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Tscheuschner L, Tzafriri AR. Cardiovascular Tissue Engineering Models for Atherosclerosis Treatment Development. Bioengineering (Basel) 2023; 10:1373. [PMID: 38135964 PMCID: PMC10740643 DOI: 10.3390/bioengineering10121373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
In the early years of tissue engineering, scientists focused on the generation of healthy-like tissues and organs to replace diseased tissue areas with the aim of filling the gap between organ demands and actual organ donations. Over time, the realization has set in that there is an additional large unmet need for suitable disease models to study their progression and to test and refine different treatment approaches. Increasingly, researchers have turned to tissue engineering to address this need for controllable translational disease models. We review existing and potential uses of tissue-engineered disease models in cardiovascular research and suggest guidelines for generating adequate disease models, aimed both at studying disease progression mechanisms and supporting the development of dedicated drug-delivery therapies. This involves the discussion of different requirements for disease models to test drugs, nanoparticles, and drug-eluting devices. In addition to realistic cellular composition, the different mechanical and structural properties that are needed to simulate pathological reality are addressed.
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Affiliation(s)
- Linnea Tscheuschner
- Department of Vascular Surgery, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Abraham R. Tzafriri
- Department of Research and Innovation, CBSET Inc., Lexington, MA 02421, USA;
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Tsugu T, Tanaka K, Nagatomo Y, Belsack D, Argacha JF, Cosyns B, De Maeseneer M, De Mey J. Impact of ramus coronary artery on computed tomography derived fractional flow reserve (FFR CT ) in no apparent coronary artery disease. Echocardiography 2023; 40:103-112. [PMID: 36607158 DOI: 10.1111/echo.15526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/07/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The ramus artery contributes to the development of turbulence, which may influence computed tomography (CT) derived fractional flow reserve (FFRCT ) even without coronary artery disease (CAD). The relationship between ramus-induced turbulence and FFRCT is unclear. METHOD AND RESULTS A total of 120 patients with <20% coronary stenosis assessed by both FFRCT and invasive coronary angiography were evaluated. The patients were divided into three groups: absent-ramus (n = 72), small-ramus that could not be analyzed by FFRCT (n = 18), and large-ramus that could be analyzed by FFRCT (n = 30). FFRCT measurements were performed at the proximal and distal segments of the left anterior descending (LAD), left circumflex (LCX), and ramus artery. With absent-ramus and small-absent ramus groups, FFRCT was measured at the distal end of the left main trunk at the same level for the proximal segments of the LAD and LCX. In absent-ramus group, proximal FFRCT showed no significant differences between three vessels (LAD = .96 ± .02; MID = .97 ± .02; LCX = .97 ± .02). However, in small and large-ramus groups, proximal FFRCT was significantly higher in the ramus artery than LAD and LCX (small-ramus, LAD = .95 ± .03, Ramus = .97 ± .02, LCX = .95 ± .03; large-ramus: LAD = .95 ± .03, Ramus = .98 ± .01; LCX = .96 ± .03; p < .05). A large ramus was associated with a higher prevalence of a distal FFRCT ≤.80 (odds ratio 7.0, 95% CI 1.2-40.1, p = .03). A proximal ramus diameter predicted distal FFRCT ≤.80 (cut-off 2.1 mm, AUC .76, sensitivity 100%, specificity 52%, 95% CI .61-.90). CONCLUSIONS The presence of a large-ramus artery may cause an FFRCT decline in no apparent CAD.
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Affiliation(s)
- Toshimitsu Tsugu
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jean-François Argacha
- Cardiology, Centrum voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bernard Cosyns
- Cardiology, Centrum voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Understanding Atherosclerosis Pathophysiology: Can Additive Manufacturing Be Helpful? Polymers (Basel) 2023; 15:polym15030480. [PMID: 36771780 PMCID: PMC9920326 DOI: 10.3390/polym15030480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
Atherosclerosis is one of the leading causes of death worldwide. Although this subject arouses much interest, there are limitations associated with the biomechanical investigation done in atherosclerotic tissues, namely the unstandardized tests for the mechanical characterization of these tissues and the inherent non-consensual results obtained. The variability of tests and typologies of samples hampers direct comparisons between results and hinders the complete understanding of the pathologic process involved in atherosclerosis development and progression. Therefore, a consensual and definitive evaluation of the mechanical properties of healthy and atherosclerotic blood vessels would allow the production of physical biomodels that could be used for surgeons' training and personalized surgical planning. Additive manufacturing (AM), commonly known as 3D printing, has attracted significant attention due to the potential to fabricate biomodels rapidly. However, the existing literature regarding 3D-printed atherosclerotic vascular models is still very limited. Consequently, this review intends to present the atherosclerosis disease and the consequences of this pathology, discuss the mechanical characterization of atherosclerotic vessels/plaques, and introduce AM as a potential strategy to increase the understanding of atherosclerosis treatment and pathophysiology.
