Escherichia coli-induced sepsis was used. After sepsis induction, pigs were treated with fluid and vasopressors and monitored for up to 12 h after bacterial infusion or until death. Bipolar electrodes for bioelectrical impedance analysis were attached to the left extremities and measurements were performed every 10 min. Among the 12 subjects, 7 pigs expired during the experiment, and the median survival was 9.5 h. As sepsis progressed with an increase in cumulative fluid balance, R0 [∝ 1/extracellular water (ECW)] decreased, while Ri [∝ 1/intracellular water (ICW)] and ratio of extracellular water to total body water (ECW/TBW) increased. The phase angle constantly decreased throughout the monitoring period, and all non-survivors died when the phase angle decreased by more than 10%. Among the variables, ΔR0 and Δphase angle showed moderate negative correlations, and ΔECW/TBW showed a moderate positive correlation with the hourly fluid balance. Compared to survivors, a greater increase in ΔECW/TBW and a decrease in phase angle were observed in non-survivors over time, with an increase in cumulative fluid balance. Differences in ΔECW/TBW and phase angle emerged at 240 min when the difference in cumulative fluid balance between the two groups (survivors vs non-survivors) exceeded 1000 mL. In conclusion, continuous measurements of bioelectrical impedance analysis in a porcine sepsis model are feasible and may reflect changes in the body water profile during fluid resuscitation.Fluid resuscitation is crucial in the initial management of sepsis; however, little is known about the serial changes and overall distribution of fluids administered into the body. To identify the feasibility of longitudinal bioelectrical impedance analysis during fluid treatment, a preclinical porcine model of The online version contains supplementary material available at 10.1186/s40635-022-00480-5. Fluid resuscitation is crucial in the initial management of sepsis because it helps improve tissue hypoperfusion . HoweverMoreover, little is known about the serial changes and overall distribution of fluids administered into the body . As distBioelectrical impedance analysis (BIA) has recently been proposed as a useful tool for assessing the volume status. It is noninvasive, inexpensive, and can provide objective real-time measurements , 13, 14.Therefore, to verify the feasibility of BIA for continuously monitoring real-time changes in body water distribution during fluid resuscitation in sepsis, a preclinical controlled study was conducted. To implement an ideal experimental sepsis model with fluid treatment, pigs with anatomic, physiologic, and hemodynamic features similar to humans were used –19. ThisAll experiments were approved by the Institutional Animal Care and Use Committee of Seoul National University Bundang Hospital (protocol no. BA-2104-317-029–03), and animals were maintained in the facility accredited by AAALAC International (#001847) in accordance with the Guide for the Care and Use of Laboratory Animals.2O; fraction of inspired oxygen, 0.21; respiratory rate, 12–15/min. The components were regulated to maintain an arterial PaO2 ≥ 65 mmHg and a PCO2 of 40–45 mmHg, as measured by arterial blood gas analysis.Twelve male three-way crossbred  pigs  were used as study subjects. Prior to the experiment, the pigs were housed in a controlled animal facility with adequate access to food and water. Anesthesia was induced by intramuscular injection of zolazepam/tiletamine  and xylazine . After anesthesia administration, the bilateral neck and inguinal areas were shaved, followed by scrubbing with a povidone-iodine soap. To monitor vital signs, a pulse oximeter, 3-lead electrocardiography monitor, and rectal thermometer were used . The pigs were intubated using a 7-Fr endotracheal tube connected to a mechanical ventilator . General anesthesia was maintained via inhalation of 2–3% sevoflurane . Volume-controlled ventilation was initially applied with the following settings: tidal volume, 6 mL/kg; positive end-expiratory pressure, 5 cmHAfter thorough preoperative dressing with povidone-iodine, surgical draping was performed on the abdomen, from both axillae to the inguinal region. Under ultrasonographic guidance, 6-Fr arterial catheters  were placed in both the femoral arteries. Each catheter was used for repetitive blood sampling and for continuous invasive blood pressure monitoring. A Swan–Ganz catheter  was inserted into the right external jugular vein for monitoring blood temperature, cardiac output, and pulmonary capillary wedge pressure (PCWP). A central venous catheter  was inserted into the left external jugular vein and was used for fluid and vasopressor administration. A Foley’s catheter was placed via suprapubic cystostomy to measure the precise urine output.R), reactance (Xc), and phase angle (θ), using three different frequencies . Briefly, when an electrical current is transmitted through the body, tissues exhibit various degrees of resistance (R) which is the opposition to the flow of electrical current. Reactance (Xc) is the opposition to a current change due to the capacitance of the human body composition. Impedance (Z) is the vector analysis of resistance (R) and reactance (Xc). During the passage of electrical current through the cell membrane, reactance (Xc) causes a time delay, creating a phase shift between voltage and current that extracts the phase angle (θ). The detailed explanation of variables is presented elsewhere  at each time point was calculated as follows:analysis . The resR0 (Ω), ΔRinf (Ω), ΔRi (Ω), ΔECW/TBW, and Δphase angle (°)], the variables 1 h before were subtracted from the variable at the point. In the comparison between survivor and non-survivor analyses, ΔECW/TBW was calculated by subtracting the variables at the baseline from the variables at the point.To identify the correlation between the hourly fluid balance and change in variables [ΔEscherichia coli . After preparing the pigs as previously described, the diluent of ESBL-producing E. coli in 1000 mL of normal saline was administered intravenously over 1 h. To generate the survivor and non-survivor groups before the end of the experiment (12 h) based on our previous modeling experience [To induce sepsis in pigs, we used extended-spectrum β-lactamase (ESBL)-producing perience , 23, cefPigs were monitored for up to 12 h after bacterial infusion or until death. The maximal support described below was provided to maintain a mean arterial pressure (MAP) > 65 mmHg. The maintenance fluid  was administered at a rate of 2 mL/kg/h. When the MAP dropped below 65 mmHg, fluid challenge of 30 mL/kg was performed with Plasma Solution A, and when it was insufficient, vasopressors were added in the order of norepinephrine, vasopressin, and epinephrine. Additional intermittent fluid loading was attempted based on the response of MAP and increase in vasopressor dose was preferred over fluid loading when the response was unidentified.The following variables were continuously monitored and recorded every 30 min: invasive arterial blood pressure, heart rate (HR), rectal and blood temperature, lead II electrocardiographic variables, pulse oximetry variables, pulmonary arterial pressure (PAP), central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), fluid input, and urine output.−5) = (MAP − CVP) Cardiac output (CO) was measured three times every 1 h using the thermodilution technique via the Swan–Ganz catheter  and the median values are presented. Stroke volume (SV) was calculated with cardiac output and heart rate (SV = CO/HR). Systemic vascular resistance (SVR) was calculated with MAP, CVP, and cardiac output .Variables are described as the mean and standard error of the mean. Pearson’s correlation analysis was performed to measure the association between variables. Two-way analysis of variance (ANOVA) for repeated measures with Sidak’s multiple comparisons test (two-way repeated measures ANOVA) was performed to compare the trends in variables between the two groups. E. coli infusion or until death. Seven animals died during the experiment, resulting in a mortality rate of 58.3% and median survival time of 9.5 h  decreased, and correspondingly, the resistance Ri (∝ 1/ICW) increased , ECW/TBW (ΔECW/TBW), and phase angle (Δphase angle) at each hour were measured to evaluate the correlation with the hourly fluid balance. While ΔRi  showed no significant relationship, ΔR0  and ΔRinf  showed moderate and mild negative correlations, respectively, with fluid balance  and Δphase angle  showed moderate positive and negative correlations with hourly fluid balance, respectively , which resulted in significant differences at 6 and 6.5 h . ΔECW/TBW increased in both groups, and the trend of ΔECW/TBW was significantly different between survivors and non-survivors, with a greater increase in non-survivors . The phase angle decreased in both groups, and the trend of the phase angle was significantly different between survivors and non-survivors, with a greater decrease in non-survivors . The time period in which the distinction became evident in ΔECW/TBW and phase angle was 240 min when the difference in the cumulative fluid balance between the two groups started exceeding 1000 mL  and Ri (∝ 1/ICW) measured by BIA decreased and increased, respectively. The ratio ECW/TBW exhibited an increasing pattern during the experiment and a positive correlation with the fluid balance. ΔR0 showed a moderate negative correlation with fluid balance, indicating that an increase in fluid balance, including ECW, could be assessed with alteration in R0. These findings were consistent with the alleged pathophysiology of sepsis involving intracellular dehydration with an increase in extracellular water [In this study, we identified