Pulsatile Research Articles

Real-time monitoring of middle cerebral artery blood flow using intraoperative transcranial doppler during trans-carotid artery revascularization

ObjectiveTranscarotid artery revascularization (TCAR) has emerged as a safe and effective method for carotid revascularization, offering several key advantages over carotid endarterectomy (CEA) and carotid artery stenting (CAS). Intraoperative transcranial Doppler (TCD) monitoring plays a pivotal role in assessing cerebral hemodynamics and detecting embolic signals during TCAR at our institution. MethodsThis review synthesizes the current literature and provides guidance for TCD monitoring throughout the various phases of TCAR, from preoperative assessment to postoperative management. Key considerations include probe placement, waveform evaluation, interpreting monitoring parameters such as mean flow velocity (MFV), pulsatility index (PI), and percentage change in the MFV (Δ%). Techniques for maintaining the insonation of the middle cerebral artery (MCA) M1 segment and optimal parameter settings for intraoperative TCD monitoring are detailed. ResultsTCAR phases are highlighted, including transcarotid access and vessel control, sheath insertion, the establishment of flow reversal, pre-dilation, stent placement, post-dilation, and closure, while emphasizing the importance of real-time feedback provided by TCD monitoring in identifying embolic signals and assessing changes in cerebral perfusion. The review discusses limitations of TCD monitoring, such as inadequate temporal windows, incorrect vessel identification and reliability issues with automatic emboli detection counters. Furthermore, practical advice is provided on how to navigate common pitfalls encountered during intraoperative TCD monitoring. ConclusionBy understanding the nuances of TCD monitoring and its application in TCAR, intraoperative TCD monitoring may aid to minimize the low but potential risk of intraprocedural embolic events, periprocedural hypoperfusion and postoperative hyperperfusion. Finally, we suggest opportunities for further research in embolization quantification and additional strategies to optimize quality control in TCAR.

Design and implementation of a cost-effective, open-source, and programmable pulsatile flow system

The primary objective of this research was to design, implement, and validate a programmable open-source pulsatile flow system to cost-effectively simulate vascular flows. We employed an Arduino-compatible microcontroller combined with a motor driver to control a centrifugal direct current (DC) motor pump. The system was programmed to produce pulsatile flows with an arterial pulse waveform. Validation with Doppler ultrasound and flow measurements confirmed that our Arduino-based system successfully replicated arterial vascular flow. The materials are easily accessible, with a total bill of materials as low as $99. This open-source programmable pulsatile pump platform offers superior cost-effectiveness and adaptability relative to commercial offerings.

The european registry for patients with mechanical circulatory support (EUROMACS): fourth paediatric EUROMACS (Paedi-EUROMACS) report.

The use of ventricular assist devices in children is increasing. However, absolute numbers in individual centers and countries remain small. Collaborative efforts such as the Paedi-EUROMACS are therefore essential in order to combine international experience with paediatric ventricular assist devices. In this paper, the results from the fourth Paedi-EUROMACS report are presented. All paediatric (<19 years) patients supported by a ventricular assist device from the EUROMACS database were included. Patients are stratified into a congenital heart disease group and a group with a non-congenital aetiology. Endpoints included mortality, transplantation and recovery. Cox proportional hazard models were used to explore associated factors for mortality, cerebrovascular accident, and pump thrombosis. 590 primary implantations were included. The congenital group was significantly younger (2.5 versus 8.0 years respectively, p < 0.001) and were more commonly supported by a pulsatile flow device (73.5% vs 59.9%, p < 0.001). Mortality was significantly higher in the congenital group (30.8 vs 20.4%; p = 0.009) than in the non-congenital group. However, in multivariable analyses, congenital heart disease was not significantly associated with mortality (HR 1.285, CI 0.8111-2.036, p = 0.740). Pump thrombosis was the most frequently reported adverse event (377 events in 132 patients; 0.925 events per patient-year) and was significantly associated with BSA (HR 0.524 CI 0.333-0.823, p = 0.005), congenital heart disease (HR 1.641 CI 1.054-2.555, p = 0.028) and pulsatile flow support (HR 2.345 CI 1.406-3.910, p = 0.001) in multivariable analyses. This fourth Paedi-EUROMACS report highlights the increasing use of paediatric ventricular assist devices. The patient populations with congenital and non-congenital aetiology exhibit distinct characteristics and clinical outcomes.

