Simulation study of the Hemopump as a cardiac assist device

A dynamic model was developed for a Hemopump that withdraws blood from the left ventricle and discharges it to the aorta through a miniature axial-flow pump. Incorporation of the Hemopump model in a previously established model for the canine circulatory system enabled the effects of the Hemopump on various haemodynamic variables of the circulatory system to be studied, and the benefit of the Hemopump to the failing heart was investigated. In addition, the influence of the physiological status of the right ventricle on the Hemopump performances was examined, and the synchronous and non-synchronous operations of the Hemopump were compared. Results verified that the Hemopump assists the failing heart by increasing the oxygen supply, while reducing the oxygen consumption of the heart through a reduction in the workload of the left ventricle. These beneficial effects were enhanced when the pump's rotation speed was increased. When pump speed was increased from 17000 to 23000 revolutions min⁻¹, the oxygen supply increased 101%, and the oxygen consumption decreased 60%. However, when the pump rotation speed was too high, the inflow to the pump could be impaired and the pump performance could be negatively affected. Predications from the model were in good agreement with the results previously obtained in animal experiments and in vitro measurements.     

冠状动脉搭桥术中移植管-宿主动脉直径比和缝合角的优化与分析

目的探索怎样的移植管-宿主动脉直径比和缝合角可以最大限度地提高冠状动脉搭桥术的成功率。方法借助ANSYS9.0对冠状动脉搭桥术进行模拟仿真,用响应面方法建立数学模型,利用优化理论寻找最优的移植管-宿主动脉直径比和缝合角,使影响手术成功率的主要因素-壁面切应力梯度最小。结果结果表明冠状动脉搭桥术中,大移植管-宿主动脉直径比和小缝合角的模型具有更好的血流动力特性。结论影响冠状动脉搭桥术成功率的因素很多,在现有条件下借助临床经验指导,选择尽可能大的移植管-宿主动脉直径比和尽可能小的缝合角的做法是可取的。     

Color Rendering in Medical Extended-Reality Applications

Cross-platform development of medical applications in extended-reality (XR) head-mounted displays (HMDs) often relies on game engines with rendering capabilities currently not standardized in the context of medical visualizations. Many aspects of the visualization pipeline including the characterization of color have yet to be consistently defined across rendering models and platforms. We examined the transfer of color properties from digital objects, through the rendering and image processing steps, to the RGB values sent to the display device. Five rendering pipeline configurations within the Unity engine were evaluated using 24 digital color patches. In the second experiment, the same configurations were evaluated with a tissue slide sample image. Measurements of the change in color associated with each configuration were characterized using the CIE 1976 color difference (ΔE). We found that the distribution of ΔE for the first experiment ranges from zero, as in the case using an Unlit Shader, to 25.97, as in the case using default configurations. The default Unity configuration consistently returned the highest ΔE across all 24 colors and also the largest range of color differences. In the second experiment, ΔEE ranged from 7.49 to 34.18. The Unlit configuration resulted in the highest ΔE in three of four selected pixels in the tissue sample image. Changes in color image properties associated with texture import settings were then evaluated in a third experiment using the TG18-QC test pattern. Differences in pixel values were found in all nine of the investigated texture import settings. The findings provide an initial characterization of color transfer and a basis for future work on standardization, consistency, and optimization of color in medical XR applications.     