that the trend of body water status, including its distribution, can be assessed using BIA. As our experimental sepsis model progressed with a positive cumulative fluid balance derived from intentional fluid therapy, resistances ar water . In addiE. coli (5.0 × 109 CFU) should be administered into the blood in a relatively short period for sepsis modeling, infusion of a large volume (1000 mL) of diluent fluid was practically unavoidable. Two hours after bacterial infusion, SV and CO progressively decreased with increase of HR and SVR until the end of the experiment while the MAP was maintained around 65 mmHg. In addition to vasodilation, ventricular dysfunction is also presumed in this stage which decreased contractility during systole  and abnormal cardiac filling  during diastole is induced by endotoxin, cytokines, and nitric oxide [During an hour of bacterial infusion (Pre ~ 0), MAP, SV, and CO increased due to increased venous return and preload attributed from the administration of 1000 mL fluid of bacteria diluent. An hour after bacterial infusion (0 ~ 1 h), MAP and SVR decreased while SV increased, suggesting reduced preload and afterload. This might have derived from leftwards movement on the Frank–Starling curve from the overloaded preload status which was induced by the previous infusion of bacteria-diluent fluid. In addition, vasodilation presumed from decreased afterload may have developed during this period due to the endothelial dysfunction including dysregulation of vasoactive molecules  and thereby relaxation of smooth muscle. However, since a massive amount of ic oxide –27. AlthIn the comparative analysis of survivors and non-survivors, SV decreased in the non-survivor group who received higher volume of fluid, suggesting that venous return might be reduced despite hypervolemia. Capillary leakage of intravascular volume including the fluid administered due to increased vascular permeability during the experiment is suspected , 29. Add0 was inversely correlated with fluid balance, which was less than 2 L. In a previous clinical study, an increasing trend in ECW/TBW among non-survivors of sepsis during initial fluid resuscitation was identified [BIA has a strong advantage in that it can be measured in real-time with less time consumption, is noninvasive, and does not require a specific clinical setting such as sedation or mechanical ventilation , 31. Owientified . Howeverentified , 15, 34.The phase angle, considered an indicator of cell membrane integrity, was also evaluated in this study. In previous studies, the phase angle was found to be lower in non-survivors of sepsis or intensive care surgery than in survivors , 35. ConR0, Rinf, Ri, and ECW/TBW variables were continuously measured, providing the scope of understanding how the above variables change from a healthy baseline status to the progression of sepsis, and further to the treatment phase. In addition, most clinical studies regarding BIA confront individual variability issues acquired from values influenced by sex, age, and height [In our experimental sepsis study, d height , 38. Thed height , 36. Basd height  includinE. coli) were used. Therefore, extrapolation to female pigs or humans with other pathogens should be approached with caution when interpreting these results. Third, the absolute values of ECW, ICW, and TBW were not provided in this study. Because the equations used to calculate body water compartments are validated in healthy, euvolemic human adults, these equations cannot be applied to porcine subjects. Therefore, to evaluate the trend of body water distribution change, the ratio of body water compartments rather than absolute values, is presented. Fourth, only one type of BIA equipment was used (InBody M20). The measured and calculated values may differ if other bioimpedance equipment are used. Fifth, although the experiments were aimed at MAP > 65 mmHg, massive hydration resulting in fluid balance > 5000 mL is far from the usual clinical setting. Further clinical studies are needed to validate the feasibility of BIA in assessing body water distribution during fluid resuscitation in patients with sepsis.This study had several limitations. First, MAP was used as a control variable for fluid administration and vasopressor due to the practical limitation of incessant preload responsiveness test and unfeasibility of passive leg raising in progressive septic shock model , 40. How0, ΔECW/TBW, and Δphase angle further emphasize the result. This suggests the potential of BIA to measure fluid balance in real-time and provide body water status to clinicians during fluid therapy in patients with sepsis. Additional studies including clinical trials should be performed to suggest criteria for discontinuing fluid administration or increasing the vasopressor dose instead of fluid treatment.In conclusion, we demonstrated the feasibility of BIA during fluid treatment for sepsis. Among the variables, the trend of ECW/TBW increased and the phase angle decreased during the fluid treatment, which was accentuated in non-survivors with increasing cumulative fluid balance. The correlations between the hourly fluid balance and ΔRAdditional file 1: Figure S1. Trends of P/F ratio, urine output, creatinine, platelet, total bilirubin and albumin levels of 12 pigs in the ESBL-producing E. coli-induced porcine bacteremia model. Data are presented as the means and standard error of the mean. P/F ratio: ratio of partial pressure of oxygen to the fraction of inspired oxygen.


A phyllodes tumour of the vulva is a rare, well-illustrated benign neoplasm having characteristic histo-morphological features similar to a phyllodes tumour of the breast. We report a case of a primary benign phyllodes tumour in a 28-year-old female patient. She was seen in an outpatient clinic presenting with a slow-growing, non-painful lesion on her vulva. Examination revealed a 2 cm cyst located on the labia minora. Complete excision of the cyst was achieved, and pathological examination revealed a benign phyllodes tumour of the vulva. Hallmarks of this rare pathology are classically a leaf-like architectural configuration and fronds projecting into the cystic spaces on a low-power magnification. To date, a grading or classification of these vulva tumours has not been established due to their rarity. There have been very few reported cases of phyllodes tumours occurring on the vulva and fewer still affecting the labia minora. Continued surveillance for recurrence should be adopted. Phyllodes tumours (PTs) of the vulva are exceedingly rare tumours that are mostly benign. There have only been 18 cases reported so far in the literature -5. PTs aA 28-year-old woman with no significant past medical history was referred for an evaluation of a non-infected, non-painful vulval lump that has been steadily growing over the years. On examination, there was a left labial cyst, which was 2x2 cm, located on the labia minora. It was mobile, non-tender and not adhered to other underlying structures. There was no evidence of inguinal lymphadenopathy. Complete excision of the cyst was performed.Macroscopic examination revealed a 2 cm partly cystic greyish-white lesion. Areas of haemorrhage and necrosis were absent. The examination revealed classic leaf-like projections into cystic spaces Figure , frond gPhyllodes tumours of the vulva are uncommon benign tumours. They have a similar histomorphologic biphasic, leaf-like configuration pattern to its counterpart in the breast. They were first reported by Hartung et al. in 1872, who were the first to report mammary-like glands in the vulva [Phyllodes of the vulva usually present as a solitary unilateral, well-circumscribed and painless mass. The labia majora, minora and interlabial cleft are the most frequent sites of presentation. Other less frequent sites include the mons pubis, periclitoral and para median area of the perineum and around the anus ,9. ThereThere is a wide variation in the age group, ranging from 17-69 years and commonly manifests in the third to fourth decade of life in women. The tumour size varies from <1 cm up to 6.6 cm with a variable growth rate. In our case report, the tumour was first noticed two years ago and had been slowly growing up to a size of 2 cm. Macroscopically, PTs are usually dirty-white, homogenous, well-delineated lesions with cystic or solid-cut surfaces. Microscopically, frond-like papillary projections or a polypoid appearance with a pushing margin are also characteristic features .There are two theories that evolve around the pathogenesis of phyllodes of the vulva. The first theory stated these lesions originated from the presence of ectopic breast tissue representing caudal remnants of the milk line ridges . HoweverThe differential diagnosis of phyllodes tumour of the vulva includes other biphasic tumours such as fibroadenoma, chondroid syringomas, papillary hidradenomas, and Mullerian adenosarcoma of the cervix that has metastasised in the vulva may have similar leaf-like architecture and biphasic pattern with increased mitotic activity, greater stromal cellularity, and increased periglandular stromal condensation ,15. ChonImmunohistochemistry is also useful and aids in differential diagnosis. Secretory epithelial cells are positively stained with oestrogen and progesterone and the myoepithelial cells are stained with p63, SMA and S100 . The strWe report an exceedingly rare benign phyllodes tumour of the vulva. They usually present as painless, slow-growing and unilateral masses. Due to rarity and paucity in the literature, a histopathological grading has not been established. Local recurrence is a possibility if there is an incomplete excision of the tumour. Follow-up is warranted in all patients with this tumour as the prognosis is unclear.