Impact of the Different Molecular Weights of Polyethylene Glycol (PEG) Coating Agents on the Magnetic Targeting Characteristics of Functionalized Magnetoresponsive Nanoclusters

In this article, we investigated the influence of molecular weight (Mw) on particle deposition efficiency after PEG-functionalized (polyethylene glycol-PEG) magnetoresponsive magnetic cluster targeting. In this work, the clusters were obtained by the solvothermal polyol method using polyethylene glycol (PEG) as a coating agent. So, we investigated three kinds of magnetoresponsive clusters: MNC-2000, MNC-6000, and MNC-10,000. These clusters were coated with PEG, and had molecular weights (Mw) of 2000 Da, 6000 Da, and 10,000 Da, respectively. The authors propose that the key to achieving maximum efficiency in targeted drug delivery is to deposit a thin, uniform layer of medication that covers the vascular wall in the area of interest. We defined a set of efficiency criteria to focus on the most essential characteristics of the targeting results. These are the obstruction degree, which measures the level of vessel obstruction; the magnet coverage degree, which evaluates the quality of particle deposition along the vessel wall; and the proximal deposition degree, which assesses the effect of pulsatile flow on deposition length. We performed several tests to determine how molecular weight affected these efficiency parameters. These tests examined (a) the effect of the injected cluster quantities, (b) the effect of the magnet distance, and (c) the effect of the injection period. Our findings indicate that an increase in PEG’s molar weight significantly impacts magnetic particle targeting efficiency.

Collateral flow and pulsatility during large vessel occlusions: insights from a quantitative in vitro study.

Acute ischemic stroke caused by large vessel occlusions is being increasingly treated with neurovascular interventions. The hemodynamics within the collateral system of the circle of Willis (CoW) hemodynamics play a fundamental role in therapy success. However, transient in vivo data on pathological collateral flow during large vessel occlusions are not available. Moreover, there are no flow models that accurately simulate the hemodynamic conditions in the CoW during large vessel occlusions. We used a circulatory loop to generate highly reproducible cerebrovascular-like flows and pressures and used non-invasive flow visualization and high-resolution flow and pressure measurements to acquire detailed, time-dependent hemodynamics inside an anatomical phantom of the CoW. After calibrating a physiological reference case, we induced occlusions in the 1. middle cerebral artery, 2. terminal carotid artery, and 3. basilar artery; and measured the left posterior communicating artery flow. Mean arterial pressure and pulse pressure remained unchanged in the different occlusion cases compared to the physiological reference case, while total cerebral flow decreased by up to 19%. In all three occlusion cases, reversed flow was found in the left posterior communicating artery compared to the reference case with different flow magnitudes and pulsatility index values. The experimental results were compared with clinical findings, demonstrating the capability of this realistic cerebrovascular flow setup. This novel cerebrovascular flow setup opens the possibility for investigating different topics of neurovascular interventions under various clinical conditions in controlled preclinical laboratory studies.

Investigation of the size and shape of nano-microcarriers for targeted drug delivery to atherosclerotic plaque in ischemic stroke prevention

