We present the case of a 29-year-old patient with a history of abdominal pain and vomiting.Based on wireless video capsule findings he was previously diagnosed with ileal Crohn's disease at a different institution...We present the case of a 29-year-old patient with a history of abdominal pain and vomiting.Based on wireless video capsule findings he was previously diagnosed with ileal Crohn's disease at a different institution,although the clinical and radiological picture was not typical and the response to corticosteroids was poor.We performed a single-balloon enteroscopy showing a short,ulcerous stenosis 50 cm proximal from Bauhin's valve.The endoscopic and clinical histopathological findings were compatible with cryptogenic multifocal ulcerous stenosing enteritis(CMUSE).High dose corticosteroids were again started,without effect.The monoclonal tumor necrosis factor-α(TNF-α) antibody infliximab was added to the medical therapy.After induction therapy,both clinical and endoscopic amelioration was obtained.Larger case studies are needed to confirm the efficacy of TNF-α inhibition in steroid refractory CMUSE.展开更多
This work is concerned with the analysis of blood flow through inclined catheterized arteries having a balloon(angioplasty) with time-variant overlapping stenosis. The nature of blood in small arteries is analyzed mat...This work is concerned with the analysis of blood flow through inclined catheterized arteries having a balloon(angioplasty) with time-variant overlapping stenosis. The nature of blood in small arteries is analyzed mathematically by considering it as a Carreau nanofluid. The highly nonlinear momentum equations of nanofluid model are simplified by considering the mild stenosis case. The formulated problem is solved by a homotopy perturbation expansion in terms of a variant of the Weissenberg number to obtain explicit forms for the axial velocity, the stream function, the pressure gradient, the resistance impedance and the wall shear stress distribution. These solutions depend on the Brownian motion number, thermophoresis number, local temperature Grashof number G_r and local nanoparticle Grash of number B_r. The results were also studied for various values of the physical parameters, such as the Weissenberg number W_i, the power law index n, the taper angle φ, the maximum height of stenosis δ~*, the angle of inclination α, the maximum height of balloon σ~*, the axial displacement of the balloon z_d~*,the flow rate F and the Froud number Fr. The obtained results show that the transmission of axial velocity curves through a Newtonian fluid(Wi=0, n=1, Gr=0, Br=0, Nt=0, Nb≠0) is substantially lower than that through a Carreau nanofluid near the wall of balloon while the inverse occurs in the region between the balloon and stenosis. The streamlines have a clearly distinguished shifting toward the stenotic region and this shifting appears near the wall of the balloon, while it has almost disappeared near the stenotic wall and the trapping bolus in the case of horizontal arteries and Newtonian fluid(Wi=0, n=1, Gr=0, Br=0, Nt=0, Nb≠0) does not appear but for the case of Carreau nanofluid bolus appears.展开更多
Mechanical stimuli play critical roles in cardiovascular diseases,in which in vivo stresses in blood vessels present a great challenge to predict.Based on the structural-thermal coupled finite element method,we propos...Mechanical stimuli play critical roles in cardiovascular diseases,in which in vivo stresses in blood vessels present a great challenge to predict.Based on the structural-thermal coupled finite element method,we propose a thermal expansion method to estimate stresses in multi-layer blood vessels under healthy and pathological conditions.The proposed method provides a relatively simple and convenient means to predict reliable in vivo mechanical stresses with accurate residual stress.The method is first verified with the opening-up process and the pressure-radius responses for single and multi-layer vessel models.It is then applied to study the stress variation in a human carotid artery at different hypertension stages and in a plaque of vascular stenosis.Our results show that specific or optimal residual stresses exist for different blood pressures,which helps form a homogeneous stress distribution across vessel walls.High elastic shear stress is identified on the shoulder of the plaque,which contributes to the tearing effect in plaque rupture.The present study indicates that the proposed numerical method is a capable and efficient in vivo stress evaluation of patient-specific blood vessels for clinical purposes.展开更多
To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior. ...To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior. METHODSTwenty pathologically and clinically confirmed CMUSE patients (males:females = 8:12; mean age: 40.4 years) between March 2002 and August 2015 from seven academic centers in South Korea were retrospectively reviewed. We evaluated small bowel series (SBS; n = 25), computed tomography (CT) enterography (n = 21), magnetic resonance (MR) enterography (n = 2), and abdominopelvic CT (n = 18) images, focusing on enteric and perienteric manifestations. Any change in radiologic features during follow-up period was recorded. We evaluated clinical data including presenting symptoms, laboratory finding and presence of relapse from electronic medical records. Histopathologic findings were also evaluated. RESULTSThe main symptoms were abdominal pain (n = 12) and anemia (n = 10). All patients showed small bowel strictures (n = 52, mean: 2.6 per patient) on initial CT/MR, located in the ileum (n = 47) or jejunum (n = 5). Strictures showed short-length (mean: 10.44 mm) and circumferential