The two-dose varicella-zoster virus (VZV) immunization schedule significantly decreased VZV infections in the US. Yet, among pediatric solid organ transplant recipients (SOT), the characterization of pre-transplant VZV immunity, VZV exposure with progression to disease, and disease outcomes remain poorly described.We performed a retrospective analysis of patients < 18 years old who received a SOT between Jan 1, 2011 - Dec 31, 2021, at the UPMC Children's Hospital of Pittsburgh, a quaternary, multi-organ pediatric care center. Inpatient, outpatient, and telephone encounters were reviewed as documented in the patients’ electronic health records (EHRs) via automated and manual data extraction.674 patients underwent 832 SOT procedures; 370 children met the inclusion criteria. 287 patients had documentation of their VZV pre-transplant vaccine status and no contraindication for vaccination; 59% had unknown, negative, or indeterminate pre-transplant VZV IgG. While 257 children received at least 1 VZV dose before SOT, another dose was administered for only 41% of those with negative or indeterminate serology in the pre-transplant period. 35 children did not have a documented VZV pre-transplant immunization status; 63% had unknown or negative VZV IgG and were eligible for vaccination by age and immunocompetence. 33 patients had VZV exposures; 2 children developed VZV disease - neither had received post-exposure prophylaxis (PEP). 5 patients were prescribed an antiviral as PEP, 2 received IVIG incidentally, and none received VZV immunoglobulin. In total, there were 4 primary VZV and 4 herpes zoster (HZ) medically attended cases among 8 patients. All 8 received antiviral treatment; 3 in the inpatient setting and 5 exclusively outpatient. All cases were limited to cutaneous lesions without dissemination. None of the patients who developed primary VZV had conclusive evidence of protective VZV IgG pre-transplant. Post-herpetic neuralgia complicated 1 HZ case.VZV exposure and disease still occur, albeit at low levels and with mild manifestations, among pediatric SOT recipients in the two-dose VZV vaccine era. Optimization of VZV immunity in the pre-transplant period and preventing progression to disease after exposure to VZV remain goals of care.Michael D. Green, MD, MPH, ADMA: Advisor/Consultant|Allovir: Advisor/Consultant|Bristol Myers Squibb: Advisor/Consultant|ITB-MED: Advisor/Consultant Judith M. Martin, MD, Merck, Sharp and Dhome: Grant/Research Support Marian G. Michaels, MD, MPH, Merck: Grant/Research Support|Viracor: Grant/Research Support


As mortality of invasive mould infections (IMI) remains high, there is a need for improved biomarkers for timely diagnosis and patient stratification. Various moulds have been shown to induce T-helper cell (Th) 1, Th2, Th9 and Th17 subsets resulting not in potent anti-Aspergillus T-cells effector mechanisms, and in elevated serum levels of cytokines such as IFN-γ and IL-6, IL-8, IL-15 and IL-17. The ECMM study “Immunologic Markers for Treatment Monitoring and Diagnosis in Invasive Mold Infection” aimed to identify circulating immunological markers that could be useful for an early diagnosis of IMI.We collected longitudinal serum samples from 33 cases with probable/proven IMI and two matched control cohorts without IMI, and from an independent validation cohort with 20 cases and 20 matched controls . None of the patients received mold active prophylaxis. A panel of 92 circulating proteins involved in inflammation was measured using a targeted proteomics platform ) and protein concentrations were compared. Correction for multiple testing was performed by Benjamini-Hochberg method.Figure 1Overview of sample collectionTable 1An overview of the main characteristics of and differences between the derivation cohort and the validation cohort, including characteristics of all cases and all controls.Abundance analysis on the day of diagnosis revealed 30 differentially regulated proteins. Nine were replicated in an independent cohort: MMP-10, IL-18, IL-18-R1, IL10, CDCP1 and IL-17C. In the analysis of serum samples collected more than 10 days before diagnosis, six proteins showed higher concentrations in the cases compared to the controls , while nine proteins had lower concentrations . The higher IL-17C concentration could be replicated in the independent validation cohort . When comparing cases only to infected controls this difference in expression was not significant anymore after correcting for multiple testing.Figure 2Figure 3We found a consistent higher expression of IL-17C in cases with IMI versus non-infected controls, both at the time of diagnosis and in samples 10 days before the diagnosis of IMI. IL-17C, known for its pro-inflammatory function at the epithelial sites, activates expression of other proinflammatory cytokines and of chemokines such as CXCL1/2/3 and CCL20, and could present an early biomarker for IMI.Abundance analysis of the primary cohort (a) at time of diagnosis, and (b) at more than 10 days before diagnosis, comparing cases with non infected controls.Abundance analysis of the validation cohort (a) at time of diagnosis, and (b) at more than 10 days before diagnosis, comparing cases with non infected controls.Table 2-1Table 2Clinical and microbiological information of the 33 cases included in the primary cohort and the 20 cases included in the validation cohort PART 1.Martin Hoenigl, n/a, Astellas: Grant/Research Support|Euroimmun: Grant/Research Support|F2G: Grant/Research Support|Gilead: Grant/Research Support|Immy: Grant/Research Support|MSD: Grant/Research Support|Mundipharma: Grant/Research Support|Pfizer: Grant/Research Support|Pulmocide: Grant/Research Support|Scynexis: Grant/Research Support


Fifteen days after application with 56 mg kg−1, the terminal residues of fenpyroximate in whole fruits and citrus flesh were <0.010–0.18 mg kg−1 and <0.010–0.063 mg kg−1, respectively; the corresponding values for total fenpyroximate (the sum of fenpyroximate and Z-fenpyroximate) were <0.020–0.19 and <0.020–0.053 mg kg−1. The levels of terminal fenpyroximate residues in citrus fruit were less than the maximum residue limits (MRLs) specified in all the existing international standards. In addition, the risk quotients RQc and RQa were both less than 100%, indicating that the long-term and short-term dietary intake risks posed to Chinese consumers by fenpyroximate in citrus fruit are both acceptable after a 15-day harvest interval.Fenpyroximate is an efficient, broad-spectrum phenoxypyrazole acaricide which is used for controlling various mites. In this study, we measured the levels of terminal fenpyroximate residues in citrus fruits, and estimated the dietary intake risks posed by fenpyroximate. To this end, a QuEChERS analytical method was used in combination with ultra-high-performance liquid chromatography–tandem mass spectrometry (UHPLC-MS/MS) to determine the residual levels of fenpyroximate and its Z-isomer (Z-fenpyroximate) in citrus fruits collected from 12 fields under good agricultural practices (GAPs). The average recoveries of fenpyroximate in whole fruits and citrus flesh were 104–110% and 92–109%, respectively, with corresponding RSDs of 1–4% and 1–3%. The average recoveries of Z-fenpyroximate were 104–113% and 90–91%, respectively, with RSDs of 1–2% in both cases. Each limit of quantification (LOQ) was 0.01 mg kg Citrus belongs to the citrus subfamily of the rutaceae family. Citrus fruits are low in protein and fat but rich in nutrients such as vitamins, dietary fiber, flavonoids, minerals, and carotenoids; they provide good health benefits to the human body ,2. GlobaFenpyroximate , as well as high-performance liquid chromatography (HPLC) and ultra-high-performance liquid chromatography–tandem mass spectrometry (UHPLC-MS/MS), have all been used to analyze the fenpyroximate in fruit juice, apple, tea, ginger, cucumber, green cabbage, orange, guava, eggplant, herbal medicines, and kiwi fruit ,13,14,15In the 2013 evaluation report of the FAO/WHO Joint Meeting on Pesticide Residues (JMPR), fenpyroximate was defined as fenpyroximate (E-fenpyroximate) for the risk assessment . HoweverThe objectives of the present study were as follows: (1) To establish a simple and accurate method of QuEChERS combined with UHPLC–MS/MS to measure fenpyroximate and its Z-isomer in citrus; (2) to study the terminal residues of fenpyroximate and its Z-isomer in citrus fruit grown in fields under GAPs; and (3) to carry out a dietary risk assessment based on the residue data obtained from supervised trials and the dietary consumption of Chinese residents. In summary, we sought in this work to evaluate the potential health risk posed to Chinese residents by fenpyroximate ingested from citrus, and also provide a proposal for the safe and rational use of this pesticide in citrus fruit cultivation.−1 was set. Using a single-pesticide standard solution for full scanning, the retention times of fenpyroximate and its Z-isomer were determined to be 2.71 and 2.28, respectively, under the mass spectrometry conditions  in the MRM mode. By means of primary mass spectrometry scanning, the value of the parent ion was determined to be 422.2, and the value of the declustering potential (DP) was optimized so that strongest signal occurred at 90 V. The values of the pieces were determined to be 366.1 and 135.0 using product ion scanning. The collision energy (CE) of the mass spectrometry was optimized to maximize the response of product ions at 23 V and 43 V, respectively. In order to separate the fenpyroximate and Z-fenpyroximate as much as possible, a slow flow rate of 0.2 mL minnditions ; then, aIn order to analyze the experimental samples accurately, the main parameter indicators of the analysis methods for the two pesticides in whole fruits and citrus flesh were validated and evaluated; these parameters included linearity, matrix effect, accuracy, precision, and sensitivity.2), and the LOQ. As can be seen in −1, and the linear correlation coefficients (R2) were greater than 0.99. The LOQ was identified as the minimum concentration for analyzing the actual samples that could be determined with acceptable precision and accuracy under the stated conditions; this was found to be 0.01 mg kg−1 for both compounds in samples of whole fruit and citrus flesh.Fenpyroximate and its Z-isomer in two matrixes were verified using linearity, the correlation coefficient  for each of the two tested compounds in both whole fruit and citrus flesh. The results are shown in Matrix effects (MEs) should be avoided as much as possible when using UHPLC–MS/MS for residue determination . It can −1). The terminal residues of the samples were collected at 15 and 25 days after application, and the total residues of fenpyroximate were calculated. The results are shown in For the terminal residue experiment, fenpyroximate was applied once to citrus from all twelve fields at the registered high dosage  of fenpyroximate in citrus fruits determined by the CAC [−1, respectively. In addition, China [−1, respectively. In this study, the terminal residues in citrus were found to be below all the above-mentioned limit values.In the samples of whole fruit and citrus flesh, the residual amounts of fenpyroximate were found to be <0.010–0.18 and <0.010–0.063 mg kg the CAC  are 0.6,n, China , the Eurn, China , and Soun, China  have estThroughout the experiment, in both whole fruit and citrus flesh, the residual concentrations of fenpyroximate, Z-fenpyroximate, as well as total residues all exhibited a decreasing trend with increases in the harvest interval. In a small number of cases, the residue concentrations after long intervals were slightly higher than the corresponding short-interval values; however, this may have been the result of uneven sampling, quartering, or scaling during sample preparation so that the experimental results were not affected. The residual concentrations of fenpyroximate in citrus flesh were lower than those in entire fruits because droplets of pesticides wholly adhered to the surface of the citrus peel after application. The total residues of fenpyroximate in whole fruit and citrus flesh were all derived from fenpyroximate because the chemical configuration of fenpyroximate in plants gives it an advantage compared to Z-fenpyroximate .