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Computational fluid dynamics modeling in intracranial atherosclerotic disease
Intracranial atherosclerotic disease (ICAD) is an important cause for ischemic stroke and transient ischemic stroke (TIA) throughout the world, especially in Asians, which is not fully appreciated, partly due to its inaccessibility and limitations of current neuroimaging methods. The computational fluid dynamics (CFD) modeling technique provides a novel approach to reveal the hemodynamic characteristics in ICAD, e.g., the distributions of pressure, wall shear stress and flow velocity.In this review article, we aim to provide an overview of the general methodology of CFD modeling in arterial stenotic diseases, the established application of this technique in coronary artery disease, and more importantly,perspectives and challenges of this technique in the investigation of ICAD. Promising findings of preliminary studies using a CFD model for hemodynamic analysis in ICAD warrant verifications. Further studies in this area will help rectify loopholes in the current secondary prevention strategy, and inform individualized treatment for ICAD patients in the near future.
Diabetic neuropathy.
The global epidemic of prediabetes and diabetes has led to a corresponding epidemic of complications of these disorders. The most prevalent complication is neuropathy, of which distal symmetric polyneuropathy (for the purpose of this Primer, referred to as diabetic neuropathy) is very common. Diabetic neuropathy is a loss of sensory function beginning distally in the lower extremities that is also characterized by pain and substantial morbidity. Over time, at least 50% of individuals with diabetes develop diabetic neuropathy. Glucose control effectively halts the progression of diabetic neuropathy in patients with type 1 diabetes mellitus, but the effects are more modest in those with type 2 diabetes mellitus. These findings have led to new efforts to understand the aetiology of diabetic neuropathy, along with new 2017 recommendations on approaches to prevent and treat this disorder that are specific for each type of diabetes. In parallel, new guidelines for the treatment of painful diabetic neuropathy using distinct classes of drugs, with an emphasis on avoiding opioid use, have been issued. Although our understanding of the complexities of diabetic neuropathy has substantially evolved over the past decade, the distinct mechanisms underlying neuropathy in type 1 and type 2 diabetes remains unknown. Future discoveries on disease pathogenesis will be crucial to successfully address all aspects of diabetic neuropathy, from prevention to treatment.
DOLORisk: study protocol for a multi-centre observational study to understand the risk factors and determinants of neuropathic pain
<ns4:p><ns4:bold>Background: </ns4:bold>Neuropathic pain is an increasingly prevalent condition and has a major impact on health and quality of life. However, the risk factors for the development and maintenance of neuropathic pain are poorly understood. Clinical, genetic and psychosocial factors all contribute to chronic pain, but their interactions have not been studied in large cohorts. The DOLORisk study aims to study these factors.</ns4:p><ns4:p> <ns4:bold>Protocol: </ns4:bold>Multicentre cross-sectional and longitudinal cohorts covering the main causes leading to neuropathic pain (e.g. diabetes, surgery, chemotherapy, traumatic injury), as well as rare conditions, follow a common protocol for phenotyping of the participants. This core protocol correlates answers given by the participants on a set of questionnaires with the results of their genetic analyses. A smaller number of participants undergo deeper phenotyping procedures, including neurological examination, nerve conduction studies, threshold tracking, quantitative sensory testing, conditioned pain modulation and electroencephalography.</ns4:p><ns4:p> <ns4:bold>Ethics and dissemination: </ns4:bold>All studies have been approved by their regional ethics committees as required by national law. Results are disseminated through the <ns4:ext-link xmlns:ns3="http://www.w3.org/1999/xlink" ext-link-type="uri" ns3:href="http://dolorisk.eu/">DOLORisk website</ns4:ext-link>, scientific meetings, open-access publications, and in partnership with patient organisations.</ns4:p><ns4:p> <ns4:bold>Strengths and limitations:</ns4:bold> <ns4:list list-type="bullet"><ns4:list-item><ns4:p>Large cohorts covering many possible triggers for neuropathic pain</ns4:p></ns4:list-item><ns4:list-item><ns4:p>Multi-disciplinary approach to study the interaction of clinical, psychosocial and genetic risk factors</ns4:p></ns4:list-item><ns4:list-item><ns4:p>High comparability of the data across centres thanks to harmonised protocols</ns4:p></ns4:list-item><ns4:list-item><ns4:p>One limitation is that the length of the questionnaires might reduce the response rate and quality of responses of participants</ns4:p></ns4:list-item></ns4:list></ns4:p>