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Wang B, Peng G, Chen L, Guo M, Zhou J, Liu Y, Chen Z, Wang L. Effect of transcutaneous electrical acupoint stimulation on remifentanil dosage during craniotomy aneurysm clipping: a prospective, randomized controlled study. BMC Complement Med Ther 2023; 23:453. [PMID: 38093254 PMCID: PMC10717748 DOI: 10.1186/s12906-023-04297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Craniotomy aneurysm clipping is one of the main treatments for intracranial aneurysm (IA). Endotracheal intubation and intraoperative operation may induce dramatic hemodynamic fluctuations and increase the risk of aneurysm rupture. Intraoperative high-dose opioid use is the main measure to reduce the intraoperative stress response, but it increases the incidence of complications such as postoperative vomiting and delayed awakening. Transcutaneous electrical acupoint stimulation (TEAS) stimulates β-endorphin expression levels and reduces opioid requirements. In this study, we aimed to assess the effects of TEAS on remifentanil dosage and oxidative stress (OS) in craniotomy aneurysm clipping. METHOD Forty-two patients with craniotomy aneurysm clipping were randomized into two groups: the TEAS group (T group) and the sham TEAS group (S group). "Hegu" (LI4), "Neiguan" (PC6) and "Zusanli" points (ST36) were selected, and a "HANS" percutaneous acupoint electrical stimulator was used for intervention 30 min before anesthesia induction until the end of the operation. The primary outcome was intraoperative remifentanil dosage. The secondary outcomes were intraoperative propofol dosage, mean arterial pressure (MAP) and heart rate (HR) 5 min before the TEAS intervention (T0), 5 min before head holder pinning (T1), immediately after pinning (T2), 5 min before craniotomy (T3), immediately after craniotomy (T4), at craniotomy (T5), and at the end of surgery (T6), as well as serum β-endorphin levels at T1, T2 and T6 and neuron-specific enolase (NSE), S100β, superoxide dismutase (SOD) and malondialdehyde (MDA) levels at T1, T2 and 24 h after surgery (T7). RESULTS The dosage of remifentanil in the T group was reduced compared to that in the S group (P < 0.05). At T2, T4 and T5, the MAP and HR in the T group were lower than those in the S group (P < 0.05). At T2 and T7, the levels of NSE, S100β and MDA in group T were lower than those in group S (P < 0.05), while the SOD levels in group T were higher than those in group S (P < 0.05). CONCLUSIONS The use of TEAS can reduce the dosage of remifentanil and reduce hemodynamic fluctuations during craniotomy aneurysm clipping. It reduces the occurrence of OS and central nervous system damage during surgery and has a certain brain protective effect. TRIAL REGISTRATION ChiCTR2100052353. https://www.chictr.org.cn/about.html .
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Affiliation(s)
- Bingyu Wang
- The First Clinical College of Medicine, Gannan Medical University, Ganzhou, 34100, China
- The Second Hospital of Ningbo, Ningbo, 315100, China
| | - Guanfa Peng
- The First Clinical College of Medicine, Gannan Medical University, Ganzhou, 34100, China
| | - Li Chen
- Department of Anesthesiology, The First Affiliated Hospital of Gannan Medical University, No. 128, Jinling West Road, Ganzhou, 34100, China
| | - Mingling Guo
- The First Clinical College of Medicine, Gannan Medical University, Ganzhou, 34100, China
| | - Jianshun Zhou
- The First Clinical College of Medicine, Gannan Medical University, Ganzhou, 34100, China
| | - Yingying Liu
- The First Clinical College of Medicine, Gannan Medical University, Ganzhou, 34100, China
| | - Zhen Chen
- The First Clinical College of Medicine, Gannan Medical University, Ganzhou, 34100, China
| | - Lifeng Wang
- Department of Anesthesiology, The First Affiliated Hospital of Gannan Medical University, No. 128, Jinling West Road, Ganzhou, 34100, China.