−1 in citrus flesh collected at 15-day intervals was used in the present study to represent the fruit classification. The average weight of Chinese adults (bw) is 63 kg, and the allowable daily intake (ADI) of fenpyroximate is 0.01 mg kg−1 bw [−4 mg kg−1 bw. The value of RQc was 3.98%, which was considerably less than 100%, indicating that, after a 15-day harvest interval, the long-term dietary intake risk of fenpyroximate in citrus was very low, and acceptable for Chinese consumers.The long-term dietary risk assessment was based on data from monitoring surveys on the nutritional and health status of Chinese residents; these were combined with STMR or MRL so that a national estimated daily intake (NEDI) could be determined. This was used to evaluate the dietary intake risk posed by edible parts of foods such as citrus flesh. At present, based on the data from the Chinese pesticide information network, the crops which are registered for fenpyroximate in China include maize, citrus, apple, and lycium . In line kg−1 bw . Table 5e) of a citrus is 0.124 kg, with a variation factor (υ) of three. The average weight of children aged 1–6 years in China is 16.1 kg; the average weight of the general population is 63 kg. In this experiment, the highest residue (HR) of fenpyroximate in citrus was found to be 0.053 mg kg−1. The acute reference dose (ARfD) is 0.01 mg kg−1 bw [−1 bw and 0.00106 mg kg−1 bw, respectively. The RQa values were 27.5% for children and 10.6% for the general population. Both these values were well below 100%, indicating an acceptable level of dietary intake risk posed by fenpyroximate in citrus, both to children aged 1–6 and to the general population in China.The short-term dietary risk posed by fenpyroximate after the intake of citrus was assessed for two different groups . According to data from the World Health Organization , the lar kg−1 bw . The sho−1) were provided by Dr. Ehrenstorfer . The 28% suspension concentrate (SC) of fenpyroximate was supplied by Shanxi Huarongkaiwei Biotech Co., Ltd. . Formic acid and chromatographic-grade methanol were purchased from Merck AG  and Thermo Fisher Scientific Co., Ltd. , respectively. Acetonitrile and HPLC-grade ammonium acetate were purchased from Tiandi Co., Ltd.  and the Tianjin Guangfu Fine Chemical Research Institute , respectively. Analytical-grade sodium chloride was purchased from Sinopharm Chemical Reagent Co., Ltd. . Purification tubes of 2 mL capacity  were purchased from Shimadzu Jier Trading Co., Ltd. .The fenpyroximate standard  and Z-fenpyroximate standard  , the ter−1 fenpyroximate SC (a registered high dosage in citrus) was applied once to the citrus. Terminal residue samples of the whole fruit and citrus flesh were collected 15 d and 25 d after application. Two independent samples were collected, each involving at least 12 fruits randomly chosen from different places on the tree. Samples were cut into pieces of less than 1 cm2 and then mixed and divided into pieces of 150 g weight by means of quartering. All samples were stored at −20 °C in preparation for testing.In order to measure the levels of terminal and dissipation residue of fenpyroximate and its Z-isomer, a dosage of 56 mg kg−1 for 3 min. A 1.5 mL amount of supernatant 1.5 mL was sucked out and transferred to a 2 mL centrifuge tube filled with 150 mg anhydrous MgSO4, 50 mg PSA, and 5 mg GCB. The tubes were vortexed at 2500 rpm for 5 min and centrifuged at 5000 rpm for 2 min. Finally, the purified liquid was filtered through a 0.22 µm membrane filter for analysis via UHPLC-MS/MS.A QuEChERS-based method  was used® BEH 1.7 µm C18 100 A . The temperatures of the column and sample plate were 30 °C and 20 °C, respectively. The mobile phase was composed of 90% aqueous phase (4 mmol L−1 ammonium acetate aqueous solution with 0.1% formic acid) and 10% organic phase (pure methanol), flowing at 0.2 mL min−1. The injection volume was 2 µL.Chromatographic conditions: UHPLC–MS/MS analyses of fenpyroximate and its Z-isomer were carried out using SCIEX Triple Quad 4500 . The chromatographic column was ACQUITY UPLCMass spectrum conditions: The mass spectrum was scanned at positive ionization mode (ESI+) in MRM mode. The ionization voltage was 5500 V, the ion source temperature was 550 °C, and the collision gas was nitrogen. The other mass-spectrometry parameters for fenpyroximate and its Z-isomer are shown in −1. A calibration curve was then drawn with the mass concentration as the X-axis and the corresponding peak area as the Y-axis; the linear correlation coefficient R2 was expected to be more than 0.99.The analytical methods used for fenpyroximate and Z-fenpyroximate in whole fruit and citrus flesh were verified with respect to linearity, matrix effect (ME), accuracy, precision, and sensitivity, in conformity with SANTE/11312/2021 . The mix−1) were added to blank matrixes of whole fruit and citrus flesh, so that the recovery and relative standard deviation (RSD) values could be calculated for the target compounds, enabling the accuracy and precision of the method to be evaluated. In order to cover the maximum detected concentration among the testing samples, we added a concentration of 0.5 mg kg−1 to the whole fruit matrix. Five repeated tests were carried out for each level. The recovery rate of the method was found to be 70–120%, and the RSD was less than 20%, which was considered a satisfactory degree of accuracy. Usually, the lowest spiked level was set as the limit of quantification (LOQ) to evaluate the sensitivity of the method.Three levels of mixed standard solutions , expressed as fenpyroximate and calculated directly using addition .c) was used to represent the long-term dietary intake risk, and the calculation formulas were as follows [−1 bw) refers to the national estimated daily intake; STMRi (mg kg−1) is the median residue of total fenpyroximate (the sum of fenpyroximate and Z-fenpyroximate) in citrus flesh collected from field trials; Fi (kg d−1) is the per capita daily consumption of citrus in China; bw (kg) is the average weight of Chinese adults; ADI (mg kg−1 bw) is the allowable daily intake of fenpyroximate taken as determined by the Joint FAO/WHO Meeting of Pesticide Residues (JMPR) [c ≤ 100% indicates that the level of risk is acceptable to consumers, whereas RQc > 100% indicates a level which is unacceptable.The method for assessing long-term dietary intake risk was recommended by the review committee of the National Pesticide Residue Standards. The risk quotient (RQ follows :NEDI = (s (JMPR) . A resul−1 bw) refers to the national estimated short-term intake; HR (mg kg−1) is the highest total of fenpyroximate residue in citrus flesh collected from field trials; Ue (kg) is the weight of a single orange; υ is a variation factor; LP (kg) represents a large portion of dietary consumption; Bw (kg) is the average weight of the consumer population; and ARfD (mg kg−1 bw) is the acute reference dose taken from JMPR [a. When RQa ≤ 100%, short-term dietary risk is at an acceptable level; when RQa > 100%, the level of risk is not acceptable.Assessment of short-term dietary intake risk was calculated in line with case 2a of the JMPR-recommended method using the following formulas :NESTI = rom JMPR ,12. The −1, respectively, which were lower than the Chinese MRL values. The terminal residues of fenpyroximate (the sum of fenpyroximate and Z-fenpyroximate) in whole-fruit and flesh citrus were <0.020–0.19 and <0.020–0.053 mg kg−1, respectively, and RQc and RQa were 3.98% and 10.6–27.5%, respectively, i.e., less than 100%, indicating that the levels of long-term and short-term dietary-intake risk posed to Chinese consumers by fenpyroximate in citrus were acceptable, given a 15-day harvest interval after application at 56 mg kg−1. In conclusion, this study provides a scientific basis for the safe use of fenpyroximate in citrus as well as basic data for revising the MRL values.In this study, a qualitative and quantitative method of analysis was established to detect fenpyroximate and its Z-isomer in whole-fruit and flesh citrus. This method was found to be simple, time-saving, effective in purification, sensitive, and accurate. This method is characterized by an excellent linear relationship, with levels of accuracy and precision which meet the requirements for detection and analysis of pesticide residues. Using this method, we obtained a short-term separation of fenpyroximate and its Z-isomer, and the effect of the separation was good. The terminal residues of fenpyroximate in whole-fruit and flesh citrus collected from twelve fields were <0.010–0.18 and <0.010–0.063 mg kg


Funding statement. One of the National Natural Science Foundation Grant Nos was displayed as “42021002.” The correct Grant No should be “42150102.” The correct Funding statement appears below.In the published article, there was an error in the “This work is supported by the National Natural Science Foundation of China (Grant Nos 42150102 and 41903017), the Strategic Priority Research Program (B) of the Chinese Academy of Sciences (Grant No. XDB18000000), Science and Technology Program of Guangzhou, China (202102020250), and the Director’s Fund of Guangzhou Institute of Geochemistry, CAS (2022SZJJZD-03 and 2020000173).”The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


This task is conducted to evaluation of teaching methods for fluid mechanics course in the mechanical engineering. With the teaching practice, the advantage of teaching method is found, and the teaching quality can be revealed by the scores of integrated test. The improvement of teaching quality is contribute the development of social. According to the self-assessment, the effects of teaching method on the professional course is revealed.  Specifications tableThe development of science and technology improves the requirement of professional person. As the foundation of skill training, the education of professional course plays an important role for the special technology In recent years, the education researchers have attention for the traditional practical course with the advanced technology The objective of this work is to develop the evaluation approach for evaluating and searching the suitable teaching method in the fluid mechanism course, which provides a new way for the professional technology course. The results represent the advantage of diversified teaching method, which is suitable to the development of interdisciplinary integration. In the basic course of mechanical engineering, the diversified teaching method could provide a better teaching quality for study of professional technology, which can be extended to the similar courses.For the fluid mechanics course, the teaching method includes traditional method, improved method and diversified method, as shown in •Traditional method: The first step of traditional method is the theoretical explanation, which describes the characteristics of viscous fluid and the discriminate method of different states. Then, the experiment operation can promote the understanding of flow states in the next step.•Improved method: Compared with the traditional method, the simulation case is introduced into the class and the flow state of viscous fluid in the tube is conducted by CFD technology. The students can see the characteristics of viscous fluid in the computer and the effects of structural parameters and operation condition on the flow state of viscous fluid are also performed.•Diversified method: Based on the above methods, the development training is added in the teaching of flow state of viscous fluid. Meanwhile, the learning resources is uploaded into the network learning platform before the class. The students study the simulation software in the space time, and the development training is conducted after class.