Kwong Ming Tse

Investigation of hemodynamics in the development of dissecting aneurysm within patient-specific dissecting aneurismal aortas using computational fluid dynamics (CFD) simulations

Aortic dissecting aneurysm is one of the most catastrophic cardiovascular emergencies that carries high mortality. It was pointed out from clinical observations that the aneurysm development is likely to be related to the hemodynamics condition of the dissected aorta. In order to gain more insight on the formation and progression of dissecting aneurysm, hemodynamic parameters including flow pattern, velocity distribution, aortic wall pressure and shear stress, which are difficult to measure in vivo, are evaluated using numerical simulations. Pulsatile blood flow in patient-specific dissecting aneurismal aortas before and after the formation of lumenal aneurysm (pre-aneurysm and post-aneurysm) is investigated by computational fluid dynamics (CFD) simulations. Realistic time-dependent boundary conditions are prescribed at various arteries of the complete aorta models. This study suggests the helical development of false lumen around true lumen may be related to the helical nature of hemodynamic flow in aorta. Narrowing of the aorta is responsible for the massive recirculation in the poststenosis region in the lumenal aneurysm development. High pressure difference of 0.21 kPa between true and false lumens in the pre-aneurismal aorta infers the possible lumenal aneurysm site in the descending aorta. It is also found that relatively high time-averaged wall shear stress (in the range of 4-8 kPa) may be associated with tear initiation and propagation. CFD modeling assists in medical planning by providing blood flow patterns, wall pressure and wall shear stress. This helps to understand various phenomena in the development of dissecting aneurysm.

Biomechanics of the Deformity of Septal L-Struts

A septal L‐strut is often preserved or created during septoplasty. The main intention is to provide structural stability and to straighten the nasal septum. Deformity or excessive deformation of the L‐strut might cause functional or aesthetic complications. The objectives were to examine the effects of material properties, the boundary conditions, the nasal tip support, and the geometry of the L‐struts on the deformity of septal L‐struts.

A computational fluid dynamics study on geometrical influence of the aorta on haemodynamics

OBJECTIVES Cardiovascular diseases, such as atherosclerosis and aneurysm, are closely associated with haemodynamic factors that are governed by luminal geometry. The present work aimed to study the effect of geometrical variation of aging aortas on haemodynamics. METHODS Six aged subjects with intricate geometrical features, such as bulging or twisted supra-aortic arteries, sharply curved arch and double-curved descending aorta, were chosen from our medical database. These six geometrically variant aortas were reconstructed and the pulsatile nature of the blood flow of these subject-specific aorta models investigated using computational fluid dynamics simulations. Realistic time-dependent boundary conditions are prescribed for various arteries of the aorta models. RESULTS This study suggests that haemodynamics in the human aorta is highly dependent on geometrical features. The positioning and contouring of the supra-aortic arteries may be associated with the skewness of velocity profiles. The flow profiles in the aortic arch or bends are generally skewed towards the inner curvature wall and this skewness may give rise to the formation of secondary flow in the inner curvature wall of the distal arch. The degree of vorticity in the distal aortic arch is found to be related to the arch curvature. The helical nature of aortic haemodynamics is predominant in the systole phrase when it begins with a left-handed rotation and then vanishes in the ascending aorta, whereas a right-handed rotation persists in the distal aortic arch. Lower wall shear stress is also found in the ascending regions where secondary flow is present. CONCLUSIONS The aorta with an irregular contour and large degree of curvature at its arch favours the development of the intra-aortic secondary flow that subsequently relates to the pathogenesis of atheroma. The present study identifies the general trend of haemodynamic behaviours associated with various local geometrical features. Combining the knowledge of the correlation between haemodynamics and the underlying risks in the development of cardiovascular diseases, our study hopes to provide a better understanding of the relationship between aortic morphology and developing pathobiology of cardiovascular diseases. As such, early medical planning as well as surgical interventions can be designed to retard or prevent the development of cardiovascular diseases.