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Zolfaghari H, Andiapen M, Baumbach A, Mathur A, Kerswell RR. Wall shear stress and pressure patterns in aortic stenosis patients with and without aortic dilation captured by high-performance image-based computational fluid dynamics. PLoS Comput Biol 2023; 19:e1011479. [PMID: 37851683 PMCID: PMC10635572 DOI: 10.1371/journal.pcbi.1011479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 11/09/2023] [Accepted: 08/24/2023] [Indexed: 10/20/2023] Open
Abstract
Spatial patterns of elevated wall shear stress and pressure due to blood flow past aortic stenosis (AS) are studied using GPU-accelerated patient-specific computational fluid dynamics. Three cases of moderate to severe AS, one with a dilated ascending aorta and two within the normal range (root diameter less than 4cm) are simulated for physiological waveforms obtained from echocardiography. The computational framework is built based on sharp-interface Immersed Boundary Method, where aortic geometries segmented from CT angiograms are integrated into a high-order incompressible Navier-Stokes solver. The key question addressed here is, given the presence of turbulence due to AS which increases wall shear stress (WSS) levels, why some AS patients undergo much less aortic dilation. Recent case studies of AS have linked the existence of an elevated WSS hotspot (due to impingement of AS on the aortic wall) to the dilation process. Herein we further investigate the WSS distribution for cases with and without dilation to understand the possible hemodynamics which may impact the dilation process. We show that the spatial distribution of elevated WSS is significantly more focused for the case with dilation than those without dilation. We further show that this focal area accommodates a persistent pocket of high pressure, which may have contributed to the dilation process through an increased wall-normal forcing. The cases without dilation, on the contrary, showed a rather oscillatory pressure behaviour, with no persistent pressure "buildup" effect. We further argue that a more proximal branching of the aortic arch could explain the lack of a focal area of elevated WSS and pressure, because it interferes with the impingement process due to fluid suction effects. These phenomena are further illustrated using an idealized aortic geometry. We finally show that a restored inflow eliminates the focal area of elevated WSS and pressure zone from the ascending aorta.
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Affiliation(s)
- Hadi Zolfaghari
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, United Kingdom
| | - Mervyn Andiapen
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Andreas Baumbach
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Anthony Mathur
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Rich R. Kerswell
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, United Kingdom
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Zhou M, Yu Y, Chen R, Liu X, Hu Y, Ma Z, Gao L, Jian W, Wang L. Wall shear stress and its role in atherosclerosis. Front Cardiovasc Med 2023; 10:1083547. [PMID: 37077735 PMCID: PMC10106633 DOI: 10.3389/fcvm.2023.1083547] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/09/2023] [Indexed: 04/05/2023] Open
Abstract
Atherosclerosis (AS) is the major form of cardiovascular disease and the leading cause of morbidity and mortality in countries around the world. Atherosclerosis combines the interactions of systemic risk factors, haemodynamic factors, and biological factors, in which biomechanical and biochemical cues strongly regulate the process of atherosclerosis. The development of atherosclerosis is directly related to hemodynamic disorders and is the most important parameter in the biomechanics of atherosclerosis. The complex blood flow in arteries forms rich WSS vectorial features, including the newly proposed WSS topological skeleton to identify and classify the WSS fixed points and manifolds in complex vascular geometries. The onset of plaque usually occurs in the low WSS area, and the plaque development alters the local WSS topography. low WSS promotes atherosclerosis, while high WSS prevents atherosclerosis. Upon further progression of plaques, high WSS is associated with the formation of vulnerable plaque phenotype. Different types of shear stress can lead to focal differences in plaque composition and to spatial variations in the susceptibility to plaque rupture, atherosclerosis progression and thrombus formation. WSS can potentially gain insight into the initial lesions of AS and the vulnerable phenotype that gradually develops over time. The characteristics of WSS are studied through computational fluid dynamics (CFD) modeling. With the continuous improvement of computer performance-cost ratio, WSS as one of the effective parameters for early diagnosis of atherosclerosis has become a reality and will be worth actively promoting in clinical practice. The research on the pathogenesis of atherosclerosis based on WSS is gradually an academic consensus. This article will comprehensively review the systemic risk factors, hemodynamics and biological factors involved in the formation of atherosclerosis, and combine the application of CFD in hemodynamics, focusing on the mechanism of WSS and the complex interactions between WSS and plaque biological factors. It is expected to lay a foundation for revealing the pathophysiological mechanisms related to abnormal WSS in the progression and transformation of human atherosclerotic plaques.
