Towards modeling of phonation and its recovery in unilateral vocal fold paralysis by fluid-structure interaction.

Introduction: Vocal folds are responsible for sound generation. In unilateral vocal fold paralysis (UVFP), the recurrent laryngeal nerve, which controls the vocal folds, is paralyzed. Medialization laryngoplasty is a surgery in which an implant is inserted to push the paralyzed vocal fold to the centerline to recover phonation. Methods: Here, a numerical simulation is used to calculate flow-related parameters to give insight into what happens in healthy and treated(implanted) vocal folds and their enhancement. In the present work, airflow over vocal folds is modeled considering fluid-structure interaction (FSI) and varying inlet pressure. The governing equations are discretized for fluid and solid domains and solved using the Galerkin finite element method. The boundary conditions for healthy and unilaterally paralyzed vocal folds were imposed to agree with real cases behavior. Results: The results showed the effectiveness of medialization laryngoplasty in treating unilateral vocal fold paralysis concerning healthy vocal folds. Conclusion: This simulation provided a better insight into treatment results for patient-specific cases.

Comparative modeling of the mitral valve in normal and prolapse conditions.

Introduction: Computational modeling is one of the best non-invasive approaches to predicting the functional behavior of the mitral valve (MV) in health and disease. Mitral valve prolapse (MVP) due to partial or complete chordae tendineae rapture is the most common valvular disease and results in mitral regurgitation (MR). Methods: In this study, Image-based fluid-structure interaction (FSI) models of the human MV are developed in the normal physiological and posterior leaflet prolapse conditions. Detailed geometry of the healthy human MV is derived from Computed Tomography imaging data. To provide prolapse condition, some chords attached to the posterior leaflet are removed from the healthy valve. Both normal and prolapsed valves are embedded separately in a straight tubular blood volume and simulated under physiological systolic pressure loads. The Arbitrary Lagrangian-Eulerian finite element method is used to accommodate the deforming intersection boundaries of the blood and MV. Results: The stress values in the mitral components, and also flow patterns including the regurgitant flow rates are obtained and compared in both conditions through the simulation. These simulations have the potential to improve the treatment of patients with MVP, and also help surgeons to have more realistic insight into the dynamics of the MV in health and prolapse. Conclusion: In the prolapse model, computational results show incomplete leaflet coaptation, higher MR severity, and also a significant increment of posterior leaflet stress compared to the normal valve. Moreover, it is found more deviation of the regurgitant jet towards the left atrium wall due to the posterior leaflet prolapse.

Multi-dimensional modeling of nanoparticles transportation from capillary bed into the tumor microenvironment.

In this study, we examined the extravasation of pharmaceutical inorganic nanoparticles (NPs) with a new approach from the leaky endothelium of tumor microvasculature (TMV) into the tumor microenvironment (TME) multi-dimensionally. We proposed a combination of prevailing macroscopic and microscopic methods and addressed the effect of interstitial fluid (IF) retention in solid tumor as an imperative parameter in drug delivery modeling. The Navier-Stokes equations and Darcy's law were utilized for blood flow and porous media, and the Starling's law was brought in for coupling effect. The blood flow was simulated as a non-Newtonian fluid alongside the Newtonian IF. We applied the Galerkin finite element method for the simulations. Our parametric study includes examining the effect of IF retention and TMV pressure on the distribution of tumor interstitial fluid pressure (TIFP), NPs concentration, and diameter on the penetration process, together with the time effect, on two-dimensional (2D) delivery of NPs. Our findings indicate that the IF retention in tumor cells increases TIFP depending on the amount of TMV pressure and IF retained. In addition to doubling pressure in the tumor necrotic region rather than the rest of TME, it enhances the TIFP which is an important parameter in drug delivery to solid tumors. By decreasing pressure drop within the TMV, pressure distribution within the TME becomes more uniform, creating a better condition for homogeneous penetration of NPs. Increasing both inlet pressure and NPs concentration leads to a nonlinear increase in the average concentration of tumor. Decreasing the diameter of NPs increases the penetration of NPs with a higher ratio in the TME.

Fluid-structure interaction of blood flow around a vein valve.

Introduction: Venous valves are a type of one-way valves which conduct blood flow toward the heart and prevent its backflow. Any malfunction of these organs may cause serious problems in the circulatory system. Numerical simulation can give us detailed information and point to point data such as velocity, wall shear stress, and von Mises stress from veins with small diameters, as obtaining such data is almost impossible using current medical devices. Having detailed information about fluid flow and valves' function can help the treatment of the related diseases. Methods: In the present work, the blood flow through a venous valve considering the flexibility of the vein wall and valve leaflets is investigated numerically. The governing equations of fluid flow and solid domain are discretized and solved by the Galerkin finite element method. Results: The obtained results showed that the blood velocity increases from inlet to the leaflets and then decreases passing behind the valve. A pair of vortices and the trapped region was observed just behind the valves. These regions have low shear stresses and are capable of sediment formation. Conclusion: The von Mises stress which is a criterion for the breakdown of solid materials was obtained. It was also observed that a maximum value occurred at the bottom of the leaflets.

