A Novel Method for Angiographic Contrast-Based Diagnosis of Stenosis in Coronary Artery Disease: In Vivo and In Vitro Analyses.

BACKGROUND: The existing diagnostic methods for coronary artery disease (CAD), such as coronary angiography and fractional flow reserve (FFR), have limitations regarding their invasiveness, cost, and discomfort. We explored a novel diagnostic approach, coronary contrast intensity analysis (CCIA), and conducted a comparative analysis between it and FFR. METHODS: We used an in vitro coronary-circulation-mimicking system with nine stenosis models representing various stenosis lengths (6, 18, and 30 mm) and degrees (30%, 50%, and 70%). The angiographic brightness values were analyzed for CCIA. The in vivo experiments included 15 patients with a normal sinus rhythm. Coronary angiography was performed, and arterial movement was tracked, enabling CCIA derivation. The CCIA values were compared with the FFR (n = 15) and instantaneous wave-free ratio (iFR; n = 11) measurements. RESULTS: In vitro FFR showed a consistent trend related to the length and severity of stenosis. The CCIA was related to stenosis but had a weaker correlation with length, except for with 70% stenosis (6 mm: 0.82 ± 0.007, 0.68 ± 0.007, 0.61 ± 0.004; 18 mm: 0.78 ± 0.052, 0.69 ± 0.025, 0.44 ± 0.016; 30 mm: 0.80 ± 0.018, 0.64 ± 0.006, 0.40 ± 0.026 at 30%, 50%, and 70%, respectively). In vitro CCIA and FFR were significantly correlated (R = 0.9442, p < 0.01). The in vivo analysis revealed significant correlations between CCIA and FFR (R = 0.5775, p < 0.05) and the iFR (n = 11, R = 0.7578, p < 0.01). CONCLUSIONS: CCIA is a promising alternative for diagnosing stenosis in patients with CAD. The initial in vitro validation and in vivo confirmation in patients demonstrate the feasibility of applying CCIA during coronary angiography. Further clinical studies are warranted to fully evaluate the diagnostic accuracy and potential impact of CCIA on CAD management.

Effects of Auricular Acupressure on Hip Flexibility and Pain in Taekwondo Participants: Randomized Controlled Trial.

BACKGROUND: In sports, hip flexibility is essential to reduce injuries and improve performance. AIM: This study aimed to examine the effects of auricular acupressure on hip flexibility and pain in Taekwondo participants. METHOD: This randomized controlled trial was performed in the Republic of Korea from January 2021 to August 2021. The Numeric Rating Scale for Pain and Hip Flexibility was used. Twenty-one participants received auricular pressure once weekly for six weeks, while 17 participants did not receive any intervention. Auricular acupressure was applied to the hip (AH13), Shinmun, and auricular acupressure points associated with the pain areas reported by the participants. RESULTS: Auricular acupressure improved hip flexibility (t = 2.67, p = .011) and back pain (t = 2.11, p = .043). The mean difference in post-pretest hip flexibility in the experimental group was 16.24 degrees (±13.63), whereas that in the control group was 4.77 degrees (±15.07). The mean difference in the experimental group's pre-post-test scores of back pain was 1.24 (±2.64), whereas that in the control group was 0.18 (±1.41). CONCLUSIONS: The results of this study showed that auricular acupressure could be used to treat pain and improve hip flexibility.

Reply to Marino et al. Choroidal Thickness Measurements in the Case of Diabetic Macular Edema. Comment on "Amjad et al. Choroidal Thickness in Different Patterns of Diabetic Macular Edema. J. Clin. Med. 2022, 11, 6169".

We are pleased to see that Marino et al. have written a Comment: "Choroidal Thickness Measurements in the Case of Diabetic Macular Edema" [...].

Axial shear rate: A hemorheological factor for erythrocyte aggregation under Womersley flow in an elastic vessel based on numerical simulation.

Erythrocyte aggregation (EA) is a highly dynamic, vital phenomenon to interpreting human hemorheology, which would be helpful for the diagnosis and prediction of circulatory anomalies. Previous studies of EA on erythrocyte migration and the Fåhraeus Effect are based on the microvasculature. They have not considered the natural pulsatility of the blood flow or large vessels and mainly focused on shear rate along radial direction under steady flow to comprehend the dynamic properties of EA. To our knowledge, the rheological characteristics of non-Newtonian fluids under Womersley flow have not reflected the spatiotemporal behaviors of EA or the distribution of erythrocyte dynamics (ED). Hence, it needs to interpret the ED affected by temporal and spatial flow variation to understand the effect of EA under Womersley flow. Here, we demonstrated the numerically simulated ED to decipher EA's rheological role in axial shear rate under Womersley flow. In the present study, the temporal and spatial variations of the local EA were found to mainly depend on the axial shear rate under Womersley flow in an elastic vessel, while mean EA decreased with radial shear rate. The localized distribution of parabolic or M-shape clustered EA was found in a range of the axial shear rate profile (-15 to 15s-1) at low radial shear rates during a pulsatile cycle. However, the linear formation of rouleaux was realized without local clusters in a rigid wall where the axial shear rate is zero. In vivo, the axial shear rate is usually considered insignificant, especially in straight arteries, but it has a great impact on the disturbed blood flow due to the geometrical properties, such as bifurcations, stenosis, aneurysm, and the cyclic variation of pressure. Our findings regarding axial shear rate provide new insight into the local dynamic distribution of EA, which is a critical player in blood viscosity. These will provide a basis for the computer-aided diagnosis of hemodynamic-based cardiovascular diseases by decreasing the uncertainty in the pulsatile flow calculation.