Development and validation of two subject-specific finite element models of human head against three cadaveric experiments

Head injury, being one of the main causes of death or permanent disability, continues to remain a major health problem with significant socioeconomic costs. Numerical simulations using the FEM offer a cost-effective method and alternative to experimental methods in the biomechanical studies of head injury. The present study aimed to develop two realistic subject-specific FEMs of the human head with detailed anatomical features from medical images (Model 1: without soft tissue and Model 2: with soft tissue and differentiation of white and gray matters) and to validate them against the intracranial pressure (ICP) and relative intracranial motion data of the three cadaver experimental tests. In general, both the simulated results were in reasonably good agreement with the experimental measured ICP and relative displacements, despite slight discrepancy in a few neutral density targets markers. Sensitivity analysis showed some variations in the brains relative motion to the material properties or markers location. The addition of soft tissue in Model 2 helped to damp out the oscillations of the model response. It was also found that, despite the fundamental anatomical differences between the two models, there existed little evident differences in the predicted ICP and relative displacements of the two models. This indicated that the advancements on the details of the extracranial features would not improve the models predicting capabilities of brain injury.

Development of a finite element head model for the study of impact head injury.

This study is aimed at developing a high quality, validated finite element (FE) human head model for traumatic brain injuries (TBI) prediction and prevention during vehicle collisions. The geometry of the FE model was based on computed tomography (CT) and magnetic resonance imaging (MRI) scans of a volunteer close to the anthropometry of a 50th percentile male. The material and structural properties were selected based on a synthesis of current knowledge of the constitutive models for each tissue. The cerebrospinal fluid (CSF) was simulated explicitly as a hydrostatic fluid by using a surface-based fluid modeling method. The model was validated in the loading condition observed in frontal impact vehicle collision. These validations include the intracranial pressure (ICP), brain motion, impact force and intracranial acceleration response, maximum von Mises stress in the brain, and maximum principal stress in the skull. Overall results obtained in the validation indicated improved biofidelity relative to previous FE models, and the change in the maximum von Mises in the brain is mainly caused by the improvement of the CSF simulation. The model may be used for improving the current injury criteria of the brain and anthropometric test devices.

Impact of complex blast waves on the human head: a computational study

Head injuries due to complex blasts are not well examined because of limited published articles on the subject. Previous studies have analyzed head injuries due to impact from a single planar blast wave. Complex or concomitant blasts refer to impacts usually caused by more than a single blast source, whereby the blast waves may impact the head simultaneously or consecutively, depending on the locations and distances of the blast sources from the subject, their blast intensities, the sequence of detonations, as well as the effect of blast wave reflections from rigid walls. It is expected that such scenarios will result in more serious head injuries as compared to impact from a single blast wave due to the larger effective duration of the blast. In this paper, the utilization of a head-helmet model for blast impact analyses in Abaqus(TM) (Dassault Systemes, Singapore) is demonstrated. The model is validated against studies published in the literature. Results show that the skull is capable of transmitting the blast impact to cause high intracranial pressures (ICPs). In addition, the pressure wave from a frontal blast may enter through the sides of the helmet and wrap around the head to result in a second impact at the rear. This study recommended better protection at the sides and rear of the helmet through the use of foam pads so as to reduce wave entry into the helmet. The consecutive frontal blasts scenario resulted in higher ICPs compared with impact from a single frontal blast. This implied that blast impingement from an immediate subsequent pressure wave would increase severity of brain injury. For the unhelmeted head case, a peak ICP of 330 kPa is registered at the parietal lobe which exceeds the 235 kPa threshold for serious head injuries. The concurrent front and side blasts scenario yielded lower ICPs and skull stresses than the consecutive frontal blasts case. It is also revealed that the additional side blast would only significantly affect ICPs at the temporal and parietal lobes when compared with results from the single frontal blast case. By analyzing the pressure wave flow surrounding the head and correlating them with the consequential evolution of ICP and skull stress, the paper provides insights into the interaction mechanics between the concomitant blast waves and the biological head model.

