Probing the possibility of lesion formation/progression in vicinity of a primary atherosclerotic plaque: A fluid-solid interaction study and angiographic evidences.

It is shown that certain locations in the arterial tree, such as coronary and cerebral arteries, are more prevalent to plaque formation. Endothelial activation and consequent plaque development are attributed to local hemodynamic parameters such as wall shear stress (WSS), oscillatory shear index (OSI), relative residence time (RRT), and stress phase angle. After a certain level of plaque progression, these hemodynamic parameters are disturbed before and after the plaque. In the current study, it is hypothesized that the vicinity of a primary lesion is susceptible for further degeneration and second plaque formation. A fluid-solid interaction (FSI) model of the coronary artery with different levels of asymmetric constriction, is simulated and the trend of hemodynamic parameters were studied in both of the plaque side (PS) and the opposite wall (facing the plaque [PF]). Also, a novel factor is introduced that can identify the high-risk regions associated with WSS oscillations to negative values. Our results indicate that when more than half of the artery is constricted, the downstream of the plaque is highly exposed to endothelial pathogenesis the PS, such that negative WSS, and as well, critical values of OSI and RRT, that is, -1.2 Pa, 0.42 and 6.5 s, respectively arise in this region. PS endothelial cells in this region exposed to the highest risk of atherosclerosis based on the proposed index (3 out of 3). As well, three cases of angiographic images are provided that confirms existence of secondary lesion close to the primary one as predicted by our computational simulations.

Design of an aortic polymeric valve with asymmetric leaflets and evaluation of its performance by finite element method.

BACKGROUND: The geometry of leaflets plays a significant role in prosthetic valves' (PVs) performance. Typically, natural aortic valves have three unequal leaflets, which differ in size. The present study aims to design an asymmetric tri-leaflet polymeric valve with one large and two small leaflets based on commissure lengths and leaflet eccentricities. METHODS: Eccentricity was related to commissure lengths based on the deformation of the free margins for the fully-opened state of leaflets. The polystyrene-block-polyethylene-polypropylene-block-polystyrene polymer characterized the material properties of the leaflets. The Finite Element Method (FEM) was used to evaluate performance parameters, including maximum geometric orifice area (GOA), average GOA, maximum von Mises stress, and leaflet's coaptation surface area (CSA). RESULTS: Asymmetric valves with no eccentricity provided a low level of GOA because the asymmetric form of small leaflets caused them to close faster than the large leaflet, leading to a sudden drop in the GOA during systole. As the radial curve tends towards a straight line, an undesirable coaptation occurs, and peak stress increases despite higher GOAs. A new radial curve consisting of two straight lines connected by an arc that provided 25.64 mm2 coaptation surface area (CAS) and 117.54 mm2 average GOA, was proposed to improve coaptation and GOA. CONCLUSION: The radial curve of leaflets affects the valve's performance more than other geometric parameters. The combination of straight lines and arcs for radial curves was selected as the reference model for asymmetric valves with one large and two small leaflets.

Left atrial appendage shape impacts on the left atrial flow hemodynamics: A numerical hypothesis generating study on two cases.

