Preliminary results of intraoperative mitomycin-C in the treatment and prevention of glottic and subglottic stenosis

Mitomycin-C is an antineoplastic antibiotic that acts as an alkylating agent by inhibiting DNA and protein synthesis. It can inhibit cell division, protein synthesis, and fibroblast proliferation. The purpose of this pilot study is to investigate intraoperative applications of topical mitomycin-C in treatment and prevention of glottic and subglottic stenosis. Eight patients with posterior glottic and/or subglottic stenosis were treated with endoscopic CO2 laser excision followed by topical application of 0.5 cc of 0.4 mg mitomycin-C per milliliter of saline for 4 minutes at the surgical site. After mean follow-up of 15 months (10-20) all patients had clinical improvement of their airway and resolution of their preoperative symptoms. No complications were noted in this study. Although a longer follow-up and further controlled studies are needed, the use of topical mitomycin-C may prove useful in the treatment and prevention of subsequent restenosis and scar formation in the larynx and trachea.     

脂肪颗粒在颈动脉中的运动及其对血液动力学的影响

很多研究表明, 动脉粥样硬化通常发生在具有复杂血液动力学的区域, 比如分叉动脉和弯曲动脉. 这些地方常伴随有低壁面剪切力或震荡壁面剪切力, 这是动脉粥样硬化形成的一大诱因. 使用计算流体力学软件对2D颈动脉分叉血管进行了模拟, 研究了脂肪颗粒在颈动脉中的运动及其对血液动力学的影响. 研究表明: 1)血管狭窄对于脂肪颗粒的运动有重要影响, 同时也影响栓塞的形成; 2)脂肪颗粒可能会黏附在血管壁面, 但由于血流的冲击作用, 脂肪颗粒会随后在壁面略微铺展; 3)颈动脉狭窄区域后方是下一个血栓的可能生长位点; 4)当栓塞形成时, 速度和壁面剪切力分布将变得复杂多变, 这对于血管是有害的.     

Pediatric Laryngotracheal Stenosis and Airway Reconstruction: A Review of Voice Outcomes, Assessment, and Treatment Issues

Laryngotracheal stenosis is defined as a congenital or acquired narrowing of the airway. Congenital causes may include subglottic membranous or cartilaginous narrowing. Acquired causes may include trauma due to prolonged endotracheal or tracheal intubation or laryngotracheal injury. Although advances have been made over the past 30 years in reconstructive surgeries to improve airway patency in these patients, long-term laryngeal function for voice production is not well defined in this population. This review examines causes, symptoms and signs, and methods for diagnosing laryngotracheal stenosis. Surgical management procedures are briefly summarized. The current literature on voice outcomes is summarized. The predominant voice characteristics in the population are presented, although results are challenged by the heterogeneity of voice presentation and paucity of data from instrumental measures. Considerations for subjective and instrumental assessment, measures of quality of life, instrumental methods, and treatment options specific to the needs of this population are discussed. Research strategies to identify long-term outcomes of surgical and behavioral treatments in this population are posed.     

Carotid plaque high-resolution MRI at 3 T: evaluation of a new imaging score for symptomatic plaque assessment

Purpose

To assess the sensitivity and specificity of intra-plaque hemorrhage (IPH), large lipid-rich necrotic core (LR-NC) and ulceration or cap rupture (UCR) for symptomatic carotid plaque characterization and to evaluate a new imaging score [Hemorrhage, Ulceration or cap rupture, Lipid-rich necrotic Core (HULC) score based on the sum of presence/absence of IPH, UCR and LR-NC; range 0–3] for assessment of recently symptomatic carotid plaques.

Material and methods

Twenty-seven recently symptomatic (< 8 weeks) and 36 asymptomatic patients with a carotid plaque thicker than 2 mm were prospectively imaged on a 3-T magnetic resonance (MR) system using high-resolution, multi-contrast MR sequences. Prior to analysis, all images were reviewed to assess image quality of each sequence. Sensitivity and specificity of IPH, LR-NC, UCR and HULC scores were calculated.