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Chen H, Yan S, Xie M, Huang J. Application of cascaded GAN based on CT scan in the diagnosis of aortic dissection. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107130. [PMID: 36202023 DOI: 10.1016/j.cmpb.2022.107130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/13/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Currently, Computed Tomography Angiography (CTA) is the most commonly used clinical method for the diagnosis of aortic dissection, which is much better than plain CT. However, CTA examination has some disadvantages such as time-consuming image processing, complicated procedure and injection of developer. CT plain scanning is widely used in the early diagnosis of arterial dissection because of its convenience, speed and popularity. In order not to delay the optimal diagnosis and treatment time of patients, we use deep learning technology and network model to synthesize plain CT images into CTA images. Patients can be timely professional related departments of clinical diagnosis and treatment, and reduce the rate of missed diagnosis. In this paper, we propose a CTA image synthesis technique for cardiac aortic dissection based on the cascaded generative adjunctive network model. METHOD Firstly, we registered CT images, and then used nnU-Net segmentation network model to obtain CT and CTA paired images containing only the aorta. Then we proposed a CTA image synthesis method for aortic dissection based on cascaded generative adversarial. The core idea is to build a cascade generator and double discriminator network based on DCT channel attention mechanism to further enhance the synthesis effect of CTA. RESULTS The model is trained and tested on CT plain scan and CTA image data set of aortic dissection. The results show that the proposed model achieves good results in CTA image synthesis. In the CT data set, the nnU-Net model improves 8.63% and reduces 10.87mm errors in the key index DSC and HD, respectively, compared with the benchmark model U-Net. In CTA data set, nnU-Net model improves 10.27% and reduces 6.56mm error in key index DSC and HD, respectively, compared with benchmark model U-Net. In the synthesis task, the cascaded generative adm network is superior to Pix2pix and Pix2pixHD network models in both PSNR and SSIM, which proves that our proposed model has significant advantages. CONCLUSION This study provides new possibilities for CTA image synthesis of aortic dissection, and improves the accuracy and efficiency of diagnosis, and hopes to provide substantial help for the diagnosis of aortic dissection.
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Affiliation(s)
- Hongwei Chen
- Department of Cardiac Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University Quanzhou, Fujian, 362000, China.
| | - Sunang Yan
- Department of Cardiac Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University Quanzhou, Fujian, 362000, China
| | - Mingxing Xie
- Department of Cardiac Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University Quanzhou, Fujian, 362000, China
| | - Jianlong Huang
- Faculty of Mathematics and Computer Science, Quanzhou Normal University, Quanzhou, 362000, China; Fujian Provincial Key Laboratory of Data Intensive Computing, Quanzhou 362000, China; Key Laboratory of Intelligent Computing and Information Processing, Fujian Province University, Quanzhou 362000, China.
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Breast MRI Segmentation and Ki-67 High- and Low-Expression Prediction Algorithm Based on Deep Learning. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1770531. [PMID: 36238476 PMCID: PMC9553330 DOI: 10.1155/2022/1770531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/11/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022]
Abstract
Background and Objective. Breast cancer is a common malignant tumor that seriously threatens the health of women in my country and even around the world. The proliferation marker Ki-67 has been utilized to distinguish luminal B from luminal A tumors and is a reliable indicator of more aggressive breast cancer growth. If a reliable prediction method for breast cancer patients to avoid invasive damage can be found to predict Ki-67 before pathological examination, it will be very beneficial for doctors to formulate later treatment plans and provide more useful treatment options. Methodology. This paper proposes a tumor segmentation and prediction framework based on the combination of improved attention U-Net and SVM. The framework first improves on attention U-Net by introducing coefficients for learning multidimensional attention. Make the attention mechanism more aware of the main situation in the segmentation process. At the same time, the segmented breast MRI results and corresponding labels were input into the SVM classifier to accurately predict the expression of Ki-67. Results. The DSC, PPV, and sensitivity of our combined model are 0.94, 0.93, and 0.94, respectively, with better segmentation performance. And we compare with the segmentation frameworks of other papers and find that our combined model can make accurate segmentation of breast tumors. Conclusion. Our method can adapt to the variability of breast tumors and segment breast tumors accurately and efficiently. In the future, it can be widely used in clinical practice, so as to help the clinic better formulate a reasonable diagnosis and treatment plan for breast cancer patients.
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De Backer P, Allaeys C, Debbaut C, Beelen R. Point-of-care 3D printing: a low-cost approach to teaching carotid artery stenting. 3D Print Med 2021; 7:27. [PMID: 34476605 PMCID: PMC8414696 DOI: 10.1186/s41205-021-00119-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Carotid Artery Stenting (CAS) is increasingly being used in selected patients as a minimal invasive approach to carotid endarterectomy. Despite the long standing tradition of endovascular treatments, visual feedback during stent-deployment is impossible to obtain as deployment is performed under fluoroscopic imaging. Furthermore, the concept of stent-placement is often still unclear to patients. 3D Printing allows to replicate patient-specific anatomies and deploy stents inside them to simulate procedures. As such these models are being used for endovascular training as well as patient education. PURPOSE To our knowledge, this study reports the first use of a low-cost patient-specific 3D printed model for teaching CAS deployment under direct visualization, without fluoroscopy. METHODOLOGY A CT-angiogram was segmented and converted to STL format using Mimics inPrint™ software. The carotid arteries were bilaterally truncated to fit the whole model on a Formlabs 2 printer without omitting the internal vessel diameter. Next, this model was offset using a 1 mm margin. A ridge was modelled on the original vessel anatomy which was subsequently subtracted from the offset model in order to obtain a deroofed 3D model. All vessels were truncated to facilitate post-processing, flow and guide wire placement. RESULTS Carotid artery stents were successfully deployed inside the vessel. The deroofing allows for clear visualization of the bottlenecks and characteristics of CAS deployment and positioning, including stent foreshortening, tapering and recoil. This low-cost 3D model provides visual insights in stent deployment and positioning, and can allow for patient-specific procedure planning. CONCLUSIONS The presented approach demonstrates the use of low-cost 3D Printed CAS models in teaching complex stent behavior as observed during deployment. Two main findings are illustrated. On one hand, the feasibility of low-cost in-hospital model production is shown. On the other hand, the teaching of CAS deployment bottlenecks at the carotid level without the need for fluoroscopic guidance, is illustrated. The observed stent characteristics as shown during deployment are difficult to assess in radiologic models. Furthermore, printing patient-specific 3D models preoperatively could possibly assist in accurate patient selection, preoperative planning, case-specific training and patient education.
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Affiliation(s)
- Pieter De Backer
- IBiTech-bioMMeda, Ghent University, Ghent, Belgium.
