MRI-based fatigue analysis predicts plaque vulnerability: A study comparing symptomatic and asymptomatic individuals

BACKGROUND: Rupture of atheromatous plaque in the carotid artery often leads to thrombosis and subsequent stroke. The mechanism of plaque rupture is not entirely clear but is thought to be a multi-factorial process involving thinning and weakening of the fibrous cap and biomechanical stress as the trigger leading to plaque rupture. As the cardiovascular system is a classic fatigue environment, the weakening of plaque leading to rupture may be a fatigue process, which is a symptomatically quiescent but potentially progressive failure process. In this study, we used a fatigue analysis based on in vivo magnetic resonance imaging (MRI) to investigate the rupture initiation location, crack propagation path and fatigue life within plaques of asymptomatic and symptomatic individuals. METHODS: Forty non-consecutive subjects (20 symptomatic and 20 asymptomatic) underwent high-resolution multi-sequence in vivo MRI of the carotid bifurcation. Fatigue analysis was performed based on the plaque geometry derived from in vivo MRI of the carotid artery at the point of maximum stenosis. Paris’ Law in fracture mechanics is adopted to determine the fatigue crack growth rate. Incremental crack propagation was dynamically simulated based on stress distributions. Plaque initiation location, crack propagation path and fatigue cycle of symptomatic and asymptomatic individuals were compared. RESULTS: Cracks were often found to begin at the lumen wall at areas of stress concentration. The preferred rupture direction was radial from the lumen center. The crack initially advanced slowly but accelerated as it developed, depending on plaque morphology. The fatigue cycles of symptomatic plaques were significantly less than those in the asymptomatic group (2.3 ± 0.9 vs 3.1 ± 0.7 (x106); p = 0.003). CONCLUSIONS: The number of cycles to rupture in symptomatic patients was higher than those predicted in asymptomatic patients by fatigue analysis, suggesting the possibility that plaques with a less fatigue life may be more prone to be symptomatic and rupture. If further validated by large-scale longitudinal studies, fatigue analysis based on high resolution in vivo MRI could potentially act as a useful tool for risk assessment of carotid atheroma.

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.

Carotid arterial plaque stress analysis using fluid-structure interactive simulation based on in-vivo magnetic resonance images of four patients

The rupture of atherosclerotic plaques is known to be associated with the stresses that act on or within the arterial wall. The extreme wall tensile stress (WTS) is usually recognized as a primary trigger for the rupture of vulnerable plaque. The present study used the in-vivo high-resolution multi-spectral magnetic resonance imaging (MRI) for carotid arterial plaque morphology reconstruction. Image segmentation of different plaque components was based on the multi-spectral MRI and co-registered with different sequences for the patient. Stress analysis was performed on totally four subjects with different plaque burden by fluid-structure interaction (FSI) simulations. Wall shear stress distributions are highly related to the degree of stenosis, while the level of its magnitude is much lower than the WTS in the fibrous cap. WTS is higher in the luminal wall and lower at the outer wall, with the lowest stress at the lipid region. Local stress concentrations are well confined in the thinner fibrous cap region, and usually locating in the plaque shoulder; the introduction of relative stress variation during a cycle in the fibrous cap can be a potential indicator for plaque fatigue process in the thin fibrous cap. According to stress analysis of the four subjects, a risk assessment in terms of mechanical factors could be made, which may be helpful in clinical practice. However, more subjects with patient specific analysis are desirable for plaque-stability study.

Impact of calcification and intraluminal thrombus on the computed wall stresses of abdominal aortic aneurysm