Results

Fifty-one patients were analyzed (26 symptomatic carotids and 67 asymptomatic carotids) after exclusion of studies with poor image quality. Sensitivity and specificity for symptomatic carotid plaque was, respectively, 46.1% and 97% for IPH, 84.6% and 73.1% for UCR and 80.7% and 76.1% for LR-NC. A HULC score of 2 or more showed a sensitivity of 73% and a specificity of 92.5%.

Conclusion

At 3 T, intra-plaque hemorrhage is the most specific criterion to characterize symptomatic carotid plaque. The HULC score offers the best compromise between sensitivity and specificity.     

Relationship between the hemodynamic changes on multi-Td pulsed arterial spin labeling images and the degrees of cerebral artery stenosis

Objective

To explore the relationship between the hemodynamic changes on multi-Td (delay time) pulsed arterial spin labeling (PASL) images and the degrees of cerebral artery stenosis, and to evaluate the value of multi-Td PASL in detecting the signal changes in cerebral arteries with stenosis.

Patients and methods

29 patients with less than 50% stenosis (mild stenosis group) and 22 patients with 50%–69% stenosis (moderate stenosis group) in M1 segment of unilateral middle cerebral artery (MCA) were included in this study. The degrees of MCA stenosis were measured using time of flight MR angiography (TOF MRA). Multi-Td PASL imaging was performed to detect the signal changes in bilateral MCA. We selected and hand-drew bilateral symmetric branches of MCA as regions of interest (ROIs) on eight-Td PASL images. The intensities of ROIs were measured, and the time-signal intensity curves were acquired by post-processing on a MR workstation. SPSS19.0 statistical software was used for statistics. The differences in the peak intensities and the times to peak intensities between the normal and narrowed sides of the mild and moderate stenosis groups were respectively examined by paired-samples t test. The differences in the changes of peak intensities and times to peak intensity of the two sides between the mild and moderate stenosis groups were examined by independent samples t test. A p value less than 0.05 was considered statistically significant.

Result

There were significant difference in the peak intensities (t = − 2.720, p = 0.011 < 0.05) and no significant difference in the times to peak intensities (t = − 1.279, p = 0.212 > 0.05) between the normal and narrowed sides of the mild stenosis group. There were both significant differences in the peak intensities (t = − 6.076, p = 0.000 < 0.05) and times to peak intensities (t = 7.232, p = 0.000 < 0.05) between the normal side and narrowed side of the moderate stenosis group. There were both significant differences in the changes of peak intensities (t = − 2.11, p = 0.040 < 0.05) and times to peak intensity (t = − 4.23, p = 0.000 < 0.05) between the mild and moderate stenosis groups.

Conclusion

The hemodynamic changes on multi-Td PASL images were different with the degrees of cerebral artery stenosis. Moderate stenosis means greater hemodynamic changes in the arteries than mild stenosis. Multi-Td PASL imaging is a promising means to evaluate the hemodynamic changes in cerebral arteries with stenosis.     

The clinical usefulness of preoperative dynamic MRI to select decompression levels for cervical spondylotic myelopathy

The study subjects included 54 patients with cervical spondylotic myelopathy who underwent a selective laminoplasty. The patients were divided into three groups according to the number of decompressed levels: two levels, three levels and four or five levels. The number of cord compressions at every intervertebral level was determined in the flexion, neutral, and extension position using a dynamic magnetic resonance imaging (MRI) scan in consideration of both static and dynamic compressions. For each group, the clinical outcomes were evaluated. Moreover, the patients were divided into two groups according to their age. Then, the appearance ratios of cord compression between the neutral and extension position were compared at each intervertebral level. The clinical outcomes were satisfactory. There were no statistical differences among the three groups, except for the age and operation time. The position of the neck influenced the number of cord compressions. The appearance ratios of cord compression, which were especially prominent at C2/3, C3/4 and C4/5, showed high scores in the aged. The preoperative dynamic MRI scan was clinically useful. In the aged, attention should be given to C2/3, C3/4 and C4/5.     