- Orsi Academy, Melle, Belgium.
| | - Charlotte Allaeys
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Roel Beelen
- OLV Hospitals Aalst-Asse-Ninove, Ghent, Belgium
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Wu CA, Squelch A, Sun Z. Investigation of Three-dimensional Printing Materials for Printing Aorta Model Replicating Type B Aortic Dissection. Curr Med Imaging 2021; 17:843-849. [PMID: 33602103 DOI: 10.2174/1573405617666210218102046] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/25/2020] [Accepted: 01/06/2021] [Indexed: 11/22/2022]
Abstract
AIM This study aims to determine a printing material that has both elastic property and radiology equivalence close to the real aorta for simulation of endovascular stent-graft repair of aortic dissection. BACKGROUND With the rapid development of Three-Dimensional (3D) printing technology, a patient- specific 3D printed model is able to help surgeons to make a better treatment plan for Type B aortic dissection patients. However, the radiological properties of most 3D printing materials have not been well characterized. This study aims to investigate the appropriate materials for printing human aorta with mechanical and radiological properties similar to the real aortic Computed Tomography (CT) attenuation. OBJECTIVE Quantitative assessment of CT attenuation of different materials used in 3D printed models of aortic dissection for developing patient-specific 3D printed aorta models to simulate type B aortic dissection. METHODS A 25-mm length of aorta model was segmented from a patient's image dataset with a diagnosis of type B aortic dissection. Four different elastic commercial 3D printing materials, namely Agilus A40 and A50, Visijet CE-NT A30 and A70 were selected and printed with different hardness. Totally four models were printed out and CT scanned twice on a 192-slice CT scanner using the standard aortic CT angiography protocol, with and without contrast inside the lumen. Five reference points with the Region Of Interest (ROI) of 1.77 mm2 were selected at the aortic wall, and intimal flap and their Hounsfield units (HU) were measured and compared with the CT attenuation of original CT images. The comparison between the patient's aorta and models was performed through a paired-sample t-test to determine if there is any significant difference. RESULTS The mean CT attenuation of the aortic wall of the original CT images was 80.7 HU. Analysis of images without using contrast medium showed that the material of Agilus A50 produced the mean CT attenuation of 82.6 HU, which is similar to that of original CT images. The CT attenuation measured at images acquired with the other three materials was significantly lower than that of the original images (p<0.05). After adding contrast medium, Visijet CE-NT A30 had an average CT attenuation of 90.6 HU, which is close to that of the original images without a statistically significant difference (p>0.05). In contrast, the CT attenuation measured at images acquired with other three materials (Agilus A40, A50 and Visiject CE-NT A70) was 129 HU, 135 HU and 129.6 HU, respectively, which is significantly higher than that of original CT images (p<0.05). CONCLUSION Both Visijet CE-NT and Agilus have tensile strength and elongation close to actual patient's tissue properties producing similar CT attenuation. Visijet CE-NT A30 is considered the appropriate material for printing aorta to simulate contrast-enhanced CT imaging of type B aortic dissection. Due to the lack of body phantoms in the experiments, further research with the simulation of realistic anatomical body environment should be conducted.
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Affiliation(s)
- Chia-An Wu
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, 6845, Australia
| | - Andrew Squelch
- Discipline of Exploration Geophysics, WA School of Mines: Mineral, Energy and Chemical Engineering, Curtin University, Perth, 6845, Australia
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, 6845, Australia
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Xu Z, Du J. A mental health informatics study on the mediating effect of the regulatory emotional self-efficacy. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:2775-2788. [PMID: 33892571 DOI: 10.3934/mbe.2021141] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To identify the internal mechanism of the relationship between physical activity and mental health in home exercises. METHODS Participants were 2233 college students with an average age of 19.34 (SD = 1.07) recruited from southern China using analysis of variance (ANOVA) and hierarchical multiple regression. They completed the college student physical activity questionnaire, regulatory emotional self-efficacy scale (RES) and Symptom Checklist (SCL-90) to explore the internal mechanism of the relationship between home exercises and mental health in the context of fitness campaign. RESULTS Statistical analysis based on ANOVA and hierarchical multiple regression, and the results showed that gender differences is a critical factor influencing the effectiveness of home exercise on mental health in college students. Furthermore, individuals with regulatory emotional self-efficacy are more likely to keep exercising, which may stimulate the positive effect on enhancing mental health. CONCLUSION Variable of emotion regulation efficacy play an important role in promoting college students positive emotions, stimulating potential, and improving physical and mental health. Further to advocate sports interventions for home-stay groups to improve their control of emotions, thereby reducing their anxiety and depression in the face of unexpected events.
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Affiliation(s)
- Zhenghong Xu
- Department of Public Physical Education, Fujian Agriculture and Forestry University, Fuzhou 350002, China
| | - Juan Du
- Department of Public Physical Education, Fujian Agriculture and Forestry University, Fuzhou 350002, China
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Carvalho V, Maia I, Souza A, Ribeiro J, Costa P, Puga H, Teixeira S, Lima RA. In vitro
Biomodels in Stenotic Arteries to Perform Blood Analogues Flow Visualizations and Measurements: A Review. Open Biomed Eng J 2020. [DOI: 10.2174/1874120702014010087] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular diseases are one of the leading causes of death globally and the most common pathological process is atherosclerosis. Over the years, these cardiovascular complications have been extensively studied by applying in vivo, in vitro and numerical methods (in silico). In vivo studies represent more accurately the physiological conditions and provide the most realistic data. Nevertheless, these approaches are expensive, and it is complex to control several physiological variables. Hence, the continuous effort to find reliable alternative methods has been growing. In the last decades, numerical simulations have been widely used to assess the blood flow behavior in stenotic arteries and, consequently, providing insights into the cardiovascular disease condition, its progression and therapeutic optimization. However, it is necessary to ensure its accuracy and reliability by comparing the numerical simulations with clinical and experimental data. For this reason, with the progress of the in vitro flow measurement techniques and rapid prototyping, experimental investigation of hemodynamics has gained widespread attention. The present work reviews state-of-the-art in vitro macro-scale arterial stenotic biomodels for flow measurements, summarizing the different fabrication methods, blood analogues and highlighting advantages and limitations of the most used techniques.