bowel wall thickening (mean: 5.56 mm) with layered enhancement (n = 48) that were also noted on initial SBS (n = 36) with shallow ulcers (n = 10). Some ulcerative lesions or wall thickening progressed into strictures on follow-up SBS/CT, and some strictures revealed recurrent ulceration on follow-up SBS. There were no penetrating disease features like fistula or abscess and no gastrointestinal tract involvement except the small bowel. Nine patients experienced disease recurrence (median relapse-free period: 32 mo) even post-operatively. Histopathologic features of surgically resected specimens were characterized as multiple superficial ulcerations confined to mucosa or submucosa and multiple strictures. CONCLUSIONUnder characteristic radiologic findings with multiple short-segmental strictures and/or shallow ulcers of the small intestine, CMUSE should be considered when assessing patients with recurrent abdominal pain and anemia.展开更多
The effects of a velocity slip and an external magnetic field on the flow of biomagnetic fluid(blood)through a stenosed bifurcated artery are investigated by using ANSYS FLUENT.Blood is regarded as a non-Newtonian pow...The effects of a velocity slip and an external magnetic field on the flow of biomagnetic fluid(blood)through a stenosed bifurcated artery are investigated by using ANSYS FLUENT.Blood is regarded as a non-Newtonian power-law fluid,and the magnetization and electrical conductivity are considered in the mathematical model.The no-slip condition is replaced by the first-order slip condition.The slip boundary condition and magnetic force are compiled in the solver by the user-defined function(UDF).Numerical solutions are obtained by the finite volume method based on a nonuniform grid structure.The accuracy and efficiency of the solver are verified through a comparison with the literature.The results are presented graphically for different parameter values,and the effects of the magnetic number,the magnetic source position,the vascular obstruction ratio,the slip parameter,and the power-law index on the flow and temperature fields are illustrated.展开更多
A female patient,13 months old,suffering from limited extension of the right thumb for 7 days,diagnosed as stenosing tenosynovitis of the thumb in children.Tuina(Chinese massage) therapy was adopted,in which,stimulati...A female patient,13 months old,suffering from limited extension of the right thumb for 7 days,diagnosed as stenosing tenosynovitis of the thumb in children.Tuina(Chinese massage) therapy was adopted,in which,stimulation was applied with fingers instead of needles,including pressing and kneading,twisting and kneading,plucking,dorsal extending,rotating as well as pushing and rubbing manipulations.The whole procedure of manipulation lasted around 15 min,once every two days,3 times weekly.Meanwhile,the parents were advised to bath the child patient's right hand into warm water every day and fix the affected thumb with splint at night.After 12 treatments with tuina therapy,the flexion and extension function of the affected thumb were returned to normal and the thumb motor function was recovered.In 2 months of follow-up,the thumb motor function was normal and the stenosing tenosynovitis was not recurred.In this case,tuina therapy is adopted in treatment of stenosing tenosynovitis of the thumb in children.As an alternative method of surgery,tuina therapy has a satisfactory clinical effect.展开更多
Objective: To observe the therapeutic effect and safety of using the hooked needle-shaped knife to treat the stenosing tenovaginitis of flexor digitorum. Methods: Sixty outpatients were divided into a treatment group ...Objective: To observe the therapeutic effect and safety of using the hooked needle-shaped knife to treat the stenosing tenovaginitis of flexor digitorum. Methods: Sixty outpatients were divided into a treatment group of 30 cases treated by using the hooked needle shaped knife, and a control group of 30 cases treated by block therapy. 6 months later, the alleviation of pain in the affected finger during movement, under pressure, traction and finger-bending anti-resistance was compared before and after treatment. Results: The alleviation of pain during movement, under pressure, traction and finger-bending anti-resistance was much better in the treatment group than that of the control group (P<0.01), with a effective rate of 93.3% in the treatment group and 80.0% in the control group (P<0.01). Conclusion: The micro-wound technique using the hooked needle-shaped knife has definite effect and safety for stenosing tenovaginitis of flexor digitorum.展开更多
This Communication deals with the blood flow of Prandtl fluid through a tapered stenosed arteries having permeable walls.The governing equations of two-dimensional Prandtl fluid model are modelled in cylindrical coord...This Communication deals with the blood flow of Prandtl fluid through a tapered stenosed arteries having permeable walls.The governing equations of two-dimensional Prandtl fluid model are modelled in cylindrical coordinates.The highly nonlinear equations are simplified with the help of non-dimensional variables under the assumption of mild stenosis.The solution of reduced nonlinear equation subject to boundary condition of porous walls having the effects of Darcy's number and slip parameter are computed analytically with the help of perturbation method.Effects of emerging parameters such as impedance A,slip parameter a,stenosis height 6,magnetic parameter and stress component Srz on velocity are illustrated graphically.The streamlines have also been presented to discuss the trapping bolus discipline.展开更多
