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This paper presents a finite-difference-based method for numerically deriving the DQ impedance model of power electronics-based power systems, specifically tailored for stability analysis. The proposed method offers a computationally efficient alternative to traditional approaches by directly applying finite-difference approximations to the large-signal dynamic system, without relying on repetitive time-domain simulations or small-signal analytical models. This method eliminates the need for additional models or complex procedures to compute the steady-state solution, streamlining the impedance modeling process. The accuracy, efficiency, and precision of the proposed method are evaluated through comparative studies with analytical and time-domain perturbation methods. Results demonstrate that the proposed approach provides accuracy comparable to analytical models while significantly reducing computational effort, outperforming perturbation methods in both speed and precision. These findings highlight the practical value of the proposed method for real-time and large-scale system analysis, making it a robust tool for power systems stability assessment.

Abstract Although abdominal aortic aneurysms (AAA) are more common in men, women are at greater risk for AAA growth/rupture. Vascular deformation mapping (VDM) utilizes deformable image registration to qualify and quantify 3D-AAA growth using computed tomography angiograms (CTA). In this study we leveraged VDM to investigate sex differences in AAA growth patterns. Patients with infra-renal AAA and ≥ 2 CTA were identified. Males and females were matched for age, hypertension, and smoking history. Patient characteristics, maximum diameter (Dmax), and AAA volume were obtained. CTA images were segmented, and VDM was conducted to quantify 3D AAA growth rate per year (GR, cm/year). Statistical shape modeling was utilized to compute mean aneurysm shapes and 3D GR. Average GR was evaluated at specific regions of the aortic surface for males and females. Seventeen males and 17 females were matched. At the individual level, there were no sex differences in changes in Dmax or AAA volume. However, females had larger GR across the anterior and right lateral AAA (1.33 vs 0.89 and 1.56 vs 0.74 cm/year, respectively), despite no difference in posterior or left lateral AAA GR. Despite comparable changes in Dmax, AAA volume, and GR magnitude, women demonstrated a more eccentric, anterior-predominant, AAA growth pattern.

Abstract We present a multi-stage neural network approach for 3D reconstruction of coronary artery trees from uncalibrated 2D X-ray angiography images. This method uses several binarized images from different angles to reconstruct a 3D coronary tree without any knowledge of image acquisition parameters. The method consists of a single backbone network and separate stages for vessel centerline and radius reconstruction. The output is an analytical matrix representation of the coronary tree suitable for downstream applications such as hemodynamic modeling of local vessel narrowing (i.e., stenosis). The network was trained using a dataset of synthetic coronary trees from a vessel generator informed by both clinical image data and literature values on coronary anatomy. Our multi-stage network achieved sub-pixel accuracy in reconstructing vessel radius (RMSE = 0.16 ± 0.07 mm) and stenosis radius (MAE = 0.27 ± 0.18 mm), the most important feature used to inform diagnostic decisions. The network also led to 52% and 38% reduction in vessel centerline reconstruction errors compared to a single-stage network and projective geometry-based methods, respectively. Our method demonstrated robustness to overcome challenges such as vessel foreshortening or overlap in the input images. This work is an important step towards automated analysis of anatomic and functional disease severity in the coronary arteries.

Introduction: Iliac vein compression syndrome (IVCS) is present in over 20% of the population and is associated with left leg pain, swelling, and thrombosis. IVCS symptoms are thought to be induced by altered pelvic hemodynamics, however, there currently exists a knowledge gap on the hemodynamic differences between IVCS and healthy patients. To elucidate those differences, we carried out a patient-specific, computational modeling comparative study.Methods: Computed tomography and ultrasound velocity and area data were used to build and validate computational models for a cohort of IVCS (N = 4, Subject group) and control (N = 4, Control group) patients. Flow, cross-sectional area, and shear rate were compared between the right common iliac vein (RCIV) and left common iliac vein (LCIV) for each group and between the Subject and Control groups for the same vessel.Results: For the IVCS patients, LCIV mean shear rate was higher than RCIV mean shear rate (550 ± 103 s−1 vs. 113 ± 48 s−1, p = 0.0009). Furthermore, LCIV mean shear rate was higher in the Subject group than in the Control group (550 ± 103 s−1 vs. 75 ± 37 s−1, p = 0.0001). Lastly, the LCIV/RCIV shear rate ratio was 4.6 times greater in the Subject group than in the Control group (6.56 ± 0.9 vs. 1.43 ± 0.6, p = 0.00008).Discussion: Our analyses revealed that IVCS patients have elevated shear rates which may explain a higher thrombosis risk and suggest that their thrombus initiation process may share aspects of arterial thrombosis. We have identified hemodynamic metrics that revealed profound differences between IVCS patients and Controls, and between RCIV and LCIV in the IVCS patients. Based on these metrics, we propose that non-invasive measurement of shear rate may aid with stratification of patients with moderate compression in which treatment is highly variable. More investigation is needed to assess the prognostic value of shear rate and shear rate ratio as clinical metrics and to understand the mechanisms of thrombus formation in IVCS patients.