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Affiliation(s)
- Manli Zhou
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Yunfeng Yu
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Ruiyi Chen
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Xingci Liu
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Yilei Hu
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Zhiyan Ma
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Lingwei Gao
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Weixiong Jian
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
- National Key Discipline of Traditional Chinese Medicine Diagnostics, Hunan Provincial Key Laboratory, Hunan University of Chinese Medicine, Changsha, China
- Correspondence: Weixiong Jian Liping Wang
| | - Liping Wang
- College of Rehabilitation Medicine and Health Care, Hunan University of Medicine, Huaihua, China
- Correspondence: Weixiong Jian Liping Wang
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Starodumov IO, Sokolov SY, Alexandrov DV, Zubarev AY, Bessonov IS, Chestukhin VV, Blyakhman FA. Modelling of hemodynamics in bifurcation lesions of coronary arteries before and after myocardial revascularization. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2022; 380:20200303. [PMID: 34974725 DOI: 10.1098/rsta.2020.0303] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/16/2021] [Indexed: 06/14/2023]
Abstract
Modelling of patient-specific hemodynamics for a clinical case of severe coronary artery disease with the bifurcation stenosis was carried out with allowance for standard angiographic data obtained before and after successfully performed myocardial revascularization by stenting of two arteries. Based on a non-Newtonian fluid model and an original algorithm for fluid dynamics computation operated with a limited amount of initial data, key characteristics of blood flow were determined to analyse the features of coronary disease and the consequences of its treatment. The results of hemodynamic modelling near bifurcation sites are presented with an emphasis on physical, physiological and clinical phenomena to demonstrate the feasibility of the proposed approach. The main limitations and ways to minimize them are the subjects of discussion as well. This article is part of the theme issue 'Transport phenomena in complex systems (part 2)'.
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Affiliation(s)
- Ilya O Starodumov
- Department of Theoretical and Mathematical Physics, Laboratory of Multi-Scale Mathematical Modeling, Ural Federal University, Ekaterinburg 620000, Russian Federation
- Ural State Medical University, Ekaterinburg 620028, Russian Federation
| | - Sergey Yu Sokolov
- Institute of Natural Sciences and Mathematics, Ural Federal University, Ekaterinburg 620000, Russian Federation
- Ural State Medical University, Ekaterinburg 620028, Russian Federation
| | - Dmitri V Alexandrov
- Department of Theoretical and Mathematical Physics, Laboratory of Multi-Scale Mathematical Modeling, Ural Federal University, Ekaterinburg 620000, Russian Federation
| | - Andrey Yu Zubarev
- Institute of Natural Sciences and Mathematics, Ural Federal University, Ekaterinburg 620000, Russian Federation
| | - Ivan S Bessonov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 625026, Russian Federation
| | - Vasily V Chestukhin
- Sklifosovsky Research Institute of Emergency Care, Moscow 129090, Russian Federation
| | - Felix A Blyakhman
- Institute of Natural Sciences and Mathematics, Ural Federal University, Ekaterinburg 620000, Russian Federation
- Ural State Medical University, Ekaterinburg 620028, Russian Federation
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Kemper P, Nauleau P, Karageorgos G, Weber R, Kwon N, Szabolcs M, Konofagou E. Feasibility of longitudinal monitoring of atherosclerosis with pulse wave imaging in a swine model. Physiol Meas 2021; 42:10.1088/1361-6579/ac290f. [PMID: 34551396 PMCID: PMC8733748 DOI: 10.1088/1361-6579/ac290f] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/22/2021] [Indexed: 12/30/2022]
Abstract
Objective.Atherosclerosis is a vascular disease characterized by compositional and mechanical changes in the arterial walls that lead to a plaque buildup. Depending on its geometry and composition, a plaque can ruptured and cause stroke, ischemia or infarction. Pulse wave imaging (PWI) is an ultrasound-based technique developed to locally quantify the stiffness of arteries. This technique has shown promising results when applied to patients. The objective of this study is to assess the capability of PWI to monitor the disease progression in a swine model that mimics human pathology.Approach.The left common carotid of three hypercholesterolemic Wisconsin miniature swines, fed an atherogenic diet, was ligated. Ligated and contralateral carotids were imaged once a month over 9 months, at a high-frame-rate, with a 5-plane wave compounding sequence and a 5 MHz linear array. Each acquisition was repeated after probe repositioning to evaluate the reproducibility. Wall displacements were estimated from the beamformed RF-data and were arranged as spatiotemporal maps depicting the wave propagation. The pulse wave velocity (PWV) estimated by tracking the 50% upstroke of the wave was converted in compliance using the Bramwell-Hill model. At the termination of the experiment, the carotids were extracted for histology analysis.Main results.PWI was able to monitor the evolution of compliance in both carotids of the animals. Reproducibility was demonstrated as the difference of PWV between cardiac cycles was similar to the difference between acquisitions (9.04% versus 9.91%). The plaque components were similar to the ones usually observed in patients. Each animal presented a unique pattern of compliance progression, which was confirmed by the plaque composition observed histologically.Significance.This study provides important insights on the vascular wall stiffness progression in an atherosclerotic swine model. It therefore paves the way for a thorough longitudinal study that examines the role of stiffness in both the plaque formation and plaque progression.