Acute stress concentration plays an important role in plaque rupture and may cause stroke or myocardial infarction.Quantitative evaluation of the relation between in vivo plaque stress and variations in blood pressure...Acute stress concentration plays an important role in plaque rupture and may cause stroke or myocardial infarction.Quantitative evaluation of the relation between in vivo plaque stress and variations in blood pressure and flow rates is valuable to optimize daily monitoring of the cardiovascular system for high-risk patients as well as to set a safe physical exercise intensity for better quality of life.In this study,we constructed an in vivo stress model for a human carotid bifurcation with atherosclerotic plaque,and analyzed the effects of blood pressure,flow rates,plaque stiffness,and stenosis on the elastic stress and fluid viscous stress around the plaque.According to the maximum values of the mechanical stress,we define a risk index to predict the risk level of plaque rupture under different exercise intensities.For a carotid bifurcation where the blood flow divides,the results suggest that the stenosis ratio determines the ratio of the contributions of elastic shear stress and viscous shear stress to plaque rupture.A n increase of the plaque stiffness enhances the maximum elastic shear stress in the plaque,indicating that a high-stiffness plaque is more prone to rupture for given stenosis ratio.High stress co-localization at the shoulder of plaques agrees with the region of plaque injury in clinical observations.It is demonstrated that,due to the stress-shield effect,the rupture risk of a high-stiffness plaque tends to decrease under high-stenosis conditions,suggesting the existence of a specific stenosis corresponding to the maximum risk.This study may help to complement risk stratification of vulnerable plaques in clinical practice and provides a stenosis mechanical property-specific guide for blood pressure control in cardiovascular health management.展开更多
The blood flow through a catheterized artery having a mild stenosis at the wall together with a blood clot at the centre is studied in the current investigation.Stenosis can occur in vessels carrying blood to brain(i....The blood flow through a catheterized artery having a mild stenosis at the wall together with a blood clot at the centre is studied in the current investigation.Stenosis can occur in vessels carrying blood to brain(i.e.,Carotid arteries),Renal arteries that supply blood to kidneys etc.The flow is refined in such vessels by application of catheter.We have used a Newtonian viscous fluid model and also distinct shapes of stenosis,(i.e.,symmetric and non-symmetric shapes)are considered for this study.The entropy generation togetherwith viscous dissipation is also taken into account for a complete description of heat transfer mechanism.Exact solutions are calculated for the problem subject to given“no slip conditions”.The results are discussed graphically.The velocity quickly increases for a non-symmetric stenosis as compared to a symmetric stenosis.When the height of mild stenosis increases and the channel becomes narrow then the velocity increases in the centre but it decreases with the stenosed wall.However,as the height of blood clotσincreases then the velocity of blood flow reduces with the wall having clot but it remains almost same with the stenosed wall.Streamlines are plotted to visualize the flow pattern.The trapping is symmetric for a symmetric stenosis shape but it changes to non-symmetric trapping when we have a non-symmetric shape of stenosis.展开更多
The gen and mao areas,and the responding area of hand were punctured in umbilicus acupuncture,reperfusion activities were also done for a stenosing tenosynovitis of styloid process of radius patient in lactation perio...The gen and mao areas,and the responding area of hand were punctured in umbilicus acupuncture,reperfusion activities were also done for a stenosing tenosynovitis of styloid process of radius patient in lactation period,sound effect were obtained.展开更多
Catheter is commonly used by the surgeons for various reasons in the treatment of a patient suffering with cardiovascular diseases. Catheterization increases the mean flow resistance in the arterial blood flow and man...Catheter is commonly used by the surgeons for various reasons in the treatment of a patient suffering with cardiovascular diseases. Catheterization increases the mean flow resistance in the arterial blood flow and many other complications are associated with the presence of catheter in the artery. Effects of catheter in stenosed artery can be estimated non-invasively by means of hemo-dynamic indicator-WSS, WSSG, volume flow rate and impedance. The effect of slip at the arterial wall, inclination of the artery and magnetic field on the hemodynamic indicators and flow profiles are computed, presented and discussed through graphs.展开更多
<em>Objective</em>: In order to take a decision about the revascularization approach to be adopted, it is of fundamental importance to determine whether coronary artery stenoses induce ischemia or not. An ...