Abstract: A reliable, real-time, and non-invasive system that can identify patients at risk for hemodynamic instability is needed to aid clinicians in their efforts to anticipate patient deterioration and initiate early interventions. The purpose of this pilot study was to explore the clinical capabilities of a real-time analytic from a single lead of an electrocardiograph to correctly distinguish between rapid response team (RRT) activations due to hemodynamic (H-RRT) and non-hemodynamic (NH-RRT) causes, as well as predict H-RRT cases with actionable lead times. The study consisted of a single center, retrospective cohort of 21 patients with RRT activations from step-down and telemetry units. Through electronic health record review and blinded to the analytic’s output, each patient was categorized by clinicians into H-RRT and NH-RRT cases. The analytic output and the categorization were compared. The prediction lead time prior to the RRT call was calculated. The analytic correctly distinguished between H-RRT and NH-RRT cases with 100% accuracy, demonstrating 100% positive and negative predictive values, and 100% sensitivity and specificity. In H-RRT cases, the analytic detected hemodynamic deterioration with a median lead time of 9.5 hours prior to the RRT call (range 14 minutes to 52 hours). The study demonstrates that an electrocardiogram (ECG) based analytic has the potential for providing clinical decision and monitoring support for caregivers to identify at risk patients within a clinically relevant timeframe allowing for increased vigilance and early interventional support to reduce the chances of continued patient deterioration.
Abstract: Elastic compression stockings (ECSs) have been widely applied in prophylaxis and treatment of chronic venous insufficiency of lower extremities. The medical function of ECS is to improve venous return and increase muscular pumping action to facilitate blood circulation, which is largely determined by the complex interaction between the ECS and lower limb tissues. Understanding the mechanical transmission of ECS along the skin surface, deeper tissues, and vascular system is essential to assess the effectiveness of the ECSs. In this study, a three-dimensional (3D) finite element (FE) model of the leg-ECS system integrated with a 3D fluid-solid interaction (FSI) model of the leg-vein system was constructed to analyze the biomechanical properties of veins and soft tissues under different ECS compression. The Magnetic Resonance Imaging (MRI) of the human leg was divided into three regions, including soft tissues, bones (tibia and fibula) and veins (peroneal vein, great saphenous vein, and small saphenous vein). The ECSs with pressure ranges from 15 to 26 mmHg (Classes I and II) were adopted in the developed FE-FSI model. The soft tissue was assumed as a Neo-Hookean hyperelastic model with the fixed bones, and the ECSs were regarded as an orthotropic elastic shell. The interfacial pressure and stress transmission were simulated by the FE model, and venous hemodynamics properties were simulated by the FSI model. The experimental validation indicated that the simulated interfacial pressure distributions were in accordance with the pressure measurement results. The developed model can be used to predict interfacial pressure, stress transmission, and venous hemodynamics exerted by ECSs and optimize the structure and materials properties of ECSs design, thus improving the efficiency of compression therapy.
Abstract: The use of hormonal contraceptive drugs is widely used in different age groups, mainly due to easy acquisition and due to a large number of prescriptions. Besides, several studies point to the high cardiovascular risk concerning the use of hormonal contraceptives. In this study, we evaluated 620 Brazilian women to demonstrate the correlation between the hormonal contraceptives uses with the increase of the predisposition of risk for cardiovascular diseases. Our data demonstrated that concomitant use of contraceptives showed a significant reduction activated partial thromboplastin time and prothrombin time similar to hypercoagulability clinical conditions. Besides, as a compensation mechanism, there was an increase in the Fibrinogen levels. We also verified a significant increase at the total cholesterol and platelet aggregation up to 10%. Therefore, it was evidenced through this study that the use of hormonal contraceptives may increase cardiovascular risk. Besides, our data represents an alert since, in Brazil, the primary contraceptive hormone prescribed in public health units consists of second-generation drugs, which are the ones that most present associations with cardiovascular risk.