Recognizing the significance of drug carriers in the treatment of atherosclerotic plaque is crucial in light of the worldwide repercussions of ischemic stroke. Conservative methodologies, specifically targeted drug delivery, present encouraging substitutes that mitigate the hazards linked to invasive procedures. With the intention of illuminating their considerable significance and prospective benefits, this study examines the impact of the geometry and dimensions of drug-loaded nano-microcarriers on atherosclerotic plaque. The research utilizes a finite element approach to simulate the motion and fluid dynamics of nano-microcarriers loaded with drugs within the carotid arteries. Carriers are available in a variety of shapes and sizes to accommodate patient-specific geometries, pulsatile fluid flow, and non-Newtonian blood properties. Optimization of drug delivery is achieved through the examination of carrier interaction with the inner wall. The results demonstrated that the interaction data between particles and the inner wall of atherosclerotic plaques exhibits micro- and nanoscale patterns that are distinct. Symmetric plaques demonstrate that nanoparticles with a 0.4 shape factor and diameters below 200 nm show the highest interaction rate. Conversely, larger particles (200 and 500 nm) with shape factors of 1 demonstrate comparatively elevated interaction rates. The optimal shape factor for drug-loaded microparticles has been determined to be one, and the number of interactions increases as the diameter of the nanoparticles increases, with a significant increase observed at a shape factor of one. Asymmetric plaques exhibit the maximum interaction rates among particles that have a shape factor of 0.4 and have diameters smaller than 500 µm. The findings establish a foundation for novel therapeutic strategies, establishing nano-microparticles as auspicious contenders for accurate and efficacious drug delivery systems that inhibit plaque proliferation.

Numerical analysis of the axisymmetric lattice Boltzmann method for steady and oscillatory flows in periodic geometries

Compared to more typical computational fluid dynamics techniques, the lattice Boltzmann method (LBM) is relatively new and unexplored. In recent years, axisymmetric LBM formulations, which can simulate flow in rotationally symmetric 3D geometries, have been published. Here we verify a novel axisymmetric LBM implementation using numerical criteria. Hagen–Poiseuille and Womersley flow are considered within a straight tube where analytic solutions are available. With this, we establish sufficient accuracy of the approximated flow and study the effects of changing simulation parameters (e.g. Reynolds number, Womersley number) and spatial/temporal parameters (e.g. relaxation time, mesh nodes, time steps). Furthermore, steady and oscillatory flows within a periodically-varying, longitudinally asymmetric geometry are considered. Analytic solutions are not available in these cases; however, the validity of the axisymmetric LBM for curved boundaries is ensured through convergence, mesh independence and qualitative observations. Guaranteeing reasonable flow field determination for the aformentioned geometry is relevant to a larger problem where particulate suspension is pumped back and forth through a membrane of axisymmetric micropores. In these circumstances, experiments have induced directed particle transport even though there is no net flow of the carrier fluid. Hence, our work aims to improve current numerical simulations of these flow problems to better understand the factors that facilitate particle transport.

Flow Analysis of Central Venous Outflow Tract: A New Approach to Understanding Pulse-Synchronous Tinnitus.

Pulse-synchronous tinnitus (PST) has been linked to multiple anatomical variants of the central venous outflow tract (CVOT) including sigmoid sinus (SS) dehiscence and diverticulum. This study investigates flow turbulence, pressure, and wall shear stress along the CVOT and proposes a mechanism that results in SS dehiscence and PST. Case series. Tertiary Academic Center. Venous models were reconstructed from computed tomography scans of 3 patients with unilateral PST. Two models for each patient are obtained: a symptomatic and contralateral asymptomatic side. A turbulent model-enabled commercial flow solver was used to simulate the pulsatile blood flow over the cardiac cycle through the models. Fluid flow through the transverse and SS junction was analyzed to observe the velocity, pressure, turbulent kinetic energy (TKE), and shear stress over a simulated cardiac cycle. Fluid flow on the symptomatic side showed increased vorticity in the presence of an SS diverticulum. Higher TKE with periodicity following the cardiac cycle was observed on the symptomatic side, and a sharp increase was observed if SS diverticulum was present. Shear stress was highest near the narrowest segments of the vessel. Pressure was observed to be lower on the symptomatic side at the transverse-SS junction for all 3 patients. Computational fluid dynamics modeling of blood flow through the CVOT in PST suggests that low pressure may be the cause of dehiscence, and tinnitus may result from periodic increases in TKE.

Hemodynamics regulate spatiotemporal artery muscularization in the developing circle of Willis.