Modern power grids are becoming more stressed, more complex, and beginning to have a significant integration of energy sources based on power electronics devices, which significantly changes the dynamics of power grids affecting the design and operation of Remedial Action Schemes such as UVLS and UFLS, where the conventional operation philosophy of these schemes is based in operating parameters such as thresholds, amount, and location of the load shedding fixed regardless of the event. Therefore, they are not adaptable to the various conditions of the modern power grids, causing their misoperation. In recent years, a wide variety of adaptive schemes around the world have been proposed as a solid solution with good performance, since its main characteristic is its ability to consider the magnitude of the event in its load shedding, turning them into more selective and with flexibility in their operating parameters. The aim of this article is to review the development of adaptive schemes in UVLS and UFLS over the years, identifying how to approach the design of such adaptable schemes, which operating parameters tend to give them greater flexibility and which have been less explored. Then broken down the methods used to give flexibility to the operating parameters of UVLS and UFLS, and also that other devices such as FACTS and ESS can enhance its operation, with the aim of provide a broad vision of how to give them flexibility to these parameters and which of them are identified as an opportunity to improve the performance of the adaptive schemes. Finally, the review includes some RAS with adaptive approach implemented in real systems which some of them includes load shedding, to show how these schemes have reconfigured their design and operation by giving flexibility to some operating parameters, it is possible to show the need of modern power grids to have adaptive RAS.

Abstract It is well known that blood exhibits non-Newtonian viscosity, but it is generally modeled as a Newtonian fluid. However, in situations of low shear rate, the validity of the Newtonian assumption is questionable. In this study, we investigated differences between Newtonian and non-Newtonian hemodynamic metrics such as velocity, vorticity, and wall shear stress. In addition, we investigated cardiovascular transport using two different approaches, Eulerian mass transport and Lagrangian particle tracking. Non-Newtonian solutions revealed important differences in both hemodynamic and transport metrics relative to the Newtonian model. Most notably for the hemodynamic metrics, in-plane velocity and vorticity were consistently larger in the Newtonian approximation for both arterial and venous flows. Conversely, wall shear stresses were larger for the non-Newtonian case for both the arterial and venous models. Our results also indicate that for the Lagrangian metrics, the history of accumulated shear was consistently larger for both arterial and venous flows in the Newtonian approximation. Lastly, our results also suggest that the Newtonian model produces larger near wall and luminal mass transport values compared to the non-Newtonian model, likely due to the increased vorticity and recirculation. These findings demonstrate the importance of accounting for non-Newtonian behavior in cardiovascular flows exhibiting significant regions of low shear rate and recirculation.

The stability issues assessment by the impedance-based method demands the computation of accurate small-signal models. However, obtaining impedance models can be a time-consuming task if analytical models or the perturbation-based method are used. Especially in large-scale, poorly damped, distributed, and frequency-dependent parameter systems. A third approach, which has been less explored, is based on numerical derivative approximations, rather than analytical equations or time-domain simulations. This approach works with large-scale systems, avoiding tedious mathematical expressions and large recursive time-domain simulations. As a step-forward in this approach, this paper proposes a numerical-oriented method, based on the finite-difference method, to compute impedance models of time-delay power-electronics-based power systems. An outstanding feature of the proposal is the capability to incorporate the exact delays into the numerical models of impedance without resorting to approximations nor increasing the size of the system model. We compare the proposed method with the analytical and perturbation methods using a grid-connected microgrid with two power electronic inverters as a test system. The results confirm the correct performance of the proposal.

