Biology and Hemodynamics of Aneurysm Rupture.

Predicting rupture risk in intracranial aneurysms is among one of the most critical questions in vascular surgery. The processes that govern an aneurysm growth are multifaceted and complex, but may be summarized into three components: hemodynamics, biology, and mechanics. We review and connect the literature in the three disciplines, identifying considerable strides in recent history and current gaps in research. Taken together, the findings from each field elucidate how and why certain aneurysms rupture, whereas others remain stable. These parameters could eventually inform a translatable predictive model that optimizes risk evaluation and physician's decision-making in treatment options for aneurysms.

Flow residence time in intracranial aneurysms evaluated by in vitro 4D flow MRI.

The process of an intracranial aneurysm development, growth, and rupture is multifaceted and complex. In addition, clinical observations have identified the potential of thrombus formation within such aneurysms. While the underlying mechanism is not fully understood, the thrombi represent a potential risk factor for ischemic stroke. Emerging studies indicate that blood residence time (RT) is a promising hemodynamic metric associated with the aneurysm rupture and formation of intra-aneurysmal thrombi. Here, we present a methodology to experimentally evaluate both trajectory-wise and local RT based on magnetic resonance imaging (MRI) velocimetry, and apply it to in vitro flow measurements in scaled-up replicas of 9 patient-specific intracranial aneurysms. Lagrangian tracks of massless tracers are integrated from the velocity fields and averaged to return the mean RT in the aneurysm sac. This is found to be closely approximated by a simple time scale based on the sac diameter and space-time average of the aneurysmal fluid velocity. The mean RT is also correlated with the inflow time scale at the parent artery. These results also provide a basis for the estimation of RT when high-resolution hemodynamic maps are not available. With the continuous increase in accuracy and resolution enabled by progress in MRI technology, the methodology described here may in the future be applicable to in vivo data.

Particle Distribution in Embolotherapy, How Do They Get There? A Critical Review of the Factors Affecting Arterial Distribution of Embolic Particles.

Embolization has tremendously evolved in recent years and has expanded to treatment of a variety of pathologic processes. There has been emerging evidence that the level of arterial occlusion and the distribution of embolic particles may play an important role in the clinical outcome. This is a comprehensive literature review to identify variables that play important role in determination of level of occlusion of blood vessels and distribution of embolic particles. The literature searches between 1996 to 2020 through PubMed and Ovid-MEDLINE yielded over 1030 articles of which 30 studies providing details on the level of occlusion are reviewed here. We divided the playing factors into characteristics of the particles, solution/injection and vascular bed. Accordingly, particle size, type and aggregation, compressibility/deformability, and biodegradability are categorized as the factors involving particles' behavioral nature. Infusion rate and concentration/dilution of the medium are related to the carrying solution. Hemodynamics and the arterial resistance are characteristics of the vascular bed that also play an important role in the distribution of embolic particles. Understanding and predicting the level of embolization is a complex multi-factor problem that requires more evidence, warranting further randomized controlled trials, and powered human and animal studies.

Design and Fabrication of a Graphene/Polyvinylidene Fluoride Nanocomposite-Based Airflow Sensor.

In recent years, flexible and stretchable sensors have been a subject of intensive research to replace the traditional sensors made up of rigid metals and semiconductors. In this paper, a piezoresistive airflow sensor was designed and tested to measure the speed of air inside a pipe. Graphene/polyvinylidene fluoride nanocomposite films were prepared using a solvent-cast technique on a flexible polyethylene substrate as a piezoresistive material. Three different solutions were studied as a function of graphene concentration. The microstructure of the nanocomposite was characterized by X-ray diffraction, scanning electron microscopy, and optical microscopy. The effect of temperature on electrical conductivity was investigated by heating and cooling the sample between the room temperature and 150 °C. The stretchability of the nanocomposite film was studied with a tensile test, and the same procedure was employed to determine the breakdown point of the electrical conductivity. The sensor response was measured in terms of the resistance change caused by air pressure and found to increase with the concentration of graphene in the composite. The sensing characteristics were simulated using the COMSOL Multiphysics software, and the modeled data were compared favorably with the experimental result. The sensitivity of the sensor was found to be 1.21% kPa-1 in the range of 0-2.7 kPa. This piezoelectric sensor possesses unique characteristics such as being lightweight, flexible, and exhibiting fast response; hence, it can have potential applications in various sectors such as ventilators, commercial HVAC, and automotive industries.

