Patient-specific multi-scale design optimization of transcatheter aortic valve stents.

BACKGROUND AND OBJECTIVE: Transcatheter aortic valve implantation (TAVI) has become the standard treatment for a wide range of patients with aortic stenosis. Although some of the TAVI post-operative complications are addressed in newer designs, other complications and lack of long-term and durability data on the performance of these prostheses are limiting this procedure from becoming the standard for heart valve replacements. The design optimization of these devices with the finite element and optimization techniques can help increase their performance quality and reduce the risk of malfunctioning. Most performance metrics of these prostheses are morphology-dependent, and the design and the selection of the device before implantation should be planned for each individual patient. METHODS: In this study, a patient-specific aortic root geometry was utilized for the crimping and implantation simulation of 50 stent samples. The results of simulations were then evaluated and used for developing regression models. The strut width and thickness, the number of cells and patterns, the size of stent cells, and the diameter profile of the stent were optimized with two sets of optimization processes. The objective functions included the maximum crimping strain, radial strength, anchorage area, and the eccentricity of the stent. RESULTS: The optimization process was successful in finding optimal models with up to 40% decrease in the maximum crimping strain, 261% increase in the radial strength, 67% reduction in the eccentricity, and about an eightfold increase in the anchorage area compared to the reference device. CONCLUSIONS: The stents with larger distal diameters perform better in the selected objective functions. They provide better anchorage in the aortic root resulting in a smaller gap between the device and the surrounding tissue and smaller contact pressure. This framework can be used in designing patient-specific stents and improving the performance of these devices and the outcome of the implantation process.

Genotyping of Chlamydia abortus using multiple loci variable number of tandem repeats analysis technique.

BACKGROUND: The correlation between various factors (geographical region, clinical incidence, and host type) and the genomic heterogeneity has been shown in several bacterial strains including Chlamydia abortus. METHODS: The aim of this study was to survey the predominant types of C. abortus strains isolated from ruminants in Iran by the multiple loci variable number of tandem repeats (VNTR) analysis (MLVA) method. C. abortus infection was evaluated in a total of 117 aborted fetuses by real-time PCR. The isolation was done via the inoculation of the positive samples in chicken embryo and the L929 cell line. Genotyping was carried out by MLVA typing technique. RESULTS: Forty samples (34.2%) were detected with C. abortus infection; however, chlamydial infection in ruminants of Charmahal/Bakhtiari (3 bovines and 35 sheep) was higher than that of Khuzestan (2 sheep). All MLVA types (MT1-MT8) were detected in the collected samples from Charmahal/Bakhtiari but only 2 types (MT1 and MT3) were reported in samples from Khuzestan. The main MT type was MT1 (32% of aborted fetuses). Although in this study only 9 cow samples were investigated, they possessed similar clusters to those obtained from sheep (MT1 and MT6). Variation of type in sheep samples (MT1 to MT8) was more than that of bovine samples (MT1, and MT6). CONCLUSION: By this research revealed that C.abortus was responsible for a significant percentage of ruminant abortion in two studied regions. The main MT type was MT1 (32% of aborted fetuses) and also 7 different genotypes were involved in infections. So it is concluded that diversity in C.abortus genotyping is high in two regions.

A computational optimization study of a self-expandable transcatheter aortic valve.

Developing an efficient stent frame for transcatheter aortic valves (TAV) needs thorough investigation in different design and functional aspects. In recent years, most TAV studies have focused on their clinical performance, leaflet design, and durability. Although several optimization studies on peripheral stents exist, the TAV stents have different functional requirements and need to be explicitly studied. The aim of this study is to develop a cost-effective optimization framework to find the optimal TAV stent design made of Ni-Ti alloy. The proposed framework focuses on minimizing the maximum strain occurring in the stent during crimping, making use of a simplified model of the stent to reduce computational cost. The effect of the strut cross-section of the stent, i.e., width and thickness, and the number and geometry of the repeating units of the stent (both influencing the cell size) on the maximum strain is investigated. Three-dimensional simulations of the crimping process are used to verify the validity of the simplified representation of the stent, and the radial force has been calculated for further evaluation. The results suggest the key role of the number of cells (repeating units) and strut width on the maximum strain and, consequently, on the stent design. The difference in terms of the maximum strain between the simplified and the 3D model was less than 5%, confirming the validity of the adopted modeling strategy and the robustness of the framework to improve the TAV stent designs through a simple, cost-effective, and reliable procedure.

Phenotypic and genotypic characterization of antibiotic-resistant in Escherichia coli isolates from patients with diarrhea.

BACKGROUND AND OBJECTIVES: Escherichia coli is a common enteric pathogen of human and livevestock. Antibiotic resistance is the main concern of public health. The aim of this study was to detect this bacterium in stool samples of diarrheal patients and identify the phenotypic and genotypic characterizations of antibiotic-resistant isolates such as dfrA1, sul1, citm, tetA, qnr, aac(3)-IV in Shahrekord. MATERIALS AND METHODS: Two hundred fifty diarrheal stool samples from patients were collected. Microbiological and biochemical examinations were done to detect E. coli. Phenotypic and genotypic antibiotic resistance of the isolates were determined using dick diffusion method and polymerase chain reaction (PCR), respectively. RESULTS: Among 114 E. coli isolates, the least resistance was for gentamicin (0%) and the most resistance was for trimethoprim (79.8%). The resistance to sulfamethoxazole, ciprofloxacin, ampicillin, and tetracycline were 71.05%, 10.5%, 52.63%, and 3.5% respectively. The results of PCR assay revealed that 10 isolates contain sul1, 49 isolates harbor citm, 8 isolates tetA, 36 isolates dfrA1, 11 isolates qnr genes but there was no isolate with aac(3)-IV gene. In comparison between phenotypic and genotypic of the isolates revealed that citm, tetA, dfrA1, qnr, sul1, aac(3)-IV genes covered 42.98%, 7.01%, 31.57%, 9.64%, 8.7%, 0% of the antibiotic resistance, respectively. CONCLUSION: Our results revealed that all isolates harbor one or more antibiotic resistance genes and that the PCR is a fast practical and appropriate method to determine the presence of antibiotic resistance genes.