<em>Objective</em>: In order to take a decision about the revascularization approach to be adopted, it is of fundamental importance to determine whether coronary artery stenoses induce ischemia or not. An index, named (Fractional Flow Reserve), based on pressure measurements has been proposed to this aim and is usually interpreted in terms of flows. The objective of this work is to compute simultaneously pressures and flow rates in the coronary network of patients with three-vessel disease, in order to study more precisely the relationship between these two quantities. <em>Approach</em>: 22 patients have been included in the study. Some pressure and flow rate measurements were collected during by-pass surgery. These clinical data allow determining parameters for a patient’s specific model, based on the electric/hydraulic analogy. Collateral pathways are included in the model, as well as the severity of the disease and the impact of revascularization. <em>Main Results</em>: For patients with stenoses on LAD, LCx, LMCA and occlusion of the RCA, the flow rate delivered to the right territory is of course a function of the aortic pressure, the left stenoses severity, and the pressure distal to the thrombosis. But it mainly depends on the capillary and collateral resistances, and on the proportion between them. Abnormal microvascular hemodynamics, may be present in patients with non-hemodynamic significant lesions as assessed by the pressure ratio. Complete revascularization with the 3 grafts is demonstrated to be fully justified. The direction of collateral flows may be reversed, depending on the pressure gradient. In any case, they remain low and become negligible when the 3 grafts are operating. <em>Significance</em>: Surgical decision based only on pressure measurements may miss some real hemodynamic problems due to the considered stenosis. This risk is even greater in case of serial stenoses.展开更多
The stenosis in the artery, which reduces the flow passage to blood, is a common cardiovascular disease that is responsible even for cardiac arrest sometimes. The hemodynaics reveals that the severe blockage in an art...The stenosis in the artery, which reduces the flow passage to blood, is a common cardiovascular disease that is responsible even for cardiac arrest sometimes. The hemodynaics reveals that the severe blockage in an artery due to stenosis generates pressure tangential stress that impacts adversely on the arterial wall downstream to stenosis and weakens the arterial wall. The site of weakened wall in the artery generates post stenotic dilatation. The objective of this paper is to study flow of blood, of non-Newtonian in nature described by Herschel-Bulkley model, in a diseased artery suffering with partly overlapped two stenoses and a dilatation distal to the stenoses. A mathematical model, describing the blood flow, has been derived using Navier-Stokes equations along with the prescribed geometry of the diseased artery. The expressions of velocity profile, resistive impedance to flow and wall shear stress (skin-friction) are derived. The effect of inclination of the vessel on the resistive impedance to flow is discussed along with the effect of rheological and geometrical parameters on the resistive impedance to flow and skin friction.展开更多
There are few biomechanical studies on Interspinous Process Implants (IPD);however none investigate the amount of wear on spinous processes. Therefore the objective of the present study was to investigate the effect o...There are few biomechanical studies on Interspinous Process Implants (IPD);however none investigate the amount of wear on spinous processes. Therefore the objective of the present study was to investigate the effect of repetitive loading of the IPD Aperius on the spinous processes in a biomechanical porcine model. For comparison, three patients treated surgically with the same device have been followed for one to two years clinically and with image analyses (X-rays, MRI, CT-scans). Four lumbar spines from 6 months old porcine were divided into seven segments, which received IPD. The segments were exposed to 20,000 cyclical loads. Afterwards the deformation (wear) of the segments was registered. The wear of the spinous processes was measured in mm on a following CT-scan. Additionally, the wear of the ex-vivo was compared to that of the spinous processes investigated by CT-scans or X-ray in three patients treated surgically with the same interspinous implant. The mean maximal deformation of porcine specimens was 1.79 mm (SD 0.25) with the largest deformation occurring in the first quarter of the loading (<5000 cycles). The mean wear of the spinous processes after loading was 6.57 mm. A similar level of wear (mean 12.7 mm) of the spinous processes was detected in the patients. The Aperius IPD creates significant wear on the spinous processes in an experimental biomechanical study. Similar wear of the spinous processes is also present in patients treated with the same device post-operatively. How these findings influence the short and long term result of this implant device remains to be investigated in further biomechanical as well as clinical studies. For future development of this type of devices a proper selection of materials and design is essential to minimize wear effects on the spinous processes and thereby increases the possibilities for the devices to function as suggested.展开更多
Objective:To systematically evaluate the clinical efficacy of extracorporeal shock wave in the treatment of stenosing tenosynovitis of radius styloid process.Methods:All randomized controlled trials of extracorporeal ...Objective:To systematically evaluate the clinical efficacy of extracorporeal shock wave in the treatment of stenosing tenosynovitis of radius styloid process.Methods:All randomized controlled trials of extracorporeal shock wave in the treatment of stenotic tenosynovitis of radius styloid process were retrieved by computer.Two researchers independently screened,extracted and incorporated the literature into the literature evaluation.The quality evaluation was carried out with the bias risk assessment tool provided by Cochrane Collaboration Network,and the meta-analysis was carried out with RevMan 5.3 software.Result:According to the prescribed retrieval method,there were 8 articles and 447 subjects.The results showed that the effective rate of extracorporeal shock wave was(OR=5.37,95%CI(2.85,10.12),P<0.00001)compared with other therapies,and the difference was statistically significant.Meanwhile,there were significant differences in VAS pain score and Cooney dysfunction score.Conclusion:Extracorporeal shock wave can effectively relieve the pain symptoms of stenosing tenosynovitis of the radius styloid process,improve wrist dysfunction and improve the clinical efficiency of stenosing tenosynovitis of the radius styloid process,but a large number of high-quality studies are needed to provide more sufficient evidence.展开更多