Abstract Coronary Artery Disease (CAD) is commonly diagnosed using X-ray angiography, in which images are taken as radio-opaque dye is flushed through the coronary vessels to visualize the severity of vessel narrowing, or stenosis. Cardiologists typically use visual estimation to approximate the percent diameter reduction of the stenosis, and this directs therapies like stent placement. A fully automatic method to segment the vessels would eliminate potential subjectivity and provide a quantitative and systematic measurement of diameter reduction. Here, we have designed a convolutional neural network, AngioNet, for vessel segmentation in X-ray angiography images. The main innovation in this network is the introduction of an Angiographic Processing Network (APN) which significantly improves segmentation performance on multiple network backbones, with the best performance using Deeplabv3+ (Dice score 0.864, pixel accuracy 0.983, sensitivity 0.918, specificity 0.987). The purpose of the APN is to create an end-to-end pipeline for image pre-processing and segmentation, learning the best possible pre-processing filters to improve segmentation. We have also demonstrated the interchangeability of our network in measuring vessel diameter with Quantitative Coronary Angiography. Our results indicate that AngioNet is a powerful tool for automatic angiographic vessel segmentation that could facilitate systematic anatomical assessment of coronary stenosis in the clinical workflow.

ObjectiveAdverse left ventricular remodeling due to a mismatch between stiffness of native aortic tissue and current polyester grafts may be under-recognized. This study was conducted to evaluate the impact of proximal aortic replacement on adverse remodeling of the left ventricle.Materials and methodsAll aortic root and ascending aortic aneurysm patients were identified (n = 2,001, 2006–2019). The study cohort consisted of a subset of patients (n = 98) with two or more electrocardiogram (ECG)-gated CT angiograms, but without concomitant aortic valve disease or bicuspid aortic valve, connective tissue disease, acute aortic syndrome or prior history of aortic repair or mitral valve surgery. LV myocardial mass was measured from CT data and indexed to body surface area (LVMI). The study cohort was divided into a surgery group (n = 47) and a control group; optimal medical therapy group (OMT, n = 51).ResultsThe mean age was 60 ± 11 years (80% male). Beta-blocker use was significantly more frequent in the surgery group (89 vs. 57%, p < 0.001), whereas, all other antihypertensive drugs were more frequent in the OMT group. The average follow-up was 9.1 ± 4.0 months for the surgery group and 13.7 ± 6.3 months for the OMT group. Average LVMI at baseline was similar in both groups (p = 0.934). LVMI increased significantly in the surgery group compared to the OMT group (3.7 ± 4.1 vs. 0.6 ± 4.4 g/m2, p = 0.001). Surgery, baseline LVMI, age, and sex were found to be independent predictors of LVMI increased on multivariable analysis.ConclusionProximal aortic repair with stiff polyester grafts was associated with increased LV mass in the first-year post-operative and may promote long-term adverse cardiac remodeling. Further studies should be considered to evaluate the competing effects of aortic aneurysm related mortality against risks of long-term graft induced aortic stiffening and the potential implications on current size thresholds for intervention.

Pulmonary arterial hypertension (PAH) is a complex disease involving increased resistance in the pulmonary arteries and subsequent right ventricular (RV) remodeling. Ventricular-arterial interactions are fundamental to PAH pathophysiology but are rarely captured in computational models. It is important to identify metrics that capture and quantify these interactions to inform our understanding of this disease as well as potentially facilitate patient stratification. Towards this end, we developed and calibrated two multi-scale high-resolution closed-loop computational models using open-source software: a high-resolution arterial model implemented using CRIMSON, and a high-resolution ventricular model implemented using FEniCS. Models were constructed with clinical data including non-invasive imaging and invasive hemodynamic measurements from a cohort of pediatric PAH patients. A contribution of this work is the discussion of inconsistencies in anatomical and hemodynamic data routinely acquired in PAH patients. We proposed and implemented strategies to mitigate these inconsistencies, and subsequently use this data to inform and calibrate computational models of the ventricles and large arteries. Computational models based on adjusted clinical data were calibrated until the simulated results for the high-resolution arterial models matched within 10% of adjusted data consisting of pressure and flow, whereas the high-resolution ventricular models were calibrated until simulation results matched adjusted data of volume and pressure waveforms within 10%. A statistical analysis was performed to correlate numerous data-derived and model-derived metrics with clinically assessed disease severity. Several model-derived metrics were strongly correlated with clinically assessed disease severity, suggesting that computational models may aid in assessing PAH severity.

Rare or opportunistic fungal infections are mostly described in immunosuppressed patients. We present a case of a cutaneous phaeohyphomycosis that developed on the dorsal foot in an immunosuppressed woman suffering from AIDS, caused by a novel Phialemoniopsis species. It clinically presented as an indurated violaceous plaque, surmounted by nodules exuding a sero-purulent discharge. A filamentous fungus was isolated from pus and cutaneous biopsy. ITS and LSU sequences phylogenetically resolved the fungus as an unknown species of Phialemoniopsis, which is an unresolved family within Sordariomycetes. In this study we describe the new species as Phialemoniopsis limonesiae, which clusters on a single branch clearly separated from its closest phylogenetic neighbours. This new strain showed low MIC to itraconazole, voriconazole and posaconazole.