(1) Explanation of basic theoryBefore the start of teaching practice, the teacher is to be known about the content of fluid mechanics course (Flow state of viscous fluid). During the preparation of course, the students could read the new knowledge by themselves and the teaching design of this course is plotted in v is the average velocity of fluid, d denotes the diameter of pipeline, and (2) Experiment setupWith the characteristics of viscosity in the actual fluid, the impact force of fluid molecules would appear in the flow path, which is different to the feature of ideal fluid. The appearance of impact force in the flow path could cause the energy loss in the process of flow. As the variation of viscosity, density and velocity, the flow state of viscous fluid has different characteristics, which are laminar flow and turbulence flow. With the state of laminar flow, the streamline of fluid is similar to straight line. As the increase of velocity, the streamline has the vibration feature and the turbulence state appears. In order to describe the flow state of fluid accurately, the Reynolds number is proposed to confirm the flow state of fluid in the pipeline, which is written as:(3) Simulation and development training of engineering caseThe experiment of flow state for fluid would reveal the relationship between Reynolds number and streamline. Then, the experiment platform is established, as shown in In order to enhance the application ability of students for hydrodynamic characteristics in the different flow state, the engineering case of fluid mechanics is developed. T-pipe is used to investigate the effects of geometry parameters on the hydrodynamic behavior of fluid, as shown in As the usual software of hydrodynamic simulation, Solidworks and Fluent are employed to the teaching of fluid mechanics course. Compared with the 2D model, the 3D model can provide a better visual effect for learning of student, and Solidworks can provide the service for the modeling with the requirement of engineering case. Then, the model is divided to many smaller elements and transferred into the Fluent software. According to the requirement of design, the boundary condition of calculation is defined and the solution of simulation is conducted.Then, the simulation results is shown in N + 1″. In the “N + 1″model, “1″ represents the test paper, which includes the essay questions of theory, explanation of fluid mechanics phenomenon and engineering calculation. “N” denotes the comprehensive evaluation system of course content, which includes classroom test, take-home test, practical training, development training and experiment test. This method records the learning process of students in the fluid mechanics course and evaluates the ability of students completely, which exploits the potential of students. Meanwhile, the students must build “Growth record card” by themselves. Then, the attention of study is conducted by students in the whole learning process and “Growth record card” could help students to review the knowledge of fluid mechanics course. The “Growth record card” consists of basic theory, example of calculation, design and building of experiment, and the outward development training. Based on the management of fluid mechanics course, the different types of scoring are added during the learning process. The evaluations of oneself and others are also introduced into the evaluation model, which would help students find the disadvantage of oneself and advantage of others. The ability test is conducted after class, and the scores of integrated test includes the theoretical calculation, design and operation of experiment, and research analysis of engineering case.Furthermore, the evaluation method is the key element for teaching method. A suitable evaluation method could provide the learning situation of students for teacher and remind the defect of study for students. In the fluid mechanics course, the multi-modes evaluation model is established, which is named “The results are list in Teaching method is crucial to the professional technology in the study. The diversified method described in this paper can effectively improve the activeness motivation of students. With a case study, this method makes it possible to successfully perform the thinking and active of student in the fluid mechanics course. Moreover, the establishment of online classroom is advantage to the use of learning time for students. The interesting and freedom can provide helpful for learning efficiency of student. Then, the development practice of engineering case provide the helpful for the improvement of professional skill application in the future, which could maximize the advantage of technology. Moreover, the professional technology course of mechanical engineering has the similar way, which is also serviced to the engineering practice and training of professional person. The teaching method of fluid mechanics course could provide reference for the course construction of other courses.The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.


Individuals with immunocompromising conditions are at high risk of severe disease from COVID-19. The objectives of this study were to describe the clinical features, risk factors, and outcomes of COVID-19 in immunocompromised (IC) adults hospitalized with acute respiratory infection (ARI).We enrolled patients ≥ 18 years of age hospitalized with ARI at two Emory University hospitals from May 2021 – Aug 2022. Patient interviews and medical abstractions were completed. Nasopharyngeal and oropharyngeal swabs were tested for SARS-CoV-2 using BioFire Respiratory Panel, and results of standard-of-care testing were recorded. IC was defined using comorbidities from the medical chart . Primary vaccination consisted of 3 mRNA or 1 J&J + 1 other dose for IC patients, and 2 mRNA or 1 J&J for non-IC patients. Vaccine effectiveness (VE) was calculated using a test-negative case-control design. Multivariable logistic regression with stepwise selection yielded a final model controlling for employment, past COVID-19, and blood disorders using SAS v9.4.Of 1677 enrolled participants, 1653 had SARS-CoV-2 testing, of whom 850 (50.7%) were positive and 231 (27.2% of 850) were IC. Compared to non-IC patients with SARS-CoV-2, IC patients were significantly older ), male (57.1%), and had underlying comorbidities, including blood disorders (13.9%) and chronic kidney disease (36.8%). IC patients were more commonly infected with the Omicron variant, while non-IC patients were more commonly infected with Alpha or Delta. Compared to non-IC, IC patients had longer hospitalization duration , required positive-pressure ventilation (CPAP/BiPAP) (13.9%), and died (6.5%). IC patients had less commonly received a full COVID-19 vaccine series (19.9% vs. 25.8%) and adjusted VE of primary COVID-19 vaccine series against hospitalization for ARI was lower in the IC ) vs. non-IC patients ).Compared to non-IC hospitalized adults, COVID-19 VE against hospitalization for ARI was lower in IC patients, who were more likely to experience severe outcomes and death.Laura A. Puzniak, PhD. MPH, Pfizer, Inc.: Employee|Pfizer, Inc.: Stocks/Bonds Robin Hubler, MS, Pfizer, Inc.: Employee|Pfizer, Inc.: Stocks/Bonds Srinivas Valluri, PhD, Pfizer Inc: Pfizer Employee and hold Pfizer stocks/options|Pfizer Inc: Ownership Interest|Pfizer Inc: Stocks/Bonds Timothy L. Wiemken, PhD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Benjamin Lopman, PhD, Epidemiological Research and Methods, LLC: Advisor/Consultant|Hillevax, Inc: Advisor/Consultant Nadine Rouphael, MD, Icon, EMMES, Sanofi, Seqirus, Moderna: Advisor/Consultant Satoshi Kamidani, MD, CDC: Grant/Research Support|Emergent BioSolutions: Grant/Research Support|NIH: Grant/Research Support|Pfizer Inc: Grant/Research Support Evan J. Anderson, MD, GSK: Advisor/Consultant|GSK: Grant/Research Support|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Kentucky Bioprocessing, Inc.: Safety Monitoring Board|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Moderna: Currently an employee|Moderna: Stocks/Bonds|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant|Sanofi Pasteur: Grant/Research Support|Sanofi Pasteur: Safety Monitoring Board|WCG/ACI Clinical: Data Adjudication Board Christina A. Rostad, MD, BioFire Inc.: Grant/Research Support|GlaxoSmithKline Biologicals: Grant/Research Support|Janssen: Grant/Research Support|MedImmune LLC: Grant/Research Support|Meissa Vaccines, Inc.: RSV vaccine technology|Merck & Co., Inc.: Grant/Research Support|Micron Technology, Inc.: Grant/Research Support|Moderna, Inc.: Grant/Research Support|Novavax: Grant/Research Support|PaxVax: Grant/Research Support|Pfizer, Inc.: Grant/Research Support|Regeneron: Grant/Research Support|Sanofi Pasteur: Grant/Research Support


Giant cell tumour most commonly occuring in epiphysis of the long bone, present and with pain, tenderness and swelling. It is a solitary lesion with restricted movement and tenderness over the lesion. The tendon sheath is where tenosynovial giant cell tumours typically develop. Because of its remarkably peculiar position, we present a case of giant cell tumour (GCT) tenosynovial of bone in the middle phalaynx in a 33-year-old female with complaints of swelling, pain in ring finger of left hand since 2 months which is rarely seen. After clinical, radiological, pathological investigations tenosynovial giant cell tumour was diagnosed. Following fine needle aspiration cytology, histopathology was utilized to confirm the tumour's diagnosis which was later treated as resection of excision of the tumour with allo/autograft reconstruction. Our case report showed no evidence of recurrence in 2 years of follow-up. Hence our case report proves that early and complete resection of the tumour shows evidence of regain of complete range of motion and decrease recurrence rate. Extremely seldomly, a bone giant-cell tumour (GCT) can develop in the phalanx of a finger. Giant cell tumour of the tendon sheath, also known as tenosynovial giant cell tumour (GCT-TS), is a single, hard, benign, nodular soft-tissue tumour that develops from the synovial lining of a tendon. The cause is not known. It is an uncommon soft-tissue tumour that often affects adults between the ages of 30 and 50. It has an overall incidence of one in 50,000 people. When it comes to imaging techniques for surgical planning, magnetic resonance imaging is frequently done . The mosPatient and observation: a 33-year-old woman complained of soreness and swelling in the left ring finger's middle phalanx over the previous two months. No prior injuries or signs of a related constitutional condition existed. With only minor pain, the swelling had been progressively growing in size. The discomfort was mild, constant, without a daily cycle, localized to the lesion site, and non-radiating. Fever, appetite loss, additional joint involvement, or swelling over any other body part are not past occurrences. No significant past, medical, family, psycho-social or genetic history.Clinical findings: upon examination, it was discovered that the left ring finger's middle phalanx had a little (2x2x1) localized edema and dull pain with no aggravating or relieving factors. On the left side of the ring finger, the swelling was globular in shape, grape like, bony hard in consistency with localized tenderness, restricted to the distal interphalangeal joint and moved along with the tendon of the muscle but was fixed when the muscle was made taught against the resistance. Normal skin underneath was stiff and showed no symptoms of inflammation, localized temperature increase, or nasal discharge  is a neoplasm that develops from the connective tissue of the bone marrow's non-bone-forming unit. The distal end of the femur, the centre of the tibia, and the distal end of the radius are the most frequent sites, respectively . BecauseAs in our case, it can occasionally appear like a soap bubble and is generally eccentric. Periosteal reaction can happen if the bone is damaged or surgically changed, despite the fact that it is uncommon. Multinucleated big cells are a common finding in bone GCT fine-needle aspiration cytology (FNAC) samples (osteoclast). A significant characteristic of the GCT is the surrounding adhesion of large cells to the clusters of mononuclear cells. The typical big osteoclastic giant cells of bone do not contribute to the tumour's ability for proliferation. Growing mononuclear cells merge to form multinucleated giant cells. The tendon sheath can rise to benign lesions called tenosynovial giant cell tumours. It is not apparent if these lesions are reactive masses or actual tumours. These lesions are frequently seen as isolated, single, subcutaneous soft tissue nodules on imaging, with weak T1 and T2 signals and mild enhancement. According to the most recent (2013) World Health Organization classification, tenosynovial giant cell tumour is the word used. Previously, they were referred to as localised or focal nodular synovitis, pigmented villonodular tumours of the tendon sheath, extra-articular pigmented villonodular tumours of the tendon sheath, and giant cell tumours of the tendon sheath (GCTTS). In 2013, these cancers were categorized by the World Health Organization (WHO). This categorization distinguishes between localised and diffuse tenosynovial giant cell tumours. Previously recognized giant cell tumours of the tendon sheath were included in the localised TGCT (GCTTS). Formerly known as nodular tenosynovitis diffuse TGCT includes both (PVNS) .Internal fixation, prolonged curettage, intralesional curettage with adjuvant therapy, intralesional curettage with bone grafting, and curettage with curettage are among the therapeutic options available . TraditiThe significance of early diagnosis of GCT by FNAC cannot be understated, since management may prevent deformity and impairment through careful surgical planning prior to an excision biopsy. In certain situations, a combination of curettage, cryosurgery, and cementation seems to produce excellent outcomes. The recommended surgical procedure is local excision of the affected bone with autograft and/or allograft replacement. Recurrence rates for standard manual curettage are 40%, whereas they are 10- 20% with prolonged curettage. The hand's recurrent GCT is more aggressive and may need amputation, which deforms the hand's appearance and reduces its functionality. Our case report shows early presentation with early diagnosis, with early surgical intervention with postoperative vigorous physiotherapy can lead to regaining of normal anatomic and physiological functions of the affected joint.