Choroidal Thickness in Different Patterns of Diabetic Macular Edema.

This observational study investigated the changes in choroidal thickness (ChT) in different patterns of diabetic macular edema (DME) based on image processing using enhanced-depth imaging spectral-domain optical coherence tomography (EDI-SD-OCT). Participants with ocular conditions affecting the fundus view, including retinal diseases, were excluded. After observing the patient's medical record, multicolor fundus photos, thickness maps, and subtypes of DME were diagnosed according to the criteria reported by the Early Treatment Diabetic Retinopathy Study (ETDRS). Edema was classified as focal or diffuse and was subdivided into cystic macular edema (CME), CME with subretinal fluid (CME+), and spongy macular edema (SME). Image processing was performed on the B-scan images from SD-OCT to segment the choroid layer and obtain the choroid thickness. A total of 159 eyes of 81 patients (46 males and 35 females; 57.53 ± 9.78 years of age), and 57 eyes of 30 healthy individuals (age 57.34 ± 8.76 years) were enrolled in this study. Out of 159 eyes, 76 had focal macular edema (FME), 13 exhibited SME, and 51 presented CME. Among those with cystic macular edema, 19 eyes showed subretinal fluid (CME+). The average choroidal thickness in FME, diffuse SME, CME, and CME+ was 216.95 ± 52.94 µm, 243.00 ± 46.34 µm, 221.38 ± 60.78 µm, and 249.63 ± 53.90 µm, respectively. The average choroidal thickness in age-matched controls was 213.88 ± 45.60 µm. Choroidal thickness increases with the severity of edema; choroidal thickness was higher in diffuse macular edema than in FME. However, choroidal thickness increased in cystic macular edema with subretinal fluid (CME+).

Numerical simulation of spatiotemporal red blood cell aggregation under sinusoidal pulsatile flow.

Previous studies on red blood cell (RBC) aggregation have elucidated the inverse relationship between shear rate and RBC aggregation under Poiseuille flow. However, the local parabolic rouleaux pattern in the arterial flow observed in ultrasonic imaging cannot be explained by shear rate alone. A quantitative approach is required to analyze the spatiotemporal variation in arterial pulsatile flow and the resulting RBC aggregation. In this work, a 2D RBC model was used to simulate RBC motion driven by interactional and hydrodynamic forces based on the depletion theory of the RBC mechanism. We focused on the interaction between the spatial distribution of shear rate and the dynamic motion of RBC aggregation under sinusoidal pulsatile flow. We introduced two components of shear rate, namely, the radial and axial shear rates, to understand the effect of sinusoidal pulsatile flow on RBC aggregation. The simulation results demonstrated that specific ranges of the axial shear rate and its ratio with radial shear rate strongly affected local RBC aggregation and parabolic rouleaux formation. These findings are important, as they indicate that the spatiotemporal variation in shear rate has a crucial role in the aggregate formation and local parabolic rouleaux under pulsatile flow.

Depletion-model-based numerical simulation of the kinetics of red blood cell aggregation under sinusoidal pulsatile flow.

BACKGROUND: Previous numerical modeling studies on red blood cell (RBC) aggregation have elucidated the inverse relationship between shear rate and RBC aggregation under steady flow. However, information on the cyclic variation in RBC aggregation under pulsatile flow remains lacking. OBJECTIVE: RBC aggregation was simulated to investigate the complex interrelationships among the parameters of RBC motion under pulsatile flow. METHODS: A two-dimensional particle model was used to simulate RBC motion driven by hydrodynamic, aggregation, and elastic forces in a sinusoidal pulsatile flow field. The kinetics of RBCs motion was simulated on the basis of the depletion model. RESULTS: The simulation results corresponded with previously obtained experimental results for the formation and destruction of RBC aggregates with a parabolic radial distribution during a pulsatile cycle. In addition, the results demonstrated that the cyclic variation in the mean aggregate size of RBCs increased as velocity amplitude increased from 1 cm/s to 3 cm/s under a mean steady flow of 2 cm/s, as mean steady flow velocity decreased from 6 cm/s to 2 cm/s under a velocity amplitude of 1.5 cm/s, and as stroke rate decreased from 180 beats per minute (bpm) to 60 bpm. CONCLUSIONS: The present simulation results verified previous experimental results and improved the current understanding of the complex spatiotemporal changes experienced by RBC aggregates during a sinusoidal pulsatile cycle.