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Affiliation(s)
- Paul Kemper
- Department of Biomedical Engineering, Columbia University, New York, NY, United States of America
| | - Pierre Nauleau
- Department of Biomedical Engineering, Columbia University, New York, NY, United States of America
| | - Grigorios Karageorgos
- Department of Biomedical Engineering, Columbia University, New York, NY, United States of America
| | - Rachel Weber
- Department of Biomedical Engineering, Columbia University, New York, NY, United States of America
| | - Nancy Kwon
- Department of Biomedical Engineering, Columbia University, New York, NY, United States of America
| | - Matthias Szabolcs
- Department of Pathology and Cell Biology, Columbia University, New York, NY, United States of America
| | - Elisa Konofagou
- Department of Biomedical Engineering, Columbia University, New York, NY, United States of America
- Department of Radiology, Columbia University, New York, NY, United States of America
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Tang H, Wang Q, Xu F, Zhang X, Zeng Z, Yan Y, Lu Z, Xue G, Zuo Q, Luo Y, Liu J, Huang Q. Underlying mechanism of hemodynamics and intracranial aneurysm. Chin Neurosurg J 2021; 7:44. [PMID: 34847937 PMCID: PMC8638472 DOI: 10.1186/s41016-021-00260-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/17/2021] [Indexed: 12/13/2022] Open
Abstract
In modern society, subarachnoid hemorrhage, mostly caused by intracranial aneurysm rupture, is accompanied by high disability and mortality rate, which has become a major threat to human health. Till now, the etiology of intracranial aneurysm has not been entirely clarified. In recent years, more and more studies focus on the relationship between hemodynamics and intracranial aneurysm. Under the physiological condition, the mechanical force produced by the stable blood flow in the blood vessels keeps balance with the structure of the blood vessels. When the blood vessels are stimulated by the continuous abnormal blood flow, the functional structure of the blood vessels changes, which becomes the pathophysiological basis of the inflammation and atherosclerosis of the blood vessels and further promotes the occurrence and development of the intracranial aneurysm. This review will focus on the relationship between hemodynamics and intracranial aneurysms, will discuss the mechanism of occurrence and development of intracranial aneurysms, and will provide a new perspective for the research and treatment of intracranial aneurysms.