Abstract: Cardiovascular diseases (CVDs) are the main cause of death globally. Most CVDs can be prevented by avoiding habitual risk factors. Separate from the habitual risk factors, there are some inherent factors in each individual that can increase the risk potential of CVDs. Vessel shapes and geometry are influential factors, having great impact on the blood flow and the hemodynamic behavior of the vessels. In the present study, the influence of bifurcation angle on blood flow characteristics is studied. In order to approach this topic, by simplifying the details of the bifurcation, three models with angles 30°, 45°, and 60° were created, then by using CFD analysis, the response of these models for stable flow and pulsatile flow was studied. In the conducted simulation in order to eliminate the influence of other geometrical factors, only the angle of the bifurcation was changed and other parameters remained constant during the research. Simulations are conducted under dynamic and stable condition. In the stable flow simulation, a steady velocity of 0.17 m/s at the inlet plug was maintained and in dynamic simulations, a typical LAD flow waveform is implemented. The results show that the bifurcation angle has an influence on the maximum speed of the flow. In the stable flow condition, increasing the angle lead to decrease the maximum flow velocity. In the dynamic flow simulations, increasing the bifurcation angle lead to an increase in the maximum velocity. Since blood flow has pulsatile characteristics, using a uniform velocity during the simulations can lead to a discrepancy between the actual results and the calculated results.
Abstract: The aim of this study is to estimate the effect of blood flow through the coronary artery in human heart so as to assess the coronary artery disease.Velocity, wall shear stress (WSS), strain rate and wall pressure distribution are some of the important hemodynamic parameters that are non-invasively assessed with computational fluid dynamics (CFD). These parameters are used to identify the mechanical factors responsible for the plaque progression and/or rupture in left coronary arteries (LCA) in coronary arteries.The initial step for CFD simulations was the construction of a geometrical model of the LCA. Patient specific artery model is constructed using computed tomography (CT) scan data with the help of MIMICS Research 19.0. For CFD analysis ANSYS FLUENT-14.5 is used.Hemodynamic parameters were quantified and flow patterns were visualized both in the absence and presence of coronary plaques. The wall pressure continuously decreased towards distal segments and showed pressure drops in stenotic segments. Areas of high WSS and high flow velocities were found adjacent to plaques deposition.
Abstract: The high prevalence of cardiovascular diseases has provoked a raising interest in the development of mathematical models in order to evaluate the cardiovascular function both under physiological and pathological conditions. In this paper, a physical model of the cardiovascular system with intrinsic regulation is presented and implemented by using the object-oriented Modelica simulation software tools. For this task, a multi-compartmental system previously validated with physiological data has been built, based on the interconnection of cardiovascular elements such as resistances, capacitances and pumping among others, by following an electrohydraulic analogy. The results obtained under both physiological and pathological scenarios provide an easy interpretative key to analyze the hemodynamic behavior of the patient. The described approach represents a valuable tool in the teaching of physiology for graduate medical and nursing students among others.
Abstract: The aim of this investigation was to validate the fluid-structure interaction (FSI) model of type B aortic dissection with our experimental results from a bench-top-model. Another objective was to study the relationship between the size of a septectomy that increases the outflow of the false lumen and its effect on the values of the differential of pressure between true lumen and false lumen. FSI analysis based on Galerkin’s formulation was used in this investigation to study flow pattern and hemodynamics within a flexible type B aortic dissection model using boundary conditions from our experimental data. The numerical results of our model were verified against the experimental data for various tear size and location. Thus, CFD tools have a potential role in evaluating different scenarios and aortic dissection configurations.
Abstract: In this work, the hemodynamics in the sinuses of
Valsalva after Transcatheter Aortic Valve Implantation is numerically
examined. We focus on the physical results in the two-dimensional
case. We use a finite element methodology based on a Lagrange
multiplier technique that enables to couple the dynamics of blood
flow and the leaflets’ movement. A massively parallel implementation
of a monolithic and fully implicit solver allows more accuracy and
significant computational savings. The elastic properties of the aortic
valve are disregarded, and the numerical computations are performed
under physiologically correct pressure loads. Computational results
depict that blood flow may be subject to stagnation in the lower
domain of the sinuses of Valsalva after Transcatheter Aortic Valve
Implantation.