Vascular smooth muscle cells (VSMCs) envelop vertebrate brain arteries and play a crucial role in regulating cerebral blood flow and neurovascular coupling. The dedifferentiation of VSMCs is implicated in cerebrovascular disease and neurodegeneration. Despite its importance, the process of VSMC differentiation on brain arteries during development remains inadequately characterized. Understanding this process could aid in reprogramming and regenerating dedifferentiated VSMCs in cerebrovascular diseases. In this study, we investigated VSMC differentiation on zebrafish circle of Willis (CoW), comprising major arteries that supply blood to the vertebrate brain. We observed that arterial specification of CoW endothelial cells (ECs) occurs after their migration from cranial venous plexus to form CoW arteries. Subsequently, acta2+ VSMCs differentiate from pdgfrb+ mural cell progenitors after they were recruited to CoW arteries. The progression of VSMC differentiation exhibits a spatiotemporal pattern, advancing from anterior to posterior CoW arteries. Analysis of blood flow suggests that earlier VSMC differentiation in anterior CoW arteries correlates with higher red blood cell velocity and wall shear stress. Furthermore, pulsatile flow induces differentiation of human brain PDGFRB+ mural cells into VSMCs, and blood flow is required for VSMC differentiation on zebrafish CoW arteries. Consistently, flow-responsive transcription factor klf2a is activated in ECs of CoW arteries prior to VSMC differentiation, and klf2a knockdown delays VSMC differentiation on anterior CoW arteries. In summary, our findings highlight blood flow activation of endothelial klf2a as a mechanism regulating initial VSMC differentiation on vertebrate brain arteries.

Hemodynamics regulate spatiotemporal artery muscularization in the developing circle of Willis

Vascular smooth muscle cells (VSMCs) envelop vertebrate brain arteries and play a crucial role in regulating cerebral blood flow and neurovascular coupling. The dedifferentiation of VSMCs is implicated in cerebrovascular disease and neurodegeneration. Despite its importance, the process of VSMC differentiation on brain arteries during development remains inadequately characterized. Understanding this process could aid in reprogramming and regenerating dedifferentiated VSMCs in cerebrovascular diseases. In this study, we investigated VSMC differentiation on zebrafish circle of Willis (CoW), comprising major arteries that supply blood to the vertebrate brain. We observed that arterial specification of CoW endothelial cells (ECs) occurs after their migration from cranial venous plexus to form CoW arteries. Subsequently, acta2+ VSMCs differentiate from pdgfrb+ mural cell progenitors after they were recruited to CoW arteries. The progression of VSMC differentiation exhibits a spatiotemporal pattern, advancing from anterior to posterior CoW arteries. Analysis of blood flow suggests that earlier VSMC differentiation in anterior CoW arteries correlates with higher red blood cell velocity and wall shear stress. Furthermore, pulsatile flow induces differentiation of human brain PDGFRB+ mural cells into VSMCs, and blood flow is required for VSMC differentiation on zebrafish CoW arteries. Consistently, flow-responsive transcription factor klf2a is activated in ECs of CoW arteries prior to VSMC differentiation, and klf2a knockdown delays VSMC differentiation on anterior CoW arteries. In summary, our findings highlight blood flow activation of endothelial klf2a as a mechanism regulating initial VSMC differentiation on vertebrate brain arteries.

Patent ductus arteriosus (also non-hemodynamically significant) correlates with poor outcomes in very low birth weight infants. A multicenter cohort study.