Computer-aided design and rapid prototyping-assisted contouring of costal cartilage graft for facial reconstructive surgery.

Complex 3-D defects of the facial skeleton are difficult to reconstruct with freehand carving of autogenous bone grafts. Onlay bone grafts are hard to carve and are associated with imprecise graft-bone interface contact and bony resorption. Autologous cartilage is well established in ear reconstruction as it is easy to carve and is associated with minimal resorption. In the present study, we aimed to reconstruct the hypoplastic orbitozygomatic region in a patient with left hemifacial microsomia using computer-aided design and rapid prototyping to facilitate costal cartilage carving and grafting. A three-step process of (1) 3-D reconstruction of the computed tomographic image, (2) mirroring the facial skeleton, and (3) modeling and rapid prototyping of the left orbitozygomaticomalar region and reconstruction template was performed. The template aided in donor site selection and extracorporeal contouring of the rib cartilage graft to allow for an accurate fit of the graft to the bony model prior to final fixation in the patient. We are able to refine the existing computer-aided design and rapid prototyping methods to allow for extracorporeal contouring of grafts and present rib cartilage as a good alternative to bone for autologous reconstruction.

Conventional and complex modal analyses of a finite element model of human head and neck

This study employs both the traditional and the complex modal analyses of a detailed finite element model of human head–neck system to determine modal responses in terms of resonant frequencies and mode shapes. It compares both modal responses without ignoring mode shapes, and these results are reasonably in agreement with the literature. Increasing displacement contour loops within the brain in higher frequency modes probably exhibits the shearing and twisting modes of the brain. Additional and rarely reported modal responses such as ‘mastication’ mode of the mandible and flipping mode of nasal lateral cartilages are identified. This suggests a need for detailed modelling to identify all the additional frequencies of each individual part. Moreover, it is found that a damping factor of above 0.2 has amplifying effect in reducing higher frequency modes, while a diminishing effect in lowering peak biomechanical responses, indicating the importance of identifying the appropriate optimised damping factor.

Effect of helmet liner systems and impact directions on severity of head injuries sustained in ballistic impacts: a finite element (FE) study.

The current study aims to investigate the effectiveness of two different designs of helmet interior cushion, (Helmet 1: strap-netting; Helmet 2: Oregon Aero foam-padding), and the effect of the impact directions on the helmeted head during ballistic impact. Series of ballistic impact simulations (frontal, lateral, rear, and top) of a full-metal-jacketed bullet were performed on a validated finite element head model equipped with the two helmets, to assess the severity of head injuries sustained in ballistic impacts using both head kinematics and biomechanical metrics. Benchmarking with experimental ventricular and intracranial pressures showed that there is good agreement between the simulations and experiments. In terms of extracranial injuries, top impact had the highest skull stress, still without fracturing the skull. In regard to intracranial injuries, both the lateral and rear impacts generally gave the highest principal strains as well as highest shear strains, which exceed the injury thresholds. Off-cushion impacts were found to be at higher risk of intracranial injuries. The study also showed that the Oregon Aero foam pads helped to reduce impact forces. It also suggested that more padding inserts of smaller size may offer better protection. This provides some insights on future’s helmet design against ballistic threats.

Mechanical response of femur bone to bending load using finite element method

Bending load is often encountered in femur bone (thigh bone) particularly in the case of lateral impact. Femur fracture is quite usual in pedestrians. It generally occurs because of bending of femur bone due to lateral impact. In order to prevent fractures in walkers and vehicle passengers from accidents, it is significant to study the bending behavior of femur bone. Femur bone is one of the most commonly fractured bones in human body as it is one of the longest and largest bones. In this work, mechanical response of femur bone to bending load is studied by the help of finite element simulation. For a given critical load, deflection, von Mises stresses and bending stresses have been obtained. For the critical bending moment of 200 N-m, the maximum von Mises stresses reaches up to 131.3 MPa, and the maximum deflection is found to be 1.8 cm. The Von Mises stress must be less than the yield stress of the material; otherwise it could lead to fracture of the bone.