Fluid-structure interaction algorithms are utilized to examine how the human circulatory system functions by simulating blood flow and capturing mechanical responses within blood vessels. These sophisticated algorithms take into account interactions between fluid dynamics, vessel walls, heart walls, and valves. By combining advanced medical imaging techniques with fluid-structure interaction models, it becomes possible to customize these models for individual patients. This customization enables clinicians to create personalized treatment plans. In this comprehensive article review, we explore various applications of fluid-structure interaction models in studying the cardiovascular system.Using fluid-structure interaction algorithms to simulate the human circulatory system is an innovative approach that can provide valuable insights into cardiovascular dynamics. Fluid-structure interaction algorithms enable us to couple simulations of blood flow and mechanical responses of the blood vessels while taking into account interactions between fluid dynamics and structural behaviors of vessel walls, heart walls, or valves. In the context of the human circulatory system, these algorithms offer a more comprehensive representation by considering the complex interplay between blood flow and the elasticity of blood vessels. Algorithms that simulate fluid flow dynamics and the resulting forces exerted on vessel walls can capture phenomena such as wall deformation, arterial compliance, and the propagation of pressure waves throughout the cardiovascular system. These models enhance the understanding of vasculature properties in human anatomy. The utilization of fluid-structure interaction methods in combination with medical imaging can generate patient-specific models for individual patients to facilitate the process of devising treatment plans. This review evaluates current applications and implications of fluid-structure interaction algorithms with respect to the vasculature, while considering their potential role as a guidance tool for intervention procedures. The human circulatory system, also known as the cardiovascular system, is a complex network of blood vessels, organs, and tissues that transports oxygen, nutrients, hormones, and other essential substances throughout the body . It playThe prospective utilization of computational models to augment our comprehension regarding the circulatory system and hemodynamics is significant. Advanced imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) can be leveraged for the creation of three-dimensional models of blood vessels. Computational fluid dynamics, also known as CFD, constitutes one tool that facilitates analyzing the bloodstream through a vessel with tri-dimensional innovation geometry along with inlet–outlet velocity profiles that are extracted from non-invasive sources, like MRI scans detecting fluid movement . The CFDNonetheless, the effectiveness of CFD is impeded by restricted resolution capabilities and an inability to consider wall movements associated with elastic artery walls during the computation of blood flow through these vessels, leading researchers to explore alternative approaches, such as the employment of FSI techniques. These methods effectively account for deformable structures and their interactions with the fluids, thereby surpassing the effectiveness and practicality achieved by conventional CFD. Furthermore, FSI methods enable a more realistic simulation of flow patterns and provide improved insight into how blood flow phenomena in vessels are affected overall ,5.The study of blood flow within the human circulatory system plays a vital role in understanding various cardiovascular diseases and designing effective treatment strategies. Computational modeling techniques have emerged as valuable tools for simulating blood flow dynamics. Among these techniques, FSI computational algorithms have gained considerable attention due to their ability to capture the complex interplay between fluid dynamics and deformable vessel walls. This literature review aims to explore the current state of research on the use of FSI computational algorithms to simulate blood flow in the human circulatory system, highlighting their applications, challenges, and potential clinical implications.FSI modeling involves the simultaneous solution of fluid dynamics equations and structural mechanics equations to accurately capture the interaction between blood flow and the compliant vessel walls. Numerical methods, such as the finite element method (FEM) and finite volume method (FVM), are commonly employed to solve the coupled equations ,7. TheseThe immersed boundary method (IBM) is a technique for incorporating boundary conditions and collaborating with different solvers. It can be utilized in conjunction with both FEM and FVM, as well as other methods. The fluid component can be computed using the lattice Boltzmann methods, which have been proven to be highly effective compared to alternative approaches. The IBM has already been successfully employed in simulations of blood flow, exhibiting faster execution times than traditional CFD methods .Alternatively, mesh-free approaches, also known as meshless methods, may be employed. These computational techniques do not require conventional structured or unstructured grids for discretizing the computing domain. Instead of using these traditional structures, distributed data points or particles are utilized to represent geometry and solve governing equations in a diverse manner. For blood vessel interactions applicable to FSI simulations, utilizing meshless methodologies can offer several advantages over other alternatives.Key factors considered in FSI methods encompass wall shear stress, strain, stress, elastic modulus (E), and pulse wave velocity (PWV). Elevated levels of stress and strain on a blood vessel can increase the risk of complications such as rupture . By utilFSI computational algorithms have been extensively utilized in cardiovascular research to investigate a wide range of physiological and pathological conditions. These include the assessment of hemodynamic parameters, such as wall shear stress, pressure distribution, and flow patterns, which are crucial for understanding disease progression and identifying regions of high stress and vulnerability. FSI models have been employed to study phenomena such as arterial stenosis, aneurysm formation and ruptures, atherosclerosis, and the performance of cardiovascular devices, such as stents and heart valves. The ability to simulate patient-specific geometries and conditions has opened up avenues for personalized medicine, allowing clinicians to tailor treatment strategies based on individual patient characteristics .Despite their potential, FSI computational algorithms present certain challenges and limitations. Accurate and efficient modeling requires a realistic representation of both the fluid and structural domains, which demands high-fidelity imaging data and detailed constitutive models for vessel walls. The computational cost associated with solving the coupled equations is another challenge, especially for large-scale simulations and real-time clinical applications. The validation of FSI models against in vitro experiments or clinical data remains crucial to ensuring their reliability and clinical relevance. Additionally, the complexity of the circulatory system, including its pulsatile nature, multi-scale dynamics, and interactions with other organs, poses further challenges in accurately capturing the physiological behavior .The use of FSI computational algorithms in simulating blood flow has the potential to significantly impact clinical practice. Patient-specific simulations can aid in preoperative planning, allowing surgeons to assess the effects of interventions on blood flow patterns and vessel mechanics. By providing insights into disease progression and rupture risk, FSI models can assist in the diagnosis and treatment of cardiovascular pathologies . FurtherThe FSI simulations involve solving a set of coupled partial differential equations that describe the fluid flow equations  and the structural mechanics equations  . These e–Monolithic approach: In the monolithic approach, the governing equations for fluid flow and structural mechanics are solved simultaneously within a single computational framework . This ap–Partitioned approach: The partitioned approach separates the fluid and structural equations into two independent solvers, which are then coupled through an interface. Each solver operates independently, and the information is exchanged at the interface during the simulation. This approach allows for the use of existing specialized solvers for fluid and structural problems, making it computationally efficient .The partitioned approach is further distinguished into two distinct strategies using computational techniques known as one-way and two-way methods. These approaches vary in their methodology towards simulating the interplay between fluid flow and solid structures.–One-way FSI: In one-way FSI, also known as loosely coupled FSI, the fluid and structural domains are treated as separate and independent simulations. The fluid flow is first simulated using CFD techniques, and the resulting fluid forces are applied as boundary conditions to the structural analysis. The structural deformation, in turn, influences the fluid flow indirectly through these imposed boundary conditions. The information exchange between the fluid and structural domains is performed in a one-way manner, with the fluid providing the driving forces for the structural response. This approach is computationally efficient but assumes that the structural deformation has a negligible impact on the fluid flow .–Two-way FSI: On the other hand, two-way FSI, also known as fully coupled FSI, considers the fluid and structure as a coupled system that interact with each other. In this approach, the fluid and structural equations are simultaneously solved in a fully coupled manner, accounting for the mutual influence between the two domains. The fluid forces affect the structural deformation, and the resulting deformation alters the fluid flow patterns. The information exchange occurs bidirectionally, allowing for a more accurate representation of the fluid-structure interaction. Two-way FSI is more computationally demanding but provides a more realistic representation of the physical phenomena involved .The main difference between one-way and two-way FSI lies in the level of coupling and information exchange between the fluid and structural domains. One-way FSI assumes a one-sided influence of the fluid on the structure, while two-way FSI considers a fully coupled interaction where both the fluid and structure mutually affect each other. It is worth noting that the FSI algorithm choice depends on various factors, including the complexity of the problem, computational resources, desired accuracy, and the specific objectives of the simulation. Researchers and engineers select the most appropriate algorithm based on these considerations to ensure accurate and efficient simulations of fluid-structure interactions. The following are some commonly used FSI algorithms.In the subsections below, the partitioned FSI approach is described using different methods. The coupling between the two solvers is achieved by explicitly defining boundary conditions at the fluid-structure interface, either through explicit iterations or other suitable strategies. A partitioned FSI approach is one of several methodologies used in FSI