To standardize the diagnosis of patent ductus arteriosus (PDA) and report its association with adverse neonatal outcomes in very low birth weight infants (VLBW, birth weight < 1500 g). A multicenter prospective observational study was conducted in Emilia Romagna from March 2018 to October 2019. The association between ultrasound grading of PDA and adverse neonatal outcomes was evaluated after correction for gestational age. A diagnosis of hemodynamically significant PDA (hsPDA) was established when the PDA diameter was ≥ 1.6 mm at the pulmonary end with growing or pulsatile flow pattern, and at least 2 of 3 indexes of pulmonary overcirculation and/or systemic hypoperfusion were present. 218 VLBW infants were included. Among infants treated for PDA closure in the first postnatal week, up to 40% did not have hsPDA on ultrasound, but experienced clinical worsening. The risk of death was 15 times higher among neonates with non-hemodynamically significant PDA (non-hsPDA) compared to neonates with no PDA. In contrast, the risk of death was similar between neonates with hsPDA and neonates with no PDA. The occurrence of BPD was 6-fold higher among neonates with hsPDA, with no apparent beneficial role of early treatment for PDA closure. The risk of IVH (grade ≥ 3) and ROP (grade ≥ 3) increased by 8.7-fold and 18-fold, respectively, when both systemic hypoperfusion and pulmonary overcirculation were present in hsPDA. The increased risk of mortality in neonates with non-hsPDA underscores the potential inadequacy of criteria for defining hsPDA within the first 3 postnatal days (as they may be adversely affected by other clinically severe factors, i.e. persistent pulmonary hypertension and mechanical ventilation). Parameters such as length, diameter, and morphology may serve as more suitable ultrasound indicators during this period, to be combined with clinical data for individualized management. Additionally, BPD, IVH (grade ≥ 3) and ROP (grade ≥ 3) are associated with hsPDA. The existence of an optimal timeframe for closing PDA to minimize these adverse neonatal outcomes remains uncertain.

Effect Of Transcatheter Heart Valve Size And Deployment Height On Coronary Flow Obstruction

Coronary artery disease (CAD) is commonly found in patients with aortic stenosis; therefore, its prevalence is high in patients that are candidate for transcatheter aortic valve replacement (TAVR). As the TAVR procedure is expanding into younger and lower-risk population, the importance of early CAD monitoring and detection, as well as determination of potential impact of implant design or deployment strategy on CAD progression is of great importance. In this study, we investigate the effect of transcatheter heart valve (THV) size and deployment height on coronary flow obstruction during normotensive hemodynamic flow conditions. We employ unsteady, pulsatile flow, generated by a left heart model, and utilize clinically relevant geometry, pressure, and flow waveforms. Of particular interest is to understand the interaction between THV and anatomy regarding coronary flow obstruction. For a wide range of parameters, we examine two distinct THV deployment scenarios: nominal deployment – high coronary blockage (ND-HCB), and high deployment – low coronary blockage (HD-LCB). Additionally, we investigated the impact of the locations of coronary ostia and THV commissure alignment onto the risk of coronary flow obstruction. With the aid of 2D-2C particle image velocimetry (PIV), the distinctive flow patterns within the aortic sinus space are identified from the response of the flow to the presence of THV. Comparison between two THV deployment scenarios revealed that ND-HCB configurations lead to formation of stagnant flow zones, while the HD-LCB configuration provided an adequate washout of the entire coronary sinus. The optimal washout of the aortic root sinus is achieved when the distance between native leaflets and coronary ostia is maximized. Furthermore, results showed that up to 4% improvement in the coronary flow rate can be achieved if commissure alignment procedure is performed. As the coronary artery obstruction phenomenon is additive in its nature, a pre-existing stenotic condition in association with suboptimal THV deployment may lead to increased risk of full coronary blockage and immediate need for coronary intervention. In conclusion, this study using an experimental coronary assessment tool may provide potential insights to inform pre-procedural TAVR strategies in challenging patients’ anatomies, thereby maximizing the associated benefit.

An In-Vitro Study On The Carotid Bifurcation And Its Influence On Arterial Haemodynamics With Newtonian And Non-Newtonian Blood Analogs

The carotid artery bifurcation is a region susceptible to atherosclerosis and cardiovascular diseases. The geometry of the bifurcation is individually unique and significant differences have been correlated to both age and gender. Identifying geometric features that produce adverse flow patterns could enable clinicians to make early assessment of an individual’s risk of developing the disease enabling proactive management. Consequently, this study aims to evaluate the influence of the carotid bifurcation angle on arterial haemodynamics using stereoscopic particle image velocimetry. Pulsatile flow conditions were applied to a Newtonian and non-Newtonian blood analog in three compliant, physiologically realistic carotid artery bifurcation phantoms with different bifurcation angles. Results indicate large bifurcation angles can produce adverse flow conditions, increasing size of stagnation regions and promoting plaque development. Additionally, an optimal bifurcation angle could exist that could be considered atheroprotective. Comparison of Newtonian and non-Newtonian blood analogs in one of the geometries show subtle yet significant differences between flow fields, suggesting the shear-thinning behaviour of blood should be carefully considered prior to adopting a Newtonian assumption, even in large vessels.