This paper is dedicated to presenting control-tuning methodologies for the rotor-side converter (RSC) and grid-side converter (GSC) of series-compensated DFIG-based wind farms (WF) and to determining the origin of subsynchronous resonance (SSR). Unlike conventional approaches to re-tuning controller gains to achieve desirable performance, these methodologies only consider the mathematical models of the states variables to be controlled. A PI cascade topology is used to control the RSC and GSC. An inner loop is required for current control and an outer loop for voltage control. Special consideration is taken for tuning the RSC because this converter is coupled with the mechanical variables as mechanical rotor speed of the DFIG. Compared with standard tuning, a better system behavior during a resonance condition is achieved with the proposed tuning methodology. Regarding the analysis of the SSR origin, the modal impedance (MI) technique is used as a tool to study SSR issues; its advantages compared to the driving point impedance technique are highlighted. In this context, the small-signal-stability (SSS) analysis is performed to evaluate the overall system. With the combination of MI and SSS, the phenomena of induction generator effect, torque interaction, and torque amplification are analyzed. As a result, the modes involved in the SSR phenomenon are identified and a discrimination procedure is described to determine the origin of the SSR.

Abstract A major challenge in constructing three dimensional patient specific hemodynamic models is the calibration of model parameters to match patient data on flow, pressure, wall motion, etc. acquired in the clinic. Current workflows are manual and time-consuming. This work presents a flexible computational framework for model parameter estimation in cardiovascular flows that relies on the following fundamental contributions. (i) A Reduced-Order Unscented Kalman Filter (ROUKF) model for data assimilation for wall material and simple lumped parameter network (LPN) boundary condition model parameters. (ii) A constrained least squares augmentation (ROUKF-CLS) for more complex LPNs. (iii) A “Netlist” implementation, supporting easy filtering of parameters in such complex LPNs. The ROUKF algorithm is demonstrated using non-invasive patient-specific data on anatomy, flow and pressure from a healthy volunteer. The ROUKF-CLS algorithm is demonstrated using synthetic data on a coronary LPN. The methods described in this paper have been implemented as part of the CRIMSON hemodynamics software package.

Abstract We implement a nonlinear rotation-free shell formulation capable of handling large deformations for applications in vascular biomechanics. The formulation employs a previously reported shell element that calculates both the membrane and bending behavior via displacement degrees of freedom for a triangular element. The thickness stretch is statically condensed to enforce vessel wall incompressibility via a plane stress condition. Consequently, the formulation allows incorporation of appropriate 3D constitutive material models. We also incorporate external tissue support conditions to model the effect of surrounding tissue. We present theoretical and variational details of the formulation and verify our implementation against axisymmetric results and literature data. We also adapt a previously reported prestress methodology to identify the unloaded configuration corresponding to the medically imaged in vivo vessel geometry. We verify the prestress methodology in an idealized bifurcation model and demonstrate the significance of including prestress. Lastly, we demonstrate the robustness of our formulation via its application to mouse-specific models of arterial mechanics using an experimentally informed four-fiber constitutive model.

Introduction: Aging has many effects on the cardiovascular system, including changes in structure (aortic composition, and thus stiffening) and function (increased proximal blood pressure, and thus cardiac afterload). Mouse models are often used to gain insight into vascular aging and mechanisms of disease as they allow invasive assessments that are impractical in humans. Translation of results from murine models to humans can be limited, however, due to species-specific anatomical, biomechanical, and hemodynamic differences. In this study, we built fluid-solid-interaction (FSI) models of the aorta, informed by biomechanical and imaging data, to compare wall mechanics and hemodynamics in humans and mice at two equivalent ages: young and older adults.Methods: For the humans, 3-D computational models were created using wall property data from the literature as well as patient-specific magnetic resonance imaging (MRI) and non-invasive hemodynamic data; for the mice, comparable models were created using population-based properties and hemodynamics as well as subject-specific anatomies. Global aortic hemodynamics and wall stiffness were compared between humans and mice across age groups.Results: For young adult subjects, we found differences between species in pulse pressure amplification, compliance and resistance distribution, and aortic stiffness gradient. We also found differences in response to aging between species. Generally, the human spatial gradients of stiffness and pulse pressure across the aorta diminished with age, while they increased for the mice.Conclusion: These results highlight key differences in vascular aging between human and mice, and it is important to acknowledge these when using mouse models for cardiovascular research.