BACKGROUND AND OBJECTIVES: The left atrial appendage (LAA) is the most common region for thrombus formation in atrial fibrillation (AF). Morphological parameters such as shape, size, and LAA volume can cause insufficient effectiveness of available therapeutic options. This study aimed to examine blood flow inside LAA and its removal effects. Computational fluid dynamic (CFD) simulations were carried out on two patients with different morphologies. METHODS: Two patients' CT was used to reconstruct the 3D geometries of the left atrium (LA) and left atrial appendage (LAA). Then, the geometries were refined in the mentioned software, and the LAA in some models was removed. Next, in generated 3D volume mesh, sinus rhythm (SR) and atrial fibrillation (AF) outflow velocity were imposed at the mitral valve as boundary conditions. Finally, CFD simulation was conducted to analyzing blood flow within LA with/without LA. RESULTS: The results confirmed that velocity and vorticity decreased under AF conditions inside the LA domain for both patients. However, removing LAA may cause unpredictable consequences, due to different shape and volume of LAA. LAA removal had insignificant effects on velocity and vorticity within LA in SR-mitral outflow. However, removing LAA increased the blood flow rate by 9.15% and vorticity by 7.27% for patient one under AF rhythm (SR)-outflow. In contrast, for patient two, LAA removal in both AF and SR decreased velocity and vorticity within the LA domain. In SR-mitral outflow, velocity dropped by 18.8 %, and vorticity by 13.2%. Also, under AF velocity and vorticity decreased by 23.33% and 18.6% respectively. Meanwhile, the results indicated that the vorticity magnitude increased inside the LAA under AF associated with the risk of thrombus formation, particularly for patient one under AF. The distal part of LAA in both patients was the most common region for blood stasis because of the lowest velocity magnitude. CONCLUSION: Overall, the morphology of LAA could be the critical parameter to determine the possibility of thrombosis formation, particularly under AF conditions. High volume, low blood flow velocity and two-lobe-appendage are more likely to have blood stasis. Furthermore, the morphology difference can affect the LAA removal result and make it more complicated. So, it could be challenging to generalize LAA removal as a therapeutic option for different patients. The implication of this CFD observation needs more investigation.

On the effect of antiresorptive drugs on the bone remodeling of the mandible after dental implantation: a mathematical model.

Bone remodeling identifies the process of permanent bone change with new bone formation and old bone resorption. Understanding this process is essential in many applications, such as optimizing the treatment of diseases like osteoporosis, maintaining bone density in long-term periods of disuse, or assessing the long-term evolution of the bone surrounding prostheses after implantation. A particular case of study is the bone remodeling process after dental implantation. Despite the overall success of this type of implants, the increasing life expectancy in developed countries has boosted the demand for dental implants in patients with osteoporosis. Although several studies demonstrate a high success rate of dental implants in osteoporotic patients, it is also known that the healing time and the failure rate increase, necessitating the adoption of pharmacological measures to improve bone quality in those patients. However, the general efficacy of these antiresorptive drugs for osteoporotic patients is still controversial, requiring more experimental and clinical studies. In this work, we investigate the effect of different doses of several drugs, used nowadays in osteoporotic patients, on the evolution of bone density after dental implantation. With this aim, we use a pharmacokinetic-pharmacodynamic (PK/PD) mathematical model that includes the effect of antiresorptive drugs on the RANK/RANK-L/OPG pathway, as well as the mechano-chemical coupling with external mechanical loads. This mechano-PK/PD model is then used to analyze the evolution of bone in normal and osteoporotic mandibles after dental implantation with different drug dosages. We show that using antiresorptive agents such as bisphosphonates or denosumab increases bone density and the associated mechanical properties, but at the same time, it also increases bone brittleness. We conclude that, despite the many limitations of these very complex models, the one presented here is capable of predicting qualitatively the evolution of some of the main biological and chemical variables associated with the process of bone remodeling in patients receiving drugs for osteoporosis, so it could be used to optimize dental implant design and coating for osteoporotic patients, as well as the drug dosage protocol for patient-specific treatments.

Local hemodynamic analysis of the C-Pulse Device by 3D fluid-structure interaction simulation.

Background: C-Pulse is a new, nonblood contacting device based on the concept of counter-pulsation that is designed for long-term implantation. However, there is a lack of comprehensive investigation of the pressure and velocity fields under the action of C-Pulse. Aim: In this paper, we aim to conduct a numerical simulation of the underlying mechanism of the device in order to analyze its performance and related undesirable issues. Materials & methods: A 3D finite element model is utilized to simulate the mechanism of the blood pumping. Results & conclusion: The simulation well reproduced the essential characteristics of the C-Pulse. Preliminary results were in a reasonable range while a couple of irregular flow patterns were identified.

Numerical simulation of hydro-mechanical coupling of periodontal ligament.