Evaluation of intracranial stenoses and aneurysms with accelerated 4D flow

The aim of this study was to evaluate intracranial arterial stenoses and aneurysms with accelerated time-resolved three-dimensional (3D) phase-contrast MRI or 4D flow. The 4D flow technique was utilized to image four normal volunteers, two patients with intracranial stenoses and two patients with intracranial aneurysms. In order to reduce scan time, parallel imaging was combined with an acquisition strategy that eliminates the corners of k-space. In the two patients with intracranial stenoses, 4D flow velocity measurements showed that one patient had normal velocity profiles in agreement with a previous magnetic resonance angiogram (MRA), while the second showed increased velocities that indicated a less significant narrowing than suspected on a previous MRA, as confirmed by catheter angiography. This result may have prevented an invasive angiogram. In the two patients with 4-mm intracranial aneurysm, one had a stable helical flow pattern with a large jet, while the other had a temporally unstable flow pattern with a more focal jet possibly indicating that the second aneurysm may have a higher likelihood of rupture. Accelerated 4D flow provides time-resolved 3D velocity data in an 8- to 10-min scan. In the stenosis patients, the addition of 4D flow to a traditional MRA adds the velocity data provided from transcranial Doppler ultrasound (TCD) possibly allowing for more accurate grading of stenoses. In the aneurysm patients, visualization of flow patterns may help to provide prognostic information about future risk of rupture.     

Psoas Muscle Volume and Attenuation are Better Predictors than Muscle Area for Hospital Readmission in Older Patients after Transcatheter Aortic Valve Implantation

Objective: This study aimed to determine whether the psoas muscle volume (PMV) and its muscle attenuation (MA) are associated with hospital readmission after transcatheter aortic valve implantation (TAVI). Method: We included 113 older patients with aortic stenosis who underwent TAVI at Sakakibara Heart Institute (mean age 85 ± 5 years, 69% women). We measured PMV and psoas muscle area (PMA) as well as total muscle area (TMA) at the third lumbar vertebra using preoperative computed tomography (CT) images. The crude values of the PMV, PMA, and TMA were normalized by dividing by height squared. Results: The median follow-up period was 724 days (interquartile range: 528-730 days), and there were 25 all-cause readmissions during the follow-up period (22% of all patients). In the multivariate Cox regression analysis adjusted for age, sex, and EuroSCORE II, the PMV and its MA and crude PMA were significantly associated with all-cause readmission [HR: 0.957 (0.930-0.985), p = 0.003, HR: 0.927 (0.862-0.997), p = 0.040], whereas the PMA and TMA and each MA were not (all p > 0.05). The groups with low PMV and MA had significantly higher incidences of all-cause readmission than that with high PMV and MA (log-rank test: p = 0.011). Conclusion: PMV and its MA measured from preoperative CT images were independent predictors of all-cause readmission in TAVI patients.     

狭窄程度对锥缩血管中脉动流的影响

建立了一个轴对称的狭窄锥缩刚性动脉模型.利用不可压缩的N-S方程作为计算的理论基础,采用有限差分方案进行数值分析.提供了3种狭窄程度下的管壁切应力分布曲线并进行了分析和比较,同时给出了模型M3(h/R₀=1/3)在一个流动周期内的流线图.结果显示狭窄附近的流场受到了干扰,特别是狭窄的喉部及其下游区域的流场,并且狭窄程度越严重,狭窄对流场的影响就越大.     

A Deep Neural Network Method for Arterial Blood Flow Profile Reconstruction

Arterial stenosis will reduce the blood flow to various organs or tissues, causing cardiovascular diseases. Although there are mature diagnostic techniques in clinical practice, they are not suitable for early cardiovascular disease prediction and monitoring due to their high cost and complex operation. In this paper, we studied the electromagnetic effect of arterial blood flow and proposed a method based on the deep neural network for arterial blood flow profile reconstruction. The potential difference and weight matrix are used as inputs to the method, and its output is an estimate of the internal blood flow velocity distribution for arterial blood flow profile reconstruction. Firstly, the weight matrix is input into the convolutional auto-encode (CAE) network to extract its features. Then, the weight matrix features and potential difference are combined to obtain the features of the blood velocity distribution. Finally, the velocity features are reconstructed into blood flow velocity distribution by a convolution neural network (CNN). All data sets are obtained from a model of the carotid artery with different rates of stenosis in a uniform magnetic field by COMSOL. The results show that the average root mean square error of the reconstruction results obtained by the proposed method is 0.0333, and the average correlation coefficient is 0.9721, which is better than the corresponding indicators of the Tikhonov, back propagation (BP) and CNN methods. The simulation results show that the proposed method can achieve high accuracy in blood flow profile reconstruction and is of great significance for the early diagnosis of arterial stenosis and other vessel diseases.     