simulations. In contrast to the partitioned approach, some FSI techniques involve solving a monolithic system of equations, where the coupled equations for fluid and structure are solved simultaneously. In this monolithic approach, the fluid and structure equations are combined into a single set of equations, and a unified solver is used to solve them. The choice between the partitioned and monolithic approaches depends on various factors, such as the complexity of the problem, computational efficiency, and desired accuracy. However, the numerical methods presented in this manuscript specifically pertain to different approaches for solving the fluid dynamics component within the partitioned FSI framework. These methods offer researchers a range of options to tackle the fluid dynamics problem while adhering to the principles of partitioned coupling. By exploring and comparing these diverse numerical methods, researchers can gain insights into the strengths and limitations of each approach within the context of their FSI simulations.The interaction between fluid and its surrounding structures is an ever-present aspect of biology that plays an integral role in the vasculature of the human body . Such inThe ALE method combines the advantages of Lagrangian and Eulerian formulations by tracking the motion of the fluid mesh. It enables the mesh to move with the fluid, accommodating structural deformations, while also providing a fixed Eulerian framework for solving the fluid equations. This method is widely used in simulating FSI problems with large deformations. The ALE method can be implemented within both partitioned and monolithic approaches in FSI simulations, depending on the specific implementation and computational framework used.–Partitioned approach: In the partitioned approach, the ALE method separates the fluid and structural equations into independent solvers. The fluid equations are solved using an Eulerian formulation, where the fluid mesh moves with the fluid motion. The structural equations are typically solved using a Lagrangian formulation, where the structural mesh remains fixed. The information is exchanged between the fluid and structural solvers at the fluid-structure interface, allowing for the interaction between the fluid and structure.–Monolithic approach: In the monolithic approach, the ALE method involves solving the fluid and structural equations simultaneously within a single computational framework. The fluid and structural equations are coupled and solved together in a fully coupled manner. This approach provides a more tightly coupled representation of the fluid-structure interaction, where the motion of the fluid mesh and the structural deformation are considered concurrently.Both approaches have their advantages and drawbacks. The partitioned approach allows for flexibility in choosing specialized solvers for fluid and structural problems, which can be computationally efficient. On the other hand, the monolithic approach provides a more integrated and accurate representation of the fluid-structure interaction but can be more computationally demanding. The choice between the partitioned and monolithic approaches depends on various factors, including the complexity of the problem, computational resources, desired accuracy, and the specific objectives of the simulation. Researchers and engineers select the most suitable approach based on these considerations to effectively capture the FSI using the ALE method.An alternative to body-fitted models is the immersed boundary formulation . First iThe embedded or embedded-boundary method involves representing the solid structure as a mesh embedded within the fluid mesh. This method allows for efficient simulations by using the fluid mesh to solve the fluid equations and incorporating the solid boundary conditions within the embedded structure . It is p–Partitioned approach: In the partitioned approach, the embedded or embedded-boundary method involves separating the fluid and structural equations into independent solvers. The fluid equations are typically solved using a traditional fluid solver, such as a finite volume or finite element method, where the fluid mesh remains fixed. The structural equations are solved separately using a structural solver. The information is exchanged at the fluid-structure interface to account for the interaction between fluid and structure.–Monolithic approach: In the monolithic approach, the embedded or embedded-boundary method solves the fluid and structural equations simultaneously within a single computational framework. The fluid and structural equations are coupled and solved together in a fully coupled manner. This approach provides a more tightly coupled representation of the fluid-structure interaction, where the fluid mesh and structural deformations are considered concurrently.Both approaches have their advantages and limitations. The partitioned approach allows for flexibility in using specialized solvers for fluid and structural problems, which can be computationally efficient. The monolithic approach provides a more integrated and accurate representation of the fluid-structure interaction but may be more computationally demanding. The choice between the partitioned and monolithic approach for the embedded or embedded-boundary method depends on various factors, such as the specific problem, computational resources, desired accuracy, and the objectives of the simulation. Researchers and engineers select the most appropriate approach based on these considerations to effectively model and simulate the fluid-structure interaction using the embedded or embedded-boundary method. These algorithms can be further complemented with advanced numerical techniques, such as finite element methods, finite volume methods, or meshless methods, depending on the specific requirements and characteristics of the FSI problem.Meshless methods, also known as mesh-free methods, are numerical techniques that do not rely on traditional structured or unstructured meshes for discretizing the computational domain . InsteadOne popular meshless method used in FSI simulations is the smoothed particle hydrodynamics (SPH) method. SPH represents the fluid and structure as a set of particles, where each particle carries properties such as position, velocity, and other relevant physical quantities. In SPH, the computational domain is discretized by placing particles throughout the domain, including the fluid and structural regions. For fluid simulation, SPH applies a smoothing kernel to evaluate the interactions between neighboring particles, allowing for the computation of fluid properties like pressure and velocity. The fluid equations, such as the Navier–Stokes equations, are solved by evaluating the interactions among the particles using this kernel function. The fluid particles interact with each other and with the solid particles representing the blood vessel walls, enabling the simulation of fluid-structure interactions.In the case of blood vessel interaction, the deformations and motions of the vessel walls are typically governed by structural equations, such as the equations of linear elasticity. The solid particles representing the vessel walls are subject to external forces from the surrounding fluid particles, allowing for the simulation of the interaction between the fluid and the deformable vessel walls. Meshless methods in FSI simulations for blood vessel interaction offer several advantages. They can handle large deformations and complex geometries without the need for re-meshing or re-gridding. They are well-suited for modeling free surface flows and multiphase flows, where the fluid domain and interfaces can evolve dynamically. Meshless methods also provide flexibility in capturing fluid-structure interfaces and handling fluid-structure coupling. Ongoing research and advancements in meshless methods continue to improve their efficiency and accuracy in modeling FSI with complex geometries .Similarly, meshless methods can be implemented using both partitioned and monolithic approaches in FSI simulations, depending on the specific implementation and computational framework used.–Partitioned approach: In the partitioned approach, the meshless method separates the fluid and structural equations into independent solvers. The fluid equations are typically solved using the meshless method, where the computational domain is discretized by a set of particles or scattered data points. The structural equations are solved separately using another meshless method or a different numerical technique suitable for structural analysis. The information is exchanged at the fluid-structure interface to account for the interaction between fluid and structure.–Monolithic approach: In the monolithic approach, the meshless method involves solving the fluid and structural equations simultaneously within a single computational framework. The fluid and structural equations are coupled and solved together in a fully coupled manner. This approach provides a more tightly coupled representation of the fluid-structure interaction, where the fluid particles and the structural particles or nodes interact directly and are solved concurrently.The SPH technique has the inherent characteristic of preserving mass balance, and its ability to trace a surface automatically eliminates the need for repeated regeneration of mesh in response to deformations ,31. SPH The choice between the partitioned and monolithic approaches for meshless methods in FSI simulations depends on various factors, including the complexity of the problem, computational resources, desired accuracy, and the specific objectives of the simulation. Researchers and engineers select the most suitable approach based on these considerations to effectively capture the FSI using meshless methods. In FSI algorithms, the “added mass effect” refers to the phenomenon where the surrounding fluid exerts an inertial force on a structure undergoing motion, or, in other words, the surrounding fluid moves with the same velocity as that of the immersed boundary . This efStrongly coupled methods necessitate achieving convergence of the fluid and solid variables at the boundary . DespiteThe arteries are intricate formations that show non-linear reactions to experiencing finite distortions. When creating models of such intricacy, multiple variables, including vessel elasticity and flow patterns, must be taken into account in FSI ,44. PatiCheng et al. challenged the classical Windkessel model by demonstrating that in addition to the heart’s power, the strain energy stored in deformed arterial vessels can contribute to propelling blood flow . The stuThe predictive capabilities of a biomechanical model in evaluating the risks associated with a non-dilated thoracic aorta affected by Stanford type A dissection, a life-threatening condition, are assessed in . A comprAzarnoosh et al. aimed to assess the impact of coarctation of the aorta (CoA) severity and duration on mechanical stimuli and arterial geometry changes using a rabbit model . DiffereThe effect of uncertainty in the elastic module (E) on a patient-specific aortic model was investigated using an FSI approach . The uncThe accuracy of pulse wave imaging (PWI) in estimating PWV in stenotic vessels was assessed . ConsequThis study investigates the relationships between twelve multi-directional/topological wall shear stress (WSS) metrics; moreover, the formation of coronary plaques was investigated using both the CFD and dynamic FSI frameworks . The resThe role of biomechanics in coronary