Orthodontic tooth movement in the alveolar bone is due to the mechanical response of periodontal ligament to applied forces. Definition of a proper constitutive model of the periodontal ligament to investigate its response to orthodontic loading is required. For this purpose, a three-dimensional finite element model of incisor tooth, periodontal ligament, and bone was built utilizing the hydro-mechanical coupling theory. Tooth displacement in response to orthodontic loading was then investigated, and the effect of different mechanical behaviors assigned to the solid phase of the periodontal ligament was compared. Results showed that where the periodontal ligament was placed in tension, pore volume was filled with fluid intake from the bone, but fluid flow direction was from the periodontal ligament toward the bone where the periodontal ligament was placed in compression. Because of the existence of interaction between solid and fluid phases of the periodontal ligament, considering biphasic material formulation was capable to address its microscopic behavior as well as time-dependent and large deformation behaviors. This article provides beneficial biomechanical data for future dental studies in determination of optimal orthodontic force.

Finite element comparison of the effect of absorbers' design in the surrounding bone of dental implants.

Despite the high success rate achieved in current dental implantation, there are still important problems to solve like incomplete early osteointegration, bone damage, and long-term implant loosening. Highly compliant stress absorbers are a possible solution to these problems. Although several works examined the stress-strain distribution in bone without and with absorbers to show their favorable results, none of them analyzed their impact on long-term remodeling. Here, we analyze this effect by comparing the evolution of stress and bone mass density without and with different designs of absorbers with those of the healthy tooth. Several finite element models with ABAQUS, corresponding to each design considered, were built to obtain the mechanical conditions in bone and implant. Then a mechanobiological bone remodeling model that considers damage accumulation and its repair during the remodeling process was used to compute the bone density redistribution. This approach allows assessing both the short-term density loss and the relative micromovement between bone and implant. We analyze the stress distributions in both bone and implant as well as the relative micromovement of the implant. We also present the evolution of damage and bone volume fraction. These results show that the addition of absorbers can reduce the stress in the bone around the implant. The obtained results also show that using stress absorbers reduces damage in bone, while increasing the number of absorbers does not necessarily improves damage reduction. We conclude that using implants with a correct design of absorbers prevents damage and stress shielding, reducing implant loosening.

Comparison of blood velocity between Transcranial Doppler and numerical method in the patient-specific Circle of Willis with aneurysm.

BACKGROUND: The development of any disturbance in the Circle of Willis (COW) can change the hemodynamics of blood flow and result in damage to the vascular system. Clinical methods such as TCD for diagnosing an aneurysm or growth factors and rupture can measure blood velocity. Several factors influence the accuracy of TCD that can lead to wrong evaluations and affect the treatment planning. OBJECTIVE: In this study, the conformity between CFD and TCD was accomplished for investigating the accuracy of the clinical method (TCD) in different vessels of the Circle of Willis. METHODS: The realistic three-dimensional models have been produced from angiography images. Considering fluid-structure interaction, a domain of the blood flow and vessel wall has been simulated by the ANSYS.CFX software. The velocity in the cerebral arteries has been calculated and compared with the velocity acquired from TCD. RESULTS: According to the findings, there were significant differences between the results obtained from computational fluid dynamics and Doppler test in different vessels of the Circle of Willis. In some areas, differences close to 80 cm/s were also reported. CONCLUSION: According to the results, there are possibilities of errors in carrying out a Doppler test in some arteries and can lead to wrong estimates and ultimately incorrect decisions.

Fluid-structure interaction of patient-specific Circle of Willis with aneurysm: Investigation of hemodynamic parameters.

BACKGROUND: Circle of Willis (COW) is a network of cerebral artery which continually supplies the brain with blood. Any disturbance in this supply will result in trauma or even death. One of these damages is known as brain Aneurysm. Clinical methods for diagnosing aneurysm can only measure blood velocity; while, in order to understand the causes of these occurrences it is necessary to have information about the amount of pressure and wall shear stress, which is possible through computational models. OBJECTIVE: In this study purpose is achieving exact information of hemodynamic blood flow in COW with an aneurysm and investigation of effective factors on growth and rupture of aneurysm. METHODS: Here, realistic three-dimensional models have been produced from angiography images. Considering fluid-structure interaction have been simulated by the ANSYS.CFX software. RESULTS: Hemodynamic Studying of the COW and intra-aneurysm showed that the WSS and wall tension in the neck of aneurysms for case A are 129.5 Pa, and 12.2 kPa and for case B they are 53.3 Pa and 56.2 kPa, and more than their fundus, thus neck of aneurysm is prone to rupture. CONCLUSION: This study showed that the distribution of parameters was dependent on the geometry of the COW, and maximum values are seen in areas prone to aneurysm formation.