Evaluation of aortic stenosis severity using 4D flow jet shear layer detection for the measurement of valve effective orifice area

Aims

The objective of this study was to evaluate the potential of 4D flow MRI to assess valve effective orifice area (EOA) in patients with aortic stenosis as determined by the jet shear layer detection (JSLD) method.

Methods and Results

An in-vitro stenosis phantom was used for validation and in-vivo imaging was performed in 10 healthy controls and 40 patients with aortic stenosis. EOA was calculated by the JSLD method using standard 2D phase contrast MRI (PC-MRI) and 4D flow MRI measurements (EOA_JSLD-2D and EOA_JSLD-4D, respectively). As a reference standard, the continuity equation was used to calculate EOA (EOA_CE) with the 2D PC-MRI velocity field and compared to the EOA_JSLD measurements. The in-vitro results exhibited excellent agreement between flow theory (EOA = 0.78 cm²) and experimental measurement (EOA_JSLD-4D = 0.78 ± 0.01 cm²) for peak velocities ranging from 0.9 to 3.7 m/s. In-vivo results showed good correlation and agreement between EOA_JSLD-2D and EOA_CE (r = 0.91, p < 0.001; bias: − 0.01 ± 0.38 cm²; agreement limits: 0.75 to − 0.77 cm²), and between EOA_JSLD-4D and EOA_CE (r = 0.95, p < 0.001; bias: − 0.09 ± 0.26 cm²; limits: 0.43 to − 0.62 cm²).

Conclusion

This study demonstrates the feasibility of measuring EOA_JSLD using 4D flow MRI. The technique allows for optimization of the EOA measurement position by visualizing the 3D vena contracta, and avoids potential sources of EOA_CE measurement variability.     

Enhancement of measurement accuracy of X‐ray PIV in comparison with the micro‐PIV technique

The X‐ray PIV (particle image velocimetry) technique has been used as a non‐invasive measurement modality to investigate the haemodynamic features of blood flow. However, the extraction of two‐dimensional velocity field data from the three‐dimensional volumetric information contained in X‐ray images is technically unclear. In this study, a new two‐dimensional velocity field extraction technique is proposed to overcome technological limitations. To resolve the problem of finding a correction coefficient, the velocity field information obtained by X‐ray PIV and micro‐PIV techniques for disturbed flow in a concentric stenosis with 50% severity was quantitatively compared. Micro‐PIV experiments were conducted for single‐plane and summation images, which provide similar positional information of particles as X‐ray images. The correction coefficient was obtained by establishing the relationship between velocity data obtained from summation images (V_S) and centre‐plane images (V_C). The velocity differences between V_S and V_C along the vertical and horizontal directions were quantitatively analysed as a function of the geometric angle of the test model for applying the present two‐dimensional velocity field extraction technique to a conduit of arbitrary geometry. Finally, the two‐dimensional velocity field information at arbitrary positions could be successfully extracted from X‐ray images by using the correction coefficient and several velocity parameters derived from V_S.     

Calcification of aortic human valves studied in situ by Raman microimaging: following mineralization from small grains to big deposits

A Raman microimaging‐based approach has been used in the current study to evaluate formation and progression of calcification in situ in human stenotic aortic valves obtained during surgical valve replacement. The capability of the method to visualize distribution of the calcified deposits resulted in structural characterization of deposits in the various phases of development. A high spatial resolution of the method along with the confocal depth profiling enabled to identify extremely small salt inclusions (of ca. 0.5 µm in diameter), formed probably at the very early stage of calcification. Structurally, these inclusions are built from an octacalcium phosphate‐like compound that during grains' growth transforms into tricalcium phosphate, mixed with the salt containing the acidic phosphate groups (HPO₄²⁻) and, finally, into stable B‐type hydroxyapatite that is the only salt present in large‐area calcium salt deposits. Copyright © 2013 John Wiley & Sons, Ltd.     

