Physics-Informed Modeling and Control of Multi-Actuator Soft Catheter Robots

Catheter-based endovascular interventional procedures have become increasingly popular in recent years as they are less invasive and patients spend less time in the hospital with less recovery time and less pain. These advantages have led to a significant growth in the number of procedures that are performed annually. However, it is still challenging to position a catheter in a target vessel branch within the highly complicated and delicate vascular structure. In fact, vessel tortuosity and angulation, which cause difficulties in catheterization and reaching the target site, have been reported as the main causes of failure in endovascular procedures. Maneuverability of a catheter for intravascular navigation is a key to reaching the target area; ability of a catheter to move within the target vessel during trajectory tracking thus affects to a great extent the length and success of the procedure. To address this issue, this paper models soft catheter robots with multiple actuators and provides a time-dependent model for characterizing the dynamics of multi-actuator soft catheter robots. Built on this model, an efficient and scalable optimization-based framework is developed for guiding the catheter to pass through arteries and reach the target where an aneurysm is located. The proposed framework models the deflection of the multi-actuator soft catheter robot and develops a control strategy for movement of catheter along a desired trajectory. This provides a simulation-based framework for selection of catheters prior to endovascular catheterization procedures, assuring that given a fixed design, the catheter is able to reach the target location. The results demonstrate the benefits that can be achieved by design and control of catheters with multiple number of actuators for navigation into small vessels.

Color Doppler and Microvascular Flow Imaging to Evaluate the Degree of Inflammation in a Case of Hidradenitis Suppurativa

Microvascular Flow Imaging is a new ultrasound technique with better ability than Color Doppler Imaging to identify small vessels that have slow blood flow, and it permits better evaluation of the features, especially microvascular architecture, of various lesions. We describe a case of inguinal hidradenitis suppurativa in a patient with positive risk factors (young age, female, smoker, and obese), diagnosed by ultrasonography using B-Mode, Color Doppler, and finally also with Microvascular Flow Imaging. Our aim is to demonstrate the usefulness of this new technique in characterization of lesions.

Interaction between Antiphospholipid Antibodies and Protein C Anticoagulant Pathway: A Narrative Review

Thrombotic antiphospholipid syndrome (APS) is a condition in which thrombosis in venous, arterial, and/or small vessels is ascribed to the presence of antiphospholipid antibodies (aPL). Among the various proposed pathogenic theories to explain thrombotic APS, those involving the interaction between aPL and the protein C system have gained much consensus. Indeed, robust data show an acquired activated protein C resistance (APC-R) in these patients. The role of aPL in this impairment is clear, but the mechanism of action is uncertain, as the type of aPL and to what extent aPL are involved remains a gray area. Lupus anticoagulant (LA) is often associated with APC-R, but antibodies generating LA comprise those directed to β2-glycoprotein I and antiphosphatidylserine/prothrombin. Moreover, the induction of APC-R by aPL requires the presence of phospholipids and is suppressed by the presence of an excess of phospholipids. How phospholipids exposed on the cell membranes work in the system in vivo is unknown. Interestingly, acquired APC-R due to aPL might explain the clinical phenotypes of thrombotic APS. Indeed, the literature reports cases of both venous and arterial thromboembolism as well as skin necrosis, the latter observed in the severe form of protein C deficiency and in catastrophic APS.

Vascular Contributions to Brain Health: Cross-Cutting Themes

As life expectancy grows, brain health is increasingly seen as central to what we mean by successful aging—and vascular brain health as central to overall brain health. Cerebrovascular pathologies are highly prevalent independent contributors to age-related cognitive impairment and at least partly modifiable with available treatments. The current Focused Update addresses vascular brain health from multiple angles, ranging from pathophysiologic mechanisms and neuroimaging features to epidemiologic risk factors, social determinants, and candidate treatments. Here we highlight some of the shared themes that cut across these distinct perspectives: 1) the lifetime course of vascular brain injury pathogenesis and progression; 2) the scientific and ethical imperative to extend vascular brain health research in non-White and non-affluent populations; 3) the need for improved tools to study the cerebral small vessels themselves; 4) the potential role for brain recovery mechanisms in determining vascular brain health and resilience; and 5) the cross-pathway mechanisms by which vascular and neurodegenerative processes may interact. The diverse perspectives featured in this Focused Update offer a sense of the multidisciplinary approaches and collaborations that will be required to launch our populations towards improved brain health and successful aging.

Melatonin drugs inhibit SARS-CoV-2 entry into the brain and virus-induced damage of cerebral small vessels

COVID-19 is a complex disease with short- and long-term respiratory, inflammatory and neurological symptoms that are triggered by the infection with SARS-CoV-2. Invasion of the brain by SARS-CoV-2 has been observed in humans and is postulated to be involved in post COVID condition. Brain infection is particularly pronounced in the K18-hACE2 mouse model of COVID-19. Here, we show that treatment of K18-hACE2 mice with melatonin and two melatonin-derived marketed drugs, agomelatine and ramelteon, prevent SARS-CoV-2 entry in the brain thereby reducing virus-induced damage of small cerebral vessels, immune cell infiltration and brain inflammation. Brain entry of SARS-CoV-2 through endothelial cells is prevented by melatonin through allosteric binding to human angiotensin-converting enzyme 2 (ACE2), which interferes with the cell entry receptor function of ACE2 for SARS-CoV-2. Our findings open new perspectives for the repurposing of melatonergic drugs in the prevention of brain infection by SARS-CoV-2 and COVID-19-related long-term neurological symptoms.