Numerical simulation of low-density lipoprotein mass transport in human arterial stenosis - Calculation of the filtration velocity.

Accumulation of cholesterol and other atherogenic lipids such as low-density lipoprotein (LDL) in artery wall causes reduction of vessel diameter and artery stenosis. The study of the mass transfer of these large molecules in the wall with considering effective factors on lumen flow and different physiological factors is the subject considered nowadays. In this paper, results of two dimensional and axi-symmetric simulations of three different models of the artery with 60% stenosis under pulsatile blood flow are presented. Filtration velocity of LDL mass transport in the permeable artery wall and shear stress of blood flow are investigated using ADINA software Three different flow models are considered. In the first and second models, the filtration velocity considered as a given parameter and constant in arterial wall boundary, while in third model arterial wall considered as porous wall, the filtration velocity is calculated from pressure difference as an input parameter of the model. The results show that filtration velocity is strongly depend on geometry and it is not constant along the wall, contrary to simplified models. The results of concentration variations in lumen and wall illustrate the increase in near wall LDL concentration or concentration polarization.

Computational fluid dynamics-based study of possibility of generating pulsatile blood flow via a continuous-flow VAD.

Until recent years, it was almost beyond remedy to save the life of end-stage heart failure patients without considering a heart transplant. This is while the need for healthy organs has always far exceeded donations. However, the evolution of VAD technology has certainly changed the management of these patients. Today, blood pumps are designed either pulsatile flow or continuous flow, each of which has its own concerns and limitations. For instance, pulsatile pumps are mostly voluminous and hardly can be used for children. On the other hand, the flow generated by continuous-flow pumps is in contrast with pulsatile flow of the natural heart. In this project, having used computational fluid dynamics, we studied the possibility of generating pulsatile blood flow via a continuous-flow blood pump by adjusting the rotational speed of the pump with two distinct patterns (sinusoidal and trapezoidal), both of which have been proposed and set based on physiological needs and blood flow waveform of the natural heart. An important feature of this study is setting the outlet pressure of the pump similar to the physiological conditions of a patient with heart failure, and since these axial pumps are sensitive to outlet pressures, more secure and reliable results of their performance are achieved. Our results show a slight superiority of a sinusoidal pattern compared to a trapezoidal one with the potential to achieve an adequate pulsatile flow by precisely controlling the rotational speed.

Laminar-to-turbulence and relaminarization zones detection by simulation of low Reynolds number turbulent blood flow in large stenosed arteries.

Laminar, turbulent, transitional, or combine areas of all three types of viscous flow can occur downstream of a stenosis depending upon the Reynolds number and constriction shape parameter. Neither laminar flow solver nor turbulent models for instance the k-ω (k-omega), k-ε (k-epsilon), RANS or LES are opportune for this type of flow. In the present study attention has been focused vigorously on the effect of the constriction in the flow field with a unique way. It means that the laminar solver was employed from entry up to the beginning of the turbulent shear flow. The turbulent model (k-ω SST Transitional Flows) was utilized from starting of turbulence to relaminarization zone while the laminar model was applied again with onset of the relaminarization district. Stenotic flows, with 50 and 75% cross-sectional area, were simulated at Reynolds numbers range from 500 to 2000 employing FLUENT (v6.3.17). The flow was considered to be steady, axisymmetric, and incompressible. Achieving results were reported as axial velocity, disturbance velocity, wall shear stress and the outcomes were compared with previously experimental and CFD computations. The analogy of axial velocity profiles shows that they are in acceptable compliance with the empirical data. As well as disturbance velocity and wall shear stresses anticipated by this new approach, part by part simulation, are reasonably valid with the acceptable experimental studies.

A Three-Dimensional Shape-Based Force and Stiffness-Sensing Platform for Tendon-Driven Catheters.