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Affiliation(s)
- Haishuang Tang
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.,Naval Medical Center of PLA, Naval Military Medical University, Shanghai, 200050, People's Republic of China
| | - Qingsong Wang
- Department of Cardiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Fengfeng Xu
- Naval Medical Center of PLA, Naval Military Medical University, Shanghai, 200050, People's Republic of China
| | - Xiaoxi Zhang
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Zhangwei Zeng
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Yazhou Yan
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Zhiwen Lu
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Gaici Xue
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Qiao Zuo
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Yin Luo
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
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Cong M, Zhao H, Dai S, Chen C, Xu X, Qiu J, Qin S. Transient numerical simulation of the right coronary artery originating from the left sinus and the effect of its acute take-off angle on hemodynamics. Quant Imaging Med Surg 2021; 11:2062-2075. [PMID: 33936987 DOI: 10.21037/qims-20-125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background An anomalous origin of the right coronary artery from the left coronary artery sinus is usually characterized by an acute take-off angle. Most affected patients have no clinical symptoms; however, some patients have decreased blood flow into the right coronary artery during exercise, which can lead to symptoms such as myocardial ischemia. Most researchers who have studied an anomalous origin of the right coronary artery from the left coronary artery sinus have done so through clinical cases. In this study, we used numerical simulation to evaluate the hemodynamics of this condition and the effect of an acute take-off angle on hemodynamic parameters. We expect that the results of this study will help in further understanding the clinical symptoms of this anomaly and the hemodynamic impact of an acute take-off angle. Methods Three-dimensional models were reconstructed based on the computed tomography images from 16 patients with a normal right coronary artery and 26 patients with an anomalous origin of the right coronary artery from the left coronary artery sinus. A numerical simulation of a two-way fluid-structure interaction was executed with ANSYS Workbench software. The blood was assumed to be an incompressible Newtonian fluid, and the vessel was assumed to be an isotropic, linear elastic material. Hemodynamic parameters and the effect of an acute take-off angle were statistically analyzed. Results During the systolic period, the wall pressure in the right coronary artery was significantly reduced in patients with an anomalous origin of the right coronary artery (t =1.32 s, P=0.0001; t =1.34-1.46 s, P<0.0001). The wall shear stress in the abnormal group was higher at the beginning of the systolic period (t =1.24 s, P=0.0473; t =1.26 s, P=0.0193; t =1.28 s, P=0.0441). The acute take-off angle was smaller in patients with clinical symptoms (27.81°±4.406°) than in patients without clinical symptoms (31.86°±2.789°; P=0.017). In the symptomatic group, pressure was negatively correlated with the acute take-off angle (P=0.0185-0.0341, r=-0.459 to -0.4167). Conclusions This study shows that an anomalous origin of the right coronary artery from the left coronary artery sinus causes changes in hemodynamic parameters, and that an acute take-off angle in patients with this anomaly is associated with terminal ischemia of the right coronary artery.
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Affiliation(s)
- Mengyang Cong
- College of Mechanical and Electronic Engineering, Shandong University of Science and Technology, Qingdao, China
| | - Huihui Zhao
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, China.,Center for Medical Engineer Technology Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, China
| | - Shun Dai
- Department of Radiology, Shanghai Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanzhi Chen
- Department of Radiology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xingming Xu
- College of Mechanical and Electronic Engineering, Shandong University of Science and Technology, Tai'an, China
| | - Jianfeng Qiu
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, China.,Center for Medical Engineer Technology Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, China
| | - Shengxue Qin
- College of Mechanical and Electronic Engineering, Shandong University of Science and Technology, Qingdao, China
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Onwuzu SWI, Ugwu AC, Mbah GCE, Elo IS. Measuring wall shear stress distribution in the carotid artery in an African population: Computational fluid dynamics versus ultrasound doppler velocimetry. Radiography (Lond) 2020; 27:581-588. [PMID: 33323312 DOI: 10.1016/j.radi.2020.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Computational fluid dynamics (CFD) and ultrasound Doppler velocimetry are diagnostic tools useful for determining carotid artery segments susceptible to atheromatous plaque development. This study computes and compares the difference in Wall Shear Stress (WSS) measurements between these two methods. METHODS The carotid artery of 204 volunteers selected using simple random sampling were scanned using standard carotid doppler protocols. Four segments of the carotid artery - the common, internal, external carotid, and the carotid bulb were sonographically assessed. The intima-media thickness, diameter, peak systolic velocity, and end-diastolic velocity were measured at a point 2 cm away from the carotid bifurcation for the three segments, while the carotid bulb was measured at the bifurcation. A 2D incompressible Navier-Stokes Equation for modelling Newtonian, pulsatile, and laminar flow in a viscoelastic pipe was applied to model velocity flow across the carotid artery using COMSOL software. WSS values were computed for experimental and CFD measurements and the results were compared. RESULTS The WSS values generated by the model had respectively peak and average values of 19.81 N/cm2 and 15.76 ± 1.81 N/cm2 for the common carotid, 10.77 N/cm2 and 7.57 ± 1.66 N/cm2 for the internal carotid, 11.51 N/cm2 and 8.05 ± 1.65 N/cm2 for the external carotid, 37.55 N/cm2 and 26.55 ± 6.62 N/cm2 for the carotid bifurcation, 1.39 N/cm2 and 3.13 ± 1.34 N/cm2 for the carotid bulb. The model measurements matched doppler velocimetry measurements with <15% variation. CONCLUSION Model based WSS values were higher but comparable with doppler velocimetry measurements. The carotid bulb had low WSS and is therefore the segment highly disposed to atheromatous plaque formation. IMPLICATIONS FOR PRACTICE Subject-specific mathematical models could be incorporated during cardiovascular scan work up for accurate WSS distribution and early prediction of possible atherosclerotic sites.