Treatment of Unique Bilateral Distal Fusiform Superior Cerebellar Artery Aneurysms with Mini-Flow Diverter Device Implantation: Case Report

Currently, surgical revascularization procedures using intracranial–intracranial (IC-IC) or extracranial–intracranial (EC-IC) bypass and distal clipping or trapping are the valid and rescue treatment modality for extremely rare unilateral distal fusiform superior cerebellar artery (SCA) aneurysms. Yet, in case of bilateral fusiform SCA aneurysms, surgical therapy reaches its limit. Mini-flow diverter devices (FDDs) have only recently become available for treating fusiform aneurysms of such small vessels. We report the unique case of bilateral distal fusiform SCA aneurysms in a 43-year-old man with subarachnoid hemorrhage (Fisher grade IV and World Federation of Neurosurgical Societies [WFNS] grade II) treated with endovascular implantation of bilateral mini-FDDs with excellent outcome and no radiographic signs of infarction. Yet, occlusion of one of the FDDs was found in the follow-up, which again shows the eminent danger of occlusion in case of an implantation of FDDs in such small-caliber vessels, which leaves the discussion about the optimal therapy method open.

Characterization of the Canine Retinal Vasculature With Optical Coherence Tomography Angiography: Comparisons With Histology and Fluorescein Angiography

Purpose: To present a methodology for quantification of the canine retinal vasculature imaged by optical coherence tomography angiography (OCTA) and validate this approach by comparison with fluorescein angiography (FA) and confocal imaging of retinal wholemounts labelled by immunohistochemistry (IHC).Methods: Six normal adult dogs underwent retinal OCTA imaging in both eyes. The images extracted from the different microvascular plexuses at eight retinal locations spanning the central and mid-peripheral fundus were analyzed using the AngioTool software. FA was performed in one eye and was compared to the OCTA images. Six eyes from three dogs were processed by IHC to examine the retinal vasculature.Results: A total of four retinal plexuses were identified by OCTA in the canine retina, and their density and topographical pattern varied with eccentricity. OCTA offered improved resolution over FA with the advantage of allowing imaging of the individual plexuses. Detection by OCTA of small vessels within the deep capillary plexus was possible and approached the level of resolution achieved with ex vivo imaging of the retinal vasculature by confocal microscopy/IHC. The plexuses herein described are analogous to human retinal vasculature.Conclusion: OCTA can be used to image and quantify non-invasively the vascular retinal networks of the canine retina. We provide normative data in eight different retinal locations that can be imaged non-invasively with this technology. This could support analysis of retinal vascular changes associated with disease and following therapeutic intervention.

Estimating Bycatch Mortality for Marine Mammals: Concepts and Best Practices

Fisheries bycatch is the greatest current source of human-caused deaths of marine mammals worldwide, with severe impacts on the health and viability of many populations. Recent regulations enacted in the United States under the Fish and Fish Product Import Provisions of its Marine Mammal Protection Act require nations with fisheries exporting fish and fish products to the United States (hereafter, “export fisheries”) to have or establish marine mammal protection standards that are comparable in effectiveness to the standards for United States commercial fisheries. In many cases, this will require estimating marine mammal bycatch in those fisheries. Bycatch estimation is conceptually straightforward but can be difficult in practice, especially if resources (funding) are limiting or for fisheries consisting of many, small vessels with geographically-dispersed landing sites. This paper describes best practices for estimating bycatch mortality, which is an important ingredient of bycatch assessment and mitigation. We discuss a general bycatch estimator and how to obtain its requisite bycatch-rate and fisheries-effort data. Scientific observer programs provide the most robust bycatch estimates and consequently are discussed at length, including characteristics such as study design, data collection, statistical analysis, and common sources of estimation bias. We also discuss alternative approaches and data types, such as those based on self-reporting and electronic vessel-monitoring systems. This guide is intended to be useful to managers and scientists in countries having or establishing programs aimed at managing marine mammal bycatch, especially those conducting first-time assessments of fisheries impacts on marine mammal populations.

A Systematic Study on Berthing Capacity Assessment of Sanya Yazhou Fishing Port by Typhoon Prediction Model

This paper sheds light on the effect of combination modes on the evaluation of berthing capacity for Sanya Yazhou Fishing Port (SYFP) under hypothetical typhoon conditions. By statistically analysing the maximum probability of moving speeds and directions of historical typhoons passing through the fishing port, the representative typhoon path was determined with the nonparametric regression method. The designed typhoon wind fields of levels 12–17 were generated based on Holland’s parametric wind model. Then, the MIKE 21 BW model was used to obtain the high-precision wave distribution in the fishing port. The boundary conditions (significant wave height and peak period) of the MIKE 21 BW model were calculated by combining the MIKE 21 SW model with the designed typhoon wind fields. In SYFP, ships usually adopt the modes of multi-ship side-by-side and single anchor mooring during typhoons. In fair weather, approximately 158 vessels can be berthed if they are all large ones, while approximately 735 vessels can be moored if they are all small ones. However, with an increase in typhoon levels, the anchoring area for small vessels decreases. From the perspective of wave distribution in the fishing port, the number of large vessels moored was hardly affected by typhoons. This can be attributed to the breakwater, which significantly decreases the large wave height in the fishing port. Finally, a study on the framework of a method for hazard assessment of berthing capacity in the coming typhoon-driven storm waves was set up.