目的:探讨前臂远1/3段超声引导下、保留主动屈伸指活动的选择性神经阻滞麻醉在手指狭窄性腱鞘炎应用效果。方法:回顾性分析2017年1月至2022年1月期间61例手指狭窄性腱鞘炎手术患者,美国麻醉医师协会(American Society of Anesthesiologi...目的:探讨前臂远1/3段超声引导下、保留主动屈伸指活动的选择性神经阻滞麻醉在手指狭窄性腱鞘炎应用效果。方法:回顾性分析2017年1月至2022年1月期间61例手指狭窄性腱鞘炎手术患者,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ级41例,Ⅱ级20例;男15例,女46例;年龄16~72岁;体质量44~75 kg。根据病变部位,在超声引导下前臂中远1/3平面对正中神经与尺神经及腕关节桡背侧对桡神经浅支采用0.5%罗哌卡因选择性进行阻滞麻醉。分别记录每种神经麻醉药用量,麻醉后每30 s针刺法检测各神经阻滞效果,记录起效时间及起效后手指主动屈伸活动情况。术后1、3、6个月通过门诊或电话随访了解松解疗效。结果:麻醉阻滞效果,优60例,良1例。1例单纯中指狭窄性腱鞘炎患者手术时有轻微疼痛,给予腕部桡神经浅支阻滞后疼痛感消失。共阻滞桡神经浅支20例,单次用药(1.7±0.3)ml,开始起效时间(0.6±0.2)min;正中神经45例,单次用药(4.1±1.0)ml,开始起效时间(1.2±0.3)min;尺神经16例,单次用药(3.9±0.5)ml,开始起效时间(1.7±0.3)min。所有患者能主动屈伸手指。61例术后均获得随访,时间6~10(8.0±2.0)个月,均无复发。结论:前臂远1/3段超声引导下选择性神经阻滞能为手指狭窄性腱鞘炎患者获得安全快速有效的麻醉效果,且保留了主动活动功能,利于判断松解程度,提高了手术疗效。展开更多
文摘We present the case of a 29-year-old patient with a history of abdominal pain and vomiting.Based on wireless video capsule findings he was previously diagnosed with ileal Crohn's disease at a different institution,although the clinical and radiological picture was not typical and the response to corticosteroids was poor.We performed a single-balloon enteroscopy showing a short,ulcerous stenosis 50 cm proximal from Bauhin's valve.The endoscopic and clinical histopathological findings were compatible with cryptogenic multifocal ulcerous stenosing enteritis(CMUSE).High dose corticosteroids were again started,without effect.The monoclonal tumor necrosis factor-α(TNF-α) antibody infliximab was added to the medical therapy.After induction therapy,both clinical and endoscopic amelioration was obtained.Larger case studies are needed to confirm the efficacy of TNF-α inhibition in steroid refractory CMUSE.
文摘This work is concerned with the analysis of blood flow through inclined catheterized arteries having a balloon(angioplasty) with time-variant overlapping stenosis. The nature of blood in small arteries is analyzed mathematically by considering it as a Carreau nanofluid. The highly nonlinear momentum equations of nanofluid model are simplified by considering the mild stenosis case. The formulated problem is solved by a homotopy perturbation expansion in terms of a variant of the Weissenberg number to obtain explicit forms for the axial velocity, the stream function, the pressure gradient, the resistance impedance and the wall shear stress distribution. These solutions depend on the Brownian motion number, thermophoresis number, local temperature Grashof number G_r and local nanoparticle Grash of number B_r. The results were also studied for various values of the physical parameters, such as the Weissenberg number W_i, the power law index n, the taper angle φ, the maximum height of stenosis δ~*, the angle of inclination α, the maximum height of balloon σ~*, the axial displacement of the balloon z_d~*,the flow rate F and the Froud number Fr. The obtained results show that the transmission of axial velocity curves through a Newtonian fluid(Wi=0, n=1, Gr=0, Br=0, Nt=0, Nb≠0) is substantially lower than that through a Carreau nanofluid near the wall of balloon while the inverse occurs in the region between the balloon and stenosis. The streamlines have a clearly distinguished shifting toward the stenotic region and this shifting appears near the wall of the balloon, while it has almost disappeared near the stenotic wall and the trapping bolus in the case of horizontal arteries and Newtonian fluid(Wi=0, n=1, Gr=0, Br=0, Nt=0, Nb≠0) does not appear but for the case of Carreau nanofluid bolus appears.
基金The authors would like to thank Prof.Shu Takagi and Prof.Huaxiong Huang for their instructive comments.The authors would also like to acknowledge Jianda Yang for assisting with FEM simulations.This work was supported by the National Natural Science Foundation of China(Grants 11372191,11232010,11650(Grant 91111138)the National Institute of Health(Grant 2R01DC005642-10A1).
文摘Mechanical stimuli play critical roles in cardiovascular diseases,in which in vivo stresses in blood vessels present a great challenge to predict.Based on the structural-thermal coupled finite element method,we propose a thermal expansion method to estimate stresses in multi-layer blood vessels under healthy and pathological conditions.The proposed method provides a relatively simple and convenient means to predict reliable in vivo mechanical stresses with accurate residual stress.The method is first verified with the opening-up process and the pressure-radius responses for single and multi-layer vessel models.It is then applied to study the stress variation in a human carotid artery at different hypertension stages and in a plaque of vascular stenosis.Our results show that specific or optimal residual stresses exist for different blood pressures,which helps form a homogeneous stress distribution across vessel walls.High elastic shear stress is identified on the shoulder of the plaque,which contributes to the tearing effect in plaque rupture.The present study indicates that the proposed numerical method is a capable and efficient in vivo stress evaluation of patient-specific blood vessels for clinical purposes.