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Affiliation(s)
- S W I Onwuzu
- Department of Medical Radiography and Radiological Sciences, University of Nigeria Enugu Campus, Nigeria.
| | - A C Ugwu
- Department of Radiography and Radiation Sciences, Nnamdi Azikiwe University, Awka, Nigeria.
| | - G C E Mbah
- Department of Mathematics, University of Nigeria Nsukka, Nigeria.
| | - I S Elo
- Department of Medical Radiography and Radiological Sciences, University of Nigeria Enugu Campus, Nigeria.
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Blood flow simulations in patient-specific geometries of the carotid artery: A systematic review. J Biomech 2020; 111:110019. [PMID: 32905972 DOI: 10.1016/j.jbiomech.2020.110019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/07/2020] [Accepted: 08/26/2020] [Indexed: 12/21/2022]
Abstract
Computational Fluid Dynamics (CFD) and Fluid-Structure Interaction (FSI) are currently widely applied in the study of blood flow parameters and their alterations under pathological conditions, which are important indicators for diagnosis of atherosclerosis. In this manuscript, a systematic review of the published literature was conducted, according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, on the simulation studies of blood flow in patient-specific geometries of the carotid artery bifurcation. Scopus, PubMed and ScienceDirect databases were used in the literature search, which was completed on the 3rd of August 2020. Forty-nine articles were included after the selection process and were organized in two distinct categories: the CFD studies (36/49 articles), which comprise only the fluid analysis and the FSI studies (13/49 articles), which includes both fluid and Fluid-Structure domain in the analysis. The data of the research works was structured in different categories (Geometry, Viscosity models, Type of Flow, Boundary Conditions, Flow Parameters, Type of Solver and Validation). The aim of this systematic review is to demonstrate the methodology in the modelling, simulation and analysis of carotid blood flow and also identify potential gaps and challenges in this research field.
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Cong M, Xu X, Qiu J, Dai S, Chen C, Qian X, Zhang H, Qin S, Zhao H. Influence of malformation of right coronary artery originating from the left sinus in hemodynamic environment. Biomed Eng Online 2020; 19:59. [PMID: 32727522 PMCID: PMC7392689 DOI: 10.1186/s12938-020-00804-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 07/23/2020] [Indexed: 11/11/2022] Open
Abstract
Background The anomalous origin of the right coronary artery (RCA) from the left coronary artery sinus (AORL) is one of the abnormal origins of the coronary arteries. Most of these issues rarely have any effects on human health, but some individuals may exhibit symptoms, such as myocardial ischemia or even sudden death. Recently, researchers have investigated the AORL through clinical cases, but studies based on computational fluid dynamics (CFD) have rarely been reported. In this study, the hemodynamic changes between the normal origin of the RCA and the AORL are compared based on numerical simulation results. Methods Realistic three-dimensional (3D) models of the 16 normal right coronary arteries and 26 abnormal origins of the RCAs were constructed, respectively. The blood flow was numerically simulated using the ANSYS software. This study used a one-way fluid–solid coupling finite element model, wherein the blood is assumed to be an incompressible Newtonian fluid, and the vessel is assumed to be made of an isotropic linear elastic material. Results The cross-sectional area differences between the inlet of the normal group and that of the abnormal group were significant (P < 0.0001). Moreover, there were significant differences in the volumetric flow (P = 0.0001) and pressure (P = 0.0002). Positive correlation exists for the ratio of the cross-sectional area of the RCA to the inlet area of the ascending aorta (AAO), and the ratio of the inlet volumetric flow of the RCA to the volumetric flow of the AAO, in the normal (P = 0.0001, r = 0.8178) and abnormal (P = 0.0033, r = 0.6107) groups. Conclusion This study demonstrates that the cross-sectional area of the AORL inlet may cause ischemia symptoms. The results obtained by this study may contribute to the further understanding of the clinical symptoms of the AORL based on the hemodynamics.