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Ali A, Ballard DH, Althobaity W, Christensen A, Geritano M, Ho M, Liacouras P, Matsumoto J, Morris J, Ryan J, Shorti R, Wake N, Rybicki FJ, Sheikh A. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: adult cardiac conditions. 3D Print Med 2020; 6:24. [PMID: 32965536 PMCID: PMC7510265 DOI: 10.1186/s41205-020-00078-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 09/04/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Medical 3D printing as a component of care for adults with cardiovascular diseases has expanded dramatically. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness criteria for adult cardiac 3D printing indications. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with a number of adult cardiac indications, physiologic, and pathologic processes. Each study was vetted by the authors and graded according to published guidelines. RESULTS Evidence-based appropriateness guidelines are provided for the following areas in adult cardiac care; cardiac fundamentals, perioperative and intraoperative care, coronary disease and ischemic heart disease, complications of myocardial infarction, valve disease, cardiac arrhythmias, cardiac neoplasm, cardiac transplant and mechanical circulatory support, heart failure, preventative cardiology, cardiac and pericardial disease and cardiac trauma. CONCLUSIONS Adoption of common clinical standards regarding appropriate use, information and material management, and quality control are needed to ensure the greatest possible clinical benefit from 3D printing. This consensus guideline document, created by the members of the RSNA 3D printing Special Interest Group, will provide a reference for clinical standards of 3D printing for adult cardiac indications.
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Affiliation(s)
- Arafat Ali
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Waleed Althobaity
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Michelle Ho
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Jane Matsumoto
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Justin Ryan
- Rady Children's Hospital, San Diego, CA, USA
| | - Rami Shorti
- Intermountain Healthcare, South Jordan, UT, USA
| | - Nicole Wake
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Zhuang Z, Fan G, Yuan Y, Joseph Raj AN, Qiu S. A fuzzy clustering based color-coded diagram for effective illustration of blood perfusion parameters in contrast-enhanced ultrasound videos. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 190:105233. [PMID: 31796224 DOI: 10.1016/j.cmpb.2019.105233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Early identification and diagnosis of tumors are of great significance to improve the survival rate of patients. Amongst other techniques, contrast-enhanced ultrasound is an important means to help doctors diagnose tumors. Due to the advantages of high efficiency, accuracy and objectivity, more and more computer-aided methods are used in medical diagnosis. Here we propose, a color-coded diagram based on quantitative blood perfusion parameters for contrast-enhanced ultrasound video. The method realizes the static description of the dynamic blood perfusion process in contrast-enhanced ultrasound videos and reveal the blood perfusion characteristics of all regions of the tissue providing assistance to the doctors in their clinical diagnosis. METHODS For effective illustration of the blood perfusion through tissues, we propose (a) an improved block matching algorithm to eliminate the image distortions caused by breathing; (b) compute the time-grayscale intensity curve for each pixel to obtain four different quantitative blood perfusion parameters; and finally (c) employ the fuzzy C-means clustering algorithm to cluster the blood perfusion parameters, where each parameter is associated with a particular color. Thus based on the correspondence between the pixel and the blood perfusion parameters, all the pixels are color-coded to obtain the color-coded diagram. RESULTS To the best of our knowledge, the proposed technique is one-of-its-kind to color code the contrast-enhanced ultrasound videos using blood perfusion parameters in order to understand the hemodynamic characteristics of the benign and malignant lesion. In our experiments, various contrast-enhanced ultrasound videos corresponding to several real-world cases were color-coded and the results of the experiments illustrated that the proposed color-coded diagrams are consistent with the diagnosis presented by the physicians. CONCLUSIONS The experimental results suggested that the proposed method can comprehensively describe the blood perfusion characteristics of tissues during the angiography process thereby effectively assisting the doctors in diagnosis.
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Affiliation(s)
- Zhemin Zhuang
- Department of Electronic Engineering, Shantou University, Shantou, Guangdong, China; Guangdong Provincial Key Laboratory of Digital Signal and Image Processing, Shantou University, Shantou, Guangdong, China
| | - Guangwen Fan
- Department of Electronic Engineering, Shantou University, Shantou, Guangdong, China
| | - Ye Yuan
- Department of Electronic Engineering, Shantou University, Shantou, Guangdong, China; Guangdong Provincial Key Laboratory of Digital Signal and Image Processing, Shantou University, Shantou, Guangdong, China
| | - Alex Noel Joseph Raj
- Department of Electronic Engineering, Shantou University, Shantou, Guangdong, China; Guangdong Provincial Key Laboratory of Digital Signal and Image Processing, Shantou University, Shantou, Guangdong, China.
| | - Shunmin Qiu
- Imaging Department, First Hospital of Medical College of Shantou University, Shantou, Guangdong, China
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3D Printed Biomodels for Flow Visualization in Stenotic Vessels: An Experimental and Numerical Study. MICROMACHINES 2020; 11:mi11060549. [PMID: 32485816 PMCID: PMC7344925 DOI: 10.3390/mi11060549] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/17/2020] [Accepted: 05/25/2020] [Indexed: 12/13/2022]
Abstract
Atherosclerosis is one of the most serious and common forms of cardiovascular disease and a major cause of death and disability worldwide. It is a multifactorial and complex disease that promoted several hemodynamic studies. Although in vivo studies more accurately represent the physiological conditions, in vitro experiments more reliably control several physiological variables and most adequately validate numerical flow studies. Here, a hemodynamic study in idealized stenotic and healthy coronary arteries is presented by applying both numerical and in vitro approaches through computational fluid dynamics simulations and a high-speed video microscopy technique, respectively. By means of stereolithography 3D printing technology, biomodels with three different resolutions were used to perform experimental flow studies. The results showed that the biomodel printed with a resolution of 50 μm was able to most accurately visualize flow due to its lowest roughness values (Ra = 1.8 μm). The flow experimental results showed a qualitatively good agreement with the blood flow numerical data, providing a clear observation of recirculation regions when the diameter reduction reached 60%.