Background: Increased biomechanical stresses within the abdominal aortic aneurysm (AAA) wall contribute to its rupture. Calcification and intraluminal thrombus can be commonly found in AAAs, but the relationship between calcification/intraluminal thrombus and AAA wall stress is not completely described. Methods: Patient-specific three-dimensional AAA geometries were reconstructed from computed tomographic images of 20 patients. Structural analysis was performed to calculate the wall stresses of the 20 AAA models and their altered models when calcification or intraluminal thrombus was not considered. A nonlinear large-strain finite element method was used to compute the wall stress distribution. The relationships between wall stresses and volumes of calcification and intraluminal thrombus were sought. Results: Maximum stress was not correlated with the percentage of calcification, and was negatively correlated with the percentage of intraluminal thrombus (r = -0.56; P = .011). Exclusion of calcification from analysis led to a significant decrease in maximum stress by a median of 14% (range, 2%-27%; P < .01). When intraluminal thrombus was eliminated, maximum stress increased significantly by a median of 24% (range, 5%-43%; P < .01). Conclusion: The presence of calcification increases AAA peak wall stress, suggesting that calcification decrease the biomechanical stability of AAA. In contrast, intraluminal thrombus reduces the maximum stress in AAA. Calcification and intraluminal thrombus should both be considered in the evaluation of wall stress for risk assessment of AAA rupture.

Structural analysis and magnetic resonance imaging predict plaque vulnerability: A study comparing symptomatic and asymptomatic individuals

Background: More than half of all cerebral ischemic events are the result of rupture of extracranial plaques. The clinical determination of carotid plaque vulnerability is currently based solely on luminal stenosis; however, it has been increasingly suggested that plaque morphology and biomechanical stress should also be considered. We used finite element analysis based on in vivo magnetic resonance imaging (MRI) to simulate the stress distributions within plaques of asymptomatic and symptomatic individuals. Methods: Thirty nonconsecutive subjects (15 symptomatic and 15 asymptomatic) underwent high-resolution multisequence in vivo MRI of the carotid bifurcation. Stress analysis was performed based on the geometry derived from in vivo MRI of the carotid artery at the point of maximal stenosis. The finite element analysis model considered plaque components to be hyperelastic. The peak stresses within the plaques of symptomatic and asymptomatic individuals were compared. Results: High stress concentrations were found at the shoulder regions of symptomatic plaques, and the maximal stresses predicted in this group were significantly higher than those in the asymptomatic group (508.2 ± 193.1 vs 269.6 ± 107.9 kPa; P = .004). Conclusions: Maximal predicted plaque stresses in symptomatic patients were higher than those predicted in asymptomatic patients by finite element analysis, suggesting the possibility that plaques with higher stresses may be more prone to be symptomatic and rupture. If further validated by large-scale longitudinal studies, biomechanical stress analysis based on high resolution in vivo MRI could potentially act as a useful tool for risk assessment of carotid atheroma. It may help in the identification of patients with asymptomatic carotid atheroma at greatest risk of developing symptoms or mild-to-moderate symptomatic stenoses, which currently fall outside current clinical guidelines for intervention.

Children’s personal exposure to air pollution in rural villages in Bhutan

Exposure assessment studies conducted in developing countries have been based on fixed-site monitoring to date. This is a major deficiency, leading to errors in estimating the actual exposures, which are a function of time spent and pollutant concentrations in different microenvironments. This study quantified school children’s daily personal exposure to ultrafine particles (UFP) using real-time monitoring, as well as volatile organic compounds (VOCs) and NO2 using passive sampling in rural Bhutan in order to determine the factors driving the exposures. An activity diary was used to track children’s time activity patterns, and difference in mean exposure levels across sex and indoor/outdoor were investigated with ANOVA. 82 children, attending three primary schools participated in this study; S1 and S2 during the wet season and S3 during the dry season. Mean daily UFP exposure (cm-3) was 1.08 × 104 for children attending S1, 9.81 × 103 for S2, and 4.19 × 104 for S3. The mean daily NO2 exposure (µg m-3) was 4.27 for S1, 3.33 for S2 and 5.38 for S3 children. Likewise, children attending S3 also experienced higher daily exposure to a majority of the VOCs than those attending S1 and S2. Time-series of UFP personal exposures provided detailed information on identifying sources of these particles and quantifying their contributions to the total daily exposures for each microenvironment. The highest UFP exposure resulted from cooking/eating, contributing to 64% of the daily exposure, due to firewood combustion in houses using traditional mud cookstoves. The lowest UFP exposures were during the hours that children spent outdoors at school. The outcomes of this study highlight the significant contributions of lifestyle and socio-economic factors in personal exposures and have applications in environmental risk assessment and household air pollution mitigation in Bhutan.