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Affiliation(s)
- Mengyang Cong
- College of Mechanical and Electronic Engineering, Shandong University of Science and Technology, Qingdao, 266590, China
| | - Xingming Xu
- Intelligent Equipment College, Shandong University of Science and Technology, Taian, 271016, China
| | - Jianfeng Qiu
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271016, China.,Center for Medical Engineer Technology Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271016, China
| | - Shun Dai
- Department of Radiology, Shanghai Tong Ren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200120, China
| | - Chuanzhi Chen
- Department of Radiology, East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Xiuqing Qian
- Department of Biomedical engineering, Capital Medical University, Beijing, 10060, China
| | - Hongbin Zhang
- College of Mechanical and Electronic Engineering, Shandong University of Science and Technology, Qingdao, 266590, China
| | - Shengxue Qin
- College of Mechanical and Electronic Engineering, Shandong University of Science and Technology, Qingdao, 266590, China.
| | - Huihui Zhao
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271016, China. .,Center for Medical Engineer Technology Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271016, China.
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Post-exercise Response of Arterial Parameters for Arterial Health Assessment Using a Microfluidic Tactile Sensor and Vibration-Model-Based Analysis: A Proof-of-Concept Study. Cardiovasc Eng Technol 2020; 11:295-307. [PMID: 32002815 DOI: 10.1007/s13239-020-00454-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/05/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Arterial stiffness and endothelial function are two established surrogate markers of subclinical atherosclerosis and are quantified by three arterial parameters: elasticity, viscosity and radius of the arterial wall. Yet, the current methods for their assessment are unsuitable for routine use. Post-exercise response of the cardiovascular (CV) system serves as a more sensitive detection of subclinical arterial abnormalities that are not apparent at-rest. The objective of this study is to propose a novel method that can measure post-exercise response of arterial parameters and is also suitable for routine use. APPROACH A microfluidic tactile sensor with a location-insensitive configuration was used for arterial pulse signal measurements on six asymptomatic male subjects, offering measurement reliability, ease use by a layperson, and affordability. By treating the arterial pulse signal as a vibration signal of the arterial wall, vibration-model-based analysis of only one measured pulse signal with no calibration was conducted for simultaneous estimation of three arterial parameters. Exercise-intensity-normalized percent changes in arterial parameters were utilized to remove the influence of variation in exercise intensity on post-exercise response, and then their measured values were compared for difference in post-exercise response between the subjects. MAIN RESULTS One subject who was obese, on subject who had insomnia, and the oldest subject in the study demonstrated differences in post-exercise response at the radial artery (RA), as compared with the three subjects free of those three factors. Despite a lack of statistical significance, the observed difference at the RA between subjects was supported by (i) their consistency with the related findings in the literature, and (ii) their consistency with the measured values at the carotid artery (CA) and superficial temporal artery (STA) and the anatomical difference between the three arteries. SIGNIFICANCE The proposed method has the potential of offering an affordable and convenient diagnosis tool for routine arterial health assessment.