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13
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Zhu G, Wei Y, Yuan Q, Yang J, Yeo JH. PIV investigation of the flow fields in subject-specific vertebro-basilar (VA-BA) junction. Biomed Eng Online 2019; 18:93. [PMID: 31492145 PMCID: PMC6731569 DOI: 10.1186/s12938-019-0711-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/20/2019] [Indexed: 12/25/2022] Open
Abstract
Background As the only arterial structure of which two main arteries merged into one, the vertebro-basilar (VA-BA) system is one of the favorite sites of cerebral atherosclerotic plaques. The aim of this study was to investigate the detailed hemodynamics characteristics in the VA-BA system. Methods A scale-up subject-specific flow phantom of VA-BA system was fabricated based on the computed tomography angiography (CTA) scanning images of a healthy adult. Flow fields in eight axial planes and six radial planes were measured and analyzed by using particle image velocimetry (PIV) under steady flow conditions of \documentclass[12pt]{minimal}
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\begin{document}$${Re}=500$$\end{document}Re=500. A water–glycerin mixture was used as the working fluid. Results The flow in the current model exhibited highly three-dimensional characteristics. The confluence of VAs flow formed bimodal velocity distribution near the confluence apex. Due to the asymmetrical structural configuration, the bimodal velocity profile skewed towards left, and sharper peaks were observed under higher Reynolds condition. Secondary flow characterized by two vortices formed in the radial planes where 10 mm downstream the confluence apex and persists along the BA under both Reynolds numbers. The strength of secondary flow under \documentclass[12pt]{minimal}
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\begin{document}$${Re}=500$$\end{document}Re=500 is around 8% higher than that under \documentclass[12pt]{minimal}
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\begin{document}$${Re}=300$$\end{document}Re=300, and decayed nonlinearly along the flow direction. In addition, a low momentum recirculation region induced by boundary layer separation was observed near the confluence apex. The wall shear stress (WSS) in the recirculation area was found to be lower than 0.4 Pa. This region coincides well with the preferential site of vascular lesions in the VA-BA system. Conclusions This preliminary study verified that the subject-specific in-vitro experiment is capable of reflecting the detailed flow features in the VA-BA system. The findings from this study may help to expand the understanding of the hemodynamics in the VA-BA system, and further clarifying the mechanism that underlying the localization of vascular lesions.
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Affiliation(s)
- Guangyu Zhu
- School of Energy and Power Engineering, Xi'an Jiaotong University, No. 28 Xian Ning West Road, Xi'an, 710049, China
| | - Yuan Wei
- School of Energy and Power Engineering, Xi'an Jiaotong University, No. 28 Xian Ning West Road, Xi'an, 710049, China
| | - Qi Yuan
- School of Energy and Power Engineering, Xi'an Jiaotong University, No. 28 Xian Ning West Road, Xi'an, 710049, China.
| | - Jian Yang
- Department of Radiology and Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Weest Road, Xi'an, 710061, China
| | - Joon Hock Yeo
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
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14
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Huang J, Brenna C, Khan AUM, Daniele C, Rudolf R, Heuveline V, Gretz N. A cationic near infrared fluorescent agent and ethyl-cinnamate tissue clearing protocol for vascular staining and imaging. Sci Rep 2019; 9:521. [PMID: 30679514 PMCID: PMC6345820 DOI: 10.1038/s41598-018-36741-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 11/23/2018] [Indexed: 12/20/2022] Open
Abstract
Understanding vascular structures and dysfunction is a fundamental challenge. This task has been approached by using traditional methodologies such as microscopic computed tomography and magnetic resonance imaging. Both techniques are not only expensive but also time-consuming. Here, we present a new method for visualizing vascular structures in different organs in an efficient manner. A cationic near infrared (NIR) fluorescent dye was developed with attractive features to specifically stain blood vessels. Furthermore, we refined the process of organ staining and harvesting by retrograde perfusion and optimized the subsequent dehydration and clearing process by the use of an automatic tissue processor and a non-toxic substance, ethyl-cinnamate. Using this approach, the time interval between organ harvesting and microscopic analysis can be reduced from day(s) or weeks to 4 hours. Finally, we have demonstrated that the new NIR fluorescent agent in combination with confocal or light-sheet microscopy can be efficiently used for visualization of vascular structures, such as the blood vessels in different organs e.g. glomeruli in kidneys, with an extremely high resolution. Our approach facilitates the development of automatic image processing and the quantitative analysis to study vascular and kidney diseases.