Cerebral hemodynamics in the presence of cerebrovascular occlusive disease (CVOD) are influenced by the anatomy of the intracranial arteries, the degree of stenosis, the patency of collateral pathways, and the condition of the cerebral microvasculature. Accurate characterization of cerebral hemodynamics is a challenging problem. In this work, we present a strategy to quantify cerebral hemodynamics using computational fluid dynamics (CFD) in combination with arterial spin labeling MRI (ASL). First, we calibrated patient-specific CFD outflow boundary conditions using ASL-derived flow splits in the Circle of Willis. Following, we validated the calibrated CFD model by evaluating the fractional blood supply from the main neck arteries to the vascular territories using Lagrangian particle tracking and comparing the results against vessel-selective ASL (VS-ASL). Finally, the feasibility and capability of our proposed method were demonstrated in two patients with CVOD and a healthy control subject. We showed that the calibrated CFD model accurately reproduced the fractional blood supply to the vascular territories, as obtained from VS-ASL. The two patients revealed significant differences in pressure drop over the stenosis, collateral flow, and resistance of the distal vasculature, despite similar degrees of clinical stenosis severity. Our results demonstrated the advantages of a patient-specific CFD analysis for assessing the hemodynamic impact of stenosis.

IntroductionA 2-year-old female with hypoplastic left heart syndrome (HLHS)-variant, a complex congenital heart defect (CHD) characterized by the underdevelopment of the left ventricle, presented with complications following single ventricle palliation. Diagnostic work-up revealed elevated Fontan pathway pressures, as well as significant dilation of the inferior Fontan pathway with inefficient swirling flow and hepatic venous reflux. Due to the frail condition of the patient, the clinical team considered an endovascular revision of the Fontan pathway. In this work, we performed a computational fluid dynamics (CFD) analysis informed by data on anatomy, flow, and pressure to investigate the hemodynamic effect of the endovascular Fontan revision.MethodsA patient-specific anatomical model of the Fontan pathway was constructed from magnetic resonance imaging (MRI) data using the cardiovascular modeling software CardiovasculaR Integrated Modeling and SimulatiON (CRIMSON). We first created and calibrated a pre-intervention 3D-0D multi-scale model of the patient’s circulation using fluid-structure interaction (FSI) analyses and custom lumped parameter models (LPMs), including the Fontan pathway, the single ventricle, arterial and venous systemic, and pulmonary circulations. Model parameters were iteratively tuned until simulation results matched clinical data on flow and pressure. Following calibration of the pre-intervention model, a custom bifurcated endograft was introduced into the anatomical model to virtually assess post-intervention hemodynamics.ResultsThe pre-intervention model successfully reproduced the clinical hemodynamic data on regional flow splits, pressures, and hepatic venous reflux. The proposed endovascular repair model revealed increases of mean and pulse pressure at the inferior vena cava (IVC) of 6 and 29%, respectively. Inflows at the superior vena cava (SVC) and IVC were each reduced by 5%, whereas outflows at the left pulmonary artery (LPA) and right pulmonary artery (RPA) increased by 4%. Hepatic venous reflux increased by 6%.ConclusionOur computational analysis indicated that the proposed endovascular revision would lead to unfavorable hemodynamic conditions. For these reasons, the clinical team decided to forgo the proposed endovascular repair and to reassess the management of this patient. This study confirms the relevance of CFD modeling as a beneficial tool in surgical planning for single ventricle CHD patients.

Children with hypoplastic left heart syndrome (HLHS) must undergo multiple surgical stages to reconstruct the anatomy to a sustainable single ventricle system. Stage I palliation, or the Norwood procedure, provides circulation to both pulmonary and systemic vasculature. The aorta is reconstructed and attached to the right ventricle and a fraction of systemic flow is redirected to the pulmonary arteries (PAs) through a systemic-to-PA shunt. Despite abundant hemodynamic data available 4–5 months after Norwood palliation, data is very scarce immediately following stage I. This data is critical in determining post-operative success. In this work, we combined population data and computational fluid dynamics (CFD) to characterize hemodynamics immediately following stage I (post-stage I) and prior to stage II palliation (pre-stage II). A patient-specific model was constructed as a baseline geometry, which was then scaled to reflect population-based morphological data at both time-points. Population-based hemodynamic data was then used to calibrate each model to reproduce blood flow representative of HLHS patients. The post-stage I simulation produced a PA pressure of 22 mmHg and high-frequency oscillations within the flow field indicating highly disturbed hemodynamics. Despite PA mean pressure dropping to 14 mmHg, the pre-stage II model also produced high-frequency flow components and PA wall shear stress increases. These suboptimal conditions may be necessary to ensure adequate PA flow throughout the pre-stage II period, as the shunt becomes relatively smaller compared to the patient’s somatic growth. In the future, CFD can be used to optimize shunt design and minimize these suboptimal conditions.