Stakeholder expectations for environmental assurance in agriculture: Lessons from the pastoral industry

This paper outlines the expectations of a wide range of stakeholders for environmental assurance in the pastoral industries and agriculture generally. Stakeholders consulted were domestic consumers, rangeland graziers, members of environmental groups, companies within meat and wool supply chains, and agricultural industry, environmental and consumer groups. Most stakeholders were in favour of the application of environmental assurance to agriculture, although supply chains and consumers had less enthusiasm for this than environmental and consumer groups. General public good benefits were more important to environmental and consumer groups, while private benefits were more important to consumers and supply chains. The 'ideal' form of environmental assurance appears to be a management system that provides for continuous improvement in environmental, quality and food safety outcomes, combined with elements of ISO 14024 eco-labelling such as life-cycle assessment, environmental performance criteria, third-party certification, labelling and multi-stakeholder involvement. However, market failure prevents this from being implemented and will continue to do so for the foreseeable future. In the short term, members of supply chains (the people that must implement and fund environmental assurance) want this to be kept simple and low cost, to be built into their existing industry standards and to add value to their businesses. As a starting point, several agricultural industry organisations favour the use of a basic management system, combining continuous improvement, risk assessment and industry best management practice programs, which can be built on over time to meet regulator, market and community expectations.

Development of a model based on Bayesian networks to estimate the probability of sheep lice presence at shearing

This paper describes the development of a model, based on Bayesian networks, to estimate the likelihood that sheep flocks are infested with lice at shearing and to assist farm managers or advisers to assess whether or not to apply a lousicide treatment. The risk of lice comes from three main sources: (i) lice may have been present at the previous shearing and not eradicated; (ii) lice may have been introduced with purchased sheep; and (iii) lice may have entered with strays. A Bayesian network is used to assess the probability of each of these events independently and combine them for an overall assessment. Rubbing is a common indicator of lice but there are other causes too. If rubbing has been observed, an additional Bayesian network is used to assess the probability that lice are the cause. The presence or absence of rubbing and its possible cause are combined with these networks to improve the overall risk assessment.

Climate change impacts on northern Australian rangeland livestock carrying capacity: a review of issues

Grazing is a major land use in Australia's rangelands. The 'safe' livestock carrying capacity (LCC) required to maintain resource condition is strongly dependent on climate. We reviewed: the approaches for quantifying LCC; current trends in climate and their effect on components of the grazing system; implications of the 'best estimates' of climate change projections for LCC; the agreement and disagreement between the current trends and projections; and the adequacy of current models of forage production in simulating the impact of climate change. We report the results of a sensitivity study of climate change impacts on forage production across the rangelands, and we discuss the more general issues facing grazing enterprises associated with climate change, such as 'known uncertainties' and adaptation responses (e.g. use of climate risk assessment). We found that the method of quantifying LCC from a combination of estimates (simulations) of long-term (>30 years) forage production and successful grazier experience has been well tested across northern Australian rangelands with different climatic regions. This methodology provides a sound base for the assessment of climate change impacts, even though there are many identified gaps in knowledge. The evaluation of current trends indicated substantial differences in the trends of annual rainfall (and simulated forage production) across Australian rangelands with general increases in most of western Australian rangelands ( including northern regions of the Northern Territory) and decreases in eastern Australian rangelands and south-western Western Australia. Some of the projected changes in rainfall and temperature appear small compared with year-to-year variability. Nevertheless, the impacts on rangeland production systems are expected to be important in terms of required managerial and enterprise adaptations. Some important aspects of climate systems science remain unresolved, and we suggest that a risk-averse approach to rangeland management, based on the 'best estimate' projections, in combination with appropriate responses to short-term (1-5 years) climate variability, would reduce the risk of resource degradation. Climate change projections - including changes in rainfall, temperature, carbon dioxide and other climatic variables - if realised, are likely to affect forage and animal production, and ecosystem functioning. The major known uncertainties in quantifying climate change impacts are: (i) carbon dioxide effects on forage production, quality, nutrient cycling and competition between life forms (e.g. grass, shrubs and trees); and (ii) the future role of woody plants including effects of. re, climatic extremes and management for carbon storage. In a simple example of simulating climate change impacts on forage production, we found that increased temperature (3 degrees C) was likely to result in a decrease in forage production for most rangeland locations (e. g. -21% calculated as an unweighted average across 90 locations). The increase in temperature exacerbated or reduced the effects of a 10% decrease/increase in rainfall respectively (-33% or -9%). Estimates of the beneficial effects of increased CO2 (from 350 to 650 ppm) on forage production and water use efficiency indicated enhanced forage production (+26%). The increase was approximately equivalent to the decline in forage production associated with a 3 degrees C temperature increase. The large magnitude of these opposing effects emphasised the importance of the uncertainties in quantifying the impacts of these components of climate change. We anticipate decreases in LCC given that the 'best estimate' of climate change across the rangelands is for a decline (or little change) in rainfall and an increase in temperature. As a consequence, we suggest that public policy have regard for: the implications for livestock enterprises, regional communities, potential resource damage, animal welfare and human distress. However, the capability to quantify these warnings is yet to be developed and this important task remains as a challenge for rangeland and climate systems science.