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Affiliation(s)
- Jiaguo Huang
- Medical Research Center, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Institute for Medical Technology, University of Heidelberg and University of Applied Sciences, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Cinzia Brenna
- Medical Research Center, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Institute for Medical Technology, University of Heidelberg and University of Applied Sciences, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Arif Ul Maula Khan
- Medical Research Center, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Institute for Medical Technology, University of Heidelberg and University of Applied Sciences, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Cristina Daniele
- Medical Research Center, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Institute for Medical Technology, University of Heidelberg and University of Applied Sciences, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Rüdiger Rudolf
- Institute for Medical Technology, University of Heidelberg and University of Applied Sciences, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Institute of Molecular and Cell Biology, Mannheim University of Applied Sciences, 68163, Mannheim, Germany
| | - Vincent Heuveline
- Director of the Computing Centre, Heidelberg University, Im Neuenheimer Feld 293, 69120, Heidelberg, Germany
| | - Norbert Gretz
- Medical Research Center, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. .,Institute for Medical Technology, University of Heidelberg and University of Applied Sciences, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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15
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Guo F, Zhu G, Shen J, Ma Y. Health risk stratification based on computed tomography pulmonary artery obstruction index for acute pulmonary embolism. Sci Rep 2018; 8:17897. [PMID: 30559454 PMCID: PMC6297138 DOI: 10.1038/s41598-018-36115-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/08/2018] [Indexed: 11/09/2022] Open
Abstract
Early effective identification of high-risk patients for acute pulmonary embolism (APE) contributes to timely treatment. The pulmonary artery obstruction index (PAOI) in computed tomography angiography (CTA) is a semi-quantitative observation index, commonly used to evaluate the severity of a patient's condition. This study explores the ability of PAOI to assess the risk stratification of APE. Thirty patients with APE were analysed. They were classified according to the guidelines, and the PAOI and cardiovascular parameters were measured in CTA. The difference of PAOI between different risk stratification patients was compared, and the predictive value of the PAOI for high-risk stratification was evaluated by the receiver operating characteristic curve. The correlation between PAOI and cardiovascular parameters was also analysed by Spearman correlation analysis. The PAOI in low- and high-risk patients was (33.2 ± 18.6)% and (68.1 ± 11.8)% respectively, and the difference was statistically significant. The PAOI was strongly predictive for high-risk patients. The cut-off value was 52.5%, with a sensitivity of 100% and specificity of 81.0%. The PAOI was correlated with the main cardiovascular parameters. We conclude that the PAOI in CTA is helpful for assessing risk stratification in patients with APE, which contributes to the selection of both the treatment plan and prognostic evaluation.
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Affiliation(s)
- Fei Guo
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Guanghui Zhu
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Junjie Shen
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Yichuan Ma
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China.
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16
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Chepelev L, Wake N, Ryan J, Althobaity W, Gupta A, Arribas E, Santiago L, Ballard DH, Wang KC, Weadock W, Ionita CN, Mitsouras D, Morris J, Matsumoto J, Christensen A, Liacouras P, Rybicki FJ, Sheikh A. Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios. 3D Print Med 2018; 4:11. [PMID: 30649688 PMCID: PMC6251945 DOI: 10.1186/s41205-018-0030-y] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/19/2018] [Indexed: 02/08/2023] Open
Abstract
Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.
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Affiliation(s)
- Leonid Chepelev
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Nicole Wake
- Center for Advanced Imaging Innovation and Research (CAI2R), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY USA
- Sackler Institute of Graduate Biomedical Sciences, NYU School of Medicine, New York, NY USA
| | | | - Waleed Althobaity
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Ashish Gupta
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Elsa Arribas
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lumarie Santiago
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO USA
| | - Kenneth C Wang
- Baltimore VA Medical Center, University of Maryland Medical Center, Baltimore, MD USA
| | - William Weadock
- Department of Radiology and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI USA
| | - Ciprian N Ionita
- Department of Neurosurgery, State University of New York Buffalo, Buffalo, NY USA
| | - Dimitrios Mitsouras
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | | | | | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Frank J Rybicki
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
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17
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Agujetas R, González-Fernández MR, Nogales-Asensio JM, Montanero JM. Numerical analysis of the pressure drop across highly-eccentric coronary stenoses: application to the calculation of the fractional flow reserve. Biomed Eng Online 2018; 17:67. [PMID: 29848333 PMCID: PMC5977766 DOI: 10.1186/s12938-018-0503-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/23/2018] [Indexed: 11/29/2022] Open
Abstract
Background Fractional flow reverse (FFR) is the gold standard assessment of the hemodynamic significance of coronary stenoses. However, it requires the catheterization of the coronary artery to determine the pressure waveforms proximal and distal to the stenosis. On the contrary, computational fluid dynamics enables the calculation of the FFR value from relatively non-invasive computed tomography angiography (CTA). Methods We analyze the flow across idealized highly-eccentric coronary stenoses by solving the Navier–Stokes equations. We examine the influence of several aspects (approximations) of the simulation method on the calculation of the FFR value. We study the effects on the FFR value of errors made in the segmentation of clinical images. For this purpose, we compare the FFR value for the nominal geometry with that calculated for other shapes that slightly deviate from that geometry. This analysis is conducted for a range of stenosis severities and different inlet velocity and pressure waveforms. Results and conclusions The errors made in assuming a uniform velocity profile in front of the stenosis, as well as those due to the Newtonian and laminar approximations, are negligible for stenosis severities leading to FFR values around the threshold 0.8. The limited resolution of the stenosis geometry reconstruction is the major source of error when predicting the FFR value. Both systematic errors in the contour detection of just 1-pixel size in the CTA images and a low-quality representation of the stenosis surface (coarse faceted geometry) may yield wrong outcomes of the FFR assessment for an important set of eccentric stenoses. On the contrary, the spatial resolution of images acquired with optical coherence tomography may be sufficient to ensure accurate predictions for the FFR value.
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Affiliation(s)
- R Agujetas
- Depto. de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, Avda. de Elvas s/n, 06006, Badajoz, Spain
| | - M R González-Fernández
- Servicio de Cardiología, Hospital Infanta Cristina, Avda. de Elvas s/n, 06006, Badajoz, Spain
| | - J M Nogales-Asensio
- Servicio de Cardiología, Hospital Infanta Cristina, Avda. de Elvas s/n, 06006, Badajoz, Spain
| | - J M Montanero
- Depto. de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, Avda. de Elvas s/n, 06006, Badajoz, Spain.