Vascular wall stiffness and hemodynamic parameters are potential biomechanical markers for detecting pulmonary arterial hypertension (PAH). Previous computational analyses, however, have not considered the interaction between blood flow and wall deformation. Here, we applied an established computational framework that utilizes patient-specific measurements of hemodynamics and wall deformation to analyze the coupled fluid–vessel wall interaction in the proximal pulmonary arteries (PA) of six PAH patients and five control subjects. Specifically, we quantified the linearized stiffness (E), relative area change (RAC), diastolic diameter (D), regurgitant flow, and time-averaged wall shear stress (TAWSS) of the proximal PA, as well as the total arterial resistance (Rt) and compliance (Ct) at the distal pulmonary vasculature. Results found that the average proximal PA was stiffer [median: 297 kPa, interquartile range (IQR): 202 kPa vs. median: 75 kPa, IQR: 5 kPa; P = 0.007] with a larger diameter (median: 32 mm, IQR: 5.25 mm vs. median: 25 mm, IQR: 2 mm; P = 0.015) and a reduced RAC (median: 0.22, IQR: 0.10 vs. median: 0.42, IQR: 0.04; P = 0.004) in PAH compared to our control group. Also, higher total resistance (Rt; median: 6.89 mmHg × min/l, IQR: 2.16 mmHg × min/l vs. median: 3.99 mmHg × min/l, IQR: 1.15 mmHg × min/l; P = 0.002) and lower total compliance (Ct; median: 0.13 ml/mmHg, IQR: 0.15 ml/mmHg vs. median: 0.85 ml/mmHg, IQR: 0.51 ml/mmHg; P = 0.041) were observed in the PAH group. Furthermore, lower TAWSS values were seen at the main PA arteries (MPAs) of PAH patients (median: 0.81 Pa, IQR: 0.47 Pa vs. median: 1.56 Pa, IQR: 0.89 Pa; P = 0.026) compared to controls. Correlation analysis within the PAH group found that E was directly correlated to the PA regurgitant flow (r = 0.84, P = 0.018) and inversely related to TAWSS (r = −0.72, P = 0.051). Results suggest that the estimated elastic modulus E may be closely related to PAH hemodynamic changes in pulmonary arteries.

Abstract Many cardiovascular diseases lead to local increases in relative pressure, reflecting the higher costs of driving blood flow. The utility of this biomarker for stratifying the severity of disease has thus driven the development of methods to measure these relative pressures. While intravascular catheterisation remains the most direct measure, its invasiveness limits clinical application in many instances. Non-invasive Doppler ultrasound estimates have partially addressed this gap; however only provide relative pressure estimates for a range of constricted cardiovascular conditions. Here we introduce a non-invasive method that enables arbitrary interrogation of relative pressures throughout an imaged vascular structure, leveraging modern phase contrast magnetic resonance imaging, the virtual work-energy equations, and a virtual field to provide robust and accurate estimates. The versatility and accuracy of the method is verified in a set of complex patient-specific cardiovascular models, where relative pressures into previously inaccessible flow regions are assessed. The method is further validated within a cohort of congenital heart disease patients, providing a novel tool for probing relative pressures in-vivo.

Ventricular-arterial coupling plays a key role in the physiologic function of the cardiovascular system. We have previously described a hybrid lumped-finite element (FE) modeling framework of the systemic circulation that couples idealized FE models of the aorta and the left ventricle (LV). Here, we describe an extension of the lumped-FE modeling framework that couples patient-specific FE models of the left and right ventricles, aorta and the large pulmonary arteries in both the systemic and pulmonary circulations. Geometries of the FE models were reconstructed from magnetic resonance (MR) images acquired in a pediatric patient diagnosed with pulmonary arterial hypertension (PAH). The modeling framework was calibrated with pressure waveforms acquired in the heart and arteries by catheterization as well as ventricular volume and arterial diameter waveforms measured from MR images. The calibrated model hemodynamic results match well with the clinically-measured waveforms (volume and pressure) in the LV and right ventricle (RV) as well as with the clinically-measured waveforms (pressure and diameter) in the aorta and main pulmonary artery. The calibrated framework was then used to simulate three cases, namely, (1) an increase in collagen in the large pulmonary arteries, (2) a decrease in RV contractility, and (3) an increase in the total pulmonary arterial resistance, all characteristics of progressive PAH. The key finding from these simulations is that hemodynamics of the pulmonary vasculature and RV wall stress are more sensitive to vasoconstriction with a 10% of reduction in the lumen diameter of the distal vessels than a 67% increase in the proximal vessel's collagen mass.