A Multi-Disciplinary Review on the Aerobiology of COVID-19 in Dental Settings.

The COVID-19 pandemic pushed dental health officials around the world to reassess and adjust their existing healthcare practices. As studies on controlled COVID-19 transmission remain challenging, this review focuses on particles that can carry the virus and relevant approaches to mitigate the risk of pathogen transmission in dental offices. This review gives an overview of particles generated in clinical settings and how size influences their distribution, concentration, and generation route. A wide array of pertinent particle characterization and counting methods are reviewed, along with their working range, reliability, and limitations. This is followed by a focus on the effectiveness of personal protective equipment (PPE) and face shields in protecting patients and dentists from aerosols. Direct studies on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are still limited, but the literature supports the use of masks as an important and effective non-pharmaceutical preventive measure that could reduce the risk of contracting a respiratory infection by up to 20%. In addition to discussing about PPE used by most dental care professionals, this review describes other ways by which dental offices can protect patients and dental office personnel, which includes modification of the existing room design, dental equipment, and heating, ventilation, and air conditioning (HVAC) system. More affordable modifications include positioning a high-efficiency particulate air (HEPA) unit within proximity of the patient's chair or using ultraviolet germicidal irradiation in conjunction with ventilation. Additionally, portable fans could be used to direct airflow in one direction, first through the staff working areas and then through the patient treatment areas, which could decrease the number of airborne particles in dental offices. This review concludes that there is a need for greater awareness amongst dental practitioners about the relationship between particle dynamics and clinical dentistry, and additional research is needed to fill the broad gaps of knowledge in this field.

Conceptual Framework Development for a Double-Walled Aortic Stent-Graft to Manage Blood Pressure.

A double-walled stent-graft (DWSG) design with a compressible gas layer was conceived with the goal of treating hypertension in patients receiving an aortic stent-graft. Early prototypes were developed to evaluate the design concept through static measurements from a finite element (FE) model and quasi-static inflation experiments, and through dynamic measurements from an in vitro flow loop and the three-element Windkessel model. The amount of gas in the gas layer and the properties of the flexible inner wall were the primary variables evaluated in this study. Properties of the inner wall had minimal effect on DWSG behavior, but increased gas charge led to increased fluid capacitance and larger reduction in peak and pulse pressures. In the flow loop, placement of the DWSG decreased pulse pressure by over 20% compared to a rigid stent-graft. Capacitance measurements were consistent across all methods, with the maximum capacitance estimated at 0.07 mL/mmHg for the largest gas charge in the 15 cm long prototype. Windkessel model predictions for in vivo performance of a DWSG placed in the aorta of a hypertensive patient showed pulse pressure reduction of 14% compared to a rigid stent-graft case, but pressures never returned to unstented values. These results indicate that the DWSG design has potential to be developed into a new treatment for hypertensive patients requiring an aortic intervention.

Magnetic Resonance Imaging Based Flow Field and Lagrangian Particle Tracking From a Left Ventricular Assist Device.

This study explores the optimal left ventricular assist device (LVAD) cannula outflow configuration in a patient-specific replica of the aorta. The volumetric velocity field is measured using phase-contrast magnetic resonance imaging (PC-MRI) under a physiologically relevant steady flow. The effect of the LVAD outflow graft insertion site and anastomosis angle on the transport of embolic particles to cranial vessels is studied by solving the particle equation of motion for spheres in the range of 0.1-1.0 mm using the measured three-dimensional (3D) velocity field. Results show that for a given aorta anatomy, it is possible to design the cannula graft location and terminal curvature so that the probability of embolic transport to the cranial vessels is significantly minimized. This is particularly important since the complex flow pattern in each cannula case affects the embolic trajectories differently, and hence the common assumption that particles distribute by the volumetric flow division does not hold.

