Arterial luminal curvature and fibrous-cap thickness affect critical stress conditions within atherosclerotic plaque: An in vivo MRI-based 2D finite-element study

High mechanical stress in atherosclerotic plaques at vulnerable sites, called critical stress, contributes to plaque rupture. The site of minimum fibrous cap (FC) thickness (FCMIN) and plaque shoulder are well-documented vulnerable sites. The inherent weakness of the FC material at the thinnest point increases the stress, making it vulnerable, and it is the big curvature of the lumen contour over FC which may result in increased plaque stress. We aimed to assess critical stresses at FCMIN and the maximum lumen curvature over FC (LCMAX) and quantify the difference to see which vulnerable site had the highest critical stress and was, therefore, at highest risk of rupture. One hundred patients underwent high resolution carotid magnetic resonance (MR) imaging. We used 352 MR slices with delineated atherosclerotic components for the simulation study. Stresses at all the integral nodes along the lumen surface were calculated using the finite-element method. FCMIN and LCMAX were identified, and critical stresses at these sites were assessed and compared. Critical stress at FC MIN was significantly lower than that at LCMAX (median: 121.55 kPa; inter quartile range (IQR) = [60.70-180.32] kPa vs. 150.80 kPa; IQR = [91.39-235.75] kPa, p < 0.0001). If critical stress at FCMIN was only used, then the stress condition of 238 of 352 MR slices would be underestimated, while if the critical stress at LCMAX only was used, then 112 out of 352 would be underestimated. Stress analysis at FCMIN and LCMAX should be used for a refined mechanical risk assessment of atherosclerotic plaques, since material failure at either site may result in rupture.

Association between biomechanical structural stresses of atherosclerotic carotid plaques and subsequent ischaemic cerebrovascular events - A longitudinal in vivo magnetic resonance imaging-based finite element study

Background: High-resolution magnetic resonance (MR) imaging has been used for MR imaging-based structural stress analysis of atherosclerotic plaques. The biomechanical stress profile of stable plaques has been observed to differ from that of unstable plaques; however, the role that structural stresses play in determining plaque vulnerability remains speculative. Methods: A total of 61 patients with previous history of symptomatic carotid artery disease underwent carotid plaque MR imaging. Plaque components of the index artery such as fibrous tissue, lipid content and plaque haemorrhage (PH) were delineated and used for finite element analysis-based maximum structural stress (M-C Stress) quantification. These patients were followed up for 2 years. The clinical end point was occurrence of an ischaemic cerebrovascular event. The association of the time to the clinical end point with plaque morphology and M-C Stress was analysed. Results: During a median follow-up duration of 514 days, 20% of patients (n=12) experienced an ischaemic event in the territory of the index carotid artery. Cox regression analysis indicated that M-C Stress (hazard ratio (HR): 12.98 (95% confidence interval (CI): 1.32-26.67, pZ0.02), fibrous cap (FC) disruption (HR: 7.39 (95% CI: 1.61e33.82), p Z 0.009) and PH (HR: 5.85 (95% CI: 1.27e26.77), p Z 0.02) are associated with the development of subsequent cerebrovascular events. Plaques associated with future events had higher M-C Stress than those which had remained asymptomatic (median (interquartile range, IQR): 330 kPa (229e494) vs. 254 kPa (166-290), p Z0.04). Conclusions: High biomechanical structural stresses, in addition to FC rupture and PH, are associated with subsequent cerebrovascular events.

Finite element analysis of vulnerable atherosclerotic plaques: A comparison of mechanical stresses within carotid plaques of acute and recently symptomatic patients with carotid artery disease