Abstract: The aim of the present study is to computationally evaluate the hemodynamic factors which affect the formation of atherosclerosis and plaque rupture in the human artery. An increase of atherosclerosis disease in the artery causes geometry changes, which results in hemodynamic changes such as flow separation, reattachment, and adhesion of new cells (chemotactic) in the artery. Hence, geometry plays an important role in the determining the nature of hemodynamic patterns. Influence of stenosis in the non-bifurcating artery, under pulsatile flow condition, has been studied on an idealized geometry. Analysis of flow through symmetric and asymmetric stenosis in the artery revealed the significance of oscillating shear index (OSI), flow separation, low WSS zones and secondary flow patterns on plaque formation. The observed characteristic of flow in the post-stenotic region highlight the importance of plaque eccentricity on the formation of secondary stenosis on the arterial wall.
Abstract: Adequate analgesia following caesarean section
decreases morbidity, hastens ambulation, improves patient outcome
and facilitates care of the newborn. Intrathecal magnesium, an
NMDA antagonist, has been shown to prolong analgesia without
significant side effects in healthy parturients. The aim of this study
was to evaluate the onset and duration of sensory and motor block,
hemodynamic effect, postoperative analgesia, and adverse effects of
magnesium or fentanyl given intrathecally with hyperbaric 0.5%
bupivacaine in patients with mild preeclampsia undergoing caesarean
section. Sixty women with mild preeclampsia undergoing elective
caesarean section were included in a prospective, double blind,
controlled trial. Patients were randomly assigned to receive spinal
anesthesia with 2 mL 0.5% hyperbaric bupivacaine with 12.5 μg
fentanyl (group F) or 0.1 ml of 50% magnesium sulphate (50 mg)
(group M) with 0.15ml preservative free distilled water. Onset,
duration and recovery of sensory and motor block, time to maximum
sensory block, duration of spinal anaesthesia and postoperative
analgesic requirements were studied. Statistical comparison was
carried out using the Chi-square or Fisher’s exact tests and
Independent Student’s t-test where appropriate. The onset of both
sensory and motor block was slower in the magnesium group. The
duration of spinal anaesthesia (246 vs. 284) and motor block (186.3
vs. 210) were significantly longer in the magnesium group. Total
analgesic top up requirement was less in group M. Hemodynamic
parameters were similar in both the groups. Intrathecal magnesium
caused minimal side effects. Since Fentanyl and other opioid
congeners are not available throughout the country easily,
magnesium with its easy availability and less side effect profile can
be a cost effective alternative to fentanyl in managing pregnancy
induced hypertension (PIH) patients given along with Bupivacaine
intrathecally in caesarean section.
Abstract: The numerical simulation has made tremendous
advances in investigating the blood flow phenomenon through elastic
arteries. Such study can be useful in demonstrating the disease
progression and hemodynamics of cardiovascular diseases such as
atherosclerosis. In the present study, patient specific case diagnosed
with partially stenosed complete right ICA and normal left carotid
bifurcation without any atherosclerotic plaque formation is
considered. 3D patient specific carotid bifurcation model is generated
based on CT scan data using MIMICS-4.0 and numerical analysis is
performed using FSI solver in ANSYS-14.5. The blood flow is
assumed to be incompressible, homogenous and Newtonian, while
the artery wall is assumed to be linearly elastic. The two-way
sequentially coupled transient FSI analysis is performed using FSI
solver for three pulse cycles. The hemodynamic parameters such as
flow pattern, Wall Shear Stress, pressure contours and arterial wall
deformation are studied at the bifurcation and critical zones such as
stenosis. The variation in flow behavior is studied throughout the
pulse cycle. Also, the simulation results reveal that there is a
considerable increase in the flow behavior in stenosed carotid in
contrast to the normal carotid bifurcation system. The investigation
also demonstrates the disturbed flow pattern especially at the
bifurcation and stenosed zone elevating the hemodynamics,
particularly during peak systole and later part of the pulse cycle. The
results obtained agree well with the clinical observation and
demonstrates the potential of patient specific numerical studies in
prognosis of disease progression and plaque rupture.
Abstract: This study was conducted to examine the possible role of serum Gamma-glutamyltransferase (GGT) and Lactate dehydrogenase (LDH) in the prediction of severity of preeclampsia. The study group comprised of 40 preeclamptic cases (22 with mild and 18 with severe) and 40 healthy normotensive pregnant controls. Serum samples of all the cases were assayed for GGT and LDH. Demographic, hemodynamic and laboratory data as well as serum GGT and LDH levels were compared among the three groups.
