Lebenswissenschaften und Ethik
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Vascular damage develops with diverging severity during and after percutaneous coronary intervention with stent placement and is the prevailing stimulus for in-stent restenosis. Previous work has failed to link mechanical data obtained in a realistic in vivo or in vitro environment with data collected during imaging processes. We investigated whether specimens of porcine right coronary arteries soften when indented with a stent strut shaped structure, and if the softening results from damage mechanisms inside the fibrillar collagen structure. To simulate the multiaxial loading scenario of a stented coronary artery, we developed the testing device ‘LAESIO’ that can measure differences in the stress-stretch behavior of the arterial wall before and after the indentation of a strut-like stamp. The testing protocol was optimized according to preliminary experiments, more specifically equilibrium and relaxation tests. After chemical fixation of the specimens and subsequent tissue clearing, we performed three-dimensional surface and second-harmonic generation scans on the deformed specimens. We analyzed and correlated the mechanical response with structural parameters of high-affected tissue located next to the stamp indentation and low-affected tissue beyond the injured area. The results reveal that damage mechanisms, like tissue compression as well as softening, fiber dispersion, and the lesion extent, are direction-dependent, and the severity of them is linked to the strut orientation, indentation pressure, and position. The findings highlight the need for further investigations by applying the proposed methods to human coronary arteries. Additional data and insights might help to incorporate the observed damage mechanisms into material models for finite element analyses to perform more accurate simulations of stent-implantations.
Finite element (FE)–based studies of preoperative processes such as folding,pleating, and stent crimping with a comparison with experimental inflation tests are not yet available. Therefore, a novel workflow is presented in which residual stresses of balloon folding and pleating, as well as stent crimping, and the geometries of all contact partners were ultimately implemented in an FE code to simulate stent expansion by using an implicit solver. The numerical results demonstrate that the incorporation of residual stresses and strains experienced during the production step significantly increased the accuracy of the subsequent simulations, especially of the stent expansion model. During the preoperative processes, stresses inside the membrane and the stent material also reached a rather high level. Hence, there can be no presumption that balloon catheters or stents are undamaged before the actual surgery. The implementation of the realistic geometry, in particular the balloon tapers, and the blades of the process devices improved the simulation of the expansion mech-anisms, such as dogboning, concave bending, or overexpansion of stent cells. This study shows that implicit solvers are able to precisely simulate the mentioned preoperative processes and the stent expansion procedure without a preceding manipulation of the simulation time or physical mass.
We investigated the role of informative feedback on the neural correlates of perceptual learning in a coherent-motion detection paradigm. Stimulus displays consisted of four patches of moving dots briefly (500 ms) presented simultaneously, one patch in each visual quadrant. The coherence level was varied in the target patch from near threshold to high, while the other three patches contained only noise. The participants judged whether coherent motion was present or absent in the target patch. To guarantee central fixation, a secondary RSVP digit-detection task was performed at fixation. Over six training sessions subjects learned to detect coherent motion in a predefined quadrant (i.e., the learned location). Half of our subjects were randomly assigned to the feedback group, where they received informative feedback after each response during training, whereas the other group received non-informative feedback during training that a response button was pressed. We investigated whether the presence of informative feedback during training had an influence on the learning success and on the resulting BOLD response. Behavioral data of 24 subjects showed improved performance with increasing practice. Informative feedback promoted learning for motion displays with high coherence levels, whereas it had little effect on learning for displays with near-threshold coherence levels. Learning enhanced fMRI responses in early visual cortex and motion-sensitive area MT+ and these changes were most pronounced for high coherence levels. Activation in the insular and cingulate cortex was mainly influenced by coherence level and trained location. We conclude that feedback modulates behavioral performance and, to a lesser extent, brain activation in areas responsible for monitoring perceptual learning.
One of the fundamental challenges in L-PBF of filigree geometries, such as aortic stents used in biomedical applications, is the requirement for a robust yet easily removable support structure that allows each component to be successfully fabricated without distortion. To solve this challenge, an integrative experimental approach was attempted in the present study by identifying an optimal support structure design and an optimized support removal strategy for this design. The specimens were manufactured using four different support structure designs based on the geometry exposed to the laser beam during the L-PBF. Support removal procedures included sand blasting (SB), glass bead blasting (GB), and electrochemical polishing (ECP). The two best-performing designs (line and cross) were chosen due to shorter lead times and lower material consumption. As an additional factor that indicates a stable design, the breaking load requirement to remove the support structures was determined. A modified line support with a 145° included angle was shown to be the best support structure design in terms of breaking load, material consumption, and manufacturing time. All three procedures were used to ensure residue-free support removal for this modified line support design, with ECP proving to be the most effective.
Patients with juvenile retinal dystrophy often report that they are unaware of their central scotoma, suggesting the presence of perceptual filling-in. We used functional Magnetic Resonance Imaging (fMRI) to determine possible neural correlates of perceptual filling-in in patients with retinal distrophy and clinically established central scotoma in both eyes. The data of 5 patients (Stargardt disease, cone-rod dystrophy; mean age 45 yrs; scotoma diameter 10-20°) and of 5 normally sighted controls were analyzed. Fixation behaviour and perimetry were measured with a Nidek microperimeter. Magnetic resonance imaging was performed using a Siemens 3T Allegra scanner. We stimulated the central visual field (30 deg) with a vertically oriented, low spatial frequency (1 c/deg) high-contrast sinewave grating that was either a) continuous, or b) was interrupted by a central grey disk. The disk was either slightly larger than the scotoma (detectable on 75% of trials) or slightly smaller (detectable on 25% of trials). To control for attention, an eccentric fixation task was performed during scanning. Data were analyzed using SPM8 (GLM with ROI analysis to obtain percent signal change for foveal projection zone). Results: for all patients, the BOLD signal in the foveal projection area was significantly higher for the small disk (i.e., condition leading to complete filling-in) than for the large disk (i.e., no filling-in). This effect was absent in the control subjects. Our findings support the existence of an active neural process that leads to filling-in in patients with central visual field scotomata.