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18
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Zhu Y, Chen R, Juan YH, Li H, Wang J, Yu Z, Liu H. Clinical validation and assessment of aortic hemodynamics using computational fluid dynamics simulations from computed tomography angiography. Biomed Eng Online 2018; 17:53. [PMID: 29720173 PMCID: PMC5932836 DOI: 10.1186/s12938-018-0485-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 04/23/2018] [Indexed: 02/02/2023] Open
Abstract
Background Hemodynamic information including peak systolic pressure (PSP) and peak systolic velocity (PSV) carry an important role in evaluation and diagnosis of congenital heart disease (CHD). Since MDCTA cannot evaluate hemodynamic information directly, the aim of this study is to provide a noninvasive method based on a computational fluid dynamics (CFD) model, derived from multi-detector computed tomography angiography (MDCTA) raw data, to analyze the aortic hemodynamics in infants with CHD, and validate these results against echocardiography and cardiac catheter measurements. Methods This study included 25 patients (17 males, and 8 females; a median age of 2 years, range: 4 months–4 years) with CHD. All patients underwent both transthoracic echocardiography (TTE) and MDCTA within 2 weeks prior to cardiac catheterization. CFD models were created from MDCTA raw data. Boundary conditions were confirmed by lumped parameter model and transthoracic echocardiography (TTE). Peak systolic velocity derived from CFD models (PSVCFD) was compared to TTE measurements (PSVTTE), while the peak systolic pressure derived from CFD (PSPCFD) was compared to catheterization (PSPCC). Regions with low and high peak systolic wall shear stress (PSWSS) were also evaluated. Results PSVCFD and PSPCFD showed good agreements between PSVTTE (r = 0.968, p < 0.001; mean bias = − 7.68 cm/s) and PSPCC (r = 0.918, p < 0.001; mean bias = 1.405 mmHg). Regions with low and high PSWSS) can also be visualized. Skewing of velocity or helical blood flow was also observed at aortic arch in patients. Conclusions Our result demonstrated that CFD scheme based on MDCTA raw data is an accurate and convenient method in obtaining the velocity and pressure from aorta and displaying the distribution of PSWSS and flow pattern of aorta. The preliminary results from our study demonstrate the capability in combining clinical imaging data and novel CFD tools in infants with CHD and provide a noninvasive approach for diagnose of CHD such as coarctation of aorta in future.
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Affiliation(s)
- Yulei Zhu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhong Shan Er Lu, Guangzhou, 510080, Guangdong, China.,School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China
| | - Rui Chen
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhong Shan Er Lu, Guangzhou, 510080, Guangdong, China.,School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China
| | - Yu-Hsiang Juan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Chang Gung University, Taoyuan, Taiwan
| | - He Li
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhong Shan Er Lu, Guangzhou, 510080, Guangdong, China
| | - Jingjing Wang
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhong Shan Er Lu, Guangzhou, 510080, Guangdong, China.,School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China
| | - Zhuliang Yu
- School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China. .,College of Automation Science and Technology, South China University of Technology, 381 Wushan Road, Guangzhou, 510080, Guangdong, China.
| | - Hui Liu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhong Shan Er Lu, Guangzhou, 510080, Guangdong, China. .,School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China.
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19
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You L, Li C, Zhao J, Wang DW, Cui W. Associations of common variants at ALDH2 gene and the risk of stroke in patients with coronary artery diseases undergoing percutaneous coronary intervention. Medicine (Baltimore) 2018; 97:e0711. [PMID: 29742731 PMCID: PMC5959384 DOI: 10.1097/md.0000000000010711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Limited data are available about the role of common variants at the aldehyde dehydrogenase 2 gene (ALDH2) on the clinical outcome in Chinese patients with coronary heart disease (CHD) undergoing percutaneous coronary intervention (PCI). In the present study, a total of 1089 patients were consecutively enrolled from January 2012 and July 2013. Six common variants at ALDH2 gene, including rs2339840, rs4648328, rs4767939, rs11066028, rs16941669, and rs671, were selected to test the associations of those polymorphisms with the cardiovascular outcome in patients with CHD after PCI. The clinical endpoints included cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. The composite of clinical endpoints was defined as the primary endpoint, and every endpoint alone was considered as the secondary endpoints. The median follow-up time was 38.27 months. Our results showed that the common variant rs2339840 was independently associated with a lower risk of stroke in patients with CHD after PCI (codominant model, HR = 0.32, 95% CI, 0.11-0.91, P = .074 for heterozygotes; HR = 0.25, 95% CI, 0.06-1.14, P = .033 for homozygotes; dominant model, HR = 0.32, 95% CI, 0.14-0.74, P = .007). However, no significant associations were found between other 5 single nucleotide polymorphisms (SNPs) and the clinical endpoints. For the first time, the common variant rs2339840 was reported to be a protective factor against stroke in CHD patients with PCI.
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Affiliation(s)
- Ling You
- Division of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province
| | - Chenze Li
- Departments of Internal Medicine and Genetic diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Jinzhao Zhao
- Departments of Internal Medicine and Genetic diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Dao Wen Wang
- Departments of Internal Medicine and Genetic diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Wei Cui
- Division of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province
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20
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Xie X, Zheng M, Wen D, Li Y, Xie S. A new CFD based non-invasive method for functional diagnosis of coronary stenosis. Biomed Eng Online 2018; 17:36. [PMID: 29566702 PMCID: PMC5863834 DOI: 10.1186/s12938-018-0468-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/17/2018] [Indexed: 02/07/2023] Open
Abstract
Background Accurate functional diagnosis of coronary stenosis is vital for decision making in coronary revascularization. With recent advances in computational fluid dynamics (CFD), fractional flow reserve (FFR) can be derived non-invasively from coronary computed tomography angiography images (FFRCT) for functional measurement of stenosis. However, the accuracy of FFRCT is limited due to the approximate modeling approach of maximal hyperemia conditions. To overcome this problem, a new CFD based non-invasive method is proposed. Methods Instead of modeling maximal hyperemia condition, a series of boundary conditions are specified and those simulated results are combined to provide a pressure-flow curve for a stenosis. Then, functional diagnosis of stenosis is assessed based on parameters derived from the obtained pressure-flow curve. Results The proposed method is applied to both idealized and patient-specific models, and validated with invasive FFR in six patients. Results show that additional hemodynamic information about the flow resistances of a stenosis is provided, which cannot be directly obtained from anatomy information. Parameters derived from the simulated pressure-flow curve show a linear and significant correlations with invasive FFR (r > 0.95, P < 0.05). Conclusion The proposed method can assess flow resistances by the pressure-flow curve derived parameters without modeling of maximal hyperemia condition, which is a new promising approach for non-invasive functional assessment of coronary stenosis.