Applications of CLIMEX modelling leading to improved biological control

Wilmot Senaratne, Bill Palmer and Bob Sutherst recently published their paper 'Applications of CLIMEX modelling leading to improved biological control' in Proceedings of the 16th Australian Weeds Conference. They looked at three examples where modern climate matching techniques using computer software produces decisions and results than might happen using previous techniques such as climadiagrams. Assessment of climatic suitability is important at various stages of a biological control project; from initial foreign exploration, to risk assessment in preparation for the release of a particular agent, through to selection of release sites that maximise the agent´s chances of initial establishment. It is now also necessary to predict potential future distributions of both target weeds and agents under climate change.

Predicting weediness - what has the CRC achieved?

Dane Panetta and colleagues recently published their paper 'Predicting weediness - what has the CRC achieved?' in Proceedings of the 16th Australian Weeds Conference. They reviewed the research outcomes from the CRC for Australian Weeds Management for predicting weediness of plant species and concluded that advances have been made in identifying traits that distinguish high impact species for a range of environments. However these were not consistent between studies. They considered that Australia's border Weed Risk Assessment System has performed well under considerable local and international scientific scrutiny though minor improvements could still be made.

Towards Ecologically Sustainable Management of the Torres Strait Prawn Fishery. CRC Torres Strait Task T1.5 – Final Report

This publication, which is the final report to the Torres Strait Cooperative Research Centre, provides an overview of all the research that was conducted as part of the Torres Strait CRC Task 1.5 - Towards Ecologically Sustainable Management of the Torres Strait Prawn Fishery The objectives of the task were: To develop cost-effective protocols to monitor and quantify the bycatch and environmental impacts of commercial prawn trawling. To monitor the status of target species using both fishery dependent and fishery independent data. To develop biological reference points for target species and undertake management strategy evaluation, in particular a risk assessment of fishing at various levels of fishing mortality. This report focuses on the second component of objective 1 and details a comparative analysis of bycatch samples collected from areas of the Torres Strait that were both closed and open to prawn trawl fishing. The report also reviews the research conducted in relation to objectives 2 and 3 which are detailed in a separate report, Stock Assessment of the Torres Strait Tiger Prawn Fishery (Penaeus esculentus).

Developing sustainable banana production systems: a case study from tropical Australia