CT模拟定位三维适形放射治疗食管癌的临床研究

目的探讨CT模拟定位三维适形放射治疗食管癌的疗效。方法1997年4月～2002年7月,经病理证实的食管鳞状细胞癌87例患者，其中男性56例，女性31例，年龄42～75岁，平均年龄62.5岁，随机分为2组，两组患者一般情况、性别、年龄及病变部位构成经统计学检验无统计学意义，一组为采用CT模拟定位进行三维适形放射治疗，另一组为常规模拟定位放射治疗，两组的剂量都为64～66Gy／32.33次／6.4～6.6周。结果采用Kaplan—Meier法计算生存率，并用Log—Rank检验其差异性。治疗计划各指标分析采用kolmogorowSmirnov法行正态分布检验，继而行t检验，以P〈0.05为差异有统计学意义。CT模拟定位三维适形放射治疗组和常规模拟定位放射治疗组1、2、3、4年生存率分别为70.1％、55.6％、40.4％、36.3％和65.4％、50.6％、30.6％、20.9％（p〉0.05）。但是对Ⅰ～Ⅱ期患者，CT模拟定位三维适形放射治疗组和常规模拟定位放射治疗组的生存率分别为81.2％、75.5％、67.3％、61.5％和80.1％、65.7％、54.9％、29.7％（P〈0，05），局部控制率分别为75.6％、71.7％、65.5％、59.0％和65.4％、50.6％、33.3％、25.6％（P〈0.05）。而对于Ⅲ～Ⅳ期的患者，两组之间的生存率和局部控制率差异无统计学意义。结论CT模拟定位三维适形放射治疗的疗效明显好于常规模拟定位放射治疗组。特别对Ⅰ-Ⅱ期早期食管癌患者两组之间差异有统计学意义，而对晚期患者差异无统计学意义。     

"虚拟中国人Ⅰ号"的动脉灌注

目的 :在“虚拟中国人Ⅰ号”建模前对其动脉进行灌注填充 ,使其能与静脉区分。方法 :一侧颈总动脉双向插管 ,按 40～ 45ml kg体重的灌注量 ,以 4.0× 10 4 Pa的灌注压力 ,灌注红色填充剂。结果 :共灌入填充剂 2 70 0ml。结论 :为“虚拟中国人I号”赋加了动脉显示特色。     

Modeling of stimulation–secretion coupling in a chromaffin cell

We constructed a chromaffin cell model for analysis of stimulation–secretion coupling in computer simulation studies. The model includes mechanisms involved in the excitatory synapse, voltage-dependent Na⁺, K⁺ and Ca²⁺ channels, Ca²⁺-activated K⁺ channels (SK type), buffered Ca²⁺ diffusion, Ca²⁺ extrusion, fluorescent Ca²⁺ indicators and Ca²⁺-triggered exocytosis. Calculations of the modeled mechanisms were carried out using the NEURON simulation environment (Hines and Carnevale, Neural Computation 9:1179–1209, 1997). A set of parameter values was determined so as to fit basic experimental results reported in the literature. The model was also applied to simulate our experimental results obtained from chromaffin cells in the perfused rat adrenal medulla. Observed profiles of Ca²⁺responses induced by electrically stimulating the splanchnic nerve with various frequencies (1–50 Hz) were adequately simulated with minor readjustments of parameter values for Ca²⁺influx and extrusion. Secretory responses measured at the same time as the Ca²⁺responses were also simulated with consideration of a time constant to detect catecholamines in the experiment. Similarly, model simulations reproduced both Ca²⁺responses and secretory responses evoked by elevations of the extracellular K⁺ concentration for different periods. The results suggest that the presented model provides a useful tool for analyzing and predicting quantitative relations in various events occurring in stimulation–secretion coupling in chromaffin cells.     

Das Magengeschwür als energiebilanzproblem: Entwurf eines cellularen automaten zur simulation von verteilungsstörungen der magenwanddurchblutung

Zusammenfassung Ein cellularer Automat, der eine vereinfachte Abschätzung von Verteilungsmustern der Magendurchblutung erlaubt, wird beschrieben. Die auf der Basis des Energiebedarfs der Säuresekretion und der Morphologie der Magenstrombahn simulierbaren Umverteilungsphänomene stimmen in Form und Lage mit dem menschlichen Magengeschwür überein. Sonderfälle der peptischen' Läsion, wie das lineare Geschwür oder die peptische' Stenose der Speiseröhre, sind mit der Theorie des submucösen Steal-Phänomens zu vereinbaren.

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Gastric ulcer as a problem of energy balance: Design of a cellular automaton for simulation of disorders of blood flow distribution to the stomach wall

Summary A cellular automaton is described, which allows a simple simulation of patterns of gastric blood flow distribution. Effects of redistribution, which can be simulated on the basis of the energy requirements of acid secretion and the morphology of the gastric vascular bed, are isomorph to form and site of gastric ulcer in man. Special forms of the peptic lesion as linear ulcers or peptic stenoses of the oesophagus are consistent with the theory of a submucous steal-phenomenon.