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Affiliation(s)
- Xinzhou Xie
- Department of Electronic Science and Technology, Northwestern Polytechnical University, 127 West Youyi Road, Xi'an, Shaanxi, People's Republic of China.
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 15 West Changle Road, Xi'an, Shaanxi, People's Republic of China
| | - Didi Wen
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 15 West Changle Road, Xi'an, Shaanxi, People's Republic of China
| | - Yabing Li
- Department of Electronic Science and Technology, Northwestern Polytechnical University, 127 West Youyi Road, Xi'an, Shaanxi, People's Republic of China
| | - Songyun Xie
- Department of Electronic Science and Technology, Northwestern Polytechnical University, 127 West Youyi Road, Xi'an, Shaanxi, People's Republic of China
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21
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Zhu Y, Wang F, Deng X. Hemodynamics of cerebral bridging veins connecting the superior sagittal sinus based on numerical simulation. Biomed Eng Online 2018; 17:35. [PMID: 29558949 PMCID: PMC5861626 DOI: 10.1186/s12938-018-0466-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/07/2018] [Indexed: 01/23/2023] Open
Abstract
Background The physiological and hemodynamic features of bridging veins involve wall shear stress (WSS) of the cerebral venous system. Based on the data of cadavers and computational fluid dynamics software pack, the hemodynamic physical models of bridging veins (BVs) connecting superior sagittal sinus (SSS) were established. Results A total of 137 BVs formed two clusters along the SSS: anterior group and posterior group. The diameters of the BVs in posterior group were larger than of the anterior group, and the entry angle was smaller. When the diameter of a BV was greater than 1.2 mm, the WSS decreased in the downstream wall of SSS with entry angle less than 105°, and the WSS also decreased in the upstream wall of BVs with entry angle less than 65°. The minimum WSS in BVs was only 63% of that in SSS. Compared with the BVs in anterior group, the minimum WSS in the posterior group was smaller, and the distance from location of the minimum WSS to the dural entrance was longer. Conclusion The cerebral venous thrombosis occurs more easily when the diameter of a BV is greater than 1.2 mm and the entry angle is less than 65°. The embolus maybe form earlier in the upstream wall of BVs in the posterior part of SSS. Electronic supplementary material The online version of this article (10.1186/s12938-018-0466-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Youyu Zhu
- Department of Anatomy, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Feng Wang
- Department of Anatomy, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xuefei Deng
- Department of Anatomy, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
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22
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Different Digitalization Techniques for 3D Printing of Anatomical Pieces. J Med Syst 2018; 42:46. [PMID: 29372421 DOI: 10.1007/s10916-018-0903-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/18/2018] [Indexed: 10/18/2022]
Abstract
The use of different technological devices that allow the creation of three-dimensional models is in constant evolution, allowing a greater application of these technologies in different fields of health sciences and medical training. The equipment for digitalization is becoming increasingly sophisticated allowing obtaining three-dimensional which are more defined and similar to real image and original object. In this work, different modalities of designing 3D anatomical models of bone pieces are presented, for use by students of different disciplines in Health Sciences. To do this we digitalized bone pieces, with different models of scanners, producing images that can be transformed for 3D printing, with a Colido X 3045 printer by digital treatment with different software.
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23
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Hu W, Tong J, Kuang X, Chen W, Liu Z. Influence of proton pump inhibitors on clinical outcomes in coronary heart disease patients receiving aspirin and clopidogrel: A meta-analysis. Medicine (Baltimore) 2018; 97:e9638. [PMID: 29504996 PMCID: PMC5779765 DOI: 10.1097/md.0000000000009638] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are usually prescribed to protect against gastrointestinal bleeding in patients on dual antiplatelet therapy. This meta-analysis reviewed clinical outcomes in patients taking aspirin and clopidogrel, with and without concomitant PPIs to address concerns of adverse reactions. METHODS We searched PubMed, Embase, and the Cochrane Library for articles published between January 1, 2010 and April 11, 2017. The primary end points were major adverse cardiovascular events and gastrointestinal bleeding. Secondary end points were myocardial infarction, stent thrombosis, revascularization, cardiogenic death, and all-cause mortality. RESULTS The meta-analysis included 33,492 patients in 4 randomized controlled trials and 8 controlled observational studies. Overall, patients taking PPIs had statistical differences in major adverse cardiovascular events [odds ratio (OR) 1.17 (95% confidence interval [CI] 1.07-1.28); P = .001; I = 28.3%], gastrointestinal bleeding [OR 0.58 (95% CI 0.36-0.92); P = .022; I = 80.6%], stent thrombosis [OR 1.30 (95% CI 1.01-1.68); P = .041; I = 0%], and revascularization [OR 1.20 (95% CI 1.04-1.38); P = .011; I = 5.1%], compared those not taking PPIs. There were no significant differences in myocardial infarction [OR 1.03 (95% CI 0.87-1.22); P = .742; I = 0%], cardiogenic death [OR 1.09 (95% CI 0.83-1.43); P = .526; I = 0%], or all-cause mortality [OR 1.08 (95% CI 0.93-1.25); P = .329; I = 0%). CONCLUSIONS Among the patients taking aspirin and clopidogrel, the results indicated that the combined use of PPIs increased the rates of major adverse cardiovascular events, stent thrombosis, and revascularization.
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Affiliation(s)
| | - Jin Tong
- Department of Respirology, The Second Affiliated Hospital/The Second Clinical Institute, Chongqing Medical University, Chongqing, China
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