The results indicated that severe preeclamptic cases had significantly increased levels of serum GGT and LDH. The symptoms in severe preeclamptic women were significantly increased in patients with GGT > 70 IU/L and LDH >800 IU/L. Elevated levels of serum GGT and LDH can be used as biochemical markers which reflects the severity of preeclampsia and useful for the management of preeclampsia to decrease maternal and fetal morbidity and mortality.
Abstract: Nonstationary and nonlinear signals generated by living complex systems defy traditional mechanistic approaches, which are based on homeostasis. Previous our studies have shown that the evaluation of the interactions of physiological signals by using special analysis methods is suitable for observation of physiological processes. It is demonstrated the possibility of using deep physiological model, based on the interpretation of the changes of the human body’s functional states combined with an application of the analytical method based on matrix theory for the physiological signals analysis, which was applied on high risk cardiac patients. It is shown that evaluation of cardiac signals interactions show peculiar for each individual functional changes at the onset of hemodynamic restoration procedure. Therefore, we suggest that the alterations of functional state of the body, after patients overcome surgery can be complemented by the data received from the suggested approach of the evaluation of functional variables’ interactions.
Abstract: The characteristics of physiological blood flow in human carotid arterial bifurcation model have been numerically studied using a fully coupled fluid-structure interaction (FSI) analysis. This computational model with the fluid-structure interaction is constructed to investigate the flow characteristics and wall shear stress in the carotid artery. As the flow begins to decelerate after the peak flow, a large recirculation zone develops at the non-divider wall of both internal carotid artery (ICA) and external carotid artery (ECA) in FSI model due to the elastic energy stored in the expanding compliant wall. The calculated difference in wall shear stress (WSS) in both Non-FSI and FSI models is a range of between 5 and 11% at the mean WSS. The low WSS corresponds to regions of carotid artery that are more susceptible to atherosclerosis.
Abstract: Functional near infrared spectroscopy (fNIRS) is a
practical non-invasive optical technique to detect characteristic of
hemoglobin density dynamics response during functional activation of
the cerebral cortex. In this paper, fNIRS measurements were made in
the area of motor cortex from C4 position according to international
10-20 system. Three subjects, aged 23 - 30 years, were participated in
the experiment.
The aim of this paper was to evaluate the effects of different motor
activation tasks of the hemoglobin density dynamics of fNIRS signal.
The chaotic concept based on deterministic dynamics is an important
feature in biological signal analysis. This paper employs the chaotic
properties which is a novel method of nonlinear analysis, to analyze
and to quantify the chaotic property in the time series of the
hemoglobin dynamics of the various motor imagery tasks of fNIRS
signal. Usually, hemoglobin density in the human brain cortex is
found to change slowly in time. An inevitable noise caused by various
factors is to be included in a signal. So, principle component analysis
method (PCA) is utilized to remove high frequency component. The
phase pace is reconstructed and evaluated the Lyapunov spectrum, and
Lyapunov dimensions. From the experimental results, it can be
conclude that the signals measured by fNIRS are chaotic.
Abstract: Human heart valves diseased by congenital heart
defects, rheumatic fever, bacterial infection, cancer may cause stenosis
or insufficiency in the valves. Treatment may be with medication but
often involves valve repair or replacement (insertion of an artificial
heart valve). Bileaflet mechanical heart valves (BMHVs) are widely
implanted to replace the diseased heart valves, but still suffer from
complications such as hemolysis, platelet activation, tissue
overgrowth and device failure. These complications are closely related
to both flow characteristics through the valves and leaflet dynamics. In
this study, the physiological flow interacting with the moving leaflets
in a bileaflet mechanical heart valve (BMHV) is simulated with a
strongly coupled implicit fluid-structure interaction (FSI) method
which is newly organized based on the Arbitrary-Lagrangian-Eulerian
(ALE) approach and the dynamic mesh method (remeshing) of
FLUENT. The simulated results are in good agreement with previous
experimental studies. This study shows the applicability of the present
FSI model to the complicated physics interacting between fluid flow
and moving boundary.