Loop-mediated isothermal amplification for detection of Legionella pneumophila in respiratory specimens of hospitalized patients in Ahvaz, southwest Iran.

BACKGROUND: Legionnaires' disease is an important public health problem that can cause substantial mortality and morbidity. Legionnaires' disease-risk estimation may be compromised by uncertainties in Legionella-detection methods. The aim of this study was the detection of L. pneumophila in respiratory specimens of hospitalized patients with respiratory symptoms by culture, PCR, and loop-mediated isothermal amplification (LAMP) methods. METHODS: Sputum and bronchoalveolar lavage samples were obtained from patients with pneumonia admitted to teaching hospitals in Ahvaz, Iran from June 2016 to March 2017. Isolation of Legionella spp. was done by culturing the samples directly onto buffered charcoal-yeast extract and modified Wadowsky-Yee agar medium. Then, PCR and LAMP assays were performed for detection of L. pneumophila via its mip gene in respiratory specimens. RESULTS: A total of 100 respiratory specimens were collected. Our results showed that 1% of the samples were culture positive for Legionella spp., and 3% and 7% of samples were positive for L. pneumophila using the mip gene on PCR and LAMP assays, respectively. CONCLUSION: Legionnaires' disease should be considered in the diagnosis of pulmonary infectious diseases. Also, the LAMP assay is a faster method with higher sensitivity and specificity than conventional methods, such as PCR and culture, for laboratory diagnosis of Legionnaires' disease.

The role of zoonotic chlamydial agents in ruminants abortion.

BACKGROUND AND OBJECTIVES: Enzootic abortion of ewes (EAE) is caused by infection of sheep and goats by Chlamydia abortus bacterium. Chlamydial abortion in bovine could occur by Chlamydia abortus, Chlamydia psittaci and Chlamydia pecorum. C. psittaci is the causative agent of psittacosis or ornithosis disease in humans and birds. It also causes acute pneumonia in cattle and sheep. The present study aimed at surveying the role of chlamydial agents in ruminants abortion. MATERIALS AND METHODS: A total of 117 aborted material samples (Cotyledon, liver, spleen, and abomasal contents of fetus) from 9 cattle and 100 sheep in Shahr-e-Kord and 8 sheep from Bagh-e-Malek were collected from different herds with abortion history during the lambing periods from 2014 to 2016. After DNA extraction, the samples were tested by species-specific PCR to detect C. abortus, C. pecorum and C. psittaci. RESULTS: Out of 117 clinical sample (108 sheep and 9 cattle), chlamydial infection was detected in 66 (56.41%) samples by Chlamydiales order-specific primers. A total of 24 (36.36%) and 24 (36.36%) samples indicated positive forms of C. abortus and C. psittasi infections, respectively. Only 1 (1.5%) C. pecorum was identified from cattle using nested PCR during this study. Among 66 Chlamydiales-positive samples, 20 (30.30%) samples with coinfection of C. abortus and C. psittaci were detected, however, infection of 3 species was not detected in the samples. CONCLUSION: Because of the high percentage of chlamydial infection in these regions and probability of coinfection, conducting epidemiological studies on the role of different animals is highly recommended.

CFD simulation of the effect of particle size on the nanofluids convective heat transfer in the developed region in a circular tube.

The CFD simulation of heat transfer characteristics of a nanofluid in a circular tube under constant heat flux was considered using Fluent software (version 6.3.26) in the laminar flow. Al2O3 nanoparticles in water with concentrations of 0.5%, 1.0%, 1.5%, 2% and 2.5% were used in this simulation. All of the thermo-physical properties of nanofluids were assumed to be temperature independent. Two particle sizes with average size of 20 and 50 nm were used in this research. It was concluded that heat transfer coefficient increased by increasing the Reynolds number and the concentration of nanoparticles. The maximum convective heat transfer coefficient was observed at the highest concentration of nano-particles in water (2.5%). Furthermore, the two nanofluids showed higher heat transfer than the base fluid (water) although the nanofluid with particles size of 20 nm had the highest heat transfer coefficient.

Effect of hysteroscopy before intra uterine insemination on fertility in infertile couples.

Uterine disorders like usual infertility factors (male factor, ovarian and tubal problems of women) may affect the outcome of infertility treatment in infertile patients. In our clinical trial, 110 couples diagnosed with infertility were candidate for intra uterine insemination (IUI). The patients were divided randomly into two equal groups (n = 55): In group one (control group), patients without hysteroscopy underwent ovulation induction by clomiphene citrate and hCG followed by intrauterine insemination. The second group (experiment group), patients were undergoing hysteroscopy before intra uterine insemination on the day 21 of the cycle and due to abnormal findings, going under surgical treatment if they needed. The rates of pregnancy complications in patients were evaluated. The age, BMI, kind of infertility, duration of infertility, number of previous trial, duration of stimulation, the type of procedures used and semen analysis (TMC, Motility and morphology of sperm) were similar for both groups and no statistically significant differences emerged at all between them. In experimental group, hysteroscopy revealed pathology in the uterine cavity in 26 out of 55 cases. The overall rates of clinical pregnancy were higher in experimental group compared to the control group. The findings from this study showed that the use of hysteroscopy as a diagnostic or therapeutic procedure before IUI, can increase the rate of pregnancy and finally decrease the failure rate of infertility treatment and perinatal complications in infertile couples.