En los últimos tiempos han aumentado el interés por la vida de los deportistas tras su carrera en la élite (Park, Lavalle,y Tod 2013).La propia idiosincrasia económica de cada deporte hace que sean interesantes las comparaciones entre diferentes grupos (Aquilina, 2013).Los objetivos de este estudio fueron analizar si la calidad de la retirada deportiva, evaluada a partir de las dificultades percibidas en diferentes ámbitos, y las condiciones asociadas a la misma (planificación, voluntariedad, tipo de carrera deportiva y nivel de estudios) era diferente para los deportistas profesionales y amateurs. Se utilizó un estudio descriptivo transversal mediante encuestas, con muestreo intencional, administrando un cuestionario de preguntas cerradas, elaborado ad hoc. Participaron un total de 127 deportistas, de ellos 53 profesionales y 74 no profesionales. Los deportistas profesionales experimentaron en mayor grado dificultades relacionadas con su carrera profesional, con su familia, con su red social y vivieron su proceso de integración laboral de una forma menos positiva que los deportistas amateurs. Estos últimos, experimentaron en mayor grado dificultades económicas. Como cabría esperar debido a un vínculo más fuerte con el deporte, un mayor número de deportistas profesionales se dedicó exclusivamente al deporte, mientras que un mayor número de deportistas amateurs compaginaron deporte y trabajo. Además, entre aquellos que compatibilizaron el deporte con los estudios, más deportistas profesionales priorizaron el deporte. La planificación de la retirada fue más frecuente entre los profesionales y no se observaron diferencias en relación a la voluntariedad de la retirada ni en el nivel de estudios.

For babies born with hypoplastic left heart syndrome, several open-heart surgeries are required. During Stage I, a Norwood procedure is performed to construct an appropriate circulation to both the systemic and the pulmonary arteries. The pulmonary arteries receive flow from the systemic circulation, often using a Blalock–Taussig (BT) shunt between the innominate artery and the right pulmonary artery. This procedure causes significantly disturbed flow in the pulmonary arteries. In this study, we use computational hemodynamic simulations to demonstrate its capacity for examining the properties of the flow through and near the BT shunt. Initially, we construct a computational model which produces blood flow and pressure measurements matching the clinical magnetic resonance imaging (MRI) and catheterization data. Achieving this required us to determine the level of BT shunt occlusion; because the occlusion is below the MRI resolution, this information is difficult to recover without the aid of computational simulations. We determined that the shunt had undergone an effective diameter reduction of 22% since the time of surgery. Using the resulting geometric model, we show that we can computationally reproduce the clinical data. We, then, replace the BT shunt with a hypothetical alternative shunt design with a flare at the distal end. Investigation of the impact of the shunt design reveals that the flare can increase pulmonary pressure by as much as 7% and flow by as much as 9% in the main pulmonary branches, which may be beneficial to the pulmonary circulation.

La resistencia antibiótica ha limitado progresivamente nuestras posibilidades terapeúticas y ha aumentado los costos. En este artículo se entrega una visión de los mecanismos más frecuentes en bacterias comunes, tanto comunitarias como nosocomiales y las implicancias terapéuticas que generan en el día a día.

Fundamento : las enfermedades venosas de los miembros inferiores se describen desde épocas muy antiguas, todavía en la actualidad repercute en los pacientes de forma frecuente causando un importante impacto socioeconómico. Objetivo : caracterización de la insuficiencia venosa crónica profunda por reflujo valvular. Método : se realizó un estudio descriptivo y longitudinal con todos los pacientes atendid os en consulta de angiología con el diagnóstico de insuficiencia venosa crónica profunda, en el Hospital Provincial Universitario Docente Manuel Ascunce Domenech de Camagüey, desde marzo de 2012 a junio de 2013. El universo estuvo constituido por 60 pacien tes, se aplicó un muestreo no probabilístico, que reunió los criterios de inclusión y exclusión establecidos. La información obtenida se procesó mediante programa estadístico SPSS - 11,5 para Windows y estadística descriptiva para obtener distribuciones de f recuencias y por cientos. Los resultados del estudio se expusieron en tablas. Resultado : se encontró que el mayor número correspondió al sexo femenino y predominó el intervalo de 46 a 55 años. Se pudo detectar que predominaron los antecedentes patológicos familiares de insuficiencia venosa crónica, seguido del estreñimiento crónico, la obesidad - sedentarismo, antecedentes patológicos personales de trombosis venosa profunda y la multipariedad. El mayor número de casos según clasificación clínica se encontrar on en los estadios cuatro y tres. Conclusiones : la insuficiencia venosa crónica es una enfermedad progresiva con una alta morbilidad y gran repercusión socio - económica. Conocer sus factores predisponentes así como sus formas de presentación, ayuda a preven ir y evitar sus estadios avanzados y mejorar la calidad de vida de estos pacientes.