Herrn Prof. Dr. Dr. rer. nat. h. c. Friedrich Stelzner zum 65. Geburtstag gewidmet     

A Bayesian Approach for Incorporating the EQ-5D Visual Analog Scale When Estimating the Health-Related Quality of Life

ObjectivesThe EuroQoL 3-level version of EQ-5D and 5-level version of EQ-5D questionnaires are often used to quantify health states. They include ordinal responses across 5 health dimensions (EQ-5D index) and an EQ-visual analog scale (EQ-VAS) overall health rating. We investigated the value of incorporating the EQ-VAS to update health utility estimates using a Bayesian framework.MethodsWe created a joint bivariate normal EQ-VAS and EQ-5D index utility model and compared this to a univariate normal EQ-5D index utility model. We tested these models for 1026 Sri Lankan patients with chronic kidney disease and 94 Australian patients with wounds. We validated our approach by simulating EQ-VAS and EQ-5D index responses and applying our Bayesian model and then comparing the modeled estimates to our observed data.ResultsThe combined model showed a reduction in estimate uncertainty for all respondents. Compared with the EQ-5D index-only model, the mean utility for Sri Lankan respondents dropped from 0.556 (0.534-0.579) to 0.540 (0.521-0.559) in men and increased from 0.489 (0.461-0.518) to 0.528 (0.506-0.550) in women, with reduced credible interval width by 13% and 23%, respectively. The mean utility in Australian respondents moved from 0.715 (0.633-0.800) to 0.716 (0.652-0.782) in men, and 0.652 (0.581-0.723) to 0.652 (0.593-0.711) in women, with reduced credible interval width by 23% and 17%, respectively. The credible interval width for simulated data also narrowed, ranging from 8.3 to 8.5%.ConclusionsIncluding the EQ-VAS through Bayesian methods can add value by reducing requisite sample sizes and decision uncertainty using small amounts of additional data that is often collected but rarely used.     

Suprachoroidal Injection of Triamcinolone Acetonide Injectable Suspension for the Treatment of Macular Edema Associated With Uveitis in the United States: A Cost-Effectiveness Analysis

ObjectivesSuprachoroidal injection of triamcinolone acetonide is the first Food and Drug Administration–approved treatment for macular edema associated with uveitis. A cost-effectiveness analysis was performed comparing this treatment with best supportive care (BSC) for the management of this indication from US Medicare and commercial payer perspectives.MethodsA patient-level simulation was developed per the patient characteristics and changes in best-corrected visual acuity letter scores observed in a phase III study of triamcinolone acetonide (PEACHTREE). The wholesale acquisition cost of triamcinolone acetonide was $1650/injection; suprachoroidal injection cost was assumed at $200/injection. Healthcare costs were informed by a US claims–based analysis. Mortality risk associated with severe vision loss and blindness was modeled by applying a hazard ratio to all-cause mortality rates of the US general population. Health-related quality of life weights, obtained from a regression model fitted to the Visual Function Questionnaire-25 data from PEACHTREE, were applied based on the best-corrected visual acuity scores of both eyes. Costs (2020 US dollar) and benefits were discounted at 3% annually. Incremental cost-effectiveness ratios were estimated over a 10-year horizon.ResultsIn the base-case, the incremental cost-effectiveness ratio comparing triamcinolone acetonide with BSC was $28 479 per quality-adjusted life-year gained. The wholesale acquisition cost for triamcinolone acetonide for suprachoroidal use was ～68%, ～56%, and ～27% below the willingness-to-pay thresholds of $150 000, $100 000, and $50 000 per quality-adjusted life-year gained, respectively. Results were robust in sensitivity and scenario analyses.ConclusionsTriamcinolone acetonide for suprachoroidal use is cost-effective compared with BSC for patients with macular edema associated with uveitis.