Objectives: There is considerable evidence that patients with carotid artery stenosis treated immediately after the ischaemic cerebrovascular event have a better clinical outcome than those who have delayed treatment. Biomechanical assessment of carotid plaques using high-resolution MRI can help examine the relationship between the timing of carotid plaque symptomology and maximum simulated plaque stress concentration. Methods: Fifty patients underwent high-resolution multisequence in vivo MRI of their carotid arteries. Patients with acute symptoms (n=25) underwent MRI within 72 h of the onset of ischaemic cerebrovascular symptoms, whereas recently symptomatic patients (n=25) underwent MRI from 2 to 6 weeks after the onset of symptoms. Stress analysis was performed based on the geometry derived from in vivo MRI of the symptomatic carotid artery at the point of maximum stenosis. The peak stresses within the plaques of the two groups were compared. Results: Patient demographics were comparable for both groups. All the patients in the recently symptomatic group had severe carotid stenosis in contrast to patients with acute symptoms who had predominantly mild to moderate carotid stenosis. The simulated maximum stresses in patients with acute symptoms was significantly higher than in recently symptomatic patients (median (IQR): 313310 4 dynes/cm 2 (295 to 382) vs 2523104 dynes/cm 2 (236 to 311), p=0.02). Conclusions: Patients have extremely unstable, high-risk plaques, with high stresses, immediately after an acute cerebrovascular event, even at lower degrees of carotid stenoses. Biomechanical stress analysis may help us refine our risk-stratification criteria for the management of patients with carotid artery disease in future.

Correlation of carotid atheromatous plaque inflammation with biomechanical stress: Utility of USPIO enhanced MR imaging and finite element analysis

Objective: The aim of this study was to explore whether there is a relationship between the degree of MR-defined inflammation using ultra small super-paramagnetic iron oxide (USPIO) particles, and biomechanical stress using finite element analysis (FEA) techniques, in carotid atheromatous plaques. Methods and Results: 18 patients with angiographically proven carotid stenoses underwent multi-sequence MR imaging before and 36 h after USPIO infusion. T2 * weighted images were manually segmented into quadrants and the signal change in each quadrant normalised to adjacent muscle was calculated after USPIO administration. Plaque geometry was obtained from the rest of the multi-sequence dataset and used within a FEA model to predict maximal stress concentration within each slice. Subsequently, a new statistical model was developed to explicitly investigate the form of the relationship between biomechanical stress and signal change. The Spearman's rank correlation coefficient for USPIO enhanced signal change and maximal biomechanical stress was -0.60 (p = 0.009). Conclusions: There is an association between biomechanical stress and USPIO enhanced MR-defined inflammation within carotid atheroma, both known risk factors for plaque vulnerability. This underlines the complex interaction between physiological processes and biomechanical mechanisms in the development of carotid atheroma. However, this is preliminary data that will need validation in a larger cohort of patients.

Identifying vulnerable carotid plaques in vivo using high resolution magnetic resonance imaging-based finite element analysis

Object. Individuals with carotid atherosclerosis develop symptoms following rupture of vulnerable plaques. Biomechanical stresses within this plaque may increase vulnerability to rupture. In this report the authors describe the use of in vivo carotid plaque imaging and computational mechanics to document the magnitude and distribution of intrinsic plaque stresses. Methods. Ten (five symptomatic and five asymptomatic) individuals underwent plaque characterization magnetic resonance (MR) imaging. Plaque geometry and composition were determined by multisequence review. Intrinsic plaque stress profiles were generated from 3D meshes by using finite element computational analysis. Differences in principal (shear) stress between normal and diseased sections of the carotid artery and between symptomatic and asymptomatic plaques were noted. Results. There was a significant difference in peak principal stress between diseased and nondiseased segments of the artery (mean difference 537.65 kPa, p < 0.05). Symptomatic plaques had higher mean stresses than asymptomatic plaques (627.6 kPa compared with 370.2 kPa, p = 0.05), which were independent of luminal stenosis and plaque composition. Conclusions. Significant differences in plaque stress exist between plaques from symptomatic individuals and those from asymptomatic individuals. The MR imaging-based computational analysis may therefore be a useful aid to identification of vulnerable plaques in vivo.

Can we safely deform a plate to fit every bone? Population-based fit assessment and finite element deformation of a distal tibial plate

Anatomically precontoured plates are commonly used to treat periarticular fractures. A well-fitting plate can be used as a tool for anatomical reduction of the fractured bone. Recent studies highlighted that some plates fit poorly for many patients due to considerable shape variations between bones of the same anatomical site. While it is impossible to design one shape that fits all, it is also burdensome for the manufacturers and hospitals to produce, store and manage multiple plate shapes without the certainty of utilization by a patient population. In this study, we investigated the number of shapes required for maximum fit within a given dataset, and if they could be obtained by manually deforming the original plate. A distal medial tibial plate was automatically positioned on 45 individual tibiae, and the optimal deformation was determined iteratively using finite element analysis simulation. Within the studied dataset, we found that: (i) 89% fit could be achieved with four shapes, (ii) 100% fit was impossible through mechanical deformation, and (iii) the deformations required to obtain the four plate shapes were safe for the stainless steel plate for further clinical use. The proposed framework is easily transferable to other orthopaedic plates.