This paper presents an efficient shape-based three-axial force and stiffness estimator for active catheters commonly implemented in cardiac ablation. The force-sensing capability provides important feedback for catheterization procedures including real-time control and catheter steering in autonomous navigation systems. The proposed platform is based on the introduced accurate and computationally efficient Cosserat rod model for tendon-driven catheters. The proposed nonlinear Kalman filter formulation for contact force estimation along with the developed catheter model provides a real-time force observer robust to nonlinearities and noise covariance uncertainties. Furthermore, the proposed platform enables stiffness estimation in addition to tip contact force sensing in different operational circumstances. The approach incorporates pose measurements which can be achieved using currently developed pose-sensing systems or imaging techniques. The method makes the approach compatible with the range of forces applied in clinical applications. The simulation and experimental results verify the viability of the introduced force and stiffness-sensing technique.

Numerical simulation of osteocyte cell in response to directional mechanical loadings and mechanotransduction analysis: Considering lacunar-canalicular interstitial fluid flow.

The osteocyte cell is a bone cell that also functions as a bone mechanosensor. In this work, a three-dimensional (3D) fluid-structure interaction (FSI) model of an osteocyte cell under different mechanical loading conditions was used to obtain a better understanding of osteocyte cell behavior under different physiological conditions. In the current study, both fluid and solid parts of osteocyte cell were considered in order to allow for more accurate results. Five different loading conditions have been applied to the osteocyte cell, and consequently the different interstitial fluid flow velocities and shear stresses have been investigated. Furthermore, using a mathematical model, the change in the stimulus function value with shear stress and NO enzyme was revealed. This work suggests that changes in osteocyte morphology and direction of loadings affect cell stimulation. It was found that cell is mostly stimulated and expanded in the direction experiencing the most shear stress. Finally, the amount of cell stimulation was shown quantitatively and there was strong dependency between stimulus function, shear stress, calcium, and NO concentration.

Knee Kinematics and Joint Moments During Stair Negotiation in Participants With Anterior Cruciate Ligament Deficiency and Reconstruction: A Systematic Review and Meta-Analysis.

OBJECTIVE: Biomechanical changes have been reported for patients with anterior cruciate ligament deficiency (ACLD) and anterior cruciate ligament (ACL reconstruction) (ACLR), likely due to loss of stability and changes in proprioception and neuromotor control. This review evaluated kinematics and kinetics of ACLD and ACLR knees, compared with those on the contralateral uninjured sides, as well as and those in asymptomatic controls during stair navigation. DESIGN: This is a systematic review and meta-analysis. LITERATURE SURVEY: Electronic database searches were conducted from their original available dates to January 2015. Studies that included participants with ACLD or ACLR and reported knee joint angles or moments during stair ascent or descent were included. METHODOLOGY: Nine studies met the inclusion criteria, and the methodological quality of these was assessed with a modified Downs and Black checklist. Effect sizes for differences between injured leg and uninjured contralateral leg or controls were calculated, and meta-analyses were performed if two or more studies considered the same variable. SYNTHESIS: Quality assessment showed an average (± standard deviation) of 70.3% ± 7.2%. Meta-analysis showed less knee flexion at initial contact for ACLR knees compared with that in contralateral knees during stair ascent, with a moderate effect size and minimal heterogeneity. Knees with ACLD showed less peak knee flexion compared with that on contralateral sides during stair ascent, with minimal heterogeneity. External knee flexion moments were lower for ACLR compared with those in controls and contralateral sides during ascent and descent, whereas these moments were decreased for the ACLD compared with controls only during ascent. Meta-analysis results exhibited moderate/high heterogeneity or small/trivial effect sizes. CONCLUSIONS: Differences for kinematics and kinetics for the ACL-injured knees indicate long-term compensatory and asymmetric movement patterns while ascending and descending stairs. Due to the heterogeneity as well as the small numbers of available studies, the consequences of these differences in terms of long-term function or posttraumatic osteoarthritis need further exploration.

Effect of surface treatment on stress distribution in immediately loaded dental implants--a 3D finite element analysis.