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12
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Ren A, Wu H, Liu L, Guo Z, Cao Q, Dai Q. Nicotine promotes atherosclerosis development in apolipoprotein E-deficient mice through α1-nAChR. J Cell Physiol 2019; 234:14507-14518. [PMID: 30585623 DOI: 10.1002/jcp.27728] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 10/16/2018] [Indexed: 01/24/2023]
Abstract
α1 Nicotinic acetylcholine receptor (α1nAChR) is an important nicotine receptor that is widely distributed in vascular smooth muscle cells, macrophages, and endothelial cells. However, the role of α1nAChR in nicotine-mediated atherosclerosis remains unclear. The administration of nicotine for 12 weeks increased the area of the atherosclerotic lesion, the number of macrophages infiltrating the plaques, and the circulating levels of inflammatory cytokines, such as interleukin-6 and tumor necrosis factor-α, in apolipoprotein E-deficient (ApoE-/- ) mice fed a high-fat diet. Nicotine also increased α1nAChR, calpain-1, matrix metalloproteinase-2 (MMP-2), and MMP-9 expression in the aortic tissue. Silencing of α1nAChR with an adenoassociated virus decreased the atherosclerotic size, lesion macrophage content, and circulating levels of inflammatory cytokines and suppressed α1nAChR, calpain-1, MMP-2, and MMP-9 expression in the nicotine group. In vitro, nicotine-induced α1nAChR, calpain-1, MMP-2, and MMP-9 expression in mouse vascular smooth muscle cells (MOVAS) and macrophages (RAW264.7), and enhanced the migration and proliferation of these cells. The silencing of α1nAChR inhibited these effects of nicotine MOVAS and RAW264.7 cells. Thus, we concluded that nicotine promoted the development of atherosclerosis partially by inducing the migration and proliferation of vascular smooth muscle cells and macrophages and inducing an inflammatory reaction. The effect of nicotine on atherogenesis may be mediated by α1nAChR-induced activation of the calpain-1/MMP-2/MMP-9 signaling pathway.
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Affiliation(s)
- Anmin Ren
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongxian Wu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liping Liu
- Department of Cardiology, Yancheng First People's Hospital, The Fourth Affiliated Hospital of Nantong Medical University, Jiangsu, China
| | - Zhenzhen Guo
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qunan Cao
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiuyan Dai
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Modern Concepts in Regenerative Therapy for Ischemic Stroke: From Stem Cells for Promoting Angiogenesis to 3D-Bioprinted Scaffolds Customized via Carotid Shear Stress Analysis. Int J Mol Sci 2019; 20:ijms20102574. [PMID: 31130624 PMCID: PMC6566983 DOI: 10.3390/ijms20102574] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 02/06/2023] Open
Abstract
Ischemic stroke is associated with a tremendous economic and societal burden, and only a few therapies are currently available for the treatment of this devastating disease. The main therapeutic approaches used nowadays for the treatment of ischemic brain injury aim to achieve reperfusion, neuroprotection and neurorecovery. Therapeutic angiogenesis also seems to represent a promising tool to improve the prognosis of cerebral ischemia. This review aims to present the modern concepts and the current status of regenerative therapy for ischemic stroke and discuss the main results of major clinical trials addressing the effectiveness of stem cell therapy for achieving neuroregeneration in ischemic stroke. At the same time, as a glimpse into the future, this article describes modern concepts for stroke prevention, such as the implantation of bioprinted scaffolds seeded with stem cells, whose 3D geometry is customized according to carotid shear stress.
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Razafindrazaka FH, Yevtushenko P, Poelke K, Polthier K, Goubergrits L. Hodge decomposition of wall shear stress vector fields characterizing biological flows. ROYAL SOCIETY OPEN SCIENCE 2019; 6:181970. [PMID: 30891301 PMCID: PMC6408383 DOI: 10.1098/rsos.181970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
A discrete boundary-sensitive Hodge decomposition is proposed as a central tool for the analysis of wall shear stress (WSS) vector fields in aortic blood flows. The method is based on novel results for the smooth and discrete Hodge-Morrey-Friedrichs decomposition on manifolds with boundary and subdivides the WSS vector field into five components: gradient (curl-free), co-gradient (divergence-free) and three harmonic fields induced from the boundary, which are called the centre, Neumann and Dirichlet fields. First, an analysis of WSS in several simulated simplified phantom geometries (duct and idealized aorta) was performed in order to understand the nature of the five components. It was shown that the decomposition is able to distinguish harmonic blood flow arising from the inlet from harmonic circulations induced by the interior topology of the geometry. Finally, a comparative analysis of 11 patients with coarctation of the aorta (CoA) before and after treatment as well as 10 control patients was done. The study shows a significant difference between the CoA patients before and after the treatment, and the healthy controls. This means a global difference between aortic shapes of diseased and healthy subjects, thus leading to a new type of WSS-based analysis and classification of pathological and physiological blood flow.
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Affiliation(s)
- Faniry H. Razafindrazaka
- Freie Universität, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin, Berlin, Germany
| | - Pavlo Yevtushenko
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin, Berlin, Germany
| | | | | | - Leonid Goubergrits
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin, Berlin, Germany
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