Numerical investigation of hemodynamic performance of a stent in the main branch of a coronary artery bifurcation.

Introduction: The effect of a bare-metal stent on the hemodynamics in the main branch of a coronary artery bifurcation with a particular type of stenosis was numerically investigated by the computational fluid dynamics (CFD). Methods: Three-dimensional idealized geometry of bifurcation was constructed in Catia modelling commercial software package. The Newtonian blood flow was assumed to be incompressible and laminar. CFD was utilized to calculate the shear stress and blood pressure distributions on the wall of main branch. In order to do the numerical simulations, a commercial software package named as COMSOL Multiphysics 5.3 was employed. Two types of stent , namely, one-part stent and two-part stent were applied to prevent the build-up and progression of the atherosclerotic plaques in the main branch. Results: A particular type of stenosis in the main branch was considered in this research. It occurred before and after the side branch. Moreover, it was found that the main branch with an inserted one-part stent had the smallest region with the wall shear stress (WSS) below 0.5 Pa which was the minimum WSS in the main branch without the stenosis. Conclusion: The use of a one-part stent in the main branch of a coronary artery bifurcation for the aforementioned type of stenosis is recommended.

Fluid-structure interaction simulation of ureter with vesicoureteral reflux and primary obstructed megaureter.

Two common abnormalities in ureters include primary refluxing megaureter (PRM) and primary obstructed megaureter (POM). The aim of this study was to represent the numerical simulation of the urine flow at the end of the ureter with vesicoureteral reflux (VUR) and POM during peristalsis. Methodologically, the peristalsis in the ureter wall was created using Gaussian distribution. Fluid-structure interaction (FSI) was applied to simulate urine-elastic wall interactions; and governing equations were solved using the arbitrary Lagrangian-Eulerian method. Theories such as wall elasticity, Newtonian fluid, and incompressible Navier-Stokes equations were used. Velocity fields, viscous stresses and volumetric outflow rate profiles were obtained through the simulation of the ureter with VUR and POM during peristalsis. In addition, the effect of urine viscosity on flow rate was investigated. When the bladder pressure increased, VUR occurred because of the ureterovesical junction (UVJ) dysfunction, leading to high stresses on the wall. In the POM, the outflow rate was ultimately zero, and stresses on the wall were severe in the obstructed section. Comparing the results demonstrated that the peristalsis leads to even further dilation of the prestenosis portion. It was also observed that the reflux occurs in the ureter with VUR when the bladder pressure is high. Additionally, the urine velocity during the peristalsis was higher than the non-peristaltic ureter.

Numerical investigation of the blood flow through the middle cerebral artery.

Introduction: The middle cerebral artery (MCA) is one of the three major paired arteries that supply the blood to the cerebrum. In the present study, the three-dimensional (3D) blood flow in the left MCA was numerically simulated by using the medical imaging. Methods: The arterial geometry was obtained by applying the CT angiography of the MCA of a 75-year-old man. The blood flow was assumed to be laminar and unsteady. Numerical simulations were done by commercial software package COMSOL Multiphysics 5.2. In this software, the Galerkin's finite element method was applied to solve the governing equations. Results: It was found that the results obtained for the Newtonian and non-Newtonian models of blood do not differ from each other significantly. Thus, the Newtonian model for blood flow in the MCA is acceptable. Also, the most susceptible region of the MCA for Atherosclerosis was detected. Conclusion: It can be concluded that the application of the Newtonian model for the blood flowing in the MCA is acceptable. Also, atherosclerosis has the potential to occur at the middle of a branch of the MCA which has the highest geometrical curvature.

An ALE-based finite element model of flagellar motion driven by beating waves: A parametric study.

A computational model of flagellar motility is presented using the finite element method. Two-dimensional traveling waves of finite amplitude are propagated down the flagellum and the swimmer is propelled through a viscous fluid according to Newto's second law of motion. Incompressible Navier-Stokes equations are solved on a triangular moving mesh and arbitrary Lagrangian-Eulerian formulation is employed to accommodate the deforming boundaries. The results from the present study are validated against the data available in the literature and close agreement with previous works is found. The effects of wave parameters as well as head morphology on the swimming characteristics are studied for different swimming conditions. We have found that the swimming velocities are linear functions of finite amplitudes and that the rate of work is independent of the channel height for large amplitudes. Furthermore, we have also demonstrated that for the range of wave parameters that are often encountered in human sperm motility studies, the propulsive velocity versus the wavelength exhibits dissimilar trends for different channel heights. Various head configurations were analyzed and it is also observed that wall proximity amplifies the effects induced by different head shapes. By taking non-Newtonian fluids into account, we present new efficiency analyzes through which we have found that the model microorganism swims much more efficiently in shear-thinning fluids.