artery disease was investigated using FSI simulations to analyze patient-specific coronary biomechanics in both spatial and temporal domains . A threeIn the context of blood flow within vascular pathways, using FSI (as opposed to CFD) is significantly important because it enables a comprehensive understanding of the intricate relationship between the fluid dynamics of blood, the structural behavior of blood vessels, and the complexity of the entire circulatory system. It helps in predicting the impact of blood flow on the structural integrity of the vessels, such as the potential for wall deformation, vessel dilation, or the development of aneurysms. Furthermore, FSI simulations provide insights into hemodynamics, including the evaluation of factors such as blood velocity, pressure distribution, and shear forces within the vessels . UnderstModels of the heart have been generated using FSI accounting for precision in the opening and closing of valves with fluid flow throughout the heart chambers . Such moA study by Bornoff et al. focused on the use of a total artificial heart (TAH) as a bridge to transplant device for end-stage biventricular heart failure patients . The ReaCat et al. investigated the mechanics of calcified aortic valve stenosis (CAVS), a common cardiovascular disease characterized by calcium buildup and tissue thickening in the aortic valve . Using aBileaflet mechanical heart valves (BMHVs) and the complications associated with their use, such as valve dysfunction, tissue overgrowth, hemolysis, and thromboembolism, were studied using FSI . ThromboA two-way immersed FSI computational model was developed and validated to study the impact of aortic annulus eccentricity and leaflet rigidity on the performance, thrombogenic risk, and calcification risk of bioprosthetic aortic valve replacements (BAVRs) . The modPatient-specific post-surgery type A aortic dissection (TAAD) models were created using computed tomography angiography images, and fully coupled two-way FSI simulations were conducted . In thisMost FSI models simulate the mitral valve, aiming to enhance the detection of blood leakage and assess the quality of valve closure. An FSI model utilizes the immersed boundary method to create a contact map, accurately representing the closure of the mitral valve without the appearance of orifice holes . The stuFang et al. conducted an FSI analysis to calculate hemodynamic parameters and employed particle residual rate (PRR) and blood renewal rate (BRR) analyses to assess thrombogenesis dynamics . This stThe utilization of computational techniques can be a viable and economical approach for assessing the flow parameters associated with heart valves. The inherent difficulties relating to long-term stability and biocompatibility in valve replacement or repair have underscored the necessity for more resilient methods that could address valvular disease effectively . A thoroIn relation to the blood flow within the heart, FSI plays a crucial role as it facilitates an all-encompassing comprehension of the intricate relationship between blood fluid dynamics, heart wall structural mechanics, and valve performance. This is particularly significant in understanding blood flow mechanisms within the heart. The FSI analysis enables the investigation into how the flow of blood interacts with the flexible and dynamic nature of the heart valves, which play a crucial role in ensuring proper unidirectional blood flow through the different chambers of the heart. By considering the interaction between the fluid and the valve leaflets, FSI simulations can provide insights into valve dynamics, including the evaluation of valve function, assessment of regurgitation or stenosis, and prediction of potential complications related to valve performance. Consequently, FSI studies contribute to advancing our knowledge of cardiovascular health, aiding in the development of diagnostic tools, treatment strategies, and the design of more effective prosthetic heart valves.Aneurysms can form anywhere within the arterial system, including the intracranial, aortic, abdominal, visceral, and peripheral arteries. Aneurysm diameter and expansion rate are risk factors that are assessed to estimate rupture risk. In cases in which the aneurysm is the result of thrombosis, diameter is also used to guide anticoagulant treatment. Computational models can be used to predict growth and likelihood of rupture of aneurysms based on parameters such as wall stress, oscillatory shear index, and patterns of blood flow .Blood flow in the brain occurs at different scales from large arteries with diameters of greater than 0.5 mm to smaller arteries and arterioles that can be as narrow as 10 μm. Cerebral aneurysms can have devastating consequences, such as subarachnoid hemorrhage, which leaves 60% of those afflicted with it dead or disabled. Most cerebral aneurysms go unnoticed until they rupture, or are incidentally noticed by brain imaging for another condition . QuantitFSI has also demonstrated its use in modeling aneurysms that occur within the aorta . FSI modCertain genetic conditions, such as Marfan syndrome, affect the elasticity of the aorta and predispose patients to aneurysms. FSI computations using a hyperelastic model of the aorta have compared the wall shear stress in Marfan syndrome patients as compared to controls and determined that wall shear stress was lower in those with Marfan syndrome, indicating vascular remodeling in the regions with the aneurysm . A phenoThe use of FSI modeling can further be incorporated into the treatment and management of aneurysms, as it can guide stent placement. FSI analysis was used to evaluate four different stents of varying materials, and factored in properties such as mechanical stresses, wall shear stress, and wall compliance . Such anA computational framework was developed to investigate and compare flow patterns in the aorta before and after thoracic aortic aneurysm (TAA) formation . The fraFSI models have been used to compare and contrast flow velocity, pressure distribution, deformation, and wall stress of two different methods of aortic aneurysm repair: stenting and wrapping. Wrapping involves placing polytetrafluoroethylene (PTFE) material around the aneurysm. It has been found that stenting creates significant changes in blood flow patterns within the aneurysm, while wrapping increases the thickness of the aneurysm and the strength of the vessel wall. Moreover, wrapping was found to have a significantly reduced amount of von Mises stress compared to the stent models .A tool combining measured aorta displacements and computed blood velocity field was developed to estimate blood flow-induced loads on the artery wall . The SPHIn the context of aneurysm repair, FSI holds particular significance as it can contribute to the selection of appropriate treatment strategies . By inteThe utilization of FSI holds significant value in assessing and analyzing a diverse array of vessels within the human body. By considering the dynamic interaction between the fluid flow and the structural response of the vessel walls, FSI simulations provide insights into the complex biomechanical behavior of the cardiovascular system. By employing FSI algorithms, researchers and clinicians can unlock a deeper understanding of the complex hemodynamic characteristics of the circulatory system. FSI simulations provide a powerful means to explore the intricate interplay between blood flow and vessel mechanics, shedding light on crucial aspects such as blood pressure distribution and flow patterns. These simulations offer insights into the development and progression of cardiovascular diseases, unraveling the underlying mechanisms and identifying potential targets for intervention. Furthermore, FSI simulations play a vital role in the design and optimization of medical devices used in cardiovascular interventions . By asseExperimental validation of computational studies is crucial, especially when simulating processes within the human body, due to several reasons. First and foremost, the human body is a complex and intricate system with numerous variables, making it challenging to capture all aspects accurately in computational models . ExperimNumerical FSI methods for simulating blood flow within the human circulatory system can be enhanced by incorporating artificial intelligence (AI) techniques . AI has The field of FSI offers a powerful quantitative approach to modeling patient-specific anatomy and the vasculature, enabling clinicians to gain detailed insights into the dynamics of blood flow within individual patients. Incorporating patient-specific geometries and physiological properties, FSI simulations provide a comprehensive view of how blood flows through the vasculature and the resulting forces acting on the vessel walls. This capability allows clinicians to identify regions of the vasculature that are subjected to varying forces, such as shear stress and von Mises stress, which are crucial indicators of vascular health. Through FSI modeling, clinicians can detect and analyze vascular disorders, including aneurysms, characterized by abnormal dilatation of blood vessels. By observing the effects of different types of stent treatments using FSI models, clinicians can make informed decisions on stent selection and placement, optimizing the restoration of blood flow and improving patient outcomes.The use of FSI computational algorithms in simulating blood flow within the human circulatory system holds immense promise for advancing our understanding of cardiovascular diseases and enhancing clinical practice. The ability to capture the intricate interplay between fluid dynamics and vessel wall mechanics empowers researchers and clinicians to conduct detailed investigations of both physiological and pathological conditions. FSI simulations enable the study of complex phenomena, such as thrombosis, atherosclerosis, and hemodynamic abnormalities, facilitating a deeper understanding of disease mechanisms and potential treatment strategies. However, it is essential to address technical challenges associated with FSI modeling, including computational efficiency, accuracy, and model validation against experimental and clinical data.This review has shed light on the current applications of FSI techniques in medical fields. By employing FSI, researchers and clinicians can explore a wide range of possibilities for improved diagnostics and treatments. However, it is essential to continuously assess the computational efficiency and accuracy of FSI techniques in comparison to experimental and clinical approaches, e.g., vFFR. Such a comparative analysis would provide a comprehensive understanding of the strengths and limitations of FSI. Furthermore, the path toward standardization emerges as a critical consideration. Standardization efforts are necessary to ensure consistent and reliable results as FSI techniques gain prominence. By discussing the current state of standardization, challenges faced, and potential strategies to achieve it, the review can contribute to the field’s advancement ,106.Hence, to fully realize the potential of FSI modeling, further research is necessary to refine and optimize the computational algorithms and numerical methods employed. Validation of FSI models against experimental and clinical data is crucial to ensure their reliability and accuracy in predicting real-world scenarios. Moreover, establishing guidelines for integrating FSI simulations into routine clinical practice is vital for effectively utilizing this technology for patient care . With co