文摘To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior. METHODSTwenty pathologically and clinically confirmed CMUSE patients (males:females = 8:12; mean age: 40.4 years) between March 2002 and August 2015 from seven academic centers in South Korea were retrospectively reviewed. We evaluated small bowel series (SBS; n = 25), computed tomography (CT) enterography (n = 21), magnetic resonance (MR) enterography (n = 2), and abdominopelvic CT (n = 18) images, focusing on enteric and perienteric manifestations. Any change in radiologic features during follow-up period was recorded. We evaluated clinical data including presenting symptoms, laboratory finding and presence of relapse from electronic medical records. Histopathologic findings were also evaluated. RESULTSThe main symptoms were abdominal pain (n = 12) and anemia (n = 10). All patients showed small bowel strictures (n = 52, mean: 2.6 per patient) on initial CT/MR, located in the ileum (n = 47) or jejunum (n = 5). Strictures showed short-length (mean: 10.44 mm) and circumferential bowel wall thickening (mean: 5.56 mm) with layered enhancement (n = 48) that were also noted on initial SBS (n = 36) with shallow ulcers (n = 10). Some ulcerative lesions or wall thickening progressed into strictures on follow-up SBS/CT, and some strictures revealed recurrent ulceration on follow-up SBS. There were no penetrating disease features like fistula or abscess and no gastrointestinal tract involvement except the small bowel. Nine patients experienced disease recurrence (median relapse-free period: 32 mo) even post-operatively. Histopathologic features of surgically resected specimens were characterized as multiple superficial ulcerations confined to mucosa or submucosa and multiple strictures. CONCLUSIONUnder characteristic radiologic findings with multiple short-segmental strictures and/or shallow ulcers of the small intestine, CMUSE should be considered when assessing patients with recurrent abdominal pain and anemia.
基金Project supported by the Fundamental Research Funds for the Central Universities of China(No.FRF-BR-18-008B)。
文摘The effects of a velocity slip and an external magnetic field on the flow of biomagnetic fluid(blood)through a stenosed bifurcated artery are investigated by using ANSYS FLUENT.Blood is regarded as a non-Newtonian power-law fluid,and the magnetization and electrical conductivity are considered in the mathematical model.The no-slip condition is replaced by the first-order slip condition.The slip boundary condition and magnetic force are compiled in the solver by the user-defined function(UDF).Numerical solutions are obtained by the finite volume method based on a nonuniform grid structure.The accuracy and efficiency of the solver are verified through a comparison with the literature.The results are presented graphically for different parameter values,and the effects of the magnetic number,the magnetic source position,the vascular obstruction ratio,the slip parameter,and the power-law index on the flow and temperature fields are illustrated.
基金Supported by Inheritance Studio of Zhong-san SUN Pediatric Tuina School。
文摘A female patient,13 months old,suffering from limited extension of the right thumb for 7 days,diagnosed as stenosing tenosynovitis of the thumb in children.Tuina(Chinese massage) therapy was adopted,in which,stimulation was applied with fingers instead of needles,including pressing and kneading,twisting and kneading,plucking,dorsal extending,rotating as well as pushing and rubbing manipulations.The whole procedure of manipulation lasted around 15 min,once every two days,3 times weekly.Meanwhile,the parents were advised to bath the child patient's right hand into warm water every day and fix the affected thumb with splint at night.After 12 treatments with tuina therapy,the flexion and extension function of the affected thumb were returned to normal and the thumb motor function was recovered.In 2 months of follow-up,the thumb motor function was normal and the stenosing tenosynovitis was not recurred.In this case,tuina therapy is adopted in treatment of stenosing tenosynovitis of the thumb in children.As an alternative method of surgery,tuina therapy has a satisfactory clinical effect.
文摘Objective: To observe the therapeutic effect and safety of using the hooked needle-shaped knife to treat the stenosing tenovaginitis of flexor digitorum. Methods: Sixty outpatients were divided into a treatment group of 30 cases treated by using the hooked needle shaped knife, and a control group of 30 cases treated by block therapy. 6 months later, the alleviation of pain in the affected finger during movement, under pressure, traction and finger-bending anti-resistance was compared before and after treatment. Results: The alleviation of pain during movement, under pressure, traction and finger-bending anti-resistance was much better in the treatment group than that of the control group (P<0.01), with a effective rate of 93.3% in the treatment group and 80.0% in the control group (P<0.01). Conclusion: The micro-wound technique using the hooked needle-shaped knife has definite effect and safety for stenosing tenovaginitis of flexor digitorum.
文摘This Communication deals with the blood flow of Prandtl fluid through a tapered stenosed arteries having permeable walls.The governing equations of two-dimensional Prandtl fluid model are modelled in cylindrical coordinates.The highly nonlinear equations are simplified with the help of non-dimensional variables under the assumption of mild stenosis.The solution of reduced nonlinear equation subject to boundary condition of porous walls having the effects of Darcy's number and slip parameter are computed analytically with the help of perturbation method.Effects of emerging parameters such as impedance A,slip parameter a,stenosis height 6,magnetic parameter and stress component Srz on velocity are illustrated graphically.The streamlines have also been presented to discuss the trapping bolus discipline.
基金This work was supported by the National Key R&D Program of China(Grant 2017YFE0117100)the National Natural Science Foundation of China(Grants 11872040 and 11232010)+1 种基金the Outstanding Clinical Discipline Project of Shanghai Pudong(Grant PWYgy-2018-08)the Science and Technology Commission of Shanghai Municipality(Grant 18ZR1433900).