Numerical investigation of blood flow in a deformable coronary bifurcation and non-planar branch.

INTRODUCTION: Among cardiovascular diseases, arterials stenosis is recognized more commonly than the others. Hemodynamic characteristics of blood play a key role in the incidence of stenosis. This paper numerically investigates the pulsatile blood flow in a coronary bifurcation with a non-planar branch. To create a more realistic analysis, the wall is assumed to be compliant. Furthermore, the flow is considered to be three-dimensional, incompressible, and laminar. METHODS: The effects of non-Newtonian blood, compliant walls and different angles of bifurcation on hemodynamic characteristics of flow were evaluated. Shear thinning of blood was simulated with the Carreau-Yasuda model. The current research was mainly focused on the flow characteristics in bifurcations since atherosclerosis occurs mostly in bifurcations. Moreover, as the areas with low shear stresses are prone to stenosis, these areas were identified. RESULTS: Our findings indicated that the compliant model of the wall, bifurcation's angle, and other physical properties of flow have an impact on hemodynamics of blood flow. Lower wall shear stress was observed in the compliant wall than that in the rigid wall. The outer wall of bifurcation in all models had lower wall shear stress. In bifurcations with larger angles, wall shear stress was higher in outer walls, and lower in inner walls. CONCLUSION: The non-Newtonian blood vessels and different angles of bifurcation on hemodynamic characteristics of flow evaluation confirmed a lower wall shear stress in the compliant wall than that in the rigid wall, while the wall shear stress was higher in outer walls but lower in inner walls in the bifurcation regions with larger angles.

Numerical investigation of pulsatile blood flow in a bifurcation model with a non-planar branch: the effect of different bifurcation angles and non-planar branch.

INTRODUCTION: Atherosclerosis is a focal disease that susceptibly forms near bifurcations, anastomotic joints, side branches, and curved vessels along the arterial tree. In this study, pulsatile blood flow in a bifurcation model with a non-planar branch is investigated. METHODS: Wall shear stress (WSS) distributions along generating lines on vessels for different bifurcation angles are calculated during the pulse cycle. RESULTS: The WSS at the outer side of the bifurcation plane vanishes especially for higher bifurcation angles but by increasing the bifurcation angle low WSS region squeezes. At the systolic phase there is a high possibility of formation of a separation region at the outer side of bifurcation plane for all the cases. WSS peaks exist on the inner side of bifurcation plane near the entry section of daughter vessels and these peaks drop as bifurcation angle is increased. CONCLUSION: It was found that non-planarity of the daughter vessel lowers the minimum WSS at the outer side of the bifurcation and increases the maximum WSS at the inner side. So it seems that the formation of atherosclerotic plaques at bifurcation region in direction of non-planar daughter vessel is more risky.

Simulation of blood flow coronary artery with consecutive stenosis and coronary-coronary bypass.

INTRODUCTION: In this research the behavior of coronary arteries has been studied with symmetric and asymmetric consecutive stenosis, and grafted vessels. METHODS: The incompressible Navier-Stokes and energy equations were discretized with second-order upwind method. Assumptions such as Newtonian fluid, wall rigidity and steady-flow were used. RESULTS: All the calculations showed the same results with Newtonians and non- Newtonian fluids. It was found that the possibility of stenosis be reduced by increasing the graft angle. However, there exists further stenosis possibility. Among the three graft angles 20, 30 ˚ and 40, the 30 ˚ was found to be the reliable ones. CONCLUSION: Based on these findings, it can be deduced that there would be a high risk of further atherosclerosis when the first stenose has the maximum percentage.

Possibility of atherosclerosis in an arterial bifurcation model.

INTRODUCTION: Arterial bifurcations are susceptible locations for formation of atherosclerotic plaques. In the present study, steady blood flow is investigated in a bifurcation model with a non-planar branch. METHODS: The influence of different bifurcation angles and non-planar branch is demonstrated on wall shear stress (WSS) distribution using three-dimensional Navier-Stokes equations. RESULTS: The WSS values are low in two locations at the top and bottom walls of the mother vessels just before the bifurcation, especially for higher bifurcation angles. These regions approach the apex of bifurcation with decreasing the bifurcation angle. The WSS magnitudes approach near to zero at the outer side of bifurcation plane and these locations are separation-prone. By increasing the bifurcation angle, the minimum WSS decreases at the outer side of bifurcation plane but low WSS region squeezes. WSS peaks exist on the inner side of bifurcation plane near the entry section of daughter vessels and these initial peaks drop as bifurcation angle is increased. CONCLUSION: It is concluded that the non-planarity of the daughter vessel lowers the minimum WSS at the outer side of bifurcation and increases the maximum WSS at the inner side. So it seems that the formation of atherosclerotic plaques at bifurcation region in direction of non-planar daughter vessel is more risky.