung damage. The results have a potential clinical application to improve the efficacy of treatment for blast injury patients.

Biomechanical model of the thorax under blast loading: a three dimensional numerical study

Injury mechanisms due to high speed dynamic loads, such as blasts, are not well understood. These research fields are widely investigated in the literature, both at the experimental and numerical levels, and try to answer questions about the safety and efficiency of protection devices or biomechanical traumas. At a numerical level, the development of powerful mathematical models tends to study tolerance limits and injury mechanisms in order to avoid experimental tests which cannot be easily conducted. In a military framework, developing a fighter/soldier numerical model can help to the understanding of many traumas which are specific to soldier injuries, like mines, ballistic impacts or blast traumas. The aim of this study is to investigate the consequences of violent loads in terms of human body response, submitting a developed and validated three-dimensional thorax finite element (FE) model to blast loadings. Specific formulations of FE methods are used to simulate this loading, and its consequence on the biomechanical model. Mechanical parameters such as pressure in the air field and also in internal organs are observed, and these values are compared to the experimental data in the literature. This study gives encouraging results and allows going further in soldier trauma investigations.

Development and validation of two subject-specific finite element models of human head against three cadaveric experiments

Head injury, being one of the main causes of death or permanent disability, continues to remain a major health problem with significant socioeconomic costs. Numerical simulations using the FEM offer a cost-effective method and alternative to experimental methods in the biomechanical studies of head injury. The present study aimed to develop two realistic subject-specific FEMs of the human head with detailed anatomical features from medical images (Model 1: without soft tissue and Model 2: with soft tissue and differentiation of white and gray matters) and to validate them against the intracranial pressure (ICP) and relative intracranial motion data of the three cadaver experimental tests. In general, both the simulated results were in reasonably good agreement with the experimental measured ICP and relative displacements, despite slight discrepancy in a few neutral density targets markers. Sensitivity analysis showed some variations in the brain's relative motion to the material properties or marker's location. The addition of soft tissue in Model 2 helped to damp out the oscillations of the model response. It was also found that, despite the fundamental anatomical differences between the two models, there existed little evident differences in the predicted ICP and relative displacements of the two models. This indicated that the advancements on the details of the extracranial features would not improve the model's predicting capabilities of brain injury.

Infrared (IR) spectral markers of bronchial epithelia in victims of fatal burns

Changes in the infrared spectra of bronchial epithelia in victims of fatal burns were investigated. The mechanism of spectral changes on the basis of cellular morphological changes was considered. The ability of spectral parameters to diagnose fatal burns was assessed. Ten cases of fatal burns and 20 control cases were selected. Their lung tissues were removed, and sections were cut and mounted on glass and barium fluoride slides. Spectra of polarized bronchial epithelia were obtained by microscopy based on their morphological changes. In the spectra, 16 major absorbance bands were evaluated to determine their ability to act as positive markers for exposure to fire. Compared with the control group, the bronchial epithelia of the fatal burn victims showed three spectral results. (1) The absorbance of 16 major bands from the spectra of polarized bronchial epithelia in fatal burn victims significantly increased. (2) For the same cell number, the absorbance at 2850, 2920, 2959, and 3084 cm(-1) decreased. (3) The degree of increased or decreased absorbance of bands is related to the degree of polarization. These spectral results suggest that there is a vital reaction induced by the inhalation of hot fumes that includes an increase in the number of bronchial epithelia and a polarization effect. Overall, Fourier transform infrared (FT-IR) microspectroscopy was shown to be a convenient and reliable method to provide objective spectral markers to assist the diagnosis of fatal burns by simultaneously monitoring several specific parameters, although these observations have yet to be applied at forensic scenes.