Abstract: Brain Computer Interface (BCI) has been recently
increased in research. Functional Near Infrared Spectroscope (fNIRs)
is one the latest technologies which utilize light in the near-infrared
range to determine brain activities. Because near infrared technology
allows design of safe, portable, wearable, non-invasive and wireless
qualities monitoring systems, fNIRs monitoring of brain
hemodynamics can be value in helping to understand brain tasks. In
this paper, we present results of fNIRs signal analysis indicating that
there exist distinct patterns of hemodynamic responses which
recognize brain tasks toward developing a BCI. We applied two
different mathematics tools separately, Wavelets analysis for
preprocessing as signal filters and feature extractions and Neural
networks for cognition brain tasks as a classification module. We
also discuss and compare with other methods while our proposals
perform better with an average accuracy of 99.9% for classification.
Abstract: Cardiovascular disease mostly in the form of atherosclerosis is responsible for 30% of all world deaths amounting to 17 million people per year. Atherosclerosis is due to the formation of plaque. The fatty plaque may be at risk of rupture, leading typically to stroke and heart attack. The plaque is usually associated with a high degree of lumen reduction, called a stenosis. The initiation and progression of the disease is strongly linked to the hemodynamic environment near the vessel wall. The aim of this study is to validate the flow of blood mimic through an arterial stenosis model with computational fluid dynamics (CFD) package. In experiment, an axisymmetric model constructed consists of contraction and expansion region that follow a mathematical form of cosine function. A 30% diameter reduction was used in this study. Particle image velocimetry (PIV) was used to characterize the flow. The fluid consists of rigid spherical particles suspended in waterglycerol- NaCl mixture. The particles with 20 μm diameter were selected to follow the flow of fluid. The flow at Re=155, 270 and 390 were investigated. The experimental result is compared with FLUENT simulated flow that account for viscous laminar flow model. The results suggest that laminar flow model was sufficient to predict flow velocity at the inlet but the velocity at stenosis throat at Re =390 was overestimated. Hence, a transition to turbulent regime might have been developed at throat region as the flow rate increases.
Abstract: In this study, numerical simulations on laminar flow in
sinusoidal wavy shaped tubes were conducted for mean Reynolds
number of 250, which is in the range of physiological flow-rate and
investigated flow structures, pressure distribution and particle
trajectories both in steady and periodic inflow conditions. For
extensive comparisons, various wave lengths and amplitudes of sine
function for geometry of tube models were employed. The results
showed that small amplitude secondary curvature has significant
influence on the nature of flow patterns and particle mixing
mechanism. This implies that characterizing accurate geometry is
essential in accurate predicting of in vivo hemodynamics and may
motivate further study on any possibility of reflection of secondary
flow on vascular remodeling and pathophysiology.
Abstract: The present study was designed to investigate the
cardio protective role of chronic oral administration of alcoholic
extract of Terminalia arjuna in in-vivo ischemic reperfusion injury
and the induction of HSP72. Rabbits, divided into three groups, and
were administered with the alcoholic extract of the bark powder of
Terminalia arjuna (TAAE) by oral gavage [6.75mg/kg: (T1) and
9.75mg/kg: (T2), 6 days /week for 12 weeks]. In open-chest
Ketamine pentobarbitone anaesthetized rabbits, the left anterior
descending coronary artery was occluded for 15 min of ischemia
followed by 60 min of reperfusion. In the vehicle-treated group,
ischemic-reperfusion injury (IRI) was evidenced by depression of
global hemodynamic function (MAP, HR, LVEDP, peak LV (+) & (-
) (dP/dt) along with depletion of HEP compounds. Oxidative stress
in IRI was evidenced by, raised levels of myocardial TBARS and
depletion of endogenous myocardial antioxidants GSH, SOD and
catalase. Western blot analysis showed a single band corresponding
to 72 kDa in homogenates of hearts from rabbits treated with both the
doses. In the alcoholic extract of the bark powder of Terminalia
arjuna treatment groups, both the doses had better recovery of
myocardial hemodynamic function, with significant reduction in
TBARS, and rise in SOD, GSH, catalase were observed. The results
of the present study suggest that the alcoholic extract of the bark
powder of Terminalia arjuna in rabbit induces myocardial HSP 72
and augments myocardial endogenous antioxidants, without causing
any cellular injury and offered better cardioprotection against
oxidative stress associated with myocardial IR injury.