In Vitro Study of Particle Transport in Successively Bifurcating Vessels.

To reach a predictive understanding of how particles travel through bifurcating vessels is of paramount importance in many biomedical settings, including embolization, thromboembolism, and drug delivery. Here we utilize an in vitro model in which solid particles are injected through a rigid vessel that symmetrically bifurcates in successive branching generations. The geometric proportion and fluid dynamics parameters are relevant to the liver embolization. The volumetric flow field is reconstructed via phase-contrast magnetic resonance imaging, from which the particle trajectories are calculated for a range of size and density using the particle equation of motion. The method is validated by directly tracking the injected particles via optical imaging. The results indicate that, opposite to the common assumption, the particles distribution is fundamentally different from the volumetric flow partition. In fact, the amount of delivered particles vary substantially between adjacent branches even when the flow is uniformly distributed. This is not due to the inertia of the particles, nor to gravity. The particle distribution is rather rooted in their different pathways, which in turn are linked to their release origin along the main vessel cross-section. Therefore, the tree geometry and the associated flow streamlines are the prime determinant of the particle fate, while local changes of volumetric flow rate to selected branches do not generally produce proportional changes of particle delivery.

Hemodynamics in a giant intracranial aneurysm characterized by in vitro 4D flow MRI.

Experimental and computational data suggest that hemodynamics play a critical role in the development, growth, and rupture of cerebral aneurysms. The flow structure, especially in aneurysms with a large sac, is highly complex and three-dimensional. Therefore, volumetric and time-resolved measurements of the flow properties are crucial to fully characterize the hemodynamics. In this study, phase-contrast Magnetic Resonance Imaging is used to assess the fluid dynamics inside a 3D-printed replica of a giant intracranial aneurysm, whose hemodynamics was previously simulated by multiple research groups. The physiological inflow waveform is imposed in a flow circuit with realistic cardiovascular impedance. Measurements are acquired with sub-millimeter spatial resolution for 16 time steps over a cardiac cycle, allowing for the detailed reconstruction of the flow evolution. Moreover, the three-dimensional and time-resolved pressure distribution is calculated from the velocity field by integrating the fluid dynamics equations, and is validated against differential pressure measurements using precision transducers. The flow structure is characterized by vortical motions that persist within the aneurysm sac for most of the cardiac cycle. All the main flow statistics including velocity, vorticity, pressure, and wall shear stress suggest that the flow pattern is dictated by the aneurysm morphology and is largely independent of the pulsatility of the inflow, at least for the flow regimes investigated here. Comparisons are carried out with previous computational simulations that used the same geometry and inflow conditions, both in terms of cycle-averaged and systolic quantities.

Lipoprotein transport in the blood stream to the arterial wall in a carotid artery bifurcation.

The carotid arteries are a common site of atherosclerotic plaque formation, which has been linked to the blood flow patterns and the mass transport phenomenon. The purpose of this research was to study the lipid transport in a human carotid artery model, focusing on the effects of local geometric and hemodynamic factors on mass transfer from blood flow to vessel wall and its concentration at the luminal surface of the artery. The Reynolds number, 250, and the Schmidt number, 6.66x105, were selected to model the mass transfer of LDL macro molecules, and in order to see the effect of Reynolds and Schmidt numbers to mass transport, the model was analyzed with different conditions. The steady state flow was used for two dimensional carotid geometry. At the inlet, the blood flow was assumed a steady fully developed laminar velocity profile with a uniform LDL concentration. The vessel wall was assumed permeable to water and semi-permeable to LDL macro molecules. The problem was analyzed with the finite element method. The results show 26% increase of LDL concentration from inlet value at the luminal surface of the artery located in the separated flow region. The maximum value of LDL concentration occurred at the separation point.