Deformable baffles coupled with pulsatile flow improve mixing in microfluidic devices

An important objective for many microfluidic mixer devices is to attain a high level of mixing efficiency at low Reynolds numbers. Previous research incorporating rigid obstacles into microchannels has shown enhanced chaotic advection and improved mixing index; however, the increased pressure drop and corresponding shear forces within the fluid domain can create issues in biological applications. In this paper, we show how an innovative micromixer strategy, i.e., incorporating deformable baffles and utilizing pulsatile flow, results in a high level of mixing efficiency at low Reynolds numbers (Re =1.25), where diffusion is the pure mechanism of mixing. The numerical investigation involved solving the continuity, Navier-Stokes, solid mechanics, and fluid-solid interaction equations alongside a convection-diffusion model to analyze species concentration. To find the best conditions of the micromixer, the mixing index as the objective function was optimized, and various parameters, including phase difference, velocity ratio, Strouhal number, baffle distance, and Reynolds number, were investigated. Through optimization of these parameters, we show a notable improvement in the mixing index (increase from 21.7 % to 78.86 %) at a Reynolds number of 1.25 with 2 mixing units, more than 92 % mixing efficiency by using 6 mixing units, and more than 95 % mixing efficiency at a Reynolds number of 0.1. Moreover, the incorporation of deformable baffles and pulsation results in a lower pressure drop. These conditions are optimal for biological applications that require thorough mixing of the sample inputs.

An In Silico Modelling Approach to Predict Hemodynamic Outcomes in Diabetic and Hypertensive Kidney Disease

Early diagnosis of kidney disease remains an unmet clinical challenge, preventing timely and effective intervention. Diabetes and hypertension are two main causes of kidney disease, can often appear together, and can only be distinguished by invasive biopsy. In this study, we developed a modelling approach to simulate blood velocity, volumetric flow rate, and pressure wave propagation in arterial networks of ageing, diabetic, and hypertensive virtual populations. The model was validated by comparing our predictions for pressure, volumetric flow rate and waveform-derived indexes with in vivo data on ageing populations from the literature. The model simulated the effects of kidney disease, and was calibrated to align quantitatively with in vivo data on diabetic and hypertensive nephropathy from the literature. Our study identified some potential biomarkers extracted from renal blood flow rate and flow pulsatility. For typical patient age groups, resistive index values were 0.69 (SD 0.05) and 0.74 (SD 0.02) in the early and severe stages of diabetic nephropathy, respectively. Similar trends were observed in the same stages of hypertensive nephropathy, with a range from 0.65 (SD 0.07) to 0.73 (SD 0.05), respectively. Mean renal blood flow rate through a single diseased kidney ranged from 329 (SD 40, early) to 317 (SD 38, severe) ml/min in diabetic nephropathy and 443 (SD 54, early) to 388 (SD 47, severe) ml/min in hypertensive nephropathy, showing potential as a biomarker for early diagnosis of kidney disease. This modelling approach demonstrated its potential application in informing biomarker identification and facilitating the setup of clinical trials.

Unsteady electroosmotic flow of Carreau–Newtonian fluids through a cylindrical tube