The north Queensland banana industry is under pressure from government and community expectations to exhibit good environmental stewardship. The industry is situated on the high-rainfall north Queensland coast adjacent to 2 natural icons, the Great Barrier Reef to the east and World Heritage-listed rain forest areas to the west. The main environmental concern is agricultural industry pollutants harming the Great Barrier Reef. In addition to environmental issues the banana industry also suffers financial pressure from declining margins and production loss from tropical cyclones. As part of a broader government strategy to reduce land-based pollutants affecting the Great Barrier Reef, the formation of a pilot banana producers group to address these environmental and economic pressures was facilitated. Using an integrated farming systems approach, we worked collaboratively with these producers to conduct an environmental risk assessment of their businesses and then to develop best management practices (BMP) to address environmental concerns. We also sought input from technical experts to provide increased rigour for the environmental risk assessment and BMP development. The producers' commercial experience ensured new ideas for improved sustainable practices were constantly assessed through their profit-driven 'filter' thus ensuring economic sustainability was also considered. Relying heavily on the producers' knowledge and experience meant the agreed sustainable practices were practical, relevant and financially feasible for the average-sized banana business in the region. Expert input and review also ensured that practices were technically sound. The pilot group producers then implemented and adapted selected key practices on their farms. High priority practices addressed by the producers group included optimizing nitrogen fertilizer management to reduce runoff water nitrification, developing practical ground cover management to reduce soil erosion and improving integrated pest management systems to reduce pesticide use. To facilitate wider banana industry understanding and adoption of the BMP's developed by the pilot group, we conducted field days at the farms of the pilot group members. Information generated by the pilot group has had wider application to Australian horticulture and the process has been subsequently used with the north Queensland sugar industry. Our experiences have shown that integrated farming systems methodologies are useful in addressing complex issues like environmental and economic sustainability. We have also found that individual horticulture businesses need on-going technical support for change to more sustainable practices. One-off interventions have little impact, as farm improvement is usually an on-going incremental process. A key lesson from this project has been the need to develop practical, farm scale economic tools to clarify and demonstrate the financial impact of alternative management practices. Demonstrating continued profitability is critical to encourage widespread industry adoption of environmentally sustainable practices

Global banana disease management - getting serious with sustainability and food security

Much research in understanding plant diseases has been undertaken, but there has been insufficient attention given to dealing with coordinated approaches to preventing and managing diseases. A global management approach is essential to the long-term sustainability of banana production. This approach would involve coordinated surveys, capacity building in developing countries, development of disease outbreak contingency plans and coordinated quarantine awareness, including on-line training in impact risk assessment and web-based diagnostic software. Free movement of banana plants and products between some banana-producing countries is causing significant pressure on the ability to manage diseases in banana. The rapid spread of Fusarium oxysporum f. sp. cubense 'tropical race 4' in Asia, bacterial wilts in Africa and Asia and black leaf streak [Mycosphaerella fijiensis] in Brazil and elsewhere are cases in point. The impact of these diseases is devastating, severely cutting family incomes and jeopardising food security around the globe. Agreements urgently need to be reached between governments to halt the movement of banana plants and products between banana-producing countries before it is too late and global food security is irreparably harmed. Black leaf streak, arguably the most serious banana disease, has become extremely difficult to control in commercial plantations in various parts of the world. Sometimes in excess of 50 fungicide sprays have to be applied each year. Disease eradication and effective disease control is not possible because there is no control of disease inoculum in non-commercial plantings in these locations. Additionally, there have been enormous sums of money invested in international banana breeding programmes over many years only to see the value of hybrid products lost too soon. 'Goldfinger' (AAAB, syn. 'FHIA-01'), for example, has recently been observed severely affected by black leaf streak in Samoa. Resistant cultivars alone cannot be relied upon in the fight against this disease. Real progress in control may only come when the local communities are engaged and become actively involved in regional programmes. Global recommendations are long overdue and urgently needed to help ensure the long-term sustainable utilisation of the products of the breeding programmes.

Analysis and Modelling of the Effects of Water Stress on Maize Growth and Yield in Dryland Conditions.

It is essential to provide experimental evidence and reliable predictions of the effects of water stress on crop production in the drier, less predictable environments. A field experiment undertaken in southeast Queensland, Australia with three water regimes (fully irrigated, rainfed and irrigated until late canopy expansion followed by rainfed) was used to compare effects of water stress on crop production in two maize (Zea mays L.) cultivars (Pioneer 34N43 and Pioneer 31H50). Water stress affected growth and yield more in Pioneer 34N43 than in Pioneer 31H50. A crop model APSIM-Maize, after having been calibrated for the two cultivars, was used to simulate maize growth and development under water stress. The predictions on leaf area index (LAI) dynamics, biomass growth and grain yield under rain fed and irrigated followed by rain fed treatments was reasonable, indicating that stress indices used by APSIM-Maize produced appropriate adjustments to crop growth and development in response to water stress. This study shows that Pioneer 31H50 is less sensitive to water stress and thus a preferred cultivar in dryland conditions, and that it is feasible to provide sound predictions and risk assessment for crop production in drier, more variable conditions using the APSIM-Maize model.