文摘Acute stress concentration plays an important role in plaque rupture and may cause stroke or myocardial infarction.Quantitative evaluation of the relation between in vivo plaque stress and variations in blood pressure and flow rates is valuable to optimize daily monitoring of the cardiovascular system for high-risk patients as well as to set a safe physical exercise intensity for better quality of life.In this study,we constructed an in vivo stress model for a human carotid bifurcation with atherosclerotic plaque,and analyzed the effects of blood pressure,flow rates,plaque stiffness,and stenosis on the elastic stress and fluid viscous stress around the plaque.According to the maximum values of the mechanical stress,we define a risk index to predict the risk level of plaque rupture under different exercise intensities.For a carotid bifurcation where the blood flow divides,the results suggest that the stenosis ratio determines the ratio of the contributions of elastic shear stress and viscous shear stress to plaque rupture.A n increase of the plaque stiffness enhances the maximum elastic shear stress in the plaque,indicating that a high-stiffness plaque is more prone to rupture for given stenosis ratio.High stress co-localization at the shoulder of plaques agrees with the region of plaque injury in clinical observations.It is demonstrated that,due to the stress-shield effect,the rupture risk of a high-stiffness plaque tends to decrease under high-stenosis conditions,suggesting the existence of a specific stenosis corresponding to the maximum risk.This study may help to complement risk stratification of vulnerable plaques in clinical practice and provides a stenosis mechanical property-specific guide for blood pressure control in cardiovascular health management.
文摘The blood flow through a catheterized artery having a mild stenosis at the wall together with a blood clot at the centre is studied in the current investigation.Stenosis can occur in vessels carrying blood to brain(i.e.,Carotid arteries),Renal arteries that supply blood to kidneys etc.The flow is refined in such vessels by application of catheter.We have used a Newtonian viscous fluid model and also distinct shapes of stenosis,(i.e.,symmetric and non-symmetric shapes)are considered for this study.The entropy generation togetherwith viscous dissipation is also taken into account for a complete description of heat transfer mechanism.Exact solutions are calculated for the problem subject to given“no slip conditions”.The results are discussed graphically.The velocity quickly increases for a non-symmetric stenosis as compared to a symmetric stenosis.When the height of mild stenosis increases and the channel becomes narrow then the velocity increases in the centre but it decreases with the stenosed wall.However,as the height of blood clotσincreases then the velocity of blood flow reduces with the wall having clot but it remains almost same with the stenosed wall.Streamlines are plotted to visualize the flow pattern.The trapping is symmetric for a symmetric stenosis shape but it changes to non-symmetric trapping when we have a non-symmetric shape of stenosis.
文摘The gen and mao areas,and the responding area of hand were punctured in umbilicus acupuncture,reperfusion activities were also done for a stenosing tenosynovitis of styloid process of radius patient in lactation period,sound effect were obtained.
文摘Catheter is commonly used by the surgeons for various reasons in the treatment of a patient suffering with cardiovascular diseases. Catheterization increases the mean flow resistance in the arterial blood flow and many other complications are associated with the presence of catheter in the artery. Effects of catheter in stenosed artery can be estimated non-invasively by means of hemo-dynamic indicator-WSS, WSSG, volume flow rate and impedance. The effect of slip at the arterial wall, inclination of the artery and magnetic field on the hemodynamic indicators and flow profiles are computed, presented and discussed through graphs.
文摘<em>Objective</em>: In order to take a decision about the revascularization approach to be adopted, it is of fundamental importance to determine whether coronary artery stenoses induce ischemia or not. An index, named (Fractional Flow Reserve), based on pressure measurements has been proposed to this aim and is usually interpreted in terms of flows. The objective of this work is to compute simultaneously pressures and flow rates in the coronary network of patients with three-vessel disease, in order to study more precisely the relationship between these two quantities. <em>Approach</em>: 22 patients have been included in the study. Some pressure and flow rate measurements were collected during by-pass surgery. These clinical data allow determining parameters for a patient’s specific model, based on the electric/hydraulic analogy. Collateral pathways are included in the model, as well as the severity of the disease and the impact of revascularization. <em>Main Results</em>: For patients with stenoses on LAD, LCx, LMCA and occlusion of the RCA, the flow rate delivered to the right territory is of course a function of the aortic pressure, the left stenoses severity, and the pressure distal to the thrombosis. But it mainly depends on the capillary and collateral resistances, and on the proportion between them. Abnormal microvascular hemodynamics, may be present in patients with non-hemodynamic significant lesions as assessed by the pressure ratio. Complete revascularization with the 3 grafts is demonstrated to be fully justified. The direction of collateral flows may be reversed, depending on the pressure gradient. In any case, they remain low and become negligible when the 3 grafts are operating. <em>Significance</em>: Surgical decision based only on pressure measurements may miss some real hemodynamic problems due to the considered stenosis. This risk is even greater in case of serial stenoses.