The present study aims to investigate the fully developed electroosmotic flow of Carreau–Newtonian fluids within a circular tube, considering two different boundary conditions of zeta potential. The unsteady behavior of Carreau–Newtonian fluids, is attributed to the pulsatile pressure-driven flow. Studying two distinct formulations, slip and no-slip zeta potentials, illustrates the relative movement of fluid particles and the charged surface. The proposed study’s framework is divided into two regions: a central region containing a non-Newtonian Carreau fluid exhibiting both shear-thinning and thickening behavior, and a peripheral region containing a Newtonian fluid with the effect of an electrical double layer at the solid wall of the cylindrical tube. The Poisson–Boltzmann equation under the assumption of Debye–Hückel approximation governs the potential distribution due to the electric double layer, facilitating the examination of electroosmotic flow through tube. Obtaining analytical solutions for the momentum equations in both regions becomes challenging due to the inclusion of pulsatile pressure-driven flow and a non-Newtonian Carreau fluid. Asymptotic series expansions are employed, utilizing small parameters such as the Weissenberg number (We≪1) and a pulsatile Reynolds number (α≪1), to derive velocity expressions for both regions. Wall shear stress fluctuations, as indicated by time-averaged wall shear stress and oscillatory shear index are assessed to gauge the temporal variation of wall shear stress from the dominant blood flow direction. By utilizing potential and hydrodynamic variables, an asymptotic formulation for the streaming potential is developed to ascertain the asymptotic expression of electrokinetic energy conversion efficiency and scrutinize the impacts of pertinent physical parameters on it. The proposed study prominently shows that the Debye–Hückel parameter, Weissenberg number, pulsatile Reynolds number, and time-dependent pressure gradient significantly influence the fluid velocity, flow rate, and flow resistance. The notable determination of the present study is that the velocity amplitude and electrokinetic energy conversion efficiency are enlarged in the slip-dependent case relative to the no-slip zeta potential. It is noteworthy that as inertial forces become more prominent compared to viscous forces, both time-average wall shear stress and oscillatory shear index experience a slight decrease, although the reduction in oscillatory shear index is minimal owing to the absence of obstruction within the tube wall. The NDSolve numerical scheme in Mathematica software is employed to calculate numerical solutions for the governing equations, which are subsequently verified against results obtained through asymptotic analysis. The findings of this study are expected to deepen our understanding of unsteady electroosmotic flows of Carreau fluid and contribute to the design and development of advanced microfluidic devices with enhanced performance for various applications.

Role of Doppler Ultrasound and Triphasic CT in Differentiation between Benign and Malignant Portal Vein Thrombosis

Abstract Background Portal vein thrombosis is typically a consequence of cirrhosis that already exists, abdominal malignancy, hypercoagulable conditions, or abdominal inflammation. Imaging techniques are used to identify portal vein thrombosis. Once a thrombus has been identified using ultrasound, Doppler ultrasonography can be used to determine if it is benign or malignant. The following step is contrast-enhanced computed tomography or magnetic resonance angiography if more information is needed. If these tests are insufficient, digital subtraction angiography should be carried out. Patients and Methods The study included 40 patients diagnosed by B mode ultrasound to have PVT and referred to the radiology department of the National Hepatology And Tropical Medicine Institute to differentiate between benign and malignant PVT using color Doppler and Triphasic CT. Results those 40 patients were classified according to triphasic CT criteria into 17 patients with benign PVT and 23 patients with malignant PVT which all of them had neovascularity and show early arterial enhancement and delayed wash out. Intra-thrombus pulsatile flow by color Doppler was detected in 19 patients with percentage of agreement 80%, sensitivity of 73.9% and specificity of 88.2%. Conclusion Color Doppler US considered an effective non invasive tool to differentiate between benign and malignant PVT, but it is an operator dependent which need an expertise to detect the vascularity within the thrombus. But is an easy, low cost, available, no contraindications to be done and no exposure to radiation. Although absence of intra-thrombus vasculature doesn`t exclude the malignant nature of the thrombus, and here come the role of Triphasic CT.

Haemodynamic effects of non-Newtonian fluid blood on the abdominal aorta before and after double tear rupture