Study of Radially Varying Magnetic Field on Blood Flow through Catheterized Tapered Elastic Artery with Overlapping Stenosis

A precise model has been developed for studying the influence of metallic nanoparticles on blood flow through catheterized tapered elastic arteries with radially varying magnetic field. The model is solved under the mild stenosis approximation by considering blood as viscous fluid. The influence of different flow parameters associated with this problem such as Hartmann number, nanoparticle volume fraction, Grashof number and heat source or sink parameter is analyzed by plotting the graphs of the wall shear stress, resistance impedance to blood flow and stream lines. The influence of the radially varying magnetic field on resistance impedance to flow is analyzed and it is observed that the significantly strong magnetic force tends to increase in resistance.     

Assessment of clinical data of nonlinear stochastic deconvolution versus block-circulant singular value decomposition for quantitative dynamic susceptibility contrast magnetic resonance imaging

Dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) allows the noninvasive assessment of brain hemodynamics alterations by quantifying, via deconvolution, the cerebral blood flow (CBF) and mean transit time (MTT). Singular value decomposition (SVD) and block-circulant SVD (cSVD) are the most widely adopted deconvolution method, although they bear some limitations, including unphysiological oscillations in the residue function and bias in the presence of delay and dispersion between the tissue and the arterial input function. A nonlinear stochastic regularization (NSR) has been proposed, which performs better than SVD and cSVD on simulated data both in the presence and absence of dispersion. Moreover, NSR allows to quantify the dispersion level. Here, cSVD and NSR are compared for the first time on a group of nine patients with severe atherosclerotic unilateral stenosis of internal carotid artery before and after carotid stenting to investigate the effect of arterial dispersion. According to region of interest-based analysis, NSR characterizes the pathologic tissue more accurately than cSVD, thus improving the quality of the information provided to physicians for diagnosis. In fact, in 7 (78%) of the 9 subjects, CBF and MTT maps provided by NSR allow to correctly identify the pathologic hemisphere to the physician. Moreover, by emphasizing the difference between pathologic and healthy tissues, NSR may be successfully used to monitor the subject's recovery after the treatment and/or surgery. NSR also generates dispersion level and non-dispersed CBF and MTT maps. The dispersion level provides information on CBF and MTT estimates reliability and may also be used as a clinical indicator of pathological tissue state complementary to CBF and MTT, thus increasing the clinical information provided by DSC-MRI analysis.     

Simulation of Variable Viscosity and Jeffrey Fluid Model for Blood Flow Through a Tapered Artery with a Stenosis

Non-Newtonian fluid model for blood flow through a tapered artery with a stenosis and variable viscosity by modeling blood as Jeffrey fluid has been studied in this paper.The Jeffrey fluid has two parameters,the relaxation time λ1 and retardation time λ2.The governing equations are simplified using the case of mild stenosis.Perturbation method is used to solve the resulting equations.The effects of non-Newtonian nature of blood on velocity profile,temperature profile,wall shear stress,shearing stress at the stenotsis throat and impedance of the artery are discussed.The results for Newtonian fluid are obtained as special case from this model.     

Hyaluronic Acid: Its Role in Voice

The extracellular matrix (ECM), once regarded simply as a structural scaffold, is now recognized as an important modulator of cellular behavior and function. One component that plays a prominent role in this process is hyaluronic acid (HA)--a molecule found in many different tissues. Research into the roles of HA indicates that it plays a key role in tissue viscosity, shock absorption, and space filling. Specifically, research into the role of HA in laryngology indicates that it has profound effects on the structure and viscosity of vocal folds. This article provides an introduction to the structure and biological functions of HA and its importance in voice. In addition, an overview of the pharmaceutical applications of HA is discussed.