An explicit finite element modelling method for masonry walls under out-of-plane loading

An explicit finite element modelling method is formulated using a layered shell element to examine the behaviour of masonry walls subject to out-of-plane loading. Masonry is modelled as a homogenised material with distinct directional properties that are calibrated from datasets of a “C” shaped wall tested under pressure loading applied to its web. The predictions of the layered shell model have been validated using several out-of-plane experimental datasets reported in the literature. Profound influence of support conditions, aspect ratio, pre-compression and opening to the strength and ductility of masonry walls is exhibited from the sensitivity analyses performed using the model.

Finite element modelling of lamb wave propagation in prestress concrete and effect of the prestress force on the wave’s characteristic

In order to assess the structural reliability of bridges, an accurate and cost effective Non-Destructive Evaluation (NDE) technology is required to ensure their safe and reliable operation. Over 60% of the Australian National Highway System is prestressed concrete (PSC) bridges according to the Bureau of Transport and Communication Economics (1997). Most of the in-service bridges are more than 30 years old and may experience a heavier traffic load than their original intended level. Use of Ultrasonic waves is continuously increasing for (NDE) and Structural Health Monitoring (SHM) in civil, aerospace, electrical, mechanical applications. Ultrasonic Lamb waves are becoming more popular for NDE because it can propagate long distance and reach hidden regions with less energy loses. The purpose of this study is to numerically quantify prestress force (PSF) of (PSC) beam using the fundamental theory of acoustic-elasticity. A three-dimension finite element modelling approach is set up to perform parametric studies in order to better understand how the lamb wave propagation in PSC beam is affected by changing in the PSF level. Results from acoustic-elastic measurement on prestressed beam are presented, showing the feasibility of the lamb wave for PSF evaluation in PSC bridges.

Curriculum frames for two different groups of teachers in Indonesia

This paper reports on a study conducted in Indonesia at a time when two curricular reforms were underway. School-based curriculum was being implemented to allow Indonesian teachers more autonomy to develop curriculum to suit their local school community and its needs. Alongside this, the second concurrent reform introducing Character Education was more strongly prescriptive, requiring all teachers, including those working in language education, to address a particular set of stipulated values across all classes. The Indonesian schooling sector employs teachers at two different levels of professional status: civil servant teachers working in the higher status public sector and non-civil servant teachers who teach in the private Islamic Schools. Each level received different professional learning opportunities to prepare for the reforms. This study is interested in whether and how EFL teachers of different status exercised degrees of professionalism as they recontextualised these reforms in their classes. Nine teachers were interviewed and three of their classes were observed. This study found that the group of teachers with more professional learning could cope better with the weaker framing of school-based curriculum, while teachers with less professional learning reported disengagement with the reforms.

Ductile deformation of single inclusions in simple shear with a finite-strain hyperelastoviscoplastic rheology

We examine the 2D plane-­strain deformation of initially round, matrix-­bonded, deformable single inclusions in isothermal simple shear using a recently introduced hyperelastoviscoplastic rheology. The broad parameter space spanned by the wide range of effective viscosities, yield stresses, relaxation times, and strain rates encountered in the ductile lithosphere is explored systematically for weak and strong inclusions, the effective viscosity of which varies with respect to the matrix. Most inclusion studies to date focused on elastic or purely viscous rheologies. Comparing our results with linear-­viscous inclusions in a linear-­viscous matrix, we observe significantly different shape evolution of weak and strong inclusions over most of the relevant parameter space. The evolution of inclusion inclination relative to the shear plane is more strongly affected by elastic and plastic contributions to rheology in the case of strong inclusions. In addition, we found that strong inclusions deform in the transient viscoelastic stress regime at high Weissenberg numbers (≥0.01) up to bulk shear strains larger than 3. Studies using the shapes of deformed objects for finite-­strain analysis or viscosity-­ratio estimation should establish carefully which rheology and loading conditions reflect material and deformation properties. We suggest that relatively strong, deformable clasts in shear zones retain stored energy up to fairly high shear strains. Hence, purely viscous models of clast deformation may overlook an important contribution to the energy budget, which may drive dissipation processes within and around natural inclusions.