ObjectivesIntimal tears caused by aortic dissection can weaken the arterial wall and lead to aortic aneurysms. However, the effect of different tear states on the blood flow behaviour remains complex. This study uses a novel approach that combines numerical haemodynamic simulation with in vitro experiments to elucidate the effect of arterial dissection rupture on the complex blood flow state within the abdominal aneurysm and the endogenous causes of end-organ malperfusion. Materials and methodsBased on the CT imaging data and clinical physiological parameters, the overall arterial models including aortic dissection and aneurysm with single tear and double tear were established, and the turbulence behaviours and haemodynamic characteristics of arterial dissection and aneurysm under different blood pressures were simulated by using non-Newtonian flow fluids with the pulsatile blood flow rate of the clinical patients as a cycle, and the results of the numerical simulation were verified by in vitro simulation experiments. ResultsHemodynamic simulations revealed that the aneurysm and single-tear false lumen generated a maximum pressure of 320.591 mmHg, 267 % over the 120 mmHg criterion. The pressure differential generates reflux, leading to a WSS of 2247.9 Pa at the TL inlet and blood flow velocities of up to 6.41 m/s inducing extend of the inlet. DTD Medium FL instantaneous WP above 120 mmHg Standard 151 % Additionally, there was 82.5 % higher flow in the right iliac aorta than in the left iliac aorta, which triggered malperfusion. Thrombus was accumulated distal to the tear and turbulence. These results are consistent with the findings of the in vitro experiments. ConclusionsThis study reveals the haemodynamic mechanisms by which aortic dissection induces aortic aneurysms to produce different risk states. This will contribute to in vitro simulation studies as a new fulcrum in the process of moving from numerical simulation to clinical trials.

Retinal microvascular remodeling associates with adverse events in continuous-flow left ventricular assist device-supported patients

BackgroundContinuous-flow left ventricular assist device (cfLVAD) use is effective in supporting patients with end-stage heart failure (ESHF). Reduced flow pulsatility within the systemic circulation in cfLVAD-supported patients may lead to alterations within the microcirculation. Temporal changes in microvasculature in relation to adverse events in cfLVAD supported patients has not been studied. We aimed to profile changes within retinal microvasculature and its association with adverse events. MethodsRetinal photography was performed using Topcon TRC-NW8 non-mydriatic fundus camera in cfLVAD supported patients and ESHF control patients. Retinal measurements including arteriolar and venular caliber, fractal dimension, branching angle, and vessel tortuosity were evaluated using a validated semi-automated program. Demographic and adverse event data were documented. Results172 images were recorded from 48 patients (n=29 cfLVAD, n=19 ESHF, mean age 54.2 ± 11.9 years). There were significant trends in retinal arteriolar caliber (B = -0.53 µm, 95% CI: -0.96 – -0.10, p = 0.016) and retinal fractal dimension parameters (B = 0.014, 95% CI: 0.001 – 0.002, p = 0.016) in linear mixed model regressions. Amongst cfLVAD patients, there was a significant association between the incidence of gastrointestinal bleeding and stepwise increases in retinal arteriolar-venular caliber ratio (HR: 3.03, 95% CI: 2.06 – 4.45, p = 0.005), a measure of arteriolar narrowing. ConclusionsWe have observed for the first time that alterations in retinal microvasculature in cfLVAD-supported patients may be associated with gastrointestinal bleeding. While understanding these temporal changes may predict future adverse events in cfLVAD-supported patients, further multi-center studies are required to confirm the associations observed.

Determining stemness and exosome production from nutrient-dependent cells: Influence of the molecular weight cut-off in hollow fiber membrane systems

This study aimed to optimize parameters for cultivating adipose-derived stem cells (ADSCs) in hollow fiber membrane systems. Enhanced ADSC cultivation was achieved in this study by utilizing a higher cell seeding rate (10 mL/min) and fibronectin coating (8 μg/cm²) on the membrane. A pulsatile flow perfusion (30 min on / 3 h off) for 24 h, followed by continuous flow perfusion at a lower rate (<20 mL/min), was employed. Notably, a two-day medium change maintained CD73 expression (79.26 %) compared to scenarios without changes (1.92 %) over eight days. Using a membrane cut-off of 20 kDa and <0.1 μm, a 1.4- and 2.8-fold increase in proliferated cells was observed; however, CD73 expression decreased by 10.07 and 33.63 %, respectively. The membrane with a pore size of <0.1 μm exhibited 1.4-fold higher exosome particle numbers. In conclusion, nutrient supplementation emerged as crucial for optimal ADSC cultivation in hollow fiber systems.