文摘The stenosis in the artery, which reduces the flow passage to blood, is a common cardiovascular disease that is responsible even for cardiac arrest sometimes. The hemodynaics reveals that the severe blockage in an artery due to stenosis generates pressure tangential stress that impacts adversely on the arterial wall downstream to stenosis and weakens the arterial wall. The site of weakened wall in the artery generates post stenotic dilatation. The objective of this paper is to study flow of blood, of non-Newtonian in nature described by Herschel-Bulkley model, in a diseased artery suffering with partly overlapped two stenoses and a dilatation distal to the stenoses. A mathematical model, describing the blood flow, has been derived using Navier-Stokes equations along with the prescribed geometry of the diseased artery. The expressions of velocity profile, resistive impedance to flow and wall shear stress (skin-friction) are derived. The effect of inclination of the vessel on the resistive impedance to flow is discussed along with the effect of rheological and geometrical parameters on the resistive impedance to flow and skin friction.
文摘There are few biomechanical studies on Interspinous Process Implants (IPD);however none investigate the amount of wear on spinous processes. Therefore the objective of the present study was to investigate the effect of repetitive loading of the IPD Aperius on the spinous processes in a biomechanical porcine model. For comparison, three patients treated surgically with the same device have been followed for one to two years clinically and with image analyses (X-rays, MRI, CT-scans). Four lumbar spines from 6 months old porcine were divided into seven segments, which received IPD. The segments were exposed to 20,000 cyclical loads. Afterwards the deformation (wear) of the segments was registered. The wear of the spinous processes was measured in mm on a following CT-scan. Additionally, the wear of the ex-vivo was compared to that of the spinous processes investigated by CT-scans or X-ray in three patients treated surgically with the same interspinous implant. The mean maximal deformation of porcine specimens was 1.79 mm (SD 0.25) with the largest deformation occurring in the first quarter of the loading (<5000 cycles). The mean wear of the spinous processes after loading was 6.57 mm. A similar level of wear (mean 12.7 mm) of the spinous processes was detected in the patients. The Aperius IPD creates significant wear on the spinous processes in an experimental biomechanical study. Similar wear of the spinous processes is also present in patients treated with the same device post-operatively. How these findings influence the short and long term result of this implant device remains to be investigated in further biomechanical as well as clinical studies. For future development of this type of devices a proper selection of materials and design is essential to minimize wear effects on the spinous processes and thereby increases the possibilities for the devices to function as suggested.
基金Central level public welfare research institutes basic scientific research operating expenses independent topic(No.ZZ11-034).
文摘Objective:To systematically evaluate the clinical efficacy of extracorporeal shock wave in the treatment of stenosing tenosynovitis of radius styloid process.Methods:All randomized controlled trials of extracorporeal shock wave in the treatment of stenotic tenosynovitis of radius styloid process were retrieved by computer.Two researchers independently screened,extracted and incorporated the literature into the literature evaluation.The quality evaluation was carried out with the bias risk assessment tool provided by Cochrane Collaboration Network,and the meta-analysis was carried out with RevMan 5.3 software.Result:According to the prescribed retrieval method,there were 8 articles and 447 subjects.The results showed that the effective rate of extracorporeal shock wave was(OR=5.37,95%CI(2.85,10.12),P<0.00001)compared with other therapies,and the difference was statistically significant.Meanwhile,there were significant differences in VAS pain score and Cooney dysfunction score.Conclusion:Extracorporeal shock wave can effectively relieve the pain symptoms of stenosing tenosynovitis of the radius styloid process,improve wrist dysfunction and improve the clinical efficiency of stenosing tenosynovitis of the radius styloid process,but a large number of high-quality studies are needed to provide more sufficient evidence.
文摘目的:探讨前臂远1/3段超声引导下、保留主动屈伸指活动的选择性神经阻滞麻醉在手指狭窄性腱鞘炎应用效果。方法:回顾性分析2017年1月至2022年1月期间61例手指狭窄性腱鞘炎手术患者,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ级41例,Ⅱ级20例;男15例,女46例;年龄16~72岁;体质量44~75 kg。根据病变部位,在超声引导下前臂中远1/3平面对正中神经与尺神经及腕关节桡背侧对桡神经浅支采用0.5%罗哌卡因选择性进行阻滞麻醉。分别记录每种神经麻醉药用量,麻醉后每30 s针刺法检测各神经阻滞效果,记录起效时间及起效后手指主动屈伸活动情况。术后1、3、6个月通过门诊或电话随访了解松解疗效。结果:麻醉阻滞效果,优60例,良1例。1例单纯中指狭窄性腱鞘炎患者手术时有轻微疼痛,给予腕部桡神经浅支阻滞后疼痛感消失。共阻滞桡神经浅支20例,单次用药(1.7±0.3)ml,开始起效时间(0.6±0.2)min;正中神经45例,单次用药(4.1±1.0)ml,开始起效时间(1.2±0.3)min;尺神经16例,单次用药(3.9±0.5)ml,开始起效时间(1.7±0.3)min。所有患者能主动屈伸手指。61例术后均获得随访,时间6~10(8.0±2.0)个月,均无复发。结论:前臂远1/3段超声引导下选择性神经阻滞能为手指狭窄性腱鞘炎患者获得安全快速有效的麻醉效果,且保留了主动活动功能,利于判断松解程度,提高了手术疗效。