OBJECTIVE: To investigate, by means of FE analysis, the effect of surface roughness treatments on the distribution of stresses at the bone-implant interface in immediately loaded mandibular implants. MATERIALS AND METHODS: An accurate, high resolution, digital replica model of bone structure (cortical and trabecular components) supporting an implant was created using CT scan data and image processing software (Mimics 13.1; Materialize, Leuven, Belgium). An anatomically accurate 3D model of a mandibular-implant complex was created using a professional 3D-CAD modeller (SolidWorks, DassaultSystèmes Solid Works Corp; 2011). Finite element models were created with one of the four roughness treatments on the implant fixture surface. Of these, three were surface treated to create a uniform coating determined by the coefficient of friction (µ); these were either (1) plasma sprayed or porous-beaded (µ=1.0), (2) sandblasted (µ=0.68) or (3) polished (µ=0.4). The fourth implant had a novel two-part surface roughness consisting of a coronal polished component (µ=0.4) interfacing with the cortical bone, and a body plasma treated surface component (µ=1) interfacing with the trabecular bone. Finite element stress analysis was carried out under vertical and lateral forces. RESULTS: This investigation showed that the type of surface treatment on the implant fixture affects the stress at the bone-implant interface of an immediately loaded implant complex. Von Mises stress data showed that the two-part surface treatment created the better stress distribution at the implant-bone interface. SIGNIFICANCE: The results from this FE computational analysis suggest that the proposed two-part surface treatment for IL implants creates lower stresses than single uniform treatments at the bone-implant interface, which might decrease peri-implant bone loss. Future investigations should focus on mechanical and clinical validation of these FE results.

Comparison of blood flow velocity through the internal carotid artery based on Doppler ultrasound and numerical simulation.

Doppler ultrasound is a usual non-invasive method to estimate the stenosis percentage in large arteries such as carotid by measuring maximum velocity of blood flow. Based on clinical investigations, because of vessel wall motions, Doppler positioning and angle correction, some errors can arise in Doppler results which lead to incorrect diagnosis. The aim of this study was to compare the results of Doppler test and the numerical simulation of blood flow in the same case. For this evaluation, two patients including an 87-year-old man and a 72-year-old woman suffering from stenosis in the internal carotid artery were selected. First, clinical information of each patient such as CT-Angio scan images and Doppler ultrasound results on different locations of the stenosed artery were obtained. Then, the geometries were reconstructed and numerical simulations were carried out using ANSYS software. Results showed that the velocity profile of Doppler test and numerical simulation were in good agreement at the regions of pre-and post-stenosis. However, the value of maximum velocity at the stenotic region had significant differences.

Turbulence detection in a stenosed artery bifurcation by numerical simulation of pulsatile blood flow using the low-Reynolds number turbulence model.

The pulsatile blood flow in a partially blocked artery is significantly altered as the flow regime changes through the cardiac cycle. This paper reports on the application of a low-Reynolds turbulence model for computation of physiological pulsatile flow in a healthy and stenosed carotid artery bifurcation. The human carotid artery was chosen since it has received much attention because atherosclerotic lesions are frequently observed. The Wilcox low-Re k-omega turbulence model was used for the simulation since it has proven to be more accurate in describing transition from laminar to turbulent flow. Using the FIDAP finite element code a validation showed very good agreement between experimental and numerical results for a steady laminar to turbulent flow transition as reported in a previous publication by the same authors. Since no experimental or numerical results were available in the literature for a pulsatile and turbulent flow regime, a comparison between laminar and low-Re turbulent calculations was made to further validate the turbulence model. The results of this study showed a very good agreement for velocity profiles and wall shear stress values for this imposed pulsatile laminar flow regime. To explore further the medical aspect, the calculations showed that even in a healthy or non-stenosed artery, small instabilities could be found at least for a portion of the pulse cycle and in different sections. The 40% and 55% diameter reduction stenoses did not significantly change the turbulence characteristics. Further results showed that the presence of 75% stenoses changed the flow properties from laminar to turbulent flow for a good portion of the cardiac pulse. A full 3D simulation with this low-Re-turbulence model, coupled with Doppler ultrasound, can play a significant role in assessing the degree of stenosis for cardiac patients with mild conditions.