Se trata de una paciente de 58 años, sexo femenino, que se presenta con hematuria, proteinuria severa y función renal normal. Pocas semanas después, ella desarrolla una trombosis de vena renal, embolia pulmonar secundaria y un episodio de insuficiencia renal aguda. Este caso clínico ilustra las distintas presentaciones clínicas de una nefropatía por IgA grave, incluyendo hematuria, síndrome nefrótico y trombosis de vena renal. Además muestra otras complicaciones serias, como embolia pulmonar y falla renal aguda. La paciente fue sometida a 2 biopsias renales, que permitieron una correlación adecuada entre las manifestaciones clínicas y la patología renal.

El trasplante combinado páncreas-riñón (TPR) para pacientes portadores de Diabetes Mellitus 1 con insuficiencia renal crónica terminal, ha demostrado ser la única terapia que permite alcanzar el estado de normoglicemia de manera estable, situación que lleva a una disminución de las complicaciones crónicas de la DM y mejora la expectativa y calidad de vida. En nuestro país la tasa de realización de este trasplante es aún muy baja, lo que se debe a factores asociados a la donación y a una insuficiente divulgación de los resultados nacionales. Objetivo: Describir los resultados obtenidos por el equipo de trasplante de Clínica Las Condes en TPR desde el inicio del programa, en marzo1994 a marzo 2009. Método: Se recopiló la información de los 12 pacientes sometidos a TPR en nuestro centro entre 1994 y marzo 2009, analizando las variables con estadística descriptiva y la sobrevida con curvas de Kaplan-Meier. Resultados: La sobrevida actuarial de pacientes a 5 y 10 años fue de 75%. La sobrevida actuarial de páncreas fue 83% a los 5 y 10 años, y la de riñón 74% en los mismos periodos. Nueve pacientes presentan injertos funcionantes a marzo 2009, todos los cuales realizan una vida normal. Discusión: Estos resultados son comparables a los presentados por centros extranjeros de prestigio internacional y se deben principalmente a avances en las técnicas quirúrgicas y de inmunosupresión. La baja tasa de complicaciones y alta sobrevida presentada refuerzan la necesidad de potenciar esta terapia en nuestro país.

Coronary anomalies can be observed in 1–1.2% of all angiograms performed. Majority of coronary anomalies are benign and do not lead to cardiac ischemia; however anomalous coronary arteries from the opposite sinus (ACAOS) are often associated with sudden cardiac deaths, typically in 0.11–0.35% of individuals who participate in vigorous physical activity (Peñalver et al., 2012). Left and right ACAOS have an incidence of 0.15% and 0.92%, respectively. Left ACAOS are often associated with higher incidence of sudden cardiac death; this could be secondary to greater territory of myocardial perfusion by the left coronary artery. ACAOS are often asymptomatic and initially present as sudden death following exertion in young athletes. The management of left ACAOS is clear and surgery is usually indicated. However there is a lack of consensus on the management of certain cases of right ACAOS. In this paper a case of 20 yo M with right coronary artery from left sinus is going to be presented with a discussion on pathophysiology, diagnosis, and management.

The odorous air emissions are increasingly less tolerated due to their effects on quality of life. Nuisances caused by odors in industrial emissions are a problem with high frequency of complaints of communities along the oversight agencies. Small concentrations of odoriferous substances are very likely to be issued in industrial activities and are often sufficient to affect the human olfactory system, which is highly sensitive. The present study aimed to investigate the perception of the population in the vicinity of a chemical industry with regard to odor generated by H2S. This perception was quantified by applying a questionnaire to assess the understanding of the link between odors and air pollution, and identify the main source of odors. From the results obtained it was found that the industry is primarily responsible for the emission of odorous compounds. It was found that the population perceives the presence of hydrogen sulfide gas emitted by industry, however, despite feeling uncomfortable with the odor, individuals realized that this is less than time ago, implying that the actions taken by the industry eased the problem.